The present study aims to review the unusual modes of presentation of sacrococcygeal teratomas (SCT) in pediatric patients. In this study we managed 23 cases of SCT, at NICH Karachi and Children's Hospital Islamabad from Jan 2004 to June 2008. Their mode of presentation and previous management issues were studied. All patients had U/S, Alpha Fetoprotein levels, CT or MRI scan beside the routine investigation. Patients were labeled as having unusual presentation, if they had either a erroneous diagnosis at referral, had complication of previous surgeries or presented late due to erroneous or missed diagnosis. Patients were managed on standard protocol with preoperative staging. Of the 23 patients been registered, there were 17 Female and 6 male suggesting a 3:1 preponderance of female. Nearly half of the patients had atypical presentation. Five patients were referred with the diagnosis of meningocele. Hematuria, inguinal lymphadenopathy, suspected abscess, ruptured SCT, fecal fistula, simultaneous abdominal and sacrococcygeal teratoma, laminectomy for lower limb weakness and fetus in fetu were presentations in one patient each. Outcome was most favorable in external SCT which was presented early. Of the 11 patients with type-I and Type-II teratomas, only one died and he had ruptured teratoma. All other survived inspite of the large external tumor masses. Of the seven patients with type-III teratomas, five survived, one died and one lost to follow-up. Of the six babies with type-IV SCT, three survived, one died and two lost to follow-up. It could be concluded that, there were many cases of unusual presentation of SCT. In some cases, it caused significant delay in diagnosis and poor outcome. The reasons were hidden tumors, ignorance of the families, lack of awareness and inadequate evaluation by the treating physicians in peripheral hospitals. In some cases, the unusual presentation was due to the natural process. A high index of suspicion, awareness of treating physicians and parents, can help in early diagnosis and better outcome. Above all, pediatric tumors like SCT need a team approach and all patients with such lesions must be referred early to tertiary care pediatric surgical facilities for optimal care and management.

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Diabetes mellitus is a heterogeneous metabolic disorder characterized by hyperglycemia. It is often associated with complications, such as cataracts. The purpose of this study was to investigate the effects of cactus pear juice on oxidative stress and cataract formation in alloxan-induced diabetic rats. Rats were divided into six groups, Group 1 untreated as negative control, Group 2 injected with alloxan only to induce diabetes as diabetic cataract positive control, Groups 3,4,5 and 6 injected with alloxan and given orally 1, 2, 3 and 4 ml concentrated cactus juice/rat/day, respectively. After 8 weeks, the animals treated with cactus juice showed a significant decrease in the level of blood glucose and lipid peroxidation in blood and lens, and a significant decrease in the concentration of lens Fas ligand, compared with negative control (group 1). Also, the treated groups showed significant increase in the level of reduced glutathione and the activity of superoxide dismutase and significant decrease in the levels of nitric oxide concentration. Slit lamp examination revealed that supplementation with cactus juice delayed the progression and maturation of cataract in the treated groups compared with positive control (group 2), which developed subcapsular cataract. The best result observed in Group 5, which was given orally 3 ml juice/rat/day. The data in the present study indicate that cactus juice is a rich source of natural antioxidants such as total phenolics, total flavonoids, vitamin C, vitamin E, β-carotene and total carotenoids. It can be concluded that regular consumption of cactus pear juice can protect the body from the oxidative stress and can attenuate the development of cataract as a complication of diabetes by reducing the level of blood sugar.

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In a prospective clinical study in North Kordofan (Western Sudan), the possible association between blood groups and anti-malarial antibody responses with clinical outcome of Plasmodium falciparum malaria among Sudanese patients was investigated. A total of 184 individuals were consecutively enrolled from an outpatient clinic. Sixty six (35.9%) patients were classified as complicated malaria (CM), 53 (28.8%) with uncomplicated malaria (UM) and 65 (35.3%) were malaria free controls (MFC). Phenotypes of ABO blood groups were typed using commercial anti-sera. The antibody responses to MSP2 malaria antigens were assessed by an enzyme-linked immunosorbent assay (ELISA). The frequency of O blood group was significantly lower in those with CM when compared with MFC and UM patients (P value < 0.001 and 0.002 respectively). The levels of IgG1, IgG2 and IgG3 antibodies were statistically significantly higher in UM and MFC compared with CM patients. Statistical analysis indicated that higher levels of total IgG, IgG1, IgG2, and IgG3 specific to the MSP2 (both antigen forms, 3D7 and FC27) were associated with a reduced risk of complicated CM in O blood type carriers than in non-O blood type carriers, P value <0.001. Taken together, the current study indicates that blood group O is associated with a reduction in the risk of developing complicated malaria in western Sudan. Our results also revealed that the natural acquisition of immunity against clinical malaria appeared to be more associated with IgG1 and IgG3 antibodies, signifying their roles in parasite-neutralizing immune mechanisms.

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Heshouwu (Polygonum multiflorum) and Dahuang (Rheum hotaoense) are Chinese vegetables. Preliminary studies in China showed hypoglycemic effect of the two plants extract mixture, PHS-E ₂ (glucoherb). This study investigated the hypoglycemic efficacy of PHS-E ₂ in comparison to that of glibenclamide in streptozotocin-induced diabetic rats. Glucoherb and glibenclamide were administered in rats orally, daily for a period of five weeks. Glucoherb was given at doses of 7 mg/kg, 15 mg/kg and 25 mg/kg. The comparable values of the three indices of cellular toxicity aspartate aminotransferase, alanine aminotransferase and bilirubin between glucoherb or glibenclamide treated rats and untreated normal control rats, suggest that glucoherb may not be toxic, at least to the liver, at the doses employed. The herbal preparation decreased the levels of total cholesterol and LDL cholesterol, in contrast to glibenclamide, which showed a tendency of total cholesterol increase at weeks 4 and 5 of the treatment. The daily oral administration of glucoherb, for five weeks at the three above doses was able to produce hypoglycemic effects between the second and the fourth weeks of treatment till the end of the experiment. The observed hypoglycemic effect was not dose dependant and was not different from that of glibenclamide in STZ-diabetic rats.

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Communication is an essential skill in the armory of any worker in the health field. It is an integral part of the skills required, not only in medical doctors, but in all health workers. Communication is more than history taking; it includes all methods of interaction with patients, patient's relatives, members of the health care team, and the public. Many studies stressed that the main complaints of patients are related to communication problems and not to clinical competency. This has contributed to an increase in the number of law suits, non-adherence to medical regimens, and the tendency of patients to keep changing physicians and hospitals. Also, it has been shown that health outcome is positively affected by proper communication. This includes patient's satisfaction and cooperation, decrease in treatment duration, decrease in painkillers requirements, and decrease in hospital stay. Also, it has been shown that communication skills can be taught and important changes in physician's behavior and in their communication skills have been demonstrated after courses of communication skills. Thus, many medical colleges in the world are including communication skills courses in their undergraduate and graduate curricula. We should do the same in our medical colleges in Saudi Arabia.

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Medical error and tort reform have increasingly taken center stage in the health care debate in our region and all over the world. Patients, policy makers and health professionals grapple with the striking prevalence and consequences of medical error, which result in patient injury and health care service. Debate ranges from legislating restrictions on cost awards in malpractice trials to ethical and moral imperatives germane to untoward clinical incidents, whether in the hospital or in outpatient settings. Fears of malpractice liability, difficulties in communicating bad news, and confusion about causation and responsibility, have long impeded comprehensive and bold initiatives designed to change the patient, family and clinician experience with medical error. Offering an apology and making full disclosure of harmful medical errors to patients and their families can do much to defuse the hurt and anger that can lead to further emotional and physical trauma.

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Both theoretical and experimental evidence support the concept of a tumor stem cell (TSC) model - a rare population of self-renewing stem cells among the heterogeneous mixture of tumor cells essential for solid tumor growth and progression. However, this growing evidence is not by itself convincing without an adequate molecular mechanism explaining how these TSCs maintain their stemness, since there is always a possibility that the so-called solid tumor TSCs may be a highly tumorigenic fraction of the heterogeneous mixture of tumor cells. The lack of knowledge of how TSCs maintain their state of stemness is therefore a major limitation that requires attention in order to improve our understanding on the stem cell model of tumor growth. An emerging and provocative concept in tumor biology is that a rare population of tumor stem cells exists among the heterogeneous population of cells within tumors. The TSC model suggests that proliferative potential and growth patterns of many human tumors may depend upon a small proportion of tumor stem cells that lead to repopulation following cytotoxic therapy. In this review, we will briefly discuss the basic concept of the TSC model and the emerging findings of the existence of the TSC fraction, even in established tumor cell lines.

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