Feasibility and impact of screening for venous thromboembolism in treatment?naive lung cancer patients–Results of a prospective cohort study

Background: Venous thromboembolism (VTE) in cancer remains underdiagnosed. This prospective study aimed to evaluate the feasibility of screening for VTE in lung cancer (LC) patients. We assess the incidence of VTE, its risk factors, and effects on overall survival (OS). Methods: Consecutive treatment?naive LC patients were screened for deep venous thrombosis (DVT) with compression ultrasonography and pulmonary thromboembolism (PTE) with computed tomography pulmonary angiography (CTPA) at diagnosis and after 3 months of treatment. The incidence rate of VTE (DVT and/or PTE) was calculated. Risk factors associated with VTE were assessed using logistic regression analysis. All participants were followed?up to 1 year after enrollment. OS was compared in LC subjects with and without VTE, using the Cox proportional hazard analysis. Results: Around 301 subjects with LC (stages IIIB?IV accounted for 83.1%) were enrolled, of which 16 had VTE (5.3%). The incidence rate of VTE was 90 per 1000 person?years (PY). PTE was asymptomatic in 27.3% of cases while all DVT episodes were symptomatic. The incidence rate of asymptomatic PTE identified during the screening was 17 per 1000 PY. The median duration from LC diagnosis to the VTE event was 96.5 days. Median OS was significantly less in VTE patients [161 versus 311 days; P = 0.007] and death was attributable to VTE in 50%. After adjusting for covariates, VTE (hazard ratio [HR] = 2.1), smoking (HR = 1.7), and Eastern cooperative oncology group performance status ?2 (HR = 1.6) were independently associated with poor OS in LC. Conclusions: VTE occurs in approximately 1 in 20 newly?diagnosed patients with LC and is associated with decreased OS. Screening for PTE may be considered even in resource?limited settings

Cytotoxicity and hepatoprotective attributes of methanolic extract of Rumex vesicarius L

BACKGROUND: To evaluate the hepatoprotective potential and invitro cytotoxicity studies of whole plant methanol extract of Rumex vesicarius L. Methanol extract at a dose of 100 mg/kg bw and 200 mg/kg bw were assessed for its hepatoprotective potential against CCl4-induced hepatotoxicity by monitoring activity levels of SGOT (Serum glutamic oxaloacetic transaminase), SGPT (Serum glutamic pyruvic transaminase), ALP (Alkaline phosphatase), TP (Total protein), TB (Total bilirubin) and SOD (Superoxide dismutase), CAT (Catalase), MDA (Malondialdehyde). The cytotoxicity of the same extract on HepG2 cell lines were also assessed using MTT assay method at the concentration of 62.5, 125, 250, 500 µg/ml. RESULTS: Pretreatment of animals with whole plant methanol extracts of Rumex vesicarius L. significantly reduced the liver damage and the symptoms of liver injury by restoration of architecture of liver. The biochemical parameters in serum also improved in treated groups compared to the control and standard (silymarin) groups. Histopathological investigation further corroborated these biochemical observations. The cytotoxicity results indicated that the plant extract which were inhibitory to the proliferation of HepG2 cell line with IC50 value of 563.33 ± 0.8 Mg/ml were not cytotoxic and appears to be safe. CONCLUSIONS: Rumex vesicarius L. whole plant methanol extract exhibit hepatoprotective activity. However the cytotoxicity in HepG2 is inexplicable and warrants further study.

Cervical gouty myelopathy in two cases at King Abdulaziz medical city

Gout is a rheumatological disorder found exclusively in human species. It is caused by deposition of crystals of monosodium urate in joints, cartilages, tendons, and soft tissues. Involvement of the spine, however, is rare. In this report, we describe two patients presented to King Abdulaziz Medical City in Jeddah with clinical features of cervical myelopathy, including neck pain, L'hermitte phenomena, quadriparesis and sensory deficit [shoulder level]. Magnetic resonance imaging confirmed the presence of cervical cord compression with intrinsic cord signal abnormalities. Both patients had laminectomy and intraoperatively; severe canal stenosis was identified. A whitish cheesy material was noticed causing significant root compression. The pathology was diagnostic of gout. In this article, we present two difficult cases with interesting clinical, radiological and pathological findings. We emphasize on the importance of early diagnosis to prevent morbidity

Economic evaluation of antibiotic prescriptions: a cost minimization analysis.

Objective of the study was to perform a cost minimization analysis of antibiotic prescriptions in pediatric cases.This was a prospective observational study conducted in the pediatric department of a teaching hospital. A total of 209 prescriptions, of both outpatients and inpatients, containing antibiotics were analyzed. Top five of the commonly prescribed antibiotics in this study were chosen as examples to illustrate the cost difference between the branded and generic versions. This study has shown a very significant difference of prices between branded and generic drugs. The cost of branded drugs prescribed was 20% to 218% more than the generic versions.

Jejunal carcinoma.

We report here the case of a patient with jejunal adenocarcinoma who presented with features of upper gut obstruction and was diagnosed post-operatively on histology.

Vertical transmission of hepatitis A.

Two hospital delivered full term newborn babies were detected to have cholestatic jaundice in the first week of life. They had raised liver enzyme levels, which gradually declined over a period of one month. Both babies were anti HAV IgM positive on 6th day of life in Case 1 and on 7th day of life in Case 2 respectively. Both the mothers had jaundice 20 and 26 days before delivery and had anti HAV IgM positivity two and three weeks prior to delivery in Case 1 and 2 respectively. Hepatitis A virus is not transmitted vertically from mother to baby. However, there are 3 such case reports in literature stating vertical transmission of HAV infection. We are reporting it in two neonates for the first time in India.

Tetralogy of Fallot in monozygotic twins.

A pair of monozygotic twins having tetralogy of Fallot is reported for the first time in the Indian literature. This case report will help in further enriching the existing data on genetic hypothesis of congenital heart defects.