Frequency of hepatitis-D in HbsAg positive cases at Peoples university of medical and health sciences for women hospital Nawabshah

To find out the frequency of delta virus [HDV] in HBV positive patients. Observational Study. This study was conducted at the Department of Medicine PUMHS Nawabshah form 01-01-2011 to 31-12-2011. 200 adult patents of conformed Hepatitis B were included in the study blood samples of all the patients were screened for HDV by Elisa method / PCR during period of one yare. Clinical status of positive and negative patients was also compared. Anti HDV was found in 32 patients [15%1] among them 20 [62%] were male and 12 [38%] were female. The prevalence of HDV infection in HBV +ve patients is significant our area. Primary eradication of Hepatitis B virus is required

Underdiagnosis and the impact of headache-related disability on the quality of life patients

To determine the extent of under-diagnosis of migraine and the impact of headache-related disability on the quality of life of patients. Prospective, Observational. This study was conducted at the Department of Neurology, Medical Unit II, PUHMS, Nawashah from 1.1.2009 to 31.12.2009. The demographic and clinical data was collected in a proforma. Migraine was diagnosed according to the International Headache Society Classification. Neurological examination and routine laboratory tests were done in all cases. CT Scan of brain was performed whenever deemed necessary. A clinically reliable Migraine Disability Assessment Scale [MIDAS] was administered to the patients with migraine headache. The disability was rated as Grade I [little or no disability] to Grade IV [severe disability] based on the information provided by the patients. Sixty-eight cases were documented. Male=31, Female = 37. Age ranged from 10-59 years. The majority were in the age group of 10-39 years. Fifty-seven [83.8%] had migraine without aura [common migraine] while 11/68 [16.2%] had migraine with aura [classic migraine]. In 36/68 [52.9%] nausea was the most frequent associated symptom. Photophobia [17.6%] was more common than phonophobia [5.8%]. Visual changes [flashing lights] was the most common associated symptom in migraine with aura. Stress was the most frequent triggering factor in majority in 29.4%. Only 8/68 [11.7] were previously diagnosed as they were taking some anti-migraine therapy whereas majority 60/68 [88.3%] were newly diagnosed at the time of our assessment. The usual frequency of headache was once/week in 30/68 [44.2%], once/2 weeks in 22/68 [32.3%] and once/month in 16/68 [23.5%]. Disability was Grade I in 8/68 [11.7%], Grade II in 12/68 [17.6%], Grade III in 30/68 [44.2%] and Grade IV in 18/68 [26.5%]. Most of our cases were unaware of their illness nor they were provided relevant information by their physician regarding migraine and its associated aspects. This study indicates that migraine is under diagnosed in a greater proportion of cases in our region. The headache-related disability caused by migraine adversely affects the quality of life of patients. Unawareness about the disease appears to be the main reason for under diagnosis and increasing disability in our patients

Young-onset stroke in the rural areas of Sindh

to determine the risk factors and clinical features in the young-onset stroke belonging to the rural areas. Retrospective, Observational. This study was conducted at the Department of Neurology, Medical Unit II, Peoples Medical College Hospital, Nawabshah from 1.1.2006 to 31.12.2006. Hospital records of acute stroke cases aged 20-45 years were reviewed. Stroke was defined according to the WHO criteria. Demographic and clinical data including the risk factors were scrutinized. Laboratory investigations and the CT Scan of brain were evaluated in all cases. Twenty-cases were documented. Male= 12 [60%], Female= 8[40%]. Age ranged from 20-45 years. Majority were uneducated and they were residents of small rural communities. Hypertension was the most frequent risk factor in 13 [65%] of cases [Table 1]. Only 2 [10%] were previously taking antihypertensive treatment while 18 [90%] were not receiving any treatment prior to stroke. Heart disease was present in 2 [10%]. Three [15%] were smokers. One [5%] had Diabetes mellitus, 3 [15%] had previous stroke and 1 [5%] had a family history of stroke. Three [15%] had none of the above risk factors. Hemiplegia was the most common presentation where 8 [40%] had right while 7[35%] had left hemiplegia and in 5 [25%] sidedness could not be ascertained because of deep coma [Table 2]. Glasgow Coma Scale [GCS] ranged from 5-12 out of 15. Cerebral infarction was more common 12 [60%] than cerebral haemorrhage 6 [30%] while in 2 [10%] CT findings were unremarkable [Table 3]. Of the 20 cases 3 [15%] expired and 17 [85%] survived [Table4]. Fatal cases had GCS of below 8 out of 15. This study indicates that hypertension is the major risk factor for stroke in young adults belonging to the rural areas. Hemiplegia was the most common presenting feature. Cerebral infarction accounts for 60% of the cases and the survival rate was 85%. Unawareness and poor control of hypertension appears to be the main reasons behind the young-onset stroke in our region

Outcome of endoscopic third ventriculostomy in hydrocephalus

To elucidate the outcome of endoscopic third ventriculostomy [ETV] in patients with hydrocephalus. Descriptive case series. Neurosurgery Department Peoples Medical College Nawabshah, from 1[st] January 2009 to 31[st] December 2009. Patients aged more than 2 years with hydrocephalus were included. Endoscope used with free hand technique and third ventriculostomy performed with Fogarty balloon. Success was defined with clinical improvement and radiological reduction in ventricular size. The study population consisted 19 patients with male preponderance 12 [63.15%] males and 7 [36.84%] females. Age ranged from 3 years to 55 years with mean age 20.8 years. Shunt conversion was done in 5 patients [26.31%]. The most common indication was tuberculous meningitis. Success rate was 68.41% [13 cases]. ETV is an alternative and effective method of treating hydrocephalus in patients with normal ventricular anatomy and thin membrane at the third ventricular floor. Patients with thick membrane and tuberculous meningitis and obscure anatomy had high failure rate

Risk factors, mortality and recovery of stroke: a prospective study on 1000 patients

To determine whether a single or multiple risk factors have a relative significance on the mortality and morbidity of stroke and whether previous treatment of major risk factors like hypertension and diabetes mellitus had any positive influence on the clinical outcome. One thousand consecutive cases of acute stroke were included in this prospective descriptive study conducted at the Dept. of Neurology, Jinnah Postgraduate Medical Centre, Karachi from Dec. 1985 to July 1988. A special proforma was designed to collect all the relevant clinical information. Functional status was assessed by using the Barthel Index activity score. Scores obtained at admission were compared with the scores obtained at six weeks follow-up. The results were then analyzed in the background of various risk factors present. Similar observations were made in assessing the mortality. The pre-stroke treatment status of major risk factors like hypertension and diabetes mellitus was also studied. Of the 1000 cases, 61% were male and 39% female. Majority of the cases were in the age group 60-69 years. Hypertension [HTN] alone was present in 58.3% followed by diabetes mellitus [DM] 5%, ischemic heart disease [IHD] 1.3%, whereas in 19.8% HTN, DM, IHD were present in various combinations, 1.5% had Valvular Heart Disease [VHD] while 14.1% had none of the above risk factors. Six-weeks follow-up was available on [673/1000] 67% cases. Gross mortality was 59% [396/673]. Higher mortality was seen in cases with Glasgow Coma Scale [GCS] range 3-9/15. Risk factor profile in fatal cases showed that 221/379 [58%] had HTN, 21/ 32 [65%] had DM, 6/12 [50%] had IHD and 6/10 [60%] had Valvular heart disease [VHD]. Some patients had multiple risk factors, among those 60/95 [63%] had HTN + DM, 19/41 [46%] had HTN + IHD, 5/7 [71%] had DM+ IHD, 11/16 [68%] had HTN + DM + IHD while 47/81 [58%] had none of the above risk factors. Relative influence of individual risk factor or in combination was not statistically significant. The functional recovery showed no significant relative difference among patients with different risk factors. There was no significant difference in the outcome among treated and untreated hypertensive and diabetic patients. Individual or multiple risk factors do not have a relative influence on the higher morbidity and mortality in stroke. For poor prognosis severity of stoke at onset is more important than the type of risk factors. Furthermore, there was no difference in outcome in patients who got pre-stroke treatment compared to those who had no treatment

Lipoprotein [a] behaviour in viral hepatitis patients

To correlate liver lipoprotein [a] level with biochemical parameters of viral hepatitis, induced due to most common causes, hepatitis B and C. This was a prospective study performed during the period of January 2008 to June 2008. Patient selection was done by simple random enrollment of adult males and females after confirmation of their diagnosis by ELISA method. Total of 80 patients positive for hepatitis B and C virus infection with and without cirrhosis were enrolled for study. Normal subjects were selected as control for study. Serum lipoprotein [a] was estimated by ELISA method and prothrombin time by one stage method. While enzymes assay was done by enzymatic method. The mean values of lipoprotein [a] were found statistically significantly diminished in all groups, which indicate decreased synthesis by the damaged liver. It showed statistically significant negative correlation with prothrombin time, AST and ALT in all patients groups. The results of our study indicate that there is an apparent decline in lipoprotein [a] level in both patients of with and without cirrhosis irrespective of causative organism, relatively more decline in patients of cirrhosis. The apparent decline and evidence of more decrease in the level of lipoprotein [a] with the increase in the stage of disease and its significant correlation with other biochemical parameters, reflects that the evaluation of lipoprotein [a] serum levels may contribute, among other markers, to a more complete evaluation of liver function in patients of viral hepatitis