Serological monitoring of HCV marker in hemodialysis patients from tertiary care hospitals of Karachi

This study was conducted to estimate the seroprevalence of HCV in maintenance hemodialysis patients. Experimental prospective study. This study had been camed out in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from 1[st] July, 2010 to 30[th] April, 2011. Irrespective of age and gender 200 samples were collected from the patients on chronic maintenance hemodialysis that at least had 20 cycles of hemodialysis from tertiary care hospital of Karachi. The nature of the sample was 5 cc blood. All the study subjects were briefed about the study program and a written consent form had been signed after getting permission from hospital ethical committee. Diagnosed patients of HCV prior to commencement of hemodialysis and patients who had less than 20 hemodialysis cycles were excluded from this study. Two hundred patients [125 male and 75 females] were between the ages of 30-77 years with mean 56.7 +/- 0.68. 29% patients were seropositive for HCV in chronic maintenance hemodialysis patients. According to duration of dialysis, 3.5% were seropositive in whom duration of dialysis was less than 1 year, 18.4% were seropositive in whom duration of dialysis is in between 1.1-2.0 years, 13.3% were seropositive in whom duration of dialysis is in between 2.1-3.0 years, 52.6% were seropositive in whom duration of dialysis is in between 3.1-4.0 years while 61% were seropositive in whom duration of dialysis is more than 4 years. Highly significant statistical difference is observed as the duration of dialysis increases as p-value is highly significant as 0.001 for HCV. Seroprevalence of HCV infection according to schedule of dialysis is insignificant as the p-value is greater then 0.05. This study confirms that HCV infection is a serious and major problem in our hemodialysis units. Duration of dialysis and surgery is directly proportional to the seropositivity, while transfusion was not statistically related to the cause of HCV infections in hemodialysis patients

Diagnostic value of fine needle aspiration cytology in the diagnosis of solitary thyroid nodule

Objectives: To determine the diagnostic value of fine needle aspiration cytology in the diagnosis of solid solitary thyroid nodules

Patients and Methods: This study was conducted at the department of Ear, Nose, Throat, Head and Neck surgery at Postgraduate Medical Institute Lady Reading Hospital Peshawar. This was cross-sectional comparative study. The duration of the study was one year from June 17, 2010 to June 16, 2011. The sample size was 82 patients with solid solitary thyroid nodule, fulfilling the inclusion criteria. Fine needle aspirations were performed in all cases and compared with open biopsies taking as gold standard

Results: Our study included 82 cases consisting of 57 [69.51%] female and 25 [30.48 %] male, with female: male ratio of 2.28: 1. The age of the patients was ranged from 16-65 years with mean age of 42.56 +/- S.D 11.60 years. Most of the patients presented in 3rd and 4th decade followed by the 5th and 2nd decade. The diagnostic yield of fine needle aspiration cytology [FNAC] in this study was accuracy 82.92%, sensitivity 88.09%, specificity 77.50% and positive predictive value was 80.43% that supported our hypothesis

Conclusion: FNAC is a primary diagnostic tool for solitary thyroid nodule because it is simple, safe, quick, reliable, minimally invasive, and cost effective

Old is gold. topical clotrimazole remains an effective treatment of otomycosis

Introduction: Otomycosis also known as fungal otitis externa has typically been described as fungal infection of the external auditory canal. The prevalence of otomycosis has been reported to be as low as 9% of cases of otitis externa and as high as 30.4% in patients presenting with symptoms of otitis or inflammatory conditions of the ear. The most common fungal agents causing otomycosis are aspergillus niger [80%], candida albicans [second most common], actinomyces, trichophyton, aspergillus fumigatus and candida tropicalis

Methods: It was descriptive case series of six months duration done at department of ENT, Islamabad Medical and Dental College Islamabad. Sample size was 119, using 50%8 efficacy of topical clotrimazole, 95% confidence level and 9% margin of error under WHO software for sample size determination

Results: A total of 119 patients of otomycosis were included in the study. Male to female ratio was 0.61:1. Average age of the patients was 32.94 years +/- 5.24 SD with range 20-40 years. The efficacy of clotrimazole in treatment of otomycosis was observed in 112 [94.12%] while in 7 [5.88%] patients show no efficacy. Age and gender have no role in efficacy of clotrimazol in treatment of otomycosis

Conclusion: Topical clotrimazole is effective in the treatment of otomycosis

GBS and AFP [acute flaccid paralysis] system in AJK

Main objective of the study is to highlight the major cause of AFP and% of GBS represents the AFP during the study period. Retrospective analytical study. This study was conducted in AJK, for the duration of three years from January 2011 to December 2013. Retrospective analysis of AFP cases reported during 2011-2013. Primarily the AFP cases investigated through history and clinical examination. Principal cause of AFP [Acute flaccid Paralysis] cases were investigated through specific tests like serum electrolytes, CSF [cerebrospinal fluid], electromyogram and viral culture from stool sample to exclude poliovirus. All the cases reported from AJK and taken on the line list labeling as GBS were included in the study during 2011-2013. Three years data analysis shows more than 50% GBS cases presenting AFP and the numbers are increasing every year. Most of the GBS and even AFP belong to 6-59 months age group. More than 55% GBS cases recover completely and this proportion increased from 2011-2013. Data analysis revealed GBS is a major cause of AFP in AJK and needs not to be overlooked to keep poliovirus transmission ceased here. AFP surveillance system is huge resource and this is a high time to study all the causes responsible for acute flaccid paralysis to strengthen polio eradication efforts and to develop understanding for prevention and control, to avoid acute flaccid paralysis related morbidity and mortality amongst children in Pakistan

Evaluation of AFP surveillance sensitivity in AJK

Main objective of the study is to analyse sensitivity of the surveillance system, required to keep poliovirus circulation ceased in AJK. Retrospective analysis of AFP cases reported during the study period. This study included all the AFP cases reported during the study period in AJK from Jan. 2011 to Dec. 2013. Historical data is used to analyse AFP surveillance for detecting poliovirus infection in children age <15 years in the study area based on few assumptions that all the results are negative and adequate information were available to make ultimate diagnosis of each AFP case reported in the area during study period. Surveillance sensitivity analysed using AFP surveillance criteria recommended by WHO and variable used in AFP surveillance system. Surveillance sensitivity is analysed based on two indicators "non polio AFP rate" and stool adequacy. Sensitivity level analysed in AFP cases aged 6-59 months for >/= 7 OPV doses including routine and SIAs revealed 6/10 districts have high sensitivity. Long absence of Polio virus in the area, creeping up of boredom among health human resource, Clinician's failure to notify all AFP cases resulting in down going Surveillance sensitivity

Captain of all these men of death - tuberculosis remains the commonest diagnosis - two years experience of bronchoscopy at Shaikh Zayed hospital, Lahore

A retrospective study of two years duration was conducted at the department of Pulmonology, Shaikh Zayed Hospital, Lahore, Pakistan to review our experience with bronchoscopy. Data was collected from145 patients who underwent bronchoscopy for different diagnostic and therapeutic indications. The study participants were having ages between 13 and 93 years. There were 85 male and 60 female patients. Bronchoscopy was performed for diagnostic purposes in 124 [85%] patients, for therapeutic purposes in 9 [6%] patients and for surveillance of airways in 13 [9%] patients. Bronchoscopy remained diagnostic in 74.19% patients. Tuberculosis was the commonest diagnosis in 34.6% patients followed by malignancy which was diagnosed in 16.1% patients. In 82% patients there was no complication during procedure, while mild haemoptysis occurred in 11.72%, 5.5% had wheezing [bronchospasm], 4.1% developed low grade fever and 1 patient died due to respiratory failure. It was concluded that bronchoscopy is found to be a useful procedure and can be used safely for diagnoses and treatment of different respiratory diseases

Oral snuff and carcinoma oesophagus

Carcinoma oesophagus is known to occur worldwide. Various dietary, environmental and genetic factors and certain pre-malignant conditions have been blamed in the causation of carcinoma oesophagus but the exact cause in unknown. This study was conducted to find out the possible role of oral snuff to carcinoma oesophagus. This descriptive analytical study was carried out in Medical, Surgical and ENT units of Khyber Teaching Hospital and Cardiothoracic unit of Lady Reading Hospital Peshawar from 1995 to 2005. Relation of oral snuff use to carcinoma oesophagus was studied in 100 patients confirmed on endoscopy and biopsy and histopathology. Oral snuff use was found to have very strong correlation [P<0.001] with carcinoma oesophagus. The effect of ingesting snuff also had very strong correlation [P<0.001] and so was the duration [more than 10 years] of use [P=0.004], however, the frequency of snuff use [i.e. number of time per day] did not have any significant effect [P=0.08]. A strong correlation of snuff use was also found with squamous cell carcinoma [P=0.001]. Oral snuff use is a risk factor for carcinoma oesophagus. Carcinoma oesophagus can be prevented by discouraging its use. Educating people against snuff use may prevent this harmful and lethal disease. This should be done on individual level by the doctors and on mass level through public media