Assessment of Dengue Fever Severity Through Liver Function Test

Objective: To assess the utility of liver function tests (LFTs) for early recognition and prediction of severity of dengue fever in hospitalized patients. Study Design: An analytical study. Place and duration of study: Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September to December 2010. Methodology: Admitted cases of dengue fever were divided into three groups: mild, moderate, and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. (survival or complication free stay) or (death or complications). Results were analyzed in SPSS version 18. Results: Out of the 353 patients with mean age of 37.12 ± 15.45 years, 245 (69.4%) were males and 108 (30.6%) were females. Seventy five patients (21.2%) had mild elevation of aminotransferases (twofold increases), 265 patients (75.1%) had moderate increases (three to fourfold), and 13 (3.7%) had severe (>4 fold increase). Alanine transaminase (ALT) was statistically higher in patients with septicemia, hepatic, and renal failure (p-value ≤0.05). Aspartate transaminase (AST) was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT. Conclusion: AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases

Sleep Fainting: A Neurocardiogenic Entity

Fainting is a common clinical presentation, with vagally mediated (neurocardiogenic) causes being the most common for syncope presentation to the emergency room, and for hospital admissions. Classic teaching is that upright posture is a prerequisite for vagally mediated syncope (VMS) and that syncope in the supine position has more sinister causes. We present five patients, three males and two females, with a mean age of 44.4 (range 29-67) years, who presented with VMS in the supine position (sleep fainting). Four patients also had a history of classic upright syncope. Based on their clinical features and thorough investigations, we excluded other causes of loss of consciousness and diagnosed these patients to be having VMS in the supine position (sleep fainting). We further describe the management and follow-up of these patients. Sleep fainting/syncope is a new entity and has to be recognized for appropriate management. A diagnosis can be established if there is clinical suspicion, preserved left ventricular function without evidence of coronary artery disease, no high-risk electrocardiographic evidence of pre-excitation, long or short QT syndrome, Brugada syndrome or arrhythmogenic right ventricular dysplasia, and normal neurological work-up

Protein toxicity in Kotri Paint industry workers exposed to Phthalic Anyhydride and Trimellitic Anyhydride

Background: Protein plays a significant role in the regulation of metabolism for normal functioning in human body. SITE area, Kotri paint industry workers are at high risk of hypersensitivity, sensitization of the respiratory tract (including asthma), skin diseases and allergy.  Reactive Low molecular weight organic acid anhydrides (OAAs) like trimelitic anhydride (TMA) and phthalic anhydride (PA) are extensively used in local paint industries of SITE AREA, Kotri, Sindh – Pakistan. These both anhydrides may easily bind with high molecular weight proteins by forming complex (adducts) leading to metabolic disorders among the exposed workers.Methods: There is no study to differentiate protein status of workers compared with normal healthy group as compare in the past. In this regard, the total protein was determined in intravenous blood samples obtained from the exposed workers to TMA and PA with control group clinically by Microlab300 (Kit Method System).Result: There is a significant decrease of protein level in paint industry workers as compared with healthy subjects, which never had exposed to TMA and PA.Conclusion: These both allergenic organic acid anhydrides like TMA and PA may be associated for changing protein function status after forming complex (adduct) by long exposure at work. SITE Area, Kotri Paint workers may at high risk of asthma, exposed to TMA and PA

Effect of air pollution on daily morbidity in Karachi, Pakistan

Levels of daily particulates (PM2.5) were monitored at two sites in Karachi, Pakistan. One site (Korangi) is an industrial and residential neighborhood, while the other (Tibet Center) is a commercial and residential area near a major highway. Monitoring was done daily for a period of six weeks during spring, summer, fall and winter. Particulate levels were extraordinarily high, with the great majority of days falling into the “unhealthy for sensitive groups” or “very unhealthy” categories. The mean PM2.5 levels in Karachi exceeded the WHO’s 24 h air quality guideline almost every day and often by a factor of greater than 5-fold. Daily emergency room (ER) visits and hospital admissions for cardiovascular diseases were obtained by review of medical records at three major tertiary and specialized hospitals. ER and hospitalizations were reported relative to days in which the concentration of PM2.5 was less than 50mg/m3 , and by 50 mg/m3 increments up to 300mg/m3 . There were statistically significant elevations in rates of hospital admissions at each of the PM2.5 categories at the Korangi site, and at concentrations .150mg/m3 at the Tibet Center site. ER visits were significantly elevated only at PM2.5 concentrations of between 151 and 200 mg/m3 at both sites. These results show that the extremely elevated concentrations of PM2.5 in Karachi, Pakistan are, as expected, associated with significantly elevated rates of hospital admission, and to a lesser extent, ER visits for cardiovascular disease

The association of complex liver disorders with HBV genotypes prevalent in Pakistan

Background Genotyping of HBV is generally used for determining the epidemiological relationship between various virus strains and origin of infection mostly in research studies. The utility of genotyping for clinical applications is only beginning to gain importance. Whether HBV genotyping will constitute part of the clinical evaluation of Hepatitis B patients depends largely on the availability of the relevance of the evidence based information. Since Pakistan has a HBV genotype distribution which has been considered less virulent as investigated by earlier studies from south East Asian countries, a study on correlation between HBV genotypes and risk of progression to further complex hepatic infection was much needed Methods A total of 295 patients with HBsAg positive were selected from the Pakistan Medical Research Council\u27s (PMRC) out patient clinics. Two hundred and twenty six (77%) were males, sixty nine (23%) were females (M to F ratio 3.3:1). Results Out of 295 patients, 156 (53.2%) had Acute(CAH), 71 (24.2%) were HBV Carriers, 54 (18.4%) had Chronic liver disease (CLD) Hepatitis. 14 (4.7%) were Cirrhosis and HCC patients. Genotype D was the most prevalent genotype in all categories of HBV patients, Acute (108), Chronic (39), and Carrier (53). Cirrhosis/HCC (7) were HBV/D positive. Genotype A was the second most prevalent with 28 (13%) in acute cases, 12 (22.2%) in chronics, 14 (19.7%) in carriers and 5 (41.7) in Cirrhosis/HCC patients. Mixed genotype (A/D) was found in 20 (12.8%) of Acute patients, 3 (5.6%) of Chronic and 4 (5.6%) of carriers, none in case of severe liver conditions. Conclusion Mixed HBV genotypes A, D and A/D combination were present in all categories of patients except that no A/D combination was detected in severe conditions. Genotype D was the dominant genotype. However, genotype A was found to be more strongly associated with severe liver disease. Mixed genotype (A/D) did not significantly appear to influence the clinical outcome

Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis

<p>Abstract</p> <p>Background</p> <p>Hepatitis B and C is common in Pakistan and various risk factors are attributable to its spread.</p> <p>One thousand and fifty consecutive male cases suffering from chronic liver disease (327 HBV and 723 HCV) were selected from the OPD of public sector hospital and a private clinic dealing exclusively with the liver patients. To compare the results 723 age and gender matched controls were selected from the blood transfusion services of the public sector hospital. A standard questionnaire was filled for all patients and controls which included the information on possible risk factors.</p> <p>Findings</p> <p>Family history of liver disease was significantly higher (43% and 34%) in HBV and HCV positive cases as compared to 5% in controls [odds ratio 15.6; 95% Confidence Interval CI: 10.1 -- 24.1, 10.9; 95% Confidence Interval CI: 7.3 -- 16.4] and same trend was seen for death due to liver disease in the family. Majority 74% hepatitis B positive cases had their shaves done at communal barbers but this practice was equally prevalent amongst controls (68%), thus negating it as a possible risk factor, but there is a significant risk with p < 0.05 associated with HCV in male that get their shave in barber. Very strong association of the disease was found with history of dental treatment (38% HCV 36% HBV and 21% controls) [Odd ratio 2.3; 95% CI: 1.8-3.0, Odd ratio 2.1; 95% CI: 1.5-2.8], surgery (23% HCV cases,14% HBV cases and 12% controls), history of blood transfusion was significantly higher in HCV (6%) as compared to controls (2.1%) [Odd ratio 2.9; 95% CI: 1.5-5.5]. History of taking injections for various ailments by the general practitioners (over 90% patients in both hepatitis B and C cases) was significantly higher as compared to 75% in controls [Odds ratio 3.8, 6.9; 95% CI: 2.4-6.1, 4.5-10.4] but hospitalization was not significant in HBV and HCV cases.</p> <p>Conclusion</p> <p>Injections, surgery and dental treatment appear as major risk factors for the transmission of hepatitis B and C in the community. Massive health care awareness drives need to be done for both health care providers and the public to reduce this menace.</p

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Abnormal Uterine Bleeding in Adolescents and its correlation with Ultrasonography Documented Endometrial Thickness and Uterine Volume

Introduction:Abnormal uterine bleeding is a term used for alterations in regularity, duration or volume of menstrual bleeding . In adolescence AUB also called dysfunctional uterine bleeding is defined as excessive prolonged or frequent bleeding of uterine origin that is not caused by a recognizable pelvic or systemic disease or by pregnancy . About 37% of teenage girls attending a Gynaecological Clinic have complaints of AUB during the first 3-5 years following the menarche. Materials and Methods : This study was conducted at tertiary maternity centre, Lalla Ded Hospital Between July 2019 to January 2020. The data was collected by enrolling patients into two groups, the study group and the control group. The study group included the adolescent girls from menarche to 18 years of age as they attended the OutPatient Department. A thorough history and examination was done and investigations like CBC, Coagulogram, Pelvic Ultrasonography were done. Results: The study and the control groups did not have any significant difference in present age, Age at menarche and BMI. In our study the mean age at present for the study group was 14.52 years whereas for the control group it was 15.95 years. The mean age at menarche for the study group was 13.38 years whereas for the control group it was 13.21 years. The BMI for the study group was 20.10 kg/m2 whereas for the control group it was 19.63 kg/m2 . Conclusion: Adolescent girls with AUB have significantly increased uterine volume irrespective of their endometrial thickness. However there is no increase in the ovarian volume thus depicting an abnormal response to the relative hyperestrogenemia state during their puberty. However this abnormal response to hyperestrogenemia needs to be studied further