Association of obesity with rapid virological response in patients with chronic hepatitis C

Objective: To determine the association of obesity with rapid virological response in patients with chronic hepatitis C on antiviral therapy

Methodology: In this prospective cohort study patients suffering from chronic hepatitis C who required treatment were included after getting ethical approval and informed consent. Patient's weight and height was measured and body mass index [BMI] was calculated. Patients were divided into 2 groups; group 1 having BMI <30 and group 2 having BMI >30 in equal numbers. All the patients were put on weekly pegylated interferon plus ribavirin in fixed divided doses. PCR was done at the completion of 4 week to check for rapid virological response [RVR]. After completion of study these 2 groups were compared to see whether any significant association exists between BMI and RVR. RVR was also stratified among age, viral load and gender to see their effect as these are potential effect modifiers

Results: There were 140 [56.3 %] male and 110 [43.7%] female patients with male to female ratio of 1.2:1. Mean age of the patients was 39.78 +/-9.85, while mean BMI was 27.40 +/-5.86. Overall the RVR was achieved in 53.2% of the patients. Frequency of RVR was 77[61.6 %] in non-obese patients as compared to 56[44.8%] in obese patients with a p value of 0.008

Conclusion: Obesity is significantly associated with poor RVR in patients with chronic hepatitis C

Malignant tumors; frequency at Sargodha, a single centre, retrospective study

As in most developing countries, incidence of cancer is also increasing in Pakistan. It is important that information on the frequency and epidemiology of malignant tumors be updated, as it is the basis of future health planning for the population at risk. This retrospective study was carried out to find the prevalence of various cancers in the population of Sargodha district [central Punjab, Pakistan] and to compare the regional and international studies, so as to plan and develop the oncology setup of Sargodha Medical College on a rationalized basis of disease prevalence. Data from July 2010 to June 2013 was retrieved from the department of statistics of the hospital and variables of interest were collected and analyzed using SPSS 10.0. It was observed that the most frequent cancer in our patients was breast cancer [n=172] while carcinoma of lungs was the most frequent carcinoma in male population [n=24]. However our observations were a bit different from the international studies published on the subject, the probable reason being the availability of treatment facility and easier access in the nearby districts of Faisalabad and Lahore where many patients still go directly. More over the illiterate and poorer faction of the society does not come to the hospitals for management of the disease but rather go to the quakes and faith healers to relieve them of their sufferings. It is concluded that the department of clinical oncology should arrange cancer awareness programs for the general population to avoid delays in getting consultation, as at present they report to the hospital when the disease is quite advance and surgery is often not possible. Our study also revealed a somewhat different pattern of malignancies in our community raising a need for further studies to evaluate the reasons for this changed pattern in relation to various etiological factors

Midstream urine isolates: sensitivity pattern of various antibiotics in pediatric patients

The objectives of the study was to determine different microorganisms responsible for causing urinary tract infections UTI in children and to evaluate sensitivity and resistance pattern of different antibiotics used in UTIs. Study was conducted in Children Hospital Complex [CHCM], Multan, Pakistan. Total 125 children having UTI were taken to determine the antibiotic sensitivity and resistance pattern against microorganisms causing urinary tract infections in children. The urine samples were collected in urine bottles and smears were made within 2 hours of sample collection. Urine sample was inoculated on agar media and then incubated for 24 hours. A smear was prepared on a slide form culture of microorganisms and gram testing was conducted. The microorganisms were then characterized by use of API [Analytical Profile Index] MICROBACT TM 24E of Oxoid England. The antimicrobial susceptibility testing of various antibiotics was performed by disc diffusion method. The percentage of Gram +ve bacteria causing urinary tract infections in children was 28%, Gram -ve 62.4% and Yeast 9.6%. The most prevailing species are S. aureus, S. epidermidis and E.coli. Results showed that female children are more prone to UTI than male children. Norfloxacin is effective in S. Aureus UTI while cefaclor is effective in S.epidermidis UTI. Amikacin, Norfloxacin and Cefuroxime are effective in UTI caused by E.coli

Association between baseline parameters and end of treatment response to combination of conventional interferon and ribavirin in patients with chronic hepatitis C

To study the association between baseline parameters and end of treatment response [ETR] to conventional interferon treatment in patients with chronic hepatitis C. This retrospective analytical study was conducted in Gastroenterology department of Lady Reading Hospital Peshawar from January 2012 to June 2012. A total of 222 patients with chronic hepatitis C, on combination of conventional interferon and ribavirin therapy were included in the study who reported with ETR. Various baseline parameters included sex [male vs. female], age [< 40years vs. >40years], weight [<70kg vs. >70kg], viral load [<800000IU/ml vs. >800000IU/ml] and ALT quotient [<3 vs. >3]. These variables were compared with ETR to see for any significant association. Two hundred and twenty two patients were included in the study out of which 94[42.3%] were male and 128[57.7%] were females. 121[54.5%] of the patient achieved ETR while 101[45.5%] failed to achieve ETR. Among various variables tested weight <70kg [59% vs. 43%] and ALT Quotient >3 [70% vs.50%] were significantly associated with ETR with a p value of 0.01 and p value of 0.013 respectively while there was no statistically significant association between other parameters and ETR. High baseline ALT and baseline low body weight are significantly associated with better ETR. Among these weight is a modifiable factor and obese patients should be advised to lose weight before embarking them on anti viral therapy in order to improve their chances of viral clearance

Clinical audit of hemodialysis patients at dialysis centre a tertiary care hospital

Background: The incidence of end stage renal disease [ESRD] is between 100-150 new cases per million per year, with a disease burden of 27000 new cases each year in Pakistan. The treatment of first choice for these patients is renal transplantation, which is available to only 5% of patients, rest have no other option except to resort to dialysis to sustain their life

Objective: The objective of the study was to critically review and analyze the data of patients on the basis of etiology, dialysis type and outcome during the last three years so as to improve the patient care

Patients and Methods: In this descriptive study, all the patients, who underwent dialysis during three years [2009-2011] was retrieved from the statistics department. Variables of interest were identified. Data was collected, entered and analyzed in SPSS version 15. The results were then compared with national and international studies on the subject

Results: In this study, a total of 457 patients under went dialysis at the centre and 14687 dialysis sessions were performed during the period under study. Male to female ratio was 1.6:1 and mean age was 44.15 years. Hypertension [70%] was the major cause of ESRD. Fifty three percent patients had an arterio-venous fistula and 23.63% were suffering from hepatitis [C] before the first dialysis. Average survival was 7.7 months and 46.17% deaths were recorded

Conclusion: The management of ESRD being very expensive, government alone with a less than 0.5 to 0.8 percent of the GDP allocation for health cannot extend this facility to all the sufferers. The society should follow healthy life style practices so as the preventable causes of ESRD such as hypertension and DM can be controlled. Social groups should be formed in which these patients should actively participate, encourage and guide each other to improve their quality of life

Klippel-trenaunay syndrome: a rare cause of intermittent lower gastrointestinal bleeding

Klippel-Trenaunay syndrome is a rare non-hereditary congenital abnormality characterized by a clinical triad of soft tissue hypertrophy of extremity, varicosities and cutaneous hemangiomas or lymphongioma. Bleeding per rectum is an uncommon but potentially serious complication. We herein report a case admitted to the gastroenterology ward Postgraduate Medical Institute, Lady Reading Hospital Peshawar, with intermittent haematocezia and symptomatic iron deficiency anemia. The patient did not seek any help for gastrointestinal bleeding until his admission to our unit. He was also having gigantism of his right leg and port wine angiomatous spots on his buttocks and leg. The literature on the evaluation and management on this case is reviewed

Hemodialysis. Socio-economic impact of hemodialysis on patients undergoing dialysis at DHQ Teaching Hospital Sargodha

Chronic renal failure/ End stage renal disease is not only a medical illness but it also has wide ranging effects on the patients and his family. The objective of the study was to evaluate socio-economic impact of hemodialysis on patients undergoing dialysis. DHQ Teaching Hospital, Sargodha. Cross Sectional survey. The study was carried out at our dialysis center. All 60 patients who were on dialysis schedule were included in the study. A structured questionnaire for socioeconomic impact of dialysis was employed to collect the required data. By a third party i.e. a teacher and students of departments of Social Work, University of Sargodha, who were not involved in any part of the patient's management, to avoid Physician bias and free expression by the patients. Data was collected on questionnaire and analyzed. A total of 60 patients were interviewed with male to female ratio of 3:1. Average age was 45.92 years. Sixty five percent lived in joint family. Majority of the patients had hypertension as the cause of renal failure. HCV was positive in fifty five percent. Eighty percent patients were started on dialysis with a central venous access catheter. Sixty one percent were satisfied by their life. About half the patients had economic stress. Forty one percent said that they have become isolated. Fifty one percent were depressed. Fifteen percent were not satisfied by the quality of medicine provided by NGO. Hemodialysis for ESRD is an expensive endeavor. No government can cope with the ever increasing number of patients with ESRD. Community participation in terms of social groups and financial assistance is an important factor to help this group of ailing population

Idmbotomy; an under utilized incision for renal and upper ureteral access

Urolithasis is a common urological ailment since antiquity. Treatment of urolithasis has witnessed a revolutionary change with the advent of minimally invasive endoscopic techniques. However in developing countries very few cases of the renal stone disease are being treated using minimally invasive techniques and vast majority are still being managed with open surgery. The objective of the study was to compare the two incisions used for renal and proximal ureter access, and find out which was better in our set up. We carried out a study at our center, comprising of 50 cases of solitary renal stones, to compare the traditional oblique lumbar [OL] incision with dorsal lumbotomy [DL]. Patients included in the study were with a BMI of less than 30, all ages, having single large stone of renal / proximal ureter, extra renal pelvis, no previous surgery on the ipsi-lateral side. The study revealed that the lumbotomy incision is better than the traditional lumbar oblique incision in terms of surgery time, post operative pain, early return to work and cosmetically accepted scar. After analyzing the data we came to the conclusion that the lumbotomy incision was superior to the oblique lumbar incision in selected cases and we recommend that it should be used specially in centers where facilities for endoscopic/minimally invasive management are not available

Correlation of radiologic evidence of rhinosinusitis with the criteria set by task force for rhinosinusitis [TFR]

The development of consensus guidelines for diagnosis and treatment for rhinosinusitis has been significant challenge for otolaryngology and primary care providers. A major break through emerged in 1997 when task force for Rhinosinusitis [TFR] set forth consensus diagnostic guidelines for acute, sub-acute and chronic sinusitis, later revised in 2003. But still there is no gold standard identified to diagnose chronic rhinosinusitis. In our study we have seen the degree of agreement between TFR criteria for CRS and CT scan paranasal sinuses findings. To examine the degree of agreement between the task force criteria for chronic rhinosinusitis and CT scan findings for rhinosinusitis. All the patients had two major or one major with two minor symptoms defined by TFR criteria were enrolled. All the patients underwent assessment as per TFR criteria and diagnosed positive or negative. CT scan paranasal sinuses of all the patients were also done and were assessed as per Lund Mackay CT scoring system. Degree of agreement between these two diagnostic modalities was seen. Forty patients were enrolled for this study. Degree of agreement between TFR criteria for CRS Lund Mackay CT scati scoring system was found to be 0.615 [+1-95% Cl + 0.54 1- +/- 0.689].When we saw the sensitivity and specificity of TRF criteria against CT scan it was calculated to be 88% and 100% respectively. Positive and negative predictive value for this criteria was came out to be 100% and 25%. Degree of agreement between TFR criteria and CT scan for CRS is satisfactory. TFR criteria is highly specific to diagnose CRS

Acetylcholinesterase and butyrylcholinesterase inhibitory potential of some Pakistani medicinal plants

The crude extracts of some selected Pakistani medicinal plants, namely, Acacia modesta, Buddleja crispa. Carthamus oxycantha, Conyza bonariensis and Tanacetum artemisioides were assessed for their inhibitory activities against acetylcholinesterase [AChE] and butyrylcholinesterase [BChE]. All the tested plant extracts exhibited dose dependent [0.25 - 1.0 mg/ml] inhibitory effects against both these enzymes with more selectivity for BChE. A. modesta and C. bonariensis showed activity against BChE only. The plant extracts of B. crispa C. oxycantha and T. artemisioides caused maximum inhibition of AChE at 1.0 mg/ml with% inhibition of 28, 34 and 48 respectively. In the BChE inhibitory evaluation all the tested plant extracts at 1.0 mg/ml produced marked inhibition [68-80%] of the enzyme activity. The results show the presence of selective BChE inhibitory constituents in the aforementioned plant extracts