Dyslipidemia is an Independent Predictor of Rapid Progressive Disease in Patientswith Chronic Liver Disease

Introduction: In chronic liver disease (CLD), the lipid profile biomarkers are altered because of decreased lipoprotein biosynthetic capacity. Objectives: To identify the association of dyslipidemia with various characteristics in chronic liver disease patients. Patients and meth­ods:  This cross-sectional study was conducted at the Department of Medicine, Civil Hospital, Karachi. The study was conducted between 1st July to 31st December 2017. A total of 211 adults with chronic liver disease were included in the study. Data regarding age, gender, body mass index (BMI), duration of CLD, family history of dyslipidemia, and severity of cirrhosis were obtained.  A 5ml fasting (12-14 hours) venous blood was collected and sent to the laboratory forthe measurement of lipid profiles. Dyslipidemia was established based the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) guidelines and definition.  Results: The mean age of the study patients was 43.16(8.63) years. The majority of the subjects were males (57.3%). The mean duration of CLD in years was 5.21(2.32). The prevalence of dyslipidemia was found to be 76.3%. Dyslipidemia was prevalent among patients of the age group > 45 years and male gender. Variables including age, gender, income, duration of CLD and family history of dyslipidemia showed significant association with dyslipidemia.  In the multivariable stage analysis, the only retained significant variables are gender and family history of dyslipidemia.  Conclusion: The prevalence of dyslipidemia among chronic liver disease patients was high. Various characteristics of the CLD patients were found to be significantly associated with dyslipidemia and identified as potential risk factors for its development.

Harmonic Scalpel versus Electrocautery: An Experience of Modified Radical Mastectomy at Tertiary Care Teaching Hospital

Background: The harmonic scalpel, commonly used in laparoscopic surgery, now has promise for MRM dissection. The harmonic scalpel's high frequency mechanical vibrations cut and coagulate intraoperatively at the same time, generating less heat injury than electrocautery. Objective: To compare the outcome of modified radical mastectomy using harmonic scalpel versus electrocautery at tertiary care teaching hospital. Methodology: The randomized controlled trial was conducted from 12th September 2018 11th March 2019 at Department of Surgery, Liaquat University of Medical and Health Science, Jamshoro. A total of 128 patients with infiltrating ductal carcinoma undergoing modified radical mastectomy, 20 to 50 years of age were included. Chronic Hepatitis, diabetes, and neo-adjuvant treatment patients were excluded. Modified radical mastectomy employing harmonic scalpel for Group A and electrocautery for Group B. Postoperative problems such as seroma development, postoperative hematoma, marginal necrosis, lymphedema, and wound infection were also observed. Results: The mean age of women in group A was 39.81 ± 6.73 years and in group B was 39.45 ± 6.60 years. Mean duration of disease was 5.41 ± 1.91 months. The frequency of seroma formation in harmonic scalpel group as 7.81% vs 26.56% in electrocautery group, p=0.005), frequency of pain is 53.13% vs 68.75% respectively, p=0.070, frequency of hematoma is 1.56% vs 17.19% respectively, p=0.002), frequency of marginal necrosis was 0.0% vs 7.81% respectively, p=0.023), lymphedema 3.13% vs 14.06% respectively, p=0.027) and wound infection 17.19% vs 35.94% respectively, p=0.016. Conclusion: This research indicated that harmonic scalpel is superior to electrocautery in modified radical mastectomy.

Frequency of Different Clinical Presentations of Systemic Lupus Erythematosus in Tertiary Care Hospital

Background: Systemic lupus erythematosus (SLE) is a multisystem, autoimmune, inflammatory disorder presenting with manifestations from various organ systems. Objective: To determine the frequency of clinical presentations in patients with systemic lupus erythematosus at tertiary care hospital Methodology: The cross-sectional study was conducted during 21st October 2018 to 20th April 2019 in the Department of Medicine Civil Hospital Karachi. Total 143 diagnosed patients were included. All patients were evaluated for the initial clinical manifestations including clinical investigations at presentation, Ocular, Mucocutaneous, Pulmonary, Cardiovascular, Gastrointestinal, Musculoskeletal, Hematological, Renal, Neuro Psychiatric, Gynaecological. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied. p value≤0.05 was taken as significant. Results: There were 18.9% male and 81.1% female patient. Mean age was 32.36±9.92 years. Mean SLE duration was 8.16±2.22 months. 79.7% were married and 20.3% were unmarried. In this study among major findings, 52.4% patients were found with fever, 79% with fatigue, 79.7% with arthralgia, 66.4% with weakness, 71.3% with body ache, 35.7% with decreased appetite, 40.6% with headache, 60.1% with photosensitivity, 67.1% with malar rash, 67.1% with alopecia, 60.8% with oral ulcer, 52.4% with Raynaud’s phenomenon, 52.4% with nausea/vomiting, 33.6% with diarrhea, 31.5% with arthritis, 37.1% with muscle atrophy, 35.7% with osteoporotic fractures, 38.5% with hemolytic anemia. Conclusion: In this study, majority of patients presented with combination of fever, fatigue, arthralgia, weakness, body ache, photosensitivity, and malar rash.

Frequency of Aids Defining Opportunistic Infections in Hospitalized HIV Infected Patients

Background: Human Immunodeficiency virus patients with AIDS defined opportunistic infections with Pneumocystis jiroveci, cryptoccocal, disseminated TB, cytomegalovirus, and cytomegalovirus associated retinitis, and cryptospordiasis. Objective: To determine the frequency of AIDS defining opportunistic infections in hospitalized HIV infected patients. Methodology: This cross sectional study was conducted from 21st October 2018 to 20th April 2019 at Department of Medicine, Civil Hospital, Karachi. Total 154 diagnosed patients of HIV were included. For diagnosis of various AIDS defining illness, clinical, radiological and bacteriological evidence of disseminated tuberculosis chronic cough, and weight loss diagnosed by AFB smear/ gene experts. Pneumocystis jiroveci was diagnosed by bronchoalveolar lavage and CD4 counts. Cryptosporidiosis with watery diarrhea and stool sample microscopy, cerebral toxoplasmosis with headache, hemiparesis, vomiting, diagnosed by serology and cytomegalovirus retinitis with blurred vision diplopia, vision impairment and Cryptococcal meningitis with fever >98.6oF. Headache, stiff neck, photophobia diagnosed by microscopy, culture, or antigen was done. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied. P value ≤0.05 was taken as significant. Results: There were 71.4% male and 28.6% female patient. The mean HIV duration was 15.25±5.09 months. The overall mean CD4 count was 174.17±12.85/cumm. 18.8% patient were found with disseminated tuberculosis, 31.2% with pneumocystis pneumonia, 12.3% with cerebral toxoplasmosis, 18.2% with cryptococcal meningitis, 3.9% with cryptospordiasis and 14.9% with cytomegalovirus retinitis. Conclusion: Pneumocystis pneumonia was the most prevalent infection followed by disseminated tuberculosis, cryptococcal meningitis, cytomegalovirus retinitis, cerebral toxoplasmosis, and cryptospordiasis.

Role of Vitamin D in Reducing the Frequency of Asthma Attacks in Patients with Frequent Exacerbation of Asthma

Introduction: Vitamin D deficiency is common among asthmatics with literature suggesting that its low levels in the body may trigger exacerbations and decrease the response to corticosteroid treatment. It has also shown to inhibit the production of cytokines, which in turn enhances the body’s response to corticosteroid treatment during an exacerbation. Therefore, maintenance of adequate levels of vitamin D in patients with asthma may reduce the risk of exacerbation and improve their general health. This study aims to explore the role of vitamin D supplementation in preventing asthma exacerbations. Methods: This single blind parallel arm interventional study was conducted in the pulmonology ward in a tertiary care hospital from June 2018 to April 2020. Two hundred (n= 200) participants with a history of frequent acute exacerbation of asthma were enrolled in the study via consecutive convenient non-probability technique. Participants were divided into two groups; the placebo and the interventional group that received 200,000 IU of vitamin D capsule. Results: Compared to day 0, mean episodes of exacerbation in the interventional group were significantly lower after 180 days (1.1 ± 0.4 vs. 0.61 ± 0.3; p-value <0.0001). Similarly, number of asthma attacks in past 7 days was significantly lower in intervention group after 180 days (4.4 ± 2.7 vs. 3.1 ± 1.5; p-value 0.0001) Conclusion: Vitamin D supplementation is a safe and cost-friendly approach to reducing asthma exacerbations. It may also help to improve the condition in severe asthmatics with low vitamin D levels.

Androgenetic Alopecia as a Marker of Metabolic Syndrome

Background: Alopecia induced by androgens in genetically predisposed individuals is termed as Androgenetic alopecia (AGA). There is proof appearance the relationship between Androgenetic alopecia and metabolic condition. Objective: To determine frequency of metabolic syndrome in Androgenetic alopecia as a biomarker of disease in adult male patients. Materials and methods: It was a Cross Sectional Study conducted at the Department of Dermatology, Liaquat University of Medical and Health Sciences Hospital, Jamshoro/Hyderabad. Total 178 diagnosed male patients of Androgenetic alopecia were included. The grading of male pattern Androgenetic alopecia was done according to modified Norwood-Hamilton classification. Norwood-Hamilton Stage I-III were regarded to be mild to moderate and Stage IV and higher were regarded as severe. Vein was engorged by a tourniquet applied above the cubital fossa. Blood glucose levels were estimated. The level of triglycerides was determined. HDL-Cholesterol was estimated by a pre­cipitant method. Descriptive statistics were calculated using SPSS. Chi square tests were applied to determine the relationship of independent variables with metabolic syndrome. Results: The overall mean age of the patients was 39.08±10.14 years. The mean waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and fasting blood glucose were 94.71±12.30 cm, 133.83±13.27 mg/dl, 48.10±7.89 mg/dl,102.94±17.67 mmHg, 76.88±8.56 mmHg, and 93.06±9.78 mg/dl respectively. A total of 10.1% of the patients were found to have metabolic syndrome. There was a significant association between metabolic syndrome and age and family income. Conclusion: Metabolic syndrome was observed in 10.1% of the patients and this was more commonly found in: the age group >40 years, married individuals, low socioeconomic status individuals, and illiterate individuals.

Clinical and Echocardiographic Profile of Rheumatic Heart Disease: A Cross-Sectional Study

Background: Rheumatic Heart disease (RHD) is the leading cause of acquired heart disease and more prevalent in developing countries. The objective of the study was to determine the clinical and echocardiographic profiles of patients with rheumatic heart disease (RHD). Materials and Methods: All patients above the age of 12 years of either gender diagnosed with Rheumatic heart disease from January 2018 to December 2019 at tertiary care hospital, Hyderabad were enrolled in the study. Detailed patient data was obtained from the hospital records. Information regarding gender, age, Electrocardiogram findings, clinical and echocardiographic manifestations was obtained. Results: Throughout the two-year study period, a total of fifty patients with RHD were studied. The mean age of the population was 33.71 years. Females (64%) outnumbered males and 60% were rural population. The clinical features observed were fever (80%), joint pain (64%), palpitation (60%), breathlessness (90%) and chest pain (50%), tachycardia (60%), raised JVP (10%), hypertension (20%). The common echocardiographic findings observed were mitral stenosis (50%), mitral regurgitation (24%) and pulmonary hypertension (36%), left atrial enlargement (56%), and right atrial enlargement (16%) whereas the majority of the patients (70%) have ejection fraction between 40-50% and thrombus was identified in 15 (30%) patients respectively. Conclusion: Common clinical findings observed were breathlessness and fever while the common echocardiographic findings were mitral stenosis and regurgitation, pulmonary hypertension, and left atrial enlargement. Population-based screening by echocardiography could be a potential route for early screening of rheumatic heart disease.

Accuracy of Resolution of ST-Segment Elevation in Electrocardiogram to Determine the Patency of Infarct-Related Artery

Introduction: There is very limited data comparing the accuracy of ECG to angiography in predicting reperfusion status. In this study, we will determine the accuracy of ECG change i.e. resolution of ST-segment elevation in predicting infarct-related artery (IRA) patency after thrombolysis in patients with ST-segment elevated myocardial infarction (STEMI), in comparison to angiography.

Methods: Three hundred and forty-one (n = 341) patients with acute STEMI received streptokinase, a thrombolytic agent within 12 hours of symptoms, and were enrolled in the study via consecutive convenient non-probability sampling. ECG was recorded as soon as the patient arrived in the emergency unit of cardiology. Subsequent ECG was recorded three hours after the administration of streptokinase to look for resolution of ST-segment elevation. ST-segment resolution was classified as greater/equal to 50% resolved or less than 50% resolved. Coronary angiography was performed within 24 hours of hospitalization and flow in the IRA was assessed.

Results: The most common site of myocardial infarction (MI) was the anterior wall (50.1%) and the commonest artery involved was the left anterior descending artery (44.2%). On ECG, ST-resolution of more than 50% was found in 242 (70.9%) participants. Thrombolysis in MI (TIMI) grade III flow in angiography was found in 211 (61.8%) participants. The sensitivity and specificity of ST-resolution to detect TIMI grade III flow was 94.79% and 67.69%, respectively, while accuracy was 84.46%.

Conclusion: ST-resolution on ECG after streptokinase can predict IRA patency on coronary angiography with moderate to good accuracy. ECG can assist in predicting the impact of streptokinase early in the course of management and give an option of monitoring patient prognosis with a non-invasive test in patients not comfortable with angiography.

The clinical and demographical profile of Coronavirus illness: The tale of Tablighi Jamaat and Zaireen in Quarantine / Isolation center at Sukkur and Hyderabad

Objectives:

To determine the clinical and demographical profile of corona-virus illness among Tablighi Jamaat and Zaireen kept in quarantine / isolation center at Sukkur and Hyderabad Sindh.

Methods:

The cross-sectional descriptive study (late March-2020 to mid of April-2020) was conducted at Diagnostic & Research Laboratory LUMHS Jamshoro / Hyderabad. All the suspected cases for COVID-19 were recruited and screened for corona virus infection. The study explored the data of the suspected and diagnosed (confirmed) case of COVID-2019 (Tablighi Jamaat and Zaireen) reported by Diagnostic Research Laboratory Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro who belonged to various parts of the country in general and province Sindh in particular. All the individuals regardless of age and gender presented either as asymptomatic, critical ill or having non-specific symptoms as fever, flu, cough; sore throat and shortness of breath were screened for COVID-19 by real time PCR after taking informed consent whereas the frequency / percentages (%) and means ±SD computed for study variables.

Results:

During study period total 920 patients were explored and screened for Corona virus infection. The mean ± SD for age (yrs) of overall population of city Sukkur and Hyderabad was 57.83±8.84 and 59.62±9.72 respectively. The 700 people from Sukkur city was screened and out of them 276 (39.4%) were positive and 424 (60.5) were negative while the cure rate was 245 (88.7%) along with mean ± SD for recovery time was 9.41±2.97. The 220 people from Hyderabad city was screened and out of them 106 (48.1%) were positive and 114 (51.8%) were negative while the cure rate was 106 (100%) along with mean ± SD for recovery time was 11.54±3.42. The majority of cases at both centers were asymptomatic (90%), symptomatic (7%) and critically ill (3%). The mortality accounted for 2.8% cases at Hyderabad isolation center and all were having smoking history and co-morbidities as ischemic heart diseases, diabetes mellitus, obstructive lung disease and cerebrovascular accident whereas no mortality was observed at Sukkur isolation center.

Conclusion:

RT-PCR measure allowed fast, delicate, and explicit discovery of SARS-CoV in biochemical diagnosis. The majority of cases at both centers were asymptomatic while the mortality was identified in 2.8% cases (having co-morbidities) at Hyderabad isolation center whereas no mortality was observed at Sukkur isolation center.

Serum zinc level in patients with pneumonia: a six-month long cross-sectional descriptive study at Liaquat University Hospital Hyderabad, Sindh, Pakistan

OBJECTIVE

To determine the serum zinc level in patients with pneumonia.

METHODS

The descriptive cross-sectional study was conducted at the Liaquat University Hospital, Hyderabad, Pakistan, from September 2008 to February 2009. All patients above 12 years of age and of either gender who had been diagnosed with pneumonia were further evaluated for their serum zinc status.The data was analysed through SPSS 10.00, and p<0.05 was considered statistically significant.

RESULT

The mean age of the 118 patients in the study was 25.64 +/- 6.53 years. The mean serum zinc level was 8.279 +/- 2.77 mmol/L, while the mean serum zinc levels in patients having low and normal levels was 6.740 +/- 1.47 mmol/L and 13.243 +/- 1.52 mmol/L respectively (p<0.001). The serum zinc was low in 42 of the 72 (58%) males, and 35 of the 46 (76%) females (p<0.04). There was also significant difference between mean serum zinc level in male and female patients (p<0.03). Out of 77 (65%) hypozincaemic patients, 69 (90%) recovered, while 08 (10%) failed to recover) during their hospital stay (p<0.33). Of the 69 who recovered, 29 (42%) patients did so in less than 2 weeks, while 40 (58%) patients recovered in more than 02 weeks.

CONCLUSION

Serum zinc level was found to be low in patients with pneumonia.

Foetal outcome in patients with meconium stained liquor

OBJECTIVE

To determine the foetal outcome and mode of delivery in patients with meconium stained liquor during labour.

METHODS

The observational study was carried out at the Obstetrics and Gynaecology Unit-II of Liaquat University of Medical Health Sciences from June to November 2007. The patients with gestational age more than 37 weeks who presented with meconium stained liquor and cephalic presentation were included and the foetal outcome and mode of delivery was assessed in all such subjects. The data was collected on pre-designed proforma and analysed using SPSS version 10. Chi square test was applied with 95% confidence interval and p-value < or = 0.05 was considered significant.

RESULTS

A total of 75 patients with meconium stained liquor were identified during the study period. The patients with reactive cardiotocography (CTG) were 50 (66.7%) and with non-reactive CTG, 25 (33.36%). Of the total, 45 (60%) patients were delivered through normal vaginal delivery, while 30 (40%) were delivered by caesarean section. The rate of instrumental delivery was also increased which was 12 (26.7%). Among the neonates exposed to meconium stained liquor, 62 (82.7%) babies were delivered with apgar score > 7. Only 13 (17.3%) babies were delivered with apgar score < 7 in one minute.

CONCLUSION

Meconium stained amniotic fluid is a common occurrence during labour and is associated with increased caesarean section rate and foetal morbidity and mortality.

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

OBJECTIVE

To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups.

STUDY DESIGN

Case control.

PLACE AND DURATION

Department of Medicine, Liaquat University Hospital from October 2007 to March 2008.

MATERIALS AND METHODS

This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of >/= 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis.

RESULTS

Majority of the patients were male with mean age +/- SD, 52.86 +/- 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication.

CONCLUSION

Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection.

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

Objective:

To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups.

Study Design:

Case control.

Place and Duration:

Department of Medicine, Liaquat University Hospital from October 2007 to March 2008.

Materials and Methods:

This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of ≥ 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis.

Results:

Majority of the patients were male with mean age ± SD, 52.86 ± 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication.

Conclusion:

Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection.

Frequency of syphilis in female sex workers at red light area of Hyderabad, Pakistan

OBJECTIVE

To determine the frequency of syphilis in female sex workers (FSWs) at red light area of Hyderabad.

METHODS

This study was conducted on female sex workers at red light area of Hyderabad, Pakistan during 2003. All female subjects who were between 17-35 years of age were evaluated and enrolled in the study. All such subjects were screened. for Treponema pallidum infection/syphilis by Treponema Pallidum Haemagglutination assay (TPHA). The frequency was determined by identifying the positive Treponema pallidum infected patients. For getting results the data was saved and analyzed in SPSS version 10.00.

RESULTS

Total fifty (50) female sex workers were studied; their mean age was 26.22 +/- 4.47 years. Syphilis was identified in 22 (44%) females with mean age of 22.68 +/-1.46 years while remaining 28 (56%) with mean age 29.00 +/- 4.06 years were free from syphilis (p < 0.001).

CONCLUSION

The female sex workers are prone and at risk to acquire sexual transmitted infections (STI), therefore for control and preventive measures, screening programmes should be initialized.

Metabolic investigations in patients with hepatitis B and C

AIM: To investigate the similarities and dissimilarities in patients with hepatitis B and hepatitis C, clinically and metabolically.

METHODS: Fifty patients with hepatitis B virus and hepatitis C virus infection were included in this study, along with fifty healthy controls for comparison purposes. Intravenous blood (10 mL) samples from patients and healthy subjects were collected and made to clot before serum was separated and immediately levels of the enzymes, alkaline phosphatase (ALK), creatinine phosphokinase (CPK), lactate dehydrogenase (LDH), serum glutamate oxaloacetate transaminase (s-GOT) and serum glutamate pyruvate transaminase (s-GPT) were determined by a kit method. For total content of each metal the serum samples were analyzed using atomic absorption spectrophotometry. Levels of cholesterol, triglycerides, urea, creatinine and uric acid were determined using a kit method on Microlab 300.

RESULTS: Serum magnesium and copper levels remained unchanged, whereas the concentration of zinc decreased and iron increased significantly in both groups of patients. Total antioxidant activity was significantly decreased in both hepatitis B and C. Among the enzymes analyzed, ALK, s-GPT, LDH and s-GOT were all significantly increased in both patients with hepatitis B and C whereas CPK was significantly decreased in patients with hepatitis B and remained unchanged in patients with hepatitis C.

CONCLUSION: The information accumulated by this study will help provide a better understanding of involved metabolic processes in order to design appropriate therapeutic approaches for treating these patients, so they can recover and lead normal lives.

Frequency and pattern of gonorrhoea at Liaquat University Hospital, Hyderabad (a hospital based descriptive study)

OBJECTIVE

To determine the frequency and pattern of gonorrhoea at Liaquat University Hospital, Hyderabad.

METHODS

This descriptive study of eight months was conducted at Liaquat University Hospital Hyderabad, Sindh, Pakistan from December 2007 to May 2008. All patients who were above 14 years of age and came with history of discharge from penis or vagina were evaluated and enrolled in the study. After recording demographic data these were screened for gonococcal infection by Gram's staining method. The frequency was determined by identifying the positive gonococcal infected patients while pattern was observed according to the presentation of patients. The data was analyzed by SPSS version 10.00.

RESULT

One hundred and eighteen patients, 92 (78%) male and 26 (22%) females were identified to have infection out of 266 patients with mean age 27.4 +/- 7.77 years. Majority of the patients 92 (78%), presented in the department of dermatology. In the study group, 77 (65%) were unmarried and 41 (35%) were married, 71 (60%) belonged to Hyderabad and 47 (40%) came from periphery of Sindh province of Pakistan. Other features and presentation identified in such patients were painful micturition 98 (83%), burning micturition 94 (80%), frequent micturition 108 (92%), genital itching 85% (72%), intermenstrual bleeding 09 (8%), painful sexual intercourse 87 (74%) and skin lesions 24 (20%). All patients were treated by syndromic management.

CONCLUSION

A relatively high prevalence of gonorrhoea (46% patients) was detected in the patients seen in Liaquat University Hospital.

Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad

OBJECTIVE

To determine the precipitating factors of hepatic encephalopathy (HE) in patients with liver cirrhosis at Liaquat University Hospital Hyderabad/Jamshoro.

METHODS

This hospital based descriptive study was conducted from April 2007 to September 2007. All the patients who were more than 12 years of age and were diagnosed as hepatic encephalopathy were studied. During this period, 87 patients of hepatic encephalopathy were admitted. All patients were carefully examined, relevant investigations were performed and data was collected through pre-designed proforma.

RESULTS

Male patients were 65 (75%), above 40 years of age 58 (67%), belonging to interior/periphery of Sindh 54 (62%), in grade IV of hepatic encephalopathy 70 (80%) and Anti-HCV positive were 52 (60%). The most common precipitating factors detected were infection 58 (67%), constipation 43 (49%) and gastrointestinal bleeding 39 (45%). Out of 87 patients, 68 had increased total leucocytes count, 09 patients had hypokalaemia, 24 patients, hyponatraemia, 64 hypoalbuminaemia and 54 patients had a disturbed coagulation profile. Fifty nine patients recovered and were discharged while 20 patients expired. Majority of expired patients had Child-Pugh score 10-15 and were in grade IV of hepatic encephalopathy.

CONCLUSION

The study concluded that there were different factors which play a key role in hepatic encephalopathy. In these factors, infection was the most common.

Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital

BACKGROUND

Nosocomial infection is defined as an infection which develops 48 hours after hospital admission or within 48 hours after being discharged. The objectives were to assess the frequency of nosocomial infection in patients admitted to intensive care unit (ICU) and to determine the etiological factors in such patients. It was an Observational Study and conducted in Intensive Care Unit, Liaquat University Hospital Hyderabad Sindh Pakistan from January 2008 to November 2008.

METHODS

All patients above 16 years of age admitted in the ICU for more than 48 hours and developed clinical evidence of infection that did not originate from patients' original diagnosis at the time of admission, were included in the study. Data was entered in a proforma and analyzed using SPSS version 10.0.

RESULTS

During the study period, 97 out of 333 patients acquired nosocomial infection. The frequency of nosocomial infection was 29.13%. Respiratory tract infection was seen in 29 (30.1%), urinary tract infection in 38 (39.1%) and blood stream infection in 23 (23.7%) patients. Other infections we identified were skin, soft tissue, wound and gastrointestinal tract infections.

CONCLUSION

Patients admitted in intensive care unit are at more risk of acquiring nosocomial infection from different sources. It is suggested that proper nursing care, sterilization and disinfection of instruments and equipment and careful handling of invasive procedures are the best tool to control these life threatening infections.