Tailored metabolic workup for urolithiasis: the debate continues

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks to years, depending upon the composition and attending risk factor. They should be targeted with concentric and tailored prevention protocols. The major urological guidelines [EAU and AUA] recommend basic stone workup for all patients. However, indication for detailed workup are less well documented, so one potential solution is to tailor metaphylaxis strategies for individual patient

Students' perception of an integrated quiz in a Malaysian medical university

Context: Improvement in the quality of teaching has been one of the important items on the agenda of curriculum development in most medical schools in Malaysia. Active teaching strategies are designed to make the learning process more interesting and thought provoking

Aims: To study the students' perception of an integrated quiz as a teaching-learning activity

Materials and Methods: An integrated quiz was conducted among 2nd year medical students in a Malaysian University. The quiz comprised questions on anatomy, physiology, biochemistry, pathology, microbiology, parasitology and nutrition. There were 8 teams, and four rounds with the four levels of questions according to Bloom's taxonomy were given. The students were divided into two groups. Group A consisted of students who participated in the quiz and Group B formed the audience. The perception of the students on the integrated quiz was assessed by administering a structured questionnaire of 20 questions and using a Likert-type scale. The respondents indicated their perception as scores; 5, 4, 3, 2 and 1 for options of strongly agree, agree, uncertain, disagree and strongly disagree respectively. In addition to the above scale, the students were given the option to give their comments and suggestions related to the session. The mean scores for each item were calculated and a comparison of the two groups made. Data were analyzed using descriptive statistics and t-test

Results: A total of 103 students participated in the study. There were more females than males in both groups. The mean perception score for Group A and Group B was 3.3 +/- 0.2 and 3.5 +/- 0.3 respectively. When the mean scores were compared, a statistically significant result was revealed. The overall ratings for the quiz by both groups were good

Conclusions: We found that Group B had a more positive response towards the integrated quiz as an active learning technique than Group A

Prevalence of dysphagia in patients with head and neck cancer at dental clinic, Hospital USM

Prevalence of dysphagia is one of the important epidemiological data which will contribute to the proper planning and support the setting up of a swallowing rehabilitation clinic at this hospital. The present study aimed to determine the prevalence of dysphagia in patients with head and neck cancer (HNC) at Hospital Universiti Sains Malaysia (Hospital USM) from 2001-2010. In this institutional retrospective study, a total of 66 records were obtained comprising of 86.4% Malay patients, 9.1% Chinese, 1.5% Indians, and 3% other ethnic groups. These data were taken from the database of HNC patients seen at the dental clinic, Hospital USM between 2001 and 2010. Difficulty swallowing, frequent coughing during meal, choking, diet modification, and non-oral nutritional support were identified as signs and symptoms associated with dysphagia. Results showed that 59.1% of patients have had dysphagia before, during, or after the treatment of HNC. Data from the present study would be instrumental in increasing awareness among clinicians involved in patient care and it may help in planning the outline of management of dysphagia. Furthermore, it is anticipated to have implications for further research in swallowing and dysphagia.

Significance of sonographic characterization and fnac of small size thyroid nodules

The purpose of this study is to determine the accuracy of various ultrasound characteristics of small size thyroid nodules in the predication of malignancy and the usefulness of ultrasound guided FNAC of these nodules. Experimental / analytic study. This study was carried out at Radiology Department Services Hospital, Lahore from October 2011 to September 2012. This study was conducted on 70 patients, in whom 76 thyroid nodules 4mm to 10mm in size were biopsied. Diagnostic ultrasound was performed with high frequency linear probe for the evaluation of following ultrasound characteristics, internal structure, echogenicity, margins, posterior acoustic shadowing, height to width ratio, halo around the nodules, calcifications and vascular flow on Doppler scan. Each character was correlated with the results of FNAC to determine the accuracy of the feature in the prediction of malignancy. Out of 76 FNACs of 4mm to 10mm size thyroid nodules 8 [10.5%] biopsies did not yield significant cytological specimen. Another 8 [10.5%] specimen were classified as indeterminate so no further analysis was done. The rate of malignancy among nodules on final diagnosis was 20%. The most accurate sonographic features associated with malignancy were posterior acoustic shadowing [88.3%], taller than wider [83%], Halo around the nodule [80%] and calcification [70%]. Small size thyroid nodules are associated with significant risk of malignancy. Certain sonographic characteristics can be used to measure the risk of malignancy. FNAC of these nodules can be safely and accurately performed with high diagnostic rate

Bioremediation of Zearalenone by using Lactobacillus acidophilus in albino rats bodies [in vivo]

Objective: This study aimed to evaluate the efficiency of Lactobacillus acidophilus to reduce zearalenone toxicity in vital systems of albino white rats

Methods: Fusarium graminearum isolate was tested to produce zearalenone toxin. L. acidophilus was used to reduce the toxin in rats. This ability was studied by many parameters such as biochemical and physiological parameters in addition to histological study

Results: The results showed that L. acidophilus had the ability to reduce zearalenone toxicity. L. acidophilus had the ability to raise Hb 11 g/dl in blood of animals that was treated with zearalenone only to 13.06 g/dl in animal's blood that was treated with zearalenone + L. acidophilus. As well as the number of red blood cells in animals blood treated with these treatment was 6.62 x 10[12] cell/ L. L. acidophilus reduces the toxicity of zearalenone through its ability to reduce the number of platelets to normal levels

Conclusion: L. acidophilus had a role in repeated biochemical parameters to normal levels. Total protein rose to 6.6 g/dl in animal's blood treated with zearalenone + L. acidophilus compared with these levels in blood of control group. Also GPT and sugar levels in animal blood that was treated with zearalenone + L. acidophilus were at normal level. Histological study proved that L. acidophilus had the ability to protect liver, kidney, and uterus from the toxicity of zearalenone

Effect of television watching on vision of school children in semi urban area of Kashmir.

Background: Schoolchildren form an important target group as any ocular morbidity in this age group has huge physical, psychological and socio-economical implications. Considering the fact that one-third of India's blind lose their eyesight before the age of 20 years and many of them are under five years when they become blind, early detection and treatment of ocular morbidity among children is important. This study aims to highlight the prevalence of ocular morbidity in governmental schools in a sub-urbanized area of India. Research question of current study was to study the Effect of TV watching on vision in school children. Methods: Study area: Government schools in a sub-urbanized area of India. Sample size: 1128 school children from class 5th to 12th. Study design: A cross-sectional study was conducted and the study population comprised of school children who were examined in their schools and afterwards referred to the hospital if required. Data was gathered using a questionnaire, snellens charts and retinoscopes. Statistical analysis: simple proportion. Data was analysed statistically using SPSS software, version 14. Results: 1128 children were examined. Percentage of male children was 42.73% and females were 57.18%. Ocular abnormality was detected in 21.3% children with refractive errors contributing 18.26%, conjunctivitis-1.95%, blepheritis-0.62%, dacrocystitis-0.17%, stye-0.35%, color blindness-0%. It was also observed that children watching TV for less than 1 hour had visual acuity of 6/6 in 42.4%, whereas children watching TV for 1-2 hours, 2-3 hours and >3 hours had lower visual acuity. Conclusion: It was concluded that moderate to high prevalence of ocular morbidity among high school children is present in block Hazratbal. Finally, the aim of all blindness control programs should be to propagate awareness in the masses of eye care and to teach the essentials of ocular hygiene and eye healthcare.

Diagnostic accuracy of magnetic resonance imaging in detection of acoustic neuroma

Acoustic neurojna is the most frequent benign tumour at cerebellopontine angle. It accou-ntsfor 8 - 10% of all primary intracranial tumours and 80% of Cerebellopontine angle tumours.[2] Meningioma constitutes 5 - 10% of Cerebellopontine angle tumors, with rare tumours constituting only a small percentage out of which epidennoid cyst is the most frequent. This study was performed to determine the diagnostic accuracy of magnetic resonance imaging in the detection of acoustic neuroma that is taking histopathology a gold standard. It is a cross sectional study conducted in the Department of Diagnostic Radiology, Lahore General Hospital, Lahore from 14-07-2012 to 14-07-2013. The study comprised of 55 patients with clinical suspicion of acoustic neuroma. Magnetic resonance imaging on a 1.5-T Philips whole body magnetic resonance system was performed. The cases were operated and histopathological results were recorded. The results of magnetic resonance imaging and histopathology were compared taking histopathology as gold standard. Out of 55 patients, 43 patients [78.2%] had acoustic neuroma on magnetic resonance imaging. After comparison of results of magnetic resonance imaging with histopathology, the sensitivity, specificity, positive piedictive value, negative predictive value and diagnostic accuracy of magnetic resonance imaging were 97.7%, 91.7%, 97-7%, 91-7% and 96.4% respectively. Magnetic resonance imaging is a highly accurate, non-invasive, safe and convenient imaging modality for the evaluation of acoustic neuroma and is valuable for guiding surgical biopsies thereby decreasing unnecessary intervention. It allows detection of small tumors which is very useful in tumor characterization and plays an integral role m early detection, planning management and estimating patient's prognosis

Neutral zone dentures versus conventional dentures in diverse edentulous periods

The objectives of this study were to compare the arrangement of teeth according to the bone support concept with the neutral zone concept, Evaluate the influence of two arrangement schemes on denture success. A total of 128 patients were equally allocated into two groups, according to period of edentulism. All groups were provided neutral zone and conventional dentures. Post insertion assessment of conventional and neutral zone dentures was compared. Both denture techniques showed satisfactory assessment results in shorter edentulous period. In longer edentulous period, neutral zone dentures showed better assessment results. Arrangement of teeth with neutral zone may improve denture success in patients with prolonged edentulous periods

Treatment of muscle invasive bladder tumor comparison between chemotherapy and cystectomy

Bladder Tumor is the second most common cancer of the genitor-urinary tract. Male to Female ratio: has been demonstrated as 3.5:1. To compare the efficacy of combined chemotherapy/or radical cystectomy with or without urinary diversion. The present study was conducted on 26 consecutive patients of either age and sex having histologically proven muscle invasive transitional cell carcinoma of the bladder .These patients were selected from different hospitals in Lahore including Lahore General Hospital, Mayo Hospital, Shaikh Zaid Hospital, and Services Hospital from 1994-1996. These patients were thoroughly investigated. At the initial diagnosis 18-30% of patients of bladder tumors are muscle invasive and 70% superficial. Although radical cystectomy is the treatment of choice for invasive bladder tumor, bladder-sparing technique are more often being used e.g. TURGB and Intra-vesicle chemo/immunotherapy in superficial bladder cancer, TURGB and Systemic chemotherapy in muscle invasive tumor. The use of combination Chemotherapy in advance disease is routine e.g. CMV and MVAC. In our present study a total of 26 consecutive patients of either age or sex having histologically proven muscle invasive tumor of bladder were included. These patients were collected from different hospitals at Lahore, from 1994 to 1996. Out of these 26 patients, 13 patients were included in group-A, [they were given MVAC chemotherapy] and the remaining 13 patients were included in group B, [in these patients cystectomy and urinary diversion were done]. It is concluded that the result using combined Chemotherapy MVAC are better [20%] as compared to total cystectomy/urinary diversion [12.23%] after one year follow up

Comparison of transvesical repair of vesico-vaginal fistula and use of free bladder mucosal graft

This study was designed to compare the efficacy and complications of the conventional transvesical repair of vesicovaginal fistula versus new technique using free bladder mucosal graft for repair. It was carried out on 16 patients aged 16-45 years in the Departments of Urology, Services Hospital and Jinnah Hospital, Lahore from 1999 to 2001. Patients were randomly divided into two groups A and B. In group A, 8 patients who underwent conventional transvesical repair of.vesicovaginal fistula whereas in group B, 8 patients who underwent repair using free bladder mucosal graft. Out of 16 patients, the recurrence was observed in 3 patients [37.5%] in group A and i patient in group B, [12.5%]. There was statistically no significant difference P > 0.05. The transvesical free bladder mucosal graft repair provides good result with minimum complications. This method is recommended for routine repair of vesicovaginal fistulae without extensive dissection of the diseased area

Complementary and alternative medicine: Attitude of medical community in Pakistan

To determine the awareness and use of Complementary and Alternative Medicine [CAM] among General Practitioners [GP's] and Medical students in Islamabad/ Rawalpindi area. In this descriptive study, a self-administered proforma with eight questions was distributed to randomly selected GP's in Islamabad and Rawalpindi area and final year medical students of Shifa college of medicine, Islamabad in 2005-2006. Responses of the participants were analyzed by computer software SPSS version 10. Up to 71% GP's and medical students claim to have self knowledge about CAM. Less than 31% had any formal education [workshop or seminar] about CAM. Less than 45% claim to have used it personally or refer patients for CAM therapy. More than 80% take history from patients about CAM use and about 50% had noted significant side effects of CAM. More than 50% GP's and students think that homeopathy, herbal medicine and acupuncture are effective way of treatment and recommend strongly to include those at National level. Knowledge of GP's and final year medical students about CAM is predominantly based on self-learning without any formal education on this subject. Practice of CAM is quite similar in terms of personal use, patient referral, patient history taking and witnessing of side effects in both groups

Separate submission of standard lymphadenectomy in 6 packets versus en bloc lymphadenectomy in bladder cancer

Our aim was to evaluate detection of nodal metastasis during radical cystectomy with standard pelvic lymph node dissection versus en bloc lymphadenectomy for the treatment of bladder cancer. Hospital records of a total of 77 patients with radical cystectomy and either standard pelvic lymph node dissection or en bloc lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examination in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. En bloc dissection specimens were sent in 2 containers marked as the right and the left pelvic nodes. Clinical and pathological findings of these two groups were compared in terms of the number of dissected lymph nodes, number of nodes with metastasis, lymph node density, and clinical outcomes. There were 34 patients with standard lymph node dissection and 43 with en bloc lymphadenectomy [anterior pelvic exenteration]. Age, sex, duration of the disease, number of transurethral resections prior to cystectomy, pathological grade at cystectomy, and stage of the primary tumor were comparable in the two groups of patients. The median numbers of nodes removed per patient were 15.5 [range, 4 to 48] and 7.0 [range, 1 to 24] in those with standard and en bloc lymphadenectomy, respectively [P<.001]. Nodal involvement was detected in 10 [29.4%] and 9 [20.9%] patients, respectively [P=.43]. Although nodal involvement was not significantly different between the two groups, standard lymphadenectomy submitted in 6 different containers significantly improved the nodal yield over en bloc resection. Obturator nodes were the most commonly involved nodes in our study

Intracytoplasmic sperm injection outcome using ejaculated sperm and retrieved sperm in azoospermic men

We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection [ICSI] cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oliogospermic and normospermic men. This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration [PESA] and 47 underwent testicular sperm extraction [TESE]. In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The differences in the outcomes of ICSI using PESA or TESE and ejaculated sperm were evaluated. The main outcome measures were pregnancy and miscarriage rates. No significant differences were seen in pregnancy and miscarriage rates with surgically retrieved and ejaculated sperm. The pregnancy rates [including frozen embryo transfer] were 43.5%, 36.2%, and 41.4% in couples with PESA, TESE, and ejaculated sperm, respectively [P=.93]. The miscarriage rates were 16.7%, 23.5%, and 12.1, respectively [P=.37]. Intracytoplasmic sperm injection in combination with PESA and TESE is an effective method and can successfully be performed to treat men with azoospermia. The outcomes with these procedures are comparable to ICSI using ejaculated sperm

C-reactive protein and acute coronary syndrome: Comparison of conservative and interventional management

Inflammation plays a key rote in the initiation and progression of atherosclerosis, the most common cause of acute coronary syndrome. C-reactive protein [CRP] that enhances plaque inflammation is synthesized six hours after myocardial infarction. High sensitivity C-reactive protein was measured by Immunoturbiditory method in 50 healthy controls and 100 patients of acute coronary syndrome on conservative or interventional management. Serum C-reactive protein levels [mg/L +/- SEM] at the time of admission were significantly raised in patients of acute coronary syndrome [11.90 +/- 2.30] as compared to controls [2.30 +/- 0.18] and further increased progressively during 24 hours of follow up period. C-reactive protein levels also increased significantly in patients who underwent interventional management [115.90 +/- 7.73] as compared to those who were on conservative management [22.28 +/- 5.54]. Serum C-reactive protein levels were found to be significantly raised in patients with acute coronary syndrome as compared to controls. In addition, patients undergoing interventional management had higher C-reactive protein levels, post intervention, as compared to those on conservative management

Magnitude of non-traumatic altered state of consciousness in department of emergency medicine hospital university Sains Malaysia [HUSM]

Non-traumatic Altered State of Consciousness [ASC] is a non-specific consequence of various etiologies. The aim of this study is to collect the demographic data and to review the various etiologies responsible for non-traumatic ASC in Emergency Department. This retrospective study was carried out in teaching Hospital, Kota Bharu for a period of 6 months. Patients' demographic characteristics and the etiologies were analyzed. The total number of patients was 221. Fifty-four percent [54.3%] of the patients were males. The mean age of the patients was 56 years old with underlying medical illnesses. Most of them were non-smokers. The most common characteristics of non-traumatic ASC were ischemic stroke [cerebral infarction] [22.6%], intracerebral bleeding [17.2%] and cardiovascular related diseases [9.5%]. Majority of them were very ill and required intensive care. Four of them died in Emergency Department. Definitely, non-traumatic ASC required intensive management at ED and critical ward. Even though the adult non-traumatic ASC was not uncommon, it was associated with high morbidity. Mean age was 56 years old and equal distribution between males and females. Most of them had hypertension, diabetes mellitus or other cardiovascular disease related. The most common non-traumatic ASC were intracranial pathology and cardiovascular related disease was the second