Association of chronic viral hepatitis with ABO blood groups and rhesus (Rh) factor

Background: Chronic viral hepatitis includes hepatitis B and hepatitis C and is responsible for causing the deaths of millions of people all across the world each year. Although there are small studies in literature about association between ABO blood groups and chronic viral hepatitis, only few studies found relation between them. The objective of this case control study is to establish a relation between the host factors and these viral infections.Methods: This is a case control study on patients diagnosed with CVHB and CVHC. The study was conducted on 508 patients reported to Nishtar Hospital, Multan and Sheikh Zayd Hospital, Rahim Yar Khan, Pakistan.709 healthy blood donors were selected as a control group from Nishtar Hospital blood bank during December 2016 and December 2017.The results were subjected to SPSS v.20 for analysis using the chi square test. The patients and blood donors were also asked about certain demographic factors like age, sex and blood transfusions.Results: Among CVHB patients,173(100%), the distribution of blood groups was following: Group A, 38 (21.96%), B, 57 (32.94%), AB, 11 (6.35%), O, 67 (38.72%). 158 (91.32%) were Rh positive and 15 (8.67%) Rh negative. In CVHC patients, 335 (100%), the distribution was following: Group A, 69 (20.59%), B, 123 (36.71%), AB, 24 (7.16%), O, 119 (35.52%). 303 (90.44%) were Rh positive while 32 (9.55%) were Rh negative. In healthy blood donors, 167 (23.55%) were group A, 225 (31.73%) group B, 41(5.78%) group AB, 276 (38.92%) group O.632 (89.13%) were Rh positive and 77 (10.86%) Rh negative.Conclusions: There was no significant difference between blood groups(p>0.5) and Rh(p>0.5) with chronic viral hepatitis. However, it was also observed that the infections of HCV increase among (26-45) years old patients while the HBV infections increase with progression of age. Association of chronic viral hepatitis infection with blood group types needs more studies to get more knowledge about this aspect

The spectrum of Evans syndrome: a literature review

Evans syndrome (ES) is an autoimmune disorder characterized by the simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) and/or immune neutropenia in the absence of any underlying cause. Evans syndrome is a rare disorder although the exact frequency is unknown. No sex predilection is known and Evans syndrome has been described in all ethnic groups and at all ages. Classification of ES includes primary, with this being an exclusion diagnosis with no underlying condition, and secondary in the presence of an underlying disease. Clinical features are associated with anemia and thrombocytopenia including pallor, weakness, fatigue, jaundice, petechiae, ecchymosis, gingivorrhagia and epistaxis. First, a detailed history must be taken from the patient to determine the risk factors for developing ES then a family history of immune disorders along with a thorough physical examination. The management of Evans syndrome remains a challenge. Steroids with and without IVIG are recommended as front-line therapy. Red blood cell/platelet transfusion is indicated only in severe symptomatic patients due to the risk of exacerbations. Splenectomy may also be considered a second-line treatment

Outcome of internal fixation procedure: miniplate vs cross K wires for displaced metacarpal metaphyseal fracture

Background: Metacarpal fractures are considered a frequent orthopedic injury seen commonly in emergency units. Objectibe of thestudy was to compare the outcome of internal fixation procedure of miniplate versus cross kirschner wires (k-wires) for displaced metacarpal metaphyseal fractures.Methods: In this experimental prospective study, 100 patients with metacarpal metaphyseal fracture were considered. internal fixation was done by miniplate in one group and cross k wires in other group. Outcomes in terms of radiological union were compared between both groups. The data was analyzed by using SPSS for windows (version 26.0).Results: Mean age of the patients was 38.70±13.61 years. Male to female ratio of the patients was 1.2:1. The radiological success was noted in 76 (76.0%) patients. Statistically insignificant difference was found between the study groups in terms of radiological success of the patients (p=0.6396). K wire fixation was recorded to have significantly shorter duration of operation time in comparison to miniplate fixation (p=0.0001).Conclusions: The internal fixation procedure of both miniplate and k wire are equally effective in terms of radiological success for management displaced metacarpal metaphysis fractures. As compared to miniplate fixation, K wire fixation was found to have significantly shorter duration of operation time

The prevalence of bipolar spectrum disorder in medical students of Pakistan

Background: Bipolar affective disorder is cyclic swinging of mood between mania or hypo-mania and depression. Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 1 to 3% in the general population. Despite a growing body of knowledge on bipolar spectrum disorder (BSD), relatively little is known about the clinical characteristics of BSD in medical students. This study evaluates the prevalence and severity of BSD in medical students in relation to certain socio-demographic factors like age, sex and class of education.Methods: A questionnaire based study was done on 298 medical students of Nishtar Medical University, Multan and Shaikh Zayed Medical College, Rahim Yar Khan chosen on basis of random sampling to test the prevalence of bipolar spectrum disorders using Mood Disorder questionnaire (MDQ). Out of these students 161 were males and 137 were females. Students were interviewed to obtain information about age, sex and academic year of education.Results: According to mood disorder questionnaire scoring, of the total 298 students 80 (26.84%) screened positive for bipolar spectrum disorder (BSD). Among 80 students who screened positive for BSD 43 (53.75%) are males while 37 (46.25%) are females. Class-wise distribution of BSD is as follows: Out of 80 students screened positive 15 (18.75%) are from 2nd year, 22 (27.5%) from 3rd year and 43 (53.75) from 4th year. Age-wise distribution of BSD is as following: Students of age 19, 20, 21, 22 and 23 years suffering from BSD were 5 (6.25%), 17 (21.25%), 23(28.75),22 (27.5%) and 13 (16.25%) respectively.Conclusions: In our study, the estimated rate of prevalence for bipolar spectrum disorder among medical students of Pakistan is 26.84%. There was no significant difference in prevalence on the basis of gender. Prevalence was increasing with both age and class wise distribution

The descriptive study of anxiety levels among diabetics: insulin users versus non-insulin users

Background: Anxiety is an emotion characterized by an unpleasant state of turmoil often accompanied by nervous behaviours such as pacing back and forth, somatic complaints and rumination. Diabetes is the most metabolically active disease which can influence the psychological state. This study evaluates the anxiety levels among diabetics (Insulin users versus non-insulin users) along with its relation to certain demographic factors like age, sex, education, type of medication and medication compliance.Methods: Hamilton anxiety rating scale (HAM-A) was used to test the anxiety levels in 187 diabetic patients visiting the diabetic clinic and research centre, Nishtar Hospital, Multan and other diabetic clinics in the area. 97 (51.87%) patients of the total sample are males and 90 (48.12%) patients are females.Results: In this study, 170 (91%) had type 2 diabetes while 17 (9%) suffered from Type 1 Diabetes. 66.66% of the patients in the sample were insulin users while 34.34% were non-insulin users. The overall mean anxiety level in insulin users is 24.55 and in non-insulin users is 23.92.Conclusions: Our study showed a high prevalence of anxiety levels in insulin users as compared to non-insulin users. Certain symptoms like anxious mood, tension, fears, depressed mood, cardiovascular and gastrointestinal symptoms appeared with mild anxiety levels while other symptoms like insomnia, somatic symptoms, autonomic symptoms, respiratory and genitourinary symptoms appeared with high severity levels. The presence of risk factors for anxiety among patients of diabetes predicts a causal relationship and deserves attention from clinicians

Anaemia in acute coronary syndrome: a cross-sectional study

Background: Acute coronary syndromes (ACS) are an imbalance between myocardial oxygen supply and demand, and the presence of anaemia further potentiates this imbalance. The burden of anaemia in patients presenting with acute coronary syndromes (ACS) is significant. Anaemia has the potential to worsen myocardial ischemic insult by decreasing the oxygen content of the blood supplied to the jeopardized myocardium. Present study investigates the prevalence of anaemia in ACS patients attending a tertiary health care institute.Methods: A total of 148 patients with ACS were recruited in the study from July 2018 to October 2018 in Multan institute of cardiology, Pakistan. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent. Patient having any other diseases known to cause anaemia were excluded.Results: Mean age of patients was 49 years. Out of 148, 114 (77%) were males and 34(23%) were females. Prevalence of anaemia was 38% in Male and 58.8% in Female. Among Male, 18.8% were microcytic, 4.54% were macrocytic and 77.27% were normocytic. Among Female, 50% were microcytic and 50%% were normocytic. Prevalence of ACS was higher is patients with diabetes and hypertension combined (31%) than in patient with diabetes alone (17.56%) or hypertension alone (21.62%). 13.51% were pure vegetarians  while 78.37% were on mixed diet consisting of vegetables+meat+pulses.Conclusions: Higher incidence of anaemia was reported in subjects having acute coronary syndrome. Incidence of anaemia in STEMI patients was greater than NSTEMI and unstable angina patients. Severe form of acute coronary syndrome i.e. STEMI was associated with higher incidence of anaemia

The descriptive study of imposter syndrome in medical students

Background: Imposter syndrome is characterized by chronic feelings of self-doubt and fear of being discovered as an intellectual fraud. Despite evidence of abilities, those suffering from imposter syndrome are unable to internalize a sense of accomplishment, competence, or skill. Overall, they believe themselves to be less intelligent and competent than others perceive them to be. IS has several potential implications for medical education. The current study was designed to find out the frequency of imposter syndrome among medical students college so that certain measures must be taken to improve the teaching and learning methodologies as well as the curriculum.Methods: A cross-sectional, psycho-social analysis was conducted from March to July, 2018 at Nishtar Medical College, Multan after taking informed consent from the students. Clance Imposter Phenomenon Sclae (CIPS) was used to assess the prevalence and degree of severity of Imposter syndrome among medical chosen on basis of random sampling. The data collected was entered and analysed on SPSS v.20.Results: Two hundred (200) students were selected for the study and were asked to return the completed 20 items questionnaire. One hundred and eighty-nine (189) students returned the questionnaires, so the response rate was 94.5%. Out of 189 students, 121(64.36%) were males and 68(35.97%) were females. According to Clance imposter phenomenon scoring, of the total 189 students the severity of imposter syndrome is as follows: mild, 5(2.64%), moderate,72(38.09%), severe,103(54.49%) and very severe, 09(4.76%). Moreover, third year students were found to have high prevalence and degree of severity of imposter syndrome.Conclusions: Imposter phenomenon exists in a significant percentage of medical students and appears to peak in the third year of medical school. Both genders are at equal risk of having imposter syndrome. It is associated with various psychological illnesses. Further discussion regarding medical education paradigms in light of high levels of imposter phenomenon is needed

Insomnia among medical students: a cross-sectional study

Background: Insomnia, the most common sleep disorder, is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following conditions: difficulty in falling asleep, frequent waking up during the night with difficulty for returning to sleep, waking up too early in the morning, or unrefreshing sleep. It is the most common sleep related complaint reported in the primary care setting. Medical students are specially at risk of developing insomnia and its consequences. This study evaluates the prevalence and severity of insomnia in medical students in relation to certain socio-demographic factors like age, sex and class of education.Methods: A questionnaire based study was done on 135 medical students of Nishtar Medical University, Multan chosen on basis of random sampling to test the prevalence of insomnia using Athens Insomnia Scale (AIS). Out of these students 75 were males and 60 were females. Students were interviewed to obtain information about age, sex and academic year of education.Results: According to Athens insomniac scale scoring, 55 (40.74%) students were found insomniac while 80 (59.25%) were non-insomniac. Out of 55 insomniac students, 23 (41.81%) were males while 32 (58.18%) were females. Likewise, out of 80 non-insomniac students, 52 (65%) were males while 28 (35%) were females. The prevalence of insomnia in medical students was found to be increased with the increasing age. It was found that the females have more insomnia prevalence as well as more severe signs and symptoms of insomnia. Moreover, final year students tend to show more prevalence and severity of insomnia than their juniors.Conclusions: According to this study, 2 out of every 5 students were insomniac. Demographic comparison showed that the prevalence and severity of insomnia was more in females and final year students. Also, it was increasing side by side with increasing age

Immunization status of students of Nishtar medical university against hepatitis B

Background: Hepatitis B virus (HBV) infection causes significant morbidity and mortality worldwide. Occupational exposure of health care workers and medical students increase their risk of acquiring HBV infection, and many authorities recommend vaccination. However, significant proportions of health care workers do not receive HBV immunization, and remain at increased risk to HBV infection. The present study was conducted on medical students to evaluate their knowledge regarding HBV and to know their vaccination status.Methods: This cross sectional, randomized, observational study was done at Nishtar medical university, Multan from November 2017 to July 2018. A pre-structured and tested questionnaire was given to 150 medical students from first year to final year. Out of these students 75 were males and 75 were females. The students were also interviewed about age, gender, year of study, screening before vaccination, history of vaccination, completion of all 3 doses and reasons for not getting vaccinated.Results: Out of 150 participants, 117 (78%) were vaccinated against HBV. In the vaccinated group, 90 (77%) completed all the three doses of their vaccination schedule and remaining 27 (23%) students were incompletely vaccinated. Rate of vaccine uptake was higher in females; 63 (84%) than in males: 53 (71%). Reasons of not being vaccinated were lack of knowledge about consequences (15.5%), casual behaviour (36%), not knowing from where to get vaccine (12%), fear of injection (10%), busy in studies (10%) and financial problems (8%). Prior screening was done in 74 (63%) students before the vaccination.Conclusions: Despite the availability and accessibility of a cost-effective hepatitis B vaccine since mid80's, the vaccination coverage among medical students is low. Health education needs to be improved in all medical students. The orientation and awareness programmes should be held to create awareness regarding HBV infection

Prosthetic rehabilitation of a patient following partial maxillectomy for Squamous cell carcinoma: A clinical report

Squamous cell carcinoma of maxillary alveolar process and palate accounts for 1-5% of all the neoplasm’s of the oral cavity. This clinical report describes a method for prosthetic rehabilitation of a patient with squamous cell carcinoma of maxilla following partial maxillectomy with a prosthetic obturator. &nbsp