Journal of the Pakistan Medical Association

Online ISSN: 0030-9982
Publications
Article
To compare the retrobulbar anesthesia and intracameral anesthesia using preservative-free bupivacaine hydrochloride 0.5% in terms of effectiveness, complications and comfort to the patient during phacoemulsification with posterior chamber intraocular lens implantation. This was a hospital based comparative study of two methods of anesthesia, conducted at LRBT Free Eye and Cancer Hospital, Lahore from January to July 2000. Study included 200 patients with uncomplicated age-related cataract, equally divided in two groups on simple random basis. Group A (100 patients) received the retrobulbar anesthesia and Group B (100 patients) received the intracameral anesthesia with bupivacaine hydrochloride 0.5% for phacoemulsification with posterior chamber intraocular lens implantation. Outcome measures like pain, visual acuity, intraocular pressure and anterior chamber reaction were compared. On day 1, 79% of the patients in group A and 82% patients in group B had unaided visual acuity ranging between 6/6-6/18. On day 7, this was 88% in group A and 89% group B. On day 1, 99% in group A and 98% in group B had <1+ cells in the anterior chamber while on day 7 this increased up to 100%. On day 1, 97% in group A and 98% group B had intraocular pressure less than 20 mmHg. On day 7, it increased up to 100% in both groups. 97% patients in group A and 96% patients in group B had painless surgery. Results were analysed using computer software SPSS version 10.0. Results showed no significant statistical difference between two groups in terms of pain, visual acuity, intraocular pressure, anterior chamber reaction and patient comfort. In the hands of expert surgeons and in selected patients, intracameral anesthesia with preservative-free bupivacaine hydrochloride 0.5% is a safe and effective technique of ocular anesthesia for phacoemulsification with posterior chamber intraocular lens implantation.
 
Article
Spinal anaesthesia is the method of choice for elective caesarean delivery. Levobupivacaine may produce a sensory and motor block that is different from that produced by bupivacaine, the most popular local anaesthetic for parturients undergoing caesarean section (CS). We present a case of unexpectedly prolonged spinal anaesthesia following a successful spinal block with levobupivacaine. There was no evidence of any neurological injury in this patient during injection.
 
Article
In order to improve our newborn care, we instituted several changes along with training of medical and nursing staff and compared survival rates in babies < 2000g before and after these changes. We also measured Perinatal Mortality Rate (PMR) and Neonatal Mortality Rate (NMR) in general, percentage of Low Birth Weight (LBW) babies and causes of early neonatal deaths at Lady Dufferin Hospital (LDH). It was an intervention study design. All admissions to NICU between 1998 and 2000 were entered in the register. Data included high risk obstetric factors, gestational age, birth weight, APGAR score, gender, need for resuscitation, diagnosis, complications and outcome. Data of rest of the babies was recorded from operation theatre, labour room and postnatal ward registers in a separate register. Of 783 perinatal deaths, 488 were stillbirths and 295 were early neonatal deaths; 2498/14867 (17%) babies were LBW. The main causes of early neonatal mortality included prematurity and related complications (35%), congenital malformations (23%), sepsis 19%), and birth anoxia (16%). Most (27/295 77%) deaths occurred in babies weighing <2500g. Deaths due to prematurity and related complications in babies weighing between 1000-1499g decreased from 17/33 (51%) in 1997 (to 13/33 (39%) 9/45 (20%), 2/38 (5%) in 1998-99 and 2000 respectively. Sepsis related deaths decreased in babies weighing between 1500 to 1999g from 5/57(8.7%) in year 1997 to 7/77 (9%), 3/76 (4%), 4/96 (4%) in 1998, 99, and 2000 respectively. The PMR/NMR decreased from 58/22.4 in year 1997 to 39/15.6, 44.4/18.6, 38.2/12.3 for year 1998, 1999 and 2000 respectively. There was a significant reduction in mortality in LBW babies after training of medical and nursing staff. Reduction in overall PMR & NMR was also due to decrease in mortality in LBW babies.
 
Article
To evaluate the impact and safety of neonatal circumcision under a uniform hospital policy using Gomco Clamp (GC). A retrospective analysis of 1000 consecutive cases of neonatal circumcisions done with Gomco clamp at the Armed Forces Hospital, Jubail, Saudi Arbia during the period January 1996 through December 1998. The outcome measures were the type and number of complications, incidence of inadequate circumcisions, redo procedures and the extent of parental satisfaction. There was 1.9% incidence of overall complications (n = 19) with mild to moderate bleeding in 6 cases (31.6% of complications), which settled with further compressive dressing. There were 4 cases (21%) of superficial sepsis and 2 frenular ulcers (10.5%), which required topical antibiotics. Four babies (21%) had soft Preputial adhesions that were separated easily under topical anaesthesia. There were 3 cases (16%) of inadequate circumcisions; however only one required a redo operation after one year. The other two were found adequate at further follow-up for two years and final appearance was acceptable to parents; 99.7% parents were satisfied with the final cosmetic appearance. The circumcision with Gomco clamp is safe and effective technique with reproducible results provided a particular care is taken in exact marking of the site on foreskin for excision and selecting a correct size of the clamp. Each hospital needs to develop its own policy keeping in view the population for best cosmetic results from circumcision to avoid disappointments and redo operations.
 
Article
To compare the efficacy of low (50 mCi) and high dose (100 mCi) Iodine-131 in ablation of differentiated thyroid cancer remnants. Baseline serum thyroglobulin (sTg), thyroglobulin antibody (Tg Ab) and diagnostic whole body iodine scan with 2 mCi of I-131 were performed in each individual. After 6 months serum Tg, Tg Ab (of-thyroxin) and WB iodine scan with 10 mCi of I-131 were done to assess the efficacy of the low and high dose of I-131. Iodine ablative therapy (IAT) was considered successful (complete ablation) if the I-131 whole body scan was negative and sTg level was undetectable. In case of positive scan and/or sTg level detectable the patient was considered as unsuccessfully/partially ablated. In group A, (high dose) successful IAT was seen in 12/20 (60%) patients. Of these 5/7 (71%) had follicular Carcinoma on histopathology and 7/13 (54%) had papillary Ca. In group B, (low dose) successful IAT was seen in 8/20 (40%) patients, out of which 3/10 (30%) had follicular Carcinoma on histopathology and had successful IAT. 5/10 (50%) patients with papillary Carcinoma had successful IAT. As far as histopathology is concerned, in group A, response to high dose I-131 was better in follicular type than papillary type. Whereas in group B, response to low dose I-131 was better in patients with papillary type than follicular. 100 mCi of radioactive Iodine-131 (I-131) is a more effective therapeutic dose than 50 mCi (I-131) in the treatment of differentiated thyroid cancer remnants. Furthermore, follicular Carcinoma respond better to 100 mCi I-131 than 50 mCi while papillary Carcinoma showed an almost equal response to both.
 
Article
To compare levels of tissue plasminogen activator and plasminogen activator inhibitor-1 levels in patients with acute myocardial infarction and unstable angina in order to understand the use of high sensitivity C-reactive protein (hsCRP), coagulation and fibrinolysis markers for cardiovascular risk assessment. The cross-sectional case-control study compared circulating concentrations of high sensitivity C reactive protein (hsCRP), fibrinogen, tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) between patients of acute myocardial infarction (AMI) (n = 67), Unstable Angina Pectoris (UA) (n = 35) and healthy control subjects (n = 39) at the King Khalid University Hospital, Riyadh, Saudi Arabia, from June 2006 to August 2007. The patients had significantly higher hsCRP (1.06 +/- 0.11 vs 0.52 +/- 0.14, p < 0.01), fibrinogen (426.21 +/- 24.09 vs 329.32 +/- 13.93, p < 0.05), PAL-1 (44.02 +/- 6.05 vs 19.35 +/- 3.94, p < 0.01) and tPA (12.31 +/- 1.16 vs 9.49 +/- 0.86, p < 0.05) compared to the controls. Fibrinogen (329.32 +/- 13.93) and PAL-1 (19.35 +/- 3.94) were higher in both angina and infarction groups compared to the healthy subjects (p < 0.01). Between the two categories of patients the difference between Fibrinogen (449.60 +/- 52.98 vs 419.46 +/- 23.42) and PAL-1 (52.00 +/- 17.34 vs 43.19 +/- 6.10) levels were non-significant. Also, the difference in tPA levels between the controls and angina patients was nonsignificant (9.49 +/- 0.86 vs 9.91 +/- 1.24 p > 0.05). It was higher in infarction patients (14.79 +/- 3.14) compared to angina patients and the controls, (p < 0.05). Compared to the controls, hsCRP levels were significantly higher in both the patient groups (0.52 +/- 0.14, 1.05 +/- 0.28, 1.40 +/- 0.20, p < 0.01). Moreover, they were significantly higher in infarction patients than those suffering from angina (p < 0.05). CAD patients had a procoagulant state and presented with higher levels of hsCRP compared to the healthy individuals. Moreover, there were significant differences in coagulation markers and hsCRP between angina and infarction patients.
 
Article
To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma. Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years. A total of 102 cases were seen with an age range of 1 to 75 years (mean, 30 years). Predisposing factors included Diabetes mellitus (8 patients) and pregnancy or puerperium (7 patients). Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever (59%), headache (57%), meningeal irritation (36%) were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed in 63 patients, of whom 88% had elevated protein, 83% had low glucose, and 84% had pleocytosis (one-third with neutrophilia). Forty-nine (50%) patients had clinical or laboratory evidence of concomitant tuberculous meningitis. Chest radiographs showed active or old tuberculous infection (25%), with a miliary pattern in 20%. Two-thirds of subjects had multiple tuberculomas (mean, 4.5 lesions per patient) on contrast CT or MRI scan. Hydrocephalus was present in 37 (37%) patients of which 21 required shunt surgery. Thirty-nine patients had > 9 months of follow up; 17 patients showed complete recovery, 20 patients had partial recovery, and 2 patients had no response. Coma at presentation and miliary pattern on chest X-ray were predictors of poor prognosis. The study demonstrate that fever, headache, signs of meningeal irritation and cranial nerve palsies are common presenting features. Complete recovery was seen in 40% patients. Coma and military TB are predictors of poor prognosis.
 
Article
Pemphigus has an average age of onset in the fifth and sixth decades of life, with a mean age of onset of about 50 to 60 years. In this study of 108 patients conducted in Karachi, Pakistan, 82 had pemphigus vulgaris, 24 pemphigus foliaceus and 2 pemphigus vegetans. Other types of pemphigus were not seen. Seventy cases were under 41 years with the mean age at the time of diagnosis being 33.8 years, which is considerably low compared to that mentioned in standard western literature. Considerable variation in the age incidence of the disease exists in different geographic locations.
 
Article
To analyze frequency of isolation and trends in antibiotic resistance among Campylobacter isolates over 11 year period in Microbiology Laboratory, Aga Khan University from the year 1992-2002. Total 52,777 stool specimens were processed during the study period. Enteric pathogens isolated from 8,483 stool samples were further analyzed for frequency of isolation and antimicrobial resistance. Statistical Analysis was done by using descriptive statistics of SPSS version 10. Values were expressed as percentages, mean and rates. Campylobacter species were third in frequency of isolation with an isolation rate of 24.8%. C. jejuni was the predominant pathogen followed by C.coli. Isolation rate of Campylobacter was higher (45.7%) among children under 2 years of age as compared to other age groups. A steady rise in resistance among Campylobacter isolates against ampicillin; tetracycline and ofloxacin has been noted whereas resistance against erythromycin remained fairly low. The isolation of Campylobacter is higher from stool specimens of children of less than two years of age rendering Campylobacteriosis to be an important cause of gastroenteritis in pediatric population. This study also demonstrates a steady rise in antibiotic resistance in Campylobacter isolates especially against quinolones with fall in resistance against erythromycin throughout the study period.
 
Article
One hundred and eleven patients were operated for various types of goitre between December, 1985 to June, 1988. These were evaluated to assess the morbidity and mortality associated with thyroid operations. A mortality of 0.9% was noted, owing to advanced age and fatal laryngeal oedema. Recurrent laryngeal nerve damage was seen in one (0.90%) case. Transient Parathyroid insufficiency appeared in 8.10% cases while the permanent damage occurred in one (0.9%) case only. Wound complications, including haematoma formation were noted in 14.40% cases. This study indicates that the thyroid surgery can be performed with acceptable morbidity and mortality, under the prevailing circumstances.
 
Article
During a period of 16 months 114 patients with cholelithiasis were studied. The diagnosis was confirmed by cholecystogram in 41 cases, by surgery in 28 and both surgery and the x-ray in 45 cases. There were 100 females and 14 males and their average age was 43.2 years. The average number of pregnancies in females was 6.5. Clinically the jaundice was observed in 9% and the gall bladder was palpable in 47% of cases. Cholelithiasis appeared to be related to increased parity but not to the body weight.
 
Article
During a period of 16 months 114 patients with cholelithiasis were studied. The diagnosis was confirmed by chelecystogram in 41 cases, by surgery in 28 and both surgery and the x-ray in 45 cases. There were 100 females and 14 males and their average age was 43.2 years. The average number of pregnancies in females was 6.5. Clinically the jaundice was observed in 9% and the gall bladder was palpable in 47% of cases. Cholelithiasis appeared to be related to increased parity but not to the body weight.
 
Article
To evaluate the efficacy and safety of photoselective prostate vapourisation with 120 w potassium titanyl phosphate laser in benign prostate hyperplasia patients receiving oral anti-coagulant therapy. The retrospective study was conducted at Istanbul Hisar International Hosptial and comprised 63 male patients who were on anti-coagulant therapy for comorbidities and who underwent prostate vapourisation for benign prostate hyperplasia with 120 Watts potassium titanyl phosphate from November 2007 to December 2010. International Prostate Symptoms Score, Quality of Life scores, uroflowmetry pre-operatively and 3 months postoperatively were obtained. Ultrasound examination was performed for each patient to evaluate prostate and residual urine in the bladder. Plasma haemoglobin, haematocrit and International Normalised Ratio levels were also checked for patients in the pre- and post-operative period. The age range of the patients was from 65-89 years with a mean of 72.3 +/- 8 years. The mean prostate weight was 45 +/-17 ml (range: 40-120). Mean operation time was 54 +/- 16 minutes (25-90). The removal of urinary catheter took place 1-3 days post-operatively. None of the patients required transfusion. The International Prostate Symptoms Score was reduced (23 +/- 6 vs. 14 +/- 3) at third month after the operation. Quality of Life scores were improved from 2.2 +/- 1.1 to 4.7 +/- 1.2, and maximal urine flow rate increased from 7.8 +/- 2.3 to 16 +/- 1 in the same period. Urinary obstruction due to clot retention was observed in 1 (1.58%) patient in post-operative 3 days. Urinary retention occurred in 5 (7.98%) patients after the removal of the urinary catheter. Permanent urinary retention, peroperative bleeding and post-operative incontinence were not observed. Treatment of benign prostate hyperplasia with photoselective prostate vapourisation is effective and safe in patients receiving anti-coaguant therapy. However, patients should be monitored in early post-operative period for macroscopic haematuria and transient urinary retention.
 
Article
A report of 122 gastroscopic examinations done on 120 patients is presented. No gastric lesion were seen in 53 patients; 17 had gastric ulcer, 22 gastric carcinomas, 14 various types of gastritides and 10 gastroenterostomies. Examination was unsatisfactory in 4 cases. This study suggests that as the standard of gastrointestinal radiology is not uniform in this country, frequent use of endoscopy as a diagnostic procedure may prove helpful in the diagnosis and follow up of various gastric lesions. The last decade has seen some major advances in gastrointestinal endoscopy. Attempts at perfection of examination techniques and improvement in the quality of fiberscopes are still in progress. Efforts in this direction are well rewarded by better understanding of evolution of various lesions of gastrointestinal tract. Fibergastroscopy is still in infancy in Pakistan. Although a variety of gastric lesions must be occurring here but our experience is limited only to those referred cases which presented some diagnostic problem to the attending clinicians.
 
Article
This paper is based on a study of 123 new born infants selected from general wards, private nursing homes. It was found that the average weight of babies born to mothers of upper social class was more than that of middle and lower social class. The chest and head circumference of upper social class was greater than the middle and lower social class, but there was no difference in their length. It was interesting to note that the incidence of prematurity was much higher in the middle and lower social class and was the incidence of congenital anomalies.
 
Article
One hundred and twenty-six patients (71 non-diabetics and 55 diabetics) suffering from mild hypertension (Diastolic BP 90-110) have been reviewed. Hypertension was idiopathic in 123 and possible renal causes were considered in 3 cases. Evidence of target organ involvement, either singly or in combination in the form of electrocardiographic evidence of left ventricular hypertrophy and ischaemic changes, cardiac enlargement on radiology, cerebrovascular insufficiency, retinopathy and albuminuria in the absence of other pre-disposing causes was present in 28.5% of the patients. The prevalence rate of these complications was higher in the diabetics (34.5%) as compared to non-diabetics (23.9%). These complications occurred in the 4th and 5th decades of life in nearly 80% of these patients. Serum cholesterol was higher in diabetic patients with complications than non-diabetics. Mild hypertension may not be an entirely benign condition and the need for controlled studies to assess the efficacy of anti-hypertensive drugs in this category is stressed.
 
Article
Tobacco use is a preventable cause of disease and death globally. Adolescents using tobacco tend to continue its use in adulthood. Analysis of data from Moroccan Global School-based Student Health Surveys for 2006 and 2010 showed statistically significant differences in prevalence of current cigarette smoking as well as current use of other tobacco products, among school attending 13-15 year old boys and girls within the year 2006 and 2010; with boys having higher prevalence than girls in each year. Combined prevalence of cigarette smoking i.e. between both boys and girls showed statistically significant difference between 2006 and 2010; with a higher prevalence in 2010. Use of tobacco in multivariate analysis of 2010 data, was found to have statistically significant associations with anxiety disorders, gender, truancy, depression, suicidal ideation, inadequate parental monitoring, and parental smoking.
 
Article
Ewing's sarcoma is the second most common primary tumour of bone in childhood. Less frequently it occurs in soft tissues. Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) is an extra ordinarily rare primary tumour in the kidney. Only very few cases of primary renal Ewing's sarcoma have been reported in the literature to date. We present a case of primary right renal Ewing's sarcoma in a 13-year-old girl who was diagnosed as a case of stage IV ES/PNET of kidney with metastases to lung and liver. Right nephrectomy was done followed by adjuvant radiotherapy and chemotherapy with complete response to local and distant area.
 
Article
To study the impact of educational intervention on knowledge, attitude and practices with regard to water pipe smoking among adolescents (14-19 years old) in Karachi. A cross-sectional survey of adolescents aged 14-19 years studying at different educational institutions of Karachi, Pakistan was conducted through multistage sampling on a pre-tested self-administered questionnaire. They were divided into high, middle and lower socioeconomic strata on the basis of monthly fee structure. The impact of health messages was assessed two months after education sessions through post-test of only high and middle socioeconomic strata. A total of 646 students were surveyed for the pre test and 250 students for the post test. A significant association was found for water pipe smoking among the socioeconomic class (p < 0.001). Water pipe is more addictive as compared to cigarettes was marked by more students after the sessions (54% vs 68%; p < 0.001). A significant difference was seen for water pipe being more socially acceptable (58% vs 80%; p < 0.001), it is part of our cultural heritage (29% vs 58%; p < 0.001). Shisha smoking was more prevalent among the high socio economic group, which might be because of the cost, accessibility and availability. The knowledge of the students regarding water pipe smoking improved after the health awareness sessions.
 
High power view of angiokeratoma (H & E staining, magnification (20x).
Article
Angiokeratomas (AC) are vascular lesions which are defined histologically as one or more dilated blood vessels lying directly subepidermal and showing an epidermal proliferative reaction with ectatic capillaries in the papillary dermis. Only three other cases of isolated mucosal angiokeratoma have been reported in the indexed literature. We reviewed all cases of angiokeratoma located on the tongue, diagnosed in our department during a study period of 10 years (1995-2005). Histologically all 14 cases showed dilated and congested blood vessels in the upper papillary dermis. They lack deep dermal involvement. Hyperkeratosis and acanthosis were also seen in most of the cases. No clinical data was available to assess systemic disease. A higher incidence of of AC in tongue is seen in our study.
 
Article
To evaluate the diagnostic importance of myelography in spinal disorders, in correlation with clinical presentation of the patients. Patients selected for myelography had presented with history of various spinal disorders such as low backache, neurogenic claudication, paraparesis or paraplegia, quadriparesis or quadriplegia, trauma to spinal region and infective spondylitis. Patients excluded were those with history of allergies to iodinated contrast agents, seizures coagulopathy and pregnant women. Contrast agent was water soluble non ionic agent--lohexol. Spinal Needles used were of 20,22 and 25 gauge. X-Ray machine with tiltable table was used for myelography. There were 1400 patients of whom 935 were males and 465 females with male to female ratio of 2.1. Age range was 8 to 65 years. Spinal disorders diagnosed on myelography were lumbar disc prolapse 866 (60%) cases, lumbar canal stenosis 113 (8%), thoracic disc protrusions 15 (1%), infective spondylitis 53 (4%) cases, spinal tumors 36 (2.5%), spinal dysraphism 28 (2%) and traumatic spine in 85 (6%) cases. Free flow of contrast agent with no block was found in 149 (10.64%) cases. These were subjected for MRI scan which revealed significant pathological lesion of surgical importance in 23 cases (1.64%) only. Myelography is the least expensive valuable diagnostic test in spinal disorders specially in lumbar disc prolapses and lumbar canal stenosis.
 
Article
There is a lack of data on the etiology and outcome of pneumothorax among the Pakistani population. Our aim was to review the etiology, clinical course, management and outcome of patients presenting with pneumothorax. All adult cases with pneumothorax admitted to a University Teaching Hospital in Karachi, between January 1992 and June 1996, were reviewed and analyzed. A total of 146 patients were reviewed. Their mean age was 46.3 years (SD +/- 17.8 years) with a male to female ratio of 3.7:1. Secondary pneumothorax was the commonest type seen (45%), followed by traumatic (21%), iatrogenic (18%) and primary (16%). Tuberculosis (47%) and COPD (45%) were most common lung diseases associated with secondary pneumothorax. Pneumothorax secondary to TB presented at an earlier age than that with COPD (49.6 vs. 60.1 years). Similarly, patients with primary pneumothorax were significantly younger than patients with secondary pneumothorax (42.3 vs. 51.7 years). Rib fracture was the most common cause of traumatic pneumothorax. Coronary artery bypass grafting, transthoracic fine needle aspiration and neck vein cannulations were the leading iatrogenic causes. The commonest symptoms of pneumothorax were dyspnea (68%) and chest pain (40%). Most cases (81%) were successfully managed by intercostal tube drainage. In our study population, secondary pneumothorax was the commonest variety seen. TB was the commonest cause of secondary pneumothorax, closely followed by COPD. Nearly 40% of pneumothorax were either traumatic or iatrogenic. Intercostal tube drainage remains the treatment of choice for pneumothorax.
 
Article
This study was carried out to observe the prevalence breast diseases of males in our setup. All cases of male breast disease diagnosed from 1991-97. One hundred and fifty (150) cases of male breast diseases were diagnosed. Age of the patients ranged from 4 to 90 years, with mean age 38.75 years (median = 33 years). Gynecomastia was the most common pathological abnormality of the male breast (58.66%). Most of the patients presented in the 3rd decade of life. Amongst the malignant conditions, infiltrating ductal carcinoma was most prevalent (82%). Most of the patients with malignancy presented in the 5th and 6th decades of life. Gynecomastia was the most prevalent male breast disorder, followed by infiltrating ductal carcinoma. Our findings correspond with that of world literature.
 
Article
To share our experience of 154 cases of clinical vitamin A deficiency in Pakistani children. The data on age, sex, date of presentation and clinical stage of vitamin A deficiency was recorded. A total of 154 children aged 0-15 years suffering from clinical vitamin A deficiency (xerophthalmia) were recorded. One hundred and twenty three (79.9%) children were 0-6 years with 99 (64.3%) male children. Blinding xerophthalmia (corneal xerosis, corneal ulcers ad keratomalacia) was present in 94 (61%) children. Thirty nine percent children presented in summer, 28% in autumn, 20% in winter and 13% in spring respectively. This report indicates that clinical cases of vitamin A deficiency in children do occur in Pakistan. Children under 6 years of age are the most vulnerable age group and there is a seasonal variation in presentation. Both life and sight of these children are at risk. Community based studies may be helpful to identify the magnitude of the problem and possible risk factors at national, provincial and district levels.
 
Article
To gain information about the indications for and complications of conventional nephrectomy as practiced in a teaching hospital of Pakistan. Medical records of patients who underwent nephrectomy during five years period from January 2001 to December 2005 were studied with regards to clinical presentation, indication for nephrectomy, histopathological report, post-operative complications and mortality. The indications for nephrectomy were divided into benign and malignant conditions. Out of 154 nephrectomies, 118 (76.6%) were performed for benign condition and 36 (23%) for malignant etiology. In the benign group, majority (i.e. 53.3%) of the patients had kidneys removed due to renal stone. Other conditions in this group included chronic pyelonephritis (20%), neglected ureteropelvic junction obstruction (16%), renal tuberculosis (7.6%) and iatrogenic (2.5%). Thirty-six (23%) patients had nephrectomy for malignant conditions i.e. renal cell carcinoma. Malignant tumors were more common in males while benign conditions necessitating nephrectomy were predominant in female patients. Patients with benign conditions were much younger (mean age 32 years) than patients in malignant group (mean age 52.8 years). Nephrectomy for malignant disease had a higher rate of complications (13.8%) than for benign conditions (7.6%). The re-operation rate was 1.29% for all patients who underwent nephrectomy. Two patients, one in each group, died post-operatively and the overall 30-day mortality was 1.29% The mean age of the patients undergoing nephrectomy for benign and malignant conditions was lower than reported from western countries. In our series there was a much higher rate of nephrectomy performed for benign conditions. Renal stone related etiology was the major indication for nephrectomy. Malignant renal tumours affected patients at a remarkably younger age and clear cell renal carcinoma was the predominant histological variety. Nephrectomy for malignant conditions had a higher rate of complications than for benign conditions while there was no difference in the overall mortality.
 
Article
To analyse outcomes of variable management strategies for the treatment of Acute Cholecystitis in relation to morbidity, mortality and conversion to open surgery. The retrospective study was conducted at Firat University Hospital, Turkey and comprised records of Acute Cholecystitis patients admitted between 2005 and 2011. Patients were divided into subgroups according to admission time as well as American Society of Anaesthesiologists score. The outcomes of early cholecystectomy, interval cholecystectomy, delayed cholecystectomy, 'cooling-off' therapy and percutaneous cholecystostomy were evaluated. Mortality, morbidity, and conversion to open surgery were calculated as measures of success. Data was analysed using SPSS. Of the 1557 patients, 1052(67.6%) were female. The overall mean age was 42.4±14.7 years. Success rates of 'cooling-off' therapy and percutaneous cholecystostomy were 89.3% and 96.3%, respectively. The conversion rate following delayed cholecystectomy was 30%, which was higher than that of both early and interval cholecystectomy (0.2% and 0%, respectively; p<0.001 each). Mortality and morbidity rates of delayed cholecystectomy (57.1% and 7.1%, respectively) were also significantly higher than early and interval cholecystectomy (5% and 0.1%; 5.6 and 0%, respectively). Early laparoscopic cholecystectomy and interval cholecystectomy shared similar outcomes and rates of efficacy. Percutaneous cholecystostomy was a successful treatment option for high-risk patients, while delayed cholecystostomy correlated to the highest rates of conversion to open surgery, mortality and morbidity.
 
Article
The co-infection of Epstein-Barr virus and Cytomegalovirus rarely gains multi-pathogenicity and leads to viral myocarditis. Also, it may lead to progressive heart failure or sudden death. We present a case series of five patients who were monitored for the impact of low-dose colchicine therapy as adjunct to conventional heart failure therapy. Epstein-Barr virus, Cytomegalovirus and other viral antibodies were determined by enzyme-linked immunosorbent assay method. Adjuvant low-dose colchicine therapy (2x0.5 mg twice daily) was prescribed for addition to the conventional heart failure therapy of these patients and it wsa continued for two years. Ejection fractions of echocardiographic examinations in all patients were 21%, 18%, 25%, 20% and 21% before low-dose colchicine therapy. After two years of treatment, the values increased to 59%, 45%, 40%, 25% and 41%, respectively. The early implementation of low-dose colchicine in these patients seemed to have beneficial effects on overall survival.
 
Article
To review 17 years experience of the stone clinic with incorporating the changes in practice over the years and to report the benefits of stone clinic in a developing country. The SIUT Stone clinic was established in 1990 with installation of HM4 Lithotriptor. This clinic is run jointly by a Urologist, Dietitian, Nephrologist, Biochemist and Radiologist. From 1990 - 2007, about 38,749 stone patients received treatment with ESWL (55%), PCNL (6.0%), URS (15.5%), litholopaxy 4.0% and open surgery 19.7%. These patients after treatment were followed in the stone clinic with stone analysis and 24 hours urine metabolic studies where indicated. Dietary and oral hydration programme combined with medical therapy was also instituted. Recurrence rate was noted in those patients who were advised diet modification, oral hydration and medical treatment. Complications of stone disease were documented during the follow-up period. In ESWL group 8226 patients were followed in the stone clinic for 5 years. In this group, 185 (2.2%) had recurrence of renal calculi. In PCNL group 1306 patients were followed, and 16 (1.1%) had recurrence. In the open surgery group of 1294 patients, 17 (1.3%) had recurrence of renal calculi. The complications of stone disease noted were renal failure and infections in 162 (1.5%) patients, during the follow-up period. This study shows the beneficial effect of a stone clinic in a developing country and positive effect on the reduction of recurrence and complications of stone disease. Our experience promotes the need to open more specialized stone clinics in areas where stone disease is highly prevalent.
 
The distribution of peripheral skinfold thicknesses for boys (b) and girls (g). 
The distribution of central skinfold thicknesses for boys (b) and girls (g). 
The distribution of sum of skinfolds and body fat percentage (calculated by Westrate-Deurenberg equation) for boys (b) and girls (g). 
Article
As skinfolds from four-sites (triceps, biceps, subscapular, suprailiac) and body fat percentage in 6-17 years is lacking in Turkey. This study was undertaken to produce references for four-site skinfolds and body fat percentage in children and adolescents. The cross-sectional study was conducted between September 2007-May 2008 in Kayseri, Turkey, after approval by ethics committee of Erciyes University and local educational authority. Data were obtained from the Determination of Anthropometric Measures of Turkish Children and Adolescents Study-II. Using multistage sampling method, 4285 children were selected from the schools representing city centre, rural and urban areas of the province. Skinfolds were measured from four sites and body fat percentage was calculated according to Westrate and Deurenberg equation. LMS Chart Maker Pro version 2.3 software was used to obtain skinfold references. There were 1914 (44.6%) boys, 2371 (55.3%) girls in the study; the age range being 6-17 years. The peripheral skinfolds increased with age for girls (7.2 mm at age 10 versus 8.7 mm at age 17), while this was true for boys until 10 years (6.2 mm at age 10 versus 4.2 mm at age 17) after which the values gradually decreased. In terms of central skinfolds, girls had higher numbers in each age (11.7 mm for boys versus 12.8 mm for girls at age 6; 24.9 mm versus 26.3 mm at age 17). Skinfolds and body fat percentage provide information that helps monitor secular trends in obesity in Turkey and may be used to make national and international comparisons in the future.
 
Article
To see the distribution of Calretinin, thrombomodulin, CK5/6 and HBME-1 markers in various subtypes of mesotheliomas and extend the published data on this topic. The positivity of adenocarcinoma specific markers (CEA and BerEP4) in malignant mesotheliomas have also been evaluated. Various markers in 173 cases of malignant mesotheliomas received over a period of 8 years were evaluated by immunohistochemistry. In majority of malignant mesotheliomas i.e., epithelioid and biphasic types, the positive staining patterns complement the gold standard histologic diagnosis. However, in a small minority mainly sarcomatoid variant, heavy reliance cannot be placed on these markers. CEA and BerEP4 are useful negative markers of mesotheliomas, although occasionally these are positive in clear cut mesotheliomas. Specificity of various markers in malignant mesotheliomas should be assessed according to histologic subtypes. The existing generation of markers is not reliable in diagnosis of sarcomatoid mesotheliomas. Fortunately this forms only a small group of mesothelial malignancy. In common epithelioid and biphasic variants calretinin, thrombomodulin, CK5/6, HBME-1 are sensitive positive markers whereas CEA and BerEP4 are negative markers of malignant mesotheliomas.
 
Top-cited authors
Naila - Kayani
  • Aga Khan University Hospital, Karachi
Mohammad Khurshid
  • Aga Khan University, Pakistan
Syed Ejaz Alam
  • Pakistan Medical Research Council
Shahid Pervez
  • Aga Khan University Hospital, Karachi, Pakistan
Sarah Saleem
  • Aga Khan University, Pakistan