Unique position of a pancreatic head insulinoma during laparoscopic enucleation: case report

Insulinomas are benign pancreatic neuroendocrine tumors that require surgical intervention as a therapeutic measure. We describe an 18-year-old male patient who presented to the emergency department with a history of syncope, blurred vision, and diaphoresis. His blood sugar level was low upon admission, and a 72-hour fasting plasma glucose test showed low serum glucose, high serum insulin, and high C-peptide. An abdominal computed tomography scan and magnetic resonant imaging revealed a solitary tumor in the pancreatic head with no sign of ductal dilatation. Laparoscopic enucleation was performed, and a histopathological examination revealed findings consistent with insulinoma. The patient’s postoperative course was uneventful, and his follow-up examination was unremarkable. In conclusion, physicians should have a high clinical suspicion index for insulinomas, especially in young patients with a history of syncope, blurred vision, and diaphoresis, in order to avoid delayed diagnosis.

Biliopancreatic diversion, duodenal switch, and vertical sleeve gastrectomy operation of patients with body mass index more than sixty retrospective study

Obesity is a complex metabolic disorder with significant health and economic consequences due to related co- morbid conditions, including diabetes, cardiovascular disease, and certain cancers, and increased mortality. So when body mass index increase mortality increase. Asses and study the result of operations of obesity associated with malabsorption operations to measure the body mass index more than sixty and To prove the benefit of this type of bariatric surgery in weight loss within short period and its benefit in decreasing co-morbidity. A retrospective study conducted in Baghdad Teaching Hospital and Dijla Private Hospital from June 2011 to June 2012 where the follow-up of eleven patients admitted to surgical ward and underwent the operation of Biliopancreatic diversion, Doudenal switch and Sleeve gastrectomy were analyzed the enhance people with diseases and postoperative diseases and complication. All patients were given nutritive instructions three months prior to surgery which was rich in vitamines and low fat. From the analysis of the results we found a rapid decline in body weight as well as the Body mass index, where in the 1[st] 3months BMI dropped of about 22%, after 6 months BMI dropped 39% and dropped more than 50% after 12 months. Also this study show clear and significant improvement in treatment of sleep problems, DM, and HPT. Operation of this type is important for weight loss in morbidly obese patients in addition to high and noticeable improvement in association comorbid diseases

Early psychosis symptoms

To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. A cross-sectional study. The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis [IROAS]. Fifty five [59%] participants were male while 41% [n=38%] were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 [55%] concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced [p < 0.001] for depressed mood [66%], worries [65%], tension [63%], withdrawal/mistrust [54%] and loss of self-confidence [53%]. Thought withdrawal [22%] and passivity [15%] were elicited only through structured interview [IROAS]. When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of longterm psychosis

Generalized anxiety disorder: can we rest now?

Generalized anxiety disorder is a complex psychiatric syndrome. Current understanding on the epidemiological risk factors, genetic vulnerability and neurobiology of the GAD is beginning to unfold the complexities behind this disorder. This narrative review has attempted to put together the recent advances in the area of GAD research with intent to identify the gaps requiring further research

Effects of Methanol Extract of Piper chaba Stem Bark on Acute Inflammation in Rats.

The plant Piper chaba Hunter (Piperaceae), a climbing glabrous shrub grows in plenty in southern Bangladesh. Popularly known as 'Choi' it is used as spices and believed to have medicinal value in a wide variety of disease conditions including arthritis, asthma, bronchitis and piles. In the present study, effect of methanol extract of Piper chaba stem bark on acute inflammation has been reported. The anti-inflammatory effect was studied in rats by injecting 0.1ml of 1% carrageenan suspension into the planter surface, where oedema of the rat's hind paw was used as an index of acute inflammation. Methanol extract of Piper chaba stem bark given orally 1 hour before injection at doses of 125 and 250 mg/kg body weight, produced significant (p< 0.05) anti inflammatory effect compared to control and the percentage of inhibition of oedema formation was 33% and 35% respectively, which however was less compared to aspirin (46%) and hydrocortisone (56%). The result suggest that in case of acute inflammation, Piper chaba stem bark possess mild to moderate anti inflammatory effect compared to that of aspirin and hydrocortisone.

Result of Simultaneous Correction of Alar Deformity with Primary Repair of Unilateral Cleft Lip.

Cleft lip and cleft palate has been a recognized congenital malformation from a very early stage in recorded history. The infant born with an orofacial deformity, which leads to develop an unwilling psychosocial problem among the parents and also among the relatives. Successful treatment of cleft is based on overcoming in tissue shortage and repositioning of the tissues in normal anatomical pattern so that it restores both appearance and function. Various modalities of theme, works, observations and involvement of multidisciplinary approaches were tried to achieve better cosmetic, aesthetic and functional aspect in management of cleft face. Poorly performed primary surgery carries a high risk of iatrogenic disturbances of subsequent orofacial growth. Delayed nasal repair in patient with cleft lip did not produce satisfactory aesthetic and functioning result. Aim & objective of the study is to achieve a cosmetically well-accepted face in respect to lip, philtrum and nose of both sides after cleft lip surgery and to reduce the incidence of secondary correction of deformed nose in a patient with cleft lip. In our study total 86 cases are studied according to preformed inclusion and exclusion criteria. Simultaneous correction of alar cartilage deformity at the time of primary repair of cleft lip may lessen the staged operative procedure and markedly reduce the economic burden to the family.

Students' research: tradition ahead of its time

This view point describes the experience of introducing research at an undergraduate level during clinical rotation in psychiatry. Objective of this initiative was to encourage critical thinking, self directed learning and sensitization to mental health issues. This contributed to student learning besides galvanizing their interest in the subject. The opinion piece aims to expose various issues to students' research in the context of medical education in Pakistan

Magnetic resonance imaging findings in patients with schizophrenia

To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging [MRI]. Comparative study. The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008. Thirty-three cases of schizophrenia [n=33] and thirty-three age-matched controls, [n=33] were enrolled for this study. Screening Magnetic Resonance Imaging [MRI] of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p <0.05. Among the total of 66 [n=66] MRI films studied for brain abnormalities, brain atrophy, presence of septum pellicudum and enlarged Virchow-Robins spaces were significantly associated with schizophrenia [p<0.001]. There was no significant difference between cases and controls for ventricular dilatation [p=0.5]. Sinusitis was mostly associated with controls and well correlated with their symptoms [p<0.001]. Brain atrophy was the most commonly seen brain change in the studied sample of patients with schizophrenia. MRI brain can be used to identify structural abnormalities in patients with schizophrenia

Leiomyoma of scrotum.

Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.

Economics of health care: an ethical dilemma

Health care has become a lucrative business where firms enter the market to earn exorbitant amount of money. In this article we have made an attempt to highlight the inequitable Agency relation governing interaction between patients and health care providers. In the absence of any robust legal frame work, patients with mental illness are at risk of exploitation and abuse

Depression in Pakistan: an epidemiolgical critique

The epidemiological studies from Pakistan have given rise conflicting findings. Besides very high prevalence in different studies, rates from Northern Pakistan are much different from big urban centre such as Karachi. If the findings of these studies are to be taken at face value than every third Pakistani is expected to be suffering from depression and Anxiety. Obviously this has serious implications for the country's mental health care scenario. There are design, sampling and methodological issues which needs to be revisited. This review aims to This review presents a critique, from an epidemiological perspective, on studies carried out in Pakistan on estimating rates and risk factors of depression. It is expected that this critique will serve to enhance awareness on research methods in psychiatry and suggest future directions for research in this important area.

Pathway to psychiatric care in Karachi

This research was done to study the care and referral pathway taken by patients before they present to a psychiatrist at a university teaching hospital in Karachi, Pakistan. The key study variables were the obstacles and delays at each level of care i.e. community, primary care physician and psychiatrist. A consultant psychiatrist conducted an initial interview for diagnostic assessment. Patients' diagnosis was based on ICD-10 clinical care version. During the study period a total of 94 initial patients were seen and assessed in the psychiatry screening of Aga Khan University Hospital [AKUH]. Of them, there were 52 [55.3%] males and 42 [44.0%] females. Among the whole sample, 15% patients were in adolescent age group [<20 years age], while 38% were in the age range of 21-to-30 years, 17% in the age range 31-to-40 years, 15% between 41-to-50, while 6.5% were above the age of 60 years. Majority [64.5%] was single while 29 [10 females, 19 males] patients were married. Only 3% were divorced or widowed. Majority of patients were housewives [30%], followed by students [20%, 12 males, 6 females] and professionals [16%; 7 females, 8 males]. Five patients were unemployed at the time of referral while 5 had retired from their respective occupation The most common diagnosis in both genders was depression [females n=26, 52%; males n=21, 37%], while schizophrenia, bipolar disorder and obsessive-compulsive disorder was diagnosed with similar frequency in both genders