Tumour induced osteomalacia

Tumour-induced osteomalacia [TIO] is a rare paraneoplastic syndrome usually presenting with bone pain, fracture of bones and muscle weakness. It is caused by high serum levels of fibroblast growth factor 23 [FGF-23], which is a hormone-regulating phosphate, and vitamin D. FGF-23 is secreted by several tumours, especially benign mesenchymal tumours which are very small and difficult to locate. There is a significant delay from onset of symptoms to the diagnosis of this entity due to occult nature of this disease. We present a case of young male who presented with long history of progressively worsening muscular pain and weakness, rendering the patient confined to bed. Our aim of presenting this patient as a case report is to make physicians realise that any patient with unexplained muscular weakness and pain must undergo workup for TIO, including serum phosphate measurement, as this is a rare but potentially curable disease

Perceptions of faculty and health care managers about managerial skills and training needs of doctors working as house officers in medical institutions

Objective: To find out the perceptions of faculty and health care managers about the managerial skills of house officers, areas in which they are deficient and the learning strategies to improve these skills

Study design: Cross sectional study

Place and Duration of Study: The study was carried out in affiliated institutions of Armed Forces Postgraduate Medical Institute Rawalpindi, Pakistan Institute of Medical Sciences, Islamabad, and Holy Family Hospital Rawalpindi, from 15[th] December 2014 to 15[th] February 2015

Material and Methods: Questionnaire was used for data collection. It consisted of three sections. It assessed the respondents' perceptions of house officers' managerial skills, areas in which they were deficient and learning strategies for these skills. A probability convenience sample of faculty members and health care managers of institutions affiliated to Army Medical College, Pakistan Institute of Medical Sciences and Holy Family Hospital Rawalpindi was selected

Results: A total of 106 health care managers and faculty members were approached, of which 88 responded. Respondents were equally divided among health care managers and faculty members. The following skills of house officers received the lowest ratings by the respondents, 'Skills of using evidence based guidelines for allocating health care resources', 'how to function in their position as a leader', 'how the Pakistan healthcare system is organized and financed'. Respondents were unanimous that medical graduates need training in managerial skills and majority [93%] of them preferred lectures as the teaching strategy

Conclusion: Health care managers and faculty members in Rawalpindi/Islamabad region perceive the managerial skills of house officers as inadequate. They believe that training is required at undergraduate level to improve these competencies

Diabetes mellitus patients; immediate dentures

Objectives: To observe Quality of Life [QoL] in diabetes mellitus patients after fabrication of immediate dentures

Setting: Department of Prosthodontics in Hamdard University Dental Hospital, Karachi

Period: Two years from October 2011 to September 2013

Methodology: Thirty patients with established diagnoses of diabetes mellitus reported. In this study by purposive non-probability sampling technique. In this study patients were selected, male and female patients were 24 and 6 respectively with the age range of 22- 74 years. After getting consent Questions mention in OHIP-14 were asked from the patients on 1[st] visit and 2 months later after fabrication of immediate denture to assess the QoL of in these patients. Data was obtained after using SPSS-version 19. For analysis Wilcoxon Signed Ranks Test was applied to get results. Probability level of P

Results: There was marked improvement in different domains of QoL in diabetes mellitus patients after fabrication of immediate dentures, most of the patients were pleased with their prosthesis. Three patients had complained of pain on buccal side which was corrected by trimming the overextended flange of their denture. All patients had improvement in phonetics [P value 0.01], better choice of food [P value 0.00], eating ability [P value 0.01], decrease embarrassment [P value 0.08] and self-assurance [P value 0.025]. However, effect of immediate denture on variable like tension was not advantageous having P-value of 0.157

Conclusion: By fabrication of immediate dentures to diabetes mellitus patients, QoL can be markedly improved in such patients

Age and site of colonic neoplastic lesions: implications of screening in south Asia

To evaluate the Age of patients and the site of Colonic Neoplastic Lesions [CNL] and to determine the appropriate screening strategy for Colorectal Carcinoma [CRC] [sigmoidoscopy versus colonoscopy] in our population. This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas [defined as polyp more than 1 cm and/or having villous morphology on histology] was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. During the study period colonic neoplastic lesions were found in 217 patients; 186 [85.7%] patients had CRC and 31 [14.3%] patients had advanced adenomatous polyps. Mean age was 55.8 +/- 14 years and amongst them 72 [33.2%] patients were less than 50 years of age while 145 [66.8%] were more than 50 years. In 144 [66.4%] patients lesions were located in the distal colon, 65 [30%] had lesions in the proximal colon while in 8 [3.7%] patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. [p value 0.85]. Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results