Clinicopathological characteristics of prostate cancer in patients presenting to a tertiary care private sector hospital

Prostate cancer [PCa] is one of the leading cancers in older males. The aim of this study was to evaluate the clinicopathological characteristics of prostate cancer and rate of detection of prostate cancer by DRE [digital rectal exam] in patients presenting to a tertiary care private sector hospital in Islamabad, and determine the awareness about PCa in these patients. There were 226 patients who presented from December 2009 to December 2015 having mean age of 68.63 +/-8.76 years and median Prostate Specific Antigen [PSA] value of 19.12 ng/mL [IQR=35.8]. Median prostatic volume was 49 [IQR=22] gram/cc in the subjects. DRE was abnormal in 164 [72.56%] patients and normal in 62 [27.43%] patients only. Majority of patients presented relatively late, which may be due to lack of screening programme or public awareness

Partial nephrectomy in adults - a single-centre experience

Partial nephrectomy is the preferred procedure in benign renal lesions requiring surgical removal. It has also been accepted procedure for malignant renal conditions of smaller size. The aim of this observational study was to determine the outcome of partial nephrectomy in terms of complications and recurrence rates. Twenty patients with renal mass underwent this procedure from January 2010 till June 2014 at our Department, with mean age of 46.51 +/- 1.53 years. There were 14 males and 6 females. Renal mass on CT scan had the mean size of 3.80 +/- 1.15cm. The mean hospital stay in this series was 5.11 +/- 1.42 days, while mean operative time was 247 +/- 79.71 minutes. Twelve patients had malignant histology. They were followed using CT scan abdomen and pelvis with contrast at six and 12 months. Out of these, 10 [83.3%] patients were found to have no recurrence after six months

Glanular hypospadias management with modified circumcision and firlit procedure

Objective: To document the results of using simple technique of Firlit procedure with modified circumcision for treatment of glanular hypospadias. Study Design: Descriptive case series. Place and Duration of Study: Department of Urology, Shifa International Hospital, Islamabad, from January 2011 till May 2017

Methodology: The subjects included pediatric patients who underwent repair of glanular hypospadias by using modified circumcision and Firlit procedure. Patients were analyzed for operative time, age, hospital stay, and peroperative and postoperative complications. Chart review was done for collection of data on specified proforma

Results: There were 73 patients with mean age of 1.81 +/- 0.92 years. Children were discharged on the same day. None of them needed catheterization and dressing. Temporary dressing was used for mild bleeding immediate post op in 13 [17.80%] cases only. Postoperative complication such as urinary retention, fever, severe pain, or urinary tract infection were not seen in children. Meatal stenosis was not seen on a 2-24 months' follow-up. Satisfactory urine stream and good cosmesis was noted by the parents

Conclusion: The Firlit technique for the repair of glanular hypospadias was simple and satisfactory in terms of urine stream and cosmesis with minimal complications

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

Comparison of outcome of percutaneous nephrolithotomy in adult versus paediatric patients

Objective: To compare the outcome of percutaneous nephrolithotomy [PCNL] in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients

Study Design: Descriptive case series

Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2010 to December 2013

Methodology: A retrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ? 12 years were included in paedriatic group [A] while patients aged > 12 years were included in adult group [B]. The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma

Results: One hundred and twenty-nine [129] patients including 44 [34.10%] females and 85 [65.89%] males with a mean age of 45.00 +/- 1.44 years were adults. Twenty-six palrents with mean age of 9.21 +/- 5.70 years, 17 [65.4%] males and 9 [34.6%] females, were included in the paedriatic group. Mean stone size was 2.12 +/- 1.01 cm in paedriatic group compared to 2.52 +/- 0.77 cm in adult group [p = 0.023]. Mean operative time in paedriatic group was 158.8 +/- 39.63 minutes compared to 119.34 +/- 37.06 minutes in adult group [p < 0.001]. Mean hospital stay in paedriatic group was 2.76 +/- 1.14 days compared to 3.12 +/- 1.27 days in adult group [p=0.1881]. Peroperative stone clearance was in paedriatic group was 93.28 +/- 9.23% compared to 90.81 +/- 12.23% in adult groups [p = 0.331]. One patient in the adult group developed urosepsis

Conclusion: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases

New direct acting antiviral agents for the treatment of hepatitis C: 2016 and beyond

Hepatitis C is one of the commonest public health problems with 130 million people infected worldwide and the burden is increasing. Previously, Interferon along with Ribavirin was the mainstay of treatment but it was associated with toxic side effects. An all-oral regimen with higher rates of sustained viral response [SVR], minimal side effects and no restriction for liver fibrosis staging, was long awaited. Several all-oral interferon-free direct acting antiviral agents [DAAs] have now been approved by FDA for different genotypes of HCV. These include Sofosbuvir, Ledipasvir, Daclatasvir, Simeprevir, Dasabuvir, Ombitasvir. Paritaprevir and Ritonavir. These agents are also available in different combinations commercially under various trade names. A number of studies have proved their efficacy and the AASLD and EASL guidelines recommend several options for each genotype in different categories including treatment naive, relapsers, failure, compensated and decompensated cirrhosis. The purpose of this article is to review the persistently changing treatment regimens for hepatitis C and to simplify the dynamicity of the subject and selection of appropriate regimen for these patients

Stone-free-rate after extracorporeal shockwave lithotripsy in the management of pediatric renal stones in lower pole and other locations - a comparative study

Objective: To determine a difference in the stone-free-rate among different renal locations in children after extracorporeal shockwave lithotripsy [ESWL]

Study Design: A descriptive study

Place and Duration of Study: Urology Department, Shifa International Hospital, Islamabad, Pakistan, from January 2007 to June 2015

Methodology: The study included children who underwent ESWL, divided into three groups based on location of stones in kidney as group A [lower pole stones], group B [upper and mid pole stones] and group C [renal pelvis stone], respectively. ESWL was done by standard technique using Storz Modulith SLX lithotripter 3rd generation. Data was collected by chart review. SPSS version 16 was used for data analysis

Results: Among 76 children with mean age of 7.55 +/- 4.16 years, 55 [72.4%] were males whereas 21 [27.6%] were females. Mean stone size was 1.08 +/- 0.59 cm. There were 34, 17 and 25 cases in groups A, B and C, respectively. Post-ESWL stone-free-rate was 47% in lower pole stones, 70.58% in upper and mid pole stones, and 68% in renal pelvis stones. Hematuria was seen in one patient from each group, sepsis in two patients from each of the mid pole/upper pole and lower pole group, while Steinstrasse in one patient from each group

Conclusion: ESWL is a safe and effective way of treating renal stones in all poles in pediatric population

Ureteroscopy for management of ureteric stones in children - a single centre experience

Objective: To determine the outcomes of pediatric patients who underwent ureteroscopic removal of ureteric stones in terms of stone free rates and complications

Study Design: Descriptive case series

Place and Duration of Study: Urology Department at Shifa International Hospital, Islamabad, from January 2012 to December 2014

Methodology: A retrospective analysis of 37 patients, who underwent ureteroscopy for the treatment of ureteral calculi at the study centre, was conducted. Data regarding mean stone size, stone location, stone clearance and complications was recorded on specified proforma. Data was analysed on SPSS version 16

Results: Thirty-seven children with mean age of 8.36 +/- 5.17 years were included. Twenty-five [67.6%] patients were male, whereas 12 [32.4%] patients were female. Mean stone size was 10.01 +/- 6.24 mm. Location-wise 25 [67.56%] patients had upper ureteric stones, 5 [13.5%] patients had mid ureteric stones and 7[18.9%] patients had distal ureteric stones. Twenty two [59.5%] children underwent one procedure, while 15 [40.5%] children underwent relook ureteroscopies. Second relook ureteroscopy was done in 13/25 [52%] patients, 1/5 [20%] patient and 1/7 [14.28%] patient in upper, mid and lower ureteric stones, respectively. Overall stone clearance rate was 35/37 [94.59%] after first procedure. Mean operative time was 52.54 +/- 12.39 minutes. Urosepsis was seen in 2 patients. No major complications were seen. After the second URS procedure, stone free rate was 100%

Conclusion: Ureteroscopy is a safe and effective procedure in children in terms of stone free rate and complications

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 manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain

To evaluate the role of manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain. In this 62 subjects randomized controlled trial 31 subjects in group A received manual therapy [manipulation] with supervised exercise regime whilst 31 subjects in group B performed only supervised exercise regime for the period of 3 weeks. Both groups had a home exercise program consisted of strengthening exercises for neck/scapuluar stability, stretching and general range of motion exercises for neck with advice regarding posture awareness and correction for 3 months. The results suggested significant reduction in pain intensity level in both groups; over 3 weeks and 12 weeks' time period in relation to baseline on visual analog scale [p=0.001]. Similarly, statistically significant improvements noticed in Neck Disability Index [NDI] [p=0.0001] in both groups while looking at baseline data with reference to 12 weeks' time period. On closer inspection, the manual therapy [manipulation] with exercise regime appeared as a favorable treatment preference compared with exercise regime alone

effectiveness of Cognitive Behavioral Therapy [CBT] with general exercises versus general exercises alone in the management of chronic low back pain

To evaluate the effectiveness of Cognitive Behavioural Therapy [CBT] along with General exercises and General exercises alone in chronic low back pain. Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine and Rehabilitation Dow University of Health Sciences Karachi

Selected patients were equally divided and randomly assigned into two groups with simple randomisation method

The Cognitive Behavioural Therapy [CBT] and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well

Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale [VAS] and Ronald Morris Disability Questionnaire at baseline and after 12 weeks. Both study groups showed statistically significant improvements in both outcomes measures p =0.000

However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In conclusion, both interventions are effective in treating chronic low back pain however; CBT and General exercises are clinically more effective than General exercises alone

Association of high serum uric acid with risk factors of cardiovascular disease in the rheumatology clinic of a tertiary care hospital of Karachi

Uric acid is the end product of purine metabolism in humans due to the loss of uricase activity. Elevated uric acid is one of the metabolic abnormalities associated with cardiovascular disease. There are some studies found that hyperuricemia has been linked with cardiovascular diseases. Hyperuricemia predispose to the development of hypertension and is also thought to result in increased oxidative stress and generation of free radicals, which eventually can be the nidus of future cardiovascular disease. To determine the association of high serum uric acid with risk factors of cardiovascular disease [obesity, hyperuricemia, diabetes or hypertension]. This Cross sectional comparative study was carried out in Tertiary Care Unit of Karachi, Pakistan from Feb, 2013 till September, 2013. A total of 120 subjects of both sexes were taken and divided into two groups. Fasting glucose levels, serum uric acid was done. Those with hyperuricemia were taken as cases and individuals with normal level were taken as controls. Lipid profile was performed in both groups by enzymatic kit. The data feeding and analysis was done on computer package SPSS [Statistical Packages of Social Sciences] version 16.0. The results were given in the mean and Standard Deviation [SD] i.e. age, weight, height, Body Mass Index [BMI], fasting blood sugar, serum cholesterol, serum triglyceride, Low Density Lipoprotein C [LDL-C], High Density Lipoprotein C [HDL-C], Very Low Density Lipoprotein C [VLDL-C] and serum uric acid. T-test was used for comparison between control and hyperuricemic patients group. In statistical analysis [p<0.01] was considered statistically significant. This study showed significantly raised levels of fasting blood glucose, serum cholesterol, LDL-C, triglyceride, systolic and diastolic blood pressure in hyperuricemic patients when compared to healthy control group [p<0.01]. The results of the present study suggest that high serum uric acid is associated with risk factors of cardiovascular disease thus hyperuricemia may results in cardiovascular disease

Frequently isolated bacteria and their culture and sensitivity pattern in a medical ICU

Empirical antibiotic therapy in seriously ill patients requires careful selection of antibiotics. This study was planned to determine the pattern of bacterial infections and culture sensitivities in patients admitted to a medical intensive care unit [ICU]. Patients with positive bacterial cultures from specimens of blood, urine, endo-tracheal tube, suction catheter, and tracheal aspirates were included. Data regarding microbial isolates and their culture sensitivities was collected. Escherichia coli [E. coli], Pseudomonas aerogenosa [PA], Klebsiella pneumonea [KP], Staphylococcus aureus [SA] and methicillin resistant Staphylococcus aureus [MRSA] were the most frequently isolated bacteria. E coli showed 100% sensitivity to sulbactam potentiated sulfoperazone, and meropenam. PA were sensitive to gentamycin, imepenam, and sparfloxacin in > 70% cases. All KP isolates were sensitive to amikacin, imepenam and sparfloxacin. SA were 100% sensitive to amikacin. MRSA were 100% sensitive to vancomycine and linezolid. Based on these results, sulbactam potentiated cefoperazone in combination with amikacin seems the best empirical antibiotic regimen. Imipenam usage can be an alternative

Validity of rockall scoring system in determining in-hospital rebleeding among cirrhotic patients with acute esophageal/gastric variceal hemorrhage using endoscopy as gold standard

The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Rockall scoring system primarily developed for patients with non variceal source of bleeding

Objective: To determine the validity of Rockall scoring system in determining in-hospital re-bleeding among cirrhotic patients with acute esophageal/gastric variceal haemorrhage using endoscopy as gold standard. The study was conducted in Allied hospital and Liver Centre Allied/DHQ Hospitals, Faisalabad

Study Period: Study was carried out from 28-06-2010 to 27-12- 2010

Patients and Methods: Total 176 cases were include in this study. The subjects were scored using Rockall scoring system and placed under observation for re-bleed in 10 days

Results: The mean age of patients was 50.99 +/- 12.47 years. Out of 87 positive cases on Rockall score, 82 cases were true positive. Out of 89 cases, that were negative, 81 were true negative. Sensitivity, Specificity and diagnostic accuracy of Rockall score was found to be 91.1%, 94.1% and 92.6%, respectively. Positive predictive value [PPV] of Rockall score was 94.2% and negative predictive values [NPV] was 90.0%

Conclusion: The risk scoring system developed by Rockall and coworkers is a clinically useful scoring system among cirrhotic patients with acute esophageal/gastric variceal haemorrhage

Bronchogenic carcinoma; smoking habits in patients

The Connection between smoking and lung cancer is now generally accepted. The objective of this study was to observe smoking habits among different histological types of bronchogenic carcinoma. Bahawal Victoria Hospital, Bahawalpur. April 2000 to March 2003. This was a simple descriptive study comprising of 30 consective histopathologically / cytologically confirmed cases of bronchogenic carcinoma that were admitted in different medical units of Bahawal Victoria Hospital, Bahawalpur. History regarding smoking was taken in detail including type of smoking, quantity of tobacco smoked and duration of smoking in years. Smoking patterns were observed with their age, gender, living conditions and type of bronchogenic carcinoma. Among eighteen cases of squmous cell carcinoma, history of smoking was present in all males. Only one female who belonged to a village was non- smoker. Cases with small cell carcinoma were six in total and all were males with five smokers, three urban areas and two rural areas. Only one was a non- smoker with a rural background. Three females and one male had adenocarcinoma. One male from city and one female from a village were smokers, while remaining two females were non-smoker and lived in urban areas. Two men suffering from large carcinoma were smokers residing in urban areas. Cigarette smoking is present in 87% of all bronchogenic carcinoma especially with squamous cell, and large cell varieties. The involvement of smoking cases of adenocarcinoma has been found to be the least common