Frequency of non-alcoholic steatohepatitis on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years

Objective: to determine the frequency of non-alcoholic steatohepatitis [NASH] on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years

Study Design: descriptive, cross-sectional study

Place and Duration of Study: department of Medicine, Dow Medical College, Civil Hospital, Karachi, from November 2013 to April 2014

Methodology: patients with type 2 diabetes mellitus of more than 5 years duration having raised alanine transaminases level and fatty liver on ultrasonography were selected. Informed consent was obtained and liver biopsy was performed in all patients by experienced physician of Civil Hospital Karachi. All samples of biopsy were sent for histopathology. Those patients with hepatitis B, C and D and steatosis like alcoholic and hypertriglyceridemia were excluded from the study. Descriptive statistics were calculated on SPSS version 17

Results: out of the 262 cases, 56.49% [148/262] showed non-alcoholic steatohepatitis on the basis of histopathology. The mean age of the patients was 50.72 +/-8.48 years. Median [interquartile] duration of diabetes mellitus of the cases was 9 years [15 - 4]. Out of 148 NASH cases, 56.1% [83/148] were males and 43.9% [65/148] were females

Conclusion: nonalcoholic steatohepatitis is an increasingly important and unrecognized spectrum of chronic liver disease associated with high prevalence of diabetes that is often overlooked and diagnosed with complications. So early recognition of these patients can prevent further complications

Frequency of eosinophilic esophagitis in patients undergoing upper Gl endoscopy

To determine the frequency of Eosinophilic Esophagitis [EoE] in patients undergoing upper Gl endoscopy. Patients undergoing upper Gl endoscopy for any indication were subjected to additional esophageal biopsies for derrnination of eosinophilic esophagitis. The additional biopsy protocol was two each from proximal esophagus, distal esophagus, stomach and duodenum. Presence of >15 eosinophils in one high power field was criteria for diagnosis of EoE. Ninety four patients were included according to sample size estimations. Eosinophilic esophagitis was found in 7 [7.4%] of patients undergoing upper Gl endoscopies. Eosinophilic esophagitis should be considered as active diagnosis in presence of suggestive symptoms

Frequency and pattern of colonization of intravenous cannula in an ICU of public sector hospital

To determine the frequency of colonization of intravenous [IV] cannula by microorganism in patients admitted to intensive care unit [ICU] and to determine the frequency of common organisms involved in colonization of IV-cannula. A total of 369 patients of age more than 12 years, and meeting inclusion criteria of the study were included from in medical ICU after taking informed consent. Staff nurse introduced intravenous cannula of appropriate bore after proper disinfection of the insertion site with povidone iodine solution and alcohol. The cannula was removed for culture within 48 hours of insertion if clinical signs i.e. redness and swelling was present. Mean age was 41 [ +/- 16.7] years. Male to female ratio was 1.07:1. Presence of colonization in IV-cannula was seen in 31 [8.4%] cases. Coagulase-Negative Staphylococci was the most common microorganism seen in 24 [77.4%] patients. The incidence of IV cannula colonization is low in this study. Bacterial colonization occurs in the indwelling intra vascular cannula despite, adequate precautions. Coagulase-Negative Staphylococci and S. Aureus were the common organisms

Frequency of depression in chronic Hepatitis C naive patients

To determine frequency of depression in chronic hepatitis C na‹ve patients before interferon therapy using CES-D questionnaire. Patients testing positive antibodies to HCV by EIA of more than 6 months duration and who have not taken interferon therapy previously were included after taking informed consent. Patients who had co-infections such as hepatitis B and D virus or human immunodeficiency virus, or patients with other coexisting chronic liver disease like primary biliary cirrhosis, chronic autoimmune hepatitis and Wilson disease were excluded from study. Urdu version of CES-D a self-reporting questionnaire in public domain was administered. A score of >/= 10 was taken consistent with depression. Ninety-six patients were included and 59.4% were depressed. These included 57.9% males and 42.1% females. Highest frequency was seen in under-graduates and positive correlation was seen with duration of hepatitis C infection. This study showed that 59.4% of patients with hepatitis C have depression before initiation of therapy and this should be evaluated and treated if necessary before starting interferon therapy

Malaria morbidity in Sindh and the plasmodium species distribution

To determine the prevalence of Malarial parasites and species responsible in Sindh Province of Pakistan. It is a cross sectional descriptive study conducted in all Districts of Sindh during January 2002 to December 2006. It was based on surveillance data of Malaria control program Sindh in which blood smears from febrile cases in all age group of male and female were seen by facility microscopist in all districts. Senior microscopist rechecked all positive slides. All slides data of different districts of Sindh was reported on monthly basis to provisional centre at Hyderabad for compiling and analysis. During 2002-2006, out of 5.84 million slides, those with positive malarial parasites were approx. 0.16 million giving an average blood examination rate [BER] 4.46, slide positivity rate [SPR] 2.94, Falciparum ratio[FR] was 41%, annual parasite incidences [API] was 1.36. More cases were seen in post monsoon season. All basic indicators of Malaria disease are higher than optimum level. Estimated burden can be much higher, Roll Back Malaria goals are lagging far behind to reduce the disease burden. As such integrated approach of diagnosis, treatment and prevention is required

Pattern of encephaloceles: a case series

Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact world wide frequency is not known. A substantial proportion of children especially those born with a large encephaloceles are physically and intellectually disabled. Our objective of this descriptive case series was to determine the patterns and surgical outcomes in various types of encephalocele in our setting. The study was carried at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh, Pakistan during year 2005 to 2007. Patients with encephalocele [occipital, Scincipital, parietal] admitted during year 2005 to 2007 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistical analysis was done by SPSS method. 25 children with encephalocele were selected during the years 2005-2007. Out of these 19 [76%] were male and 6 [24%] female. Age range was 06 days to 2 years. Most common type of encephalocele was occipital 20 [80%]. All patients underwent surgery. Out of 25 only one patient was died. Postoperative follow up showed uneventful results. Most common type of encephalocele is occipital in our set up. Contents of the sac of encephaloceles are dysplastic brain tissue and there is no harm to sacrifice it

Patterns of acute poisoning and its outcome reported at civil hospital Karachi

To determine frequently used agents in acute poisoning, mode of poisoning, influencing factors, time interval between intoxication and hospital arrival outcome. The study was conducted in the department of Medicine, Civil Hospital Karachi in year 2006. It was a Descriptive and observational study. All cases of acute poisoning admitted in medical unit IV were included in this study. In all the cases a previously prepared Performa was filled, the Performa included patient's demographic patterns, agent used for poisoning, various influencing and precipitating factors of acute poisoning, route of poisoning, time interval between intake and arrival in hospital, past history of such episode, psychiatric history and outcome. Total of 118 cases of acute poisoning admitted during the study period. Sixty two [52.85%] were female and fifty six [47.15%] were males. Oral route was used in all cases. Mode of poisoning was suicidal [61.02%], deliberately self harm [22.03%], accidental [11%] and homicidal [5.08%]. Common reasons for poisoning in males were financial constraints [48%] and unemployment [40%]. Common reason for poisoning in females was family conflictions [68%]. Fifteen patients [12.54%] had previously attempted the poisoning as well. Previously known psychiatric illness was found in five [4.24%] of patients. Most of the patients [102] reached within eight hours, only six arrived within two hours. Eleven patients [9%] expired in which six were females and five were males. Organophosphorus compounds were found to be the commonest incriminating agent in poisoning. Family conflictions and financial constraints were the main reasons behind poisoning. Most of the patients are reaching late in hospital, Majority of the deaths are occurring immediately after arrival and within two days. Reattempt of poisoning was found in significant number of patients which were although preventable. Mortality in cases of poisoning is still high

Corrlation of adjusted blood requirement index with treatment intervention and outcome in patients presenting with acute variceal bleeding

To determine the correlation of ABRI with treatment intervention and outcome as discharged or expired in patients of acute variceal bleed. Cross-sectional study Records of all the patients admitted in Medical Unit-IV, Civil Hospital Karachi with acute variceal bleeding during January 2004 to October 2006 were retrieved. Use of vasoactive agents [Terlipressin/Octreotide], endoscopic band ligation [EBL] and outcome [Discharged/Expired] were noted. ABRI was calculated by the following formula: ABRI= Blood Units Transfused/ [[Final Hematocrit - Initial Hematocrit] + 0.01] Mean ABRI were compared by Student's 't' test according to vasoactive therapy, EBL and outcome. Correlation of ABRI with the same variables was also studied by plotting Receiver Operative Curves [ROC]. Seventy six patients fulfilling inclusion criteria were selected. No statistically significant difference was observed in the mean ABRI scores when compared according to vasoactive drug administration, EBL and outcome. Significant correlation with mortality was seen on ROC plot with significantly larger area under the curve. ABRI correlated significantly with mortality in this study. Larger prospective studies with appropriate power are required to evaluate its association with other variables

Hyperglycemia: an unusual cause for hemichorea-hemiballism

Hemichorea - hemiballism is a rare neurologic disorder due to oxidative stress leading to neurodegeneration of the dentate nuclei and striata. It is rarely observed in diabetes. One such case occuring in an adult female diabetic is described

Unusual presentation of an unusual hepatitis

Autoimmune hepatitis is an uncommon cause of chronic hepatitis in Pakistan. One such case is described occurring in an adult female cirrhotic diagnosed on raised serum IgG and LKM-I

Correlation of quality of life in patients of cirrhosis of liver with etiology and disease severity using disease-specific quality of life questionnaire

Quality of Life has an important status in patient management suffering from chronic disease like cirrhosis and health related quality of life has significant impact on patient management. This study was conducted to evaluate the correlation of health related quality of life with disease severity in patients of cirrhosis of liver. This cross-sectional study was conducted at Medical Unit-IV, Dow University of Health Sciences, Karachi, during the period January 2006 to October 2006. All patients of cirrhosis of liver admitted during the study period were selected. Patients with encephalopathy, hepatocellular carcinoma were excluded. The 29 item chronic liver disease questionnaire [CLDQ] was administered to the patients by a postgraduate trainee. Internal validity of responses was checked statistically and correlation of responses was done with disease severity by Child-Pughs Criteria. 109 patients were selected with 72 males and 37 females. Patient classification according to Child class A, B and C was 30, 38 and 41 respectively. The mean CLDQ score in the patients was 89.5 +/- 30.4. It correlated significantly with Child Class but did not correlate with the gender, age and etiology of cirrhosis. Health related CLDQ scores correlate with the severity of liver disease

Frequency and comparative analysis of hepatitis in patients seeking treatment for hepatitis B

To find the frequency of hepatitis 'D' in patients of hepatitis 'B' seeking treatment and to compare clinical and biochemical features in patients harboring HDV with those who are not. Cross-sectional study. Medical Unit-IV, Civil Hospital Karachi, Medical Unit-VI and Surgical Unit-VII, Lyari General Hospital, Dow University of Health Sciences, Karachi; from July 2003 to June 2005. HBsAg positive patients seeking treatment were enrolled in the study. Anti-HDV was done in all. Patients were split into two groups according to their anti-HDV status into HDV positive and HDV negative groups. Liver biochemistries and viral profile for HCV, anti-HBc IgM and HBeAg were done and compared between the two groups. A total of 246 patients were selected. HDV was positive in 66 [26.8%] patients. No significant difference was observed in the frequency and stages of cirrhosis between the two groups while significant differences were observed in the mean SGPT [95% CI: -381.09 to -110.74; P = 0.001] and albumin levels [95% CI: 1.87 to 7.73; P = 0.007] and in the frequency of HBeAg [P = 0.001], anti- HBc IgM [P = 0.02] and HBV DNA [P < 0.001]. HDV infection was common in patients with HBV in this cohort of patients. All patients of HBV should be screened for HDV before treatment decision for the former is taken

Thrombocytopenia in hospitalized malaria patients

To assess the occurrence and severity of thrombocytopenia in hospitalized Malaria patients. Prospective hospital based case series from August 2003 to December 2004 conducted in the medical unit of tertiary care center. All hospitalized patients with acute febrile illness without localizing signs were considered for the study. Peripheral smear examination for malarial parasite was taken as a gold standard for the diagnosis of malaria. Those with positive MP were then included in the study. Hematological parameters were determined by using automated analyzer. Those with reduced platelet count were re-evaluated with manual method. A total of 128 patients were subjected for malaria testing during the study period. Sixty patients had a positive peripheral smear. Fifty one [85%] were P falciparum positive and 9 [15%] were P vivax positive. Forty two [70%] patients had thrombocytopenia. Thirty two were [76%] male and ten [24%] female. Thirty nine [93%] patients with thrombocytopenia were P falciparum positive and only 3 [7%] patients had vivax malaria. Thrombocytopenia was mild in 29 [70%] patients, moderate in 9 [22%] and severe in 4 [8%] patients. Higher frequency of mild to severe thrombocytopenia was observed in hospitalized patients, which should alert the possibility of malarial infection. In these cases P falciparum was found to be common species

Haemorrhagic stroke-incidence, risk factors and mortality

Cases of haemorrhagic stroke admitted to the Medical Unit V of Civil Hospital, Karachi from January 1992 to December 1993 were studied to determine the incidence, risk factors, site and size of haemorrhage and mortality. Out of 2073 patients admitted during the study period, those with stroke were 169 [8.15%]. Of these, 52 patients had haemorrhagic stroke thus accounting for 30.77% of stroke patients and 2.51% of all admissions. There were 34 [65.38%] male and 18 [34.62%] female patients. Forty [76.92%] of the 52 patients were above the age of 40 years. Hypertension was found in 32 [61.54%] patients. Site of haemorrhage was ganglionic in 18 [34.61%], thalamic in 9 [17.31%], subcortical lobar in 17 [32.69%], pontine in 3 [5.77%] and cerebellar in 2 [3.85%] patients while 3 [5.77%] patients had sub-arachnoid haemorrhage. The size of haemorrhage was >4cm in 4 patients, 3-4cm in 9 patients, 2.5-3cm in 8 patients and <2.5cm in 28 patients. Twenty nine patients died during hospitalization giving a case fatality rate of 55.77%