AAA syndrome, case report of a rare disease

Triple A [Allgrove] syndrome, an autosomal recessive disease is characterized by achalasia, alacrimia and ACTH-resistant adrenal failure with progressive neurological syndrome including central, peripheral and autonomic nervous system impairment, and mild mental retardation. The triple A syndrome gene, designated AAAS, localized on chromosome 12q 13 encodes for a 546 amino acid protein called ALADIN [Alacrimia-Achlasia-Adrenal Insufficiency and Neurologic disorder]. This report relates to two sisters, aged 8 and 12 years, who had vomiting, muscle weakness, alacrimia, excessive fatigue and dysphagia. Abdominal sonography, esophago-gastroduodenoscopy, barium swallow, esophageal manometry, CT scan abdomen and brain, biochemical profiles, as well as neurologic and ophthalmic evaluations were consistent with Allgrove's syndrome. Management consisted of pneumatic balloon dilatation for achalasia and initiation of cortisone therapy with successful resolution of dysphagia and other symptoms

Youth attitudes towards water pipe smoking in Amman - Jordan

To investigate attitudes, beliefs, and perceptions related to water pipe [WP] smoking among school children in Amman, Jordan. A cross-sectional study was conducted in 2006 - 2007 of ten public and private schools in Amman, Jordan and a total of 513 seventh and tenth grade students were interviewed [32.8% males and 67.2% females]. Surveys were conducted to assess the attitudes; knowledge, use of, and norms about water pipe use amongst youth, and the data were analyzed using STATA and SPSS. Two hundred sixty five of the students surveyed [52.2%] had tried water pipe smoking before. About a quarter [26.5%] of the participants had tried a water pipe when they were <10 years of age. Smoking mothers had more of an influence in attracting youth towards water pipe smoking. An anti-smoking campaign should start at early ages. WP hazards must be incorporated into the school curriculum. WP smoking in public places such as restaurants should be restricted

Emerging respiratory and novel coronavirus 2012 infections and mass gatherings

Mass gatherings are attended by an increasingly global audience and thus raise the concern of possible acute public health risks not normally encountered by the host population. The potential acute risks to individual and population health include communicable diseases. The communicable disease risks include emerging and re-emerging diseases in host and visiting populations. In this review, we provide an overview of the literature on respiratory infections at mass gatherings, then describe the impact of novel coronavirus 2012 [nCoV], an emerging respiratory disease virus, on the preparations for mass gathering. Although, nCoV emerged prior to the 2012 Hajj pilgrimage season, Muslims completed their religious duty without acquiring infections by nCoV. Clearly, the global nature of mass gatherings and their potential risks to international health make it imperative that research on such events and guidelines produced for their management are relevant to diverse contexts and are a collaborative effort between global experts

Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft

To evaluate whether use of fibrin glue instead of sutures for the treatment of recurrent pterygium with conjunctival auto-graft [CAG] further decreases its recurrence. A prospective, clinical open trial of 50 eyes of 50 patients with recurrent pterygium, who were randomly assigned to either, pterygium excision and CAG with fibrin glue [Group 1] or with 6 interrupted sutures [Group 2], was carried out from January 2009 to July 2010 at the outpatient department of Subharti Medical College, Meerut, North India. Both groups had 25 patients each. The groups were compared with regards to the surgical time taken, development of recurrence, postoperative symptoms [irritation, watering, and redness], and complications. Recurrence was seen in one [4%] eye in group I, and 3 [12%] eyes in group II after 9-13 months of follow up. The difference between the 2 groups was not statistically significant. The surgical time was significantly reduced, and postoperative inflammation and complications were less in group I. Postoperative symptoms were significantly more in group II patients. While conjunctival autograft with sutures for management of recurrent pterygium appears to be a safe and feasible modality, fibrin glue fixation of the autograft is a more viable option in terms of surgical ease, less time consuming, less postoperative complications, and less recurrence

Co-relation of lactic dehydrogenase levels with severity of pre-eclampsia

The elevated levels of LDH may reflect the severity of pre-eclampsia and occurance of complications. This study was carried out as a comparative study at Social Security Teaching Hospital, Lahore from June 2004 to January 2006: A total of 120 pregnant women with preeclempsia [60 with mild and 60 with severe pre-eclampsia] and 60 healthy normotensive controls were included in the study. The total number of deliveries during the same period was 5402. The patients were divided in three groups after admission through outpatient and emergency departments. Group I: [n-60] third trimester healthy pregnant women. Group II: [n-6o] women with mild pre-eclampsia. Group III: [n-60] women with had severe pre-eclampsia. The three groups were matched according to the age, parity, gravidity, maternal weight, haemodyanamic and laboratory tests. A statistically significant difference in terms of age, weight and parity were noticed in 3 groups p <0.05. Primigravida were 20% in normotensives, 40% were with mild pre-eclampsia and 60% with severe pre-eclamptia. In comparison of group II and III [severe pre-eclampsia] showed a statistically significant increase in terms of LDH and liver enzymes [p<0.05] in group III. LDH levels >600 IU/l were seen in 62% of women with severe pre-eclampsia compared to 10% in group I and II woman. LDH concentrations >800 IU/1 had significant increase in frequency of epigastric pain and vomiting and no significant difference in other system. Severe pre-eclampsia with LDH >800 IU/l women had significant increase in all complications noticed, eclampsia being the most frequent one. Elevated levels of LDH, indicative of cellular damage, can be used as a biochemical marker because it reflects complications and foetal outcome

Comparison of nifedipine with salbutamol as tocolytic agents in preterm labour

This study was carried out to evaluate the tocolytic efficacy for prolongation of pregnancy with oral nifedipine in comparison to salbutamol, and to evaluate side effects of nifedipine. It was an interventional study and was performed for a period of one year in Sir Ganga Ram hospital, and in the department of obstetrics and gynaecology, Fatima Jinnah Medical College. Sixty women were enrolled in this study. A questionnaire was filled for each patient. Once randomised the women received oral nifedipine or intravenous salbutamol in recommended dosage for acute tocolysis. Measurements of maternal pulse, blood pressure and foetal heart rate were recorded for upto 24 hours and compared over the treatment course. Outcome measures were prolongation of pregnancy as a result of tocolysis and recorded in hours and days, along with maternal and foetal side effects. Delivery was deferred for 48 hours, 3 to 7 days and more than 7 days in 30%, 6.66% and 3.33% respectively in nifedipine group compared with 26.66%, 3.33% and 3.33% of women respectively in salbutamol group [no significant difference P > 0.05]. Major maternal and foetal side effects were significantly less common in nifedipine group [0%] than in salbutamol group [13.33%] P value = 0.05. Nifedipine is almost as effective as salbutamol in suppressing preterm labour. Its use is associated with less frequent side effects

Medical Quiz

A twenty-six year old Indian labourer had arrived in Bahrain since seven days. He presented to accident and emergency department of Salmaniya Medical Complex with a history of abdominal pain in the right iliac fossa, loss of appetite, vomiting and watery loose motions of five days duration. There was no history of passing mucus or blood in the stools. He denied any past history of similar complaints. The patient was afebrile with a pulse rate of 82 per minute. General physical examination was normal. The abdomen felt soft, non-distended with mild tenderness and guarding. Rebound tenderness was also elicited in the right iliac fossa with the possibility of a mass. The liver was not enlarged. Investigations showed haemoglobulin-14.5 g/dl, total leucocyte count is 20.5 X10 9 cells, differential leucocyte count showed polymorphs 76%, lymphocytes 8%, monocytes 14%, band forms 1% and atypical lymphocytes 1%. Liver function tests showed Serum albumin of 29 g/1 and serum globulin of 41 g/1. Total bilirubin was 15 umol/L and mildly raised alkaline phosphatase of 188 u/L. Serum electrolytes showed mild lowering of sodium 136 mmol/L and serum chloride 98 mmol/L. Abdominal ultrasound has suggested the possibility of an appendicular mass. The patient underwent an emergency appendectomy. Peri-operatively, a discrete retrocaecal appendicular mass with thickened peritoneum and meso-appendix was noted. There was no pus found in the mass or the abdominal cavity. Large bowel was unremarkable except for mild thickening of the caecum. The patient did not report during the follow-up period. Pathological findings showed appendix grossly measured 10.5 X 1x 1 cms and looked brownish with exudate on the outer aspect. Histology revealed inflammatory exudate covering patchy areas of ulcerations Ql. What is the histologic finding? Q2. What is your diagnosis? Q3. What is the characteristic finding ? How do you confirm such a diagnosis ? Q4. How do you distinguish Entamoeba histolytica from non-pathogenic Entamoeba coli? Q5. Name the complications of this condition? What are the other abdominal sites where such a pathology can occur?

Solitary neurofibroma of the floor of the mouth

We present a case of neurofibroma in the floor of the mouth. A 74-year-old female complained of painless swelling in the right side of the floor of the mouth for 3 months. Clinical examination and CT revealed a tumor involving the right side of the floor of the mouth. Histological features were characteristic of a neurofibroma. Such a tumor arising in the area of the mouth is very rare. We review the clinical and pathological features of a neurofibroma arising in the mouth

pathological expression of Brunner's gland hyperplasia into adenoma and hamartoma

The terms Brunners gland adenoma and hamartoma are 2 pathological expressions of hyperplasia of these glands. We report 3 patients and review the recent literature to support our hypothesis of common pathology. Awareness of the existence and character of Brunners gland lesions will increase the possibility of their accurate diagnosis

Oesophageal cancer in Bahrain

Data from all 148 cases of oesophageal cancer in Bahrain during 1952-99 were analysed according to patient sex and age and site and histological pattern of tumour, and compared with other Gulf countries. In Bahrain, oesophageal cancer accounted for 2.6% of malignant neoplasms. The female:male ratio was 1.8:1, and the majority of patients were >/=51 years and

Primary actinomycosis presenting as chronic perianal abscess. Report of a case and review of literature

A case of primary perianal actinomycosis in a diabetic male Bahraini patient is reported. Although rare, it should be suspected if a non-tender perianal mass on drainage shows thin pus and characteristic yellow sulfur granules. Special stains and anaerobic cultures confirm the diagnosis. Surgical drainage and antibiotic therapy usually eradicate the infection effectively

Cataract backlog free zone in India: a pilot project in Datia district

To evaluate its efficacy in treating mass cataract blindness, the concept of "cataract free zone" was put into practice in India's Datia district that has a population of 372,454. The completed Datia plan has shown that with a proper political, administrative, and professional backing it is possible to make a given geographical area with a population of up to 400,000 cataract free in a time-bound program of three to four months. [Pakistan Journal of Ophthalmology 9: 15-19, January, 1993]

Surgical history of intestinal obstruction

Hippocrates observed and treated Intestinal obstruction. Praxagoras [350 BC] probably performed the earliest recorded operation for intestinal obstruction. However, non-operative treatment remained the general rule including reduction of Hernias, opium for pain, orally administered mercury lead shot. Electrical stimulation and gastric lavage in an endeavour to overcome the obstruction, surgery became more frequently used for intestinal obstruction amid considerable debate in the nineteenth century

pattern of intestinal obstruction in Jinnah postgraduate medical centre, Karachi

Two hundred and ninety five cases of intestinal obstruction admitted to JPMC were reviewed. They comprised about 20% of all admissions for acute abdominal conditions. It was found that hernia is by far the commonest cause followed by adhesions caused by previous surgery. This interesting finding is compared with the western figures. Other common findings are carcinomas and faecal impaction. Tuberculosis is still an essential cause, other common causes are also discussed along with findings in the published literature

Eye camps-are they Needed?

Alarming reports that 400 out of 534 eyes operated on at two eye camps in India lost their sight led to the National Seminar on Safe Approach to Eye Camp Surgery on September 7, 1986, at New Delhi. The proposals published here were made at this Seminar by the experts to improve safety and performance of eye camps and to avert similar mishaps in the future, and were approved by the Third General Assembly of the International Agency for the Prevention of Blindness