Spontaneous perforation of the colon or rectum is a rare cause of acute abdomen in surgery. The presentation of this entity is similar to any other cause of peritonitis and preoperatively remains a diagnostic dilemma. We report a case of a 56-year-old man who presented with spontaneous rectal perforation and an emergency laparotomy was performed. Surgeons should be aware of the possibility of this fatal disease and despite its rare incidence, it is important to recognize this condition at an early stage because it has high mortality if not treated early. Conversely, the surgical outcome is satisfactory provided surgery is performed in due time.

BACKGROUND: World Health Organization (WHO) has defined harm reduction (HR) programs specifically in relation to injection drug users (IDUs) which states that the comprehensive intervention included in HR package aims to prevent the propagation of blood borne infections including HIV that occurs through sharing of contaminated injecting equipment and drug preparations. In the present systematic review, we aim to describe HR programs targeted towards IDUs in South Asia (SA) and to explore the trend of HIV infection and risk behaviors among IDUs in these countries.

METHODS: Online search was done using electronic databases including PubMed (Medline), Psychinfo, SCIRUS Studies (Elsevier and Google Scholar). Studies that described HR program, HIV infection and risk behaviors among IDUs were included in the review. The authors selected the original articles in English language, extracted the data and performed narrative analyses based on WHO’s comprehensive intervention criteria evaluating the prevention and treatment of HIV among IDUs.

RESULTS: Search resulted in 76 peer reviewed and 78 grey literature manuscripts from 1991 to 2010. HIV among IDUs has been reported in all countries of SA except in Bhutan and Maldives. The problem is concentrated (>5%) in India, Nepal and Pakistan. HR interventions are implemented in all countries where HIV among IDUs exists, but the coverage is low. The access of IDUs to the HR program ranged from 17% in Afghanistan to 50% in India. None of the countries had all elements of the WHO’s comprehensive intervention package. Considerable decline in HIV prevalence and risk behaviors among IDUs is observed in Nepal and India (north-eastern states). The initiation of HR program in Bangladesh has maintained low HIV prevalence among IDUs, but HIV prevalence in Pakistan and other areas of India continues to increase.

 CONCLUSION: Decrease in risk behaviors and HIV prevalence among IDUs have been found in areas with good coverage of HR program. Hence, the SA countries should continue HR interventions with emphasis on increasing the comprehensive coverage. However, the inconsistent results from the region and the lack of effectiveness studies makes it difficult to reach a general conclusion about the role of HR program in reducing HIV infection and risk behaviors among IDUs in SA. Therefore, there is a need for effectiveness studies of available HR programs in SA.

BACKGROUND: Cerebral venous thrombosis (CVT) is a disease with high potential of disability and high rates of mortality. It affects females more than males. The estimated annual incidence of CVT is 3 to 4 cases per 1 million, but the incidence rate is much higher in Iran. It particularly increases in Ramadan and Zilhijjah months of the Islamic calendar. We hypothesized that the use of contraceptive components especially during the month of Ramadan is associated with an increase in the risk of CVT in women.

METHODS: A longitudinal descriptive study was conducted from 2010 to 2011 including two consecutive months of Ramadan in Zanjan Province of Iran. The data of 32 female patients with verified CVT, including demographic variables and main CVT risk factors was obtained from hospital records and interview with patients’ families.

RESULTS: The annual incidence rate for women in all age groups and child-bearing age was 31.5 and 49 per 1,000,000, respectively. The incidence trends of CVT are increased in concordance with ageing (p-value =0.01). 26 patients (81.25%) reported a history of contraceptive use as a main CVT risk factor. History of OCP administration was 15 times more likely than non-OCP to be vulnerable for CVT (p-value <0.05). More than half of the cases (56.25%) occurred in the month of Ramadan (p-value <0.05).

CONCLUSION: The higher incidence rate of CVT in Zanjan province more than the statistics cited in the literature is related to the higher incidence of CVT in women but not in men. Use of contraceptive components by women in Ramadan, Hajj times or pilgrimage to postpone their menstruation should be considered by healthcare system to control the incorrect use of them among Muslim women.

ipomas are the most frequent mesenchymal benign soft tissue tumors. Here we report a thirty-month-old girl who presented with giant progressively enlarging mass on the right side of the posterior chest wall for the past one and a half years. An ultrasonography found a solid neoplasm measuring 29 cm in its major axis. Patient underwent radical surgical excision of the mass and the histology report confirmed the clinical suspicion of lipoma.

BACKGROUND: Reproductive tract infections (RTIs), which include sexually transmitted infections (STIs), cause considerable morbidity among women of reproductive age worldwide. Any morbidity in this group presents as a huge obstacle to the overall socioeconomic development of the community. Countrywide data in India indicate a higher prevalence in rural areas compared to urban areas. This study was conducted to determine the prevalence of RTIs in married women aged 18 to 45 years in a rural area of Kancheepuram District, Tamil Nadu, and to determine its association with social, demographic, obstetric factors, and contraceptive and menstrual hygiene practices.

 METHODS: This was a community based, cross sectional study conducted between March and November 2011, using a three stage sampling method on the prevalence of RTIs among married women aged 18-45 years. The study recorded the symptoms in the previous 12 months in the Karanai Puducheri village of Panchayat (Kancheepuram district, Tamil Nadu) using a standardized, semi-structured questionnaire.

RESULTS: Among the 520 women who participated in the study, the prevalence of RTIs was 33.3% (95% CI: 33.3+3.4%). Vaginal discharge was the commonest symptom (23.7%). RTIs were significantly associated with age of women, duration of marriage, contraceptive practices, and personal and menstrual hygiene practices (p<0.05).

CONCLUSION: The high prevalence of symptoms of RTIs and their association with modifiable risk factors, such as contraceptive usage and, personal and menstrual hygiene factors, suggest scope for intervention through health education programmes among women in preventing RTIs.

Ingested metallic foreign bodies are of rare occurrences. Early skillful intervention is necessary to avoid subsequent life threatening complications such as migration. Diagnosis is from positive history of foreign body ingestion and confirmed by neck soft tissue radiograph. However, some foreign bodies may be swallowed unnoticed, especially if mixed in cooked food. A case of uncomplicated esophageal metallic foreign body ingestion is presented. The foreign body was a wire which was removed using rigid esophagoscopy.

BACKGROUND: Bangladesh is a developing nation and despite economic constraints, Bangladesh has a vision for all round growth and intends to enter the group of developing nations by the year 2020. To achieve these ambitious targets, all sections of society, not only disabled people, but also people with the autism spectrum disorder (ASD) have to be included in the process of developing the nation. This research is a descriptive cross sectional study and aims to find the socio-economic profile of persons with ASD and to correlate the condition of autism with the socio-economic profile.

METHODS: This descriptive cross sectional study was conducted in two autism schools in Dhaka City, Bangladesh from January to June, 2012. All the subjects of the study are the parents of autistic children who were educated and living in Dhaka.

 RESULTS: The highest numbers of autistic children were aged 7-9 years (32%) and 4-6 years (28%); 78% were male and 22% were female children. With respect to birth order, 58% were first born and 33% were second born. Parents’ education and occupation were associated with this disorder but family income was not. Autistic children were more likely to have illiterate parents (32%) followed by parents with primary level education (21%). The majority of the patients (87%) were from nuclear families and 66% were from urban areas. On the other hand, only 38% of the children went to school regularly.

 CONCLUSION: This study highlighted the relationship of autism with birth order, parent’s education, economic status and family status. We also found that autistic children were less likely to attend a school

Lung cancer can present in a wide variety of ways on radiological examination. Hilar prominence, solitary or multiple pulmonary nodules, obstructive pneumonitis, mediastinal widening  and  pleural effusion are the common presentations. Pneumothorax or hydropneumothorax is a very rare presenting feature of lung cancer. Here we report a case which presented as left sided hydropneumothorax and was subsequently found to have lung cancer.

Chorea is a rare neurological manifestation of coeliac disease. A 35-year-old male presented with a nine month history of chorea, starting from the right little finger and spreading over the next few months to involve the right upper and lower limbs. History and physical examination were not suggestive of an underlying cause. CT scan and MRI scan did not reveal any structural abnormality. Levels of serum IgA anti- tissue transglutaminase antibodies were very high (396EU/ml). Duodenoscopy and duodenal histology were normal. Marked symptomatic improvement was seen with gluten free diet, along with disappearance of anti-tissue transglutaminase antibodies. Chorea can occur as an atypical manifestation of coeliac disease. This possibility must be kept in mind when the cause of chorea is not easily identifiable.