Cronkhite-Canada Syndrome- The first case from Pakistan: a case report.

Chronkhite-Canada Syndrome is characterised by diffuse gastrointestinal polyposis, dystrophic changes of the fingernails, cutaneous hyperpigmentation, alopecia, diarrhoea, weight loss, and abdominal pain. This disease is also associated with peripheral neuropathies and autoimmune disorders. Its association with other diseases may cause the polyps to turn into malignant tumours and worsen the condition. The first-line treatment is a combination of prednisone and mesalamine. NSAIDs and antibiotic administration is based on the symptoms and needs of patients. Here, we describe a 51-year-old male who presented to us with abdominal pain and significant weight loss. His physical examination showed dystrophic nails, alopecia and hyperpigmentation. Endoscopy and colonoscopy showed multiple polyps. His manifestations were consistent with Cronkhite-Canada syndrome. We prescribed oral corticosteroids, which improved his condition.

Predicting Central Venous Pressure by Measuring Femoral Venous Diameter Using Ultrasonography.

OBJECTIVES: The objective of this exploratory study was to find out the correlation of femoral vein diameter (FVD) to central venous pressure (CVP) measurements and to derive a prediction equation to help ascertain the fluid volume status in a critical patient. PATIENTS AND METHODS: This was a single-centered prospective cohort study designed and conducted by the critical care department of Shifa International hospital in Islamabad, Pakistan. Patients were enrolled from the medical and surgical intensive care units. The inclusion criteria consisted of patients > 18 years of age, and an intrathoracic central venous catheterization (CVC) in place for producing CVP waveform through the transducer. Patients having contraindications to CVP placement and those unable to lie supine were excluded from the study. Critical Care fellows with sufficient training in performing venous ultrasonography measured the FVD. They were blinded to the CVP values of the same patients. RESULTS: The study included 108 patients. Among these 70/108 (64.8%) were males. Mean age was 53.85 (SD=16.74). The CVP and femoral vein diameter were measured in all patients. Mean CVP was 9.89 cmH2O (SD=3.46) and mean femoral vein diameter was 0.92 cm (SD=0.27). Multiple regression was used to generate a prediction model. FVD, age and sex of the patient were used as predictor variables to predict CVP diameter. The model was statistically significant with a p-value of < 0.000 and an F-value of 104.806. R-squared value for this model came out to be 0.744, thus the model was able to explain about 74.4% of the variance in the values observed for CVP. When controlled for age and sex, FVD was found highly correlated with CVP diameter with a p-value of < 0.000. A regression equation was derived that can be used to generate predicted values of CVP in millimeters of mercury with an R-square of 0.745 if FVD in centimeters is provided; CVP (cmH2O) = -0.039 + 10.718* FVD. CONCLUSIONS: FVD was found highly correlated to CVP measurements and it suggests an alternate non-invasive method of ascertaining the volume status in the critically ill.

Risk factors of prostate cancer: a case-control study in Faisalabad, Pakistan.

BACKGROUND: Prostate cancer is the third most commonly diagnosed cancer among males in Pakistan but very little is known about risk factors among the Pakistani population. Therefore a hospital-based, case-control study was carried out in Faisalabad to identify potential risk factors. MATERIALS AND METHODS: This study was based on 140 prostate cancer cases and 280 normal controls. Logistic regression was used to estimate odds ratios and 95% confidence intervals for odds ratios to assess the relationship between prostate cancer and different risk factors. RESULTS: Family history of prostate cancer, age, smoking, obesity, consumption of red meat and frequent use of fat items significantly increased the prostate cancer risk (odds ratios and 95% confidence intervals of: 7.32; 1.79-29.8; 16.9, 5.60-50.8; 2.47, 1.17-5.18; 5.79, 2.66-12.6; 2.71, 1.07-6.91; and 3.39, 1.47-7.83, respectively. On the other hand, more consumption of fruit, fluid intake and better lifestyle (physical activity) significantly reduced the risk of developing prostate cancer with odd ratios and corresponding 95% confidence intervals of: 0.27, 0.11-0.61; 0.05, 0.02-0.12; and 0.28, 0.13- 0.58. CONCLUSIONS: The results of the present study suggested that age, family history of prostate cancer, smoking, obesity, fluid intake, frequent use of fat items, consumption of fruits and better lifestyle might be associated with prostate cancer among Pakistani males.