Primary hepatic carcinoid tumor with poor outcome

Primary Hepatic Carcinoid Tumor [PHCT] represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 opted for palliative care and expired in one month's time. Surgical resection was advised to the second case, but he left against medical advice

Knowledge, awareness and practices of harmful effects of anabolic steroids among body builders in Rawalpindi and Islamabad

To determine the knowledge, awareness and practices of anabolic steroids amongst body builders of Rawalpindi and Islamabad. Cross sectional study. The study was conducted in various gyms and fitness centers in Rawalpindi and Islamabad from November 2013 to May 2014. A structured close ended questionnaire was filled from the body builders in various Gyms/fitness centers after taking informed consent. A total of 310 male body builders between age group of 15-35 years were interviewed by non-probability convenience sampling technique. Standard descriptive and analytical statistics were used to analyze the data. Data analysis was done including variables like age, education, legality, motivation, workout, side effects and withdrawal symptoms of steroids. Chi-square test was used to ascertain the association between categorical variables, 95% confidence intervals [95% CI] and p value less than 0.05 was considered significant. A total of 310 male adolescents were surveyed, 64% reported past or present use of anabolic steroids. Mean [SD] age of the body builders was 24.7 [+ 3] years and most [84%] of them were educated. More than 72% of all the body builders had the knowledge that the steroids are harmful for their health. About the side effects of steroid use, 37% knew about ham loss, acne 21%, aggression/hypertension 14%, and sterility/infertility 15%. Bodybuilders who were aware that steroid use is illegal was 62% but still they were using them [p<0.001] The withdrawal symptoms of steroids were not known to 64% bodybuilders [p<0.001]. Trainers and friends seemed to be the main motivationa2 forces [p<0.008] .Bodybuilders taking steroids were satisfied using them [p<0.000]. It was interesting to note that the bodybuilders who were themselves hooked onto steroids were not willing to recommend others to use them [p<0.001]. Mood swings were seen majority [61%] of bodybuilders. about 17% of the non-users of steroids were planning to start it in future. Steroids in the injectable from were used by 83% of the bodybuilders. Use of steroids in bodybuilders is rising and a large number of body builders are using anabolic steroids without proper knowledge of the adverse effects and withdrawal symptoms of steroids. People being aware that steroids are illegal, continue using them Trainers, peer pressure are main motivators for steroid use. Most of the body builders who are taking steroids seem pleased with its effect on the body. In addition, our study showed that there were unregulated sources of steroids in Rawalpindi and Islamabad from where the majority of the participants can have easy access, Media and health care professionals can play a vital role in the dissemination of knowledge

Choanal atresia; diagnosis and simple endoscopic repair at remote primary care centers

Choanal atresia [CA] is a rare, congenital malformation resulting as a failure in communication between the posterior nasal cavity and the nasopharynx. The clinical course is often asymptomatic in unilateral CA leading to higher rates of misdiagnosis, in comparison to bilateral CA, which manifests itself as a surgical emergency at birth. Most cases present as isolated malformations, but it may also be associated with other congenital anomalies in 20-50% of cases. Currently, the most important diagnostic tool for CA is computerized tomography [CT] and confirmatory diagnosis is usually achieved with the help of nasoendoscopic examination. Although, different surgical approaches have been used in the past, transnasal endoscopic repair is currently preferred over others. Herein, we describe our experience of three cases and share our simple stentless endoscopic technique, to facilitate physicians working in low facility units for a timely diagnosis and prompt treatment

Wilson's disease: experience at a tertiary care hospital

Wilson's disease [WD] is a rare autosomal recessive disorder of copper metabolism. Data regarding WD is not available from Pakistan. A cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, and all patients admitted with primary and secondary diagnosis of Wilson's disease were added. A total of 47 patients were seen; 68% [n = 32] were male. The mean age was 26.6 +/- 9.97 years. Most of the patients presented with hepatic, [n = 22, 46.8%], neurological, [n = 17, 36.2%] and psychiatric [n = 8, 17%] symptoms. Mean ceruloplasmin level was 0.17 +/- 0.13 g/dl; it was < 0.25 g/dl in 39 [86.6%] patients. Serum copper [Cu] was reduced in 32 [68.1%] patients and 24-hr-urinary Cu was raised in 22 [47.6%] patients. Slit lamp examination for Kayser-Fleischer [KF] rings was done on 15 [31.9%] patients and 9 [60%] of them had KF rings. Mean serum aspartate transaminase [AST] / alanine transaminases [ALT] ratio was 1.92 and median alkaline phosphatase / total bilirubin ratio was 79.30 [IQR 35.05; 166.50]