Diverticular Disease: An Update on Pathogenesis and Management

Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. Recently, there has been a significant paradigm shift in our understanding of diverticular disease and its management. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. Symptomatic uncomplicated diverticular disease (SUDD) is currently considered a type of chronic diverticulosis that is perhaps akin to irritable bowel syndrome. Mesalamine, rifaximin and probiotics may achieve symptomatic relief in some patients with SUDD, although their role(s) in preventing complications remain unclear. Antibiotic use for acute diverticulitis and elective prophylactic resection surgery are considered more individualized treatment modalities that take into account the clinical status, comorbidities and lifestyle of the patient. Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. Paradigm shifts in several areas of the pathogenesis and management of diverticular disease are explored in this review.

Pyrus pashia: a persuasive source of natural antioxidants

Pyrus pashia Buch. and Ham. was subjected to extraction with methanol. Methanolic extracts of fruit, bark and leaf were partitioned separately with four organic solvents in order of increasing polarity, asn-hexane, chloroform, ethyl acetate and n-butanol after dissolving in distilled water. Phytochemical screening revealed the presence of phenolics, flavonoides, alkaloids and cardiac glycosides in large amount in chloroform, ethyl acetate and n-butanol soluble fractions. The antioxidant activity of crude methanolic extracts, all the obtained fourorganic fractions and remaining aqueous fractions was evaluated by different methods such as: 1,1-diphenyl-2-picrylhydrazyl [DPPH] free radical scavenging activity, ferric reducing antioxidant power [FRAP] assay and total antioxidant activity by phosphomolybdenum complex method as well as determination of total phenolics. The results of antioxidant activity exhibited that chloroform soluble fraction of fruit showed the highest value of percent inhibition of DPPH [48.16 +/- 0.21 microg/ml] at the concentration of 10microg/ml. Ethyl acetate soluble fraction displayed the lowest antioxidant activity having/C[50] value of bark as [8.64 +/- 0.32microg/ml] relative to butylated hydroxytoluene [BHT], having IC[50] of 12.1 +/- 0.92microg/ml. The ethyl acetate soluble fraction of bark revealed the highest FRAP[s] value [174.618 +/- 0.11 TE microM/ml] among all the three parts. This fraction also showed the highest value of total antioxidant activity as [1.499 +/- 0.90], determined by phosphomolybdenum complex method. Moreover, this fraction also conferred the highest phenolic content [393.19 +/- 0.72] as compared to other studied fractions of fruit and leaf

If it's itchy, its scabies not always

Scabies is commonly characterized by the presence of itchy rash but this typical symptom does not necessarily always mean scabies. A female infant presented to the paediatrics department of Kuwait teaching hospital with a characteristic pruritic rash on soles suggestive of scabies. However, failure of the anti-scabies treatment, absence of positive personal and hygienic history and progression towards the deterioration of existing situation lead to the establishment of a history and clinical based diagnosis of Infantile Acropustulosis. The treatment was started accordingly and soon after starting treatment, the patient showed the signs of recovery. No doubt that scabies is comparatively more common as compared to infantile acropustulosis but yet scabies must not be considered as an absolute diagnosis for a patient presenting with an itchy rash particularly on soles

study of the spectrum of presenting symptoms, diagnostic investigations, treatment and outcome of severe malaria in the admitted children of Kuwait Teaching Hospital ,Peshawar, Pakistan

Objectives: to document the spectrum of presenting symptoms, diagnostic investigations, treatment and outcome of severe malaria in the hospitalized children of Kuwait teaching hospital

Methodology: this was a descriptive study using patient case records of children admitted from 1[st] January till 31[st] December 2013. All children with malaria requiring admission and treatment with parenteral anti-malarial were categorized as severe malaria and included in the study. Data was analyzed using Microsoft office Excel 2007

Results: 32 cases fulfilled the inclusion criteria. Fever was the commenest presenting symptoms present in 100% of cases [n=32]. Fifty percent children [n=16] had pallor, 12.5%[n= 4] cough, 9.3%[n=3] had dysuria and 6.25%[n=2] had fits recorded as additional presenting symptoms. 71.8% [n=23] had parasitological confirmation test before commencement of treatment. 100% of this parasitological confirmation was done by peripheral blood smear/microscopy test. Out of the 23 who had microscopy done 60.86%[n=14] had negative result and 39.13%[n=9]were positive for plasmodium of which,88.88%[n=8]were vivax and 11.11%[n=1] was falciparum.93.75%[n=30] of the parenteral anti-malarial used was intravenous quinine. All except one child 96.8%[n=31] recovered with the anti-malarial treatment used

Conclusions: fever and pallor are the two most common presenting symptoms of hospitalized children with severe malaria. Microscopy remained the most common investigation for the diagnosis of malaria. Quinine is the most frequently used drug for severe malaria. The study highlighted the need to further improve the case management of severe malaria in children

Etiology and postnatal management of prenatal hydronephrosis: a study of two teaching hospitals of Khyber Pakhtunkhwa

Background: Hydronephrosis is the most common abnormal finding in the urinary tract during prenatal ultrasonography screening. It is important to differentiate between obstructive and physiologic hydronephrosis because obstructive pathology may lead to recurrent urinary tract infection and end stage renal disease

Objectives: To determine the aetiology of prenatal hydronephrosis and see its outcome following treatment at two teaching hospitals of Khyber Pukhtoon Khawa. Study type, settings and duration: This descriptive retrospective study was conducted in Department of Paediatrics in Kuwait Teaching Hospital, Peshawar and Department of Urology in Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar from January 2008 till December 2010

Patients and Methods: A total of 64 neonates were included in the study with a mean follow up of 14.5 months. Data of antenatal ultrasound, postnatal ultrasound, clinical features, urea, creatinine, voiding cysto-urethrogram, renal scan and operative and non operative information was collected on structured Proforma and was analyzed on SPSS version 17

Results: Out of 64 neonates, 39 were males and 28 females. Ultrasonography showed unilateral hydronephrosis in 52 patients and bilateral in 12. Based upon prenatal ultrasonography using Antrerio posterior diameter, 37 patients had mild hydronephrosis, 14 had moderate and 13 had severe hydronephrosis. Etiologically 44 patients had physiologic hydronephrosis, 11 pelvi-ureteric junction obstruction, 5 vesicouretric reflux and 4 posterior urethral valves. Surgery was performed in 15 patients which included open pyeloplasty in 11, vesicostomy followed by posterior valve fulguration in 4 patients. All patients vesicouretric reflux were treated medically. The severity of prenatal hydronephrosis was significantly associated with need for definitive urological surgery [p <0.005]. Ancillary procedures like percutaneous nephrostomy were inserted in 7 patients

Conclusion: Physiological hydronephrosis and vesicouretric reflux can be successfully treated with medical treatment. However, obstructive pathology requires surgical correction

Standardization of symptom checklist-R on psychiatric and non psychiatric sample of Lahore city

The present research was conducted to standardize Symptom Checklist-R on psychiatric and non psychiatric population of Lahore city. Lahore. The research consisted of two stages. At stage one, an indigenous Symptom Checklist developed by Rahman and Sitwat in 1990[1], was reviewed by the research team comprising of 4 trainees of Advanced Diploma in Clinical Psychology and I supervisor. After thorough review, 83 more symptoms were added in that indigenous list of symptoms according to DSM-IV[APA, 1994][2][to make the checklist more comprehensive to use with the psychiatric population. After finalizing the list, Symptom Checklist-R was administered on a sample of 120 subjects residing in different areas of Lahore city from different socioeconomic classes: lower; middle and upper. The analyses of each item revealed that no item /symptom obtained a mean value of more than 7 which clearly show that the non psychiatric respondents did not experience any of these symptoms which were related to different psychopathologies. To determine reliability of SCL-R, 120 subjects from non psychiatric population and 45 subjects from psychiatric population were re-administered the SCL-R within 7-10 days. For the validation of the checklist, 120 psychiatric subjects diagnosed as having different psychopathologies were administered SCL-R along with some other translated instrument. 30 depressed patients were administeredSCL-R and BDI-II[3]; 18 somatic patients were administered SCL-R and two scales: Hysteria and Somatic Anxiety of CCEI[4]; 30 anxiety patients were administered SCL-R and STAI[5], 20 OCD patients were administered SCL-R and Padua Inventory; 32 psychotic patients were administered SCL-R and PANSS[6] and all psychiatric patients were administered LFT scale of SCL-R along with LFT Inventory[7], The psychiatric sample was collected from each of the above mentioned pathologies from different psychiatric units of teaching hospitals: Sir Ganga Ram; Mayo; Services; Punjab Institute of Mental Health [PIMH], Lahore and from out patient clinic of Centre for Clinical Psychology, University of the Punjab, Lahore. The high correlation coefficients between the scores of SCL-R and scores on other instruments clearly indicate that SCL-R is a reliable and valid tool to diagnose psychiatric clients. After determining reliability and validity of SCL-R, the cut offs based on psychiatric and non psychiatric population -were developed separately to use the checklist to diagnose different psychopathologies