BACKGROUND: Prevalence of hair fall and its relationship with stress has not been studied in Pakistan. Our study attempts at determining the prevalence of hair fall among female medical students of Dow Medical College, Karachi and to examine the relationship between stress and hair fall.

METHODS: A cross-sectional study was conducted. All female medical students of Dow Medical College were offered to participate in the study. Those who gave consent were assessed for level of stress using Perceived Stress Scale and were asked not to shampoo their hair for the next 24 hours for Hair Pull Test. Subjects with PSS scores ranging from 0-13 were considered low stress, scores ranging from 14-26 were considered moderate stress and scores ranging from 27-40 were considered high perceived stress.

RESULTS: A total of 375 female students participated in the study. Mean age was 20.5 ± 1.4 years. As per study criteria, only seven (1.9%) students fulfilled the criteria of excessive hair loss. The results of stress test showed that 15 (4.0%) students had mild stress, 303 (80.8%) had moderate stress while 57 (15.2%) had high stress.

CONCLUSION: Hair fall is less prevalent among medical students of Dow Medical College and no significant association was found between stress and hair fall.

BACKGROUND: The existing trials on the long term effectiveness of cognitive behavior therapy (CBT) for the treatment of postpartum depression have conflicting results. Therefore, we performed a systematic review to summarize the current evidence.

METHODOLOGY: Literature search was performed using electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsychINFO were explored from January 2000 to March 2013. All peer-reviewed English-published randomized controlled trials were eligible if they assessed the long term (at least at 24 weeks post partum) effectiveness of CBT versus standard postpartum care for prevention of postpartum depression.  Data from eligible studies were abstracted by using structured data extraction form and pooled for calculation of relative risk ratio.

RESULTS: Five randomized controlled trials fulfilled eligibility criteria. In the included studies, the total number of women was 1087 with age ranged from 17 years to 42 years. Assessment carried on the ‘Cochrane Risk of Bias Tool’ showed the trials included in this review had low risk of bias. Two trials had sample size less than 50. Two out of five trials reported beneficial effect of CBT whereas three trials found no difference. Meta-analysis [random effect model] revealed 30% reduction in the prevalence of depression in the intervention group as compared with the control group [RR: 0.70 (95% C.I: 0.55 to 0.90)]. However, these results showed effectiveness of intervention because of one large trial and excluding this trial, there was no significant difference.

CONCLUSION: In this systematic review, we found a beneficial effect of CBT in the prevention of postpartum depression at 24 weeks of postpartum period. However, the evidence is limited by a small number of trials with results being dominated by a single large trial. Robust research with larger sample size is needed to determine the long-term effectiveness of CBT for treatment of postpartum depression.

Foreign body in the lower urinary tract is uncommon, urinary bladder being the most common site. A variety of foreign bodies such as surgical gauze, intrauterine contraceptive device, metal wire, ball pen and thermometer have been extracted from urinary bladder. The foreign body if not removed acts as a nidus for recurrent infections, and may also cause pelvic pain, hematuria, retention and secondary stones. Depending upon the size of the foreign body, either minimally invasive procedures such as endoscopic management or open surgical exploration are recommended. Here we present a case of a patient who, after sustaining a rubber bullet injury to the suprapubic region, was initially managed at a medical center and the bullet was missed while the patient underwent exploratory laparotomy. The patient later presented to us with inability to pass urine and his workup revealed a large circular rubber bullet in the bladder.

BACKGROUND: Prevalence of diabetes is increasing in Iran. While national statistics are available for diabetes in Iran, regional statistics are lacking. Therefore, we assessed the prevalence of diabetes and evaluated the relationship of diabetes with its risk factors in East Azerbaijan, Iran.

METHODS: A total of 990 men and women aged between 15 and 64 years were enrolled in the study using a cluster-stratified sampling method from East Azerbaijan province, northwest of Iran. Data were collected on demographic, nutritional, risk factors of diabetes and patients’ physical characteristics using a structured questionnaire based on the stepwise guidelines of the World Health Organization in 2007. We calculated the age and gender specific prevalence of diabetes. A hierarchical logistic regression analysis was applied in two steps using the enter method to examine the associations between different risk factors and diabetes.

RESULTS: We estimated the crude prevalence of diabetes to be 10.6% (95% CI: 8.7-12.7). The peak prevalence of diabetes was reported among participants between 55 and 64 years. Residence in urban areas (OR: 2.2, 95% CI: 1.4-3.4), family history of diabetes mellitus (OR: 2.6, 95% CI: 1.63-4.66) and past history of hypertension (OR: 1.6, 95% CI: 1.2-3.1) were most strongly associated with diabetes mellitus (p < 0.001).

CONCLUSION: We found high prevalence of diabetes and impaired fasting glucose in the surveyed population. Residence in urban areas, family history of diabetes mellitus, hypertension and age were significantly associated with diabetes mellitus.

BACKGROUND: The salivary glands tumors are relatively uncommon neoplasms of oral and maxillofacial region with an annual incidence of 2.2 to 2.5 cases per 100,000 in the United States. The aim of the present study was to assess the immunohistochemical expression of two genes, C-erb-B2 (also known as HER-2/neu) and vimentin, in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma to observe these tumor markers as predictors of grade and stage in salivary gland tumors.

METHODS: Thirty consecutive cases, histologically diagnosed as epithelial salivary gland tumors, were included in the study. Fifteen cases were adenoid cystic carcinoma and the remaining cases were polymorphous low-grade adenocarcinoma. Immunohistochemical techniques were used to detect the expression of vimentin and C-erb-B2. 

RESULTS: We found that C-erb-B2 was expressed in all (100%) cases of adenoid cystic carcinoma and in 93.3% cases of polymorphous low-grade adenocarcinoma. Normal tissues did not show any staining pattern (p<0.001). The peak incidence of both neoplasms was observed between the fourth to sixth decades of life, males were affected more than females and the palate was the commonest affected site. There was no significant correlation between C-erb-B2 and vimentin expression with other factors except significant (p<0.05) positive correlation with gender.

CONCLUSION: C-erb-B2 is expressed in both tumors compared with the controls suggesting its oncogenic potential. However, we did not find any significant association between C-erb-B2 or vimentin expression and the tumor grade or stage suggesting that these two may be important in oncogenesis but not in determining the tumor grade or stage.

A 35-year-old man complaining of progressive paresis in his lower extremities presented to the neurosurgical ward. The patient had history of spinal hydatid cysts and had undergone surgical resection 5 years ago. Multiple lesions were observed at the regions of previous surgery on spine magnetic resonance imaging. Thus, this patient had recurrent spinal cord hydatid cysts. Patient was prescribed albendazole 400 mg twice a day and then underwent surgical resection of the hydatid cyst withT-12 to L-4 laminectomy. Following surgery, patient’s symptoms improved gradually after the surgery and with regular physiotherapy sessions during the follow-up period. In addition to the limb weakness, the patient recovered control of urination and defecation with time.

BACKGROUND: Human cystic echinococcosis (CE), caused by Echinococcus granulosus, is one of the most important and widespread parasitic zoonoses in the developing world. Postsurgical relapses or treatment failure is a frequent risk and a long-term clinical and serological follow-up is required to evaluate the success and failure of therapy. Therefore, the present study was aimed to identify the immunological markers that correlate with the effectiveness of pharmacological and surgical treatment.

METHODS: The relation of serum cytokine levels and outcome of chemotherapy and surgery was evaluated in 50 patients with cystic echinococcosis (CE). Serum IL-4, IL-10 and interferon-gamma (IFN-γ) concentrations were determined by ELISA before and after pharmacological and surgical treatment.

RESULTS: The serum cytokine levels of IL-4, IL-10 and IFN-γ were elevated in significant proportion of patients during the active stage of disease. IL-4, IL-10 and IFN-γ were measurable in 41 (82%), 37 (74%) and 25 (50%) patients before the treatment. Clinical and radiological assessment of patients at 2 years, after the pharmacological and surgical treatment, showed that 48 of the 50 patients had responded to the treatment. IL-4 and IL-10 levels were decreased significantly (P<0.05) in these patients. Conversely, of the patients who did not respond had high levels of IL-4 and IL-10 and undetectable levels of IFN-γ.

CONCLUSION: In conclusion, the results indicate that the serum IL-4 and IL-10 cytokines are useful immunological markers demonstrating the effectiveness of surgical and pharmacological treatment in the follow-up of patients with cystic echinococcosis.

Acute subtalar dislocation accounts for only 1-2% of joint dislocations. The management of such cases is to perform a closed manual reduction under procedural sedation or general anaesthesia. The use of regional blocks in the management of these types of injuries has not been highlighted. In this case report, we present a case of a patient with subtalar dislocation, which was successfully reduced under regional ankle block.