Non-malignant lesions; clinico-pathological profile of nasal cavity and paranasal sinuses

The presence of a mass in the nasal cavity and paranasal sinuses may seem to be simple problem, but it is very difficult to differentiate clinically from potentially malignant tumors. To evaluate the clinical presentation and histopathological features of the non malignant lesions of nasal cavity and paranasal sinuses. Prospective descriptive study. Study was carried out in departments of Paediatrics and ENT at Ghulam Muhammad Mahar Medical College Hospital Sukkur from Jan 2009 to Dec 2012. The study included all cases of nonmalignant masses of nasal cavity and paranasal sinuses, those attended the Paediatric and ENT department and underwent the surgical intervention. One hundred twenty non-malignant cases were enrolled for this study. A separate pro-forma was filled to record the cases biodata, history, clinical examination, investigations and histopathological diagnosis. All histopathologically proven malignant masses were excluded from the study. Out of 120 cases 78 [65%] were males and 42 [35%] were females, with M:F ratio of 1.8:1. The age of presentation ranged from 8 years to 70 years and mean age was 26.3years. Sinonasal masses were found to be bilateral in 20 cases [16.67%], right sided in 65 [54.17%] and left sided in 35 [29.16%] cases. The main presenting symptoms were nasal blockage 110 [91.66%], nasal discharge 102 [85%], sneezing 60 [50%], hypoinsomnia 36 [30%], epistaxis 24 [20%], headache 20 [18.33%] and mouth breathing 18 [15%] cases. Polyp was the most common lesion in 86 [71.66%] cases observed in this study. The common histopathological diagnosis was simple inflammatory nasal polyp in 48 [40%], allergic nasal polyps 30 [25%] and fibroepithelial polyp in 8 [6.7%], inverted papilloma in 12 [10%], angiofibroma 6 [5%], capillary hemangioma 4 [3.34%] and rhinosporidiosis 4 [3.34%] cases. Sinonasal masses have various differential diagnoses and are still thought to be simple problem in our society. There is a need for early recognition and referral to ENT surgeon and need histopathological examination of every mass to confirm the diagnosis

Vitamin D levels in OPD patients in teaching hospital Sukkur

It is well established that low levels of 25 [OH] Vitamin D [<30 ng/dl] are a common finding world over, affecting over a billion of the global population. Aches and pains in joints and muscles are frequently seen in patients with Vitamin D deficiency and patients are misdiagnosed with other diseases. To determine the level of Vitamin D in patients attending outpatient department with aches and pains. Prospective and observational. This study was conducted at Orthopedic department of Ghulam Muhammad Mahar Medical College Hospital [GMMMCH], Sukkur from February 2011 to March 2012. All patients attending orthopaedic OPD of GMMMCH with aches and pains had their Vitamin D level done. They were divided in three diagnostic categories based on their serum 25 [OH] Vitamin D levels. Those with below 8 ng/dl were categorized to have severe deficiency, levels between 8-19ng/dl as moderate deficiency and levels of 20-29 ng/dl as mild deficiency. A total of 400 patients were studied. Minimum age was 15 years and maximum age was 75 years. Serum Vitamin D level was found low [<30 ng/dl] in [92%] patients. Their mean age was 44.3 +/- 18.3 years, with female to male ratio 4:1. Ten percent [10%] had severe, 60% moderate and 30% had mild deficiency. We observed high proportion of patients with aches and pains having low levels of Vitamin D. The specific cause [s] for this observed high prevalence of low 25 [OH] vitamin levels are not clear and need to be investigated further upon

Sensitivity and specificity of phenotypic and genotypic tests for detection of methicillin-resistant staphylococcus aureus in clinical isolates

Methicillin-resistant Staphylococcus aureus [S. aureus] [MRSA] is an important pathogen in hospitals and communities. There is advance in technologies but infections by MRSA are difficult to diagnose. The current study was conducted to compare three phenotypic methods for with a genotypic method. Cross-sectional study. Methicillin resistance was tested in 450 isolates of S. aureus retrieved from various clinical samples received in Dr. Ziauddin Laboratory Department of Molecular Genetics [DMG], Karachi from January to October 2011. Methods used were, oxacillin disc diffusion, oxacillin screen agar, cefoxitin disc diffusion and Polymerase Chain Reaction [PCR] for mecA gene, which was taken as the gold standard. The Kirby Bauer disc diffusion, using cefoxitin discs 30microg, identified a total of 174 [38.6%] S. aureus isolates as methicillin resistant. With oxacillin disk diffusion test, 152 [33.77%] strains were MRSA with sensitivity of 87.35% and specificity of 100%. Oxacillin-agar screen detected 168 [37.33%] strains with sensitivity of 96.5% and specificity of 100%. PCR method detected mec A gene in 169 [37.55%] isolates with sensitivity of 97.12%, specificity of 100%. The cefoxitin disc diffusion, as suggested by the Clinical and Laboratory Standards Institute [CLSI], is a consistent method for MRSA diagnosis but must be augmented with other methods like oxacillin screen agar, so that no MRSA is overlooked. PCR although taken as the gold standard cannot be recommended as routine because of the high cost and time consumption

Experience of malaria at tertiary care hospitals Sukkur

To determine Plasmodium species, clinical features, and hematological changes in Malaria. Prospective Descriptive Study. This study was carried out at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical college Hospital sukkur and chandka Medical Collage Larkan, from July 2007 to July 2011. This is prospective descriptive study, including 250 patients with fever and malaria confirmed on microscopy and immunochromatography, at both departments were included. After consent a separate pro- forma was filled for each patient to record demography and data about clinical presentation and laboratory investigations. Out of 250 malaria cases, the classical clinical presentation was found in 198 [79.2%] of patients while 52 [20.8%] had other symptoms. Males were in majority 164 [65.6%] and age range 1 year to 12 years. Splenomegaly was found in 135 [54%] and hepatomegaly in 86 [34.4%] of patients. Microscopy results of malaria patients revealed P. Falciparum in 97 [38.8%], P. Vivax 91 [36.4%] and 62 [24.8%] mixed infection of P. Falciparum and P. Vivax. Anemia was found in most of patients 84% [Hb <10g/dl]. Thrombocytopenia [platelets < 150,000/cmm] was found in 50 [20%] of patients. The classical presentation of Malaria was seen in majority of cases but one should be careful about atypical or very serious complicated clinical presentation of malaria, and early diagnosis of P. falciparum or mixed infection is very essential to save the life of young children

Significance of gram's stain in the diagnosis and management of lower respiratory tract infections

Respiratory tract infections are one of the leading causes of ill health worldwide. For the diagnosis of LRTI, expectorated sputum is the most commonly used specimen. To establish the importance and relationship of Gram's staining and positivity of sputum culture in lower respiratory tract infections. Experimental study. This study was carried out in the Dept. of Microbiology Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, from January 2001 to September 2001. Sputum sample of one hundred clinically suspected cases of lower respiratory tract infections attending OPD or admitted in the wards were included in the study. Early morning sputum samples were collected in sterile container. Gram's staining culture and sensitivity were carried out according to the standard methods. It was very interesting to note that a direct relationship exists between Gram's staining and positivity of culture. Number of pus cells seen per HPF was directly proportional to the isolated bacterial pathogen. <15 pus cells/ HPF had 13.2% cases positive for bacterial pathogen. Pus cells 15- 20/HPF had 54.5% cases positive for bacterial pathogen and specimens in which there were >20 pus cells/ HPF, 90% cases were positive for bacterial pathogens. Gram's staining is a simple and cost effective method that could provide a basis for culture positivity of the specimen. Higher the number of pus cells in sputum sample greater was the culture positivity. Based on Grams staining results it would be possible to start empiric therapy and alter the therapy after the sensitivity of isolates if needed

Cutaneous leishmaniasis in Karachi

Cutaneous leishmaniasis [CL] is an infection caused by a protozoan parasite of the genus Leishmania, which is endemic in various parts of Sindh and Baloachistan and is widely spreading day by day. To know the frequency of Cutaneous Leishmaniasis in the dermatology OPD and ward of JPMC, Hospital, Karachi. These patients were sent to microbiology Department, Basic Medical Centre, Karachi, for observing Amastigotes [LD Bodies] by microscopy to diagnose the cases. Experimental study. This study was carried out in the Department of Microbiology at BMSI, JPMC, Karachi, from November 2003 to April 2004. The suspected cases of Cutaneous Leishmaniasis on clinical ground were sent by the dermatology OPD and ward of JPMC, Hospital, wounds were cleaned by the alcohol [spirit] swab. The smear prepared from the skin ulcer tissues were stained Field Stain A and B for microscopy for confirm the diagnosis by detecting Amastigotes [LD Bodies]. The total of 67 suspected patients with skin lesions were examined and 42 were found to be suffering from CL, on the basis of observing Amastigotes [LD Bodies] by microscopy. Their ages ranges from 2 years to 58 years. Among these cases 29 [69.04%] were males and 13 [30.96%] were females. Multiples lesions were seen in 16 [38.10%] cases only. Size of lesion varies from 1-10cms. Body distribution were 16 [38.10%] on upper limbs, 13 [30.95%] on lower limbs, followed by 2 [4.76%] head, 3 [7.15%] neck, 4 [9.53] face and 2 [4.765] nose, 1[2.38%] trunk and abdomen 1 [2.38%]. Morphological patterns seen were crusted plaques, non-healing ulcers, erythematous infiltrated nodules and papules. From above morphological forms 25 [59.14%] were wet type of lesions and 17 [42.86%] were dry type of lesions Majority of the cases were from the rural area 32 [76.19%] as compared to 10 [23.81%] urban area of the city. Cutaneous leishmaniasis is endemic and increasing in Karachi and its surrounding area

Profile of enteric fever in children at tertiary care Hospital Sukkur Pakistan

Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To study the clinical profile and complication of enteric fever in children. Prospective descriptive study. This study was conducted at the Paediatric Department at Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2010 to December 2011. This was a prospective study, included all patients of enteric fever, of both sex and age ranged from 1 year to 13 years. All cases of enteric fever were confirmed by serological test Typhidot IgM or IgM and IgG positive. A total of 360 patients of enteric fever were studied during 2 years. Mean age of presentation was 7.47 years and 166 [46.12%] patients were < 5 years whereas 194 [53.88%] were > 5years of age. Male: Female ratio was 2:1. Clinical profile of patients shows, that fever was present in all cases, vomiting 180 [50%], anorexia 180 [50%], headache 126 [35%], abdominal pain 108 [30%], diarrhea 108 [30%], weakness 102 [28.33%], cough 90 [25%], constipation 36 [10%] cases, and coated tongue was found in 275 [75%], tender abdomen 140 [38.88%], hepatomegaly 90 [25.0%], splenomegaly 76 [21.11%], toxic appearance 72 [20.0%], dehydration 70 [19.44%], pallor 54 [15%] and relative bradycardia 12 [3.33%] of cases. Complications were found in 88 [24.44%] of cases, raised ALT in 66 [18.3%] jaundice 6 [1.66%], intestinal hemorrhage in 4 [1.11%], peritonitis and osteomyelitis 3 [0.83%] respectively. Common clinical features of enteric fever include fever, vomiting, anorexia, abdominal pain, headache, coated tongue, anemia, hepatomegaly and elevated liver enzymes. Diarrhea is more common in children < 5 years. Complication due to late diagnosis and drug resistance will persist in our part of country

experience of thrombocytopenia in children at Tertiary Care Hospitals Sukkur and Larkana

Thrombocytopenia is the most common cause of bleeding in children. Patients with thrombocytopenia may experience petechiae, epistaxis, gum bleeding, hematuria or gastrointestinal hemorrhage or intracranial bleeding, seizures and unconsciousness. To determine the various causes, and clinical features of thrombocytopenia in children. Prospective descriptive study. This study was conducted at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical College Hospital Sukkur and Chandka Medical College Hospital Larkana, from July 2009 to July 2011. This was a prospective descriptive study, include 200 patients1 to 12 year of age, presenting with fever, mucocutaneous bleeding and thrombocytopenia on peripheral smear at both departments. After consent a separate pro-forma was filled for each patient to record demography and data about various causes, clinical presentation and laboratory investigations. Out of 200 thrombocytopenic patients 128 [64%] were males and 72 [36%] females, majority in age group of under 10 years 154 [77%]. The most common cause was the malaria in 50% of cases, followed by ITP 20 [10%], aplastic anemia and thalassemia [hypersplenism] in 7.5% respectively. Dengue fever and Typhoid fever was [5%] of cases. The other minor causes were severe malnutrition, acute leukemia, hemolytic uraemic syndrome 2.5% each. The most common clinical presentation was petechiae and echymosis in 92 [46%], followed by epistaxis and gum bleeding 68 [34%] of cases, subconjuctival hemorrhage in [14%] and hematuria in [08%] of cases. Unconsciousness was present in [9%] of cases. Anemia was found in most of patients [71%]. Splenomegaly was present in 79 [39.5%] and hepatomegaly in 59 [29.5%] of patients. Platelets were less than 50,000/cmm in majority [60%] of patients. The common cause of thrombocytopenia in febrile children was malaria, followed by ITP, Aplastic anemia and thalassemia [hypersplenism], Dengue hemorrhagic fever and enteric fever was less common. The other minor causes were severe malnutrition, acute leukemia, hemolytic uremic syndrome and lymphoma

Transfusion transmitted infections [TTIS] among blood donors of Sukkur

To estimate an approximate disease burden of HIV, HBV, HCV, and Syphilis in healthy blood donors. Blood transfusion department not only screen transmitted infections but also give clue about the prevalence of these infections in healthy population. The objective of this study was to estimate an approximate disease burden of HIV, HBV, HCV, and Syphilis in healthy blood donors, so as to determine how well we are doing in fight against these killers. As most of these healthy blood donors are first time donors aged 18-60 years, the results can also be utilized to estimate the prevalence in healthy population of this age group. Retrospective Study. This study was conducted in blood Bank of Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2008 to December 2010. All healthy blood donors reporting to the blood bank in the specified study period were screened for HIV, Hepatitis B, C and Syphilis. A total of 7085 were screened, out of these 364 donors [5.14%] were seropositive for hepatitis C, 268 [3.78%] were seropositive for hepatitis B, 36 [0.5%] were seropositive for Syphilis and only 4 [0.05%] had shown seropositivity for HIV. Transfusion transmitted infections are a major threat associated with unscreened blood donations. In Pakistan the prevalence of hepatitis B and C is very high in occult form. Selection of healthy blood donors and public awareness programs targeting local community will be an important measure to stop its transmission through blood transfusion

Etiological aspects of penicillin-failure in the treatment of tonsillitis and pharyngitis caused by group A, beta-hemolytic streptococci [GABHS]

To observe and study the cause of penicillin-failure and to see the therapeutic effects of other drugs and find out more effective and better remedy. A Retrospective study. This study was conducted in Microbiology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, National institute of Child Health from April 2004 - June 2005. A total of 300 children attending OPD's and admitted [250 suspected and 50 Normal as control cases] of age group 5 - 15 years were included in this study. Drug sensitivity pattern of streptococcus pyogenes isolated in infected and control children was observed. Antibiotic discs used were Penicillin [10] units and Erythromycin [15 micrograms]. The organism isolated GABHS shows 100% sensitivity to penicillin, while in case of erythromycin, it was sensitive in 24[85.7%] infected cases and resistant to 4[14.3%] cases. Pharyngotonsillitis is a disease of poor community, the therapy with penicillin is economical compared with Cephalosporin group. Penicillin therapy is helpful in preventing the supporative and n supporative complications caused by GABHs

Frequency of HBs Ag and anti-HCV in trauma patients

This study was carried out to determine the frequency of Hepatitis B and C Viral infection in patients undergoing emergency surgical operations after trauma, and to evaluate the associated risk factors. Descriptive Study. This study was conducted at General Surgical, Orthopaedic and Paediatric Surgery Department of Ghulam Muhammad Mahar Medical College Hospital Sukkur from May-2011 to April-2012. All the patients who were admitted in the Surgical and orthopaedic department for emergency surgical operations followed by trauma were included in the study. The patients were screened for HBsAg and Anti-HCV using immunochromatography [ICT] method. Those who were weak positive by ICT were further confirmed by Enzyme Linked Immunosorbent Assay [ELISA]. 592 patients were admitted in Surgical and orthopaedic department during a period of last one year for emergency operations after trauma and were screened for HBsAg and Anti-HCV. Out of these 592 patients 472 [79.7%] were males and 120 [20.27%] were females. Mean age of these patients was 40 years. After screening, 33 [5.57%] patients were found HBsAg positive and 117 [19.76%] were Anti-HCV positive, while 09 [1.5%] were positive for both. Hepatitis-B was found in 21 [2.3%] males and 12 [1.3%] females, while Hepatitis-C was predominantly found in 68 [7.44%] males and 49 [5.36%] female patients. Parenteral injections by Quacks, previous surgery, blood transfusion and shaving by barbers were found to be the risk factors. High frequency of HBs Ag and Anti-HCV was found in trauma patients undergoing emergency surgery. Our message is that "Prevention is better than cure". So it is essential to prevent the spread of Hepatitis B and C by screening every patient before surgery and counseling of patients

Treatment outcome of enteric fever in children at tertiary care hospital Sukkur Pakistan

Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To evaluate the treatment outcome of enteric fever in children. Retrospective descriptive study. This study was conducted at the Paediatric department, Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2009 to December 2011. This was a retrospective study, included all patients of enteric fever, of both sex and age ranged from 6m to 13 years. All enteric patients were confirmed by serological test Typhidot IgM or IgM and IgG positive. The data was collected from case record for demography and treatment outcome. A total of 360 patients were diagnosed to have enteric fever during this period. Mean age of presentation was 6.47 years and 166 [46.12%] patients were <5 years whereas 194 [53.88%] were > 5 years of age. Male: Female ratio was 2:1. Serological test typhidot IgM was positive in 290 [80.5%] and both [IgM + IgG] were positive in 70 [19.45%] of cases. Raised ALT was seen in 90[25%] of cases. Complications were seen in 52 [14.4%] of cases, hepatitis 10 [2.77%], hepatic abscess 3 [0.83%] intestinal hemorrhage 8 [2.22%], peritonitis 4 [1.11%] intestinal perforation 4 [1.11%], cholecystitis 6 [1.66%], paralytic ileus 3 [0.83%] enteric encephalopathy 3 [0.83%], meningitis 1 [0.27%]. Two patients expired [0.55%], one was enteric encephalopathy and other intestinal perforation with peritonitis. enteric fever remains a major cause of morbidity and mortality in our part of country. Major complications found in our cases were hepatitis, hepatic abscess, intestinal hemorrhage, intestinal perforation, peritonitis, cholecystitis, enteric encephalopathy, meningitis, osteomyelitis, septic arthritis

Glucose-6-phosphate dehydrogenase [G6PD] deficiency in neonates presenting with jaundice at tertiary care hospital Sukkur

Glucose-6-phosphate dehydrogenase [G6PD] deficiency is the most important disease of the hexose monophosphate pathway. G6PD is an X-linked recessive enzymopathy that is a well-know cause of hyperbilirubinemia that may be severe enough to cause kernicterus, or death in neonates. Early detection of this enzymopathy and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia. This emphasizes the necessity of neonatal screening of G6PD deficiency. To detect the frequency of glucose-6-phosphate dhydrogenase [G6PD[deficiency in neonates presenting with Jaundice. Retrospective study. This study was conducted at Paediatric department of Ghulam Muhammad Mahar Medical College Hospital [GMMMCH], Sukkur from March 2011 to June 2012. This retrospective study was conducted in paediatric department of GMMMCH, Sukkur from March 2011 to June 2012. Two hundred forty cases of neonatal Jaundice of both sexes admitted to hospital were enrolled in the study. Detailed history and clinical examination was recorded. Al the neonates were subjected to be estimation of serum bilirubin [Total, Direct and Indirect] and G6PD qualitative detection. Out of 240 icteric neonates, 192 [80%] were males and 48 [20%] were females. Twenty nine [12.1%] neonates were found to be G6PD deficient. The age of presentation of G6PD deficient neonates was between 2[nd] to 4[th] day of life. In G6PD deficient patients, male to female ratio was 8.7:1. Serum total bilirubin level of 10-40 mg/dl was found in these G6PD deficient neonates. G6PD deficiency is quite high in neonates presenting with Jaundice. The diagnosis is simple and if left undetected may cause serious consequences in situations of oxidant stress

Serum zinc level in patients with liver cirrhosis

To determine the serum zinc level in patients with liver cirrhosis. This descriptive cross sectional study was conducted at Liaquat University Hospital Hyderabad Sindh, Pakistan. All patients above 12 years of age, of either gender and known [diagnosed] cases of liver cirrhosis were further evaluated for their serum zinc level. The data was analyzed in statistical software [SPSS] and the p value <0.05 was considered as statistically significant. One hundred twenty seven cirrhotic patients with means age 42.7559 +/- 15.8894 were evaluated and assessed. The serum zinc was low in 69% patients. According to Child-Pugh classification 72% zinc deficient cirrhotic subjects were in class C, 16% in class B and 12% in class A. 94% subjects had hepatitis C virus infection, 4% had hepatitis B virus infection and 2% had history of alcoholism. The serum zinc level was low in patients with liver cirrhosis