Cd20 Expression and Effects on Outcome of Relapsed/ Refractory Diffuse Large B Cell Lymphoma after Treatment with Rituximab

Introduction: Down regulation of CD20 expression has been reported in diffuse large B cell lymphoma (DLBCL)). Therefore, it is important to determine whether chemotherapy with rituximab induces CD20 down regulation and effects survival. Objectives: To determine the incidence of down regulation of CD20 expression in relapsed DLBCL after treatment with rituximab and to compare outcomes and assess pattern of relapse between CD20 negative and CD20 positive cases. Methodology: We retrospectively reviewed patients with relapsed DLBCL who received rituximab in the first line setting at Aga Khan University Hospital between January 2007 and December 2014. Data were recorded on predesigned questionnaires, with variables including demographics, details regarding date of diagnosis and relapse, histology, staging, international prognostic index, treatment and outcomes at initial diagnosis and at relapse. The Chi square test was applied to determine statistical significance between categorical variables. Survival curves were generated by the Kaplan–Meier method. Results: A total of 54 patients with relapsed DLBCL were included in our study, 38 (70 %) males and 16(30%) females. Some 23 (43%) patients were at stage IV at the time of diagnosis and 34 (63%) had B symptoms. The most frequent R-IPI at diagnosis was II in 24 (44%) patients. Only 6 (11%) did not show CD20 expression on re-biopsy for relapsed/refractory disease, 2 with CD20 negative DLBCL responding to second line chemotherapy. A complete response after salvage chemotherapy was noted in 16 (29.6%) cases with relapsed/refractory DLBCL. Seven (13%) patients underwent an autologous bone marrow transplant as consolidation after second line treatment. Median overall survival was 18 months in CD20 positive vs. 13 months in CD20 negative patients. Conclusion: This study demonstrated that a small percentage of patients treated with rituximab lose their CD20 expression at the time of relapse. However, it is unclear whether this is associated with an inferior outcome

Pakistani Physicians: Exploring the Paradox of Public Service Motivation and User Orientation

The desire to support single beneficiary of public services (user orientation) has divergence with desire to support society at large, both motivations compete in same dimensional space. Extra ordinary usage of broad spectrum antibiotics creates negative externalities for society as large because excessive use of antibiotics creates resistance among bacteria that become hard and expensive to cure. There exists large gap to comprehend difference between discrete choices of both motivations of public service. The antibiotics prescriptions behavior of Pakistani general physicians (Doctors) has been analyzed in this study to investigate the association between Public Service Motivation and user orientation with this behavior. 250 Pakistani general practitioners were chosen in both private and public sector to investigate the PSM relationship with user orientation. The findings indicate that there is different association between Public Service Motivation and user orientation regarding prescription behavior of the general physicians (Doctors). This entails that it is necessary to investigate this behavior difference to know whether the public service provider is fascinated towards helping single beneficiary or be concerned more about society

Neurological disorder burden in Faisalabad, Punjab-Pakistan:data from the major tertiary carecenters of the city

The burden of neurological disorders (NDs) in developing countries is 4-5%, compared to 10-11% in developed countries. This burden is rising in developing countries due to prolonged life expectancy, improved health facilities, easy access to diagnostic facilities, and a trend in urbanization. There is inadequate data about the epidemiology of major NDs in Pakistan and most available information are hospital-based estimations or physicians’ collected data

Weyl collineations that are not curvature collineations

Though the Weyl tensor is a linear combination of the curvature tensor, Ricci tensor and Ricci scalar, it does not have all and only the Lie symmetries of these tensors since it is possible, in principle, that "asymmetries cancel". Here we investigate if, when and how the symmetries can be different. It is found that we can obtain a metric with a finite dimensional Lie algebra of Weyl symmetries that properly contains the Lie algebra of curvature symmetries. There is no example found for the converse requirement. It is speculated that there may be a fundamental reason for this lack of "duality".Comment: 9 page

Epidemiological Data of Neurological Disorders in Pakistan and Neighboring Countries: A Review

Neurological disorders are the impairments of nervous system and are an important and growing cause of morbidity, mortality, and disability. In addition to health costs, those suffering from these conditions are also frequently victimized of stigmatization and discrimination. Stigmatization further minimizes the patients\u27 access to treatment and social activities. These disorders, therefore, require special attention particularly in developing countries where unfortunately, the burden of these disorders remains largely unrecognized. Moreover, the burden imposed by such chronic neurological conditions in general can be expected to be particularly devastating in poor populations. These conditions are emerging as severe public health concerns in the developing countries due to the facts such as unawareness, Illiteracy, large numbers of people who are untreated, and unavailability of inexpensive but effective interventions. Regrettably, reliable population-based data from developing countries including Pakistan on the epidemiology of neurological disorders are extremely limited. Although, some information on epidemiological aspects of neurological diseases are available from some developing countries (Pakistan, Iran, India, Sri Lanka, Saudi Arabia and China) but disease prevalence and pattern are based on geographical, social, cultural, religious, and ethnic factors. In this review, w e critically analyzed data of 209 studies regarding the burden and prevalence of hypertension, depression, Stroke, Alzheimer\u27s disease (AD), epilepsy, and Parkinson\u27s disease (PD) in Pakistan and neighboring countries

Functional Foods and Human Health: An Overview

Functional food is a whole ingredient or a part of food that used as food for specific therapeutic purposes. It is divided into two wide categories: Conventional and modified functional foods. Conventional functional Foods are composed of natural or whole-food ingredients that provide functional substances while modified functional is food or food products in which add additional ingredients for specific health purposes. Plant-based food such as fruits, vegetables, herbs, cereals, nuts and beans contain vitamins, minerals, fiber, omega-3 fatty acids, antioxidants and phenolic compounds that play a functional role in the human body against chronic diseases including cancer, cardiovascular and GIT-related disease. Some other foods or food products like juices, dairy products, fortified eggs and seafood are composed of functional components. Fish contain omega-3 fatty acids (EPA and DHA) that are played a functional role in heart health and brain development

Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus

Purpose: One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods: A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results: Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). Conclusion: Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.info:eu-repo/semantics/publishedVersio