Colorectal carcinoma and chronic inflammatory demyelinating polyneuropathy: is there a possible paraneoplastic association?

A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.

Genotypes of GSTM1 and GSTT1: useful determinants for clinical outcome of bladder cancer in Pakistani population

Background: Incidence of bladder cancer has increased rapidly worldwide in the past few years. Environmental as well as genetic factors are involved in the etiology of bladder cancer. Glutathione S transferase mu 1 [GSTM1] and glutathione S transferase theta 1 [GSTT1] genes are two xenobiotic metabolizing genes in phase II of detoxification process

Aim: The current study was aimed to find out the association of different environmental factors and GSTM1 and GSTT1 gene polymorphisms with susceptibility to bladder cancer in Pakistani population

Method: Bladder cancer cases [236] and control blood samples [270] were screened using phenol chloroform method of DNA extraction followed by multiplex PCR

Results: With respect to age; bladder cancer was more prevalent in age >60 years and low grade tumors were more frequent than high grade tumors. Smokers had a significantly higher incidence rate of cancer; also family history of cancer was found to be strongly associated [P < 0.05] with bladder cancer. Commonly reported symptoms by the patients of bladder cancer were hematuria, lower urinary tract symptoms [LUTS] and flank pain. A larger number of patients had undergone surgery, chemotherapy and radiotherapy. Similarly GSTM1 [OR 2.24; CI 1.5-3.2; P = 0.0001] and GSTT1 [OR 2.9; CI 1.4-6.1; P = 0.002] gene deletion showed a highly significant association with bladder cancer. Simultaneous deletions of both GSTM1 and GSTT1 genes also showed highly significant association [OR 5.3; CI 2.1-13.1; P =0.0001] with cancer risk. No association was found when both of the two genes deletion was compared with bladder cancer among smokers

Conclusion: This study suggests that GSTM1 and GSTT1 gene polymorphisms may be associated with increased susceptibility toward bladder cancer in Pakistani population

effect of two weeks preoperative finasteride therapy in reducing prostate vascularity

Objective: To determine the effect of two weeks preoperative finasteride therapy in reducing prostate vascularity in terms of mean microvessel density [MVD] and expression of VEGF in prostate urothelium among patients of BPH by comparing with controls. Study Design: Randomized controlled trial. Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2013 to January 2014

Methodology: A total of 80 patients of Benign Prostatic Hyperplasia [BPH] planned for Trans-Urethral Resection of Prostate [TURP] having prostate size of more than 40 grams on trans-abdominal ultrasonography was randomized into two groups, each group having 40 patients. The finasteride group [Group A] was prescribed oral 5 mg of finasteride daily for 2 weeks before surgery. The control group [Group B] did not receive any agent. After 2 weeks, TURP was performed and prostate samples were sent for histopathological determination of MVD and expression of VEGF

Results: The mean age of patients was 66.21 +/- 10.08 years, ranging from 48 to 86 years. The mean prostate gland size was comparable in both groups [55 +/- 10.7 vs. 58.1 +/- 10.8 grams, p=0.21]. Mean MVD in finasteride group [20.25 +/- 10.3] was significantly lower as compared to control group [48.9 +/- 22.6, p < 0.001]. Similarly expression of VEGF was also significantly lower in finasteride group [30%] as compared to control group [65%] [p= 0.0017]. Mean MVD had a significant weak correlation with the size of prostate gland on Pearson correlation test [2-tailed] with r = 0.222

Conclusion: Finasteride reduces microvessel density and hence prostate vascularity with only 2-week therapy and the mean MVD is clearly correlated with size of prostate

Paediatric percutaneous nephrolithotomy [PCNL]

To describe Paediatric Percutaneous Nephrolithotomy [PCNL] in terms of safety and efficacy in a group of 26 children. An observational study. Shifa International Hospital, Islamabad, from January 2011 to June 2013. PCNL of 26 children was done by standard technique. The patients were analyzed for age, gender, presenting symptoms, stone size, site, PCNL approach, operative time, stone clearance, hospital stay and per-operative and postoperative complications. Descriptive statistics were obtained. The mean age was 9.21 +/- 5.70 years. Seventeen [65.4%] patients were male whereas 9 [34.6%] patients were female. Flank pain was the most common presenting symptom. Mean stone size was 2.21 +/- 1.04 cm. Mean operative time was 158.8 +/- 39.63 minutes and mean hospital stay was 2.84 +/- 1.14 days. Postoperative transfusion was required in only one case [4%]. There was no episode of sepsis or perinephric collection. Per-operative stone clearance was 93.28% +/- 9.23%. Conversion to open was seen in one [4%] case. DJ stent was placed in 7 [27%] cases. PCNL is a safe and effective way of treating renal stones in paediatric age group

Constipation in pediatric patients with Lower Urinary Tract Symptoms

Objective: To determine the frequency of constipation in patients with pediatric age group presenting with Lower Urinary Tract Symptoms [LUTS]

Study Design: Descriptive study

Place and Duration of Study: Outpatient Department of Urology in Pakistan Kidney Institute at Shifa International Hospital, Islamabad, from November 2012 to February 2014

Methodology: Two hundred pediatric patients presenting with Lower Urinary Tract Symptoms [LUTS] were studied in terms of age, gender, obstructive and irritative types of LUTS along with any associated symptoms. Constipation was assessed by Bristol stool chart in these patients. Patients with exstrophy of bladder were excluded from the study. Descriptive statistics were measured for both qualitative and quantitative variables. For qualitative variables like gender, presenting symptoms, constipation and stool types, percentages and frequencies were calculated. For quantitative variables like age, percentages / mean +/- SD were calculated

Results: Mean age was 6.87 +/- 3.64 years with a range of 2 - 14 years. Constipation was found in 37.5% of the pediatric patients with lower urinary tract symptoms

Conclusion: Constipation is frequent and overlooked problem in pediatric patients having urinary symptoms. Irritative lower urinary tract symptoms are more common. Children up to 5 years of age are the most common sufferers. Knowing the burden of constipation in such patients can help physicians in better treatment of such cases

Role of iron supplementation in the improvement of hemoglobin level, in the third trimester of pregnancy and in the prevention of iron' deficiency anemia

To evaluate the role of iron supplementation in the improvement of hemoglobin level in the third trimester of pregnancy and in the prevention of iron deficiency anemia. This non-interventional descriptive study was conduced at Mother and Child Health Centre [MCH], Nishtar Hospital, Multan during the period from July 2003 to March 2004. A total of 100 women of variable age groups and of different socio-economic status with 5 months of pregnancy were included in the study. After history and clinical examination their hemoglobin level were. checked by photometric method. Then these women were provided iron supplement for three months and their hemoglobin levels were rechecked by same method and the results. were compared. Out of 100 women enrolled in the study the compliance of iron supplementation was seen only in 80 women. There mean hemoglobin level before iron intake was 8.8 gm/dl and 60 [75%] had hemoglobin level less than 10 gm/dl. Out of these 60 anemic women, 51[85%] were multiparae or grand multiparae. They mostly belonged to lower socio-economic status. Only 9 [15%] were primigravidae. Iron deficiency anemia is very common in pregnant women in Pakistan particularly in multiparous and grand multiparous women of lower socio-economic status. Improvement of diet especially enhancing assess to iron rich, foods and iron supplementation at least in third trimester can reduce the frequency of anemia in pregnant women