Distal penile fasciocutaneous flap for stricture disease of anterior urethra

Objectives: To develop curative treatment for complex stricture disease involving anterior urethra

Materials and Methods: Twenty patients with a median age of 35 years with history of repeated optical internal urethrotomies >5 underwent surgery

Stricture site and length were evaluated by Retrograde and Antegrade urethrogram. Stricture calibration was done by retrograde ureteric catheter insertion of variable sizes. Onlay or tubular was flap applied over partial or blind stricture respectively ranging from 5cm to 15cm

Results: The period of follow up was 24 months. Complications like patchy necrosis of penile skin [3] external meatal stenosis [2], Fistula [1] stricture at anastomotic site [1]and post void dribbling [5] were noted. The patient's quality of life improved following surgery

Conclusion: Distal penile fasciocutaneous flap is an effective tool for recurrent stricture disease involving anterior urethra

Burden of Haemophilus influenzae type B disease in Pakistani children

Estimates of the burden of Haemophilus influenzae type b [Hib] in children in Pakistan are limited. A prospective surveillance was set up in 8 sentinel sites in Karachi and Hyderabad in January 2004. A total of 1481 children aged < 5 years underwent lumbar puncture for suspected acute bacterial meningitis. Specimens from 237 [16.0%] children met the criteria for probable bacterial meningitis, and Hib was detected in 45 of them [19.0%]. The minimum detected incidence of Hib meningitis in the Hyderabad area was 7.6 per 100 000 in children < 5 years of age, and 38.1 per 100 000 children < 1 year. Hib vaccination is justified for inclusion in Pakistan's expanded programme of immunization

Comparison of patients quality of life treated with two different regimens for advanced gallbladder cancer

Still there is no standard regimen for the treatment of patients with advanced gallbladder malignancy who suffer from poor quality of life. Hence we wanted to evaluate the quality of life in patients with advanced gallbladder cancer treated with either 5-fluorouracil [5-Fu] and Folinic acid [FA] or with Gemcitabine [Gem] plus Cisplatin [Cis]. Records of all patients, including quality of life questionnaire were reviewed retrospectively. These patients with unresectable locally advanced or metastatic adenocarcinoma of gallbladder were seen in oncology clinic at Ziauddin Hospital and Baqai Institute of Oncology Karachi. Out of 40 patients, twenty received 5-FU with Folinic Acid [FA] [Group-1] and remaining twenty patients received Gem plus Cis [Group-2]. In Group-I, out of twenty patients, two [10%] were males and eighteen [90%] were females. Eleven [55%] patients showed relief in few symptoms for a mean duration of 5.9 [ +/- 3.3] months. There was no major impact of treatment on improving quality of life. In Group-II, out of twenty, three [15%] were males and seventeen [85%] were female patients who were treated with Gemcitabine plus Cisplatin.In this group sixteen [80%] patients showed a significant improvement in quality of life with relief of many symptoms for a mean duration of 6.2 [ +/- 3.4] months. Gemcitabine plus Cisplatin is effective in the management of patients with advanced gallbladder cancer and showed improvement in quality of life as compared to, 5-Fu with FA which does not result in improving the quality of life and is ineffective

Clinico-pathological features of lung cancer and incidence of familial malignancies a study of population in Karachi

A prospective, non randomized multi-institutional study was conducted to assess the clinicopathological features and incidence of familial lung cancer in patients presenting in major oncology centres in Karachi. A total of 71 patients were interviewed all but 4 were married. Majority belong to middle and low income group. More than half did not have University education. More than two third were urban dwellers. About half had white collared jobs. Tobacco use was rampant in the study population. Majority had good ECOG performance status at presentation. More then 50% had diabetes and hypertension and comorbids. Chest pain, cough, weight loss and breathlessness were the chief presenting complaints, while consolidation/collapse, effusion and lymph adenopathy were major physical findings. Half of the study population underwent bronchoscopy biopsy as diagnostic procedure. Three fourth of them had NSCLC. Squamous cell carcinoma was the major histological type. Among NSCLC early and advanced staged disease was evenly distributed while extensive disease was predominant stage of SCLC. Family size, particularly the extended family, in our population appears to be fairly large. No direct

Vaccine-preventable childhood diseases in Pakistan: a situational analysis

Many childhood diseases that cause great morbidity and mortality in the developing countries are vaccine preventable. Vaccines for six common diseases are available and vaccination programmes against these diseases have been a major factor in decreasing morbidity and mortality among children worldwide. The vaccination programme adopted by Pakistan as the National Expanded Programme on Immunization [EPI] in 1978 was based on World Health Organization's EPI initiative. The last two decades have seen the programme being implemented in Pakistan with lots of promises for disease prevention and/or eradication.. High goals were set but unfortunately the programme has fallen far short of goals and expectations. In this paper. we have reviewed the burden of vaccine preventable diseases in Pakistan and the current state of the EPI Programme. The possible reasons behind the relative failure of the programme are also discussed and our strategies for increasing immunization rates among our children

An outbreak of cholera in Karachi following monsoon rains 2003

An epidemic of acute gastroenteritis was observed in the province of Sindh following a heavy monsoon season in July-August 2003. In Karachi, a mega-metropolitan city, large numbers of patients were evaluated for gastroenteritis and many were severely dehydrated and needed hospitalization. This study was carried out to describe epidemiologic features of the epidemic of gastroenteritis and investigate the causative agents responsible. We reviewed the medical records of all the pediatric patients admitted to the Aga Khan University [AKU] Hospital, Karachi, with the diagnosis of "Acute Gastroenteritis" over a 3 month period [1st June 31st August 2003], and analyzed their demographic and stool culture results. Epidemiological and clinical observations were recorded and the findings were correlated with the onset of the monsoon rains. A total of 327 pediatric patients were sick enough to be hospitalized with acute gastroenteritis to the AKU hospital over the 3-month period. A 3-fold increase in the number of patients admitted with gastroenteritis was noted in the period coinciding with heavy rains [mid-July to mid-August] compared to the baseline period before the onset of rains [June 2003]. Of the 327 patients hospitalized, 134 [41%] patients had stool cultures performed. Of these 134 patients, 53 [40%] had a positive stool culture. Vibrio cholerae were isolated from 34 of the 53 [64%] positive stool cultures with an overall isolation rate of over 25% from all stool samples submitted for culture. There was a significant increase in the number of cases of gastroenteritis, specifically cholera following a heavy monsoon season in Karachi. Adequate public health measures to prevent the occurrence of outbreaks of cholera and to educate the public about the dangers of drinking contaminated water are urgently needed

Oral cancer and bio-nutrition

Conspicuous national and international variations in oral cancer incidence and mortality rates, as well as observations in migrant populations, raise the possibility that diet and nutritional status could be an important aetiologic factor in oral carcinogenesis. Abuse of alcohol and tobacco have serious nutritional implications for the host and generate increased production of reactive free radicals as well as elicit immunosuppression. Maintenance of optimal competence of the immune system is critical for cancer surveillance. Active oxygen species and other reactive free radicals mediate phenotypic and genotypic alterations that lead from mutation to neoplasia. Consequently the most widely used chemopreventive agents against oral cancer [e.g. Vitamin A, E, C and beta carotene] are antioxidants/ free radical scavenger. These antioxidants, both natural and synthetic, neutralize metabolic products, interfere with activation of procarcinogens, prevent binding of carcinogens to DNA, inhibit chromosome aberrations, restrain replication of the transformed cell, suppress actions of cancer promoters, and may even induce regession of precancerous oral lesions such as leukoplakia and erythroplakia. This review article underscores the compounding but important roles of nutritional/dietary factors in the longestablished causal link between abuse of alcohol and tobacco [smoking and smokeless] with oral cancer

Social isolation and induced delusional disorder, folie a trois

Three cases of shared delusional psychosis are described - Mr. H., his sister Miss H and his girlfriend Miss C. They have lived a very closely knit existence, In the same environment for a long time. They have many interests in common and deep and dependent relationships with each other. They share their life experiences, their needs and wishes, particularly their experience of being isolated from the outside world. Mr. H is the dominant partner while Miss H and Miss C are relatively passive and dependent in the relationship. The three of them developed symptoms of delusional psychosis. Mr. H being the first to be affected. Later he transmits those to the other two in the network. The delusional symptoms and the social isolation further reinforced each other until a crisis arose. Mr. H was subsequently admitted to Hospital and the other two people were moved to residential accommodation together. After some months they all improved, but only partially. The Multi-disciplinary team was then faced with the dilemma of their future placement

Multiparameter studies in t-cell acute lymphoblastic leukemia [T-all] in Karachi children

T-ALL is known to be associated with bad prognosis within ALL. Morphology of the ten cases studied showed L2 70% while L1 was 30% indicating the more malignant nature of the disease. Haematological blood parameters showed high haemoglobin and platelets and low numbers of blasts in the marrow indicating better preservation of the marrow and suggesting non-marrow origin of the disease. Acid phosphatase reaction was positive in majority of the blasts. P.A.S. stain was negative in majority of the cases while myeloperoxidase and alpha-napthyl esterase was negative. Sheep red blood cells rosettes were negative in a few cases suggesting that surface marker develop at a later stage than cytochemical enzymes since acid phosphatase was positive in all cases. This study shows continental variation of T-ALL since we report low presentation counts and high frequency of L2 in T-ALL. This further explains the more malignant nature of the disease and explain the poor prognosis of ALL in Karachi Children