Splenic abscess in cancer patients: a retrospective review

The objective of the study was to review our experience in the management of splenic abscess in cancer patients at a cancer hospital in Pakistan. This study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and data reviewed from January 2007 till December 2012. Demographic, pathologic, radiologic and treatment records of each cancer patient with splenic abscess were retrieved from the electronic database. Patients were followed for a period of six months. Twelve patients were diagnosed with splenic abscess in the last six years. Males were ten compared to two female patients. Mean age was 41.1 years [range 3-64]. All except one were adults. Six patients had hematological malignancies while six were diagnosed with solid organ tumors, among the solid organ tumors three had metastatic disease with unknown primary. Six patients had multiple splenic abscesses while six patients had solitary abscesses. Bacterial cultures were positive in four patients, Pseudomonas species and Escherichia coli in two patients each; one patient with mycobacteria tuberculosis; no fungal growth identified in any patient. Antibiotics were given to all patients except one patient who died before any therapy due to end stage hepatocellular carcinoma. Three patients were treated with antituberculous therapy, two of them recovered while one was lost to follow-up. Percutaneous aspiration/drainage [PCD] was done in five patients; Surgery was performed in three patients. One patient who underwent PCD died due to septicemia while one patient died of cardiac event, two patients were lost to follow up while eight patients recovered completely. Percutaneous aspiration/drainage is an equally good option for treating splenic abscess as compared to surgery along with adequate antibiotics

Dengue infection in cancer patients

Objective: to study the clinical behavior of dengue infection in cancer patients

Material and Methods: we reviewed medical records of cancer patients who were diagnosed with dengue infection in year 2011 as per discharge notes. Patients fulfilling revised dengue WHO/TDR classification with positive dengue lgM serologist were finally chosen for analysis

Results: from initially screened 63 patients, 43 fulfilled revised dengue WHO/TDR classification criteria, 31 [of these 43] with positive dengue lgM were finally analyzed. There were 16 males and 15 females, mean age was 39.0 [23.0] years. 23 patients were = 18 years of age. 81 % patients reported within first three days of illness. Major cancer bulk was from solid organ cancer group [n=21] followed by hematological group [n=10]. Presenting features were fever [100%] followed by aches [58.1 %], hemorrhagic manifestations [35.5%], vomiting [29%] and diarrhoea [25.8%]. Twelve [38. 7%] patients developed severe dengue with one death making 3.2% crude mortality rate

Conclusion: the spectrum of dengue infection severity in cancer patients seems to be different from general population. Clinically dengue was more severe with solid organ cancers as compared to hematologic cancers possibly highlighting the role of cellular mediated immunity. Other risk factors identified were relatively elder age and more co-morbid conditions

Effect of pioglitazone on lipid profile in type 2 diabetic patients

To determine the effect of pioglitazone on lipid profile in type 2 diabetic patients treated and followed up for three months after initiation of therapy. This hospital based quasi-experimental study was conducted in the medical B unit, Lady Reading Hospital Peshawar from July 2008 to June 2009. A total of 161 patients with type 2 diabetes mellitus were included in this study using convenient [non-probability] sampling. Clinical and laboratory evaluation of all the patients were done to note the change in lipid profile after the use of 30 mg pioglitazone. Continuous variables such as age and lipid profile [triglycerides; Low Density Lipoprotien [LDL]; High Density Lipoprotien [HDL]; cholesterol] at baseline and after 3 months time were expressed as mean +/- S.D. Paired sample t-test was used to analyze the mean difference in pre-post lab investigation by SPSS version15. Out of the 161 patients, 79 [49.1%] were males and 82 [50.9%] were females. The mean age of the sample was 51.2 +/- 11.33 years. Triglycerides decreased from 219.2 +/- 34.4 to 189.2 +/- 33.7 mg/dl with a mean difference of 29.9 mg/dl [p<0.001]. Total cholesterol changed from 201.4 +/- 29.8 to 203.2 +/- 28.9 mg/dl with a mean difference of 1.8mg/dl [p<0.001]. LDL changed from 153.7 +/- 21.1 to 154.7 +/- 20.7 mg/dl with a mean difference of 0.9 mg/dl [p<0.001]. HDL increased from 37.2 +/- 2.9 to 41.5 +/- 3.1 mg/dl with a mean difference of 4.3 mg/dl [p<0.001]. Pioglitazone was found to have beneficial effects on lipid profile. It significantly reduced the levels of triglycerides and increased levels of HDL cholesterol in patients with Type 2 diabetes

Effect of pregnancy on the disease activity in ulcerative colitis

To study the effects of pregnancy on the disease activity in ulcerative colitis. This experimental study was conducted at department of Medicine at Sultan Qaboos University Hospital Oman from July 2002 to December 2004. A total 60 diagnosed cases of ulcerative colitis proven on colonoscopy and biopsy and fairly well controlled disease at the time of enrollment were included in the study. Those who conceived and delivered during the study period were inducted as experimental group [total 30 patients], and those who did not conceive during the study period were inducted as control group [total 30 patients]. Out of total 60 patients, 30 patients who were included in the study group, 24 remained well with mild exacerbation requiring only increased dose of mesalamine, four patients had moderate disease exacerbation requiring oral steroids along with mesalamine. Two patients had severe exacerbation that was controlled on parental steroids. Among control group, 25 had mild exacerbation, 4 had moderate exacerbation and 1 had severe exacerbation during the study period. The eventual out come was good in all patients. It is thus concluded that a planned pregnancy when the disease is well controlled minimizes the risk of complications in patients of ulcerative colitis and also has got favorable outcome of pregnancy