Risk of acquiring cutaneous leishmaniasis in tribal areas of Pakistan

Objective: To assess the risk of acquiring cutaneous leishmaniasis [CL] in tribal areas of Pakistan. Study Design: A cross sectional observational study. Place and duration of study: Combined Military Hospital, Okara, from Oct 2014 to Mar 2015

Material and Methods: A total of 4500 persons between the ages of 22 to 50 years, who were moved from central areas of Punjab to Waziristan on duty, were studied for the occurrence of CL. All cases was developed cutaneous lesions and were confirmed as having CL were included in the study. During the same period, 4300 persons living at Okara, who did not have any exposure to the Federally Administered Tribal Area in same age group, were also observed and studied as control group

Results: A total of 36 patients suffered from CL in the study population, while one case from the control group developed the disease [p<0.05]. This patient was resident of Sindh and had repeated visits to his home station. The risk of developing CL was greater in Waziristan as compared to central Punjab as odds ratio [OR] was calculated as 30.79

Conclusion: There is substantial risk of developing CL in persons exposed to tribal areas of Pakistan

Comparative efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma

To compare the efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma It was a quasi-experimental interventional study, conducted on 60 patients of acute severe asthma, presenting to the emergency department of MH Rawalpindi. Military Hospital Rawalpindi from Jan 2001 to Dec 2002. Patients fulfilling the criteria were divided into two groups of 30 patients each by convenience sampling. Group-I received intravenous methylprednisolone sodium succinate 125 mg as a single dose within half an hour of admission while group-2 received intravenous hydrocortisone 200 mg bolus followed by three doses of 100mg at six hours interval for next 24 hours. In addition, both the groups received nebulized salbutamol 2.5 mg diluted with 5 ml of distilled water at an interval of 30 minutes for first hour then 4 hourly along with oxygen at a rate 4-5 liters /minutes. Pulse rate and peak expiratory flow rate [PEFR: best of three attempts] were recorded on admission and subsequently at interval of six, twelve, eighteen and twenty-four hours of admission. Significant improvement in pulse rate was defined as its fall below 100 per minute and that of PEFR as its rise above 65% of predicted. Out of sixty patients, 41 were males and 19 were females. Their mean age was 38 years [range 19-50 years]. Significant improvements in pulse rate and PEFR were noted at interval of 24 hours in both groups, and this improvement was more marked in gropu-2. Target reduction [< 100/minute] in mean pulse rate was seen in 70% of patients in group-2 versus 26.7% in group-1. Target mean PEFR [> 65% of predicted] was achieved in 86.7% [group-2] and 40% [group-1]. The differences of mean pulse rate and PEFR at 24 hours were statistically significant. Intravenous hydrocortisone is more effective than intravenous methylprednisolone, at the dosages selected, in setting of acute severe asthma

Relative efficacy of fine needle aspiration cytology in diagnosis of nodular goitre

To evaluate the diagnostic accuracy and limitation of Fine Needle Aspiration Cytology [FNAC] in nodular goiter. The study was carried out at Military Hospital Rawalpindi and the department of Pathology, Army Medical College Rawalpindi from March 2000 to March 2001. It was a comparative study. 145 patients with nodular goiter who reported to outpatient department were selected for FNAC after taking informed written consent; FNAC was done in department of Pathology of Army Medical College. They were again asked for diagnostic surgery but only 54 patients consented for it. The specimens were studied for histopathology. The data was collected and analyzed by comparison of both procedures by using Gallen and Gambino method. FNAC revealed 44 out of 54 [88.1%] cases as benign and 3 [5.55%] as malignant, while 7 [13%] had indeterminate cytology. All benign lesions were confirmed on histopathology except 01 which turned out to be papillary carcinoma. So FNAC has 98.1% accuracy rate with 92% negative predictive and 100% positive predictive value. FNAC has significant efficacy in differentiating malignant lesions from benign lesions of thyroid. However caution is mandatory in a negative report with strong clinical suspicion of malignancy

Response of Interferon alone and with Ribavirin in patients of chronic HepatitisC

The aim of the study was to compare the response of interferon alone and interferon plus ribavirin in patients of chronic hepatitis C. Design: A case control interventional prospective study. Place and Duration of Study: Military Hospital and Combined Military Hospital, Rawalpindi from January 2000 to January 2001. Materials and Sixty patients of chronic hepatitis C were selected on the basis of raised ALT, presence of antiHCV antibodies, detection of viral RNA on PCR and liver biopsy. They were divided into 3 groups. Group I constituted 20 patients who received treatment of interferon alpha alone. Group II included 20 patients who received combination therapy of Interferon alpha and ribavirin. Group III included 20 patients, who were unwilling for treatment due to personal reasons and were used as control group. Patients were then closely observed for 1 year for efficacy and safety of the treatment. At completion of treatment HCV'RNA levels in serum were not detectable in 15 of 20 [75%] patients who received interferon alpha and ribavirin combination therapy as compared to 10 of 20 [50%] patients who received interferon alpha alone. Only 1 patient became HCV RNA negative in the control group. Normalization of ALT concentration and histologic response was proportionate to the virological response. Combination therapy of interferon and ribavirin is more effective than treatment with interferon alone for minimizing viral load, improving ALT levels and histology

Cerebrovascular stroke at high altitude

To asses the high altitude as a risk factor for cerebrovascular stroke in people residing at a height greater than 15,000 feet above sea level. Design: A case control study. Place and Duration of Study: The study was conducted at Military Hospital, Rawalpindi from June 2000 to May 2001. Patients and Four thousand persons between the ages of 20-40 years, residing at the height of 15,000 feet or above, were studied for occurrence of stroke. All cases of stroke referred from Northern areas of Pakistan, with positive CT scan, were included in the study. They were then investigated at Military Hospital, Rawalpindi to find out any other risk factor for stroke. During the same period four thousand persons living at Rawalpindi [height-2,000 ft] in same age group were also observed as control group. Ten patients suffered from stroke at high altitude while just one case had stroke in indexed age group at lower heights [p-value<0.05]. Relative risk was 10 times greater at high altitude. High altitude is a risk factor for stroke in persons residing at altitudes of over 15,000 ft