clinical value of immediate second transurethral resection in patients with high grade non-muscle inasive bladder Cancer [HG-NMIBC]

Objectives: this study was designed to estimate the value of a second transurethral resection of bladder tumor in patients with initially diagnosed T1 High-grade bladder cancer

Material and Methods: between October 2008 and November 2015, a total of 350 patients were diagnosed with T1 high grade non-muscle invasive bladder cancer. These patients were divided into two groups. Group A: 150 patients who underwent an early reresection. Group B: 200 patients who did not undergo early re-resection. Data were collected retrospectively which included patient's history, physical examination, and investigation, histological parameters including presence of detrusor muscle at initial TUR and at second TUR, recurrences and progression rates

Results: the detrusor muscle was present in 90 patients out of 150 patients [60%] in Group A and in 158 patients out of 200 patients [79%] in Group B, at initial TUR. At early re-resection, detrusor muscles were present in 76.67% of patients. The residual tumor was present in 55% of re-resected patients. The overall incidence of tumor recurrence was 34.66% and 42% in Groups A and B, respectively. There was a significantly higher rate of tumor progression in patients who did not undergo early re-resection during follow up. [Group 14.28% v. s. Group 3.85% P<0.05]

Conclusion: a second TUR should be routinely advised in all patients with T1 high grade bladder cancer, to achieve a complete resection and to identify patients who may need to undergo radical cystectomy

Prevalence of hepatitis C, hepatitis B and human immunodeficiency virus infection among blood donors at Fatimid center Multan

To find out the prevalence of Hepatitis C, Hepatitis B and HIV infection among blood donors at Fatimid Center, Multan., determine whether the laboratory methods to be used for the detection of HBV, HCV and HIV infection and disseminate the findings of the study for the constitution of proper screening programme at blood transfusion centers. This cross-sectional study was designed to know the screening pattern of Hepatitis B, Hepatitis C and human immunodeficiency virus in blood donors at Fatimid Center Multan during the period from November 2001 to December 2001. Hepatitis C, Hepatitis B and HIV infection is commonly transmitted via blood, blood products and unsafe sex from one person to another in the community. 1014 blood donors were screened for Hepatitis B, Hepatitis C and HIV antigen. 79 were found reactive for HBV, 37 reactive for HCV and HIV reactive was found none. The recipients of Hepatitis C and Hepatitis B reactive blood are 20 times more likely to have evidence of post transfusion Hepatitis C and Hepatitis B infection than recipient of Hepatitis C and Hepatitis B non reactive blood. This study was carried out with the objectives to see prevalence of Hepatitis C, Hepatitis B and HIV infection in blood donors, Hepatitis B Hepatitis C and HIV infection association with parentraI therapies, etc. Blood donors record for HBV, HCV and HIV was collected from blood bank of Fatimid Center Multan. Among 79 Hepatitis B reactive blood donors 30 [37.97%] had history of previous blood transfusion, 7 [8.86%] had parentral therapy, 2 [2.53%] had history of drug addiction, 2 [2.53%] had history of sexual contact while 37 Hepatitis C reactive blood donors 5 [13.51%] had history of previous blood transfusion and 20 [54.05%] had history of parentral therapy. None had history drug addiction, 9 [24.32%] had history of sexual contact. Luckily no HIV infection reactive case was found. The results of the present study underline the dire need to have a national comprehensive plan with multidisciplinary approach for HBV, HCV, HIV prevention is the community. It is suggested that blood and blood products should be screened for HCV, HBV, HIV infection before transfusion and use of disposable syringes, other sterilized instruments during hospital stay and use of disposable razors at barbers shop must be kept in mind

Weaning practices in urban and rural areas of Pakistan

Weaning practices varies in different communities and affected by beliefs. Family feeding order, attitudes towards weaning nutrition, geography, economic status, climate etc. Detailed knowledge of above factors is essential to improve the child nutrition. The growth of an infant and a young child is almost totally dependent on the nutrition he is getting. Improper feeding practices and poor nutrition of a young child can lead to ill health and malnutrition. It is essential to explore the knowledge, customs, beliefs and their effects to overcome malnurition and growth retardation. It is also necessary to know about the knowledge, attitude and practices relating to weaning in different communities and factor influencing these. The study is conducted on mothers of children at the age of weaning from both unban and rural origin. Simple random sampling technique is adopted for the study purpose. A questionnaire prepared to evaluate knowledge, beliefs, customs, and dietary habits relating to weaning and effect of economy, demography, literacy etc. on the believes, customs and practices. After collection of data, analysis done to draw conclusions. The study shows that 65% children are weaned at the age of 4 to 6 months in urban population while 50% in rural areas. In both population middle class weaned their children early, education also improved the situation. Weaning before the age of 3 months existed to some extent in both populations. Mixed feeding prevalent in both communities. Trend towards introduction of processed foods is more in both populations, food fads and to boos are also present, but more prevalent in rural areas, due to these high energy and protein foods are usually prohibited for a young child. In urban areas, children of working mothers also affected due to improper look after by the servants and relatives. The study shows that many children in both rural and urban population do not receive the right food to eat in their early childhood. This is resulted in growth retardation, and ill health in most children. This is true more in rural areas as compared to urban areas, but there are no significant differences in both populations, Predisposing factors include low income of the family, illiteracy, delayed weaning, late introduction of high-energy foods, protein and other nutrients for infant growth. In case the weaning foods are introduced to the infant at the right age, their frequency is less than required number of feeds per day

Hallervorden-spatz syndrome magnetic resonance image [MRI] appearance

25 years male presented to the medical outdoor with signs and symptoms of extra pyramidal dysfunction and abnormal body movements and reflexes. Initial diagnosis was Wilson disease. Patient was referred to MRI department for brain MRI. On MRI images there were typical findings of hallervordon - spatz syndrome

Assessment of health services provided to the prisoners with pulmonary tuberculosis at central jail hospital, Multan

Prisoner department of the Punjab consist of 28 jails, out of which two are situated in Multan. Currently 52,596 prisoners confined in a space with official accommodation capacity of 17,413. To assess, health services provided to the prisoners with pulmonary tuberculosis at central jail hospital Multan, a descriptive cross sectional study was conducted involving 35 prisoners. A semi structured interview questionnaire was designed to determine client's satisfaction. A checklist was designed to assess health facilities and TB case management. Study was conducted in December 2000. All patients who were present at the time of interview were included in this study. Thirty-five prisoners were included in the study and were interviewed. Health facilities being provided to the inmates were assessed to study the current practices and factors affecting the management of sick inmates confined in the jail. Almost 65.7% of the prisoners belonged to the age group ranging from 21-40. Only male prisoners were included in the study. Majority of these prisoners 78% were facing still trials in their concerned courts. Majority belonged to labour and fanner's class and 51.3% were held under section 302. According to conservative estimates one third of the world's Population is infected with the T.B. Bacillus. There are 15 - 20 millions cases of infectious tuberculosis in the word. This infectious pool is maintained by the occurrence of 4 - 5 million new cases[1]. The magnitude of the problem is such that WHO declared it a global emergency in 1993. More recently during 1996, estimated 7.4 million people developed tuberculosis bringing the global suffers to about 22 millions[2]. La Pakistan out of approximately 130jnillion Populations, about 15 millions suffer from T.B. More than 210,000 new cases occur each year[3]. Tuberculosis affects almost every stratum of the society including prisoners visiting the Jails. Due to some unavoidable circumstances prisoners carry a much greater burden of various diseases than other members of society. Like other developing countries prisoners in Pakistan are suffering from a lot of health and social problems. The incidence of T.B. among prisoners has long been recognized as a significant problem. Since 1985 the problem of active T.B. has been exacerbated by the increasing prevalence of HIV. The prevalence tuberculosis of prisoners was 30% and the incidence of new infection attributable to incarceration was 5.9 per 100 inmates per year[4]. The basic health facilities such as adequate supply of essential medicines, necessary diagnostic facilities, provision of specialized care to the needy prisoners and their timely referral to the tertiary care facility, are not upto the required standard to maintain harmony in the prison health services. At times, the prisoners are not being provided with the proper emergency care[5]