Volume 5 Issue-1 Jan-Apr, 16

It is common place to assess research productivity through citation index, impact factor or the number of publications. These are contentious parameters to quantify research creativity. Individuals are generally aware of the impact of their research in the domain of policy and practice. However, the various avenues of research dissemination and marketing of products have made the matters complicated. As one advances through his professional research-career one moves on to robust methodology (including research design) based on the research question and epidemiological acumen…..

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Background:

Chronic Hepatitis C (CHC) is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development & worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus.

Methods:

This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months (from July2013 to October2013). A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma & non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean (±SD) were computed for quantitative variables. Categorical variables (such as gender and outcome variables i.e. anxiety and depressive symptoms) were measured in frequencies and percentages. Stratification was done with regard to age group & gender to see the impact of these on the outcome followed by application of chi-square test with P-value <0.05 taken significant.

Results:

Total 120 patients were included in the study & 119 completed the questionnaire. Male patients were 55.5%. Mean age of patients was 32.59 ± 8.56 years (Range: 16-56 years). Primary outcome i-e; frequency of depression & anxiety in patients on interferon were 77.3% & 70.6% respectively. (n=92) had depression. Frequency of depression of almost similar in both genders (77.3% in males & 77.4% in females; p value= 0.584), while anxiety was more in females than males (75% vs 68.2%; p value= 0.273). Both psychiatric symptoms increased with increasing age from 16-26 years to 47-56 years of age (p values = 0.432 & 0.736 respectively). Vast majority (86.6%) were treated with interferon while only 13.4% received the PEGylated interferon therapy. Patients treated with PEGylated interferon had less frequency of depression than those treated with interferon (62.5% vs 79.6%; p value= 0.131).

Conclusion:

Depression and anxiety were found to be common in CHC patients who had been or are being treated with antiviral treatment leading to increased risk of morbidity and mortality. Screening for risk of depression, proper education and timely treatment through anti-depressant followed by close monitoring is mandatory to achieve success in antiviral treatment.

Key Words:

Hepatitis C, Depressive symptoms, Anxiety, Interferon alpha.

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Background:

About 50% cases of recurrent miscarriages are idiopathic. The association of fibrinolytic defects with recurrent pregnancy failure is a novel research avenue and was first recommended in early 1990s. High Plasminogen activator inhibitor-1 (PAI-1) levels are found to be associated with recurrent miscarriage in various studies. The association of Plasminogen activator inhibitor -1 with recurrent pregnancy loss and its various variables are detrermined.

Methods:

This study was conducted at Ziauddin University Hospital Karachi, from Feb 2014 to Nov 2014. All non pregnant and non-obese women with history of consecutive two or more miscarriages, with no co-morbid diseases, visiting a gynecologist were included. Studied variables included were age, BMI, no. of miscarriages, time of miscarriage and plasma PAI-1 levels. The data was expressed in terms of median and percentages with a confidence interval of 95%. Analysis was done on SPSS version 20.

Results:

The median age of females was found to be 27.34± 5.09 years. Out of seventy five females with history of recurrent miscarriages, (81.3%) (n=61) women had Plasma PAI-1 levels within normal range whereas (18.7%) (n=14) had value greater than normal. The median plasma PAI-1 was found to be 29.6±22.16 ng/ml.

Conclusion:

PAI-1 was not found to be a risk factor for recurrent miscarriages in a local population of Karachi. Furthermore, studies on a large sample size need to be undertaken to assess the role of PAI-1in our population.

Key Words:

Recurrent pregnancy loss. Plasminogen activator inhibitor-1, Fibrinolysis

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Background:

To compare the frequency of habits among different stages of oral submucous fibrosis.

Methods:

A cross-sectional study was conducted. Patients were recruited through purposive sampling technique from Dental OPD of Ziauddin Dental College, Clifton campus and Keamari campus, Ziauddin Hospital, Karachi. There were 50 stage 1 OSMF patients with limited mouth opening between 26-35 mm and 50 stage 2 OSMF patients with limited mouth opening less than 26mm. A detailed questionnaire was filled with details regarding patient’s medical history along with the frequency of pan, ghutka, betelnut, tobacco and alcohol. Co-relations were studied between various continuous variables. Cross-tabulations were performed between frequency of habits and different stages of OSMF.

Results:

In the present study, 100 OSMF patients, 70 (70 %) males and 30 (30 %) females, were recruited and diagnosed into different stages on the basis of limited mouth opening. Majority of addictions in OSMF stage 1were due to pan chewing (54%) followed by ghutka (40%), tobacco (34 %) and betelnut (28%) respectively. OSMF stage 2 patients showed highest consumption of ghutka (68%) followed by pan (60%), betelnut (50%) and tobacco (42%) respectively. Alcohol consumption alone in both stages was found insignificant causative factor in OSMF disease.

Conclusion:

The present study revealed that the relative risk of disease becomes higher with increased frequency and duration of daily consumption of pan for stage 1 and ghutka for stage 2 OSMF patients.

Key Words:

Oral sub mucous fibrosis, frequency, ghutka, betelnut, tobacco, pan

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Background:

Hemodialysis patients are vulnerable to infections with Hepatitis B Virus and hepatitis C virus (HCV). Patients who are on maintenance hemodialysis are considered as high-risk group for acquiring hepatitis B virus, resulting in high morbidity and mortality. Therefore, to vaccinate them against the virus is mandatory. Compared to a response rate of over 90% in the normal population, only 50 to 60% of those with end-stage renal disease achieve adequate antibody levels following immunization and the objective of this study was to determine the antibody level after Hepatitis B vaccination in chronic hemodialysis patients.

Methods:

118 patients, undergoing chronic hemodialysis (HD) at the dialysis unit of Liaquat National Hospital, fulfilling the inclusion and exclusion criteria were enrolled between April 2013 and September 2013, after taking informed consent and approval from ethical review committee. AntiHbs (Hepatitis B surface antibody) titers were measured. Patients were differentiated as Immune and non immune based on antibody titers, with levels of >10IU/l being considered as immune and levels of <10IU/las non immune. AntiHbs titer was measured by ELISA (Enzyme Linked Immunosorbant Assay). Data was analyzed using SPSS version 14.0 for windows. Chi square test were used to ascertain the statistical significance. P value <0.05 was taken as statistically significant. In addition, the effect of age, gender and duration of Hemodialysis on antibody titer was also observed.

Results:

Out of 118 patients enrolled, 103 (87.3%) had an adequate antibody response and were considered immune while only 15 patients (12.7%) had an inadequate antibody response rendering them non immune. AntiHbs titers showed no significant co-relation with gender and duration of Hemodialysis therapy(p>0.05), while age was found to have significant correlation as younger age group (<60years) had more immune response (p<0.001).

Conclusion:

Our study showed a very good antibody response to Hepatitis B vaccination among hemodialysis patients that correlated with age with younger age group having a better response but no correlation to gender and duration of dialysis.

Key Words:

Hepatitis B virus, Anti-HBs antibody, Hemodialysis, Prevalence, Vaccination.

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Background:

Hepatitis C virus is proving to be a global disease causing serious and debilitating effects on the general health of the public. It has been recognized that hepatitis C manifests itself through hepatic and a variety of extra hepatic diseases. The common two being; diabetes mellitus and thyroidal dysfunctions. A range of thyroid hormones disturbances are reported in association with hepatitis C infectivity, for example,Overt and Subclinical hyperthyroidism along with Overt and Subclinical hypothyroidism. To determine the relation between Hepatitis C Sero-Positivity and Thyroidal Dysfunction.

Methods:

We studied 274 Chronic Hep C sero positive, non cirrhotic cases (Jan 2010 –Jun 2014) in OPD of an urban tertiary care hospital (i.e Baqai Medical University Hospital Nazimabad).Out of this, 203(b/w 20 to 60years of age) cases were found to be evaluable (i.e undergone TSH/FT4 evaluation at baseline). TSH, was taken according to age groups (i.e age 20y-54y (0.4-4.2) μIU/ml & 55-87(0.5-8.9) μIU/ml) & FT4 (all age group)0.8-2.7ng/dL.

Results:

Thyroid dysfunction was found in 17 patients (8.4% [n = 203]).The Thyroidal dysfunction among the study group include; 01 patient with Overt Thyrotoxicosis (5.88% [n = 17]) , 05 with Clinically Hypothyroid (29.41% [n = 17]) status and 11 cases with Sub-Clinical Hypothyroidism (64.70% [n = 17]).

Conclusion:

An association of thyroidal dysfunction and Chronic HCV infection is noted in the study population without known pre-existing thyroidal disease.

Key Words:

Hepatitis C, Thyroid dysfunction (TD), Frequency.

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Background:

Diabetes mellitus is a growing menace and the cost of treatment and debilitation is high especially in poor societies. Hyperglycemia in diabetes is associated with deranged lipid profile. Various parts of plants and herbs have been indigenously used around the world for treatment of diabetes mellitus. Root, bark, leaves and latex of Calotropis procerahave been experimentally studied for their antidiabetic effect. This study was undertaken to explore the antidiabetic and antidyslipidemic effect of the flowers of Calotropis procera.

Methods:

Diabetes was induced by streptozotocin. Calotropis procera flowers aqueous extract (CFEX) was given orally in doses of 10,20,30,40 and 50 mg/kg body weight. Serum levels of total cholesterol, triglycerides, HDL and LDL were measured at the beginning of experiment and at intervals of 1 day, 1 week, 2 weeks and 3 weeks and compared with those in positive controls treated with glibenclamide and untreated negative control animals.

Results:

Weight loss in CFEX-treated animals was not significantly different from positive control group. Decrease in serum glucose levels, comparable to positive controls, was observed in animals treated with CFEX 20,30,40 and 50 mg/kg body weight. The TC, TG and LDL significantly decreased while a significant increase in HDL was seen.

Conclusion:

Calotropis procera flowers extract has shown antihyperglycemic and antidyslipidemic effects in experimental diabetic rats and may have the potential of a potent antidiabetic agent.

Key Words:

Calotropis procera flowers, diabetes mellitus, antihyperglycemic, dyslipidemia, cholesterol, triglycerides, high density lipoproteins, low density lipoproteins

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Background:

Physicians play a crucial role in the promotion and support of breastfeeding. Although many studies have been conducted to evaluate the knowledge about breastfeeding in mothers, few studies are found in literature discussing the knowledge and practice of physicians regarding breastfeeding .To assess the knowledge, attitude and practice of medical practitioners about breastfeeding at a tertiary care hospital.

Methods:

A cross-sectional study was conducted on 200 physicians of Ziauddin University belonging to the specialties of Pediatrics, Gynecology/Obstetrics, General Medicine and Family Medicine. The participants filled a structured questionnaire after informed consent. Data was analyzed on SPSS 20.0. Categorical variables were expressed as frequencies and percentages while continuous variables were presented as mean. P value of <0.05 was considered significant.

Results:

A total of 200 medical practitioners participated in the study. 97% of the respondents recommended exclusive breastfeeding for the first six months of life. Formula feeding was also considered equally acceptable by 66.5%. Pre-lacteal feeds were forbidden by 74% and 82% of the participants had not attended any Continuing Medical Education (CME) program on breastfeeding in the last 03 years.

Conclusion:

The shortcomings in the breastfeeding counseling skills of physicians and in their ability to manage lactational problems need to be addressed. A written hospital policy on breastfeeding is mandatory.

Key Words:

Breastfeeding, Lactation, Attitude, Practice, Pre-lacteal.

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Background:

Association of anxiety disorders in women with polycystic ovarian syndrome Association of Clinical and metabolic features of PCOD with anxiety

Methods:

A comparative cross sectional study was conducted for a one year period from October 2013-October 2014.200 control subjects were compared with 200 patients with PCODs aged 18-35using Rotterdam Criteria. Anxiety and depression symptoms were assessed using the HADS questionnaire.

Results:

Anxiety and depression disorders were significantly higher in PCODs as compared to control p value (<0.001). Anxiety was associated with hirsutism p value (<0.001 and obesity p value (<0.003).However, no association was found between abnormal lipid profiles and altered fasting blood sugar levels.

Conclusion:

Women with PCODs experience elevated anxiety and depression. Other aspects like weight reduction, behavioral therapy need to be emphasized for a healthy life style.

Key Words:

anxiety, acne, hirsutism, quality of life

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The incidence of recurrent pregnancy loss in women of reproductive age group is 0.5%–3%, And idiopathic causes accounts for 50%–60% of recurrent pregnancy losses. Approximately 30%–50% of conceptions end in spontaneous miscarriage before the completion of first trimester. Miscarriages mostly occur at the time of implantation. The causes of recurrent pregnancy loss are many including parental chromosomal abnormalities, maternal thrombophilias, immunologic causes and endocrine disorders. Recurrent pregnancy loss is an extremely distressing clinical problem for women as well as health professinals. According to current studies the decidualized endometrium act as a biosensor of good quality embyos , if it is faulty ,may lead to implantation of embryos resulting in miscarriage. Other factors implicated in the pathophysiology of miscarriage are Systemic and placental oxidative stress. Vascular endothelial damage, abnormal vascularity of placenta and immunologic reactions have been proposed to play some role in causing recurrent miscarriage. The objective of this review is to discuss the causes of recurrent miscarriage, based on the published research articles.

Key Words:

Recurrent pregnancy loss, Immunology, Miscarriage.

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Hemorrhoids are a common cause of rectal bleeding with a prevalence of 4 to 40% worldwide, varying in different geographical locations. The current treatment modality for 3rd degree hemorrhoids includes hemorrhoidectomy, but newer methods like rubber band ligation are rapidly gaining popularity. The purpose of our review was to establish if rubber band ligation can replace the traditional hemorrhoidectomy for the treatment of 3rd degree hemorrhoids.All databases were searched for relevant studies. A total of sixteen studies were included in the review. Current national and international literature points out that the results of rubber band ligation are comparable to hemorrhoidectomy and there are lesser complications associated with rubber band ligation.Reviewing the current recommendations, results, evidence and literature, our study recommends rubber band ligation as the treatment of choice for 3rd degree hemorrhoids.

Key Words:

Hemorrhoidectomy, Rubber Band Ligation, Hemmoroids

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Background:

An HIV positive individual from nontraditional background presented with abdominal lymphadenopathy. The human immunodeficiency virus (HIV) is a lenti virus (a subgroup of retrovirus) that causes HIV infection and AIDS (acquired immunodeficiency syndrome).AIDS is a condition in which progressive failure of the immune system allows life threatening opportunistic infections and malignancies.

Methods:

We present a case of 40yrs male, who presented with abdominal pain, vomiting and diarrhea accompanied with weight loss. Laboratory data shows pancytopenia, raised lactate dehydrogenase, CT scan abdomen reports; multiple enlarged lymph nodes along celiac trunk, mesenteric vessels, para-caval, aorto-caval, peri-pancreatic regions respectively.

Results:

Findings were suggestive of lymphoma. His HIV antibody (on ELISA) was positive and he was advised to be followed it up by western blot technique.

Conclusion:

This case report suggest that even a person not belonging to a traditional high risk group can have HIV and its complications such as lymphoma.

Key Words:

Human immunodeficiency virus, acquired immunodeficiency syndrome, vomiting, diarrhea, weight loss.

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