Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy.

OBJECTIVE: To assess proliferative diabetic retinopathy (PDR) and to describe the difference in angiographic representation of new vessels (NVs) and Intra retinal microvascular abnormalities (IRMA) on optical coherence tomography angiography (OCTA). METHODS: A cross-sectional observational study was performed at ISRA Postgraduate Institute of Ophthalmology, Karachi, from March 2018 to September 2018. Forty-two eyes of 21 patients with history of diabetes mellitus (DM) were examined. Twenty-eight eyes with a clinical diagnosis of severe non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) according to early treatment diabetic retinopathy study (ETDRS) were included and evaluated using Swept source optical coherence tomography angiography (SS-OCTA). Then face wide field SS-OCTA images and co registered structural optical coherence tomography (OCT) with flow overlay were used to distinguish the features of IRMA and retinal NVs. RESULTS: Forty-two eyes (21 patients) were examined clinically. Fourteen eyes had moderate NPDR, 15 had severe NPDR and 13 eyes had changes consistent with PDR. After clinical diagnosis, we included 28 eyes in our study based on inclusion criteria. These 28 eyes went through SS-OCTA evaluation and we observed 15 cases with PDR and 13 with severe NPDR changes. The OCTA and clinical diagnosis were similar except in 2 eyes, which is critical but not statically significant showing the importance of this noninvasive technology. CONCLUSIONS: Widefield OCTA can work as an alternative to fundus fluorescein angiography (FFA) in the diagnosis of diabetic retinopathy (DR). As it is a non-invasive and depth encoded technique so can be used frequently to monitor the retinal changes and their progression.

Cross-cultural validation of the Urdu translation of the Patient Health Questionnaire for Adolescents among children and adolescents at a Pakistani school.

OBJECTIVES: There is a high prevalence of depressive disorders among children and adolescents globally, accounting for 45% of disability-adjusted life years among 10- to 24-year-olds. Although it has been recognized as a major public health concern in Pakistan, there have been no studies exploring the development or cross-cultural validation of instruments for screening and assessing the severity of adolescent depression. Therefore, the present study was designed to validate the Urdu translation of the Patient Health Questionnaire for Adolescents (PHQ-A) among Pakistani children and adolescents. STUDY DESIGN: This is a cross-sectional study. METHODS: A total of 452 children and adolescents responded to a survey comprising demographic characteristics, the Urdu translation of PHQ-A, and the Urdu version of Strengths and Difficulties Questionnaire (SDQ). It was hypothesized that total scores on the PHQ-A would correlate significantly with the SDQ scores. Reliability analysis and exploratory factor analyses were carried out using SPSS v.20. Additional confirmatory factor analyses were conducted using the FACTOR program. RESULTS: No floor and ceiling effects were reported for PHQ-A total scores. Factor analysis confirmed good results for language interchangeability and unidimensionality among the sampled adolescents. Similarly, the findings showed good internal consistency (Cronbach's alpha 0.76), test-retest reliability (intraclass correlation coefficient = 0.61; 0.53-0.68), and concurrent validity. CONCLUSION: The Urdu translation of the PHQ-A is a valid and reliable instrument for assessing depression among Pakistani adolescents, based on the Diagnostic and Statistical Manual diagnosis criteria.

Macrophage Migration Inhibitory Factor and microRNA-451a in Response to Mindfulness-based Therapy or Treatment as Usual in Patients with Depression, Anxiety, or Stress and Adjustment Disorders.

Background: Macrophage migration inhibitory factor is a proinflammatory cytokine that has been associated with various psychiatric disorders. MicroRNA-451a can directly target macrophage migration inhibitory factor and downregulate its expression in cells. However, the role of macrophage migration inhibitory factor and microRNA-451a in psychiatric patients treated with psychotherapeutic interventions is unknown. In this study, our aim was to investigate levels of macrophage migration inhibitory factor and its regulating microRNA-451a in patients with depression, anxiety, or stress and adjustment disorders who underwent mindfulness-based therapy or treatment as usual. Methods: A total of 168 patients with psychiatric disorders were included from a randomized controlled trial that compared mindfulness-based therapy with treatment as usual. Plasma levels of macrophage migration inhibitory factor and microRNA-451a were measured at baseline and after the 8-week follow-up using Luminex assay and qPCR. Results: Macrophage migration inhibitory factor levels decreased significantly in patients posttreatment, whereas microRNA-451a levels showed a nonsignificant change. Macrophage migration inhibitory factor levels were inversely associated with microRNA-451a expression levels at baseline (ß=-0.04, P=.008). The change in macrophage migration inhibitory factor levels (follow-up levels minus baseline levels) was associated with the change in microRNA-451a (follow-up levels minus baseline levels) (ß=-0.06, P < .0001). The change in either macrophage migration inhibitory factor or microRNA-451a was not associated with improvement in psychiatric symptoms. Conclusion: We demonstrate that the levels of macrophage migration inhibitory factor decreased after psychotherapeutic interventions in patients with psychiatric disorders. However, this reduction was not associated with an improvement in psychiatric symptoms in response to the treatment. We also found an association between macrophage migration inhibitory factor and its regulating microRNA. However, this association needs to be further examined in future studies.

Dietary effects of soy and citrus flavonoid on antioxidation and microbial quality of meat in broilers.

The current study investigated dietary effects of soy genistein (SG) and citrus hesperidin (CH) on microbial spoilage and antioxidant quality of chicken meat. Broilers were divided to six treatment groups: control (C), SG and CH, supplemented with 5 mg of SG and 20 mg of CH per kg of feed, respectively, and SGCH1, SGCH2 and SGCH3, supplemented with 5, 10 or 20 mg of SG + CH (1:4) per kg of feed respectively. Both SG and CH reduced (p < .01) the microbial load of spoilage organisms in breast meat at 0 and 15 days of refrigeration. Hepatic and muscle total antioxidant and superoxide dismutase activities, and crude protein contents were generally improved (p < .05), whereas hepatic malondialdehyde concentration and muscle fat was decreased (p < .01) by the dietary treatments. In conclusion, soy genistein and CH supplementation could improve meat composition, antioxidant and microbial quality of broilers meat.

What factors are important in smoking cessation and relapse in women from deprived communities? A qualitative study in Southeast England.

OBJECTIVES: Women are relatively more susceptible to smoking-related diseases and find it more difficult to quit; however, little research exists on factors associated with smoking cessation and relapse in women. We examined attitudes towards and perceptions of factors associated with smoking cessation and relapse in women from deprived communities. STUDY DESIGN: Qualitative interview study. METHODS: Participants included eleven women, smokers and ex-smokers, from disadvantaged communities in East Sussex, England, who had used the National Health Service (NHS) stop smoking service. Data were collected through a focus group and semi-structured interviews, and subjected to thematic analysis. RESULTS: Participants opined that it is more difficult for women to quit smoking than men. Women felt that postcessation weight gain was inevitable and acted as a barrier to quitting. Hormonal fluctuations during the menstrual cycle and greater levels of stress were perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited effects of smoking on physical appearance, oral hygiene and guilt about exposing children to passive smoke as powerful motivators to quit; and highlighted the impact of public health campaigns that focused on these factors. Views diverged on whether quitting with someone close to you is a help or hindrance. Other themes including alcohol intake, daily routine and being in the presence of smokers emerged as situational triggers of relapse. CONCLUSIONS: Interventions that address women's concerns related to postcessation weight gain, hormonal fluctuations during the menstrual cycle and stress may aid with smoking cessation and reduce relapse. Public health campaigns should consider the impact of smoking on physical appearance and the effect of passive smoke on children.

Helicobacter pylori downregulates expression of human ß-defensin 1 in the gastric mucosa in a type IV secretion-dependent fashion.

Helicobacter pylori establishes a chronic lifelong infection in the human gastric mucosa, which may lead to peptic ulcer disease or gastric adenocarcinoma. The human beta-defensins (hßDs) are antimicrobial peptides, hßD1 being constitutively expressed in the human stomach. We hypothesized that H. pylori may persist, in part, by downregulating gastric hßD1 expression. We measured hßD1 and hßD2 expression in vivo in relation to the presence, density and severity of H. pylori infection, investigated differential effects of H. pylori virulence factors, and studied underlying signalling mechanisms in vitro. Significantly lower hßD1 and higher hßD2 mRNA and protein concentrations were present in gastric biopsies from infected patients. Those patients with higher-level bacterial colonization and inflammation had significantly lower hßD1 expression, but there were no differences in hßD2. H. pylori infection of human gastric epithelial cell lines also downregulated hßD1. Using wild-type strains and isogenic mutants, we showed that a functional cag pathogenicity island-encoded type IV secretion system induced this downregulation. Treatment with chemical inhibitors or siRNA revealed that H. pylori usurped NF-κB signalling to modulate hßD1 expression. These data indicate that H. pylori downregulates hßD1 expression via NF-κB signalling, and suggest that this may promote bacterial survival and persistence in the gastric niche.

The association between apolipoprotein M and insulin resistance varies with country of birth.

BACKGROUND AND AIMS: Risk of type 2 diabetes mellitus (T2DM) differs according to ethnicity. Levels of apolipoprotein M (ApoM) have been shown to be decreased in T2DM. However, its role in different ethnicities is not known. We examined the differences in plasma ApoM levels in Swedish residents born in Iraq (Iraqis) and Sweden (Swedes) in relation to T2DM and insulin resistance (IR). METHODS AND RESULTS: Iraqis and Swedes, aged 45-65 years residing in Rosengård area of Malmö were randomly selected from census records and underwent an oral glucose tolerance test. Plasma levels of ApoM were quantified in 162 participants (Iraqis, n = 91; Swedes, n = 71) by a sandwich ELISA method. Age-, sex-, and body mass index (BMI) adjusted plasma ApoM levels differed by country of birth, with Swedes having 18% higher levels compared to Iraqis (p = 0.001). ApoM levels (mean ± SD) were significantly decreased in Swedes with T2DM (0.73 ± 0.18) compared to those with normal glucose tolerance (NGT) (0.89 ± 0.24; p = 0.03). By contrast, no significant difference in ApoM levels was found between Iraqis with T2DM (0.70 ± 0.17) and those with NGT (0.73 ± 0.13; p = 0.41). In multivariate linear regression analysis with an interaction term between IR and country of birth, low ApoM levels remained significantly associated with IR in Swedes (p = 0.008), independently of age, sex, BMI, family history of diabetes, HDL, LDL, and triglycerides, but not in Iraqis (p = 0.35). CONCLUSION: Our results show that ApoM levels differ according to country of birth and are associated with IR and T2DM only in Swedes.

Effect of ascorbic acid concentrations, methods of cooling and freezing on Boer goat semen cryopreservation.

To improve the Boer goat semen quality during cryopreservation process, three experiments were carried out to investigate the effect of (i) different concentration of ascorbic acid supplementation (ii) rate of cooling with chilled semen characteristics and (iii) method of freezing on post-thaw Boer goat sperm using Tris-based extender. Ascorbic acid at 8.5 mg/ml improved the sperm parameters (motility, integrity of membrane and acrosome, morphology and viability), compared to control in cooled samples (p < 0.05). With regard to other concentrations and post-thawed parameters, ascorbic acid at 2.5-8.5 mg/ml led to higher percentages of sperm motility and integrities of membrane and acrosome when compared to control (p < 0.05). Slow cooling rises to higher percentages of sperm motility, acrosome integrity and viability, in comparison with fast cooling, in terms of cooled and frozen samples (p < 0.05). Programmable freezing method produced the higher percentages of sperm motility, integrities of membrane and acrosome and viability when compared to the freezing method of polystyrene box during goat sperm freezing (p < 0.05). In conclusion, chilled and post-thawed sperm quality of Boer goat was improved when a Tris-based extender supplemented with ascorbic acid was used at stages of different cooling rates and freezing methods.

THE SIGNIFICANCE OF EPIDERMAL GROWTH FACTOR RECEPTOR AND SURVIVIN EXPRESSION IN BLADDER CANCER TISSUE AND URINE CYTOLOGY OF PATIENTS WITH TRANSITIONAL CELL CARCINOMA OF THE URINARY BLADDER.

OBJECTIVE: To assess whether epidermal growth factor receptor (EGFR) and survivin immunostaining of tumour cells in urinary cytology and tissue of patients with bladder cancer has a prognostic significance. DESIGN: Prospective study SETTING: Department of Surgery (Division of Urology), Mubarak Al-Kabeer Teaching Hospital and Faculty of Medicine, Kuwait University, Kuwait SUBJECTS: Urine cytology smears obtainedpriorto cystoscopy in patients with transitional cell carcinoma (TCC) of the bladder were immunostained for EGFR and survivin. Bladder cancer tissue resected at surgery was also immunostained for EGFR and survivin expression. Tissue expression of EGFR and survivin in TCC of the bladder was compared to their expression in urine cytology and relationship to tumour grade and stage. RESULTS: 178 patients were studied (43 newly diagnosed bladder cancer, 58 with recurrent TCC and 77 in disease remission). Twenty five patients with normal urothelium served as controls. The mean sensitivity of urine cytology, tissue survivin immunohistochemistry (IHC) and tissue EGFR IHC was 30.5%, 62% and 59% respectively. The corresponding mean specificity was 95%, 79% and 38% respectively. For grades 1, 2 and 3 bladder tumors, tissue expression positivity for EGFR was 47.8%, 92.9%, 100% and for tissue survivin it was 27.8%, 18.2% and 33.3% respectively. For grades 1, 2 and 3 bladder tumors, urine expression positivity for EGFR was 35.7%, 40% and 67.7% and for urine survivin it was 8.3%, 42.9% and 33.3% respectively. CONCLUSION: Positive EGFR immunostaining of urine cytology specimen or tumour tissue increases with histological grade of TCC of the bladder. Survivin expression is less consistent in both urine cytology specimen and tissue samples. EGFR immunostaining may provide a useful tool in the grading of bladder TCC and aid in the selection of patients that may benefit from administration of EGFR inhibitors.

Supratotal Resection: An Emerging Concept of Glioblastoma Multiforme Surgery-Systematic Review And Meta-Analysis.

BACKGROUND: The severe neurologic tumor known as glioblastoma (GBM), also referred to as a grade IV astrocytoma, is rapidly progressive and debilitating. Supratotal resection (SpTR) is an emerging concept within glioma surgery, which aims to achieve a more extensive resection of the tumor than is possible with conventional techniques. METHODS: We performed a language-independent search of PubMed, Scopus, and Cochrane CENTRAL to identify all available literature up to August 2022 of patients undergoing SpTR assessing survival outcomes in comparison to other surgical modalities. RESULTS: After screening for exclusion, a total of 13 studies, all retrospective in design, were identified and included in our meta-analysis. SpTR was associated with significantly increased overall survival (hazard ratio 0.77, 95% CI 0.71-0.84; P < 0.01, I2 = 96%) and progression-free survival (hazard ratio 0.2, 95% CI 0.07-0.56; P = 0.002, I2 = 88%). CONCLUSION: SpTR is associated with greater overall survival and PFS when compared with other glioblastoma surgeries like GTR or SubTR.

Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

BACKGROUND AND AIM: While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population. METHODS: This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA. RESULTS: Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the second week of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients. CONCLUSIONS: The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.

Correction: Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

[This corrects the article DOI: 10.7759/cureus.48994.].

PET imaging of patients with non-small cell lung cancer employing an EGF receptor targeting drug as tracer.

BACKGROUND: We have previously developed (11)C-erlotinib as a new positron emission tomography (PET) tracer and shown that it accumulates in epidermal growth factor receptor (EGFR)-positive lung cancer xenografts in mice. Here, we present a study in patients with non-small cell lung cancer (NSCLC) investigating the feasibility of (11)C-erlotinib PET as a potential method for the identification of lung tumours accumulating erlotinib. METHODS: Thirteen patients with NSCLC destined for erlotinib treatment were examined by contrast-enhanced computed tomography (CT), (11)C-erlotinib PET/low-dose CT and (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET/low-dose CT before start of the erlotinib treatment. After 12 weeks treatment, they were examined by (18)F-FDG PET/contrast-enhanced CT for the assessment of clinical response. RESULTS: Of the 13 patients included, 4 accumulated (11)C-erlotinib in one or more of their lung tumours or lymph-node metastases. Moreover, (11)C-erlotinib PET/CT identified lesions that were not visible on (18)F-FDG PET/CT. Of the four patients with accumulation of (11)C-erlotinib, one died before follow-up, whereas the other three showed a positive response to erlotinib treatment. Three of the nine patients with no accumulation died before follow-up, four showed progressive disease while two had stable disease after 12 weeks of treatment. CONCLUSION: Our data show a potential for (11)C-erlotinib PET/CT for visualizing NSCLC lung tumours, including lymph nodes not identified by (18)F-FDG PET/CT. Large clinical studies are now needed to explore to which extent pre-treatment (11)C-erlotinib PET/CT can predict erlotinib treatment response.

Sonographic fetal biometry charts for a Pakistani cohort.

This study aimed to develop growth centiles at different gestational weeks for fetal biparietal diameter, abdominal circumference, femur length and head circumference in a Pakistani cohort. Data were collected at a tertiary referral hospital from pregnant women at gestational ages 13-40 weeks referred for obstetric ultrasound as a part of routine antenatal care. A total of 1599 fetal sonographic biometric measurements were collected after screening for the inclusion criteria. For each measurement, separate regression models were derived to estimate the mean, standard deviation and reference percentiles at each week of gestational age for this cohort. The best fitting model for each variable was selected. These charts will help radiologists and clinicians in predicting dates of delivery, assessing fetal growth and identifying intrauterine fetal insufficiency in the Pakistani population.

Management of ruptured amoebic liver abscess: 22-years experience.

BACKGROUND: Amoebiasis affects approximately 10% of the population all over the world. Amoebic liver abscess (ALA) is the commonest complication of amoebiasis affecting 3-9% victims. It is an ancient disease as Hippocrates notified large hepatic abscesses likely to be amoebic abscesses. Objective of this study was to see the efficacy of conservative treatment in the management of ruptured amoebic liver abscess. METHODS: Record of 1,083 patients of amoebic liver abscess, who were treated and managed at Liaquat University Hospital between January 1986 and December 2007, was reviewed retrospectively. Amongst these, 36 (3.32%) patients, found to have intra-peritoneal rupture of the liver abscess were included in this study. The record of these patients was reviewed. The patients were divided into group A and B depending upon the mode of treatment employed. Group A included 16 (44.44%) patients in whom exploratory laparotomy was performed while group B included 20 (55.55%) patients who were treated conservatively. RESULTS: Group A consisted of 16 (44.4%) patients who underwent laparotomy for acute peritonitis due to non-availability of ultrasound in the initial period of the study. In group B, all twenty patients were treated conservatively after a diagnosis of ruptured amoebic liver abscess made by ultrasound guided percutaneous aspiration of pus. These patients were treated with ultrasound guided aspiration of pus with placement of peritoneal drain under local anaesthesia. Six patients in group A died compared to one patient in group B. the overall mortality of ruptured amoebic liver abscess was 19.4%. It was higher in patients treated surgically (37.5%) compared to patients who were treated conservatively (5%). CONCLUSION: Conservative treatment is an effective modality of treatment for ruptured liver abscess with minimum mortality and mortality if diagnosis is made early.

High-risk behaviours among juvenile prison inmates in Pakistan.

OBJECTIVES: To assess the sexual- and drug-use-related risk behaviours of male juvenile detainees in Karachi, Pakistan. DESIGN: Cross-sectional study. METHODS: A cross-sectional study was conducted of prison inmates aged 15-21 years in Karachi Juvenile Prison in 2002. In total, 321 inmates were interviewed about sexual orientation and behaviours, and knowledge about human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Urine specimens were collected and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction. RESULTS: A substantial proportion (n=111, 34.6%) of the participants were sexually active. Sixty-two (19%) and 67 (21%) had had sex with a male or female before incarceration, respectively. Twenty-seven (8.4%) participants had an STI, and 50% of the 109 sexually active participants had had multiple sexual partners. Use of addictive substances was associated with sexual activity. The mean knowledge score computed from the sum of 16 items was 4.7, with a median of 2.9. A large proportion (40%) of participants knew about condoms, but very few (3.4%) had ever used one. The mean+/-standard deviation risk score from nine items was 2.4+/-1.7. On the basis of behavioural and biological markers, 117 (36.4%) participants had high-risk behaviour. In multivariate logistic regression analysis, knowledge, risk perception and age were predictive of higher risk. CONCLUSIONS: HIV risk behaviours are common among adolescent inmates. Although inmates do have knowledge about modes of transmission and condom use, the use of condoms is significantly low. Interventions are needed for behavioural change among this group.

Spectrophotometric determination of tranexamic acid using vanillin.

A new spectrophotometric method has been examined for the determination of the tranexamic acid (TA) by derivatization with vanillin (VAN). The molar absorptivity of TA was calculated 25,160 L x mol(-1) x cm(-1) at lambdamax 354 nm and obeyed the Beer's law within 0.5-2.5 microg x mL(-1). The color reaction was highly stable and did not show any change in absorbance up to 24 h. The method was applied for the analysis of TA from capsules, injections and tooth pastes. The amounts of TA found in capsules, injections and tooth pastes of various pharmaceutical companies were observed with 249.0-250.9 mg/capsule, 249.3-250.7 mg/injection and 0.048%-0.049% in tooth pastes with relative standard deviation (RSD) 0.2%-5.0% (n = 3).

Determination of cadmium in whole blood and scalp hair samples of Pakistani male lung cancer patients by electrothermal atomic absorption spectrometer.

A large number of epidemiologic studies have been undertaken to identify potential risk factors for cancer, amongst which the association with cadmium has received considerable attention. There is compelling evidence in support of positive associations between cadmium and risk of lung cancer. In present study we measured the concentration of Cd in whole blood and scalp hair samples of 120 male lung cancer patients (smokers) and 150 controls or referents (smokers and nonsmokers) from different cities of Pakistan. Both referents and patients were of same age group (ranged 40-70 years), socio-economic status, localities and dietary habits. The scalp hair and whole blood samples were oxidized by 65% nitric acid: 30% hydrogen peroxide (2:1) ratio in microwave oven. To check the validity of the proposed method, a conventional wet acid digestion method was used to obtain total Cd concentration in certified samples of human hair BCR 397 and Clincheck control-lyophilized human whole blood. All digests were analyzed for Cd concentration by electrothermal atomic absorption spectrometer (ETAAS). The results of this study showed that the average Cd concentration was higher in the blood and scalp hair of lung cancer patients at different stages as compared to controls (p<001). The smoker referents have high level of Cd in both biological samples as compared to nonsmoker subjects. These results illustrate that the patients who continued smoking after confirmed diagnosis of lung cancer have 34.2-67.26 and 22.4-57.3% more Cd in blood samples and scalp hair than lung cancer patients who cease smoking. This study is compelling evidence in support of positive associations between cadmium, cigarette smoking and lung cancer risk.

Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan.

BACKGROUND: The study was planned to review the case series of pregnant women requiring intensive care due to severe acute maternal morbidity in the public sector university hospital, in order to identify failures and priorities in maternal health care provision in Pakistan. METHODS: A retrospective case series study was performed of critically ill obstetrics patients admitted to general intensive care unit of Liaquat University Hospital Hyderabad, Pakistan, from January 1st to 31st December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. RESULTS: Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three % of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy (50%) and sepsis (17%) were the two main obstetrical conditions responsible for maternal illness. Respiratory failure (57%) and haemodynamic instability (40%) were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support (33%). The foetal mortality rate was 43%, while maternal mortality rate was 33%. CONCLUSION: Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive intervention through a team approach involving obstetricians, intensivists and anaesthetists.

Congenital hernias of the diaphragm in children.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a major congenital malformation. Different types have been described. Bochdalek hernia (BH) remains most prevalent with high mortality rates. Other variants are less common and carry good prognosis. Although, the diagnosis can be made antenatally, the presentation may be delayed. There is paucity of national literature on CDHs. We present our experience with these challenging paediatric malformations. METHODS: Medical records of 18 patients (< or =14 years) treated by the group of authors between October 1998 and April 2002 were retrospectively reviewed and demographic data, clinical presentation, morbidity and outcome were studied. RESULTS: There were 13 (72%) children with Bochdalek hernia, 2 (11%) with eventration of the diaphragm, 2 (11%) with hiatus hernia and 1(6%) with a Morgagni hernia. The lesions were more common in girls and all the defects were left sided. The average age at the time of presentation of BH was 23 hours (2 to 72 hours) commonly presenting with cyanosis and respiratory distress. Associated anomalies were documented in 10 (77%) cases; six had multiple malformations and four died before surgery. In other types of CDHs, the mean age at presentation was 39 (18-60) months and they mostly presented with recurrent respiratory tract infections and/or mild gastrointestinal symptoms. Diagnosis was made on history, physical examination, plain x-ray chest, and gastrointestinal contrast study, when required. 14 (78%) children were operated and a sac was present in 5. Post-operative complications occurred in 5 (55%) patients with Bochdalek hernia, which were managed conservatively. The overall survival rate was 67% (n=12). CONCLUSION: The different types of CDHs presented from neonatal age to later childhood with distinct symptoms. Surgery was safe and effective. Higher morbidity and mortality was observed in newborns with Bochdalek hernia.