quest for normal values of serum aminotransferase and its association with age and body mass index

Objective: To determine the reference range for serum alanine arninotransferase [ALT] levels for young healthy individuals in our population and to find out effects of age and body mass index on alanine arninotransferase

Study Design: Descriptive cross sectional study

Place and Duration of Study: Military Hospital Rawalpindi; from Dec 2009 to April 2010

Material and Methods: Five hundred and fifty three young healthy adults were included in the study. Detailed history was taken. Parameters like Age, height and weight were measured. Relevant investigations were carried out for each subject which included blood complete picture, Chest X-Ray, ECG, Urine routine examination, liver function tests, serum urea, serum creatinine, serum uric acid, plasma glucose [F], Anti HCV antibodies, HBsAg, HIV antibodies and VDRL. Data was analyzed using SPSS version 22

Results: Age of subjects ranged from 19 to 50 years [29 +/- 6] years, BMI 15.59 to 29.8, [21.58 +/- 2]

Serum alanine arninotransferase ranged from 17 to 81 IU/1, [29.9 +/- 8] IU/1. Serum alanine arninotransferase for subjects with body mass index more than 25 Kg/m2 was 29.6 +/- 7 IU/L. There is no significant difference in value of mean ALT overall and in those with BMI of more than 25 [p=0.149]

Conclusion: Mean serum alanine arninotransferase value in young healthy adults included in this study was 29.9 +/- 8 IU/L which is lower than normal reference provided at present which is 40 IU/1. Statistical analysis revelaed that serum ALT is not significantly influenced by age and BMI

Ruptured Hydatid cyst in biliary tract

A lady aged 26 years reported with a 2 months history of fever, upper abdominal pain and weight loss. Her abdominal ultrasonographic scan revealed a complex cystic mass in left lobe of liver suggestive of hydatid cyst that was confirmed on magnetic resonance imaging of abdomen and magnetic resonance cholangiopancreatogram. With strong suspicion of a hydatid cyst, endoscopic retrograde cholangiogram was performed which confirmed the diagnosis. During the procedure, hydatid membranes protruding from the papilla were removed after sphincterotomy. She was put on albendazole 400 mg twice daily after the procedure and showed a remarkable clinical improvement

out break of more than 1300 cases of acute viral hepatitis in a tertiary care hospital in Rawalpindi in summer of 2009

To find out the short-term clinical course including common clinical features, laboratory parameters, treatment provided and outcome of cases of acute viral hepatitis hospitalized in a tertiary care hospital. Descriptive observational study. Military Hospital in Rawalpindi from May to July 2009. Patients hospitalized with acute viral hepatitis, both male and female, older than 12 years of age were included in the study. A detailed proforma including patients' particulars, clinical features; laboratory parameters, treatment provided, disposal/ outcome was designed and filled for each patient. During the study period a total 1334 patients were hospitalized, 1279 [95.87%] were male while only 55 [4.13%] were female. Majority of patients were young adults. Mean age was 26 years with a range of 12 to 85 years. Maximum serum bilirubin levels of 559 micromoles /I and serum alanine aminotransferase [ALT] levels of 7750 IU/L were observed. Maximum prothrombin time [PT] ranged from 105 seconds to failed to clot, against a control of 13 seconds. Thrombocytopenia was observed in some patients especially those with coagulopathy and encephalopathy but recovered with improvement in LFTs. Anti HEV serology was sent in a third of all admitted patients and was positive for IgM in patients tested. Five patients were pregnant ladies. Two patients also had laboratory proven malaria along with acute viral hepatitis. Majority of patients had uneventful recovery. A total of 13 patients went in to hepatic encephalopathy while three unfortunate patients died. HEV has been an important cause of acute viral hepatitis in Pakistan, particularly in adults from lower socioeconomic groups. The problem is more serious for those living in military camps, residential institutions and in segregated areas who consume untreated water from a common source. Outbreaks like the one described have significant morbidity and not ignorable mortality for the affected persons

Studies of ketoprofen toxicity in avian species

Certain environmental factors are very important to stabilize the wild life; avian diseases, vulture crises and ecological annoyance. This should be fixed scientifically to minimize the health hazards. Thus; we have aimed this project to evaluate effects of toxic dosage levels of Ketoprofen in broiler chickens. Two hundred and twenty five [225] healthy broiler chickens were reared upto 28 days and divided into five groups 25 birds in each group. On day 29[th] four groups were medicated twice a day at dose rate of 50 mg/kg body weight respectively intra-muscularly for four days. Feed and water were provided ad libitum. A physical examination, toxicity and mortality rate were recorded daily. Blood samples was drawn to determination the serum values of Aspartate Transaminase [AST], Alanine transaminase [ALT], Uric Acid, Alkaline phosphatase [ALP], and Creatinine. Postmortem performed on day 41 after all samples taken. In second experiment other 100 birds were divided into five groups comprising of 20 birds in each group. One of the groups was injected I/M Ketoprofen 5mg/kg twice a day. Postmortem performed after medication on 5th day. Based on the necropsy findings and biochemical analysis it was found that Ketoprofen was not safe drug in the avian species. Keeping in view the environmental problem [vultures crises] it is recommended that Ketoprofen which has good pharmacological effects in human medicine should be avoided in veterinary practice

Endoscopic management of common bile duct stones experience at military hospital, Rawalpindi

To determine the characteristics of patients presenting with common bile duct [CBD] stones, to know the type of endoscopic therapy employed and to see procedure related complications. A descriptive study Palace and Duration of Study: The study was conducted in the Department of Gastroenterology of Military Hospital, Rawalpindi from Jan 2007 to Dec 2007. Adult patients with common bile duct stones who underwent endoscopic retrograde cholangiopancreatography [ERCP] enrolled in a consecutive manner. The procedure was done under sedation with midazolam and meperidine after informed and written consent. Patients data was obtained from the department and entered on a spread sheet to calculate percentages and frequencies .The data was analyzed using Statistical Package for Social Sciences [SPSS] version 10 to document the endoscopic procedures done and the procedure- related complications. Two hundred and twenty five patients underwent ERCP for evaluation and treatment of CBD stones. Mean age was 45 years with female to male ratio of 1.9: 1. Out of 225 patients, cannulation failed in 4 cases due to duodenal stenosis and 154 [70%] out of 221 cases of CBD stones mandated endoscopic treatment with balloon trail, basket extraction, placement of plastic biliary stent temporarily or use of mechanical lithotriptor. Duct clearance was achieved in 67% cases. Complication rate has been 9% with bleeding being the most common complication with no mortality. A duct clearance rate of over 67% was achieved with sphincterotomy combined with balloon trail, basket extraction and lithotripsy. Bleeding was the most common procedure- related complication. Very large CBD stones/ Mirrizi syndrome cases were referred for surgical intervention

Indications for endoscopic ultrasound and diagnosis on fine needle aspiration and cytology

To determine common indications for requesting Endoscopic Ultrasound [EUS] and to describe the diagnosis made after endoscopic ultrasound/Fine-Needle Aspiration and Cytology [FNAC] during two years at a tertiary gastrointestinal unit. Cross-sectional descriptive study. The study was carried out in Gastrointestinal Department of Military Hospital, Rawalpindi, from March 2006 to February 2008. One hundred and eighty nine patients who underwent EUS during study period at Military Hospital were included in the study. Patients too ill [hypoxemic/hypotensive] to undergo procedure safely and those with complete esophageal blockage at upper end by tumour not allowing scope/EUS probe to advance beyond were excluded. EUS was done with Olympus Exera EUS 160, linear or radial scope, as required. EUS findings were recorded against indications as enlarged lymph nodes, tumour, staging, normal or incomplete. Fine-Needle Aspiration [FNA] was done as per findings on EUS using 21-22 G needle. An on-site cytopathologist made the provisional cytopathological diagnosis. Final cytology/histopathology report was given after review of slides by consultant histopathologists at Armed Forces Institute of Pathology [AFIP], Rawalpindi, and were documented as tuberculosis, malignancy, chronic pancreatitis or reactive hyperplasia. Data was analyzed for documentation of patients' age, gender, common indications, findings on EUS/FNAC, using SPSS version 10. Percentages and frequencies were calculated for the presence of these above-mentioned variables. Of the 189 patients, 145 [77%] were male and 44 [23%] female. Age was 18-80 years [mean 49 years]. Major indications for referral were lymphadenopathy in 92 [49%], suspected growth pancreas in 57 [28%], growth of stomach in 20 [11%] and a heterogeneous group included esophageal, liver, retroperitoneal masses, rectal and other pathologies. Findings on EUS included lymphadenopathy in 76, mostly in sub-carina and AP window. Mass in pancreas was seen in 36, followed by stomach tumour in 17 and esophagus in 9. FNAC was done in 142 out of 189 patients. Final diagnosis out of 67 FNAC/histopathology of lymph nodes were tuberculosis in 26 and malignant lesions in 23. These included metastatic adenocarcinoma in 8, lymphoproliferative disorder in 7, metastatic squamous cell carcinoma in 5, small cell carcinoma in 2 and anaplastic in 1. Pancreatic tumours were adenocarcinoma in 16, poorly differentiated in 3 and neuroendocrine in 2. Stomach tumours were found in 11, and included lymphomas 5, GIST 3, carcinoids 2, metastatic choriocarcinoma 1 and adenocarcinoma in 1. Therapeutically, 3 celiac blocks and one pancreatic pseudocyst drainage was done. The main indication of EUS and pathology of mediastinal and celiac nodes were metastatic malignancy and tuberculosis. Pancreatic adenocarcinoma was another common cause for asking EUS

Prevalence of hepatitis B and C in a healthy cohort

Hepatitis B virus [HBV] and hepatitis C virus [HCV] are the commonest causes of chronic liver disease all over the world including Pakistan. Earlier studies show wide variation in the results regarding the positivity of HBV and HCV infections [total number 665] in different groups of Pakistani populations. Prospective, descriptive. July-September 2004, Combined Military Hospital, Khuzdar and Armed Forces Institute of Pathology [AFIP], Rawalpindi. Healthy adults belonging to different areas of Pakistan were screened for Hepatitis B surface antigen [HBsAg] and anti-Hepatitis C virus antibodies [Anti-HCV] by rapid method and positive cases were confirmed by ELISA from Armed Forces Institute of Pathology [AFIP] Rawalpindi. The sero-positivity of anti-HCV was found to be 3.3% and that of HBsAg was 3%. There was wide variation in prevalence of anti-HCV and HBsAg in different areas of Pakistan. This study indicates that although there is trend toward decline in prevalence of hepatitis B, there is considerable HCV and HBV threat to our population and there is a genuine need for strict adherence to preventive measures

Relationship between disease activity indices and colonoscopic findings in ulcerative colitis

Ulcerative colitis previously thought to be a western disease has a world wide distribution with increasing incidence even in Pakistan. The clinical presentation is highly variable and is characterized by periods of symptomatic flare-ups and remissions. This study was designed to seek relationship between disease activity indices and colonoscopic findings in ulcerative colitis including extent, macroscopic and microscopic grade of disease. This is a review article