Exploring The Link Between Obesity And Hypothyroidism.

BACKGROUND: Obesity and hypothyroidism are two common clinical conditions that are often connected. This connection is now more important because of an exceptional rise in the prevalence of obesity around the world. Both of these conditions have a noteworthy impact on human health and well-being. The main objective of this study was to determine the frequency of hypothyroidism in obese patients presenting at Ayub Teaching Hospital, Abbottabad. METHODS: This cross-sectional study was carried out on 242 patients in the Department of Medicine of Ayub Teaching Hospital, Abbottabad from 1st March to 31st August 2022. SPSS version 23.0 was used for data analysis. RESULTS: In this study, 242 obese patients were included. The mean age of the patients was 39.55±9.361 years. The mean BMI was 41.62±8.099kg/m2 ranging from 31 to 61kg/m2, the mean TSH level was 3.04±2.604mU/l, the mean T4 level was 8.53±2.215pmol/L and the mean T3 level was 1.2195±0.35795nmol/L. Out of a total of 242 patients, 34 (14.0%) were male and 208(86.0%) were female patients. Patients found with overt hypothyroidism were 11 (4.5%), subclinical hypothyroidism were 31 (12.8%) and euthyroid were 200 (82.6%). CONCLUSIONS: The proportion of hypothyroidism among the obese patients was quite less in our setup and not significantly associated with age and gender of the patients.

Covid-19 Pandemic-Knowledge, Perception, Anxiety And Depression Among Frontline Healthcare Workers Of Ayub Teaching Hospital Abbottabad, Pakistan.

Background: The COVID-19 pandemic is a viral infection that spreads through different mediums and has a high rate of mortality. At its initial stages, there is no particular medicine that can cure patients of COVID-19. The aim of the present study was to understand the COVID-19 knowledge, perception, and its effects in terms of anxiety and depression among frontline health care workers of Ayub Teaching Hospital, Abbottabad. Methods: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad from June to July 2021 in which data was collected from 200 hospital healthcare workers who have performed duties in COVID isolation wards through standard questionnaire. SPSS version 24.0 was used for data analysis. Results: Out of 200 participants in the study 100 (50.0%) were male. Regarding safety measures taken during COVID -19, 144 (72.0%) individuals reported that they have not been given training to handle known or suspected cases of COVID-19. Moderate anxiety and depression was found in 153 (76.5%) healthcare workers, mild in 25 (12.5%) and 22 (11.0%) had severe anxiety and depression at the time of COVID-19 pandemic. Conclusion: This study revealed that a significant anxiety and depression was found in frontline healthcare workers during the COVID-19 pandemic. In addition, a more extensive study should be conducted which involves many other hospitals like Ayub Teaching Hospital.

Frequency Of Folic Acid Deficiency In Women Of Childbearing Age Presenting At Ayub Teaching Hospital Abbottabad.

BACKGROUND: Folic acid deficiency is one of the most common deficiencies among women of childbearing age. It can lead to neural tube defects, a significant cause of disability and mortality among infants. Therefore, the main objective of this study was to determine a folic acid deficiency in women of childbearing age in Ayub Teaching Institute, Abbottabad. METHODS: This cross-sectional study was carried out in Ayub Teaching Institute, Abbottabad from January to June 2020. In this study, a total of 193 women of childbearing age were included through consecutive sampling. RESULTS: In this study 193 women of childbearing age were included. Mean age was 30±4.87 years. Out of 193 patients, 56.7% were found to be anemic and 38.9%were found to have folic acid deficiency. CONCLUSIONS: Our study concludes that the majority of women of child bearing age are anemic in our set up. Moreover, the frequency of folic acid deficiency is 38.9 % which is high.

Impact of COVID-19 on the wellbeing of micro and small entrepreneurs of rural Pakistan.

According to the constitution of Pakistan, the state is responsible for the provision of necessities of life to its citizens whenever their livelihood is permanently or temporarily threatened. COVID-19 and its associated lockdowns were a series of events where amenities of life around the world were seriously endangered. Especially, hard hit were the small- and medium-sized entrepreneurs (SMEs) of rural Pakistan. To quantitatively assess the social and economic impact of COVID-19, we interviewed the local microenterprise owners in rural Pakistan from January to February 2021 and then June 2021. Mean comparison tests were estimated for pre- and post-COVID-19 periods. Results reveal that the COVID-19 pandemic has significantly and negatively affected wellbeing of micro and small entrepreneurs in the regions as the income of most of the sampled entrepreneurs significantly decreased during the pandemic. Disaggregated consumption analysis however revealed that nominal consumption of food, clothing, energy, health, and education all increased, except for communication, during the pandemic. Furthermore, the regression analysis revealed that changes in income, occupation, borrowing during COVID-19, and family type of the respondents were significant factors in mitigating the effects of COVID-19. Based on the findings, policy recommendations are also spelled out in the last section.

The Moderating Role of Organizational Citizenship Behavior Toward Environment on Relationship Between Green Supply Chain Management Practices and Sustainable Performance.

The purpose of this study was to investigate the moderating role of "organizational citizenship behavior toward the environment" (OCBE) on the relation between "green supply chain management" (GSCM) practices and sustainable performance. The participants of the current study were manufacturing firms, and non-probability convenience sampling technique was used for selecting the sample size. The survey method used while data were collected from manufacturing firms was cross-sectional; a total of 151 responses were received and used in the analysis. For statistical analysis, "SmartPLS partial least square, structural equation modeling" PLS-SEM was used. From the findings, it was evident that in the measurement model, convergent and discriminant validities were established. In the second stage, a structural model was developed for hypotheses testing. It was found that sustainable performance was associated with proposed GSCM practices, excluding environmental management. OCBE being a moderator has significant impacts concerning GSCM operations and sustainability functions of firms. However, OCBE did not play the role of moderator between internal environmental management and EE and sustainable performance. The present study is significant for managers and policymakers for the attainment of competitive advantage, enhancement of OCBE, and sustainable performance. Furthermore, this research study is the first empirical study that has used OCBE as a moderator through the lens of NRBV.

Bilaterally Asymmetrical Becker's Nevus.

Becker's nevus is a main epidermal hypermelanotic condition that usually presents in adolescence, though childhood cases are seen less commonly. Congenital cases have been rarely reported. Nevus is usually unilateral having increased pigmentation and is characterized by hypertrichosis. It usually presents as a patch on back, proximal upper extremities, arms and upper trunk. Becker's Nevus presenting as bilateral asymmetrical patch is rare. A case of 23 year's old male with bilateral hyperpigmentad patch over the back has been reported. The histological exams established the clinical hypothesis of Becker's Nevus.

Effectiveness Of Oral Omega 3 In Reducing Mucocutaneous Side Effects Of Oral Isotretinoin In Patients With Acne Vulgaris.

BACKGROUND: Acne vulgaris has been a common clinical condition. Due to. high prevalence and unclear etio-pathogenesis of acne vulgaris, large number of treatment options have been available across the globe. Limited work has been done to explore the options which may manage or prevent these adverse effects and improve the adherence to the prescribed medications. We therefore conducted this trial to look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. OBJECTIVE: To look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. It was a randomized control trial conducted at Department of Dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020. METHODS: A total of 60 patients of acne vulgaris put on oral isotretinoin by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the placebo along with oral isotretinoin while Group B received oral omega 3 in standard dose in addition to oral isotretinoin. Comparison was made in both the groups regarding common mucocutaneous side effects. RESULTS: Out of 60patients with acne vulgaris and put on isotretinoin included in the study, 26 (43.3%) received placebo in addition to isotretinoin while 34 (56.7%) received omega 3 in addition to isotretinoin. Forty (66.7%) patients were female while 20 (33.3%) were male. Cheilitis 35 (58.3%) was the commonest side effect followed by lip dryness 33 (55%). Application of chi-square test revealed that cheilitis, lip dryness and xerosis were significantly found in more patients who received placebo as compared to those who received omega 3 along with isotretinoin. CONCLUSION: Mucocutaneous side effects were a very common finding among patients of acne vulgaris managed with isotretinoin. Cheilitis was the most reported mucocutaneous side effects among the target population. This RCT demonstrated that omega 3 was superior to placebo in order to prevent or manage cheilitis, xerosis or dry lips.

Role Of Intralesional Vitamin-D In Viral Wartse.

BACKGROUND: The study was to look for effectiveness of vitamin D-3 in cutaneous warts in comparison with cryotherapy at dermatology department of Pak Emirates Military Hospital Rawalpindi. It was a randomized control trial conducted at the Department of dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020. METHODS: A total of 50 patients of cutaneous warts diagnosed by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the Intralesional vitamin D 3 while Group B received cryotherapy. Comparison was made in both the groups regarding the response as complete or partial or no resolution of the wart. RESULTS: Out of 50 patients with cutaneous warts on any location of the body, 23 (46%) received intralesional vitamin D3 while 27 (54%) received cryotherapy as allocated treatment. Twenty-four (48%) patients were female while 26 (52%) were male. Planter warts 41 (82%) were the commonest type according to the site of warts followed by palmar 6 (12%). Application of chi-square test revealed that Vitamin D3 was statistically significantly related to complete resolution of warts as compared to cryotherapy (p-value<0.05). CONCLUSION: Cutaneous warts were most commonly seen on the feet of the affected patients. They had a good response to both of the therapies but intralesional vitamin D3 emerged as more effective option of the two in terms of management of these cutaneous warts.

Protocols Of Treatment Of Meningitis In Medical Department: Are There Any?

BACKGROUND: Meningitis, whether viral or bacterial is associated with high mortality rate and risk of severe lifelong disability. Early antibiotics administration and favourable outcomes have been demonstrated by previous studies. The purpose of the study was to evaluate whether the patients with suspected meningitis in general medicine department of Ayub Teaching Hospital Abbottabad were being managed according to protocols. METHODS: This cross-sectional study was carried out in the Medical Department of Ayub Teaching Hospital Abbottabad from March 2018-March 2019 in which data was retrospectively collected from the hospital records of all patients with suspected meningitis admitted in Medical Ward. SPSS version 20.0 was used for data analysis. RESULTS: Out of 41 patients in the study 19 (51.74%) were male. Viral encephalitis accounted for 23 (56.1%) tuberculous meningitis for 14 (34.1%), and 4 (9.8%) patients had septic meningitis. Lumbar puncture for CSF examination was performed in 38 (92.7%). Out of 41 patients, 19 (46.3%) received a combination of Ceftriaxone, Acyclovir and Dexamethasone, 16 (39.0%) patients received anti tuberculous treatment (ATT), Dexamethasone and Streptomycin combination, 3 (7.35%) patients were given Ceftriaxone (2g) and Dexamethasone and 1 ( 2.45%) patient was given a combination of Ceftriaxone(2gm) along with Vancomycin (1gm) and Dexamethasone; while 2(4.9%) patients were given a combination of Acycolvir and Dexamethasone. CONCLUSIONS: This study identified practice gaps in the management of patients with suspected meningitis according to guidelines, as lumbar puncture and CSF-RE were not timely done and proper laboratory records were not maintained. Secondly blood culture facilities were not available in the hospital.

Inquiring Voluntary Turnover For Female Nurses In Pakistan Through Focused Ethnography.

BACKGROUND: Pakistan is a country with very low nurses to population rate. This problem becomes more prominent due to voluntary turnover; especially among female nurses. This problem could be attributed to several social and demographic factors. PURPOSE: This study sought to identify the factors affecting voluntary turnover of female nurses in Pakistan. METHODS: This study is qualitative in nature. Focused ethnography was used for detailed exploration of the issue of voluntary turnover among female nurses. Ethnographic interviews of informants were conducted to identify the social and organizational determinants of voluntary turnover among female nursing staff. RESULTS: Social factors affecting voluntary turnover include religious beliefs, cultural values, lack of social respect, marital disruption, and lack of psychological support. While organizational factors affecting voluntary turnover include sexual harassment, work-family conflicts, workload and job stress, emotional labour, undefined career path and lack of promotion opportunities and bullying behaviour of co-workers. DISCUSSION: Both social and organizational issues affect voluntary turnover among female nursing staff. Policymakers at national and organizational level must identify and address these issues to provide congenial work environment and to reduce turnover of female nurses in Pakistan.

Validity Of Transabdominal Ultrasound Scan In The Prediction Of Uterine Scar Thickness.

BACKGROUND: Caesarean section rate is increasing throughout the world, which increases the risk of complications in subsequent pregnancy with increased maternal and foetal morbidity and mortality. There is risk of uterine rupture in subsequent pregnancy with trial of labour after caesarean section (TOLAC). Therefore, accurate prediction of uterine rupture can be of significant value during the management of subsequent pregnancies after previous caesarean delivery. The aim of this study was to evaluate the accuracy of prenatal transabdominal sonography in determining the lower uterine segment thickness in women with previous caesarean section, to document relevant risk factors in the obstetric history of subjects predisposing to uterine scar rupture and to define a cut-off value of uterine thickness for prediction of uterine rupture. METHODS: This cross-sectional validation study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad from May to October 2017.Transabdominal ultrasound was carried out in all patients before labour for the measurement of uterine scar thickness. Patients were followed till caesarean section and intraoperative findings were recorded. RESULTS: A total of 117 patients were enrolled. Out of these 33% had thin or dehiscence/rupture scar. At the cut-off value of ≤5 mm the sensitivity was 76.9%, specificity 48.7% and accuracy was 58.12%. No significant association was found between clinical features and scar dehiscence/rupture. CONCLUSIONS: No definite USG cut-off limit could be established to provide guidance regarding the clinical decision of opting for VBAC or repeat caesarean/section; scar thicknesses ≤5.0 mm should be judged cautiously.

Jak 2 Mutation In Recurrent Foetal Loss.

BACKGROUND: The frequency of recurrent fetal loss (RFL) is around 1% of the total pregnancy. Workup is recommended in patients after three consecutive fetal losses. A multitude of chromosomal, environmental, structural immunological and hematological factors can result in RFL. Frequency of pregnancy loss is increased in MPD patients carrying JAK2 V617F mutation. In fact, JAK2 mutation is an independent risk factor for pregnancy complication and fetal loss. This study was conducted to assess the role of the JAK 2 mutation in recurrent pregnancy loss. METHODS: This was a case control study conducted in Armed Forces Institute of Pathology, Rawalpindi. Using un-matched case-control situation a sample size of 216 cases and 216 controls was calculated using the WHO sample size calculator with assumption of 95% confidence interval, 1:1 ratio of cases to control, expected proportion of mutation as 0.10% and 1.06% in control and cases respectively. DNA analyses were performed and results were recorded done by kit method. The data was entered and analyzed using SPSS version 18.0. Odds ratio was calculated to assess the association between JAK2 V617F mutation and recurrent fetal loss. RESULTS: Three out of 216 cases were positive for JAK 2 mutation while one control had positive JAK 2 mutation. The prevalence of JAK2 mutation in cases of RFL was 1.38% (95% C.I 0.58- 2.17%). The odds ratio for JAK 2 mutation in cases and controls was 3.028 (95% C.I of 0.28- 76.13) and a p-value of 0.623. CONCLUSIONS: JAK2 positive females are 3.03 times more at risk of having RFL as compared to JAK2 negative pregnant females. JAK2 mutation testing may be recommended for inclusion in the workup to manage RFL.

Risk Factors Of Chronic Kidney Disease Leading To Dialysis In Patients Presenting At Ayub Teaching Hospital Abbottabad.

BACKGROUND: There has been an immense increase in the incidence and prevalence of chronic kidney disease (CKD) in the last few years globally. Developing countries are more prone to suffer the complications due to greater poverty and higher expenses of treatment. Dialysis has become a routine procedure rather than exception. This study was conducted with the purpose to determine risk factors of CKD patients leading to dialysis. METHODS: This cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad (ATH) from December 2018 to April 2019. Patients admitted at the dialysis unit of ATH with the diagnosis of CRF were included. Data was analysed using SPSS version 20.0. RESULTS: Out of 152 CRF patients 99 (65.1%) were males. Majority of patient with CKD were on dialysis for more than 10 months. Out of 152 patients of CRF, 32 (21.1%) were diabetic. Hypertension was previously diagnosed in 148 (97.4.%). CONCLUSION: Hypertension was identified as major cause leading to CRF and subsequently dialysis.

Association Of Different Risk Factors In Prevalence Of Cerebral Infaraction.

BACKGROUND: Cerebral infraction is one of the important causes of cerebrovascular accident. This study was conducted to see which risk factors are more prevalent in cerebral infraction. METHODS: It is a hospital based descriptive study of 130 patients of different types of strokes. Results: Out of 130 patients 70 were male and 60 females. Majority (58%) of the patients were between 41-60 years of age. Patient presented with variable risk factors. The majority (60% male and 73% female) were hypertensive. The percentage of other factors including diabetes mellitus, atrial fibrillation, smoking, high serum cholesterol, obesity and carotid artery stenosis was observed. RESULTS: Five program directors (83.3%) and 195 interns (82.9%) responded to the questionnaires. Implant dentistry was taught to the undergraduate students in multidisciplinary departments with teaching hours ranging from 22-30 hours. Only three schools exposed students to laboratory (workshop) or clinical training. There was agreement among the program directors in respect of the didactic contents. Majority of the interns reportedly acquired knowledge regarding implant dentistry based on theoretical (96.1%), laboratory (33.5%) and/or clinical (30%) training. While 50% of the interns agreed to acquire knowledge by assisting and observing dental implant procedures, only 52.8% of the interns expressed satisfaction regarding implant dentistry training obtained during their undergraduate period. CONCLUSIONS: Cerebral infraction is the most common cause of stroke in our community and all the other factors that are included in our study showed their association in occurrence of cerebral infraction.

Smoking Cessation After Counselling In Patients Presenting With Acute Coronary Syndrome.

BACKGROUND: The long-term cardiovascular health risks associated with cigarette smoking are well established. It is a major risk factor for all manifestations of coronary artery disease, stroke, and peripheral vascular disease. Patients with acute coronary syndrome, who quit smoking, reduce their risk of cardiovascular events immediately and significantly when compared to those who continue smoking. The study was conducted to determine the frequency of smoking cessation after counselling in patients presenting with acute coronary syndrome (ACS). METHODS: Patients of age 35-80 years of either gender presenting with Acute coronary syndrome presented in emergency within 12 hours of symptoms having history of smoking (>1pack year for >5 years) were included in the study. A total 225 patients were enrolled in the study from emergency of Punjab institute of cardiology, Lahore for the duration of six months. Informed consent was obtained from all patients. Their demographic information was also noted. Then patients under went counselling session with researcher himself in presence of psychiatrist from Department of Psychiatry, Services hospital, Lahore. After admitting patients in ward, patients received standard in-hospital treatment for smoking cessation which consisted of an assessment of their smoking behaviour and a personalized brief quit advice. Then patients were followed-up for 12 weeks. On weekly visit, patients were counselled for smoking cessation. After 12 weeks, patients were assessed for cessation of smoking. RESULTS: Smoking cessation was seen in only 37 (16.4%) in ACS patients. Highest frequency of smoking cessation was seen in patients >65 years of age, i.e., 35.1%. Highest frequency for smoking cessation was seen in patients whose BMI was <30 (70.3%), patients with low socioeconomic status (45.9%) and patients with educational status as under matric (40.5%). None of these factors were significantly associated with smoking cessation in patients who presented with ACS. CONCLUSIONS: Results of this study demonstrate low frequency of smoking cessation among patients presenting with ACS. However, there is a strong need to identify those factors that were associated with failure to reduce smoking.

Seroprevalence Of Brucellosis Among Patients Presenting With Non - Specific Symptoms At Ayub Teaching Hospital Abbottabad.

BACKGROUND: Brucellosis is one of the prevalent zoonotic diseases worldwide. It not only adds to the global burden of disease but also has huge economic impact. Clinical features of human brucellosis are usually vague. This study was carried out to find out the frequency of brucellosis among patients presenting with nonspecific symptoms in hospital setting and to find out risk factors. METHODS: Study was carried out in outpatient Medicine Department of Ayub Teaching Hospital Abbottabad for the period of 3 months. Patients presenting with nonspecific symptoms of fever, body aches, myalgias, arthralgia, headache, backache, malaise and insomnia of either gender between the ages of 18-60 years were included in the study through consecutive sampling technique. Blood Samples from patients were sent for screening Brucella antibodies by serum agglutination method. Antibodies were checked for both Brucella abortus and mellitensis. RESULTS: total 70 patients were recruited in the study. Out of these 49 (70%) were found positive for Brucella. These positive Brucella patients were mostly 42 (85.71%) female and majority 35 (71.4%) were in the age group of 21-40 years. In both male and female patients' majority were positive for both species of Brucella. Nonspecific symptoms included Aches, Pains and Myalgia in all the patients with additional symptoms of Malaise in 13 (18.6%), headache 10 (14.3%) and insomnia and fever in 9 (12.9%) each. Majority of the enrolled patients 53 (75.71) gave negative history of using boiled/pasteurized milk in their daily consumption while 17 (24.3%) patients suggested use of boiled/pasteurized milk. CONCLUSIONS: A high frequency of human brucellosis was found among patients presenting with nonspecific symptoms, therefore it is recommended that such patients should be screened for brucellosis.

Association Of Tricuspid Regurgitation And Severity Of Mitral Stenosis In Patients With Rheumatic Heart Disease.

BACKGROUND: Rheumatic heart disease is a common ailment in Pakistan and Mitral stenosis is its flag bearer Severity of mitral stenosis is the key factor in deciding for mitral valve surgery. METHODS: This case series study was conducted at Ayub Teaching Hospital .Cases of Rheumatic heart disease with mitral stenosis were diagnosed clinically. 2D echocardiography was used to find severity of mitral stenosis. Data was entered into SPSS-17.0 and results were recorded and analysed. Pearson's two tailed correlation was used to find the correlation between presence of tricuspid regurgitation in patients with severe mitral stenosis, p was <0.05. RESULTS: A total 35 patients with pure mitral stenosis were included in study, out of which 8 were male and 27 were females. Mean age in males was 34.5±15.85 years while in females it was 31±8 years. Twenty-two out of 35 (62.86%) patients had tricuspid regurgitation while 13 out 35 (37.14%) had no tricuspid regurgitation. Mean (MVA) mitral valve area in patients with tricuspid regurgitation was 0.84±0.3 cm2 while mean (MVA) mitral valve area in patients without tricuspid regurgitation was 1.83±0.7 cm2. Mean left atrial (L.A) size was 45.23±1.5 mm2 in patients with tricuspid regurgitation, while it was 44.13±6.14 mm2 in patients without tricuspid regurgitation. Mean RSVP was 57.5mmHg in patients with tricuspid regurgitation while RSVP could not be calculated in patients without tricuspid regurgitation. CONCLUSIONS: It was concluded that tricuspid regurgitation was strongly associated with severe mitral stenosis as almost all patients with severe mitral stenosis had tricuspid regurgitation and none of the patients with mild mitral stenosis had tricuspid regurgitation.

Frequency of seropositivity of Helicobacter pylori in patients presenting with dyspepsia.

BACKGROUND: Dyspepsia is a common health problem and most of the causes of dyspepsia are related to infection by Helicobacter pylori (H. pylori). Prevalence of H. pylori infection is different in different parts of the world. Purpose of our study was to determine the frequency of H. pylori infection in patients with dyspepsia in our setting where the prevalence of H. pylori was expected to be high. Objective of this study was to determine the frequency of H. pylori seropositivity in patients with dyspepsia. METHODS: A Cross sectional, descriptive study was conducted at the Department of Medicine, Ayub Medical College, Abbottabad from March to September 2009. Patients presenting in Medical outpatient departments of Ayub Teaching Hospital, Abbottabad with dyspepsia were included in the study and interviewed according to Reflux Disease Questionnaire and their serum sent for estimation of anti H. pylori IgG antibodies by enzyme linked immunosorbent assay (ELISA). RESULTS: A total of 92 patients were included in this study. Out of these 31 (33.7%) were males and 61 (66.3%) were females. Out of them 68 (73.9%) were found seropositive for H. pylori by ELISA. CONCLUSION: H. pylori infection is frequent in patients with dyspepsia in our setting and apparently uncomplicated dyspepsia should always be tested for H. pylori and all seropositive patients should be offered eradication therapy.

Postnatal encephalitis: a diagnosis not to be missed.

BACKGROUND: Viral encephalitis is a common condition but only a few studies are available on occurrence of viral encephalitis in postnatal women. The objective of this study was to determine the frequency of postnatal encephalitis among patients presenting with cerebral neurological complications during puerperium and to determine a response to 10 day course of acyclovir therapy and final outcome of the patients. METHODS: This cross-sectional descriptive study was conducted at Department of Medicine, Unit A, Ayub Teaching Hospital, Abbottabad from Jan to Dec 2011. All patients presenting with encephalitis in their postnatal period were enrolled. Eclampsia patients were excluded from study. The diagnosis of encephalitis was made on clinical assessment, CSF routine examination, CT scan and MRI. RESULTS: Among patients 16 (84.2%) presented with fever, 13 (68.42%) with headache, 8 (42.1%) with meningeal irritation, 7 (36.84%) with hemiparesis, 18 (94.7%) with altered sensorium, 13 (68.42%) with seizures, and 7 (36.84%) with coma. Cerebrospinal fluid of 16 (84.21%) patient had the changes consistent with viral encephalitis. It was normal in 2 (10.52%) patients and showed picture of pyogenic meningitis in 1 (5.26%) cases. On CT scan of brain, 3 (15.78%) had normal scans, 3 (15.78%) had cerebral oedema, 4 (21.05%) had ischemic infarct, 3 (15.78%) had meningo-encephalitis, 2 (10.52%) had infarct plus cerebral oedema, 1 (5.26%) had encephalitis and 3 (15.78%) had infarct plus haemorrhage. On MRI brain 15 out of 17 (88.2%) had lesions consistent with encephalitis. All 19 (100%) patients were treated with 10 days course of acyclovir and a broad spectrum third generation antibiotic. After hospitalisation 11 (57.8%) patients were discharged with complete recovery, 5 (26.31%) were discharged with partial recovery and 3 (15.78%) patients expired. CONCLUSION: Clinical presentation of the patient is most important in diagnosing viral encephalitis in postnatal women especially when patient presents with fever, altered sensorium and convulsions. Acyclovir therapy should be started without delay while awaiting other investigations.

Presentations of tuberculosis in northern Pakistan.

BACKGROUND: Tuberculosis (TB), which is a very common droplet infection. If untreated, the disease may be fatal within 5 years in more than half of cases. The aim of this hospital based descriptive study was to see mode of its presentation in our set-up. METHOD: The study was conducted in Medical Unit, Ayub Teaching Hospital, Abbottabad and 500 diagnosed cases of tuberculosis were included in this study. History regarding presenting symptoms, age, sex, etc. was taken. RESULTS: Out of the 500 patients, 277 (55.4%) were male and 223 (44.6%) were female. Two-hundred-three (40.5%) were in age group 21-35 years, 136 (27.1%) were in age group 36-50 years, 141 (28.1%) were in age group 51-65 years while 20 (4%) were above 65 years of age. Three-hundred-and-eighty (76%) presented as Pulmonary TB, 47 (9.4%) as Abdominal TB, 45 (9%) as TB Meningitis, 13 (2.6%) as Pott's Disease. 7 (1.4%) as TB Lymphadenitis, 6 (1.2%) as Constrictive Pericarditis, 1 (0.2%) as Psoas Abscess and 1 (0.2%) as TB Orchitis. CONCLUSION: TB in its various forms remains a killer disease in our part of the world. The commonest presentation is Pulmonary TB which is probably due to three major factors namely poor hygienic practices, late diagnosis and non-compliance.