Role of zinc supplementation in acute diarrhea in pre-school children

Objective: To monitor the therapeutic impact of zinc supplementation on clinical course of acute diarrhea i.e. frequency of stool, on stool amount and duration of acute diarrhea

Study Design: Randomized controlled trial

Place and Duration of Study: Family medicine department, PAF Hospital, Islamabad Pakistan from Jul to Dec 2009

Material and Methods: One hundred and twenty eight children aged6 months to 60 months in an Outpatient pediatric department of PAF Hospital, E-9 Sector Islamabad with acute diarrhea of less than 14 days were included in this randomized controlled trial. They were further divided into two groups zinc supplemented group [n=65] and non-zinc supplemented group [n=65]

Results: Baseline characteristics were similar in both the groups. Mean age in zinc supplemented group was 33.67 +/- 16.45 months and in non-zinc supplemented group 33.63 +/- 16.44 months. Reduction in stool frequency per day was found 62% in zinc supplemented group and 26% reduction was found in non-zinc supplemented group with obvious difference of 36% between these two groups from day 3 to day 5, which was found statistically significant [p=0.01]. Similarly, significant difference [p=0.01] was observed for reduction in amount of stool per day from day 3 and day 5 with obvious difference of 45% between the study groups

Conclusions: Oral zinc administration in acute diarrhea reduces the frequency of diarrhea, output of stool and decreases total duration of diarrhea

Bone mineral density in patients with metastatic prostate cancer with or without androgen deprivation therapy

Prostate cancer commonly metastatize to skeletal sites. Androgen deprivation therapy [ADT], the primary treatment of metastatic prostate cancer, may result in osteoporosis. Bone mineral density evaluation during androgen deprivation therapy can detect patients at risk of osteoporotic fractures

Objectives: 1-To determine BMD [T-score] in patients with metastatic prostate cancer with or without androgen deprivation therapy. 2-To compare BMD in metastatic prostate cancer patients with age matched controls

Study Design: case-control study

Setting: Urology Department, Allied Hospital Faisalabad

Materials and Methods: BMD of patients with metastatic prostate cancer [30 with ADT, 30 without ADT sampled with nonprobability convenience method] were compared with age matched control group of 60 subjects. Inclusion criteria. Group-I: 60-80 years aged consecutive patients of carcinoma prostate who have been taking anti androgen therapy at least six months. Group-II: 60-80 years consecutive patients with metastatic prostate cancer who have not started any antidrogen deprivation therapy. Group-III: 60-80 years aged healthy men from general population [preferably from patient's family] without prostate cancer. Exclusion criteria: From all groups, men taking for any reason, chemotherapy, radiation thyroxin, warfarin, corticosteroids, methrotrexate, anticonvulsants, post organ transplant therapy, chronic heparin, antipsychotic medications, long term lithium therapy and calciuretic diuretics were not included in the study

Results: Out of 120 subjects, 31% had normal BMD, 27% osteopenia, 42% osteoporosis. In metastatic prostate cancer patients taking ADT [n=30], 7% subjects had normal BMD, 37% osteopenia and 56% osteoporosis. In metastatic prostate cancer patients without ADT [n=30], 13% subjects had normal BMD, 63% osteopenia, 24% osteoporosis. In healthy controls [n=60], 52% subjects had normal BMD, 33% osteopenia, 15% osteoporosis

Conclusions: BMD is affected by prostate cancer and its treatment. Bisphosphonates use should be rationalized according to the patients need

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases

Ruptured ovarian teratoma presenting as peritonitis

A 55-year-old lady reported to the surgical OPD with clinical findings of acute peritonitis. Emergency laparotomy was performed. The peritoneal cavity was full of purulent material, however, the gut was normal. An 8 x 6 cm thick walled cyst was found in the left ovary with a minute perforation and purulent fluid coming out of it. Thorough peritoneal lavage along with left oophorectomy was performed. The postoperative recovery was smooth. Histopathology confirmed benign cystic teratoma of ovary

Acute acalculous perforated cholecystitis

A case of acute acalculous perforated cholecystitis with acute generalized peritonitis in a middle aged cachectic man, presenting late in a moribund condition, is reported. He underwent emergency laparotomy [subtotal cholecystectomy], went into multi-organ failure and was managed accordingly. The patient recovered in about 2 weeks and was followed-up regularly

Open extraperitoneal mesh repair for abdominal wall hernias in females

To determine the outcome of treatment in terms of infection and recurrence using open extraperitoneal mesh repair technique. Quasi-experimental study. The department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment, from February 2006 to November 2008. Female patients with abdominal wall hernias with defect of 4 cm or more were studied. A history of previous surgery along with clinical findings on examination like size of defect and previous scar were noted. At surgery, hernial sacs were carefully opened and omental and intestinal adhesions were carefully separated. Polypropylene mesh was placed over extraperitoneal space and secured with interrupted vicryl 2/0 sutures. Redivac drains were placed over the mesh and the fascial repair. The patients were discharged on the 3rd - 4th postoperative day and were followed-up at 3 monthly intervals for postoperative sequelae like seroma, haematoma, infection and recurrence. There were 32 cases with a mean age of 41.25 +/- 10.79 years. The mean follow-up period was 15.78 +/- 9.02 months. Previous abdominal surgical intervention was found in 16 [50%] cases. Out of those, 14 [43.7%] had defects through the previous scar. A history of multiple caesarean sections alone, or in combination with either hysterectomy or laparotomy in the last 5 years was present in 7 patients. There were 12 [37.5%] cases of paraumbilical hernia, 4 [12.5%] of a recurrent paraumbilical hernia, 5 [15.6%] epigastric hernia, 2 [6.2%] mix hernia, 7 [21.8%] incisional hernia and 1 [3.1%] each of Spigelian hernia and postlaparoscopic cholecystectomy portal [paraumbilical] hernia. The mean size of the defect was 4.9 cm in primary paraumbilical hernias and 7.2 cm in recurrent paraumbilical hernias. The mean size of the defect in incisional hernias was 9.4 cm, larger than all other types. Superficial wound infection was seen in only 1 morbidly obese [BMI > 30] patient. No case of seroma, haematoma, deep seated abscess or recurrence was noted in the follow-up period. Abdominal wall hernias are common in female patients, especially those with previous surgical intervention. Open extraperitoneal mesh repair with placement of redivac drains is an effective method for the management of abdominal wall hernias with a smaller complication rate and less recurrence

Primary perisplenic hydatid cyst

Splenic parasitic cysts due to flat worm Ecbinococi resuling in hydatid disease are a rare presentation as primary site even in the endemic regions. Primary splenic parasitic cysts have an incidence of 0.5-4%. A 21-year-old male with pet dogs at home, presented with 3 months history of gradually increasing discomfort in the left hypochondrium and tender splenomegaly. He had marked eosinophilia with normal liver function tests and positive serum IgM Echinococcus antibodies. Ultrasonography showed a cyst in the hilar region of spleen having septations with internal echos. An upper midline laparotomy was performed and a perisplenic cyst was removed along with spleen from the sub-diaphragmatic location. Histopathological examination confirmed acellular fibrous wall of hydatid cyst with germinal layer and scolices in the centre. Postoperatively, patient was continued on oral Albendazole for one month

Retroperitoneal masses: different clinical scenarios

We present two cases of retroperitoneal masses with different presentations and outcomes. The first case was a 22 years old primigravida lady who underwent emergency caesarean section for preterm premature rupture of membranes with breach. On the operating table, a large retroperitoneal mass was identified and the biopsy confirmed Burkitt's lymphoma. Post operative chemotherapy did not have a favourable result and the patient had a fatal outcome. The other case was a 15 years old boy who had a progressively increasing retroperitoneal mass. Exploratory laparotomy revealed a hard, fixed, unresectable tumour extending into the mesentery of the small gut, biopsies were taken which showed tuberculosis. Post operative antituberculosis treatment had a marked response and the tumour disappeared after 6 months

Pierre Robin sequence as birth asphyxia in a new born

A new born baby boy presented with birth asphyxia and respiratory distress. He went into cardiac arrest twice but was resuscitated. On detailed evaluation, he had low set ears and micrognathia with glossoptosis consistent with features of Pierre Robin sequence. Episodes of apnoea disappeared, on nursing, the baby in prone position and later on tongue-lip retention suture were applied. Prompt diagnosis and efficient airway management by following the principles of airway resuscitation can save the lives of such babies without specialized care

Psychosocial factors associated with symptoms of depression and anxiety following acute myocardial infarction

To study factors associated with symptoms of depression and/or anxiety following acute myocardial infarction [AMI]. This Cross-sectional analytical, non-interventional, hospital based study was carried out at Punjab Institute of Cardiology [P.I.C] and Services Hospital, Lahore. One hundred consecutive inpatients with AMI diagnosed using WHO criteria, with the age range of 30-60 years [who were without physical complications] were included in the study. The Urdu version of Hospital Anxiety and Depression Scale [HADS] was administered to each patient during the period of 5-7 days following AMI. A semi structured clinical interview was also conducted which included demographic information, psychiatric assessment and risk factors related to AMI especially psychosocial factors. Results were analyzed using Statistical Package for Social Sciences [SPSS]. Out of 100 subjects, 80 [80%] were males and 20 [20%] were females. The age range was between 30-60 years [50.92 +/- 8.53]. Over all, symptoms of depression and/or anxiety were found in 50 [50%] patients. More particularly, symptoms of depression were found in 14%, symptoms of anxiety in 18%, and mixed symptoms [depression and anxiety] in 18% of the patients. A significant association was found between symptoms of depression and/or anxiety following AMI and family history of AMI [p < .007], type A behavior traits [p < .001], job stress [p < .01] and lack of confiding relationships [p < .002]. However, no significant association was found between symptoms of depression and/or anxiety following AMI and past history of AMI. The findings highlight the critical need to assess symptoms of depression and/or anxiety following AMI along with the factors leading to these. This would be particularly important in patients who have a family history of MI, job related stress, lack of confiding relationships and type A behavior traits

Cholecysto-hydatid cyst fistula

We present a case of recurrent hydatid cyst liver in a 32-year-old female. Previous surgery was performed 8 years ago elsewhere. Pre-operative assessment at presentation revealed a 110 x 105 mm hydatid cyst in the right lobe of the liver. On exploration, a 5 mm fistulous communication was found between the hydatid cyst and the gallbladder. Patient was subjected to endocystectomy [partial cystectomy], cholecystectomy and closure of the fistula followed by obliteration of the cavity with omentum. Postoperative recovery was uneventful

Symptoms of deperession and anxiety in post-myocardial infarction patients

To assess the frequency of symptoms of depression and/or anxiety following acute myocardial infarction [AMI] and to analyse their association with demographic variables. Design: A cross-sectional analytical, non-interventional hospital based study. Place and Duration of Study: The study was carried out at Punjab Institute of Cardiology [PIC], Lahore, from January 2000 to January 2001. Patients and A total number of 100 inpatients suffering from AMI were studied. After a careful selection of the subjects the Urdu version of Hospital Anxiety and Depression Scale [HADS] was administered to each patient during the period of 5-7 days following AMI to assess symptoms of depression and anxiety. A semi-structured clinical interview was also conducted which included demographic information, psychiatric history and other variables. Results were analyzed by using Statistical Package for Social Sciences [SPSS version 8.0]. Out of 100 subjects, 80 [80%] were males and 20 [20%] were females. Their ages ranged from 30-60 years [mean age, 50.92+8.53]. Overall, symptoms of anxiety and/or depression were found in 50 [50%] patients. More specifically, symptoms of depression were found in 14%, anxiety symptoms in 18% and mixed symptoms [anxiety and depression] in 18% of the patients. Results revealed that patients above 45 years of age [i.e. 46-60 years] were more likely to experience symptoms of depression and/ or anxiety following AMI. A significant association was also found between female sex [p <0.02], lower socioeconomic status [p <0.05] and symptoms of depression and/ or anxiety in these patients. However, no significant association was found in relation to educational status, marital status and origin [urban/rural]. The high proportion of patients with AMI found to be suffering from symptoms of depression and/ or anxiety one week after AMI highlights the essential need to assess these symptoms in all such patients during the post-MI period as they merit appropriate treatment alongwith the other complications of AMI

comparison of graduates of an innovative medical school and a conventional school in relation to primary health care

A comparative study of the attitudes and performances of graduates from an innovative medical school and a conventional one in relation to primary health care [PHC] was conducted. The aim was to identify the impact of a community-oriented medical education. The results showed that both groups were aware of PHC but those of the innovative school had received practical training in PHC centres, had skills to approach solving community problems, and gave due emphasis to promotional and preventive aspects of patient management. The study concludes that a community-oriented medical education is more appropriate to community needs