Impact of age at diagnosis on clinicopathological outcomes of oral squamous cell carcinoma patients in Karachi

Objective: A recent trend in diagnosis of oral cancer in young age is observed, however its impact on various clinicopathological parameters needs to be explored. The aim of the current study was to compare and analyze impact of age at diagnosis with clinicopathological parameters of oral squamous cell carcinoma patients

Methods: In this cross sectional study conducted at Department of Oncology Ziauddin Hospital Karachi, we included histologically confirmed cases of oral squamous cell carcinoma. The patients were categorized as young age group [40yrs and younger] and old age group [41 yrs and above]. A total of 115 patients diagnosed between 2013 and 2016 were enrolled in the study. The variables considered were age at diagnosis, sex, site of lesion, positive family history, tumor grade, stage, uric acid level and survival

Results: A statistically significant difference was observed between two age groups in overall survival, uric acid level and positive family history of cancer. No significant difference was observed in tumor location, grade and stage

Conclusion: Majority of oral cancer patients present at an advanced stage irrespective of age at diagnosis but young age has an overall improved survival. Moreover, a positive family history of cancer in young age group mandates further exploration of possible role of genetic polymorphisms which might be responsible for early onset of the disease

Clinicopathological features associated to MiRNA-195 expression in patients with breast cancer: Evidence of a potential biomarker

Background and Objective: MiRNAs are a systematic class of small non-coding RNAs with impending role; tumor biomarkers. Our objective was to identify the level of expression of Mir-195 in patients with brea cancer along with its correlation with clinicopathologic features

Methods: A total of 209 females in which 139 historically diagnosed breast cancer [BC] cases and] healthy controls matched for age, their relative clinical and histopathological findings were recorded fro their laboratory reports and hospital record of the patients. Plasma was used for extraction of total l" and cDNA was prepared by using both miR-195 stem loop RT primers and gene specific antisense prime while U6 IT was used as control. Quantitative real-time PCR [qRT-PCR] for miR-195 expression status w< performed and amplification [down regulation] was recorded

Results: Of 139 samples the expression of miR-195 was down regulated in 72.6% cases and the remains 27.3% cases behaved same as 70 healthy or normal controls. Significant correlation of low miR-15 expression with higher differentiation grade, lymph node metastasis and clinical stage was found

Conclusion: Significant correlation between miR-195 expression and some Clinicopathological feature were recognized. MiR-195 could be used as potential non-invasive, molecular biomarker for early detectio of breast cancer

Concurrent cisplatin-based chemoradiation in squamous cell carcinoma of cervix

Objective: to evaluate the efficacy of cisplatin-based concurrent chemoradiation in squamous cell carcinoma of cervix and the frequency of acute toxicity

Study Design: case series

Place and Duration of Study: department of Clinical Oncology, Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN], Karachi, from September 2010 to September 2011

Methodology: eighty patients with histologically proven squamous cell carcinoma of cervix were included. Patients were treated with concurrent chemoradiation. External beam radiation was delivered with 50 Gy whole pelvis along with 40 mg/m2 weekly cisplatin followed by brachytherapy three insertions of 6.5 Gy each, one week apart. Response to treatment was assessed using response evaluation criteria in solid tumours [RECIST] criteria at 4 weeks after treatment. Acute toxicity of chemoradiation was assessed using common toxicity criteria

Results: out of the 80 patients, 8 patients were lost to follow-up. Remaining 72 patients aged 28 - 65 years with mean age of 48.03 +/- 8.9 years. Forty-eight patients [66%] were in stage II-B, 5 [7%] were in stage III-A, 7 [10%] were in stage III-B, and 12 [17%] were in stage IV-A. Overall response to treatment was 92%, in which 39 [54%] had complete response, and 27 [38%] had partial response while 6 [8%] show progressive disease. About 70% patients had diarrhea, 61.2% patients developed vomiting, 45.8% patients had dermatitis, 43% patients had vaginal mucositis, 40.3% had anemia, 13.9% patients had neutropenia, 27.8% patients had dysuria, and 22.2% patients had proctitis

Conclusion: cisplatin-based concurrent chemoradiation is an effective treatment in locally advanced stage of cervical cancer with manageable toxicity

Effect of outflow obstruction on the relative renal function estimation with [99m] Tc-MAG-3 and [99m] Tc-DMSA

Several areas of controversy still exist in the selective preference of the method for estimation of relative renal function in patients with outflow obstruction. The aim of this study was to compare the estimation of relative renal function by [99m]Tc-MAG-3 and [99m]Tc-DMSA in patients with unilateral outflow obstruction. [99m]Tc-DMSA scintigraphy was done on 34 patients with outflow obstruction on [99m]Tc- MAG3 scintigraphy. Relative renal functions were calculated and effect of obstruction on the relative renal function was compared. Good correlation was observed in the estimation of relative renal function estimated by both the methods. One third of the patients had overestimated renal function on [99m]Tc-DMSA scintigraphy, however the difference was not statistically significant. Although [99m]Tc-DMSA and [99m]Tc-MAG3 relative renal function estimation show a statistically significant correlation, the over estimations of relative renal function by [99m]Tc-DMSA in a significant number of case with outflow obstruction needs further clarification

Interobserver and intraobserver agreement in radiographic diagnosis of osteoporosis

Osteoporosis is a common bone disorder which means paucity of bone particularly of trabecular bone. This leads to increased tendency to fractures and bone pains. The radiological diagnostic workup usually starts from plain x-rays followed by bone mass measurement techniques. To determine the inter- and intra-observer agreement in plain x-ray diagnosis of osteoporosis using a standardized grading system. It was a cross-sectional analytical study conducted from May 2004 to June 2005 at Radiology department Dow University of Health Sciences and Civil Hospital, Karachi and Osteoporosis Diagnostic Clinic Karachi. Plain non digital x-rays of femur of post menopausal females [a group known to be at risk of and clinically suspected with osteoporosis] were independently read by three qualified professionals-two radiologists and a nuclear physician specialized in osteoporosis diagnosis. Standardized radiological grades of osteoporosis [Singh Index] were assigned to plain x-rays of pelvis and femur. Kappa statistics were used to determine inter- and intra-observer agreement by computing k-value. A total of 98 patients were included in the study. All were post menopausal females with age of 59 +/- 6.5 years Kappa [k-] value for inter-observer agreement ranged from 0.21 to 0.44. For intra-observer agreement, it was 0.69 to 0.78. The inter- and intra-observer agreement for diagnosis of osteoporosis on plain x-rays alone is markedly low, necessitating the use of multiple and sensitive techniques rather than plain x-rays alone

Radiographic morphometry of the osteoporotic femur: comparison with densitometry

To determine the accuracy of radiographic morphometry i.e. grading of osteoporosis on plain x-rays of femur [Singh index] compared with bone densitometry by dual energy x-ray absorptiometry [DEXA] in post menopausal females. From May 2004 to June 2005 at Radiology Department, Dow University of Health Sciences [DUHS], and Civil Hospital Karachi [CHK] in collaboration with Osteoporosis Diagnostic Clinic, Karachi. Post menopausal females referred for evaluation of clinically suspected osteoporosis by both plain x-rays and DEXA were included in the study. Those with history of previous trauma or radiation, other systemic disease with bony component, advanced degenerative disease, metastatic disease and bony metallic implants or prosthesis, were excluded. A standardized system of grading skeletal osteoporosis on plain x-rays of femur/pelvis [Singh index grades 1-6] was exercised. Bone mineral density and T-score were determined on DEXA. Sensitivity and specificity of each assessed was determined against the gold standard T-score. There were 98 patients in all with mean age of 59 +/- 6.5 years and mean post menopausal interval of 9.66 +/- 6.52 years. The predominant distribution was, 26.5% in grade 6 and 31% in grade 3. Nineteen had normal T-score [>-1], 49 were osteopenic [T- score between -1.00 and -2.5] and 30 were osteoporotic with T-score below -2.5. For grade 3 and below, the sensitivity and specificity of Singh index [SI] were 55% and 84% respectively. For SI grades 4 and above, the values were 44% and 97% respectively. Singh index or radiographic morphometry grading of osteoporosis is fairly accurate for advanced osteoporosis with high specificity. The sensitivity is low requiring use of bone densitometry for early detection