Prevalence of Hepatitis D in HBsAg positive patients visiting liver clinics

Objective: To estimate the prevalence of hepatitis D in HBsAg (hepatitis B surface antigen) positive patients visiting liver clinics. Methodology: All HbsAg positive patients who had visited two liver clinics; in Karachi and in Jacobabad, from October 2007 to March 2008, were included in this study. These patients were tested for HBV DNA and HDV RNA by PCR technique, HBeAg and anti-HDV. Clinical status of the patients was evaluated by examination, routine biochemical tests and ultrasound. Results: Total numbers of patients included in the study were 362 comprising of 151 patients from the clinic in Jacobabad and 211 from Karachi. The patients ranged from 4 to 70 years age (mean age 29.75 ±11.27). Out of the total patients 297 (82%) were males. All the patients were screened for HDV antibody out of which 212 (58.6%) tested positive. Total 65 anti-HDV positive patients were tested for the HDV RNA by PCR, out of which 30 (46.2%) tested positive for the virus. Three hundred and forty (340) patients were screened for HBeAg, out of which 71 (20.9%) tested positive. Three hundred and seven patients were screened for HBV DNA by PCR, out of which 88 (28.7%) were positive for the virus. HBV DNA was positive in 16.2% of HbeAg negative patients (pre-core mutants). The frequency of positive HDV antibody was 69.23% in patients from Kashmore, 67% in Jacobabad, 65.4% in Jaffarabad, 65.21% in Quetta, 60% in Naseerabad, 36.58% in Karachi, 58.33% in other areas of Balochistan and 60.71% in other areas of Sindh. Positive HDV antibody status was associated with more severe and advanced disease (p\u3c0.0001) Conclusion: This data shows extremely high prevalence of hepatitis D in the referred patients from some areas of Southern Pakistan. Effective preventive measures are the need of the hour and Pakistan may be considered as one of the areas of highest HDV prevalence around the globe (JPMA 59:434; 2009)

Cardiff Acne Disability Index based Quality of Life in Acne Patients, Risk Factors and Associations

BACKGROUND: Acne Vulgaris is a frequently seen dermatological condition having physical and psychosocial implications. Current study aims to assess Quality of life (QoL) in acne patients and study the associated risk factors. METHODOLOGY: This descriptive cross sectional study was conducted in 6 months duration at Dept. of Dermatology, Rawal Institute of Health Sciences Islamabad after ethical approval. Total 205 cases of acne (age>12 years) were included. Patients with severe systemic illness and endocrine disease were excluded. Global Acne Grading Scale (GAGS) was used to grade acne as mild, moderate or severe. Quality of life assessed by Cardiff Acne disability index (CADI) with outcome as no impairment, mild impairment, moderate impairment or severe impairment. Data analyzed via SPSS version 17 with Chi-square test applied for significance. The p-value <0.05 considered to be statistically significant. RESULTS: Among 205 acne cases (24% males and 76% females), mean age was 25+5.7 (14-36) years. As per GAGS score; mild acne was present in 45.4%, moderate acne(44%), severe acne (8.35%) and very severe acne (2.4%). As per CADI score, there was no impairment in 7.3%, mild mpairment (19.5%), moderate impairment (61%) and severe impairment in (12%). The impaired QoL was found to be associated with gender, socioeconomic class, education, acne grade, obesity and use of alternative medicine (p<0.05). CONCLUSION: Acne vulgaris significantly impairs QoL in adolescents to varying degrees. Higher grade of acne, female gender, obesity, illiteracy and poverty are the proposed risk factors for impaired QoL in acne cases. Early identification of acne cases at risk of impaired Qol may be helpful to take QoL measures like counseling and psychological intervention in parallel with medical management. This may improve the social and psychological wellbeing of acne cases

Recognition of Antibiotic Resistance in Spontaneous Bacterial Peritonitis Caused by Escherichia coli in Liver Cirrhotic Patients in Civil Hospital Karachi

Introduction Spontaneous bacterial peritonitis (SBP) is the most common life-threatening infection in patients with ascites due to liver cirrhosis. The infection is most commonly caused by the bacterium Escherichia coli, commonly referred to as E. coli. Over the past few years, the incidence of antimicrobial resistance against E. coli has risen drastically, leading to increased morbidity and mortality. Methods This cross-sectional study was conducted to determine the pattern of resistance using variations of antibiotics against E. coli, to prevent its empirical usage and initiate an appropriate target antibiotic therapy. The data were collected from May 2017 to October 2017 and included a total of 184 patients. The patients had previously been diagnosed with chronic liver disease and had presented with E. coli-induced SBP in the medicine wards at Civil Hospital, Karachi, which is the largest tertiary care hospital in the city. All participants underwent diagnostic paracentesis, and the ascitic fluid samples were sent to labs for culture and sensitivity to antibiotics. Results The sample population consisted of 184 participants, of which two-thirds (63.6%; n=117/184) of the population consisted of males. The mean age of the participants was 47.6±10.7 years. More than half of the patients had hepatitis C (54.9%; n=101/184) while the remaining were diagnosed with hepatitis B (45.1%; n=83/184). The ascitic fluid showed varying percentages of resistance for drugs, with no resistance to imipenem and meropenem while ciprofloxacin showed the highest resistance in eradicating the bacterium, E. coli. Additionally, a statistical correlation was tested between drug resistance and factors like age, gender, duration of liver disease, and duration of ascites. Ciprofloxacin and tetracycline showed a positive correlation between the resistance of these drugs and the age, gender, and duration of chronic liver disease in the participants while trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, and piperacillin/tazobactam showed a positive association with the duration of ascites. Conclusion A rapid diligent intervention of cirrhotic patients with complicated ascites is crucial to alleviate patient mortality. Due to the rising bacterial resistance, primarily, epidemiological patterns should be assessed and analyzed in our regional hospitals, and then, antibiotics should be prescribed meticulously