study of the spectrum of presenting symptoms, diagnostic investigations, treatment and outcome of severe malaria in the admitted children of Kuwait Teaching Hospital ,Peshawar, Pakistan

Objectives: to document the spectrum of presenting symptoms, diagnostic investigations, treatment and outcome of severe malaria in the hospitalized children of Kuwait teaching hospital

Methodology: this was a descriptive study using patient case records of children admitted from 1[st] January till 31[st] December 2013. All children with malaria requiring admission and treatment with parenteral anti-malarial were categorized as severe malaria and included in the study. Data was analyzed using Microsoft office Excel 2007

Results: 32 cases fulfilled the inclusion criteria. Fever was the commenest presenting symptoms present in 100% of cases [n=32]. Fifty percent children [n=16] had pallor, 12.5%[n= 4] cough, 9.3%[n=3] had dysuria and 6.25%[n=2] had fits recorded as additional presenting symptoms. 71.8% [n=23] had parasitological confirmation test before commencement of treatment. 100% of this parasitological confirmation was done by peripheral blood smear/microscopy test. Out of the 23 who had microscopy done 60.86%[n=14] had negative result and 39.13%[n=9]were positive for plasmodium of which,88.88%[n=8]were vivax and 11.11%[n=1] was falciparum.93.75%[n=30] of the parenteral anti-malarial used was intravenous quinine. All except one child 96.8%[n=31] recovered with the anti-malarial treatment used

Conclusions: fever and pallor are the two most common presenting symptoms of hospitalized children with severe malaria. Microscopy remained the most common investigation for the diagnosis of malaria. Quinine is the most frequently used drug for severe malaria. The study highlighted the need to further improve the case management of severe malaria in children

Hematological studies in chickens infected with hydropericardium syndrome

The present research project was designed to determine the hematologiacal values in infected broiler flocks with hydropericardium syndrome from January to June, 2012 in order to adjoining areas of Hyderabad Sindh. A total of 72 containing population 96,500 broiler chicken were surveyed to observe for hematological variation during the study period. Only 30 [41.66%] flocks were found affected with Hydro pericardium syndrome. Out of these flocks, the incidence of syndrome was recorded as 5.4% during the month of January, 7.41% in February, 10.8% in March, 13% in April, 15.1 in May and 12.8% during the month of June. The hematological studies were conducted in infected broilers with hydropericardium syndrome and found increase in white blood cells [WBC] from 14.500 +/- 2.298 to 25.820 +/- 844.00 and concentration of erythrocytic sedimentation rate [ESR] from 2.340 +/- 0.89 to 3.458 +/- 0.291. Amongst leukocytic count, showed marked increase with neutrophils and relative decrease of lymphocytes from 69.360 +/- 0.152 to 55.480 +/- 2.132, monocytes 4.660 +/- 0.598 to 3.340 +/- 270, eosinophils 1.496 +/- 0.204 to 1.004 +/- 0.097 and basophils 0.878 +/- 0.55 to 0.734 +/- 0.067 in infected birds

Women health in Saudi Arabia: a review of non-communicable diseases and their risk factors

This is a review of the changing pattern of chronic diseases among women in the Kingdom of Saudi Arabia [KSA]. Data from national surveys conducted in KSA, whose results were published between 1996 and 2011 were used. The results showed that over a period of ten years the prevalence of obesity increased in Saudi women from 23.6% to 44.0% and in men from 14.2% to 26.2%; self-reported physical inactivity worsened in both women [from 84.7% to 98.1%] and men [from 43.3% to 93.9%]; prevalence of smoking in women increased [from 0.9% to 7.6%], while it declined in men [from 21.0% to 18.7%]. The prevalence of metabolic syndrome was significantly greater in women than men [42.0% versus 37.2%; p < 0.01]. In conclusion, Saudi women are potentially at a greater risk than a decade ago to develop cardiovascular diseases and diabetes mellitus, with a notable increase in obesity compared to men

Experiences of stigma among hepatitis B and C patients in Rawalpindi and Islamabad, Pakistan

Hepatitis B and C are chronic diseases with mental and social impacts which can result in poor quality of life. The aim of this study was to determine the experiences of stigma in a sample of hepatitis B- and C-positive patients in Pakistan. In a cross-sectional study, 140 inpatients and outpatients from 3 tertiary-care hospitals in Islamabad and Rawalpindi answered a semi-structured questionnaire about stigma experienced from relatives, friends, spouse and health-care providers, and about work/financial problems. The majority of patients [75%] said they had had to change their lifestyle, and significantly more were males than females. Stigma was marked in terms of disease transmission, with 66% of patients fearing that they could transmit the infection to others; 19% said that family members avoided sharing towels, soap and eating and drinking utensils. Marital relationships were affected for 51% of married patients who had told their spouse. Patients' comments showed a sense of family and societal discrimination resulting in feelings of disappointment and isolation

Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures

A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [HCV] of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease [CLD]. There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and majiageprient of needy CLD patients as a poverty-reduction health intervention

Essential medicines management during emergencies in Pakistan

This paper illustrates the experiences of essential medicine management in providing cure and care to victims of Pakistan's 2005 earthquake in a safe, rational and effective mode. The health interventions assured access to essential medicine, sustained supply, inventory control through a computerized logistic support system and rational use of medicines. World Health Organization Pakistan outlined modalities for acceptance of donated medicines, assisted in speedy procurement of medicines and designed customized kits. Proper storage of medicines at controlled temperature was ensured in warehousing facilities in 12 locations. A steady supply of medicines and their consumption without stock-outs in the 56 first-level care facilities of calamity-hit areas helped to ascertain the average consumption and cost of essential medicines and supplies for the catchment population. Tools for quantification and forecasting of medicines and supplies were developed and shared. Medicines and medical supplies were efficiently used resulting in minimum wastage

Human organ and tissue transplantation in Pakistan; when a regulation makes a difference

Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio-economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities

Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan

The study was planned to review the case series of pregnant women requiring intensive care due to severe acute maternal morbidity in the public sector university hospital, in order to identify failures and priorities in maternal health care provision in Pakistan. A retrospective case series study was performed of critically ill obstetrics patients admitted to general intensive care unit of Liaquat University Hospital Hyderabad, Pakistan, from January 1[12] to 31[12] December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three% of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy [50%] and sepsis [17%] were the two main obstetrical conditions responsible for maternal illness. Respiratory failure [57%] and haemodynamic instability [40%] were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support [33%].The foetal mortality rate was 43%, while maternal mortality rate was 33%. Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive intervention through a team approach involving obstetricians, intensivists and anaesthetists

Pulmonary function tests: normal values in non-smoking students and staff at the Aga Khan University, Karachi

To estimate normal values of peak expiratory flow rate [PEFR], forced expiratory volume in first second [FEV1], forced vital capacity [FCV] and ratio between FEV1/FVC among non-smoking staff and students at The Aga Khan University [AKU] Hospital, Karachi, and to study the effect of age, gender and body mass index [BMI] on these variables. A corss-sectional study. This study was conducted at the Multidisciplinary Laboratory [MDL] of AKUH, Karachi from May to November 2005. Two hundred forty-one healthy never smokers were approached through non-probability convenient sampling among the staff and students of AKU and were screened through a questionnaire. Data from 200 subjects was used for analysis. Subjects were excluded if pregnant, body mass index [BMI] not ranging from 17-25, FEV1/FVC% less than 70 or with non-reproducible results. The mean values of FVC, FEV1, FEV1/FVC% and PEFR among males and females in different ages were compared by 't' test. Linear regression was applied to study the effect of age and BMI on the outcome variables. Mean FVC, FEV1 and PEFR were found to be higher in males than the females in all the age groups, the difference in FVC was significantly higher in the age groups of less than 20 years and 20-29 years [2.09L, CI: 1.27 - 2.92] and [1.51 L, CI:1.29 - 1.73] respectively. The above spirometric values declined with age and increased with height. Increase in age by one year resulted in 0.051 L decline in FVC [CI: -0.056, -0.034] whereas increase in height by a centimeter improved the FVC by 0.044L [CI: 0.03, 0.056]. The mean FVC, FEV1 and PEFR were higher in males in each age group. Females had higher FEV1/FVC%. Height had positive linear relationship and age was inversely related whereas BMI was not significantly associated with these variables. In order to generalize these reference values, a larger study following the ATS criteria is needed

B-type natriuretic peptide [BNP] for screening and monitoring the severity of heart failure and other cardiovascular disease: a minireview

The B-type natriuretic peptide [BNP] test has been approved by the Food and Drug Administration, USA, for use in the diagnosis of heart failure; it has proven highly effective in differentiating heart failure from other causes of dyspnea. However, BNP has also proven useful in other clinical situations, such as risk stratification for patients with heart failure and acute coronary syndromes. The prognostic information provided by BNP means that targeting individuals with high BNP concentrations for preventative therapies can potentially halt the advance of the cardiovascular disease in these patients and save lives. While BNP can identify patients with heart failure or cardiovascular disease, following BNP levels after intervention can potentially be used to adjust therapies to an optimal level. Finally, many other uses of BNP have been proposed. Upcoming studies will undoubtedly help clarify established guidelines and help set new ones

Assessment of diastolic dysfunction in hypertensive patients and its association with left ventricular mass index

Early detection of diastolic dysfunction in hypertensive patients to reduce complications and improve outcome. East Medical and Cardiology wards of Mayo Hospital Lahore. Study A descriptive cross-sectional study. 51 hypertensive patients between 50 - 80 years of either sex enrolled through out patient department of Mayo Hospital Lahore underwent Doppler Echocardigraphy and data was analyzed by using Chi-square and Students 't' tests. The percentage of left ventricular hypertrophy [LVH] was 66.66%. On comparing hypertensive patients with and without LVH, E and A wave velocities, E:A ratio, deceleration time and isovolumic relaxation time were similar. 33.33% of patients had no LVH in the presence of diastolic dysfunction so LVH was not an independent factor associated with abnormal flow patterns in hypertensive patients with normal systolic contractility. Impaired relaxation was the predominant pattern of diastolic dysfunction an d increased further with age

Evaluation of the nucleolar organizer region associated proteins in exfoliative cytology of buccal mucosa of smokers and non-smokers

Background: Cigarette smoking influences proliferative activity in buccal mucosal cells. The argyrophylic nucleolar organizer region [AgNOR] count has been found to a reliable parameter in determining the proliferative activity. The present study aims at assessing AgNOR count in buccal mucosal cells of smoker and nonsmokers

Methods: The cytological smears of normal buccal mucosa in 75 smokers and 75 nonsmokers were stained for AgNORs. The AgNORs were counted in 100 cells independently by two observes. The count values of groups were compared and analyzed using student's t test

Results: The difference between counts of the two observers was found to be non significant [p> 0.05]. The AgNORs count per cell in smokers [3.280.41] was significantly higher [p<0.01] than AgNORs count per cell in non-smokers [1.820.28]

Conclusion: It is possible on the basis of AgNORs count to differentiate between smoker's buccal mucosaI cells and that of non-smoker's - the effect of smoking. This study also indicates that the AgNOR technique is a simple, rapid, reproducible and inexpensive method. It is concluded that cigarette smoking influences the proliferative activity in buccal mucosal cells

Comparison of lipid profile in thrombotic and haemorrhagic stroke patients

To compare lipid profile in thrombotic and haemorrhagic stroke patients. All general medical and neurology wards of Mayo Hospital Lahore. Study was conducted in 40 consecutive patients of stroke admitted in hospital. Serum lipid [total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio] were estimated in all selected patients within 7 days of onset of stroke and findings were entered on study proforma specifically designed for this purpose and analyzed statistically by students "t" test. Out of 40 patients included in the study, 22[55%] were suffering from thrombotic stroke while 18[45%] suffered from haemorragic stroke. The difference in the values of total cholesterol, triglycerides, low-density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio was not statistically significant between the two groups of patients. It is concluded that serum lipids i.e., total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins, high density lipoproteins and LDL/HDL ratio does not have any differential effect in the causation of thrombotic or haemorrhagic strokes

Precipitating factors for diabetic ketoacidosis

The objective of the study is to evaluate different precipitating factors for diabetic ketoacidosis. All medical wards of Mayo Hospital, Lahore. This descriptive study was conducted on 50 patients. Patients and their relatives were selected for interview on the basis of convenient sampling. The data was collected on specially designed proforma. The proforma was filled for each patient. All patients were investigated with various blood tests, urine tests, ECG and chest X-rays. The data analysis was computer based. SPSS 10 was employed for this purpose. The mean age was 31.3 years. 60% of the patients were males. Diabetes mellitus was newly diagnosed at presentation in 22% patients. Vomiting was present in 44% patients. Mean blood sugar level was 509mg/dI [380-98mgIdl]. Mean arterial p1-I value was 7.05 [6.9-7.2]. Infection [56%] and non-insulin compliance [38%] were the most common precipitation factors. Poor knowledge about disease, treatment and follow up was also noted. Infection and poor medication compliance are major precipitating factors for diabetic ketoacidosis. Level of health education is very poor; so more emphasis should be given to the health education of the diabetics

Is there a correlation between degree of viremia and liver histology in chronic hepatitis C?

To determine the correlation between degree of histological liver damage and serum HCV RNA level in patients of chronic hepatitis C, in order to evaluate the usefulness of HCV RNA estimation as an alternate to liver biopsy. This non-interventional descriptive study, was carried out at the department of Pathology, Army Medical College, Rawalpindi, Pakistan between April and September 2002. Core needle liver biopsies of fifty five patients of chronic hepatitis C were evaluated according to Knodell's histological activity index system. The patients were categorized into four subgroups depending upon the grade and stage of disease according to Desmet's classification, and into three groups according to degree of viremia. Five patients had mild viremia, 43 moderate and 7 had severe viremia. Seven patients had minimal disease, 9 mild, 22 moderate and 17 had severe chronic hepatitis. Eight patients had no fibrosis, 20 had fibrous portal expansion, 19 bridging fibrosis, and 8 patients had cirrhosis. No significant correlation was found between serum HCV RNA levels and grade or stage of the disease, with correlation coefficients of rs = -.054 and rs =.034 respectively. Moreover, no individual component of the HAI correlated with serum HCV RNA levels. Serum HCV RNA level does not determine the degree of hepatic injury precisely and liver biopsy is necessary to accurately evaluate the extent of liver damage

Etiology of chronic liver disease in children

To review the clinical spectrum and etiology of chronic liver disease in children at National Institute of Child Health, Karachi. Prospective study in children aged 1 to 14 years with suspected chronic liver disease. Complete blood count, LFT's, prothrombin time, serum albumin and ultrasound of abdomen were done in all patients. Liver biopsy was done in majority of the cases. Viral markers included HBsAg, anti HCV and ANA to determine etiology. Those who were negative for hepatitis B, C and autoimmune disease, were subjected to slit lamp examination of eyes and 24 hours urinary copper estimation for Wilson's disease. Alpha-1-antitrypsin levels were done in selected patients. A total of 55 cases were studied. The common presenting features were edema, ascites [44 patients], jaundice [27], variceal bleeding [23] and fever [22]. On examination anemia was present in 52 patients, edema in 46, jaundice in 37, splenomegaly in 42 and hepatomegaly in 35 patients. Fortynine patients had hypoalbuminemia [<2.5 gm%], 45 raised ALT [>80 IU/L] and 49 prolonged PT [>4 sec of control]. Ultrasonography showed a dilated portal vein in 34 patients and esophageal varices were seen in 46 patients on endoscopy. Thirteen [24%] had chronic hepatitis B, 9[16%] autoimmune disease, 9 [16%] Wilson's disease and all were anti HCV negative. Etiology remained uncertain in 24 [44%] cases. Hepatitis B was the leading cause of chronic liver disease in children followed by Wilson's disease and autoimmune liver disease. None of the patients had hepatitis C in this study

Diagnostic efficacy of stool antigen test [HPSA], CLO test and serology for the detection of helicobacter pylori infection

The diagnosis of Helicobacter pylori infection was initially being made through invasive methods but now non invasive methods have been developed to make the diagnosis easier. The present study was done to evaluate the diagnostic efficacy of a two non invasive tests i.e. Helicobacter pylori Stool antigen test [HpSA] and Helicobacter pylori IgG serology with an invasive method i.e. Campylobacter like organism [CLO] gel test. Methods. The study was conducted in the gastroenterology unit of Pakistan Medical Research Council Research Centre Karachi. Adult patients with gastroduodenal disease were selected for study and their medical history was recorded. Endoscopy was done on all patients and the antral biopsy sample was tested for H.pylori using CLO test. Serology [IgG] was done elsewhere using ELISA and titers of over 50 units were recorded as positive. HpSA was done to determine the presence of H.pylori antigen in stool. Results. Out of 43 patients 34 [79%] were males and 9 [21%] females. The main presenting symptom was epigastric pain in 74% cases. Although H.pylori IgG antibody titers of over 50 were taken as positive but for this study titres of over 100 were taken as significant for comparison with other tests. CLO test was positive in 26 [60.5%] cases, H. Pylori antibody titers of over 100 IU were present in 33 [76.7%] cases and HpSA in 21 [48.8%]. Using CLO test as the gold standard the sensitivity of serology was 81% and that of HpSA 65% with a 29% and 76% specificity respectively. Conclusion. In our setting CLO test is still the best diagnostic test for H. Pylori detection. Both non invasive tests i.e. serology and stool HpSA are less sensitive than CLO but amongst each other both are equally sensitive