Frequency and features of nocturnal enuresis in Pakistani children aged 5 to 16 years based on ICCS criteria: a multi-center cross-sectional study from Karachi, Pakistan.

BACKGROUND: Nocturnal enuresis (NE) is a common symptom in children worldwide. International Children's Continence Society (ICCS) defines enuresis as either mono-symptomatic, NE with lower urinary tract symptoms and NE with co-morbid conditions. The objectives of this study were to determine the frequencies and types of NE and associated symptoms and conditions in children aged 5 to 16 years based on ICCS criteria. METHODS: A multi-center cross sectional study was conducted between November 2012 and December 2013 in the primary care clinics of four hospitals in Karachi. Children aged five to fifteen years were included through consecutive sampling. Informed consent was obtained from the parents and a pre-coded semi-structured questionnaire was used to obtain the information. Data was entered on SPSS version 20.0 and multivariable logistic regression analysis was used for data analysis. RESULTS: Out of 429 children aged between five and sixteen years, 243(56.9%) were boys and the remaining 186(43.1%) were girls. One hundred and eighty three children (43%) had nocturnal enuresis (NE). Forty four (10.3%), had mono-symptomatic NE, 57(31.1%) had associated lower urinary tract symptoms (NE-LUTS), whereas 30 (16.3%) had NE with a co-morbid condition. Fifty two (28.4%) NE's had at least one of both LUTS and a co-morbid condition. Out of the 246(57%) non-enuretic's, 31(12.6%) had a LUTS, 95(38.6%) had a co-morbid condition and 57(23.2%) had at least one of both LUTS and a co-morbid condition. The remaining 63 (25.6%) were symptom free. Increased voiding frequency, urgency, dysuria, suprapubic pain and daytime incontinence were the LUTS significantly associated with NE. Co-morbid conditions significantly associated with NE included constipation, congenital defects, developmental delay, and learning and sleep problems. CONCLUSION: Although NE can be an only symptom, it is often associated with lower urinary tract symptoms like dysuria, urgency, suprapubic pain, and daytime incontinence. Children presenting with NE often have co-morbid conditions like constipation, urinary tract infection, sleep disorders, and developmental delay. Many children presenting with these conditions as the primary complaint may also have NE. It should be addressed as unrecognized and untreated NE can cause additional morbidity and distress.

Rationale use of unenhanced multi-detector CT (CT KUB) in evaluation of suspected renal colic.

OBJECTIVE: To assess the yield of non-contrast enhanced CT (CT KUB) across different ordering specialties and need of developing an algorithm for its rationale use. MATERIALS AND METHODS: We retrospectively reviewed 1550 consecutive CT KUB studies requested for suspected renal colic carried out at a single institution in a calendar year. The data was analyzed for demographic characteristics, referring clinician and final diagnosis. Only patients with CT as primary imaging for clinically suspected reno-ureteral colic were included. Departments ordering these CT KUB examinations were divided into three divisions: Urologist, emergency room (ER) physician and others. RESULTS: Of 1550 CT KUB performed in the study period 766 met the inclusion criteria. Urologists (57%), followed by ER physicians (30%) mostly ordered the examination. The overall positive yield for urolithiasis was 64% (n = 490), rate of incidental/alternate findings was 15% (n = 116) and 21% (n = 160) were negative. Urologist has the highest positive yield of 67.4% (n = 295) followed by ER physician 67% (n = 152) and others 42.5% (n = 43); p < 0.001. Rate of incidental/alternate findings was highest in CT ordered by other specialties 23.7% (n = 24) followed by ER physician 17.6% (n = 40) and urologist 11.8% (n = 52); p = 0.005. CONCLUSION: There is statistically significant difference of yield across specialties. CT KUB as an initial imaging modality for suspected urolithiasis should be ordered in consultation with the urologist and ER physicians. Tool of good history taking and physical examination has proved to be essential steps in algorithm of ordering CT KUB, which can avoid unnecessary radiation exposure.

Current understanding of treatment and management protocol for adult diabetic in-patients at a tertiary care hospital.

OBJECTIVE: To assess the current understanding of treatment and management protocols for adult diabetic inpatients at a tertiary care hospital. METHODS: This cross-sectional study, conducted at the Civil Hospital Karachi from July to September 2009, involved 450 participants, who were interviewed through a well-structured questionnaire regarding the patient's demography, clinical features, past medical history, type of diabetes mellitus, duration, associated complications, and also involved patient notes for laboratory tests and management. SPSSv15.0 was used for descriptive analysis. RESULTS: The study population of 450 diabetics had 144 (32%) males and 306 (68%) females. Of the total, 435 (96.7%) patients had type 2 diabetes. There were 231 (51%) patients using insulin, 168 (37.3%) oral hypoglycaemic drugs, and 51 (11.3%) using both. Among patients using insulin, regular insulin usage stood at 30% followed by a combination of regular insulin and NPH (26.7%) and NPH alone at 6%. The most popular drug used was metformin (27.3%) and the least used drug was glitazones (4%). In the study population, 73.3% patients controlled their diabetes with diet, and 24.7% with regular exercise. CONCLUSION: Majority of the study population had type 2 diabetes with a female preponderance. Insulin was prescribed for half the patients. Metformin was the most frequently used oral hypoglycaemic drug.

Transient osteoporosis of the hip.

Transient Osteoporosis of Hip (TOH) is an uncommon disorder of idiopathic nature, particularly in the Asian population. It has been described to mostly occur in middle aged men and women in their third trimester of pregnancy. A distinctive hallmark of this condition is that it is self limiting and resolves in a few months. The patient presents to the physician with pain on movement and impaired mobility of the affected joint, developing without any history of trauma. MRI is the main diagnostic tool. We report herein a case of a forty five year old male, who developed transient osteoporosis of the hip, and was managed conservatively.

Rituximab therapy for flare-up of rheumatoid arthritis after total knee replacement surgery.

A variety of drug types are used alone or in combination to manage Rheumatoid Arthritis along with physiotherapy. We report herein the case of a 51 year old female patient with a history of Rheumatoid Arthritis whose disease remained active despite being on routinely used multiple disease modifying antirheumatic drugs. The patient underwent bilateral total knee arthroplasty with subtotal synovectomy due to the severe pain caused by her concomitant age related osteoarthritis which was only aggravated by her active rheumatoid arthritis disease. Three months following surgery, the patient's knee pain with typical rheumatoid flare and swelling reappeared for which a B cell monoclonal antibody, rituximab, was given. Her number of tender and swollen joints reduced to less than three and her C-reactive protein levels and erythrocyte sedimentation rate reduced significantly along with considerable improvement in her Global Assessment score. Her severity of pain also decreased to 3 from an initial score of 8 on the Visual Analog Scale. Thus, Rituximab helped improve our patient's symptoms from recurrence of synovitis after total knee replacement.

Adherence to adult intramuscular injection protocol at Civil Hospital Karachi.

OBJECTIVE: To assess the level of adherence to Adult Intramuscular Injections Protocol by health care providers of Civil Hospital Karachi. METHODS: This analytical cross sectional study was conducted in July and August of 2009, at Civil Hospital Karachi after institutional permission. Data was collected with a pre tested data collection tool. Two hundred and seventeen house officers and nurses were interviewed. SPSSv16.0 was used for descriptive and scoring analysis. RESULTS: With a 94% response rate, 156 (76%) interns and 49 (24%) nurses were interviewed. Majority scored well regarding preparation of intramuscular injections with 40 (19.5%) participants scoring 12 out of 15 marks. Highest score about administration of intramuscular injects questions.was 7 in 43 (21%) of the participants. Twenty three (11%) failed to reply about contraindications and 14 (20%) mentioned that there are no contraindications. CONCLUSION: Health care providers at Civil Hospital Karachi are partially adhering to Adult Intramuscular Injections protocol, which calls for intensive training.