Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey

Background: Pakistan lacks data on the prevalence of risk factors for common noncommunicable diseases [NCDs]. Objectives: This study aimed to determine the prevalence of risk factors for NCDs among a population-based sample in Punjab and Sindh provinces, Pakistan. Methods: This study was conducted in 2013–2014. The NCD risk factors examined were: current daily smoking, eating fewer than 5 servings of fruits/vegetable a day, low physical activity, overweight and obesity. A total of 7 710 households were selected and 1 adult was enrolled from each household. Data were collected using the WHO STEPS instrument [Step 1 and 2], and analysed according to the STEPS statistical plan. Results: The prevalence of tobacco use was 19.7%. The majority of the respondents [96.5%] consumed fewer than 5 servings of fruits/vegetables a day, 41.5% had a low level of physical activity, 26.3% were overweight and 14.9% were obese. The prevalence of stage I and stage II hypertension, including those on medication, was 37% and 15.9% respectively. The prevalence of NCD risk factors differed significantly by sex and occupation [P = 0.0001] but not by age group [P = 0.118], level of education [P = 0.668] and province [P = 0.056]. Only 0.6% of the sample had none of the 5 NCD risk factors while 40% had 3–5. Conclusion: The high prevalence of NCD risk factors in Punjab and Sindh provinces is of concern. Urgent public health interventions are needed to reduce them, especially in youth and young adults

Impact of age at diagnosis on clinicopathological outcomes of oral squamous cell carcinoma patients in Karachi

Objective: A recent trend in diagnosis of oral cancer in young age is observed, however its impact on various clinicopathological parameters needs to be explored. The aim of the current study was to compare and analyze impact of age at diagnosis with clinicopathological parameters of oral squamous cell carcinoma patients

Methods: In this cross sectional study conducted at Department of Oncology Ziauddin Hospital Karachi, we included histologically confirmed cases of oral squamous cell carcinoma. The patients were categorized as young age group [40yrs and younger] and old age group [41 yrs and above]. A total of 115 patients diagnosed between 2013 and 2016 were enrolled in the study. The variables considered were age at diagnosis, sex, site of lesion, positive family history, tumor grade, stage, uric acid level and survival

Results: A statistically significant difference was observed between two age groups in overall survival, uric acid level and positive family history of cancer. No significant difference was observed in tumor location, grade and stage

Conclusion: Majority of oral cancer patients present at an advanced stage irrespective of age at diagnosis but young age has an overall improved survival. Moreover, a positive family history of cancer in young age group mandates further exploration of possible role of genetic polymorphisms which might be responsible for early onset of the disease

Use of performance enhancing drugs, their effects and types used by the students of faisalabad medical university

Objectives: To find out the percentage of students from Faisalabad Medical University that are currently using Performance enhancing drugs, to find out the types of Performance enhancing drugs that are currently being used by the students and to find out the effects of these performance enhancing drugs on the health of the students

Study Design: Cross sectional study

Setting: 25 students each from 2nd year, 3rd year, 4th year and 5th year studying at Faisalabad Medical University were included in the study

Study Period: January, 2015 to June, 2015

Materials and methods: A total of one hundred medical students were anonymously given a 10-item questionnaire. 25 students each from 2nd year, 3rd year, 4th year and 5th year were involved in the study. The team randomly distributed the questionnaire among the students on alternative days. The completed questionnaire was sealed in envelopes and analyzed

Results: The age of the students completing the Performa ranged from 19-25 years. In the male population the highest use of PEDS was observed in the age group of 22 years, while the lowest use of PEDS was observed in the age group of 19 years. The highest percentage of females that used PEDS was observed in the age group of 22 years as well similar to the male ratio of PEDS use at the high level. The lowest use of PEDS was observed at the age group of 19 and 25 which was 5 % in both age groups

Conclusion: The results indicated that PEDS were used by the male students in a higher percentage as compared to the female students. The Caffeinated energy drinks were used more commonly. The results of this strategic survey have provided for the first-time valuable information about the use of PEDS by students of FMU to achieve desirable effects. It demonstrates that the use of PEDS in the students was high as compared to expected results; especially higher in those male students involved in sports or gym activities specifically bodybuilding athletes

Anaphylactic reaction from atracurium

For induction of anaesthesia many agents are administered intravenously, anaphylactic reaction can occur to any of these agents

Neuromuscular blocking agents are most commonly implicated as the cause of anaphylactic reaction in anaesthesia practice

Amino-steroids, benzylisoquinoliniums and suxamethonium are being commonly used for intubation and perioperative muscle relaxation. We are presenting a case of anaphylactic reaction to benzylisoquinolinium i.e. atracurium in a young patient. The patient was revived with a prompt diagnosis and treatment

Type and frequency of mutations in katg and rpob genes in multi-drug resistant strains of mycobacterium tuberculosis complex.

Background: Tuberculosis remains a major cause of morbidity and mortality in several parts of world. Genetic basis and mutations in katG and rpoB genes are responsible for isoniazid and rifampicin resistance in most of the cases of Mycobacterium tuberculosis

Objectives: To determine the mutations in katG and rpoB genes in confirmed multi-drug resistant tuberculosis isolates and to find the frequency of mutations Study design, settings and duration: This descriptive study was undertaken in PHRC TB research Centre, Department of Pulmonology, KEMU/Mayo Hospital Lahore. Polymerase chain reaction and genotyping was done at Institute of Molecular Biology and Biotechnology [IMBB], University of Lahore, Lahore from June 2013 to July 2014

Patients and Methods: A total of 100 acid-fast bacilli smear positive specimens of MDR TB suspects and rifampicin resistant on GeneXpert were collected. Drug susceptibility of isoniazid and rifampicin was carried out by standard drug proportion method. Gene amplification and sequencing was done to detect mutations in katG and rpoB genes

Results: A total of the 53% were females and 47% males with male to female ratio of 1:1.1. Mutations in rpoB Gene were found to be 98% of rifampicin resistant cases and in katG 76.7% of isoniazid resistant cases. Most of the mutations [60%] in rpoB Gene were observed on codon 531 while all the mutations in katG Gene were observed on codon 315. No novel mutation was found in this study

Conclusion: Mutation pattern of rpoB gene that confers rifampicin resistance is different to a little extent from other national and international studies while pattern is same for katG gene that confers isoniazid resistance. No novel mutation was observed in present study

Assessment of attitude, an insight from hepatitis patients and their relatives/ attendants of Islamabad, Pakistan

Background: Pakistan is the 2[nd] highest hepatitis C prevalent country while hepatitis B endemnicity is intermediate. Population has poor knowledge and understanding of these diseases therefore they face different types of stigmas. Stigmatization leads to barriers in the access of prevention and care of this disease. This study was conducted to evaluate the feelings and experiences of patients and their attendants [relatives] about hepatitis B and C and identify the gaps to ease access to treatment and care

Study design, settings and duration: Qualitative study conducted in Pakistan Institute of Medical Sciences and Federal Government Services Hospital, Islamabad for 08 months

Patients and Methods: Patients suffering from hepatitis B and C and their relatives who came to the OPDs of PIMS and Polyclinic were selected from the study. After taking consent from these 2 hospitals and consent from participants, the patients and relatives were grouped into 4 groups each comprising of 5-8 participants. Four focus group discussions [FGD's] were conducted for these patients and their attendants separately. Structured FGD guide was developed and special probes were used to stimulate discussion

Results: There were 06 participants in each of patient group and 07 subjects in relative groups. Among patients, majority had negative perceptions about disease and related the disease with fear. They had misconceptions about disease spread. Most of them experienced change in the attitude of family members, relatives and friends especially in sharing clothes, shoes, and utensils. Break up of relationships and discrimination in getting a job due to the disease was also reported resulting in social and financial problems. The attendants also had negative perception about the disease and its mode of transmission. Although they were cautious about the sharing of utensils and during patient care but they had positive feeling for their patient

Conclusion: Due to misconception about disease spread, the attendants/relatives were not sharing items of daily use items like cloths, crockery and bed linen with the patients thus giving them a feeling of dejection. Proper information about disease spread and its prevention along with the counseling of the patients and their attendants/relatives may build a positive relationship between them and thus ease help and care which is required for these patients

Policy message: There is need of public awareness about mode of transmission of hepatitis B and C and its preventive measures

Risk factors for thoracic surgery

Thoracic anesthesia for non-cardiac surgery has become a subspecialty and has its own challenges of being proficient in new surgical techniques and equipment in the clinical practice. Risk factors for thoracic surgery numerous, and include generally poor health of the patient, obesity, smoking, alcohol abuse, tumors pressing airways or great vessels of chest and pneumonectomy. Intraoperatively requirements of lateral position, one lung anesthesia and expected hemorrhage are the main risk factors. Postoperatively, infection, hemorrhage, risk of pulmonary embolism, tension pneumothorax and blow out of stump may adversely affect the outcome. Good selection and preparation of patients for thoracic surgery is very important to avoid high morbidity and mortality. Main aim of a good thoracic anesthesia plan is to avoid hypoxia and cardiovascular morbidity in the perioperative period

Radiation dose-rate reduction pattern in well-differentiated thyroid cancer treated with I[-131]

To determine the patterns of dose rate reduction in single and multiple radioiodine [I[-131]] therapies in cases of well differentiated thyroid cancer patients. Analytical series. Department of Nuclear Medicine and Radiation Physics, Multan Institute of Nuclear Medicine and Radiotherapy [MINAR], Multan, Pakistan, from December 2006 to December 2013. Ninety three patients [167 therapies] with well differentiated thyroid cancer treated with different doses of I[-131] as an in-patient were inducted. Fifty four patients were given only single I[-131] therapy dose ranging from 70 mCi [2590 MBq] to 150 mCi [5550 MBq]. Thirty nine patients were treated with multiple I[-131] radioisotope therapy doses ranging from 80 mCi [2960 MBq] to 250 mCi [9250 MBq]. T-test was applied on the sample data showed statistically significant difference between the two groups with p-value [p < 0.01] less than 0.05 taken as significant. There were 68 females and 25 males with an age range of 15 to 80 years. Mean age of the patients were 36 years. Among the 93 cases of first time Radio Active Iodine [RAI] therapy, 59 cases [63%] were discharged after 48 hours. Among 39 patients who received RAI therapy second time or more, most were discharged earlier after achieving acceptable discharge dose rate i.e 25 microSv/hour; 2 out of 39 [5%] were discharged after 48 hours. In 58% patients, given single I[-131] therapy dose, majority of these were discharged after 48 hours without any major complications. For well differentiated thyroid cancer patients, rapid dose rate reduction is seen in patients receiving second or subsequent radioiodine [RAI] therapy, as compared to first time receiving RAI therapy

In vitro interaction of antimicrobial agents in combination with plant extract against multidrug-resistant bacterial strains

Aims: To evaluate the possible in vitro interaction between methanolic extract of root of Adiantumcapillus-veneris and certain known antimicrobial drugs i.e. Oxacillin, Ceftazimide, Cefriaxone, Ofloxacin, Meropenem, Erythromycin, Cefuroxime, Cefoxitin, Cefotaxime and Ampicillin. Methodology and results: The study was carried out against ten bacterial strains (Staphylococcus aureus, S. epidermidis, Salmonella typhi, Klebsiella pneumoniea, Shigella dysentriea, Proteus vulgaris, Pseudomonas aeruginosa, Providencia species, Citrobacter freundii and Escherichia coli isolated from urine, pus and blood samples. Both disc diffusion and well diffusion methods were used to determine antimicrobial activity of plant extract in combination with antibiotics. Antimicrobial sensitivity showed that Meropenem was the most effective antibiotic with zone of inhibition (ZI) of 25-33 mm among all tested antibiotics followed by Ofloxacin (10-26.5 mm), Ceftriaxone (8-20 mm), while Oxacillin showed no activity against almost all bacterial strains. The study showed that most bacterial strains were resistant to most of the antibiotics used, ranging from 20-60%. The methanolic extract (mEXT) of A. capillus-veneris used alone was active against most of the bacterial isolates with maximum activity against E. coli with 16 mm ZI. The study also indicated that there was an increased activity in case of combination of mEXT with antibiotics. The combined effects of plant extract with antibiotics were synergistic against most of the bacterial strains. The mEXT showed maximum synergistic effect with Ceftazimide with ZI of 42 mm followed by Meropenem (40 mm) and Ceftriaxone (28 mm) against multidrug-resistant (MDR) bacterial strains. Conclusion, significance and impact of study: The data suggests that plant extract could be used as alternative to antibiotics. These results give scientific backing that combination between plant extract and antibiotics would be useful in fighting the emerging drug-resistant bacterial pathogens.

Evaluation of laryngoscopes decontamination practices in different hospitals

To find disinfection and sterilization practices of laryngoscope in different hospitals. Descriptive study. Combined Military Hospital Gujranwala, from Jan 2010 to Jan 2011. laryngoscope decontamination practices in different hospitals were evaluated in this study which was based on a telephonic structured questionnaires. Preset questions were asked on phone from operation room technicians of 50 different hospitals. For clarification and confirmation of procedure anesthesiologist of the hospital was contacted. Laryngoscope decontamination practices were asked as per questionnaire and data collected was recorded and analyzed. Results were documented and compared with studies regarding laryngoscope decontamination practices of different countries. Most exercised methods were manual decontamination with simple gauze [50%], alcohol gauze [11%] or tap water [27%]. The use of disposable blades and sheathing of blades was not practiced by any of the hospitals. Similarly chemical disinfectants were used rarely [2%]. Rinsing laryngoscopes with water [always 27%, sometime 23%] was very common while, autoclaving or sheathing of blades was not done in any of the hospital. The rate of different postoperative infections is on the increase in our hospitals and one likely contributing source in contaminated laryngoscopes. Lack of awareness and poor practices among health care professionals, over work and economic constraints are the major contributing factors which need to be controlled by adhering to international standards

Preoperative administration effect of metronidazole, ceftriaxone sodium and their combination on stenotic index of jejunal anastomotic segment of dogs / 대한수의학회지

The jejunum is the longest part of the small intestine and its lumen is mainly involved in the absorption of the nutrients. The present study was conducted to evaluate the effects of metronidazole, ceftriaxoine sodium and their combination on the stenotic index of the end to end jujunal anastomotic site. To accomplish this, 20 healthy stray dogs were subjected to end to end jejunal ansastmosis. Dogs in Group A (control) underwent jejunal anstomosis with no antibiotic prophylaxis, while those in Group B received surgery and metronidazole alone at 50 mg/kg, those in Group C received ceftriaxone sodium intravenously at 30 mg/kg body weight prior to surgery and dogs in Group D were given metronidazole in combination with ceftriaxone sodium at 50 mg/kg and 30 mg/kg, respectively, 2 h before surgical intervention. No significant difference (p > 0.05) in the stenotic index was observed at 14 days after jejunal anastomosis. These findings indicate that prophylactic administration of metronidazole and ceftriaxone sodium alone or in combination had no significant effect on the stenotic index of the jejunum.

Pollution Based Study of Heavy Metals in Medicinal plants Aloe vera and Tamarix aphylla.

The main objective of this study was to generate perception in community regarding pollution of heavy metals contained in Aloe vera and Tamarix aphylla plants which have wide range of medicinal use but having toxic concentration of heavy metals. The plant samples were collected at three different areas referred as spots i.e. polluted (spot 1), less polluted (spot 2) and non- polluted (spot 3) from District Kohat, Khyber Pakhtunkhwa, Pakistan. In the present study, essential heavy metals such as Cobalt (Co), Nickel (Ni), Chromium (Cr), Copper (Cu), Iron (Fe) and Zinc (Zn) and non-essential heavy metals Cadmium (Cd), Lead (Pb) were analyzed in Aloe vera leaves and Tamarix aphylla by using Flame atomic absorption spectrophotometer. Heavy metals concentration in different spots were found to be in order as Spot 1> Spot 2>Spot 3 with the concentration range of found heavy metals., Cd 0.25-0.51 mg/kg, Pb BDL-15.23, Co 1.90-3.31mg/kg, Ni 2.98-4.01 mg/kg, Cr 4.86- 6.01 mg/kg, Cu 2.32-3.01 mg/kg, Fe 12.42-22.47 mg/kg, Zn 34.53-53.08 mg/kg for Aloe vera leaves and concentrations of the same heavy metals like Cd 0.13-0.31 mg/kg, Pb 1.00-18.01 mg/kg, Co 0.25-2.90 mg/kg , Ni 3.75-5.93 mg/kg , Cr 3.83-5.32 mg/kg , Cu 1.01-1.90 mg/kg, Fe 23.65-30.10 mg/kg , Zn 13.70-25.63 mg/kg were observed in the bark of Tamarix aphylla. Thus it was concluded from the present study that the samples collected from polluted area were found more contaminated with heavy metals as compared to less polluted and nonpolluted area.

Vitamin d levels among pregnant and lactating women

To assess the serum level of vitamin D in pregnant and lactating women. Case-control study. Gynaecological Unit 1 of Jinnah Hospital, Lahore, from December 2010 to May 2011. A total of 100 women comprised of three groups: pregnant [n = 40], lactating [n = 40] and control [n = 20] groups. The information regarding age, educational level, socioeconomic status, exposure to sunlight and dietary vitamin D intake were collected through self-structured questionnaire. Serum concentration of vitamin D was measured by ELISA and serum calcium and phosphate levels were measured by chemistry analyzer. Statistical analysis was done using SPSS [version 13]. The values were considered significant at 0.05 level of significance. The mean serum vitamin D level in the pregnant and lactating mothers was 26.5 +/- 17.1 nmol/L and 21.4 +/- 16.3 nmol/L respectively and in control group was 33.8 +/- 21.1 nmol/L. The mean calcium level in the pregnant, lactating and control group was 10.3 +/- 1.2 mg/dL, 9.7 +/- 1.3 mg/dL and 9.7 +/- 1.3 mg/dL respectively. The mean phosphate in pregnant was 3.2 +/- 0.76 mg/dl, in lactating was 3.3 +/- 0.76 mg/dl and in control was 3.5 +/- 0.92 mg/dl. Significant difference [p = 0.041 and p = 0.037 respectively] in the serum levels of vitamin D and calcium was observed among the pregnant and lactating women as compared to control group. Low serum vitamin D concentration was observed in lactating women and pregnant women as compared to control group.

Captain of all these men of death - tuberculosis remains the commonest diagnosis - two years experience of bronchoscopy at Shaikh Zayed hospital, Lahore

A retrospective study of two years duration was conducted at the department of Pulmonology, Shaikh Zayed Hospital, Lahore, Pakistan to review our experience with bronchoscopy. Data was collected from145 patients who underwent bronchoscopy for different diagnostic and therapeutic indications. The study participants were having ages between 13 and 93 years. There were 85 male and 60 female patients. Bronchoscopy was performed for diagnostic purposes in 124 [85%] patients, for therapeutic purposes in 9 [6%] patients and for surveillance of airways in 13 [9%] patients. Bronchoscopy remained diagnostic in 74.19% patients. Tuberculosis was the commonest diagnosis in 34.6% patients followed by malignancy which was diagnosed in 16.1% patients. In 82% patients there was no complication during procedure, while mild haemoptysis occurred in 11.72%, 5.5% had wheezing [bronchospasm], 4.1% developed low grade fever and 1 patient died due to respiratory failure. It was concluded that bronchoscopy is found to be a useful procedure and can be used safely for diagnoses and treatment of different respiratory diseases

diagnosis of exclusion: idiopathic pulmonary arterial hypertension presenting as intractable shortness of breath - a case report and review of the subject

A 35 year old house wife was evaluated for gradual onset and progressively worsening dyspnea. She had normal vitals, but raised JVP, loud P2, normal vesicular breathing in chest and normal systemic examination. Her chest radiograph showed cardiomegaly and echocardiography was consistent with severe pulmonary hypertension of non cardiac origin. Extensive investigations to find any cardiovascular, respiratory or systemic disorders were negative ruling out an underlying cause of occult pulmonary hypertension and she was finally diagnosed as having idiopathic pulmonary hypertension [IPAH]. She responded well to treatment with pulmonary vasodilator drugs and was advised regular follow ups in pulmonary out patients department

DFT for exploring the antioxidant potential of homogentisic and orsellinic acids

In recent years, much attention has been focused on the antioxidant potential of different phenolic acids. But still no theoretical investigation is reported on the antioxidant potential of Homogentisic and Orsellinic acids. In this study, computational investigation based on the density functional theory [DFT] has been carried out to understand the antioxidant potential of Homogentisic and Orsellinic acids. The bond dissociation enthalpy [BDE] of O-H, spin densities and electronic properties such as dipole moment, ionization potential, electron affinity, HOMO and LUMO energies, electronegativity, electrophilic index, energy gap, softness and hardness have been calculated. These properties show that both phenolic acids are good antioxidants. Comparison of BDE of Homogentisic and Orsellinic acids with many other phenolic acids also indicate the good antioxidant potential of these compounds. Homogentisic acid has very high antioxidant potential due to the presence of semiquinone structure. This study will be helpful for the better utilization of these compounds in pharmaceutical and food industry

Frequency of coronary heart disease risk factors among nurses

To find out frequency of various risk factors for coronary heart diseases in nurses. This was a cross-sectional study. Nurses working in three shifts at Lady Reading Hospital, Khyber Teaching Hospital, Nursing school of Lady Reading Hospital Peshawar, were included in the study. All participants were interviewed in detail including their family history, past medical history, smoking and dietary history. Pulse, blood pressure, body mass index [BMI] and waist: hip ratio was determined. Their random blood sugar and total cholesterol was checked. Data was analyzed for cardiovascular risk factors using SPSS version 16. A total of 165 nurses were screened and interviewed. Mean age was 40.75 +/- 8.577 years. Mean BMI was 28.80 +/- 4.77. Mean systolic BP was 124.82 +/- 20.91 mm Hg, while mean diastolic BP was 82.45 +/- 13.07 mm Hg. Mean random blood sugar was 128.39 +/- 52.74 mg /dl. Diabetic nurses were 18[10.9%],hypertensive nurses were 31[18.8%], nurses having high cholesterol were 4[2.4%], nurses having documented CAD were2[1.2%], other than above risk factors or conditions were present in 34[20.6%] of the nurses, not having any of the mentioned risk factors or diseases were present in 76[46.1%]. Nurses not having any regular exercise schedule were 104 [63%]. We noticed that among modifiable risk factors hypercholesterolemia, diabetes and hypertension were less frequent in nurses while obesity, physical inactivity and sedentary life style with more duty hours and smoking were more prevalent

Correlation between amount of smoking and decline in lung function among urban male population

A cross sectional study of six months duration was conducted at the Department of Pulmonology, Shaikh Zayed Hospital, Lahore to compare the lung function decline [percentage of predicted forced expiratory volume in one second with amount of smoking in different groups of subjects according to pack years of smoking. Data was collected from four hundred current smokers meeting inclusion and exclusion criteria collected by arranging free spirometry camps by non-probability purposive sampling. The study participants were having ages between 20 and 67 years with mean age of 38.1 +/- 12.2. It was found that cases in group up to 5 pack years of smoking had highest average FEV[1] 98.0+/-5.3 and FEV[1] decreased smoothly as number of pack years escalated. It was 96.0+/- 10.9 in 6-10 pack year group, 90.0 +/- 9.8 in 11-15 pack years group, 85.3+/-7.2 in group 16-20 and it was 71.9 +/- 16.2 in group 21 and above pack years of smoking. In our study we also found that 79 [19.75%] participants had FEV[1] between 80-50% of predicted out these 58 [73.41%] were in group 21 and above pack years of smoking whereas 08 participants had FEV[1] less than 50% of predicted. It was concluded that the prevalence of undetected persistent airflow obstruction was high and more frequent in smokers having history more than 21 pack years of smoking

Validity of ultrasound in diagnosis of liver fibrosis resulting from chronic viral hepatitis

To determine the validity of ultrasound in diagnosis of liver fibrosis associated with chronic viral hepatitis, considering histopathological findings as gold standard. Validation study. Department of Radiology, Military hospital Rawalpindi, from March 2007 to February 2008. Patients with positive laboratory findings of viral hepatitis were sonographically evaluated in Radiology department in lying position with 2-5 MHz frequency convex and 5-12 MHz frequency linear probes of Aloka prosound [ssd] 5500 ultrasound machine. An Ultrasound scoring system using both the low and high frequency probes was performed by evaluating the edge, surface and parenchymal texture of the liver. Each score was obtained by evaluating three parameters; the bluntness of the liver edge, the irregularity of the surface and coarseness of the parenchymal texture were evaluated and then compared with the histological findings. Amongst 50 patients with history of chronic viral hepatitis, 31[62%] were males and 19 [38%] were females. Ages of patients ranged between 26-60 years [mean 40.8 years]. The US [ultrasound] accumulated scores of the liver edge, liver surface and liver parenchymal texture were compared with the fibrosis stage obtained based on the biopsy findings. The accumulated US scores of these three parameters [fibrosis stage 0-IV- No fibrosis, mild, moderate and sever fibrosis] however, were found to be the most reliable indicator. Thirty Two [64%] patients showed true positive, 4 patients [08%] showed false positive, 09 [18%] patients showed true negative and 05 patients [10%] patients showed false negative results. [Table .1] Sensitivity, Specificity, positive predictive values, Negative predictive values and accuracy of Ultrasound in diagnosis of liver fibrosis were calculated to be 86.48%, 69.23%, 88.88%, 64.28% and 82% respectively. [Table.2] Ultrasound evaluation of the liver fibrosis stage based on the scoring system using both low and high frequency probes has been found to be a reliable and effective alternative to the histological staging in chronic liver disease