Gallbladder carcinoma: a retrospective analysis of twenty-two years experience of a single teaching hospital

BACKGROUND: The purpose of this study was to retrospectively evaluate our experience with gallbladder cancer since the establishment of a tumour registry in our institute. METHODS: Between 1975 and 1998, 23 consecutive patients with gallbladder cancer were identified using the tumour registry database. There were 18 females (78%) and 5 (22%) males. The mean age at diagnosis was 70.6 (range 42–85) years. The diagnosis was achieved either intra-operatively or following the histological analysis of the gallbladder (n = 17), following gallbladder or liver biopsy (n = 4) or at autopsy (n = 2). Presenting symptoms included upper abdominal pain, weight loss, nausea, vomiting, fever, painless jaundice, hepatomegaly, upper abdominal mass, upper abdominal tenderness, and gastrointestinal haemorrhage. RESULTS: Histological examination revealed 20 adenocarcinomas (87%), 2 squamous cell carcinomas (9%) and one spindle cell sarcoma (4%). At presentation, 14 (61%) gallbladder cancers were stage IV, 5 (22%) were stage III and 4 (17%) were stage II. Kaplan Meier analysis revealed a mean survival of 3.2, 7.8 and 8.2 months for stage IV, III, and II disease respectively. Out of 14 patients with stage IV disease, 8 patients received adjuvant chemotherapy and survived for 4.6 months whereas six patients who did not receive adjuvant chemotherapy survived for 1.3 months. This difference was statistically significant (p = 0.04). CONCLUSION: The majority of patients with gallbladder cancer presented with advanced stage disease (stage IV) which carries a dismal prognosis. Patients who received chemotherapy with stage IV disease, however, did better than those who did not, but this is probably a reflection of patient selection

Evaluation of erectile dysfunction with color Doppler sonography

Objective: To assess the role of Color Doppler Sonography in the evaluation of erectile dysfunction.Methods: A cross-sectional study was conducted at the Radiology Department, Aga Khan University Hospital Karachi from 5-6-2002 to 2-9-2003. All consecutive patients presenting with erectile dysfunction and undergoing penile color Doppler evaluation with injection PGE1 20 mcg were included in this study.Results: A total of 70 patients with an age range of 24-70 years (mean 41 +/- 12.25 years) were included in the study. A normal response was noted in 45 (psychogenic) cases. Vasculogenic causes were observed in 23 patients, 12 with arterial insufficiency and 11 with venous leak. Peyronie\u27s disease was diagnosed in 2 patients.CONCLUSION: Color Doppler evaluation of erectile dysfunction is an effective method for differentiating psychogenic and vasculogenic causes of erectile dysfunction

Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets

OBJECTIVE: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D. STUDY DESIGN: Case control. PLACE AND DURATION OF STUDY: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004. METHODOLOGY: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups A and B. Group A was given oral vitamin-D and group B was given intramuscular injection of vitamin-D on the first day and then they were followed for two more visits at 30 and 90 days with clinical, biochemical and radiological examinations to assess the outcome. RESULTS: There were 50 confirmed cases of rickets in each group. The mean age was 10.9+5.1 months and 14.7+8.1 months in group A and B respectively. In these children, clinical features were weakness, difficulty in walking, frontal bossing, ribcage deformity and widening of wrist were seen. After one dose of vitamin-D (cholecalciferol), there was appreciable gain of weight and height and raised levels of alkaline phosphatase became normal during follow-up. Radiological florid rickets and non-florid rickets in both groups healed clinically during follow-up period. Oral and injectable forms of vitamin-D (cholecalciferol) were effective but injectable form was shown to be statistically significant. There were no undesirable side effects and both forms of treatment were well-tolerated

Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets

OBJECTIVE: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D. STUDY DESIGN: Case control. PLACE AND DURATION OF STUDY: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004. METHODOLOGY: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups A and B. Group A was given oral vitamin-D and group B was given intramuscular injection of vitamin-D on the first day and then they were followed for two more visits at 30 and 90 days with clinical, biochemical and radiological examinations to assess the outcome. RESULTS: There were 50 confirmed cases of rickets in each group. The mean age was 10.9+5.1 months and 14.7+8.1 months in group A and B respectively. In these children, clinical features were weakness, difficulty in walking, frontal bossing, ribcage deformity and widening of wrist were seen. After one dose of vitamin-D (cholecalciferol), there was appreciable gain of weight and height and raised levels of alkaline phosphatase became normal during follow-up. Radiological florid rickets and non-florid rickets in both groups healed clinically during follow-up period. Oral and injectable forms of vitamin-D (cholecalciferol) were effective but injectable form was shown to be statistically significant. There were no undesirable side effects and both forms of treatment were well-tolerated

Improving statistical inference with uncertain non-sample prior information

In the classical inference, the observed sample data is the only source of information. The Bayesian inferential methods assume prior distribution of the underlying model parameters to combine with sample data. Often non-sample prior information (NSPI) on the value of the model parameters is available from previous studies or expert knowledge which could be used along with the sample data to improve the quality of statistical inference. Obviously the NSPI is not always correct and hence there is uncertainty in the suspected value of the parameter. Any such uncertainty can be removed by conducting an appropriate statistical test, and the quality of statistical inference can be improved by including the outcome of the test in the inferential procedure. This paper provides the underlying methodology to illustrate the process and include an example to demonstrate its application

NEW SLANT ON HYPERLIPIDEMIA: PREVENTION BY VITAMIN B-3 AND COMMON FRUIT ZIZIPHUS JUJUBA

Coronary artery disease (CAD) is complication of primary or secondary hyperlipidemia. Etiological factors for hyperlipidemia include inherited genetic defects in low density lipoproteins (LDLs), persons accustomed to sit for prolong time, cigarette smoking, diabetes mellitus, and hypertension. This research work’s aim was to compare hypolipidemic features of an allopathic agent vitamin B-3 and another medicinal plant Z. Jujuba. Study was conducted from January 2016 to June 2016 at Jinnah Hospital Lahore, Pakistan. 60 male and female hyperlipidemic patients age range from 20 to 70 years were selected from the hospital. Written and explained consent was taken from all patients. They were divided in two groups. Group-I was advised to take two grams vitamin B-3 in divided doses for the period of two months. Group-II was advised to take 500 grams of fruit Z. Jujuba daily for 60 days per their convenience. Their initial LDL and HDL cholesterol was determined by Friedwald’s formula. After 60 days therapy, their post treatment lipid profile was measured and mean values with ± SD were analyzed biostatistically by using SPSS version 2; 2010. Group-I which was on vitamin B-3 their LDL cholesterol decreased significantly and HDL cholesterol was increased significantly. In group-II patients LDL cholesterol was decreased significantly but HDL increase was not significant with p-value of >0.05. It was concluded from the research study that vitamin B-3 is potent hypolipidemic agent as compared to medicinal plant Z. Jujuba

Antimicrobial resistance in typhoidal salmonella: Surveillance for enteric fever in Asia project, 2016-2019

Background: Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan.Methods: From September 2016-September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility.Results: We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal.Conclusions: Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine

Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis [Letter to the Editor]

It is a scientific note on a published paper correcting some significant errors

Statistics for evidence-based decisions - use, misuse and abuse

Increasingly decision-makers are relying on an evidenced- based approach, using results extracted by analysing exponentially growing data. Statistical methods have become an integral part of analysing and interpreting simple or complex data to make valid and accurate decisions for society and science in the face of uncertainty. Because of its power to uncover, otherwise unavailable, valuable information from data, statistics is increasingly being applied for both private and public benefit including business and trade, not to mention its crucial role in research and innovative technologies. The key role of statistics is engraved in the planning and development of every successful nation and international agency. In fact, the scope of statistics is not confined by borders as it disseminates through regional and international organisations and agencies driving social, economic, environmental, health, poverty elimination, education and other agendas for planned development. Obviously statistical methods are capable of analysing data to determine various indices, indicators, predictions, estimates, and perform tests to help identify any problems and take appropriate measures to remedy them. Because of the obvious power of statistics it has been used, misused and abused by those who are in authority and power