Unusual sex differences in tuberculosis notifications across Pakistan and the role of environmental factors

In developing countries, only one-third of new tuberculosis cases notified are from women. It is not clear whether tuberculosis incidence is lower in women than men, or whether notification figures reflect under-detection of tuberculosis in women. Pakistan, however, presents an unusual pattern of sex differences in tuberculosis notifications. While 2 of the 4 provinces [Sindh and Punjab] report more notifications from men [female to male ratios 0.81 and 0.89 respectively in 2009], the other 2 provinces [Khyber-Pakhtunkhwa and Balochistan] consistently report higher numbers of smear-positive tuberculosis notifications from women than men [1.37 and 1.40]. No other country is known to have such a large variation in the sex ratios of notifications across regions. Large variations in female to male smear-positive notification ratios in different settings across a single country may indicate that environmental factors, rather than endogenous biological factors, are important in influencing the observed sex differences in tuberculosis notifications.

Seminal fructose in various classes of infertile patients

A great number of substances have been found in sperm plasma but so far it has not been possible to provide evidence of clinical significance for all of them. Fructose occupies the most important place on biochemical investigations. Fructose acts as a donor of energy to the spermatozoa. Fructose is secreted from the seminal vesicles and the accessory sex glands. It is the major carbohydrate found in seminal plasma, and appears essential for normal sperm motility. We present results of a prospective study of seminal fructose in patients referred for routine semen analysis prior to infertility treatment. Qualitative measurement of fructose in seminal fluid was carried out by Resorcinol method. Fructose level in various groups of male infertility, and sperm concentration in various groups was estimated. They were classified as azoospermic, oligozoospermic, polyzoospermic, normozoospermic, asthenozoospermic, and teratozoospermic on the basis of sperm concentrations, motility and morphology respectively. It is indicated that the true corrected fructose level is a simple method for assessment of the seminal vesicular function

Meatal stenosis in circumcised males - Is it preventable?

Meatal stenosis is most commonly seen among the circumcised males. The true incidence of this post circumcision complication is not known. The most favored hypothesis regarding the etiology is ammoniacal fumes produced in the wet diapers, which cause meatitis of unprotected glans. It is treated by meatoplasty. 26 pediatric patients suffering from meatal stenosis were treated between Jan. 2003 and Dec. 2005 both inclusive [Mean age was 4.36 years and ranging 2 - 10] and mean follow up was 4 months. Patients were studied for presenting symptoms, size of meatus, perimeatal balanitis, pyuria and postoperative complications such as bleeding, infection and recurrence. They were advised postoperative dilatation with ophthalmic ointment nozzle for one month. Patients with prior history of circumcision were included in the study. The most common symptom in our study was thinning of urinary stream 17 [65.4%] cases. Other common symptoms were painful micturition in eight and bloody spotting in seven cases. Eight patients were having pin hole meatus and three cases were having pyuria. Compliance for post operative dilatation was 76.9% [20 cases]. No case of recurrence was seen. It can be concluded that meatal stenosis is related to infant circumcision. It is treated by meatoplasty with satisfactory outcome. Whether we would be able to prevent this post circumcision complication ? There is no obvious solution to this problem for the time being

Outcome of Priapism after early and late management

To assess the outcome of patients presenting with priapism during the last six years. Record of the patients presenting with priapism was evaluated retrospectively. Following parameters were assessed; etiology, duration, management, complications and final outcome. Fifteen patients with mean age of twenty seven years presented from Jan 2000 to Dec. 2006. Etiological factors were intracavernosal injection of papavarine 6 [40%]. hakeem medication 4 [26.7%], thalasemia 2 [13.3%] and idiopathic in 3[20%] patients. Mean duration of priapism was 80.8 hours. Initial conservative management was successful in 7 [46.7%] patients. Non responders were treated with distal cavernosospongiousus shunt. Out of eight, three [37.5%] patients responded and remaining four ended up with corporeal fibrosis and erectile dysfunction[ED]. One patient develop urethrocutaneous fistula. Intracavernosal injection of papaverine and hakeem medicines are common etiological factors. Patient usually present late because of embarrassment. Outcome of management depends upon duration of priapism

Acute epididymo-orchitis - is empirical therapy for Chlamydia trachomatis justified?

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20's. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 [43%] patients and in only 12 [14%] of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis

Incidence of urinary tract infection during pregnancy

Incidence of urinary tract infection [UTI] during pregnancy among Pakistani women was examined. Midstream urine was collected from 250 pregnant and 100 control women and streaked on blood agar and incubated. Growth was considered significant if > / = 10[5]/mL bacteria were present. Among the pregnant women, 28.5% had UTI; 30.0% of controls had UTI. Among the pregnant and control women, 24.4% and 20.0% respectively had UTI symptoms, such as incontinence, nocturia and urgency. Symptoms did not correlate with incidence. Socioeconomic status, personal hygiene, education level, pregnancy duration, postcoital washing, contraceptive use and use of underclothing had no significant association with UTI occurrence. A history of past urological problems was associated with an increased incidence of UTI in pregnancy

Median cervical cleft

There are very few reports about median cervical cleft in the literature. Unless there is an awareness of this condition this may easily be confused with other congenital conditions like infected thyroglossal tract and acquired conditions like tuberculous sinuses. In the last 20 years of paediatric surgical practice this is the first case that we have come across with typical features of median cervical cleft. The interesting findings of this case and review of literature are discussed

Pseudomyxoma peritoneii: a case report and review

A case of pseudomyxoma peritoneii in a forty year old male is presented. The origin of the disease from an appendix cyst adenoma was established. The difficulties in preoperative diagnosis are illustrated, with emphasis placed on the usefulness of the recently described abdominal ultrasonography and Computed Tomography scanning signs. Biochemical analysis of the gelatinous aspirate was found to be supportive of the diagnosis, as were estimations of raised serum and aspirate levels of Carcinoembryonic Antigen and IgG. Although surgical debulking is the basic treatment, due to the intra-abdominal recurrence of the disease, mucolytic treatment with 5% dextrose in water was found to be useful when used for peroperative and post-operative lavage

Studies on normal and abnormal excretion patterns of uric acid in Bahawalpur

Uric acid concentration in serum and urine of 296 persons of Bahawalpur city is reported. Although the general pattern corresponds to the studies in other regions of the world but the range of uric acid concentration in male and female serum and uric acid is slightly higher. Correspondingly the incidence of uricemia is also high in the region with some cases of gout. Statistically, the serum urate level were more compact and had smaller coefficient of variance. Only persons with serum urate level above 125mg/100ml showed signs and symptoms of gout

Radiotherapeutic management of carcinoma nasopharynx

Carcinoma nasopharynx is an extremely difficult cancer to manage due to difficulty in diagnosis and proximity of pathology to vital structures like the brain, the spinal cord, the eyes and the ears. Over a 2 years period we have managed 19 patients by radiotherapy to primary tumour and all potential local and regional extensions of the disease by applying large fields. The results are encouraging