Secretory paraspinal paraganglioma of thoracolumar spine: Case report and review of literature

Background: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla chromaffin cells, however, when present extra-adrenally they are called paragangliomas. Paragangliomas rarely produce catecholamine in excess, which is evident by clinical symptoms, urine, and blood biochemistry. Total resection of these tumors can lead to complete clinical and biochemical resolution. This case report presents the clinical features, radiological findings, and neurological outcome in a middle-aged female with a secretory paraganglioma.Case description: We present the case of a 34-year-old female who presented with a 2-year history of dizziness, flushing, headache, palpitations, and hypertension. Her blood workup showed raised urinary catecholamine levels. Magnetic resonance imaging (MRI) and iodine-123-meta-iodobenzylguanidine (MIBG) scans demonstrated a retroperitoneal mass located anterolateral to T11-T12 vertebral bodies reaching up to T12-L1 intervertebral disc. The patient was otherwise neurologically intact. She underwent resection of the tumor after alpha-adrenergic and beta-adrenergic blockade. En bloc resection was achieved without neurological complications. Postoperatively, the patient was initially hypotensive and subsequently became normotensive, and on follow-up, the patient had resolution of her symptoms and was stable.Conclusion: Secretory paraganglioma of the dorsal spine are rare and difficult to excise, needs preoperative preparation with pharmacological intervention, good operative technique, and postoperative care

Focused abdominal CT scan for acute appendicitis in children: can it help in need

OBJECTIVE: To evaluate the focused abdominal CT scan [FACT] in clinically equivocal cases of acute appendicitis in paediatric population. METHODS: A cross-sectional study was conducted at the Radiology Department of Aga Khan Hospital, from August 2007 to November 2008. A total of 84 patients (42 males & 42 females) with clinically equivocal signs and symptoms of acute appendicitis referred to radiology department for CT evaluation were studied. CT findings were compared with histopathology and clinical follow-up. RESULTS: The sensitivity of focused CT for acute appendicitis was 91%; specificity was 69% and accuracy of 76% while PPV and NPV were 58%, 94% respectively. CONCLUSION: Focused unenhanced CT is a quick, accurate and non invasive modality for the assessment of clinically equivocal cases of acute appendicitis for ruling out patients and reducing negative appendectomies

Modeling Energy Consumption, Carbon Emission and Economic Growth: Empirical Analysis for Pakistan

This study examines the short run and long relationship among carbon emission, energy consumption and economic growth in case of Pakistan for the time period 1980 to 2012. For this purpose we have employed Johansen co-integration approach and the results reveal that there exists long run relationship among Energy, Growth and Environment (E-E-E) in Pakistan. It is found that the Environmental Kuznets Curve hypothesis is valid in long run but not in short run. Also there exists unidirectional causality between energy consumption to energy emission in Pakistan. Unidirectional causality also found between financial development and economic growth running from financial development to economic growth.   Keywords: Environmental Kuznets Curve, Energy, Growth, Co-integration, Pakistan JEL Classifications: G00; Q43; Q5

Validation Study of the Mini-Mental State Examination in Urdu Language for Pakistani Population

Validation study of the Mini-Mental State Examination in Urdu language for Pakistani population. Objective: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 ± 5.6 (range 0-30) as compared to the controls 26.8 ± 2.6 (range 7-30). This difference between groups was statistically significant (p\u3c0.001). Educational based MMSE score below 15 yielded perfect sensitivity and specificity for the diagnosis of dementia. Conclusions: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population

Validation Study of the Mini-Mental State Examination in Urdu Language for Pakistani Population

Validation study of the Mini-Mental State Examination in Urdu language for Pakistani population. Objective: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 ± 5.6 (range 0-30) as compared to the controls 26.8 ± 2.6 (range 7-30). This difference between groups was statistically significant (p\u3c0.001). Educational based MMSE score below 15 yielded perfect sensitivity and specificity for the diagnosis of dementia. Conclusions: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population

Bone Age practices in infants and older children among practicing radiologists in Pakistan: Developing world perspective

Objective To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group. Materials and methods A cross-sectional survey was conducted among 147 practicing radiologists in Pakistan. A pre-validated survey form was adopted from a similar study conducted amongst members of the Society for Pediatric Radiology. The survey collected demographic information, choice of bone age assessment technique in each age group and confidence of bone age assessments in each age group. Results The hand-wrist method of Greulich and Pyle was used by 87.5% of respondents when assessing bone age in infants (less than one year), followed by Gilsanz-Ratib hand bone age method (7.3%). In children aged one to three years, Greulich and Pyle method was chosen by 85.7% of respondents, followed by Gilsanz-Ratib hand bone age method (6.1%) and the Hoerr, Pyle, Francis\u27 Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.1%). In children, older than three years, the Greulich and Pyle technique was used by 83.7% of respondents. This was followed by Gilsanz-Ratib hand bone age method (5.8%) and the Hoerr, Pyle, Francis\u27 Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.8%). 26.4% were very confident in bone age assessments conducted among infants. In children aged one to three years, 38.1% were very confident . In children, greater than three years, 48.6% were very confident in their chosen technique. Conclusion Greulich and Pyle is the dominant method for bone age assessments in all age groups, however, confidence in its application among infants and young children is low. It is recommended that clear recommendations be developed for bone age assessments in this age group alongside incorporation of indigenous standards of bone age assessments based on a representative sample of healthy native children

Women Home Based Workers in Rural areas of Pakistan

Home-based work is a “general category of work within the informal or unorganized sector where workers carry out remunerative activities within their homes or in the surrounding areas but not at the premises of an employer”. The women Home-based workers defines as “The Women who work in their own dwelling or home stations. It is the moneymaking activity. The home based work includes the embroidery, handicrafts, stitching, weaving, shoe making, football making, garments, handmade jewelry and decoration piece making etc. The main purpose of this study was to explore awareness among women home based worker about their rights. The study was conducted in District Faisalabad. Multistage sampling technique was used in this study. At first stage, one Tehsil Faisalabad out of five Tehsils was selected by using simple random sampling technique. At second stage 4 union councils including UC-49, UC-157, and UC-274 were selected by using simple purposive sampling technique. At third stage four villages from each union council out of five villages (Chack No- 225 RB, Malkhawala), (Chack No-217 RB, Chakaira), (Chack No-218 RB, Pronkawala) and (Chack No-61 JB, Dharora) were selected purposively. The study was conducted in rural area of District Faisalabad. The sample size of one twenty women was selected by using simple random sampling.  Questionnaire was used as a tool for data collection and collected data were analyzed by using Statistical Package for Social Sciences (SPSS). Results of the study revealed that 61.7% of the respondents were illiterate, about 38.3% of the respondents earned 2501-5000 rupees, the significant majority 86.7% of the respondents belonged to lower class, about one third 40% of the respondents involved in stitching, more than half 51.7% of the respondents worked up to 6 hours per day, the majority 67.5% the of the respondents had muscular pain, and the significant majority 87.5% of the respondents had no awareness about their rights

Frequency of primary solid malignant neoplasms in both sexes, as seen in our practice

Background: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopdies. Method: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004. Results: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin\u27s lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. Conclusion: Out of 20,000 biopsies, there were 4616(23.08%) malignant neplasms. Carcinoma of oral cavity is very common in our population in both sexes

Temporal trends in hepatitis B and C infection in family blood donors from interior Sindh, Pakistan

<p>Abstract</p> <p>Background</p> <p>Hepatitis B (HBV) and C (HCV) infections are a serious global and national public health problem. Earlier studies have reported increasing rates of hepatitis infection in Pakistan, particularly in rural areas. Pakistan has no active surveillance program to monitor trends of these infections. The objective of this study was to verify this trend in blood donors from the rural Sindh area of the country.</p> <p>Methods</p> <p>The study analysed the data of blood donors of interior Sindh who donated blood at JPMC blood bank from January 1, 2004 to September 15, 2007. HBsAg status was determined by using HBsAg Serodia kit and antibodies to HCV using the Detect HCV ™ V.3 Kit. Samples repeatedly reactive for HBsAg or anti-HCV were considered positive for HBV or HCV infection respectively.</p> <p>Results</p> <p>The overall seroprevalence of HBV infection among donors was 6.2 % (95% CI 5.5%–6.9%) and did not change significantly over the study period. Overall seroprevalence of HBV infection in literate blood donors was 5.7 %(95% CI 4.7%–6.8%). Prevalence decreased significantly in this group over the study period (p = 0.05). No other significant trends in seroprevalence of HBV infection were seen in the stratified analyses.</p> <p>The overall seroprevalence of HCV among donors was 7.5% (95% CI 6.8%–8.3%) and increased significantly over the study period from 7.2% (95% CI 5.8%–8.7%) in 2004 to 8.9% (95% CI 7.4%–10.6%) in 2007 (p = 0.02). Significant increase in seroprevalence was particularly seen in literate (p = 0.03), non–first time (p = 0.01) and Sindhi speaking (p = 0.01) donors.</p> <p>Conclusion</p> <p>Our study finds a steady increase in the prevalence of HCV infection in blood donors from interior Sindh between 2004 and 2007. On the contrary, decreasing prevalence of HBV was found, particularly in literate blood donors. There may be a need to have rural community-based epidemiological studies to identify the determinants of the spread of HCV infection and also those that are limiting the spread of HBV infection particularly in the literate blood donor population.</p

Monitoring of Cadmium and Lead Accumulation in Soil-Forage-Animal Continuum in Pasture Land Irrigated with Ground Water in Bhalwal, Punjab, Pakistan

Recent study was directed to check the accumulation of Cd and Pb in pasture land treated with ground water. In particular the transfer of cadmium and lead from soil to forages and in turn to animal (buffaloes) was conducted in Bhalwal, Punjab, Pakistan which comes under sub-tropical environmental conditions. The Cd and Pb concentration in selected samples was explored by atomic absorption spectrophotometer (AA-6300 Shimadzu Japan). The results depicted the concentration of cadmium in water, soil, forages, milk and hair of buffaloes was in the range of 0. 00320 – 0.00866 mgL-1, 1.9500 to 5.3000 mg/kg, 0.300 to 0.7100 mgkg-1, 0.1033 to 0.4133 mgL-1 and 0.037 to 0.0656 mg/kg, respectively. The lead concentration was ranged from 0.004 mg/L to 1.963 mgL-1 for water, 5.960 -13.600 mg/kg for soil, 0.293 to 2.570 mg/kg for forages, 0.2166 to 6.100 mg/L for milk and 0.0206 to 0.074 mg/kg for hair samples. Various indices (BCF, PLI, EF, DIM and HRI) were examined and results presented that PLI and EF of Cd, EF and HRI for Pb was above 1 indicating that metal was causing pollution while value of BCF and DIM was below one. If exposed for an extended period of time through feed, forages with a higher Cd and Pb content may harm animal\u27s cells, create respiratory issues and have an adverse effect on the animal\u27s kidney, liver and lungs