Volume 4 Issue-2 Apr-June,15

Breast cancer, the most frequent cancer in females is the major cause of morbidity and mortality in the world as well as in Pakistan. Screening of breast cancer or early detection requires a reliable biomarker that has high specificity and sensitivity for use in clinical practice. Certain diagnostic biomarker have been identified but are not fit for clinical use due to their low sensitivity like MUC1 (mucin glycoprotein) and CA 15-3 and CA 27-29 (cancer antigens)…

Background:

Salivary urea, correlates well with serum urea, can be utilized as a low-cost, easily accessible and noninvasive diagnostic tool for screening patients in early stages of kidney disease, especially for developing countries with limited resources. Saliva for diagnostic purpose, is inexpensive, non-invasive, easy to collect, use, store and transport, contain high amount of disease biomarkers and shows efficient and reliable results.

Objective:

To asses and prove the salivary diagnostics as reliable alternate to serum in renal diseases. Methods: A cross-sectional validation study of 1 year duration from June 2012 to June 2013 was conducted. Non-probability consecutive sampling technique was employed on the patients attending the Nephrology OPD or those who were admitted to Jinnah Postgraduate Medical Centre Karachi.

Results:

Significant correlation (.00) was found between the levels of serum and salivary urea and creatinine. A slight increase in the level of serum urea and creatinine results in a significant increase in the level of salivary urea and creatinine. Almost 63.2% and 64.6% of changes in serum urea and creatinine can be explained by the changes in salivary urea and creatinine levels respectively.

Conclusion:

Saliva can be developed as a diagnostic fluid that is an alternative to blood. It is non invasive, less expensive and collection procedure does not require technicians. The use of salivary assay for diagnostics of chronic renal failure (urea and creatinine) can be established as a cost effective test for developing countries.

Key Words:

Saliva, Tool, Renal Failure, Oral Pathology.

Background:

Chronic hepatitis C and interferon both have their effect on thyroid gland function including clinical and subclinical thyroidal dysfunction (TD) that form major clinical manifestations of chronic hepatitis c.

Objective:

To assess Pegylated interferon based therapy related thyroidal dysfunction in chronic hepatitis C patients and to compare it with those who are hepatitis C Sero positive but have not receive interferon based treatment.

Methods:

A case control study in which, 203 patients of Chronic, compensated hepatitis C(130 females,73 males) were included from Baqai University Hospital Karachi Liver Clinic (b/w Jan 2010–Jun 2014). The participants were checked for thyroid dysfunction at the onset, 17 patients were found to have thyroidal dysfunction in the beginning and were excluded from the total 203 cases, then out of the remaining 186 cases, 101 patients (who were not having TD initially) opted treatment with pegylated interferon/ribavarin (Treated Group) and the rest (85 cases) were taken as control group.

Results:

Thyroid dysfunction was identified in 7 patients giving a frequency of 6.9%. Out of these 7 patients only one patient was male while the rest were females. The mean age of the patients with thyroid dysfunction was 39.2 ± 7.13 years. Amongst the patients identified with the thyroid dysfunctions, 2 (28.5%) had overt hypothyroidism and 5 (71.4%) had sub-clinical hypothyroidism. The treatment with combination therapy was significant for development of thyroid dysfunction in patients with hepatitis C (p=0.013) as compared to control group in which 85 patients of chronic hepatitis C who have not developed (TD) during the study period.

Conclusion:

dysfunction after pegylated interferon/ribavarin treatment in chronic hepatitis C is statistically significant with sub-clinical hypothyroidism is the predominant type in the study population.

Key Words:

Hepatitis C, Interferon, Thyroidal Dysfunction.

Background:

Laparoscopic cholecystectomy is the procedure of choice for cholecystitis. There are variable rates of conversion of laparoscopic cholecystectomy to open cholecystectomy. Various studies have highlighted gall bladder wall thickness and age as independent risk factors for conversion from laparoscopic to open procedure. This study was done to determine the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy in patients undergoing laparoscopic cholecystectomy with a gall bladder wall thickness of more than 3mm as determined on pre operative ultrasound.

Objective:

To find frequency of conversion to open procedure in patients undergoing laparoscopic cholecystectomy with a gall bladder wall thickness of more than 3mm as determined on pre operative Ultrasound.

Methods:

This Case series was conducted at the Surgical Unit IV Civil Hospital Karachi, Pakistan from 15th July 2012 to 15th January 2013. A total of 129 patients were included in the study with gall bladder wall thickness of more than 3mm on Ultrasound. Patients were stratified according to age, sex, gall bladder wall thickness, frequency of difficult cholecystectomy and duration of disease.

Results:

A total of 129 patients were included in the study. Female to male ratio is 5.7:1. The mean age of patients was 43.33±11.5 years. The average gall bladder wall thickness was 4.07±0.63 mm and duration of disease was 4.53±4.67 years. Regarding preoperative findings, bleeding during separation from liver bed was the commonest finding in general i.e. 35.7% followed by local adhesions 33.3% and perforation of gall bladder was observed in 7.8% cases. All (n=13) patients who had conversion to an open procedure had wall thickness between 4.1 to 6 mm. Similarly rate of conversion was found to be in higher in patients with symptoms for more than 5 years (i.e. 9 out of 24).

Conclusion:

Ultrasound for gall bladder wall thickness is a good predictor for difficult cholecystectomy. It should be used as anticipative measure for difficult cases and patient should be properly counseled regarding chances of conversion.

Key Words:

Difficult Laparoscopic Cholecystectomy, Gall Bladder Wall Thickness, Conversion To Open Cholecystectomy.

Objective:

Assess the outcome of intraticular comminuted fracture distal radius treated with orthofix external fixator.

Methods:

Prospective study with inclusion criteria of Comminuted intraarticular fractures distal radius , 20 to 60 years age, close and open fractures and exclusion criteria of patient above 60 years , extraarticular fracture , volar and dorsal barton fractures , more then 10 days old fracture.

Results:

From Januarry 2012 to sept 2014 , 63 patient with intraarticular comminuted fracture distal radius treated with orthofix external fixator included in this study. Functional outcome was assessed on Gartland and Wesley scoring system. 40 (63%)male and 23(37%) female patients, 35(56%) road traffic accident and 28(44%) have fall. AO C1, were 32(51%), C2 ,19(30%), C3, 12(19%) patients. Additional kwire fixation applied in 54 patients.Fixator removed at 6 weeks. Functional result were excellent in 26 patient(41%) , good 32(51%) , satisfactory in 4 patient(6%) , poor in 1(2%). Complication observed were , minor and major pin track infection 30(65%), tethering of external indicis tendon 3(7%) patient, k wire loosening 10(22%) and sudecks atrophy 3(7%) patients.

Conclusion:

Orthofix external fixator application in intraarticular comminuted fracture distal radius is recommended because it is minimal invasive technique ,have excellent to good outcome . Most of the times needs additional kwire fixation for the fragment stabilization.

Key Words:

Intraarticular , Comminuted , Distal Radius , Orthofix External Fixator, K Wire.

Objective:

To evaluate cases presenting with parathyroid tumors and the efficacy of treatments offered.

Methods:

Six cases presented with bony manifestations in mandible, femur, tibia and maxilla while one presented with an overt neck swelling. Renal calculi showed in one case. All cases were subjected to assessment of serum parathyroid hormone level and radionuleotide scan.Sonography was done in addition in two of the cases . In all cases parathyroid tumors were identified and subjected to exploratory parathyroid surgery, In addition bony pathologies were subjected to excisions of the lesions.

Results:

In all the cases serum parathyroid hormone levels were raised.MIBI scans picked parathyroid tumors in almost all the cases. Six of the excised tumors were parathyroid adenomas while one was adenocarcinoma. Additional surgeries done in these cases include excisions of mandibular growths, maxillectomy and osteotomies on tibia and femur. All were giant cell tumours.One case with adenocarcinoma expired. The other cases showed normalization of parathyroid hormone levels.

Conclusion:

Parathyroid adenoma is the common benign tumor of parathyroid gland usually presenting with exaggerated parathyroid hormone levels. Ultrasound scan screening with tc99 Sestamibi scanning are most helpful in establishing the diagnosis. Parathyroid surgery is safe in experienced hands and is the standard treatment modality to reverse the morbidity associated with pathologies. In all bony lesions with a doubtful clinical diagnosis screening for Parathyroid lesions is mandatory. Gross disfigurements, functional disabilities call for excision of bony lesions.

Key Words:

Parathyroid Gland, Adenoma, Gaint Cell Tumour, Sestamibi Scan.

Background:

Multiple renal pathogenesis manifested as unilateral or bilateral size changes, therefore there should be normative reference data for proper comparison. Our goal is to determine normal standard value ranges for renal dimensions in pediatric population in Karachi. Sonographically renal length in 150 children were measured and correlate with age, gender, body height, weight and BMI.

Objective:

Sonographic Measurement of Normal Renal Size and Correlation with Somatic Variables in Subset of Karachi Pediatric Population.

Methods:

A six month cross sectional hospital based assessment of kidney size (length, width) was evaluated with the help of sonography. XarioTM 200 Toshiba with convex 3.5 frequency transducer will be used. The mean renal dimensions with standard deviation (SD) were estimated for every group of age. The renal length and width were determined and corresponded with different somatic variables. Descriptive statistics with Regression analysis was done.

Results:

The normal length and the width of kidneys and its ranges were obtained. Right kidney length moderately and significantly correlated with height and weight (r=0.651, r=0.654) and age (r=0.538) respectively. However, moderately insignificant with BMI (0.129). Lefts kidney moderately and significantly correlated with height and weight (r=0.665 r=0.705), negative insignificant with age (0.564) and moderately weak insignificant relationship with BMI (0.174).

Conclusion:

The research presents the normal range parameters of renal size and measurements by sonography in healthy pediatric population in Karachi. Guideline measurements of kidneys represent a statistically important and comprehensive interaction with specifications of growth which allows us to easily calculate the renal size by derived regression analysis.

Key Words:

Renal Size, Sonography, Children, Chronic Renal Disease.

Background:

Influenza is a common disease affecting people of all age groups. Generally considered to be a mild disease, it can however, cause devastating effects in the very young, elderly and immunocompromised people.

Objective:

To assess and compare the knowledge of influenza and its vaccine amongst medical students and practicing physicians.

Methods:

A cross sectional survey was conducted on medical students and doctors at a tertiary care hospital. The participants were asked to fill out a structured questionnaire regarding knowledge and beliefs about influenza disease and its vaccine. Information thus obtained was tabulated and analysed and the two groups compared. Knowledge scores were calculated and the respondents were considered to have adequate knowledge if they scored> 60% on the knowledge part of the questionnaire.

Results:

There were 179 participants in the study, of which 79 were medical students and 100 were practicing doctors. Majority of the respondents in both the groups knew the causative agent, mode of transmission and preventative measures of influenza. However, they lacked knowledge about complications of influenza. Respondents’ knowledge was significantly deficient regarding many aspects of the influenza vaccine. Analysis of the knowledge scores revealed that only 49% of the physicians and 31.6% of the medical students had adequate knowledge about influenza disease and its vaccine.

Conclusion:

Medical students and practicing physicians lack adequate knowledge about influenza and its vaccine. More emphasis needs to be placed on educating health care professionals about influenza and the importance of its vaccination program.

Key Words:

Influenza, Vaccination, Preventive Measures.

Introduction:

True unilateral condylar hyperplasia (CH) of mandible including its variants is an uncommon maxillofacial deformity. It represents unilateral abnormal growth of the mandible including its body and ramus. Discrepancy in the growth of the mandible causing vertical facial asymmetry, creating aesthetic problem resulting in malocclusion as well as psychological issues requiring bi-maxillary surgical correction. In this report we discuss the use of imaging in the diagnosis of these pathologies and investigate its variants.

Key Words:

Condylar Hyperplasia (CH), Condylar Hyperplasia Variants, Facial Asymmetry.

Introduction:

Complete heart block also known as third-degree atrioventricular block (AV block) is a condition in which there is no conduction of the impulse produce in the sinoatrial node (SA node) in the atrium to the ventricle.1 Complete heart block may be congenital or acquired. There are certain conditions which can lead to third-degree heart block, commonest being the coronary ischemia. Initially there may be first degree atrioventricular block (AV block), second degree atrioven-tricular block (AV block), bundle branch block or bifasicular block ultimately leading to complete heart block. In most cases third-degree AV block presents with acute myocardial infarction.2,3 A 45 years old male with no known comorbids and without any risk factors for coronary heart disease coming with a short duration of complaints of dizziness and vertigo was diagnosed as a case of complete heart block without any functional and anatomical impairment in conduction system.

Key Words:

Complete Heart Block, Atrioventricular Block (AV block), Sinoatrial Node (SA Node), Coronary Ischemia, Bifasicular Block, Myocardial Infarction, Conduction System.

Introduction:

Schmidt’s syndrome is a rare disease which is a one of the types of autoimmune polyglandular autoimmune syndrome. In these polyglandular autoimmune syndrome autoimmunity with auto-antibodies directed against different endocrine organs suggest in the pathogenesis of the disease. In addition there is role of genetic and familial predisposition of the disease. Autoimmune thyroid disease in combination with Addison disease is the most common presentation. In addition Diabetes mellitus Hyperparathyroidism, Pernicious Anemia, Hypogonadism, Vitiligo, Chronic atrophic gastritis, Chronic autoimmune hepatitis, Alopecia, Myasthenia gravis, Rheumatoid arthritis, Sjögren’s syndrome and Thrombocytic purpura may or may not be present. So in patients suffering from one endocrine hormone deficiency should be thoroughly looked for the deficiency of other hormones. We present a case of 23 year old man who present with symptoms of gastritis and was refractory to treatment and on further evaluation was diagnosed as a case of Schmidt syndrome.

Key Words:

Schmidt’s Syndrome, Autoimmune Hypothyroid, Polyglandular.

Abstract:

Approximately one in every nine Pakistani women is likely to suffer from breast cancer. This is one of the highest incidence rates in Asia. Mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. Breast magnetic resonance imaging (MRI) has become increasingly important in the detection and delineation of breast cancer in daily practice. The utility of diagnostic value of MRI is mainly on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional imaging, assessing for the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer. The standard breast MRI protocol includes T2 sequences (anatomy and signal analysis), T1 gradient-echo sequences which can detect markers placed after biopsy, and injected dynamic 3D sequences for performing volume and multiplanar reconstructions, which are particularly useful for locating lesions. Good patient positioning is essential. These aspects limit movement artefacts which alter subtraction sequences; it must be compared with the native sequences. New functional imaging sequences are now appearing in an attempt to increase the specificity of MRI, which is one of its main limitations. Of these, magnetic resonance spectroscopy appears to be the most promising.

Key Words:

Magnetic resonance imaging; Breast Cancer; Mammography; Early detection; Diffusion-weighted imaging;Spectroscopy;

Abstract:

Oral submucous fibrosis (OSMF) is a chronic, irreversibly progressive and precancerous disease that effects oral, oropharyngeal and oesophageal mucosa. OSMF is characterised by the inflamation and progressive fibrosis of lamina propria that leads to difficulty in mastication, speech, swallowing and causes limited mouth opening. Arecoline (major alkaloid) in areca nut is the main aeitiological factor in causing the disease. Prevalance of OSMF ranges from 0.2 % to 0.5% in South India. The malignant rate of transformation over 17-year period was 7.6%. Trace elements (part of metalloenzymes) are recognised as versatile biomarkers which may be helpful in early detection, prognosis and can reduce the incidence of cancer. Copper, Iron, Zinc, Selenium, Cadmium, antioxidants (Superoxide Dimutase, Vitamin A, Vitamin C, Vitamin E), immunoglobulins and alternation in oncosupressor genes and other genes have been emphasized as biochemical parameters that play an important role in its pathogenesis. These parameters can also serve as important biomarkers in early detection of a premalignant condition and cancer progression.

Key Words:

Oral submucous fibrosis, trace elements, biomarkers, antioxidants, oncosuppressor genes