Interdigitated versus sequential high-dose-rate intracavitary brachytherapy with external beam radiotherapy in locally advanced carcinoma cervix

Aims: To decrease overall treatment time (OTT) and to compare the clinical outcome of interdigitated high-dose-rate intracavitary brachytherapy (HDRICBT) versus sequential HDRICBT with external beam radiotherapy (EBRT) in the treatment of locally advanced carcinoma cervix. Methods: Eighty-two patients with histologically confirmed carcinoma of the cervix, untreated International Federation of Gynecology and Obstetrics Stage IIB–IIIB, were included and randomized into two groups. The study group received EBRT 50 Gy/25 fractions with interdigitated HDRICBT 8 Gy/fraction weekly a total of three fractions. Patients in the control group received EBRT 50 Gy/25 fractions with sequential HDRICBT 8 Gy/fraction weekly a total of three fractions. At the end of the study, results of both groups compared in terms of OTT, acute and late toxicities, and response to therapy clinically. Results: A total of 82 patients were enrolled 41 in each arm. Seventy-two patients completed treatment and were analyzed. Mean OTT in study group and control group was 40 and 60 days, respectively. The median follow-up duration was 10 months (3–18). Most of the acute and late toxicities were of Grade 1 and 2 type and comparable in both study and control groups. Treatment interruption due to treatment-related toxicity was slightly higher in the study group than the control group, but it was statistically insignificant. Os negotiability was not found to be a limiting factor for interdigitated HDRICBT. Conclusion: Interdigitated HDRICBT has equivalent response and toxicities as sequential HDRICBT with the advantage of significant reduction in OTT

In vitro antimalarial and xanthine oxidase inhibition of 2-Aminoanthraquinone

In the present research study 2-Aminoanthraquinone were scrutinized for their antimalarial and Xanthine oxidase inhibitor potential. It demonstrated marked concentration dependent antimalarial activity with maximum effect of 89.06% and with IC[50] of 34.17 micro M. Regarding Xanthine oxidase inhibitor activity, it evoked significant effect with 57.45% activity with IC[50] value of 81.57.19 micro M. In conclusion, 2-Aminoanthraquinone showed potent antimalarial and xanthine oxidase inhibitory activity

Association of Streptococcus with Plaque Type of Psoriasis.

Background: Guttate psoriasis has a well-known association with streptococcal throat infections, but the effects of these infections in patients with chronic plaque type of psoriasis remains to be evaluated. In Bangladesh several studies were done on psoriasis but no data about association between streptococcal throat infection and plaque type psoriasis are available so far. Considering the co-morbidities of psoriasis patients, it might be justifiable to find out the events that provoke the initiation or exacerbation of psoriatic disease process. Objective: To observe the association of streptococcus with plaque type of psoriasis. Materials and Methods: This observational study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Forty seven patients clinically and histopathologically diagnosed as having plaque psoriasis were selected as cases and patients with skin diseases other than psoriasis were selected as controls. Results: In this study majority of subjects (55%) were diagnosed as chronic plaque psoriasis. Among the subjects with guttate flare of chronic plaque psoriasis 64.2% gave a positive history of sore throat. ASO titer was raised (>200 IU/mL) in 28 (59.5%) patients of chronic plaque psoriasis and 7 (17.9%) patients of non-psoriatic respondents. The difference between two groups was significant (p<0.05). Streptococcus pyogenes was found in 12 (25.5%) in chronic plaque psoriasis patients versus in 4 (10.2%) in controls (p>0.05). Conclusion: This study shows that streptococcal throat infections are associated with plaque psoriasis and early treatment of throat infections may be beneficial for plaque type of psoriasis patients.

Blood morphology of patients suffering from malaria

To find out changes in peripheral blood of patients suffering from malaria. Descriptive case series. The study was conducted at Shah Noor Medical Laboratory, Bannu Khyber Pakhtoon khawa from 1[st] May 2014 to 31[st] August 2014. In this study 160 cases of malaria patients were selected by non probability random sampling technique with informed consent of the patients. These patients were subjected to complete blood counts performed by Hematology analyzer Sysmex 21 and manual method using Neubaur's chamber and thick and thin films stained with Giemsa stain to confirm malarial parasite. The data was recorded in preformed designed proforma and was analysed by using a Statistical Package for Social Sciences [SPSS] version 16 for percentages, means and standered deviation. Out of 160 patients 93 [58%] were males and 67 [41.87%] females. Most 59 [36.8%] were in the age range of 1-10 years. Plasmodium vivax found in 135 [84.3%] and Plasmodium falciparum in 25[15.6%] cases. Minimum total leukocyte count [TLC] was 1300/cmm and maximum was 19500/cmm, Low Hemoglobin level was 4.50 g/dl and high value was 15.20 g/dl. Platelets minimum count was 35000/cmm and maximum was 590000/cmm. Anemia was present in 103 [64.37%], thrombocytopenia was present in 65 [40.62%], leucopenia was present in 34 [21.25%], bicytopenia was present in 24 [15%] and Pancytopenia was found in 5 [3.12%] of cases, where as high TLC was encountered in 6 [3.75%] cases. This study shows that person suffering from malaria have significant changes in blood morphology especially cytopenias causing morbidity and mrtality needs special attention regarding accurate diagnosis and prompt treatment to avoid the complications

old dietary regimen as a new lifestyle change for Gastro esophageal / reflux disease: a pilot study

Treatment of gastro esophageal reflux disease [GERD] is becoming a challenge for medical profession. Proton pump inhibitors [PPIs] are commonly recommended but many disadvantages of these drugs are being reported, particularly when used for long term. Transient lower esophageal sphincter relaxations [TLESRs] are important cause of acid reflux. Gastric distention in upper stomach is the strongest stimulus for generation of TLESRs and is aggravated by intake of food in between meals. In an earlier cases report, two meals a day with intake of only fluids in between was suggested as a remedy for GERD. Present pilot study was conducted on 20 patients with endoscopically proven reflux esophagitis [Los Angles Grade a, b or c], who followed our advice to take meal twice a day with consumption of only soft drinks [fruit juices, tea, coffee, water, etc] in between and no medication for two weeks. On 14[th] day 15 patients [75%] were free of reflux symptoms, 2 [10%] had partial improvement and 3 [15%] reported no difference. It is concluded that two meals a day with intake of only fluids in between, whenever the patient feels hungry or thirsty, is a useful dietary regimen for the management of GERD. Further investigations are needed to confirm the benefits of this physiological lifestyle change

Patient related factors associated with delayed reporting in oral cavity and oropharyngeal cancer

Background: Delayed reporting resulting in advanced stage disease is a common problem in Indian cancer patients. This study analysed the impact of various sociodemographic and psychosocial factors on the delayed reporting to Healthcare Professional [HCP] in oral and oropharyngeal cancer patients

Methods: This cross sectional observational study was conducted using a structured questionnaire. Questionnaire included questions to assess socio-demographic and psychosocial factors associated with delay. Delay was defined as time intervals of more than 3 month from first symptom recognition to first medical consultation to a HCP. Association of delay with these factors was analyzed using logistic regression analysis

Results: Final analysis was done on 259 patients. Delay in reporting to HCP was present in 156 [60%] patients. Among sociodemographic factors delayed reporting was highly significant with older age group [P = 0.001], low socioeconomic status [P = 0.02], rural residence [P = 0.026] and with insufficient knowledge of Head and Neck cancer [P = 0.014]. Sex and marital status were statistically insignificant factor for delay. Among psychosocial factors attribution of symptoms as minor [P = 0.011], absence of fear [P = <.001] and use of alternate therapy [P = 0.001] were significant factors responsible for delay. Disclosure to other and motivation were statistically insignificant in our study

Conclusions: The results of this study provide guidance towards interventions to reduce patient delay. Interventions should target the rural, older age group and lower socioeconomic population for educating them and to change their psychosocial behavior for oral and oropharyngeal cancer

Efficacy of Immunodiagnosis of Falciparum Malaria at Different Levels of Parasitemia.

Background: Among the several human species of malarial parasites, Plasmodium falciparum can cause severe infection and if left untreated, there may be fatal complications. Early diagnosis and prompt treatment have been proposed to reduce the morbidity and mortality from malaria. Objective: To assess the diagnostic efficacy of antigen detection by immunochromatographic test (ICT) at different levels of parasitemia for diagnosis of malaria. Materials and Methods: This study was carried out in the department of Microbiology, Mymensingh Medical College for a period of one year from July 2005 to June 2006. A total of 98 clinically suspected malaria patients were included in this study. Peripheral blood films (PBF) were examined under microscope and parasite count/μL of blood was performed. Subsequently ICT for malaria antigen was done for each case. Results: Out of 59 cases positive by microscopic examination of blood films, 54 cases had parasitemia >600 parasites/μL of blood and all these cases were positive by ICT for malaria antigen. Rest 5 cases showed parasitemia <600 parasites/μL of blood and one case was found positive by ICT for malaria antigen. Conclusion: Immunochromatographic test can be used for early diagnosis of malaria with hyperparasitemia, especially for cerebral malaria.

effect of thymoquinone, an active component of Nigella sativa, on isoproterenol induced myocardial injury

Myocardial injury constitutes a major cause of morbidity and mortality in humans. Present study aimed to investigate protective role of thymoquinone, which is an active principle of Nigella sativa [N. sativa] seed [Commonly called as black seed], in isoproterenol induced myocardial injury, a classical example of excess catecholamines related coronary insufficiency and 'stress cardiomyopathy'. Thymoquinone, in olive oil, was administered orally [12.5, 25 and 50mg/kg] to three groups of Wistar albino rats for 7 days, while two control groups were given plain olive oil. Thereafter, thymoquinone receiving groups and one control group were injected, subcutaneously, with isoproterenol [125mg/kg] for 2 days. Myocardial injury was assessed by biochemical markers [plasma LDH, TBARS, GR and SOD and myocardial GSH/GSSG ratio] and cardiac histopathology. Plasma LDH, TBARS and GR increased in control groups receiving isoproterenol, while there was a dose related decrease in these markers in thymoquinone treated groups, down to levels in controls given olive oil only. Decrease in plasma SOD and myocardial GSH/GSSG ratio and histological changes produced with isoproternol were also reversed in thymoquinone treated rats. Results of our study revealed that thymoquinone protects the heart from injury induced by isoproterenol

Diabetes from ancient to modern era

The story of diabetes mellitus, its discovery, description, and treatment is a remarkable chronicle covering around 3, 500 years of medical history. History reveals that diabetes has always been a part of medical research and discussion, although in a very primitive form in the ancient ages. In the Medieval Ages the Unani physicians carried out extensive literary and clinical research into the signs and symptoms and complications of diabetes. Among these works, Maqala fil-Baul of Rufs al-Afsi [2nd century A.D.], Kitab fil-Baul of Hunain Ibn Ishaaq [d. 1188 A.D.] and Kitab Ma'rfa al-Baul of Ishaaq Bin Hunain [828- 911 A.D.], are worth mentioning. Later, in-depth research by numerous scientists led to the discovery of insulin and the role of beta cells of pancreas in the pathology of diabetes

Epithelial ovarian cancer; epidemiology and clinicopathological features

Epithelial ovarian cancer is the most common cancer of gynaecologic origin in Pakistani women. It ranks among the ten most common cancers in our women. Despite being commonly encountered, information regarding the clinicopathological features is lacking. To study the clinical and pathological features of epithelial ovarian cancer in our patients.. Department of Medical Oncology, Jinnah Hospital Lahore. Period: Jan 01,2001 to Dec 31, 2002. Patients and All patients with histological or cytological diagnosis of epithelial ovarian cancer regardless of stage were included in the study. Information was obtained from medical records which were reviewed thoroughly. Blood samples for analysis of BRCA mutations were sent to University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada. 75 patients were accrued. Mean age of the patients was 47 years. The well defined risk factors such as nulliparity, lack of lactation, early menarche and late menopause were not present in the majority of our patients. One striking feature was the number of patients with family history of cancer [18.7%]. Majority were first degree relatives of the patients and most had ovarian or breast cancer. BRCA1 and BRCA2 were seen in nine [12%] of the patients. Clinical presentation and histologic features were similar to American and European patients, the only difference was that a large number [88%] of our patients presented with advanced [stage III or IV] disease. Epithelial ovarian cancer manifests itself in a younger population of our women. Higher frequency of positive family history was another striking feature of Pakistani patients

Frequency of depression and somatic symptoms in patients on interferon alpha/ribavirin for chronic Hepatitis C

Large numbers of patients suffering from Chronic Hepatitis C [HCV] are seeking treatment with interferon alpha [IFN] because of significant advances in overall improvement in the course of HCV and its complications. Objectives were to estimate the frequency of depression and somatic symptoms in patients on interferon alpha/ribavirin treatment for chronic hepatitis C. It was an observational study conducted in the out-patient Department of Gastroenterology Shaikh Zayed Hospital, Lahore during a period of three months, i.e., from September to November 2008. One hundred consecutive patients undergoing interferon alpha/ribavirin treatment for chronic HCV were included in the study. All patients, irrespective of age, sex or duration of treatment were administered with a check list of common physical complaints and DSM-IV symptoms for Major Depressive Episode. Out of a total of 100 subjects 37 were male and 63 were female. In all, 39 [39%] patients fulfilled the diagnostic criteria of DSMIV for Major Depressive Episode. Major Depression was more common in female 28 [44.4%] as compared to male 11 [28.7%] patients. Somatic symptoms were common in all the patients but they were reported more frequently by patients with Major Depression compared to those without Major Depression. Myalgias, headache, joint pain, nausea/vomiting, abdominal pain and palpitation were the most common physical symptoms. Major Depression and somatic complaints are a common consequence of interferon alpha/ribavirin treatment for chronic hepatitis C. All patients receiving this treatment should be periodically assessed for the detection of these side effects to promptly address relevant treatment options

Intestinal anastomosis; comparative evaluation for safety, cost effectiveness, morbidity and complication of single versus double layer

To evaluate the safety and cost effectiveness of single layer interrupted intestinal anastomosis in comparison with the double layer conventional method of intestinal anastomosis. Prospective comparative study. Surgical unit 4 DHQ hospital Faisalabad operated by single team during 12 months starting from Feb. 2007 to Jan. 2008. The cases were assigned to the two techniques, each being applied on alternate patient, single layer extra mucosal interrupted anastomosis and double layer anastomosis. In group 1 we used black silk 3/0 and in double layer we used vicryl 3/0 for inner continuous layer and black silk 3/0 for outer continuous layer. Comparison between two techniques was done on the bases of procedure time, cost effectiveness, morbidity in terms of rate of leakage. Average time for the construction of the single layer anastomosis was 20 minutes and in double layer was 35 minutes, the difference in average time is statistically significant [p<.001] while average duration of stay was 168 hrs and 216 hrs in group 1 and 2 respectively [p<.001]. Leakage rate was double [12%] in group 2 while 6% in group 1. Moreover structure material consumption was more in two layered technique and longer stay added to that lead to more hospital expenses on two layered technique. Anastomosis using a single layer interrupted extra mucosal technique was faster to perform, cost effective, less likely to leak and as strong as a 2-layer anastomosis

Survival and impact of tumor grade, residual disease and age in patients suffering from epithelial ovarian cancer

Objective: to determine the overall survival and impact of histopathological grade, residual disease and age on survival of patients with epithelial ovarian cancer

Study Design: retrospective study

Place and Duration of study: department of Medical Oncology, Jinnah Hospital Lahore, from Jan 01, 2001 to Dec 31, 2002

Patients and Methods: patients with all stages of epithelial ovarian cancer with histological documentation of the disease ·were- included- in- the- study.- Patients with malignant ascites consistent with adenocarcinoma with an ovarian mass were also included. Patients with germ cell" or stromal tumors were excluded. Patients with ovarian metastases from any other malignancy were also excluded. Survival from the date of diagnosis was the end point. Overall survival was calculated from the date of diagnosis to the date of death or the date when the patient was last known to be alive. The impact of age of the patient [< 50 yrs. vs= 50 yrs.], tumor grade [low grade vs. intermediate and high grade] and residual disease [1.5 cm] on survival was evaluated. Information was collected from medical records and a thorough review was done. The data was analyzed by SPSS. Survival was. Evaluated by the Kaplan Meier Survival plot

Results: seventy-five patients were accrued to the study. Median age of the patients was 47 years. Mean overall survival was 36 months [95% C.I, 26 to 47]. Overall 5-year survival rate was 38% .Younger age at presentation, high tumor grade and bulky residual disease are poor prognostic factors, having an adverse effect on survival in epithelial ovarian cancer. Patients with well-differentiated tumors had a mean survival of 44 months as compared to just 17 months for patients with moderate to poorly differentiated tumors [p=.002]. Patients with minimal residual disease after initial surgery had a mean survival of 52 months whereas those with bulky disease had a survival of 13 months only [p=.000]. The overall survival of patients younger than 50 years was 29 months and those older than 50 years was 39 months

Conclusion: younger age at diagnosis, high histological grade and suboptimal debulking are associated with inferior survival in patients with epithelial ovarian cancer

Clinical profile of subacute sclerosing panencephalitis

To describe the clinical manifestations of subacute sclerosing panencephalitis in children. Case series. This study was conducted in the Department of Neurology at The Children's Hospital and the Institute of Child Health, Lahore, from April 2005 to April 2007. Fifty patients were diagnosed as subacute sclerosing panencephalitis during the study period. Their diagnosis was based on a detailed history, clinical examination, presence of antimeasles antibodies in Cerebrospinal Fluid [CSF] and typical electroencephalogram [EEG]. The findings were described as average, mean and percentages. Fifty patients were included in this study. The average age of the patients was 8 years. Thirty-eight [76%] were males and 12 [24%] were females. The average duration of symptoms before presentation was 66.72 days. History of measles infection was present in 31 patients [62%] and measles vaccination in 43 patients [86%]. Motor regression was present in all [100%] patients and cognition decline in 43 patients [86%]. Seizures were focal [10%], generalized tonic-clonic [16%] and myoclonic [74%]. Burst-suppression pattern Electroencephalogram [EEG] and the antimeasles antibody in CSF were positive in 100% of patients. SSPE is an indicator of high incidence of measles infection among the paediatric population even among vaccinated children. Males are more common sufferers. SSPE can present with different types of seizures, cognition decline and motor regression being supported by suggestive EEG and presence of anti-measles antibodies in CSF

Hypertrophic pyloroduodenal tuberculosis

Hypertrophic pyloroduodenal tuberculosis is a rare cause of Gastric Outlet Obstruction [GOO] often forgotten in the differential diagnosis of gastric outlet obstruction. Since laboratory and radiological investigations often prove inconclusive in reaching the diagnosis of hypertrophic pyloroduodenal tuberculosis, surgery has a key role in the management of hypertrophic pyloroduodenal tuberculosis. Postoperative anti-tuberculosis chemotherapy [ATT] becomes imperative for complete resolution of hypertrophic pyloroduodenal tuberculosis. This case report describes the condition and management in a young girl

Oral and intraperitoneal LD[50] of thymoquinone, an active principle of Nigella sativa, in mice and rats

Thymoquinone is the major active principle of Nigella saliva [N. sativa] and constitutes about 30% of its volatile oil or ether extract. N. sativa oil and seed are commonly used as a natural remedy for many ailments. Using modern scientific techniques, a number of pharmacological actions of N. sativa have been investigated including immunostimulant, anti-inflammatory, anticancer, antioxidant, antihistaminic, antiasthmatic, hypoglycemic, antimicrobial and antiparasitic. There are only few reports regarding the toxicity of thymoquinone. The present study was carried out to determine LD[50] of thymoquinone both in mice and rats, orally as well as intraperitoneal, by the method of Miller and Tainter. Autopsy and histopathology of liver, kidney, heart and lungs were also determined. The LD[50] in mice after intraperitoneal injection was determined to be 104.7 mg/kg [89.7-119.7, 95% confidence interval] and after oral ingestion was 870.9 mg/kg [647.1-1094.8, 95% confidence interval]. Whereas, LD[50] in rats after intraperitoneal injection was determined to be 57.5 mg/kg [45.6-69.4, 95% confidence intervals] and after oral ingestion was 794.3 mg/kg [469.8-1118.8, 95% confidence intervals]. The LD[50] values presented here after intraperitoneal injection and oral gavages are 10-15 times and 100-150 times greater than doses of thymoquinone reported for its anti-inflammatory, anti-oxidant and anti-cancer effects. Thymoquinone is a relatively safe compound, particularly when given orally to experimental animals

Applicability of international prognostic index in non Hodgkin's lymphoma in Pakistan

Aggressive non Hodgkin's Lymphomas [NHL] are common in Southeast Asia, Middle East and Africa. Data on survival with relation to prognostic factors is scarce. The primary objective of the study was to evaluate the applicability of International Prognostic Index [IPI] to predict overall survival [OS] and disease free survival [DFS] in developing countries. Two hundred and nineteen patients of NHL consecutively presenting to the Department of Oncology, Jinnah Hospital Lahore between August 1998 to July 2000 were analyzed. All patients underwent initial staging according to Ann Arbor staging system. The patients were categorized by five independent risk factors: patient age, disease stage, serum lactate dehydrogenase [LDH] levels, performance status, and number of extranodal sites involved. Patients were divided into three risk categories Low [0 or one risk factors], Intermediate [2 risk factors] and High [3 or more risk factors]. According to IPI low risk category comprised of 15%, intermediate 21% and high 64% of patients, Overall survival [OS] for 2 years and 5 years [n=197] was [69%], [51%], [32%,] and [64%], [46%], [13%] respectively [p=0.0008]. Disease free survival [DFS] for 2 years and five years [n=197] was [66%], [43%], [34%] and [66%], [43%], [18%] respectively. Age adjusted [60] DFS for 2 and 5 years [n=164] was [70%], [45%], [40%] and [63%], [45%] [19%] respectively. OS for 2 and 5 years [n=164] was [71%], [52%], [34%] and [64%], [46%],[l 1%] respectively [p=0.0013]. Conclusions: The IPI accurately predicted survival in our population. Modification of treatment protocols according to specific risk groups will be beneficial to the developing countries with limited resources

Hodgkin's diseases: Analysis of 75 patients

To evaluate patients suffering from Hodgkin's disease to identify its epidemiological characteristics, modalities of treatment and features of survival. Place and Duration of Study: The study was conducted between July 1997 to June 1999 at the Oncology Department of Jinnah Hospital, Lahore. Subjects and A total 75 patient with Hodgkin's disease underwent cotswold staging classification, complete hematological, renal and hepatic profile, LDH and uric acid. Chest radiograph abdominal and pelvic ultrasonography and CT scan / MRI bone marrow biopsies. All the patients received combination chemotherapy. Patients with bulky disease received field ratiation. Median age was eight [<18 years] and 26 [>18 years]. Male to female ratio was 3.5:1, advanced disease accounted for 68%, mixed cellularity was documented in 61% of patients. Eighty-two% of patients belonged to lower socioeconomic strata. Forty-six patients [65.4%] achieved complete remission [CR] Major toxicities were hematological with febrile neutropenia in 14.6% patients. OS of patients achieving CR with good socioeconomic status was superior compared to patients with lower socioeconomic status [p<0.02]. Treatment delays were due to economic constraints, illiteracy, malnutrition and co-morbid conditions. Advanced disease, mixed cellularity and male predominance was common. Socioeconomic status had a significant impact on the presentation of the disease. Poor tolerance to chemotherapy and enhanced toxicities are especially seen in the low socioeconomic group