Mesalazine-induced eosinophilic variant of wegener's granulomatosis in an ulcerative colitis patient

A 24-year-old woman presented with two weeks history of progressive shortness of breath associated with sharp chest pain. She had been on mesalazine for two years for Ulcerative Colitis. Chest X-ray showed bilateral pulmonary infiltrates with left sided pleural effusion. Blood investigations revealed, positive pANCA, negative cANCA and peripheral eosinophillia. Video assisted thoracoscopic lung biopsy specimen was consistent with eosinophillic variant of Wegener's granulomatosis. She responded to combination of withdrawal of mesalazine and high dose steroids. To our knowledge this is the first reported case of mesalazine induced eosinophilic variant of Wegener's granulomatosis

Effect of folic acid supplementation on homocysteine level in postmenopausal women

Hyperhomocysteinemia is an independent risk factor for atherosclerotic diseases including Ischaemic heart disease, stroke and peripheral vascular disease. Homocysteine [Hcy] is an intermediate formed during the catabolism of essential sulphur containing amino acid methionine, increased Hcy is associated with endothelial dysfunctions in healthy human. Plasma Hcy is significantly lower in premenopausal women than young men but after menopause basal homocysteinemia increases significantly in women approaching those in men. Several studies showed that hyperhomocysteinemia to be stronger risk factor for CHD [Coronary Heart Disease] in women than men. It seems likely that altered hormonal status and age related low folate intake are responsible for this. The present study was designed to evaluate the effect of folic acid supplements for six months, on Hcy level in postmenopausal women. Hcy was estimated by Flourescence Polarization Immunoassay [FPIA]. There was a significant [p < 0.001] decrease in Hcy level after six months of folic acid supplements. Hcy is an independent risk factor for atherosclerotic disease, this study favours the view that after menopause Hcy level increases significantly and a simple non Toxic and relatively inexpensive vitamin [folic acid] intervention might be useful in primary cardiovascular prevention in this high risk group because Hcy is a stronger risk factor for CHD in postmenopausal women than men

Waist hip ratio as an index for identifying women with raised TC/HDL ratios

Background: Obesity cannot be described solely as fat mass but the location of fat deposition is very important to determine the relation between obesity and disease. Abdominal type of obesity is linked to risk factors of atherosclerosis and to metabolic disease. Waist Hip Ratio [WHR] is a practical, simple and non-invasive index of adipose tissue distribution

Methods: We looked for a relation between WHR and TC/HDL-C ratios of a group of postmenopausal women. All the subjects in each major group were of comparable age and BMI, but the WHR varied from subject to subject. Each group was sub-divided into three tertiles based upon the WHR. Serum total cholesterol [TC] and HDL cholesterol [HDL-C] values were determined for all the subjects and TC/HDL-C ratio, which is a recognized CHD risk screening index was calculated

Results: The WHR distribution was significantly different in postmenopausal women from the pre-menopausal controls, and most of the postmenopausal women showed android type of obesity with no subject in the tertile with least WHR. It was noted that the TC/HDL-C ratio increased in direct proportion with the increase in WHR and its mean value was above the desirable value in both the tertiles of postmenopausal women. The test performance characteristics of WHR showed that WHR is a sensitive and specific index for screening of high TC/HDL-c ratio

Conclusion: We conclude that WHR [at a cut-off point of 0.84] can serve as a sensitive and specific outpatient screening index to detect postmenopausal women with an elevated TC/HDL-C ratio

survey of urinary bladder injuries in Abbottabad

Background: Injury of urinary bladder is not very uncommon. It has iatrogenic and non iatrogenic causes. This study was designed to determine the pattern, mode of diagnosis and management of urinary bladder injuries presenting at Ayub Teaching Hospital, Abbottabad

Methods: Ten years hospital record of urinary bladder injuries reporting at Urology, Surgical and Gynaecology wards of Ayub Teaching Hospital, Abbottabad was analysed. The cause of injury, associated injuries, diagnostic method and management protocols were analyzed

Results: During 10 years period 260 patients were treated for bladder injuries. The age range was from 5-75 years while there were more males than females. In 35% the injuries were due to RTA, in 20% by a fall from a height, in 10% by a gun shot wound and in the remaining 35% the injury was iatrogenic. Gynaecological procedures were the major cause for iatrogenic bladder injuries

Conclusions: Most of the bladder injuries seen at our hospital are due to road traffic accidents or iatrogenic causes. Both of these factors can be minimized by taking appropriate steps to improve road safety and operative procedure safety respectively