Anaplastic thyroid cancer: a retrospective analysis of 120 cases

Anaplastic Thyroid Cancer [ATC] is one of the most lethal malignancies with very short survival and extremely poor treatment outcome. ATC accounts for 2-5% of all thyroid cancers worldwide with an annual incidence of about 2/million. To review the natural history and treatment outcome of ATC patients treated at King Faisal Specialist Hospital and Research Centre [KFSH and RC] located at Riyadh, Saudi Arabia. Retrospective review of 120 Saudi cancer patients collected from registry data at KFSH and RC from 1976-2008. Search key words included: thyroid cancer, anaplastic, undifferentiated and not otherwise specified. Search was not restricted to particular age, gender, treatment or tumor size. Demographic information, baseline patient characteristics including date of diagnosis, type of treatment and date of death were obtained from KFSH and RC registry data and Saudi death registry. A total of 120 cases were identified at our cancer centre from 1976 to 2008. Of these total, 73 were females [60.8%] and 47 were males [39.2%]. The average age at diagnosis was 63.34 +/- 12.8 years. Thirty-four patients underwent surgery [28.3%], 52 had a palliative radiation treatment [43.3%] and only 5 had chemotherapy [4.2%]. The median survival was 53 days [0-457]. Our review proves that ATC is rapidly fatal cancer and is unresponsive to currently available therapeutic options. More research is needed to understand the tumor biology and novel treatment options

Development of standard operating procedure [SOP] of a unani pharmacopoeial formulation

In various Unani pharmacopoeias thousands of formulations are present which have been formulated by eminent physicians of Unani System of Medicine. The majority of these formulations are based on plant origin drugs and their efficacy may get altered as a result of seasonal variation, use of different drying methods, their storage conditions and microbiai contamination. To avoid these alterations, standardization of drugs is necessary especially in case of compound formulations the use of Standard Operating Procedures [SOPs] for their manufacturing is essential. It will help to prepare a formulation repeatedly with the same quality. The present study was designed to develop the SOP of a Unani pharmacopoeial formulation i.e., Habbc Gule Aak [HG]. Total eight batches of HG were prepared with different conditions i.e., binder, particle size, time of drying and temperature of drying'. All the eight batches of HG were evaluated thrice for the hardness, friability and disintegration time. The batch with minimum friability, hardness nearest to standard value and minimum disintegration time as per pharmacopoeias was selected as final batch and all conditions regarding powder size, binder, temperature of drying and time of drying used in the preparation of frnal batch were fixed as its Standard Operating Procedure. Out of eight batches the Batch No. 2 with 150 micron particle size [100 mesh sieve], mucilage of 30% w/w samaghe arabi [binder], dried at 80°C for 150 minutes was selected as final batch. The final batch showed minimum friability [0.05 +/- 0.01], hardness nearest to the standard value [4.59 +/- 0.30] and considerable disintegration time [33.67 +/- 0.33]. The resulting SOP will be helpful in setting the pharmacopoeial standards of HG and the methodology of the work will help in the development of SOPs for other Unani formulations too

Furcation entrance dimensions in Malaysian permanent molars and its periodontal implication in root planing

The objectives of this study were to measure the Furcation Entrance Dimensions of first and second permanent molars in Malaysian samples and to compare the Furcation Entrance Dimensions with the blade widths of periodontal Gracey’s curette used for root surface instrumentation. A total of 199 extracted permanent teeth were measured, which comprised of 51 mandibular first molars, 51 mandibular second molars, 45 maxillary first molars and 52 maxillary second molars. Furcation Entrance Dimension was measured using calibrated test gauges. Results showed 51.91% of Furcation Entrance Dimension was <0.70mm. Forty eight percent (48.09%) of Furcation Entrance had Furcation Dimension of more than 0.70mm. It was concluded that 51.91% of all the Furcation Entrance Dimensions of these teeth were less than the blade width of new Gracey curettes. Therefore, new periodontal Gracey’s curette of small dimension may be the best choice of instrumentation and that ultrasonic debridement using a narrow tip may be a more appropriate choice.

Prognostic significance of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction

The contribution of diastolic dysfunction in patients with preserved left ventricular [LV] systolic function to impaired functional status and cardiac mortality in myocardial infarction [MI] is unknown. Assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 150 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function [n=59]; group B: LV systolic dysfunction with preserved diastolic function [n=8]; group C: LV diastolic dysfunction with preserved systolic function [n=49]; group D: combined LV systolic and diastolic dysfunction [n=33]. The cardiac mortality rate at 6 months was significantly higher in groups C [12%] and D [36%] compared to A [2.5%] [p<0.01]. Multivariate regression analysis identified LV diastolic dysfunction [p=0.001], killip class >/= II [p=0.005], and age [0.007] as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction is associated with increased morbidity and mortality following acute MI

Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with co- existing diabetes mellitus

A review was made of the records of all patients with pulmonary tuberculosis and diabetes mellitus admitted over a 5- year period to a teaching hospital in Karachi, Pakistan. Among 42358 the total number with both tuberculosis and diabetes was 173. The prevalence of tuberculosis patients, in diabetic patients was 10- times higher than in non- diabetic patients and prevalence increased with duration of diabetes. The lower lung field was most frequently involved, followed by the upper and middle. Bilateral involvement was seen in half and an associated pleural effusion in one- third of the patients. Cavitating lesions were seen in 32% of men and 15% of women

Genotypic and environmental interaction in advanced lines of rice under salt-affected soils of Punjab

Sixteen genotypes developed through hybridization and mutation breeding techniques were evaluated during the year 2003-04 on nine locations covering most of the area of Punjab province including Faisalabad, Toba Tek Singh and Jhang. NIAB-IRRI-9, Jhona-379 salt tolerant genotypes and super Basmati, a salt sensitive variety were included as standard checks. The tested material [six genotypes] was generated by crossing fine varieties of rice viz. Basmati-370 and Basmati-385 with three coarse varieties of rice viz. NIAB-IRRI-9, Jhona-349 and NIAB-Rice-1. The mutants [seven mutants] were derived by gamma irradiation of rice varieties, Basmati-370 and Basmati-385. The nine sets of experiments were conducted in the naturally high saline sodic soils having EC range of 9.2-18.13 d/Sm pH=8.65-9.50, and SAR=20.7-37.15. The seed yield data collected at maturity and stability parameters were computed to know genotypic x environment interaction and varietals performance. The combined analysis of variance showed highly significant variance in case of varieties, locations and varieties x locations interaction. Varieties and varieties x Environment [Lin] also showed highly significant differences. It means that genotypes exhibited different behavior in different locations / environments which is due to their different genetic make up. The behavior may be cross over [in which significant change in ranking occurs from one environment to another] or cross over nature [in which case the ranking of genotype remains constant across environments and the interaction is significant because of change in the magnitude of response] depending upon the ranking order of genotypes performance under different environment. In our study, only super Basmati behavior was of almost non cross over nature, while others had cross over type of interaction. Based on overall mean seed performance, mutant NIAB-Rice-4 and DM-38/88 produced significantly the highest grain yield [5.6 t/ha] followed by mutant line NIAB-Rice-5 [5.4 t/ha] and NIAB-rice-2 [5.3 t/ha]. The lowest performing genotype was super Basmati [3.0 t/ha]. The coarse variety Jhona-349 produced [4.8 t/ha] grain yield. Mutant line DM-38/88 showed significant regression co-efficient differences from unity while mutant line NIAB-Rice-4 showed non significant difference of regression co-efficient from unity. Mutant line, NIAB-Rice-4 also showed non significant difference of standard deviation to regression co-efficient from zero. All the three parameters of stability i.e. overall mean seed yield, regression co-efficient and standard deviation to regression, provided clear evidence that mutant line NIAB-Rice-4 produced maximum stable yield compared to super Basmati

Smoking prevalence, knowledge and attitudes among medical students in Karachi, Pakistan

A survey of smoking prevalence and attitudes was made among medical students randomly selected from classes at the Aga Khan University, Karachi, Pakistan. Of 271 respondents, 14.4% were current smokers [22.0% male and 3.8% females] and 3.3% ex-smokers. A majority of students recognized the dangers associated with active as well as passive smoking although only 55% of current smokers planned to quit in the near future. Most smokers [96%] believed that they as well as other health professionals needed training on smoking cessation and 95% of all students believed that doctors should play a role model in smoking cessation by not smoking themselves. Specific training and counselling should be a part of the required curriculum at medical schools

Evaluation of advanced rice germplasm under water stress environment

Thirteen genotypes of rice comprising of approved varieties and elite candidate lines were studied at three different water regimes by supplying 12, 8 and 4 numbers of irrigations at different intervals/ stages. The experiment was conducted at NIAB Farm Faisalabad, Pakistan on a clay loam soil applying normal doses of N and P fertilizers during 2002-2003 keeping varieties in the main plot while treatments in sub plot. The data for twelve morphological characters i.e. days to flower, days to mature, plant height, panicle length, number of productive tillers, number of primary and secondary branches, 1000 grain weight, sterile grains per spike, number of total grains per spike, fertility percentage, grain yield were recorded and subjected to analysis of variance and means were compared following DMR test. Effect of water stress on different morphological attributes in all treatments showed significant differences. Plant height, branches per plant, number of grains and grain yield reduced at less number of irrigations while sterility percentage was increased at less moisture conditions. Maximum grain yield [5349 Kg/ha] was achieved at T1 where 12 number of irrigations were applied at T2 [8 irrigations] and T3 [4 irrigations]. The yield reduction was observed from 30.32% to 42.53%, respectively as compared to T1 [12 irrigations]. Rice variety DM 64198 produced the highest seed yield [4766 Kg/ha] followed by DM-3-89 [4770 Kg/ha].This might be due to different genetic make up of the breeding lines and their behavior and interaction in water stress environment. Furthermore, high irrigation level made possible the appropriate water availability possible at proper time for performing different types of physiochemical processes of development that hindered at less number of irrigation or water stress environment. It may be concluded that for achieving maximum economic yield, at least 12 irrigations were essential otherwise the production will be reduced to a considerable extent

Genotype and environment interaction effect on yield of cotton under naturally salt stress condition

Thirteen genotypes of cotton developed through hybridization and mutation breeding techniques were evaluated during two consecutives years 2002-03-04 on eight locations covering most of the area of Punjab province including Faisalabad, Toba Tek Singh and Jhang. The eight sets of experiments were conducted in the naturally highly saline sodic soils, EC ranges from 7.8-36.1 d/Sm, pH=8.1-8.8, SAR=10.1-40.5, Saturation percentage 31.3-40.8 and texture Sandy Clay loam and Clay loam. The seed yield data was collected at maturity and stability parameters were computed to know genotypic environment interaction and varietals performance. The combined analysis of variance showed highly significant variance in case of varieties, locations and varieties x environment [Lin] also showed highly significant differences. It means that genotypes exhibited different behavior in different locations/environments which is due to their different genetic make up. The behavior may be cross over [in which significant change in ranking order occurs from one environment to another] or cross over nature [in which case the ranking of genotypes remains constant across environments and the interaction is significant because of change in the magnitude of response] depending upon the ranking order of genotypes performance under different environments. In our study only S-12 behavior was of almost non cross over nature, while others had cross over type of interaction. Based on over all seed yield cotton variety NIAB-999 and CIM-707 produced highest seed yield cotton [3.2 t/ha, 3.17t/ha]. The lowest seed yield cotton was noted in S-12 [1.86 t/ha]. All the three parameters of stability i.e. overall mean seed yield cotton, regression coefficient and standard deviation to regression provided clear evidence that variety NIAB-999 and CIM-707 produced maximum stable yield compared to S-12

Genotypic and environmental interaction in advanced lines of wheat under salt-affected soils environment of Punjab

Wheat cultivars of diverse origin including approved varieties of different provinces of Pakistan i.e. Punjab, NWFP and Sindh were tested against different salinity levels in laboratory as well as in naturally saline fields in different ecological zones. Initially, 16 genotypes were studied for germination test at 6 different salinity levels ranging from 0-25 dS/m [2, 5, 10, 15, 20, 25, EC= dS/m]. Then, out of 16 cultivars, 11 were studied for the relative growth rate at different levels of salinity and after their study in the laboratory, 9 genotypes were selected for testing in the naturally saline areas of Punjab province. Under germination percentage study, the varieties viz. Pasban-90, Sarsabz, Bakhtawar, 93032 and 933118 were less affected than other varieties. As regards the relative plant growth, varieties viz. Sarsabz, Bakhtawar, and Pasban-90 were tolerant to salinity at seedling stage while Inqlab was graded as sensitive to salt stress. Regarding field performance, significant differences were observed in the varieties grown under different saline environments and varieties x environment interaction. Varieties x environment [Lin] interaction was non significant while nonlinear interaction [pooled deviation] was significant. Based on overall yield performance, the Sarsabz variety produced the highest seed yield [4.37 T/ha] followed by Bakhtawar [4.24 T/ha] and Pasban-90 [3.93 T/ha]. Regression coefficient values showed non significant differences to unity while standard deviation to regression showed significant differences to zero. These results indicated that the genotypes viz. Sarsabaz, Bakhtawar and Pasban-90 are better tolerant to saline environment as compared to others. The two genotypes, Marvi and 25219 had low regression values and can fit under stress environment

Genotype and environmental interaction in cowpea [Vigna Unguiculata-L] for yield and disease resistance

Twenty-six cowpea cultivars were tested for yellow mosaic virus resistance at NIAB Faisalabad. NCPM-1, Elite, IT-84-552, No.44, P-518, S.A. Dandy, IT-97k-350-4, IT-93K-452, IT-97K-1042-8 and IT-97K-497-2 showed resistant reaction to yellow mosaic virus disease. As the study was aimed to select disease resistant and high yielding cultivars. Five cultivars viz. NCPM-1, Elite. S.A. Dandy, IT-97K-497-2 and IT-97K-1042-8 were chosen and evaluated at five different ecological zones during the year 2003. At each location, the experiment was laid out in a randomized complete block design keeping 7.2 m[2] plot size in three repeats. At maturity the seed yield was collected and subjected to analysis of variance following stability parameters, varieties, environment and varieties x environment showed significant differences. Significant and highest seed yield [880 kg/ha] was observed in NIAB cowpea mutant-1 followed by Elite [729 Kg/ha]. The highest yielding genotypes i.e. NIAB cowpea Mutant-1 and Elite showed non-significant differences of regression coefficient from one. Moreover these genotypes also exhibited non-significant difference of standard deviation to regression from zero. Based on three parameters i.e. high mean seed yield, regression coefficient and standard deviation to regression, these genotypes showed excellent and trustworthy stable performance over different environment. Hopefully these genotypes will definitely be helpful for increasing one local production of cowpea crop

Tuberculosis diagnosis and treatment practices of private physicians in Karachi, Pakistan

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis [TB]. The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of the doctors were aware of the 4 first-line anti-TB drugs. Efforts to improve the knowledge of private practitioners, and strategies to enhance public-private collaboration for TB control in urban areas are urgently required

Pneumothorax: a review of 146 adult cases admitted at a university teaching hospital in Pakistan

OBJECTIVE: There is a lack of data on the etiology and outcome of pneumothorax among the Pakistani population. Our aim was to review the etiology, clinical course, management and outcome of patients presenting with pneumothorax. PATIENTS AND METHODS: All adult cases with pneumothorax admitted to a University Teaching Hospital in Karachi, between January 1992 and June 1996, were reviewed and analyzed. A total of 146 patients were reviewed. Their mean age was 46.3 years [SD +/- 17.8 years] with a male to female ratio of 3.7:1. Secondary pneumothorax was the commonest type seen [45%], followed by traumatic [21%], iatrogenic [18%] and primary [16%]. Tuberculosis [47%] and COPD [45%] were most common lung diseases associated with secondary pneumothorax. Pneumothorax secondary to TB presented at an earlier age than that with COPD [49.6 vs. 60.1 years]. Similarly, patients with primary pneumothorax were significantly younger than patients with secondary pneumothorax [42.3 vs. 51.7 years]. Rib fracture was the most common cause of traumatic pneumothorax. Coronary artery bypass grafting, transthoracic fine needle aspiration and neck vein cannulations were the leading iatrogenic causes. The commonest symptoms of pneumothorax were dyspnea [68%] and chest pain [40%]. Most cases [81%] were successfully managed by intercostal tube drainage. In our study population, secondary pneumothorax was the commonest variety seen. TB was the commonest cause of secondary pneumothorax, closely followed by COPD. Nearly 40% of pneumothorax were either traumatic or iatrogenic. Intercostal tube drainage remains the treatment of choice for pneumothorax

Dental implantology in Pakistan: report of 34 osseointegrated core-vent implants after 24 months

Osseointegrated implant supported dentures are an accepted method of replacing lost natural teeth. In Pakistan we introduced this technology of Core-Vent implants three years ago. We report on the status of the thirty-four consecutively placed Core-Vent corporation dental implants in six patients. Of the thirty-four placed two failed to integrate. The remaining were able to sustain implant supported dentures in all six of the patients