Managing hot flushes in menopausal women: a review

Hot flushes during menopause are distressing for women and result in poor quality of life. Purpose of the current review was to evaluate the available treatment modalities that should be utilised for the management of hot flushes. Menopause refers to last menses of women life and can be declared after amenorrhea of 12 months. Vasomotor symptoms including hot flushes and night sweats are common after menopause, affecting almost 50 - 85% women older than 45 years. The mean increment in core body and skin temperature is 0.5 degree C and 0.25 - 3 degree C during a hot flush attack. Low level of estrogen during menopause and its association in triggering episodes of hot flushes, is still under debate. The most accepted hypothesis is a narrowing of the thermoneutral zone [TNZ] triggered by estrogen fluctuations. Although, hormone replacement therapy [HRT] remains the standard treatment for the alleviation of such symptoms, incidence of life threatening side effects restrained medical professionals from its use. Complications associated with the use of HRT can be avoided by appropriate evaluation of patients before initiating therapy. Several guidelines have also recommended HRT [estrogen and progesterone] to be safe for up to a period of seven years. Both hormonal and non-hormonal treatments are used for the management of hot flushes. Since hot flushes are the least appreciated and neglected complication of menopause, current review provides detailed information on its background, pathophysiology and management, and emphasises the need of its treatment

Yield of closed pleural biopsy and cytology in exudative pleural effusion

Objective: To determine diagnostic yield of Closed Pleural Biopsy [CPB] and Cytology in Exudative Pleural Effusion [PE]

Methods: This prospective comparative study was conducted at Chest Unit-II and Medical Unit-IV of Dow University of Health Sciences, Karachi Pakistan from January 2011 till December 2014

Results: Ninety-four patients with exudative PE were finally included. The mean age [SD] was 44.0 [13.8] years. Overall Specific Diagnosis was reached in 76/94 patients; 46 Tuberculosis PE [TPE] and 30 Malignant PE [MPE]. CPB diagnosed all TPE patients alone and 28/30 of MPE. Cytology diagnosed only 10/30 patients of MPE with 8 patients having both CPB and Cytology positive for malignancy whereas in the remaining two cases only Cytology positive. The sensitivity of CPB in detecting TPE and MPE was 93.9% and 82.4% respectively whereas specificity for both was 100%. The diagnostic yield of cytology in detecting MPE is only [33.3%]. The diagnostic yield of CPB for TPE and MPE is 100% and 93.3% respectively. The overall specific diagnostic yield of CPB is 78.7%

Conclusion: CPB is better than pleural fluid cytology alone with the later adding little to diagnostic yield when both combined in distinguishing TPE from MPE, the two main differential of exudative PE in a TBEndemic country

Frequency of clinical manifestations, in cases of liver abscess in hospital based study

The study was designed to determine frequency of clinical manifestations, associated risk factors and early diagnosis to avoid complications in cases of liver abscess in hospital based study. Descriptive study. This study was conducted in the Medical Unit, Bolan Medical Complex Hospital, Quetta, Pakistan from August 2006 to Feb: 2008. 100 consecutive cases of liver abscess were reviewed. 99 cases [99%] were amoebic and 01 [1%] gynogenic. Majority of liver abscess were single and in right lobe [92%]. Four [04%] in left lobe and four [04%] in both lobes. Ultrasound guided aspiration with metronidizole was performed in 35% of our patients. These patients had abscess that were usually larger then 5cm in diameter. The other cases were managed initially empirically with parental antibiotics then with oral antibiotics. We found that percutaneous aspiration of liver abscess is helpful to confirm diagnosis provides the a better bacteriological culture yield, gives a good outcome and may uncover clinically unsuspected conditions like malignancy and tuberculomas which may mimic the presentation of liver abscess. We recommend that ultrasound guided aspiration is a safe, economical easy way of management of liver abscess with low morbidity and negligible mortality

Immediate Relief TMJ Clicking Following Low Level Laser Therapy After Orthodontic Treatment :- A Case Report.

Introduction: To determine efficacy of low level laser therapy for clicking temporomandibular joint (TMJ) with a diode laser following orthodontic treatment. Methods: Performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in a case of an orthodontic patient following the termination of treatment. Patient had a history of severe clicking before initiation of treatment protocol. Low level diode laser ((λ= 905 nm, power = 0.7 watt, mode = continuous, Time = 60 seconds)), applied for the purpose of relieving the signs.Results: During the process of intervention and establishing the proper dental occlusion sign of temporomandibular joint dysfunction i.e. clicking reduced significantly (p<0.05) but remained at the lowest level from the perspective of frequency and severity index. Patient had no sign and symptom at the end of treatment. Clicking was reemerged in the retention period, i.e. after six months. Clinical signs disappeared immediately after the application of laser once (p<0.05) with no recurrence after four months follow up.Conclusion: Low level laser therapy serves as an adjuvant to orthodontic treatment while establishing the proper occlusion of stomatognathic system has pivotal role in function and stability of outcome.

Postembolization infarction in juvenile nasopharyngeal angiofibroma

We report the occurrence of cerebro-vascular accident, following selective embolization of internal maxillary artery [IMA] in a young male patient aged 18 years admitted at ENT Department, Abbasi Shaheed Hospital [ASH] with diagnosis of recurrent juvenile nasophayrngeal angiofibroma [JNA]. Angiography and selective trans-femoral embolization was done as an adjunctive measure before the definite surgical removal of this benign tumourous condition. The child developed weakness of the right half of body with slurred speech and drowsiness. CT scan of brain revealed the diagnosis of postembolization infarction. The patient recovered with no obvious signs of clinical residual weakness. Surgical excision after ligation of feeding vessel has been planned

Brown tumor of maxilla - a rare occurrence

We report a case of a middle age male patient who presented in our outpatient department at Abbasi Shaheed Hosptial [ASH] with a swelling at [L] half of face and [L] half of hard palate that histologically proved to be a Brown tumor of Maxilla with normal parathyroid hormone [PTH] levels and an elevated serum Ca[++] levels. The site of brown tumor in our case is a rarity. Our aim for presenting this case report is to highlight the rare site of presentation and to emphasize t he multidisciplinary approach incorporating the maxillofacial surgeons, endocrinologists and radiologists for the optimum patient care and management

Profile of extrahepatic portal venous obstruction [EHPVO] in a tertiary care hospital in Pakistan

To study the clinical and laboratory profile of patients with EHPVO in a tertiary care hospital of Pakistan and to differentiate EHPVO from cirrhosis of liver and to see the effect on liver function tests. This is a prospective observational study conducted at Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad.Twenty five patients of 12-55 years of age with the features of portal hypertension were included in this study. After careful history and physical examination patients were subjected for laboratory investigations including liver function test, renal function test, blood CP, PT, APTT, HbsAg and anti HCV, other specialized procedures including endoscopy, liver biopsy and ultra sound was also done in all patients. Portal vein thrombosis was the predominant cause of EHPVO, accounting for 88% of cases. All patients were presented with upper GI bleeding, splenomegaly was observed in 88% of patients. None of the patients had clinical, biochemical or liver biopsy evidence of chronic liver disease. The diagnosis of extra hepatic portal venous obstruction and differentiation from cirrhosis can be easily made by characteristic clinical features, normal liver function tests and doppler ultrasound. Portal vein thrombosis [PVT] is the predominant cause of EHPVO in Pakistani patients, as seen at this tertiary care hospital in Pakistan

Risk factors and microbiologic profile in catheter related urinary tract infection

To describe the consequences of uretheral catheterization in terms of the incidence of catheter related infection, duration of catheterization relation with UTI and changes in microbiologic pathogens. May 2006 to August 2006. Only 214 were included in final analysis, 28 were excluded from the study because these patients expired before the observable endpoint, these were critically ill. Adult patients in whom are indwelling foley's catheter was inserted with past 24 hours at the Emergency Room, Urology Wards, male and female surgical wards, medical wards, orthopedics wards, gynaecology wards, pediatrics wards, neurosurgery wards and ICU of Nishtar Hospital, Multan and Bakhtawar Amin Memorial Trust Hospital, Multan were included in the study. Out of 110 patients who acquired UTI, [83 single bacterial infection, 16 with pure candidal infection, 6 with double bacterial infection and 5 with both bacteria and yeast]. Majority of the isolated organisms were gram negative bacilli [66.9%]. E. coli being the most common [27] followed by Kiebsiella SP [26]. Other gram negative organisms isolated were acinetobactor SP [12], pseudomonas aeruginaosa [8], Enterobactor SP [6] and proteus Sp [2]. Ninteen [15.7%] were gram positive organisms, Enterococcus [9], coagulase negative staphococcus [7] and staphylococcus aureus [3]. Candida spieces were recovered in 17.4% of isolates. Fifty five percent of E. coli were isolated at 2 days post-catheterization while majority of the other organisms were isolated at more than 2 days after catheterization

Comparative study of tramadol and propacetamol for postoperative pain management in patients undergoing nasal surgeries

To compare the analgesic and side effects of propacetamol and tramadol after nasal surgeries. King Abdul Aziz University Hospital, Riyadh [KSA]. From January 2006 to February 2007. A total number of 40 surgical patients were prospectively randomized into two equal groups of 20 and were entered into single blinded clinical trial. Anaethesta. protocol was similar for all patients. Pain intensity was measured based on a 4-point verbal rating scale [VRS]. VRS was obtained before analgesic administration [T0] and at 0.5, 1.5, 3, 4.5, 6, 12, 18 and 24 hours, Patients received either tramadol 100 mg I/V or propacetamol 2 gm I/V at T0 and then 50 mg tramadol or 1.5 gm propacetamol at 6, 12, 18 and 24 hours if pain was present. The results of this study showed that propacetamol is less effective as analgesic in severe pain requiring more supplementary morphine as compared to tramadol. On the other hand tramadol is associated with higher incidence of nausea and or vomiting than with parcetamol. It was concluded from the study that propacetamol is less effective as analgesic in severe pain receiving more supplementary morphine as compared to tramadol

Management practices of childhood diarrhea

To elicit management practices of childhood diarrhea in this region. A cross-sectional survey. This study was carried out in CDDU-CHC [Control of Diarrheal Disease Unit Children Hospital Complex] Multan, over a period of nine months [March-Nov 2005]. Five hundred and twenty patients [age group 2 months-5 years] presenting with diarrhea and dehydration at CDDU-CHC Multan, were randomly selected. Management practices; use of medicines and intravenous fluids, preparation and use of ORS and other home made rehydration solutions, feeding practices during diarrheal attack were determined. Interviewing each mother, a pre-designed questionnaire was filled. Most of the families belonged to a poor socio-economic class; only 18.3% mothers could read and write. Mean duration of diarrheal attack was 4.1 days. Most of the mothers [95%] used allopathic medicine but only 49% from qualified doctors. Mothers [78%] knew about ORT [Oral Rehydration Therapy], but preparation and use of ORS and home available solutions was not appropriate in most of the cases. A large number of mothers withheld semisolid foods during diarrheal attack. ORT and adequate feeding during and after diarrhea are keys to the successful management of diarrhea. With regard to the management practices, there is a great need to improve awareness among mothers and caretakers about continuation of breast-feeding and/or semisolids during diarrheal attack, hand washing practices, preparation and use of ORS and avoiding antidiarrheal drugs

Awareness of malnutrition and diarrheal diseases among mothers in multan region

To assess the knowledge, attitude and practices of mothers about malnutrition and diarrheal diseases; perceptions about signs and symptoms of dehydration; preparation and use of ORS; breast feeding and weaning practices. A cross -sectional descriptive study. The study was carried out in [CDDU-CHC] Control of Diarrheal Disease Unit, Children Hospital Complex, Multan, over a period of six months [March-Aug 2005]. A total of 400 mothers, with children of age group 2 months-5 years, were randomly selected and knowledge, attitude, behavior and practices regarding malnutrition and diarrheal diseases were determined on a pre-coded questionnaire. The data was analysed using SPSS-10 software. The baseline knowledge of the mothers about malnutrition, diarrheal diseases, breast feeding, weaning practices and hand washing was not adequate, probably because of low literacy rate. Considering high prevalence of malnutrition and diarrheal diseases and the relative lack of knowledge, it is imperative that a public health intervention program be initiated in the communities. This must include the education of caretakers as well as health workers

Risk factors for hepatocellular carcinoma

Primary hepatocellular carcinoma is one of the most common malignancy in world. It is most common gastrointestinal carcinoma in Saudi Arabia. Liver carcinoma was responsible for 9.1% gastrointestinal cancer in Qassim region. Aim to conduct survey in this region for the rate etiological factors and for other possible causes yet unknown. Out of 24 cases, only 6 were HBsAg positive, 7 anti-HCV positive, only 1 was positive having both HBsAg and Anti-HCV negative. None of the cases were alcoholic. In present study malignancy was slow growing, and there was relatively long survival after diagnosis. Older age group, male predominance and comparatively low levels of AFP were also dominant factors. It is concluded that HCC is one of the common malignancies in southwestern provinces of Saudi Arabia. The prevalence of hepatitis-B and C is also high in these regions

Morphologic variations of malignancies in relation to age, sex and histologic type

Regional differences in the pattern of cancer are obvious in Saudi Arabia. From January 2003 to December 2005 1106 new cases of cancer [642 males, 464 females] were diagnosed in Al-Qassim region. Overall lymphomas, non-Hodgkin's and Hodgkin's disease combined were the most common malignancy seen [15.10%], followed by esophageal carcinoma [7.77%]. Thyroid cancer was the most common malignancy among females [12.5%], followed by breast cancer [9.48%]. The majority of the patients were in the younger age group [77% were < 50 years of age]. Among the hematological malignancies, acute lymphoblastic leukemia was the most frequent type [36.23%]. Lymphomas were also the most common malignancy [66.12%] seen in the pediatric age group [0-14 years], followed by leukemias and brain tumours. The pattern of cancer in Al-Qassim region is generally similar to other regions of Saudi Arabia, with few regional variations. Prominent among such variations is the high frequency of non-Hodgkin's lymphoma [NHL], esophageal and thyroid carinomas

adult with morquio syndrome

We report a case of a 25-year-old male who came to endocrine clinic to get medical certificate so as to claim as the shortest man of the world. He was evaluated for short stature and eventually diagnosed with type-IV mucopolysaccharidosis [MPS] or Morquio syndrome

Lithium - Induced Nephrogenic Diabetes insipidus

We report a case of a 43 year-old female who presented with lithium-induced nephrogenic diabetes insipidus. This patient had history of bipolar disorder for which she had been taking lithium carbonate for last 16 years. Appropriate work up was done and she was diagnosed with nephrogenic diabetes insipidus, secondary to lithium toxicity, and was managed accordingly