Risk factors and outcomes of peptic ulcer bleed in a Pakistani population:A single-center observational study

BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori infection.AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani population.METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022.Data on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was collected.RESULTS The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting symptoms.Most patients(73.2%)were discharged within five days.The mortality rates at one week and one month were 10.6%and 14.8%,respectively.Re-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,respectively.Most ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed rates.NSAID use was associated with more FCⅢulcers.Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.

Frequency of Depression and Anxiety among Tuberculosis Patients

Objective: The aim of present study was to determine the frequency of depression and anxiety among tuberculosis patients. Methods: It was a descriptive study that had investigated the co-morbidity of depression and anxiety among tuberculosis patients with reference to gender. This study was conducted in Jinnah Post Graduate Medical Centre—Chest ward (TB clinic) from July 2014 to September 2014. Hundred diagnosed patients of tuberculosis (50 males and 50 females) were randomly selected. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were used to assess the level of anxiety and depression. Results: Findings indicated that 56% tuberculosis (TB) patients had moderate to severe level of depression, whereas 65% TB patients had moderate to severe level of anxiety. Female patients had significantly high prevalence of depression as compared to males (t = –2.173, P –3.468, P Conclusion: Likelihood of depression and anxiety was frequent in tuberculosis patients. However, better management of these psychiatric morbidities may improve treatment adherence, illness perception and patient coping skills.

Asymptomatic dengue infection in adults of major cities of Pakistan

Objective: To determine the asymptomatic dengue infection in adults of Pakistani population.Methods: This study was conducted in five major cities(Islamabad, Karachi, Lahore,Multan, and Peshawar) of Pakistan.A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories.Those who were confirmed for dengue previously were excluded.Of the total, 62.6%(n = 3 276) were male with an average age of 34.6 years.Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue Ig G test using enzyme linked immunosorbent assay.The brief information related to age, gender and area was also taken on proforma.Results: Overall 32.3%(n = 1 691) was having asymptomatic dengue infection which was 67.5%(n = 756) in Karachi followed by 39.1%(n = 391) in Islamabad, 29.9%(n =316) in Lahore and 21%(n = 228) in Peshawar and none from Multan.More males were affected with asymptomatic dengue infection than females.The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups.Conclusions: The asymptomatic dengue infection is higher in cities i.e.Karachi,Islamabad and Lahore which are at risk of developing secondary dengue infections.There is a need of awareness among the public about secondary dengue infection.

Comparison of GeneXpert MTB/RIF Assay in Broncho Alveolar Lavage and Gastric Lavage Samples

Objective: To compare the yield from Gastric lavage (GL) and Broncho alveolar lavage (BAL) samples in adult patients suspected case of Tuberculosis but not producing sputum. Methodology: 80 adults with suspected case of tuberculosis but not producing sputum were recruited. 72 patients were then subjected to one gastric lavage followed by Broncho-alveolar lavage in the same morning. The collected samples were subjected to GeneXpert MTB/RIF assay. Result: Of the 72 patients samples, the mean age was 38.6 years. 41 (56.9%) were male and 31 (43.1%) were female. History of TB contact was present in 25 (34.7%) patients. 37 (51.4%) patients had GeneXpert MTB/RIF positive on BAL and/or GL samples. The GeneXpert MTB/RIF of BAL fluid was positive on 35 (48.6%), which was not significantly greater than that for specimens from GL, which was 28 (38.9%) (p > 0.05). In 26 (36.1%) cases, GeneXpert MTB/RIF was positive in both BAL and GL samples. Conclusion: This study showed the yield of GeneXpert MTB/RIF in GL was comparable to BAL to detect Mycobacterium tuberculosis complex. Patients who can’t produce sputum, GL can be a good alternative to BAL to detect Mycobacterium tuberculosis complex in resource poor areas and patients who do not tolerate Bronchoscopy.

Changes in Serum Lipid Profile among Patients Suffering from Chronic Liver Disease Secondary to Hepatitis C

Objective: To find out the changes in lipid metabolism among patients suffering from chronic liver disease secondary to hepatitis C. Study Design: Hospital based observational study. Setting: Medical Unit-I, Ward–5, Jinnah Postgraduate Medical Centre, Karachi. Duration: July 2013 to December 2013. Patients and Methods: About 110 patients admitted in Medical Unit-I with a diagnosis of chronic liver disease were included in the study. Patients suffering from DM, HTN, CKD were excluded from the study. Fasting lipid profile was done in all cases. Results and Observations: There were 44 (40%) male and 66 (60%) female patients. Mean age of the patients was 50.18 (±11.7) years. Total cholesterol was decreased in 76 (69.09%) patients. Normal range was present in 34 (30.91%) patients. None of the patient had hypercholesterolemia. Serum triglyceride levels were low in 14 (12.72%) patients, normal in 82 (74.54%), borderline high in 7 (6.36%) and hypertriglyceridemia was seen in 7 (6.36%). HDL-c was below normal in 26 (23.63%) cases, normal in 78 (70.91%), and high in 6 (5.45%). LDL was near optimal/above optimal in only 5 (4.5%) patients. Mean TC/HDL ratio was 2.53 (±1.02). Mean LDL/HDL ratio was 1.23 (±0.73). Mean TC of HCV +ve patients was 130.5 mg/dl as compared to that of HCV –ve patients which was 82.85 mg/dl (P-value: 0.011). Mean TGs of HCV +ve group was 151.5 mg/dl while that of HCV –ve was 79.9 mg/dl (P-value: 0.025). Mean HDL & LDL levels were 43.67 mg/dl and 39.78 mg/dl in HCV group while 34.83 mg/dl & 64.67 mg/dl in the other group with P-value of 0.026 and 0.081 respectively. Conclusion: When it comes to its relationship with lipid metabolism, HCV is a remarkable virus. Its interaction with lipoproteins and its ability to induce massive steatosis are quite unique and idiosyncratic. Despite of causing hepatic steatosis, chronic HCV infection is associated with a paradoxically favorable lipid profile, although its reason cannot be enlightened precisely. There is a need for very well settled molecular and genetic studies to well understand HCV infection and lipid metabolism.

巴基斯坦原发性耐多药结核病流行情况

背景:巴基斯坦是世界第6位结核病高负担国家。据世界卫生组织(WHO)估计,巴基斯坦结核病发病率为181/10万,全国每年新增结核病患者28.6万例。来自于医院的资料表明:巴基斯坦耐多药结核病(MDR-TB)问题已十分严重,急需在社区水平对耐多药结核病的严重程度开展评估。本研究为针对巴基斯坦耐药结核病流行状况开展的横段面研究,所使用的痰标本来自于巴基斯坦全国742例未经治疗的新诊断的肺结核患者。目的:评估巴基斯坦原发性耐药的流行情况结果:在672例痰培养阳性患者中,有76例(11.3%)出现了对1种或多种抗结核药物耐药。36例(5.4%)患者对链霉素(10μg/ml)耐药; 51例(7.6%)患者对异烟肼(1μg/ml)耐药;15例(2.2%)患者对利福平(5μg/ml)耐药;12例(1.8%)患者对乙胺丁醇(10μg/ml)耐药;22例(3.3%)患者对吡嗪酰胺耐药。有46例(6.8%)患者痰标本中分离的结核菌株耐1种抗结核药物, 10例(1.5%)同时耐2种抗结核药物,12例(1.8%)同时耐3种抗结核药物,6例(0.9%)同时耐4种抗结核药物,2例(0.3%)同时耐全部5种抗结核一线药。原发性耐多药率为1.8%,(n= 12)(异烟肼1μg/ml,利福平5μg/ml)。结论:研究结果表明,巴基斯坦原发性耐多药率<2%,需要进一步实施有效的DOTS策略。

Use of social media while driving from an orthopedic resident's perspective

Purpose:To investigate the orthopedic injuries sustained while driving and using social media on cellular phones from an orthopedic resident's perspective.Methods:A total of 118 patients who presented with a history of road traffic accident secondary to social media usage and suffered from fractures were included in this cross-sectional study.These patients were reported from October 2018 to April 2019.We collected the data including the type of collision,type of social media usage during driving,location of injury,wearing of safety equipment's such as helmet and seat belt during driving.Results:The mean age of patients was(34.86±12.73)(range 15-71)years.The common types of accident on the basis of collision of vehicles were:car versus motorbike 45(38.1%),motorbike versus motorbike 28(23.7%),and motorbike versus pedestrian 22(18.6%).Most of the accidents(61,51.7%)occurred due to mistake of motor-bikers.Out of them,44(37.3%)occurred on traffic signals,followed by 29(24.6%)while driving on main roads.The common timing of accident was normal hours with frequency of 44(37.3%),followed by 39(33.1%)at late night.According to fracture type,closed injuries were 98(83.1%)and open fractures were 20(16.9%).The most common fracture was clavicular fracture(21,22.5%)followed by soft tissue injury in 19(16.1%)patients.The most common social media application usage during driving was Facebook 43(36.4%),followed by Whatsapp 24(20.3%),Google 19(16.1%),and Instagram 15(12.7%).Conclusion:This study provides evidence that social media usage while driving put the drivers and other road users'lives at high risk.The most common social media addiction while driving is Facebook and Whatsapp.So there is a need to make strict rules and penalties for using cell phone during driving so as to save the lives of drivers and other people using road.