Role of Anticholinergic, Uroselective α 1D/1A Blocker, Combination of Two Drugs and Placebo in Treatment of Ureteral Stent Related Discomfort and Urinary Symptoms

Introduction: The ureteral stent placement has become a partof urological clinical practice to relieve ureteral obstructioncaused by variety of urological condition since 1967. Studyaimed to access the role of anticholinergic (Tolterodine),uroselective α 1D/1A blocker (Naftopidil) alone and incombination to evaluate DJ stent related discomfort or pain,lower urinary tract symptoms and impact on quality of life.Materials and methods: This was a randomized double blindplacebo controlled comparative prospective clinical studyconducted between May 2013 to February 2015 to access therole of anticholinergic (Tolterodine), uroselective α 1D/1Ablocker (Naftopidil) alone and in combination to evaluate DJstent related discomfort or pain, lower urinary tract symptomsand impact on quality of life.Result: Total of 280 patients were enrolled for the study. 33patients were excluded. We found Naftopidil and combinationto be significanty better for pain score, combination beingmore effective for storage symptoms, voiding symptoms andquality of life scores.Conclusion: Combination of Tolterodine and Naftopidil canbe recommended for relief of stent related discomfort andurinary symptoms.

Celiac disease; effectiveness of treating previously untreated patients with both a gluten free diet and bisphosphonate, gluten free diet alone

To evaluate effectiveness of treating previously untreated patients with celiac disease with both a gluten free diet and bisphosphonate in order to significantly increase their BMD's to a greater extent than a gluten free diet alone. The study was conducted in National Institute of Child Health [NICH] Karachi to evaluate the effectiveness of treating previously untreated patients with celiac disease with a gluten free diet and bisphosphonate in terms of increase in bone mineral density in comparison to a gluten free diet alone over a period of three months [January 2013 - March 2013]. The study includes 30 children patients below fifteen years of age either sex. All study subjects were untreated celiac patients diagnosed by clinical presentation, small bowel histology and serologic testing. On day dexa scan was done. Fifteen patients kept on Gluten Free Diet [GFD] and remaining 15 patients kept GFD plus tablet of bisphosphonate. After three months dexa scan was repeated. The patients with other disease of bone or mineral metabolism, as well as subjects taking systemic glucocorticoids or high doses of thyroid hormones, were excluded. A total of 30 patients with celiac disease were included in this study. Out of 30 patients 18 [60%] were female and 12 [40%] male [M: F = 1:1.5]. Thirty patients were divided in two equal groups [15 patients in each group]. In group-I we gave gluten free diet and in group-II we gave gluten free diet and one tablet of bisphosphonate. Mean +/- SD of Bone Mineral Density [BMD] in group-I was 0.402 +/- 0.081 gm/cm2 [range=0.234 - 0.503 gm/cm2], and in group-II was 0.543 +/- 0.098 gm/cm2 [range= 0.402 - 0.743 gm/cm2], mean difference of bone mineral density was significant between two groups [P-value=0.0002]. At three months DEXA scan showed a significant rise in BMD in group-II as compared to group-I

Prevalence of oral submucous fibrosis and use of tobacco and related products amongst school going males

This cross-sectional study was conducted to evaluate the prevalence of oral sub-mucous fibrosis among male school going children in a low socio-economic class and to analyze the relationship between oral submucous fibrosis and the use of various form of tobacco and areca nut. It was conducted on 54 male school going children aged between 10-19 years studying in classes VI to X of a public school in the catchment area of Hamdard University Dental Hospital Block-L North Nazimabad, Karachi. Results of the study showed that 50% of the study subjects used tobacco and its related products and amongst them 7.4% of Oral Submucous Fibrosis cases were identified. Tobacco and its related products have flooded the Pakistani market being cheap and convenient and have become popular in school age groups. They have been identified as a high risk for occurrence of the precancerous lesion [oral submucous fibrosis]. Screening system in all schools must be introduced to identify precancerous lesion at an early stage

Investment in paediatric tuberculosis prevention in Pakistan: loss or gain?

To assess the effectiveness of paediatric tuberculosis prevention, by reevaluation factors in children exposed to tuberculosis from less privileged strata of Pakistan. This cross sectional descriptive study was conducted at National Institute of Child Health, from January 2004 to December 2005. Paediatric patients under 15 years of either gender, diagnosed with active tuberculosis were enrolled. Interviews were conducted with parents regarding common preventive measures and factors advocating tuberculosis spread. Later factors leading to non-compliance to safety recommendations were also evaluated. Fifty five [70%] children younger than 5 years, had index cases in direct contact within their own house. Fifteen [14%] patients contracted the infection from neighbours, with 11 being older than 5 years. There were 82 [51%] cases with Protein Calorie Malnutrition [PCM]. Total of 66 [41%] cases of PCM were <5 years age [p <0.005]. Data showed 123 [77%] children living in a family with 5 or more members. Sixty eight [55%] children of these large families had to live in a single room house. There is a high frequency of direct contact tuberculosis in children belonging to the lower socio-economic class. This is attributed to poor housing condition and over crowding. The current paediatric tuberculosis prevention strategies as adapted from World Health Organizations' Millennium Development Goals are ineffectual to make changes in children exposed to tuberculosis from less privileged strata of Pakistan. Our societal and demographic factors remain static, continually exposing our children to higher risk of tuberculosis exposure

Bilateral spontaneous perinephric hematoma

A-55-year-old man presented with a history of generalized swelling all over the body and uremic symptoms. Physical examination revealed pallor, anasarca, and hypertension. A gradual elevation of serum creatinine level from 1.6 mg/dL to 6.49 mg/dL was documented within 3 weeks. Urinalysis did not show any abnormal sing. Ultrasonography revealed the right kidney sized 9.5 x 3 cm and the left kidney, 10 x 4.9 cm, with large bilateral perinephric collections. Doppler ultrasonography revealed a 1.3 cm midopole aneurysm in the right kidney and multiple left renal aneurysms. Computed tomography revealed heterogeneous bilateral collection with fascial thickening in the peripheral spaces suggestive of bilateral perirenal hematomas with bilateral renal artery aneurysms. He was subjected to bilateral renal angiography and coiling of the aneurysms. Perinephric collection was evacuated by flank incision. Subcapsular renal hematomas occur secondary to variable etiologies and Page Kidney phenomenon can les to kidney failure. When occurs unilaterally, it can be managed expectantly, but page kidney in a solitary unit or bilateral Page kidney can lead to acute kidney failure, necessitating intervention to avoid the irreversible kidney damage

Management of Acute Asthma in children using metered dose inhaler and small volume nebulizer

To determine whether the administration of 32 - agonist by Metered Dose inhaler [MDI] with accessory device [AD] is a as effective as the administration of 32 - agonist by small volume nebulizers [SVN] for the treatment of acute asthma. A cross sectional study was conducted at Emergency Room [ER] of National Institute of Child Health [NICH], Karachi, between October 2000 to March 2001. This study included 150 children, 6 months and older with a history of wheeze and presenting with an acute asthma exacerbation. Children were categorized into mild, moderate and severe asthma according to medical scoring system. Children were assigned randomly into group A and B to receive standard dose of 32 - agonist [salbutamol] by MDI/AD [group A] or SVN [group B]. Baseline : characteristics and asthma severity were recorded. All variables [dyspnoea, use of accessory muscles, cyanosis, respiratory rate, heart rate, blood pressure, oxygen saturation, pulsus paradoxus, and wheeze] and Peak Expiratory Flow Rate [PEFR] in children 5 years and older, were determined at pre and post inhalation therapy. Both groups did not differ in demographic characteristics. There were no significant differences in outcome measures. In children treated with MDI/ADs and SVNs. PEFR increased significantly in both the groups after completion of treatment, but PEFR was not statistically significant when compared in between groups. The data suggested that MDI/AD is an effective alternative to nebulizer for the treatment of children with acute asthma exacerbation in the ER