Comparison of presentation and outcome in 100 pediatric Hodgkin lymphoma patients treated at children hospital, Lahore, Pakistan and royal Marsden hospital, UK

Objective: To compare differences in demographics and outcomes in childhood Hodgkin lymphoma [HL] presenting at the Children's Hospital Lahore [CHL], and Royal Marsden Hospital [RMH], UK

Study Design: An observational comparative study

Place and Duration of Study: From January 2011 to February 2012 at CH, Lahore and from October 2008 to February 2012 at RMH, UK

Methodology: Consecutive HL patients [50 from each hospital] were inducted. Data regarding age, gender, staging, histopathology and outcome were analysed. Clinical and pathological staging done according to Ann-Arbor and World Health Organization classification. Treatment duration was 6-8 months. They were followed for 6 months post-treatment. Frequencies of variables were noted and compared. Chi-square test was used for determining significance

Results: Patients from Children's Hospital, Lahore were younger [mean 7.9 years] with male predominance [n=42, 84%]. Histopathology showed Mixed Cellularity [MC] in 32 [64%], Nodular Sclerosis [NS] in 5 [10%], Lymphocyte Rich in 4 [8%] and lymphocyte depleted in 1 [2%], nodular lymphocyte predominant [NLP] in 1 [2%] each. Majority presented in stage IV [n=25,50%], or stage III [n=20,40%]. Constitutional B symptoms were present in 37 [74%]. Bone marrow involvement observed in 23 [46%]. Remission was achieved in 42 [84%] patients; 2 [4%] relapsed, 4 [8%] expired and 2 [4%] left against medical advice. In contrast, RMH patients were older [mean 11.8 years.] and 30 [60%] were males. NS [n=40,80%] and NLP [n=6,12%] types were predominant. Two [4%] patients were in stage I, 27 [54%] in stage II, 12 [24%] in stage III and 9 [18%] presented in stage IV. Fourteen [28%] had B-symptoms. None had bone marrow disease. Event free survival was 46 [92%]. Four [8%] patients relapsed. Three responded to second line therapy and one relapsed postautologous transplant

Conclusion: Significant differences were observed in age at presentation, stage, histopathology and extent of bone marrow involvement between the groups. Of interest is the bone marrow involvement in stage IV patients in Pakistan. Delayed diagnosis account for advanced stage but difference in pathological subtype needs further study

Coverage and predictors of vaccination among children of 1-4 years of age in a rural sub-district of Sindh

To estimate the proportion of children 1-4 years of age vaccinated in the first year of their life and determine socio-demographic factors associated with vaccination in the rural sub-district Khairpur, Sindh, Pakistan. Cross-sectional study. The study was conducted in 9 Union Councils of sub-district Gambat, district Khairpur, Sindh, from August to October 2008. A questionnaire based representative multi-stage cluster survey was conducted. A total of 549 children aged 1-4 years were assessed for coverage and predictors of vaccination. Univariate and multivariate analysis was done using logistic regression to determine the unadjusted and adjusted relationship between socio-demographic predictor and outcome [vaccination status]. The coverage for complete vaccination was 71.9% [95%CI=68.1%-75.7%]. Educational level of mother [p=0.042], father [p=0.001] and child birth at hospital [p=0.006] were significantly associated with the vaccination status. Mother's educational level of intermediate and above was the strongest predictor [OR=12.19, 95%CI=1.57-94.3] for vaccination. Education of parents, particularly mother's education was important determinant of vaccination status of the children. In addition, distance from taluka health facility and misconception of parents were among the main reasons of not getting the children vaccinated. There is a need to educate the parents especially mothers about the importance of vaccination and organize EPI services at Basic Health Unit level to improve the vaccination coverage in rural areas of Pakistan

Clinical hypoglycemic effects of Allium cepa [red onion] in type 1 diabetic patients

Type 1 diabetes mellitus is an autoimmune disease caused by destruction of pancreatic islet beta cells and characterized by defect in insulin secretion. The present study was carried out to investigate the hypoglycemic effects of Allium cepa in patients with type 1 diabetic patients. In the assessment of the hypoglycaemic activity of Allium cepa in type 1 diabetic patients [n=21], crude Allium cepa [100 g] caused a considerably lowered value in the fasting blood glucose levels by about 89 mg/dl in relation to insulin [145 mg/dl] after 4 hours. Also the ingestion of crude Allium cepa by type 1 diabetic patients produced a significant reduction in the induced hyperglycemia [GTT] by about 120 mg/dl in relation to water [77 mg/dl] and the standard drug insulin [153 mg/dl]. Crude Allium cepa produced hypoglycemic effects, thus it could be used as a dietary supplement in management of diabetes

Non-fatal limb injuries in motorbike accidents

To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims. Cross-sectional observational study. Study was conducted at Jinnah Postgraduate Medical Centre [JPMC], Karachi, from October 2006 to March 2007. Trained data collectors prospectively collected data from the emergency department of JPMC, Karachi using structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with single or multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgery department were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chi-square test was applied to find out statistical significance at 95% confidence level. P-value <0.05 was considered as significant. A total of 137 [39%] patients presented with tibial injury among the study sample of 348 patients, which was significantly higher than the bone injuries of the body part [p<0.001]. Out of those, in 26% of patients, fibula was also involved along with tibia fracture. Other bone injuries included femur [16%], radius [9.2%], humerus [8.3%] and others. Radius was the commonest injured bone and in highest proportion among upper limb injuries [p<0.001]. Overall, 66% of the injuries in motorbike involved lower limb fractures. The highest proportion of motorbike accidents were observed on Saturdays [31%]. Majority of the accident victims were in the age group between 16 and 30 years [41% accident cases], 27% in age group 30 to 45 years, 15% in 45 to 60 years and 5% in >60 years. Those with less than 15 years accounted for 12% of cases. Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposed position while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lower limb involvement in motorbike accidents

[Olfactory Identification ability in schizophrenia spectrum disorders]

The aim of this project was a two fold; one was to compare the olfactory identification ability in patients with schizophrenia or schizotypy with that of the patients with mood disorders as well as the normal subjects; the other was to assess any possible changes after treatment in olfactory identification ability in patients with schizophrenia. The subjects of the study comprised 22 patients afflicted with schizophrenia and five with schizotypy [mean age of 41 years old], 28 patients with mood disorders [13 with major depressive and 14 with bipolar disorders with the mean age of 39 years old], and finally 27 normal subjects [mean age of 39 years old]. All subjects were assessed initially and the patients with schizophrenia were assessed twice more three and six weeks after the commencement of treatment with the University of Pennsylvania Smell Identification Test [UPSIT]. The data were analyzed by KruskalWallis, Chi- square, Mann-Whitney, and Freedman tests. A significant difference was found between patients with schizophrenia and schitypy with normal subjects in olfactory identification ability. There was not any significant difference between other groups on this matter. No significant changes in olfactory identification ability were detected in schizophrenic patients after 3 and 6 weeks of treatment. Deficit in olfactory identification ability of patients with schizophrenia spectrum disorders, and its persistence despite treatment is testimonial to its trait-like characteristic in such disorders

Establishment of new evaluation and accreditation system for graduate medical education in Iran

Graduate Medical Education is one of the stage of the continuum of medical education in Iran. At present, near 5500 residents are being trained in 24 specialties and 21 subspecialties in 26 Universities of Medical Sciences. Based on a special Act of National Parliament in 1973, the Iranian Council for Graduate Medical Education is responsible for supervision on the quality of Graduate Medical Education. Despite significant activities in this field during last three decades, there has been no integrated effort for evaluation and accreditation of specialty education units, yet. In this regard, the Secretary of the Council appointed a committee for preliminary studies and presentation of new approaches. In this article, the authors first describe the details of the activities of this committee. Thereafter, challenges of Graduate Medical Education and relevant supervisory bodies have been discussed. In the end, activities for the establishment of new accreditation system of Graduate Medical Education in Iran have been described