Level of polychlorinated biphenyls in tumor and blood serum of breast cancer patients and control subjects from Punjab, Pakistan.

The current study examined the level of Polychlorinated biphenyls (PCBs) in tumor and blood serum of female breast cancer patients and control individuals recruited from Punjab, Pakistan. Breast tumor and blood serum from 40 patients and only blood serum from ten control subjects were obtained and concentration of 32 PCB congeners was analyzed through Gas chromatography coupled with Mass spectrophotometry. Sociodemographic variables of the patients along with essential clinical and haematological parameters were taken as covariates. Tumor reflects the highest median (min-max) concentration (ng g-1 lw) of Æ©PCBs at 115.94 (0.05-17.75) followed by 16.53 (0.09-2.94) and 5.24 (0.01-0.59) in blood serum of cancer patients and control group respectively. Median concentrations (ng g-1 lw) of non-dioxine like Æ©PCBs were considerably higher at 83.04, 32.89 and 4.27 compared to 13.03 and 3.50 and 0.97 for dioxin like Æ©PCBs in tumor, serum of breast cancer patients and control subjects respectively. PCB-87 was most dominant congeners in tumor followed by PCB-170 and -82 whereas PCB-28 and -52 reflected greatest contribution in serum of breast cancer patients. Blood haemoglobin, potassium and chloride ions showed significant positive whereas body mass index reflect inverse relationship when regressed with Æ©PCBs in tumor. This pioneer study depicts elevated concentrations of PCBs in patients compared to control, reflecting potential positive association of PCBs with breast cancer which need further confirmation. We concluded that chronic exposure to PCBs might be associated with an increasing number of breast cancer incidences in developing countries like Pakistan, which should be further elucidated through detail in vitro and in vivo studies.

Inhibition of microbial growth by silver nanoparticles synthesized from Fraxinus xanthoxyloides leaf extract.

AIMS: Conventional antibiotics have been failed to treat infectious diseases due to emergence of multidrug resistance (MDR) in some common pathogens. The current study aimed to formulate new antimicrobials from greener sources. In the midst of these efforts, nanotechnology is a newly emerged field, in which the synthesis of new nanoparticles through novel and efficient means is on the rise. METHODS AND RESULTS: The current work has been carried out to assess the potential of Fraxinus xanthoxyloides (FX) leaf extract in biosynthesis of silver nanoparticles (FX-AgNPs). This method is economical and simple one-step approach to synthesize AgNPs. Characterization of FX-AgNPs has been done by UV-Visible spectroscopy, scanning electron microscope (SEM), X-ray diffraction (XRD), transmission electronic microscope (TEM) and Fourier transforms infrared spectroscopy (FT-IR). The formation of FX-AgNPs has confirmed through UV-Visible spectroscopy (at 430 nm) by change of colour owing to surface Plasmon resonance. Based on the XRD pattern, the crystalline property of FX-AgNPs has established. Functional groups existing in F. xanthoxyloides leaf extract are confirmed by FT-IR spectrum. SEM and TEM authenticated morphology of the AgNPs. The newly synthesized nanoparticles were evaluated for their antimicrobial potential. Minimum inhibitory concentration was determined against Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA) strains, Pseudomonas aeruginosa and Candida albicans by microtiter plate assay. The lowest inhibition (69%) observed against MRSA was at a concentration of 50 ppm FX-AgNPs and maximum inhibition (81%) observed was against P. aeruginosa. The biosynthesized AgNPs triggered up to 68·6% reduction of the P. aeruginosa biofilm when compared to the control. CONCLUSION: It can be concluded that nanoparticles could be a better alternative of antibiotics with greater efficacies and represent a valuable milestone to fight against infections caused by MDR pathogens. SIGNIFICANCE AND IMPACT OF THE STUDY: This study imparts a useful insight into the development of a new antimicrobial agent from a novel source.

Nocebo and the potential harm of 'high risk' labelling: a scoping review.

AIMS: A discussion of the existence, prevalence and characteristics of the nocebo effect in health care. BACKGROUND: There is increasing but inconsistent evidence for nocebo effects (the opposite of placebo). Causal mechanisms are believed to be similar to placebo (negative effects result from suggestions of negative clinical outcomes). Risk screening in health care may produce this unintended effect through labelling some patients as high risk. Given health care's almost universal coverage this potentially affects many people. DESIGN: Discussion paper following a scoping review of the existence and frequency of nocebo. DATA SOURCES: Literature databases (PsycINFO, MEDLINE, CCTR, CINAHL and EMBASE) searched from inception dates to 2013. IMPLICATIONS FOR NURSING: Significant empirical evidence indicates that negative beliefs may impact on health outcomes (incidence estimates range from 3-27%). The nocebo effect, rooted in the complex interplay between physiological functioning and social factors, appears significantly more common among women and where prior negative knowledge or expectations exist. Pre-existing psychological characteristics (anxiety, neuroses, panic disorder or pessimism) exacerbate it. CONCLUSION: While the placebo effect is well documented, there has been no systematic attempt to synthesize primary empirical research on the role of nocebo. It is possible that nocebo outcomes may be preventable through careful consideration of information provision and the prior identification of potentially high risk individuals. This paper summarizes the scale and importance of the nocebo effect, its distribution according to a range of social and clinical variables and its known relation to psychological precursors. It identifies important gaps in the research literature.

Effect of the ratios of diameter of silo to bead on the pressure screening in granular columns.

We present the apparent mass measurements at the bottom of granular packings for different bead and silo sizes. The redirection parameter K in Janssen theory is found to increase with the ratios of the diameter of the silo to the bead. We attribute this feature to the friction between the beads and the confining wall of silo; it is the role of friction that leads to variations in the shielding of vertical stresses as well as pressure screening.

D2 gastrectomy for an antral stomach tumour.

The place of a D2 gastrectomy for dealing with an antral stomach cancer inpatients in the West is a matter of continuing debate. This article describes a standardised operative procedure with the aim of achieving a satisfactory clearance of the gastric cancer in the antrum and a systematic removal of the regional draining lymphatics.

Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is one of the mainstays in the diagnosis and treatment of hepatobiliary and pancreatic diseases, and is also increasingly used for patients with previous Billroth II gastrectomy. The aim of this study was to review our experience of ERCP in patients with Billroth II gastrectomy, and the complications associated with this procedure. PATIENTS AND METHODS: The records of 110 patients with Billroth II gastrectomy, treated between January 1993 and December 1997, were received retrospectively. Details noted included indications for ERCP, therapeutic interventions, causes of failure, and complications. RESULTS: A total of 110 patients underwent ERCP; the total number of ERCP attempts was 185. The major indications for ERCP were cholangitis (31%), common bile duct stones (22%), and jaundice (15%). The endoscope was successfully passed up to the papilla in 134 examinations (71%), and selective cannulation was successful in 122 of these (66%). There were 63 (34%) failed ERCP attempts. Causes of failure were: difficulty in entering the afferent loop (n = 19, 10%), failure to enter the duodenum (n = 23, 12%), endoscope-related bowel perforation (n = 9, 5%), and failed cannulation (n = 10, 6%). The other two failures were caused by desaturation in the patient, and inability to distend the duodenum. The major complication of the procedure was perforation, which occurred in 11 examinations (6%). Of these perforations, nine occurred in the small bowel while the endoscope was being manipulated through the afferent loop; these patients required laparotomy. Two patients had retroduodenal perforations, one occurring after sphincterotomy and one after cannulation. Both patients were successfully managed conservatively. Three patients suffered bleeding after sphincterotomy (3/185 procedures, 1.6%), and one patient developed acute pancreatitis. These were managed conservatively. The overall complication rate was 8%. There were two deaths among the patients with small-bowel perforations, and consequently an overall mortality rate of 1% (2/185 procedures). CONCLUSIONS: Most complications of ERCP in patients with previous Billroth II gastrectomy were caused by bowel perforation while the endoscope was being manipulated through the afferent limb. Such perforations are intraperitoneal and require surgical intervention.

Endoscopic management of advanced oesophageal cancer.

Effective palliation of dysphagia is the goal in the majority of patients with oesophageal cancer. A number of methods have been developed to achieve this objective. The choice of method is determined mainly by the physical characteristics of the tumour causing the dysphagia. The low complication rate, ease of insertion as a result of small delivery systems, and the large stent diameters which are achieved with self-expanding metal stents, have made these an increasingly popular alternative compared to other methods.

Comparative evaluation of therapeutic approaches in stage III and IV squamous cell carcinoma of the thoracic esophagus with conventional radiotherapy and endoscopic treatment in combination and endoscopic treatment alone: a randomized prospective trial.

PURPOSE: To define the role of endoscopic dilatation/intubation and radiotherapy in squamous cell carcinoma of esophagus patients to improve their quality of life. METHODS AND MATERIALS: One hundred and four patients with squamous cell carcinoma of the thoracic esophagus having Stage III and IV disease were enrolled in the present study, with 90 patients in Group 1 (nonesophagorespiratory fistula group) and 14 patients in Group 2 (esophagorespiratory fistula group). From Group 1 patients, 47 were subjected to radiotherapy (conventional) and had endoscopic dilatation and/or intubation whenever and wherever required (Group 1a), and 43 patients were allowed to follow the natural course of the disease except palliation with endoscopic dilatation and/or intubation whenever and wherever required (Group 1b). From Group 2, 4 patients received radiotherapy in addition to endoscopic intubation, while 10 patients received only endoscopic intubation. RESULTS: The median survival for Group 1a was 7 months, for Group 1b--3 months, for Group 2a--4.25 months, and Group 2b--3.6 months. Only three patients from Group 1a survived more than 18 months, while no patient from Groups 1b, 2a, or 2b survived for more than 1 year. The difference in survival between Group 1a and 1b was statistically significant. CONCLUSION: The addition of radiotherapy to endoscopic treatment definitely prolongs survival as well as improves the quality of life of these patients. We recommend both for the adequate palliation of patients with this disease.

HLA frequencies in Pakistani population groups.

HLA Antigen A, B and DR frequencies were determined in 912 subjects who were prospective donors and recipients for renal transplantation. Of the 912, 305 were Sindhi, 248 Punjabi, 315 Urdu and 44 Pushto speaking. HLA A1, A2, A11 and A19 were common in all these groups. A3 was more frequent in Pushto, A9 (24) in Punjabi, A10 (26) in Sindhi and A28 in Urdu-speaking group. HLA B5 (51) and B40 (60) were common in all, while B8 in Sindhi and Punjabi, B35 in Sindhi, Urdu and Pushto and B27 in Punjabi and Urdu speaking individuals. HLA-DR3 and DR2 (15) were common in all groups. DR6 (13) in Sindhi, Urdu and Pushto and DR6 (14) in Punjabi, DR5 (11) in Urdu, Punjabi and Pushto speaking subjects. Overall, Pakistani frequencies showed linkage to Caucasians and Orientals. This paper describes differences in frequencies in various population groups within Pakistan which may have relevance in factors where HLA system plays a crucial role.