Frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer

Study Design: A case series

Place and Duration of Study: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012

Methodology: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapy's side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at the end of treatment. The data was analyzed by using SPSS version 16

Results: Out of the 99 enrolled patients, 58 [58.6%] had uterine and 41 [41.4%] had cervical cancer. Mean age was 54.54 +/- 10.29 years. Thirty-five [35.4%] patients received chemotherapy with RT. Mean RT dose was 60.72 +/- 7.15 Gy. The most common gastrointestinal adverse effect was diarrhea in 64 [64.6%] followed by proctitis in 55 [55.5%], nausea in 33 [33.3%] and vomiting in 16 [16.2%] patients. Grade [G] 1 was the most frequently observed severity. The most common hematological toxicity was anemia in 37.8% [n=31/82] [[G1=18 [21.9%], G2=11 [13.4%], G3=2 [2.4%]] followed by thrombocytopenia in 22.8% [21/92] [[G1=16 [17.3%], G2=2 [2.1%], G3=3 [3.2%]] and neutropenia in 21 [21.2%] [[G1=12 [12.1%], G2=5 [5%], G3=3 [3%], G4=1 [1%]]. Urinary toxicity was observed in 49 [49.5%] patients. On stratification, chemotherapy and higher RT dose were strong predictor of increased hematological and upper gastrointestinal toxicity [p < 0.05] and age > 60 years for diarrhea [p < 0.05]

Conclusion: The frequency and severity of acute toxicity of pelvic radiotherapy in women with gynecologic cancers was found intermediate to high

Treatment updates regarding anaplastic oligodendroglioma and anaplastic oligoastrocytoma

Anaplastic Oligodendroglioma / Anaplastic Oligoastrocytoma [AO/AOA] is a WHO Grade-III primary brain tumor. These tumors comprise about 5 - 10% of all gliomas, which make them the third most common primary brain tumors after glioblastoma multiforme and astrocytomas. For many years standard of treatment remained Maximum Safe Resection [MSR] followed by Radiotherapy [RT]. These tumors have also been known to be sensitive to alkylator-based chemotherapy particularly the subset having 1p/19q co-deletion signature. There is robust data showing that these tumors are responsive to chemotherapy in recurrent or progressive setting. Recently, up front chemotherapy has been added to standard post-surgery RT. It has been found that subset of AO/AOA having 1p/19q co-deletion responded very well to the addition of chemotherapy. This substantial benefit in terms of median Overall Survival [OS] and median Progression Free Survival [PFS] have intrigued the personalized treatment of AO/AOA on the basis of molecular signature markers

Efficacy of imidacloprid and fipronil gels over synthetic pyrethroid and propoxur aerosols in control of German cockroaches (Dictyoptera: Blatellidae).

Background & objectives: Resistance amongst cockroaches has been reported to most of the spray insecticides apart from the problem of food contamination and inconvenience. Gel baits which can be selectively applied have been found effective in control of cockroaches in laboratory studies but very few field studies are available. This trial was planned to evaluate the efficacy of fipronil (0.01%) and imidacloprid (2.15%) gels over synthetic pyrethroid (0.02% deltamethrin + 0.13% allethrin) and propoxur (2%) aerosols in control of cockroaches in the field. Methods: Survey was done to find out pre-treatment density in catering establishments and houses by visual count and sticky trap methods. A total of 10 catering establishments and 10 houses having high cockroach infestation were selected by sampling (two catering establishments and houses for each insecticidal treatment and two for control). Propoxur and synthetic pyrethroid aerosols were used for spraying the infested sites once only. Single application of fipronil and imidacloprid gels was used as crack and crevice treatment. Visual count method gave better indications of cockroach infestation as compared to sticky trap method, hence, the same was followed for post-treatment evaluation every week up to 12 weeks. Results: Synthetic pyrethroid could not bring about the desired reduction in cockroach infestation in the present study. Single application of fipronil gel was able to reduce cockroach infestation up to 96.8% at the end of 12 weeks whereas imidacloprid application resulted in 90.9% reduction and propoxur resulted in 77.5%. However, propoxur was more effective in reducing the cockroach density by first week in comparison to imidacloprid and fipronil gels but its efficacy started declining after 8th week. Difference was found statistically significant by Kruskal-Wallis H-test. Conclusion: The study reports the efficacy of propoxur aerosol, imidacloprid gel and fipronil gel baits for control of cockroaches.

Result of surgical decompression and internal fixation with titanium cage in patients with carries spine

The objective of the study is to assess, the postoperative outcome of the intervertebral titanium cage, in patients operated for Caries spine with unstable spine with/without neurological deficits. This is a retrospective study, carried out in department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan, during 2 years, from January 2006 to December 2007. All patients underwent a neurological and radiological assessment. Those patients who had collapse of vertebral body/s, with/without gibbus formation having some neurological deficit were included. Patients fit for surgery, were operated upon, with placement of intervertebral adjustable titanium cage. These patients were followed up for eighteen months. The study comprised of 11 patients, with their age ranging from 20 to 53 years having 7 males and 4 females. The patients were admitted through OPD or the emergency department in neurosurgical ward of Sheikh Zayed hospital, Rahim Yar Khan. The majority of the patients had D10-11 lesion [36.3%] followed by L2 in 18.1%. The neurological status of the patients received showed paraplegia in 27.27% while paraparesis in 72.72% of patients. The neurological outcome of 11 patients, after eighteen months of follow up, showed marked improvement in 72.72% patients of incomplete spinal cord compression [paraparesis]. While some improvement in 27.27% patients of complete spinal cord damage [paraplegia]. All patients with kyphotic lesions had near normalization of the anatomical curve of the spine. All patients were kept on antituberculous chemotherapy for one year. Our experience with usage of the titanium cage for internal fixation in Caries spine showed very promising results, especially in patients of paraperesis with/without gibbus formation. This technique may become a main stay of surgical management in Caries spine for thoracolumber region in our setup

study of complications seen in 300 cases of ventriculo peritoneal shunts managed at Sheikh Zayed Hospital, Rahim Yar Khan

The objective of the study is to assess, the postoperative complications of 300 hydrocephalic patients, operated with ventriculo peritoneal shunting system. This is a retrospective study, carried out in the department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan. 300 patients including both adults [20.3%] and children [79.6%] with various causes of hydrocephalus were operated upon. All patients underwent a neurological and radiological assessment, and all those patients who had clinical and radiological evidence of hydrocephalus and were fit for surgery, were operated. All patients underwent a ventriculo peritoneal shunt placement. The follow up of the patients was for six months and all the complications were noted and dealt with. The common cause of hydrocephalus seen in children was Aequeductal stenosis, followed by post meningitis hydrocephalus, whereas in adults, trauma and tumours were responsible for the disease. Most common complication seen in our study was shunt blockade [33%] followed by wound infection and meningitis [23%].The study was to identify complication rate of ventriculoperitoneal shunt in our setup. Inspite of low socioeconomic setup and poor hygiene our results are still comparable to some foreign studies

Chilblains among soldiers - a negative impact of this preventable disease on military preparedness in peace

The objective of this study was to determine the frequency of chilblains among soldiers in general and recruits and cadets in particular during peace time at a climatically cold weather station. A descriptive study. The study was carried out in dermatology department of Combined Military Hospital, Abbottabad during the winter months of Dec 2004 to Mar 2005. Serving soldiers of all ranks who were clinically diagnosed to be suffering from chilblains were included in the study. They were interviewed in detail and examined thoroughly. All the findings were recorded in a pre designed proforma. A separate proforma was filled for each patient. During the period mentioned above, 493 soldiers were registered in dermatology outpatient department of Combined Military Hospital, Abbottabad for various skin diseases. A total of 41 [8.3%] soldiers were diagnosed and treated as chilblains cases. Out of 364 regular soldiers [Officers, Junior Commissioned Officers and Other Ranks] 10 [2.7%] were having chilblains. On the other hand, out of 129 newly inducted soldiers [Recruits and cadets] 31 [24.0%] were diagnosed as having chilblains. Twenty eight [90.3%] of these newly recruited soldiers belonged to climatically warmer areas and this was their first winter at this cold weather station. Twenty nine [70.7%] of the 41 soldiers were treated in outdoor, whereas 12 [29.3%] were hospitalized. The number of wasted days ranged from 20 to 106 with a mean of 34.66 days. Chilblains are more frequent among newly recruited soldiers, who are not acclimatized properly and are more exposed to cold because of their training activities