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.

Prevalence of tuberculosis in Kotli, Azad Kashmir.

BACKGROUND: Tuberculosis is highly prevalent in Pakistan. It is a contagious disease and causes a lot of morbidity and mortality. Its treatment is costly especially for poor countries like Pakistan. But fortunately it is a preventable disease. Objective of this study was to analyse various epidemiological features of tuberculosis in District Kotli, a remote area of Northern Pakistan. METHODS: This cross sectional study was conducted in District Kotli, Azad Kashmir from January to December 2009. Data was collected from eight national TB centres of District Kotli. It included all the diagnosed cases of tuberculosis, registered there during the study period. Various epidemiological aspects of these patients were analysed. RESULTS: Total number patients registered during the study period were 752. Of these 579 (76.99%) were pulmonary and 173 (23%) were extra-pulmonary tuberculosis (EPT). Total prevalence of tuberculosis was found to be 100.27 per 100,000. Prevalence of pulmonary TB was 77.2 while that of EPT was 23.07 per 100,000. There were 405 males (53.85%) and 347 females (46.14%). Most patients were 61-75 years of age (220, 29.25%). Overall 417 (55.44%) were 46-75 years. Housewives were affected most frequently (324, 43.08%). Labourers were also commonly involved (40.82%). All cause mortality was 29 (3.85%). Mortality due to tuberculosi as was 11 (1.04%). Among pulmonary tuberculosis, 259 (44.78%) were sputum smear positive and 320) (55.26%) were sputum smear negative. In EPT, most frequent was pleural effusion (74, 42%) and least frequent was skin involvement (3, 1.73%). CONCLUSION: Prevalence of tuberculosis in Kotli was lower than the overall prevalence in Pakistan. Male to female ratio was lower than that generally observed in Southeast Asia. It was more common in middle to old age population. Frequency was higher in housewives and labourers. Very significant proportion of pulmonary TB was sputum smear positive. Among EPT, pleural effusion was the most common mode of presentation.

Frequency of hepatitis C in asymptomatic patients in District Headquarters Hospital Kotli, Azad Kashmir.

BACKGROUND: Hepatitis C is a common problem in developing world. It can affect a large number of asymptomatic people in whom it may cause serious complications in long run. Moreover, these asymptomatic infected people pose a serious risk for the transmission of infection to healthy population. Objective of this study was to estimate the frequency of Hepatitis C in asymptomatic adult patients attending medical OPD of District Headquarters Hospital Kotli, Azad Kashmir, and to assess the risk factors associated with its transmission. METHODS: This was a cross-sectional study that included asymptomatic patients of both genders, aged 15-80 years, attending medical OPD of District Headquarter Hospital Kotli, Azad Kashmir from January to December, 2008. They attended the OPD for problems other than Hepatitis and most of them presented with vague complaints like generalised body aches, tiredness and dyspeptic symptoms. They were randomly tested for Hepatitis C virus (HCV) antibodies by Immunochromatographic kit method. Positive samples for Hepatitis C antibodies were confirmed by third generation ELISA. Those who were confirmed were assessed for the risk factors associated with HCV transmission. RESULTS: The study included 9,564 patients. Out of them 4,230 (44.22%) were males and 5,334 (55.77%) were females. A total of 611 (6.38%) cases were positive for HCV; 257 (6.08%) were males, and 354 (6.64%) were females. Highest frequency (36%) was found between 21 and 30 years of age, and 60.54% positive patients were 21-40 years old. Blood transfusion was the most common (34.36%) risk factor followed by history of dental procedures (24.54%). In 27.16% no risk factor could be detected. CONCLUSION: Frequency of Hepatitis C is quite high in our population. Rate is higher in young adults. It is needed to adopt organised preventive strategies to overcome this problem. Blood transfusion is still the most significant risk factor followed by dental and surgical procedures. Health related procedures are still not safe in our set up and need to be addressed.

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.

Frequency of hepatitis B in asymptomatic patients of District Headquarter Hospital Kotli, Azad Kashmir.

BACKGROUND: Hepatitis B is prevalent throughout the world including Pakistan. A large proportion of patients suffering from Hepatitis B may be asymptomatic and can transmit the disease to healthy population. Objectives of this study were to estimate the frequency of Hepatitis B in asymptomatic adult population coming to District Headquarter Hospital Kotli, Azad Kashmir and to determine the risk factors associated with its transmission. METHODS: This was a cross-sectional study extending from January to December 2008. Subjects were randomly selected from those who attended the medial OPD of DHQ Hospital Kotli, Azad Kashmir for non-Hepatitis related problems. Both males and females between the ages of 15-80 years were included in the study. Blood samples taken from selected subjects were analysed for Hepatitis B surface antigen (HBsAg) by Immunochromatographic kit methods (ICT). Hepatitis B positive samples were further confirmed by third generation ELIZA. The patients thus confirmed were interrogated for different risk factors associated with transmission of Hepatitis B. RESULTS: A total of 9,564 patients were analysed. Out of them 4230 (44.22%) were males and 5334 (55.77%) were females. Overall 141 (1.47%) patients were positive for HBSAg, 71 (1.68%) males and 70 (1.31%) females. Patients between 21-30 years of age were most commonly effected (35.46%, n = 50). Blood transfusion was the most common risk factor (24.82%, n = 35) associated with Hepatitis B transmission followed by dental procedures (14.18%, n = 20). CONCLUSION: Frequency of Hepatitis B in asymptomatic people in this study was quite high. Blood transfusions and dental procedures were the most common risk factors associated with the transmission of Hepatitis B.

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.

Haematological findings in relation to clinical findings of visceral Leishmaniasis in Hazara Division.

BACKGROUND: Visceral Leishmaniasis (VL) has worldwide distribution including Pakistan. The disease is characterized by a spectrum of clinical features along with serious complications in untreated cases. This study describes the correlation between clinical manifestations with haematological changes of VL in Hazara Division. METHODS: This cross sectional study was carried out in the children wards of Women & Children Hospital an Ayub Teaching Hospital Abbottabad. Seventy cases were included in this study, Sign, symptoms, complications and haematological parameters were recorded in detail and their comparison was carried out. RESULTS: Majority of the patients (98.57%) presented with fever followed by abdominal distension (47%) Pallor, (44%) weight loss (43%) diarrhoea (17%), vomiting (15%) and epitasis (8%) and hepatosplenomegaly was found in about 83% along with lymphadenopathy (20%) purpura (13%) and peripheral oedema (11%). Laboratory findings revealed anaemia in all the cases followed by neutropenia 43%, lymphocytosis 86% with thrombocytopenia 79%. Bone marrow in most of these cases showed myeloid hyperplasia with increased megakaryocytosis. CONCLUSION: There exists a new focus of visceral leishmaniasis in Hazara Division. The disease mainly affects children below 5 years and is more common in males than in female children. Bone marrow examination provides a reliable and simple tool for diagnosis of visceral leishmaniasis and the condition can be affectively managed with Sodium stibogluconate or meglumine antimoniate.

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.

Butterfly rash due to cutaneous leishmaniasis.

A remarkable spectrum of clinical expressions of cutaneous leishmaniases is observed in humans ranging from nodular, hyperkeratotic, sporotrichoid, erysipeloid, zosteriform, eczematoid, warty, impetiginized and lupoid forms. Uncommon forms may also be observed. This case describes a 55-year-old lady who apparently looked liked offering from systemic lupus erythematosis due to butterfly distribution of a rash on face. She was misdiagnosed till laboratory tests including histopathology revealed that her lesion was due to cutaneous leishmaniases. Due to cosmetically sensitive site, treatment was started with antimonials and she improved considerably in 3 weeks with diminution in swelling and rubescence.

Pattern of malarial infection diagnosed at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Malaria is endemic in Abbottabad and the adjoining areas like many other parts of the country. Depending upon the environmental conditions different species of malarial parasite are found in different areas. The present study was planned to see the pattern of malarial infection diagnosed at Ayub Teaching Hospital, Abbottabad. METHODS: Giemsa stained thick and thin blood films of indoor and outdoor febrile patients sent to the laboratory of Ayub Teaching Hospital Abbottabad with a suspicion of malaria, were examined. Thick film was examined for the diagnosis of malaria while thin films were seen to know the species. RESULTS: Out of 1994 patients screened, 145 (7.2%) were found infected. Plasmodium vivax was seen in the majority (72.47.2%). Plasmodium falciparum was the second common species detected in 24.1% cases. Mixed infection was seen in 3.44% cases while Plasmodium malariae and ovale was not seen in any patient. CONCLUSION: Plasmodium vivax was the commonest type of malaria diagnosed at Ayub Teaching Hospital, Abbottabad, during 2002- 2004.