Journal of Islamabad Medical & Dental College
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Hepatocellular Carcinoma in Patients Suffering from Chronic Hepatitis B versus Co-Infection of Hepatitis B and D Virus
Get PDFObjective: To determine the frequency of hepatic cancer in subjects suffering from chronic liver disease due to hepatitis B versus hepatitis B with co-infection of viral hepatitis D. Patients and Methods: This cross-sectional study was carried out in the Department of Medicine (Hepatology & Gastroenterology) at Isra University Hospital, Hyderabad Sindh, from March 2015 to February 2016. Both male and female patients, from 20-70 years of age either suffering from viral Hepatitis B alone or co-infected with viral hepatitis D were included in our research. Individuals having co-infection of Human Immunodeficiency virus, Viral hepatitis C, Wilson's disease, Hepatitis due to auto-immune diseases, alcoholic fatty liver disease, haemochromatosis, pregnant women and those patients who refused to give consent were excluded from study. Results: Out of total 200 patients, 142(71%) were males while 58(29) were females. Mean age was 52.83+15.6 years. Total 173(86.5%) patients were suffering from viral hepatitis B alone, while 27(13.5%) were infected by co-infection of Viral hepatitis B and D. Total frequency of hepatocellular carcinoma was 45(22.5%) in all cases. HCC was more frequent (33.34%) in patients with co-infection of chronic hepatitis B and D, as compared to only chronic hepatitis B patients (20.80%) but the difference was non-significant (p-value 0.14). Conclusion: Hepatocellular carcinoma was more frequent amongst patients co-infected with viral hepatitis D as compared to alone infection of hepatitis B virus. 
Knowledge and Awareness about Genetic Problems Associated with Consanguineous Marriages among Non-Medical Students of Islamabad
Get PDFObjective: To access the level of knowledge of non-medical students about genetic problems related to consanguinity. Methodology: A descriptive study was conducted from September 2015 to June 2016 to collect information regarding acquaintance and perceptions about, consanguineous marriages among students of different colleges and universities of Federal Capital. Specially designed performa was used to collect data. The collected data was analyzed by using Statistical Package for Social Sciences (SPSS) software version 16.0. Demographic characteristics of participants were calculated as Mean±SD. Chi-square test was applied to check the level of significance among different categorical variables. Results: A total of 424 students were surveyed, out of which 155 (36.6%) were male and 269 (63.4%) were female. The mean age of the study population was 20.39 ±2.44. The data analysis showed only 9.7% of students are fully aware of the problems associated with consanguinity. Girls were found to be more aware as compared to boys (p= 0.05) and among all ethnic groups, Punjabis were found to be more aware (16.9%). In subjects with a history of parental consanguinity and consanguinity in siblings, low level of awareness (8.8% and 8.5% respectively) was found. Conclusion: Efforts should be made to increase the knowledge about consanguinity and its association with genetic diseases among non-medical students. 
Management of Thalassemia in Pakistan
Get PDFBeta Thalassemia is the most common genetic disorder. The disorder is prevalent worldwide. About 3% of the world’s population carries the genes for Beta Thalassemia and it is estimated that every year about 60000 thalassemic babies are born all over the world.1 Approximately 79% of affected births are in the Asian population. Carrier rate in Pakistan ranges between 5-8%, and around 5000 children are diagnosed each year with beta thalassemia in Pakistan.2 Consanguinity is the main factor leading to high prevalence in Pakistan. There are 25,000 children registered with thalassemia federation of Pakistan however the actual figure is much higher which may be around one lac, as a lot many are living in villages that are not registered with any thalassemia cente
The Rising Global Burden of Hemoglobinopathies, A Challenge and an Opportunity for Health Care in Pakistan
Get PDFSevere hemoglobinopathies, namely thalassemia major and sickle cell disease, are the most frequent lifethreatening non-communicable disease of children globally: A minimum estimate of 300.000 newborns yearly have some symptomatic globin disorder, these births occur largely in low- and middle-income countries (LMICs) where prevention and management programs are often lacking or insufficient1,2. Hematopoietic stem cell transplantation, also known as blood or marrow transplantation (BMT), is the only established curative modality with success rates over 85% in low risk children with a compatible sibling3–5, moreover, BMT can normalize long-term health-related quality of life (HRQoL)6,7 and be highly cost effective8,9. However, there is a dire shortage of BMT centers in hemoglobinopathy-prone regions10 which often fall in the low- and middle-income country (LMIC) strata, so that many families have to migrate to affluent countries seeking cure for their beloved ones; this not only aggravates misery, psychological and economical burden but perpetuates the hemorrhage of professional and financial resources to high-income countries (HIC)
Limb Defects in Developing Chick Embryos after Administration of Glucose
Get PDFObjective: To assess the role of administered glucose on gross development of limbs of the chick embryos, in comparison with age matched controls. Materials and Methods: Fertilized eggs of Egyptian Fayyumi breed were injected with glucose (5% weight/volume solution) into egg albumen. The eggs were put in the incubator under standard conditions of temperature and humidity. Eggs were divided in two groups, control (A) and experimental (B). Each group is subdivided in two subgroups comprising of 30 eggs each. Eggs were opened on day 10 of incubation in subgroup (A1, B1) while eggs from subgroup (A2, B2) were allowed to hatch on day 21 or day 22 of incubation. The exposed embryos were compared with age matched control subgroups. Effects of glucose were assessed by observing limb defects in the embryos from two groups. Results: The experimental animals had limb defects manifested as absent, one hind limb in 5 out of 53 (9.433%). Both hind limbs were absent in 6/53 (11.32%). In turned phalanges with inability to stand and limping gait was found in 8/53 (13.79%). No embryo of the control group demonstrated such findings. Conclusion: Administration of glucose resulted malformation such as limb defects and turned digits in growing chick embryos. 
Efficacy of the Epidural Blood Patch for the Treatment of Post Epidural Puncture Headache
Get PDFObjective: To evaluate the efficacy of the epidural blood patch for the treatment of post-Dural puncture headache (PDPH). Patients and Methods: This cross sectional study was conducted in the Department of Anesthesia and Intensive care, Nishtar Hospital Multan. Out of total 326 patients, 186 were male 140 were female. Patients having age 16 years and above, presented with PDPH started from previous 24 hours up to last six days were included in the study. Efficacy of treatment was measured on patients comment about relief from pain after PDPH. Chi-Square along with Fisher exact test was used to see effect modification. Results: Overall, there were 326 (100%) patients in this study, among them 57% (n=186) were males and 43% (n=140) were females. ASA-1 and ASA-2 noted as 73.3% and 26.7% respectively. The main outcome of this study was efficacy of treatment. It was observed that after 1st patch, efficacy was noted as good in 75.8% (n=247) patients, while after 2nd patch it was good in 97.5% (n=318) patients. There was significant difference between the efficacy of 1st and 2nd patch. (P value=0.000), according to Fisher exact test. Conclusion"Results of our study concluded that epidural blood patch (EDBP) is the better choice for treatment of epidural puncture headache (EDPH). If one time it is incompletely effective its 2nd patch can be considered
Role of Modified CT Severity Index in Assessment of Acute Pancreatitis at Tertiary Care Hospital
Get PDFObjective: To evaluate the diagnostic role of Modified CT Severity Index (MCTSI) in terms of severity of disease process and its complication in correlation to APACHE II score.Patients and Methods: This cross-sectional study was conducted in CT & MRI Centre, Dow University of Health Sciences/ Dr. Ruth K. M. Pfau Civil Hospital Karachi, from 1st July to 31st December 2017. This study includes 93 patients with clinical features of acute pancreatitis referred to our department for contrast enhanced CT of abdomen within 24 hours of presentation. Patients were selected according to the study criterion. The pancreatitis was classified into mild, moderate and severe disease in term of severity by modified CT severity index. APACHE II score was calculated within 24 hours of admission. Clinical outcome parameters in terms of any intervention, systemic infection, organ failure and mortality were also collected. Results: Mean age of the patients was 39.82 + 12.04 years in the range of 20-70 years. Majority of patients were categorized as moderate pancreatitis (45.16%) according to Modified CT severity index followed by severe pancreatitis in 36 (38.71%) patients and mild pancreatitis in 15 (16.13%). Raised APACHE II score was observed in patients of severe pancreatitis. The clinical outcome parameters in terms of need of intervention, development of infection, organ failure and death rates, were also increased in patients with higher MCTSI.Conclusion: Contrast enhanced CT had an excellent diagnostic value to assess the disease extent and to grade its severity. Modified CTSI is a simplified and powerful tool with good sensitivity and specificity to assess the severe acute pancreatitis in correlation to APACHE II
Frequency of Hepatitis C Virus Infection and Estimation of Serum Alanine Aminotransferase in HCV Positive Patients
Get PDFBackground: Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Hepatitis C is rapidly emerging as a major health problem in developing countries including Pakistan. Serum Alanine Aminotransferase (ALT) is the most frequently utilized screening test in routine evaluation of liver damage. This study was conducted to determine the seroprevalence of hepatitis C virus infection and its association with serum alanine aminotransferase.
Objective: Determination of the seroprevalence of hepatitis C virus infection and its association with serum alanine aminotransferase in patients at social security hospital, Islamabad.
Material and Methods: A cross sectional study was conducted at clinical laboratory of social security hospital Islamabad, from May 2009 to October 2009. All samples referred to social security hospital for hepatitis profile were included in the study. All patients were screened serologically for hepatitis C virus antibodies and serum alanine aminotransferase was determined in selected HCV positive patients only.
Results: Out of 1006 blood samples 146 were positive for anti-HCV antibodies with an overall positivity of 14.5%. Out of these 55% cases were males and 45% were females. Seroprevalence of HCV was found to be 8% in the age group of <20 years, and almost equal i.e. 46% and 49% in 20-40 years and >40 years age groups respectively. Serum ALT was determined in total 83 patients only: they showed levels less than 30U/L in 25% patients, 30-45U/L in 15% patients, 46-60U/L in 19% patients, 61-100U/L in 29% patients and more than 100U/L in 12% patients.
Conclusion: The present study revealed that prevalence of HCV was 14.5% and ALT levels were found to be more than 45U/L in 75% of the anti HCV positive cases, showing the significance of this biochemical marker as diagnostic tool in such patients
Diabetes Mellitus and its Laboratory Diagnosis
Get PDFDiabetes mellitus is a group of metabolic disorder characterized by hyperglycemia either due to deficiency of insulin production or resistance of organs to the effect of normal amount of insulin or both.1 In healthy individuals after taking meals, according to the blood glucose concentration appropriate amount of insulin is produced by the pancreas and this insulin transports glucose from blood into the cells. In diabetic individual, either little or no insulin is produced by the pancreas, or the cells do not give appropriate response to the produced insulin. This insulin dysfunction leads to decreased synthesis and increased degradation of glycogen, protein and fat in the body, ultimately causing hyperglycemia and overflow of glucose into urine.2 Characteristic symptoms of diabetes are thirst, polyuria, weight loss and blurring of vision. Most severe form is characterized by ketoacidosis or non ketotic hyperosmolar coma, ultimately leading to stupor, coma and death. Chronic hyperglycemia develops pathological and functional changes characterized by retinopathy, nephropathy and neuropathy. Risk of cardiovascular, peripheral vascular and cerebrovascular diseases is also common in chronic state.3 Diabete
Use of Ondansetron for Prevention of Spinal Induced Hypotension
Get PDFObjective: To compare the efficacy of prophylactic administration of Ondansetron before induction of spinal anesthesia with placebo, in preventing spinal induced hypotension. Patients and Methods: This Randomized Control trial was carried out at Holy Family Hospital, Rawalpindi from 29 April 2015 till 28 October 2015. A total of 106 patients were enrolled in the study. Patients in group A, received 6 mg Ondansetron. Patients in group B received normal saline. Mean arterial pressure (MAP) and heart rate (HR) were recorded every 5 minutes after performing spinal anesthesia. The study drug was considered efficacious if absence of hypotension for 20 minutes was recorded after inducing spinal anaesthesia. Data was analyzed using SPSS 17. Results: Hypotension occurred in 7.5% cases in Ondansetron group compared to 28.3% in normal saline group (p=0.005). Conclusion: Ondansetron is effective in preventing spinal induced hypotension.