ABSTRACT
Mucormycosis is a life threatening fungal infection and remains an important cause of morbidity and mortality in immunocompromised patients after hematopoietic stem cell transplant. We report here a case of hepatosplenic mucormycosis in a patient after autologous stem cell transplant. A young man with anaplastic large cell lymphoma underwent autologous hematopoietic stem cell transplant after achieving complete remission with standard chemotherapy and consolidative radiotherapy. He was found to have incidental hepatosplenic hypodensities on follow up imaging, that were proved to be mucormycosis on histopathology after getting CT-guided biopsy of splenic lesions. He was treated with intravenous amphotericin-B followed by complete radiological resolution of hepatosplenic lesions. Although these infections are often life threatening but limited disease may have better outcome if diagnosed and treated early and aggressively
ABSTRACT
The purpose of developing [Sepsis Guidelines for Pakistan] [SGP] is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign [SSC] tailored to available resources. These recommendations are not meant to replace the SSC Guidelines. SGP is an initiative of Pakistan Society of Critical Care Medicine [PSCCM]. Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committeei.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, essential interventions to manage sepsis, and general measures for provision of a comprehensive care to patients in sepsis according to the level of education and training of healthcare providers and facilities and resources available in different levels of hospitals. The draft was presented at the 3[rd] Sepsis Symposium held on13[th] September, 2014 in Karachi. The final document was approved by a panel of experts from across the country, representatives of relevant societies and Global Sepsis Alliance [GSA]. Hospitals are divided into basic, intermediate and tertiary depending on the availability of diagnostic facilities and training of the medical personnel. Modified definitions of sepsis,severe sepsis, and septic shock are used given the lack of facilities to diagnose sepsis according to international definitions and criteria in Pakistan. Essential interventions include fluid resuscitation,vasopressors to support the circulation, maintaining oxygen saturation >/= 90% with oxygen, non-invasive ventilation or mechanical ventilation with lung protective strategies, prompt administration of antibiotics as recommended by the Medical Microbiology and Infectious Diseases Society of Pakistan [MMIDSP] and early source control. It is recommended to avoid starvation, keep an upper blood glucose 7.20, avoid fresh frozen plasma in the absence of bleeding, transfuse platelets if indicated, not use intravenous immunoglobulins and avoid neuromuscular blocking agents [NMBAs] in the absence of ARDS, target specific titration endpoints when continuous or intermittent sedation is required in mechanically ventilated patients and use continuous renal replacement therapy [CRRT] to facilitate management of fluid balance in hemodynamically unstable septic patients in tertiary care centers. In addition a comprehensive, meticulous and multidisciplinary general care is required to improve outcome of sepsis by reinforcing hand hygiene and other infection control measures, adequate monitoring and documentation tailored to the available resources. Goals of care and prognosis should be discussed with patients and families early and either shifting the patient to a hospital with better facilities or limiting or withdrawing therapy in case of poor prognosis should be considered
Subject(s)
Adult , Humans , Shock, Septic , Hypotension , Disease ManagementABSTRACT
The objective of the study was to review our experience in the management of splenic abscess in cancer patients at a cancer hospital in Pakistan. This study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and data reviewed from January 2007 till December 2012. Demographic, pathologic, radiologic and treatment records of each cancer patient with splenic abscess were retrieved from the electronic database. Patients were followed for a period of six months. Twelve patients were diagnosed with splenic abscess in the last six years. Males were ten compared to two female patients. Mean age was 41.1 years [range 3-64]. All except one were adults. Six patients had hematological malignancies while six were diagnosed with solid organ tumors, among the solid organ tumors three had metastatic disease with unknown primary. Six patients had multiple splenic abscesses while six patients had solitary abscesses. Bacterial cultures were positive in four patients, Pseudomonas species and Escherichia coli in two patients each; one patient with mycobacteria tuberculosis; no fungal growth identified in any patient. Antibiotics were given to all patients except one patient who died before any therapy due to end stage hepatocellular carcinoma. Three patients were treated with antituberculous therapy, two of them recovered while one was lost to follow-up. Percutaneous aspiration/drainage [PCD] was done in five patients; Surgery was performed in three patients. One patient who underwent PCD died due to septicemia while one patient died of cardiac event, two patients were lost to follow up while eight patients recovered completely. Percutaneous aspiration/drainage is an equally good option for treating splenic abscess as compared to surgery along with adequate antibiotics
ABSTRACT
A high-pressure liquid chromatography [HPLC-UV] based simple and specific method for simultaneous quantitative determination of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium has been developed and validated according to ICH guidelines. Chromatographic separation of the three drugs was carried out on 4.6 x 250mm x 5micro Licrospher RP Select B Column, using mobile phase constituted of methanol and phosphate buffer pH 3.5 [650: 350], pH adjusted to 3.5 +/- 0.05 with dilute ortho-phosphoric acid and delivered at a flow rate of 1ml/min. The eluents were detected at UV wavelength of 220nm and the retention times for Ofloxacin, Fexofenadine HCl and Diclofenac Potassium were 2.5 minutes, 4 minutes and 11.5 minutes, respectively. This method is suitable and specific for the three drugs and was found to be linear [R2>0.996], accurate, specific, reproducible and robust over a concentration range of 0.05 to 0.15mg/ml for Ofloxacin, 0.015 to 0.045mg/ml for Fexofenadine HCl and 0.0125 to 0.0375mg/ml for Diclofenac Potassium. The proposed method is simple and convenient, hence easily utilized for the characterization and quantitation of the three drugs in a single formulation for combination therapy of rheumatoid arthritis, sepsis, infection with fever and flu
ABSTRACT
Objective: to study the clinical behavior of dengue infection in cancer patients
Material and Methods: we reviewed medical records of cancer patients who were diagnosed with dengue infection in year 2011 as per discharge notes. Patients fulfilling revised dengue WHO/TDR classification with positive dengue lgM serologist were finally chosen for analysis
Results: from initially screened 63 patients, 43 fulfilled revised dengue WHO/TDR classification criteria, 31 [of these 43] with positive dengue lgM were finally analyzed. There were 16 males and 15 females, mean age was 39.0 [23.0] years. 23 patients were = 18 years of age. 81 % patients reported within first three days of illness. Major cancer bulk was from solid organ cancer group [n=21] followed by hematological group [n=10]. Presenting features were fever [100%] followed by aches [58.1 %], hemorrhagic manifestations [35.5%], vomiting [29%] and diarrhoea [25.8%]. Twelve [38. 7%] patients developed severe dengue with one death making 3.2% crude mortality rate
Conclusion: the spectrum of dengue infection severity in cancer patients seems to be different from general population. Clinically dengue was more severe with solid organ cancers as compared to hematologic cancers possibly highlighting the role of cellular mediated immunity. Other risk factors identified were relatively elder age and more co-morbid conditions
ABSTRACT
A high-pressure liquid chromatography [HPLC-UV] based simple and specific method for simultaneous quantitative determination of aspirin, amlodipine besylate and simvastatin in a capsule formulation has been developed and validated according to ICH guidelines
Chromatographic separation of the three drugs was carried out by aSpherisorbODS2 reverse phase column [4.6 x 250 mm; 5 microm] using amobile phase, which consisted of 70: 30 [v/v] mixture of acetonitrile and triethylamine phosphate buffer [pH 3; 0.015 M] with final pH adjusted to 2.5 using dilute ortho-phosphoric acid, at a flow rate of ImL/min. The eluents were detected at UV wavelength of 237 nm and the retention times for aspirin, amlodipine besylate and simvastatin were -2.7 mins, -6.1 mins and 10.5mins, respectively. This method is suitable and specific for the three drugs and was found to be linear [R[2]>0.995], accurate, specific, reproducible and robust in the concentration range of 375 to 1125mcg/ml for aspirin, 25 to 75mcg/ml for amlodipine besylate and 50 to 150mcg/ml for simvastatin. This simple and convenient method could be easily utilized for the characterization and quantitation of the three drugs in a single formulation for combination therapy of cardiovascular diseases
ABSTRACT
Dengue fever has now affected all the major cities of country. About 41,354 patients underwent antibody screening for dengue fever from Shaukat Khanum Memorial Cancer Hospital, Lahore, during the epidemic period [October 1st 2010 to December 20[th] 2010]. Out of them, 1294 [3.1%] patients were positive for IgM antibodies, and 124 [0.3%] for IgG antibodies. A total of 722 [1.7%] patients were borderline positive for IgM antibodies and 108 [0.26%] were borderline positive for IgG antibodies. Dengue fever has emerged as a global problem over the last 5 years. It has also hit Lahore badly especially after the floods in 2010. High index of suspicion should be there in case of related symptoms
Subject(s)
Humans , Disease Outbreaks , Immunoglobulin M , Immunoglobulin GABSTRACT
Tuberculosis of breast is a rare entity and may be confused with carcinoma of the breast. We present a case series of 14 patients with granulomatous mastitis, seen over a seven-year period from a cancer centre in Lahore, Pakistan. The cases were retrieved using electronically coded records and clinical, radiological and pathological data reviewed. Cases with a histologic diagnosis of granulomatous mastitis were included. Granulomatous mastitis was seen at a frequency of 0.37% of the 3768 patients seen with breast diseases [3722 women; 46 men] during this time period. The average age at presentation was 40.7 years [range 14- 65 years]. The most common presentation was a lump in the upper outer quadrant of the breast. Mammography showed a range of appearances. Diagnosis was obtained via fine needle aspiration [10 cases], core biopsy [2 cases] and excision [2 cases]. Acid-fast bacilli were seen in five out of the 14 patients. Ten out of 14 patients completed treatment at our centre with satisfactory response. Granulomatous mastits is an uncommon disease and typically presents with a lump in the breast. The diagnosis can be established by fine needle cytology in the majority of cases. Acid-fast bacilli are seen a minority of the cases