[en] The hepatitis D virus super-infection contributes significantly to the morbidity and mortality of hepatitis B virus infection. The objectives were to describe the incidence of Hepatitis D virus and comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without super-infection of hepatitis D virus. This Cross-sectional comparative study was conducted at Department of Medicine and Gastroenterology Clinic Jinnah Postgraduate Medical Centre, Karachi, Pakistan from February 2007 to July 2007. HBsAg positive patients who attended our Gastroenterology clinic were selected for the study. After screening for Anti-HDV these patients were segregated in to Anti-HDV positive and negative groups. Data was analyzed on SPSS 12. Eighty-four patients were selected. Seventy-three patients who fulfilled the inclusion criteria were enrolled in to the study. Anti-HDV was positive in 23 (31.5%) patients. Among these 23 anti-HDV positive, HDV-RNA was detected in 15 (75%) patients. The differences of age, gender, marital status and area of residence whether rural or urban were not significant between the two groups. HBV-DNA was significantly suppressed in majority of anti- HDV positive patients (p=0.019). Mean serum ALT levels were significantly higher in patients who had HDV infection (p=0.014). HDV infection was common in this series of patients with a frequency of 31.5%. All patients of chronic HBV should be screened for HDV whether they are asymptomatic HBV carriers or have chronic active hepatitis particularly when they have raised serum ALT. (author)

[en] Tuberculosis, being an infectious disease, carries a risk of infection to contacts attending tuberculous patients. This study was conducted to evaluate the risk for household contacts of tuberculous patients as compared to non-contacts. The study was conducted at PGMI, Gulab Devi Hospital and Defence Housing Authority Lahore. The study included 120 household contacts and 80 non-contacts. A Cross sectional study for evaluation of antituberculous antibodies levels by ELISA method in two groups; Mantoux positive household contacts 49, Mantoux negative household contacts 71 and normal healthy persons non contacts 80. Routine Haematological investigations like HB, TLC and ESR were done by conventional methods and all the sera of 200 subjects included in the study were tested for IgM, IgG and IgA anti tuberculous antibodies by enzyme linked immunosorbant assay (ELISA). Purified protein derivative 0.1 ml containing 5 TU was injected intradermally. The test was read after 72 hours by measuring the induration around injection site of forearm. There was no difference in the average age of the household contacts and non-contacts. The complaints of pyrexia, night sweats and weight loss were more in house hold contacts as compared to non-contacts. The awareness about BCG vaccination was equal in both. There were 49 contacts with positive Mantoux test while negative Mantoux test was found in 71 contacts. There were only three Mantoux positive among eighty non-contacts. There was no significant difference in the presence of IgM among household contacts as compared to non-contacts. However both IgG and IgA were present in significantly higher number of household contacts compared to non-contacts, household contacts of patients suffering from active pulmonary tuberculosis have more chances of being infected with Mycobacterium tuberculosis as compared to the healthy non-contact, as shown by the higher levels of antituberculous antibodies and positivity of Mantoux test. (author)

[en] Chronic hepatitis has become a major health problem all over the world especially in the third world countries. The most common cause of chronic hepatitis in Pakistan is hepatitis C which can lead to liver cirrhosis and hepatocellular carcinoma. In Pakistan Pegylated Interferon Alpha is still corner stone of therapy for chronic hepatitis C. One of the major side effect of this therapy is the development of thyroid dysfunction, i.e., hypothyroidism and hyperthyroidism. This study was done to assess the frequency of hypothyroidism in hepatitis C patients after three months of pegylated interferon therapy. Method: This study was conducted from 1st October 2013 to 31st march 2014 at outpatients department (OPD) of Gastroenterology and Hepatology, Lahore General Hospital Lahore. Descriptive case series study design was used. The sample of 200 patients was taken from the patients who visited OPD and fulfil the inclusion criteria of the study. Serum thyroid stimulating hormone level (TSH) was done before and after completion of three months therapy at centre for Nuclear Medicine (CENUM) laboratory, Mayo Hospital, Lahore by immune-radiometric assay (IRMA) and patients having TSH>4.0 mIU/L (normal range: 0.2-4.0 mIU/L) were considered hypothyroid. Results: The mean age of the patients was 36.29+-8.5 years. One hundred and twenty-three (61.5 percent) were male and 77 (38.5 percent) were female. After 3 months of interferon therapy, 163 (81.5 percent) patients were euthyroid and 37(18.5 percent) patients were having thyroid dysfunction. There were total 29 (14.5 percent) hypothyroid patients; 8 (27.6 percent) were male and 21 (72.4 percent) female. Conclusion: It is concluded from this study that frequency of hypothyroidism in patients with chronic hepatitis C was 14.5 percent after treatment with pegylated interferon therapy for 3 months. Female patients were more prone to develop hypothyroidism as compared to male patients. (author)

[en] Firearm injuries cause significant morbidity and mortality among its victims. The present study, carried out at a major tertiary care hospital of Peshawar, Pakistan was aimed at highlighting the extent and severity of firearm-related morbidity and resultant mortality despite expert medical care. All victims of firearm injury brought to the Lady Reading Hospital Peshawar Emergency Department and thereafter admitted to hospital wards during the period mid-2006 to mid- 2007 were included in the study prospectively regardless of age, gender or socio-economic status. Data relevant to the background of firearm use, type of firearm used, types and extents of injuries, clinical condition of the patients and final outcome were collected on performas and entered into SPSS 15.0 for analysis. Seventy-four cases of firearm injury were recorded during the study period, with a predominant male to female ratio (9.6:1). Most victims (79.7%) were in the age group of 15-35 years. Although there were more cases from Peshawar (28.4%), there was no major referral pattern noted. High velocity weapons were used in 95.9% of cases and homicide was the main motive for injury (60.8%). Injuries were sustained most frequently in the abdomen and pelvis (44.6%) and 67.6% of victims sustained internal injuries. There were only 5 (6.8%) deaths from firearm injuries. It is concluded, the young males of the population must be targeted for lifestyle adjustments such as training to refrain from anger or disputes (usually over petty things) and to prevent the easy access of firearms as a weapon to settle disputes. (author)

[en] Diseases caused by Hepatitis B virus (HBV) have a worldwide distribution. Pakistan adopted the recommendations of World Health Organization (WHO) for routine universal infant vaccination against hepatitis B in 2002, currently being administered at 6, 10, and 14 weeks of age in a combination vaccine. This study was conducted to determine the immune response and anamnestic immune response in children, 9 months-10 years of age, after a 3-dose primary Hepatitis B vaccination. Methods: This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from January to June, 2014. A total of 200 children of either sex between the ages of 9 months to 10 years, docu mented to have received 3 doses of hepatitis B vaccines according to Expanded Program of Immunization (6,10,14 weeks) schedule in infancy, were recruited by consecutive sampling. The level of serum anti-HBsAb by ELIZA was measured. Children with anti-HBs titers =10 mIU/mL were considered to be immune. Those with anti-HBsAb levels <10 mIU/mL were offered a booster dose of infant recombinant hepatitis B vaccine. The second serum sample was obtained 21-28 days following the administration of the booster dose and the anamnestic immune response was measured. Data was analysed using SPSS 17 to determine the relation between time interval since last vaccination and antibody titer. Chi square test was applied. Results: Of the 200 children, protective antibody response was found in 58 percent. Median serological response was 18.60 (range 2.82-65.15). Antibody levels were found to have a statistically significant (p-value 0.019) negative correlation with the time since last administration of vaccine. A booster dose of Hepatitis B vaccine was administered to all non-responders, with each registering a statistically significant (p-value 0.00) anamnestic response. Conclusion: The vaccination schedule with short dosage interval was unable to provide protection to 42 percent of the study population. Introduction of birth dose of Hepatitis B vaccine to the existing schedule is recommended. (author)

[en] Vanadyl sulphate is available as herbal medicine against diabetes mellitus and body building supplement, over the counter worldwide. The available data on its safety is controversial and inadequate. The objective of this study was to analyse its safety in usual therapeutic dose range. Methods: It was an experimental study carried out at the Department of Biochemistry and Molecular Biology, Army Medical College, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from Jun 2014 to Oct 2018. The study was carried out on 105 Sprague Dawley rats for duration of 24 weeks. The animals were randomly distributed in three groups of 35 each. The group I rats were marked as control while rats of group II and III were administered vanadyl sulphate 0.06mg/day and 0.3mg/day respectively. Alanine amino transferase (ALT) and Malondialdehyde (MDA) were measured in serum while comet assay was performed on WBCs. Results: The plasma levels of ALT and MDA were significantly raised in group II and III subjects. Single cell gel electrophoresis (SCGE) / comet assay showed minimal “tail moment” in control group and increased tail moment in group II and III in a dose dependent manner which indicates dsDNA breaks. Conclusion: It was observed that vanadyl sulphate causes hepatocellular toxicity, oxidative stress and damage to the DNA in usual therapeutic/ supplemental doses. Due to hazardous effects, its use in humans as alternate medicine may be reviewed. (author)

[en] Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period. This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients (19 males, 15 females) underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months. Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium (LA) (79%) followed by the right atrium (RA) (14%). Only one patient had myxoma in the right ventricle (RV). Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study. Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity. (author)

[en] The objective of this study was to determine the mortality rate in patients presenting with Necrotizing Fasciitis. This prospective study was conducted at ward 26, JPMC Karachi over a period of two years from March 2001 to Feb 2003. All patients above the age of 12 years diagnosed to be having Necrotizing Fasciitis and admitted through the Accident and emergency department were included in this study. After resuscitation, the patients underwent the emergency exploration and aggressive surgical debridement. Post-operatively, the patients were managed in isolated section of the ward. The patients requiring grafting were referred to plastic surgery unit. The patients were followed up in outpatients department for about two years. Over all, 25 male and 5 female patients fulfilled the inclusion criteria and were included in this study. The common clinical manifestations include redness, swelling, discharging abscess, pain, fever, skin necrosis and foul smelling discharge etc. The most common predisposing factor was Diabetes mellitus whereas the most commonly involved site was perineum. All patients underwent aggressive and extensive surgical debridements. The common additional procedures included Skin grafting, Secondary suturing, Cystostomy and Orchidectomy. Bacteroides and E. coli were the main micro-organisms isolated in this study. Bacteroides was the most common microorganism isolated among the eight patients who died. Necrotizing Fasciitis is a potentially life threatening emergency condition and carries the mortality rate of about 26.6%. The major contributing factors to increase the mortality missed initially diagnosed, old age, diabetes mellitus truncal involvement and late presentation. Anorectal involvement of disease carry worse prognosis. Hyperbaric oxygen therapy and proper use of unprocessed honey reduced the mortality rate. (author)

[en] Osteoporosis is a bone disorder, characterized by loss of bone mass density. Osteoporosis affects more than 30 percent of post-menopausal women. Osteoporosis is often associated with restricted body movement, pain and joint deformities. Early identification and early intervention can help in reducing these complications. The primary objective of this study was to estimate the burden of Osteoporosis in Urban setting of Sindh among women of different age groups and to access the effect of different protective measures that can reduce the risk of Osteoporosis. Method: In this study, 500 women's of 3 major cities of Sindh were approached by non-probability convenience sampling technique. Women bearing age 20 years or more were included. Women who fall under inclusion criteria were screened for BMD (Bone mineral density) test and were classified as Healthy, Osteopenic and Osteoporotic based on their T-score. The association of different protective measures and risk of osteoporosis was assessed by prevalence relative risk (PRR). Result: The result of this study indicate that the burden of Osteoporosis is very high among the women of Sindh, only 17.4 percent (84) women were found to have normal BMD score. The life style of majority of women was sedentary. The PRR calculated for Exposure to sunlight, regular exercise, and use of nutritional supplement was 12.5, 5.19 and 2.72 folds respectively. Conclusion: The results of study reveal that exposure to sunlight, regular physical exercise and use of nutritional supplements found to be effective in reducing the risk of osteoporosis among women of all age group. Health education and promotion toward osteoporosis prevention can significantly contribute in reducing the morbidity of osteoporosis. (author)

[en] Background: To evaluate the medium to long term cancer control, morbidity, mortality and functional outcome in men undergoing open radical retro pubic prostatectomy (RP) and pelvic lymph node dissection (PLND) for clinically localized adenocarcinoma prostate (CaP). Methods: A total of 200 patients were operated with intention to treat for localized CaP, from January 1998 to October 2013. Patients' characteristics, operative data, progression-free survival rate, recurrence rate, morbidity, mortality and functional outcome were analysed. Statistical analysis was performed using SPSS v.19. Kaplan Meir curves were plotted for survival estimate. Results: The mean age was 63.6+-6.2 years and median pre-operative PSA was 11+-2.1 ng/ml. RP and bilateral PLND were performed in 172 patients of which 35 (20 percent) had nerve-sparing surgery. In 8 cases with gross lymph node metastasis at frozen section, only bilateral orchiectomy was done while remaining 20 patients had RRP+PLND with bilateral orchiectomy. The final study population was therefore 192. Mean length of hospital stay was 6+-1 day with zero 30-day perioperative mortality. On final histopathology, 78 percent of tumours were confined to the prostate gland. Twenty four (12.5 percent) patients had positive surgical margins. Overall, 163 (85 percent) patients regained full continence. Nearly half of patients with nerve sparing approach were potent without any supportive measures. Most common long term complication was urethral stricture (8 percent). At median follow up of 41 months, the progression-free and overall survival rates were 85 percent and 94 percent, respectively. Seven percent had biochemical recurrence while 4 percent had local recurrence and 4 percent had metastatic disease. Conclusions: Our results indicate that RP has an excellent potential for cancer control with low morbidity and good functional outcome in men with localized CaP. Our data is consistent with larger series from other centres across the globe. (author)