ABSTRACT
Background: Squamous cell carcinoma (SCC) of head and neck is highly prevalent in South-asian countries, owing to high consumption of areca nut/gutka and chewing tobacco. p27kip1 is a tumor suppressor gene, thought to be downregulated in oral squamous cell carcinoma. Therefore, in the present study we used immunohistochemical analysis to investigate an association between low p27kip1 expression in SCC of the head and neck and adverse outcomes/risk factors. Methods: Total 105 cases of SCC of head and neck excision specimens were selected from records of pathology department archives that underwent surgeries at Liaquat National hospital, Karachi from January 2008 till December 2013. Clinical and pathologic characteristics of patients were evaluated and p27kip1 immunohistochemistry was applied on tumor blocks. Results: In our study, low expression of p27kip1 in SCC of head and neck was seen in 39(37.1%) cases while 66(62. 9%) of the cases showed high expression for p27kip1. Significant association of p27kip1 expression with pan/gutka usage (p = 0.004), and recurrence (p = 0.001) was noted; however, no significant association of p27kip1 expression with other clinicopathologic features was seen. Multivariate binary logistic regression showed cases with history of pan/gutka usage were more likely to show low p27kip1 expression. Similarly, we also found that recurrence was more likely to develop in patients with low expression of p27kip1 in comparison to cases showing high p27kip1 expression. Conclusion: Loss of p27kip1 expression is a significant event involved in the pathogenesis of SCC head and neck especially that of oral cavity. Significant association of gutka/areca nut with low p27kip1 expression in our study suggests that loss p27kip1 expression is a major event involved in areca nut induced SCC of head and neck in this part of the world; however, more large scale molecular based studies are required to validate this observation. Moreover, significant association of low p27kip1 expression with tumor recurrence suggests its importance as a prognostic biomarker in SCC of head and neck (AU)
Subject(s)
Humans , Male , Female , Nicotiana/adverse effects , Mouth Neoplasms/complications , Immunohistochemistry/methods , Carcinoma, Squamous Cell , Biomarkers , Cyclin-Dependent Kinase Inhibitor p27 , Head and Neck Neoplasms/geneticsABSTRACT
Objective: To compare the efficacy of carbon dioxide [CO[2]] laser with cutting diathermy as a cutting device in surgical excision of early carcinoma tongue
Study Design: Experimental study
Place and Duration of Study: Combined Military Hospital [CMH], Rawalpindi and CMH, Lahore, from July 2008 to July 2011
Methodology: Twenty two biopsy proven cases of T[1] and early T[2] squamous cell carcinoma of tongue were divided in two equal groups of 11 each labeled as A and B. Tumor was excised by CO[2] laser in group A while cutting diathermy was done in group B. For both groups tumor excision time, per-operative blood loss, postoperative oral swelling and pain was recorded. Excision time of tumor was assessed in minutes and amount of blood loss in milliliters till complete hemostasis after removal of primary tumor. Postoperatively patients were assessed on 12 hourly basis for 48 hours for pain. Pain was analyzed on visual analogue score 1 - 10. Oral swelling was assessed once after 24 hours and labeled as mild, moderate and severe. Independent sample t-test was applied for analysis of excision time, postoperative pain and per-operative blood loss for both groups. Postoperative swelling was analyzed using Fisher's exact test. P-value of < 0.05 was considered significant
Results: The mean age at diagnosis in group A was 49.36 +/- 5.27 years, while in group B patients had mean age of 50.73 +/- 8.13 years. In group A, 4/11 [36.3%] patients were having tumor stage T[1] while 7/11 [63.6%] had T[2] stage tumor. In group B, 5/11 [45.4%] were having T[1] and 6/11 [54.5%] were having stage T[2] tumor. Excision time was significantly shorter for group B [p=0.003], but group A had less postoperative pain [p=0.001], less per-operative blood loss [p=0.001] and less postoperative oral swelling [p=0.021]
Conclusion: Early carcinoma tongue is better removed by laser than electrocautery in terms of postoperative morbidity, per-operative blood loss, postoperative pain and oral swelling
ABSTRACT
Background: Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management
Objective: To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi
Methods: This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board
Results: One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years [mean age 56.8 +/- 11.8]. Statistically significant difference was found in under 50 age group where cases were only n=8 [14%] as compared to controls n=25[42%]. Parsi ethnicity showed strong association with osteoporosis [OR 2.23]. Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis [OR 2.8, CI at 95% 1.2-6.3] and Calcium deficiency [OR 2.2, CI at 95% 1.1-4.7]
Conclusion: The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions
ABSTRACT
Objective: to study and analyze the surgical results of distal femoral Varus osteotomy in patients with genu-valgum
Material and Methods: between September 2006 to November 2013, 18 distal femoral oste tomies were performed on 14 patients at department of orthopedic surgery Services Hospital Lahore. After taking the history and physical examination, appropriate radiographs were taken. We did Varus femoral osteotomy by standard lateral approach and 95 angled dynamic compression screw [DCS] fixation, then followed the patient clinically and radiographically till sound healing of osteotomy was achieved
Results: this study was done on 18 knees [14 patients] with mean age 17 years [range 16 to 19 years].The mean duration of follow up was 7.9 months [range 6 to 9 months]. The tibiofemoral angle before and after operation was compared. The average tibiofemoral angle before operation was 19.24degree [14degree to 24degree] and follow up was 6.75degree [5degree to 8degree]. Mean lateral distal femoral angle [LDFA] before surgery was 7 4.85degree [67degree to 83degree] and after surgery was 86.90degree [83degree to 90degree]
Conclusions: distal femoral osteotomy wit DCS fixation through lateral approach can be reliable procedure for the treatment of valgus knee deformity. In this procedure tibiofemoral angle correction can be achieved without compromising the function of quadriceps muscle which helps in the early rehabilitation of the patient in terms of restoring the knee movements. Another advantage of lateral approach is, along with genu-valgum correction, the patella can be stabilized simultaneously
ABSTRACT
Objective: to study wide resection and arthrodesis of wrist, utilizing an autologous iliac crest for giant cell tumour of distal radius [Campanacci Grade-I I I]
Material and Methods: between Feb 2004 to Nov 2011 ,fourteen patients with amean age of 31 .5 years [21-42 years] with Campanacci Grade-Ill GCT of distal radius were admitted in orthopaedic ward Services hospital Lahore. Thirteen patients were managed with wide excision of tumour and reconstruction with ipsilateral iliac crest, fixed with small fragment plate to the remnant of radius. Primary autogenous iliac crest grafting was done at iliac crest radial junction in all the patients
Results: all the patients were followed to bony union, and twelve out of 14 patients were available at mean follow up of 24 months [10 to 26].The mean time to union was four months [3.0 to 6.0] at iliac crest-carpal site and 4.5 months [3.0 to 6.60] at iliac crest- radial site. Eleven patients had a reasonably good range of supination and pronation. The mean Musculoskeletal Tumour Society score was 23.21[77.38%, range21 to 25]. Among the complications, two patients developed radioulnar synostosis, one patient had a local recurrence, but with no bony involvement. Local excision was done and no local recurrence took place thereafter and he is disease free. One patient developed stiffness of fingers, which improved with physiotherapy. There was no other complications like nonunion at the graft bone junction, wound infection [superficial or deep], skin necrosis deformity and bony metastasis and refracture at the reconstruction site
Conclusions: iliac crest provides a local corticocancellous bone graft to reconstruct the defect left after excision of the distal radius for giant cell tumour. Iliac crest graft has advantage over the fibular and ulna graft of having the early union and better incorporation to the host bone, with no evidence of nonunion in our studies. It provides good stability at wrist with contouring of DCP over its concave surface, while retaining a good function of hand and forearm rotation
ABSTRACT
Objective: to determine the efficacy of ponseti method in the treatment of club foot
Material and Methods: this descriptive case series was conducted at Department of Orthopaedic Surgery, Services Institute of Medical Sciences [SIMS]/ Services Hospital Lahore. Sample size of 100 was calculated with 95% confidence using non probability purposive sampling technique. Children of age 6 month to 1 year with club foot of either sex were included, while those with any associated congenital anomaly were excluded. Children with idiopathic club foot having skin disease and pressure sore due to POP cast were also excluded. All children had six casts at weekly interval by Ponseti's technique. Prior to the fifth cast percutaneous Achilles tenotomy was done under local anesthesia if dorsiflexion was not possible beyond neutral. Following the removal of the last cast all the feet were placed in a Foot Abduction Orthosis [AFO]. Sixth months after the completion of plaster treatment all feet were assessed by Pirani score
Results: a total of 100 children were included in the study. The mean age was 5.78 +/- 3.21 months. Majority of the patients were between 0-9 months of age i.e. 63% [n=63], and between 10-12 months 37% [n =37]. Male to female ratio was 1.127:1. Percutaneous Achillies tenotomy was done in 82% of cases. Pirani score six months after cast treatment was calculated which showed 88% [n=88] children had good results and 12 % [n=12] didn't have effective results. Efficacy of Ponseti method in the treatment of club foot reveals Pirani score <1 in 88% [n =88] while >1 in 12% [n=12]. Stratification for efficacy of Ponseti method with regards to age before treatment reveals that out of 88 cases 68.18% [n=60] were between 0-9 months of age and 31.82% [n=28] were between 10-12 months of age. Stratification for efficacy of Ponseti method with regards to initial Pirani score before treatment reveals that out of 88 cases 88.64% [n=78] had< 4 and 11.36% [n =10] had >4 Pirani score
Conclusion: we concluded that Ponseti method is highly effective for the management of club foot in children up to 12 months of age and need for extensive corrective surgery is greatly reduced. We recommend the Ponseti method as standard therapy in clubfoot management
ABSTRACT
Synthesis of twelve hitherto unreported esters of abietyl alcohol and screening of these esters against four cancer cell lines including one breast cancer line MCF7 and four hepatocellular carcinoma cell lines [HCC] Huh7, Hep3B, Snu449 and Plc has been determined using SRB assay. The Cell cycle progression showed changes in cellular behaviour after 48 and 72 hours in MCF7 and Huh7 cell lines. Abietyl alcohol was obtained from the reduction of abietic acid, a tricyclic diterpene, isolated from oleoresin of Pinus longifolia Roxberghii
ABSTRACT
Objective: To examine the prevalence and magnitude of gender discrimination experienced by undergraduate medical students, and its repercussions on their academic performance and emotional health
Methodology: A cross sectional study of 500 medical and dental students studying at a private medical college in Lahore, Pakistan
Results: Majority [78%] of students reported being victims of gender discrimination. Females were the main perpetrators [70.8%]. Most common forms were denied opportunities [63%], followed by neglecting students' needs [44.3%], and unethical talk [43.6%]. Most common places of gender discrimination were teachers' offices [43.7%] and lecture halls [37.2%]. Most of the perpetrators were clerical staff [48%] and professors [43%]. Gender discrimination did not affect the academic performance of most victims [62.6%]. The most common emotional responses were anger [57.6%], frustration [46.7%] and helplessness [40.3%]. 52.4% of students said that gender discrimination still continues and the majority [83.3%] did not report the problem to college authorities
Conclusions: Results demonstrate that gender discrimination is widely prevalent in undergraduate medical education. Females are both the main victims as well as the main perpetrators. In most cases gender discrimination does not affect academic performance but does cause emotional distress
ABSTRACT
Saadat Hasan 'Manto' is widely acknowledged as one of the greatest short story writers in the world. He died at the age of forty three from complications of alcoholism. All of his life, he suffered from symptoms of anxiety and depression and his alcohol abuse was intimately linked both to his mental distress as well as his creative genius. This paper examines the life of Manto from a psychiatric perspective and the link between creativity and mental illness. We show how Manto's particular family circumstances led to the development of restlessness and later anxiety in his life; how his substance abuse, especially alcohol abuse exacerbated this mental distress and how it eventually led to his death and how all of these factors were intimately linked to his creative genius and were the source of so many of his literary masterpieces
Methods: We reviewed seventy five short stories considered to be his best. Writings about Manto's life including his own were reviewed to construct a picture of his life as well as find clues to his mental distress and alcohol abuse. A literature search for articles related to creativity and mental illness was conducted using Google Scholar containing the search terms 'creativity and madness' and 'creativity and mental illness' in the titles of the articles. References most relevant to our case study were identified
Conclusion: Manto suffered from symptoms of anxiety and depression which today would meet the diagnostic criteria for Alcohol Dependence and, in later life, Alcohol-induced Psychosis. Appropriate treatment may have prolonged his life although that may have come at the expense of his creativity
ABSTRACT
Objective: The objective was to assess the early [immediate post-operative] and final outcome of fracture union, mal-union, non-union, avascular necrosis, implantfailure and infection
Material and Methods: A prospective study of fifty five patients of intertrochanteric fractures treated with dynamic hip screws [DHS] without radiological control [C-arm and X-rays] was conducted at Orthopaedic Department, Services Hospital Lahore. AO classification of intertrochanteric fractures was used and fractures were classified as A1, A2 and A3 fractures
Results: There were 20 [40%] A1, 25 [50%] A2 and 5 [10%] A3 fractures. All fractures were reduced and fixed with DHS. 19 patients [38%] had ideally placed implants, 18 patients [36%] had less ideally placed implants and 13 patients [26%] had implants in non-ideal [unsatisfactory] position that required immediate re-do surgery. Overall complication rate was 88% in A2 fractures and 80% in A3 fractures
Conclusion: DHS osteosynthesis in intertrochanteric fractures without radiological control should be discouraged. It is always better to refer the cases where radiological facilities are available in order to avoid morbidity, increased hospital stay and financial burden on the already financially constrained individuals
ABSTRACT
Objective: To observe the outcome of primary [early] soft tissue coverage of type III open fractures and develop a safe protocol for these injuries
Material and Methods: A prospective study of 65 patients suffering from open fractures of tibia Gustilo and Anderson type III A and B, treated with external fixation and primary soft tissue coverage was carried out in the Department of Orthopedic Surgery, Services Hospital, Lahore from February 2004 to June 2006. Motorcycle and automobile vs pedestrian accidents were the commonest cause comprising 90% of the injuries encountered. Strict criteria for inclusion in the study included debridement within 12 hours of injury, no sewage or organic contamination and absence of peripheral vascular disease. Poly-trauma patients were excluded. In all patients radical debridement and stabilization with mono-lateral AO external fixator was done within 12 hours, followed by primary soft tissue coverage
Results: At mean follow-up of 9 months [7-11], the outcome was excellent in 86.7%, good in 6.4% and poor in 6.9%. A total of 16 complications occurred in 12 patients; superficial infections occurred in 09, deep infections in 05 and 02 patients developed non-union requiring further surgery
Conclusion: Primary soft tissue coverage with the above indications optimizes the recovery of the patients in terms of lesser soft tissue infections and bone non-union due to chronic osteomyelitis
ABSTRACT
Smoking is a pollution and injurious to health. More than 4,000 individual compounds have been identified in tobacco and tobacco smoke. Among these are about 60 compounds that are carcinogens, tumor initiators [substances that can result in irreversible changes in normal cells] and tumor promoters [substances that can led to tumor growth once cell changes begin]. Some of these compounds are tar, carbon monoxide, hydrogen cyanide, phenols, ammonia, formaldehyde, benzene, nitrosamine, and nicotine. We have already carried out population survey of cigarette smoking in Karachi, Multan and Abbottabad. In this paper we present comparison of smoking pattern between Karachi, Multan and Abbottabad. The study was carried out on 3000 subjects residing in different localities of Karachi, Multan and Abbottabad. A specifically designed questionnaire was filled. Out of the study population, 43.53% citizens of Karachi, 40.02% citizens of Multan and 33.00% citizens of Abbottabad were found to be indulged in smoking. It is suggested that smokers should decide to quit the smoking once for all