Rare case of combined small cell lung cancer with adenocarcinoma and squamous cell carcinoma

AbstractCombined small cell lung cancer (cSCLC) is relatively unusual. We report a case of cSCLC in a 78-year-old man with no prior medical history who presented for evaluation of right upper lobe (RUL) lung mass. A CT scan showed a 3.0×2.5×2.3cm RUL lung mass with mildly prominent mediastinal and hilar lymphadenopathy. A right thoracotomy with right upper lobectomy and lymphadenectomy was performed. Histological examination and immunohistochemical stains confirmed the diagnosis of combined small cell lung carcinoma (SCLC) with adenocarcinoma (AC) and squamous cell carcinoma (SCC) components.While there are available guidelines for treating SCLC, the optimal treatment for cSCLC which will improve prognosis has not been adequately determined. We report a very rare category of primary lung malignant neoplasm to represent our institution's experience in diagnosing and managing this type of rare case

Tubulointerstitial Nephritis and Uveitis Syndrome—A Case Report and Review of Literature

A very little subset of patients diagnosed with interstitial nephritis have the tubulointerstitial nephritis and uveitis (TINU syndrome). A considerable number of cases have been documented in the pediatric nephrology and ophthalmology literature. We report a 12-year-old girl who presented with a history of allergic/drug-induced tubulointerstitial nephritis and diagnosed months later to have uveitis after stopping steroids. This considered a very rare combination and the diagnosis of tubulointerstitial nephritis and uveitis syndrome was established. She was treated successfully with topical steroid and topical cycloplegic agent for about 7 weeks. About 250 cases have been reported worldwide, and this is the first reported case in Jordan

Frequency of Lingual Nerve Injury after the Removal of Impacted Mandibular Third Molar

Objective: to determine the frequency of lingual nerve injury after the removal of impacted mandibular 3rd molar. Study Design: Cross sectional study Place and duration: outdoor patient department of Oral and Maxillofacial Surgery Hitec Dental College, Foundation College of Dentistry Peace Gernal Hospital, Nishtar Institute of  Dentistry,Multan from January 2018 to January 2019 in one year duration. Results: Study included 335 patients with mean age of 20.86+ 1.95 yrs. Males were 190(56.7%) and females were 145(43.3%).lingual nerve injury was found in 28 patients(8.4%)while it was absent in 307 patients(91.6%).There was no significant effect was found on the frequency of lingual nerve injury for age or gender of the patient population. Conclusion: Lingual nerve injury is a commonly encountered complication among those undergoing extraction of impacted third molar. It should be carefully sought in all the patients undergoing the surgical procedure and improvement in surgical skills and techniques needs to be emphasized to further reduce the incidence and risk of this complication. Keywords: Impacted third molar, Lingual nerve, OPG (orthopantomogram), Dentistry, Mandible. DOI: 10.7176/JMPB/57-01 Publication date: July 31st 201

Spectral Fletcher-Reeves Algorithm for Solving Non-Linear Unconstrained Optimization Problems

Abstract The non-linear conjugate gradient method is a very useful technique for solving Large-Scale minimization problems and has wide applications in many fields . In this paper, we present a new spectral type, a non-linear conjugate gradient algorithm the derivatation of this algorithm is based on Fletcher -Reeves and Newton algorithm, the descent property for the suggested algorithm is proved provided that the step size satisfies the Wolfe conditions. Numerical results show that the new algorithm is efficient in practical computation and superior to the Fletcher -Reervs algorithm in many situations. . ‫ﺍﻟﻤ‬ ‫ﻠﺨ‬ ‫ﺹ‬ ‫ﺨﻭﺍﺭﺯﻤﻴـﺔ‬ ‫ﺘﻁـﻭﻴﺭ‬ ‫ﺍﻟﺒﺤـﺙ‬ ‫ﻫﺫﺍ‬ ‫ﻓﻲ‬ ‫ﺘﻡ

Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. Methods GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifi cally. Findings The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disabilityadjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition aff ecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure aff ected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region’s health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our fi ndings, we call for increased investment in health in the region in addition to reducing the confl icts

The spectrum of primary immunodeficiencies at a tertiary care hospital in Pakistan

Background: Primary Immunodeficiency Disorders (PIDs) are well-known disorders in the West. but the recognition and diagnosis of these disorders is challenging in developing countries. We present the spectrum of PIDs seen at a tertiary care center in Pakistan, identified using clinical case definitions and molecular methods.Methods: A retrospective chart review of children suspected to have PID was conducted at the Aga Khan University Hospital (AKUH) Karachi, Pakistan from 2010 to 2016. Data on demographics, clinical features, family history of consanguinity, sibling death, details of laboratory workup done for PID and molecular tests targeted panel next generation sequencing (NGS) or whole exome sequencing (WES) performed at the Geha laboratory at Boston Children\u27s Hospital, USA was collected. The study was exempted from the Ethical Review Committee of AKUH.Results: A total of 43 children visited the hospital with suspected PID during the study period. Genetic testing was performed in 31/43 (72.1%) children. A confirmed diagnosis of PID was established in 20/43 (46.5%) children. A pathogenic gene variant was identified in 17(85%) of the 20 confirmed cases (Table 1). Twelve (60%) of the confirmed cases of PID were male. The most common presenting symptom was recurrent diarrhea 11/20 (55%). The mean (±S.D) age of the cases at the time of diagnosis was 4.2 (±4.1) years. Chronic granulomatous disease (CGD) was the most common 6/20 (30%) disorder, followed by severe combined immunodeficiency (SCID) 3/20 (15%), leukocyte adhesion deficiency (LAD) 3/20 (15%), agammaglobulinemia/hypogammaglobulinemia 3/20 (15%), and Hermansky-Pudlak Syndrome (HPS) 2/20 (10%). Wiskott-Aldrich Syndrome, Immunodeficiency Centromeric Instability and Facial Anomalies Syndrome (ICF 2), Trichohepatoenteric syndrome (TRES), and C3 deficiency were each diagnosed once {1/20 (4.3%) each} (Table 1). Of these 20 confirmed cases, almost all 19/20 (95%) had a family history of consanguinity. Sibling death was reported in 5/20 (25%) of these cases. Five out of the 20 (25%) children died over the 7-year period for various reasons.Conclusion: PIDs are not uncommon in Pakistan; their diagnosis may be missed or delayed due to the overlapping of clinical features of PID with other diseases and a lack of diagnostic facilities. There is a need to build capacity for early recognition and diagnosis of PIDs to decrease morbidity and mortality

Review: The effect of different nanofiller materials on the thermoelectric behavior of bismuth telluride

This review paper summarizes and discusses the effect of nanosized fillers on bismuth telluride nanocomposites for thermoelectric applications. Classified into various dimensions based on electron confinement in space, the nanofiller effect on the figure-of-merit value is studied. By combining experimental data with theoretical models, the mechanisms for enhancing the thermoelectric properties were proposed. The outcomes of this review paper suggest that doped bismuth telluride composites (doped with selenium for n-type or antinomy for p-type) offer better thermoelectric properties compared to undoped composites. Moreover, improvements in undoped bismuth telluride composites are exclusive for the n-type only. The figure-of-merit value for bismuth telluride composites is less than two, where the 2D nanofillers show optimum ZT improvements. Nevertheless, the inconsistency of reported data in the thermoelectric area is a problem that must be addressed to have more control over the precision of the reported results for a better understanding of the concepts in this field.This work was supported by Grant no. NPRP10–0206–170366 from Qatar National Research Fund (a member of the Qatar Foundation). The statements made herein are solely the responsibility of the authors. Open access publication of this article was funded by the Qatar National Library

Response of extensively drug resistant salmonella typhi to treatment with meropenem and azithromycin, in Pakistan

Introduction: Salmonella Typhi is one of the leading health problems in Pakistan. With the emergence of extensively drug resistant (XDR) Salmonella Typhi, treatment options are limited. Here we report the clinical manifestations and the response to treatment of patients with XDR Typhoid fever. The patients were treated with either Meropenem or Azithromycin or a combination of both.Methods: We reviewed the records of culture confirmed XDR typhoid who visited Aga Khan University Hospital (AKUH), Karachi and Aga Khan Secondary Care Hospital, Hyderabad from April 2017 to June 2018. Symptoms developed during disease, unplanned treatment extension and complications developed while on antimicrobials was recorded. Means with standard deviation were calculated for duration of treatment, time to defervescence, and cost of treatment.Results: Records of 81 culture confirmed XDR typhoid patients admitted at the AKU hospitals were reviewed. Most, (n = 45; 56%) were male. Mean age of the cases was 8.03 years with range (1-40). About three quarter (n = 66) of the patients were treated as inpatient. Fever and vomiting were the most common symptoms at the time of presentation. Oral azithromycin alone (n = 22; 27%), intravenous meropenem alone (n = 20; 25%), or a combination of azithromycin and meropenem (n = 39; 48%) were the options used for treatment. Average (95% confidence interval) time to defervescence was 7.1(5.5-8.6), 6.7(4.7-8.7), and 6.7(5.5-7.9) days for each treatment option respectively whereas there were 1,0 and 3 treatment failures in each treatment option respectively. Average cost of treatment per day for azithromycin was US$5.87 whereas it was US$88.46 for meropenem.Conclusion: Patients treated with either Azithromycin, Meropenem alone or in combination showed similar time to defervescence. Because of the lower cost of azithromycin, it is preferable in lower socio-economic areas. Background estimates for power calculation can be made for more robust clinical trials using this observational data

Outcome of inadvertent high dose BCG administration in newborns at a tertiary care hospital, Karachi- Case series

Bacillus Calmette-Guérin (BCG) vaccine is given to newborns soon after birth. BCG vaccine overdose has been rarely reported. Here we report the outcome of newborns who accidently received high dose BCG at a tertiary care hospital, Karachi. We reviewed records of 26 newborns, who accidentally received intradermal high dose BCG, used for the treatment of urinary bladder cancers and 80 times higher dose than the BCG used for routine vaccination. The incident happened from 14-16th April, 2016 at Aga Khan University Hospital, Karachi. Analysis was carried out using SPSS. A total of 23/26(88.5%) newborns were followed for atleast 3 months and 11/26 (42.3%) were followed for atleast one year. 13/26 (50%) were male. All 26 patients were prescribed isoniazid and rifampicin for 3 months. 3/26 (11.5%) were lost to follow-up before completion of anti-tuberculous drugs (ATT). Lesions at the BCG site were observed in 16/26 (61.5%) infants, of which 15 (93.8%) had a papule, 3 (18.8%) developed a pustule, 3 (18.8%) had skin induration and 2 (12.5%) had skin erythema. Axillary lymphadenopathy was observed in 1/26 (3.8%) patient. Coagulation was deranged in 3/26 (11.5%) of babies. Intracranial bleeding was observed in 1/26 (3.8%) case. Localized skin lesions were the most common adverse events. None of them developed clinical tuberculosis. Chemoprophylaxis for inadvertent high dose BCG administration should be given for atleast 3 months. Furthermore, vigilant follow-up, transparency and disclosure are the vital steps in the management of any medical error

Synthesis and characterisation of doxorubicin-loaded functionalised cobalt ferrite nanoparticles and their in vitro anti-tumour activity under an AC-magnetic field

Purpose: To synthesise and evaluate the anti-tumour properties of doxorubicin-loaded xanthan gumfunctionalised cobalt ferrite nanoparticles (CoFe2O4.NPs@XG-Doxo) under an AC-magnetic field.Methods: Multidimensional magnetic cobalt ferrite (CoFe2O4) nanoparticles (NPs) were synthesised by a co-precipitation method. The synthesised cobalt ferrite nanoparticles (CFNPs) were functionalised with xanthine gum (XG) and subsequently characterised by Fourier transform-infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA) and contact angle studies. Vibrating sample magnetometry (VSM) was used for magnetic measurements of the native and XG-coated CFNPs. The microstructural morphology of the uncoated and XG-coated CFNPs was established using scanning electron microscopy (SEM), atomic force microscopy (AFM) and dynamic light scattering (DLS) studies. Finally, the doxorubicin release profile of the drug-loaded functionalised CFNPs was evaluated using an oscillating magnetic field (OMF) apparatus in the presence of an externally applied magnetic field.Results: XG coating decreased the contact angle of the native CFNPs from 92° to 40°, which indicates that it modified the CFNP surface from hydrophobic to hydrophilic. VSM analysis demonstrated that CoFe2O4.NPs@XG also retained the magnetic characteristics of the bare cobalt ferrite nanocrystals, endorsing its application as a promising magnetic nanovector (MNV). The synthesised CoFe2O4.NPs@XG-Doxo exhibited significantly higher controlled discharge of doxorubicin at acidic pH (5.0) than at neutral pH (7.4). In vitro analysis revealed the remarkable lower systematic toxicity of XGcoated CoFe2O4.NPs compared with uncoated CFNPs against Chinese hamster ovary (CHO) and Huh7 cell lines.Conclusion: These results indicate that XG-coated CFNPs are a biocompatible MNV for doxorubicin.Keywords: Cobalt ferrite, Cytotoxicity, Drug delivery, Nanoparticles, Xanthan gu