Patterns of failure and clinical outcomes of post-operative buccal mucosa cancers treated with adjuvant ipsilateral radiotherapy

Purpose@#Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT. @*Materials and Methods@#One hundred sixteen cases of post-operative buccal mucosa cancers—pT3 or more, node positive, close margins (1–5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm—treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60–66 Gy (44 Gy in the first phase and a coned down boost of 16–22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes. @*Results@#Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01). @*Conclusion@#Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.

Optimization of antibacterial activity of ethanolic extracts of eucalyptus tereticornis and nigella sativa: response surface methodology

The screening of plants for medicinal purposes represents an effort to discover newer, safer, and possibly more effective drugs. Design of the present study was made aiming to the optimization of the antibacterial activity of ethanolic extracts of Eucalyptus tereticornis [leaves] and Nigella sativa [seeds] against bacteria belongings to both Gram-positive [Bacillus subtilis and Staphylococcus aureus] and Gram-negative [Escherichia coli] spectrum by using response surface methodology. 20 g powder of each E. tereticornis [leaf] and N. sativa [seeds] were mixed with 200ml of ethanol at room temperature, and then it was centrifuged at 4000 rpm for 10 min to separate the supernatants, and allowed to dry in order to obtain ethanol free extracts. A fresh bacterial culture of 100microl of test microorganism was inoculated onto media and spread homogeneously. The antimicrobial activity of ethanolic extracts showed that all the concentrations tested were effective against the test microorganisms. The diameters of zones of inhibition exhibited by S. aureus PCSIR-83 were in the range of 0-28mm, E. coli PCSIR-102 [0-28mm] and B. subtilis PCSIR-05 [15-26mm]. The combination of N. sativa [15mg/micro l] and E. tereticornis [20mg/micro l] were found most effective at pH 9.0 and temperature 35°C. Our results clearly indicate that Gram positive bacteria showed more sensitivity than Gram-negative bacteria

[Public health system response to 5 December 2012 South Khorasan earthquake [a case study]]

Disasters such as earthquake induce large volume of human needs. One of the most important of them is primary health care needs. Following the 5 December 2012 South Khorasan earthquake, the public health system of the province actively involved to provide primary health care for the affected people. This case study investigated the response operations of public health system to earthquake. In this case-descriptive study, data collected by researchers using checklists, interview with healthcare workers in earthquake-affected areas, reviewing documents, and observation of the response operations. An earthquake measuring 5.5 on the Richter scale hit Qaenat and Zirkouh areas caused 6 deaths and 23 injuries. About 2143 people were affected and 38 villages destroyed about 30 to 100%. Responding to the health needs, a rapid health needs assessment was performed immediately. Then, a response plan designed according to "National Public Health Disaster and Emergency Operation Plan". Public health system in collaboration with expert health groups provided the primary health care services for the affected communities. Although the recent earthquake was mild and occurred in the early of night, but it killed some people and destroyed a number of structures. Public health system provided an appropriate response according to EOP. Nevertheless, because Iran is a disaster prone country, the health system should be prepared for different types of hazards

Frequency of hepatic encephalopathy in HCV cirrhotic patients with and without diabetes mellitus

Objective: to compare the frequency of hepatic encephalopathy [HE] in HCV cirrhotic patients with and without Diabetes Mellitus

Material and Methods: this cross sectional survey of 100 patients was conducted in all medical units of Mayo Hospital Lahore after meeting the inclusion criteria. Patients were classified as diabetic if they were on oral hypoglycemic agents or insulin or have BSF>126mg/dl and non-diabetic if they had BSF<126 mg/di. The assessment for presence or absence of hepatic encephalopathy was determined using criteria defined in operational definition. HCV LIVER CIRRHOSIS is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scare tissue and regenerative nodules. Cirrhosis was confirmed by Ultrasonography abdomen and hepatitis C was confirmed with ELISA test

Results: mean age of patient was 44.43+/-10.16 years with minimum and maximum ages 18 and 60 years respectively. Frequency of DM was determined as 34% among HCV cirrhosis patients while in 66% patients the diabetes was not seen. Hepatic encephalopathy was seen in 31 [91.2%] of diabetics and in 48[72. 7%] of non-diabetic patients. HE was not seen in 21 % of patients in which 3 were diabetics and 18 were non diabetic. In this study frequency of HE was higher in diabetic group as compared to non-diabetic group i.e. P- value=0.032

Conclusion: according to this study, frequency of Hepatic encephalopathy [HE] is significantly higher in diabetic patients as compared to non-diabetic patients i.e. P value 0.032. Frequency of HE was seen in 91.2% of the diabetic patients and in 72. 7% of non-diabetic patients

Antibacterial activity of silver nanoparticles dispersion against MSSA and MRSA isolated from wounds in a tertiary care hospital of north India.

Staphylococcus aureus, the main cause of nosocomial infection worldwide result in significant increases in mortality, morbidity, and cost related to prolong treatments. Silver compound has been in use since time immemorial for the treatment of burns, wounds and several other bacterial infections. In the present work, we explore the antibacterial activity of silver nanoparticles (Ag-NPs) dispersion (5-10 nm) against reference strain and clinical isolates of Methicillin-sensitive S. aureus (MSSA), and Methicillin-Resistant S. aureus (MRSA).The typical minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against standard reference strain as well as, MSSA and MRSA were observed in the range of 12-48 μg/ml and 12-96 μg/ml, respectively. The MBC/MIC ratios against all strains were found in the range of ≤1 to ≤4, which shows that Ag-NPs inhibit bacterial growth in a bactericidal rather than a bacteriostatic manner. Our finding suggests that Ag-NPs are effective broad-spectrum antibacterial agents regardless of their drug-resistance mechanisms.

To determine the efficacy of intravenous l-ornithine l-aspartate in combination with current treatment in patients with hepatic encephalopathy

Hepatic encephalopathy [HE] is the syndrome of disordered consciousness and altered neuromuscular activity that is seen in patients with acute or chronic hepatocellular failure or porto systemic shunting

Objective: To determine the efficacy of intravenous L-ornithine L-aspartate [LOLA] in combination with current treatment in patients with hepatic encephalopathy

Study Design: Quasi experimental

Setting: Study was conducted in medical unit I, Services Hospital, Lahore

Duration of Study: The study was carried out over a period of one and a half years

Subjects: Patients of chronic liver disease presenting with hepatic encephalopathy fulfilling inclusion criteria were enrolled in study

Methods: Sixty patients of hepatic encephalopathy were taken. They were divided into two groups of thirty each. Thirty patients labeled as group A were given the conventional treatment of hepatic encephalopathy; second group of thirty patients was labeled as group B and was given intravenous LOLA in addition to conventional treatment

Results: Group B patients showed statistically significant improvement in encephalopathy and reduction in serum ammonia levels after seventy two hours of treatment. However, there was statistically insignificant reduction in duration of hospital stay

Conclusion: Addition of LOLA in conventional treatment improves recovery from hepatic encephalopathy; but it needs further studies to document role of L-ornithine L-aspartate as regular part of treatment of hepatic encephalopathy