Diagnostic Accuracy of Doppler Ultrasound in Diagnosis of Prostatic Neoplastic Etiology Recognizing Histopathology as the Gold Standard

Objective: To utilize histopathology as the gold standard, ascertain the diagnostic accuracy of doppler ultrasound inthe detection of prostatic neoplasm utilizing histopathology as gold standard.Methodology: Study was conducted at the Radiology Department Rawalpindi Medical University from 20thSeptember 2021 to 19th February 2022. A cross-sectional descriptive type, consisting of 157 male patients agedbetween 50 to 80 years with elevated prostatic serum antigen (PSA) and prostatomegaly on trans-abdominalultrasonography. Patients, who have previously been diagnosed with prostate cancer, took chemotherapy forprimary or secondary cancers and h/o radiation therapy were excluded. Trans-abdominal gray-scale and dopplerultrasound examinations were performed and gray-scale trans rectal ultrasound (TRUS) was performed on patientswith inconclusive trans-abdominal ultrasound. Representative photos with any focal lesions were recorded. Biopsywas performed with TRUS or transurethral resection of prostate (TURP) and follow up with biopsy report.Results: 80 (True Positive) of the 88 individuals with Doppler USG positivity for prostate cancer had the disease, whileonly 8 (False Positive) did not, according to histopathology. Among 69 patients who tested negative for Doppler USG,13 (False Negative) had prostate cancer on histology, while 56 (True Negative) did not. Sensitivity, specificity, positivepredictive value, negative predictive value, and diagnostic accuracy of conjunct Doppler USG on prostatic lesion wascalculated as 86.02 percent, 87.50 percent, 90.91 percent, 81.16 percent, and 86.62 percent, respectively, usinghistopathology as the gold standard.Conclusion: Doppler ultrasound is the non-invasive modality of preference with excellent diagnostic accuracy foridentifying prostate cancer.Keywords: Doppler Ultrasound; Prostate Cancer; Sensitivit

Role of Herbal Intervention in Reducing Pain and Discomfort in Oral Lichen Planus. A Systematic Review

Introduction: Oral lichen planus is a chronic autoimmune disorder that necessitates prompt treatment aimed at alleviating its symptoms. Evidence to support the efficacy of any singular treatment for oral lichen planus is minimal. Among all possible treatments, steroids are considered the gold standard in oral lichen planus therapy due to their effectiveness. This, however, comes with adverse effects that may exacerbate the patient's already miserable life. Herbal interventions (HIs) were tried in the treatment of OLP as safer alternatives. The most appropriate study to evaluate their efficacy would be a randomized controlled trial (RCT). The present systematic review aims to compare with those of steroids in OLP-related randomized controlled trials. Methodology: PubMed, MEDLINE, the Cochrane Central Register of Controlled Trials, Scopus, and grey literature were searched in this study. Eight studies are perhaps available for review.  The registration number of the article on Prospero is CRD420251111982 Results: Within each study, significant reductions in clinical severity were observed in the groups; between-group differences were not noteworthy. Conclusion: The effectiveness of herbal therapy in OLP must be considered cautiously due to the high risk of bias present in the studies. Keywords: Herbal intervention, Oral lichen planus, Randomized controlled trial, Steroi

Identification of Additional Cytogenetic Abnormalities in Chronic Myeloid Leukemia Cases with t (9;22) Chromosome Translocations

Objective: The objective of this study is to detect additional simple and complex variant translocations with t(9;22) in chronic myeloid leukemia patients. Methodology: This retrospective cross-sectional study was conducted at the hem-oncology department of Dr. Ruth K. M. Pfau Hospital in Karachi. It comprised data from patients between 2015 and 2023. Criteria for the study involved patients diagnosed with CML through blood count, bone marrow biopsy, and cytogenetic or molecular biology, showing additional chromosomal abnormalities, whether they are inpatients or outpatients of chronic myeloid leukemia. Results: A total of 88 patients were Philadelphia-positive CML, out of which 53 (60.2%) were males & 35 (39.7%) were females. The mean age was 48 yrs ± 11.43. The group of 9 (10.2%) patients who harbor these complex variant translocations are comprised of 4 males and 5 females; the age range of these patients at diagnosis is from 32 to 66 yrs. All the patients were in the chronic phase at presentation. Chromosomal study in CML patients reveals 9 variant translocations with t(9;22)(q34;q11). These three-way variant defects/translocations were observed as 1p13, 1q21, 1p22, 2q31, 3q21, 3p21, 11q13, 15q24, and Xp11.2. Conclusion: In our study, 9 patients had complex variants of t (9;22). These complex variants at diagnosis and during the TKI treatment may announce treatment failure and/or transformation into an advanced stage (accelerated or blast). Keywords: Philadelphia chromosome, Three-way variant translocations, t(9;22)(q34;q11)

Blood Neutrophil to Lymphocyte Ratio as a Predictor of Outcome of Acute Exacerbation of COPD

Objective: To look into the relationship of neutrophil-to-lymphocyte ratio with outcomes in patients presenting with acute exacerbation of COPD. Methodology: This cross-sectional study was conducted at the Department of Medicine, Pakistan Atomic Energy Commission (PAEC) Hospital, Islamabad, over three months. A total of 105 adult patients presenting with acute exacerbation of COPD were enrolled in the study. Patients with significant comorbidities, concurrent infections, or immunocompromised status were excluded. The study investigated clinical outcomes such as mortality, ventilatory support, ICU transfer, and hospital stay. The data were analyzed using SPSS version 20. Results: Elevated NLR was significantly associated with increased systemic inflammation, longer smoking and disease duration, prolonged hospital stay, higher need for ventilatory support, and increased early mortality. Multivariable analysis confirmed elevated NLR as an independent predictor of ventilator requirement and mortality. Conclusion: NLR is a reliable, inexpensive, and readily available biomarker that correlates with disease severity and adverse outcomes in AECOPD and may aid early risk stratification and management decisions. Keywords: Chronic obstructive; Lymphocytes; Mortality; Neutrophils; Pulmonary disease

From Fever to Arthralgia: Unraveling Adult-Onset Still's Disease in Adults. A Case Report

Systemic disorder of unknown etiology, characterized by arthritis, fever, transient rash, and other systemic presentations. We report a case of AOSD with history of high-grade fever, joint pains and clinical examination, which revealed the characteristic Salmon-pink evanescent rash is seen in AOSD, which could have been easily missed as it disappears when fever subsides, and its diagnosis was supported by very high levels of serum ferritin, and we confirmed the diagnosis by fulfilling the Yamaguchi criteria after excluding the other possible diagnoses. She showed a partial response to prednisolone but later was advised to take methotrexate, which resulted in further alleviation of her residual symptoms. Conclusion: Every Fever doesn’t carry an infectious etiology; try to think outside of the box and careful history and examination and in turn, supported by the pertinent investigations, can lead to solve these sorts of enigmatic cases as was done in our case Keywords: Adult-onset still’s disease, AOSD, Arthritis, Evanescent rash, Prednisolone, Yamaguchi criteri

Effectiveness of Platelet Rich Plasma (PRP) in Pain Management of Knee Osteoarthritis

Objectives: To determine mean change in pain score in patients with knee osteoarthritis after intra-articular injection of platelet-rich plasma. Methodology: A quasi experimental study was conducted at the departments of Hematology and Pain Management clinic at Shifa International Hospital Islamabad from 22nd December 2019 to 23 January 2022. A total of 52 patients diagnosed with Osteoarthritis Knee joints, 50 to 70 years of age were included. All patients received intra-articular injection of 5 ml PRP into the affected knee joint. Pain was calculated through Visual Analog Scale (VAS) using numerical scale from 0 to 10 and was measured prior to treatment at 3 and 6 months Results In this study, at baseline, mean pain score was 6.90 ± 1.47 and at 6 months, mean pain score was 1.48 ± 0.89 with p-value of 0.0001. PRP injection in the intra-articular joint was effective in pain management in the early osteoarthritis with an average variation in the level of pain of 5.54 ± 1.55, indicating a substantial improvement following PRP therapy.  Conclusion: Intra-articular injections of platelet-rich plasma are important in reducing pain in patients with mild to moderate knee osteoarthritis and represent an effective therapeutic option for early disease management. Keywords: Intra-articular injection; Osteoarthritis; Platelet-rich plasm

Snake Venom Toxins in Cancer Therapy: Current Advances and Future Perspectives

Background: Cancer remains one of the most serious health challenges worldwide, driving an urgent search for innovative treatments. Efforts to develop effective therapies are ongoing worldwide, with venom and its toxic peptides garnering considerable attention for their therapeutic potential against cancer. Objective: This review aims to evaluate the potential of venom from snakes, highlighting their effects on various cancer cell lines. Methodology: Published literature was examined to identify experimental and preclinical studies reporting anticancer activities of venoms and venom-derived peptides. Studies involving various cancer cell lines and mechanistic evaluations were included.   Results: Studies show that these venoms can inhibit tumor growth, slow down the division of cancer cells, and reduce the progression of the disease. According to recent findings, venoms of snakes demonstrated anticancer activities involving mechanisms like apoptotic, antimetastatic, immunomodulation, multispecific targeting, cytotoxic, antiangiogenic, and antiproliferative. The cancer cell lines, including lung, breast, liver, colorectal, skin, brain, and blood, were inhibited by the venom of these organisms. Conclusion: These findings offer hope, pointing to the potential of venom-based therapies to contribute to future breakthroughs in cancer treatment. Keywords: Cancer therapy, Snake, Toxins, Veno

Serological Detection of Human Toxoplasmosis by using IgG and IgM Antibodies Among Suspected Individuals from Selected Regions of Islamabad, Pakistan

Objective: To determine the prevalence rate of human toxoplasmosis using IgG and IgM antibodies to identify potential risk factors from selected regions of Pakistan. Methodology: A total of 352 suspected individuals were included in the study, with clinical and demographic data collected retrospectively from medical records (2019–2023) and blood samples collected between January 2024 and December 2024 from Rawal General and Dental Hospital, Islamabad. Serological testing for T. gondii IgG and IgM antibodies was performed using chemiluminescent microparticle immunoassay (CMIA). The data were analyzed using SPSS, applying the chi-square test to determine associations, with a significance level of p < 0.05. Results: This study discovered that the prevalence of Toxoplasma varied by age and gender, occurring in those aged ≤10 years and >40 years at rates of 11.5% and 17.6%, respectively (p-value = 0.031). The prevalence of toxoplasmosis infection was higher in females (12.9%) than in males (7.8%) (p-value = 0.030). Conclusion: Toxoplasmosis remains a significant public health concern in urban areas of Pakistan, particularly among vulnerable populations such as pregnant women and older adults. These findings highlight the need for routine screening and preventive measures. Further multicenter studies are recommended to validate these findings and identify additional risk factors like foodborne transmission, environmental exposure, cat contact, demographics, etc. Keywords: Epidemiology, IgG, IgM, Seroprevalence, Toxoplasma gondii, Toxoplasmosis