Progression of fibroadenoma to malignant phyllodes tumour in a 14-year female

Phyllodes tumours are uncommon breast tumours which account for less than 1% of all breast neoplasms. High-grade malignant phyllodes tumour is a very rare but aggressive breast malignancy and forms approximately 15-30% of all phyllodes tumours. The transformation of a benign fibroadenoma into a malignant phyllodes tumour in a teenaged female is even rarer. We report here an interesting case of malignant phyllodes tumour in a 14-year female patient who was operated twice previously with the diagnosis of complex fibroadenoma in the same breast. There was a large tumour involving whole of the breast and infiltrating the skin. The patient was operated and total mastectomy was done. Diagnosis was confirmed after histopathological examination and immunohistochemistry of the resected specimen. Patient received adjuvant radiotherapy and there was no recurrence on 6-month follow-up. Owing to the rare occurrence of malignant phyllodes tumour in this age group along with previous operations for complex fibroadenoma, this case is being reported here

Appraisal of tipu sultan's contributions toward development of unani medicine: a critical analysis

Unani system of medicine has enjoyed the status of being royal since antiquity, and various rulers and governments have paid special attention toward its growth and development. In India, Tipu Sultan, a highly cultured intellectual, academician, physician, scholar, and a great scientist, was one of those who played an important role in the advancement of Unani medicine. He had an imperial library located at Srirangapatna housing more than 2000 manuscripts in Arabic, Persian, Turkish, Urdu, and Hindi, dealing with medicine, military science, music, Hadith, law, Sufism, history, philosophy, grammar, astrology, poetry, and mathematics, of which 62 books were related to medicine. He also possessed vast expertise in treating various diseases, which is inferred from his personal letters and communications. He not only showed interest in preserving Unani manuscripts but also mentioned about 45 books on the subject of medicine in his memoirs. The health system was highly sophisticated in his territory among his contemporary kingdoms. Moreover, physicians and surgeons were regularly inducted to serve the injured and wounded soldiers in every battalion. The present study judiciously inspected the contributions of Tipu Sultan toward the patronage and promotion of Unani medicine, especially in the southern part of India in the 18[th] century

Seroprevalence rate of poliovirus antibodies among the healthy and protein energy malnutrition children

To study the association between Protein energy malnutrition and polio-specific immunoglobulin G antibodies production among children in Gadap Town Karachi, Pakistan. Comparative cross sectional survey conducted at fixed EPI center and Pediatric OPD of a tertiary care hospital Karachi. Children were selected by convenient sampling method during the period from 17 March to 17 May 2013. It was ensured that they must have received more than seven oral polio vaccine doses as eligibility criteria for the study. A total of 170 blood samples were collected and tested for the presence of polio-specific IgG antibodies using Poliomyelitis IgG ELISA Test Kit produced. Statistically significant relation was found between PEM and IgG antibodies production OR [P = 0.000]. Overall Seroprevalence rate among the study population was 98.8%, PEM group 97.6% and healthy group 100%. The study demonstrated that there is a need to focus on the protein energy malnutrition among the children as an immunization strategy for the 100% seroprevalence rate in all population against polio in Pakistan

Novel influenza A [HINI] virus-induced hemophagocytosis: first case reported in Saudi Arabia

H1N1 is a novel subtype of the influenza A virus. Since its reemergence in 2008, it has been reported to cause a variety of illnesses ranging from mild flu-like symptoms to severe multiorgan failure. We report a case of a young immunocompetent man who presented with progressive shortness of breath and rapidly developed multiorgan dysfunction, including pancytopenia from H1N1 infection during the 2010-2011 influenza season. His H1N1 pneumonia caused severe acute respiratory distress syndrome, respiratory failure requiring mechanical ventilation, rhabdomyolysis, myocarditis, hepatitis, encephalitis, and renal failure. During the diagnostic workup, a bone marrow biopsy was performed, showing hemophagocytosis secondary to the H1N1 infection. Unfortunately the patient died despite aggressive measures. Published reports contain only a few records of H1N1-induced hemophagocytosis. This is the first case report from Saudi Arabia with H1N1-induced secondary hemophagocytosis. It also highlights the fact that the virus is still very virulent and will pose a major annual health risk along with the seasonal influenza for at least the next few years

Elective hemi transurethral resection of prostate: a safe and effective method of treating huge benign prostatic hyperplasia

To evaluate the safety and efficacy of elective hemi-resection of prostate in patients with huge gland, weighing more than 120 grams. Multicentric, analytical comparative study. Department of Urology, Karachi Medical and Dental College, Abbasi Shaheed Hospital and Dr. Ziauddin Hospital, Karachi, from August 2006 to July 2009. All benign cases were included in this study and divided into two groups. In group A, patients having huge prostate [> 120 grams] were placed and hemi TURP was performed. In group B, patients having 60 to 100 grams prostate were placed and conventional Blandy's TURP was performed. Results of both groups were compared in terms of duration of surgery, amount of tissue resected, operative bleeding, postoperative complications, duration of postoperative catheterization, re-admission and re-operations. Effectiveness of procedure was assessed by a simple questionnaire filled by the patients at first month, first year and second year. Patients satisfaction in terms of their ability to void, control urination, frequency, urgency, urge incontinence, haematuria, recurrent UTI, re-admission and re-operations were also assessed. Fisher exact test was applied to compare the safety and efficacy of variables. In group A and B, average age range was 72 and 69 years, average weight of prostate was 148 and 70 grams, average duration of surgery was 102 and 50 minutes respectively. Average weight of resected tissue was 84 and 54 grams and haemoglobin loss was two grams and one gram respectively. Total hospital stay was 5 and 4 days. Total duration of indwelling Foley's catheter [postoperative] was 5 days and 2 days. Patient satisfaction in term of urine flow, urinary control, improvement in frequency and nocturia were comparable in both groups. UTI and re-admission was more in hemi-resection group. At the end of 2 years follow-up, there is no statistical difference between the safety and efficacy of two methods of treatment. In selected population, elective hemi TURP for huge obstructed prostate is a safe treatment. It's safety and short terms efficacy is comparable with the results of conventional TURP

Pattern of burns at lady reading hospital, peshawar

To describe the pattern of burn in Plastic Surgery and Burn Unit Lady Reading Hospital. This one year [January 2009 to December 2009] descriptive study was carried out at Plastic surgery and Burn Unit Lady Reading Hospital, Peshawar. Manual and computerized data comprising epidemiological variables of all the patients presenting with acute burn was recorded. Results were analyzed with SPSS 15. During one year study period, 758 patients were included. Male to female ratio was 1.5: 1. Mean age was 13.59 years [Std. deviation 14.162]. Median age was 7 years. Mean Total Body Surface Area [TBSA] burn was 14.53%. Home was the site of accident in most cases [88.1%]. There was no statistical significance in gender and percentage of burn area [p value: 0.363]. Scald and flame burn were the cause of burn in 91.2% of the cases. 519 [68.5%] of the patients were from Peshawar district. Majority of burn victims [59.2%] were below 10 year of age. Majority of burn accidents occur at home and are preventable. Scald injury is the most common cause of burn resulting in two third of the total burns. Majority of the patients are children

Irrigation free transurethral resection of prostate [TURP]

To assess the safety and feasibility of irrigation free TURP in our routine practice. This study was carried out at Department of Urology, Karachi Medical and Dental College and Abbasi Shaheed Hospital, from March 2009 to February 2010. In this interventional study our inclusion criteria was benign disease and prostate weight up to 70 grams. Patients having more than two systemic medical illness like Diabetes, Hypertension [HTN], Ischemic heart disease [IHD], Cerebro-vascular accident [CVA] and Parkinsonism, were excluded from study. Patients remains on anti coagulant medications, patients with present or persistent urinary tract infections were also excluded. Patients who had surgical trauma, incidentally invent urethral stricture and vesical stones were also excluded. All cases were operated by one qualified, experienced surgeon. The decision of irrigation free TURP was taken on the basis of satisfactory hemostasis and good peri operative blood pressure control. Irrigation free TURP was ordered in post operative notes and such cases were closely observed for next 24 hours. After initial advice of irrigation free group if the patient needed irrigation because of haematuria, different patient's and operative variables were reviewed. There were total 50 patients aged 52-84 years with prostate weight ranging from 35 to 70 grams. Mean weight of prostate was 50.12 grams. Our 27% patients were hypertensive, 20% were diabetic and 17% patients had two comorbid conditions. Out of 50 patients 39 that is 78% cases remained irrigation free and followed the routine post operative course and were discharged. Patients who developed haematuria and had irrigation were 22%, seven had about two liters irrigation fluid over 6 hours and 4 patients had larger amount of fluid for 24 hours. In those patients who needed irrigation, seventy six percent were hypertensive, forty two percent were diabetic and twenty percent had two comorbid conditions. History of urinary infection was positive in ninety percent cases. Size of prostate and duration of surgery had no major impact on post operative period in this study. Seventy percent of the patients who needed irrigation had low blood pressure during surgery and became hypertensive in post operative phase. Post TURP Irrigation is an important step that helps in avoiding clot retention in early post operative phase. It increases the work load and treatment cost. In selected patients who have moderate gland, no major co morbidities and no infection, irrigation free TURP can be practised under close observation

[Study on air pollutants and their effects]

In this study, the agents and reasons for increases in gases [CO, SO[2] and No[2]] and suspended particles which pollute the air were scrutinized. Increases in the mentioned substances are found mainly urban areas where there is an imbalanced growth of population and construction and heavy traffic of vehicles. Kabul is among the cities which have the highest level of air pollution. Upon study of gases and suspended particles in the air, it may be deduced that anlo1,lg the gases comprising the air, increases in CO, SO[2] and No[2] and suspended particles cause air pollution. Kabul City has significant levels of such pollutants: [PM10, PM2.5] 261[micro]g/m[3], NO[2] = 24 [micro]g/m[3] and SO[2] 37 [micro]g/m[3]. The above figures exceed the norms accepted by the WI-I0 concerning air pollution. The main causes for increases in suspended particles and gases polluting the air are dust, exceedingly high level of vehicles movement, and use of old tires, rubber and used vehicle oil as fuel

Circumcisional injuries: a neglected negligence

To describe the spectrum and management of circumcisional injuries. It was a two years [January 2006-December 2007] descriptive study. All patients with complications of circumcision, presenting immediately or late and fulfilling the inclusion criteria were included in this study. A total of 24 patients were included in this study. Common complications in order of frequency were urethrocutaneous fistula 8[33.3%], glans injury 6[25%] and bleeding 5[20.8%]. In majority of cases 20[83.33%], the circumcision was performed by unqualified circumciser. In our country majority of circumcisions are performed by traditional untrained persons with high complication rate, often disastrous one. Properly training the paramedical staff can not only reduce the physical morbidity but will also save the resources spent on management of these potentially preventable complications

Evaluation of the teratogenic potentials of neem seed oil in albino rat

The safe use of medicines, both modern as well as traditional, during gestation is becoming an increasingly contentious issue because many therapeutic agents have proved to be menace as they produce congenital malformations in offspring when used during pregnancy. The present study was undertaken to investigate the effects of Neem Seed Oil administration during gestation on young ones of albino rat. 300 off springs of albino rat were used in this study. They were obtained from 60 pregnant rats at term or at 20[th] day of gestation. The pregnant rats were divided in four groups. Group A received freshly extracted Neem Seed Oil 0.5 ml orally from 6[th] to 12[th] days of gestation. Groups B and C received 1.0 and 2.0 ml of oil orally for same period. Group D behaved as control and received 0.5 ml of distilled water orally for same period. The pregnant rats were observed for duration of pregnancy, weight gain, abortions and number of pups given birth. The obtained pups were examined for any structural malformations. There was no incidence of abortion in treated animals like controls. There were no resorptions in control group. Treated group A, B and C had incidence of 2.3, 5.7 and 15.3% respectively. no gross structural malformation was found in control or any of the treated groups. Neem Seed Oil was not found to be embryo/feto toxic in terms of causing abortions, reduced number of litter, retarded growth of young ones, fetal death, fetal resorptions and gross structural malformations in all doses tested

Nephroprotective activity of some herbal preparations

The present paper is the first review of published literature on plants and their products which have been studied experimentally/clinically for their effects on renal functions. It covers literature reports that have appeared till June 2003 and covered in PubMed and MAP A [Medicinal and Aromatic Plants Abstracts]

Two-stage aivar bracka repair in hypospadias salvage cases

To evaluate the outcome of Aivar Bracka repair in hypospadias salvage cases. This descriptive study was conducted in Plastic Surgery Unit, Hayatabad Medical Complex Peshawar, from 1999 to 2004. Two stage Hypospadias repair was performed in 78 re-operative cases having at least one previous failed attempt. Number of previous surgeries, meatal site and state were recorded. Any associated problem at presentation was noticed. Post-operatively, patients were followed up at two weeks, three months, six months and yearly as per protocol. Any functional or cosmetic complication was recorded. Mean age at presentation was 11.86 years [range 3-39 years]. Mean previous surgeries were 2.2 per patients [range 1-9]. Major complications necessitating an additional procedure were noticed in 10 patients [12.82%] with fistula in 6 [7.69%] cases, circumcision for redundant prepuce in 2 [2.56%] cases and exploration for bleeding in 2 [2.56%] patients. Excellent cosmetic and functional results were achieved in rest of 68 patients [87.17%] with two-stage Aivar Braka repair. Two-stage Aivar Bracka repair is a simple, safe and versatile procedure with low complication and high success rate. Even in salvage surgery, the results are excellent both functionally as well as cosmetically

Association of leukocyte count with albumin excretion in type 2 diabetes mellitus

In type 2 diabetes Mellitus albumin excretion rate correlates with leukocyte count. One of the major components of chronic sub clinical inflammation associated with both insulin resistance and other sclerosis. The aim of this study was to determine the relationship between leukocyte count and Albumin excretion in patients with type 2 diabetes Mellitus. A prospective study conducted on patients with type 2 diabetes during 2004 at BMSI Jinnah Post graduate Medical Centre Karachi. A total of 100 subjects of either sex were included, out of which 75 type 2 diabetics were selected from diabetic clinic Jinnah post graduate Medical Centre Karachi and 25 non diabetics as control from general population. Each subject was interviewed, examined and investigated for blood pressure measurements, body weight, fasting serum glucose urinary volume, urinary albumin, albumin creatinine ratio, urinary albumin excretion and leukocyte count. Patients having acute illness and proteinuria due to cardio vascular disease and other causes were excluded. Leukocyte count was significantly high [P<0.001] in all patient groups as compared to control group, also it shows significant increase in smoker diabetics as compared to non smoker diabetics. A strong relation ship was found between leukocyte count and albumin excretion r =0.786, P< 0.001 in type 2 diabetes Mellitus. Albumin excretion rate correlates with leukocyte count in patients with type 2 diabetes Mellitus

modified water proofing layer in two stage hypospadias repair: five years experience

To assess the outcome of modified water proofing fascial layer in two stage hypospadias repair.January 1999 to December 2003, Plastic surgery unit Hayatabad Medical Complex, Peshawar.Descriptive and prospective study.A modified waterproofing technique was used in two stage repair of Hypospadias. Two hundred consecutive cases were included in this study. Fifty two cases were Hypospadias cripple. Fistula was the most common major complication occurring in 18 patients. Four of these fistulae closed spontaneously while 14 underwent surgical repair. Catheter related minor complication occurred in 5 patients. 4 patients underwent revisional surgery for cosmetic reason.This modified waterproofing technique is simple, safe and versatile adjuvant to Hypospadias repair. Reduction in complication rate is significant with minimal learning curve

Gestational trophoblastic disease in Quetta

To find out the prevalence of gestational trophoblastic disease [GTD] in Quetta. The study was conducted in Radiology department of Bolan Medical Complex Hospital Quetta. From May 2000 to August 2004 about 15023 pregnant women were examined by trans-abdominal ultrasound with real time scanner. Of the total 61 cases were diagnosed as GTD. A limited number of cases were referred to histopathology for confirmation. The incidence of GTD was calculated as 4.06/1000 pregnancies. Out of 61 diagnosed cases of GTD, hydatidiform mole was seen in 52 cases, [85.2%]. The maternal age ranged from 17 to 47 years. Of the presenting symptoms 19 patients [31.1%] had excessive uterine bleeding, 11 [18%] had features of hyperemesis gravidarum while 25 patients [40.5%] had no complaints and underwent an ultrasound for confirmation of their pregnancy. Uterus was enlarged for dates in 33 patients. Thirtyfour patients [55.7%] belonged to the poor socioeconomic group and 28 were severely anemic. The prevalence of gestational trophoblastic disease in Quetta is around 4/1000 pregnancies

unusual foreign body in the esophagus

Foreign body ingestion is commonly seen in childhood. In adults it is reported in psychiatric patients, and body packers. The ingested foreign bodies are usually small in size, regular and smooth in shape but the patient we are reporting had ingested a large sized, irregular foreign body