Ascitic fluid culture in cirrhotic patients with spontaneous bacterial peritonitis

Objective: to determine the frequency and compare the culture yield of bacterial isolation by conventional and blood culture BACTEC bottle techniques in cirrhotic patients with spontaneous bacterial peritonitis [SBP]

Study Design: cross-sectional comparative study

Place and Duration of Study: pathology Department, Bannu Medical College, Bannu, KPK, from January 2012 to December 2013

Methodology: paracentesis of 20 ml of ascitic fluid tapped from cirrhotic patients with SBP was carried out by a single technologist. The analysis included differential leukocyte count [DLC], while 5 ml each of the fluid was inoculated into conventional culture media and BACTEC blood culture bottle. All the data were analysed on [SPSS] version 16 to determine frequencies with percentages and mean values with standard deviation. Chi-square test was used for comparing the yield of conventional and blood culture bottle methods. P-value was considered significant if < 0.05

Results: in 105 cases of ascitic fluid analyses, 27 [25.72%] had positive ascitic fluid culture whereas 78 [74.28%] had negative ascitic fluid culture. Ascitic fluid culture was positive in 6 cases by conventional culture media and in 27 cases by BACTEC culture bottle media [p < 0.001]. Bacterial isolation was obtained by both culture methods in 6 cases [p < 0.001]

Conclusion: direct bedside inoculation of ascitic fluid by BACTEC culture bottle method has better yield as compared to conventional culture method

Child Labour in Pakistan - A tip of an iceberg

To study the basic demographic characteristics of child laborers and to ascertain their working conditions. This cross sectional study was conducted in district Rawalpindi from January to September 2008 and 700 children between 4 - 18 years were enrolled after taking informed consent from both children and their masters. Information on demography and work details was recorded on a structured performa. Total 700 children 4-18 years old with mean age of 13.5 years were enrolled. Male: Female ratio was 5.4:1. Most of the children [401] had a family size of 5-8 members. In 634 cases, 1-4 family members were earning while 05 had 10-12 earning members. Only 479 [68%] children ever attended school, mostly [291, 42%] till primary level. 258 children's families had monthly income of more than PKR 8000, 210PKR 6000-8000, 167 PKR 4000-5000 and 63 families were earning less than PKR 3000/ month. Mostly [270] worked in shops. Reason of work was low family income in 222 and poverty in 207 children. 283 children worked for 7-10 hours per day, 216 for 07 days, 115 for 4-6 hours, 45 for more than 12 hours and 39 for 1-3 hours. Maximum monthly pay was 1000- 2000 rupees in 187 and minimum 500 rupees per month in 106 children. 284 cases sustained injury while at work. Most child labourers are male with a family size of 5-8 members, never attended any school and living in a family whose monthly income is less than 8000 Pakistani Ruppee. The major reason of work was low family income and poverty

Seminal volume in the investigation of male infertility

To determine the seminal volume among infertile males and the frequency distribution of hypospermic and hyperspermic patients in infertile males. Cross-sectional observational study. Department of Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad, from 2002 to 2009. Semen examinations of infertile male were carried out according to the standardized method of the World Health Organization. Seminal volume of 2-6 ml were considered normal, while volumes less than 2 ml and higher than 6 ml were considered hypospermic and hyperspermic respectively. Out of 1521 patients, 355 were hypospermic [23.34%], 1046 were normospermic [68.78%] while 120 were hyperspermic [7.88%]. In the hypospermic cases, 57 out of 355 [16.05%] had a volume of less than 1 ml. Of those 57 patients, 34 were found to be azoospermic, 12 were asthenozoospermic, one each were terato and polyzoospermic, while 6 had normal counts. Among the hyperspermic patients [n=120], 3 were azoospermic, 24 were oligozoospermic and 19 cases [15.84%] had count within the normal range, while 1 patient was polyzoospermic. Significant differences [p < 0.05] were observed among azoospermic, oligoasthenozoospermic and teratozoospermic groups when comparing hypo and hyperspermic patients. Seminal volume is an important parameter for assessment of infertility investigation and its abnormalities constitute a valuable index of problems with the male partner, even if the count and motility are well within the acceptable limits

Trend of fertility potentials with increasing age in Pakistani males

The objective being to examine the magnitude and the shape of the relationships between age and semen volume, sperm concentration and sperm motility by keeping the other factors affecting fertility directly constant among patients undergoing infertility evaluation at National Institute of Health, Islamabad, Pakistan. This experimental study with non-probability sampling was conducted in Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad during 2006-2009. A total 350 patients [21-50 years] were divided age wise into three groups [21-30, 31-40 and 41-50 years] to compare alteration in sperm count and motility. Semen profile was evaluated according to WHO reference value for normal semen characteristics. The result of Sperm concentration showed a non significant [p>0.05] decreasing trend with increasing age that was 0.047million/ml for every year where as sperm motility declined significantly with increasing age at p>0.05. Age-related decreases in semen qualities particularly decline in sperm motility revealed that men may become progressively less fertile as they age. However, unlike women, there appears to be no evidence of an age threshold for men

Assessment of male reproductive health by conventional method of semen analysis

Data available over the past twenty years reveal that in approximately 30% of cases of infertility, pathology is found in man alone, and in another 20% both man and woman are abnormal. Therefore, the male factor is at least partly responsible in about 50% of infertile couples. The longer a couple remains sub fertile, the worse is their chance for an effective cure. This study was planned to analyse the complete semen picture of infertile men for assigning the specific cause to male infertility related to concentration, motility and morphology and to know the distribution and pattern of male infertility in the various subclasses in Pakistani population. It was a prospective descriptive analytical study conducted at Department of Reproductive Physiology/ Health, Public Health Divisions, National Institute of Health [NIH], Islamabad. One thousand five hundred twenty-one [1,521] infertile male patients, and 97 proven fathers, taken as a control. Conventional semen analysis was performed on all samples. Out of 1,521 infertile men, 13.3% were azoospermic, 23.2% oligozoospermic, 0.9% polyzoospermic, 14.5% normozoospermic, 35.2% asthenozoospermic 10.5% oligoasthenozoospermic and 2.4% teratozoospermic. Sperm concentration and active motility of proven fathers, was significantly higher [p<0.05] than the normal concentration group. Least liquefaction time was recorded in case of polyzoospermic subjects, and highest for azoospermic cases. Although, the liquefaction time of azoospermic and oligozoospermic subjects varied non-significantly [p>0.05] with the proven fathers. Normal forms were significantly higher [p<0.05] among the proven fathers and polyzoospermic cases, in comparison with the other groups. Head defects were more in teratozoospermic group, followed by oligoasthenozoospermic and oligozoospermic patients. Neck defects were more profound in oligoasthenozoospermic and oligozoospermic patients, while, tail defect showed significant increase in teratozoospermic and asthenozoospermic cases only. Head and neck defect varied significantly [p<0.05] with proven fathers in all groups, while tail defect varied significantly [p<0.05] in oligozoospermic, asthenozoospermic and teratozoospermic groups only when compared with proven fathers. Complete semen analysis which provides important information about the quality and quantity of the sperm, should be performed before reaching a final conclusion

Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan

Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex [HMC], Peshawar, Pakistan, from July 2006 to June 2007. During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 [28.33%] patients in the 3 units collectively, 1[st] generation 127 [24.47%], and penicillin 99 [19.08%], while macrolides were the least used. The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients

Relationship between blood groups and male infertility

Blood is man's complete and unchangeable identity. The ABO and Rh groups are recognised as major and clinically significant blood groups. Blood group antigens are not only important in relation to blood transfusion and organ transplantation, but also have been utilised in genetic research, anthropology and tracing ancestral relation of humans. The objective the present study is to examine the blood group antigens in infertile men for assessing the relationship to male infertility and to know the frequency of various blood groups among infertile males in our population. A total of 1,521 patients along with 460 proven fathers as controls were recruited for the present study from both rural and urban areas of Pakistan and referred to Department of Reproductive Physiology/Health, Public Health Divisions, NIH, Islamabad, during 2002 to 2006. Blood grouping [ABO] and Rhesus factors [Rh] was done by the antigen antibody agglutination test. Overall distribution of blood groups in the studied population of 1,521 subjects was 35.50%, 28.27%, 26.89% and 9.34% for blood groups O, B, A and AB respectively. The ratio of control to patient was 1:3.3. The present preliminary study revealed that in our population the prevalence of male infertility in blood group O is invariably higher than in all other ABO blood groups, showing a strong relationship between blood group O and male infertility

Rising prevalence of hepatitis B and C and risk factors at district headquarter teaching hospital Bannu, Khyber-Pakhtunkhwa

HBV and HCV are common health problems in developing countries like Pakistan, sharing the same mode of transmission. The purpose is to determine the prevalence of HBV and HCV, and its risk factors in Bannu. A cross sectional descriptive study was conducted in medical units of DHQTH, Bannu, from January, 2004 till December, 2008. A total of 25944 patients comprising 13953 males [53.7%] and 11991 females [46.3%] all above the age of 15 years, were screened for HBV and HCV by rapid method and confirmed by ELISA technique. Out of those, 1352 [5.2%] patients were found positive either for HBV or HCV, 502 [1.93%] patients for HBV, whereas 850 [3.27%] patients for HCV. Non of the patients were found positive for both HBV and HCV. Nine hundred and five [67.0%] were males and 447, [33.0%] were females. Average age was 35-55 years. Keeping in mind the above mentioned results, the most important goal to be achieved is to increase the literacy rate and awareness among people about HBV and HCV so that it endeminity could be controlled

Morbidity and mortality in children in rural community of district Peshawar

In Pakistan more than 20 million people are under five years age. The aim of this study was to determine the mortality rate, morbidity and its various causes in children of less than 5 years age in a rural community of District Peshawar. This descriptive study was conducted in the village Budhni of District Peshawar, from 1[st] January 2005 to 31[st] July 2006. Sampling technique was purposive. The data was analyzed in PMRC Research centre PGMI, Peshawar by using SPSS version 14. Descriptive statistics was given for qualitative variables and presented in the form of frequency and percentage. Two hundred and eighty-three children under 5 years age, presented to Budhni Health Centre during the study period. Male to female ratio was 1.9:1. Nine deaths occurred in children under 5 years during the study period. Most of the deaths 7[78%] were in the neonatal period. Among the diseases, acute respiratory infection was the leading disease comprising 27% of the total. Causes of death were neonatal jaundice [22%], diarrhea [11%], fits [11%], and unknown [45%]. Majority of deaths occurred in the neonatal period, which enhances the importance of antenatal care in the first month after birth. Infant/Child mortality in this region can be reduced by improvement in the health care system at peripheral level

Oral snuff and carcinoma oesophagus

Carcinoma oesophagus is known to occur worldwide. Various dietary, environmental and genetic factors and certain pre-malignant conditions have been blamed in the causation of carcinoma oesophagus but the exact cause in unknown. This study was conducted to find out the possible role of oral snuff to carcinoma oesophagus. This descriptive analytical study was carried out in Medical, Surgical and ENT units of Khyber Teaching Hospital and Cardiothoracic unit of Lady Reading Hospital Peshawar from 1995 to 2005. Relation of oral snuff use to carcinoma oesophagus was studied in 100 patients confirmed on endoscopy and biopsy and histopathology. Oral snuff use was found to have very strong correlation [P<0.001] with carcinoma oesophagus. The effect of ingesting snuff also had very strong correlation [P<0.001] and so was the duration [more than 10 years] of use [P=0.004], however, the frequency of snuff use [i.e. number of time per day] did not have any significant effect [P=0.08]. A strong correlation of snuff use was also found with squamous cell carcinoma [P=0.001]. Oral snuff use is a risk factor for carcinoma oesophagus. Carcinoma oesophagus can be prevented by discouraging its use. Educating people against snuff use may prevent this harmful and lethal disease. This should be done on individual level by the doctors and on mass level through public media

Bilateral protrusion of femoral head into the pelvis in neglected osteomalacia

Osteomalacia is a metabolic bone disease in a mature individual, caused by lack of vitamin D or its active metabolites, on account of a number of factors. Osteomalacia is common in females and in countries with less sun shine. It typically presents with body aches, weakness, alongwith signs of bone tenderness and proximal myopathy. Diagnosis is made on the basis of clinical presentation and investigations; serum calcium, phosphorus, serum alkaline phosphates, 24 hour urine for calcium and phosphorus and skeletal radiology

possible role of steroid hormones present in vitex negundo and its efficacy as a contraceptive

Vitex negundo is used as a contraceptive in traditional medicine. Most of the oral contraceptive pills used in allopathic medicine are the combination of estrogen and progesterone. Some contraceptive pills [mini pills] contain progesterone alone. The present study shows that the extract of Vitex negundo contains estrogen, testosterone and progesterone, their concentrations were found to be 947.7 pg/ml, 22.276 ng/ml and 6.022 ng/ml respectively. From these findings it is assumed that this high concentration of steroid hormones may contribute to its contraceptive action but it may have some side effects on the female reproductive physiology as it contains male hormone i.e. testosterone in addition to the progesterone and estrogen. On the basis of these findings, it is suggested that the trial of this drug on animals followed by clinical study should be carried out to see its anti-fertility activity and side effects

PAP smear screening for precancerous conditions of the cervical cancer

To find the presence of cervical cancer in PAP smears taken from Pakistani women of different age groups. Department of Cytology, Public Health Laboratory Division. National Institute of Health, Islamabad. Data of all cervical smears sent to the cytology department of NIH between 1st January 2001 to 31st December 2004 was retrospectively analysed to see the presence of malignancy. A total of 546 smears were assessed during the study period. Of these, 302[55.31%] showed inflammatory changes, 124[22.71%] were normal, 40[7.33%] were atrophic, 17[3.12%] showed dysplastic changes, in which 10 cases were of low grade squamous intraepithelial lesion [LSIL], and 07 cases were of high grade squamous intraepithelial lesion [HSIL]. Carcinoma in situ, was seen in 11 [2.02%]. Inadequate sample was reported in 52 [9.52%] cases with an advise to repeat the test. Awareness campaigns and screening program for cervical cancer in women of reproductive age is recommended especially in those having prolonged symptoms