Retrospective cost-utility and budget impact assessments of Hypericum perforatum in contrast with Fluoxetine treatment for depression in Karachi, Pakistan

In this study we have compared two different types of therapies i.e. herbal and allopathic system of therapies for Depression and studied them from the social perspectives. The Hypericum perforatum is compared with Fluoxetine [HCL] in terms of cost-utility and financial savings thereby evaluating its influence on annual expenditure of depressive patients that were randomly selected from 178 union councils of the city of Karachi, Pakistan. For both system of therapies a total of 356 patients were selected by stratified random sampling. Taking frequency of depression as '1' annually with discount rate at 3% for calculating the burden-of-illness in terms of disability-adjusted-life-years. The cost-utility and the budget-impact assessments were carried out to assess incremental-cost-effectiveness-ratio, and the budget-impact-per-onset as well as budget-impact-per-year values. In comparison with the Fluoxetine therapy, the Hypericum perforatum was found to relieve symptoms in 21.47% less cost; owing 29.23% less disability-adjusted-life-years and 21.45% less budget-impact-per-onset as well as budget-impact-per-year. The annual mean incremental-cost-effectiveness-ratio was found to be at 36.95±270.74 (less than GDP per capita threshold of Rs. 38,173.02). Hypericum perforatum provide the optimal utility with less impact on budget of a patient in comparison with the treatment of symptoms of depression with Fluoxetine.

Dyslipidimia; to determine the various lipid profile pattern in patients of chronic renal failure

To determine the various lipid profile pattern of dyslipidimia in patients of chronic renal failure. Cross-sectional study. This study was conducted at Nephrology department of Isra University hospital Hyderabad and Medicine Department Civil hospital Nawabshah, from October 2013 to September 2014. This study consisted of 237 patients of chronic renal failure asses on detailed history regarding chronic renal failure, patients were subject to relevant investigations i.e. fasting lipid profile and venous blood was drawn after 14 hours fasting state in the early morning and sent to laboratory for analysis of fasting lipid profile. Inclusion Criteria were all patients of chronic renal failure with 1 years history, age > 35 to 60 years and either any sex. Diagnosed on the basis of serum creatinine as define in operational definition. Exclusion Criteria were patients on lipid lowering agents, acute complication of diabetes mellitus such as diabetic keto-acidosis, patients suffering from hypothyroidism, type 1 DM and HTN, lactic-acidosis, hypoglycemia. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Out of 237 patients, 113[47.68%] patients were 51 to 60 years of age, 94 [39.66%] were 41 to 50 years of age and 30[12.66%] were 35 to 40 years as presented in Chart No 1. The average age of the patients was 50.11 +/- 6.94 years. There were 54.43% [129/237] male and 45.57% [108/237] female. Various lipid profile pattern of dyslipidimia in patients of chronic renal failure are presented in table-l. Results of fasting lipid profile are Triglycerides high in 86[36.3%], HDL low in 76[32.1%] cases, LDL in high 83[35%] cases, Cholesterol high in 105[44.3%] cases and VLDL-cholesterol high in 68[28.7%]. Stratification analysis showed that lipid profile pattern of dyslipidemia was insignificant between male and female as presented in table 2. While with respect to age groups, rate of Cholesterol, triglycerides, LDL-cholesterol was high in above 40 years of age groups as compare to 30 to 40 years of age groups. Rate of low HDL was also high in above 40 years of age groups as compare to 30 to 40 years as presented in table 3. In conclusion, our study demonstrated that dyslipidemia often our patients chronic renal failure. This underscores the need for the first test patients with lipid abnormalities early treatment can prevent cardiovascular events delay chronic kidney disease

Audit of beta-thalassemia cases at sheikh Zayed medical college/ hospital, Rahim Yar Khan

Background: Beta-thalassemia is one of the common genetic disorders in our community. Therefore, it is deem necessary to study and probe it to encompass all aspects of this disorder

Objectives: The objective of the study was to find out the distribution of beta-thalassemia in different age groups, prevalence of transfusion related viral infections and serum ferritin levels

Methodology: All cases of thalassemia major and thalassemia intermedia registered with the Centre for Thalassemia Care, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, were included in the study. The cases were divided into three different age groups, i.e. 0-5 years, 5.1-10 years, 10.1 years and above. The cases were diagnosed as of beta-thalassemia by history and examination, peripheral blood picture, hemoglobin electrophoresis and confirmed by genetic analysis. All cases were screened for HCV, HBV, and HIV. Some of the cases were tested for serum ferritin levels

Results: Two hundred and eighty three [63% males and 37% females] registered cases of beta-thalassemia were included in the study. Two hundred fifty seven [91%] patients were suffering from thalassemia major and 26 [9%] were having thalassemia intermedia. Out of 283 cases, 196 [69%] were belonging to rural areas and 87 [31%] were residing in urban areas. Fifty-five [19.4%] beta-thalassemic patients were found to be positive with anti-HCV antibody and 3[1%] cases were positive for HBV surface antigen. There was a significant difference [p<0.05] between the means of serum ferritin levels in thalassemia major [2775] and thalassemia intermedia cases [1519]

Conclusion: Majority of thalassemic patients were suffering from beta-thalassemia major. Males were predominantly suffering from beta-thalassemia major while in thalassemia intermedia sex distribution was almost equal. The overall prevalence of beta thalassemia in rural areas was comparatively high. Nineteen per cent of beta-thalassemia patients were positive for anti-HCV antibody. There was significant difference in means of ferritin levels among the patients of thalassemia major and of thalassemia intermedia

Prevalence of hepatitis B and hepatitis C carrier state among healthy blood donors in Rahim Yar Khan

Background: The carrier state of hepatitis B and C has been emerging in our community. Thousands of deaths have occurred as the consequences of these viral infections

Objective: To evaluate the prevalence rate of hepatitis B and C among healthy blood donors

Subjects and Methods: A cross-ssectional study was carried out at Sheikh Zayed Medical College Hospital/Rahim Yar Khan. The data was taken from the Blood transfusion Units from the District and Tehsil Headquarter Blood Transfusion Units located at Sadiqabad, Khanpur and Liaqatpur Hospitals

Method: The subjects were the healthy young blood donors. They were screened for HBsAg and anti-HCV using ICT screening kits. The data was collected from the monthly Blood Donor Reports present in the Blood Transfusion Units

Results: A total of 2,17,847 healthy, young blood donors from 1st January 2009 to 31st August 2014 were screened for HBV and HCV. Of these, 5143 [2.4%] were found to be positive for HBsAg and 6407 [2.9%] were positive for anti-HCV. At the District Unit [draining mostly urban areas], 2,03,522 subjects were screened. Of these, 4449 [2.2%] were positive for HBsAg and 5611 [2.7%] were positive for anti-HCV. For Tehsil Units [draining mostly rural areas], total 14,325 subjects were screened, of these 694 [4.8%] were positive for HBsAg and 789 [5.5%] were positive for anti-HCV

Conclusion: Our study showed that prevalence of HBV and HCV infection among healthy blood donors is high and it is comparatively low in urban areas as compared to peripheral rural areas of district Rahim Yar Khan

prospective study of extracorporeal shock wave lithotripsy [ESWL] induced hypertension in Lahore division, Pakistan

Our aim was to evaluate the hypothesis in a randomized clinical trial, whether extra- corporeal lithotripsy [ESWL] causes any blood pressure change, in subjects with different genders having normal blood pressure and kidney lithiasis. A descriptive cross sectional study. This study was carried out at the Department of lithotripsy, Khan Kidney Hospital and King Edward Medical University, Lahore from February 2012 to January 2013. Adult patients [

Comparison of working length in curved mesial canals of mandibular molar between pre-flared and non-flared group

The aim of this study was to compare the working length in the curved mesial canals of mandibular molars between pre-flared and non-flared groups. It was a comparative study which was carried out at Dental Department of PIMS [Pakistan Institute of Medical Sciences] Islamabad from 2003 to 2004. A total of 60 patients were divided equally into pre-flared and non-flared groups. In both groups a 15 # K file was used for the measurement of working length but in the pre-flared group the coronal portion of the canal was flared with Hedstrom files [25-55] or Gates Glidden Drills from # 02 to # 05 before inserting the # 15 K file. Then the tooth was radiographed at this moment and the distance between the tip of the file and the radiographic apex. The location of the tip was classified as a] within 1 mm of the radiographic apex b] more than 1 mm of radiographic apex c] over extended, beyond the radiographic apex. In the non-flared group 33.3% of the cases belonged to group [a], 40% to group [b] and 26.7% to group [c]. In the pre-flared group 73.3% of the cases belonged to group [a], 10% to group [b] and 16.7% to group [c]. It was concluded that when the coronal portion of the canal is constricted, then the clinicians cannot discern the accuracy of what they feel apically because quite often the file bends or stucks more coronally than apically. When the coronal portion of the curved canal is pre-flared or prepared then it greatly improves the access to apical portion of curved canal and thus to the apical constriction, which is an apical reference for correct working length determination, by removing the dentinal hindrances in the coronal portion of the curved canals. Thus pre-flaring is a highly recommended procedure, especially in curved canal for correct working length determination

Comparison of liver enzymes and cardiovascular risk factors in hypertensive and normal subjects

To compare the liver enzymes between hypertensive and normal subjects. Cross-sectional, descriptive study. Basic Medical Sciences Institute, J.P.M.C, Nehal Hospital and Shamsi Hospital Karachi, from December 2006 to March 2011. The study has compared the liver enzymes and associated cardiovascular risk factors like blood pressure, BMI, waist hip ratio, blood sugar, lipid profile between 100 normal and 100 hypertensive subjects. The assessment was done by applying independent t test and Pearson correlation using statistical package for social sciences 15. The normal and hypertensive subjects were compared with liver enzymes, systolic and diastolic blood pressure, lipid profile, BMI and waist/hip ratio. All values showed significant correlation [P < 0.001] using independent t test. In the hypertensive subjects all the liver enzymes were found to be raised in comparison with hypertensive but were within their normal ranges. The levels of GGT [Gamma glutamyl transferase] was found to be raised beyond its normal range and was compared according to type I and Type II stage of hypertension and was found to be raised significantly. Among all the liver enzymes compared with uncontrolled hypertensive GGT was found to be most significantly correlated with all the factors increasing cardiovascular risk, and needs to be measured in every hypertensive individual

Uric Acid, creatinine and proteinuria: do they have any relationship with leptin during pre-eclampsia?

To determine the relationship between serum leptin, uric acid, creatinine and proteinuria during pre-eclampsia. Comparative cross-sectional study. This study was carried out in the department of physiology, Basic Medical Sciences Institute, JPMC, in collaboration with the department of Gynaecology and Obstetric, JPMC from Jan 2007 to Dec 2007. For this purpose 45 primigravidas with normal pregnancy and 45 primigravidas with pre-eclamptic pregnancy were selected who were in their third trimester. All the subjects were of the same maternal age, gestational age, height and weight. Serum leptin levels were determined by immunoenzymometric assay and total lipid profile was determined by enzymatic colorimetric method. Serum uric acid and serum creatinine were determined by uricase method and jaffe's method by photometric system. To perform the dipstick urine analysis, multistix URS-10 test strips were used. The study included 90 patients, divided into two groups. Serum uric acid was found to be significant in pre-eclamptic group [p<0.001] but there was no difference between serum creatinine of the two groups. No significant correlation was found between serum leptin, uric acid and creatinine. It was found that the level of leptin rises with the level of proteinuria. From this study, it was concluded that serum leptin levels during pre-eclampsia were not strongly associated with serum uric acid and creatinine but relation with proteinuria was found to be significant

Association of socioeconomic strata with fecolith in acute appendicitis

To determine the association of socioeconomic strata with fecolith in acute appendicitis. Case control study Department of Surgery Combined Military Hospital and the Military Hospital Rawalpindi, Six months from Jan 2008 to July 2008. 80 patients were included in study. Forty were from high social class and 40 from low social class. History and examination of each patient were noted, including monthly income. Appendicectomy was performed under general anesthesia. Each resected specimen was examined for presence of fecolith and sent for histopathological examination. A total of 80 patients fulfilled the criteria of the study. Out of these 40 patients belonged to high social class and 40 patients belonged to low social class. Both the groups were comparable with respect to age [p = 0.435] and gender [p = 0.104] [Table-1 and 2]. On naked eye examination fecolith was present in 20 [50%] patients of high social class and 9 [22.5%] patients of low social class [p=0.011]. Odds ratio calculated was 1.759

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

Evaluation of integrated learning program of undergraduate medical students

When medical schools attempt to place, up to date information without coherence into their vast curricula, students face an overwhelming burden of dispersed information and desperately opt for rote memorisation rather than understanding. The objective of this study was to compare response and performance of students as a result of change from non-integrated to integrated curricula. The need of integration came from students' response to a non-integrated curriculum. Integrated Learning Program [ILP] was designed by curriculum development and integration committee. A structured questionnaire on perception of teaching methodologies and active learning was obtained from 95 students and 14 faculty members. Assessment test results were compared with a nonintegrated module. Overall satisfaction with ILP was shown by 78% students and 72% faculty members. The students realised greater command on subject and utility of course for better prospects in university exam and clinical orientation. Significant test performance was observed [p<0.001] by integrated curriculum. Competency based education and professional learning of medical students can be enhanced by complete integration in basic sciences curriculum

Acute pancreatitis; evaluation of modified glasgow scoring system [IMRIE]

To determine whether in our setup the Modified Glasgow Scoring System is still an accurate marker for the assessment of severity in acute pancreatitis. Observational study. Surgical Unit, CMH Peshawar. January 2005 to January 2008. It is an observational study of 50 male and female patients between ages of 1 5-75 years [Mean 43.3]. Male to female ratio was 1:1.3. They were graded mild, moderate and severe using the 8 variables / markers of Modified Glasgow Scoring System. Exclusion from this study were the patients with acute pancreatitis who were treated at the same institution but not admitted to the surgical ICU, those admitted after inter institutional transfer for tertiary care and patients admitted as sick transfer from other hospitals after 24 hours. On the basis of variables in the Modified Glasgow scoring system [Imrie], 18 patients were predicted with the severe outcome, but only 15 [83%] cases had an actual severe outcome. Whereas 3 cases [17%] did not follow the prediction and behaved as moderate pancreatitis. Similarly, 16 cases predicted as moderate pancreatitis, 14 [88%] followed the prediction and only 2 [12%] cases behaved as mild cases.16 cases were predicted mild, but 13 [81%] followed the prediction and only 3 [19%] switched to moderately severe group. Thus the overall accuracy of Modified Glasgow Scoring System was found in 42 [84%] cases. Bililary pathology remained the main aetiological factor. Two of the variables were significantly deranged in severe cases. These were age over 50 [4 cases], and WBC count > 20x 10[9]/l [12 cases]. Hospital stay varied between 4-21 days [Mean 9 days]. Conclusion: The Modified Glasgow Scoring System remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple, easy to apply with good predictive value and can be used in all hospital settings

Comparison of gamma glutamyltransferase in normal and in type 2 diabetics

Comparison of gamma glutamyltransferase in normal and type 2 diabetics. In a cross-sectional study, 100 apparently normal healthy subjects and, 47 type 2 diabetic subjects were selected from either sex with ages between 18-65 years.Subjects were measured for waist/hip ratio, BMI and serum levels of ALT, AST.Alk Phosphatase and Glutamyl Transferase [GGT]. The study excluded by screening for AntiHCV, HBsAg and patients with aspartate amino transferase [SGOT], alanine amino transferase [SGPT], GGT levels more than three times the normal and subject with a total leukocyte count more than 10,000/microl. The levels of GGT levels were found to be most significant among all the liver enzymes [P = 0.001]. The levels of GGT compared with type 2 diabetics was found to be significantly increased when compared with BMI, waist/circumference, cholesterol, triglycerides [TG], High Density Lipoprotein [HDL], Low density Lipoprotein [LDL], fasting blood sugar level and blood pressure [P = 0.001]. The pearson regression analysis showed a positive relation with systolic, diastolic blood pressure and fasting blood sugar. These results indicate that levels of GGT were raised with increased waist girth, BMI, blood pressure TG and low HDL, all of these are the features of metabolic syndrome according to ATP III criteria. Hence, serum GGT may be an important investigation for diabetes and metabolic syndrome

comparison of the effects of gamma glutamyltransferase on age and obesity among normal, hypertensive and type 2 diabetics

The purpose of this work was to compare the effects of Gamma Glutamyltransferase on age and obesity among normal, hypertensive and type 2 diabetics. It is a cross-sectional study which was conducted in the department of Physiology B.M.S.I., J.P.M.C. Karachi from December 2006 to October 2007. All subjects who have never used alcohol in their lifetime were selected. A total of 100 normal, 50 each diabetic and hypertensive patients were recruited to the study. Increase in age was significantly associated with raised GGT levels in normal, hypertensive and type 2 diabetic subjects [p < 0.01]. GGT levels were significantly [p < 0.001] greater in both hypertensive and diabetic subjects compared to normal subjects. The study confirms the relation between age obesity with GGT levels among non-alcoholics. This study also indicates the significance of GGT among diabetics and hypertensive patients

Brain natriuretic peptide, systolic and diastolic blood pressures

Hypertension is an increasingly important medical and public health issue. Because of life time risk of hypertension Joint National Committee-7 introduced a new term "Pre-hypertension" for those with systolic blood pressure 120-139 mmHg and diastolic blood pressure 80-89 mmHg. Individuals prone to the development of hypertension often have a hyperdynamic circulation antedating the onset of hypertension by several years. Brain Natriuretic Peptide is a new promising cardiovascular risk marker due to its association with high blood pressure via its key role in salt and water homeostasis and hence blood pressure. This study was designed to find out the levels of plasma Brain Natriuretic Peptide in normotensive, pre-hypertensive and newly diagnosed hypertensive and to observe its association with increasing values of blood pressure. This was an cross-sectional study conducted in the Department of Physiology Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi. Study included 85 adult males, aged between 20-60 years, non- smokers, non- diabetic and having no other chronic illness. Systolic blood pressure and diastolic blood pressure values were measured and divided into three groups on the basis of normotensive to hypertensive as stated by Joint National Committee -7. Brain Natriuretic Peptide was assayed by AxSym technology. Brain Natriuretic Peptide developed a positive and statistically significant correlation with both systolic and diastolic blood pressures and was also found out to be significantly raised in prehypertensive group. His study concluded that Brain Natriuretic Peptide is positively related with increasing values of both variables i.e. systolic as well as diastolic blood pressures. It also concluded out Brain Natriuretic Peptide to be significantly elevated in pre-hypertensive stage which may remain increased in sustained hypertension

Evaluation of serum leptin levels during normal pregnancy and in pre-eclampsia

The present study was designed to compare the serum leptin levels in normal pregnancies with those pregnancies which are complicated by pre-eclampsia and to investigate the possibility of leptin being a marker of severity of pre-eclampsia. This was a comparative cross-sectional study, conducted at the Department of Gynaecology and Obstetric, Jinnah Postgraduate Medical Centre [JPMC], Karachi. For this purpose 45 primigravidas with normal pregnancy and 45 primigravidas with pre-eclamptic pregnancy were selected who were in their third trimester All the subjects were of the same maternal age, gestational age, height and weight. Serum leptin levels were determined by immunoenzymometric assay. The study included 90 patients, divided into two groups. The serum leptin levels were found to be elevated in pre-eclamptic group as compared to normal pregnancy. When comparison was made on the basis of severity of pre-eclampsia, the serum leptin levels were found to be increased in severe group as compared to mild group. From this study it was concluded that the levels of serum leptin were higher in pre-eclamptic group when compared to controls during the third trimester of pregnancy indicating the possible role of leptin in the pathogenesis of pre-eclampsia. Also the elevated level of leptin may help in the prediction of the disease and may serve as a marker of severity of pre-eclampsia

Glucose 6- Phosphate dehydrogenase deficiency associated with neonatal jaundice

Glucose-6 Phosphate Dehydrogenase [G-6PD] deficiency is the commonest enzymopathy in human beings. It is transmitted as X-linked recessive disorder. Acute hemolytic crisis is the most common presentation of G-6PD deficiency, but in neonatal period it usually presents as jaundice. To find out the proportion of G-6PD deficiency cases in patients with neonatal pathological hyperbilirubinemia and study the clinical course of disease. The study was conducted at the neonatal unit of The Children's Hospital and Institute of Child Health, Lahore from January 2000 - April 2001. One hundred jaundiced neonates with unconjugated hyperbilirubinemia in pathologic range [peak serum bilirubin more than 12 mg/dl in full term and more than 15 mg/dl in preterm neonates] were included. Screening for G-6PD deficiency was done by dye decolorization test, which is semi quantitative, visual colorimetric assay. Out of 100 study cases, 62% were male and 38% were female. 10% of the cases were found to be G-6PD deficient; all were male. One case of G-6PD deficiency developed jaundice during first 24 hrs of life, 8 cases between 1 -7 days and one case after 7 days of life. Peak serum bilirubin levels in neonates with G-6PD deficiency were < 20 mg/dl in 2 cases, 20-30 mg/dl in 6 cases and >30 mg/dl in 2 cases. Evidence of hemolysis [reticulocyte count >5% and Hb% <12.5 gm%] was present in two neonates. In the G-6PD deficiency group, 40% of the cases underwent exchange transfusion compared to 26.6% of cases in the G-6PD normal group. One neonate with G-6PD deficiency had kernicterus at admission. Two neonates with G-6PD deficiency died, due to culture proven sepsis. G-6PD assay should be included in all jaundiced neonates with unexplained neonatal unconjugated pathological hyperbilirubinemia. G-6PD deficiency associated neonatal jaundice is not only hemolytic in origin, but is also related to the impairment of hepatic bilirubin conjugation and excretion

Prevalence of microalbuminuria in type 2 diabetic patients in Karachi: Pakistan a multi-center study

To determine the frequency of microalbuminuria and its associations in type-2 diabetic subjects attending diabetes centers/clinics across Karachi, Pakistan. Two thousand one hundred subjects with type-2 diabetes were screened for microalbuminuria using Micral test strip II. A single screening test was performed in 25 diabetes centers/units in different districts of Karachi from January 2003 to December 2003. The overall prevalence of microalbuminuria was 34%. Mean age of subjects was 53.1 years + 11.9 years, mean BMI was 25.8 ' 4.1 and mean duration of diabetes was 8.8 ' 5.21 years. Fifty seven percent were males and 43% females. Sixty two percent of the subjects had a systolic blood pressure >130 mmHg. Forty five percent had a family history of diabetes and 5% had a family history of hypertension. Univariate analyses demonstrated significant associations between microalbuminuria and age, duration of diabetes, male gender, smoking status, microvascular and macrovascular complications, hypertension, high triglycerides, high serum LDL, low serum HDL, and high fasting and random blood sugars. When adjusted for the effects of other variables in the model, age, diastolic blood pressure, serum LDL and retinopathy were found to be significantly associated with microalbuminuria. The prevalence of microalbuminuria in type 2 diabetic subjects in this cross-sectional multicentre study across Karachi was 34% and this was significantly related to age, diastolic blood pressure, serum LDL and retinopathy