An autopsy study of sudden cardiac death

To determine the cause of sudden cardiac death and observe the morphological changes in the heart after death. A cross sectional survey of 66 cases was carried out at Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1992 to 1994. A detailed autopsy including external and internal postmortem examination was done. Representative sections were taken for histopathological examination and some viscera were sent to Chemical Examiner at Lahore for chemical analysis. All the cases were male with age range from 21 to 58 years. These cases died within 60 minutes with or without onset of symptoms. Fifty two cases revealed mild to severe atherosclerosis. Coronary occlusion with thrombosis was seen in 37 cases whereas 9 cases showed critical narrowing without evidence of thrombosis. Five showed both symmetric and asymmetric hypertrophy. Changes in conduction system of the heart were seen in 4 individuals. Myocarditis was noted in 2 cases only. The cause of death could not be determined in 3 cases. Majority of the cases died of coronary atherosclerosis whereas 17% cases revealed hypertrophic cardiomyopathy, changes in conduction system and myocarditis and 4% cases were undetermined. A detailed and thorough postmortem examination is mandatory to ascertain the cause of sudden cardiac death

Subclassification of hepatitis B virus carriers

Hepatitis B virus [HBV] carriers are sub-categorised as [supercarriers] and [ordinary carriers] according to their HBeAg/anti-Hbe status. This subcategorization helps in the determination of grade of infectivity, viral activity, as well as therapeutic considerations in these cases. Between January 1990 and December 1993, 405 HBV carriers were evaluated for their serum [e] antigen/antibody status and out of these 129 [32%] and 246 [61%] cases were found to be HBeAg and anti-HBe positive respectively, whereas 30 [7%] carriers were doubly negative. There were no age or sex-related differences in the two groups. In conclusion, nearly one third of our HBV carriers were HBeAg positive "supercarriers" with a potentioal of high grade of infectivity. The finding is important regarding the active/passive prophylaxis of the off springs of HBeAg positive mothers

Hepatitis E in Pakistan

In Pakistan, sporadic cases of hepatitis E occur throughout the year. However, small outbreaks and epidemics of hepatitis E have been reported from the cities of Peshawar, Mardan, Abbottabad, Rawalpindi-Islamabad, Sargodha, Multan, Hyderabad, Quetta and Karachi. A large epidemic of hepatitis E occurred in one of the army garrisons at Lahore in early 1995, when more than 600 cases were treated as inpatients. Wherever epidemiological investigations have been carried out, the cause of the outbreak has always been found to be contamination of water supplies with sewage. This paper considers the epidemiology, diagnosis, clinical features, treatment, prevention and control of hepatitis E in Pakistan

Antenatal screening for detection of hepatitis B carrier state

The screening for hepatitis B carrier state was carried out on the sera of 205 asymptomatic pregnant women coming for antenatal checkup at the Holy Family Hospital, Rawalpindi. The sero analysis for hepatitis B virus [HBV] infection, was performed at two reputable centres, one in the Army Medical College, Rawalpindi and the other in the U.S.A [NIH, Bethesda, Maryland]. The results showed hepatitis B surface antigen to be positive in 16 [7.8%] women, while hepatitis e antigen was negative in all the cases, but antibody to hepatitis B core antigen [anti-HBc] was detected in 68 [33.2%] of them. The usefuluness and implications of these findings are discussed. It is recommended that further studies, to delineate the maternal HBV carrier rate with the possible threat of vertical transmission, be carried out during the antenatal period in our pregnant females in other parts of Pakistan

role of hepatitis B and C viruses in the aetiology of hepatocellular carcinoma in northern Pakistan

The sera from 23 patients with histologically confirmed HCC were tested for seropositivity against hepatitis B [HBsAg and/or anti-HBc] and hepatitis C antibodies [anti-HCV], to ascertain the evidence of infection due to these viruses. While 16 [69.6%] of the patients expressed positivity for the seromarkers of hepatitis B virus infection, it was only in 3 [13%] cases that the antibodies against the HCV [anti-HCV] could be demonstrated. In the sera from 2 [8.7%] subjects, positivity for seromarkers of both B and C viruses was detected. Six [26.1%] cases of HCC had no seromarkers for either HBV or HCV. The data thus indicated that in northern Pakistan, infection with HBV was more common and had a major role to play in the causation of HCC, whereas HCV infection was implicated in only a few cases of HCC

Viral hepatitis B: diagnostic difficulties

Hepatitis B is highly endemic in Pakistan with about 10% of the population being carrier for hepatitis B virus [HBV]. These carriers may develop jaundice or acute viral hepatitis like picture due to many other causes. If a test to detect hepatitis B surface antigen [HBsAg] is only performed to classify the type of hepatitis, the patient may get mislabelled. At the Armed Forces Institute of Pathology, Rawalpindi, a total of 1570 adult cases, clinically presenting with hepatitis, were studied between January 1991 and December 1993. Out of the 361 cases found positive of HBsAg by RPHA and ELISA method. There were 110 [110/361, 30.5%] cases which expressed positively for Anti-HBc IgM; an indication of recent infection in the immediate past. The rest 251 [251/361, 69.5%] patients were, most probably, the HBV carriers and their current ailment was not due HBV. To diagnose a case of acute hepatitis B, it is essential that both HBsAg and Anti-HBc IgM must be looked for in patient's

deception by hepatitis B surface antigenaemia negativity in acute viral hepatitis cases

It is because of the limited availability of viral hepatitis serology services in Pakistan that Hepatitis B Virus [HBV] surface antigen [HBsAg] detection is being used widely as the sole diagnostic marker for HBV in the screening of blood donors and for the diagnosis of acute hepatitis-B cases. As a consequence, a negative hepatitis B surface antigenaemia could possibly lead to false diagnosis in cases of acute viral hepatitis [AVH] on the part of attending laboratory staff and treating clinician. This possibility necessitates added use of other relevant viral hepatitis markers which could help in establishing a correct diagnosis in acute viral hepatitis B cases. From December 1989 - November 1993, a total number of 746 cases of AVH, initially diagnosed on the basis of their clinical picture and liver function profiles, and with a negative HBsAg status, were further tested for anti HBc-IgM in their sera by ELISA technique. In this series there were 8 cases AVH which were positive for anti-HBc IgM, thereby confirming that these 8 cases had a recent HBV infection. In conclusion, a negative HBs-antigenaemia in isolation must be interpreted with caution. In cases, where a strong clinical suspicion of acute HBV infection exists, the estimation of anti HBc IgM must be carried out, particularly in cases of fulminant viral hepatitis

incidence, nature of causative organisms and histological diagnosis of mycetoma foot in Pakistan

The mycetomas are localized, chronic infections associated with sinus formation and purulent discharge containing granules of various colours. We carried out a study in the Pathology Department, Army Medical College, Rawalpindi to find out the incidence and Pattern of mycetomas in our area. The mycetomas were uncommonly diagnosed over a period of 12 years [1980-1991] and only 13 cases of mycetomas of foot were diagnosed in our laboratory. Most of the patients were females [77%] belonging to the 3rd to 5th decades of life. They all came from rural background with poor personal hygiene and belonged to low socioeconomic group. The actimonycetomas were more common as compared to eumycetomas [4.5:1]. On histopathological examination, Streptomyces somaliensis and actinomyces spp. were most commonly diagnosed [8/13] while Medurella mycetomatis was found in 2 cases only. An early diagnosis alongwith differentiation between actiomycetoma and eumycetoma is imperative to institute appropriate medical treatment or embark on surgical intervention

Hepatitis C as a cause of chronic liver disease in northern Pakistan

he antibodies to hepatitis C virus [HCV] were tested in 45 histologically confirmed cases of chronic liver disease. Twelve cases had chronic hepatitis, 24 cirrhosis and 9 hepatocellular carcinoma. Anti-HCV was detected in 6 patients. Two [16.67%] were suffering from chronic hepatitis, 3 [12.5%] had cirrhosis and one [11.11%] hepatocellular carcinoma. None of the anti-HCV positive cases had past history of blood transfusion. The patients of chronic liver disease in this study had a much higher prevalence of HBV infection which indicates that in northern Pakistan hepatitis C virus infection is not a common cause of chronic liver disease whereas HBV infection plays an aetiological role in a much larger number of these cases

colorectal carcinoma in Northern Pakistan: a retrospective study

Colorectal carcinoma is an important malignancy which if recognized and diagnosed at an early stage may lead to better prognosis. A total of 3634 cases of malignancy were diagnosed on histopathology in the Pathology Department, Army Medical College, Rawalpindi between 1980-89. Of these 118 patients [3.25%] had malignancy of colorectal region. The majority of patients with colorectal carcinoma were males [65.25%] with a male to female ratio of 1.8:1.A significant number [29.65%] of colorectal carcinomas were diagnosed in patients who were under 40 years of age. Bleeding per rectum [44%] and intestinal obstruction [24%] were the main presenting complications. The majority [62.71%] arose from the rectum; the rest were from the colon. The most common historical type was well-differentiated to moderately well-differentiated adenocarcinoma [17.19%] followed by mucoid carcinoma [11.02%]. The year wise distribution of cases of colorectal carcinoma revealed an upward trend

Infection with delta agent in Pakistan - introduction of a new hepatitis agent

Delta agent is a defective virus which may coinfect with hepatitis B virus [HBV] or superinfect a carrier of hepatitis B surface antigen [HBsAg], Sera from 1130 adult and young jaundiced patients and volunteers of both sexes were tested for seromarkers of viral hepatitis by ELISA technique. One hundred and ninety three cases, positive for HBsAg, were further tested for delta antibody. A low prevalence [3.11%] of delta agent infection was found in these HBsAg positive individuals. As HBsAg carrier rate in general population is fairly high in Pakistan [10%] and all modalities of spread of HBV/delta agent are also present, so the risk of spread of delta agent is also high. The mandatory use of disposable syringes and elimination of HBsAg positive blood units for transfusion should be strongly emphasised to prevent the further spread of HBV/delta agent infection in the country

seroepidemiological study of acute viral hepatitis in Northern Pakistan

The seroepidemiological study carried out to find out the pattern of acute viral hepatitis [AVH] revealed that NANB hepatitis was the commonest type of AVH in adults [77.16%] while hepatitis A was the most frequent variety [59.3%] in children in our country. Several epidemics of enterically transmitted [ET] NANB hepatitis were also documented in various cities. The screening of the apparently healthy, adult population revealed that 97.100% of adult population was immune to hepatitis A and a carrier rate of HBsAg was present in 8.10% of general population. However, the analysis of seromarkers in HBsAg positive patients/healthy volunteers showed a low frequency of delta antibody [3.1%]. Poor hygienic conditions, bad sanitation, consumption of polIuted and unclean water and use of non-disposable glass syringes are considered to be the important causes of high endemicity of various types of acute viral hepatitis in our country

pattern of acute viral hepatitis in children: a study based on Seroepidemiology and biochemical profile

The study of pattern of acute viral hepatitis [AVH] in children revealed that hepatitis A was most common in children [59.3%] followed by NANB hepatitis [29.7%]. A dual infection with hepatitis A and hepatitis B was present in 4.4% of cases. Hepatitis A was more commonly diagnosed in younger children [54.9%] while the frequency of NANB hepatitis increased with the advancing age. Liver function tests in children were more disturbed in hepatitis A and NANB hepatitis as compared to hepatitis B. A seasonal variation [late summer and winter] was noticed in the occurrence of hepatitis A. Poor hygienic conditions, improper sanitation, overcrowding and the use of inadequately sterilized syringes are important factors in the transmission of all types of acute viral hepatitis in children

Spordaic non-A, non-B hepatitis: a sero-epidemiological study in urban population

The frequency and epidemiology of sporadic non- A, non-B [NANB] hepatitis was studied in adult urban population. The diagnosis of NANB hepatitis was made on the basis of exclusion by serological markers of acute viral hepatitis A and B and other aetiological factors. A frequency of 77.16% of NANB hepatitis was found in adults in Northern Pakistan which ranks as one of the highest in the world. The faecal oral route is considered to be the most likely method of spread of sporadic NANB hepatitis in Northern Pakistan due to poor hygienic conditions prevailing in the country

clinicopathological study of 107 ovarian tumours

One hundred and seven patients operated for ovarian tumours were assessed clinically and histoio-gically. Most patients were multiparous, between 19 - 39 years of age, presenting with low abdominal pain, pelvic mass, vague gastrointestinal symptoms and bleeding per vaginum. Histologically 72.85% tumours were benign and 27.06% malignant. Mucinous epithelial tumour was the commonest type of tumour. Serous epithelial tumours were 22 [14 benign, 8 malignant]. There were 33 teratomas of ovary, majority being benign and only 2 were malignant. The tumours of stromal cell origin were seen in 6.5% cases