Growth factors in cystic fibrosis

Introduction: Cystic fibrosis is one of the most common autosomal recessive diseases that affects sweat glands and mucosa. CF is a hereditary disease with annual incidence of about 2500 new cases in United Kingdom. Insulin-like growth factor-1 [IGF-1] and insulin-like growth factor binding protein-3 levels decrease in CF. The aim of this study was to assess the role of growth peptides in patients with CF

Method: We searched PubMed, Google scholar, IranMedex, and Scientific Information Database [SID] in September 2012 to April 2014. We included clinical studies with available abstracts and full texts that were in English or Persian languages. Manual searching was conducted within the reference lists of articles. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data

Result: The earliest study was published in 1997 and the most recent one was in 2014. Study participants were adults in 3 studies [20%] and 12 studies [80%] were conducted in children. Patients with CF have lower levels of IGF-1 and there is a significant correlation between IGF-1 levels and growth index in patients with CF

Conclusions: IGF-1 decreases in children with CF and might be the cause of poor growth and low body mass index in these children

Penile squamous cell carcinoma involving corpus cavernosum in a circumcised male - a case report

Background: Penile carcinoma is an uncommon condition, accounting for less than 1% of all male cancers. It typically presents as a superficial lesion involving the Glans and Penile Shaft. Risk factors for penile carcinoma include phimosis, human papilloma virus infection and tobacco smoking. The spread of the tumor to the loco-regional lymph nodes is the most relevant prognostic factor

Case Presentation: The current case report is about a 65 years old male who presented with non-healing ulcer involving glans and shaft of penis for two months. Examination of Perineum revealed an ulcer of size about 3 cm in length involving glans and distal penile shaft, with eaten up most of glans surface. Wedge biopsy histopathology report showed moderately differentiated Squamous cell carcinoma of the penis involving sub-epithelial tissue with lympho-vascular invasion and involvement of corpora cavernosa. CT-Scan abdomen with IV contrast showed no evidence of metastasis or lymphadenopathy. So partial penectomy was planned and carried out subsequently

Conclusion: Although squamous cell carcinoma of the penis a rare disease, mainly affecting the elderly population but all the penile ulcers not responding to medial therapy must be evaluated for malignancy. Most of these cases remain neglected because of inadequate evaluation and investigation by the local doctors which leads to late presentation. Due to these circumstances the patients have already metastatic disease at presentation. So, it is required to educate local doctors as well as general population to create proper awareness of this disease

Forgotten DJ stents; a misery to the patients

Background: DJ Stents have been in use since long for the management of ureteral obstruction. The obstruction may be due to stone, stricture, PUJ Obstruction etc. DJ Stents if kept for long time are associated with different complications like, blockage, break, migration, encrustation, stone formation etc. These long stayed DJ Stents need additional procedures for their removal like, URS, PCNL, and Pyelolithotomy etc

Objectives: i] to analyze the data retrospectively to see the number of patients having forgotten DJ Stents. ii] to see the level of awareness of patients regarding their DJ removal

Study Design: retrospective study

Place and duration of study: Urology Department, Allied Hospital, Faisalabad from Jan 2011 to Dec 2014

Materials and Methods: record of patients of forgotten DJ Stents for 4 years

Results: during 4 years period 35 patients were found to have forgotten DJ Stents and maximum duration of forgotten DJ Stents was 14 years. 41.66% patients in first group [indwell time 3- 12months] were having encrustations. Overall 11/35 [31.42%] needed litholopaxy for their DJ removal and 24/35 [68.57%] needed URS and it was successful in 22/24 patients. One patient needed PCNL and one had pyelolithotomy for their removal

Conclusion: patients should be stressed / counseled properly regarding its removal by telling its complication. Thread attached to the DJ stent may be left outside external urethral meatus. It must be properly documented in discharge slip. A register must be maintained to keep record of these patients and it should have their address and phone number so that they should be reminded of about their DJ removal well in time

Synbiotics in children with cow's milk allergy: a randomized controlled trial

Cow's milk protein allergy usually occurs in infants within the first months of life. It can affect several organs, but gastrointestinal symptoms are the most clinical symptoms observed. The most effective treatment is restricting the cow 's milk protein in mother and infant's diet. Lactobacillus GG supplementation in infant could be effective through modulation of the immune system and the gut microflora. Thirty two breastfed infants with Cow's milk protein allergy were enrolled in a double-blinded randomized controlled trial in which they received Synbiotic [n=16] or placebo [n=16] once a day for one month, simultaneously with Cow's milk protein restriction in mother and infant's diet. Clinical gastrointestinal symptoms [vomiting, colic, rectal bleeding and diarrhea], head circumference, body length and weight were recorded at the beginning, the end of the first and third month of study. Percentage of increment in head circumference and weight were statistically more in synbiotic group compared with placebo group at the end of the first and third month of study. There was no significant difference in resolution of clinical gastrointestinal symptoms [vomiting, colic, rectal bleeding or diarrhea] and percentage of increment in body length. Synbiotic supplementation in infants may improve increment of head circumference and weight gain, but has no effect on resolution of clinical symptoms

Comparing the operational related outcomes of a robotic camera holder and its human counterpart in laparoscopic ovarian cystectomy: a randomized control trial

Purpose: Glioblastoma Multiforme [GBM] brain tumor is heterogeneous in nature; so, its quantification depends on how to accurately segment different parts of the tumor, i.e. active tumor, edema and necrosis. This procedure becomes more effective when physiological information like diffusion-weighted-imaging [DWI] and perfusion-weighted-imaging [PWI] are incorporated with the anatomical MRI. In this preliminary tumor quantification work, the idea is to characterize different regions of the GBM tumors in an MRI-based multi-parametric approach to achieve more accurate characterization of pathological regions, which cannot be obtained by using individual modalities. Methods: For this purpose, three MR sequences, namely T2-weighted imaging [anatomical MR imaging], PWI and DWI of five GBM patients were acquired. To enhance the delineation of the boundaries of each pathological region [peri-tumoral edema, tumor and necrosis], the spatial fuzzy C-means [FCM] algorithm is combined with the region growing [RG] method. Results: The results show that exploiting the multi-parametric approach along with the proposed segmentation method can improve characterization of tumor cells, edema and necrosis in comparison to mono-parametric imaging approach. Conclusion: The proposed MRI-based multi-parametric segmentation approach has the potential to accurately segment tumorous regions, leading to an efficient design of the treatment planning, e.g. in radiotherapy

Role of intravenous urography and ultrasonography in the management of vesicovaginal fistula [VVF]

Background: It has been a matter of great controversy whether the sonography [USG] and intravenous urography [IVU] both are mandatory for the evaluation of hydronephrosis and hydro ureter in female patients having urinary fistulae. So we planned to conduct a study on this subject

Objectives: To compare the sensitivity of IVU and USG in showing the degree of Hydro nephrosis and hydro ureter in the patients having VVF

Study Design: Prospective study

Place and Duration of Study: Department of Urology Punjab Medical College /Allied Hospital Faisalabad from January 2013 to October 2014

Methodology: Thirty consecutive female patients suffering from urinary incontinence who presented in outpatient department and were diagnosed to have VVF were taken for study. Patients with urge incontinence, patients with malignancy, patients who underwent surgery or received radiation were excluded from this study. Informed consent for study purpose and surgery were taken. USG and IVU were done in every patients to find the hydronephrosis or hydro ureter

Results: Twenty seven out of thirty patients who had not hydronephrosis on USG, they also had not hydronephrosis or hydro ureter on IVU, while only three patients had hydronephrosis on USG had also hydronephrosis on IVU

Conclusion: This study concluded that USG and IVU have almost equal sensitivity in finding hydro nephrosis or hydro ureter in patients having VVF. Therefore, any one of them can suffice to find out hydronephrosis. IVU is an invasive procedure and have the risk of reaction to contrast material and exposure to radiations. USG is cost effective, non-invasive and hence can be used in place of IVU

Synbiotic for prevention of antibiotic-associated diarrhea in children: a randomized clinical trial

Antibiotic- associated diarrhea is a common problem in pediatric population. There is growing interest in probiotics, probiotics and synbiotics for prevention of this complication because of their worldwide availability as dietary supplements. The aim of this study was to assess the efficacy of a synbiotic mixture in prevention of antibiotic- associated diarrhea. In this randomized controlled trial, 218 patients [111 in the synbiotic and 107 in the placebo group] aged 6 months to 14 years with respiratory tract infection and/ or otitis media who needed antibiotic treatment in outpatient setting, were enrolled. They received 1 billion Colony Forming Unit of seven probiotics species plus Fructooligosaccharide in form of powder or placebo [matched for size, shape, and volume] for 7 days. Amoxicillin, Amoxicillin-clavalanic acid, cefixim and Azithromicin were the most common drugs used by physcicians Mothers recorded stool frequency and consistency daily for 7 days. We found no significant difference [P>0.05] in occurrence of diarrhea between synbiotic and placebo groups. This synbiotic mixture did not appear to reduce antibiotic- associated diarrhea in children. Further studies are needed to investigate the potential benefits of Synbiotics in prevention of this disease

Utility of modeling end-stage liver disease in children with chronic liver disease

Chronic liver diseases consist of wide spectrum disorders that may be complicated by cirrhosis and therefore need to transplantation. The pediatric end-stage liver disease [PELD] score and model of endstage liver disease [MELD] score has been used as predictors of mortality chronic liver diseases listed for liver transplantation. The aim of this study is evaluation of relation between PELD MELD score and evidence of cirrhosis in children with choronic liver disease. This cross-sectional study conducted on 106 patients of chronic liver disease referred to Ghaem haspital, Mashhad university of medical science, Iran during 24 months period [2010-2013]. PELD and MELD score were calculated for all patients. Clincal and patholoogical findings of cirrhosis were recorded. Mean age of patients was 68/3 +/- 41.8 months. Mean PELD MELD score was -1/59 +/- 9/64. There was significant correlation between PELD MELD score and clinical icter, spelenomegaly, evidence of hepatopulminary syndrome, esophageal varices, evidence of cirrhosis in tissue specimences. PELD MELD score appear to be benefit for detection of cirrhotic children among paients with choronic liver disease

Effects of iron supplementation twice a week on attention score and haematologic measures in female high school students

<p><b>INTRODUCTION</b>Iron deficiency, associated with a decline in cognitive function, is the most common nutritional deficiency globally. The present study aimed to identify the impact of weekly iron supplements on the attention function of female students from a high school in North Khorasan Province, Iran.</p><p><b>METHODS</b>This was a blind, controlled, clinical trial study, involving 200 female students who were chosen using the stratified randomised sampling method. First, laboratory studies were performed to detect iron consumption limitations. Next, the 200 students were divided randomly and equally into case and control groups. The case group was treated with 50 mg of ferrous sulfate twice a week for 16 weeks. We compared both groups' data on attention, iron status and erythrocyte indices. Questionnaires were used to collect demographic data, while clinical data was collected using complete blood count and Toulouse-Piéron tests. Data was analysed using descriptive statistics, as well as paired and independent t-tests.</p><p><b>RESULTS</b>The mean attention scores of the case and control groups were 104.8 ± 7.0 and 52.7 ± 9.6, respectively (p < 0.001). The mean haemoglobin levels of the two groups were 12.5 ± 0.9 and 11.2 ± 1.0, respectively (p < 0.001). Compared to the control group, the attention scores and haemoglobin concentrations of the case group were found to be improved by approximately 90% and 10%, respectively.</p><p><b>CONCLUSION</b>Oral iron supplements (50 mg twice a week for 16 weeks) were able to improve the attention span and haematologic indices of female high school students.</p>

Molecular determination and genotyping of Cryptosporidium spp. in fecal and respiratory samples of industrial poultry in Iran

OBJECTIVE@#To identify the genotypes of prevalent Cryptosporidia in broiler chickens in Lorestan province, Iran.@*METHODS@#A total of 1 000 fecal and 1 000 trachea samples were collected from chickens. Smears from both fecal and tracheal samples were stained with modified Ziehl-Neelsen method and nested PCR-RFLP according to amplification of 18S rRNA gene using Ssp I and Vsp I restriction enzymes and DNA sequencing.@*RESULTS@#From the examined chickens 0.7% was positive for Cryptosporidium. Infection was present in 0.5% fecal samples and also in 0.5% trachea. Only 0.3% of simultaneous infections in fecal and tracheal samples were observed. Nested PCR of our isolates demonstrated Cryptosporidium baileyi.@*CONCLUSIONS@#In our work, low rate of Cryptosporidium baileyi infection was detected, but in critical situations and our poor management circumstances, cryptosporidiosis occurs in serious feature especially in immune suppressed individuals.

Molecular identification of Leishmania tropica infections in patients with cutaneous leishmaniasis from an endemic central of Iran

The most common form of the disease is cutaneous leishmaniasis (CL) which is a public health and social problem in many countries especially Iran. In endemic areas where other diseases with similar clinical symptoms occur, definitive diagnosis of CL is very important. The detection and identification of Leishmania in infected patients is crucial for achieving a correct treatment and prognosis. To our knowledge, this is the first comprehensive study in terms of geographical distribution and molecular identification of Leishmania tropica isolates in central of Iran. This study was performed between 2010 and 2011, during which 218 CL suspected patients referred to Shahid Sadoughi University of Medical Sciences in Yazd, Iran for confirmation were examined. After microscopic analysis, DNA extraction was performed for identification. The molecular target region was ITS1 gene. Results showed that out of 218 isolates, 102 (46.8%) samples were positive for Leishman body using molecular assay. After PCR-RFLP, analysis identified 50 (49.01%) samples as L. major and 52 (50.98%) as L. tropica. Two samples showed a different pattern that were reported as unknown. Among L. tropica, six different isolates were identified in this endemic area. Finally, this study showed heterozygosity among L. tropica isolates in this endemic area such as some other studies from the world. This heterozygosity among the strains may suggest a sexual recombination or genetic exchange between strains.

Characteristics and outcome of three forms of autoimmune hepatitis in Iranian children

To define the clinical features, biochemical and histological findings and outcome of three forms of autoimmune hepatitis. In a cross sectional study between November 2001 to January 2008 in Tehran and Mashhad university of medical sciences, 61 children who diagnosed as AIH [40 girls and 21 boys] have been analyzed for their clinical, serological, and histological data. Variables analyzed included age, sex, clinical presentation, hepatic function, immunoglobulins, autoimmunity markers, histology and clinical evolution. According to the auto-antibodies profile, AIH patients were classified as type I AIH [ANA or smooth-muscle antibodies or both positive], type II [anti-LKM-1 positive] and type III [antibody negative]. We analyzed data of 61 children with AIH. 51 patients [median age: 10 [0.7-14] years had anti-nuclear and/or smooth muscle antibody [ANA/ASMA or both], 5 [median age: 7 [2-8] years] had liver/kidney microsomal antibody [LKM-1]. 5 patients had no detectable autoantibody. At presentation: 60% had jaundice or symptoms of acute hepatitis; LKM-1 positive were younger. Interface hepatitis was seen in 100% and fibrosis +/- cirrhosis were found in 70%. Frequency of AIH was 2:1 in girls. Type 1 was the most frequent diagnosis [83%] and was more frequent in older children. Relapse and treatment failure were common in type II. AIH may have different clinical presentation in children. Althout most of cases may have high inflammatory activity or cirrhosis, good response to treatment and remission may accur

Determine efficacy of a short course of montelukast in children with intermittent asthma and viral infection

Mild intermittent asthma is common in children and viral infections are responsible for the majority of exacerbations. As leukotrienes are potent inflammatory mediators, some studies have shown that Montelukast, a leukotriene receptor antagonist, may be effective on reduction of asthma symptom. To determine whether a short course of Montelukast in asthmatic children with common cold would modify the severity of an asthma episode. Children, aged 6-12 years with intermittent asthma participated in this randomized, double-blind, placebo-controlled clinical trial. Treatment with Montelukast or placebo was initiated at the onset of viral upper respiratory tract infection and continued for 7 days. Primary outcomes included the clinical manifestation: duration of episodes, daily symptom, nights symptoms and activity limitation. Secondary outcomes included the need for beta agonist usage, oral prednisolone, physician visit, hospital admission and school absence. A total of 187 children with intermittent asthma were randomized, 93 to Montelukast group and 94 to placebo group. Montelukast significantly decreased the cough by 17.3% [P<0.001], nighttime awakenings by 5.4% [P=0.01], interference with normal activity by 6% [P<0.01], time off from school by 6% [P<0.01], beta-agonist usage by 17.2% [P<0.001] and doctor visits by12.2% [P<0.01] compared to placebo. Whereas there was a non significant reduction in wheezing, tachypnea, respiratory distress, asthma exacerbation, oral prednisolone and hospitalization [P=0.8]. A short course of Montelukast, introduced at the first sign of a viral infection, results in a reduction in cough, beta-agonist use and nights awakened, time off from school and limitation of activity. More studies are needed to evaluate the optimal dose and duration of treatment

Kawasaki disease presenting as acute clinical hepatitis

Kawasaki disease is a systemic vasculitis of children. Among gastrointestinal symptoms of this disease jaundice occurs uncommonly. We present a 23 month boy with icter and clinical hepatitis and final diagnosis of kawasaki disease

Percutaneous nephrolithotomy [PCNL]: comparison of tubeless versus conventional method in terms of hospital stay and duration of operation

Introduction: Percutaneous Nephrolithotomy [PCNL] is an effective treatment for large renal calculi and usually a nephrostomy tube is placed in the kidney at the end of PCNL

Objective: To compare the outcome of conventional percutaneous nephrolithotomy with postoperative PCN tube versus tubeless Percutaneous Nephrolithotomy, in terms of duration of surgery and postoperative hospital stay

Study Design: Randomized control trial

Setting: Urology Department Punjab Medical College / Allied Hospital Faisalabad

Materials and Methods: Sixty patients were taken with non probability consecutive sampling technique. They were divided into group A[n=30] with conventional PCNL having postoperative nephrostomy tube and group B[n=30] with tubeless PCNL by computer generated random number table. They were compared in terms of duration of surgery and post operative hospital stay

Results: Age distribution of total patients ranged from 15 to 77 years, mean age was 35.07 +/- 15.89. Mean duration of postoperative hospital stay was 6.2 +/- 0.81and 4.07 +/- 1.2 days [p-value=00001] in group A and group B respectively. The operating time was 80 to 145, minutes, mean time 110.17 +/- 15.87 in group A. In group B, operating time was between 65 to 140 minutes mean time 95.18 +/- 22.43

Conclusion: Tubeless PCNL reduces duration of surgery and postoperative hospital stay significantly as compared to conventional PCNL with postoperative nephrostomy tube

Outcome of intracorporeal cystolithotripsy in children

Objectives: To evaluate the success and complications of intracorporeal cystolithotripsy in children

Design: It was prospective and descriptive study

Place and duration of study: Study was conducted in Department of Urology Allied Hospital, [PMC] Faisalabad from January 2011 to December 2012

Patients and Methods: Total number of 40 patients with vesical stone

Results: Children with average age of 7.23 years were included in study. Stones were completely removed in [90%] patients. Perforation occurred in 2.5% patients, 5% patients required redo intracorporeal cystolithotripsy due to stone impaction in urethra. 2.5% Patients needed open vesicolithotomy due to bleeding

Conclusion: Intracorporeal cystolithotripsy with pneumatic lithoclast is a safe and valid procedure for management of vesical calculi in children

A Short Term Follow Up Comparison of Genu Varum Corrective Surgery Using Open and Closed Wedge High Tibial Osteotomy

Introduction: Knee deformity associated with osteoarthritis (OA) is one of the most common complications seen in patients referred to orthopaedic surgeons. High tibial osteotomy (HTO) is an accepted method for treatment of medial knee osteoarthritis with varus deformity. The aim of this study was to compare results of osteotomy methods in patients with genu varum (GV) deformity. Methods: In this cohort study, the sample consisted of 32 patients with genu varum deformity (42 knees) who were divided into two groups and matched according to age and gender. The patients were treated with open or closed wedge osteotomy. After surgery, they were followed-up and compared for 6 months. Results: The sample consisted of 25 women (87.2%) and 7 men (21.8%). Ten patients (31.2%) presented with bilateral deformity. The incidence of complications was the same for both procedures (12.5%); this included one peroneal nerve injury following closed wedge surgery. Overall, patient satisfaction was 87.5% and 75% for the open and closed wedge methods respectively. Operative time, days to full weight bearing, and days to return to routine activities were significantly shorter for patients treated with the open wedge method (p<0.001). Conclusion: Open wedged HTO is associated with shorter operating time, shorter recovery time, higher patient satisfaction, and probable lower risk of neurological injury.

Crossing vessels as a cause of pelvi-ureteric Junction [PUJ] obstruction

Foetal hydronephrosis is commonly caused bycongenital pelviureteric Junction [PUJ] obstruction.It is either due to nerve deficiency or due to intrinsicmuscular defect at PUJ or it may be due to lowerpolar aberrant crossing vessel just compressing thePUJ. The purpose of this study is to see thecontribution of crossing vessels in causing the PUJobstruction

Aims and objectives: [1] to find thecontribution of crossing vessels in causing PUJobstruction on naked eye examinationperoperatively, [2] To histologicaly verify the causeof PUJ obstruction in cases of crossing vesselscompressing the pelvi-ureteric junction [PUJ]

Patients and methods: 27 cases of Congenital PUJobstruction were taken during four year period whowere candidatesfor operation. All underwent Anderson HynesPyeloplasty and specimen of PUJ with narrowsegment below it was taken and preserved in 10%formalin. The specimen was sent to histopathologistalong with other specimens where PUJ obstructionwas not caused by crossing vessels for nervedetection by S-100 immunohistochemistry and forhistopathological examination

Results: Five out of27 cases of PUJ obstruction were caused by crossingvessels and in these five cases, four [80%] werehaving normal histology showing that crossingvessels were the cause of PUJ obstruction merelycompressing the PUJ mechanically

Vesicovaginal fistula, causative factors and outcome of surgical management: an experience at PMC/allied hospital Faisalabad

Objectives: To assess the causative factors and outcome of surgical management of Vesicovaginal fistula [VVF] in our set up

Duration and Design of Study: Retrospective descriptional study from January 2008 to June 2012 conducted at Department of Urology PMC/Allied Hospital Faisalabad

Methodology: All patients with VVF who presented in our out patient department and underwent surgical repair in our department were included in this study. The records of patients were reviewed and data was entered in a structured proforma and analyzed. After history, physical examination, relevant investigations, IVU, Cystoscopy and vaginoscopy, patients were divided into two groups. Patients with supratrigonal fistula were operated through abdominal approach and those with infratrigonal fistula were operated through vaginal approach. The outcome of surgical procedures and post operative complications were noted

Results: This study included 68 patients. In 42 [61.76%] patients, cause of VVF was iatrogenic injury during hysterectomy, and 26 [38.24%] patients developed VVF due to obstetric causes. Fifty patients [73.53%] had supratrigonal fistula and eighteen patients [26.47%] were having trigonal or subtrigonal fistula. We achieved 90% and 83.33% success rate with abdominal and vaginal repair respectively

Conclusion: The most common cause of VVF is iatrogenic injury during hysterectomy. Both approaches of surgical repair had almost equally good results

Ultrasonographic triangular cord sign and gallbladder abnormality in diagnosis of biliary atresia

Early diagnosis of biliary atresia is very important for better outcome of treatment. Ultrasonography is one of the diagnostic tools for early differentiation of biliary atresia from other causes of neonatal cholestasis. It has been reported that triangular cord sign [TACS] in sonography is a reliable sign for diagnosis of biliary atresia. The aim of this study was to re-assess the accuracy of TACS alone and coupled with an abnormal gallbladder in the diagnosis of biliary atresia. Infants with prolonged cholestatic jaundice underwent ultrasonography and liver biopsy. Results of ultrasound scans [TASC and gallbladder abnormality] were compared with histopathological findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Ultrasonographic findings for diagnosis of biliary atresia based on liver histopathology were studied. The sensitivity, specificity and accuracy of TACS for diagnosis of biliary atresia were 36%, 95% and 77% respectively. Positive predictive value and negative predictive value was 77%. The sensitivity and specificity of gallbladder abnormality for diagnosis of biliary atresia were 36% and 88% respectively. Positive predictive value of TACS coupled with gallbladder abnormality for diagnosis of biliary atresia was 100%. The Ultrasonographic TACS is very specific for diagnosis of biliary atresia. Positive predictive value and accuracy of this sign is much higher than of gallbladder abnormality. The sensitivity of TACS for diagnosis of biliary atresia is very low