Positive Response to Fluorouracil and Oxaliplatin in Signet Ring Cell Adenocarcinoma of the Bladder Presenting With Retroperitoneal Fibrosis.

Bladder adenocarcinoma is an uncommon type of bladder cancer. Signet ring cell pathology is a rare subtype of bladder adenocarcinoma. Global incidence rates of signet ring cell adenocarcinoma of the bladder have not been established. Management of signet cell bladder cancer is challenging as it is aggressive in behavior with frequent relapse despite chemotherapy. Here we present a case of stage IV signet cell bladder cancer with retroperitoneal fibrosis treated with FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) regimen with a complete durable response.

Efficacy of Venetoclax and Dexamethasone in Refractory IgM Primary Plasma Cell Leukemia with t(11;14) and TP53 Mutation: A Case Report and Literature Review.

Primary plasma cell leukemia (pPCL) is an uncommon disease. IgM multiple myeloma (MM) is an infrequent subtype that accounts for less than 1 percent of MM cases. IgM pPCL is quite rare with only a few cases published to date. We describe a case of a patient with IgM pPCL who initially presented with hyperviscosity syndrome requiring urgent plasma exchange. His bone marrow biopsy demonstrated t(11;14). He progressed on proteasome inhibitors, immunomodulating agents, and other chemotherapy medications but later achieved very good partial response (VGPR) to venetoclax and dexamethasone. Given the poor prognosis of pPCL, further studies using venetoclax alone or in combination with other novel agents as first-line treatment options are warranted particularly in patients with t(11;14).

Risk of new-onset atrial fibrillation and stroke after radiofrequency ablation of isolated, typical atrial flutter.

BACKGROUND: Radiofrequency ablation (RFA) is considered a curative procedure for typical atrial flutter (AFL); however, patients remain at risk for developing new atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine the incidence and predictors of new-onset AF and stroke after RFA of isolated AFL in a multicenter cohort. METHODS: The study included 315 consecutive patients who underwent successful RFA of isolated, typical AFL from 2006 to 2013 at 4 community and teaching hospitals. Patients with any history of AF prior to RFA were excluded. RESULTS: During 2.5 ± 1.8 years of follow-up after RFA, 80 patients (25%) developed new AF. In multivariate analysis, after adjusting for baseline medical therapy, obstructive sleep apnea and left atrial enlargement were independently associated with the development of new AF. Presence of a cardiac implantable electronic device (CIED) was associated with a 3.6-fold (95% confidence interval 1.9-6.6, P <.0001) increase in the likelihood of AF detection. New AF was detected in 48% of patients with CIED and 35% of those who underwent Holter ECG vs 19% of those with clinical follow-up only (P <.0001). Anticoagulation was stopped in 58% patients an average of 3.3 ± 4.8 months after RFA. Stroke occurred in 3 patients (1%) during the follow-up period. CONCLUSION: New AF occurs in ≥25% of patients after RFA of isolated typical AFL, but stroke is relatively rare. Obstructive sleep apnea and left atrial enlargement are risk factors for AF. The presence of a CIED significantly enhances the likelihood of detecting new AF, demonstrating the importance of arrhythmia surveillance after RFA of AFL.

Factors associated with Helicobacter pylori infection, results from a developing country - Pakistan.

BACKGROUND: It is known that blood group antigens are related to the development of peptic ulcer and gastric carcinoma. Infections due to H. pylori are most widespread among the developing regions due to poor standard of public health. This study sought to determine the association of H. pylori with ABO blood groups, age, gender, and smoking status among inpatients at a public sector hospital in Karachi. MATERIALS AND METHODS: A cross-sectional study was conducted at endoscopy suite at a public sector hospital in Karachi in the year 2011. All the symptomatic patients coming for upper GIT endoscopy were included in this study. RESULTS: Biopsy for histopathology was taken from 93 patients, with an age range from 15-65 years. Age group of 15 to 20 years was found to be associated with H. pylori infection but without significance (p-value 0.83). In all, 36 (38.7%) turned out to be H. pylori positive with a significant male preponderance (p=0.04). Distribution of ABO blood groups in H. pylori positive group were A=31.4%, B=15.4%, AB=25.0% and O=53.7%, with a statistically significant link for blood group O (p=0.05) . Rhesus factor was also compared but significant relationship was evident (p-value 0.73). CONCLUSIONS: This study demonstrated that H. pylori infection can be related to ABO blood group, middle age persons and male gender. People of blood group O are more prone to develop infection related gastritis, ulcers, and even perforations, so they should be more cautious against transmission of the bacterium.

Smoking practices and nicotine dependence among adolescents in Pakistan.

OBJECTIVE: To find out the smoking prevalence and associated factors among in-school and out-of-school adolescents and their nicotine dependence. METHOD: The cross-sectional study was conducted from April to June 2008 comprising 1014 adolescents aged 12-18 years residing in two rural districts of Sindh and Punjab. Trained interviewers collected information from the adolescents regarding age, ethnicity, religion, occupation and education of parents, smoking behaviour, smoking history of family/friend, type of family system, number of siblings and place of residence. Statistical package Epi-Info version 6 was used to enter the data and analysis was performed by using SPSS version 12. RESULTS: Overall smoking prevalence among the 1014 adolescents was 15.2%, with significant gender stratification (7.9% among girls versus 20.2% among boys). Of these, 50% were moderately nicotine dependent. However, the prevalence among in-school adolescents (14.6%) was not significantly different from out-of-school adolescents (16.1%). The factors associated with adolescents' smoking were father's illiteracy (adjusted odds ratio [OR] = 8.2), friend's smoking (adjusted OR = 6.8), father's smoking (adjusted OR = 5.4) and nuclear family setup (adjusted OR = 3.6). When explored for the first place of smoking, friends' home was mentioned by majority of adolescents boys and girls. CONCLUSION: Although there was a significant difference found between the prevalence of smoking among adolescent males and females, but any difference among in-school and out-of-school adolescents smoking prevalence could not be established.

Use of smoke-less tobacco amongst the staff of tertiary care hospitals in the largest city of Pakistan.

BACKGROUND: Use of smoke-less tobacco (SLT) is very common in South and South-East Asian countries. It is significantly associated with various types of cancers. The objectives of this study were to assess the proportion of hospital staff that use SLT, and to identify the factors associated with its use and their practices. METHODS: In a cross-sectional study, 560 staff of two tertiary care hospitals were interviewed in the year 2009. Nurses, ward boys and technicians were counted as a paramedic staff while drivers, peons, security guards and housekeeping staff were labeled as non-paramedic staff. SLT use was considered as usage of any of the following: betel quid (paan) with or without tobacco, betel nuts with or without tobacco (gutkha) and snuff (naswar). RESULTS: About half (48.6%) of the hospital staff were using at least one type of SLT. Factors found to be statistically significant with SLT were being a male (OR=2.5; 95% CI=1.8-3.7); having no/fewer years of education (OR=1.7; 95% CI=1.2-2.4) and working as non-paramedic staff (OR=2.6; 95% CI=1.8-3.8). Majority of SLT users were using it on regular basis, for >5 years and keeping the tobacco products in the oral cavity for >30 minutes. About half of the users started due to peer pressure and had tried to quit this habit but failed. CONCLUSION: In this study, about half of the study participants were using SLT in different forms. We suggest educational and behavioral interventions for control of SLT usage.