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Lahore, Pakistan

Raja S.G.,Harefield Hospital | Akhtar S.,Abbottabad International Medical College | Shahbazc Y.,Jinnah Hospital | Masoodd A.,Canterbury Health Center
Interactive Cardiovascular and Thoracic Surgery

Hydroxyethyl starch (HES) solutions are commonly used for volume replacement in cardiac surgery patients. The degree of impairment of the haemostatic system depends on the molecular weight and substitution degree of HES solutions. It is claimed that as HES 130y0.4 (Voluven ®) exhibits a lower in vitro molecular weight and a lower degree of hydroxyethyl substitution than HES 200y0.5 (HAES-steril ®) therefore it has less impact on haemostasis. A best evidence topic in cardiac surgery was written according to a structured protocol to verify this statement. The question addressed was: in cardiac surgery patients does volume replacement with Voluven ® impair coagulation less than other colloids? Using the reported search 12 papers, three in vitro and nine clinical studies, were found to represent the best evidence to answer the clinical question. The nine clinical studies were all randomised controlled trials. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The in vitro studies suggest that HES 130y0.4 has no significant effect on platelet variables, shows a faster clot formation process and a better clot retraction as compared with the other HES solutions. On the other hand, current best available evidence (level 1b) from clinical studies, limited by heterogeneity predominantly in terms of dosage of HES 130y0.4 administered and the sample size of individual trials, overwhelmingly suggests that HES 130y0.4 compared with HES 200y0.5 or gelatin-based volume replacement fluid affects coagulation to the same extent resulting in similar degree of blood loss. It can be concluded that contrary to in vitro studies HES 130y0.4 in clinical practice has comparable effects on blood loss after cardiac surgery. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. Source

Assir M.Z.K.,Medical Unit 1 | Ahmad H.I.,Jinnah Hospital | Masood M.A.,Medical Unit 1 | Kamran U.,Medical Unit 1 | Yusuf N.W.,Allama Iqbal Medical College
Scandinavian Journal of Infectious Diseases

Objective: We conducted this study to review deaths due to dengue fever (DF) during a large outbreak of DF in Lahore, Pakistan. Methods: We reviewed deaths due to DF at Jinnah Hospital Lahore between August and November 2011. Clinical and laboratory data were abstracted. The 2011 World Health Organization Regional Office for South-East Asia (WHO SEARO) guidelines were used to classify the disease. Results: Out of 128,634 probable DF patients who visited the outpatient department, 2313 patients were hospitalized; 1699 (73.3%) were male. RT-PCR was positive in 92 of 114 hospitalized patients (DENV-2 in 91 patients and DENV-3 in 1 patient). Sixty dengue-related deaths were reported; 41 (68.3%) were male. The mean age (± standard deviation) was 44 (± 20.5) y. The diagnosis at the time of presentation was DF in 5 (8.3%), dengue haemorrhagic fever without shock in 16 (26.6%), dengue shock syndrome in 20 (33%), and expanded dengue syndrome in 19 (31.7%) patients. Expanded dengue syndrome included encephalopathy in 12 (20%) patients, intracerebral bleed in 3 (5%), multiorgan failure in 3 (5%), and Guillain-Barré syndrome in 1 (1.6%). Twenty-nine (48.3%) patients had at least 1 comorbidity. Conclusion: Dengue shock syndrome and expanded dengue syndrome were the most common causes of death. © 2014 Informa Healthcare. Source

Ijaz B.,University of Punjab | Ahmad W.,University of Punjab | Javed F.T.,Jinnah Hospital | Gull S.,University of Punjab | Hassan S.,University of Punjab
Virology Journal

Background and Aims: ELISA is still used as primary test for diagnosis HBV disease. However, ELISA-positive patients were marked as HBV inactive after confirmation with PCR and vice versa. Our aim was to assess the performance of new cut-off value of ALT, HBV DNA load and significance of AST as screening tool for HBeAg (-) chronic active or inactive patients in Pakistani population. Materials and methods. In a cross-sectional, cohort study, 567 HBeAg (-) patients followed for one year were selected. Patients with persistent elevated ALT than normal and HBV DNA ≥ 100,000 copies/mL were taken as active chronic. Diagnostic values for ALT, AST and HBV DNA load in HBV HBeAg (-) chronic active and inactive patients compared using receiver operation characteristic (ROC) curves. Results: Of 567 HBeAg (-) patients, 228 were classified as chronic inactive and 339 as active. HBV infection was dominant in male. Serum ALT, AST and HBV DNA levels showed significant and high AUROC to differentiate chronic HBeAg (-) inactive patients from active. AUROC for Serum ALT, AST and HBV DNA were observed 0.997, 0.969 and 1.000, respectively. For revised cut off value for ALT (30 IU/L for male and 19 IU/L for female) and HBV DNA load ≥ 100,000 copies/mL, a PPV of 97%, NPV of 94%, a sensitivity of 98%, and a specificity of 92% was observed to discriminate active carriers from inactive carriers. We also observed 93.5% specificity, 83.1% sensitivity, 82% PPV and 89.5% NPV for AST ≤ 20 IU/L to differentiate inactive carriers from active ones in our study group. Conclusions: Revised cut off value of ALT and NIH derived HBV DNA value can better discriminate between HBeAg (-) chronic active and inactive patients. © 2011 Ijaz et al; licensee BioMed Central Ltd. Source

Tahir M.N.,University of Sargodha | Khan A.H.,Jinnah Hospital | Shad H.A.,University of Sargodha
Acta Crystallographica Section E: Structure Reports Online

The title Schiff base, C14H11NO3, crystallizes as a zwitterion (i.e. proton transfer from the carboxylic acid group to the imine N atom). The dihedral angle between the aromatic rings is 19.59 (6)° and an intramolecular N - O hydrogen bond closes an S(6) ring. In the crystal, inversion dimers linked by pairs of O - O hydrogen bonds generate R 2 4(24) loops. The dimers are linked by C - O interactions, generating (211) sheets. Source

Ahmad W.,University of Punjab | Ijaz B.,University of Punjab | Javed F.T.,Jinnah Hospital | Jahan S.,University of Punjab | And 3 more authors.
World Journal of Gastroenterology

AIM: To investigate the prevalence of hepatitis C virus (HCV) genotypes and their association with possible transmission routes in the general population of Lahore, as the data exclusively related to this city is limited. METHODS: Complete data regarding patient's history, possible route of infection and biochemical tests was collected from the public hospital for 1364 patients. SPSS version 16 windows software was used for data analysis by univariate and multivariate techniques. RESULTS: Age range ≤ 40 years showed high prevalence of HCV infection. HCV genotype 3a was dominant (55.9%), followed by 1a (23.6%), 4a (12.5%), 3b (3.2%), untypable (2.5%), 4b (1.2%) and mixed type (1.2%). Blood transfusion, dental surgery and barber shops were the main risk factors for HCV transmission. Genotype prevalence was independent of age (P = 0.971) and gender (P = 0.122) while risk factors showed a significant association with age (P = 0.000) and genotypes (P = 0.000). We observed an independent association of risk factors and genotype 3a, while patients with genotype 1 and 4 were mostly infected due to dental surgery blood transfusion and barber shops. Risk factors of intravenous drug use and sexual exposure were exclusively found in ≤ 40 years age group. CONCLUSION: An increase in genotypes 1a and 4a suggest migration of people, possibly from Balochistan and the northern war-zone area. Government should focus on public education regarding infection routes. © 2010 Baishideng. All rights reserved. Source

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