Breast papillary lesions: a retrospective analysis from oncology set up of Pakistan

Background: Papillary lesions of the breast are a heterogeneous group of breast lesions that are difficult to diagnose as benign or malignant. These lesions have varied morphologic features that carry differing prognostic implications for affected patients. Accurate diagnosis is required to ensure that effective treatment is achieved. Papillary lesions can have increased risk of carcinoma and recurrence, in these patients even for lesions yielding a benign concordant diagnosis of papilloma at percutaneous biopsy, surgical excision may be warranted. Malignant lesions are usually surgically treated. Depending on stage-adjuvant chemotherapy and/or radiation therapy is given.Methods: A retrospective study was conducted at Shaukat Khanum Memorial hospital and Research Centre Lahore Pakistan. We reviewed the electronic records of diagnostic and registered patients from January 2007 till December 2017 in women imaging section, in age range of 25 to 75 years. Total 150 diagnosed patients with benign or malignant breast papillary lesions were selected and their conventional breast imaging (mammography and ultrasound) and histopathology was retrospectively analyzed on SPSS.Results: Patients were predominantly asymptomatic or on follow-up to an abnormal mammogram. Of the 150 cases most of the patients had intra-ductal papilloma followed by invasive papillary carcinoma and intra cystic papillary carcinoma. Few patients had intra-ductal papillomatosis and invasive micro papillary carcinoma.Conclusions: Conventional breast imaging remains the first main stay and quite sensitive in detecting breast papillary lesions leading to early detection and management.

Frequency and pattern of removal of teeth in a sample of population of southern Punjab

Removal of non-restorable teeth is a routine cost-effective procedure. A cross-sectional study was conducted in the Department of Oral and Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan, Pakistan from 1[st] April 2016 to 30[th] October 2016 to find out frequency and pattern of teeth removal in southern Punjab population. Both genders were included and causes of extraction were categorized. Chi square test applied to assess the significance of association. Two thousands and seventy two teeth were extracted from 1700 patients [786 male 45.2%, and 932 female 54.8%] presented to oral surgery department. Mean age of the sample was 40 +/- 15.01. A total of 1339 [64.6%] were extracted due to advanced dental caries, the leading cause of tooth extraction followed by periodontal disease 217 [10.5%]. Molars [45%] were most common teeth extracted. It was concluded that there was strong need for directing more financial resources to community awareness programs to prevent premature teeth loss

Nigella sativa fixed and essential oil improves antioxidant status through modulation of antioxidant enzymes and immunity

The onset of 21[st] century witnessed the awareness among the masses regarding the diet-health linkages. The researchers attempted to explore traditional products/plants were in the domain of pharmacy and nutrition focussing on their health benefits. In the present research intervention, we investigate the role of Nigella sativa fixed oil [NSFO] and essential oil [NSEO] in improving antioxidant status and modulation of enzymes. The National Institute of Health [NIH] provided us 30 Sprague Dawley rats that were equally placed in three groups. The groups were fed on their respective diets [56 days] two experimental diets i.e. D[2] [NSFO @ 4.0%] and D[3] [NSEO @ 0.30%] and control. The indices pertaining to antioxidant status, antioxidant enzymes, and parameters pertaining to immunity were evaluated at 4 weeks interval. The experimental diets [NSFO@ 4.0% and NSEO@ 0.30%] modulated the activities of antioxidant enzymes i.e., catalase [CAT], superoxide dismutase [SOD], glutathione transferase [GST], glutathione reductase [GR] and glutathione peroxidase [GPx], positively. Indices of antioxidant status like tocopherols and glutathione were in linear relationship with that of GPx, GR and GST [P<0.01]. Myeloperoxidase activities were in negative correlation with GST [P<0.01] but positive correlation with some other parameters. In the nutshell, the fixed and essential oil of Nigella sativa are effective in improving the indices pertaining to antioxidant status, however, the immune boosting potential needs further clarification. However, authors are of the view that there is need to explore the molecular targets of Nigella sativa fixed and essential oils. Findings from such studies would be useful to validate this instant study for health promoting potential against diabetes mellitus and cardiovascular disorders

Use of a portable oxygen concentrator and its effect on the overall functionality of a remote field medical unit at 3650 meters elevation

The supply of oxygen is a complex issue in disaster situations and snowbound mountainous areas. Innovative solutions are required for safe anesthesia practice; one such innovation is a small portable oxygen concentrator for oxygen therapy in remote austere environment. We conducted this study to ascertain the economy achieved by employing this equipment to improve functionality of a surgical unit in an austere environment. Retrospective review of patient records and cylinder consumption from 1st October 2008 to 30th March 2009 was carried out and this data was classified as group A. While group B consisted of all the patients, who required oxygen therapy from 1st October 2009 to 30th March 2010, and were divided into sub-groups, on the basis of type of anesthesia or oxygen therapy. They were further categorized with respect to use of oxygen concentrator or oxygen cylinder for oxygen provision. The percentages of patients in these subgroups were summed to ascertain the economy achieved in the use of oxygen cylinders by comparing cylinder/patient ratio between group A and B respectively. Percentage economy achieved was then calculated. In group A cylinder/patient ratio [21/53] was '0.4' as compared to [3/81] '0.03' of group B. Percentage economy achieved was hence found to be [0.4/0.03%]] 1333%. Use of oxygen concentrator is an innovation which is economical, easily applicable and highly recommended in remote austere environments

Complete elimination of indigenously isolated agrobacterium tumefaciens strains by quinolone and metallo beta-lactam antibiotics

The present study aimed to isolate Agrobacterium tumefaciens strains from lycoperiscum esculantum [Tomato] galls and investigate in vitro the potential killing activities of various antibiotics. Seven Agrobacterium tumefaciens strains namely WF2, WF7, WF7d, WF11, WF12, WF14 and WF15 were isolated from galls of different lycoperiscum esculantum from various fields in district D.I.Khan. The isolated strains were assayed for their ability to initiate tumors by using a carrot and potato disc assay. Primarly six antibiotics were screened for susceptibility against Agrobacterium tumefaciens by a disc diffusion assay. The antibiotic with the widest zones of inhibition were used for determination of the minimum inhibitory concentration [MIC] and minimum bactericidal concentrations [MBC].The MIC and MBC of meropenem against almost all strains were the same [0.025mg/ml] except for WF14, [MIC/MBC 0.05mg/ml]. The ciprofloxacin was reported as the second most active antibiotic against A. tumefaciens. Suppression of the growth of all strains occurred at 0.0031mg/ml except for WF7 and WF14 with MIC 0.0062mg/ml. The MBCs of all strains are the same as the corresponding MICs. However, the strain WF15 was two times higher [0.0093mg/ml]. The amoxicillin also represented comparatively lower MIC/MBC [0.2mg/ml] except WF14 [MIC 0.4mg/ml, MBC 0.8mg.ml] without clavulanic acid. It is concluded that both meropenem and ciprofloxacin were highly effective in eliminating the Agrobacterium tumefaciens in a low concentration. These findings prove the effective use of ciprofloxacin and meropenem in agrobacterium mediated transformation in plants

Comparison of haemodynamic changes after laryngeal mask airway insertion with propofol versus sevoflurane

To compare haemodynamic changes on Laryngeal Mask Airway [LMA] insertion using tidal volume induction technique with sevoflurane at high concentration versus an intravenous induction with propofol. Randomized Controlled Trial [RCT]. Place and Duration of study: The study was carried out at Department of Anaesthesiology, Intensive Care and Pain Management, Military Hospital Rawalpindi from May 2006 to April 2007. One hundred patients were enrolled after written informed consent. Patients were divided in two groups. Group A received propofol and group B received sevoflurane for induction of general anaesthesia. Heart rate and mean arterial pressure [MAP] were recorded one minute before induction of anaesthesia and three minutes after induction and LMA placement. Independent sample "t-test" was applied to compare means for MAP and mean heart rate in both the groups and p value was inferred to judge the significance. In group A 20 males and 30 females were enrolled for the study while in group B there were 16 males and 34 females. The mean age of the patients in group A was 30.5 +/- 4.8 years while in group B was 28.4 +/- 5.2 years. Mean weight was 60.5 +/- 5.8 and 62.2 +/- 4.7 kilograms respectively in both groups. Twenty two patients were ASA I and 28 were classified as ASA II in group A while 27 were ASA I and 23 were ASA II in group B. In the group A, MAP was recorded to be 90 +/- 5.3 mmHg before induction and 79.9 +/- 7.5 mmHg after LMA placement following propofol induction. Whereas MAP in Group B before induction of anaesthesia and after LMA placement were 90 +/- 4.8 and 84.2 +/- 7.03 mmHg respectively. The fall in MAP was found to be significant in Group A when compared to Group B after induction and insertion of LMA [p value < .005]. In group A, mean HR was recorded to be 79.1 +/- 4.3 before induction and 82.2 +/- 8 per minute after LMA placement following propofol induction. While mean HR in Group B was 78.1 +/- 7.8 before induction and 83.3 +/- 8.0 per minute after LMA placement following sevoflurane induction. Hence, we found no significant difference in terms of change in mean HR between the two groups [p value > 0.4] before and after LMA insertion. Considering more fall in the MAP following propofol induction in group A and as there was no significant change in MAP and heart rate before and after sevoflurane induction, we conclude that sevoflurane provided better haemodynamic stability than propofol for LMA insertion

Open cholecystectomy; management of ponv: comparison of sub hypnotic dose of propofol vs metoclopramide

Postoperative nausea and vomiting [PONV] are most common and distressing complications after anaesthesia and surgery, leading to various problems. Metoclopramide, a benzamide, used as an anti-emetic, has got various side-effects. Propofol, a short acting induction agent, possesses anti-emetic properties in sub hypnotic doses, without having unwanted side- effects in this low dose. To compare the frequency of PONV in patients treated with propofol and metoclopramide. Experimental study. Setting: Department of anaesthesia and intensive care, Combined Military Hospital Rawalpindi. Duration: 06 months [01[st] July to 31[st] December 2004]. 1 82 female patients scheduled for open cholecystectomy were selected for this study. All of them received general anaesthesia without any prophylactic antiemetic. Out of them, 60 patients who complained of PONV in post anaesthesia care unit [PACU] were selected by non probability convenience sampling and were equally divided into two groups. Group [A] received propofol [0.5 mg/kg] while group 'B' received metoclopramide [0.2 mg/kg]. Recurrence of PONV was recorded 60 min after administration of the study drug. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication i.e. I/V ondansetron [4mg]. Results: In group [A], 18 patients responded to intervention [60%] whereas 26 [86.66%] patients gave a positive response in group [B] [p; 0.020]. More patients who received propofol needed the rescue medication [40%] than those who received metoclopramide [13.33%] [p 0.020]. Metoclopramide is a better option for managing PONV than propofol

Kartagener syndrome

A 23 years male presented with history of breathlessness and nasal congestion. On investigations based on clinical, radiological and laboratory findings a diagnosis of Kartagener Syndrome was made which has situs inversus, primary ciliary dyskinesia, bronchiectasis, chronic sinusitis and azospermia. He was married since few years before but had no issue