Influence of body mass index and polycystic ovarian syndrome on ICSI/IVF treatment outcomes: a study conducted in Pakistani women

Background: obesity may establish a crucial barrier for effective fertility treatment in polycystic ovary syndrome [PCOS] females

Objective: to compare results of intra-cytoplasmic sperm injection [ICSI] in females with and without polycystic ovarian syndrome and further appraise the effect of obesity in PCOS females

Materials and Methods: a cross-sectional study from June 2015 to July 2016 included non-PCOS and PCOS [recognized by Rotterdam criteria] females who underwent ICSI. The PCOS were further stratified into non-obese and Obese according to the South Asian criteria for body mass index. Results were categorized on the basis of beta-human chorionic gonadotropin [beta-hCG] and transvaginal scan into non-pregnant [beta-hCG <25 mIU/ml], preclinical abortion [beta-hCG >25 mIU/ml with no fetal cardiac activity] and clinical pregnancy [beta-hCG >25 mIU/ml with fetal cardiac activity on transvaginal scan]. In addition, reproductive outcomes; implantation rate, clinical pregnancy rate and miscarriage rate among obese and non-obese PCOS and non-PCOS patients were compared

Results: our results revealed 38.5% clinical pregnancy rate in non-PCOs females, 23.8% in non-obese PCOS females whereas 26.4% in obese PCOS. Preclinical abortions were found to be highest [31.5%] in non-obese PCOS females and were the lowest [26.2%] in non-PCOS females. In non-PCOS group and non-obese PCOS females 35.4% and 44.6%, respectively, failed to become pregnant

Conclusion: the success after ICSI in terms of number of clinical pregnancies was more in non-PCOS patients as compared to PCOS. Increase in body mass index reflected a negative impact on the reproductive outcome in PCOS patients

Efficacy and safety of sorafenib-gemcitabine combination therapy in advanced hepatocellular carcinoma: an open-label Phase II feasibility study

Sorafenib is considered a standard of care in advanced hepatocellular carcinoma [HCC]. Its combination with gemcitabine, a pyrimidine analogue with limited friendly hepatic profile may prove beneficial in advanced HCC. The primary objective was to evaluate the efficacy and safety of a sorafenib and gemcitabine combination in patients with advanced HCC. This was a non-randomized, open-label, single-arm, multi-centric Phase II study conducted in Pakistan where 30 treatment-naive patients aged between 26 and 73 years with Child-Pugh score A or B were treated with sorafenib [400 mg oral] twice daily for 16 weeks along with gemcitabine [1000 mg/m[2] intravenous] administered on day 1 and day 8 of a four-week cycle for 16 weeks. Of the 18 patients [60%] who completed all four cycles of treatment, eight patients had stable disease, two had partial response, and eight had progressive disease. There was no complete response. The most common [>/= 10% patients] treatment-emergent adverse events were gemcitabine-related thrombocytopenia [40%] followed by sorafenib-related hand-foot skin reaction and anorexia [33% each]. The efficacy of sorafenib gemcitabine combination therapy is similar to the sorafenib alone treatment. However, frequent dose adjustments due to gemcitabine-related toxicities, delays, and corrective treatments make this combination therapy unsafe in the treatment of advanced HCC.

Contact lens use and its compliance for care among healthcare workers in Pakistan.

Background: Poor care and hygiene of contact lens (CL) results in eye problems and infections. Healthcare workers have an important role in advocating correct lens care. Objectives: To determine the practices of CL care and the adverse consequences of poor CL care among healthcare workers. Setting and Design: A cross-sectional study in one public and three private sector hospitals in Karachi, Pakistan, in 2009–2010. Materials and Methods: We questioned 500 healthcare workers of all ages and both sexes, who wore CL, about compliance with advice on care and any complications due to improper hygiene practices. Ethical approval was obtained. Chi-square tests were used to determine significance and p-value less than 0.05 was considered statistically significant. Results: Of the total CL users, 385 (77%) were females. Most (75%) respondents wore CL to correct myopia, whereas 54% wore CL only occasionally. Surprisingly, only 24% knew the CL cleaning protocol. Lens solution was changed daily by 33% of users and after more than 2 weeks by 42%. Although 412 (82%) participants practised reasonable hand hygiene before inserting CL, 88 (18%) did not. Infection and eye dryness were statistically significantly (P < 0.01) associated with sex, hand-washing, and frequency of CL use. Conclusion: Noncompliance with the CL protocol was common among healthcare workers in our society. This behavior calls for targeted health education and awareness programs for healthcare workers

Application of LC-MS/MS for quantitative analysis of glucocorticoids and stimulants in biological fluids / 药物分析学报

Liquid chromatography tandem mass chromatography (LC-MS/MS) is an important hyphenated technique for quantitative analysis of drugs in biological fluids. Because of high sensitivity and selectivity, LC-MS/MS has been used for pharmacokinetic studies, metabolites identification in the plasma and urine. This manuscript gives comprehensive analytical review, focusing on chromatographic separation approaches (column packing materials, column length and mobile phase) as well as different acquisition modes (SIM, MRM) for quantitative analysis of glucocorticoids and stimulants. This review is not meant to be exhaustive but rather to provide a general overview for detection and confirmation of target drugs using LC-MS/MS and thus useful in the doping analysis, toxicological studies as well as in pharmaceutical analysis.

multicentre phase-II feasibility study evaluating gemcitabine/ vinorelbine / prednisolone combination chemotherapy in relapsed / refractory Hodgkin's lymphoma

To determine the efficacy and toxicity of Gemcitabine, Vinorelbine and Prednisolone [GVP] salvage chemotherapy in relapsed / refractory Hodgkin's Lymphoma [HL]. A phase-II non-randomized single arm study. This study was conducted at Combined Military Hospital and Medical College Lahore, Mayo Hospital, King Edward Medical University, Lahore, Allied Hospital, Punjab Medical College, Faisalabad and Combined Military Hospital, Rawalpindi, from January 2007 to December 2007. Fifty adult patients with relapsed/refractory HL, adequate marrow reserve, hepatorenal and pulmonary functions, with radiological measurable disease and Karnofsky performance status of 0 - 2 non-candidates for stem cell transplantation, were enrolled. Four 28 days cycles of GVP [Gemcitabine 1000 mg/m2, Vinorelbine 30 mg/m2 on day 1 and 8 intravenously with oral Prednisolone 100 mg/day on day 1 - 5] were given. Response evaluation done according to Cotswolds meeting recommendations and toxicity was evaluated with NCI-CTC [National Cancer Institute - Common Terminology Criteria for adverse events v 3.0]. Forty patients completing 4 cycles of GVP, 14 refractory/early relapse and 26 late relapsed [one year postprimary treatment with ABVD] were available for evaluation. The overall response [CRu+PR] rate was 77.5% with better response 85% in late relapsed patients. Haematological toxicity was most common and seen in 70% of cases. GVP is well-tolerated regimen with high response rate and needs to be tested in late relapsed H

Her 2 neu metflstatic breast cancer; low dose sequential docetaxel - capecitabine chemotherapy as first line treatment a clinical trial of cancer research group Pakistan

To evaluate the efficacy and toxicity of low dose sequential docetaxel-capecitabine chemotherapy as first line treatment of HER 2 negative metastatic breast cancer [MBC]. Experimental Study, Clinical Trial. Three different oncology centers, collaborating under the Cancer Research Group Pakistan. From June 2006 to December 2007. Female breast cancer patients with visceral or visceral and bone metastases and a KPS > 70 were eligible. Results: 38 patients were enrolled. Median age was 49 years [Range 32-70]. With docetaxel treatment, CR was seen in 06 [16%] patients and PR in 20 [53%] with an overall response rate of 69%. Stable disease was seen in 10 [26%] and PD in 02 [05%]. Four out of six complete responses were in patients with liver metastases. Thirty six patients received capecitabine. Thirty were evaluable for response. Capecitabine added one CR [3.33%] and six partial responses [20%]. Two patients [6.67%] who had a partial response to docetaxel relapsed during capecitabine treatment. As a result at the completion of the therapy CR was seen in 07 patients [18.42%], PR in 23 patients [60.53%] with SD and PD in, 4 patients [10.53%] each. An overall RR of 78.94% was seen. Median time to progression was 10.9 months [range, 3-22 months] and at a median follow up time of 24 months [range, 16 -34 months] 13 patients have died with an overall survival probability of docetaxel -capecitabine sequential therapy of 0.68. Significant docetaxel specific grade 3/4 toxicities included neutropenia and diarrhea in 14 [36.84%] and 03 [07.89%] respectively. Febrile neutropenia was seen in 06 [15.79%]. Capecitabine specific significant grade 3 toxicities included hand-foot syndrome in three patients [8.33%] and diarrhea in 2 [5.56%]. Stomatitis, dermatitis, fatigue was seen in one patient [2.78%] each. This treatment schedule of low dose sequential docetaxel - capecitabine is an effective first line treatment of HER 2 negative MBC that provides good overall response rate, manageable toxicity and improved survival

Weaning; knowledge and practices

To evaluate the awareness and practices regarding weaning in lactating mothers of infants. A cross sectional descriptive study. At pediatrics OPD in Ghurki Trust Teaching Hopsital, Lahore. From October to December 2007. A non probability convenience sampling was done to collect data from 50 mothers who were attending out patient department along with their infants on a pre-formed questionnaire. After gathering, data was analyzed and presented in the form of tables and graphs. In the present study, 66% mothers were in the age group of 20-29 years, all were house wives, 34% were matriculate and 72% lived in joint family system Mean age of weaning was 4-6 months in more than 64% of the sample. Among the women interviewed, 44% used home-made weaning diets, 30% used mixture of homemade and commercially prepared diets, while 16% used only commercially prepared diets. Breast feeding was continued during and after weaning, by 64% of respondents along with weaning diets. Mothers need to be educated about the importance of weaning, the recommended age of weaning and about the types of weaning food. This can be achieved by using lady health workers and lady health visitors and the mass media. Importance of breast feeding with weaning diet should be emphasized upon

Single agent low dose capecitabine subsequent to docetaxel chemotherapy in HER-2 negative metastatic breast cancer

The objective of this study was to evaluate the efficacy and toxicity of low dose capecitabine chemotherapy in patients with metastatic breast cancer [MBC] who have previously received first line docetaxel chemotherapy. Metastatic breast cancer patients who responded or achieved a stable disease with first line docetaxel were enrolled. Female patients with visceral or visceral and bone metastases and a KPS > 70 were eligible. Adequate marrow, renal and hepatic function was required. Metastatic brain disease and bone as the only site of disease were excluded. Informed consent was obtained from all patients. Capecitabine 1,000 mg/m2 B.I.D 14 days for four cycles were given. Cycles were repeated every 3 weeks. Response Evaluation Criteria in Solid Tumors [RECIST] was used for evaluation of response and common Toxicity Criteria [CTC] Version 3.0 for evaluation of toxicity. From September 2006 to December 2007, 38 patients were enrolled. Median age was 49 years [Range 32-70]. Thirty six patients had received docetaxel at a dose of 75 mg/m2 for four cycles. Six patients had already achieved a complete response, 20 partial response and ten had achieved stable disease. Capecitabine added one CR [3.33%] and six partial responses [20%]. Median time to progression after capecitabine was 6.9 months [range, 3-22 months] and at a median follow up time of 24 months [range, 16 -34 months] 13 patients have died with an overall survival probability of docetaxel - capecitabine sequential therapy of 0.68. Significant grade 3 toxicities included hand-foot syndrome in three patients [8.33%], diarrhea in 2 [5.56%], stomatitis, dermatitis, fatigue and decrease in appetite in one patient [2.78%] each. Grade 2 toxicity included hand-foot syndrome in 12 [33.33%] patients, diarrhea and stomatitis in 8 patients [22.22%] each. Most common hematological toxicity included lymphopenia and anemia seen in 16 [44.44%] and 14 [38.89%] respectively. This treatment schedule of low dose capecitabine after docetaxel treatment is an effective treatment of MBC and has a manageable toxicity profile

Occurence of carcinoma in situ in association with invasive cancer of breast

The objectives of this study were to find out the frequency and the pattern of carcinoma in situ occurring in association with different types of breast cancers. This study was conducted in the Department of Clinical Oncology and the Department of Pathology, King Edward Medical University/ Mayo Hospital, Lahore on breast cancer patients diagnosed between 1[st] January 2001 and 31[st] December 2005. The age, menopausal status, histopathological type, grade, and presence or absence of carcinoma in situ were recorded. Histopathological features were recorded according to WHO system. Grade was recorded only when it was assigned according to the Elston-Ellis modification of Scarff-Bloom-Richardson grading system. A total of 1230 histopathologically documented invasive and non-invasive breast cancers patients were included in the study. DCIS alone was seen in seven patients [00.57%] and LCIS alone in two patients [00.16%]. Invasive ductal carcinoma was seen in 998 patients [81.14%] and invasive lobular carcinoma in 96 patients [07.80%]. Majority of breast cancers were grade II whereas grade I seen in 23.90% patients only. Areas of carcinoma in situ in different types of invasive cancers were seen in 328 [26.86%] patients. Majority of these patients were below 50 years of age. DCIS was present in 246 of 998 patients [24.65%] of invasive ductal carcinoma [NOS]. Comedo pattern was seen in 154 of 290 [53.10%] of DCIS. LCIS was present in 38 of 96 patients [39.58%] of invasive lobular carcinoma. Carcinoma in situ of breast is a turely diagnosed disease entity in our setting. It is seen mostly in association with invasive carcinoma of breast cancer. Ductal carcinoma in situ with comedo pattern is most frequent

phase II study of cisplatin and 5-fluorouracil combination chemotherapy and concurrent thoracic radiation in squamous cell carcinoma of lung

To evaluate the efficacy and toxicity of cisplatin, 5-fluorouracil combination chemotherapy and concurrent thoracic radiation in squamous cell carcinoma of lung. A prospective, non randomized, quasi-experimental, phase II study which was conducted in the Department of Clinical Oncology Mayo Hospital/KEMC Lahore. This study was conducted from September 2002 to May 2004. Twenty two patients of histopathologically confirmed squamous cell carcinoma of lung were enrolled. Stage III B or stage IV patients requiring radiation therapy for control of local symptoms were included. These patients were treated with chemotherapy and concurrent chest radiation. The treatment regimen included cisplatin 80mg/m2 on day one and day "28" and 5-FU 750mg/m2 day 1-4 and day "28-31". Radia-tion was started on day one and a tumor dose of 50 Gy was delivered in 25 fractions. Common Toxicity Criteria and RTOG criteria were used to assess toxicities. Miller's criteria were used for response evaluation. Responses were evaluated two weeks after the completion of concurrent chemoradiotherapy. All the twenty two patients completed the planned treatment. Complete response was not achieved in any patient. Partial response was seen in 15 patients [68.18%], stable disease in five patients [22.73%] and progressive disease was seen in two patients [9.09%]. CTC Grade-II nausea was seen in eight patients [36.36%], vomiting in five patients [22.73%] and mucositis in six patients [27.27%]. Grade-III neutropenia was observed in three patients [13.64%] and Grade-III mucositis and diarrhea in five patients [22.72%] each. Grade-IV neutropenia was seen in two patients [9.09%]. Cisplatin and 5-Fluorouracil combination chemotherapy concurrent with 50 Gy radiation is an effective and well tolerated treatment modality for this subset of lung cancer patients

phase II study of doxorubicin, vincristine, cyclophosphamide, prednisolone [CHOP] chemotherapy with intathecal [IT] methotrexate and prophylactic cranial irradiation in a patients with high grade non hodgkin's lymphoma [NHL]

The objective of this phase II study was to evaluate the efficacy and toxicity of [CHOP] chemotherapy with intrathecal methotrexate and prophylactic cranial irradiation in patients with high-grade Non Hodgkin's lymphoma. From January 2002 to December 2002 tewenty consecutive patients with histopathologically and immunohistochemically confirmed high grade NHL with Ann Arbor stage III and IV were enrolled. ECOG performance status of 0 or 1 was required. Written informed consent was obtained from all patients. Patients with symptomatic meningeal or brain involvement were excluded from the study. Cyclophosphamide 750 mg /m2, vincristine 1.4 mg / m2 [maximum 2 mg], doxorubicin 50 mg / m2 was given I/V on D1 and prednisolone 100 mg PO was given from D1 - D5. Cycles were repeated after every 21 days. Intrathecal methotrexate was given at a dose of 12 mg once during 3rd week, twice weekly on 5th and 6th week and once during 7th week. A total dose of 1800 cGy was given to whole brain in 10 fraction s with a daily tumor dose of 180 cGy using a Cobalt 60. Common Toxicity Criteria was used for evaluation of toxicity and WHO criteria for response evaluation. All 20 patients were able to complete the planned therapy. Grade IV neutropenia was observed in 45% [9/20] of patients. Episodes of febrile neutropenia were seen in 20%[4/20]. Grade II diarrhea was seen in 25%[05/20]. 20%[4/20] had grade II cutaneous toxicity. No immediate radiation related toxicity was seen except grade II nausea and vomiting. Overall response was found in 75%[15/20] of patients, CR in 60%[12/20] and PR in 15%[03/20]. 15%[03/20] patients showed stable disease and 10%[02/20] had progressive disease. This combined modality treatment of CHOP chemotherapy with intrathecal methotrexate and prophylactic cranial irradiation has been feasible and effective with acceptable toxicity in this group of patients with high-grade Non Hodgkin's lymphoma

Role of 5-HT[7] receptors on lordosis behaviour and LH release in the female rats

The present study was designed to investigate the role of the 5-HT [7] receptors in lordosis and release of LH and compare the lordotic responses with 5-HT [IA] agent. Ovariectomised but oestradiol benzoate [OB] [10 micro g] for 48 h plus by progesterone [0.5 mg]- primed receptive rats were used for the study. Thirty min. prior to progesterone 5-HT [IA] and 5-: HT [7] agonists were administered intra-peritoneally [i.p.]. Lordotic quotient and release of LH were measured. Agonistic effect was then antagonized by respective antagonists. Effects on the above parameters were noted and correlated for possible interplay. 5-HT [7] agonist mimicked inhibitory effect of 8-OH DPAT on lordosis in receptive rats, however, the response was generally attenuated. Treatment by 5-HT [IA] antagonist, WAY 100135 causing a protective effect was evident transiently. Attenuation of lordotic quotient was again evident in rats treated with 5-HT [7] antagonist. 5-HT and the 5-HT [IA/7] receptor agonist, 8-OH-DPAT, injected i.p. into the female rat inhibit the LH release and the effects of both are blocked by 5-HT [IA] antagonist, WAY 100135 and 5-HT [7] antagonist, SB 269970-A as both 5-HT [IA] agonist, 8-OH-DPAT and 5-HT [7] agonist, 5-CT have moderate activity at the 5-HT [7] receptor subtype, indicating the possibility that this subtype might mediate these effects has been investigated. Ovariectomised but steroids primed rats induces an LH surge. [5-CT], a potent but non-selective agonist at 5-HT [7] receptors, like 5-HT and 8-OH-DPAT inhibited the LH surge at 2 mg injected i.p. The selective 5-HT [7] receptor antagonist SB-269970-A blocked LH surge when given systemically at both 5-HT [IA] and 5-HT [7] receptor subtypes. These data indicate that 5-HT [7] receptors play a role in the regulation of lordosis and release of LH and there exist a direct correlation between the two

phase II study of gemcitabine concurrent with radiation in locally advanced squamous cell carcinoma of head and neck: a trial of the cancer research group Pakistan

To evaluate the efficacy and toxicity of weekly gemcitabine as a radiosensitizer concurrent with radical radiotherapy in locally advanced carcinoma of head and neck. From August 2001 to January 2002, thirty-nine patients with stage III or IV B inoperable carcinoma of head and neck were enrolled. Patients with histopathologically confirmed squamous cell carcinoma with at least one bidimensionally measurable lesion, no prior chemotherapy or radiotherapy, and a KPS of 60 or above were included. Patients with nasopharyngeal, glottic or sub-glottic cancer were excluded. Gemcitabine 150mg/m2 or a total dose not exceeding 200 mg was given on day 1, 8, 15, 22, 29, and 36 during radiation treatment. Radiation was delivered with conventional fractionation to a total dose of 66-70Gy. Miller's criteria was used for response evaluation. RTOG/EORTC acute radiation [and chemotherapy] morbidity scoring system and WHO grading of acute and sub acute toxicity criteria were used for documentation of toxicity. All 39 patients were evaluable for toxicity but only 35 patients were evaluable for response. An overall response rate of 94.3% [95% CI; 80.8-99.3] was seen with a partial response rate of 71.4% and complete response rate of 22.9% [95%CI; 10.4-40.1]. Grade 3 mucositis was seen in 28 patients [71.8%]. Grade 4 mucositis was seen in 2 patients [5.1%]. Pharyngeal toxicity was the second-most common toxicity. Grade 2 toxicity was seen in 12 patients [30.8%] and grade 3 in 6 patients [15.4%]. Despite vigorous symptomatic and supportive care acute toxicities led to treatment interruption in 40% of patients. A high overall response rate and a high rate of acute toxicity are seen at a weekly gemcitabine dose of 150mg/m2 concurrent with radiation. This shows that gemcitabine is a potent radiosensitizer with a marked tumor and normal tissue radio sensitization

Vesico vaginal fistula after interval debulking in epithelial ovarian cancer

Mrs. S.E, 45 years of age was diagnosed as a case of ovarian carcinoma and had interval debulking, following which she developed vesico-vaginal fistula. Continuous bladder drainage was done for 6 weeks and she was given post operative chemotherapy with cisplatin and gemcitabine. On her 6 weeks postoperative examination, the fistula had healed completely. She is receiving her chemotherapy cycles and is in satisfactory condition

Clinical outcome of managment of acute myeloid leukemia with idarubicin plus cytarabine

A prospective study was conducted at Department of Clinical Oncology, King Edward Medical College / Mayo Hospital, Lahore from July 2003 to June 2004 to evaluate the effect of Idarubicin plus Cytarabine in chemo naive Acute Myeloid Leukemia [AML] patients. A total of 15 consecutive patients were enrolled with age group 15-58 years. Patients were classified according to French American British [FAB] classification. Induction therapy with Cytarabine as continuous infusion for 7 days and Idarubicin was given on day 1-3. For assessment of response, all patients were subjected to bone marrow examination fifteen days after completion of Induction chemotherapy. Consolidation Therapy with high dose Cytarabine was given on days 1, 3 and 5. Cytarabine was repeated after 28 days for 4 cycles in patients with complete remission after induction therapy. A remission induction rate of 66.7% was observed. Four patients died because of complications. One patient lost to follow up. Idarubicine and cytarabine is effective r egimen for achieving complete remission in AML Chemo-naive patients

Primary intracranial brain tumours; a clinico-pathological study

Seventy-eight patients of different brain Tumours were studied from April 1998 to June 1999. Age, sex, presenting complaints, and location of tumour were analyzed. After presurgical evaluation these patients were operated and specimens were sent for histopathological examination. Majority of patients presented with signs and symptoms of raised intracranial pressure. Focal cerebral syndromes attributable to frontal, temporal, parietal and occipital lobe were also seen. Incompletely resected grade II astrocytomas received post-operative radiotherapy only. Whereas high grade astrocytomas whether completely or incompletely resected were given post-operative radiotherapy and chemotherapy. Histopathological analysis revealed that majority of the patients had astrocytomas others included pituitary adenoma, craniopharyngioma, meningioma, medulloblastoma and schwannoma. Some degree of necrosis was present in both anaplastic astrocytoma and glioblastoma multiform patients [46.43%]. But extensive necrosis was seen only in patients with glioblastoma multiform. Infiltrative component was seen in the majority of astrocytoma patients [90.48%]

Role of cisplatin and cyclosphosphamide chemotherapy in bulky residual disease after primary cytoreductive surgery of epithelial ovarian cancer

From May 1993 to June 1997, 58 patients with bulky residual disease after primary cytoreductive surgery of epithelial ovarian cancer were treated with cisplatin and cyclophosphamide combination chemotherapy. Overall responses were seen in 30 patients [51.72%] with complete responses in 9 patients [15.51%] and partial responses in 21 patients [36.11%] at 4 months. 28 patients [48.27%] were non-responders. Response in relation to the size of residual disease revealed that 24 out of 36 patients [66.66%] did not show a complete response to chemotherapy. It is concluded that bulky residual disease of greater than 4 cm responds poorly to cisplatin and cyclophosphamide combination chemotherapy