Efficacy of Vitamin C in Lowering Serum Uric Acid.

The objective of the study was to determine the efficacy of vitamin C in reducing serum uric acid (UA). This study was a double-blind placebo-controlled randomized trial conducted in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh from July 2007 and August 2008. Study participants were included from out patient department (OPD) of Rheumatology of BSMMU suffering from various Rheumatological problems other than gouty arthritis. All of the participants were non-smokers, non-alcoholics, and randomized to take either placebo or vitamin C (500 mg/day) for 12 weeks. A total of 98 subjects were enrolled in the study; 71 completed the trial, with 34 in the placebo group and 37 receiving vitamin C. Serum uric acid levels were not significantly reduced in the experimental group and they increased in the placebo group. In the vitamin C group, the mean change was -0.32mg/dl [95% confidence interval -0.73, 0.77], whereas in the placebo group, the mean change was +0.12mg/dl [95% confidence interval was -0.22, 0.47]. Subgroups were defined by sex, body mass index, and quartiles of baseline serum uric acid levels. In a subgroup analysis, vitamin C lowered serum uric acid significantly in those who had comparatively higher baseline uric acid levels. Although vitamin C did not lower serum uric acid significantly, participants with higher baseline serum uric acid levels experienced a significant uric acid lowering effect, but as the sample size was very small, it is difficult to draw any definitive conclusion.

Thrombolysis of acute portal vein thrombus.

We report a middle-aged woman who presented with postpartum acute severe central abdominal pain. Portal vein, thrombosis was diagnosed by ultrasonography and confirmed by splenoportogram. She received thrombolytic therapy with symptomatic improvement and gradual disappearance of the thrombus on ultrasound. Early thrombolytic therapy seems to be effective in the treatment of acute portal vein thrombosis.

Self-esteem in a palliative care population.

OBJECTIVE: To study the effects of palliative care treatment in cancer patients, on their self-esteem. DESIGN AND SETTING: It was a cross-sectional study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan (SKMCH & RC). PARTICIPANTS: A total of 60 referred cancer patients receiving palliative care were interviewed using the Mehrabian self-esteem scale (MSE). No follow-up was required. All the patients were over 16 years of age. The sample was not restricted to any one type of cancer. Since lack of education could be a contributing factor, only patients who had a minimum of an eighth-grade education were included in the study. RESULTS: Four variables were studied: gender, age, diagnostic-related group, and performance status. Performance status was determined using the Eastern Cooperative Oncology Group Scale (ECOG). The only significant correlation was between self-esteem and performance status, with a p value of 0.04. CONCLUSION: We conclude that the patients who are functionally active (not disabled) have a higher level of self-esteem, as compared to those who are disabled. This is quite understandable, as the patients who are not dependent on others for their needs feel worthy, resulting in higher self-esteem. This was the first study of its kind done in Pakistan. We identified two limitations. First, the sample size was small. Second, although the Mehrabian self-esteem scale is a valid, reliable, and standardized scale, it was not standardized for the population of Pakistan.

Injuries at school: a review.

Injuries are the leading cause of morbidity and mortality in children older than 1 year, with a significant proportion occurring in the school. This article reviews the past 10 years of literature on school-related injuries. The incidence, types, anatomic locations, sites, and activities related to injuries on school premises are presented. Comprehensive studies in a population where injuries occur in a supervised environment are needed. The role that cooperative programs involving schools, parents, and other agencies can play in developing school safety policies is discussed. Because injuries are common in the daily lives of thousands of school children, a proactive attitude coupled with intensive research on the causes, prevention, and better on-site management would impact immensely or the health status of school-going Texans.

Empyema thoracis: a problem with late referral?

BACKGROUND: Patients are often referred to thoracic units for management of empyema after the acute phase has been treated with antibiotics but without adequate drainage. This study evaluates the effects of delay in surgical treatment of empyema thoracis on morbidity and mortality. METHODS: Thirty nine consecutive patients were studied from January 1991 to June 1992. Two groups (group 1, 16 patients; group 2, 23 patients) were compared depending on the time spent under the care of other specialists before referral to the thoracic unit (group 1, seven days or less; group 2, eight days or more). The reasons for delay in referral were analysed. RESULTS: Four patients were treated conservatively with chest drainage alone (all in group 1). Thirty five patients required rib resection and drainage of their empyema (group 1, 12 patients; group 2, 23 patients). Nineteen (all in group 2) of the 35 patients who had rib resections went on to have decortication. The commonest cause of empyema was post-pneumonic (37 out of 39 patients). Staphylococcus aureus was the commonest organism isolated. Misdiagnosis (five patients), inappropriate antibiotics (six patients), and inappropriate placement of chest drainage tubes (three patients) all contributed to persistence and eventual progression of empyema. The overall mortality was 10% and mortality increased with age. The median stay in hospital was 9.5 days (range 7-12 days, n = 4) for patients treated with closed tube drainage only; 18 days (range 10-33 days, n = 16) for patients who had undergone rib resections and open drainage; and 28 days (range 22-49 days, n = 19) for patients who underwent decortication. The likelihood of having a staged procedure (antibiotics, closed tube drainage, open drainage with rib resection, and finally decortication) increased when closed tube drainage was persevered with for more than seven days. The total hospital stay was positively related with the time before referral for surgical treatment. Anaemia, low albumin concentrations, and worsening liver function were found in group 2 compared with group 1. CONCLUSIONS: Early adequate operative drainage in patients with empyema results in low morbidity, shorter stays in hospital, and good long term outcome. These patients should be treated aggressively and early referral for definitive surgical management is recommended.

Profile of alcoholism in a multiracial society.

Demographic characteristics of all patients with a diagnosis of alcoholism or alcoholic psychoses admitted between 1975 and 1978 to the Psychiatry Department, General Hospital, Kuala Lumpur, were examined. The diagnosis of alcoholism or alcoholic psychoses accounted for 2% of the total psychiatric admissions. Males greatly predominated over females and Indians greatly predominated over Malays and Chinese. Reasons for these differences are discussed.