Comparison of diagnostic accuracy of core biopsy for breast lesions with fine needle aspiration cytology

To assess and compare the diagnostic usefulness of fine needle aspiration cytology [FNAC] of trucut biopsy of breast lesion. A comparative cross sectional study. The study was conducted in the surgical and pathology department of CMH Peshawar from February to August 2007. The first eighty two consenting female patients presenting with palpable breast lumps were subjected to FNAC then Trucut biopsy under local anaesthesia and later excision biopsy. Finally the results of FNAC and Trucut biopsy were compared in the light of excision biopsy results. There were 18 malignant and 64 benign cases on histopathology. On FNAC there were 5 in C5 category [confirmed on histopathology], 12 in C4 category [10 malignant on histopathology], 22 in C3 category [1 malignant on histopathology], 27 in C2 category [confirmed on histopathology] and 16 in C1 category [2 malignant on histopathology]. On Trucut 60 were benign and 17 malignant all of which were confirmed on histopathology. Five specimens were inadequate on Trucut [1 malignant on histopathology]. Sensitivities of FNAC and Trucut biopsy were 93.75-% and 100% and specificities were 96% and 100% respectively. Area under Receiver Operating Characteristic [ROC] curve for Trucut biopsy was found to be more than that of FNAC, showing that Trucut biopsy was more accurate than FNAC. Trucut biopsy has significantly higher diagnostic accuracy as compared to FNAC

Predictors of intractable childhood epilepsy

To determine the prognosis of seizures in epileptic children and identify early predictors of intractable childhood epilepsy. Case-control study. The Epilepsy Centre of the Children's Hospital Lahore, from February 2005 to April 2007. All children [aged 1 month to 16 years] with idiopathic or cryptogenic epilepsy who were treated and followed at the centre during the study period were included. The patients who had marked seizures even after two years of adequate treatment were labeled as intractable epileptics [cases]. Children who had no seizure for more than one year at last follow-up visit were the controls. Adequate treatment was described as using at least three anti-epileptic agents either alone or in combination with proper compliance and dosage. Records of these patients were reviewed to identify the variables that may be associated with seizure intractability. Of 442 epileptic children, 325 [74%] intractable and 117 [26%] control epileptics were included in the study. Male gender [OR=3.92], seizures onset in infancy [OR=5.27], >/= 10 seizures before starting treatment [OR=3.76], myoclonic seizures [OR=1.37], neonatal seizures [OR=3.69], abnormal EEG [OR=7.28] and cryptogenic epilepsy [OR=9.69] and head trauma [OR=4.07] were the factors associated with intractable epilepsy. Seizure onset between 5-7 years of age, idiopathic epilepsy, and absence seizures were associated with favourable prognosis in childhood epilepsy. Intractable childhood epilepsy is expected if certain risk factors such as type, age of onset, gender and cause of epilepsy are found. Early referral of such patients to the specialized centres is recommended for prompt and optimal management

Short term Neurodevelopmental outcome of asphyxiated newborns at tertiary care unit

To find out the short term neurodevelopmental outcome of asphyxiated newborns. Cross-sectional study using prospective data. Neonatal unit of Children's Hospital, Lahore from August, 2000 to July, 2001. We included 150 cases of birth asphyxia and survivors were followed till the age of six months and neurodevelopmental status was assessed by Denver developmental screening test II [DDST-II]. Severity of asphyxia was categorized as no encephalopathy, three different stages of HIE. During follow up visits, normal to delayed developmental status was expected. Infants were divided into two groups. Group A included neonates without HIE and group B with encephlopathy. Among group B, newborns developmental delay was found in 9 neonates and 48 neonates died while in group A neonates there was no child who had developmental delay and only six newborns died.[P value<0.05] There were 117 [78%] males, 35 mothers [23%] had antenatal visits to trained medical professionals. Majority of mothers [76%] had their visits to non doctor personnel like midwives, lady health visitors or nurse. Majority [61%] of study population were home delivered, 24% at private clinics and maternity homes while only 14% came from hospitals. Different stages of HIE have strong correlation with the outcome of these neonates. More effort and resources should be directed to this preventable community problem

Levamisole in steroid dependent and frequently relapsing nephrotic syndrome

To determine the efficacy of levamisole in steroid dependent [S.D] and frequently relapsing [F.R] nephrotic, from syndrome [N.S]. Quasi-experimental study. Department of Nephrology at The Children's Hospital, Lahore, over a period of 5 years from January 2000 to December 2004. S.D.N.S and F.R.N.S patients between the ages of 1-15 years, were given levamisole on alternate day in a dose of 2.5mg/kg, if either the dosage of steroids to maintain remission was >1mg/kg/every other day [EOD], or Z with CARON 0.5mg/kg/EOD with signs of steroid toxicity. The agent was continued for a period of one year and the steroids were gradually tapered off by 2.5-5mg every four weeks to less than 0.5mg/kg/EOD. The patients were monitored for maintenance of remission and side effects of drug. Seventy patients with a mean age of 5.50 +/- 2.97 years, with male to female ratio of 4:1 were studied. Nineteen [27.14%] patients did not relapse on therapy, while it was ineffective in 11[15.7%]. Rest of 40 [57.14%] patients, though, relapsed during therapy, their duration of remission was prolonged from six months to one year, and dose of corticosteroids could be significantly reduced [0.1-0.3mg/kg/EOD]. It was also observed that levamisole is more effective in older children [>5 years versus <5 years] [P-value 0.03]. The only side effects were transient rash and occasional vomiting. Levamisole is a safe and effective steroid sparing drug, in steroid dependent and frequently relapsing nephrotic syndrome, for the prolongation of remission, especially in older children