Calcitonin gene-related peptide (CGRP) concentrations outside migraine attacks in peripheral blood as a potential biomarker for chronic migraine / Concentrações de peptídeo relacionado ao gene da calcitonina (CGRP) fora dos ataques de enxaqueca no sangue periférico como um potencial biomarcador para enxaqueca crônica

Introduction: Chronic migraine is a debilitating condition that affects a significant portion of the population. Accurate diagnosis and treatment of chronic migraine remain a challenge due to the lack of objective biomarkers. Calcitonin gene-related peptide (CGRP) is a neuropeptide involved in the pathophysiology of migraine and has been proposed as a potential biomarker for migraine. Methods: We measured CGRP levels in peripheral blood samples collected from 142 participants with chronic or episodic migraine and 24 healthy controls during ictal periods, i.e., outside migraine attacks. We compared CGRP levels between the three groups and assessed the correlation between CGRP levels and clinical features of chronic migraine. Conclusion: Our study provides evidence that CGRP levels in peripheral blood during ictal periods may serve as a potential biomarker for chronic migraine. Further studies are needed to validate these findings and to explore the clinical utility of CGRP as a biomarker for chronic migraine.

Introdução: A enxaqueca crônica é uma condição debilitante que afeta uma parcela significativa da população. O diagnóstico preciso e o tratamento da enxaqueca crónica continuam a ser um desafio devido à falta de biomarcadores objetivos. O peptídeo relacionado ao gene da calcitonina (CGRP) é um neuropeptídeo envolvido na fisiopatologia da enxaqueca e foi proposto como um potencial biomarcador para enxaqueca. Métodos: Medimos os níveis de CGRP em amostras de sangue periférico coletadas de 142 participantes com enxaqueca crônica ou episódica e 24 controles saudáveis ​​durante períodos ictais, ou seja, fora das crises de enxaqueca. Comparamos os níveis de CGRP entre os três grupos e avaliamos a correlação entre os níveis de CGRP e as características clínicas da enxaqueca crônica. Conclusão: Nosso estudo fornece evidências de que os níveis de CGRP no sangue periférico durante os períodos ictais podem servir como um potencial biomarcador para enxaqueca crônica. Mais estudos são necessários para validar estes resultados e explorar a utilidade clínica do CGRP como biomarcador para enxaqueca crónica.

Evaluation of Outcome of Non-cemented Total Hip Arthroplasty in Avascular Necrosis of Femoral Head in 25 to 40 Years Age Group

Background: The proper treatment of Avascular Necrosis(AVN) of Femoral Head has become a major challengeworldwide in younger age group as they are main effectiveforce of family and society. The patients who are young andsuffer from AVN of femoral head become immovable, worklessand unproductive. Thus they become burden to family andsociety. The Hip Replacement is a better way of treatment forthis type of patients, making them pain free and movable andimproving their everyday activity.Objective: To evaluate outcome of non-cemented total hiparthroplasty in avascular necrosis of femoral head among theactive younger age group of patients.Method: This was a prospective observational study of 30patients and all the patients had done non-cemented total hiparthroplasty (THA) through lateral approach at the NationalInstitute of Traumatology and Orthopaedic Rehabilitation(NITOR), Dhaka.Results: Mean age of the patients was 32 ±5.12 years,patients were diagnosed as Avascular Necrosis of FemoralHead in which 63% were affected at Right sided Hip 37%patients were at Left sided hip. Final outcome after six monthsof operation evaluated with Modified Harris Hip Score revealedthat, there was significant (p<0.005) improvement in functionalability of the patients after THA. Among the 30 studied cases,21 (70%) patients carried slight pain and 63.4% of them wereable to walk unlimitedly. Outcome of supporting functionanalysis indicated 76.7% patients could walk and climb stairswithout support and 100% patients could sit on chair, 66.7%patients among them could walk without limping. On clinicalassessment of deformity, range of motion before and afteroperation, significantly resolved the deformities and increasedthe range of motion (2100-2300). After evaluation with ModifiedHarris Hip Score showed that 60% excellent (HHS 90-100),30% good (HHS 80-89), 10% had fair (HHS 90-100) outcome.Conclusion: The progressive study of the patients of THAshowed that non-cemented THA has resulted in a better wayamong the younger age group of people

Laparoscopic Surgery in Pediatric Age Group – Our 10 Years Experience from a Tertiary Care Centre

Background: To study the role of Laparoscopic surgery in Pediatric age group. Settings: Department of General and Minimal Access Surgery, Government Medical College Srinagar. Methods: Three hundred and sixty four pediatric patients referred to our tertiary care center in the pediatric age group were operated upon laparoscopically for various conditions from January 2009 to January 2019. Results: A total of 364 non-infantile pediatric cases were operated upon laparoscopically which included 107 Non-palpable UDT, 71 Appendectomies, 67 Diagnostic laparoscopies, 31 Cholecystectomies, 5 VATS procedures, 8 Varicocelectomies, 2 Advance urological procedures, 55 Herniotomies, 3 umbilical hernia laparoscopic anatomical repairs, 7 Hepatic Hydatid cyst surgeries, 5 Laparoscopic assisted Soaves procedures, 1 each of Laparoscopic Pyeloplasty, Morgagni hernia repair and Ladd’s procedure for Malrotation of Gut. There were 5 conversions to open procedure and 8 cases were completed by laparoscopic assisted methods. The complication rate including minor complications was approximately 4%. Conclusion: Laparoscopy including Videoassisted Thoracoscopic Surgeries (VATS) in pediatric age group is safe, feasible and rapidly gaining popularity even for advanced and reconstructive procedures. However the threshold for better judgement should be low for decreasing avoidable morbidity in small children.

Comparison between peak systolic velocity of the inferior thyroid artery and technetium-99m pertechnetate thyroid uptake in differentiating Graves' disease from thyroiditis

ABSTRACT Objectives The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake. Subjects and methods We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake. Results Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%. Conclusion Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

Public knowledge of cardiovascular disease and its risk factors in Tangail, Bangladesh: a cross-sectional survey

Background: Cardiovascular Disease (CVD) is a major public health problem throughout the world. In Bangladesh, the reliable data concerning various aspects of CVD is inadequate at present due to lack of national population-based surveys or central administrative health data. Given the rising incidence of CVDs in Bangladesh, an improved understanding of the CVD, symptoms and risk factors is needed. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors.Methods: A descriptive cross-sectional survey was conducted from May 2018 to June 2018 using standard questionnaire on a sample of 350 randomly selected Bangladeshi individuals. All the data of the study were input in SPSS (Statistical Package for the Social Sciences) version 20.0 software from IBM for windows and the gathered data thus analyzed using SPSS & Microsoft Excel.Results: The respondents’ knowledge about types of CVD, symptom heart attack, symptom of stroke and the risk factors of CVD are 38.9%, 67.7%, 35.7%, and 92.9% respectively. The most common risk factors of CVD found to be known by around than two-third of respondents were unhealthy diet (66.9%), physical inactivity (64.3), obesity (61.4%), and smoking (58.6%).Conclusions: The respondents’ knowledge about types of CVD, symptom heart attack, symptom of stroke and the risk factors of CVD are 38.9%, 67.7%, 35.7%, and 92.9% respectively. The most common risk factors of CVD found to be known by around than two-third of respondents were unhealthy diet (66.9%), physical inactivity (64.3), obesity (61.4%), and smoking (58.6%).

Patterns of Failure in Breast Cancer Patients of Kashmir Valley

Breast cancer is the most frequent cancer among women and also the leading cause of cancer related deaths in women. The patterns of failures in carcinoma breast seem to differ by cell type, pathological stage and by the treatment modality instituted. Breast cancers can recur locally, regionally and distantly. Survival rates decrease progressively as the stage of the disease increases. Aims & Objectives: To evaluate the patterns of failure in patients with Breast Carcinoma after definitive treatment modalities. Methods: We conducted an analytical, nonrandomized, cross-sectional study on the Patterns of Failure in 1238 patients with primary breast cancer who reported to our Regional Cancer Centre from 2002 to 2010. Results: A total of 1238 patients with 1189 females and 49 males were evaluated. Most of the patients were above fifty years of age with breast lump being the most common presentation. Infiltrating ductal carcinoma was the most common histology and stage II being the commonest stage of presentation. Most of the patients were hormone receptor positive and Her 2 neu receptor negative. Overall local failure was 3.9%, regional failure 2.7% and distant failure 22.5%. Overall 5 year disease free survival was 78.4%. Conclusion: The most common form of local failure is chest wall recurrence, regional failure is supraclavicular lymphadenopathy and distant failure is bone metastasis. The 5 year disease free survival is lower for all the stages when compared to world scenario. This may be attributed to more aggressive disease behaviour in our patients.

Assessment Of Therapeutic Efficacy And Safety Of Delphinium Denudatum Wall (jadwar) And Local Application Of Iris Florentina (roghan Sosan) In Painful Diabetic Neuropathy: A Randomised Single Blind Standard Controlled Study

The current study was conducted to assess the efficacy and safety of Delphinium denudatum(Jadwar)androghansosan in patients with painful diabetic neuropathy. A randomised single-blind standard controlled trial was carried out on 30 diagnosed patients of painful diabetic neuropathy at National Institute of Unani Medicine Bangalore-India. After obtaining ethical clearance, 30 eligible patients were randomly allocated into test and control groups, comprising 15 patients in each group. Patients of test group were given Delphinium denudatum wall (Jadwar) 500mg in tablet form twice daily and local application of;Iris florentina (roghansosan) on both feet twice daily. The patients of control group were given Strychnosnuxvomica (Azaraqi) 500 mg in tablet form twice daily for a period of 45 days. The subjective parameter- Visual analogue scale (VAS) was statistically analysed by applying Student’s test, two tailed dependent for intragroup comparison, two tailed independent for intergroup comparison and Levene’s test for the homogeneity of variance. VAS showed strongly significant difference (p<0.001) in intragroup comparison in both groups. The study revealed that test drugs appeared to be efficacious in the management of painful diabetic neuropathy and exhibited significant effects in improvement of neuronal function. No adverse effects or toxicity has been reported during or after the trial.

​Clinico-demographic Profile and Treatment Patterns of Ovarian Cancer in Kashmir

Introduction: Ovarian cancer is the fourth most common cause of cancer deaths world wide and also the commonest causeof death among all gynecological cancers.Aims and Objectives: To study the clinico demographic profile and treatment patterns of Ovarian Ca in our population.Material and Methods: We conducted an analytical, non-randomized, cross-sectional study on the Clinico-Demographic profileof 731` patients with Ovarian Carcinoma who reported to our OPD between 2008 to 2015.Results: The mean age of patients was 45±1. 49 years. Most common age group of our patients at presentation was 46-60 years.Majority of patients 70% in our study were from rural area. The major clinical presentation of ovarian in our study was pelvic pain(36%) followed by abdominal distention (34%) and ascites (22%). Most common type of ovarian cancer was of surface epithelialtype (94%) followed by sex cord stromal tumor (3%) and germ cell tumour (1. 6%). Most of the cases 61% in the present studyhad presentation at advanced stages (stage III & IV) while as only 39% cases had presented at early stages (stage I & II).Majority of the patients having ovarian tumors underwent surgical staging with surgery in 88% cases. Chemotherapy was themost common adjuvant therapy in 38% patients who had malignant ovarian pathology and had advanced stage of diseases.while as 7 patients (1%) received radiotherapy for brain and bone mets.Conclusion: Majority of patients were from rural background with pelvic pain as most common presenting symptom Most ofour cases presented in late stages of disease. Greater awareness among our community is needed to reduce the morbidityand mortality associated with Ovarian Ca

Evaluation of antihyperglycemic activities of Bangladeshi medicinal plant Cinnamomum tamala Leaf extracts in alloxan treated Albino Rats

Background: Diabetic mellitus is a multifactorial disorder associated with its devastating consequences has assumed epidemic proportion in Bangladesh.Methods: The study evaluates the anti-hyperglycemic activity of the aqueous extracts of C. tamala (CTLEt) leaves in blood glucose of albino rats. Type II diabetes mellitus was induced by injecting alloxan at the concentration of 100mg/kg body weight in male albino rats. The diabetic rats were administered orally with aqueous CTLEt at the amount of 1.0ml, 1.5ml and 2.0ml with lab diet and glibenclamide (5mg/kg of body weight). Then blood glucose levels were estimated in all groups after 2 hours, 4 hours, 6 hours, 12 hours and 18 hours of the treatment with CTLEt and a known antidiabetic drug glibenclamide.Results: A comparison was made between the action of CTLEt and glibenclamide. Blood glucose levels of the CTLEt on 18th hours of the study were 8.6 to 5.1mmol/L (1ml CTLEt with lab diet), 10.4 to 4.9mmol/L (1.5ml CTLEt with lab diet), 14.7 to 4.3mmol/L (2.0ml CTLEt with lab diet) in comparison of diabetic control (9.5 to 8.5, 8.7 to 7.8, 7.7 to 7.1mmol/L) and glibenclamide (13.9 to 6.5, 16.3 to 6.1, 9.5 to 5.1mmol/L). Among the sample level, the 2.0ml CTLEt showed a higher efficiency of hypoglycemic effect on alloxan induced diabetic rats.Conclusions: Till date, there is no specific experimental work in Bangladesh about the evolution of antidiabetic activity of C. tamala plant in animal model. Further studies should be undertaken to find out the molecular mechanism of the leaf powder of C. tamala medicinal plant.

Communication skills workshop for doctors, resulting in better healthcare delivery

Objective: To assess the role of workshop in communication skills training of doctors resulting in better healthcare delivery

Study Design: Quasi-experimental interventional study

Place and Duration of Study: Combined Military Hospital Bahawalpur, from Jun 2013 to Aug 2013

Material and Methods: The participants were divided into two groups, those who received the intervention [n=10] and those who received the placebo [n=5]. Intervention was offered in the shape of a workshop that imparted knowledge via lectures and handouts and skill and attitude via audiovisual tapes and role playing. The placebo comprised of an academic workshop which had nothing to do with communication skills. The patients of both groups of doctors were given DISQ [Doctors interpersonal skills questionnaire] and their level of satisfaction based on their interaction with the doctors was evaluated

Results: The overall reliability of the study design and the method of its administration, pre and post the administration of the intervention was 93.2% and were deemed high enough to be considered reliable. The patients of doctors who received the intervention scored a mean of 37.2350 on DISQ with SD of +/- 8.68139 before intervention and mean of 42.0550 with SD of +/- 10.22176 after intervention. The patients of doctors who received the placebo scored a mean of 35.7100 with a SD of +/- 9.81166 before placebo and mean of 36.5900 with SD of +/- 8.55770 after placebo. The p-value was =0.001 [highly significant] when intervention group was compared before intervention and after intervention. However p-value was 0.433 [not significant] when control group was compared before and after placebo

Conclusion: Doctors who received the workshop designed to enhance the effectiveness of their communication skills were able to satisfy their patients to a greater degree compared as to those who received the placebo

Dysplasia epiphysealis hemimelica

Dysplasia epiphysealis hemimelica [DEH] is a developmental disorder with a very low incidence. It is characterized by overgrowth of bone and cartilage in one or more epiphyses. The usual presentation of disease is in a single limb and is hemimelic [involving either lateral or medial compartment]. Lower extremities are more frequently affected. Here we present a case of a male patient at 2.5 years of age presenting with bilateral involvement of knee joints by DEH. The diagnosis was confirmed on both radiological and histopathological findings

A lignan with glucose uptake activity in 3T3-L1 adipocytes from the stem bark of Knema patentinervia

A new naturally occurring dibenzylbutyrolactone lignan named isocubebinic ether has been isolated from Knema patentinervia. The structure was established by spectroscopic methods, which include Ultraviolet, Infrared, Nuclear Magnetic Resonance and Mass Spectrometry. The compound showed activity in the stimulation of glucose uptake by 3T3-L1 adipocytes

Potential of nano-emulsions as phytochemical delivery system for food preservation

Nature is a rich source of bioactive phytochemicals. These plant based compounds have rich scope as antioxidants, antimicrobial compounds and food preservatives and so for long time to be used in meat, fruits, vegetables and processed food items, either as added preservative or as coating material in various food applications, but the major limitation is their limited solubility in a food grade medium. Nano-emulsion is a best choice as a medium having vast area of application. The major advantage of nano-emulsion would be the solubility of a vast group of compounds, due to the presence of water and lipid phases. In this way, nano-emulsions can be proved to be the most suitable candidate as phytochemical delivery system for food preservation. In present article, the use of phytochemicals as potent food preservatives has been reviewed, in context of solubility of phytochemicals in nano-emulsion and applications of food grade nano-emulsions to food systems

Coronary CT Angiography in Asymptomatic Diabetes Mellitus.

Background: Coronary artery disease is often asymptomatic in diabetic patients until the onset of myocardial infarction or sudden cardiac death. . Coronary artery CT angiography can detect Coronary artery disease with high specificity and sensitivity. Aims &objectives: To evaluate the prevalence of coronary artery disease by CT angiography in type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additive risk factors for coronary artery disease. Methods: This hospital based observational study was conducted from March 2013 to August 2014 at GMC Srinagar. This study was carried out among Type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additional risk factors for coronary artery disease. Total of 52 patients with Type 2 diabetes patient underwent Cardiac CT. Results: Mean age of study population was 57.08 ±9.33 years..34 were males and 18 were females. 65.39% of total patient who underwent CT Angiography had plaque in coronary arteries while 34.61% have no plaque and normal coronary vessels. 19.23% patients have significant stenosis defined by luminal narrowing more than 70%. There was statistically significant relation between those who have patient significant stenosis and nonsignificant stenosis with regards to mean age, BMI, duration of diabetes , HDL ,LDL ,total cholesterol ,TG, HbA1c and coronary calcium score. Conclusion: Asymptomatic diabetics with additional risk factors have high prevalence of atherosclerotic plaques with 19% having obstructive CAD .The timely detection of CAD can help in optimizing treatment.

Clinicoradiological and Histopathological Comparative Study of Nodal Metastasis in Head and Neck Cancers.

Background: Detection of regional lymph nodes in head and neck cancers greatly modifies the staging, treatment and prognosis of the patient and helps in planning the management of these patients. Methods: A prospective study was conducted in the Department of E.N.T., S.M.G.S. Hospital, G.M.C. Jammu, in collaboration with the Department of Radio diagnosis and Imaging, G.M.C. Jammu & Department of Radiation Oncology GMC, Srinagar from 2008 to 2012 in which patients attending / admitted in the Department of E.N.T., with cancer of head and neck, were assessed for lymph node metastasis (at different levels). 16 patients, all cases of squamous cell carcinoma head and neck, underwent appropriate neck dissections. The patients were examined clinically as well as with ultrasonography for detection of various enlarged lymph nodes at different levels. Computed tomography and magnetic resonance imaging were done, wherever indicated. Patients were subjected to fine needle aspiration cytology in cases of palpable lymph nodes. The removed lymph nodes were examined histopathologically. Results: The findings of clinical, radiological and histopathological studies were compared. We concluded that clinical palpation should be supplemented by ultrasonography in every case of head and neck cancer. However, since computed tomography picks up lymph nodes missed by ultrasonography in a significant number, is important in imaging primary tumour and picks up necrosis and extracapsular spread at the most, it should be included in each case of head and neck cancer. Conclusion: Magnetic resonance imaging being equivalent to computed tomography in picking up the nodes, but lagging behind the criteria such as picking up of nodal necrosis and extra capsular spread of lymph nodes, and is too costly, so may be included as an imaging modality wherever computed tomography is contraindicated.

Cancer cervix: An uncommon malignancy in Kashmir, India.

OBJECTIVE: To study the distribution of cancers among females with particular emphasis on cancer cervix in Kashmiri population, which is geographically and socio‑culturally distinct from the rest of India. MATERIALS AND METHODS: All patient records were screened from January 1, 2009 to December 31, 2011 at Regional Cancer Centre, Srinagar. Most common cancers among females were recorded and analysis of cancer cervix cases was performed. RESULTS: Female cancers comprised of 40% of total cancers with oesophageal and breast cancer as most common malignancies. Cancer cervix did not figure in top ten cancers and only 45 (0.01%) cases were recorded of the total of 3084 adult female cancers. CONCLUSION: We conclude that due to different socio‑cultural and sexual practices, this cancer is highly uncommon in Kashmir and screening or possibly should be directed specifically at only high risk selective subjects.

Leonurus sibiricus L. (honeyweed): A review of its phytochemistry and pharmacology

Leonurus sibiricus is a herbaceous plant found in many countries in Asia and America. This plant is widely practiced as a remedy for the treatment of diabetes, menstrual irregularities, and bronchitis. The approval of therapeutic implications of any drugs depends on the well characterized mode of actions of the compounds. The bioactive compounds like diterpenes, triterpenes, flavonoids and phenolic acids in Leonurus sibiricus show analgesic, anti-inflammatory, anti-oxidant, anti-atherogenic and anti-hemorrhagic, anti-diabetic, anti-bacterial and allelopathic potency. Interestingly, the expression level of some genes is altered by the crude extract treatments, which are effective against cancers, diabetes and cardiovascular diseases where the molecular mechanisms are yet to be explored. Intriguingly, the extracts significantly induce nitric oxide production by endothelial nitric oxide synthase, a signaling molecule of vasodilation in combination with interferon-γ indicating positive effect on atherosclerosis. Further investigations are required to unlock the effects of bioactive compounds found in extracts at clinical settings.

effects of pre-Emptive bupivacaine infiltration of the nephrostomy tract in patients undergoing percutaneous nephrolithotomy: a case controlled study

Background percutaneous Nephrolithotomy [PCNL] is a surgical procedure used for the removal of renal stones. The technique is minimally invasive and is often used for the removal of renal stones that are located near the pelvis. The topical administration of local anesthetics in the surgical area has been proven effective in minimizing post-operative pain after various surgical procedures

Purpose this study was conducted to compare the mean post-operative pain score in patients with pre-operative Bupivacaine infiltration of nephrostomy tract with placebo in control group of patients undergoing percutaneous Nephrolithotomy

Methods a randomized controlled trial was carried out in Department of General Surgery, Kuwait Teaching Hospital, Peshawar with diagnosis of renal stones. A total of 66 patients [33 males and 33 females] age: 16-50 years were admitted with diagnosis of renal stones. Statistical analysis was performed by using SPSS version 17

Results patients with renal stones who underwent PCNL were randomly divided into Group A [Bupivacaine] and Group B [Placebo]. The overall Average pain score for Group A was 4.15 +/- 1.48 range [2 to 7] on visual analogue scale [VAS], while that for Group B was 6.06 +/- 1.02 range [4 to 8] p-value < 0.05, which indicates that preoperative infiltration of bupivacaine significantly decreases the postoperative pain in patients undergoing Percutaneous Nephrolithotomy

Conclusion the study concludes that local bupivacaine infiltration along the nephrostomy tract is an effective method of management of postoperative pain after PCNL, regardless of age and gender as shown by results of the study

Outcome of Adjuvant Concurrent Chemo-Radiation in Operated Locally Advanced Rectal Cancer.

Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective: To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods: In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m2 on day 1 followed by 5-fluorouracil 500 mg/m2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results: Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion: A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients.

Renal profile in cases subjected to blunt trauma

To study the occurrence of renal failure in cases subjected to blunt trauma. Analytical study. This study was carried out at the Medico-legal clinic, Services Hospital, Lahore from January to December, 2007. The study was based upon 50 cases of blunt trauma reporting at Medico-legal clinic, Services Hospital, Lahore. Twenty normal healthy controls were taken for comparison purposes. The cases were clinically examined for presence of evidence of trauma. Urine and blood samples were taken for estimation of blood urea, creatinine, potassium and calcium. There were 47 males [94%] and 3 females [6%]. The age of the subjects ranged between 18-70 years with mean of 30.9 +/- 12.34, maximum number [62%] below the age of 30. The injuries found were abrasions / bruises in 45 cases [90 %], lacerated wounds in 5 cases [10%]. In most of the cases [40%] injuries were distributed in more than one body region. As single area involvement the head and face area was affected in one case [2%], chest in 4 cases [8%] and limbs in 25 cases [50%]. The most commonly involved areas were buttocks, thighs, back of chest. Twenty nine cases [58%] reported for examination within 24 hours. Thirteen cases [26%] reported between 24-48 hours and 8 cases [16%] reported between 48-72 hours after being traumatized. Urine Examination showed yellow colour in 44 cases [88%] and brownish red in 6 cases [12%]. Specific gravity ranged between 1010-1030 with mean of 1020.6 +/- 6.59. It was between 1010-1019 in 14 cases[28%], 1020-1029 in 27 cases [54%] and 1030-1039 in 9 cases[18%]. pH ranged between 5 - 8 with mean of 5.8 +/- 0.75. It was between 5 - 5.9 in 7 cases[14%], between 6.0 - 6.9 in 27 cases [54%], between 7.0 - 7.9 in 14 cases [28%] and 8.0 and above in 2 case [4%]. In control group it ranged between 6.0 - 7.0 with mean of 6.4 +/- 0.50. Blood was positive in 7 cases [14%], and negative in 43 cases [86%]. Microscopic Examination of urinary sediment showed pus cells 0 - 5 /HPF in 35 cases [70%], and above 5/PHF in 15 cases [30%]. The red blood cells were present in 15 cases [30%]. Calcium oxlate crystals were found in 39 cases [78%], triple phosphate in 5 cases [10%]. In 6 cases [12%] no crystals were found. The cellular casts were present in 6 cases [12%]. In blood examination blood urea ranged between 15.5 - 86.0 mg/dl with a mean of 43.54 +/- 15.06 . The blood urea was above reference range in 7 cases [14%]. Blood Creatinine ranged between 0.5 - 2.6 mg/dl with mean of 0.97 +/- 0.47. The raised blood creatinine was found in 7 cases [14%]. These cases are the same cases which have raised blood urea. Serum Potassium ranged between 3.2 - 5.9 mmol/dl with mean of 4.45 and S.D. 0.78. It is above reference range in 9 cases [18%]. In cases with raised blood urea and creatinine it was raised in all cases. Serum Calcium ranged between 5.6 - 10.74 with mean of 8.84 +/- 1.01. The hypocalcaemia was seen in 25 cases [50%]. In the cases with raised blood urea and creatinine the calcium was low in all cases. In our study 14% cases have shown the evidence of renal function derangement. The cases subjected to blunt trauma are at threat to develop renal failure particularly in cases with dehydration and acidosis