Visceral leishmaniasis: a cause of pyrexia of unknown origin

Objective: To determine the cause of pyrexia of unknown origin

Study Design: Cross-sectional study

Setting: The subjects for this study were enrolled at the private setup in northern areas of Gilgit and Hyderabad from January 2006 to December 2007

Method and Material: All patients presenting with pyrexia unresponsive to antibiotic and antimalarial therapies with negative serology for salmonella, malaria, tuberculosis and brucellosis underwent bone marrow aspiration. The specimens were analyzed at Armed Force Institute of Pathology [AFIP] Rawalpindi and Department of Pathology, Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro. Patients were treated on the basis of microscopic findings and observations were recorded

Result: Among total 77 subjects 72 [98.51%] were of <8-years age and 5 [6.49%] were of 8-25 years age. Males were 53 [68.83%] and females were 24 [31.17%]. Microscopic examination reported all 77 specimens as amastigote positive. Subjects became symptom-free after anti-leishmaniasis therapy

Conclusion: Patients belonging to the Northern areas and Azad Kashmir living anywhere in Pakistan, not responding to antibiotics and antimalarial treatment with negative serology for salmonella, brucellosis, tuberculosis and malaria should be considered for visceral leishmaniasis and be investigated and treated promptly

Frequency of control of blood glucose in patients with type 2 diabetes mellitus at tertiary medical care unit

Objectives: Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia resulting from the defective secretion or action of the insulin. As the serious complications of diabetes mellitus are associated with control and duration of the disease, so this study was planned to observe the frequency of control of blood glucose in patients with diabetes mellitus. Design: A descriptive study Setting: This study was designed at Mohammad Medical College Mirpurkhas Sind. Patients were collected in months of Jan-Mar 2008 in a weekly blood sugar camp arranged at MMC hospital

Methods: Five hundred diagnosed patients of Type 2 diabetes mellitus were included in this study. Their parameters were recorded in detail on pre-designed proforma. Control of blood sugar was evaluated by fasting blood sugar, 2 hours postprandial blood sugar, urine detailed report and hemoglobin A1C

Results: Majority of patients had unacceptable control of diabetes mellitus. Three hundred and sixty-six [73.2%] patients had poor control of blood glucose, while only 134[26.8%] patients had acceptable control of blood glucose

Conclusion: This study proved that control of blood glucose remained poor, i.e. 73.2% patients remained uncontrolled even after attempts to treat the disease; it shows that because of this poor control of blood glucose huge number of patients in future will land up with serious complications. Huge number [93.2%] patients had no knowledge about the disease

Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection

The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C [CHC] patients and HCV outcome. Descriptive study. This study was conducted at Outpatient Department of Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad from September 2005 to September 2007. One hundred cases of CHC, proven by anti-HCV and HCV RNA-positive with baseline TSH, FT[4] and FT[3] within the normal reference range, who were treated with interferon alpha-2b [3 million unit subcutaneously three times per week] and oral ribavirin [1000-1200 mg per day] were included in this study. All patients were assessed for TSH, FT[4], FT[3] levels at 12 weeks and 24 weeks during therapy. Among the 100 patients, overt thyroid disease developed in 13 [13%] and sub-clinical thyroid disease in 5 [5%]. Out of 13 patients of overt thyroid disorders, 11 [84.6%] had hypothyroidism and 02 [15.3%] hyperthyroidism. Four [80%] patients were of sub-clinical hypothyroidism and 01 [20%] patient was of sub-clinical hyperthyroidism. Overall, thyroid disorders developed in 18 [18%] both as overt and sub-clinical thyroid disorders. Ninety one [91%] patients became negative by HCV RNA. Treatment of HCV with IFN-alpha and ribavirin can be safely continued in patients with over and sub clinical hypothyroidism because thyroid disease responds well to treatment

Sequelae of chronic rheumatic heart disease among patients at two teaching hospitals in Sindh, Pakistan

Objective: To evaluate different sequelae in adult patients of chronic rheumatic heart disease

Design: A descriptive study

Setting: This study was conducted at Liaquat University Hospital and Isra University Hospital, Hyderabad- Sindh from January 2003 to December 2004

Methods: Patients of chronic rheumatic heart disease who presented at Liaquat University Hospital and Isra University Hospital were enrolled in the study. Demographic details of patients such as age, sex, socioeconomic status as well as their symptoms such as dysponea, palpitation and chest pain were noted on a proforma. Number of rheumatic fever attacks in the past were also noted. Patients were examined carefully for cardiac valvular lesions and for signs of acute rheumatic fever. Patients underwent different investigations such as blood complete picture, ESR, ASO titre, ECG, X-ray chest, echocardiography and Doppler. All patients had their calcium levels and collagen profile checked to exclude non rheumatic causes of valvular heart disease

Results: One hundred adult patients of chronic rheumatic heart disease were studied for various valvular sequelae. Out of 100 patients studied, 49 [49%] patients were males and 51 [51%] were females. Seventy-three [73%] patients were below 30 years of age [Group A] and 27 [27%] patients were above 30 years of age [Group B]. Patients age ranged between 12 and 60 years. Forty-eight [48%] patients had predominant mitral stenosis. Forty-two [42%] patients had predominant mitral regurgitation. Nine [9%] patients had aortic regurgitation and one [1%] had aortic stenosis along with mitral valve disease

Conclusion: From this study, it is concluded that mitral valve stenosis is frequently observed than mitral regurgitation and aortic valve is least affected, therefore, in every case of chronic rheumatic fever mitral valve should be thoroughly examined

Alpha-fetoprotien as a diagnostic tool in differntiating hepatocellular carcinoma from benign hepatic disorders

Objective: Differential diagnosis of hepatocellular carcinoma [HCC] from benign lesions of the liver is often difficult yet of great clinical importance. In the present study, we analysed diagnostic value of alpha-fetoproteins in hepato- cellular carcinoma. Design: A descriptive study Setting: Department of Internal Medicine, Liaquat University Hospital, Jamshoro, Sindh from February 2000 to December 2002

Subjects and Methods: Total 200 persons were studied. 100 presented with liver mass and other symptoms directing toward liver pathology, later confirmed histopathologically, as suffering from HCC while the other 100 subjects came to the department with jaundice and were HbsAg and anti-HCV positive on blood screening. All these subjects underwent blood test for alpha-fetoprotien. This tumor marker was analyzed by using enzyme immunoassay-based kit

Results: The alpha-fetoprotien positivity was statistically evaluated. In HCC, this test was statistically significant with p value of <0.001. In this study sensitivity of alpha-fetoprotien was 72%, specificity 89%, positive predictive value 86.7% and negative predictive value of 76.1%

Conclusion: These findings suggest that alpha-fetoprotien has the potential to differentiate between benign and malignant liver diseases and it is a useful tool in the diagnosis of HCC