Radiological presentation of post primary tuberculosis in adult sputum smear positive patients

Background: Pulmonary Tuberculosis [TB] is traditionally classified into primary and post primary tuberculosis; both have distinct characteristics on radiology. Adetailed knowledge of different radiological patterns is helpful in diagnosis of TB

Objective: To determine the frequency of various radiological presentation of post primary tuberculosis in adult sputum smear positive patients

Methodology: This cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on adult sputum smear positive pulmonary TB patients. A total of 250 new cases of pulmonary TB with no previous history of Anti-Tuberculosis treatment were included in this study. Socio demographic data and findings of X -ray Chest from each sputum smear positive patient were collected and recorded on a predesigned performa. The data was entered and analyzed by using SPSS version 17

Result: Out of 250 patients, 146 were male and 104 were female with mean age of 35.76 +/- 16.25 years. Left lung was most affected in 40.4% cases, right lung in 35.6%, while 24% has bilateral involvement. Duration of illness prior to diagnosis was 3 +/- 1.66 months. Among the radiological presentation, cavitation was seen in 49.2% cases, alveolar consolidation in 42.4%, nodular pattern in 3.2%, reticulonodular pattern in 3.2% and reticular pattern in 2% cases. There was significant association of alveolar consolidation with male gender [0.03] while reticulonodular pattern was significantly seen in female gender [0.007]. Majority of the patients were young; 42.8% were below the age of 30 years and 82% patients were below the age of 50 years and there was a delay of > 03 months in the diagnosis

Conclusion: According to this study, cavitations and alveolar consolidation were the commonest radiological presentations of post primary TB. Majority of patients were young and there was a considerable delay in diagnosis

Pregnancy outcome variables and associated factors in different nationalities living in Kuwait

This study aimed to investigate differences in pregnancy outcome among various nationalities residing in Kuwait. Cross-sectional data were collected from 369 mother–infant dyads at delivery on mother height [MH], mother haemoglobin [mHb], child haemoglobin [cHb], mid-upper arm circumference [MUAC], gestational age [GA], placental weight [PW], birth weight [BW], crown–heal length [CHL], and head circumference [HC]. Significant differences among various nationalities were observed in mHb, HC, CHL, PW and MH. Kuwaiti and Indian women had lower PW and their babies had lower HC and CHL. Prevalence of anaemia [Hb <11.0 g/dL] ranged from 7.1% [Lebanese] to 30.0% [Kuwaiti] with the overall prevalence of 19.5%. Prevalence of low birth weight was 3.5%. Multiple linear regression analysis revealed PW as a significant predictor of BW, CHL and HC. Significant differences among various nationalities were observed in mHb, HC, CHL, PW and MH.The significance of these differences and their contributing factors needs further research

Prevalence and correlates of vitamin D deficiency-perspectives from Pakistan

Health outcomes of vitamin D deficiency [VDD] are beyond rickets, osteomalacia, osteoporosis, falls and fractures and have now touched the boundaries of CVD, diabetes and many types of cancer. Therefore, thinking of mere dependence on the sun to meet vitamin D requirements under the existing set of conditions is erroneous. Pakistan as a developing economy of South Asia and a region spanning latitude 24[degree sign] 35' North and longitude 61[degree sign] East to 78[degree sign] East, gravely suffers from increased VDD among pregnant women, neonates, infants, children, adolescents, adults, and the elderly people despite its abundant sunshine. Multiple indicators inflating VDD have been widely reported such as food habits, sociocultural and religious taboos, restricted sun exposure, unavailability of fortified diets, age, season, gender, lack of vitamin D supplementation, skin pigmentation and genetic factors. Strategies entailing mandatory food fortification, pragmatic implementation of vitamin D supplementation program, developing awareness on health damaging effects of the syndrome and sagacious sun exposure in tandem with global support to incline the government, program managers and consumers, need to be followed. Concerted efforts are further required to scale up the surveillance and monitoring of the magnitude of VDD by taking NGOs, industry, academia and health sector into loop to devise remedies for VDD in Pakistan

Role of HRCT and 3D MRI in children with congenital sensorineural hearing loss

Background: Congenital hearing loss sensorineural variety is one of the most common birth defects. Imaging is very important to determine the underlying pathology of such cases

Objective: To assess the various cochlea vestibular bony and nerve anomalies by HRCT scan of temporal bone and MRI scan with 3D reconstruction images of inner ear

Methodology: A total of 140[280 ears] children with congenital deafness [88 males and 52 females], between 1 January 2012 to 30 September 2014 were included in this cross sectional study. All patients were assessed radiologically by HRCT scan of temporal bone and MRI with 3D scan of inner ear. This study was conducted at Al Razi Health Care Hospital, Lahore and Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. The frequency of cochlear, vestibular aqueduct anomalies were noted. The data was entered an analyzed by using SPSS version 15

Results: We found various congenital anomalies of bony labyrinth and vestibulocochlear nerve in this study. Out of 280 inner ears we found 37 [13.2%] anomalous inner ears. Out of these 37 inner ears 25 [67%] has cochlear anomaly, 30 [83.1%] has anomalous vestibule, 19 [52.2%] has abnormal vestibular aqueduct and 9 [24.9%] has abnormal cochlea vestibular nerves

Conclusion: The study showed that most common ear anomaly in congenital sensorineural loss was cochlear vestibular, internal auditory canal anomalies. This study shows the outcome of preoperative inner ear assessment by radiological imaging mainly HRCTof temporal bone and MRI with 3D reconstruction

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

unusual presentation, pilomatrixoma in the buttock area - a case report

Pilomatrixoma is benign tumor of skin appendages it is rare tumor mainly involving head, neck face and upper extremities. 1 A 16-year-old male developed a lesion, over a period of 2 year, at the middle of right buttock. The presumed diagnosis was a sebaceous cyst / pyogenic granuloma. An excision biopsy was performed and the histopathologic diagnosis was a pilomatrixoma

Flaxseed - a miraculous defense against some critical maladies

Presence of omega-3, omega-6 rich oil, alpha-linoleic acid, dietary fibers, secoisolariciresinol diglucoside, protein and minerals in flaxseed constitute a very strong basis for the utilization of flaxseed in various food preparations as a curative agent. An extensive body of literature illustrates that flaxseed has gained a significant position in the domain of nutritional sciences owing to its pivotal role as an antioxidant agent. The review discusses at length, numerous health benefits of flaxseed typically focusing its preventive role against cardiovascular diseases, cancer, diabetes and enhancement of spatial memory. Massive increase .in the size of population with a special emphasize to the developing countries, there is an urge for exploration of the alternative dietary resources that can meet the dietary and nutritional needs of forthcoming generations. With respect to its remarkable nutritional importance, the review in question enables researchers engaged in nutritional sciences to further investigate the therapeutic value of flaxseed functional components and their dietary application in various food products and availability in processed foods as well as in the human cell line

Prevalence of depression in untreated patients of hepatitis c

Background: Hepatitis C virus infection is a public health problem worldwide, clinicians are suggesting that it may be associated with the depression even if there is no interferon therapy started

Objective: To assess the prevalence of depression in untreated patients of Hepatitis C

Place and Duration of Study: This despriptive study was conducted in the Department of Medicine, Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur, from January 4, 2012 to April 9, 2012

Patients and Methods: The sample consisted of 100 patients visiting Outpatient Department [Male 42, Female 58], pre-diagnosed HCV positive, not getting any treatment for Hepatitis C. They were interviewed and results were analyzed using SPSS version 16, from the entries in a Performa and Hamilton Rating Scale for Depression

Results: Mean age of our patients was 37.82 years. Depression was found in 38% of the patients, 12% patients had mild depression, 20% patients had moderate depression, 4% patients had severe depression and 2% patients had very severe depression

Conclusion: Our study corroborates presence of depression among patients who did not take any treatment for Hepatitis C, suggesting that depression may also caused by disease process itself

Role of genetic counselling in prenatal diagnosis of p-thalassaemia in Pakistan

To compare the response towards prenatal diagnosis [PND] of [3-thalassaemia, in individuals who had not received genetic counselling and a genetically counselled population. Cross-sectional survey. Department of Haematology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from March 2009 to December 2010. Using non-probability consecutive sampling, a total of 176 individuals having thalassaemic children, were interviewed regarding PND of thalassaemia, by using a structured questionnaire. Forty two individuals were taken as controls as they had received genetic counselling for PND, whereas the remaining 134 were taken as cases. Responses towards PND were compared using chi-square test. Odds ratio was also calculated for subsequent PND utilization. Seventy [52.2%] cases and 42 [100%] controls were aware of the availability of PND in Pakistan. This difference in awareness was statistically significant [p < 0.001]. In the controls, 40 [95.3%] individuals were aware of the appropriate timing of the test, in contrast to 52 [39%] cases [p < 0.001]. PND was used in subsequent pregnancies by 50 [37.3%] cases and 32 [80%] controls [p < 0.001]. The calculated odds ratio for subsequent PND utilization was 5.37. The study reflects a very positive attitude of genetically counselled thalassaemia affected families towards PND. For better utilization of PND, genetic counselling services should be available at all health strata

Depression; in dissociative [conversion] disorder patients; in a tertiary care teaching hospital

Prevalence of depression in Dissociative [Conversion] disorder Patients. The study was conducted in the Department of Psychiatry and Behavioural Science / Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur, from February 2012 to May 2012. The sample consisted of 100 consecutive in patients [Female 84, Male 16] of Dissociative [Conversion] disorder. They were interviewed and results were analyzed from the entries in a Performa and Hamilton Rating Scale for Depression. Majority of the patients were female [84%], uneducated [54%] and unmarried [60%]. Mean age of our patients was 21.84 +/- 7.29 years. Depression was found in 76% of patients. Out of 76 depressed patients had moderate depression, 24 had severe depression. Our study collaborates that depression was present in high proportion in patients with dissociative [conversion] disorder, which shows that co-morbid depression should not be over looked in these patients. It is recommended that every patient presenting with dissociative [Conversion] disorder should be assessed for co-morbid depression and should be managed accordingly

Diffuse lung uptake on [99m]Tc-MDP bone scintigraphy-case report

A [99m]Tc-methylene diphosphate [MDP] bone scan of a 35 years old female patient performed for possible skeletal metastasis from carcinoma breast. Diffuse [99m]Tc-MDP uptake was seen in both the lung fields on [99m]Tc-MDP bone scintigraphy. Biochemical and radiological evaluation excluded all the known causes of the diffuse [99m]Tc-MDP lung uptake. Raised serum ferritin levels of 1226ng/ml [normal range for adult female = 13 - 15 ng/ml] was the only abnormal biochemical finding and attributed as the possible cause of lung uptake

Daily contact with a patient and poor housing affordability as determinants of pulmonary tuberculosis in urban Pakistan

This study aimed to evaluate the factors associated with pulmonary tuberculosis [TB] among individuals aged 15 years or more in urban Karachi, Pakistan. A case-control design was implemented in three major tertiary-care hospitals to select cases [n = 342] with active pulmonary TB [i.e. two sputum smears positive for Mycobacterium tuberculosis with clinical and radiographic evidence of current pulmonary TB and diagnosed between August 2002 and October 2003. Selected controls [n = 342] were surgery patients from the same hospitals at time of recruitment of the cases, without clinical and radiographic evidence of pulmonary TB. Multivariable logistic regression model showed that daily contact with a pulmonary TB patient [adjusted odds ratio [OR[adj]] = 5.07; 95% CI: 3.31, 7.78], and poor housing affordability [i.e. rented vs. owned] [OR[adj] = 1.59; 95% CI: 1.13, 2.26] were significantly associated with pulmonary TB status. The overall adjusted summary population attributable risk [%] for both the risk factors together was 38.7. Reaching out to underprivileged TB patients for delivery of DOTS and focused education of patients and their contacts about M. tuberculosis transmission mode may substantially minimize pulmonary TB risk in this and similar settings

Frequency of janus associated kinase 2 [V617F] mutation in patients of polycythemia vera

To determine the frequency of Janus associated kinase 2 [JAK2] mutation in patients of polycythemia vera [PV]. Descriptive cross-sectional. Haematology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from January 2008 to December 2009. Forty-six consecutive patients of PV diagnosed by the conventional haematological criteria were included in the study. Blood samples of all patients were screened for G-T point mutation [V617F] in the JAK2 gene on chromosome 9 by an allele specific polymerase chain reaction [PCR]. JAK2 V617F mutation was found in 43 out of 46 patients [93.5%] with PV. Among them, 30 were males [65.2%] and 16 were females [34.8%]. Mean TLC in patients with PV was 16.5 +/- 9.1 x 109/L, mean haemoglobin [Hb] was 17.8 +/- 2.0 g/dl, mean platelet count was 531 +/- 261 x 109/L, mean PCV was 57.9 +/- 6.3 l/l, mean MCV was 78.8 +/- 11.0 fl and mean MCH was 24.4 +/- 4.8 pg. Peripheral blood mutation screening for JAK2 V617F can be incorporated into the initial work up of patients suspected to have polycythemia as this mutation is present in majority of such patients

Spectrum of dermatological conditions in a ruralcommunity

Objective: To determine the prevalence ofdermatological conditions in a rural community

Study Design: Cross-sectional descriptive study

Place and Duration of study: Study was conductedin Tehsil Headquater Hospital Bhawhana in May,2011

Materials and Methods: 300 patientsbelonging to Tehsil Bhawana and surroundingvillages reported in the camp. Forty three patientsboth male and female had dermatological conditionsand were included in the study. They wereevaluated, diagnosed and given treatment forvarious dermatological conditions

Results: Meanage of patients was 24.48 +/- 14.48. Out of thesePatients 17 patients [39.53%] had Scabies,6[13.95%] had Acne Vulgaris, 5[11.6%] hadurticaria, 4 patients [9.3%] had contact dermatitis, 2[4.6%] had pemphigus vulgaris [PV], 2 [4.6%]hadburn injuries, 2 [4.6%] had seborrhic dermatitis and1 patient [2.3%] each of vitiligo and Helmenthicinfections, 3 patients [6.9%] had lichen planus [LP]

Conclusion: Scabies is the most prevalentdermatological condition in rural communities andthe scenario can be improved by improvement in thehygienic conditions and the general publicawareness

Time series cross-correlation analysis of HIV seropositivity and pulmonary tuberculosis among migrants entering Kuwait

There is a paucity of published data on burden and pattern of dual infection with Mycobacterium tuberculosis and HIV among migrants from South Asia, South-east Asia and sub-Saharan Africa entering the Middle-East, particularly Kuwait. Therefore, this study assessed the overall prevalence of HIV infection and pulmonary tuberculosis [TB] and evaluated the ecological relationship between them. Time series cross-correlation analysis was used to determine the ecological time-lagged relationship between the monthly proportions [per 100,000] of HIV seropositive and pulmonary TB cases among migrant workers that entered Kuwait between January 1, 1997 and December 31, 2006. During the study period, overall prevalence [per 100,000] of HIV seropositivity and pulmonary TB among the migrants was 21 [494/23,28,582] [95% CI: 19-23], and 198 [4608/23,28,582] [95% CI: 192-204], respectively. Estimated cross-correlation function revealed a significant positive correlation [0.292 +/- 0.093] at lag -3 representing a positive relationship between the proportions of HIV seropositive [per 100,000] migrants tested 3 months earlier and the proportion of pulmonary TB [per 100,000] cases detected among migrants in a given month. Thus, the peak in proportion of pulmonary TB cases preceded the peak in proportion of HIV seropositive migrants indicating a direct time-lagged association between HIV seropositivity and the prevalence of pulmonary TB among migrants. HIV infection seemed to have played a significant role in the re-activation of latent M. tuberculosis infection in this migrant population. While currently less evident, in near future, however, TB and HIV/AIDS control programmes in the countries of origin of migrants may face a crucial challenge. Knowledge of serious consequences of association between HIV infection and pulmonary TB allows the promotion of public heath education to reduce the exposure to these infections. Future studies may focus on evaluating the impact of public health education programs on this dual burden of HIV infection and pulmonary TB in migrants

Evaluation of lipid profile in leprosy patients

Leprosy is a chronic infectious disease that, inspite of its ancient origin, still affects thousands of people throughout the world. It is caused by Mycobacterium leprae, which mainly affects the skin and peripheral nerves, leading to sensory loss in the skin, muscle weakness and often permanent disabilities of hands and feet. Leprosy is now known to be neither sexually transmitted nor highly infectious after treatment. Approximately 95% of people are naturally immune and sufferers are no longer infectious after as little as 2 weeks of treatment It is completely curable by using multi drug therapy. Mycobacterium leprae was discovered in 1873, by G. H. Armauer Hansen in Norway, therefore leprosy is referred as Hansen's disease. It is a mutilating, debilitating, devastating and deforming disease. To evaluate the lipid profile in leprosy cases and compare them with healthy control subjects. Case Control Study. Present study was carried out in the Department of Biochemistry, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi, in collaboration with Marrie Adelaide Leprosy Centre [National Training Institute of Leprosy Control Programme], Karachi from June 2009 to May 2011. A total of 60 newly diagnosed leprosy patients of both sexes and all ages were included in this study, among them 44 males and 16 females, aged 13 to 70 years [mean 37.8 +/- 1.71 years]. The diagnosis were on clinical ground and bacterial examination by slit skin smear test and 30 age, sex matched healthy control subjects were taken from general population for comparison. Informed consent was taken from each patient and control subject for this study. All the lipid fractions except HDL cholesterol were decreased significantly high [p<0.01] where as HDL Cholesterol was increased significantly [p<0.05] in leprosy patients when compared with control group. In present study total cholesterol was 127.1 +/- 1.46 mg%, Triglyceride 111.7 +/- 1.68 mg%, HDL Cholesterol 45.4 +/- 0.89 mg% and LDL Cholesterol 80.2 +/- 1.72 mg% in leprosy subjects. It is concluded that, all the lipid fractions except HDL cholesterol were decreased significantly high, where as HDL Cholesterol was increased significantly in leprosy patients when compared with control group, which are in favour of lepers

Self-confidence of medical students in performing clinical skills acquired during their surgical rotation assessing clinical skills education in Kuwait

To assess the self-confidence of clinical years' medical students in performing clinical skills/ procedures. A cross-sectional study was conducted in April 2011 at the Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Safat, Kuwait. A questionnaire was used to collect data from students who had completed their surgical rotation of their first clinical year. The students reported their level of self-confidence in performing specific skills/procedures related to that rotation. Data were presented using frequencies and percentages. A total score of confidence was calculated for each student. The Mann-Whitney and Kruskal-Wallis tests were used to assess the association between the students' sociodemographic characteristics and confidence score. Of the 122 students invited to participate in the study, only 15 [12.3%] declined to comply. Most students reported high confidence level [>75%] in performing 7 of the 13 history taking/physical examination skills, and 2 of the 39 diagnostic/ treatment procedure skills. The highest confidence level was in performing abdominal examination, while the lowest level was in care of Jackson-Pratt drain site and emptying the drain bulb. The total confidence score was significantly higher among males [p=0.021], and students with higher monthly income [p=0.002]. Medical students appeared to have poor self-confidence in performing clinical skills/ procedures. Curriculum planners should explore potential reasons, and methods for the improvement of confidence level among medical students in performing skills/procedures they were expected to learn during their surgical rotation

Knowledge and self-reported practice of universal precautions among Kuwait university medical students in their clinical years

This cross-sectional study aimed to assess the knowledge and practice of universal precautions among Faculty of Medicine, Kuwait University, medical students in their clinical years. A self-administered questionnaire including 9 knowledge and 9 practice questions of universal precautions was used. A score was calculated for both knowledge and practice. These scores were dichotomized into less than median score [poor] and more than median score [good]. 244 students were invited to participate. Of the 244 students, 220 [90.2%] accepted to participate. Of the 9 knowledge questions about universal precautions, 7 were answered correctly by more than 60% [range 64.8-90.4] of the students. All questions regarding the practice of universal precautions were answered correctly by over 60% [range 61.8-96.4] of the students. The prevalence of poor knowledge was 38.2% [84/220] and poor practice was 27.7% [61/220]. Grade point average was significantly [p = 0.008] associated with the knowledge status of the respondents; however, it was not significantly associated [p = 0.397] with practice of universal precautions. Furthermore, neither the knowledge status nor any of the sociodemographic variables were significantly associated with the practice of universal precautions. A substantial number of students of the Faculty of Medicine, Kuwait University, in their clinical years appeared to have poor level of both knowledge and practice of universal precautions. Efforts are needed to optimize the level of knowledge and practice among students to minimize the risk of preventable infections

Depression; prevalence in patients presenting with alcohol and drug addiction

Prevalence of Depression in patients presenting with Alcohol and Drug addiction. The study was conducted in the Department of Psychiatry and Behavioural Sciences, Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur from March, 2009 to May, 2009. The sample consisted of 50 in-patients [Male 46, Female 4] with Alcohol and Drug addiction. They were interviewed and results were analysed from the entries in a Performa and Hamilton Rating Scale for Depression. Majority of the patients were male [92%], age group majority [74%] were between 21-40 years. Depression was found in 23[46%] patients, 14[28%] had severe depression and 9[18%] had mild to moderate depression. Significant numbers of patients of alcohol and drug addiction have depression as co-morbidity, which can have important implications in the aetiology and prognosis. So every patient seeking treatment for alcohol and drug addiction should be assessed for depression and we should develop a protocol to treat depression in these patients

Giant dedifferentiated retroperitoneal liposarcoma

A 72 years old lady presented with a gradually increasing abdominal mass for the last 25 years, with more rapid increase in the last 05 years. Examination revealed a large mass spanning the whole abdomen. CAT scan revealed a huge retroperitoneal tumour, with tortuous ureters passing through the tumour and three tiny nodules in the right lung field. A subtotal piecemeal excision of the tumour was done after stenting the ureters with single J stents. The excised tumour mass weighed 46 Kg. The patient had a prolonged ileus that recovered in 5 days. Histopathology revealed the mass to be dedifferentiated liposarcoma. The patient and the family were satisfied with the short-term outcome of the surgery. She was ambulating with little support and was able to manage her daily affairs