Prevalence and prediction of pressure ulcers in admitted stroke patients in a tertiary care hospital.

Pressure ulcer (PU) is a localized injury to the skin or underlying tissues usually over a bony prominence, which results due to pressure or pressure in combination with shear. It is an expensive health care problem that have deterring impact on the length of hospitalization and cause extra nursing care time. Moreover, PUs negatively impacts patients' health related quality of life. High PUs prevalence figures were found in specialized hospital units such as intensive care unit (ICU), orthopedics, surgery, and also in stroke patients in medical units. The major purpose of this study is to assess the frequency of pressure ulcers in stroke patients at Ayub teaching hospital. The methodology used for carrying out the research was cross-sectional study conducted during months of September, October, and November 2020. Questionnaire was used to collect the data and well-informed written consent was taken from the patients. A total of 120 stroke patients were initially included with the intention to study the frequency of PUs among them. Different age groups were taken but majority (48.3%) belonged to the age group 31-60 years. Maximum patients were hypertensive (65%), while few of them were diabetic (35%). From the results of proposed work, it is found that out of 120 stroke patients, 75.8% presented with ischemic stroke while 24.2% presented with hemorrhagic stroke. 8.3% that is 10 out of 120 stroke patients developed pressure ulcers of grade 1 (1.7%), grade 2 (1.7%), grade 3 (2.5%), and grade 4 (2.5%) mostly in the sacral region (6.7%) and also on ankle (0.8%), and shoulder (0.8%) respectively. Patients in the study group had unsatisfactory hygiene (6.7%) were malnourished (11.7%) and were not using preventive mattresses (79.2%). Those at the risk of developing pressure ulcers were not being repositioned (6.7%) and did not had awareness (10%). Prevention and treatment used in ward is 100%. Conclusively, the frequency of pressure ulcers in stroke patients was determined to be 8.3% and the most frequent localization was sacrum. The PU care in this hospital is appropriate but still could be improved further by improving risk assessment, prevention specially use of air mattress and patient education regarding PUs. The main objective of the study is to identify the frequency of PUs in stroke patients and to highlight various factors that would avoid PUs development.

Secondary Plasma Cell Leukaemia.

Plasma cell leukaemia is a clinical condition in which plasma cells circulating in the peripheral blood constitute >20% of white blood cells (WBC) and there is evidence of plasma cell monoclonality. It is important to be diagnosed early for better treatment outcome. Although it is a rare disease, cases have been reported from Pakistan and other countries (including our neighbouring countries), hence making this case report. After taking history of present and past ailments, physical examination was carried out. Blood and bone marrow sampling were done after taking informed written consent from the patient. Blood samples were obtained in plain bottle, anticoagulated bottle and bone marrow was obtained from posterior iliac spine under 2% lignocaine. Plasma cell leukaemia is a rare and aggressive disease, difficult to diagnose and treat, requires early recognition and therapeutic intervention.

Vitamin D Profile Of Outdoor Patients Presenting With Aches And Pains.

BACKGROUND: Vitamin D, a fat-soluble vitamin, plays regulatory role in more than 300-800 genes. Daily requirement of vitamin D depends upon the age and exposure to sun. Approximately one billion people in different parts of the world including Pakistan are either Vitamin D deficient or have insufficient levels of vitamin D. The present study, a descriptive cross-sectional study, aimed at knowing the status of vitamin D3 in outdoor patients from Hazara division, having aches and pains. It was conducted over a period of four years on 453 outdoor patients of either sex and all the age groups presenting to Ayub Teaching Hospital. Sample was selected by non-random convenience sampling technique. METHODS: Common causes of aches and pains other than Vitamin D deficiency were excluded by history, examination and basic laboratory tests. Vitamin D3 estimation was done by immunoassay. RESULTS: Mean age of the participants was 40±19.62 years; the mean level of vitamin D was 21.88±14.12 ng/ml. As much as 398 (87%) participants aged 20-60 years were either vitamin D3 deficient 330 (69.9%), or had vitamin D insufficiency 68 (17.7%). Gender wise, 295 (65%) were females and 158 (35%) males, with female to male ratio of 1.29:1. Normal vitamin D3 level was detected in 55 (12.5%) participants with male predominance. CONCLUSIONS: Vitamin D deficiency is alarmingly high in patients presenting with aches and pains, in all age groups, effecting females more than males.

Morphology Of Bone Marrow In Visceral Leishmaniasis.

BACKGROUND: Visceral Leishmaniasis (Kala Azar), a vector borne parasitic disease is endemic in many parts of the world including South East Asia. It is a chronic febrile ailment caused by Leishmania Donovani (LD). More than three hundred million people living in the endemic areas are at high risk and fourteen million are living with the disease. METHODS: This prospective study was conducted on seventy-five patients over a period of twelve years at the department of Pathology Ayub Medical College Abbottabad, focusing on the morphology of bone marrow aspirate obtained from patients. The aspirate was smeared on glass slides, fixed with alcohol and stained with Giemsa stain. The microscopic examination of stained slides was carried out by the single microscopist to avoid the difference of opinion. The initial diagnosis was further confirmed by tow experienced microscopists. RESULTS: A minor difference was observed in the number of male and female participants, 38 versus 37, with male to female ratio of 1.02:1. The majority of the patients were 1- 15 years old. As much as 45.2% patients were 1-5 years old. In this age group, males were affected more than the females with male to female ratio of 1.4:1. Most of the patients belonged to district Battagram and Tor Ghar. Bone marrow aspiration was easy and the marrow aspirate was found having marrow fragments on naked eye examination in majority of the patients. Extrahistiocytic LD bodies alone were seen in 100%, extra and intrahistiocytic in 80% and intrahistiocytic alone in 33.3% patients. The parasite index was 1-5 to 1-10 in 53.4% and 26.6% patients respectively. CONCLUSIONS: Visceral Leishmaniasis is endemic in the study area. Bone marrow examination, although an invasive procedure, gives direct microscopic diagnosis of visceral Leishmaniasis and may be considered where indicated.

Visceral Leishmaniasis In Adults.

Visceral Leishmaniasis (also known as Kala Azar) is a parasitic infection caused by Leishmania Donovani in the East and Leishmania Infantum in the west. It is prevalent in many countries including India, Bangladesh, Nepal, Africa and part of America. The disease follows chronic course and is usually lethal if left untreated. It has also been reported from different parts of Pakistan, including Northern areas, Districts Mansehra & Abbottabad and Hilly areas of Khyber Pukhtoonkhawah. Most the cases have been reported in paediatric population. Except one case, reported previously from Abbottabad. The present two cases were also seen in adults.

Screening For Hypothyroidism-Results Of A Study Conducted At District Headquarter Hospital, Abbottabad.

BACKGROUND: Sub-clinically hypo-functioning thyroid is a condition in which there is biochemical evidence of hypothyroidism but patient is clinically asymptomatic. This concept is not new. The typical picture of this condition is increased thyroid stimulating hormone and normal thyroxine levels. Subclinical hypothyroidism has been found to have variable prevalence ranging from 4-10% to 10- 26%. METHODS: This cross sectional study was conducted on 378 adult patients coming to outpatient department of District Headquarter Hospital Abbottabad over a period of two years from February 2013 to February 2015. RESULTS: Out of the 378 individuals studied, 37 (9.78%) had subclinical hypothyroidism. Mean age of the patients was 43.5±10.5 years. Females outnumbered males, i.e., 24 out of 37 (65%). It was noted that there was no correlation between mean TSH level and gender or age of the patients. CONCLUSIONS: Subclinical hypothyroidism is not an uncommon condition and its diagnosis is established easily by doing thyroid hormone levels in fasting condition. Early diagnosis and therapeutic intervention may not only prevent the progression to clinical hypothyroidism but also help in preventing the wastage of resources on doing unnecessary investigations.

Clinical presentations in immune thrombocytopenic purpura.

BACKGROUND: Thrombocytopenia is an important cause of mucocutanaeous bleeding in adult and paediatric patients. Immune thrombocytopenia is one of the common causes of thrombocytopenia. Its clinical presentations vary from patient to patient, not studied in our area previously. The present study was planned to see the frequency of clinical presentations of Immune Thrombocytopenic Purpura (ITP) in our patients. METHODS: This prospective study was conducted on 125 patients with ITP, diagnosed by exclusion of secondary causes of thrombocytopenia. Bone marrow examination was performed on all the patients. RESULTS: Bruising, epistaxis and gum bleeding were the commonest clinical presentations in adults and children. Bleeding was more severe in acute cases. Increased menstrual bleeding was seen in female patients. CONCLUSION: Bruising, epistaxis and gum bleeding are the commonest clinical presentations of ITP. Our results are not much different from those of the other studies conducted in Pakistan.

Visceral leishmaniasis: adult population of Abbottabad at risk now.

Leishmaniasis is a disease complex caused by the parasite of genus Leishmania. Visceral Leishmaniasis is caused by Leishmania donovani transmitted to human by sand fly. Some wild animals and human reservoir is the major reservoir in most of the cases. The disease is prevalent in different parts of the world including India, Nepal, Bangladesh, Sudan and Brazil. It has also been reported from Northern half of Pakistan. In Hazara Division, it has been reported from Galiat, Battagram, Kaladhaka, Kohistan, Balakot, Kaghan and adjoining areas of Azad Jammu & Kashmir. A focus of visceral Leishmaniasis was detected in villages located about 15 Km from Abbottabad city in year 2000. Sporadic cases were reported from the suburbs of Abbottabad but not from Abbottabad city. All these cases and cases from the other parts of Pakistan were children <12 years of age and the disease was not seen in adults except only one child, 11 year old. We report the 1st case from this area which is 16 years old girl.

Response rate of Pakistani children with acute lymphoblastic leukaemia to Medical Research Council acute lymphoblastic leukaemia 97 chemotherapy protocol.

BACKGROUND: Acute lymphoblastic leukaemia (ALL), a malignancy of lymphoid lineage cells, has excellent prognosis in children. In Pakistan, a few studies highlighted the response of ALL to chemotherapy. The Present study was planned to see the response rate of Pakistani children with ALL to Medical Research Council ALL 97 (MRCALL97) chemotherapy protocol. This descriptive case series was conducted at the Department of Haematology, Armed Forces Institute of Pathology and the Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi from 16th of February 2007 to 16th of August 2007. METHODS: Diagnosed children with ALL fulfilling the inclusion criteria were interviewed regarding history of the present, past illnesses, and family history. Physical examination was performed. Presenting clinical features, blood counts and blood and bone marrow blasts percentage were used to see the response on day 29 post chemotherapy. The data was recorded on a structured proforma for statistical analysis. RESULTS: A total of 33 patients were studied including 26 males and 7 females. Twenty-five patients belonged to age group 2-9 years, and 8 to < 2 or > 9 years, median age being 4.5 years. Presenting WBC count was < 50 x 10(9)/L in 30 patients and > 50 x 10(9)/L in 3 patients. At the end of induction, complete remission was achieved in 31 out of 33 (94%) patients while two patients did not achieve remission. CONCLUSION: Response rate of Pakistani children with ALL to chemotherapy was superior to the previously reported figures from Pakistan.

Seroprevalence of hepatitis C in pregnant females of Hazara division.

BACKGROUND: Hepatitis C Virus (HCV), the causative agent of Hepatitis C is prevalent in different countries including Pakistan. Studies have been conducted on various aspects of HCV in Pakistan. The present study was planed to see the prevalence of hepatitis C in pregnant females of Hazara Division. METHODS: Five hundred pregnant females of reproductive age group from Hazara Division selected by non probability convenient sampling technique were studied from 1st March 2006 to 28th February 2007 at Ayub Teaching Hospital, and District Headquarter Hospitals Abbottabad, Haripur and Mansehra. After initial serving by immunology technique positive cases were confirmed by Enzyme Linked Immunosorbant Essay (ELISA). RESULTS: Seroprevalence of HCV in pregnant females of Hazara division was 8.9%. Females aged from 25-35 constituted the largest group among positive cases. HCV was more prevalent in District Abbottabad as compared to the other districts of Hazara division. CONCLUSION: Seroprevalence of HCV in pregnant females of Hazara Division is different from the figures already reported form the other parts of Pakistan.

Seroprevalence of hepatitis B in outdoor female patients of reproductive age group at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Hepatitis B is inflammation of the liver caused by a Hepatitis B virus, having a parenteral mode of entry and infecting millions of people around the world. OBJECTIVE: The present study was planned to assess the seroprevalence of Hepatitis B in women of reproductive age in Hazara in order to promote disease prevention in the perinatal period by vaccination against Hepatitis B. SUBJECTS AND METHODS: Women 15-45 years old belonging to Hazara Division were included in this descriptive, cross-sectional study conducted over a period of one year at the Department of Microbiology, Ayub Medical College, Abbottabad in collaboration with the Department of Pathology, Ayub Teaching Hospital, Abbottabad from 1st March 2006 to 28th February 2007. Non-probability convenience sampling was done to select 500 females from those visiting Ayub Teaching Hospital Abbottabad as outdoor patients or accompanying person. History, examination, and serum alanine aminotransferase estimation were followed by the initial screening for Hepatitis B surface Antigen (HBsAg) using immunochromatographic device. Enzyme linked Immunosorbent assay was used to confirm the presence of HBsAg. RESULTS: HBsAg was detected in 3% of the women. History of multiple injections was present in 100%, blood transfusion in 22%, dental procedure in 46% and surgical procedure in 43% of the subjects. Only 1% women had been vaccinated. CONCLUSION: Seroprevalence of the Hepatitis B is not different from the figures reported by the studies previously conducted on general population in Pakistan. However it is different from those reported for the special groups.

Seroprevalence of hepatitis B and hepatitis C in health care workers in Abbottabad.

BACKGROUND: Hepatitis B and C viruses (HBV & HCV) are hepatotropic viruses causing viral hepatitis, chronic liver disease and hepatocellular carcinoma. Modes of infection are more or less similar. HBV is vaccine preventable while HCV is not. They are prevalent in different parts of the world including Pakistan. The rate of prevalence varies from region to region and among different population segments. The present study was planned to see the prevalence of HBV & HVC among health care workers in various hospitals of Abbottabad. METHOD: The study was conducted at the District Headquarter Teaching Hospital Abbottabad over a period of one year on 125 health care workers of different categories and either sex. Brief history was taken from each individual and physical examination was performed. Blood samples were taken for HBV and HC serology. Positive sera were confirmed by 3rd generation ELISA. RESULTS: As much as 8% individuals were positive for HBV or HCV. HBV alone was seen in 3 out of 10 (30%) individuals. HCV alone was also found in 3 out of 10 (30%) individuals. HBV and HCV co-infection was seen in 4 out of 10 (40%) individuals. Dental procedures, needle prick and surgical procedures were found the common risk factors. Blood transfusion was known in 2 out of 10 (20%) individuals. Family history of hepatitis was not positive in any individual. CONCLUSION: Results of the present study differ from those of the previous studies conducted on health care workers in Pakistan.