Plasminogen activator inhibitor-1: is it a risk factor for recurrent miscarriage?

Background: About 50% cases of recurrent miscarriages are idiopathic. The association of fibrinolytic defects with recurrent pregnancy failure is a novel research avenue and was first recommended in early 1990s. High Plasminogen activator inhibitor-1 [PAI-1] levels are found to be associated with recurrent miscarriage in various studies. The association of Plasminogen activator inhibitor -1 with recurrent pregnancy loss and its various variables are detrermined

Methods: This study was conducted at Ziauddin University Hospital Karachi, from Feb 2014 to Nov 2014. All non pregnant and non-obese women with history of consecutive two or more miscarriages, with no co-morbid diseases, visiting a gynecologist were included. Studied variables included were age, BMI, no. of miscarriages, time of miscarriage and plasma PAI-1 levels. The data was expressed in terms of median and percentages with a confidence interval of 95%. Analysis was done on SPSS version 20

Results: The median age of females was found to be 27.34+/- 5.09 years. Out of seventy five females with history of recurrent miscarriages, [81.3%] [n=61] women had Plasma PAI-1 levels within normal range whereas [18.7%] [n=14] had value greater than normal. The median plasma PAI-1 was found to be 29.6+/-22.16 ng/ml

Conclusion: PAI-1 was not found to be a risk factor for recurrent miscarriages in a local population of Karachi. Furthermore, studies on a large sample size need to be undertaken to assess the role of PAI-1in our population

Comparison of frequency of habits among different stages of oral submucous fibrosis

Background: To compare the frequency of habits among different stages of oral submucous fibrosis

Methods: A cross-sectional study was conducted. Patients were recruited through purposive sampling technique from Dental OPD of Ziauddin Dental College, Clifton campus and Keamari campus, Ziauddin Hospital, Karachi. There were 50 stage 1 OSMF patients with limited mouth opening between 26-35 mm and 50 stage 2 OSMF patients with limited mouth opening less than 26mm. A detailed questionnaire was filled with details regarding patient's medical history along with the frequency of pan, ghutka, betelnut, tobacco and alcohol. Co-relations were studied between various continuous variables. Cross-tabulations were performed between frequency of habits and different stages of OSMF

Results: In the present study, 100 OSMF patients, 70 [70 %] males and 30 [30 %] females, were recruited and diagnosed into different stages on the basis of limited mouth opening. Majority of addictions in OSMF stage 1were due to pan chewing [54%] followed by ghutka [40%], tobacco [34 %] and betelnut [28%] respectively. OSMF stage 2 patients showed highest consumption of ghutka [68%] followed by pan [60%], betelnut [50%] and tobacco [42%] respectively. Alcohol consumption alone in both stages was found insignificant causative factor in OSMF disease

Conclusion:The present study revealed that the relative risk of disease becomes higher with increased frequency and duration of daily consumption of pan for stage 1 and ghutka for stage 2 OSMF patients

Role of chewing habits and cigarette smoking in differentiation of oral squamous cell carcinoma

Background: Oral squamous cell carcinoma [OSCC] is one of the most common cancers in the world. Cigarette smoking, gutka and pan are the most common addictions in Pakistan. This study is conducted to evaluate the frequency of these risk factors [cigarette smoking, gutka and pan] and correlate it with histopathological grade of OSCC.The objective of the study is to evaluate the role of cigarette smoking, gutka and pan consumption in the histopathological differentiation of Oral Squamous Cell Carcinoma

Methods: A cross-sectional study was conducted. OSCC patients [n= 138] were recruited through purposive sampling technique from Dental OPD of Ziauddin Dental College, Ziauddin Hospital, Karachi. A detailed questionnaire was filled with information regarding patient's medical history along with the daily consumption of cigarette, gutka and pan. Co-relations were studied between various continuous variables. Cross-tabulations were performed between frequency of habits and different histopathological grades of OSCC

Results: In the present study, 138 OSCC patients, 108 [78.3%] males and 30 [21.7 %] females, were enrolled and histopathologically diagnosed into well differentiated, moderately differentiated and poorly differentiated OSCC. Association of histopathological grades of OSCC with different age groups revealed moderately differentiated OSCC as the predominant histopathological differentiation in 30-39 years age group [46.3%]. Majority of OSCC cases with cigarette smoking and gutka consumption used these products with frequency of > 15 packets per day, while, most of the pan consumers used 5-15 pan per day. All these patients had poorly differentiated OSCC i.e. 48.7% cigarette smokers, 64.1% gutka and 43% pan consumers

Conclusion: This study concludes that most of OSCC patients with habits of gutka, cigarette smoking and pan were associated with poorly differentiated carcinoma with more cases occurring in younger age group. This point to an alarming situation and serious thought should be given to early detection and prevention

Assessment of OPD patient's satisfaction with health care services at Al-Nafees medical hospital

Objective: To determine socio-demographic profile among the OPD patients and the overall satisfaction level of the patients utilizing the OPD

Study Design: A descriptive cross sectional study

Place and Duration: Conducted in OPD of Al-Nafees Hospital Islamabad from 12th January -12th March 2015

Methodology: Through convenient sampling a closed ended structured questionnaire was employed to collect the quantitative data. OPD patients aged 18-64 who showed willingness to participate were included in the study. Indoor patients, patients below 18 and above 64 and those who were not willing were excluded

Results: The study was conducted on 209 patients. Overall satisfaction level of patients with the OPD health services was 86.2%. Satisfaction level was found to be more in females than males. 42.6% had a family income of >15000 Rupees but satisfaction level with OPD services was same among respondents falling in different categories of family income. Patients with primary level of education were more satisfied. 41.1% waited 15-30 minutes for the examination by the doctor. 89% of the patients were satisfied from the registration staff. 73.3% were satisfied with doctor's service. The satisfaction level from the nurses was 64.6%. 63.3% were satisfied from the services provided by the pharmacy. 63.2% said that the medical expenses were affordable. 88% of the patients agreed upon the cleanliness of the building of the hospital and 77% stated that that signs and boards were easy to follow

Conclusion: In the current study it was found that majority of respondents were highly satisfied with the OPD services offered at Al-Nafees Hospital. Patients were satisfied with the behavior of registration staff, Physicians' communication skills, waiting time for examination, nursing care, pharmacy services and logistic arrangements

Frequency and determinants of Hepatitis B and C virusin general population of Farash Town, Islamabad

Background and Objective: Both Hepatitis B virus [HBV] and hepatitis C virus [HCV] infections are rapidly spreading in the developing countries. Both of them are blood borne and are transmitted through un-screened blood transfusion, inadequately sterilized needles and equipment. According to WHO's criteria of endemicity, Pakistan has high disease burden of Hepatitis B and C. The present study was planned to determine the frequency and to identify the risk factors of hepatitis B and C virus in the general community of Farash town

Methods: This descriptive study was carried out in Al Nafees Medical Hospital Lab, from January 2013 to December 2013. Both the genders and all age groups were included in the study. All the patients who fulfilled the inclusion criteria had given a written consent. Data was collected through questionnaire and was analyzed on Statistical Package for Social Sciences [SPSS] version 21

Results: Three-hundred and forty five patients were studied. Among these 92 [27%] were males and 253[73%] were female, 33% of them had hepatitis C, 9% had hepatitis B. History of injections was reported in all of the patients. Visit to community barbers was present in 58.6% and 41% cases of hepatitis B and C. History of dental procedures was obtained in 7[24%] and 15[13%] patients of hepatitis B and C

Conclusion: Major contributors for Hepatitis B and C in Farash town are use of unsterilized therapeutic injections and visit to community barbers. Education of the barbers regarding sterilization may help in reducing the burden of infection in this community

Potentially significant biomarkers in oral submucous fibrosis

Oral submucous fibrosis [OSMF] is a chronic, irreversibly progressive and precancerous disease that effects oral, oropharyngeal and oesophageal mucosa. OSMF is characterised by the inflamation and progressive fibrosis of lamina propria that leads to difficulty in mastication, speech, swallowing and causes limited mouth opening. Arecoline [major alkaloid] in areca nut is the main aeitiological factor in causing the disease. Prevalance of OSMF ranges from 0.2% to 0.5% in South India. The malignant rate of transformation over 17-year period was 7.6%. Trace elements [part of metalloenzymes] are recognised as versatile biomarkers which may be helpful in early detection, prognosis and can reduce the incidence of cancer. Copper, Iron, Zinc, Selenium, Cadmium, antioxidants [Superoxide Dimutase, Vitamin A, Vitamin C, Vitamin E], immunoglobulins and alternation in oncosupressor genes and other genes have been emphasized as biochemical parameters that play an important role in its pathogenesis. These parameters can also serve as important biomarkers in early detection of a premalignant condition and cancer progression

Imipenem Resistant Pseudomonas aeruginosa: The fall of the final quarterback

Objective: To isolate, determine the frequency, and study the demographic trends of MBL positive Pseudomonas aeruginosa from imipenem resistant isolates collected from clinical samples in a tertiary care hospital of Pakistan. Methods: In this cross sectional study a total of 230 strains of Pseudomonas were isolated from various clinical specimens on the basis of culture and biochemical tests. Imipenem resistant isolates were selected by Kirby Bauer Diffusion technique, followed by screening for MBL production by Imipenem EDTA Combined Disk Test. Demographic details of each patient were recorded on a separate questionnaire. Chi-Square goodness-of-fit test was computed to review the isolation of MBL positive isolates [P-value = 0.05] in different specimen. Results: Out of 230 strains of P. aeruginosa 49.5% were imipenem resistant; MBL production was confirmed in 64.9% of the resistant isolates. Resistance to polymyxin B [12.5%] was notable. Majority of the MBL positive strains were isolated from patients aged between 20-39 years [45.9%] and the predominant source was pus [43.24%] which was found to be statistically significant [P-value=0.04]. Outpatient departments [24.3%] and burn unit [21.6%] were the major places for resistant isolates. Conclusion: MBL production is one of the major causes of IRPA. Increasing resistance to polymyxin B is grave. Due to acquisition of MBL strains MDR P. aeruginosa has become endemic in tertiary setups

Alpha-SMA as a mesenchymal marker in Chronic Hepatitis C infection

Background: Liver biopsy so far, is the mainstay of diagnosing hepatic fibrosis. Activated HSCs express certain mesenchymal markers, of which Smooth Muscle Actin is a well-known marker. This study aims to appreciate expression of Alpha Smooth Muscle Actin in hepatic stellate cells of CHC cases and to find out the frequency of alpha-SMA positive HSCs in perisinusoidal, periportal and pericentral regions of liver

Methods: Liver biopsies of sixty Chronic Hepatitis C cases were immmunostained using anti alpha-SMA antibody. To assess immunoexpression, semi quantitative scoring was done in three areas in each sample; pericentral, periportal and perisinusoidal area

Results: Immunoexpression of alpha-SMA was observed in all area with strongest staining on HSCs of perisinusoidal area

Conclusion: alpha-SMA can represent a useful marker for early hepatic stellate cells activation in our population and can help target patients requiring aggressive therapy

Drug use among prisoners in three main prisons in Khartoum, Sudan

Drug use among prisoners in the three main prisons in Khartoum, Sudan in 1994 was studied. The results show variations in the use of drugs with regard to age, occupation, education, marital status and social status of inmates. Drug use was common among most prisoners, with alcohol and hashish being the most frequently used drugs. Alcohol use was more common among married prisoners; hashish use was more popular among single prisoners. Alcohol was frequently used with other drugs. Most prisoners started using drugs between the ages of 12 and 20 years. The principal reasons for drug use were temptation by friends and to escape social pressures