A lesion on lip – Hemangioma with Chronic Granuloma.

Infections as well as tumours and tumour-like conditions are common in the oral cavity. While hemangiomas are benign vascular tumours which may be encountered in any part of the body, granulomatous infections are unusual in the mouth. We discuss below the rare occurrence of a hemangioma on the lip which was associated with a chronic granuloma.

Routine immunization services in Pakistan: seeing beyond the numbers

Vaccine-preventable diseases continue to be a major cause of morbidity and mortality among children under 5 years of age in Pakistan, and the country remains one of the last reservoirs of polio, posing a threat of viral spread within the region and globally. This structured review describes challenges in the achievement of vaccination targets and identifies arenas for policy and programmatic interventions and future research. Burdened with limited demand and inefficient vaccination services, the recently devolved Expanded Programme on Immunization [EPI] faces multiple hurdles in increasing immunization volumes, improving the quality of services and ensuring timely vaccination. The EPI requires multi-pronged, multi-level, coordinated interventions to improve programme functioning and to enhance vaccination uptake at community level. Additionally, a lack of rigorous scientific enquiry on vaccination services limits the introduction of well-developed, responsive interventions. The paper describes systemic bottlenecks, proposes potential solutions and suggests lines of further enquiry to understand and reduce the languishing immunization rates in Pakistan

Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope

We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals [MDG] 4 and 5 in the Eastern Mediterranean Region [EMR]. We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group

Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi

Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30- 70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values <0.05 were considered as statistically significant. Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine [p<0.001], HbA1c [p<0.05] and BMI [p<0.024]. A strong correlation exists between age and serum creatinine [r=0.73]. The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control [high HbA1c>7%] or heredity factors. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control

clinicopathological study of urinary bladder neoplasms in patients at three centers in Khartoum, Sudan

To present the histopathological pattern of urinary bladder neoplasms using the WHO/ISUP classification system and relate it to the outcome. This study was conducted in the period from January 2004 through December 2005 at f three centres in Khartoum, Sudan. One hundred and six patients with urinary bladder neoplasms were included in the study. The commonest affected age group was 60-80 years with male to female ratio 4.6:1. Urothelial neoplasms were found in 72 [67.9%], Squamous cell carcinoma [SCC] in 26 [24.5%], Urothelial neoplasms with Squamous differentiation in 3 [2.8%], and other types in 5 [4.7%] of the patients. There were 43.4% of the urothelial neoplasms graded as papillary carcinoma of high grade, 52.6% papillary carcinoma of low grade, 1.3% papillary neoplasm of low malignant potential, 1.3% papilloma, and 1.3% was graded as flat neoplasm. Of the SCCs, twelve [42.9%] were poorly differentiated SCCs, nine [32.1%] moderately differentiated, and seven [25%] cases were well differentiated SCCs. Follow-up information was available in 32 patients. At last follow-up, fifteen [46.9%] patients were dead of the disease, twelve [35.5%] were alive with no evidence of disease, four [12.5%] were alive with disease, and one [3.1%] was alive and terminally ill. Histological grade [P: 0.006], and muscle invasion [P: 0.002] were significantly associated with survival. A subset of the cases could not be assessed for muscle invasion due to madequate sampling; we thus recommend proper trans-urethral bladder biopsy [TUEP] sampling

Management of post traumatic posterior urethral sticture; internal urethrotomy versus perennial urethroplasty

To compare the efficacy and cost effectiveness of cold knife optical internal urethrotomy with perineal urethroplasty [excision and end to end anastomosis] in the management of post traumatic short posterior urethral stricture. Design: an observational prospective study. Place and duration of study: the study was performed in the department of urology and kidney transplantation Services hospital/post graduate medical institute Lahore, from September 1997 to December 1999. Patients and methods: Forty male patients of post traumatic posterior urethral stricture revealed by their urethrogram were included in the study. Patients were divided in two groups randomly [group A and group B]. After complete evaluation, patients of group A were managed by internal uretherotomy, while those of group B by perineal urethroplasty. Follow up was done at 1,3,6,9 and 12 months. age range of the patients was 20 to 59 years with the mean age of 35.5 years. Road traffic accident was the main cause [82.5%]. After facing the traumatic urethral injury, there was history of attempted Foley catheterization [47.5%], bouginage [15%] and intervention by rail road technique in 10% of the patients. All patients were with supra pubic catheter because of failure to void. The length of stricture varied from 0.5 to 2.0 cm [mean 1.4 cm]. Clinical response at the end of the study in group A and B was "good" in 58.82% and 66.66%, "satisfactory" in 23.52% and 22.22% and "poor" in 17.64% and 11.11% respectively. The mean cost of operation, hospital stay and loss of working hours were less in group A as compared to that of group B. The results of perineal urethroplasty are comparatively better than optical urethrotomy. The other differences of the two procedures lie in operative time cost of the operation and mean hospital stay. It is concluded that optical urethrotomy is an acceptable alternative to urethroplasty in patients with short post traumatic posterior urethral stricture

Transuretheral resection of prostate [TURP] - a treatment modality for benign prostatic hyperplasia [BPH]

This prospective study was done to know the complications of TURP as a treatment modality for BPH. 1200 patients having TURP at Jinnah and Mayo Hospital, Lahore from 1996 to 2002 were included. All the patients were evaluated by history, examination and investigations. Age range included from 45 to 115 years. Retention of urine was commonest indication for the procedure followed by raised prostatic symptom score. Seventy-two% patients had prostate size between 31 to 50 gram on DRE and Ultrasonography. Hypertension, DM and pulmonary diseases were common comorbid conditions in these patients. In early complication clot retention in 8% and ITTI in 7.6%, and failure to void in 4.7%. In the late complication stricture 6%, impotence 2.3% and incontinence 0.5%. Histopathology detected carcinoma of the prostate in 6% patients

Salivary gland tumors - a three years experience at King Edward medical college, Lahore

Salivary gland tumours make an important part of oral and maxillofacial pathology. Only few studies have been done in Pakistani population. The aim of this study was to describe morphological types of salivary gland tumours diagnosed at King Edward Medical College/ Mayo Hospital, Lahore during the years 1999-2001 and to compare their demographic data with those previously published. Material and This descriptive cross-sectional study was carried out at King Edward Medical College/ Mayo Hospital, Lahore. It reports 117 cases of salivary gland tumours diagnosed at Pathology Department during 1999-2001. Of the 128 specimens of salivary glands, 117[91.4%] were confirmed as salivary neoplasms. Out of them, 62.7% were benign and 37.6% malignant and a slight female predominance [58.1%] was found. The most common location was the parotid gland [65.8%] followed by minor salivary glands [19.6%]. Majority oft he t tumours was diagnosed during 3rd to 5 decades of life. Median age for benign tumours was 33 years [range 1-78] and a female predominance [58.9%] was seen again. Median age for malignant neoplasms was 45 years [range 9-70] with a female predilection [56.8%]. However, 4 out o f 5 patients with Warthin's tumour were men. Pleomorphic adenoma was the most frequent tumour [51.3%], followed by mucoepidermoid carcinoma [25.6%], adenoid cystic carcinoma [7.7]], Warthin's tumour [4.3%] and monomorphic adenoma [2.6%]. Two cases each of oncytoma and adenocarcinoma were recorded. Rare categories [single case each] of salivary tumours included lipoma, acinic cell carcinoma, basal cell adenoma, capillary haemangioma, metastatic carcinoma and non Hodgkin's lymphoma. The principal site of salivary tumours was the parotid gland and females were most affected. Pleomorphic adenoma was the most frequent finding. The results of this study are comparable with other studies

Meningococcaemia with arthritis

A patient is described with acute meningococcaemia and arthritis, but without meningitis. Although he had a positive blood culture, repeated synovial fluid cultures were sterile. Over the course of his illness and as his septicemia recovered with antibiotic treatment, the pattern of his arthritis changed from that of a polyarthritis to oligoarthritis and then a monoarthritis of the left knee. The knee deteriorated in fact while all the other features showed complete recovery. Repeated aspirations of the knee involved did not help. However, a local injection of a depot preparation of methylprednisolone into the involved knee led to a quick and complete recovery. This paper reviews different patterns of arthritis due to meningococcal infection and discusses its management

Cold knife visual internal urethrotomy the procedure of choice in urethral strictures

Fifty patients were treated with cold knife endoscopic urethrotomy over a period of two years with a success rate of 71%. This is comparable to results from other centres and believed to be the procedure of choice in urethral strictures of the membranous and bulbar urethra

Neutropenia related to captopril

Two patients are described with severe neutropenia which developed during captopril therapy. The first patient received captopril for congestive cardiac failure. She developed neutropenia within 5 weeks of captopril therapy, complicated by infection which proved to be fatal. The second patient was suffering from systemic lupus erythematosus [SLE], hypertension and renal failure. While on captopril therapy she developed severe neutropenia which reverted to normal after discontinuing the drug

Ureterosigmoidostomy: a useful technique

Eight patients of bladder extrophy who had ureterosigmoidostomy have been retrospectively analysed. Six patients experienced no postoperative complications. There was no mortality. Open transcolonic mucosa to mucosa proves to be a useful technique of anastomosis. This type of urinary diversion is socially acceptable to Pakistani patients