Surveillance report on endemic measles in district Bannu

Objective: The objective of the current study was to report the surveillance of endemic measles in district Bannu and its peripheries

Study Design: Observational / descriptive study

Place and Duration of Study: The study was conducted in Women and Children Teaching Hospital Bannu and various BHUs and dispensaries of countryside's of the district from Jan, 2016 to March, 2016

Materials and Methods: Patients up to 16 years old were screened for febrile rash illnesses at women and children teaching hospital district Bannu and BHUs/dispensaries. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria.16 most critical patient's blood samples were sent to CMH hospital laboratory Peshawar, KPK for further confirmation where test was done by ELISA technique utilizing IgM antibodies

Results: Results showed that male children were highly infected than female. Children from 1-3 years were most affected, followed by children with 1 to 12 months. Least no of cases were reported in children from 4-8 years. Bannu city surrounded areas like mammashkhel, shiekhan, surrani were more affected from measles outbreak while nearby areas are at constant threat

Conclusion: It is concluded that the peripheries were more affected from measles outbreak while nearby areas are at constant threat. In light of our findings, it can be stated that proper steps should be taken by government and non- government organization to control the situation in affected areas and to prevent the nearby areas specially the city from the current outbreak

Systemic inflammatory response syndrome [SIRS]; patients with liver cirrhosis

Systemic inflammatory response syndrome [SIRS] is a generalized disorder, immune response to infection which results in disturbed microcirculation, visceral perfusion and ultimately visceral failure. Objectives: To determine the frequency of systemic inflammatory response syndrome in patients with liver cirrhosis. Design: Cross sectional descriptive. Period: Six months study. Setting: At Liaquat University Hospital Hyderabad. Patients and methods: All the patients with liver cirrhosis for 06 months duration admitted in the ward were further evaluated for systemic inflammatory response syndrome. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results: During six months study period, total 100 cirrhotic subjects were studied for SIRS. The mean +/- SD for age in all [100] cirrhotic patients was 45.74 +/- 7.537. The mean temperatures was 40.42+/-0.32 where as it was 39.72+/-0.43 and 38.92+/-0.11 in male and female population respectively. The mean heart beat was 128.42+/-6.74 where as it was 115.83+/-8.93 and 120.62+/-5.53 in male and female population respectively. The mean respiratory rate was 25.31+/-3.52 where as it was 23.52+/-2.31 and 26.63+/-3.21 in male and female population respectively. The mean white blood cell count was 28.81+/-4.51 where as it was 23.74+/-4.73 and 30.83+/-5.73 respectively. The SIRS was observed in 70% subjects of which 47[67.1%] were males and 23[32.9%] were females [p=0.04]. Majority of SIRS subjects were 30-39 years of age and male population was predominant [p=0.03]. The gender distribution in relation to severity of liver disease was statistically significant [p=0.05] while the SIRS in relation statical analysis. Conclusions: The systemic inflammatory response syndrome occurs in patients with liver cirrhosis

Hepatitis C infection; type II diabetes mellitus patients in a tertiary care hospital, Karachi

Objectives: To determine the prevalence of Hepatitis C virus infection in Type II Diabetes Mellitus patients and its associated risk factors in our population

Duration and Place of Study: Study was conducted in Jinnah Post graduate Medical Centre, Karachi between December 2013 to December 2014

Study Design: It is a Cross-sectional study

Data collection and Results: Data was collected from registered diabetic patients, 355 diagnosed Type II diabetes mellitus patients including 128[36.1%] males and 227[63.9%] females were selected and their Hepatitis C screening was done by ICT method. The bio-data of the patients, history and duration of diabetes mellitus, history of blood transfusion, previous surgery, accidents, shaving from barber, tattooing, nose piercing, acupuncture, insulin use were recorded on a proforma. Out of the 355 diabetes mellituspatients tested, 33 were positive for anti-HCV antibodies giving a prevalence of 9.3%

Conclusion:There is increased prevalence of HCV infection in diabetic patients when compared with general prevalence of HCV in Pakistan

C-reactive protein [CRP]; in patients with metabolic syndrome

To determine the frequency of raised C-reactive protein [CRP] in patients with metabolic syndrome. This cross sectional descriptive study of six months study was conducted at Liaquat University Hospital Hyderabad. All the patients of 20 to 60 years of age, of either gender presented with symptoms of metabolic syndrome for more than 01 year duration were admitted and evaluated for C-reactive protein. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Total one hundred patients [59 females and 41 males] with metabolic syndrome were evaluated for C-reactive protein. The mean waist circumference for males and female patients with raised CRP was 48.93 +/- 2.33 and 48.42 +/- 3.41 while the mean +/- SD of serum triglycerides level for male and female with raised CRP was 192.41 +/- 3.21 and 196.31 +/- 3.43 respectively. The mean +/- SD of serum HDL-C level for male and female with raised CRP was 28.32 +/- 1.22 and 25.31 +/- 1.42. The mean +/- SD of systolic and diastolic pressure for males and female patients with raised CRP was 150 +/- 3.42 and 100.51 +/- 4.42. The mean +/- SD of serum fasting blood sugar for male and female patients with raised CRP was 131.52 +/- 3.33 and 143.42 +/- 7.42 respectively. The mean +/- SD of CRP for male and female patients with raised CRP was 4.42 +/- 1.21 and 5.8 +/- 2.52. In relation to gender distribution, the majority of subjects from 40-49 years of age group with female predominance [p = 0.01] while the CRP was raised in 67% patients in relation to age [p=0.05] and gender [p=0.04] respectively. Out of 67 subjects with raised CRP 44 were females and 23 were males

Ultrasonographic assessment of amniotic fluid index in post date pregnancies

To assess fetal outcome in postdate pregnancies [40 weeks and beyond] with women having amniotic fluid index [AFI] < 6 cm and between 6-15cm using greyscale ultrasound. Cross-sectional comparative study. CMH Rawalpindi from 26 October 2006 to 09 May 2007. A total of 60 patients were studied. The antenatal fetal surveillance in these patients was based on ultrasound assessment of AFI after 40 weeks. An abnormal AFI was defined as less than 6 cm, between 6-8 cm as equivocal and more than or equal to 8 as normal. Patients were equally divided into two groups of 30 each based on AFI as group I having AFI <6 cm and group II with AFI of 6-15 cms. Delivery mode, fetal distress and early neonatal complications were main assessment parameters for the fetus. Rate of caesarean section [50%] in the women with AFI< 6 cm was found significantly higher than 17% rate of caesarean section of the women having AFI > 6 cm .Proportion of early neonatal complications was also significantly higher in the women with AFI< 6 cm. AFI assessment by ultrasound is a reliable fetal surveillance test. It may allow the conservative approach till 42 weeks to reduce the caesarean section rate and neonatal complications

To determine the effect of wearing shoe covers by medical staff and visitors on infection rates, mortality and length of stay in intensive care unit

Intensive Care Units [ICUs] experience higher infection rates due to the severity of illness and frequent use of invasive devices. Use of personal protective equipment reduces the risk of acquiring an infection. This study has been conducted to determine the role of using shoe covers by medical staff and visitors on infection rates, mortality and length of stay in ICU. It is a descriptive study, performed in Shifa International Hospital, Islamabad from January 2012 to July 2012. The rates of infection [by checking patients for common ICU pathogens], mortality and length of stay of patients admitted in MICU and SICU from January 2012 to March 2012 were measured. Use of shoe covers was abandoned during this period. The same parameters were measured for the patients admitted from May, 2012 to July, 2012; the period during which shoe covers were strictly used by all the staff members and visitors. The data was then analyzed and compared using chi-square test with significance value at p < 0.05. A total of 1151 patients were studied in 06 months period. Among the two groups of patients, managed with and without using shoe covers in ICU, statistically significant decrease was seen in terms of length of ICU stay[as P value is less than 0.05] in patients managed in duration of shoe covers. However, the time period in which shoe covers were used the infections with three common ICU pathogens MRSA, VRE and acinetobacter were statistically significant more than the periods in which shoe covers were not used. There was no significant difference in mortality for both groups [P value = 0.146]. Use of shoe covers in critical care area is not helpful in preventing infections of common ICU pathogens and length of stay in ICU patients; nor has it decreased the mortality

Obesity and Diabetes: an experience at a public sector tertiary care hospital

To detect the frequency of Obesity in type 2 diabetic patients. It was a Cross Sectional study carried out at Diabetes Clinic, Medical Unit III, Jinnah Postgraduate Medical Centre Karachi from 1[st] Jan 2012 to 30[th] June 2012. Three hundred and eighty seven [387] type II diabetic patients of either sex and any age were included in the study. Non-purposive convenience sampling technique was used to enroll patients in the study. History regarding diabetes, hypertension [HTN], Cerebrovascular Accidents [CVA], smoking and other tobacco exposure was taken. Physical examination was carried out and height, weight, body mass index [BMI], blood pressure, peripheral pulses and anklebrachial index [ABI] was calculated. Categorical variables such as Gender, Age groups, BMI groups, HTN, smoking, hyperlipidemia and ABI were expressed as frequencies and proportions. Means with standard deviations were calculated for continuous variables such as age, duration of diabetes, BMI, duration of HTN and duration dyslipidemia. For categorical variables, differences between patients were tested using the chi-square test. P value of

Diagnostic accuracy of saline hysterosonography in cases of abnormal uterine bleeding

To evaluate diagnostic accuracy of saline hysterosonography in diagnosing endometrial hyperplasia taking histopathology as gold standard. Validation study. Radiology Department MH/CMH Rawalpindi form 10th July 2006 to 10th January 2007. Fifty cases of Abnormal Uterine Bleeding comprising both pre and post menopausal patients were included. They were selected on non probability convenience sampling technique. Saline hysterosonography was conducted in the Radiology Department and results compared with histopathological findings. Among 50 patients who underwent saline hysterosonography, 40 patients were diagnosed to have positive findings while 10 did not show any abnormality on saline hysterosonography. Of the 10 patients whose endometrium did not show any abnormality on saline hysterosonography, 8 were found to be normal on histopathology and 2 cases showed abnormality. One case was of endometrial hyperplasia and the other showed a benign endocervical polyp which was missed on saline hysterosonography. This showed that Saline hysterosonography has a sensitivity of 94.7%, specificity of 66.7%, and an overall diagnostic accuracy of 88%. Saline hysterosonography is highly accurate in the diagnosis of endometrial pathologies. It is cost effective, well tolerated by patients and can be performed as an outpatient procedure

D - dimers assay as an adjunct to diagnosis of cerebral venous sinus thrombosis

To determine the frequency of raised D-dimer in patients of cerebral venous sinus thrombosis [CVST] at Neurology Department, Military Hospital Rawalpindi. Descriptive study. One year duration conducted in the Department of Neurology at Military Hospital Rawalpindi from 1[st] May 2010 to 1[st] May 2011. Thirty patients were selected randomly from Neurology Department, who were recently diagnosed cases of cerebral venous sinus thrombosis [CVST] on the basis of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV]. D-dimer test samples were drawn and subjected to latex agglutination test. There were 22[73.33%] males and 8[26.67%] females in our study. D dimmer assay analyses revealed 90% [27 patients] as positive and 10% [3 patients] as negative. Raised D-dimer levels are highly suggestive of CVST provided other conditions are clinically excluded and they can be used as an adjunct in the diagnosis of cerebral venous thrombosis

Peripheral artery disease in type II diabetes

To determine the frequency of peripheral arterial disease [PAD] in type 2 diabetic patients. Cross-sectional observational study. Diabetes Clinic, Medical Unit III, Jinnah Postgraduate Medical Centre, Karachi, from January to June 2010. Three hundred and eighty seven [387] type II diabetic patients of either gender and any age were included in the study. Patients with a previous history of trauma to the arterial vasculature, pregnancy and those who underwent arterial graft procedures were excluded. Non-purposive convenient sampling technique was used to enroll patients in the study. PAD was diagnosed when ankle-brachial index [ABI] was less than 0.9. A p-value of less than 0.05 was considered statistically significant. Out of 387 studied patients, 128 were males [33.1%] and 259 were females [66.9%]. Mean age was 52.22 +/- 9.671 [22 -76] years in the entire cohort. Mean duration of diabetes was 9.38 +/- 6.39 years. PAD was detected in 152 [39.28%] of the total study subjects. Thirty-one of 128 male patients [24.22%] had PAD disease while 121 out of 259 female patients [46.71%] had evidence of PAD [p = 0.001]. Hypertension was a significantly associated factor [p = 0.002]. A high frequency of PAD was observed in the diabetic population particularly with hypertension and more prevalent in females

study of doppler waveform pattern of hepatic veins in patients of acute viral hepatitis in comparison with control population

The objective of this study was to evaluate hepatic vein flow patterns in adults with acute viral hepatitis and to compare the findings with a control group of healthy people using Doppler ultrasound. Cross-sectional comparative study Radiology Department Military Hospital and Combined Military Hospital Rawalpindi from 15 May 2007 to 15 November 2007. Eighty patients who underwent doppler ultrasound at Military Hospital and Combined Military Hospital Rawalpindi during the study period were divided into two groups of 40 each. Cases were selected from the Out Patient Departments of Military Hospital and Combined Military Hospital Rawalpindi. Group I comprised patients with diagnosis of acute viral hepatitis based on clinical and laboratory findings. Group II included the control group comprising 40 healthy volunteers. Doppler ultrasound of hepatic veins was carried out in both the groups of patients. Abnormal wave pattern of hepatic veins on Doppler ultrasound was noted in 35 [87.5%] in group I and in 1[0.25%] of group II. One patient having abnormal Doppler wave pattern in group II subsequently developed acute viral hepatitis. Doppler ultrasound assessment of wave pattern in hepatic veins is an accurate method to differentiate a diseased liver from a normal one. Doppler ultrasound of hepatic veins is a good technique to study disease status of liver

Awareness of novel h1n1 pandemic influenza among non-medical personnel, medical students and medical professionals

To study the awareness of swine flu among general population, medical students and medical professionals Descriptive study. Place and Duration of Study: Study was carried out in the department of Pathology [Microbiology], Army Medical College, the Military Hospital [MH] and Combined Military Hospital, Rawalpindi, from 17th January 2010 to 24th January 2010. Materials and A total of 519 people were included in this study, 228 were medical students, 181 were doctors and 110 were non health care professionals. A questionnaire with closed questions regarding the awareness of the basics of swine flu was required to be filled by all participants. It was found that the general population was totally unaware to the extent that 1/3rd had never heard of this disease. The survey of medical students showed reasonable knowledge in the senior classes [80-85%] knew the main features of the disease], whereas the 2nd year students had the awareness around 40-45%. Among the medical professionals the knowledge was excellent in the seniors, whereas the trainees and house officers had suboptimal knowledge of swine flu. The result of this study show a significant gap between the seniors specialists and the juniors and this gap warrants immediate bridging. The general public also need to be informed by various means more comprehensively

Spontaneous bacterial peritonitis in patients with cirrhosis and ascites

drsyedabdulrasheed@yahoo.com To find out the frequency and clinical presentation of spontaneous bacterial peritonitis [SBP] in cirrhosis with ascites secondary to hepatitis c infection. Descriptive study. Department of Medicine, Military Hospital, Rawalpindi, from September 2004 to February 2005. Fifty nine subjects with cirrhosis and ascites secondary to hepatitis c infection were included. Frequency of SBP with its presenting clinical features was determined. Mean ascitic fluid protein level was compared between SBP and non SBP groups. Child pugh class was determined in SBP subjects. P-value was calculated by applying test of significance. Out of fifty nine subjects, fourteen were having SBP. Abdominal pain / tenderness and jaundice were common presenting features in 78.57% and 64.28% of subjects respectively. Patients were asymptomatic in 7.14%. Mean ascitic fluid protein content was found to be low in SBP as compared to non SBP patient's 1.41 gm% vs. 2.20 gm%. Because of heterogeneous clinical presentation, ascitic fluid should be analyzed routinely in all patients admitted in hospital with cirrhosis and ascites

Reference range values of haematological parameters in healthy Pakistani adults

This study has been designed and conducted to establish the normal values of various haematological parameters for healthy adult Pakistani males and females, and to compare these values with those obtained for other populations in both western and tropical countries. This study was under taken in reference adult Pakistani Populations in the area of Multan, Pakistan. A total 302 healthy volunteers whose ages ranged between 20-45 years, were investigated. All laboratory analysis was conducted under standardized conditions at the Haematology Section, Department of Pathology, Bakhtawar Amin Memorial Trust, Hospital [BAMTH] and Multan Institute of Cardiology, [MIC]. In Males, the mean Haemoglobin concentration [Hb] of 13.04 g/dl and Haematocrit [HCT] ratio of 0.39 1/1 were significantly higher than females value of 11.63 g/dl and 0.35 1/1 respectively. The mean Red Blood Cell [RBC] count of 5.3x10[12]/1in males was also significantly higher than the corresponding value of 4x10[12]/1 in females [p<0.05]. The value of Mean Corpuscular Volume [MCV] in males [76.30 fl] was significantly higher than in females [73.84 fl], [p<0.05]. Similarly the Mean Corpuscular Haemoglobin [MCH] and Mean Corpuscular Haemoglobin Concentration [MCHC] were significantly higher in males than corresponding values in females [p<0.05]. On the other hand, the mean White Blood Cell count [WBC] of 8.25x10[9]/1 in males was lower than mean value of 8.42x10[9]/1 in females [p<0.05]. Similarly the values for Platelet count of 255x10[9]/1 in males were also significantly lower than corresponding values of 255x10[9]/1 in females [p<0.05]. This study has established baseline values for haematological parameters in healthy Pakistani adults of Multan and surrounding areas. The sex difference of measured levels of all of these parameters has attained statistical significance. When the observed values of this study were compared with those quoted for the methods in use and those drawn from different populations, significant differences were revealed. Such differences are of accurate clinical interpretation of haematological investigation of patients