Needle Biopsy of Pleura in the Aetiological Diagnosis of Pleural Effusion.

Exudative pleural effusion appears as manifestation of underlying specific disease process and pleural biopsy is usually enough to find out the underlying causative disease. The aim of the study was to find out the efficacy of needle biopsy of pleura in the aetiological diagnosis of pleural effusion. This cross-sectional study was conducted for a period of one year from January 2008 to December 2008 in the Department of Medicine, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh enrolling 50 subjects with exudative pleural effusion. The cases with transudative pleural effusion were not included. Needle biopsy was done in all the cases. Histopathological reports of pleural biopsy specimen were correlated with other data and analyzed to detect the causes of effusion. Major incidence of malignant effusion occurred between 41 to 70 years of age. No malignant effusion was found before 30 years of age. Incidence of tuberculous and malignant pleural effusion was much more common in males than in females. Sensitivity and specificity of combined pleural biopsy and pleural fluid analysis in the diagnosis of pleural effusion was 97.06% and 100.% for tuberculosis and 81.82% and 100.0% for malignancy. The present study reveals that pleural biopsy was very effective method in the diagnosis of cause of pleural effusion.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan / Qualidade de água potável de váris fontes dos distritos de Peshawar, Mardan, Kohat e Swat da província de Khyber Pakhtunkhwa, Paquistão

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Resumo O presente estudo envolve a análise química e bacteriológica de água de diferentes fontes, ou seja, furo, poços, garrafa e torneira, dos distritos de Peshawar, Mardan, Swat e Kohat da província de Khyber Pakhtunkhwa (KP), Paquistão. De cada distrito, 50 amostras de água (10 amostras de cada fonte), independentemente do status urbano e rural, foram coletadas dessas fontes e analisadas para sulfatos, nitratos, nitritos, cloretos, sólidos solúveis totais e coliformes (E. coli). Os resultados indicaram que a maioria das fontes de água tinha uma contagem inaceitável de E. coli, ou seja, > 34 UFC / 100 mL. As amostras positivas para E. coli foram elevadas no distrito de Mardan, seguido por Kohat, Swat e distrito de Peshawar. Além disso, algumas fontes de água também foram contaminadas quimicamente por diferentes fertilizantes inorgânicos (nitratos/nitritos de sódio, potássio), mas em níveis seguros, enquanto os resíduos agrícolas e industriais (compostos de cloreto e sulfato) estavam em níveis inseguros. Entre todos os distritos, a qualidade da água foi considerada comparativamente mais deteriorada nos distritos de Kohat e Mardan do que nos distritos de Peshawar e Swat. Essas fontes de água química e bacteriologicamente impróprias para beber podem causar problemas à saúde humana.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Resumo O presente estudo envolve a análise química e bacteriológica de água de diferentes fontes, ou seja, furo, poços, garrafa e torneira, dos distritos de Peshawar, Mardan, Swat e Kohat da província de Khyber Pakhtunkhwa (KP), Paquistão. De cada distrito, 50 amostras de água (10 amostras de cada fonte), independentemente do status urbano e rural, foram coletadas dessas fontes e analisadas para sulfatos, nitratos, nitritos, cloretos, sólidos solúveis totais e coliformes (E. coli). Os resultados indicaram que a maioria das fontes de água tinha uma contagem inaceitável de E. coli, ou seja, > 34 UFC / 100 mL. As amostras positivas para E. coli foram elevadas no distrito de Mardan, seguido por Kohat, Swat e distrito de Peshawar. Além disso, algumas fontes de água também foram contaminadas quimicamente por diferentes fertilizantes inorgânicos (nitratos/nitritos de sódio, potássio), mas em níveis seguros, enquanto os resíduos agrícolas e industriais (compostos de cloreto e sulfato) estavam em níveis inseguros. Entre todos os distritos, a qualidade da água foi considerada comparativamente mais deteriorada nos distritos de Kohat e Mardan do que nos distritos de Peshawar e Swat. Essas fontes de água química e bacteriologicamente impróprias para beber podem causar problemas à saúde humana.

Role of Ommaya Reservoir in Pediatric Hydrocephalus: Experience in Bangladesh Medical College Hospital from 2019-2021.

The goal of this study was to analyze the efficacy of the Ommaya reservoir within all the different types of hydrocephalus in pediatric patients. At the same time, it's safe for repeated aspirations or long-term retention of the reservoir in the body. This retrospective, cross-sectional study was performed from January 2019 to December 2021, 33 consecutive cases of reservoir implantation were taken into the study irrespective of the etiology of hydrocephalus in the Neurosurgery Department of Bangladesh Medical College Hospital, Dhaka, Bangladesh. These were mostly placed along with endoscopic third ventriculostomy and some were placed as an intermediary procedure to combat shunt complications in emaciated infants. Cerebrospinal fluid (CSF) aspiration was done in case of failed endoscopic third ventriculostomy and the frequency of aspiration depended upon the production of cerebrospinal fluid. Acetazolamide was routinely administered in each patient to reduce the frequency of aspiration. Most of the patients required ventriculo-peritoneal (VP) shunt while they had sufficient body weight and few required no surgery. The average age at presentation was 76.88 days. All the neonates and infants had less weight in terms of their age. 42.4% of babies needed aspiration 2 times per week. Among all cases, 9.1% developed reservoir complications. Complications were not related to the number and volume of aspiration or duration of the reservoir in the body. Two (2) patients died after one year of reservoir implantation due to unknown etiology. Out of the 31 survivors, 3 patients did not need any further aspiration and 19 patients needed a ventriculo-peritoneal shunt, but the reservoir was kept in situ for a future emergency. The rest of them is waiting for a definitive shunt procedure. Other findings include low socioeconomic group was more prone to low birth weight and they carried the burden of congenital hydrocephalus and meningomyelocele. Most affected babies had their prenatal period in arsenic-affected areas in Bangladesh. Overall folic acid supplementation was started after the formation of the neural tube irrespective of socioeconomic status. Ommaya reservoir placement along with endoscopic third ventriculostomy plays a vital role in delaying shunt in endoscopic third ventriculostomy failure. It is a 'time buying' procedure until the baby has sufficient weight for successful shunt surgery. It has been found very effective intermediary intervention for managing shunt infection and it also helps revive a channel in shunt obstruction.

Roosting ecology and morphometric analysis of Pteropus medius (Indian flying fox) in Lower Dir, district, Pakistan / Ecologia de roosting e análise morfométrica de Pteropus medius (raposa-voadora indiana) no distrito de Lower Dir, Paquistão

Abstract The present study was conducted to explore morphometric variations of Pteropus medius (the Indian flying fox) and the roosting trees in Lower Dir, Pakistan. The bats were captured from Morus alba, Morus nigra, Brousonetia papyrifera, Pinus raxburghii, Hevea brasiliensis, Platanus orientalis, Populous nigra, Melia azedarach, Eucalyptus camaldulensis and Grevillea robusta through sling shot and mess net methods. A total of 12 bats were studied for the differential morphological features based on age and sex. Male bats were recorded higher in weight than females. The variations were found in body mass (821.1±34.65gm), circumference of body with wings (25.43±0.39cm), wingspan (112.58±1.90cm), Body length (20.73±0.68cm), Snout length (3.42±0.04cm), Eye length (1.45±0.033cm), Length of ear (3.56±0.05cm), Width of ear (2.46±0.04cm), Length b/w ear (5.51±0.11cm), Circumference of neck (12.23±0.24cm), Circumference of body without wings (18.68±0.31cm), Arm wing length (23.2±1.03cm), Length of thumb (5.43±0.1cm), Length of nail (1.89±0.05cm), Hand wing length (29.1±0.51cm), Maximum width of wing (21.03±0.68cm), Length b/w tip of wing to 5th digit (29.39±0.30cm), Length b/w 5th digit to foot (22.97±1.09cm), Length b/w feet (18.31±0.74cm) and Length of foot claw (4.23±0.05cm). This study was designed for analysis of external morphological variations for P. medius (the Indian flying fox) that may help in identification of these bats and their roosting sites.

Resumo O presente estudo foi conduzido com o intuito de explorar variações morfométricas de Pteropus medius (raposa-voadora indiana) e árvores de repouso em Lower Dir, Paquistão. Os morcegos foram capturados de Morus alba, Morus nigra, Broussonetia papyrifera, Pinus roxburghii, Hevea brasiliensis, Platanus orientalis, Populus nigra, Melia azedarach, Eucalyptus camaldulensis e Grevillea robusta por meio de estilingues e redes. Doze morcegos foram estudados quanto às características morfológicas diferenciais com base na idade e no sexo. Os morcegos machos apresentaram maior peso do que as fêmeas. As variações foram encontradas em massa corporal (821,1 ± 34,65 g), circunferência do corpo com asas (25,43 ± 0,39 cm), envergadura (112,58 ± 1,90 cm), comprimento do corpo (20,73 ± 0,68 cm), comprimento do focinho (3,42 ± 0,04 cm), comprimento do olho (1,45 ± 0,033 cm), comprimento da orelha (3,56 ± 0,05 cm), largura da orelha (2,46 ± 0,04 cm), comprimento entre as orelhas (5,51 ± 0,11 cm), circunferência do pescoço (12,23 ± 0,24 cm), circunferência do corpo sem asas (18,68 ± 0,31 cm), comprimento da asa da pata dianteira (23,2 ± 1,03 cm), comprimento do polegar (5,43 ± 0,1 cm), comprimento da unha (1,89 ± 0,05 cm), comprimento da asa até a ponta do dedo (29,1 ± 0,51 cm), largura máxima da asa (21,03 ± 0,68 cm), comprimento entre a ponta da asa e o quinto dedo (29,39 ± 0,30 cm), comprimento entre o quinto dedo e a pata (22,97 ± 1,09 cm), comprimento entre as patas (18,31 ± 0,74 cm) e comprimento da garra da pata (4,23 ± 0,05 cm). Este estudo foi desenvolvido para análise de variações morfológicas externas de P. medius (raposa-voadora indiana) e pode auxiliar na identificação desses morcegos e seus locais de nidificação.

Roosting ecology and morphometric analysis of Pteropus medius (Indian flying fox) in Lower Dir, district, Pakistan

Abstract The present study was conducted to explore morphometric variations of Pteropus medius (the Indian flying fox) and the roosting trees in Lower Dir, Pakistan. The bats were captured from Morus alba, Morus nigra, Brousonetia papyrifera, Pinus raxburghii, Hevea brasiliensis, Platanus orientalis, Populous nigra, Melia azedarach, Eucalyptus camaldulensis and Grevillea robusta through sling shot and mess net methods. A total of 12 bats were studied for the differential morphological features based on age and sex. Male bats were recorded higher in weight than females. The variations were found in body mass (821.1±34.65gm), circumference of body with wings (25.43±0.39cm), wingspan (112.58±1.90cm), Body length (20.73±0.68cm), Snout length (3.42±0.04cm), Eye length (1.45±0.033cm), Length of ear (3.56±0.05cm), Width of ear (2.46±0.04cm), Length b/w ear (5.51±0.11cm), Circumference of neck (12.23±0.24cm), Circumference of body without wings (18.68±0.31cm), Arm wing length (23.2±1.03cm), Length of thumb (5.43±0.1cm), Length of nail (1.89±0.05cm), Hand wing length (29.1±0.51cm), Maximum width of wing (21.03±0.68cm), Length b/w tip of wing to 5th digit (29.39±0.30cm), Length b/w 5th digit to foot (22.97±1.09cm), Length b/w feet (18.31±0.74cm) and Length of foot claw (4.23±0.05cm). This study was designed for analysis of external morphological variations for P. medius (the Indian flying fox) that may help in identification of these bats and their roosting sites.

Resumo O presente estudo foi conduzido com o intuito de explorar variações morfométricas de Pteropus medius (raposa-voadora indiana) e árvores de repouso em Lower Dir, Paquistão. Os morcegos foram capturados de Morus alba, Morus nigra, Broussonetia papyrifera, Pinus roxburghii, Hevea brasiliensis, Platanus orientalis, Populus nigra, Melia azedarach, Eucalyptus camaldulensis e Grevillea robusta por meio de estilingues e redes. Doze morcegos foram estudados quanto às características morfológicas diferenciais com base na idade e no sexo. Os morcegos machos apresentaram maior peso do que as fêmeas. As variações foram encontradas em massa corporal (821,1 ± 34,65 g), circunferência do corpo com asas (25,43 ± 0,39 cm), envergadura (112,58 ± 1,90 cm), comprimento do corpo (20,73 ± 0,68 cm), comprimento do focinho (3,42 ± 0,04 cm), comprimento do olho (1,45 ± 0,033 cm), comprimento da orelha (3,56 ± 0,05 cm), largura da orelha (2,46 ± 0,04 cm), comprimento entre as orelhas (5,51 ± 0,11 cm), circunferência do pescoço (12,23 ± 0,24 cm), circunferência do corpo sem asas (18,68 ± 0,31 cm), comprimento da asa da pata dianteira (23,2 ± 1,03 cm), comprimento do polegar (5,43 ± 0,1 cm), comprimento da unha (1,89 ± 0,05 cm), comprimento da asa até a ponta do dedo (29,1 ± 0,51 cm), largura máxima da asa (21,03 ± 0,68 cm), comprimento entre a ponta da asa e o quinto dedo (29,39 ± 0,30 cm), comprimento entre o quinto dedo e a pata (22,97 ± 1,09 cm), comprimento entre as patas (18,31 ± 0,74 cm) e comprimento da garra da pata (4,23 ± 0,05 cm). Este estudo foi desenvolvido para análise de variações morfológicas externas de P. medius (raposa-voadora indiana) e pode auxiliar na identificação desses morcegos e seus locais de nidificação.

Prostatic biopsies in selected men aged 75 years and older guide key clinical management decisions.

PURPOSE: Increasing life expectancy and PSA testing has increased the number of men over the age of seventy-five presenting for investigation of potential prostate malignancies. Prostatic biopsies provide diagnostic information; however, they are invasive and may not alter management decisions. Therefore, this study aimed to investigate whether prostate biopsies in this age group were justified. MATERIALS AND METHODS: All men aged 75 years and older who underwent prostatic biopsies between January 2010 and November 2011 at Bedford Hospital were identified and the indication for the biopsies, histopathological results and subsequent management plan investigated. RESULTS: One hundred and thirty-eight (138) prostatic biopsies were undertaken and malignancies identified in 60/138 (43 %) cases. Prebiopsy PSA and examination findings had a poor positive predictive value of 54 %. Fifty-five out of sixty (92 %) cancers were classified as high or medium risk disease with 30/60 (50 %) patients commencing radiotherapy treatment with curative intent. CONCLUSION: In selected patients aged 75 years or over, prostatic biopsies provide important diagnostic information which directly impacts on clinical decisions, supporting their use in this age group.

Wegener's granulomatosis: treatment and survival characteristics in a high-prevalence southern hemisphere region.

Our aim was to describe the treatment and survival characteristics of Wegener's granulomatosis (WG) in Canterbury, New Zealand. The medical records of 48 patients diagnosed between 1 July 1997 and 31 December 2008 and fulfilling validated classification criteria for WG were reviewed to characterise survivorship in the province of Canterbury, New Zealand. The age at diagnosis was 61 years (range 20 to 83 years) with an equal number of males and females. Using Kaplan-Meier product-limit analysis, the probability of survival at 1 and 10 years was 91% and 62% respectively. Of the 12 deaths in the cohort, four occurred within 12 months of diagnosis: two from pulmonary haemorrhage and two from renal failure. Beyond 12 months, two patients died of renal failure, two of myocardial infarction and one from cardiac arrhythmia, one from cerebrovascular disease and two from colorectal carcinoma. The median time to relapse was 6.75 years, and the probability of relapse within 10 years was 67%. Survivorship, treatment response rate and the rate of relapse from WG in a cohort of patients from this high-prevalence southern hemisphere region were similar to that reported for northern hemisphere cohorts with a similar prevalence.

Corticosteroid Induced, HHV-8 Positive Kaposi's Sarcoma in a Non-HIV Elderly Patient.

Kaposi's sarcoma (KS) was first described in 1872 by Moritz Kaposi. In 1994, Chang et al. first identified DNA sequences corresponding to human herpesvirus-8 (HHV-8) in AIDS-associated Kaposi sarcoma biopsies. It is now believed that presence of HHV-8 is necessary but not sufficient to cause KS. Other factors like immunosuppressive therapy also play a role. We describe an HIV-negative elderly patient who developed KS of skin and mucous membrane after prolonged use of corticosteroids for knee pain. The patient was positive for HHV-8.

The role of kisspeptin and RFamide-related peptide-3 neurones in the circadian-timed preovulatory luteinising hormone surge.

Many aspects of female reproduction often require intricate timing, ranging from the temporal regulation of reproductive hormone secretion to the precise timing of sexual behaviour. In particular, in rodents and other species, ovulation is triggered by a surge in pituitary luteinising hormone (LH) secretion that is governed by a complex interaction between circadian signals arising in the hypothalamus and ovarian-derived oestradiol signals acting on multiple brain circuitries. These circadian and hormonal pathways converge to stimulate a precisely-timed surge in gonadotropin-releasing hormone (GnRH) release (i.e. positive-feedback), thereby triggering the preovulatory LH surge. Reflecting its control by afferent circadian signals, the preovulatory LH surge occurs at a specific time of day, typically late afternoon in nocturnal rodents. Although the specific mechanisms mediating the hormonal and circadian regulation of GnRH/LH release have remained poorly understood, recent findings now suggest that oestradiol and circadian signals govern specific reproductive neuropeptide circuits in the hypothalamus, including the newly-identified kisspeptin and RFamide-related peptide (RFRP)-3 neuronal populations. Neurones producing kisspeptin, the protein product of the Kiss1 gene, and RFRP-3 have been shown to provide excitatory and inhibitory input to GnRH neurones, respectively, and are also influenced by sex steroid and circadian signals. In the present review, we integrate classic and recent findings to form a new working model for the neuroendocrine regulation of the circadian-timed preovulatory LH surge in rodents. This model proposes kisspeptin and RFRP-3 neuronal populations as key nodal points for integrating and transducing circadian and hormonal signals to the reproductive axis, thereby governing the precisely-timed LH surge.

Formulation, and physical, in vitro and ex vivo evaluation of transdermal ibuprofen hydrogels containing turpentine oil as penetration enhancer.

The aim of the present study was to investigate the transdermal permeation enhancing capability of turpentine oil for ibuprofen from hydrogels. Ibuprofen 1% w/v hydrogels were developed with carboxypolymethylene with and without turpentine oil. Turpentine oil was incorporated in increasing concentrations, i.e. 0.5, 1, 1.5, 2, 2.5 and 3% of the total gel formulation, and its permeation enhancing effect was examined. Gels were examined physically for pH, viscosity, spreadability, extrudability, smoothness and appearance. To study the in vitro and ex vivo permeation potential of formulated gels, permeation studies were performed with a Franz diffusion cell using cellulose membrane and excised rabbit abdominal skin. Ibuprofen hydrogel with 3% turpentine oil showed a maximum flux of 10.87 mg/cm2/h across artificial skin and 17.26 mg/cm2/h across rabbit abdominal skin.

Repair of cleft lip and simultaneous repair of cleft hard palate with vomer flap in unilateral complete cleft lip and palate: a comparative study.

UNLABELLED: Repair of anterior palate after repairing the cleft lip in complete cleft lip and palate patient is sometimes very difficult. It needs wide, extensive and difficult dissection, and has later chances of wound infection, wound dehiscence, complete wound disruption, recurrent oronasal fistula formation and also maxillary hypoplasia. In this study, we compare the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). METHODS: A prospective study was carried out in 43 patients with UCLP. In Group A, 23 patients underwent cleft lip and cleft hard palate repair with vomer flaps simultaneously, and only cleft lip repair was done in another 20 patients in Group B at the first sitting. After 3 months in both groups, repair of the cleft soft palate and cleft entire palate was done. The gaps of the cleft alveolus and posterior border of the cleft hard palate were measured during the first and second operation, and duration of operations, postoperative complications and requirement of blood transfusion during the operation were also recorded. RESULTS: The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with a vomer flap is easy to perform. Cleft alveolar and gap of the posterior border of the cleft hard palate were reduced remarkably. No fistula formation occurred and no blood transfusion was needed, but the procedure took some extra operating time. These were compared with simple cleft lip repair. CONCLUSION: Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.

Pain management for unilateral orchidopexy in children: an effective regimen.

BACKGROUND: The reported high incidence of 30-60% postoperative pain after an elective day surgical orchidopexy is undesirable. We evaluated the efficacy of our analgesic regimen for unilateral orchidopexy in preschool children performed as a day surgical procedure. METHODS: Between January 2004 and December 2006, 247 children (mean age: 3.3 +/- 1.6 years) underwent a unilateral orchidopexy as a day surgical procedure. They were prospectively analyzed for postoperative pain during a period of 48 h by using the Visual Analogue Scale (VAS). After standardized general anesthesia, all children had a 0.25% levo-bupivacaine hydrochloride ilio-inguinal block and a rectal diclofenac sodium suppository. Orchidopexy was performed through transverse inguinal and scrotal incisions. The wounds were infiltrated with 0.25% levo-bupivacaine hydrochloride at the end of the operation. Postoperatively acetaminophen and ibuprofen were given orally at regular intervals for 48 h. RESULTS: On first assessment in the recovery room, 148 out of 247 (60%) patients were pain-free, and 99 of 247 (40%) patients had pain: VAS score ranged from 3 to 10. By 3 h, 27 (11%) had mild-to-moderate pain, with VAS scores between 3 and 7. All children were discharged home at 4 h with no pain. At home, 95% were pain-free at 10 h and 97% by 24 h, with a declining pain score. All children were pain-free at 32, 40, and 48 h. Pain scores were unrelated to the duration of surgery (r (s) = 0.54). CONCLUSION: Clinical effectiveness of our institution analgesic regime justifies the performance of unilateral orchidopexy as a day-case procedure.

Inflammatory markers, insulin resistance and carotid intima-media thickness in North-Indian type 2 diabetic subjects.

OBJECTIVE: To study the interrelationship of the inflammation, insulin resistance and atherosclerosis in recently diagnosed type 2 diabetes. METHODOLOGY: Eighty-one newly diagnosed type 2 diabetic patients were compared with 81 healthy age, sex and BMI matched controls. Plasma glucose and insulin (fasting and after 2 hours of 75 gm of oral glucose), lipids and serum levels of C-reactive protein (CRP), fibrinogen and Tumour Necrosis Factor (TNF)-alpha were measured. Carotid (Intima-Medial Thickness) IMT was measured using high "resolution B-Mode ultrasonography. Insulin resistance was calculated using HOMA-IR model. Electrocardiogram (ECG) and exercise ECG were recorded for the evidence of coronary heart disease (CHD). RESULTS: Carotid IMT was significantly thicker in diabetic patients than in control group across the whole age range (p < 0.01). In merged group of diabetes, composite IMT was significantly correlated with LDL-cholesterol, fasting insulin, serum cholesterol, BMI and HOMA-IR (p < 0.01). After controlling for age and sex, all glycaemic parameters were correlated with IMT in both diabetic and control group. HOMA-IR, waist hip ratio, serum triglycerides, serum cholesterol, fasting serum insulin and CRP were significant predictor of IMT. Concentrations of inflammatory markers were significantly higher in diabetic patients than in control group. Serum levels of CRP (p < 0.05) were found to be higher in diabetic patients with CHD than without CHD. CRP was significantly correlated with IMT (r = 0.603, p < 0.01) in diabetic subjects with and without CHD after controlling for age and sex. CONCLUSION: Inflammatory markers are associated with type 2 diabetes but only CRP is associated with development of accelerated atherosclerosis and subsequent CHD.

The constipated child: how likely is Hirschsprung's disease?

The incidence of Hirschsprung's disease (HD) was determined in children who presented with constipation to a specialist paediatric surgical unit. During a 5-year period, 355 rectal biopsies were performed on 182 neonates, infants and children presenting with chronic constipation or intestinal obstruction: 25 (14%) were diagnosed HD. One hundred and four patients had suction and 78 had full-thickness rectal biopsies. Haematoxylin-eosin (HE) staining and acetylcholinesterase (AChE) histochemistry was used. In 13 cases (8%) of suction and 2 cases (2.5%) of full thickness rectal biopsies, specimens were inadequate to diagnose HD. The mean age of all patients was 2.9 years and that of patients diagnosed with HD was 3.64 months. Nineteen patients with HD were diagnosed in the first month, 5 in 1-12 months and 1 at 4 years of age (Fig. 1). The authors found that along with onset of constipation convincing indications for rectal biopsy to exclude HD were as follows: those infants and children who do not pass meconium within 48 hours, have low intestinal obstruction of unknown cause, severe constipation, chronic abdominal distension and failure to thrive. A diagnostic accuracy of 94% was achieved with AChE histochemistry for suction rectal biopsy. After this review, referring paediatricians were advised that screening of other common organic causes of constipation with the least invasive investigations, including laboratory, dietary and paediatric gastroenterology advice, should be undertaken to avoid unnecessary rectal biopsy to exclude HD and related disorders.

In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children.

PURPOSE: To reduce the incidence of nephrectomy or hydronephrosis in children. MATERIALS AND METHODS: From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients. RESULTS: In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications. CONCLUSIONS: Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.

Synthesis of 5-chloro-1-(2,3-dideoxy-3-fluoro-beta-D-glycero-hex-2- enopyranose-4-ulosyl)uracil as potential anticancer/antiviral agent.

Peracetylated alpha-D-glucose was coupled with silylated 5-chlorouracil. The product (2) was deacetylated and 4',6'-hydroxyls were then protected with 4',6'-O-isopropylidene group. Fluorine was introduced at the 3'-position, followed by acetylation, deprotection, tritylation, oxidation and deritylation of subsequent compounds gave the target compound (10).

Clinicopathological patterns and distribution of Schistosomiasis in Asir Region.

OBJECTIVE: The objective of this study is to report, for the first time, the histopathologic pattern of Schistosomiasis from the Asir Region and to compare it to patterns reported from other regions of the Kingdom of Saudi Arabia. Several studies have reported the patterns of Schistosomiasis in other regions of the Kingdom of Saudi Arabia and other countries where Schistosomiasis is endemic. Schistosomiasis is endemic in certain areas of Asir region, however no data is available concerning the clinicopathological pattern of Schistosomiasis in the Asir Region. METHODS: This is a retrospective analysis of 217 cases of Schistosomiasis from surgical and biopsy files of Asir Central Hospital during a period from January 1990 to October 1999. RESULTS: Our study revealed that Schistosomiasis was more common among the expatriate population of Asir Region than Saudi nationals residing in this area. The urinary tract was most commonly involved, and then in descending frequency came the vermiform appendix, liver and large bowel. CONCLUSION: These findings are somewhat different from those observed in the Riyadh Region where the vermiform appendix was the most commonly affected organ. Based on the histopathologic pattern, our study describes the pattern of Schistosomiasis in the Asir Region and may serve as a base-line for future research work.

Prevalence and correlates of smoking on the roof of the world.

OBJECTIVE: To determine the prevalence and correlates of cigarette smoking among adults in high mountain rural areas of northern Pakistan. DESIGN: Cross sectional survey. PARTICIPANTS: A sample of 4203 adults (aged 18 years and over) were selected by stratified random sampling from 16 villages. MAIN OUTCOME MEASURE: Self reported smoking prevalence; age of smoking initiation; daily cigarette consumption and association between current smoking and sociodemographic variables, use of snuff, wine, body mass index, blood pressure, family history of stroke, and hypertension. RESULTS: 614/1406 men (43.7%) and 154/2797 (5.5%) women reported smoking cigarettes. The age standardised prevalence of smoking was 40.5% for men and 6.3% for women. Men were more likely (odds ratio (OR) 6.5, 95% confidence interval (CI) 4.75 to 8.79) to be smokers. Smokers were more likely to use snuff (OR 1.39, 95% CI 1.12 to 1.73), drink wine (OR 3.47, 95% CI 2.81 to 4.29), and were more likely to work as farmers (OR 1.55, 95% CI 1.05 to 2.29) or shopkeepers (OR 2.63, 95% CI 1.67 to 4.14). Individuals with college level education and with desirable body mass index were less likely to smoke (OR 0.55, 95% CI 0.35 to 0.87; OR 0.74, 95% CI 0.57 to 0.96). CONCLUSION: Cigarette smoking is a major public health problem in this high mountain community of Pakistan, particularly among the male population, the majority of whom begin to smoke quite early in life. A comprehensive tobacco control effort incorporated into the existing community based health infrastructure is needed.