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Abstract:The aim of this article is to review the pathophysiology and clinical role of serotonin receptor modulators used in the treatment of irritable bowel syndrome. Serotonin is an important monoamine neurotransmitter that plays a key role in the initiation of peristaltic and secretory refl exes, and in modulation of visceral sensations. Several serotonin receptor subtypes have been characterized, of which 5HT3, 5HT4, and 5HT1b are the most important for GI function. 5HT4 agonists (eg, tegaserod) potentiate peristalsis initiated by 5HT1 receptor stimulation. 5HT4 agonists are therefore useful in constipation predominant form of IBS and in chronic constipation. 5HT3 antagonists (Alosetron and Cilansetron) prevent the activation of 5HT3 receptors on extrinsic afferent neurons and can decrease the visceral pain associated with IBS. These agents also retard small intestinal and colonic transit, and are therefore useful in diarrhea-predominant IBS. Tegaserod has been demonstrated in several randomized, placebo controlled trials to relieve global IBS symptoms as well as individual symptoms of abdominal discomfort, number of bowel movements and stool consistency. Several randomized, controlled trials have shown that alosetron relieves pain, improves bowel function, and provides global symptom improvement in women with diarrhea-predominant irritable bowel syndrome. However, ischemic colitis and severe complications of constipation have been major concerns leading to voluntary withdrawal of Alosetron from the market followed by remarketing with a comprehensive risk management program.

Objective: Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Study Design: Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. Patients and methods: 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct (lacunar/cerebral). Results: Out of 132 ischemic stroke patients 36 (27%) were diabetics and 96 were nondiabetics. Hjipertension was present in 83 (62%). Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics (16.6% Vs 9.3% p<0.05). Disability was also more frequent in diabetics (25% Vs 13.5% p<0.05). In diabetic group good recovery (8.8% Vs 12.5%) as well as partial recovery (50% Vs 64.5%) was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths (15.3% Vs 7% p<0.05) and disability (15.3% Vs 10.7% p<0.05) than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality (20.8% Vs 11.8% p<0.05) as well as disability (33.3% Vs 15.2% p<0.05). Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality (17.6% Vs 9.8% p<0.05) as well as disability (26.4% Vs 14.2% p<0.05). Conclusion: Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome.

BACKGROUND: Objective of the study is to find out the most suitable procedure for surgicaltreatment of typhoid ileal perforation in children. It is a Descriptive retrospective study, conducted atDepartment of Pediatric surgery Lady Reading Hospital Peshawar from January 2012 to June 2014.MATERIALS AND METHODS: This study included all patients who had operative findings oftyphoid ileal perforation. All the patients were admitted at Pediatric Surgery Unit Lady ReadingHospital Peshawar, as emergency. A total of 78 patients were managed during the study period. Patientswere admitted, nasogastric tube was inserted, intravenous fluids and antibiotics in the form ofquinolones, metronidazole and gentamycin were administered. Informed consent from the parents wastaken in all cases. Surgical Procedure was tailored according to the peroperative findings. Data wasanalyzed using SPSS version 16.RESULTS: Out of 78 patients, 49(62.8%) were male and 29(37.1%) were female. The mean age ofpresentation was 10.4 years. Duration of symptoms ranged from 7 to 20 days. The commonestsymptoms observed were fever in 78(100%),pain abdomen 78(100%),abdominal distension28(35.89%)and vomiting in 51(65.38%).The choice of surgical procedure was done peroperativelydepending on the extent of contamination of peritoneal cavity and the general condition of the patient.Mean hospital stay was 8 days.CONCLUSION: Early presentation and referral to tertiary care hospital can improve the mortality andmorbidity in children with typhoid ileal perforation. All patients who underwent ileostomy recoveredwell and is the procedure of choice in patients who present late.KEY WORDS: Typhoid ileal perforation, surgical options, ileostomy.

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