Metastatic pancreatic carcinoma and experience with FOLFIRINOX - a cross sectional analysis from a developing country

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources.MATERIALS AND Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a pre-designed, coded questionnaire looking at patient characteristics, treatment given and outcome.Results: 101 patients were found to be eligible. Mean age was 56.7 ± 12.8 years, the male to female ratio was 2:1 and most patients had a good performance status. More than half of the tumors were located in the head (57%, n=58) and almost all were adenocarcinomas (95%, n=96). Some 58% (n=59) received first line chemotherapy of which 49% (n=29) received gemcitabine-based regimens and 39% (n=23) received FOLFIRINOX. The median progression free survival for gemcitabine based treatment was 2.9 months (IQR=1.6-5.6) as opposed to 7.3 months (IQR=4.5-9.2) for FOLFIRINOX (P=0.02). Median overall survival was 4.9 months (IQR=2.3-9.5) for first line gemcitabine based treatment and 10.5 months (IQR=7.0-13.2) for first line FOLFIRINOX therapy (P=0.002). Patients on FOLFIRINOX had better survival across all subgroups. Inpatient admissions and dose reductions were more frequent with FOLFIRINOX but the difference between the two regimens was not statistically significant. FOLFIRINOX could be successfully administered as outpatient therapy to a number of patients.CONCLUSIONS: FOLFIRINOX remains a suitable first line option in patients with metastatic pancreatic cancer with good performance status even in a resource-poor country where diagnostic and supportive care facilities may be less than optimal and cost is a limitation

Incidence of venous thromboembolism in cancer patients treated with cisplatin based chemotherapy - a cohort study

Background: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.Methods: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals.Results: The baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4±10.7years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 - 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 - 6.8) compared to the control group.CONCLUSION: A high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens

Difficulty breathing or just a case of the nerves? Incidental finding of primary pleural schwannoma in a COVID-19 survivor

Schwannoma is a rare tumor that arises from the Schwann cells, which are specialized, myelin-producing cells of the peripheral nerve sheaths. As anatomic logic would dictate, these masses commonly occur in the skull base, cerebellopontine angle, and posterior spinal roots. Of this already rare entity, rarer still are the pleural schwannomas, representing approximately 1-2% of thoracic tumors. These tumors commonly affect adults with a propensity for the third and sixth decades of life and a comparative male predilection. Schwannomas are benign, indolent, and follow an asymptomatic course. As such, they often come to light incidentally.Here we report a case of primary pleural schwannomas in a 68-year-old female, found incidentally on a CT scan of the chest. To the best of our knowledge and literature review, no other similar case has been reported in our country, Pakistan. Around three weeks before her presentation, she was diagnosed with COVID-19. Her infection had run a mild course with quick recovery without the need for any hospitalization. Therefore, the manifestation of shortness of breath after resolution of all other symptoms prompted a further workup. Radiographic chest x-ray revealed an incidental finding of a large right upper lobe lung mass, slightly impinging on the trachea. This was followed by a chest CT scan at our radiological imaging facility, which showed a large, well-encapsulated, right upper lobe lung mass in the paraspinal apical location. She then underwent an image-guided biopsy of the aforementioned mass, pathological analysis of which was suggestive of a benign peripheral nerve sheath tumor (PNST) arising from the pleura (pleural schwannoma). She underwent right posterolateral thoracotomy with uneventful complete surgical removal of the pleural-based lung mass. Postoperative investigations included a chest x-ray that showed interval complete resection of the mass. Currently, she is asymptomatic and her clinical condition has improved with the successful resumption of her daily routine.Physicians thus need to keep pleural schwannomas in mind as a probable diagnosis of intrathoracic tumors. Indolent and asymptomatic, they are very amenable to surgical resection with little to no chances of recurrence in the long term. However, these patients should be closely followed with repeat imaging studies when symptomatic

The implementation of corporate social responsibilities (CSR) among G7 contractors in Malaysia / Hamimah Adnan ... [et al.]

Corporate Social Responsibility (CSR) is one of way to encourage among the stakeholders to improve not only the society, but environment and economy of affected people. This paper aims to identify the implementation, challenges and ways to enhance Corporate Social Responsibility (CSR) among G7 Contractors registered under the Malaysian Construction Industry Development Board. (CIDB in Malaysia. Quantitative and qualitative methodology were involved which involved questionnaires survey and interviews. Questionnaires were distributed to 150 respondents with 32 replied and 5 interviews were held among the respondents. The findings show that the highest level of CSR implementation is in the relationship with clients and suppliers. Most respondents agreed that the biggest challenges in implementing CSR were lack of support from top management and lack of time. It also showed that most respondents agreed that the ways to enhance the implementation of CSR were the involvement of system of governance transparency with investors and shareholders, application of policy by employees, close relationship with the clients and suppliers, concrete actions towards community and adoption of measures on the environmental impact. It is recommended for the implementation of CSR and ways to overcome the challenges needed to be enhanced to reach the highest level of implementation and every stakeholder needs to act for effective improvement to enhance the implementation

The implementation of corporate social responsibilities (CSR) among G7 contractors in Malaysia / Hamimah Adnan … [et al.]

Corporate Social Responsibility (CSR) is one of way to encourage among the stakeholders to improve not only the society, but environment and economy of affected people. This paper aims to identify the implementation, challenges and ways to enhance Corporate Social Responsibility (CSR) among G7 Contractors registered under the Malaysian Construction Industry Development Board. (CIDB in Malaysia. Quantitative and qualitative methodology were involved which involved questionnaires survey and interviews. Questionnaires were distributed to 150 respondents with 32 replied and 5 interviews were held among the respondents. The findings show that the highest level of CSR implementation is in the relationship with clients and suppliers. Most respondents agreed that the biggest challenges in implementing CSR were lack of support from top management and lack of time. It also showed that most respondents agreed that the ways to enhance the implementation of CSR were the involvement of system of governance transparency with investors and shareholders, application of policy by employees, close relationship with the clients and suppliers, concrete actions towards community and adoption of measures on the environmental impact. It is recommended for the implementation of CSR and ways to overcome the challenges needed to be enhanced to reach the highest level of implementation and every stakeholder needs to act for effective improvement to enhance the implementation

Machine Learning to Ensure Data Integrity in Power System Topological Network Database

Operational and planning modules of energy systems heavily depend on the information of the underlying topological and electric parameters, which are often kept in database within the operation centre. Therefore, these operational and planning modules are vulnerable to cyber anomalies due to accidental or deliberate changes in the power system database model. To validate, we have demonstrated the impact of cyber-anomalies on the database model used for operation of energy systems. To counter these cyber-anomalies, we have proposed a defence mechanism based on widely accepted classification techniques to identify the abnormal class of anomalies. In this study, we find that our proposed method based on multilayer perceptron (MLP), which is a special class of feedforward artificial neural network (ANN), outperforms other exiting techniques. The proposed method is validated using IEEE 33-bus and 24-bus reliability test system and analysed using ten different datasets to show the effectiveness of the proposed method in securing the Optimal Power Flow (OPF) module against data integrity anomalies. This paper highlights that the proposed machine learning-based anomaly detection technique successfully identifies the energy database manipulation at a high detection rate allowing only few false alarms

Vehicle Blind Spot Monitoring Phenomenon Using Ultrasonic Sensor

This paper evaluates a conceptualization of Vehicle Blind Spot Monitoring System (VBMS), which performs a more effective approach in eliminating blind spot of the driver. The newly developed smart blind spot monitoring system simply focusing on an advancement of the preceding work, along with compromising user compatibility and cost-effectiveness. Compact design, reliable and low-cost that contributes to a highly affordable safety feature are the flagship of this new system. Components selection is the main role in constructing an inexpensive blind spot detection system in the present work. Thus, Arduino UNO R3 model and HC-SR04 ultrasonic sensors were employed for the VBMS system due to reasonable market price. Plus, the ultrasonic sensor has demonstrated a remarkable performance in the past blind spot detection system application. Concerning easy installation as well as maintenance on any vehicle, the VBMS is designed as a compact device which assembles the main control unit and sensory partsin a single body to be located at the bottom of the side mirror. Meanwhile, the hazard-warning signal is separately located at the passenger compartment for easily visible by the driver. The angle and sensing range of sensors are both adjustable but vital as their projections define the blind spot limit accurately by characterizing low to a high potential hazard. At the end of this work, a complete VBMS functional prototype of has been establish which effective for real traffic on-road experimentation, with various conditions specified (static, various speed, and overtaken). From the data collected, all targets of the present work have been attained regarding monitoring phenomenon shown by the new-built system. Both pros and cons of VBMS are discussed for further improvement ideas on product developmen

The Importance of Total Quality Management and Leadership Communication to Enhance Islamic Quality at Malaysian Civil Service

In the leadership communication styles, most of the middle management positions such as managers, assistant managers and those at executives’ level are practicing good leadership communication via enhancing the Islamic quality at Malaysian Public Service. A two-way communication does exist among the staff especially in meetings, discussions and working in team. A good leadership communication among the staff and their involvement are important in Malaysian Civil Service in order to achieve the total quality management objective. Reason being is that the leadership communication is the most important tool and vital part in all organisational operations. Leadership communication could be the basis for understanding, cooperation, teamwork and positive action, which without it such goals would be undermined at Malaysian Civil Service. Two-way communication gives more opportunities to the staff to be involved in discussions and meetings which create the spirit of togetherness in the organisation. The Total Quality Management (TQM) has positively affected job satisfaction, the employees' ability to work together, improve the staff work and builds leadership communication at Malaysian Public Service. Obviously, provide a significance relationship between leadership communication and quality management in Islamic perspectives on job satisfaction among the staff at Malaysian Public Service. Keywords: Total Quality Management

Design Of Engine Mounting For Single Seated Educational Racing Vehicle

The power train system for a single seated educational racing vehicle is consists of an engine and a transaxle. This power train unit is attached to the chassis frame of the vehicle. Therefore, it is desirable that both the engine and transaxle can be easily installed to the vehicle chassis frame. For a racing vehicle for educational competition, an adjustable engine mounting system is provided to allow for fine adjustment of the engine position and the transaxle. The alternative term for transaxle is called as the chain tension that includes a selective lock-out feature. This feature allows an operator to lock out the selected forward or reverse gears to alter the vehicle performance during racing. In this work, three design of engine mounts for the use of single-seated educational racing vehicle are proposed. The design process is carried out using CATIA V5 educational software. Once all the proposed designs of the engine mounts are completed, Finite Element Analysis (FEA) is performed. Furthermore, a modal analysis using ANSYS Workbench Release 16.0 is also conducted to determine the natural frequency of the component. The results suggest that the best design of engine mount is Design 2. This selection is based on the low natural frequency of the component