Laparoscopy offers better clinical outcomes and long-term survival in patients with right colon cancer: experience from national cancer center

Purpose@#Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. @*Methods@#Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. @*Results@#A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. @*Conclusion@#This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.

Surgical management for symptomatic giant liver hemangiomas: a meta-analysis

Objective: To conduct a meta-analysis of reported evidence on surgical management for symptomatic giant liver hemangiomas

Methodology: A systematic literature search was conducted to identify studies on adult patient surgeries for symptomatic giant liver hemangiomas from January 2009 to July 2015. The primary outcome measures included postoperative symptom resolution, mortality, complications, and blood transfusions. Quality of life after surgery was taken as a secondary outcome. Meta-analysis was performed using a random-effect model with comprehensive meta-analysis software

Results: Fourteen studies with 1,557 patients were included. There were only two mortalities. Overall event rate for minor and major complications was low as 0.15 and 0.14, respectively, with a high symptom resolution rate of 0.69 [95%, CI 0.64-0.73]. Pooled analysis for blood transfusion stayed insignificant due to high calculated heterogeneity across studies. Quality of life results after surgery are reported good by three studies, in most of their patients. The adverse outcome rate between enucleation and resection was comparable

Conclusion: Liver hemangioma surgery is a safe treatment option with negligible mortality and low morbidity. It is effective in terms of symptom control and overall quality of life

Rapid emergence of ESBL producers in E. coli causing urinary and wound infections in Pakistan

Objectives: Production of extended spectrum beta -lactamases [ESBLs] by clinical isolates of pathogenic E. coli is a very serious therapeutic threat. This study was aimed to investigate the prevalence of ESBLs and associated drug resistance in E. coli isolates from urine and pus, and to report the drift from 2005 to 2009-10

Methodology: Among 173 E. coli isolates, 82 were phenotypically detected as ESBL producers by standard cefotaxime / clavulanic acid and ceftazidime / clavulanic acid disc diffusion tests. Antimicrobial resistance of all ESBL producers was assessed by disc diffusion method. Presence of CTX-M, TEM, SHV and OXA groups was investigated by PCR

Results: The prevalence of ESBL producing E. coli increased significantly from 33.7% in 2005 to 60.0% in 2009-10 [urine: 31.8% to 62.9%; pus: 41.1% to 55.5%]. Resistance to cefotaxime, ceftazidime, ciprofloxacin, gentamicin, nalidixic acid, ticarcillin-clavulanic acid, and trimethoprim-sulfamethoxazole was above 85% in both sets of isolates. Imipenem and Fosfomycin resistance was non-existent in 2005 but ranged from 3-15% in 2009-10. Remarkable increase from 9.5% to 64.7% in urinary tract isolates and from 0 to 55% in pus isolates was observed in colistin sulphate resistance. The dissemination of genes encoding ESBLs was: CTX-M 3.5%; TEM 10.7%; both CTX-M and TEM 3.5% in 2005, and CTX-M 42.5%; TEM 48.1%; both CTX-M and TEM 29.6% in 2009-10

Conclusions: Our results showed very rapid emergence of multidrug resistant ESBL producing E. coli in Pakistan posing a very serious threat in the treatment of nosocomial and community acquired infections

Association of smoking and low serum bilirubin antioxidant concentrations

Objectives: The objective of this study was to identify the association between cigarette smoking and serum bilirubin antioxidant concentrations

Study Design: A descriptive cross sectional study

Place And Duration: Study was conducted at the Department of Biochemistry at Sheikh Zayed hospital Lahore over a period of one year from January 2012 to December 2012

Methodology: The sample size was sixty with an equal distribution of healthy and control group. Thirty were known smokers and thirty were healthy controls. Thirty smokers who had been smoking for at least five pack years [20 cigarettes per day for one year is equal to one pack year] were included after ruling out coronary artery disease by Exercise Tolerance Test. Same no. of healthy control subjects were selected from general population with no history of smoking, CAD, Diabetes and hypertension

Results:The results of the study have shown that smoking decreases the serum bilirubin concentrations. The mean value of serum bilirubin in 50%[n=30] smokers was 0.59 + 0.034. While in control group 50%[n=30], it was 0.85 + 0.057

Conclusion: From the results, it was concluded that cigarette smoking lowers the bilirubin antioxidant concentration

Association of serum bilirubin concentration with risk of coronary artery disease

Objectives: Objective of this study was to assess the serum bilirubin concentration [within the reference range] as a marker for coronary artery disease [CAD]

Study Design: It was a descriptive cross sectional study and simple random sampling technique was adopted for the proceedings

Place And Duration: The study was conducted in the Department of Biochemistry and Cardiology at Sheikh Zayed hospital Lahore over a period of one year

Methodology: Thirty known patients of CAD diagnosed by angiography were selected. Same numbers of healthy controls were selected

Results: The results have shown that there was a significant difference in serum bilirubin levels of both groups, when compared statistically

Conclusion: The study suggests an inverse association between serum bilirubin concentration [within the reference range] and risk of CAD and it can be used as a marker to assess predisposition towards ischemic heart disease

novel multiplex PCR for detection of pseudomonas aeruginosa: a major cause of wound infections

Wound infections are often difficult to treat due to various bacterial pathogens. Pseudomonas aeruginosa is one of the common invaders of open wounds. Precise diagnosis of this etiological agent in wound infections is of critical importance particularly in treatment of problematic cases. The existing diagnostic methods have certain limitations particularly related to specificity. Our objective was to establish a comprehensive and reliable multiplex PCR to confirm diagnosis of P. aeruginosa. A multiplex PCR test was developed for rapid and comprehensive identification of P. aeruginosa. Four highly specific genes were targeted simultaneously for detection of genus, species and exotoxin production [16S rDNA, gyrB, oprL and ETA] in P. aeruginosa; additionally one internal control gene invA of Salmonella was used. The specificity of the multiplex PCR was confirmed using internal and negative controls. Amplified fragments were confirmed by restriction analysis and DNA sequencing. The developed method was applied on 40 morphologically suspected P. aeruginosa isolates [from 200 pus samples] and 18 isolates were confirmed as P. aeruginosa. In comparison, only 12 could be identified biochemically. Combination of the four reported genes in multiplex PCR provided more confident and comprehensive detection of P. aeruginosa which is applicable for screening of wound infections and assisting treatment strategy

Current status of fluoroquinolone and cephalosporin resistance in Salmonella enterica serovar Typhi isolates from Faisalabad, Pakistan

Currently fluoroquinolones and cephalosporins are at the forefront of typhoid treatment. The objective of this study was to assess the current drug resistance status of S. Typhi isolates from Faisalabad region by conventional and molecular methods. Drug resistance pattern of 30 clinical isolates [2011] against 8 drugs [nalidixic acid, ciprofloxacin, ofloxacin, gatifloxacin, cephradine, cefixime, ceftriaxone and cefpodoxime] was determined. MICs were noted by E-test. ESBL production was also tested. Relevant drug resistance genes bla[TEM], bla[OXA], gyrA, gyrB, parC, parE, qnrS and qnrA were targeted and QRDR regions of gyrA, gyrB, parC, and parE were sequenced for mutations. Nalidixic acid and ciprofloxacin resistance were seen in 30.0% and 10.0% of isolates respectively. No resistance was detected towards ofloxacin and gatifloxacin. Resistance to cephradine, cefixime, cefpodoxime and ceftriaxone was found in 46.7%, 13.3%, 16.7%, and 3.3% of isolates respectively. In ciprofloxacin resistant isolates a single mutation at codon Ser83 in gyrA gene was detected. A slow increase in ciprofloxacin resistance was indicated. However, newer fluoroquinolones ofloxacin and gatifloxacin are still very effective. Among cephalosporins, ceftriaxone showed promising results but emerging resistance was evident. Fortunately no ESBL producing isolate was detected. No correlation between two groups was detected in emergence of drug resistance

Outcome of therapeutic penetrating keratoplasty in non healing microbial keratitis

Purpose of Study: To study the outcome of therapeutic penetrating keratoplasty in non healing microbial keratitis

Materials and Methods: This prospective, interventional case series was done in Ophthalmology department, Madina Teaching Hospital, Faisalabad. The duration of this study was 3 years, from 1[st] April 2007 to 31[st] March 2010. The patients were selected from the out patient department of Madina Teaching Hospital Faisalabad. Penetrating keratoplasty was performed in these patients. In the postoperative period the patients were assessed on the basis of [1] eradication of infection, [2] graft clarity, [3] post-operative visual acuity and [4] complications

Results: Out of 32 patients 20 [62.5%] were males and 12[37.5%] were females. Among the etiological agents 16[50%] were bacteria, 8[25%] were fungi, 2[06%] were viral and in 6[19%] of the patients no growth was found. The pre-operative visual acuity in 22[68.75%] patients was less than 6/60, in 07[21.87%] was 6/60-6/18 and in 3[9.37%] patients it was more than 6/18. The post-operative visual acuity in 7[21.87%] patients was less than 6/60, in 20[62.50%] was 6/60-6/18 and in 5[15.62%] patients it was more than 6/18.Clear grafts were obtained in 20[62.5%] of the patients. Therapeutic success was achieved in 29[91%] patients while recurrence of infection occurred in 03[9%] of the patients

Conclusion: This study confirmed that therapeutic penetrating keratoplasty is an effective procedure for the management of microbial keratitis not responding to the medical therapy

Nested PCR based diagnosis of salmonella enterica serovar paratyphi a directly from blood samples

Development of a rapid, reliable PCR - based method for molecular identification of Salmonella enterica serovar Paratyphi A directly from blood samples. S. Paratyphi A isolates were used for regular PCR targeting specific region of fliC-a gene. New primers were designed and conditions were optimized for a nested PCR that could be directly applicable on blood samples. The procedure was tested on 70 blood samples from suspected cases of typhoidal infection and comparison made with blood culture. Blood culture was able to diagnose only four patients as infected with S. Paratyphi A. Regular PCR was unable to detect S. Paratyphi A directly from blood where as nested PCR detected S. Paratyphi A in blood of thirteen patients. S. Paratyphi A, which is emerging as a major pathogen can be detected with better sensitivity by nested PCR as compared with blood culture

Prevalence of hepatitis-C in Faisalabad region of Pakistan

To study the prevalence of HCV in a population attending Madina Teaching Hospital, Faisalabad for ophthalmic procedures. It is a retrospective audit of patients found to be HCV positive on routine testing, attending Madina Teaching hospital, Faisalabad for ophthalmic procedures. Anybody who required a surgical intervention is routinely screened for hepatitis B and hepatitis C in this department for last number of years. A total of 1027 patients from June 2007 to August 2007 [3 months] were selected for the study. Among them 278 [27.06%] were found to have HCV antibodies in their serum and 749 [72.93%] were HCV antibody negative. In HCV positive group 158 were males [56.83%] and 120 females [43.16%]. Furthermore it was more prevalent in age group 50 - 70 years in both sexes. Hepatitis C is significantly more prevalent in Faisalabad region than reported previously. Also it is more common in age group 50 to 70 years and is equally distributed in both sexes. Cause [s] of this distribution is unknown and should be investigated

Differentiation of common gram negative pathogens by PCR- ribotyping

Gram negative bacteria especially members of family Enterobacteriaceae are among the most frequently isolated organisms from the clinical specimens. Rapid diagnosis of the pathogen in a clinical sample is always very important. Conventional methods are time-consuming. Among molecular techniques, PCR is very useful but unless very specific primers are used, non-specific amplifications are a problem. PCR-ribotying is a technique that gives very specific multiple bands by use of a single primer set. This study was designed to establish patterns for five common pathogens of Enterobacteriaceae, namely Escherichia coli, Salmonella enterica serovar Typhi [Salmonella Typhi], Proteus vulgaris, Klebsiella aerogenes, and Cirtobacter freundii along with another very common and problematic gram negative pathogen Pseudomonas aeruginosa. Each species gave a specific ribotyping pattern. Escherichia coli gave four amplification products of 1200, 850, 800, and 700 bps. Four amplification products of different sizes were also observed in Citrobacter freundii [3000, 850, 700, and 580 bps], Proteus vulgaris [900, 800, 750 and 700 bps], and Klebisella aerogenes [3000, 870, 700 and 520 bps]. More discrimination with five amplification products was seen in Salmonella Typhi [3000, 1200, 900, 850, and 700 bps]. On the other side of spectrum was Pseudomonas aeruginosa only a single amplification product of 750 bps was observed. PCR-ribotyping can very efficiently and specifically differentiate between opportunistic gram negative human pathogens

Significant incidence of typhoid in hepatitis C patients

Only proven way of transmission of Hepatitis C is through blood. The origin is unknown in nearly half the cases. Pollution is suspected as a cause but it is impossible to prove this relationship directly. We thought that typhoid being a proven pollution related disease, determination of its confection in Hepatitis C patients representing same Socio-economic group would be of interest. A typhoid in Hepatitis C patients can easily be overlooked because symptoms like fever and abdominal discomfort are present in both diseases. Blood samples were collected from three groups of study as mentioned in materials and methods. These samples were processed for 4[th] generation HCV ELISA. PCR for HCV, PCR for typhoid. Blood culture for typhoid and widal test as required [details are given in methodology]. Finally the data thus obtained was analysed and conclusions were drawn. Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering [NIBGE] and Millat Laboratory Faisalabad. April 2004 to Oct 2004. The parameters included were PCR, blood culture and widal test. There were three groups of study, PCR and ELISA positive patients of Hepatitis C [105] - further subdivided into two groups, with history of exposure to known causes of spread of HCV in last one year [65] and those without such history [40]; clinically diagnosed cases of typhoid [30]; and healthy controls [50]. In the three groups, PCR was positive in 9.5[7.7 and 12.5], 63.3, and 2.0% cases respectively. Figures for blood culture were 4.7[3.1 and 7.5], 33.3, and 0% in the same order, and the respective figures for widal test were 34.2[33.8 and 35.0], 56.6, and 24.0%. The increase in PCR and blood culture positivity in Hepatitis C cases as compared with normal subjects is statistically significant [P< 0.05]. These results clearly suggest that the source of infection for the two diseases is same in many cases, and therefore, provides a strong indication of a relationship between pollution and Hepatitis C

Response of the adult female rats to ovariectomy as determined by luteinsing hormone radioimmunoassay

This study was carried out to see the response of ovariectomy in adult female rats as determined by rat Luteinising Hormone [rLH] Radioimrnunoassy [RIA]. Animals were divided in two groups. Group I [control, n=6] were sham ovariectomised and group II [experimental, n=4] were ovariectomised. Next day at 1400 hours rats were sacrificed and their plasma was collected for rLH, RIA. It was observed that there was highly significant increase in plasma rLH [P<0.001] in experimental group as compared to controls. Also the increase in the weights of hypothalamus and anterior pituitary of experimental group was highly significant [P<0.001] as compared to controls. This shows that this rise in plasma rLH and weights of hypothalamus and anterior pituitary was due to loss of negative feed back effect of ovarian steroids