Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan / Prevalência de leishmaniose cutânea na maior cidade populosa de Karachi, Paquistão

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p<0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

O estudo foi realizado de setembro de 2018 a abril de 2019 para determinar a prevalência de leishmaniose tegumentar em seres humanos que vivem em seis distritos de Karachi. Pessoas suspeitas foram rastreadas para a doença e os casos positivos foram identificados com base em lesões de pele e amostras de sangue. As amostras foram observadas montando seu esfregaço. Um total de 207 indivíduos de diferentes idades e grupos sexuais foi investigado, no entanto apenas 192 (92%) dos casos suspeitos foram encontrados para ter a doença; 64% dos casos eram do sexo masculino, que foram significativamente elevados (p < 0,05), e do sexo feminino 36%. A lesão foi detectada com maior frequência entre os jovens de 21 a 30 anos (31%) em comparação com os outros grupos. Em ambos os sexos, as pernas estavam mais infectadas (25% homens + 20% mulheres), seguidas pelos braços (20% homens + 0% mulheres) e rosto (15% homens + 11% mulheres). As partes mistas do corpo mostraram as infecções mais baixas (4% homens + 5% mulheres). Em conclusão, as infecções de leishmaniose mais altas e mais baixas foram observadas no Distrito Oeste (23% homens + 9% mulheres) seguido pelo Distrito Leste (15% homens + 7% mulheres), Distrito Malir (11% homens + 4% mulheres), Distrito Central (7% homens + 5% mulheres), Distrito Korangi (4% homens + 7% mulheres) e Distrito Sul (4% homens + 4% mulheres), respectivamente.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan

Abstract. The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Resumo O estudo foi realizado de setembro de 2018 a abril de 2019 para determinar a prevalência de leishmaniose tegumentar em seres humanos que vivem em seis distritos de Karachi. Pessoas suspeitas foram rastreadas para a doença e os casos positivos foram identificados com base em lesões de pele e amostras de sangue. As amostras foram observadas montando seu esfregaço. Um total de 207 indivíduos de diferentes idades e grupos sexuais foi investigado, no entanto apenas 192 (92%) dos casos suspeitos foram encontrados para ter a doença; 64% dos casos eram do sexo masculino, que foram significativamente elevados (p 0,05), e do sexo feminino 36%. A lesão foi detectada com maior frequência entre os jovens de 21 a 30 anos (31%) em comparação com os outros grupos. Em ambos os sexos, as pernas estavam mais infectadas (25% homens + 20% mulheres), seguidas pelos braços (20% homens + 0% mulheres) e rosto (15% homens + 11% mulheres). As partes mistas do corpo mostraram as infecções mais baixas (4% homens + 5% mulheres). Em conclusão, as infecções de leishmaniose mais altas e mais baixas foram observadas no Distrito Oeste (23% homens + 9% mulheres) seguido pelo Distrito Leste (15% homens + 7% mulheres), Distrito Malir (11% homens + 4% mulheres), Distrito Central (7% homens + 5% mulheres), Distrito Korangi (4% homens + 7% mulheres) e Distrito Sul (4% homens + 4% mulheres), respectivamente.

Factors Responsible for Work Stress among Health Care Providers and Frequency of Antidepressant Medicine Use

Objective:To assess the contributing factors of occupational stress and frequency of antidepressant medicine use among healthcare providers working at Isra University Hospital.Study Setting: IsraUniversity Hospital, Hyderabad Sind Pakistan.Study Design: Cross-sectional.Materials and Methods:All the health care providers of Isra University Hospital, Hyderabad of either gender formed the sample of the study. A structured questionnaire in English language was designed to gather data on factors contributing to occupational stress. Data was analyzed by using SPSS version 20.Results:The impact of work stress on work performance was explored in 100 study participants. The results indicated that 87% of study sample affirmed that stress lead topoor performance. Out of all participants, 79% were female and 21% were males. The analysis of stress elevating factors showed that 56% study participants had stress due to low salary, 17% felt stress due to seniors ‘negative attitude’ and 15% due to low job satisfaction. Result showed that 27.0% subjects reduce stress by sharing with theirfriends, 25% by prayers, 21% use the music during stress, 19.0% share with family and 8% using the antidepressant medicine during stress.Conclusion:It was concluded that low job satisfaction, lesser pay and seniors’ attitude are common contributing stress factors. Sharing with family and friends, music, prayers and use of the antidepressant medicine were the common methods of stress reduction

Quality of Life after Chronic Post Stroke Patients

Background/objectives: To assess the quality of life among patients presented with chronic post-stroke patients in our population. Materials and methods: This was a survey type study conducted at physiotherapy department of Liaquat University of Medical and Health Science. Study duration was six months from June 2014 to November 2015. All the patients with the chronic stage of stroke, age 20 to 60 years and patient should not have any disability other than stroke were included study. Patient’s demographic data and information regarding quality of life was assessed by self-maid questioner. Data were analyzed by SPSS version 16.0. Results: Total 100 cases were selected in the study, their mean age was 45.35+3.4 years, most of the cases 73 (73.0%) were with right side affected by stroke. Majority of the cases 47 (47.0%) had acceptable health and 18 (18.0%) patient’s health was poor. 66 (66.0%) patients presented with a history of previous stroke. Most of the patients were moved by help of someone, almost half of patients can move by himself, few patients can’t move and they were completely dependent on others. When patients were interviewed psychologically 41 (41.0%) patients feeling lonely and 31 (31.0%) were depressed and unhappy, 19 (19.0%) had suicidal thought. When patients were interviewed regarding behavior with your family 36 (36.0%) answered as not good behavior of family members, these cases justified that they belong to the poor families and they are as a burden. Conclusion: It was concluded that there was poor quality of life among chronic post-stroke patients especially patients belongs to poor families

Effects of gamma irradiation on the physico-chemical and biological properties of levofloxacin

The aim of the present study was to examine the effect of gamma radiation on levofloxacin. Powder form of levofloxacin was subjected to different radiation doses [25, 50, 75, 100 and 125kGy] of Cobalt-60 source in a Gammacell-220 at a rate of 8.5 Gray/hr. The effect of radiation has been investigated with the aid of different spectroscopic techniques [UV-Vis, FT-IR], scanning electron microscopy [SEM], X-ray diffraction [XRD], and by antibacterial activities. UV data did not reveal significant changes in the structure of levofloxacin which is supported by scanning electron microscopy. However, X-rays diffraction shows a change in crystallinity of levofloxacin to an amorphous structure and this has been reflected on the morphology of this compound as indicated by SEM images. The antibacterial activities, on the other hand, reveal resistance of irradiated levofloxacin against bacteria, where some bacteria were highly affected by the irradiated drug. Similarly, FT-IR data show some changes in the functional groups principal absorption bands, in the IR spectrum, at frequencies 3286, 2846, 1716 and 1620 cm-1 for the O-H stretching band of quinolone, C-H stretching band, and C=O stretching band of carboxylic and pyridine. In addition, new peaks appeared which were not seen in the non-irradiated spectrum. In conclusion, some changes occurred in levofloxacin drug with the passage of radiation but the drug was chemically stable

Adipokine Serum visfatin level in pregnancy induced hypertension and uncomplicated pregnancy

Background and Objectives: Hypertensive disorder in pregnancy is the significant disease that badly affects the maternal and fetal prognosis and lead to higher mortality and morbidity in the prenatal period. Visfatin, potentially a new adipokine has emerged having high contribution in pathogenesis of preeclampsia. The objective of the study was to find the level of Visfatin in pregnancy induced hypertension and normal pregnant women

Methods: This study was carried out in tertiary care hospitals, Peshawar from March-October 2014. A total of 234 pregnant women [gestational age >20 weeks] were included in the study with distribution as Preeclampsia [PE=86], Eclampsia [E=74] and control [N=74]. Blood was taken for measuring Visfatin level by Enzyme Linked Immunosorbent Assay [ELISA] technique. SPSS version 19 was used for statistical analysis. Student's t test was performed to evaluate the mean differences in patients and control

Results: Serum level of visfatin was significantly higher in pregnancy induced hypertension when compared with control [P value <0.001]. Comparisons of mean value of visfatin with age group of 21-40 years, body mass index [BMI], primary parous and parity 2-4, gestational age of >36 weeks and both systolic and diastolic blood pressure were highly significant in pregnancy induced hypertension when compared with control [p value <0.001]

Conclusion: Pregnancy induced hypertensive women showed increased level of serum Visfatin than normal pregnant women

Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy

PURPOSE: To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). MATERIALS AND METHODS: This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. RESULTS: The mean age of the patients in group A was 37.31+/-10.1 years and that in group B was 40.1+/-11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). CONCLUSIONS: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.

Risk factors for diabetic foot ulcer

Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study, had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. Out of 196 patients 80.1% were male. One hundred and forty-six [74.48%] patients were in the range of 40-70 years. Right foot was more commonly involved [65.3%], 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients; staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease, grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. Neuropathy, peripheral arterial disease, duration of diseases and underlying osteomylitis are the major risk factors and need to addressed while educating patients

Evaluation of patients with coronary artery disease for major modifiable risk factors for ischemic heart disease

Incidence of cardiovascular diseases is on the rise in developing countries. Deaths due to ischemic heart disease can be reduced by modifying the risk factors. The present study was conducted to evaluate the patients scheduled for Coronary Artery Bypass Surgery for the presence of major modifiable risk factors for ischemic heart disease [IHD]. It was a descriptive study. All patients who underwent elective Coronary Artery Bypass cardiac surgery between November 1, 2008 and February 28, 2009 at Rehman Medical Institute, Peshawar, were included in the study. Presence of Diabetes, Hypertension, Smoking, Dyslipidemia, Sedentary life style, and Obesity was looked for in these patients. A total of 104 patients were studied during this period. Majority [97.11%] of patients had at least one major modifiable risk factor for IHD. Sedentary life style [53.84%] was the most common risk factor present in these patients followed by hypertension and dyslipidemia [47.11% each], smoking [43.27%], diabetes [35.57%], and obesity [9.61%]. Multiple risk factors [two or more] were found in 78 [75.0%] of patients. Most of the patients with coronary artery disease, severe enough to warrant coronary artery bypass grafting, have at least one of the major modifiable risk factors for IHD. Modification of these factors may well reduce the disease burden of CAD and reduce the cardiovascular mortality.

Planning and reform of human resources for health in Afghanistan

Afghanistan is ranked 155 out of 169 countries on the human development index [HDI], a composite measure of three basic dimensions of human development, one of which is health. While some progress has been made, many of the key indicators of health status have not improved in the last decade. Many factors contribute to the lack of progress, but central to improving the situation is strengthening the national health system, particularly in the arena of human resources. The Ministry of Public Health [MoPH] has prioritized the issue of human resources, viewing this as a fundamental necessity to the provision of healthcare. To bring together a number of distinct planning efforts, the General Directorate of Human Resources [GDHR], MoPH organized a process to develop a comprehensive plan. In this paper, we summarize the process that was established by the GDHR to lay a foundation for developing the strategic plan to address human resources for health [HRH] in Afghanistan. This plan includes the synthesis and harmonization of data and the involvement of all key stakeholders. We document both success and shortcomings, discuss the remedial action initiated to continue to advance the HRH agenda, and conclude with several recommendations

diagnostic value of fine needle aspiration cytology in masses of the salivary glands

To determine the sensitivity and specificity of fine needle aspiration cytology in masses of the various salivary glands. The study included 49 cases. It was conducted at the Departments 0f ENT, Hayatabad Medical Complex, Peshawar and Saidu Teaching Hospital, Saidu Sharif, Swat from January 1, 2002 to December 31, 2009. Patients undergoing Fine Needle Aspiration Cytology followed by open biopsy were included in the study. The results obtained on FNAC were compared with those obtained on biopsy findings of the respective specimens and the specificity and sensitivity of FNAC were calculated from the data. The FNAC findings in salivary glands were; Benign 38, Malignant 7 and Suspicious 4. The biopsy findings were; Benign 33 and Malignant 16. Comparison of FNACs and biopsy in the salivary glands taken as True Negative, True positive, False Negative and False Positive respectively was; 32, 10, 6 and 1. The Sensitivity and Specificity for FNAC were calculated at 62.50% and 96.97% respectively. The results of this study show that FNA cytologic diagnoses in the salivary gland tumours are reliable and treatment can be planned on its basis. However, owing to a higher number of false negative cases occurring in this study, it is recommended that a negative cytology report should be viewed with suspicion. The diagnosis should be confirmed by open biopsy if clinical suspicion persists

Association of lipoprotein- alpha with obesity in children and adolescents in district Swat

Studies have demonstrated that atherosclerosis has its silent beginning during childhood. Coronary artery disease, particularly when it presents early in adult life has been observed to have a familial tendency. Lipoprotein-alpha [Lp-alpha], has a strong genetic association and raised levels when combined with obesity increase the risk of premature coronay heart disease. Thus in adults, has emerged the possibility of preventing or delaying the coronary artery disease when appropriate measures are applied early in life. In our study, we assessed the prevalence of overweight and obesity and its association with Lp-alpha in the child population of district Swat. The study was carried out in Saidu Teaching Hospital and Biochemistry Department, Saidu Medical College, Swat, from May to July 2007. Both boys and girls between 10-20 years of age were included. The prevalence of obesity was detected in 200 subjects by using body mass index. One hundred subjects were selected to compare the anthropometric and cardiovascular parameters of obese subjects with control group. Lp-alpha was measured in children of both the groups. The prevalence of obesity in adolescent boys was 6.7% and that in adolescent girls was 10%. The prevalence was higher in female subjects, compare to male subjects. Obese subjects had significantly higher weight, body mass index, blood pressure values and Lp-alpha levels as compared to control group. Lipoprotien-alpha level is higher in obese children and adolescents than in non-obese

Use of AgNOR index in grading and differential diagnosis of astrocytic lesions of brain

This study was conducted to see the importance of AgNOR staining in grading and differential diagnosis of Astrocytic lesions. It was a descriptive and prospective study conducted in Department of Pathology King Edward Medical University, from June-December 2002. AgNOR staining was performed on 60 randomly selected brain specimens of Astrocytic lesions including Astrogliosis and Astrocytoma. AgNOR count, size and dispersion were normal in Astrogliosis, low in Pilocytic Astrocytoma, high in grade II, higher in grade III and highest in grade IV. AgNOR counts of different grades of astrocytoma [2.97 +/- 0.96, 3.97 +/- 0.43, 6.01 +/- 2.74 and 8.01 +/- 3.56] were significantly [P< 0.01] greater as compared with counts of normal brain [0.40 +/- 0.01], and reactive gliosis [0.60"0.01]. There was no statistical difference in normal brain tissues and inflammatory lesions of the brain. AgNOR size and dispersion were of higher grade in significantly greater proportion in malignancy as compared to benign conditions. [P <0.05]. AgNOR size and dispersion were normal in Astrogliosis. Typing of AgNOR count, size and dispersion was found to be an important marker in grading and differential diagnosis of Astrocytic lesions, especially in Astrogliosis and low grade Astrocytoma

Relative frequency of hepatitis B and C viruses in patients with hepatic cirrhosis at DHQ teaching hospital D. I. Khan

Background: Hepatic cirrhosis is an important cause of morbidity and mortality worldwide. It is generally considered irreversible and premalignant condition. However reversibility of the disease has been demonstrated in some cases after removal of the cause. There are various causes leading to cirrhosis but viral cause is the most common cause worldwide. In developing countries its prevalence i$ more where poor knowledge about viral infections is the main cause of spread. Mode of spread and sequel of Hepatitis B Virus [HBV] and Hepatitis C Virus [HCV] are almost similar. The present study was designed to know the relative frequency of both viruses in patients with cirrhosis

Method: This study was conducted in the Medical unit of District Teaching Hospital of Dera Ismail Khan, from the first of May to 30[th] November 2002. Cirrhotic patients were admitted to Medical ward and necessary investigations were done on blood specimen for HBV and HCV. Immunoassay chromatographic technique one-step device [ACON Laboratories, USA] was applied for its viral screening. At the end 60 cirrhotic patients were analyzed for findings and comparison with other studies

Results: Out of 60 patients, 28 [46.67%] were found infected with HBV, 8[13.33%] with HCV, 24 [40%] with no markers of either two viruses. One case [0.16%] was found positive for both viruses

Conclusion: Cirrhosis liver due to HBV is more common than HCV in this region. Males are affected more than females

Performance of ICT-TB test in the detection of pulmonary and extra-pulmonary tuberculosis

Tuberculosis is a major public health problem of the developing nations including Pakistan. We need a simple, economical and non invasive test to make an early diagnosis of T.B. in order to avoid the complications. A study was conducted at the Dept. of Pulmonology, PGMI LRH Peshawar and Ayub Teaching Hospital Abbottabad with the collaboration of Deptt of Pathology KMC Peshawar from Jan 1998 to Dec 2002. A total of 129 patients were included in the study. Out of these 129 patients 52 were pulmonary TB [PTB] smear positive, 30 were PTB smear negative, 30 pleural effusion and 17 were TB lymphadenitis. The control group consisted of 25 non TB patients and healthy subjects. Antibody was detected in 23 of 52 [44%] sputum positive patients, 11 of 30 [36%] sputum negative PTB patients, 10 of 30 [20%] patients of TB pleural effusion and 6 of 17 [35%] patients of TB lymphadenitis. Antibody was detected in none of the control subjects. The overall sensitivity for Pul-T.B. Sputum positive patients was 44%, 36% for sputum Negative Pulmonary TB, 20% for TB pleural effusion and 35% for TB lymphadenitis. The specificity was 100%. ICTTB is a highly specific, but less sensitive aid in the diagnosis of Pulmonology and extra Pulmonology TB

Efficacy, safety and tolerability of streptokinase in multiloculated empyema

Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety of intra-pleural Streptokinase in loculated empyemas. A total of 15 patients admitted in Pulmonology unit with multiloculated empyemas whose drainage via drainage tube was less than 100 ml during the last 24 hours were included in the study. Aliquots of 250,000 units of Streptokinase in 100 ml of normal saline were instilled into the pleural cavity and the tube clamped for 3 hours. Response was assessed by clinical outcome, measurement of drain output after unclamping and subsequent chest radiography and serial chest ultrasounds. Streptokinase enhanced drainage in all patients with complete resolution of Empyema in 13 patients. Two patients with thickened visceral pleura following empyema drainage were referred to thoracic surgeon for decortication. The number of instillations of Streptokinase per patient ranged from 1 to 3 and the volume of drained empyema fluid ranged from 60 ml to 600 ml per patient. Streptokinase was well tolerated in all patients. Intrapleural Streptokinase is a safe and effective means of increasing the tube drainage in multiloculated Empyema without causing systemic fibrinolysis