Has the significance of incidental findings on unenhanced computed tomography for urolithiasis been overestimated? A retrospective review of over 800 patients

Objectives: To evaluate the detection of clinically unsuspected pathologies using 64-slice multidetector computed tomography (CT) of the abdomen in patients with flank pain. The presence of significant incidental findings (those warranting immediate management) was also correlated with that of urolithiasis, to assess potential changes of management.PATIENTS AND Methods: The study included 899 patients undergoing CT in a 6-month period between June and December 2008. Patients who were referred from outside, with no medical record in the hospital where the study was conducted, and those who were lost to follow-up, were excluded. All of the CT examinations were reported after a radiology resident and a consultant radiologist with \u3e4years of experience evaluated the CT. Genitourinary and extra-genitourinary findings were assessed and divided into clinically significant or not.Results: The overall incidence of additional and incidental findings was 14%. Besides urolithiasis and obstruction there were 34 (28%) genitourinary findings and 87 (72%) extra-genitourinary findings; most of the former were insignificant. Of the extra-genitourinary findings, significant diagnoses were documented in 34 cases.CONCLUSIONS: Abdominal multidetector CT detects more incidental findings which are clinically significant

Somatic embryogenesis, biochemical alterations and synthetic seed development in two varieties of coriander (Coriandrum sativum L.)

Somatic embryogenesis (SE), biochemical alterations and syntheticseed formation were carried out in two Coriandrum sativum L. varieties(Rajendra Swathi ‘RS’ and Co-1). Callus was induced profusely in 1.0 mg/l 2,4-dichlorophenoxy acetic acid (2,4-D) added MS medium but Co-1 had more callus induction frequency (96.0%) compared to RS (89.3%). The callus turned into embryogenic tissue and variable embryogenic frequency (77.6% in RS and 72.8% in Co-1) was noted. Somatic embryos started to differentiate on the same 2,4-D added medium but the numbers of somatic embryos were more in RS (63.0 embryos per culture) compared to Co-1 (51.0 embryos per culture). These somatic embryos progressed well and showed maximum maturation inRS (78.7%) in 0.25 mg/l 6-benzyl adenine (BA) + 0.5 mg/l α-naphthalene acetic acid (NAA) added medium. The biochemical analyses of non-embryogenic-, embryogenic-callus and different stages of embryos were conducted in order to know the changes of physiology in different tissues. Sugar and proline content were noted to be high at embryo induction stage while protein level was higher at embryo maturation stage. Biochemical analysis also revealed that the catalase(CAT) and superoxide dismutase (SOD) activities were higher at maturation stage of embryos compared to other embryogenic stages. Matured somatic embryos were germinated in MS added with 1.0 mg/l BA + 0.5 mg/l gibberellic acid (GA3) in which 83.3% and 76.7% plantlet regeneration were noticed in RS and Co-1 respectively. Somatic embryos were encapsulated in various alginate and calcium chloride (CaCl2) solutions and were kept in different temperature regimes for varied periods. On regeneration medium, the encapsulated embryos germinated into plantlets; in 3% sodium alginate + 100 mM CaCl2,maximum plant regeneration (74.0% in RS and 70.6% in Co-1) was noted. The influence of low temperature on storage of synthetic seeds and their conversion into plantlets were also studied and we noted that the 4°C was the optimum temperature for synthetic seed conservation and plantlet regeneration compared to -20°C and 25oC temperature conditions

EFFECT OF VERTICAL TRAILING ON VEGETATIVE, REPRODUCTIVE AND YIELD OF LUFFA AS INTERCROP IN COCONUT FIELD

Abstract Intercropping trial in coconut (Cocos nucifera L), was carried out for generating more income/yield. The experiment was conducted at Coastal Agricultural Research Station (CARS) Farm, PARC, Karachi. The Tori varieties planted ridge gourd (Luffa acutangulla Roxb.) and sponge gourd (Luffa cylindrica L.) under the trail staked and unstaked Tori were grown satisfactory under coconut plot. The results showed that the staked method compared to unstaked had 30-35% increase in yield and also insect pest protection. The yield data recorded showed that staked gave maximum yield. It was also found that the intercropping did not affect the agronomic trails and yield of the coconut, but increase the yield compared to palms alone

Relationship among Fatness, Blood Lipids, and Insulin Resistance in Pakistani Children

Observations on associations between fatness and metabolic risks among South-East Asian adults have resulted in devising lower thresholds of body mass index (BMI) for them. Metabolic abnormalities, including type 2 diabetes, are now also appearing in children and are associated with obesity. There has not been much work done to identify indicators of metabolic risks among South Asian children. This study was undertaken to observe the relationship among fatness, blood lipids, and insulin resistance in Pakistani children. Fatness, lipids, and insulin resistance were assessed in 92 middle-class Pakistani school children aged 8-10 years. Height, weight, waist, hips, mid-arm circumference, and triceps skin-fold, measured in school, were used for calculating various indicators of fatness, i.e. BMI, waist hip ratio (WHR), and arm-fat percentage. Fasting blood samples were analyzed for total lipids, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and insulin levels. Homeostasis model assessment (HOMA) index was calculated to assess insulin resistance. Two separate multiple regression models of various risk indicators (family history, sex, BMI, WHR, arm-fat percentage) showed that only arm-fat percentage had a significant positive association both with insulin levels (b=2.04, p= 0.044) andLDL (b= 2.11, p= 0.037). Only five children were overweight(BMI-for-age>85th percentile according to National Center for Health Statistics 2000 reference). Neither overweight children nor those who were in the uppermost tercile of BMI-for-age differed significantly from other children in terms of presence of higher-than-desirable values of lipids or insulin. However, compared to those in the lowest tercile, children who were in the uppermost tercile of arm-fat percentage had a significantly higher frequency of high blood cholesterol (40% vs 67%, p=0.027), high LDL (33.3% vs 61.3%, p=0.026), and markedly higher proportion above average insulin levels (16.7% vs 35.5%, p=0.083). Arm-fat percentage could be developed as a practical tool for determining the risk status of children. However, further cross-sectional assessments are needed to ascertain accurate relationships among arm-fat percentage, lipid profiles, and insulin resistance in larger and varied groups of children

Optimization of Knitted Fabrics for better Thermo-Physiological Comfort by using Taguchi-based Principal Component Analysis

The water, air permeability and thermal resistance of fabrics are important attributes that have a significant impact on the thermal comfort properties of sportswear fabrics in different environmental conditions. In this work, terry and fleece fabrics were developed by varying the fibre content and mass per unit area of fabrics. Moreover, the thermo-physical properties of the developed fabrics, including air permeability, water vapor permeability and thermal resistance, were analysed before and after washing. The multi-response optimization of the thermal comfort properties of knitted fabrics was performed using principal component analysis (PCA) and the Taguchi signal-to-noise ratio (PCA-S/N ratio) to achieve optimal properties. It was determined that the selected parameters (fabric type, finishing, fibre content and fabric mass per unit area) had a significant effect on the thermal comfort properties of knitted fabrics. The PCA analysis showed that 100% cotton terry fabric before washing with an aerial weight of 220 g/m2 had higher air and water vapor permeability value, but a lower thermal resistance value

Castor Leaves-Based Biochar for Adsorption of Safranin from Textile Wastewater

The prospect of synthesizing biochar from agricultural wastes or by-products to utilize them as a promising adsorbent material is increasingly gaining attention. This research work focuses on synthesizing biochar from castor biomass (CBM) and evaluating its potential as an adsorbent material. Castor biomass-based biochar (CBCs) prepared by the slow pyrolysis process at different temperatures (CBC400 °C, CBC500 °C, and CBC600 °C for 1 h) was investigated for the adsorption of textile dye effluents (safranin). The pyrolysis temperature played a key role in enhancing the morphology, and the crystallinity of the biochar which are beneficial for the uptake of safranin. The CBC600 adsorbent showed a higher safranin dye removal (99.60%) and adsorption capacity (4.98 mg/g) than CBC500 (90.50% and 4.52 mg/g), CBC400 (83.90% and 4.20 mg/g), and castor biomass (CBM) (64.40% and 3.22 mg/g). Adsorption data fitted better to the Langmuir isotherm model than to the Freundlich isotherm model. The kinetics of the adsorption process was described well using the pseudo-second-order kinetic model. The study on the effect of the contact time for the adsorption process indicated that for CBC600, 80% dye removal occurred in the first 15 min of the contact time. After three regeneration cycles, CBC600 exhibited the highest dye removal efficiency (64.10%), highlighting the enhanced reusability of CBCs. The crystalline patterns, functional binding sites, and surface areas of the prepared CBCs (CBC400, CBC500, CBC600) were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, and Brunauer–Emmett–Teller surface area measurements, respectively

Mesenteric panniculitis with pedal edema in a 33-year-old Pakistani man: a case report and literature review

<p>Abstract</p> <p>Introduction</p> <p>Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death.</p> <p>Case presentation</p> <p>A 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The patient underwent an exploratory laparotomy based on the finding of mesenteric soft-tissue density on computed tomography. The laparotomy did not prove to be of any diagnostic or therapeutic value. Upon review of the pre-operative computed tomographic scan at our institution, a diagnosis of mesenteric panniculitis was made. An acceptable resolution of abdominal pain and pedal edema was attained after a 4-week trial of immunosuppressive therapy. This is the first reported case of mesenteric panniculitis with pedal edema as part of its presentation.</p> <p>Conclusion</p> <p>An increased awareness may lead to the development of a less invasive diagnostic approach and optimal treatment for this rarely recognized condition.</p

Risk factors of gallbladder cancer in Karachi-a case-control study

<p>Abstract</p> <p>Background</p> <p>Gallbladder carcinoma (GC) is a relatively rare malignancy worldwide but is the second commonest gastrointestinal cancer in Pakistani women. Gallstones have a positive association with GC but other factors also influence in causation.</p> <p>Methods</p> <p>This is a retrospective case control study over a period of 19 years. The cases (Group A) were patients with histopathological proven carcinoma gallbladder (N = 60) and controls were patients with cholelithiasis but no carcinoma gallbladder on histopathology (N = 120). Multivariate regression analysis was done to calculate the odds ratio, 95% confidence interval and P-Value. A positive relationship was found between size of stone > 1 cm, solitary stone, age > 55 years and multi-parity in women.</p> <p>Results</p> <p>There were 60 patients in Group A and 120 patients in Group B. mean age of diagnosis in Group A patients was 57 ± 2.4 years while mean age of diagnosis in Group B patients was 48 ± 1.35 years. Sixty seven percent of cancer group patients were female as compared to 78% females in non-cancer group. In Group A, 69% of female patients were multiparous (parity of more than 5) while 43% of group B patients were multiparous. For body mass index (BMI), both groups were not very different in our study population i.e. around 78% patients in each group has BMI of more than 23 Kg/m2. In Group A, 37% (n = 22) have solitary stones as compared to 15% (n = 18) in group B. similarly Group A patients has larger stone size as compared to Group B i.e.59% (n = 36) patients in Group A have stones of more than 1 cm when compared to 35% (n = 41) patients in Group B. After using multivariate regression analysis, age more than 55 years (OR - 7.27, p value- < 0.001), solitary stone (OR - 3.33, p value - 0.002) and stone of more than 1 cm (OR - 2.73, p value - 0.004) were found to be independent risk factors for development of gallbladder cancer.</p> <p>Conclusion</p> <p>Most of the patients (78%) with GC were female, and the statistically significant risk factors were older age, solitary stones and stones size more than one centimeter. A case can be made for prophylactic cholecystectomy in such a high risk group. However a population based study is required to calculate the true incidence of GC in Karachi and a prospective multi center study is needed to produce strong evidence for screening and prophylactic cholecystectomy.</p> <p>Trial Registration</p> <p>As this was a retrospective review of medical records, as per institution policy, its gives waiver from any registration (ethical/trial).</p

Educating and Informing Patients Receiving Psychopharmacological Medications: Are Family Physicians in Pakistan up to the Task?

Introduction: Studies have shown a high prevalence of psychiatric illnesses among Patients in primary health care settings. Family physicians have a fundamental role in managing psychiatric illness with psychopharmacological medications. Providing information about the disease, its management and the potential adverse effects of the medications is an important part of the management of mental illnesses. Our objective was to determine if Patients who were prescribed psychopharmacological drugs by family physicians at a community health center in Karachi, Pakistan were provided adequate education about their disease and its management. Methods: A cross-sectional study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital Karachi, Pakistan. Details about the prescriptions and Patient education were acquired from the Patients after their consultations. Results: A total of 354 adult Patients were interviewed during 3 days. Among them, 73 (20.6%) were prescribed psychopharmacological medications. Among Patients receiving psychopharmacological medicines, 37 (50.7%) did not know their diagnosis, 50 (68.5%) were unaware of the disease process, 52 (71.2%) were unaware of alternative treatments, 63 (86.3%) were not cautioned about the potential adverse effects of the drugs, 24 (32.9%) were unaware of the duration of treatment and in 60 (82.2%) of the participants an appropriate referral had not been discussed. For all aspects of education, Patients prescribed psychopharmacological medications knew less as compared to those Patients that were prescribed other medications. Discussion: The practice of imparting information to Patients who receive psychopharmacological medications seems to be inadequate in Pakistan. We have hypothesized about the possible reasons for our findings, and identified a need for further research to determine the cause for such findings and to address them accordingly. At the same time there is a need to educate family physicians in Pakistan about the special importance of providing adequate information to such Patients

Serum ferritin levels, socio-demographic factors and desferrioxamine therapy in multi-transfused thalassemia major patients at a government tertiary care hospital of Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Beta thalassemia is the most frequent genetic disorder of haemoglobin synthesis in Pakistan. Recurrent transfusions lead to iron-overload manifested by increased serum Ferritin levels, for which chelation therapy is required.</p> <p>Findings</p> <p>The study was conducted in the Pediatric Emergency unit of Civil Hospital Karachi after ethical approval by the Institutional Review Board of Dow University of Health Sciences. Seventy nine cases of beta thalassemia major were included after a written consent. The care takers were interviewed for the socio-demographic variables and the use of Desferrioxamine therapy, after which a blood sample was drawn to assess the serum Ferritin level. SPSS 15.0 was employed for data entry and analysis.</p> <p>Of the seventy-nine patients included in the study, 46 (58.2%) were males while 33 (41.8%) were females. The mean age was 10.8 (± 4.5) years with the dominant age group (46.2%) being 10 to 14 years. In 62 (78.8%) cases, the care taker education was below the tenth grade. The mean serum Ferritin level in our study were 4236.5 ng/ml and showed a directly proportional relationship with age. Desferrioxamine was used by patients in 46 (58.2%) cases with monthly house hold income significant factor to the use of therapy.</p> <p>Conclusions</p> <p>The mean serum Ferritin levels are approximately ten times higher than the normal recommended levels for normal individuals, with two-fifths of the patients not receiving iron chelation therapy at all. Use of iron chelation therapy and titrating the dose according to the need can significantly lower the iron load reducing the risk of iron-overload related complications leading to a better quality of life and improving survival in Pakistani beta thalassemia major patients.</p> <p>Conflicts of Interest: None</p