An autopsy study of sudden cardiac death.

OBJECTIVE: To determine the cause of sudden cardiac death and observe the morphological changes in the heart after death. METHODS: A cross sectional survey of 66 cases was carried out at Armed Forces Institute of Pathology (AFIP) Rawalpindi from 1992 to 1994. A detailed autopsy including external and internal postmortem examination was done. Representative sections were taken for histopathological examination and some viscera were sent to Chemical Examiner at Lahore for chemical analysis. RESULTS: All the cases were male with age range from 21 to 58 years. These cases died within 60 minutes with or without onset of symptoms. Fifty two cases revealed mild to severe atherosclerosis. Coronary occlusion with thrombosis was seen in 37 cases whereas 9 cases showed critical narrowing without evidence of thrombosis. Five showed both symmetric and asymmetric hypertrophy. Changes in conduction system of the heart were seen in 4 individuals. Myocarditis was noted in 2 cases only. The cause of death could not be determined in 3 cases. CONCLUSION: Majority of the cases died of coronary atherosclerosis whereas 17% cases revealed hypertrophic cardiomyopathy, changes in conduction system and myocarditis and 4% cases were undetermined. A detailed and thorough postmortem examination is mandatory to ascertain the cause of sudden cardiac death.

Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.

An outbreak of hepatitis caused by hepatitis E virus (HEV) in Abbottabad, Pakistan was traced to fecal contamination of a water system. Of 109 men hospitalized with hepatitis, 104 (95%) had serologic evidence of acute hepatitis E (IgM antibody to HEV [anti-HEV]), three (3%) probably had acute hepatitis E (high titers of IgG anti-HEV without IgM), and two had acute hepatitis A. Among a subset of 44 men with acute hepatitis E from whom three serum specimens were obtained over a four-month period, the anti-HEV IgG geometric mean titers (GMTs) decreased from 1,519 during the outbreak to 657 at four months. The IgM anti-HEV was detected in 40 (91%) of 44 sera obtained at admission (GMT = 533 during acute disease), but in only six (14%) four months later. The prevalence of anti-HEV in this population before the outbreak was estimated to be 30%. The presence of IgG anti-HEV appeared to protect against clinical hepatitis or development of serologic evidence of new infection with HEV. This is the second major epidemic of hepatitis E in the Pakistani military confirmed by an anti-HEV enzyme-linked immunosorbent assay (ELISA). Evidence that pre-existing antibody as measured by this ELISA protects against disease is important for assessment of vaccine development.

Hepatitis E in Pakistan

In Pakistan, sporadic cases of hepatitis E occur throughout the year. However, small outbreaks and epidemics of hepatitis E have been reported from the cities of Peshawar, Mardan, Abbottabad, Rawalpindi-Islamabad, Sargodha, Multan, Hyderabad, Quetta and Karachi. A large epidemic of hepatitis E occurred in one of the army garrisons at Lahore in early 1995, when more than 600 cases were treated as inpatients. Wherever epidemiological investigations have been carried out, the cause of the outbreak has always been found to be contamination of water supplies with sewage. This paper considers the epidemiology, diagnosis, clinical features, treatment, prevention and control of hepatitis E in Pakistan