Impact of multidisciplinary care in gynecological cancer patients

Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients through multidisciplinary meetings [MDM] at MCH centre, Pakistan Institute of Medical Sciences [PIMS], Islamabad

Study Design: A pre and post intervention comparative study

Place and Duration of Study: The study was conducted at MCH centre, PIMS and Nuclear Oncology and Radiotherapy Institute, Islamabad from 1[st] April 2009 to 31[st] Mar 2010

Material and Methods: MDM is a regularly scheduled meeting of core and limited team members for the purpose of prospective treatment and care planning of newly diagnosed cancer patients. It was started in 2009 in order to improve the management of the cancer patients according to the international recommendations. In a total of 1 year study period 24 meetings were held. The major audit tool was the documentation of the meeting and its outcomes, patient communication and record of the Nuclear Oncology and Radiotherapy Institute of Islamabad [NORI]. A postgraduate student was deputed for documentation

Results: The study identified that MDM helped in achieving many of the best practices of international recommendations which include team approach to treatment planning as well as to care provision, throughout the complete patient pathway. The workload almost doubled as regards the surgery and outdoor cancer claims. There was a shorter delay to first seen in the cancer clinic and shorter duration from diagnosis to treatment. Team members were present in 90-100% of the meetings

Conclusion: MDM has swiftly improved the quality of care and follow up of patients with gynecological cancers and should be conducted at all tertiary care hospitals. Problems of access to high quality and timely care of poor patients in public sector should be addressed as poor patients are not compliant to timely follow-up

Comparative study of hepatic serum enzymes in albino rats after treatment with tamoxifen and taurine

To compare the mean values of serum hepatic enzymes of albino rats after treatment with tamoxifen and taurine. A prospective experimental study. This study was conducted in the Department of Anatomy, Khyber Medical College, Peshawar from July 2011 to December 2011. Sixty adult female albino rats were divided into four groups [A-control, B-tamoxifen-treated, C tamoxifen plus taurine-treated, and D-taurine treated]. Each group was further divided into three subgroups [1, 2, 3] according to the period of treatment which was one, three and six weeks, respectively. Body weights were recorded at the commencement and end of the study period. At the end of the respective period of treatment the animals were sacrificed under deep ether anesthesia. By a midline incision, the anterior abdominal wall was opened. Blood samples were collected with 5cc syringes by cardiac puncture for estimation of serum hepatic enzymes [serum glutamic pyruvate transaminase-SGPT, Serum glutamic oxaloacetic transaminase [SGOT] and serum alkaline phosphatase [ALP]. The livers were removed, washed with normal saline, and their weights were recorded. Formalin fixed, paraffin embedded 4 micron thick sections were stained with H and E for histopathological examination. The mean values [I.U/L] of SGPT levels of albino rats in control groups Al, A2 and A3 were 40.83 +/- 1.62, 42.02 +/- 0.95 and 41.09 +/- 0.87 respectively, and in the tamoxifen-treated groups Bl, B2 and B3 were 155.2 +/- 12.47, 243.60 +/- 11.96 and 277.60 +/- 12.84 respectively. This data show a highly significant increase [P<0.001] in the SGPT levels in all the B-subgroups [tamoxifen - treated] albino rats, in comparison with the control subgroups. The mean values [I.U/L] of SGPT in the tamoxifen plus taurine treated groups Cl, C2 and C3 were 67.99 +/- 1.89, 107.77 +/- 2.28 and 137.93 +/- 8.29. Compared to the corresponding B subgroups, the data show highly significant decrease [P<0.001] in SGPT levels in groups Cl and C3, and moderately significant decrease [P<0.01] in SGPT levels in group C2. The mean values of serum levels [I.U/L] of SGOT in control groups Al, A2 and A3 were 38.66 +/- 0.89, 37.12 +/- 1.15 and 38.52 +/- 1.74 respectively. The mean values of SGOT in subgroups Bl, B2 and B3 were 73.60 +/- 4.98, 152.48 +/- 13.00 and 247.40 +/- 18.53 I.U/L respectively. Thus there was moderately significant increase [P<0.01] in SGOT levels in Bl, and highly significant increase [P<0.001] in B2 and B3 as compared to the control subgroups. The mean values of SGOT in subgroups Cl, C2 and C3 were 65.20 +/- 3.15, 109.20 +/- 4.83 and 124.98 +/- 5.83 respectively. The data show insignificant decrease in SGOT level in subgroup Cl [P>0.05], significant decrease in C2 [P<0.05], and moderately significant decrease [P<0.01] in C3 as compared to subgroups Bl, B2 and B3, respectively. The mean values [I.U/L] of serum ALP in the control groups Al, A2 and A3 were 146.60 +/- 17.73, 196.40 +/- 22.47 and 164 +/- 24.60 respectively, and in the tamoxifen-treated groups Bl, B2 and B3 were 436.80 +/- 30.92, 467.80 +/- 15.43 and 684.20 +/- 18.64 respectively. This shows highly significant increase in the serum levels of ALP [P<0.001] in all B subgroups. The mean values [I.U/L] of serum ALP in subgroups Cl, C2 and C3 were 394.20 +/- 20.79, 376.60 +/- 20.02 and 420.00 +/- 14.66 respectively. This data show that there was insignificant decrease [P>0.05] in serum ALP in Cl, moderately significant decrease [P<0.01] in C2 and highly significant decrease [P<0.001] in C3, when compared with Bl, B2, and B3, respectively. Concomitant taurine administration lowers the mean values of serum hepatic enzymes in albino rats treated with heavy doses of tamoxifen

Effect of chemotherapy on serum lactate levels in malignant neoplasia

The present study was designed to look at the levels of serum lactate in various malignancies and to observe the effect of chemotherapy on serum lactate concentration in malignant neoplasia as a whole. The study was also intended to look for the difference, if any, in this effect for haematopoietic and non-haematopoietic neoplasias, so as to see whether evaluation of lactate levels could represent an additional and useful parameter in determining the clinical and prognostic aspect of the disease Observational and comparative study. This study was conducted at Radiotherapy Department, Jinnah Postgraduate Medical Centre, Karachi In this study 131 patients of Malignant Neoplasia were taken from the out-door patients in which 56 patients of haematopoietic group and 75 patients of non- haematopoietic group. Blood samples of 131 patients suffering from haematopoietic and non-haematopoietic neoplasia and 20 healthy control subjects were collected and analyzed for lactate, pyruvate and the NADH/NAD ratio. Blood lactate, Pyruvate levels and NADH/NAD* ratio were significantly higher in all groups of neoplasia before chemotherapy when compared with control subjects. The NADH/NAD+ ratio and the levels of blood lactate and Pyruvate decreased significantly with chemotherapy in all groups of patients suffering from neoplasia. Observation of low levels of these parameters, particularly that of serum lactate, after the course of chemotherapy can be used as an indicator of prognosis and also considered helpful in assessing the effectiveness of chemotherapy in malignancies