effects and underlying mechanism of interferon therapy on body weight and body composition

Body weight changes in HCV patients on interferon therapy are well documented. However, the underlying mechanism involved in these changes is poorly understood and rarely reported. The main objectives of this review are to 1] discuss changes in body weight and other compartments of body composition, particularly, body fat, and 2] to discuss the underlying mechanism for these changes. The literature review suggests weight loss [12-29%] as a function of interferon therapy is common, affecting up to 90% of HCV patients. Whilst, loss in weight means proportionate loss in other body compartments [lean body mass and body fat, in particular] data on changes in segmented body composition are fragmentary. The possible mechanisms underlying weight loss or changes in other body composition have been reported and these include suppressed appetite due to induction of TNF by IFN, a decrease in serum leptin level, and importantly mitochondrial damage induced by the therapy. It is, therefore, suggested that close monitoring of chronic HCV patients receiving PEG-IFN and/or ribavirin for side effects of these drugs, particularly those related to weight loss, is vitally important from clinical point of view

Nutritional care of patients with pressure ulcers: some evidence based guidelines

Malnutrition has been shown to be a significant factor in the development and deterioration of pressure ulcers [PU]. However, whether nutritional intervention can be effective in the treatment of PU is still unclear and controversial mainly due to inconsistent results reported in some recent studies. The objective of this review is to evaluate the effectiveness of nutritional care in patients with PU. The review is expected to comprehend the definition, prevalence and effectiveness of nutritional care on the prevention and treatment of PU. In addition a discussion on the level of adequacy of nutritional care and the role of enteral and parenteral nutrition on the prevention and treatment of PU is also provided. Data from survey reports, health statistics, descriptive, cross-sectional and longitudinal studies published between 1990-2008 on the topic were included. Data searches concentrated on human studies only excluding those with irrelevant and incomplete conclusions. The literature was accessed using data bases and abstracting systems including Medline, PubMed, Science Direct, Research GATE, etc. The prevalence of PU may range from 5-50%. Nutritional status is an independent risk factor for the development of pressure ulcers. Data from nutrition supplementation studies show faster recovery from PU and lesser hospital stay. Diets with high energy and protein, supplemented with vitamins, minerals and immunomodulators are generally indicated in PU. Enteral and parenteral nutrition are indicated when the patient fails to achieve nutritional needs through oral route and are recommended to be used without any contraindications

Ultrasonography in diagnosis of retinoblastoma

Retinoblastoma is a common childhood malignant intraocular tumor. Early detection and urgent treatment enhances survival in terms of sight and life. Ultrasonography has emerged as an indispensable tool for its examination and diagnosis. To evaluate the reliability of ophthalmic Ultrasonography as a diagnostic tool for retinoblastoma in children. Eye [A] unit department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan, from January, 2007 to January, 2009. Patients with suspected clinical features of retinoblastoma were admitted in referral center for retinoblastoma. After recording history, patients underwent investigations which included Ultrasonography later supported by examination under anesthesia and C.T Scan orbit and brain. Treatment was offered following initial diagnosis. A total of 25 children were initially diagnosed as retinoblastoma and were admitted in Eye [A] unit during the last 2 years. There were 16 males and 9 females. There were 16 unilateral and 9 bilateral cases. On ophthalmic Ultrasonography, out of 34 eyes [25 patients], 33 [97%] revealed calcification and high reflectivity. Later a C.T Scan orbit and brain was also done. Histopathological confirmation was carried out in 17 enucleated eyes of 25 patients; where 9 patients had bilateral disease, 4 specimens were lost and 4 patients had intracranial extension and therefore enucleation was not advised in this group. Ophthalmic ultrasound is an easy, reliable and non invasive method for the diagnosis of retinoblastoma

Factors influencing the success rate of myringoplasty

To know the factors influencing the success rate of myringoplasty. This descriptive study was conducted at Lady Reading Hospital Peshawar, from June to December, 2004. Fifty patients of central perforations in the tympanic membrane with dry ears for at least 6 months and no focus of infection in ear, nose, sinuses or throat were included in the study. Twenty-five patients underwent Underlay technique while in 25 patients Onlay technique was carried out. Graft was taken up successfully in 80% [40/50] cases. Success rate was 84% in patients with underlay technique [21/25] and 76% in patients with onlay technique [19/25]. The graft take up rate was 83.3% where temporalis fascia [30/36] was used and 71.4% where tragal perichondrium [10/14] was used as a graft material. The success rate was 100% in cases of traumatic perforation [6/6] and 77.3% in perforation caused by chronic suppurative otitis media [CSOM] [34/44]; 87.5% in patients with medium sized perforation [14/16] and 83.3% in patients with large central perforation [20/24]; 71.4% in patients with sclerotic mastoid [20/28] and 91% with cellular mastoid [20/22]; 97.5% in patients with good Eustachian tube function [39/40] and 10% in diseased Eustachian tube [1/10]. The success rate of myringoplasty is affected by various factors especially age, nature and size of perforation, the type of graft used, cellularity of mastoid and good functioning eustachian tube. Graft take up was better in cases of traumatic perforation than the perforation caused by CSOM

Experience with removal of foreign bodies tracheo-broncheal tree with rigid broncoscope

The aim of the study was to evaluate the presentation and management of different types of foreign bodies in tracheo-bronchial tree [TBT]. The study was conducted from July 2001 to December 2001 at the department of ENT, PGMI, HMC Peshawar. Patients with hlstory of foreign body inhalation were included in the study. Relevant history was recorded. The data collected was age and sex of patients, history of foreign body and type of foreign body inhalation, duration, symptoms and signs of foreign body inhalation. The findings of X-ray chest, treatment given and peri-operative complications and bronchoscopic findings were recorded. Bronchoscopy was done under general anaesthesia. Out of 50 patients, 32 [64%] were less than three years of age. Thirty two [64%] patients reached to the hospital with-in 24 hours. The commonest symptom was chocking sensation in 36 [72%] cases. Radiological changes, suggestive of foreign body tracheo- bronchial tree were observed in 16 [32%] of cases. The commonest foreign body removed was peanut in 27 [54%] cases. Right main bronchus was the common site for foreign body lodgment. Common complications encountered were laryngospasm in 3 cases [6%] and cardiac arrest in 2 cases [4%], with mortality rate of 2% [1 case]. Chocking, stridor, wheeze and coughing are the common presentations of foreign body tracheo-bronchial tree inhalation. Rigid bronchoscopy in experienced hands under general anaesthesia is safe and effective diagnostic and therapeutic procedure

rare case of malignant ameloblastoma with Multicentric presentation

Malignant ameloblastoma accounts for less than 1% tumour of the faciomaxillary region, arising from epithelial odontogenic cells or dental lamina. The commonest site is the ascending ramus of mandible and maxilla. A rare case of malignant ameloblastoma at unusual sites is reported. It is important to identify this condition to offer adequate excision and prevent recurrence. This is a case of 9 years old male child, who presented a mass in left cheek and inguinal mass with amputated right leg. Complete excision of the maxilla and inguinal mass was carried out and confirmed as a metastatic malignant ameloblastoma both in maxilla and inguinal region. There was recurrence of the same growth in the right maxilla and skull bones after one year. This is a unique presentation of ameloblastoma spreading to remote areas in the body that has not been reported in the literature. A 9 years old male child was admitted in our ENT Department at Lady Reading Hospital, Peshawar on May-June 1998 with history of swelling left cheek and right inguinal mass. The cheek swelling appeared 10 months back and rapidly increased in size in the last 3 months. It was progressively pushing the left eye ball upward and medially with a proptosis and intact vision. There was history of nasal obstruction with blood stained nasal discharge. He had epiphora as well. On physical examination patient revealed 8x9 cm irregular solid mass of the left cheek which totally occupied the left nasal cavity with protrusion of the lateral wall, left palate and alveolus resulting in loosening of teeth. The mass was smooth and non-tender. The local temperature over the mass was normal, the overlying skin was intact and freely mobile over the mass. On systemic examination there was a mass 8x9 cm in the right inguinal region. The overlying tissue was normal, in the past patient suffered from the same lesion of the right lower limb which was amputated on October 10,1992. Mass from the right axilia was excised by the general surgeon and reported as adamantinoma on histopathology in November 13, 1996. The lesion of the left maxilla and right groin appeared during the last ten months

Hydatid disease of the submandibu;ar gland

Echinococcosis is a tissue infection of the human caused by the larval stage of Echinococcus granulosus or E. multilocularis. Hydatid cyst of the head and neck region is uncommon and the involvement of salivary glands, especially the submandibular gland, is very rare. A case of submandibular gland hydatid cyst is reported in this article, in a patient who was presented with swelling of this area of three months' duration. Examination revealed a soft, non-tender, mobile mass measuring 6x4 cm. Chest X-ray and abdominal ultrasonography were normal. Excision of the whole mass was performed and pathological examination confirmed the fine needle aspiration cytology report. A 7 years old female child was admitted in ENT unit, Lady Reading Hospital, Peshawar, with a swelling on the right side of her neck in the submandibular region of a duration of three months, prior to which the patient had no complaints. The swelling had increased in size, but had remained painless and without any other significant problem. She had a course of conservative management, but there was no response. No history of cough, hemoptysis or jaundice was reported, and examination revealed her to be afebrile. The skin overlying the mass was soft, non-tender, mobile and showed no redness or warmth. The size of the mass was 6x4 cm and intraoral examination revealed no stones in the right submandibular gland duct. Milking of the submandibular glands showed decreased saliva production on the involved side, which was clear and examinations of her chest and abdomen proved normal. X-ray of the submandibular region, however, showed a soft mass with no radiopaque shadow or erosion of the mandible. Ultrasonography of the submandibular area revealed a large non-vascular predominantly cystic mass having some internal solid components with a few enlarged lymph nodes. Fine needle aspiration cytology [FNAC] of the mass showed many scolyces and hooklets along with some inflammatory cells. Complete blood count and sedimentation rate were normal except mild eosinophilia. The tuberculin test [PPD] was also normal. With the impression of hydatid cyst of right submandibular gland, surgery was performed via a horizontal incision about 4 cm below the lower edge of the mandible. After dissection of the surrounding tissue, the submandibular gland was exposed and completely removed without rupturing the cyst. The submandibular gland was incised and a 4x4 cm sized cyst containing a whitish-yellow fluid was seen. The patient was discharged from the hospital with no complications.5 The pathologic report showed a hydatid cyst. Periodic check-ups, including abdominal ultrasonography and x-ray examination, were performed during the first six months postoperatively which revealed no pathological findings