Evaluation of serum sex hormones and CD4+ count among HIV patients on HAART, HAART naive patients and apparently healthy subjects in Sokoto, Nigeria

Background: Acquired Immunodeficiency Syndrome (AIDS) is a chronic disease associated with Human Immunodeficiency Virus (HIV) which progressively induces depletion of CD4+ T cells, and increased vulnerability to opportunistic infections. Previous reported studies associated HIV-infected men with sexual dysfunction; hypogonadism is the most common endocrinological disorders. Its prevalence remains poorly defined and widely ranging from different studies.Methods: This study evaluated a total of 135 serum sex hormones (testosterone, estrogen, follicle stimulating hormone and luteinizing hormone) and its correlation with CD4+ counts among HIV patients on HAART, HAART naïve patients and negative control subjects (n=45). CD4+ cell counts were estimated using standard flow cytometry method and serum sex hormones by competitive enzyme immunoassay technique.Results: There were significantly lower testosterone and CD4+ levels (p<0.05) among HIV positive HAART naïve men compared to negative control. LH and FSH indicated significant increased (p<0.05) among HIV positive men on HAART.Conclusions: Antiretroviral therapy improves sexual functions in males infected with human immunodeficiency virus. Hence, further study to evaluate its effects on other sexual behaviors.

Extended spectrum Beta-lactamase producing Escherichia coli and Klebsiella pneumoniae bacteremia. Risk factors and outcome in the Eastern Region of Saudi Arabia

To study the risk factors for bacteremia caused by Escherichia coli [E.coli] or Klebsiella pneumoniae [K.pneumoniae] producing extended-spectrum beta-lactamase [ESBL] and their outcome. A case-control study was conducted in King Abdul-Aziz National Guard Hospital, Al-Ahsa, Kingdom of Saudi Arabia from January 2006 through December 2007. All adult patients for whom culture results were positive for E. coli or K. pneumoniae were eligible. Twenty-nine patients with ESBL producing bacteremia [cases] were compared with 80 patients with non-ESBL producing bacteremia controls. Hospital mortality was the primary end point. Univariable and multivariable logistic regression were performed to analyze risk factors for ESBL bacteremia and its 30-day mortality. A total of 109 patients with bacteremia were enrolled that included 29 cases and 80 controls. Forty-nine percent of the patients were male. The mean age was 60.2 +/- 21.1 years. Nosocomial infection was the only independent risk factor for bacteremia due to ESBL-producing pathogens [odds ratio [OR] 3.40, 95% confidence interval [CI] 1.14-8.44, p=0.02]. Overall 30-day mortality was 22%, and was similar in both groups. The nosocomial infection [OR 3.20, 95% CI 1.48-6.94, p=0.01], presentation with septic shock [OR 48.88, 95% CI 6.01-397.32, p=0.004], and intensive care unit care [OR 7.40, 95% CI 1.94 -28.34, p=0.001] were the independent risk factors for 30-day mortality. The ESBL rate is high in our study among the bacteremic patients. Nosocomial infection is identified both as a risk factor for ESBL bacteremia and mortality

Audit of head and neck cancer: hospital based statistics of Islamabad

Head and Neck Cancers are the leading cancer of South East Asia. Because of dietary habits of this region and poor socioeconomic conditions oral cavity cancers and pharyngeal cancers are common respectively. A hospital based cancer registry is maintained from February 2000 to February 2004 in Pakistan Institute of Medical Sciences, Islamabad and National Oncology Research Institute [NORI], Islamabad. All cancer patients reported in that period examined, staged, biopsied, discussed and treated accordingly. 714 cases were seen, 458 male [64.1%] and 256 females [35.9%]. Leading cancer was oral cavity 228 [31.9%], larynx 127 [17.8%], hyopharynx 105 [14%], nose and nasopharynx 69[9.6%] and unknown primary 44 [6.16%]. Summing up the results oral cavity and laryngopharyngeal cancers constituted 72.5% of head and neck cancers

effects of diabetes oncatecholamine neurotransmitter mediating enzymedopamine-beta-hydroxylase and other biochemicalparameters in human serum

In Bangladesh weather, environment and pattern of life style are significantly different from those of other developed as well as developing countries. So this makes us curious to determine the serum Dopamine-p-Hydroxylase [DBH] activity, its cofactors and other biochemical parameters in Bangladeshi diabetic patients at different ages of both sexes to determine their changes with age. The study was done in six different age groups of both sexes namely Group I: 10-15 years, Group II: 15-25 years, Group III: 25-35 years, Group IV: 35-45 years, Group V: 45-55 years and Group VI: 55+ years. DBH activity was increased in Groups I, II and decreased in Group VI of both sexes. DBH activity was variable in all other groups. One of the cofactors, ascorbic acid was slightly decreased in all groups. Another cofactor copper was variable. Among the parameters of lipid profiles, only the triacylglycerol level increased in all groups. Other biochemical parameters were variable. From our studies, we concluded that diabetes affects the DBH activity, its cofactors and other biochemical parameters

Prevalence of chronic complications and associated factors in type 2 diabetes

To determine the prevalence of chronic complications and associated factors in type 2 diabetes in 500 diabetic patients, age >/= 25 years, attending the clinic of Diabetic Association of Pakistan [DAP], Karachi. Every 5th registered diabetic patient >/= 25 years age, was examined for the presence/absence of micro and macro vascular complications and associated factors. Blood samples were collected for HbA1c, lipid profile and serum creatinine. Urine was examined for albumin and microalbumin. Of the 500 diabetic patients examined [160 males, 340 females, mean age 55.2 10.6 years], retinopathy was seen in 43%, neuropathy in 39.6% and foot ulcers in 4%. Nephropathy was found in 20.2%, and was significantly associated with hypertension. The prevalence of microvascular complications was higher in the group of patients with HbA 1 c >8% and was significantly related to duration of diabetes, hypertension and obesity. Hypertension was manifest in 64.6% patients, 61% had raised Body Mass Index and Waist Hip Ratio was more than normal in 88% subjects. Macrovascular complications were encountered in 102 diabetic patients, with angina in 85 [17%], heart attack in 25 [5%] and stroke in 13 [2.6%]. The prevalence of diabetic microvascular complications was higher in people with poor glycaemic control, longer duration of diabetes and associated hypertension and obesity

Emerging bacterial resistance patterns in febrile neutropenic patients: experience at a tertiary care hospital in Pakistan

To look at the clinical presentations, spectrum and site of isolation of the organisms, sensitivity patterns of the organisms and the antibiotic prescribing practices for the treatment of febrile neutropenic patients at our hospital. The data were collected retrospectively from the records of all neutropenic patients with an absolute neutrophil count [ANC] of less than 500/ml admitted during the period of 3 years from August 1999 to July 2002 at AKUH. Out of the total of 404 patients, 65% had hematological malignancies and around half of them had leukaemia, 86% of the patients presented with fever. A total of 124 bacterial organisms were isolated from 96 patients among which 47% were gram positive and 53% were gram negative organisms; 16.1% of the patients had septicaemia. Coagulase Negative Staphylococci [CoNS] were the most common gram positive and E coli was the most commonly isolated gram negative organism. Most of the gram positive organisms were isolated from blood [67%]. There was emerging resistance to all commonly used antibiotics including imipenem, cloxacillin, vancomycin and amikacin. The average duration of neutropenia was 6.4 days. The mortality rate was 6%. There is increasing trend of gram negative organisms developing resistance to commonly used antibiotics. Gram positive bacteria including Enterococcus spp. and CoNS are also showing emerging resistance to vancomycin

Superior mesenteric vein thrombosis complicating appendicular masses

Mesenteric vein thrombosis [MVT] is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography [CT] scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation

Survey regarding AIDS awareness among indigenous population at Karachi [Pakistan]

A health survey about AIDS awareness in Pakistan was conducted during 1998-99 as a joint venture of International Collaboration Medical Team of Japanese National Institute of Public Health, Nagoya University, School of Medicine, Nagoya, Japan and Awan Hospital, Karachi, Pakistan. It is important to be aware of the attitude and behavior related to AIDS infection, because the number of people infected by it has been increasing rapidly in many countries of Asia. The information collected in this survey can serve as a guide for health policy in Pakistan. A randomized survey comprising 5110 [2400 male and 2710 female] Pakistani nationals of different age groups were tested in this study. The marital status and educational background were also recorded. A questionnaire was distributed to the subject individuals, which was based upon the information about the modes of AIDS spread. The mass survey for its awareness in general public has successfully been conducted for the first time in Pakistan. The survey revealed several striking facts and figures that will help build up our future strategy to combat the challenge of this deadly disease. With reference to this survey, about 12% of the total population was completely in dark about AIDS [including 9.7% illiterate]. It is recommended that the people at large should be fully made aware of AIDS. The most effective medium for such an education oriented programme [as revealed by this survey] is television. The authorities should allocate sufficient time on television for programmes like drama, group discussions, interviews by the AIDS victims and open question-answer sessions

Anorectal abscesses: bacterial isolation and antimicrobial resistance

A total of 68 cases of pus or pus swabs were received at the laboratory of Abbasi Shaheed Hospital, Karachi from anorectal absecesses. They were collcted from 1993 to 1996. All samples were subjected to culture of which 53 [77.94%] showed growth. The organisms isolated from positive sample were Escherichia coli 22 [41.51%], Staphyloccus aureus 19 [35.85%], Staphyloccus epidermidis 4 [7.55%], Proteus vulgaris 3 [5.66%], Pseudomonas aeruginosa 3 [5.66%] and Streptococcus pyogenes 2 [3.77%]. Different antibiotic sensitivity and resistance patterns were found for different organisms. There was increased antimicrobial resistance observed in the present study. Proper identification, isolation and sensitivity pattern of organism is essential for successful treatment besides adequate dosage of antibiotics for appropriate duration of time By using this methodology we will decrease the chances of drug resistance in our population

Toxoplasmosis and abortion: serological co-relation

This study involved the analysis of serum samples and product of conception in 105 females for Toxoplasmosis. The serum analysis for IgM and IgG were done by enzyme immuno assay [EIA] in our population. All human sera were also screened for human immnuno deficiency virus [HIV] to rule out that toxoplasma infection was not due to immuno suppression. The product of conception was used for making wet mount, stained preparation and mice innoculation [with saline control]. One group of mice was sacrificed on 3rd or 4th day and the other on or about 3rd week. Out of the 105 samples tested for IgM antibodies specific to Toxoplasma, 16 [15.2%] were sero-positive [both groups]. Fourteen [25.9%] sera were positive for IgM antibodies in 54 patients having had spontaneous abortion and 35 [33.3%] samples were sero-positive for IgG antibodies out of a total of 105 cases. In AB group there were 27 [50.0%] sero-positive out of 54 screened and in TA group out of 51 cases tested 8 [15.7%] were sero-positive. HIV screening by EIA in both AB and TA groups did not reveal any sero-positive case. HIV result showed that sero-positivity of Toxoplasma was not due to immuno suppression. Product of conception was subjected to wet mount and stained preparation [Alkaline Methylene Blue and Giemsa] in which we observed parasite in 2 cases. Serum study done in mice sacrificed on 3rd or 4th day showed no sero-positivity for IgG and IgM type of antibodies, whereas mice sacrificed on 3rd week gave 2 [3.1%] sero-positivity of IgM and IgG specific to Toxoplasma in AB group out of 54 cases. Wet mount and stained preparation revealed parasites from peritoneal wash of mice sacrificed on 3rd or 4th day. Toxoplasmosis situation in our country is acute and needs launching of national programme for sero-diagnosis of pregnant women and adopting preventive measures to overcome serious consequences of disease

AIDS-diagnosis and management

HIV infection is universal with an ever increasing number of HIV infected people. However the pattern of infection varies depending on the region involved. In Pakistan, 960 HIV positive cases were detected, of which 52 were AIDS cases. HIV is transmitted more commonly in individuals who are involved in risk activities or who belong to the high risk group. The disease has varied presentations and needs a high degree of suspicion from the health care providers. Two different types are identified; HIV [widest distribution] and HIV-2 [mostly in West Africa]. Most of HIV-1 individuals have antibodies detectable in all assasy, excepting those who have been recently exposed. No patient with suggestive symptoms or signs should be dismissed on the basis of a single negative test results and no patient should be informed definitely about a positive finding without confirmed positive results. ELISA, PCR and virus culturing are methods for diagnosis the disease

Toxoplasm IgM antibodies and reproductive losses in women of child bearing age

A survey of reproductive losses in women of child bearing age was carried out in hospitals of Karachi to find out the prevalence of and association with toxoplasmosis. The study included a total of 1330 women, comprising a pregnancy wastage group [with or without history handling] and women with normal reproductive performance. All cases were tested for IgM class of antitoxoplasma antibodies by Enzyme Immune Assay [AIE] technique. A total of 269 [20.23%] was sero-positive out of 1330 women screened. In the group with pregnancy wastage only these were 121 [22.41%] sero-positive cases out of 540, whereas in the group with pregnancy wastage and history of animal handling 118 [30.41%] women were positive out of 388 cases. There were 30 [7.46%] positive cases amongst the 402 women with normal reproductive performance. The highest number of IgM sero-positive cases was seen in the 16-25 age group. A high percentage of Toxoplasma cases in this survey indicates the need for launching a national programme for the treatment and prevention of toxoplasmosis

IgM and IgG antibodies specific to rubella in child bearing women

Three hundred fifty five pregnant women were tested for IgM and IgG type of antibodies by Enzyme Immuno Assay [EIA]. Sero- positivity for IgM and IgG antibodies were 13% and 29% respectively. Of 212 pregnant women with abortion, 39 [18%] and 80 [38%] were sero-positive and of 143 pregnant women with normal reproductive performance, 7 [5%] and 23 [16%] were positive for IgM and IgG respectively. Premarital screening and vaccination of Sero-negative girls is recommended to reduce morbidity and mortality related to rubella virus