Remission rate of acute lymphoblastic leukemia [ALL] in adolescents and young adults [AYA]

Objective: To determine the remission rate in adolescent and young adult [AYA] patients with acute lymphoblastic leukemia [ALL]

Study Design: Descriptive study

Place and Duration of Study: Department of Oncology, Jinnah Postgraduate Medical Centre [JPMC], Karachi from January, 2016 to March, 2017

Methodology: Adolescent and young adult [AYA] patients aged 15-39 years, newly diagnosed with acute lymphoblastic leukemia from January, 2016 to March, 2017. Diagnosis was confirmed by bone marrow trephine biopsy and immunophenotyping. All the patients were treated with daunorubicin, vincristine, prednisone, and L-asparaginase in the induction phase. The response evaluation was done on day 35 of the induction phase and the remission rate was assessed by the bone marrow examination

Results: Of the total 50 AYA patients diagnosed with ALL, 41 patients could complete induction phase and 9 patients died during the first week of induction, therefore excluded from the study. Forty [97.8%] patients were <35years of age, 28 [68.3%] were male, of female 10 [24.4%] were housewives, 33 [80.5%] patients belonged to Sindh, 28 [68.3%] presented with fever and body ache, 17 [41.5%] patients had precursor B cell type ALL, with 7 [17.1%] patients had hemoglobin of <7 g/dL,11 [26.8%] patients had white cell count of >30x109/L, platelet count of <20x103/µL in 6 [14.6%] patients and complete morphological remission was reported in 29 [70.7%] patients

Conclusion: The remission induction rate was 70.7% in the adolescents and young adults with acute lymphoblastic leukemia at the study centre

Association and implications in triple negative and triple positive breast cancer: relationship with sociodemographic and reproductive factors in pakistan

Background and Objectives: Triple negative and triple positive breast cancer have adverse effects than other types of breast cancer. However, triple negative has poor prognosis with short survival as compared with triple positive breast cancer. Good prognosis is one of the key factors for successful treatment trial. This study aimed to find out the association of sociodemographic and reproductive features like parity, menopause, number of child bearing as risk factors in the development and prognosis of triple negative and triple positive breast cancer

Methods: This study is a part of an ongoing project which is being conducted in Karachi from 2013 to 2020. Informed consent from triple negative breast cancer [n=134] and triple positive breast cancer [n=87] patients were taken prior to their recruitment into the study. Demographic, anthropometric, reproductive and disease history of patients were recorded. Means, frequency distribution, data classification and association analyses were done by SPSS version 17.0

Results: Statistical analyses revealed that delayed first child bearing age and lower number of children are associated with the development of triple negative breast cancer. However, no significant effect of these parameters has been observed on the outcomes of triple positive breast cancer

Conclusions: Reproductive factors have more pathological implications than sociodemographic factors in both triple positive and triple negative breast cancer development. These findings might prove to be beneficial for effective and better breast cancer management

The complete clinical response in rectal Carcinoma after Chemo radiation

Objective: To determine the complete clinical response in rectal carcinoma after neoadjuvant chemo radiation

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted in Clinical Oncology department, Jinnah Postgraduate Medical Centre Karachi, from Jan 2016 to Jan 2017

Material and Methods: Seventy Two Patients meeting the inclusion criteria were enrolled in study after complete staging workup. Neoadjuvant concurrent chemoradiotherapy was planned, consisting of oral capecitabine 825mg/m2 BID five days a week along with 50.4 Gy Radiotherapy with linac machine. Radiation was delivered over a period of 5 weeks at a rate of 1.8 Gy/day. Patients received Radiotherapy in Atomic Energy Medical Centre [AEMC] and in Sindh Institute Urology and Transplant [SIUT], Radiation department. Chemotherapy was given in clinical oncology department of JPMC. Sixty one patients completed planned treatment and were available for post concomitant chemo radiotherapy response assessment with Pelvic CT/MRI after 6-8 weeks of completion of concomitant chemo radiotherapy. Response assessment was done according to Response Evaluation Criteria in solid tumor [RECIST] criteria version 1.1 and then Patients were referred for surgical evaluation

Result: A total of 61 cases of locally advanced adenocarcinoma rectal cancer patients were included in the study.Mean age of the patients was 41 years with +/- 17.06 years SD. Complete clinical response was identified in 4 [6.6 percent] while 31 [50.8 percent] were identified as partial response, progressive disease was 13 [21.3 percent] and 13 [21.3 percent] were with stable disease. All confounding variables were found statistically significant with p-value found less than 0.05

Conclusion: Neo-adjuvant chemoradiotherapy for locally advanced rectal cancer is associated with high rates of tumor response in terms of downs tagging [complete and partial] and is relatively safe with acceptable morbidity, which favors its use in future

Studies on antihyperlipidemic and endothelium modulatory activities of polyherbal formulation [POL[4]] and its ingredients in high fat dietfed rats

A compound herbal formulation [POL[4]] is used traditionally in interior parts [Distt. Badin] of Sindh, Pakistan, for the treatment of metabolic disorders like diabetes and hyperlipidemia. This study is aimed to determine the effectiveness of POL[4] and its ingredients in hyperlipidemia and associated endothelial dysfunction and hypertension. POL[4] is composed of equal proportion of Nigella sativa, Cichorium intybus, Trigonella foenum graecum and Gymnema sylvestre mixed in powdered form. Chronic [6 to 7 weeks] administration of POL[4] and its ingredients mixed in diet caused a notable attenuation in total cholesterol, low density lipoprotein cholesterol, triglycerides, atherogenic index, Creactive protein and glucose, while it has increased high density lipoprotein levels. POL[4] intervention markedly [p<0.01] reduced systolic blood pressure in rats to 127+/-1.92 vs. 145.4+/-1.07 mm of Hg using tail-cuff method and significantly [p<0.05] improved endothelium-dependent relaxation [75+/-2.88 vs. 82.75+/-1.22%] to acetylcholine in isolated aortae of rats in treatment groups using force transducer and PowerLab system. Similar activities were assessed on the part of ingredients of POL[4]. These findings indicate that POL[4] and its ingredients possess antihyperlipidemic, endotheliumdependent modulatory and antihypertensive activities, thus providing an evidence to the vernacular use of POL[4] in hyperlipidemia and hypertension

Polymorphisms in MTHFR, MS and CBS genes and premature acute myocardial infarction in a Pakistani population

High prevalence of premature coronary heart disease in Pakistanis compared to other populations points towards the genetic predisposition of this population to develop this disease. Since no investigations have been carried out in Pakistan to study the relationship of polymorphisms in genes involved in homocysteine cycle, the objective of the present study was to find out if there is any association of methylenetetrahydrofolate reductase [MTHFR] C677T, A1298C; methionine synthase [MS] A2756G; cystathionine-beta-synthase [CBS] 844ins68, G919A polymorphisms with premature acute myocardial infarction [AMI] in a population of Pakistani patients with this disease. In a cross-sectional study, DNA samples of 143 AMI patients [age <45 years] and 153 healthy controls were genotyped for the above mentioned polymorphisms using PCR-RFLP methods. Plasma/serum samples of both patients and healthy controls were screened for homocysteine, folate and vitamin B12. One way ANOVA and chi-squared test were used for analysis of data. Mean plasma homocysteine levels in premature AMI patients and healthy controls were found to be 23 +/- 17.2 and 23 +/- 13.4 micro mol/l, respectively which are higher than the upper normal limit of this biomarker [15micro mol/l]. MTHFR 677 CT genotype in healthy controls and MTHFR 677 TT genotype in AMI patients were found to have significantly increased levels of plasma homocysteine [p value <0.05], while all other polymorphisms did not show any significant difference in mean levels of homocysteine between AMI patients and healthy controls. Moreover, no association was observed between MTHFR C677T, A1298C; MS A2756C; CBS844ins68 polymorphisms and premature AMI in this population. This indicates that common polymorphisms in MTHFR, MS and CBS genes have no role in premature AMI in Pakistani population

To determine the factors responsible for diagnostic delay of breast cancer among women

Background: Breast cancer is the most common cancer among women throughout the world. Early diagnosis of this cancer is important for its early treatment and favorable outcome. The diagnostic pathway is divided into patient, doctor and system interval. This study will look into the reasons for delay in diagnosis

Objectives: To determine the frequency of diagnostic delay [patient, doctor and system delay] of breast cancer among adult women [>/= 18 years] and factors responsible for it. Study design, settings and duration: Hospital based cross-sectional study conducted at Oncology/ Radiotherapy unit of Jinnah Post Graduate Medical Centre. Karachi from February 2015 to December 2015

Subjects and Methods: Adult women [2 18 years] diagnosed with breast cancer and reporting at Oncology/Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi were enrolled. Convenient sampling was used, sample size was 288 women with breast cancer. Variables included age strata, socio-demographic characteristics, age at menarche, parity and breast feeding history [if applicable], intervals of diagnostic pathway [patient, doctor and system] and reasons of delay. Questionnaire based instrument was used for data collection. SPSS version 16 was used for data analysis and descriptive frequencies

Results: The mean age of the patients was 42 years [range 21-80 years]. Breast lump was the main presenting symptom [90%,]. Complete physical and breast examination was performed by health care provider in 97% cases. Median patient, doctor and system interval was 90, 45 and 35 days respectively. Median diagnostic pathway [patient+ doctor+ system] was 165 days [5.5 months] and ranged from 2- 405 days [13.5 months]. It was further found that after confirmation of the diagnosis, median interval to report to oncology/radiotherapy unit was 18 months. First consultation with the health care provider was delayed due to carelessness in 57%, due to financial reasons in 55%, due to fear of cancer in 23% and due to time constraints to visit hospital by the family members in 13% cases. Univariate regression analysis showed that late presentation to first health care provider by the patient [patient interval] was mostly seen in women having children who were less educated [illiterate/primary] without any ethnic group being specific. Univariate regression analysis showed that delay in reporting to oncology/radiotherapy unit was seen in women without any ethnic group been specific and those having children. Multivariate regression analysis showed that delay in reporting to oncology/radiotherapy units was mostly seen in women aged between 18-25 years who had children and belonged to either Sindhi, Baluchi or Pushto origin

Conclusion: Delay in the diagnosis of breast cancer among adult women attending the tertiary care public sector hospital as not due to doctor or system interval but was due to fear of cancer. Policy statement: Awareness campaigns should be used to communicate to women folks that breast cancer is curable if diagnosed and treated early

Re-recurrent dermatofibrosarcomaprotuberans of the chest wall

Dermatofibrosarcomaprotuberans is a rare, soft tissue tumour with high rate of recurrence. It is locally aggressive, with a low rate of metastasis. We describe the case of a 42 year old man who presented with a re-recurrent, large tumour situated on the anterior chest wall in the sternal region. We did a wide local excision and covered the resulting defect by using bilateral, pectoralis major myocutaneous flaps. Histopathology and immunohistochemical staining findings were consistent with the diagnosis of Dermatofibrosarcoma Protuberance. Post operatively the patient was treated with chemotherapy and radiotherapy

Mediastinal synovial sarcoma

The mediastinum is an uncommon site of synovial sarcoma which is a rare soft tissue malignancy. An 18 year old boy was admitted for right sided chest pain since one year. Based on the CT scan chest findings, tru-cut biopsy of the mass was performed and histopathology initially reported as neurofibroma. The tumor was excised via posterolateral thoracotomy and excisional biopsy established the diagnosis of primary synovial sarcoma arising from the mediastinum. Patient was started on adjuvant chemotherapy at the oncologist tumor board's recommendation and he received 6 cycles of adriamycin and ifosfamide. At last follow up he is free of tumor recurrence

Biodeterioration studies of thermoplastics in nature using indigenous bacterial consortium

Thermoplastics, poly vinyl chloride and low-density polyethylene were treated in the presence of indigenously developed bacterial consortium in laboratory and natural conditions. The consortium was developed using four bacteria, selected on the basis of utilization of PVC as primary carbon source, namely P. otitidis, B. aerius, B. cereus and A. pedis isolated from the plastic waste disposal sites in Northern India. The comparative in-vitro treatment studies as revealed by the spectral and thermal data, illustrated the relatively better biodegradation potential of developed consortium for PVC than the LDPE. Further, the progressive treatments of both the thermoplastics were conducted for three months under natural conditions. For this purpose, bioformulation of consortium was prepared and characterized for the viability up to 70 days of storage at 25±1ºC. The consortium treated polymer samples were monitored through SEM and FT-IR spectroscopy. Analytical data revealed the biodeterioration potential of the developed consortium for PVC and LDPE, which could help in disposing the plastic waste.

Laparoscopic cholecystectomy: an experience of 550 cases at Sukkur

To see the results and complication rate of Laparoscopic cholecystectomy at Sukkur. Prospective Study. This study was conducted at Ghulam Mohammad Mahar medical College Hospital Sukkur and Sukkur Blood Bank Hospital from December 2004 to December 2009. The study comprises of 550 case. All were admitted from OPD of both hospitals. All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy whether successful or converted were included in study. The procedure was carried out by standard four port technique. Clinical examination, investigations, operative time, postoperative complications, reasons for conversion and hospital stay were recorded on proforma and results were drawn. The male patients were 100 and female patients were 450, male to female ratio was 1:4.5. Mean age of patients were 47.63 years ranging from 25 years to 75 years there were 127 [23.09%] obese, 72 [13.90] controlled hypertensive. Anatomical obstacle noted in 40 [7.27%] patients. Adhesions in 52 [9.45%] and acute cholecystitis in 22 [3.75%] patients. Overall conversion rate was 4%. In total of 22 patients which were converted, causes were slipped clip, 2 hemorrhage from falciform ligament 1, severe hemorrhage 3, unclear anatomy 6, common bile duct injury 4, intra abdominal adhesions 4, gangrene gall bladder 1, and advance carcinoma 1. mean hospital stay was 1.8, ranges from 1 day to 10 days. Laparoscopic cholecystectomy has a gold standard procedure. It is safe and effective and becoming cost effective day by day. Incidence of complication is low, morbidity and mortality are low. The pain free postoperative period and early ambulation lead to saving of value able working hours

High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi

Primary renal lymphoma

A 62-year-old male patient presented with right flank pain and right renal mass on CT scan. Patient left against medical advice and had nephrectomy done elsewhere. Histopathology revealed a diffuse large cell B-cell lymphoma. Patient presented again, with disseminated disease and was started on chemotherapy. Although a rare disorder, missing primary renal lymphoma as one of the causes of renal mass can lead to disseminated disease and unnecessary nephrectomy, in spite of chemotherapy being standard management

Cisplatin nephrotoxicity and hydration protocols

To evaluate the nephrotoxicity of cisplatin in cancer patients, using different protocols of hydration. Randomized controlled trial. This study was conducted between 1st June to 30th November 2004. Ninety-nine patients with normal renal Junction were enrolled in the study and randomly assigned into the 3 study groups, each group having 33 patients. In group 1 hydration was done with saline [2 liter] alone, in group 2 with saline [2 liter] and furosemide [40mg] and in group 3 with saline [2 liter] and mannitol [100ml]. All 3 group patients were given cisplatin infusion 100 mg/m2 over 1 hour and the cycles repeated every 21-28 days. Twenty four hour creatinine clearance was measured before and after 6th day of the chemotherapy in all patients. For the first cycle of chemotherapy the 24-hour urinary creatinine clearance before chemotherapy for saline group was 95.54 +/- 15.27, for saline and furosemide group 98.43 +/- 13.44 and for saline and mannitol group 97.45 +/- 14.05 ml/min and after 6th day of cisplatin infusion was 77.4 +/- 14.59 for saline group, 86.06 +/- 11.9 for saline and furosemide group and 82.29 +/- 13.64 for saline and mannitol group. The reduction in creatinine clearance was less with saline and furosemide group [12.6%] as compared to saline and mannitol group [15.6%] and saline alone [18.9%] which is statistically significant. Each patient in these 3 study groups received many courses of cisplatin and showed the similar pattern. Hydration with saline and furosemide is less nephrotoxic than other protocols with cisplatin infusion

Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis

To compare the results of unfractionated heparin [UFH] with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. Randomized control trial. Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. The age of the patients ranged from 16-82 years. There were 15 females [50.00%] and 15 males [50.00%]. Pain and swelling were present in all patients [100%], while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients [43.33%], right lower limb involvement in 12 patients [40.00%] and both limbs involvement in 5 patients [16.67%]. In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients [p-value=0.068]. Improvement in swelling was observed after 6th day in 11 patients [group 1], while before 6th day in 8 patients [group 2] [p-value=0.171]. Bleeding time was prolonged in 5 patients in group1and statistically found significant [p-value=0.014], while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 [p-value 0.0815]. The hospital stay was more than 10 days in group1 [12 patients], and less than 10 days in group 2 [13 patients]. It was found statistically significant [p-value=0.001]. Three patients died in group 1, while no mortality was observed in group 2. Treatment with low melecular weight heparin [LMWH] has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay

Diagnostic yield of color doppler ultrasonography in deep vein thrombosis

To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. Descriptive study. The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females [60.00%] and 10 males [40.00%]. Left lower limb involvement was seen in 12 patients [48.00% +/- 0.51], right lower limb involvement in 10 patients [40.00% +/- 0.50] and both limbs involvement in 3.0 patients [12.00% +/- 0.33]. Color Doppler ultrasound was positive in 16 patients [64.00% +/- 0.48] while venography was positive in 21 patients [84.00% +/- 0.37%]. Doppler ultrasonography and venography showed that 11 patients [52.38%] had distal DVT, while 10 patients [47.62%] had distal as well as proximal DVT. Ten patients [100.00%] of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients [100.00%] of distal DVT only in whom 6 patients [54.54%] were diagnosed by CDU, while 5 patients [45.46%] had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7

Correlation between pulmonary function abnormalities and sputum cytological finding in cigarette smokers

To evaluate the relationship between changes of lung function parameters and sputum cytology among smokers with or without chronic obstructive pulmonary disease [COPD] and non-smoker healthy controls, sixty nine male cases were studied. Thirty two patients were in smokers' group [n=22 COPD, mean age + SD, 41+5 years old, n=10 without COPD, mean age + SD, 61+11 years old] twenty nine in ex-smokers group [n=23 COPD, mean age + SD, 61+11 years old, n=6 without COPD, mean age + SD, 41+5 years old] and eight in non-smokers healthy group [mean age + SD, 40+7 years]. Spirometric measurements FEV1 and FEV1/FVC ratio were noted and sputum processed and cell counts were performed by a blinded observer. There was a negative correlation FEV1/FVC ratio and increasing age [r=-0.72, p<0.001], same with duration of cigarette smoking [r=-0.66] and also with pack-year cigarette smoking [r=-0.66]. Neutrophil counts were significantly increased in smoker and ex-smoker groups as compared to non-smokers group [p<0.005]. There were significant differences in the number of macrophages, pigmented macrophages, neutrophils, mucus spirals and columnar epithelial cells [p<0.001]. This study concludes that cessation of cigarette smoking could reduce number of inflammatory cells and my improve airway obstruction