Frequency and comparative analysis of hapatitis D in petients seeking treatment for hepatitis B.

OBJECTIVE: To find the frequency of hepatitis 'D' in patients of hepatitis 'B' seeking treatment and to compare clinical and biochemical features in patients harboring HDV with those who are not. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Medical Unit-IV, Civil Hospital Karachi, Medical Unit-VI and Surgical Unit-VII, Lyari General Hospital, Dow University of Health Sciences, Karachi; from July 2003 to June 2005. PATIENTS AND METHODS: HBsAg positive patients seeking treatment were enrolled in the study. Anti-HDV was done in all. Patients were split into two groups according to their anti-HDV status into HDV positive and HDV negative groups. Liver biochemistries and viral profile for HCV, anti-HBc IgM and HBeAg were done and compared between the two groups. RESULTS: A total of 246 patients were selected. HDV was positive in 66 (26.8%) patients. No significant difference was observed in the frequency and stages of cirrhosis between the two groups while significant differences were observed in the mean SGPT (95% CI: -381.09 to -110.74; P = 0.001) and albumin levels (95% CI: 1.87 to 7.73; P = 0.007) and in the frequency of HBeAg (P = 0.001), anti-HBc IgM (P = 0.02) and HBV DNA (P<0.001). CONCLUSION: HDV infection was common in patients with HBV in this cohort of patients. All patients of HBV should be screened for HDV before treatment decision for the former is taken.

Correlation between clinical endoscopic and histological findings at esophago-gastric junction in patients of gastroesophageal reflux disease.

OBJECTIVE: To determine the correlation between the clinical, endoscopic and histological findings in patients of GERD. DESIGN: An observational, cross-sectional study. PLACE AND DURATION OF STUDY: Lyari General Hospital, Dow University of Health Sciences from November 2003 to October 2004. PATIENTS AND METHODS: Patients complaining of heartburn and/or acid regurgitation at least twice per week for at least 3 months were inducted in the study. Presence of clinical symptoms of epigastric pain, retrosternal burning, and reflux were recorded. Patients were subjected to esophagogastroduodenoscopy and four biopsies were taken from esophago-gastric junction. Correlation/regression analysis was done on clinical, endoscopic and histological findings. RESULTS: A total of 196 patients were selected and endoscopically examined. Most common grade given by patients to epigastic pain was grade-4 (42.9%), retrosternal burning as grade-4 (41.8%) and reflux grade-5 (36.7%). There was significant correlation between the clinical severity of epigastric pain with endoscopic findings (p = 0.002) and reflux (p = 0.0) but no correlation was observed with histological findings (p = 0.19). Out of 109 (55.6%) patients who had normal mucosa on endoscopy but on histology 70 (35.7%) of them had inflammation. Grading of endoscopic and histological findings showed significant correlation with each other (p = 0.0). CONCLUSION: Endoscopic negative GERD is common; severity of clinical symptoms does not correlate [corrected] with endoscopic findings while histopathological findings correlate with those of endoscopic findings [corrected]

Retinoblastoma in Karachi, Pakistan.

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1(st)January 1998 to 31(st) December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, 34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years (95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents'and children'emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation for surviving retinoblastoma patients.