ABSTRACT
Objective: To determine the complete clinical response in rectal carcinoma after neoadjuvant chemo radiation
Study Design: Cross-sectional study
Place and Duration of Study: This study was conducted in Clinical Oncology department, Jinnah Postgraduate Medical Centre Karachi, from Jan 2016 to Jan 2017
Material and Methods: Seventy Two Patients meeting the inclusion criteria were enrolled in study after complete staging workup. Neoadjuvant concurrent chemoradiotherapy was planned, consisting of oral capecitabine 825mg/m2 BID five days a week along with 50.4 Gy Radiotherapy with linac machine. Radiation was delivered over a period of 5 weeks at a rate of 1.8 Gy/day. Patients received Radiotherapy in Atomic Energy Medical Centre [AEMC] and in Sindh Institute Urology and Transplant [SIUT], Radiation department. Chemotherapy was given in clinical oncology department of JPMC. Sixty one patients completed planned treatment and were available for post concomitant chemo radiotherapy response assessment with Pelvic CT/MRI after 6-8 weeks of completion of concomitant chemo radiotherapy. Response assessment was done according to Response Evaluation Criteria in solid tumor [RECIST] criteria version 1.1 and then Patients were referred for surgical evaluation
Result: A total of 61 cases of locally advanced adenocarcinoma rectal cancer patients were included in the study.Mean age of the patients was 41 years with +/- 17.06 years SD. Complete clinical response was identified in 4 [6.6 percent] while 31 [50.8 percent] were identified as partial response, progressive disease was 13 [21.3 percent] and 13 [21.3 percent] were with stable disease. All confounding variables were found statistically significant with p-value found less than 0.05
Conclusion: Neo-adjuvant chemoradiotherapy for locally advanced rectal cancer is associated with high rates of tumor response in terms of downs tagging [complete and partial] and is relatively safe with acceptable morbidity, which favors its use in future
ABSTRACT
Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation [DUE] studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization [WHO] guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower [LRTI] 16.8% [n=42] and upper [UTI] 13.2% [n=33]. The estimated total number of drug units administered per month was greater with cefixime [46] and ciprofloxacin [45] both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem [47, 46 and 29.25] correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup