A Rare Case of Non-small Cell Lung Carcinoma Squamous Phenotype with Epstein-Barr Virus Positivity with Prolonged Response to both Chemotherapy and Radiotherapy / 中国肺癌杂志

We present a rare challenging case of metastatic non-small cell lung cancer with Epstein-Barr virus positivity that was also diagnosed with pulmonary tuberculosis at the same time. Palliative chemotherapy gemcitabine and carboplatin was started after two weeks of anti-tuberculosis treatment with the hopes that this period would be sufficient to keep acid fast bacilli non-viable to minimise risk of tuberculosis re-activation due to chemotherapy induced immunosuppression. She completed four cycles of chemotherapy and six months of anti-tuberculosis treatment with good results and minimal side effects. Two years later, there was disease recurrence in cervical and mediastinal lymph nodes which was treated with local treatment i.e. surgery and palliative radiotherapy. It has been two years since last radiotherapy and overall more than five years since diagnosis with no active disease at present. Given the complexity and rarity of this case, significant multidisciplinary team involvement, including oncologists and radiation oncologists, pulmonologists with special interest in tuberculosis and pathologists was necessary throughout.

Ethanolic ficus carica leaf extract supplementation affects the behavior of male albino mice

Ficus carica has been known for its medicinal benefits for the treatment of metabolic, cardiovascular and respiratory problems but little information is available regarding the effects of its leaf extracts on behavior. Present study was designed to report the effect of Ficus carica leaf extract on the selected aspects of male albino mouse behavior. Six week old male albino mice were orally treated for 14 days either with 100 mg/ml solvent/ Kg body weight of Ficus carica leaf extract or with commercially available saline solution [Otsuka, Pakistan]. A battery of neurological tests [Morris Water Maze, Elevated Plus maze, Novel object test] were applied in order to determine the effect of Ficus carica extract on exploratory behaviour, learning and memory in male albino mice. It was observed that oral supplementation of 100mg/ ml solvent/Kg body weight of Ficus carica leaf extract for 2 weeks enhanced neuromuscular co-ordination as they had significantly higher mean speed [P = 0.001] than control group during elevated plus maze test. Morris water maze and novel object test performance remained unaffected [P > 0.05] when compared between Ficus carica leaf extract treated and untreated mice

Oral supplementation of Thuja oreintalis leaf extract moderately affects the behavior in albino mice in a gender specific manner

Present study was designed to demonstrate the effect ethanolic leaf extract of Thuja orientalis on the learning and memory formation in albino mice. Four week old albino mice were either orally supplemented with 50mg/ml solvent/Kg body weight of Thuja orientalis or with equal volume of saline solution [0.9% NaCl] for seven days. A battery of neurological tests [Elevated plus maze, Rota Rod, light and dark box, open field and novel object recognition test] were applied at the end of dose supplementation. Thuja orientalis leaf extract treated female mice spent significantly les time on rotating rod [P = 0.02] than male treated with saline solution [indicating poor neuromuscular coordination]. While all other neurological test performances varied non significantly [P > 0.05] when compared between Thuja orientalis treated albino mice [of both genders] with their respective control groups indicating a moderate effect of 50mg/ml solvent/Kg body weight of Thuja orientalis on the behavior of young albino mice

Thrombotic thrombocytopenic purpura - analysis of clinical features, laboratory characteristics and therapeutic outcome of 24 patients treated at a tertiary care center in Saudi Arabia

Objective: Thrombotic thrombocytopenic purpura [TTP] is a life-threatening disease. The primary aim was overall response rate [ORR] assessment in the treated patients

Methods: This retrospective study included 24 patients treated during 2006-2015. TTP patients with microangiopathic hemolysis [MAHA] and thrombocytopenia were included. We analyzed clinical features, laboratory characteristics and treatment outcomes of 24 TTP patients treated at our tertiary care center [KFMC]

Results: Twenty-four TTP patients [18 females; 6 males] had a mean age of 33.5 +/- 13.9 years; 22[91%] had neurologic features, 7[29%] fever, 10[42%] renal impairment; 4[20.83%] cardiac manifestations; 22[91.7%] had triad with additional neurologic abnormalities; only 2[8.2%] had pentad of TTP. Majority [54.16%] had idiopathic TTP. All patients received therapeutic plasma exchange [TPE]; 23[95.8%] received adjunctive corticosteroids and 13[54.2%] received rituximab either due to refractoriness to TPE on tilde day7, or earlier. Twenty-one out of 24 [87.5%] achieved complete remission [CR] without any subsequent relapse. At 22 months [median, range 1-113], 20 patients [83.3%] are alive at the time of report. Three patients died during acute episode because of sever disease or delayed treatment and one died in CR

Conclusion: TPE, steroids and or rituximab was very effective in preventing high risk of mortality and achieving durable CR in 87.5% of patients. More awareness is needed for early diagnosis and early referral to centers with appropriate tertiary care facilities

Trends in adherence to secondary prevention medications in post-acute coronary syndrome patients

To evaluate patients' adherence to evidence-based therapies at an average of 2 years after discharge for Acute Coronary Syndrome [ACS] and to identify factors associated with non-adherence. This study was conducted at Hospital Pulau Pinang, Malaysia. A random sample of ACS patients [n=190] who had discharged on a regimen of secondary preventive medications were included and followed up over a three follow-up appointments at 8, 16, and 23 months post discharge. At each appointment, patients were interviewed and given Morisky questioner to complete in order to compare their level of adherence to the prescribed regimens across the three consecutive time periods. Majority of patients reported either medium or low adherence across the three time periods with only small portion reported high adherence. Furthermore, there was a significant downward trend in the level of adherence to cardio protective medications during the study period [p<0.001]. This study also identified 6 factors-age, gender, employment status, ACS subtype, number of co morbidities and number of prescription medications per day that may influence Patients' adherence to their medications. Our findings suggest that long-term adherence to secondary prevention therapies among patients with ACS in Malaysia is sub optimal and influenced by many demographic, social as well as clinical factors

Effect of creatine monohydrate supplementation on relative serum level of IL-6 and IL-18 following neonatal hypoxia ischemia in male albino mouse

IL-6 has been reported to have neuroprotective effects against cerebral ischemia while IL-8 is a pro inflammatory cytokine structurally related to interleukin-1 family. In the present study, we tried to determine whether 2% Creatine monohydrate supplementation for variable duration influence the IL-6 and 18 concentrations in the serum of male albino mouse following right common carotid artery ligation and hypoxia [8% oxygen] for 25 minutes. Our result revealed that serum concentration of IL6 [P=0.0001] as well as IL-18 [P=0.003] were significantly higher in mice supplemented with creatine monohydrate for 15 weeks than in male albino mice on normal rodent diet following hypoxic ischemic insult indicating that long term creatine monohydrate supplementation up regulates the IL-6 and IL-18 concentrations triggering the neuroinflammatory and neuroprotective responses

Acute coronary syndrome; frequency of hypomagnesaemia in patients

Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation after potassium. Magnesium plays a fundamental role in many functions of the cell, including energy transfer, storage, and uses protein, carbohydrate, and fat metabolism; maintenance of normal cell membrane function; and the regulation of parathyroid hormone [PTH] secretion. To determine the frequency of hypomagnesaemia in patients presenting with acute coronary syndrome [ACS]. Cross -sectional study. Coronary Care Units and medical ward in Allied Hospital Faisalabad, from 26-01-2010 to 25-07-2010. The study was conducted in medical unit II and coronary care unit of Allied Hospital Faisalabad. Sample Size: Sample size was calculated by using WHO sample size calculator taking confidence level 95%, population proportion 7.7% and required precision 4%. Sample size n = 171. Non-probability consecutive sampling. A total of 171 patients fulfilling the criteria of ACS admitted in M-ll and CCU were enrolled in the study, demographic details, history and clinical examination of the patients were recorded. Blood sample was collected in estimation of serum magnesium level. In this study the mean serum magnesium was 1.59 +/- 8.380 in males and 1.56 +/- 7.678 in females. Among the 171 acute coronary syndrome patients, 14 [8.2%] were diagnosed with hypomagnesaemia. There were 8 [8.8%] male and 6 [7.5%] female patients. 157 [91.8%] patients did not have hypomagnesaemia out of 83 [91.2%] were male and 74 [92.5%] were female patients. There was male predominance. Male to male ratio was 1.33:1. The results showed that frequency of hypomagnesaemia in acute coronary syndrome was significantly high and comparable to other studies. There was male preponderance. However, there was variation in the occurrence of hypomagnesaemia in acute coronary syndrome. Early assessment of serum magnesium concentration is needed in acute coronary syndrome in order to implement proper magnesium supplementation

DFT for exploring the antioxidant potential of homogentisic and orsellinic acids

In recent years, much attention has been focused on the antioxidant potential of different phenolic acids. But still no theoretical investigation is reported on the antioxidant potential of Homogentisic and Orsellinic acids. In this study, computational investigation based on the density functional theory [DFT] has been carried out to understand the antioxidant potential of Homogentisic and Orsellinic acids. The bond dissociation enthalpy [BDE] of O-H, spin densities and electronic properties such as dipole moment, ionization potential, electron affinity, HOMO and LUMO energies, electronegativity, electrophilic index, energy gap, softness and hardness have been calculated. These properties show that both phenolic acids are good antioxidants. Comparison of BDE of Homogentisic and Orsellinic acids with many other phenolic acids also indicate the good antioxidant potential of these compounds. Homogentisic acid has very high antioxidant potential due to the presence of semiquinone structure. This study will be helpful for the better utilization of these compounds in pharmaceutical and food industry

Infrastructure, inventory, human resource of mother and child health centers of Lahore and its impact on maternal health services

It is a common observation that there is load on tertiary care facilities which is logical outcome of under utilized primary level. For identification, quantification and gauging of these gaps current study was conducted at MCH Centers of City District Government Lahore. It was cross-sectional descriptive study conducted at City District Government, Lahore. 18 MCH centers were selected by randomization technique at each town. The current study depicted that 44.44% centers were not having any telephone, fax, generator and ambulance service. While at 11.11% centers the post of dai are vacant. It was also found the 27.78% centers were not delivering service of IUD and inject able family planning services. It was also found that 88.89% of centers had the approved furniture, equipment and linen but in majority of cases it was non functional conditions. It was also found that 83.33% MCH Centers were lacking oxygen cylinder, artery forceps and tooth forceps. 88.89% MCH centers were not having vaginal retractors and dressing seizers. Umbilical Tape, Casco Vaginal Speculum, weighing machine were absent at 100% MCH centers. First aid box was present at 17 94.44% MCH Centers. Examination Couch, almirah, towel stand, iron bed and overalls were available at 88.89% of the MCH Centres but mostly they were in poor condition. Office chair, delivery couch, bed sheet and table cloth were available in all MCH Centres while bench, bucket, towel stand and durries were available in 94.44 MCH Centres. The preceding lines depict that although majority of centers have got sanctioned equipment and furniture but they are non functional and due to this fact this chain of MCH Centers for Maternal Health Services are not delivering up to the mark. Investment in the form of financial resources determines the success or failure of any setup

Detection of Babesia bovis in blood samples and its effect on the hematological and serum biochemical profile in large ruminants from Southern Punjab

<p><b>OBJECTIVE</b>To determine the presence of Babesia bovis (B. bovis) in large ruminants in southern Punjab and its effect on hematological and serum biochemical profile of host animals.</p><p><b>METHODS</b>Blood samples were collected from 144 large ruminants, including 105 cattle and 39 buffaloes, from six districts in southern Punjab including Multan, Layyah, Muzaffar Garh, Bhakar, Bahawalnagar and Vehari. Data on the characteristics of animals and herds were collected through questionnaires. Different blood (hemoglobin, glucose) and serum (ALT, AST, LDH, cholesterol) parameters of calves and cattle were measured and compared between parasite positive and negative samples to demonstrate the effect of B. bovis on the blood and serological profile of infected animals.</p><p><b>RESULTS</b>27 out of 144 animals, from 5 out of 6 sampling districts, produced the 541-bp fragment specific for B. bovis. Age of animals (P=0.02), presence of ticks on animals (P=0.04) and presence of ticks on dogs associated with herds (P=0.5) were among the major risk factors involved in the spread of bovine babesiosis in the study area. ALT concentrations were the only serum biochemical values that significantly varied between parasite positive and negative cattle.</p><p><b>CONCLUSIONS</b>: This study has reported for the first time the presence of B. bovis in large ruminant and the results can lead to the prevention of babesiosis in the region to increase the livestock output.</p>

Etiology and diagnosis of obstructive jaundice, our experience

Obstructive jaundice is a common problem faced by surgeons. To ascertain various etiologies of obstructive jaundice in our set up and to evaluate the usefulness of available diagnostic modalities. Descriptive study. This study was conducted at Allied and District Head Quarter Hospital, Faisalabad from April 2010 to Sep. 2010. Eighty-five patients with obstructive jaundice were included in the study. They were evaluated on the basis of history, clinical examination, biochemical tests and ultrasonography. CT scan abdomen was done in suspected malignant cases only. Operative findings were compared with preoperative ultrasound and CT scan findings. The results were then prepared and analyzed. In our study. 56.5% patients were of benign etiology and 34.5% were of malignant etiology. Female to male ratio was 2:1. Serum bilirubin was raised more in malignant diseases than in benign diseases. and accuracy of 80% of ultrasound and 86% of CT scan abdomen was found out after performing different surgical procedures in our patients. In benign group of patients the most common cause was choledocholithiasis, 47.1% while in malignant group the most common cause was carcinoma of head of pancreas, 34.1%. Common causes of obstructive jaundice in our study were choledocholithiasis and carcinoma head of pancreas. Ultrasound is a reliable tool for diagnosis of obstructive jaundice and CT scan is helpful in evaluation of malignancy scan is helpful in evaluation of malignancy

Correction of airway obstruction in congenital micrognathia by mandibular distraction osteogenesis

Varying degrees of upper airway obstruction is almost universally present in patients of congenital micrognathia which needs to be corrected as early as possible. This allows appropriate feeding and growth and prevents long-term complications such as pulmonary hypertension and cor pulmonale. We report the case of a tracheostomy-dependent, 4-year-old child with congenital micrognathia who was treated with mandibular distraction osteogenesis. This is the treatment of choice for surgical correction of mandibular hypoplasia and for the challenging airway management in infants. Once a bone length of 2 cm was achieved through distraction osteogenesis, the child was completely relieved of respiratory obstruction and tracheostomy tube was removed through the process of decannulation

Metabolic syndrome frequency in patients presenting with acute myocardial infarction

To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction [MI]. Cross -sectional, observational, multi center study. Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Out of 690 patients, 420[60.86%] were male and 270[39.14%] were females with average age 55.90 +/- 10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar [42%] levels. Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction

Effect of vitamin d replacement in patients of fibromyalgia

Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. It is a chronic pain disorder that is difficult to treat. Recently Vitamin D has shown promising impact in the treatment of this disorder. To see the therapeutic role of vitamin D replacement in patients of fibromyalgia. Prospective study. Multicentre, Three private clinics. Out of 223 patients presenting with body aches and pains over the course of six months [January to June 2008], 100 patients [96 females and 4 males] between 20 to 50 years of age fulfilled the American College of Rheumatology [ACR] criteria of fibromyalgia and were included in the study. Using standard proforma, frequency of complaints other than ACR criteria were also documented.All of them were on some form of pain medication by various general practitioners/ consultants for more than three months but their symptoms were persistent. After informed consent, their serum vitamin D3 [25OHD3] level was requested as the cost of investigation was to bear by patients themselves. Patients were then replaced with vitamin D with an expected target of > 50 ng/ml and followed for 6 months duration. Supplementation with calcium in a dose of 1000mg/day was also done. In this study 83% of patients were having vitamin D between 11-20 ng/ml[mean =13 +/- 2], 11% between 5-10 ng/ml [mean=7 +/- 1] and 6% were below 5ng/ml [table-2]. There were four male patients, all [100%] with age distribution of 41-50 year and all were deficient in vitamin D [<20ng/ml]. Among 96 female patients 80[76.8%] were having level between 11-20 ng/ml, 10 [9.6%] between 5- 10ng/ml and 6 [5.7%] were below 5 ng/ml. After replacement with vitamin D achieving expected target serum levels >50ng/ml. Improvement in ACR criteria of fibromyalgia syndrome consisting of widespread musculoskeletal pains and 11 out 18 tender points was improved in more than 76% of the patients. Improvement in the associated conditions was also observed e.g. restless legs in 91.3% chronic fatigue in 97.6%. Similarly 85% reported relief from muscle spasm and 65% from tingling. There was also improvement in neuropsychiatric conditions like depression 71%] and anxiety 46.8%. Moreover, improvement in cognitive function like concentration and forgetfulness was also reported by 69.8% and 67.7% respectively [Table-4]

Management of dental waste in a dental hospital of lahore

It is a descriptive study based on personal observations at Punjab Dental Hospital, Lahore carried out over a period of two weeks. A structured checklist was made to collect the data regarding the management of Dental hospital waste and filled in by observation. Final analysis was made with the help of Epi info 2002 statistical package. There was no categorization and segregation of infectious waste at the point of origin. Bags and containers for infectious waste were not marked with Biohazard symbol. White bags were not available for the general waste. There is no incinerator, storage site and landfill sights in the dental hospital. Transportation of waste within the hospital is through open baskets. Dental Hospital sends its infectious waste to the Children Hospital Lahore for incineration twice a week. Amalgam/mercury, X-ray developer and fixer waste were drained through main sewage system. Sanitary workers are not provided with the protective clothing, gloves, masks and shoes. Waste management at Punjab Dental Hospital is not satisfactory. Interest and motivation in hospital waste management is lacking. The administration is required to play its role

Self efficacy: relationship with stress, anxiety and depression

The aim of the present research is to examine the relationship of general self-efficacy with psychological wellbeing. Correlational Study Federal Urdu University for Arts, Science and Technology, Karachi, from August 2005 to February 2006. After detailed literature review following hypotheses were formulated: a] There would be a significant inverse relationship between self-efficacy and stress. b] There would be a significant inverse relationship between self-efficacy and depression. c] There would be a significant inverse relationship between self efficacy and anxiety. Science students ['including females=84 males=113] from different departments of Federal Urdu University, Karachi were selected and were required to complete the questionnaires. Age range of the sample was from 19 to 25 years and minimum educational level was intermediate. Entire sample was recruited from middle socioeconomic class. To assess the psychological wellbeing, the Depression Anxiety Stress Scales[1] [DASS21] was administered. A measure of General Self-efficacy[2] [GSE] was also administered. In order to interpret the data in statistical terminology the Pearson product moment correlation was applied. General self efficacy was found to have significant inverse relationship with stress [r=-.166; p<0.05], anxiety [r=-.186; p<0.01] and depression [r=-157. p<0.05]. High self efficacy as the perceived capability to organize and execute the courses of actions appears to have positive effects on a person 's mental health

Current practice of doctors regarding the diagnosis and use of antibiotics in enteric fever in children: knowledge, attitude and practice

The objectives were to know current practice and knowledge of doctors regarding the diagnosis and use of antibiotics in Enteric Fever in children. The study was conducted in Lahore-city. It was a descriptive, epidemiological study. 150 doctors participated in the study. 51% were MBBS, 33% were postgraduate trainees and 16% had postgraduate degrees. Ciprofloxacin was prescribed as first choice by 51% and second choice by 37.8%. Ofloxacin was advised as first line by 21% doctors and injection Ceftriaxone by 18.6%. Chloramphenicol was advised by 8% doctors. Only 67.3% doctors prescribed the antibiotics for recommended duration. 62% doctors did not know the dosage in children. Second line antibiotics are used irrationally and those are prescribed for less than recommended duration, which leads to multi-drug resistance and relapse of fever

Knowledge and practices of the medical practitioners about management of childhood tuberculosis, Gujrat City

The objective was to describe current practices and knowledge of medical practitioners about management of childhood tuberculosis. The study was conducted in Gujrat city. It was a descriptive, epidemiological study. A sample size of 248 Doctors was obtained who were interviewed with the help of semi-structured questionnaire. Final data was analyzed with the help of EPI - INFO Computer Program. The results showed that for diagnosis of tuberculosis in children using Kenneth Jone's Criteria, only 33% of medical practitioners answered correctly. Thirty two percent of the doctors knew the correct regimen for treatment of childhood tuberculosis. About 63% doctors know at least partially the guidelines of tuberculosis management and 3% of the doctors practicing did not know and never heard about the guidelines for tuberculosis management. Majority of the doctors answered correctly about the symptoms and signs, only 39% gave advice for regular and complete course. It was concluded that knowledge among medical practitioners regarding management of childhood tuberculosis is lacking. Due to poor knowledge about the treatment regimens it is essential to update their knowledge by attending the workshops/seminars/conferences / short courses and by reading the new guidelines for management of childhood tuberculosis

Co-relation of birth weight with periventricular hemorrhage-a prospective study of two groups of newborns

To determine the difference between prevalence of Periventricular - Intraventricular Hemorrhage [PIVH] in the newborns on the basis of birth weight. Prospective study. Neonatology Unit, Department of Paediatrics, Post Graduate Medical Institute / Services Hospital, Lahore, from 1[st] April to 31[st] July 2000. All new born admitted in Neonatal Unit of Services Hospital within 24 hours of birth were included in the study. Birth weight was documented. Cranial ultrasonography was done twice in all babies, once within 24 hours of birth and second between 4 and 5 days of life. All newborns included in the study were divided into two groups on the basis of birth weight; One group with birth weight less than 1500 gms the second group with weight 1500 gm and more. In babies with PIVH, the extent of hemorrhage was graded. 364 out of 448 [81%] fulfilled criteria for admission to this study. Cranial ultrasound was done twice in all babies, irrespective of diagnosis. 36 babies [9.9%] died within 72 hours of life. Babies with birth weight less than 1500 gm were 110 [30%], whereas, those more than 1500 Gm birth weight it was 68 [62%], 54 [21%] babies were delivered at Services Hospital, 79 [22%] in different maternity centers and 169 [46%] were home delivered. Distribution of grading of PIVH showed that 64 cases had grade-l hemorrhage, 27 had grade-ll, 18 had grade-Ill and 13 had Grade-IV hemorrhage. First scan detected 55 [45%] cases. Cranial ultrasound should be done in all premature and low birth weight newborns within 4-5 days of life to detect PIVH fairly accurate and easily.Co-relation of birth weight with periventricular hemorrhage

comparison of responses on human figure drawing of orphan and non-orphan children

The aim of the present study was to explore the difference in the level of intellectual maturity and emotional disturbance between orphan and no orphan children. On the basis of literature review it was hypothesized that the [Orphan children would be more prone to emotional disturbance as compared to non-orphan children] and [The level of Intellectual maturity of orphan children would be low as compared to non-orphan children]. In order to test the hypotheses, a sample of 241 school going children, consisting of 120 orphan children and 121 non-orphan children, including 124 females [non orphan 63and orphan 61] and 11 7 males [non-orphan 58 and orphan 59] were selected from different orphan organizations and schools of Karachi. Parental loss duration was at Least two years for orphan children. The age range of sample was between 5 to 12 years and their minimum educational level was grade one. The entire sample belonged to lower socioeconomic class. The Human Figure Drawing [Koppitz, 1968] was administered to assess the level of intellectual maturity and emotional disturbance. In order to interpret the results in statistical terminology, t- test and descriptive statistics were computed. Results were consistent with the hypotheses, i.e. there are more orphan children [75.83%] who score high on emotional indicators as compared to non-orphan children [55.37%]. Further, orphan children were found to be less intellectually mature as compared to non-orphan children [t= -4.077, df =239, p< .001]