Functional outcome of Hirschsprung's disease in children: A single center study at The Children's Hospital Lahore.

AIM: Hirschsprung's disease (HD) is a congenital bowel disorder resulting in functional dysmotility. Advancement in surgical techniques has improved outcomes, but recent studies have identified problems having significant impact on patient's quality of life. The aim of this study is to analyze postoperative functional outcome after definitive surgery for Hirschsprung's disease. METHOD: A retrospective study was conducted at the Department of Pediatric Surgery, The Children's Hospital Lahore. The record of 64 patients was reviewed from the year 2009 to 2019. Parents were interviewed on phone calls and a predesigned questionnaire was filled. Degree of constipation, incontinence and voluntary bowel movements was analyzed according to Krickenbeck classification. RESULTS: Median age at initial presentation was 11 days, with male to female ratio of 3.9:1. Most common presentation was delayed passage of meconium (38%). Diagnosis was made on biopsy in 70.3%, but contrast enema and biopsy in 29.7%. Aganglionosis was limited to short segment in 81.3% and long segment in 14.5%. Decompressing enterostomy was made in 63% at a mean age of 191 days. Definitive surgery included Duhamel pull-through in 89.1%. Mean age at follow-up was 10.6 ± 4.19 years and alive patients were 95.4%. Postoperative enterocolitis was reported by 27%, while 35.5% reported fecal incontinence and 16.1% complained of constipation. 80% could voluntarily hold bowel movement, among which 5% had a feeling of urge and 15% had the capacity to verbalize. In 25% of the patients, fecal incontinence was a constant social problem and in 25% of these patients constipation was resistant to diet and laxatives. CONCLUSION: On long-term follow-up, fecal incontinence was more worrisome, affecting quality of life and requiring help of the bowel management program. Such patients need close follow-up after definitive procedure, so that they have normal stooling habits in their adulthood and lead a normal life.

Assessment of the Psychometric Properties of the Organisational Commitment Scale for Physicians in Pakistan.

This study assesses the psychometric properties of Allen and Meyer's three-component model of organizational commitment focusing on physicians in Pakistan and explores the determinants of each form of commitment. The cross-sectional study implemented a self-reported questionnaire at a hospital in Pakistan. Data were collected from 478 permanently employed physicians. This study offers evidence for the generalizability of this model to the health sector, particularly for physicians. Age, experience, and qualification explained the higher commitment levels. This study suggests adjustments to the commitment scale for physicians. Hospital administrations should formulate effective strategies at individual levels to enhance commitment.

Serum osteocalcin is associated with measures of insulin resistance, adipokine levels, and the presence of metabolic syndrome.

OBJECTIVE: Osteocalcin has been reported to influence insulin secretion in experimental animals. We investigated whether serum osteocalcin was associated with measures of insulin resistance, circulating adipokine levels, and the presence of metabolic syndrome (MetSyn). METHODS AND RESULTS: Serum osteocalcin was measured by solid-phase sandwich immunoassay in 1284 blacks (64+/-9 years; 71% women) and 1209 non-Hispanic whites (59+/-10 years; 57% women) belonging to hypertensive sibships. MetSyn was defined per Adult Treatment Panel III criteria. The prevalence of MetSyn was 50% in blacks and 49% in non-Hispanic whites. In each ethnic group, after adjustment for age and gender, osteocalcin levels were inversely correlated with body mass index, fasting glucose and insulin, homeostasis model assessment of insulin resistance, triglycerides, and leptin, and positively correlated with adiponectin (P<0.001 for each variable). In multivariable regression analyses that adjusted for age, gender, smoking, serum creatinine, and statin and estrogen use, osteocalcin levels in the highest quartile (compared with the lowest quartile) were associated with a lower odds ratio (OR) of having MetSyn: OR (95% CI) in blacks, 0.33 (0.23 to 0.46); OR in non-Hispanic whites, 0.43 (0.31 to 0.63). CONCLUSIONS: Serum osteocalcin is associated with measures of insulin resistance, adipokine levels, and the presence of MetSyn, suggesting a novel cross-talk between bone and adipose tissue.

Plasma carboxy-terminal provasopressin (copeptin): a novel marker of insulin resistance and metabolic syndrome.

CONTEXT: Stress-mediated hypothalamic-pituitary-adrenal axis activation, regulated by arginine vasopressin (AVP), may have a role in the pathophysiology of metabolic syndrome (MetSyn). OBJECTIVE: The objective of the study was to investigate whether plasma C-terminal provasopressin fragment (copeptin), a surrogate for circulating AVP, was associated with measures of insulin resistance and presence of MetSyn. DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter, community-based study, investigating novel biomarkers for vascular disease. Participants included 1293 African-Americans (AA) (64 +/- 9 yr) and 1197 non-Hispanic whites (NHW) (59 +/- 10 yr) belonging to hypertensive sibships. MAIN OUTCOME MEASURES: Plasma copeptin levels were measured by an immunoluminometric assay. MetSyn was defined per Adult Treatment Panel III criteria. Generalized estimating equations were used to assess whether plasma copeptin was associated with measures of insulin resistance and MetSyn. RESULTS: The prevalence of MetSyn was 50% in AA and 49% in NHW. In each group, after adjustment for age and sex, plasma copeptin levels significantly correlated with body mass index, fasting plasma glucose and insulin, homeostasis model assessment of insulin resistance, triglycerides, and (inversely) high-density lipoprotein cholesterol (P < 0.05 for each variable). In multivariable logistic regression models that adjusted for age, sex, smoking, statin use, serum creatinine, education, physical activity, and diuretic use, plasma copeptin levels in the highest quartile were associated with an increased odds ratio of having MetSyn compared with bottom quartile: odds ratio (95% confidence interval) in AA, 2.07 (1.45-2.95); in NHW, 1.74 (1.21-2.5). CONCLUSIONS: Our findings indicate a novel cross-sectional association between plasma copeptin and measures of insulin resistance and MetSyn.

Plasma midregional pro-atrial natriuretic peptide is associated with blood pressure indices and hypertension severity in adults with hypertension.

BACKGROUND: Midregional pro-atrial natriuretic peptide (MR-proANP) is a newly described stable fragment of the N-terminal part of pro-atrial natriuretic peptide. We tested the hypothesis that in adults with essential hypertension, plasma levels of MR-proANP would be associated with systolic blood pressure (SBP), pulse pressure, and hypertension severity. METHODS: Participants included 1,034 African Americans (65 +/- 9 years, 72% women) and 880 non-Hispanic whites (61 +/- 9 years, 55% women) belonging to sibships ascertained on the basis of hypertension. MR-proANP was measured by an immunoluminometric assay. Hypertension severity was based on number of hypertension medication classes used and multiples of SBP and diastolic blood pressure (DBP) deviations from 120/70 mm Hg. Generalized estimating equations were used to assess whether plasma levels of MR-proANP were associated with SBP, pulse pressure, and hypertension severity independent of potential confounding variables. RESULTS: In African Americans, after adjustment for age, sex, body mass index, estimated glomerular filtration rate (eGFR), smoking history, diabetes, total cholesterol, high-density lipoprotein cholesterol, medication (beta-blocker, statin, and aspirin) use, and previous history of myocardial infarction or stroke, higher MR-proANP levels were significantly associated with greater SBP (P < 0.0001), pulse pressure (P < 0.0001), and hypertension severity (P = 0.0013). The associations were replicated in non-Hispanic whites; after adjustment for the above variables, higher MR-proANP levels were significantly associated with greater SBP (P = 0.013), pulse pressure (P = 0.0006), and hypertension severity (P = 0.028). CONCLUSION: Plasma MR-proANP may be a marker of arterial stiffness and severity of hypertension in adults with hypertension.