Evaluation of hematological causes in cases of nasal bleeding

To find the causes of hematological disorder in patients of epistaxis attending ENT department, Abbasi Shaheed Hospital. This cross sectional study was carried out in ear, nose and throat and hematology departments of Abbasi Shaheed Hospital from Jan 2006 to Dec 2008. Patients of epistaxis attending ENT out patient deptartment and emergency were included. A questionnaire was filled including brief clinical history, general and local examination. Based on history, patients were stratified into two groups. Group 1 included patients with single episode of epistaxis while in group 2 patients with a history of recurrent epistaxis were enrolled. For hematology workup complete blood count with peripheral film examination, bleeding time, prothrombin time and activated partial thromboplastin time were done. Specialized test like platelet aggregation test, VonWillibrand factor Ag, Ristocetin cofactor and factor VIII assay were carried out in selected cases. Bone marrow aspiration and trephine biopsy were done for the workup of cytopenia. The causes of bleeding assayed and recurrent epistaxis were compared with single episode. 10% patients were having various hematological disorders. In majority of cases no cause was found. Recurrent epistaxis or epistaxes with mucocutaneous bleeding were found to be more associated with hematological disorder and in the absence of local pathology it should be thoroughly investigated

Acute organophosphate insecticide poisoning

To describe the clinical course, diagnosis, out come of acute organophosphate [OP] insecticide poisoning. Descriptive study. At National Poisoning Control Centre [NPCC], Medical unit 1, Jinnah Post Graduate Medical Centre, Karachi, from 1st January 2000 to 31st December 2007. A total of 6539 pts were admitted to the ICU of NPCC, out of which 2708 [41%] were of organophosphate poisoning. Lab investigations done included blood complete picture, urea, creatinine, ABG's and serum cholinesterase levels. Data was retrieved from the files on a structured performa. Variables of the study include gender, mode of exposure, clinical course, management and complications. There were 1391[51%] were males and 1317 [48%] females. 713 [26%] had accidental exposure, while 1995 [73%] attempted suicide. The majority of patients exhibited the classic clinical features of parasympathetic over activity. 1608 patients received atropine, while pralidoxime alone was given to only 399 patients and atropine along with pralidoxime was given to 701 patients. Complications encountered during their treatment and stay in the hospital included aspiration pneumonia observed in 310 patients, hyperglycemia in 982 patients. 102 patients had respiratory failure and thus required mechanical ventilation with mean ventilation duration of 2.3 +/- 1.5 days. 500 patients had urinary tract infection and 789 patients developed cellulitis or phlebitis. A total of 147 patients died making a mortality rate of 0.05%. The widespread use of organophosphates as a household and agricultural pesticide, in the absence of adequate regulations and education in their use is probably the most important reason for OP poisoning in an agricultural country like Pakistan. Despite severe toxicity in most of our cases, there were very few fatalities. This reflects the necessity of early diagnosis, treatment and the implementation of advanced supportive care in ICU

Frequency of hepatitis-C virus in the spouses of HCV positive patients and risk factors of the two groups

To find out frequency of HCV in the spouses of HCV positive cases and risk factors of the two groups. Study Design: Descriptive study. Place and Duration: Ward 5 JPMC Karachi from August 2003 to January 2004. Patients And Fifty patients infected with HCV, aged 18 year and above of both sexes and their spouses were included through structured questionnaire while others suffering from HBV, HIV and other etiologies were excluded. Samples were collected from the spouses for anti-HCV using micro particle enzyme immunoassay [MEIR] method. Data was analyzed using SPSS. Anti-HCV detected in 9 [18%] spouses of positive cases. The risk factors were unsterlized injections by GPs [58%], previous surgery and dental procedure in 48% patients, blood transfusion and sharing of shaving razors equally figured in 19 [38%] patients, sharing of towels 40% and toothbrush was 28%. Duration of marriage contributed a major role; average duration was 17.86 ' 8.91 years. There was high frequency of HCV in the spouses of positive cases and major risk factors were blood transfusion, I/V drug abuse, unsterlized injections, previous surgery, dental procedures and longer duration of marriages