A different strategy for management of a case of adenoid cystic carcinoma of bartholin gland

Adenoid cystic carcinoma of the Bartholin gland is a rare vulval cancer. Available literature suggests an aggressive nature with protracted clinical symptoms and local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. This case demonstrates the role of neoadjuvant chemotherapy and interstitial brachytherapy with less radical surgery, in the treatment of adenoid cystic carcinoma of the Bartholin gland. A 63-year-old woman presented in the clinic four months after the removal of vulvar mass with histopathology report showing adenoid cystic carcinoma of the Bartholin gland with positive margins. Clinical examination and imaging showed local disease extension up to the levator ani and abutting anal margin. She was given four cycles of neoadjuvant chemotherapy followed by ipsilateral hemivulvectomy with inguino-femoral lymphadenectomy followed by 25 cycles of external beam radiation and three cycles of interstitial brachytherapy. The patient has been disease free for more than 30 months. The use of neoadjuvant chemotherapy in treatment of Bartholin carcinoma along with conser vative surgery and radiotherapy can be a good treatment strategy as it reduces the morbidity associated with radical surgery without recurrence to date

Desire to limiting child birth and the associated determinants among married females: Sukh survey-Karachi, Pakistan

Objective: High rates of population growth negatively influence the social and economic development of a country. This study aimed to determine the women\u27s desire to limiting child birth in future (fertility intention) and its determinants among Pakistani women of reproductive age resident of Karachi.Methods: A community-based, multistage cross-sectional study was carried out among residents of the squatter settlements in Karachi. The were 4,485 married residents, and currently non-pregnant females of 18 to 49 years old. Framework adapted has been based on Pullum 1980 to operationalize the outcome of determining the desire to limiting childbearing and the factors related with controlling the family size. Multivariable logistic regression using SPSS 13.0 was used.Results: The survey comprised of a total sample of 4485 females who participated and acquiring a median (interquartile range) age of 30 (25 to 35) years. Whereas, the living children count was found to be [median: 3 children; (IQR: 2 to 4)]. From the total, 2109 (47%) wanted to limit the future child birth. Multivariable logistic analysis showed that women who did not want to limit child birth significantly (p-value 37 years (referent category), who belonged to poor wealth category (aOR=0.41), were ever contraceptive users (aOR=0.49), were currently not a contraceptive user (aOR=0.53), not educated (aOR=0.34), and having sons less than the daughters (aOR=0.74). Conversely, females with perceived family structure of ≤two children ideally (aOR=2.62), were autonomous (aOR=1.25) and who had equal daughters and sons (aOR=1.13) rather than more number of sons, had more probability to limiting child birth at a statistically significance (p-value) of less than 0.05.Conclusions: The survey highlights the strategic independent determinants and there is a need of devising behaviour modification modalities accordingly to expedite the use of contraceptive methods and to encourage fertility decline among women

Association of Etiological and Pathological Features of Brain Abscess with Outcome

To study the etiological andpathological factors of brain abscess and to relatewith the final outcome.Methods: In this observational study patients withbrain abscess were observed in detail with theclinical profile, etiology, microbiology and theirfinal outcome after one year.Chi-square test wasapplied to associate etiological and pathologicalfactors with management outcome.Results: The majority of patients were in their 2ndand 3rd decade of life with two third proportioncomprising of males. The most frequent etiologicalfactor was chronic suppurative otitis media (CSOM)( 55%),followed by head injury (12% ) and congenitalheart disease (10%). Microbiological data revealed16% streptococci, 10% staph. aureus, 7% staph.epidermidis and 5% proteus as major pathogens inthe study patients. Head injury and CSOM werefound associated with death and morbidity in thisstudy.Conclusion: Brain abscess has multi dimensionalcauses. CSOM and head injury were foundassociated with death and severe morbidity ashemiparesis and fits. CT findings andmicrobiological data were not associated withoutcome

Miniaturized and flexible FSS-based EM shields for conformal applications

This article reports on very efficient and highly miniaturized wideband polygon-shaped frequency selective surface (PFSS) shields for the planar and conformal applications in the X-band. These shields have been analyzed for both lossy as well as for low-loss substrates. The conformal configurations of PFSS are particularly investigated for inward, outward, and double-curved profiles useful for a variety of applications. The conformal designs have been tested for two different radii of curvatures. The models have been simulated using a hybrid simulation approach for electrically large geometries. The equivalent circuit model as well as the analytical model are determined. The proposed PFSS designs offer stable angular response up to 60° for planar and all conformal geometries on both lossy and low-loss prototypes. Shielding effectiveness of at least 55 dB and 48 dB has been measured for flat/nonconformal and conformal configurations, respectively

Availability and helpful environment of school health services in Rawalpindi and Islamabad region

Objective: To assess the status of health services and environment in the public and private schools of Rawalpindi and Islamabad.Methodology: A cross sectional study was conducted at Islamabad Medical and Dental College, Islamabad from April to September 2017. A survey was done in the schools of Rawalpindi and Islamabad through a questionnaire, distributed to the school heads and/or administrators. The study outcome was measured in terms of status of school health services and health environment.. Out of the total list of government, private and semi government schools the number for visit and interview was selected systematically. Data was entered and analyzed by using SPSS 20 version. Results: Overall 60.1% schools had a health team. Health teams were found in 47.6% of government, 58.3% of private and 80.0% of semi government schools. Only 42.4% had received any health-related training for students or personnel in the schools, 28.3% schools had presence of doctor while 30.9% had a nurse. Safe drinking water and adequate washroom facility was available in majority of schools along with playing area and proper lighting and ventilation condition. Conclusion: School health services are very poor at the schools in Rawalpindi and Islamabad region. There is lack of health training for students and staff with only 42.4% getting it

Pattern of Antimicrobial Sensitivity and Resistance in Large Series of Indoor Patients at a Tertiary Care Hospital

Objective: In the era of increasing antibiotic resistance, associated with increasing hospital stay and morbidity, the purpose was to define guidelines for antibiotics in different clinical situations. Patients and Methods: This study was conducted at Khan Research Laboratories Hospital, Islamabad, Pakistan, from July 2014 to December 2016. 3277 patients admitted in Medical, Surgical, Gynaecology & Obstetrics, ENT, Eye and Dental departments were included. Positive cultures from different sources including blood, urine, pus, central venous lines, bronchial washings and cervical swabs were taken. Age, gender, common pathogens, their sensitivity and resistance to 27 antimicrobial drugs were taken into account. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis. Results: 53.1% (n=1738) were females while 46.9% (n=1539) were males.2800 samples were available for analysis. Majority of the patients belonged to Medical ward, 56.9% (n=1864). Major source of culture was urine, 38.3% (n=1073). Escherichia coli (E. coli) was the most common isolate 51.3% (n=1436) followed by Staphylococcus aureus 19.9% (n=558). E. coli showed maximum sensitivity to Imipenem i.e. 94% (n=1349) followed by Amikacin, 93% (n=1335). It was resistant to ceftriaxone (77%).Staphylococcus aureus showed maximum sensitivity to Linezolid and Vancomycin i.e. 98% (n=548) followed by Chloramphenicol 84% (n=470), while being resistant to ciprofloxacin and levofloxacin (54%). Klebsiella pneumoniae showed maximum sensitivity to Imipenem i.e. 75%, while showing resistance to Amoxicillin/Clavulanic Acid (95%) and Ceftriaxone (80%).Staphylococcus epidermidis showed maximum sensitivity to Linezolid i.e.99%. Pseudomonas aeruginosa showed maximum sensitivity to Piperacillin and Tazobactam i.e. 76% . Acinetobacter baumannii showed maximum sensitivity to Colistin i.e. 91%.Salmonella typhi showed maximum sensitivity to Ceftriaxone i.e. 99% while resistance to Ciprofloxacin (94%).Enterococcus faecalis showed maximum sensitivity to Linezolid i.e.100% and Salmonella Paratyphi A showed maximum sensitivities to Cefixime and Ceftriaxone i.e 100% Conclusion: Antibiotic resistance is emerging. Rationale use of antibiotics is required to curtail the surge of antibiotic resistance. There is also a need to modify treatment guidelines in different clinical situations based on local sensitivity and resistance patterns in order to reduce hospital stay, morbidity and mortality.&nbsp

ANALYSIS OF MORTALITY IN PATIENTS ADMITTED IN MEDICAL INTENSIVE CARE UNIT OF KHAN RESEARCH LABORATORIES HOSPITAL, ISLAMABAD, PAKISTAN

OBJECTIVE: This study was conducted to ascertain the causes of death and mortality rate in patients admitted to medical intensive care unit (ICU) of Khan Research Laboratories (KRL) Hospital, Islamabad, Pakistan. METHODS: Current study enrolled 775 patients admitted in Medical ICU of KRL Hospital, Islamabad, Pakistan from April 16, 2016 till April 16 2017. KRL Hospital is a 350 bedded hospital and has a 13-beded level II ICU. This was a descriptive study involving non-probability consecutive sampling. Statistical analysis was done using statistical package for social sciences (SPSS version 20). RESULTS: Out of 775 patients, 125 (16.1%) patients died. Out of these 125 patients, 68 (54.4%) were males and 57 (45.6%) were females. Majority of patients (n=69; 55.2 %) were ranging in age from 71-100 years of age, while 37 (29.6%) patients were ranging in age from 56-70 years and 19 (15.2%) were less than 55 years of age. Among the deceased, pneumonia was the most common reason (n=49; 39.2 %) for admission followed by urinary tract infection (n=16; 12.8%) and septicemia (n=14; 11.2%). Hypertension (n=33; 26.4%) was the most common co-morbid followed by diabetes mellitus (n=24; 19.2 %) and ischemic heart disease (n=18; 14.4 %). CONCLUSION: More than half of deceased patients admitted to ICU had age more than seventy years. Sepsis related conditions were responsible for death in more than sixty percent of patients. Majority of patients had diabetes mellitus, hypertension or ischemic heart disease as co-morbid conditions

Histomorphological effects of sodium arsenite on uterus of rats

Background: Arsenic is highly toxic agent and a risk factor for disease and disability. Arsenic is present in drinking water of many developing and developed countries including Pakistan and due to rapid industrialization its quantity in soil and water is increasing day by day.Methods: In an 18 month study in which we took two principal groups, labelled as control group A and experimental group B. The animals of experimental group B were administered 4 µg of sodium arsenite dissolved in 10 ml of distilled water by oral gavage daily for 14 days. The uterus was removed and processed for paraffin embedding and stained with hematoxylin and eosin (H and E). The histological parameters; uterine luminal diameter, height of uterine luminal epithelium, area occupied by epithelial component of uterine glands and the thickness of myometrium were measured and evaluated by civil AutoCAD 2013 software. The data was analyzed statistically with the statistical package for social sciences (SPSS).Results: Histological results showed the degenerative effects. The luminal diameter of uterine horns was reduced in experimental animals. The height of uterine epithelium was reduced. Area occupied by epithelial component of uterine glands was reduced along the reduction in the thickness of myometrium.Conclusions: The histological abnormalities observed in uterus showed that the degenerative effects may be due to oxidative stress produced by the exposure to sodium arsenite. As sodium arsenite produces the oxidative stress by the formation of free radicals and by the denaturation of proteins

We won\u27t go there: Barriers to accessing maternal and newborn care in district Thatta, Pakistan

Accessibility and utilization of healthcare plays a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing services. The aim of this study was to explore the multifaceted barriers that inhibit women from seeking maternal and newborn health care in Thatta, Sindh, Pakistan. This study employed an interpretive research design using a purposive sampling approach. Pre-tested, semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. The study identified individual, sociocultural, and structural-level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included mistrust towards public health facilities and inadequate symptom recognition. The three identified sociocultural barriers were aversion to biomedical interventions, gendered imbalances in decision making, and women\u27s restricted mobility. The structural barriers included ineffective referral systems and prohibitively expensive transportation services. Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers

Construction and Optimization of TRNG Based Substitution Boxes for Block Encryption Algorithms

Internet of Things is an ecosystem of interconnected devices that are accessible through the internet. The recent research focuses on adding more smartness and intelligence to these edge devices. This makes them susceptible to various kinds of security threats. These edge devices rely on cryptographic techniques to encrypt the pre-processed data collected from the sensors deployed in the field. In this regard, block cipher has been one of the most reliable options through which data security is accomplished. The strength of block encryption algorithms against different attacks is dependent on its nonlinear primitive which is called Substitution Boxes. For the design of S-boxes mainly algebraic and chaos-based techniques are used but researchers also found various weaknesses in these techniques. On the other side, literature endorse the true random numbers for information security due to the reason that, true random numbers are purely non-deterministic. In this paper firstly a natural dynamical phenomenon is utilized for the generation of true random numbers based S-boxes. Secondly, a systematic literature review was conducted to know which metaheuristic optimization technique is highly adopted in the current decade for the optimization of S-boxes. Based on the outcome of Systematic Literature Review (SLR), genetic algorithm is chosen for the optimization of s-boxes. The results of our method validate that the proposed dynamic S-boxes are effective for the block ciphers. Moreover, our results showed that the proposed substitution boxes achieve better cryptographic strength as compared with state-of-the-art techniques