Duplication errors due to brand name confusion; It is not always the name-Short case series.

Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.

Differences in expression of Wnt antagonist Dkk1 in healthy versus pathological bone samples.

Wnt/ß-catenin signalling components was shown to affect bone cells function including chondrocytes.Secreted Dkk1, a potent osteogenesis inhibiting factor mediates bone loss in diseased bones by suppressing the biological actions of Wnt proteins. In addition, increased Dkk1 signalling inhibits chondrogenesis in new bone formation. Recent findings also show there exists a cross-talk between the chondrocytes and the cells of the osteoblast lineage, which are the most affected cell types in muskuloskeletal disorders. This study investigated whether spatial expression of Dkk1 is confined to only osteoblasts, osteocytes or chondrocytes. The second objective was to detect a difference in the Dkk1 expression pattern in healthy subjects when compared to pathological state. To elucidate the cell specificity of Dickkopf-1 (Dkk1) in healthy bones, samples from female Sprague-Dawley rats were tested against two different antibodies with the two most widely accepted visualization system (ABC and Envision). The findings show Dkk1 specificity predominantly for osteoblasts, chondrocytes and osteocytes depending upon the antibody used. In addition, Dkk1 expression was evaluated in different cells of human osteoarthritis (OA) and rheumatoid arthritis (OA) patients. Its overexpression in pathologic state also suggests the role of Dkk1 in bone formation. This is scientifically and clinically important in studying the effect of Dkk1 in bone healing and in designing treatments for patients with compromised bone status. Taking into consideration the paradigm that cartilage and subchondral bone behave as an interconnected functional unit, normalization of cell behaviour in one compartment may have benefits in both tissues.

The burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka.

AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes.

Proctocolectomy for persistent haematochezia in a patient with Cronkhite-Canada Syndrome.

Cronkhite-Canada syndrome is an extremely rare condition of gastrointestinal polyposis in which the main presenting features are diarrhoea and dysgeusia. The polyps in this condition are characteristically distributed throughout the entire gastrointestinal tract except the oesophagus, and these patients exhibit unique ectodermal abnormalities. Herein, we report a 50-year-old male who had recurrent episodes of severe haematochezia from the polyps in the colon. Further examination and investigations revealed a diagnosis of Cronkhite-Canada syndrome. Proctocolectomy was carried out for medically refractory haematochezia and the patient is asymptomatic at present.

Disease-related knowledge in inflammatory bowel disease: experience of a tertiary care centre in a developing country in South Asia.

INTRODUCTION: Disease-related knowledge plays a critical role in facilitating patients' acceptance of their diagnosis and compliance with active participation in the treatment of inflammatory bowel disease (IBD). The aim of this study was to analyse the deficits in knowledge for future health education programmes. METHODS: A validated questionnaire was used to assess and analyse disease-related knowledge among patients with ulcerative colitis (UC) and Crohn's disease who attended outpatient gastroenterology clinics of a tertiary care hospital in Sri Lanka. RESULTS: There were 184 patients (83 males) with a mean age of 44.5 (range 20-78) years. 83.2 percent of the patients had UC. The mean duration of IBD was 8.17 (range 1-28) years, and 33.7 percent of the patients had IBD for over ten years. The mean Crohn's and Colitis Knowledge questionnaire score was 6.86. The majority (68.5 percent) of the patients were aware that sulfasalazine can be used to reduce exacerbations. There was no statistical difference in disease-related knowledge between genders, but the level of education showed a significant difference. Only 14.1 percent of patients were aware that prolonged IBD is a risk factor for colorectal cancer and that screening for colorectal cancer is important. 9.2 percent of the study population was aware of restorative proctocolectomy. CONCLUSION: There is a lack of knowledge regarding colorectal cancer risk and surgical interventions. There was no significant difference in the knowledge scores between genders but there was a significant association with the educational level.

The value of routine histopathological analysis in patients with fistula in-ano.

OBJECTIVE: To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano. METHOD: Histopathology reports of all the patients who underwent surgery for fistulae-in-ano over a period of 36 months were reviewed. RESULTS: Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11-68). Forty-one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn's disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid-fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn's disease in one (1.2%) patient. All three patients had recurrent fistulae. CONCLUSION: As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in-ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn's disease.

Sister Mary Joseph's nodule as the sole presenting feature of disseminated squamous cell cancer of the esophagus: a rare case.

Umbilical nodule due to tumor metastasis is a rare presentation which is known as Sister Joseph's nodule. This is usually due to disseminated intra abdominal malignancies which are mostly adenocarcinomas. Esophageal squamous cell cancer commonly presents with progressive dysphagia, and it usually metastasizes to liver, lungs, bones, and regional lymph nodes; however, spreading to the umbilicus is an extremely rare occurrence. In this paper, we report a 77-year-old man presenting with a painful umbilical nodule as the only presenting feature of disseminated, poorly differentiated squamous cell carcinoma of the esophagus.