Non-invasive Assessment of Interleukin 6 and its Clinico-pathologic correlation in patients with Oral Squamous cell carcinoma.

Background: Interleukin-6 (IL-6) is a pro inflammatory cytokine that promotes inflammation, development and progression of cancer. Quantitative assessment of IL6 in saliva will help in the early diagnosis of oral cancer. Whole saliva as an alternative laboratory tool to blood comprises a non-invasive, easy, rapid to collect, easy to handle and cost-effective sample convenient both for patient and the health personnel during screening of larger population. Hence the study aimed to estimate the concentration of salivary IL6 and clinically correlate these levels in patients with oral Squamous cell carcinoma. Methods: A total of 72 subjects aged between 31-60 yrs were included in the study. Group I: Thirty six histological proven cases of oral Squamous cell carcinoma. Group 2: Thirty-six healthy controls. Unstimulated whole saliva sample was collected and the samples were analysed for interleukin-6 using ELISA kits. Data was analyzed using SPSS software version 22. Results: The study showed a statistically significant elevation ofinterleukin-6 in saliva of patients with oral cancer 214.29�.64 pg/mL as compared to the healthy control group 17.11�83 pg/mL with a p value of 0.001. The Salivary IL6 levels did not show any correlation with gender of patients both in OSCC and control subjects. The median Salivary IL6 levels were significantly higher in stage (I-II) compared to stage(III -IV). Conclusion: Estimation of IL6 in saliva can be considered as a non invasive alternative laboratory tool to blood for oral cancer for screening among high risk subjects.

Usefulness of salivary sialic acid as a tumor marker in tobacco chewers with oral cancer

Aim:This study aims to assess the usefulness of salivary sialic acid (SA) as a tumor marker in the detection of oral squamous cell carcinoma (OSCC) among tobacco chewers. Materials and Methods:After the approval of study protocol by the Institutional Ethics Committee and informed voluntary consent, salivary samples were collected from 96 participants in each group of tobacco chewers with OSCC, tobacco chewers without precancerous or cancerous lesion, and healthy controls. Salivary protein-bound SA (PBSA) and salivary-free SA (FSA) were measured by Yao et al.'s method of acid ninhydrin reaction, and the data were subjected to appropriate statistical analysis. Results: The salivary PBSA and FSA levels in the Groups 1, 2, and 3 participants were 31.17 ± 7.6 mg/dL and 63.45 ± 9.8 mg/dL, 25.45 ± 16.61 mg/dL and 33.18 ± 11.38 mg/dL, and 22.73 ± 3.01 mg/dL and 21.62 ± 8.86 mg/dL, respectively. Salivary FSA levels were significantly increased among the tobacco chewers with OSCC patients (Group 1) and tobacco chewers with no premalignant lesions of the oral cavity (Group 2) compared to the healthy controls (Group 3) with P < 0.05 being statistically significant. Salivary FSA levels were significantly increased in Group 1 as compared with Group 2. The salivary PBSA was high among Group 1 as compared to the control Group 3; there was however no significant difference in the levels of salivary PBSA between Group 1 and Group 2. There was no significant difference in the PBSA levels between OSCC patients of Group 1 and the tobacco chewers without precancerous or cancerous lesion in the oral cavity of Group 2. Conclusion: Salivary PBSA and FSA are significantly raised in both tobacco chewers with OSCC and in tobacco chewers with no precancerous or cancerous lesions in the oral cavity. SA should therefore be used cautiously while considering it as a marker for the early detection of oral cancer. Tobacco can be a crucial confounding factor when SA is used as a biomarker in OSCC since their levels are elevated to some extent even in tobacco chewers without any clinically obvious precancerous or cancerous lesions in the oral cavity

Frequency of Type-2 diabetes mellitus in Nephropathic patients and comparison of mean magnesium levels in Nephropathic patients with and without Type-2 diabetes mellitus

Objective: The objective of this study was to determine the frequency of Type 2 diabetes mellitus [T2DM] in patients with nephropathy [i.e. Chronic Kidney Disease Stage 1 to 3] and to compare the mean magnesium levels in diabetic nephropathic patients and non-diabetic nephropathic patients

Methods: This cross-sectional study was conducted in department of Medicine, Mayo Hospital Lahore from August 2014 to February 2015. Using non-probability purposive sampling 200 nephropathic [Chronic Kidney Disease Stage 1 to 3] patients were selected. Patients were assessed for T2DM and divided in two groups on the basis of presence or absence of DM. Magnesium levels were recorded in both groups. Percentages, mean, standard deviation and unpaired t-test was used to assess the data. SPSS was used for analysis of information

Results: Total number of cases were 200, 43.5% [n=87] out of them were between 25-50 years of age while 56.5% [n=113] patients were between 51-70 years. The Mean+SD was calculated to be 51.38+11.51 years, The male patients were 48.5 %[ n=109] while 51.5 %[ n=91] were females. The frequency of DM in patients with nephropathy was 25.5% [n=51]

Comparison of mean magnesium levels in nephropathic patients with and without diabetes was done. The results showed nephropathic patients having diabetes had 1.54+0,301 mg/dL magnesium levels while cases without diabetes had 1.92+0.313 mg/dL levels of magnesium, p value was calculated as 0.001 showing a significant difference between the two groups

Conclusion: The frequency of diabetes mellitus is higher among patients with nephropathy while on comparison of mean magnesium levels, nephropathic patients with diabetes had significant lower levels of magnesium as compared to without diabetes

Ponv; dexamethasone effect on post operative nausea and vomiting in laparoscopic cholecystectomy

Background: Postoperative nausea and vomiting is reduced if inj Dexamethasone is given preoperatively in patient undergoing Laparoscopic Cholecystectomy. The aim of this prospective randomized, controlled trial was to look into effectiveness of dexamethasone before surgery may improve nausea, vomiting after surgery in patients undergoing laparoscopic cholecystectomy

Study Design: Prospective randomized study

Setting: Department of Surgery, King Edward Medical University, Lahore - Pakistan. Period: Nov 2010 to April 2012

Methods: 138 Patients with Laparoscopic Cholecystectomy were randomized to receive 08 mg Dexamethasone [n=66] or placebo [n=72] intravenously before surgery. Seven patients were excluded on account of already on steroid treatment due to various reason. Vomiting and nausea were seen in next 24 hours after operation. Dexamethasone has minimal side effect after single dose administration. Six patients [12%] has nausea and vomiting in treatment group while 26 [47%] in the control group [p<0.001]. Patient having dexamethasone, five [10%] need antiemitics as compare to 24 [44%] of those receiving placebo [p<0.001]

Conclusion: Single dose of Inj Dexamethasone given preoperatively reduce nausea and vomiting markedly in Laparoscopic Cholecystectomy and may be routinely used in Laparoscopic procedure

Endoscopic evalution of acute dysphagia due to mechanical obstruction

To find out the common causes of mechanical dysphagia in South Punjab and determine the endoscopic features of benign and malignant stricture to decide for either therapeutic intervention [endoscopic dilatation/stunting] or biopsy. This descriptive study was conducted in Medical Unit-1, Gastroenterlogy Nishtar Hospital Multan Pakistan during the period from September 2004 to December 2005. A total 50 patients were included in the study. Foreign body in esophagus, was seen in 3 patients [6%] 2 female and one male. Two patients [4%] had esophageal web, both patients were female and upper part of oesophagus was involved in both of them. Benign stricture was the commonest abnormality. Lower third of oesophagus was the commonest site of involvement [62.5%], middle one third was involved in 31.25% of cases while upper third was involved in only 1 patient [6.25%]. Carcinoma oesophagus was predominantly found in males and lower one third was the commonest site [71.4%]. No patient had involvement of upper third while middle third was involved in 28.6%. Mean age of the patients was 42; age range was 14 to 63. Duration of dysphagia ranged from one day to 35 days; mean duration was 18 days. Upper gastrointestinal endoscopy is a safe and valuable procedure in individuals of all age groups with dysphagia and often leads to positive therapeutic intervention even in quite frail subjects. Benign esophageal stricture, esophagitis and esophageal carcinoma, are the commonest causes of dysphagia in South Punjab

Complications of total laryngectomy

To find out various complications after total laryngectomy, with reference to their presentation, diagnosis, and management. It was a prospective descriptive study. Otolaryngology, Head and Neck Surgery department, Pakistan Institute of Medical Sciences Islamabad, from 1st July 1999 to 31st June 2001. 25 patients undergoing total laryngectomy for proven carcinoma larynx [Ca larynx] were included in this study. Patients were reviewed after surgery and any complication that occurred was recorded. The presentation, diagnosis, and management of these complications are discussed, along with voice rehabilitation after total laryngectomy. There were 23 males and 2 females. Age of patients ranged from 40 - 65 years. Complications included wound infection [06], pharyngocutaneous fistula [03], pharyngeal stenosis [03], and nodal metastasis [02]. Wound infection and pharyngocutaneous fistula are most common complications after total laryngectomy. Preoperative radiotherapy and low postoperative haemoglobin level are important risk factors for development of pharyngocutaneous fistula in total laryngectomy patients. Postoperative radiotherapy to the neck reduces the risk of nodal metastasis after total laryngectomy

comparison of the effect of simple and succussed dilutions of acetylcholine on isolated heart

Homeopathic practitioners have reported the specific effects of various potentized and diluted drugs [Chand, 1995 and Taylor, 1998] since long time. On the basis of this concept they are treating various diseases with confidence and success. However, the scientific basis for this concept is not available in the research literature involving isolated tissues. In the present study, the dilutions of Acetylcholine [ACh] prepared in deionized water have been tested on electrical and mechanical activity of isolated rabbit's heart for both simple dilutions [SD] and succussed dilutions [SUD]. Results demonstrated that the difference in the effect of SD and SUD was found significant at 9x and 3x for systolic force and at 2x for heart rate, duration of action potential and duration of phase 4. However, both the SD and SUD of ACh could produce opposite to the normal effect in different dilutions on heart rate, systolic force, duration of cardiac action potential and its phase 4. It is concluded that SD and SUD differ in properties and effects on isolated tissue. Further, a drug in both the SD and SUD can change its configuration due to interaction with water and air at its surface [Simson, 1909] to produce opposite effect than its normal one