Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures.

A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and management of needy CLD patients as a poverty-reduction health intervention.

Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures

A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [HCV] of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease [CLD]. There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and majiageprient of needy CLD patients as a poverty-reduction health intervention

Influence of angiotensin converting enzyme inhibitors on stable myocardial ischemia in menopausal cardiac patients.

OBJECTIVE: The aim of the study was to investigate the influence of angiotensin converting enzyme inhibitor (Captopril) on stable demand ischemia in menopausal cardiac female patients. METHODS: In a prospective non-randomized evaluation of the effect of angiotensin converting enzymes inhibitors (ACE-I) (Captopril) on demand myocardial ischemia, 16 normotensive menopause female patients, mean age of 52 years with stable angina and known coronary artery disease (CAD) but normal left ventricular function, underwent a treadmill exercise test (Bruce Protocol), at baseline (T1) and one week following (50-75 mg) a daily dose of Captopril (CAPT2). Onset of symptoms, duration of exercise, magnitude of peak ST depression and homodynamic parameters were monitored. RESULTS: Captopril significantly increased the duration of exercise from (467 +/- 169 to 536 +/- 145 seconds, (p value < 0.02), but with increased peak of ST segment depression (from -1.4 +/- 0.6 mm to -1.93 +/- 1.2 mm, p value < 0.15). The double product remained unchanged (251 x 103 +/- 55 in T1 and 248 x 103 +/- 55 in CAPT2; the p value was < 0.8. All adverse effects on the treadmill were noted. CONCLUSION: Although captopril tends to significantly effect prolongation of exercise time, there is no amelioration of the markers of ischemia.

Diabetes mellitus is equally frequent in chronic HCV and HBV infection.

OBJECTIVE: To see the association of type 2 diabetes mellitus (Type 2 DM) in patients suffering from chronic HBV or HCV related liver disease. SETTING: Patients were selected from the gastroenterology OPD of the medical research centre, diabetic controls from private diabetes clinic and healthy controls from the blood bank of the hospital. METHODS: Patients with chronic liver disease had HBV, HCV tested using ELISA and blood sugar using a glucometer mostly as a 2 hour post prandial sample. Healthy controls had their sugar and ALT checked while donating blood and HBV, HCV were checked routinely. In diabetic controls, blood sample was taken as sera stored for HBV,HCV and ALT and later tested in batches. A random sugar of > or = 200 mg/dl was taken as diabetes. RESULTS: Of 400 patient with chronic liver disease 302 had HCV and 98 HBV infection. Diabetes was found in 24.5% HCV and 19.4% HBV related cases (not significant). Out of 410 healthy controls 18 were HCV and 17 HBV positive. Diabetes was found in only 1 (5.6%) HCV positive control and none of the HBV positive controls. Of 196 diabetics 10 (5.1%) were HCV positive and none HBV positive. Diabetes was more frequent in patients having liver cirrhosis than in those having chronic hepatitis (P < 0.01). CONCLUSION: Diabetes is equally frequent in both HBV and HCV related disease but is significantly more in those with chronic liver disease than in controls. The pancreatic damage secondary to extrahepatic viral replication appears to be the major cause but genetic factors also need to be explored.

Smoking prevalence and awareness about tobacco related diseases among medical students of Ziauddin Medical University.

OBJECTIVE: To determine the prevalence of smoking and awareness of tobacco related diseases among medical students. METHODOLOGY: A survey of all medical students of Ziauddin Medical University in the year 2000. The data was collected by a self-administered questionnaire. RESULTS: A total of 264 (92%) out of 288 students responded to the survey. Smoking was more prevalent among males (26%) as compared to female students (1.7%). The knowledge about tobacco related diseases regarding lung cancer and stroke was significantly higher among females, while knowledge about small for date babies was significantly higher in males. CONCLUSION: Smoking prevalence was higher among male students of Ziauddin Medical University, a trend similar to other medical colleges. Further studies regarding risk factors of smoking will help us to better understand the complex etiology of smoking related disorders.

C-reactive protein is a marker for a complex culprit lesion anatomy in unstable angina.

BACKGROUND: The putative theory is that the clinical syndrome of unstable angina is caused by rupture of the atherosclerotic plaque with superimposed thrombus formation. It is characterized by angiographically complex coronary lesions in the majority of patients. HYPOTHESIS: This study aimed at assessing the correlation between C-reactive protein (CRP) and the complexity of culprit coronary lesions in unstable angina. METHODS: We identified culprit lesion complexity in 96 patients with unstable angina and normal creatine kinase (CK) and CK-MB mass. Serum concentrations of CRP (N < 5.0 mg/l) and cardiac troponin T (cTnT; N < 0.1 ng/ml) were measured on admission. RESULTS: There was a trend toward a higher grade of anatomical complexity of the culprit lesion in patients with elevated CRP (p = 0.007) and cTnT levels (p = 0.027). Patients who had intermediate- or high-grade lesion severity had a higher level of CRP (8.5 +/- 5.7 mg/l) and cTnT (0.118 +/- 0.205 ng/ml) on admission than those who had normal or low-grade lesions (5.7 +/- 4.0 mg/l, 0.017 +/- 0.021 ng/ml, respectively); Mann-Whitney U, p = 0.002 and p < 0.001, respectively. Furthermore, the likelihood of having intermediate- or high-grade complexity of the culprit lesion was higher when CRP levels were elevated in all patients (p = 0.007, odds ratio [OR] = 4.286; 95% confidence interval [CI] 1.492-12.310) and in those with normal cTnT levels (p = 0.025, OR = 3.876; 95% CI 1.185-12.678). Also, higher CRP levels strongly correlated with the need for revascularization interventions (p < 0.0005). CONCLUSION: Elevated CRP level on admission is a marker for anatomic complexity of culprit lesions and need for revascularization interventions in unstable angina.

The incidence of vaccine preventable influenza-like illness and medication use among Pakistani pilgrims to the Haj in Saudi Arabia.

Over the 33-day duration of the 1999 Haj in Saudi Arabia, we collected daily health status reports for 2070 Pakistani pilgrims over 13 years of age, 54% of whom had elected to receive influenza vaccine immediately before departing for the Haj. We calculated vaccine preventable outcome incidence as the difference in attack rates between vaccinated and unvaccinated persons. The incidences of vaccine preventable influenza-like illness (sore throat in combination with cough or fever of at least 38 degrees C), fever, and any symptom of upper respiratory infection were 22, 17, and 24 per 100 pilgrims per Haj. For every 100 persons who attended the Haj, 17 had a course of antibiotics and 23 had a course of nonprescription cold medication that was preventable with influenza vaccine use. Influenza leads to significant morbidity and medication use among Haj pilgrims. Vaccine against influenza should be considered for pilgrims before entry into Saudi Arabia.

Orelox (cefodoxime) in typhoid fever.

OBJECTIVE: To study the efficacy of Orelox (Cefodoxime) in Typhoid fever in children. SETTINGS: Open, non-comparative, multicentre study carried out in GP settings in various cities of Pakistan. PATIENTS: Children aged 1-15 years were included in the study. Positive Widal test was the only diagnostic inclusion criteria. RESULTS: Four centers participated in the study. Of the total 77 patients (51 males and 26 females), 61 (79%) cured, 5 (7%) improved (less severe signs and symptoms) and 11 (14%) failures. CONCLUSION: Treatment of typhoid fever in this study showed 86% efficacy in producing clinical responses suggesting that this drug can be effectively and safely used in the treatment of typhoid fever in children.

Comparison of five different treatment regimens for H. pylori eradication.

AIM: Treatment response to five different H. Pylori eradication regimens were evaluated to see which is the best regimen in our setup. METHODS: Patients presenting with upper GI symptoms of acid peptic disease underwent upper GI endoscopy and an antral CLO test. All those with a positive CLO test were included in the study. The study was carried out over a year and one trial was followed by another. The treatment regimens comprised of (1) Omeprazole 20 mg once a day, colloidal bismuth subcitrate 120 mg three times a day, Metronidazole 200 mg three times a day (18 cases). (2) Colloidal bismuth subcitrate three times a day, furazolidone 100 mg three times a day, metronidazole 200 mg three times a day (28 cases). (3) Omeprazole 20 mg once a day, Clarithromycin 500 mg twice a day (21 cases). (4) Lansoprazole 30 mg once a day, Amoxycillin 500 mg three times a day (21 cases). (5) Lansoprazole once a day, Amoxycillin 500 mg three times a day and Roxithromycin 150 mg twice a day (14 cases). Therapy for all 5 groups comprised of 14 days. Endoscopy and CLO test were done prior to the entry in the trial and at 28 days to see the response. RESULTS: Meta analysis was done for all the 5 regimens. For the purpose of analysis patients were divided into 2 groups, i.e., those with peptic ulcer and positive CLO (peptic ulcer disease (PUD) and those without peptic ulcer but positive CLO test (Non ulcer dyspepsia (NUD). PUD was seen in 14 of 18 cases in group 1, 18 of 28 cases in group 2, 16 of 21 cases in group 3, 6 of 21 cases in group 4 and 3 of 14 cases in group 5. In PUD after 14 days of therapy, lesions healed and CLO became negative in 50% cases each in group 1 and 2, 56% in group 3, 83% in group 4 and all in group 5, while in NUD, 25%, 60%, 80%, 47% and 82% respectively showed H. Pylori eradication. CONCLUSION: Of the different therapies one proton pump inhibitor with two antibiotics gave best results in ulcer healing and H. pylori eradication in ulcer and non ulcer dyspepsia.

Is there a safe anticoagulation protocol for pregnant women with prosthetic valves?

We studied the outcome of 41 pregnancies in an attempt to identify an appropriate and safe anticoagulant regimen for pregnant women with cardiac valve prosthesis. The cumulative number of events: (neonatal death, premature deliveries, intrauterine fetal death and spontaneous abortion) was 66.6%, 20%, 12.5% and 20% in the Coumadin, Fraxiparine, Heparin and porcine valve groups, respectively. We conclude that in pregnant women with mechanical heart valves, low molecular weight heparin therapy is a superior strategy compared to warfarin.

Prevalence and pattern of smoking in Pakistan.

OBJECTIVE: To determine the prevalence and pattern of smoking amongst Pakistanis. SAMPLING DESIGN: A two stage stratified sample design was adopted for the survey, Primary Sampling Units (PSU's) and Secondary Sampling Units (SSU's). SETTING: Urban and Rural, Pakistan 1990-94. SUBJECTS: Stratified systematic sample of 9441 males and females aged 15 years and above. MAIN OUTCOME MEASURES: Smokers were defined as, subjects who were currently smoking and who had smoked > or = 100 cigarettes/beedis or chillum/huqqa in their life time. RESULTS: In Pakistan 21.6% (36% males and 9% females) of 9441 subjects were smokers. In urban areas it was 20.7% and in rural 22.0%, males were predominant in both urban and rural areas. Proportion of smokers who used cigarette/beedi were significantly higher in males (60%) while chillum/huqqa were more in females (62%). Prevalence increased with age upto 64 years, after which it declined but in urban females it continued to rise with age. Among both males and females; illiterate, married individuals with poor general health were more likely to smoke. These factors were 2 to 3 times more in males and 2 to 5 times more in females who were more likely to be smokers than those who were literate, single individuals with good general health. CONCLUSION: Smoking was more prevalent in illiterate, married persons and those with poor general health.

Maternal sociocultural status: a novel assessment of risk for the birth of small for gestational age, low birth weight infants.

OBJECTIVES: We assessed the significance of material sociocultural status within the family as a risk factor for low birth weight-small for gestational age (LBW-SGA) births using a novel scoring system and also isolated related medical risk factors. METHODS: A prospective matched pairs case control study of 396 LBW-SGA infants (cases) and 396 term, appropriate for gestational age infants (controls) was set up. RESULTS: Low maternal sociocultural status (p = 0.02) was significantly associated with LBW-SGA births as were nonregistration for antenatal care (p = 0.001), maternal weight at delivery < 50 kg (p < 0.0001), antepartum hemorrhage/preeclampsia (p < 0.01), primigravidity and previous small baby (p <0001). Other risk factors included birth interval < 24 m (p < 0.001) and poor maternal or paternal education (p < 0.05). Conditional logistic regression identified maternal weight at delivery < 50 kg (OR 4.8, 95% C.I. 3.0-7.6), lack of antenatal care (OR 2.0, 95% C.I. 1.4-2.9), antepartum hemorrhage/preeclampsia (OR 4.3, 95% C.I. 1.7-10.8) and previous small baby (OR 4.3, 95% C.I. 2.1-8.9) as independent risk factors. CONCLUSIONS: Low sociocultural status of the mother within the family is significantly associated with having a LBW-SGA baby. Further studies are warranted to study this risk factor.

Does the rapid healing of duodenal ulcers mean longer remissions?

A study was conducted to test the response to therapy and the relapse rates of endoscopically-confirmed duodenal ulcers. Endoscopy to check for healing was performed at 4 and 8 weeks in cases receiving H2-blockers and misoprostol and at 14 and 28 days in cases receiving a proton pump inhibitor. Endoscopy was repeated at 1, 3, 6 and 12 months to check for relapses. Healing rates were 61%-77% and 75%-85% at 4 and 8 weeks in the group receiving H2-blockers and misoprostol. Healing rates were 68% and 100% at days 14 and 28 with the proton pump inhibitor. The relapse rates within 3 months were 72%-86% and 100% respectively. This study indicates that the faster the ulcer healed, the earlier the relapse occurred

Are non-specific reactions to tuberculin common?

Three thousand four hundred eighty-five BCG scar negative school children were given tuberculin test. Results showed very little non-specific reactions, suggesting BCG should produce high levels of protection in our population.

Famotidine 40mg B.I.D. in the treatment of reflux oesophagitis.

To assess the efficacy of famotidine in the healing of reflux oesophagitis, 25 endoscopically proven cases were treated with famotidine 40 mg B.I.D. for 6 to 12 weeks. Six patients were lost to follow-up, of the 19 cases analysed, 16 (84.2%) healed at 6 weeks and 17 (89.5%) at 12 weeks. Twelve cases (63%) became asymptomatic within six weeks of treatment. In conclusion famotidine 40 mg B.I.D. is effective in the healing of reflux oesophagitis.