Age and site of colonic neoplastic lesions: implications of screening in south Asia

To evaluate the Age of patients and the site of Colonic Neoplastic Lesions [CNL] and to determine the appropriate screening strategy for Colorectal Carcinoma [CRC] [sigmoidoscopy versus colonoscopy] in our population. This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas [defined as polyp more than 1 cm and/or having villous morphology on histology] was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. During the study period colonic neoplastic lesions were found in 217 patients; 186 [85.7%] patients had CRC and 31 [14.3%] patients had advanced adenomatous polyps. Mean age was 55.8 +/- 14 years and amongst them 72 [33.2%] patients were less than 50 years of age while 145 [66.8%] were more than 50 years. In 144 [66.4%] patients lesions were located in the distal colon, 65 [30%] had lesions in the proximal colon while in 8 [3.7%] patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. [p value 0.85]. Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results

Parasitic infestation in children of district Vehari: an underdeveloped area of Pakistan

To determine parasitic infestation among children of rural and urban areas of district Vehari. Children Complex Hospital, at District Headquarter Hospital Vehari and PMRC Research Center, Nishtar Medical College, Multan, Pakistan. A cross-sectional study was done in 2006 where 500 children aged 1-10 years presenting with anaemia and malnutrition were studied. Demographic information included residential area [rural/urban], gender, socio-economic status, hygienic conditions, source of drinking water were recorded on a questionnaire. Parents were interviewed, while stool and blood samples of children were collected for parasites and to determine anemia. Parasites were found in 140[28%] children and anemia in 236[47%]. Prevalence of protozoa 102 [20.4%] was greater than intestinal helminthes 38 [7.6%]. The most common protozoa was Entamoeba histolytica 101 [20.2%] and in nematodes, Hymenolepis nana was seen in 28 [5.6%], Ancylostoma duodenale [hook worm] in 5 [1%], Ascaris lumbricoides [round worm] in 3 [0.6%] and Taenia saginata [tape worm] in 2 [0.4%]. Diarrhoea was seen in 254 [50.8%] cases, constipation in 191 [38.2%], abdominal pain in 245 [49%], anorexia in 181 [36.2%] and abdominal distension in 86 [17.2%] children. Rural children were significantly more infected with parasites, 81 cases [32.27%] compared with urban children 59 cases [23.69%] [p<0.05] and same was for poor children 81 [34.9%] compared with middle income 57[21.8%] [p<0.05]. Infected cases with poor hygienic conditions [77 cases 35.2%] were more infected than those with satisfactory 62 [24.4%] and good hygiene 1[3.7%]. Worm infestation was common 84[35.9%] in those using drinking water from hand pumps compared to those obtaining drinking water from government water supply 47[23.9%] and water filtration plant 9[13.%], a significant difference in infection due to poor quality drinking water was observed[p<0.05]. Worm infestation and anemia were inter related and 85 [60.7%] children with anaemia had parasites against 55 [39.3%] who were not anaemic [p<0.05]. Poor sanitation, hygiene and source of drinking water have appeared as major contributors towards parasitic infestation. Ent.histolytica was the most common protozoal infection found compared to helminths. Use of clean drinking water and good hygienic practices should be instituted throughout the country

Palynological studies of family Euphorbiaceae from kaghan valley, Mansehra, N.W.F.P., Pakistan

Palynological study of 04 species belonging to 04 genera of the family Euphorbiaceae from Kaghan Valley was conducted. Pollen grains of Euphorbiaceae are suboblate to prolate or prolate spheroidal to subprolate, 3-colporate, amb circular, circular-lobate or inter-subangular, colpi varying in length, in width and in thickness of margin, ora mostly not crassimarginate, transversally parallel, but some of them, ora transversally elliptic or circular, rarely crassimarginate, exine 1-3 micro m thick, tectum psilate or with scabrate, verrucate, gemmate or baculate processes, sexine mostly granulate or finely reticulate, with OL- or croton-pattern, nexine as thick as sexine. Size of grain varies from 15 to 60 micro m

Palynological and ethnobotanical studies of Genus Pinus from Hazara, N.W.F.P., Pakistan

Pollen morphology of genus Pinuss growing wild in Hazara, N.W, F.P., Pakistan was studied. Grains were vesiculate, exine 3-4 micro thick, sexilte reticulate. Size of the grain varies from 36 x 54 [53 x 73.8]64 x 96 micro m to 40 x 614 [47.2 x 75]567 x 88.3 micro m

Association Of Urogenital Anomalies With Anorectal Malformations: a review of 200 cases

To find out the association of urogenital anomalies with anorectal malformations [ARM]. Design ct Retrospective observational study from January 2001 to June 2005.Department of Paediatric Surgery, Bolan Medical Complex Hospital, Quetta..All patients who presented with anorectal malformations.The data of the above mentioned children was collected and analyzed, especially for the presence of urogenital anomalies.Out of the total 200 patients, there were 116 [58%] males and 84 [42%] females. High and low type of ARM was seen in 60% and 40% patients respectively. Amongst these 97 [48.5%] patients had associated anomalies involving other systems; urogenital abnormalities were detected in 50 [25%] patients. The highest incidence of associated genitourinary anomalies were found amongst boys [23] with high type of ARM than in girls [8].Patients with anorectal malformations have a high incidence of associated urogenital anomalies. Evaluation of the common affected organ systems in these patients is essential, because these associated anomalies account for most of the morbidity and mortality

Palynological and ethnobotanical studies of Chrysanthemum leucanthemum l. from gallies [Abbottabad], N.W.F.P., Pakistan

Pollen morphology of Chrysanthemum leucanthemum L. growing wild in grassy places in Gallies, Abbottabad, was studied. The genus is characterized by 3-colporate pollen grains with spheroidal to oblate-spheroidal outline. Tectum with subechinate processes

Palynological study of pinaceae of Hazara, N.W.F.P. [Pakistan]

Pollen morphology of five species [4 genera] of Pinaceae from Hazara, N.W.F.P., Pakistan was studied. The family Pinaceae is characterised by bisaccate pollen grains with spheroidal to sub-spheroidal outline. Tectum is psilate or with scabrate processes

Urethral stricture disease: a review of 100

A prospective study on 100 cases of urethral stricture seen at the Sindh Institute of Urology and Transplantation, revealed majority [41] of them to be in the 3rd to 5th decade of life. They belonged mostly [78] to the urban areas and the commonest site was bulbar part [43] followed by membranous urethra in 36 cases. Sixty two patients presented with retention of urine, 28 with stream problems and 10 with recurrent UTI. Road traffic accidents [42] and falls [21] were the most common causes of stricture development. Fifty nine cases were treated with urethral dilatation, 20-by optical urethrotomy and 21 by urethroplasty. We recommend optical urethrotomy for simple and short strictures, urethroplasty for complex strictures and dilation for superficial, post-TURP and shincteric strictures or elderly, unfit patients

Prediction of renal function recovery in opstructive renal failure due to stones

Two hundred and thirty-nine patients with renal and ureteric calculi associated with renal failure were evaluated for recovery potential before definitive surgery. Ultrasonography was carried out pre-operatively in all, followed by percutaneous nephrostomy [PCN] as an initial management before definitive surgery. Diethylene triamine penta acetic acid [DTPA] scan was done in 125 patients after percutaneous nephrostomy, findings of pre- operative DTPA scan were correlated with post-operative drop in serum creatinine. Urine pH, urine Na+, initial diuresis, creatinine clearance and serum creatinine were measured serially after 24 hours and then every week for 6 weeks. Patients were re-evaluated with serum creatinine after 3 months of surgery. Ultrasonography was found to be reliable in predicting future recovery of renal functions in 76.5% cases and true obstruction of shorter duration [F4-group] on DTPA scan in 81.9% cases. Urine pH of 6 or less, post-PCN diuresis and natriuresis were good prognostic indicators. PCN was found to be most reliable method of predicting future recovery of renal function after relief of obstruction with 97.8% accuracy

Comparison of intraocular lens power calculation using the binkhorst and SRK formulae: a clinical study

Comparison of results of intraocular lens implants with IOL powers obtained by Binkhorst and SRK Linear Regression formulae was done using various models and brands of intraocular lenses. Of 887 pseudophakic patients, 415 patients received IOL's with their powers calculated for planned emmetropia, by means of theoretic formula devised by R.D. Binkhorst and in the remaining 472 eyes the IOL power was calculated with the SRK Linear Regression method. No significant difference [P<0.05] was found between visual acuities, obtained with IOL's alone or after postoperative overcorrection of residual refractive errors between the two groups

Management of urinary calculi associated with renal failure

Three hundred and sixty patients of urinary calculi associated with renal failure were included in this prospective study. The male to female ratio was 4.1:1 while adult to paediatric ratio was 6.5:1. One hundred and eighteen [32.8%] patients presented with calculus anuria while 242 [67.2%] were admitted with symptoms of chronic renal failure. Serum creatinine at the time of first admission ranged form 3-35 mg/100 ml. In the initial management, precutaneous needle nephrostomy was done in 217 cases, dialysis in 106, dialysis and PCN in 22 and retrograde catheterization followed by JJ stent in 15. Definitive surgical procedures were undertaken in 277 cases; 29 passed stones spontaneously after PCN. At two year follow-up 72% patients of calculus anuria and 49.5% of calculus renal failure improved their renal function and remained with serum creatinine below 2 mg/100 ml. There was 13.6% mortality in calculus anuria group and 17.4% in calculus renal failure. Overall loss to follow-up was 7.6% and 12% in the two groups respectively

review of 1000 cases of intraocular lens implantation

One thousand cases of cataract extraction with Intraocular lens implantation done at Shaikh Zayed Postgraduate Medical Institute, Lahore are reviewed. Pre and post-operative visual status is compared. The power of IOL to be implanted was determined by Estimation method in 34% and by Biometric computation in 66% of patients. lOLs were implanted under a cushion of air in 48% of cases and with the help of a viscoelastic substance in 52%. Final best corrected visual acuity of 6/12 or better was achieved in 88.6% of the patients who completed the follow up study period. Post-operative complications are discussed. A comparison of results with two international studies is presented