Esophageal manometry profile in patients of upper gastrointestinal symptoms in Western India: A retrospective cohort study

INTRODUCTION: High-resolution esophageal manometry (HREM) is a technique to determine the pressure pattern which is a function of esophageal musculature and integrity of LES. The indications for HREM evaluation include evaluation of nonobstructive dysphagia, symptoms of regurgitation and noncardiac or atypical chest pain unexplained by endoscopic evaluation To analyse profile of esophageal motility disorders in patient presenting with refractoryAIM: gastroesophageal reflux disease (GERD), dysphagia and atypical chest pain in tertiary care centre in Western India METHODS: We enrolled patient presented with refractory GERD, dysphagia and atypical chest pain from Jan 2020 to March 2022 at Department of gastroenterology, National Institute of Medical College & R, Jaipur. Upper GI endoscopy and high-resolution esophageal manometry was done in all patients Ineffective esophageal peristalsis,RESULTS: achalasia cardia, hypercontractile esophagus, fragmented peristalsis and esophagogastric junction outflow obstruction were common diagnosis made by high resolution esophageal manometry In our study ineffectiveConclusion: esophageal motility most common and achalasia cardia second most common diagnosis identified on esophageal manometry

Clinical and dosimetric impact of adaptive intensity-modulated radiotherapy in locally advanced head-and-neck cancer

Background: Radiotherapy in head-and-neck cancer (HNC) is a challenging task, and the anatomical alterations occurring during the course of intensity-modulated radiotherapy (IMRT) can be compensated by adaptive radiotherapy (ART) which utilizes repeat computed tomography (CT) scans during the treatment course for replanning. In this study, the clinical and dosimetric benefits of ART were compared with the conventional IMRT. Materials and Methods: Sixty patients with locally advanced HNC were randomized into two arms to receive IMRT up to a curative dose of 70 Gy with concurrent weekly chemotherapy and were prospectively analyzed between March 2018 and March 2019. Repeat CT scan was acquired after the 3rd week of radiation. Patients in the study arm underwent replanning, whereas those in the control arm continued with the first IMRT plan. Assessment was done weekly till the end of treatment and at 1, 3, and 6 months post IMRT for disease response and toxicities. Tumor volume reduction rate (TVRR) and dose reduction to organs at risk were also recorded. Results: Complete response was observed in 90% and 96.7% patients in the control and study arms, respectively, at the end of 6 months. Insignificant differences were found between the two arms in terms of toxicities. Xerostomia was statistically significantly higher in the control arm at 6 months (P = 0.01). TVRR was found to be 31.85%. Dose to spinal cord, ipsilateral, and contralateral parotid reduced by 4.3%, 6%, and 2.2%, respectively, with ART. Conclusion: Mid-treatment adaptive replanning can help in better target coverage and minimize toxicities in HNC patients

Metronomic palliative chemotherapy in locally advanced, recurrent and metastatic head-and-neck cancer: A single-arm, retrospective study of a regional cancer center of North India (Asia)

Background: Head-and-neck cancer is the most common cancer in developing countries of Southeast Asia. Most of the patients present to the hospital in advanced stage and have a poor prognosis. This study aims to evaluate the efficacy and toxicity profile of oral metronomic chemotherapy (MCT) in the form of methotrexate and celecoxib in locally advanced, recurrent and metastatic head-and-neck cancers. Materials and Methods: This was a single-arm retrospective observational study that included posttreatment patients with locally advanced, recurrent and metastatic disease in the year 2016 (January 1, to December 31, 2016). A total of 84 patients warranting palliative chemotherapy but not willing to take intravenous chemotherapy were included in the study. The oral MCT schedule consisted of oral celecoxib (200 mg twice daily) and oral methotrexate (15 mg/m2/week). Response evaluation was done using the Response Evaluation Criteria in Solid Tumors criteria version 1.1, and toxicity profile was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Descriptive statistics and Kaplan–Meier analysis were performed. Results: Eighty-four patients, 68 males and 16 females, with a median age of 62 years (range: 35–80 years), were enrolled in the study to receive oral MCT. The Eastern Cooperative Oncology Group performance status was 0–1 in 62 patients and 2–3 in 22 patients. The primary sites of disease were buccal mucosa (18), tongue (22), tonsil (24), lower alveolus (7), hypopharynx (10), and soft palate (3). The best clinical response rate in post oral MCT was seen in the first 4 months (120 days). Objective response was observed in 67% of patients in the form of stable disease (56%) and partial response (11%). Disease progression was observed in 27% of patients. The median follow-up was 192 (6.4 months) days. The median estimated overall survival was 195 (6.5 months) days. The median estimated progression-free survival was 110 (3.6 months) days. Symptomatic relief with respect to pain was reported in about 75% of patients. Eighteen (21%) patients had Grade I–II mucosal reactions. Grade III–IV mucosal reactions were observed in five (6%) patients. Seventy-eight (93%) patients died at the end of the study at 1 year. Dose reduction was required in 15 (18%) patients. Conclusion: Oral MCT using celecoxib and methotrexate is an effective, economical, and well-tolerated regimen with good pain control and low toxicity profile in patients with locally advanced, recurrent and metastatic head-and-neck cancer.

Acute treatment-related toxicity in elderly patients with good performance status compared to young patients in locally advanced esophageal carcinoma treated by definitive chemoradiation: A retrospective comparative study

Introduction: The benefit of definitive chemoradiotherapy (CRT) in elderly patients with locally advanced esophageal cancer is not well established. We perform a single institutional retrospective study of CRT in terms of toxicity in elderly patients (age more than 60 years) as compared with young cohort (age <60 years) in locally advanced nonmetastatic esophageal cancer. Patients and Methods: A total 145 of patients, 79 in young age (Group A) and 66 patients of elder age (Group B) with Stage II and III squamous cell carcinoma of the esophagus with ECOG PS of 0–1, who had undergone definitive CRT at our institute from January 2015 to November 2018 were selected for this analysis. Chemotherapy was cisplatin (40 mg/m2) given concurrently on weekly basis with radiotherapy (RT). Total prescribed dose of RT was 50.4 Gy at the rate of 1.8 Gy per fraction. Median age was 40 years (25–60 years) and 65 years (60–75 years) in young and elderly group, respectively. Follow-up is done at median of 28 months (1–48 months) after treatment. Results: Acute Grade 2–3 esophagitis was seen in 48.10% in young cohort, while it was 60.6% in older group. Grade 2–3 nausea and vomiting was seen in 32.91% in young age patients, while it was 45.5% in elder patients. No statistically significant difference is seen in acute treatment-related toxicity in young and elderly group. Conclusion: Our conclusion is that patients with adequate functional status should not be excluded from curative CRT based on age alone

Long-course versus short-course palliative cranial irradiation in brain metastases: a comparative study

Background: Brain metastases are the most common intracranial malignancy in adults and their management poses a significant healthcare problem. Of the various options available, whole brain radiotherapy (WBRT) remains the mainstay of treatment. Nonetheless, there is a need to develop fractionation schedules for best symptom palliation and prolonged survival. This prospective study aims to compare treatment outcome in terms of overall survival in two different WBRT schedules and determine the prognostic factors affecting this outcome.Methods: Sixty previously untreated patients with symptomatic brain metastases were randomized in two arms of 30 patients each to receive WBRT. Arm A patients received 30Gy in 10 fractions (long-course) and arm B received 20Gy in 5 fractions (short-course). All patients were assessed during and after completion of WBRT at 1, 3, 6, 9 and 12 months.Results: At 12 months post WBRT, the objective response rate i.e. complete and partial response (CR+PR) was 6.67% in arm A and 13.34% in arm B (p=0.96). Both WBRT regimens showed similar survival (p=0.65). On multivariate linear regression analysis, age ≤65 years, Karnofsky performance score (KPS) ≥70 and lack of extra-cranial metastases were significantly associated with improved survival at the end of 12 months post WBRT. EORTC QLQ-C30 showed similar improvement in quality of life in both the arms (p=0.86).Conclusions: This study suggests comparable results in the two fractionation schedules. Therefore, short-course WBRT may be used as a more convenient option in favour of shorter hospital stay and lesser burden on RT machines.

Polymorphism of glutathione S-transferase M1 and T1 genes and susceptibility to psoriasis disease: A study from North India

Background: Increased oxidative stress and resulting inflammation has been emphasized as a factor in the pathogenesis of many diseases including psoriasis. Glutathione S-transferases (GSTs) protect against oxidative stress, inflammation, and genotoxicity. Polymorphisms in the GST genes may lead to an imbalance in pro- and antioxidant systems resulting in the increased production of reactive oxygen species that could influence the pathogenesis of psoriasis. Aim: The aim of this study was to investigate the association between GSTs (GSTM1 and GSTT1) gene polymorphism in patients with chronic plaque psoriasis as a factor in the susceptibility and development of psoriasis. Materials and Methods: We assessed 128 patients with psoriasis and 250 age- and sex-matched healthy controls. Genomic DNA was extracted from peripheral blood by the phenol chloroform method. The null GSTT1 and GSTM1 genotypes were identified by multiplex polymerase chain reaction (PCR) method. Results: The null genotype of GSTM1 and GSTT1 was seen in 45.3% and 40.6% in psoriasis patients whereas in the controls it was 34.4% and 20.0%, respectively. A significant association was seen between the null alleles of the GSTT1 (OR = 2.74) and GSTM1 (OR = 1.58) alone or in combination with tobacco use (P < 0.001) and psoriasis risk. The presence of both null genotypes of GSTM1 and GSTT1 further increased the risk of psoriasis (OR = 3.52) when compared with the positive genotypes of GSTM1 and GSTT1. Limitations: A major limitation of this study was the small sample size. A large epidemiological study is necessary to confirm these findings. Conclusions: The null genotype of GSTT1 is a strong predisposing factor for psoriasis in North India.

Airway management in a patient with severe Ankylosing Spondylitis causing Bamboo Spine: use of Aintree Intubation Catheter

Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter [AIC] with intubating fiberoptic bronchoscope

Diagnosis of post-radiotherapy local failures in nasopharyngeal carcinoma: a prospective institutional study

This prospective study was conducted to evaluate and compare the efficacies of nasopharyngoscopy and CT scan in the diagnosis of local failure of external beam radiotherapy [EBRT] for nasopharyngeal carcinoma. Total 52 patients of histopathologically proven nasopharyngeal carcinoma treated with external beam radiotherapy [EBRT], were included in this study. For every patient computed tomography [CT], nasopharyngoscopy and nasopharyngeal biopsies were performed 3 months after completion of EBRT. Three months after completion of EBRT, 9 patients [17.3%] had evident disease on histological examination of biopsies. Nasopharyngoscopy showed 77.78% sensitivity, 93.03% specificity, 70% positive predictive value and 95.24% negative predictive value in diagnosing the residual/recurrence of tumor. There was statistically significant agreement between the endoscopic findings and the histological findings [Kappa reliability coefficient=0.562, p<0.01]. On the other hand, CT scan showed a 55.56% sensitivity, 39.53% specificity, 16.13% positive predictive value and 80.95% negative predictive value in diagnosing the residual tumor/recurrence. There was no statistically significant agreement between the CT scan findings and the histological findings [Kappa reliability coefficient = 0.038, p>0.05]. Nasopharyngoscopy should be considered the primary follow-up tool after radiotherapy of nasopharyngeal carcinoma. CT scan should be reserved for patients with histological or any symptomatic indications. Routine postnasal biopsies are not required

Double primary malignancies: a clinical and pathological analysis report from a regional cancer institute in India

Patients which have diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Cancer victims could survive longer due to settling treatment modalities, and then would likely develop a new metachronous malignancy. This article aims to report our observed trend of increasing, in prevalence of both synchronous and metachronous second primary malignancy, among the cancer victims, and to review the relevant literature. A hospital based retrospective gathering of prospective data, among the patients that have diagnosed with second de novo malignancy. The study has conducted over a 4 years period from 2009 to 2012. All patients that have diagnosed with a histologically proven second malignancy as per Warren and Gates criteria have included. Various details which have regarded site, age at presentation, sex, synchronous or metachronous, treatment have recorded. Among 41 cases of multiple primary malignancies that have observed, 8 were synchronous [19.51%] and 33 were metachronous [80.49%]. Out of 41 patients, 25 [60.98%] were females and 16 [39.02%] were males. The most common sites of primary tumor were head and neck cancers that have followed by gynecological cancers, breast cancer, lung cancer, esophageal cancer, and then the others. Among the second malignancy, the most common site was breast and gastrointestinal tract that have followed by lung and gynecological cancers. Out of the total number of cases with double location, 14 tumors [34.15%] have belonged to the breast, out of which 5 [12.20%] have represented first locations and 7 [17.07%] have been second locations. Both locations have belonged to the breast in 2 patients [4.9%]. In 5 cases [12.20%], there were associations of breast-cervix and in 6 cases [14.63%], there were association of lung-head and neck cancers. The incidence of multiple primary malignancies has not been rare at all. Screening procedures have especially been useful for the early detection of associated tumors, whereas careful monitoring of patients has treated for primary cancer, and then a good communication between patients and medical care team would certify not only an early detection for secondary tumors, but only finally and subsequently, an appropriate management

Effects of position on oxygen saturation in acute respiratory distress in neonates

To determine the effects of prone versus supine positions of the patient on oxygen [O[2]] saturation in neonates with acute respiratory distress. Observational Cross sectional study. Department of Paediatrics Chandka Medical College Hospital Larkana, from December 2011 to June 2012. One hundred neonates were included in this study by non-probability sampling. All the patients with respiratory distress [RD] were kept in supine position for three hours after all necessary resuscitative measures and oxygen saturation was recorded with pulse oximeter. After that they were kept in prone position for six hours. With pulse oximeter oxygen saturation and respiratory rate were measured every two hours interval for six hours. Age ranged from 1 hour - 25 days. There were 77 [77%] term, 19 [19%] preterm and 4 [4%] post term babies with male to female ratio of 1.3:1. There were a total of 200 supineprone cycles. After 6 hour in prone position the PaO[2] of all patients increased by about 7%. In supine position it was 86.4 +/- 5.7 and in prone 93.5 +/- 4.1 with p value of < 0.001 which is statistically highly significant. Prone position improves oxygenation in majority of patients as compared to supine position

Experience of acute systemic lupus erythematosus in indoor and outdoor patients

The aim of this study was to determine spectrum of clinical and Laboratory diagnosis of Systemic lupus erythematosus at tertiary care unit. Descriptive type, [cross sectional]. This study was conducted at the Department of General medicine and Paediatric Medicine in indoor and outpatients CMC, Shaheed Muhatarma Benazir Bhutto University Medical Larkana from February 2010 to February 2012. We studied prospectively 44 patients with SLE who were seen consecutively either as inpatients or outpatients. All were met the American College of Rheumatology [formerly American Rheumatism Association, ARA] revised criteria for SLE and underwent medical interview as well as routine general physical examination by a researcher, and the laboratory investigations were carried out from single laboratory of Larkana, all these characteristics features of patients were collected in a protocol form. These investigations were includes the CBC, serology for ANA, anti dsDNA and urine for protienuria. X-ray chest and echocardiography was also done for pleural and pericardial effusion. Forty-four patients fulfilled the ACR criteria for SLE, most common presentation were cutaneous 30 [68.2%] cases, mucocutaneous ulceration 26 [59.1%] Fever 26 cases [59.1%], pallor 47 [67.14], cough 34 [48.57%], swelling of body 12 [17.14%], headache in 10 [22.7%] and Major physical signs were arthritis and arthralgia 30 [68.2%], Hepatosplenomegaly 20 [45.5%], generalized lymphadenopathy 12[27.3%], pleural effusion 08 [18.2%] and 02 [4.5%] patients had pericardial effusion, Raynaud's phenomenon 10 [22.7%], while direct comb test, ANA, anti dsDNA antibodies were found to be positive in 10 [22.7%], 42 [95.5%], 34[77.3%] cases respectively. Most patients presented almost universally with fever and arthralgias or arthritis in combination with malar rash or oral ulcers and in some patients a combination of all of the above was observed. A combination of positive anti nuclear antibody test, increased ESR and proteinuria were found to be a sensitive and cost effective set of laboratory findings for the diagnosis of patients suffering from SLE. The set of these clinical and laboratory features would help in the correct and early diagnosis of patients suffering from SLE, a relatively rare disease, in the busy medical outpatient and inpatient departments in our set up

Treatment outcome of enteric fever in children at tertiary care hospital Sukkur Pakistan

Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To evaluate the treatment outcome of enteric fever in children. Retrospective descriptive study. This study was conducted at the Paediatric department, Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2009 to December 2011. This was a retrospective study, included all patients of enteric fever, of both sex and age ranged from 6m to 13 years. All enteric patients were confirmed by serological test Typhidot IgM or IgM and IgG positive. The data was collected from case record for demography and treatment outcome. A total of 360 patients were diagnosed to have enteric fever during this period. Mean age of presentation was 6.47 years and 166 [46.12%] patients were <5 years whereas 194 [53.88%] were > 5 years of age. Male: Female ratio was 2:1. Serological test typhidot IgM was positive in 290 [80.5%] and both [IgM + IgG] were positive in 70 [19.45%] of cases. Raised ALT was seen in 90[25%] of cases. Complications were seen in 52 [14.4%] of cases, hepatitis 10 [2.77%], hepatic abscess 3 [0.83%] intestinal hemorrhage 8 [2.22%], peritonitis 4 [1.11%] intestinal perforation 4 [1.11%], cholecystitis 6 [1.66%], paralytic ileus 3 [0.83%] enteric encephalopathy 3 [0.83%], meningitis 1 [0.27%]. Two patients expired [0.55%], one was enteric encephalopathy and other intestinal perforation with peritonitis. enteric fever remains a major cause of morbidity and mortality in our part of country. Major complications found in our cases were hepatitis, hepatic abscess, intestinal hemorrhage, intestinal perforation, peritonitis, cholecystitis, enteric encephalopathy, meningitis, osteomyelitis, septic arthritis

Risk factors for severe acute malnutrition in children under the age of five year in Sukkur

Severe acute malnutrition [SAM] affects approximately 13 million children under the age of 5 year and is associated with 1-2 million preventable child deaths per year. To determine the risk factors for severe acute malnutrition in children under the age of five year. Settings and duration: Nutrition stabilization center of Ghulam Muhammad Mahar Medical College Hospital Sukkur from February 2011 to January 2012. This was a prospective descriptive study. All children diagnosed as severe acute malnutrition, defined as weight for height measurement of < 70% of the median or > 3 SD below the mean World Health organization reference values or the presence of bilateral pitting edema of nutritional origin admitted in Nutrition Stabilization Center were included in this study. Two hundred seventy [270] children were admitted during study period. The age ranged from 06 to 59 months. Maternal illiteracy was present in 216[80%] and paternal illiteracy in 180[66.7%] cases. Parent's income was less than 5000/month in 198[73.3%], family size with more than 4 or more children was seen in 180[66.7%] cases. Exclusive breast feeding was present in only 70[25.9%], mixed feeding was seen in 170[62.9%] and only bottle feeding was seen in 30[11.1%] cases. Late weaning was started in 150[55.6%]. Recurrent diarrhoea was seen in 120[44.4%]. The common risk factors associated with severe acute malnutrition were parental illiteracy, large family size, poverty, non exclusive breast feeding and recurrent diarrhoea. Policy message: To decrease childhood malnutrition mothers should be encouraged for exclusive breast feeding. Parent's education can play an important role in improving child health

Experience of malaria at tertiary care hospitals Sukkur

To determine Plasmodium species, clinical features, and hematological changes in Malaria. Prospective Descriptive Study. This study was carried out at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical college Hospital sukkur and chandka Medical Collage Larkan, from July 2007 to July 2011. This is prospective descriptive study, including 250 patients with fever and malaria confirmed on microscopy and immunochromatography, at both departments were included. After consent a separate pro- forma was filled for each patient to record demography and data about clinical presentation and laboratory investigations. Out of 250 malaria cases, the classical clinical presentation was found in 198 [79.2%] of patients while 52 [20.8%] had other symptoms. Males were in majority 164 [65.6%] and age range 1 year to 12 years. Splenomegaly was found in 135 [54%] and hepatomegaly in 86 [34.4%] of patients. Microscopy results of malaria patients revealed P. Falciparum in 97 [38.8%], P. Vivax 91 [36.4%] and 62 [24.8%] mixed infection of P. Falciparum and P. Vivax. Anemia was found in most of patients 84% [Hb <10g/dl]. Thrombocytopenia [platelets < 150,000/cmm] was found in 50 [20%] of patients. The classical presentation of Malaria was seen in majority of cases but one should be careful about atypical or very serious complicated clinical presentation of malaria, and early diagnosis of P. falciparum or mixed infection is very essential to save the life of young children

Profile of enteric fever in children at tertiary care Hospital Sukkur Pakistan

Enteric fever [Typhoid fever] is widely recognized as a major public health problem in developing countries. To study the clinical profile and complication of enteric fever in children. Prospective descriptive study. This study was conducted at the Paediatric Department at Ghulam Muhammad Mahar Medical College Hospital Sukkur from January 2010 to December 2011. This was a prospective study, included all patients of enteric fever, of both sex and age ranged from 1 year to 13 years. All cases of enteric fever were confirmed by serological test Typhidot IgM or IgM and IgG positive. A total of 360 patients of enteric fever were studied during 2 years. Mean age of presentation was 7.47 years and 166 [46.12%] patients were < 5 years whereas 194 [53.88%] were > 5years of age. Male: Female ratio was 2:1. Clinical profile of patients shows, that fever was present in all cases, vomiting 180 [50%], anorexia 180 [50%], headache 126 [35%], abdominal pain 108 [30%], diarrhea 108 [30%], weakness 102 [28.33%], cough 90 [25%], constipation 36 [10%] cases, and coated tongue was found in 275 [75%], tender abdomen 140 [38.88%], hepatomegaly 90 [25.0%], splenomegaly 76 [21.11%], toxic appearance 72 [20.0%], dehydration 70 [19.44%], pallor 54 [15%] and relative bradycardia 12 [3.33%] of cases. Complications were found in 88 [24.44%] of cases, raised ALT in 66 [18.3%] jaundice 6 [1.66%], intestinal hemorrhage in 4 [1.11%], peritonitis and osteomyelitis 3 [0.83%] respectively. Common clinical features of enteric fever include fever, vomiting, anorexia, abdominal pain, headache, coated tongue, anemia, hepatomegaly and elevated liver enzymes. Diarrhea is more common in children < 5 years. Complication due to late diagnosis and drug resistance will persist in our part of country

experience of thrombocytopenia in children at Tertiary Care Hospitals Sukkur and Larkana

Thrombocytopenia is the most common cause of bleeding in children. Patients with thrombocytopenia may experience petechiae, epistaxis, gum bleeding, hematuria or gastrointestinal hemorrhage or intracranial bleeding, seizures and unconsciousness. To determine the various causes, and clinical features of thrombocytopenia in children. Prospective descriptive study. This study was conducted at the Paediatric Departments of Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical College Hospital Sukkur and Chandka Medical College Hospital Larkana, from July 2009 to July 2011. This was a prospective descriptive study, include 200 patients1 to 12 year of age, presenting with fever, mucocutaneous bleeding and thrombocytopenia on peripheral smear at both departments. After consent a separate pro-forma was filled for each patient to record demography and data about various causes, clinical presentation and laboratory investigations. Out of 200 thrombocytopenic patients 128 [64%] were males and 72 [36%] females, majority in age group of under 10 years 154 [77%]. The most common cause was the malaria in 50% of cases, followed by ITP 20 [10%], aplastic anemia and thalassemia [hypersplenism] in 7.5% respectively. Dengue fever and Typhoid fever was [5%] of cases. The other minor causes were severe malnutrition, acute leukemia, hemolytic uraemic syndrome 2.5% each. The most common clinical presentation was petechiae and echymosis in 92 [46%], followed by epistaxis and gum bleeding 68 [34%] of cases, subconjuctival hemorrhage in [14%] and hematuria in [08%] of cases. Unconsciousness was present in [9%] of cases. Anemia was found in most of patients [71%]. Splenomegaly was present in 79 [39.5%] and hepatomegaly in 59 [29.5%] of patients. Platelets were less than 50,000/cmm in majority [60%] of patients. The common cause of thrombocytopenia in febrile children was malaria, followed by ITP, Aplastic anemia and thalassemia [hypersplenism], Dengue hemorrhagic fever and enteric fever was less common. The other minor causes were severe malnutrition, acute leukemia, hemolytic uremic syndrome and lymphoma

Response of primary torticollis to physiotherapy

To determine the response of torticollis including sternocleidomastoid tumor to physiotherapy and positioning. Descriptive case series. Department of Paediatric Medicine at Chandka Medical College [CMC], Shaheed Muhatarma Benazir Bhutto University, Larkana, from January 2007 to June 2008. All children with swelling at the side of neck, difficulty in head movement, not feeding on one side of breast and with the history of prolonged or difficult labor, were included. Diagnosis of torticollis and /or sternocleidomastoid tumor was based on history and physical examination of the swelling in the neck. They were advised physiotherapy and proper position as per protocol for 4 weeks to 24 weeks. Patients were reviewed at 4 weeks interval for response to physiotherapy. The data were analyzed by SPSS version 10.0. A total of 170 patients of torticollis were enrolled during the study period. Most of the cases were below four weeks of age [n 61- 35.9%] with overall male to female ratio of 1.4:1. The common presentation of torticollis were excessive cry with neck movement [n105, 61.7%], followed by sternocleidomastiod tumor or swelling on side of neck [n 95, 55.09%], history of prolonged/difficult labor [n 84, 49.04%] and not feeding from one side of breast [n 75, 44.11%]. Major physical signs were head tilt on one side in all cases and swelling in right side of neck in 95[55.09%] cases. 154 [90.60%] patients improved completely within 4 weeks to 4 month of physiotherapy while 15 [8.80%] cases showed partial improvement. Majority of cases completely improved on physiotherapy and rest showed considerable improvement

Pattern of solid paediatric malignant neoplasm at LUMHS, Jamshoro, Pakistan

To evaluate pattern and frequency of solid malignant tumour in paediatric age group in our region. A retrospective study of 113 patients, whose surgical biopsies submitted in histopathology section of Pathology department, LUMHS Jamshoro from January 2001 to December 2005. Total of 113 cases, 61 male and 52 female children in age group from 4 months to 15 years were diagnosed as solid malignant tumour with M/F ratio of 1.79:1 and mean age of 6.6 year. Maximum no. of patients was in 0-4 age 50.4%, followed by 32.7% in 4-9 and 16.8% in 10-15 years. The five most common tumours were Retinoblastoma 38.9%, Wilm's tumour 13.2%, Brain tumour [Glial tumours] 10.6%, Hodgkin disease 9.7% and soft tissue sarcomas 9.7%. Retinoblastoma and Wilm's tumour were common in 0-4 year age group, where as rest of tumour were more frequent in 5-9 and 10-15 years age group. Brain tumours and soft tissue sarcomas were common in females, while Hodgkin's disease was more common in males. Retinoblastoma was most common solid malignant tumour in early age group. It calls for ophthalmologic screening of all children below 1 year and high risk children until the age of 7 year, in order to detect retinoblastoma as early as possible

Hepatitis-B surface antigen [HBSAG] screening and vaccination experience in Tharparkar

Hepatitis B is a very common communicable viral disease due to multiple uses of syringes and infusions, unsafe blood transfusions. Tharparkar desert where doctors and health facilities are less as compare to other parts of Sindh Province, a study based on proforma filled during free hepatitis B vaccination and Hepatitis B surface antigen [HBsAg] tests, conducted with the sponsorship of pathologist and philanthropists In two towns [Naukot and Chalhar total population of 10,000] of Tharparkar desert selected for this services during January 2005 to January2006. Total 612 residents of theses towns were enrolled for screening and and vaccination services of Hepatitis B out of 612, residents 321 were male 291 were female their age was ranging, from less than 10 years to more than 60 years. The HBsAg surface antigen was positive in 45 males and 28 females showing 73 out of 539 +ve cases giving HbsAg positive rate 11.9%. which is more than the national average of 10%. Study found early adolescence and teenagers showed high carrier rate. This is an alarming situation and needs urgent remedlal steps to prevent this growing problem HBV Vaccine in EPI is showing positive results and children below 10 are showing low infection rate than adults showing and adolescent ages