A Rare Case of Non-small Cell Lung Carcinoma Squamous Phenotype with Epstein-Barr Virus Positivity with Prolonged Response to both Chemotherapy and Radiotherapy / 中国肺癌杂志

We present a rare challenging case of metastatic non-small cell lung cancer with Epstein-Barr virus positivity that was also diagnosed with pulmonary tuberculosis at the same time. Palliative chemotherapy gemcitabine and carboplatin was started after two weeks of anti-tuberculosis treatment with the hopes that this period would be sufficient to keep acid fast bacilli non-viable to minimise risk of tuberculosis re-activation due to chemotherapy induced immunosuppression. She completed four cycles of chemotherapy and six months of anti-tuberculosis treatment with good results and minimal side effects. Two years later, there was disease recurrence in cervical and mediastinal lymph nodes which was treated with local treatment i.e. surgery and palliative radiotherapy. It has been two years since last radiotherapy and overall more than five years since diagnosis with no active disease at present. Given the complexity and rarity of this case, significant multidisciplinary team involvement, including oncologists and radiation oncologists, pulmonologists with special interest in tuberculosis and pathologists was necessary throughout.

Trends in adherence to secondary prevention medications in post-acute coronary syndrome patients

To evaluate patients' adherence to evidence-based therapies at an average of 2 years after discharge for Acute Coronary Syndrome [ACS] and to identify factors associated with non-adherence. This study was conducted at Hospital Pulau Pinang, Malaysia. A random sample of ACS patients [n=190] who had discharged on a regimen of secondary preventive medications were included and followed up over a three follow-up appointments at 8, 16, and 23 months post discharge. At each appointment, patients were interviewed and given Morisky questioner to complete in order to compare their level of adherence to the prescribed regimens across the three consecutive time periods. Majority of patients reported either medium or low adherence across the three time periods with only small portion reported high adherence. Furthermore, there was a significant downward trend in the level of adherence to cardio protective medications during the study period [p<0.001]. This study also identified 6 factors-age, gender, employment status, ACS subtype, number of co morbidities and number of prescription medications per day that may influence Patients' adherence to their medications. Our findings suggest that long-term adherence to secondary prevention therapies among patients with ACS in Malaysia is sub optimal and influenced by many demographic, social as well as clinical factors

Infrastructure, inventory, human resource of mother and child health centers of Lahore and its impact on maternal health services

It is a common observation that there is load on tertiary care facilities which is logical outcome of under utilized primary level. For identification, quantification and gauging of these gaps current study was conducted at MCH Centers of City District Government Lahore. It was cross-sectional descriptive study conducted at City District Government, Lahore. 18 MCH centers were selected by randomization technique at each town. The current study depicted that 44.44% centers were not having any telephone, fax, generator and ambulance service. While at 11.11% centers the post of dai are vacant. It was also found the 27.78% centers were not delivering service of IUD and inject able family planning services. It was also found that 88.89% of centers had the approved furniture, equipment and linen but in majority of cases it was non functional conditions. It was also found that 83.33% MCH Centers were lacking oxygen cylinder, artery forceps and tooth forceps. 88.89% MCH centers were not having vaginal retractors and dressing seizers. Umbilical Tape, Casco Vaginal Speculum, weighing machine were absent at 100% MCH centers. First aid box was present at 17 94.44% MCH Centers. Examination Couch, almirah, towel stand, iron bed and overalls were available at 88.89% of the MCH Centres but mostly they were in poor condition. Office chair, delivery couch, bed sheet and table cloth were available in all MCH Centres while bench, bucket, towel stand and durries were available in 94.44 MCH Centres. The preceding lines depict that although majority of centers have got sanctioned equipment and furniture but they are non functional and due to this fact this chain of MCH Centers for Maternal Health Services are not delivering up to the mark. Investment in the form of financial resources determines the success or failure of any setup

Knowledge and practices of the medical practitioners about management of childhood tuberculosis, Gujrat City

The objective was to describe current practices and knowledge of medical practitioners about management of childhood tuberculosis. The study was conducted in Gujrat city. It was a descriptive, epidemiological study. A sample size of 248 Doctors was obtained who were interviewed with the help of semi-structured questionnaire. Final data was analyzed with the help of EPI - INFO Computer Program. The results showed that for diagnosis of tuberculosis in children using Kenneth Jone's Criteria, only 33% of medical practitioners answered correctly. Thirty two percent of the doctors knew the correct regimen for treatment of childhood tuberculosis. About 63% doctors know at least partially the guidelines of tuberculosis management and 3% of the doctors practicing did not know and never heard about the guidelines for tuberculosis management. Majority of the doctors answered correctly about the symptoms and signs, only 39% gave advice for regular and complete course. It was concluded that knowledge among medical practitioners regarding management of childhood tuberculosis is lacking. Due to poor knowledge about the treatment regimens it is essential to update their knowledge by attending the workshops/seminars/conferences / short courses and by reading the new guidelines for management of childhood tuberculosis

Co-relation of birth weight with periventricular hemorrhage-a prospective study of two groups of newborns

To determine the difference between prevalence of Periventricular - Intraventricular Hemorrhage [PIVH] in the newborns on the basis of birth weight. Prospective study. Neonatology Unit, Department of Paediatrics, Post Graduate Medical Institute / Services Hospital, Lahore, from 1[st] April to 31[st] July 2000. All new born admitted in Neonatal Unit of Services Hospital within 24 hours of birth were included in the study. Birth weight was documented. Cranial ultrasonography was done twice in all babies, once within 24 hours of birth and second between 4 and 5 days of life. All newborns included in the study were divided into two groups on the basis of birth weight; One group with birth weight less than 1500 gms the second group with weight 1500 gm and more. In babies with PIVH, the extent of hemorrhage was graded. 364 out of 448 [81%] fulfilled criteria for admission to this study. Cranial ultrasound was done twice in all babies, irrespective of diagnosis. 36 babies [9.9%] died within 72 hours of life. Babies with birth weight less than 1500 gm were 110 [30%], whereas, those more than 1500 Gm birth weight it was 68 [62%], 54 [21%] babies were delivered at Services Hospital, 79 [22%] in different maternity centers and 169 [46%] were home delivered. Distribution of grading of PIVH showed that 64 cases had grade-l hemorrhage, 27 had grade-ll, 18 had grade-Ill and 13 had Grade-IV hemorrhage. First scan detected 55 [45%] cases. Cranial ultrasound should be done in all premature and low birth weight newborns within 4-5 days of life to detect PIVH fairly accurate and easily.Co-relation of birth weight with periventricular hemorrhage

Current practice of doctors regarding the diagnosis and use of antibiotics in enteric fever in children: knowledge, attitude and practice

The objectives were to know current practice and knowledge of doctors regarding the diagnosis and use of antibiotics in Enteric Fever in children. The study was conducted in Lahore-city. It was a descriptive, epidemiological study. 150 doctors participated in the study. 51% were MBBS, 33% were postgraduate trainees and 16% had postgraduate degrees. Ciprofloxacin was prescribed as first choice by 51% and second choice by 37.8%. Ofloxacin was advised as first line by 21% doctors and injection Ceftriaxone by 18.6%. Chloramphenicol was advised by 8% doctors. Only 67.3% doctors prescribed the antibiotics for recommended duration. 62% doctors did not know the dosage in children. Second line antibiotics are used irrationally and those are prescribed for less than recommended duration, which leads to multi-drug resistance and relapse of fever