Hepatitis B and C single and co-infection in chronic liver disease and their effect on the disease pattern

OBJECTIVE

To find the frequency of hepatitis B and C virus (HBV and HCV) infection and their coinfection in chronic liver disease and any differences in the clinical features of single and coinfections. METHODOLGY: All clinically recognisable adult CLD patients admitted to Military Hospital, Rawalpindi in years 1999-2000, were included in the study. Their history and clinical features were recorded. Seromarkers for HBV (HBsAg, anti-HBc) and HCV (anti-HCV) were done.

RESULTS

A total of 97 (52 male, 45 female) patients were included in the study. Mean age was 51.6 years (range 16-75 years). Cirrhosis was present in 74.2%, chronic hepatitis (Ch Hep) in 18.6% and hepatocellular carcinoma (HCC) in 7.2%. Among the 74.1% patients with cirrhosis 28.5% were HBsAg positive, 55.5% anti-HBc positive and 68.1% anti HCV positive. In the chronic hepatitis cases 27.8% were HBsAg positive, 23.6% anti-HBc positive and 61.1% anti HCV positive. Among the patients of HCC 59.7% were HBsAg positive, 71.4% anti-HBc positive and 42% anti HCV positive. Regarding coinfection 7.2% were anti-HCV and HBsAg positive while 35.1% were anti-HCV and anti-HBc positive.

CONCLUSION

Ninety percent of patients with CLD had evidence of HBV, HCV or coinfection. Disease was more severe in patients with coinfection. Anti-HBc was found to be a sensitive indicator of past HBV.

Mothers' fear of child death due to acute diarrhoea: a study in urban and rural communities in northern Punjab, Pakistan

The investigation of cultural models of diarrhoeal illness which are employed by mothers and their emotional responses to children's illnesses is presented in a study of 595 households in urban and rural communities in Punjab, Pakistan. The household survey of mothers of children 0-36 months was complemented with in-depth interviews of a subsample of 70 mothers. Findings indicate that diarrhoea must be regarded not only as a disease but as a symptom belonging to several popular illness categories. Mothers' emotional responses to symptoms are in part shaped by the illness categories to which they assign a child's diarrhoea episode, and maternal fears that symptoms of diarrhoea may be life threatening are associated with previous experiences with death of children, with treatment choices and help-seeking. A significantly higher proportion of mothers who fear diarrhoea to be life threatening to their children than mothers with other concerns choose to use NIMKOL, the Pakistan ORS. The necessity of recognizing the complexity of interpretive and emotional processes which shape the care of children and the home treatment of childhood disease is emphasized.

Hepatitis C as a cause of chronic liver disease in northern Pakistan

The antibodies to hepatitis C virus (HCV) were tested in 45 histologically confirmed cases of chronic liver disease. Twelve cases had chronic hepatitis, 24 cirrhosis and 9 hepatocellular carcinoma. Anti-HCV was detected in 6 patients. Two (16.67%) were suffering from chronic hepatitis, 3 (12.5%) had cirrhosis and one (11.11%) hepatocellular carcinoma. None of the anti-HCV positive cases had past history of blood transfusion. The patients of chronic liver disease in this study had a much higher prevalence of HBV infection which indicates that in northern Pakistan hepatitis C virus infection is not a common cause of chronic liver disease whereas HBV infection plays an aetiological role in a much larger number of these cases.

Feeding practices for young Pakistani children: usual diet and diet during diarrhoea

Diarrhoea is among the foremost disorders responsible for high mortality and morbidity in children of third world countries. In addition, improper feeding during diarrhoea leads to a vicious cycle of frequent episodes of diarrhoea and malnutrition in these children. In this study 595 households (200 urban and 395 rural) with 741 children who met the age criteria of 36 months or less were randomly selected for assessing the feeding practices during diarrhoea. Out of these, 276 (37%) were infants and 465 (63%) were toddlers. The majority of both breastfed and non breastfed children were also receiving solids and liquid foods. Animal milk was used by 89% of non-breastfed children. Forty six percent of breastfed and 78% of non-breastfed children were given "Khitchri" (rice cooked with lentils) as a solid diet. During diarrhoeal episodes, most mothers (70%) continued breast feeding their children. Whereas, 53% children also received solid and semi-solid diet which was either "Khitchri" or banana as mentioned by more than half of the respondents. The majority of mothers (97%) considered breast-feeding to be a good practice during childhood diarrhoea.

The use of ORS (Nimkol) in management of childhood diarrhoea by mothers in the suburbs of Rawalpindi-Islamabad

A total of 595 respondents (200 from urban Kachi-abadis and 395 from rural communities of Rawalpindi-Islamabad) were interviewed for their knowledge about the use of ORS (Nimkol) in childhood diarrhoea. Most of the respondents were mothers with low literacy rate (23%). The prevalence of current diarrhoea among children was 36.8% on the day of interview whereas 57% of the children had history of having suffered from an episode of diarrhoea during the past two weeks. About 75% respondents claimed that they had an experience of using ORS (Nimkol). Most of them (72.1%) had used ORS (Nimkol) for childhood diarrhoea and dehydration and 28% had used it for diseases other than childhood diarrhoea or on doctor's advice. Only 11% mothers of children who were currently suffering from diarrhoea were using ORS (Nimkol) and a few mothers mentioned of giving home made fluid remedies like salt-water, salt-sugar-water or lemon-sugar-salt water for childhood diarrhoea. The use of ORS (Nimkol) was more common among the families with higher income. Regarding the preparation of ORS (Nimkol) solution, 57.8% respondents had fairly accurate knowledge. Fifty percent of the respondents had procured ORS (Nimkol) from the hospitals or clinics.

Indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) and IgM capture ELISA for detection of antibodies to lipopolysaccharide in adult typhoid fever patients in Pakistan

Sera from 339 adult febrile patients in Pakistan were tested for antibodies to Salmonella typhi lipopolysaccharide by indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assay (ELISA) and IgM capture ELISA. A total of 55 patients had S. typhi cultured from their blood, 20 had S. typhi cultured from their stool, 24 were blood or stool culture positive for S. paratyphi A, 41 were culture negative but clinically diagnosed as having enteric fever, 41 had gastrointestinal or urinary tract infections, 41 were clinically diagnosed as having malaria, 20 were smear-positive patients with malaria, 58 had respiratory infections, and the remaining 39 individuals were placed in a miscellaneous group who did not have Salmonella infection. The sensitivities of the indirect IgG ELISA, indirect IgM ELISA, and IgM capture ELISA determined with specimens obtained from the blood culture-positive patients with typhoid fever (positive controls) were 80, 64, and 62%, respectively. The specificities of the assays determined with sera from the patients with respiratory infections (negative controls) were 95, 95, and 97%, respectively. The percentage of smear-positive patients with malaria who were positive by these assays was lower than that in the negative control group. The percentages of individuals in the other patient categories who were positive by these tests were between those obtained with the positive and negative controls. Of the positive controls, 26 were positive by both IgM assays, 9 were IgM positive only by indirect ELISA, and 8 were IgM positive only by IgM capture ELISA. A total of 70% of the positive control patients who were tested for O agglutinins by the Widal tube agglutination assay were positive; however, 29% of the negative control patients were also positive. The indirect IgG ELISA was the single most effective test for the serodiagnosis of typhoid fever in this population.

Effect of feeding BHC on the biochemical parameters of blood in rabbits

Studies were made by feeding 25 mg per kg body weight of BHC to rabbits daily for twelve weeks. BHC in the blood increased progressively without affecting blood pH. The levels of glucose, cholesterol, total proteins and creatinine increased while that of urea decreased in the blood of treated animals. The differences among the control and treated rabbits for these parameters were highly significant as every one microgram per ml accumulation of BHC in the blood, affected a corresponding increase of 1.82 mg/dl glucose, 2.618 mg/dl of cholesterol, 0.02 g/dl of total proteins and 0.13 mg/dl of creatinine, while a decrease of 0.105 mg/dl of urea was observed. The feeding of BHC, therefore, affected these vital biochemical parameters significantly.