Triple combination of palliative oral metronomic chemotherapy in recurrent and metastatic epithelial ovarian cancer: A retrospective study

Background: Ovarian cancer is a leading cause of death from gynecological cancer in the world and in India. This study aims to evaluate the efficacy and toxicity profile of oral metronomic chemotherapy (MCT) in the form of etoposide, cyclophosphamide, and tamoxifen in recurrent and metastatic ovarian cancer. Methods: This was a retrospective observational study that included those post?treatment patients who had the recurrent or metastatic disease after completion of treatment in 2018 at Regional Cancer Centre, Bikaner, Rajasthan. Forty patients who were unfit for further intensive intravenous chemotherapy were included. The oral MCT constituted etoposide, cyclophosphamide, and tamoxifen. Descriptive statistics and Kaplan?Meier analyses were performed. Progression?free survival (PFS) and overall survival (OS) were assessed. Results: Forty women with a median age of 62 (range: 35?80) years were enrolled in the study to receive oral MCT. The Eastern Cooperative Oncology Group?Performance Status (ECOG?PS) was 0�in 28 patients and 2�in 12 patients. The best clinical response rate post?oral MCT was seen in the first 4 months. Objective response was observed in 24 (60%) of patients in the form of stable disease (19, 47.5%) and partial response (5, 12.5%). Disease progression was observed in 10 (25%) of patients. The median follow?up was 6.4 months (4.5�2 months). The median estimated OS was 6.5 months. The median estimated PFS was 3.7 months. Nineteen (47.5%) patients had grade?I/II mucositis. Grade?III/IV mucositis were observed in 9 (22.5%) patients. Thirty?seven (92.5%) patients died at the end of the study at 1 year. Dose reduction was required in 15 (37.5%) patients. Conclusion: Oral MCT was found to be an effective and well?tolerated regime with good symptomatic control and low?moderate toxicity profile in patients with relapsed and metastatic ovarian cancer. However, 22% of patients showed grade?III/IV thrombocytopenia.

Quality assessment and impact of parent literacy on national immunization days campaign in district Jamshoro Sindh-Pakistan

This study was designed to assess quality of National Immunization Days [NIDs] for Oral Polio Vaccination campaign by specific indicators like age, sex day wise attendance of children, their parents literacy level and distance from house to reach the camp. The arrangements for social mobilization and publicity material were also inspected. The study is descriptive and cross sectional carried on 187 under five children who were brought at fixed oral polio vaccination centre opened in EPI centre in OPD department of Liaquat University Hospital Jamshoro branch. Study was conducted from 7[th] August to 11[th] August 2007 during NIDs round of five days. Data was analyzed on SPSS version 14. Children who were brought to OPV Centre were included in study. Children who were given drops by mobile teams at homes were excluded. The five day NIDS campaign data showed that 187 children of under five years were registered and vaccinated with oral polio drops, the mean number of children per day was 37.4 with Standard Deviation +/- 30.4 and Median was 33 children. 51.8% children were male and 49.2% were female. 9.1% in the age of 1 to 29 days and 25.1% in age between one month to 11 months. Majority of parents who brought children were illiterate and came from distance more than 5km. Quality of physical arrangements, like publicity material, social mobilization, site and furniture as well cold chain and vaccine supply was satisfactory. Study concluded that it was high quality NIDs campaign in Jamshoro District of Sindh and pointed that in 2008 Pakistan may he polio free country

Genetic polymorphism of drug metabolizing enzymes (CYP2E1, GSTP1) and susceptibility to bladder cancer in North India.

Glutathione-S-transferases (GSTs) are active in the detoxification of wide variety of endogenous or exogenous carcinogens and genetic polymorphisms of CYP2E1 and GSTP1 genes have been studied extensively to evaluate the relative risk of various cancers. In the present study, we examined associations with CYP2E1 and GSTP1 gene polymorphisms in sporadic bladder cancers from North Indian patients. The subjects were 106 bladder cancer (Ca-B) cases and 162 age-matched controls. The GSTP1 313 A/G polymorphism was determined by the PCR/RFLP method using peripheral blood DNA. Binary Logistic Regression Model was used for assessing differences in genotype prevalence and their associations between patient and the control group. We observed a non-significant association in Pst1 polymorphism of the CYP2E1 gene; though the A/G genotype (OR = 2.69, 95% CI=1.57- 4.59, P= 0.000) and G/G genotype (OR = 7.68, 95% CI=2.77- 21.26, P= 0.000) of the GSTP1 gene polymorphism alone or in combination with tobacco users were highly significant (OR=24.06; 95% CI: 4.80- 120.42; P =0.000) when compared to the controls. The results of our study demonstrated that the GSTP1 313 G/G polymorphism is a strong predisposing risk factor for bladder cancer in the North Indian population.

Epidemic of cutaneous leishmaniasis in Taluka Johi, District Dadu, Sindh

The objective of the study was to investigate the epidemic of Cutaneous Leishmaniasis in Dadu District where this disease first emerged in 2002, and still is continuing in the district till the data of the study was collected in Oct. - Dec. 2004. A descriptive study with a total of 236 cases registered for various skin diseases in Taluka Johi District Dadu. Of these 108 cases were diagnosed as Cutaneous Leishmaniasis Place of work: Taluka Hospital Johi during October - December 2004. The highest sufferers from the Cutaneous Leishmaniasis were children and women. The upper limb was found 39.6% of the total lesions of the body while face, eyelids were 27.8% of the total lesions. There is a disease Epidemic form of Cutaneous leishmaniasis and more remedial measures are recommended as it is still a Public Health Problem

Allelic variation of GSTT1, GSTM1 and GSTP1 genes in North Indian population.

Glutathione S-transferase (GST) enzymes are involved in detoxification of many potentially carcinogenic compounds. Homozygous deletions or null genotypes of GSTT1 and GSTM1 genes and an A to G substitution at nucleotide 313 in GSTP1 have been reported in different populations. Intra-ethnic as well as interethnic differences are known to exist in the frequencies of the above GST genes. The present study was therefore undertaken to determine the prevalence of GSTM1 and GSTT1null alleles, as well as the GSTP1 gene polymorphism, in 370 healthy individuals in a North Indian population. Genotyping of M1 and T1 was performed using a multiplex polymerase chain reaction and the GSTP1 polymorphism was determined by the polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method. The frequencies of GSTM1 and GSTT1 null alleles in normal healthy individuals were observed to be 33.0% and 18.4% respectively. In 7.0% of individuals' concomitant lack of M1 and T1 genes were observed. For GSTP1, wild (Ile/Ile), heterozygous (Ile/Val) and mutant (Val/Val) genotypes were observed for 44.3%, 50.3% and 5.4% of individuals respectively. The prevalence of the M1 null allele is significantly lower than those documented for English, Turkish, Chinese, Caucasians, Japanese and white (Brazilian and American) populations. However, a significantly higher frequency for T1 null was reported in Chinese and Japanese population. Furthermore, Japanese and African American populations have exhibited significantly higher frequencies of wild and mutant P1 genotypes, respectively, than the Indian population. Thus, our results signify an impact of ethnicity and provide a basis for future epidemiological and clinical studies.

Role of radionuclide perfusion study in cold solitary thyroid nodule for diagnosis of malignancy: a complimentary diagnostic modality to fine needle aspiration cytology.

One hundred and forty eight subjects with euthyroid solitary thyroid nodules (STN) were taken up for radionuclide perfusion study. They were found to have a cold STN on 99mTc thyroid static scan. All had fine needle aspiration cytology (FNAC), and except for subjects with chronic lymphocytic thyroiditis, were subjected to surgery for tissue diagnosis by histopathology. The diagnostic findings in these patients of solitary thyroid nodules were correlated with the histopathology. Radionuclide perfusion study is considered useful to differentiate benign from malignant cold thyroid solitary nodules with high degree of sensitivity (95%) and specificity (87.9%).

Histopathological & immunohistochemical evaluation of ageing changes in normal human brain.

As age related changes in the brain have not been systematically studied in the Indian population though there is an impression that they are less frequent, we studied 52 brains collected at autopsy from individuals above the age of 60 yr. The incidence of senile plaques (SPs) and neurofibrillary tangles (NFTs) together were found to increase with age from 21 per cent in the seventh decade to 33 per cent in the eighth decade and 54 per cent in the ninth decade, the increasing incidence of NFTs being statistically significant. The SPs were found both in the hippocampus and frontal cortex while NFTs were seen only in the hippocampus in non-demented aged individuals. In contrast, in the three cases of Alzheimer's disease (symbol: see text) AD studied, the NFTs and SPs were found in high density in both hippocampus and frontal cortex. By immunohistochemistry, various morphological forms of SPs were found to have beta amyloid protein consistently, while ubiquitin and phosphorylated neurofilament occurred variably. More number of SPs could be labelled by amyloid immunostaining than by conventional silver stains. The NFTs contained ubiquitin and phosphorylated neurofilament protein as the antigenic components, both in AD and normal ageing. The incidence of age related changes and their antigenic character in the limited sample studied from south India appears to be comparable to findings from the West. Multicentric studies on a large sample derived from different ethnic groups in India are needed to further evaluate these features.

Renal dysfunction detected by beta-2 microglobulinuria in sick neonates.

OBJECTIVE: To assess renal involvement in sick neonates referred to Neonatal Intensive Care Unit (NICU) using standard renal parameters and urinary beta 2 microglobulin (B2M) excretion. DESIGN: Descriptive study. SETTING: Level II NICU and Nephrology Division of Pediatric Tertiary hospital. SUBJECTS: Forty six term sick neonates transferred for neonatal care and forty healthy term neonates who served as normal controls for urinary B2M excretion. METHODS: Standard tests including estimation of BUN, serum creatinine, blood pH, serum bicarbonate, serum and urinary electrolytes, urine output, and urinalysis. Urinary B2M levels were estimated from urine collected on day 1 (D1) and day 3 (D3) in all and 18 neonates were tested on day 7 (D7) by radio-immunoassay method. RESULTS: Statistically significant elevation of mean values of urinary B2M were noted when sick neonates were compared with normal controls irrespective of primary disease, indicating tubular dysfunction (41/46 = 90%), whilst only 7 of these (17%) had abnormalities indicating renal involvement when judged by standard tests. Very high levels of urinary B2M were noted with birth asphyxia (n = 9), sepsis (n = 8) and renal disease (n = 7). Transient elevation of urinary B2M was noted in meconium aspiration syndrome (n = 4). Ten surgical cases with non renal congenital malformations showed high urinary B2M and 12/18 tested on D7 had persistently high urinary B2M due to multiple factors. CONCLUSIONS: Elevated urinary B2M in 90% sick neonates with apparently normal renal parameters in majority (34/41) indicates subclinical proximal tubular dysfunction especially in neonates with asphyxia, sepsis and congenital malformations. Persistent elevation of urinary B2M appear to be a sensitive diagnostic indicator for defining a group of neonates with subtle renal tubular dysfunction, the clinical relevance of which on long term basis is a subject for future study.

Touch imprints cytology of lymph nodes

Touch imprints [Tl] is an inexpensive and a rapid diagnostic technique that can be utilized during surgery. In this study touch imprints of 54 cases of lymphadenopathy were studied and reports were delivered on the same day. The results were correlated with histopathology later on. In 38 cases tuberculosis was diagnosed, 5 were Non Hodgkin's lymphoma, 2 Hodgkin's lymphoma, 7 metastatic tumour and 2 had reactive hyperplasia. From this study it was concluded that touch imprints give early diagnosis with more than 90% accuracy, so it can be used for intraoperative diagnosis in radical surgery

Predictor of outcome of hyperthyroidism due to Graves disease: serum triiodothyronine/thyroxine ratio.

There is a proportionally greater increase in the serum T3 than Serum T4 concentration in patients with hyperthyroidism due to Grave's disease which results in an elevation of serum T3 to T4 ratio. The study was undertaken to investigate the alteration of serum T3 to T4 ratio in relation to the outcome of antithyroid drug therapy. 98 patients of hyperthyroid Grave's disease were studied and 78 patients had T3 to T4 ratio greater than 20 ng/microgram before therapy (normal range 14-20; mean 16.0) In 16 out of 78 patient T3 to T4 ratio remained high during a 18 months course of antithyroid drug therapy and in 13 of them (81%) hyperthyroidism recurred after stoppage of treatment. In the remaining 62 patients, the initial high T3 to T4 ratio became normal (< 20) during treatment and 34 of them (54.9%) had a remission of the disease after stoppage of the drug. Of the 20 patients in whom the initial T3 to T4 ratios were within normal range, the ratio remained normal during treatment and 16(80%) had a remission. Goiter size was larger in patients with high serum T3 to T4 ratio and reduction of goiter size occurred in some patients (59%) with decreasing T3 to T4 ratios. It is concluded that serum T3 to T4 ratio is a single and a useful predictor of the outcome of antithyroid drug therapy in patients with hyperthyroidism due to Grave's disease. A ratio greater than 20 throughout therapy indicates that the chances of relapse is high and a ratio below 20 either initially or during therapy is an indication of prolonged remission.