SPINDLE CELL CARCINOMA OF LARYNX- A DISTINCT CLINICOPATHOLOGICAL AND HISTOLOGICAL ENTITY

Spindle cell carcinoma (SpCC) is a variant of squamous cell carcinoma with biphasic components and more aggressive behaviour. Its rarity and histopathological pattern pose a diagnostic challenge. Early diagnosis and treatment result in a decrease in local and distant metastasis. Case 1 is a 71-year-old female presented with hoarseness of voice and dyspnoea for 2 years without any risk factors. Fibre-optic laryngoscopy (FOL) revealed smooth polyp hanging from anterior two-third of the left vocal cord. Microlaryngoscopic excision revealed SpCC followed by post-operative radiotherapy and is currentlyalive. Case 2 is a 72-year-old male presented with worsening stridor for 2 years post-excision of laryngeal nodule and history of smoking and hookah use for >20 years. He developed dysphonia after a few months with fixed hard level 3 nodes at the right side. FOL showed a polypoid mass extending from the left vocal cord into the supraglottis. Fine-needle aspiration cytology of the neck swelling confirmed the diagnosis of SpCC. Computerised tomography (CT) chest/abdomen showed distant metastasis. Palliative radiotherapy was given, but the patient died after 3 months due to locoregional failure. Case 3 is a 35-year-old male presented with a history of hoarseness for 3 years with no risk factors. FOL showed a 1.2-cm polypoid growth on the right vocal cord. Total laryngectomy was performed and histopathology showed SpCC. Radiotherapy was given and the patient is alive without disease with regular follow-ups. Smoking and alcohol are thought to be the contributing factors causing this disease. Biphasic nature of the tumour requires pathological sampling for diagnostic confirmation. Surgery combined with radiotherapy has a better survival outcome. SpCC is a rare tumour with a tendency for locoregionalrecurrence. Surgery should remain the mainstay of treatment followed by post-operative radiotherapy for a better control.Key words: Larynx, radiotherapy, spindle cell carcinom

ORAL METHOTREXATE AS SECOND LINE CHEMOTHERAPY IN PLATINUM-REFRACTORY OR RELAPSED SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

Purpose: Platinum-refractory or relapsed squamous cell carcinoma of the head and neck (SCCHN) is considered to have poor prognosis. Although cetuximab is currently recommended as category 1 in this group of patients, the use of it is hampered in low- and middle-income countries (LMICs) like Pakistan due to nancial constraints. Further, majority of the population of these countries is unable to tolerate toxicity related to other intravenous chemotherapeutic agents due to lower socioeconomic background with poor nutrition status. The aim of this study is to evaluate the response rate and toxicity of oral methotrexate (MTX) in platinum-refractory or relapsed SCCHN. Methods: Between June 2008 and December 2012, 71 patients received palliative oral MTX either due to recurrent or persistent disease. With a median age of 51 years (range 22–75), there were 68% of males and 32% of females. Site distribution was as following; oral cavity 58%, nasopharynx 25%, hypopharynx 7%, paranasal sinuses 6%, larynx 3%, Oropharynx 1%. Patterns of recurrence; local 32%, regional 07%, loco regional 10%, distant 15% and persistent disease in 36% of the patients. All the patients received oral MTX 10 mg once a day, 4 days a week. To contain the possible side effects associated with MTX, folinic acid 15 mg per oral every 6 hourly on day 5 was prescribed. Response assessment was done on two monthly basis. Response, toxicity, mean response time and mean time to progression were determined. Results: Response to MTX was as following; complete response 3%, partial response 4%, stable disease 11% and progressive disease in 82% of the patients respectively. Toxicity related to oral MTX includes neutropenia Grade III in 1% while mucositis Grade III in 10% of the patients, respectively. None of the patient had Grade IV mucositis or haematological toxicity. Treatment was stopped in 13% of the patients due to poor compliance. Mean response time was 4 months (range 1 – 20) and mean time to progression was 5 months (range 1–23). Conclusion: Oral MTX is a simple, cost-effective and well-tolerated regimen to be used on outpatient basis for palliation in platinum refractory or relapsed SCCHN in LMICs and debilitated patients. This treatment merits further evaluation in large-scale clinical trials. Key words: Oral methotrexate, platinum refractory, relapsed squamous cell carcinoma of head and neck

Geotechnical Perspective of the Causes of Cracks in Building of University Campus (Sindh University Jamshoro Sindh Pakistan)

The building construction throughout world faces the defects from normal to heavy and destructive like cracks and fractures which cause damages and eventually collapses to heavy life losses alongside economical and financial. The cracks like structures are found in wall and columns also. For the aim of the study, the international experts have classified the minimum allowable standards of those defects which can not be harmful to buildings and other people living there. This research study has been administered to research the most reasons to research the causes of cracks during a newly completed and used buildings in where some distinct cracks appeared immediately and after some years. Often these cracks seem in almost in walls, columns, beams, and so-like structures having different patterns. the foremost useful and customary methods consisting of reconnaissance survey; building inspection and laboratory testing were wont to investigate the causes of those distinct cracks which will cause the formation of cracks were considered and analyzed by the utilization of reconnaissance survey, factors like width, pattern, and conditions of the cracks were identified during the building inspection stage and therefore the soil properties associated with the creation of cracks were determined during the laboratory test. supported the results of the study; there was no distinct evidence of things like a matured system which will cause the creation of cracks within the building; The pore water pressure during this sort of soil takes longer time to fade, which may be expressed by the very low value of the coefficient of permeability (1.90x 10-7 to 2.15 x 10-7 m/s) acquired from different soil samples collected from the study area. Hence the cracks during this sort of building were found to be caused by the settlement of the building thanks to the character of the predominant soil type that was found within the study area, all the cracks are active cracks with their width increasing with time and therefore the soils within the entire block of the building possessed high percentage of fine materials with high moisture content and plasticity indices

Effectiveness of Nerve Blocks for Management of Head and Neck Cancer Associated Neuropathic Pain Disorders; a Retrospective Study

Introduction: A portion of patients with head and neck cancer (HNC)-associated pain may not experience relief in symptoms with non-invasive modalities. A nerve block is a procedure in which a local anesthetic agent is injected along the nerve track to preferentially block sensory transmission. The literature on the effectiveness of nerve blocks in the management of HNC-related pain is limited. The purpose of this study was to determine the effectiveness of nerve blocks in management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders. Materials and Methods: A retrospective chart review of patients who underwent a nerve block or infiltration procedure in the regions of head and neck for management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders in the Orofacial Pain Medicine clinic, Shaukat Khanum Memorial Cancer Hospital and Research Centre, between November 2018 and November 2019 was completed. Information regarding demographics, diagnosis, and pain characteristics was extracted and reviewed. The Fisher-exact test and Mann-Whitney U test were used for analysis between independent and dependent variables. Results: A total of 27 participants were included in the investigation, of which 66.7 % were males. The average pre-procedure pain score was 6.85 ± 2.54. Following intervention, 81.5 % of the participants experienced greater than 75 % relief in pain for longer than 48 hours. The mean immediate post-procedure pain score was 0.26 ± 1.02 and the average duration of relief was 6.10 ± 6.50 weeks. The significant effect of nerve blocks was found to be statistically associated with the concurrent use of amitriptyline (p = 0.017). Conclusion: Nerve blocks, as an adjunctive therapy to pharmacologic treatment, can provide significant relief to patients with breakthrough HNC-associated trigeminal and cervical neuropathic pain disorders. However, the duration of relief experienced by the participants is inconsistent. The beneficial effect of nerve blocks appears to be more common in patients that were concurrently using amitriptyline

SURVIVAL OUTCOMES IN EARLY GLOTTIC CARCINOMA; A SINGLE INSTITUTION EXPERIENCE

Purpose: Laryngeal cancers are amongst the most common cancers affecting head and neck region. In this study, we analyse the overall survival (OS) following hypofractionated radiotherapy (RT) in early stage glottic carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. Methods: Between October 2003 and June 2009, 87 patients with early stage glottic carcinoma were treated with hypofractionated RT. All patients were included in the study. The ratio of male: female is 94%:6%. Mean age was 62 years (range 31–83 years). 66% of the patients were smokers. AJCC stage was T1a in 76%, T1b 20% and T2 in 4% of the patients. Histological distribution was; squamous cell carcinoma 97%, verrucous carcinoma 2% and squamous cell spindle variant 1%. Median follow-up time was 59 months (range 4–122 months). RT dose was 55 Gy in 20 fractions over a period of 4 weeks. Median RT treatment time was 28 days (range 23–35 days). Patients that lost to follow-up were contacted through telephone. Results: The 10-year OS was 83%. Patterns of failure was 7 local and 1 distant while 1 patient had persistent disease. 15 patients were dead at the time of study. Cause of death; 13 patients died due to Ischemic heart disease and 2 due to primary disease. Conclusion: Hypofractionated RT 55 Gy in 20 fractions seems to achieve good OS while offering potential for optimizing resources usage. Key words: Glottic carcinoma, hypofractionated, overall survival, radiotherapy

Reasons for Admission and Outcome to an Acute Palliative Care Unit in Patients with Advanced Malignancy in a Cancer Hospital

Introduction: The alleviation of suffering is a primary goal of palliative care team for patients with terminal cancer. In some cases, patients experience symptoms requiring inpatient care. The purpose of this investigation was to assess the clinical presentation and outcomes of hospitalization in patients that were admitted to the acute palliative care service. Materials and Methods: This is a retrospective descriptive study looking at admissions to an acute palliative care unit in a single center over a 24-month period. Medical records of all patients, admitted in palliative care unit from 1st January 2013 till 31st December 2014, were reviewed for reason of admission and outcome. Results: A total of 226 patients were identified and included in the present investigation. Among these 55.5 % (125) were females. The median age of the cohort was 48 (15 - 86) years. The most common reasons for admission were alteration in consciousness (19.5 %), respiratory tract infection (18 %), diarrhea and/or vomiting (14.2 %) and respiratory distress (not related to infection) (13.4 %). The median duration of hospital stay was 4 (0-27) days. Majority of the patients were discharged home (65.1 %). However, a significant portion (33.1 %) of the patients did not survive the hospitalization. Following discharge from the hospital, at 4-weeks follow-up the survival rate was 38.7 %. This dropped to 21.7 % at 8-weeks. Conclusion: Patients with advanced disease have a multitude of reasons to seek acute inpatient care. Majority of the patients were discharged following care. However, the survival rate of patients following discharge was low

Post-Flood Rehabilitation of Affected Communities by NGOs in Punjab, Pakistan-Learning Lessons for Future

Flood is one of the most frequently occurring disasters in the world which causes loss of thousands of human lives and properties worth millions of dollars. Pakistan faced severe flood during the year 2010. Most of the damage occurred in Punjab, the most populous province of the country. The federal and provincial governments attempted to rescue people and to restore/provide shelter. But both could not meet public expectations due to lack of institutional capacity and financial resources. In this situation, several NGOs took part in rehabilitation of affected communities on existing as well as new sites. Two of such communities have been taken as case studies. A detailed investigation reveals that NGOs played very effective role in improving living conditions and quality of life in affected communities. Resultantly, a vast majority of residents is satisfied. Some issues pertaining to the rehabilitation process and maintenance of settlements have also surfaced. Nevertheless, the experience of NGOs in this regard demonstrates many attributes of good rehabilitation strategy which are worth considering by other countries.    &nbsp