Hypovitaminosis D in Hepatitis C patients and its relation with demographic and laboratory data.

OBJECTIVE: To determine the frequency of vitamin-D deficiency in hepatitis C patients and its relation with demographic and baseline laboratory data. METHODS: The cross-sectional study was conducted at the University Institute of Medical Laboratory Technology, Faculty of Allied Health Sciences, The University of Lahore, Pakistan, from April 3 to July 24, 2017, and comprised diagnosed hepatitis C genotype 3 patients aged 18-60 years. Demographic data was collected on a predesigned proforma. Tests included complete blood counts, liver function test, hepatitis C viral load and 25-hydroxy Vitamin-D level. Data was analysed using SPSS 24. RESULTS: Of the 115 patients, 54(47%) were male and 61(53%) were females. Mean vitamin-D level was 22.3±11.3. Total 25(21.7%) patients showed normal level of vitamin-D while the level was low in 90(78.3%) patients; 41(35.6%) showed vitamin-D insufficiency and 49(42.6%) vitamin-D deficiency. Significant effect of sun exposure was recorded on patient's vitamin-D level (p=0.00). Significantly low hepatitis C viral load was seen in patients with normal vitamin-D (p= 0. 02 6 ). CONCLUSIONS: Patients with hepatitis C virus infection had high incidence of hypo-vitaminosis D.

The Predictors Of Re-Bleeding In Chronic Liver Disease Patients After Endoscopic Variceal Band Ligation.

BACKGROUND: Variceal bleeding is a key and most fatal complication observed in chronic liver disease patients with portal hypertension and is a major contributor to the high morbidity and mortality seen in these patients. Exploring the predictors of rebleeding in chronic liver disease patients is of paramount importance to alter disease course and impact on morbidity and mortality. METHODS: About 50 patients with chronic liver disease who previously had evidence of varices on upper GI endoscopy and had at least one episode of rebleeding after EVBL were included in this study. Patients were assessed for the possible contributors to rebleeding through complete history, clinical examination, coagulation profile and platelet count, ultrasound features (splenic size and portal pressure), and upper GI endoscopic findings (site and grade of varices, red sign). Sample selection was done using non-probability purposive sampling technique and sample size calculated using the standard WHO formula. Data was entered and analyzed using SPSS version 20. RESULTS: In this study, mean age of the patients was 51.34±6.34 years with male predominance (64%). Rebleeding was significantly associated with grade of varices, presence of red sign on upper GI endoscopy, site of varices, splenic size and coagulopathy. CONCLUSIONS: Rebleeding in chronic liver disease patients following EVBL is predicted by grade, extent and site of varices, red sign on upper GI endoscopy, splenic size and coagulation disturbances.

Antimicrobial sensitivity patterns of enteric fever in Pakistan: a comparison of years 2009 and 2019.

BACKGROUND: Pakistan is one of the endemic regions for typhoid fever and paratyphoid fever. This study aimed to identify the evolving antimicrobial sensitivity patterns of Salmonella species causing enteric fever and its implications on the clinical prescribing of antimicrobials. METHODS: This was a retrospective descriptive study conducted at a university hospital. Antimicrobial resistance was defined in terms of non-resistant, multidrug resistant (MDR) and extended drug resistant (XDR) as per WHO guidance. Data were collected from the years 2009 and 2019. Chi squared was applied to test for statistical significance (p < 0.05). RESULTS: A total of 200 patients (100 from 2009 and 100 from 2019) were included in the study. Non-resistant enteric fever cases reduced from 100% in 2009 to 44% in 2019, whereas the MDR and XDR enteric fever cases increased to 16% and 40%, respectively (p < 0.05). Cross tabulation carried out for individual drugs showed an independent rise in the sensitivities of individual first-line antimicrobials. CONCLUSION: Antimicrobial resistant enteric fever has become a big challenge for Pakistan. The choice of antibiotic prescription has narrowed down to broader spectrum antimicrobials making it difficult to treat, leading to increased morbidity and mortality.

The psychological impact of COVID-19 on healthcare workers in Pakistan.

INTRODUCTION: The COVID-19 pandemic has challenged healthcare facilities and healthcare professionals' stamina and wellbeing. This study examines the psychological impact of COVID-19 on healthcare professionals. METHODS: This analytical cross-sectional study was conducted in July 2020 after institutional review board approval at a tertiary care institution in Lahore, Pakistan. A total of 175 healthcare workers participated following an online Depression, Anxiety and Stress Scale-21 (DASS-21) questionnaire invitation and 41 were excluded following pre-existing mental health conditions. Data was analysed using MS Excel and SPSS Amos 23. Chi-squared test and regression were applied for comparison and impact of confounding variables respectively (p<0.05 was considered significant). RESULTS: Out of 134, 66 (49%) were doctors, 24 (18%) were nurses and 44 (33%) were non-medical professionals. Ninety-five (70%) with age 21-30 years. Male to female ratio was 2:1. Overall mean depression score accounted for 6.89 ± 6.64; anxiety score was 7.28 ± 6.74 and stress score was 8.83 ± 6.93. Mild depression, anxiety and stress was noted in 21 (15.6%), eight (6%) and 27 (20.1%) healthcare workers, respectively. A statistically significant difference (p<0.05) was observed among healthcare workers for depression, anxiety and stress. CONCLUSION: This study demonstrated considerable impact of COVID-19 on mental health of healthcare workers. A well-structured targeted mental health support programme is needed urgently to support and reduce the long-term impact on healthcare workers' mental health and wellbeing.

Determining the Frequency of Acquired Cystic Kidney Disease in End Stage Renal Disease Patients on Hemodialysis at Dialysis Centre of Tertiary Care Hospital.

Objectives To determine the frequency of acquired cystic kidney disease (ACKD) among patients of end-stage renal disease. Methods This cross-sectional study was conducted at the University of Lahore Teaching Hospital after approval from the ethical review committee. About 150 patients with end-stage renal disease fulfilling the inclusion criteria and undergoing three hemodialysis sessions per week for six months were approached. The patients underwent ultrasonography by the same consultant radiologist and the presence of acquired polycystic kidney disease was noted in the proforma. Data was stratified for age, gender and duration of hemodialysis and the chi-square test was applied. Results The mean age of the study participants was 47.31±9.44 years and males were majority in number with 92 (61.3%). The acquired cystic kidney disease was noted in 20 (13%) participants. There was significant difference noted in different age groups as six (6.5%) patients in the 18-40 age group and 14 (24%) patients in the 40-80 age group have acquired kidney disease (p-value=0.002). No important association between ACKD, age, and gender were found. None of these patients had evidence of renal cell carcinoma, extrarenal cysts, retroperitoneal or intrarenal hemorrhage. Conclusion There was a significant correlation between acquired cystic kidney disease and the duration of hemodialysis, and the chances of the development of acquired cystic kidney disease rise progressively with increasing time on hemodialysis.

Frequency of Left Ventricular Hypertrophy Among Patients on Maintenance Hemodialysis by Voltage Criteria and Its Relationship with Biophysical-Chemical Parameters.

Background Among the dialysis population, left ventricular hypertrophy (LVH) is becoming a major cause of cardiovascular death, mainly due to myocardial infarction, heart failure, and arrhythmias. Electrocardiography (ECG) is a cheap and easily available test to detect the presence of left ventricular hypertrophy. The basic purpose of this study was to assess the frequency of left ventricular hypertrophy among the maintenance hemodialysis patients by applying different voltage criteria for the diagnosis of LVH and its relationship with various biophysical and biochemical parameters. Methods A total of 68 patients of end-stage renal disease (ESRD) were included in the study who were on maintenance hemodialysis at the dialysis center of Sughra Shafi Hospital. Baseline characteristics were recorded from the patients' data. Blood samples were drawn and electrocardiographs were taken, both before and after hemodialysis. Results Results showed variability in the detection of left ventricular hypertrophy in the pre- and post-dialysis period, as it was positive for 45%, 21%, and 17% in the pre-dialysis period versus 40%, 32%, and 25% in the post-dialysis period, when the Framingham, Sokolow-Lyon, and Cornell criteria were applied, respectively. The study showed a significant relationship between left ventricular hypertrophy with a high body mass index (BMI), hypertension, and pre- and post-dialysis hypomagnesemia (P <0.05). A significant association was also seen with low serum albumin levels over the past year. Conclusion According to this study, almost half of the dialysis patients were having left ventricle hypertrophy when Framingham criteria were applied. Good control of factors that are significantly associated with the occurrence of left ventricular hypertrophy can reduce morbidity and mortality among dialysis patients secondary to cardiovascular events. In this study, these factors included hypertension, hypomagnesemia, hypoalbuminemia, and high BMI.

Clinical Characteristics of 47 Death Cases With COVID-19: A Retrospective Study at a Tertiary Center in Lahore.

Introduction Coronavirus disease 2019 (COVID-19) presents with a wide spectrum of symptoms, ranging from patients being asymptomatic to having life-threatening acute respiratory distress syndrome (ARDS). COVID-19 emerged as a pandemic and has led to multiple causalities worldwide. A better understanding of the clinical characteristics of the COVID-19 patients and their disease course will aid in better management of these patients and hence may positively impact their outcomes as well. Methodology This was a retrospective observational study conducted from April 15, 2020, to August 31, 2020, after gaining institutional review board approval at the University of Lahore Teaching Hospital, Lahore, Pakistan. A total of 47 patients with severe disease who had died due to COVID-19 during this period were enrolled by the consecutive method. Patients were evaluated for their epidemiological, biochemical, clinical, and radiological features. The modified Radiographic Assessment of Lung Edema (mRALE) score was used to calculate the extent of alveolar opacities and percentages of lung involvement in chest radiographs. Furthermore, patients' management plans were also evaluated. Data were analyzed using SPSS Statistics version 23 (IBM, Armonk, NY). Results The mean age of the patients was 61.53 ±13.35 years. The male-to-female ratio was 2:1, and the mean BMI was 28.05 ±3.52 kg/m2. Diabetes was the most prevalent comorbidity among the patients (32, 68.1%), followed by hypertension (six, 12.8%), ischemic heart disease (five, 10.6%), and chronic kidney disease (four, 8.5%) respectively. The predominant symptom observed among patients was cough (95%), followed by shortness of breath (93%), fever (63%), sputum (23%), and gastrointestinal symptoms (6.4%). The mean D-dimer was 1,567.13 ±1,903.77 ng/mL, mean ferritin was 1,730.34 ±1,382.35 ng/mL, mean C-reactive protein (CRP) was 202.59 ±104.97 mg/dl, and the mean neutrophil-to-lymphocyte ratio was 10.50 ±9.58. Bilateral lung involvement was seen among 40 (85.11%) patients whereas unilateral right lung involvement was reported in three (6.38%) and unilateral left lung involvement in four (8.51%) respectively. The mean mRALE score for bilateral lung involvement was 18.78 ±4.89. The mean area radiologically involved in bilateral lung fields was 72.12 ±18.45%, followed by unilateral right lung involvement of 67.87 ±15.97%, and unilateral left lung involvement of 61.38 ±17.95% in the cohort respectively. The most common type of radiological pathology was diffuse ground-glass opacities, which was observed in 18 (38%) patients. Most patients received antibiotics (39, 63.83%), while nine (19%) received tocilizumab, four (8.5%) had antiviral therapy, and three (6.4%) were given plasma treatment. All patients received glucocorticoids and anticoagulation. The most common cause of death was ARDS, which was observed in 12 (25.5%) patients. Conclusion This study significantly demonstrated that most cases were males above 50 years of age with chronic medical comorbidities of diabetes, hypertension, and ischemic heart disease. COVID-19 has a predilection for multisystem involvement leading to mortality. In addition, elevated D-dimer and neutrophil-to-lymphocyte ratio may be indicative of a poor prognosis. A combination of antimicrobials had no positive impact on the outcomes in this cohort. It is difficult to predict the efficacy of tocilizumab and remdesivir as only a few patients in the cohort received these drugs.

An Unusual Presentation of a Patient with Leg Ulcers: A Case Report.

Leg ulcers have been a common presentation in clinics; disruptions in the mechanism of ulcer healing are vascular insufficiency, anemia, metabolic disturbances, neuropathy, and autoimmunity. The term 'non-transfusion-dependent thalassemia' encompasses the milder forms of thalassemia traits that require intermittent or no transfusion at all, and are mostly associated with leg ulcers. We present the case of a 19-year-old female with beta-thalassemia major who presented with non-healing leg ulcers and anemia. The clinical findings and lab evidence suggested hemolytic anemia evidenced by pathologic fractures, hepato-splenomegaly, and normal iron studies. Hemoglobin electrophoresis confirmed beta-thalassemia major with its complications including adrenal insufficiency and pathological fractures, all of which remained well compensated till the second decade of life.

Correlation Between Severity Of Portal Hypertensive Gastropathy And Size Of Oesophageal Varices In Cirrhotic Hepatitis-C Patients.

BACKGROUND: Portal hypertension can lead to oesophageal varices (EV) and portal hypertensive gastropathy (PHG). The aim of this study is to determine the relationship between severity of Portal hypertensive gastropathy and size of oesophageal varices. METHODS: One hundred and ninety-five patients of hepatitis C positive chronic liver disease having oesophageal varices were assessed for severity of portal hypertensive gastropathy. RESULTS: Mild Portal Hypertensive Gastropathy was observed in 16 (8.2 %), moderate in 54 (27.7 %) and severe in 120 (61.6 %) patients. Grade 1 Oesophageal Varices were present in 79 (40.5%) patients, grade 2 in 44 (21.9%) patients, grade 3 in 62 (31.8%) and grade 4 in 10 (5.2%) patients. No significant correlation was observed between grades of gastropathy and size of varices. CONCLUSIONS: The frequency of portal hypertensive gastropathy was 97.5% in Hepatitis C positive cirrhotic patients having oesophageal varices. Severity of gastropathy is not related to the grade or size of oesophageal varices.