Syed Ejaz Alam

The incidence of vaccine preventable influenza-like illness and medication use among Pakistani pilgrims to the Haj in Saudi Arabia.

Over the 33-day duration of the 1999 Haj in Saudi Arabia, we collected daily health status reports for 2070 Pakistani pilgrims over 13 years of age, 54% of whom had elected to receive influenza vaccine immediately before departing for the Haj. We calculated vaccine preventable outcome incidence as the difference in attack rates between vaccinated and unvaccinated persons. The incidences of vaccine preventable influenza-like illness (sore throat in combination with cough or fever of at least 38 degrees C), fever, and any symptom of upper respiratory infection were 22, 17, and 24 per 100 pilgrims per Haj. For every 100 persons who attended the Haj, 17 had a course of antibiotics and 23 had a course of nonprescription cold medication that was preventable with influenza vaccine use. Influenza leads to significant morbidity and medication use among Haj pilgrims. Vaccine against influenza should be considered for pilgrims before entry into Saudi Arabia.

Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis

BackgroundHepatitis B and C is common in Pakistan and various risk factors are attributable to its spread.One thousand and fifty consecutive male cases suffering from chronic liver disease (327 HBV and 723 HCV) were selected from the OPD of public sector hospital and a private clinic dealing exclusively with the liver patients. To compare the results 723 age and gender matched controls were selected from the blood transfusion services of the public sector hospital. A standard questionnaire was filled for all patients and controls which included the information on possible risk factors.FindingsFamily history of liver disease was significantly higher (43% and 34%) in HBV and HCV positive cases as compared to 5% in controls [odds ratio 15.6; 95% Confidence Interval CI: 10.1 -- 24.1, 10.9; 95% Confidence Interval CI: 7.3 -- 16.4] and same trend was seen for death due to liver disease in the family. Majority 74% hepatitis B positive cases had their shaves done at communal barbers but this practice was equally prevalent amongst controls (68%), thus negating it as a possible risk factor, but there is a significant risk with p < 0.05 associated with HCV in male that get their shave in barber. Very strong association of the disease was found with history of dental treatment (38% HCV 36% HBV and 21% controls) [Odd ratio 2.3; 95% CI: 1.8-3.0, Odd ratio 2.1; 95% CI: 1.5-2.8], surgery (23% HCV cases,14% HBV cases and 12% controls), history of blood transfusion was significantly higher in HCV (6%) as compared to controls (2.1%) [Odd ratio 2.9; 95% CI: 1.5-5.5]. History of taking injections for various ailments by the general practitioners (over 90% patients in both hepatitis B and C cases) was significantly higher as compared to 75% in controls [Odds ratio 3.8, 6.9; 95% CI: 2.4-6.1, 4.5-10.4] but hospitalization was not significant in HBV and HCV cases.ConclusionInjections, surgery and dental treatment appear as major risk factors for the transmission of hepatitis B and C in the community. Massive health care awareness drives need to be done for both health care providers and the public to reduce this menace.

Maternal Sociocultural Status: A Novel Assessment of Risk for the Birth of Small for Gestational Age, Low Birth Weight Infants

Objectives: We assessed the significance of maternal sociocultural status within the family as a risk factor for low birth weight‐small for gestational age (LBW‐SGA) births using a novel scoring system and also isolated related medical risk factors.

Correlation of Histology, CLO, Dental Plaque, and Saliva in Patients Undergoing Upper GI Endoscopy

Correlation of Histology, CLO, Dental Plaque, and Saliva in Patients Undergoing Upper GI Endoscopy

Delta hepatitis in Pakistan.

The key finding of this pilot study was the difficulty that we encountered in tracing cases. Though this prevented us from establishing a consensus on the reasons for absconding, it offers a perspective into the social construction of TB in this resource-poor setting. Failure to provide a legitimate address and defaulting from the diagnostic process may both reflect the stigma that affects TB control efforts. That controls were more likely to have had personal contact with TB may reflect diminished prejudice or heightened awareness of the merits of TB diagnosis. Data from Malawi and Thailand have suggested that gender and cost may influence uptake of diagnostic services. However, in our setting cost and access to services was not an issue – a greater proportion of untraceable subjects were women. It is plausible that some of our subjects were of no fixed abode. This vulnerable group is known to be at high risk of TB with erratic and piecemeal health-care-seeking behaviour; opportunities to provide healthcare should not be overlooked. Future attempts to revise or create diagnostic algorithms in resource-poor settings should take account of these sociocultural factors to optimize the chances of success of TB control programmes. Helen Ouyang BA Felipe Chepote Robert H Gilman MD DTMH David AJMoore MD DTMH Johns Hopkins School of Medicine, Baltimore,Maryland, USA; AB PRISMA, San Miguel, Lima; Universidad Peruana Cayetano Heredia,Ingenieria, SMP, Peru; Imperial College London,London, UK

Idiopathic portal hypertension:an overlooked entity

Abstract Following the criteria laid down by the Japanese Committee on Idiopathic Portal Hypertension (IPH), 89 cases of IPH were diagnosed. Though not confirmed, infections appeared to play some role in its etiology. Major presenting features were haematemesis and anaemia; one third of cases had haemoglobin of less than 7 g/l; hypersplenism was present in 14%. Liver function test were within normal range in the majority of the cases. Long term control of rebleeding was achieved satisfactorily with oral propranolol. Of the shunting procedures, proximal splenorenal shunt showed better results. It is concluded that IPH can be managed well with good long term survival. The diagnosis of IPH as the cause of portal hypertension assures an optimistic prognosis.

Innovative Solution to Sharp Waste Management in a Tertiary Care Hospital in Karachi, Pakistan

BACKGROUND Prevalence of hepatitis B and C in Pakistan is 2.5% and 4.5%, respectively. Major cause of these infections is reuse of syringes. OBJECTIVE To determine a cost-effective, innovative solution to prevent syringe reuse and break the transmission cycle of blood-borne infections. STUDY DESIGN, SETTINGS, AND DURATION: Analytical study in a tertiary care hospital, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, July 2011 to June 2012. METHODS Healthcare workers from 30 wards included in the study were trained on injection safety, use of needle remover and needle pit, and management of needlestick injuries. Each ward was provided with 2 needle-removing devices, and a pit was constructed for disposal of needles. Usage of the device in wards and pit use were monitored regularly. RESULTS In 28 (93.3%) wards, sharp containers were accessible by public and were slack. Syringes were recapped using both hands in 27 (90%) cases; needlestick injury was reported by 30% of paramedics, while 25 (83.3%) of the interviewed staff had not received any formal training in injection safety. Vigilant monitoring and information sharing led to healthcare workers in 28 (96.5%) wards using the device. Needle containers were emptied in 27 (93.1%) wards, and needle pits were used in 26 (96.3%) wards. Needlestick injury was nil in follow-up. CONCLUSIONS Needle removers permanently disable syringes. The needle pit served as a cost-effective, innovative method for disposal of needles. The intervention resulted in reducing the risk of needlestick injury.