Detection of acute dengue infection using NS1 rapid test on blood donors of Rawalpindi

Background: During recent years, many cases of dengue virus transmission, through blood transfusion have been reported, including two cases from Karachi, Pakistan. NS1 antigen detection in blood donors can serve as a rapid mean for detection of acute dengue infection thus could prevent transmission through blood donation by affected individuals

Objectives: The aim of this study was to screen high risk blood donors for active dengue infection during an outbreak in the city of Rawalpindi and rejection of NS1-positive donors to save patients from dengue infected transfusions

Subjects and Methods: After approval from the IRB Shaikh Zayed Hospital, high risk blood donors during the outbreak were identified in blood banks of selected government hospitals. The objective of the study was explained and an informed consent was obtained from each participant. Blood sample of 3cc was drawn at the time of cross-match. Serum was separated and analyzed for dengue NS1 Ag. Data was entered and analyzed using SPSS version 20.0

Results: Overall 600 blood donors were included in the survey with the majority of male participants [n=583] than female participants [n=17]. Most of the blood donors [57.8%] were falling in the age group of less than 30 years and highest donations were from [B] positive blood group followed by [O] positive and [AB] negative with least donations. None of the sample screened positive for NS1 antigen

Conclusion: Blood of high risk asymptomatic donors taken were having no dengue NS1 Ag positivity

review on requirements for vitamin D fortification in Pakistan

Despite the fact that Pakistan is a country situated near equator and has plenty of sunshine, it still has major population deficient in vitamin D3. The majority of food opted by general public is not sufficient source of vitamin D. For the reason vitamin D fortification is a compulsory requirement for healthy living. Developed countries like United Kingdom and Canada have overall improved their population vitamin D status by fortifying foods with vitamin D. For applying a well maintained vitamin D food fortification strategy in Pakistan , it is necessary to review various methods , type of food and their fortification results implemented all over the world. This review investigates all such prospective approaches which could be used for the fortification of foods in Pakistan. Looking at the socio economic status the majority of Pakistani residents, vitamin D fortification of staple foods such as whole grains, flour and rice by spray methods might serve as viable approaches in targeting majority of Pakistani population to ingest and improve their vitamin D status

Type and frequency of mutations in katg and rpob genes in multi-drug resistant strains of mycobacterium tuberculosis complex.

Background: Tuberculosis remains a major cause of morbidity and mortality in several parts of world. Genetic basis and mutations in katG and rpoB genes are responsible for isoniazid and rifampicin resistance in most of the cases of Mycobacterium tuberculosis

Objectives: To determine the mutations in katG and rpoB genes in confirmed multi-drug resistant tuberculosis isolates and to find the frequency of mutations Study design, settings and duration: This descriptive study was undertaken in PHRC TB research Centre, Department of Pulmonology, KEMU/Mayo Hospital Lahore. Polymerase chain reaction and genotyping was done at Institute of Molecular Biology and Biotechnology [IMBB], University of Lahore, Lahore from June 2013 to July 2014

Patients and Methods: A total of 100 acid-fast bacilli smear positive specimens of MDR TB suspects and rifampicin resistant on GeneXpert were collected. Drug susceptibility of isoniazid and rifampicin was carried out by standard drug proportion method. Gene amplification and sequencing was done to detect mutations in katG and rpoB genes

Results: A total of the 53% were females and 47% males with male to female ratio of 1:1.1. Mutations in rpoB Gene were found to be 98% of rifampicin resistant cases and in katG 76.7% of isoniazid resistant cases. Most of the mutations [60%] in rpoB Gene were observed on codon 531 while all the mutations in katG Gene were observed on codon 315. No novel mutation was found in this study

Conclusion: Mutation pattern of rpoB gene that confers rifampicin resistance is different to a little extent from other national and international studies while pattern is same for katG gene that confers isoniazid resistance. No novel mutation was observed in present study

Factors affecting sputum smear conversion time in newly diagnosed pulmonary tuberculosis patients

Background: Patients having tuberculosis are registered in the TB DOTS program for their treatment. During the treatment sputum samples are sent periodically to the laboratory to check treatment efficacy. Usually after two months of treatment sputum smear becomes negative but presence of multiple cavities in the lung, bacillary load, diabetes mellitus and tobacco smoking, slows the sputum smear conversion time

Objectives: To determine the factors affecting sputum smear conversion time in newly diagnosed pulmonary tuberculosis patients

Study design, settings and duration: This cross sectional, analytical study was done by Pakistan Medical Research Council, TB Research Centre in collaboration with Institute of TB and Chest Medicine King Edward Medical University/Mayo Hospital, Lahore from April 2013 to March, 2014

Patients and Methods: All newly diagnosed pulmonary tuberculosis patients who were registered and given treatment by the DOTS program were included in the study. All patients underwent sputum smear microscopy along with Complete Blood Count and ESR at the time of enrollment. The patients were followed for next 6 months while on treatment. Sputum samples were tested at 2[nd] and 6[th] month to check the sputum conversion rate and indirectly to see the efficacy/compliance to treatment

Results: A total of 400 patients were enrolled with slightly more males [52%] as compared to females [48%]. Smear became negative within two months of starting treatment in 85.7% patients while in 14.2% it remained positive at 2[nd] and 6[th] months of therapy. There were more females [10.7%] whose sputum smear did not became negative as compared to males [3.5%]. Predominant factors affecting sputum smear conversion were low resistance, raised initial bacillary load, decreased hemoglobin level, and long duration of symptoms at the time of diagnosis

Conclusion: Factors like low resistance, high initial bacillary load and decreased hemoglobin levels affect the sputum smear conversion and should be addressed while assessing efficacy of anti-tuberculosis treatment

Vitamin A deficiency among school going children affected by flood

Background: Vitamin A deficiency increases the risk of night blindness and death due to common childhood illnesses that are prevalent during emergencies like floods. The relief diet provided to flood victims is often deficient in micronutrients and minerals including vitamin A. There is a need to assess the levels of vitamin A among flood affected children to prevent morbidity and mortality caused by malnutrition

Objective: To assess the frequency of Vitamin A deficiency among school going children [8-14 years] affected and unaffected by floods of 2010 in district Nowshera

Subjects and Methods: Study was conducted in Government-registered schools situated in flood affected and unaffected areas of district Nowshera of KPK Province of Pakistan. A total of 353 children [8-14 years] were registered for study, including 190 from flood affected and 163 from unaffected areas. A questionnaire was filled for each child which included the demographic information. Three milliliter blood was drawn from each child which was processed for the estimation of vitamin A levels. Data was entered and analyzed using SPSS 20.0

Results: Among flood affected children frequency of vitamin A deficiency was 18.9%, whereas among flood unaffected children it was 6.1% showing strong association with children affected by floods [p < 0.001].Among illnesses during floods, children who had acute respiratory infection were on an average 3.5 times more likely to have vitamin A deficiency as compared to those who did not suffer from this disease [p = 0.037]

Conclusion: Vitamin A deficiency was substantially higher among children affected by floods and those who had acute respiratory infection

Active case detection among household contacts of multi drug resistant tuberculosis patients in a tertiary care setting

Close contacts of multi drug resistant tuberculosis patients are expected to be at increased risk of developing the disease and therefore need screening on priority basis to have an effective TB control program. Active household contact screening is an effective and cheaper way to detect and treat MDR-TB at its early stages. To determine active TB cases among household contacts of MDR-TB patients in a tertiary care setting. Descriptive study, conducted at PMRC TB Research Centre in collaboration with Institute of Chest Medicine, King Edward Medical University/Mayo Hospital, Lahore from November 2012 to December 2013. Patients suffering from MDR-TB and seeking treatment from Institute of Chest Medicine were selected as index patients. Their contacts [spouses, children, parents, siblings and other relatives] underwent sputum smear microscopy. Those found positive for AFB were subjected for MTB RIF assay by GeneXpert to determine rifampicin resistance. Data was analysed using IBM Statistics SPSS version 20.0. A total of 692 contacts of 112 MDR-TB patients were studied. Among them, 374[54%] were males and 318[46%] female. Seventeen contacts were found smear positive and of these 15[88%] were also confirmed as MTB by GeneXpert. Four [23%] contacts were rifampicin resistant. Of the affected contacts, majority were sisters [23.5%]. Active TB was detected in contacts of patients having MDR-TB with few also showing rifampicin resistance. TB screening should be done in all contacts of TB patients, especially those having drug resistance

Predictive value of TLC and CRP in children with clinically suspected acute appendicitis

Acute appendicitis represents one of the most common abdominal emergencies in children. Initially inflammation is localized to appendix but if untreated can lead to generalized peritonitis. It is often difficult and challenging even for the most experienced surgeon to make a definite diagnosis in paediatric patients. Inflammatory markers like Total Leukocyte count [TLC] and C-reactive protein [CRP] can help in making an early and accurate diagnosis in difficult cases

Objective: To evaluate the predictive value of TLC and CRP in children with clinically suspected acute appendicitis in whom physical findings were equivocal

Study Design: Cross sectional analytical

Setting: This study was conducted in Pediatric Surgery Department of Shaikh Zayed Postgraduate Medical Institute, Lahore

Subjects and Methods: All patients from 5-14 years of age fulfilling the inclusion criteria were admitted for this study. Preoperative blood samples for total leukocyte count and CRP were collected and submitted to hematology and microbiology laboratories. Postoperatively, specimen of appendix was sent to histopathology laboratory of Shaikh Zayed Hospital. The histological results of report were differentiated into non-inflammcd and inflamed appendix

Results: The mean age of the patients was 9.9+/-2.2 years. The mean TLC of the patients was 14.1+/-6.4 [10[9]/L]. The mean CRP of the patients was 19.0+/-8.7 mg/dl. Histopathology showed that 70 [69.4%] patients had inflamed appendix. The sensitivity of TLC and CRP was 82%, specificity 75% and diagnostic accuracy was 79%. The positive predictive value of TLC and CRP was 83% and negative predictive value was 73%

Conclusion: It is concluded from the results of this study that TLC and C-reactive protein can provide help in making accurate diagnosis of acute appendicitis. There monitoring enhances the diagnostic accuracy of acute appendicitis thus reducing the morbidity associated with delay in diagnosis and negative explorations

Captain of all these men of death - tuberculosis remains the commonest diagnosis - two years experience of bronchoscopy at Shaikh Zayed hospital, Lahore

A retrospective study of two years duration was conducted at the department of Pulmonology, Shaikh Zayed Hospital, Lahore, Pakistan to review our experience with bronchoscopy. Data was collected from145 patients who underwent bronchoscopy for different diagnostic and therapeutic indications. The study participants were having ages between 13 and 93 years. There were 85 male and 60 female patients. Bronchoscopy was performed for diagnostic purposes in 124 [85%] patients, for therapeutic purposes in 9 [6%] patients and for surveillance of airways in 13 [9%] patients. Bronchoscopy remained diagnostic in 74.19% patients. Tuberculosis was the commonest diagnosis in 34.6% patients followed by malignancy which was diagnosed in 16.1% patients. In 82% patients there was no complication during procedure, while mild haemoptysis occurred in 11.72%, 5.5% had wheezing [bronchospasm], 4.1% developed low grade fever and 1 patient died due to respiratory failure. It was concluded that bronchoscopy is found to be a useful procedure and can be used safely for diagnoses and treatment of different respiratory diseases

Evaluation of patients with coronary artery disease for major modifiable risk factors for ischemic heart disease

Incidence of cardiovascular diseases is on the rise in developing countries. Deaths due to ischemic heart disease can be reduced by modifying the risk factors. The present study was conducted to evaluate the patients scheduled for Coronary Artery Bypass Surgery for the presence of major modifiable risk factors for ischemic heart disease [IHD]. It was a descriptive study. All patients who underwent elective Coronary Artery Bypass cardiac surgery between November 1, 2008 and February 28, 2009 at Rehman Medical Institute, Peshawar, were included in the study. Presence of Diabetes, Hypertension, Smoking, Dyslipidemia, Sedentary life style, and Obesity was looked for in these patients. A total of 104 patients were studied during this period. Majority [97.11%] of patients had at least one major modifiable risk factor for IHD. Sedentary life style [53.84%] was the most common risk factor present in these patients followed by hypertension and dyslipidemia [47.11% each], smoking [43.27%], diabetes [35.57%], and obesity [9.61%]. Multiple risk factors [two or more] were found in 78 [75.0%] of patients. Most of the patients with coronary artery disease, severe enough to warrant coronary artery bypass grafting, have at least one of the major modifiable risk factors for IHD. Modification of these factors may well reduce the disease burden of CAD and reduce the cardiovascular mortality.

Knowledge, attitude and practices of dentists about hepatitis B and C infection in Lahore

To assess the knowledge, attitude and practices of dentists of public and private sector in Lahore about Hepatitis B and C infection. This cross-sectional analytical study was conducted on private dental practitioners and public sector dental surgeons working in hospitals of Lahore. Private sector dentists of Lahore working in Shahdara, Badami Bagh, Mughalpura, Baghbanpura, Gulberg, Shadman, Mozang, Feroz pur Road, Model Town, Multan Road, Johar Town and Tohkher Niaz Baig were selected for the study. In the public sector hospitals, dental surgeons were selected from Demont Morency Dental College and Hospital, Mayo Hospital, Services Hospital, Govt. Mozang Hospital, Jinnah Hospital, Lahore General Hospital, Mian Munshi Hospital, Sheikh Zaid Hospital, Railway Hospital, Wapda Hospital and Combined Military Hospital by using convenient sampling technique. A self-administered, close- ended questionnaire was used and information was gathered about their knowledge, attitude and practices for HBV/HCV infection and its prevention. Data was entered in the SPSS-13 computer program. Frequency and percentages were calculated for different segments and comparison between the two groups was performed by using z-test for proportion. p-value

Frequency of prostate cancer in patients undergoing trans-urethral resection of prostate [TURP] for clinically benign symptomatic enlarged prostate

To determine the frequency of carcinoma prostate in patients undergoing trans-urethral resection of prostate [TURP] for clinically benign symptomatic enlarged prostate. A descriptive study including all patients who had the clinical symptoms of BPH and operated with TURP in the RMI was designed. The study spanned from June 2009 to June 2010. Patients' data, clinical history, examination and operation notes were saved in a file. All the patients were properly evaluated by the team comprising of the authors pre-operatively. On the basis of these evaluations, a malignancy was not anticipated. All the patients were operated using TURP by the same team under spinal anesthesia. Prostate chippings collected at TURP from each patient were sent as routine, for histopathological evaluation and reporting. Majority of patients [n=44, 66.7%] were older than 60 years. Patients' ages ranged from 48 to 100 years with a mean of 69.5 years. Out of all the patients in this study, 9 patients [13.6%] presented with acute urinary retention and 57 patients [86.4%] presented with Lower Urinary Tract Symptoms [LUTS] and chronic urinary retention. In 9 patients [13.6%] malignancy of the prostate on histopathological examination was confirmed with 8/9 having definitive adeno-carcinoma. Two patients had Gleason score 6/10 and 6 patients had Gleason score 8/10] of the prostate while 1/9 had carcinoma in situ. Out of the 9 patients with malignancy 8 patients [88.9%] were more than 60 years of age ``while 1 patient [11.11%] was aged 56 years. The substantial proportion of patients with confirmed PCA in patients undergoing TURP for clinically symptomatic benign enlarged prostate emphasizes the need for early diagnosis through histopathological examination

see the gross qualitative parameters such as general appearance of rats and their testes after long and short term use of sildenafil citrate

To see the gross qualitative parameters such as general appearance of rats and their testes after long and short term use of Sildenafil Citrate. As very little attention has been given to explore the effects of a sildenafil citrate on histological aspects of testes, hence this experimental study was designed to check whether the drug which is being used indiscriminately in our country and abroad is safe or it has any harmful effect on the architecture of rat testis. Experimental Study. This study was conducted in departments of Anatomy and Histopathology Shaikh Zayed Hospital Lahore for a period of six weeks from 02.05.2008 to 17.06.2008. Sample size consisted of 45 animals, divided into Group A [Control], Group B and C [Experimental], Each group was consisting of 15 animals. Physical examination of rats and their testis was done every day by the author himself and recorded. After giving drug, on inspection of rats all the animals were active and healthy and the gross appearance of the testes was normal except in an animal, in which the testes were smaller than the associates of the same group. Eating habits of all the animals were normal, taking food and water freely. After half an hour of giving the drug, they were mounting over each other and looked aggressive. The comparison of all the groups, A vs B, A vs C and B vs C remained statistically non -significant [P>0.05]. No significant difference was observed in qualitative parameters [general appearance] of the rats and their testes after giving sildenafil citrate

Thyroid status and urinary iodine levels in women of endemic goiter area

To determine the thyroid function tests and urinary iodine levels in women belonging to goiter endemic area. Descriptive study conducted in women of goiter endemic area in Saggian Lahore. Saggian Lahore is a goiter endemic area. A total of 293 women between the ages of 18-45 years residing in the area were clinically screened for goiter. Of them 73 women having goiter were recruited for the study. Information regarding demographic profile clinical presentation and physical examination of the goiter was recorded on a questionnaire. The goiter size was graded according to WHO, UNICEF and the International Council for the Control of Iodine Deficiency Disorder. About 5ml of blood sample was drawn from each women and run for thyroid function tests i.e. T3 T4 and TSH using Elisa kits [Human scientific Co. Germany]. Urinary iodine was checked by chemical method. Mean age of 73 women was 28.5 years. Marital status showed that 48[65.7%] were married and 25[34.3%] were unmarried. Visible diffuse goiter was seen in 56[77%] cases. Pressure symptoms as cough and shortness of breath was seen in 30[41%] and 31[42.5%] women respectively. Among the 73 women 24.6% [18 cases] took treatment for goiter. Adverse pregnancy outcome secondary to goiter was seen in 58% [28 cases] out of 48 married women. Thyroid function tests result showed that 72% [53 cases] were euthyroid, 18% [13 cases] were hypothyroid, and 10% [7 cases] were hyperthyroid. Urinary iodine levels showed that 99% women were iodine deficient. Thyroid functions do not indicate iodine deficiency in all cases of goiter, therefore, Urinary iodine levels need be estimated while investigating goiter cases. Policy message: Iodine deficiency should be diagnosed and treated on priority basis

Association of diet with hirsutism in females of reproductive age

Causes of hirsutism range from minor illnesses like fever, nausea, headache to severe conditions like adrenal hyperplasia and polycystic ovarian syndrome while, in some cases the cause remains obscure and dietary factors are placed under this heading. To study the role of dietary factors in causing hirsutism. Department of Dermatology, NHRC, Sheikh Zayed Medical Complex, Lahore from Dec 2008- Dec 2009. Fifty clinically confirmed cases of hirsutism and 50 healthy females aged between 12-20 years were studied. A modified Ferriman-Gallwey [FG] score was used to determine the severity of hirsutism which were graded into 4 grades. Cases with virilism, post menopausal, menopause cushing's syndrome were excluded. Informed consent was obtained from all participants and their demographic data, height and weight and dietary pattern was recorded on specially designed performa. All 50 healthy controls had grade 1 or no hirsutism, while among hirsute females, 10[20%] had grade 2, 28[56%] grade 3 and 12[24%] grade 4 hirsutism. Consumption of red meat and broiler chicken was more in hirsute females whereas, intake of milk and vegetables was more in healthy controls. Dietary habits also appear to play some role in hirsutism in females

Association of insulin resistance with obesity in children

Insulin resistance is the primary metabolic disorder associated with obesity. Little is known about its role as a determinant of the metabolic syndrome in obese children. To assess the association of insulin resistance with metabolic syndrome in obese and non obese children. Study type and settings: Cross sectional analytical study conducted among children of ten Municipal Corporation high schools of Data Ganj Buksh Town Lahore. A total of 46 obese and 49 non obese children with consent were recruited for the study. Fasting blood glucose, serum insulin, high density lipoprotein cholesterol, triglycerides, cholesterol, non HDL-cholesterol LDL cholesterol were measured using standard methods. Data were analyzed by using statistical software SPSS-Version 15. A total of 95 children 49 obese and 46 non obese were recruited for the study. A significant association of serum triglyceride [p<0.001], high density lipoprotein cholesterol [p<0.001], fasting blood glucose [p<0.001], and insulin levels [p<0.001], was seen between the two groups. For each component of metabolic syndrome, when insulin resistance increased so did odds ratios for cardio metabolic risk factors. Insulin resistance was seen in 34.7% children. Metabolic syndrome was found in 31.6% children reflecting that obese children are at high risk for metabolic syndrome and have low HDL-cholesterol and high triglycerides levels

Correlation between amount of smoking and decline in lung function among urban male population

A cross sectional study of six months duration was conducted at the Department of Pulmonology, Shaikh Zayed Hospital, Lahore to compare the lung function decline [percentage of predicted forced expiratory volume in one second with amount of smoking in different groups of subjects according to pack years of smoking. Data was collected from four hundred current smokers meeting inclusion and exclusion criteria collected by arranging free spirometry camps by non-probability purposive sampling. The study participants were having ages between 20 and 67 years with mean age of 38.1 +/- 12.2. It was found that cases in group up to 5 pack years of smoking had highest average FEV[1] 98.0+/-5.3 and FEV[1] decreased smoothly as number of pack years escalated. It was 96.0+/- 10.9 in 6-10 pack year group, 90.0 +/- 9.8 in 11-15 pack years group, 85.3+/-7.2 in group 16-20 and it was 71.9 +/- 16.2 in group 21 and above pack years of smoking. In our study we also found that 79 [19.75%] participants had FEV[1] between 80-50% of predicted out these 58 [73.41%] were in group 21 and above pack years of smoking whereas 08 participants had FEV[1] less than 50% of predicted. It was concluded that the prevalence of undetected persistent airflow obstruction was high and more frequent in smokers having history more than 21 pack years of smoking

Myringoplasty: anatomical and functional results

Myringoplasty is an established procedure. However, the quest is on to improve the results further by studying the different factors that could possibly affect the outcome. The objectives of myringoplasty are essentially to restore the eardrum integrity and improve hearing level. We have retrospectively reviewed the myringoplasty operations performed in ENT department Combined Military Hospital Kharian, between January 2000 to December 2002, corresponding to 105 surgical interventions. It has been tried to find out the possible factors that affect the anatomical and functional outcome. We analyzed functional results in ears with anatomic success. 73% of patients had successful surgery and 65% of these patients had good functional outcome. This series suggest that patient with smaller perforation and shorter duration of disease has better anatomical and functional outcome