PRIMARY GASTROINTESTINAL STROMAL TUMOUR OF THE PROSTATE: A CASE REPORT OF A RARE TUMOUR

A 70-year-old gentleman underwent prostatectomy for bladder outlet obstruction due to enlarged prostate and was found to have primary extragastrointestinal stromal tumour (EGIST). He has been started on imatinib therapy and is presently on follow-up. Prostatic EGIST should be one of the differential diagnoses in patients with enlarged prostate with normal prostate-specific antigen levels.Key words: Prostate, gastrointestinal stromal tumour, PSA 

DOES PATHOLOGICAL T3A UPSTAGING OF CLINICAL T1 STAGE HAS ANY DIFFERENCE ON LONG-TERM SURVIVAL WHEN COMPARED TO PATHOLOGICAL AND CLINICAL T1 STAGE RENAL CELL CARCINOMA

Background: A high number of clinical T1 (cT1) stage renal cell carcinoma (RCC) is upstaged to pathological T3a (pT3a) stage on histopathological findings. Several study results show that there is no survival difference among those cT1 stage who are upstaged on histopathological findings to those who remain pT1 stage RCC.Objectives: The objectives of this study were to assess any survival difference for cT1 stage renal cell carcinoma (RCC) which is upstaged to pT3a stage as compared to those which remain pT1 stage RCC on histopathological findings.Materials and Methods: It was a retrospective cohort study looking at patient aged ≥18 years with cT1 RCC who underwent nephrectomy between January 2006 and December 2016. Patients were divided into two groups based on histopathological findings (pT1 vs. pT3a). Survival was analysed for the  two groups using Kaplan–Meier method, and the difference in survival was calculated using log-rank model.Results: The study included 187 patients. The mean age at presentation was 52.56 years, with 58.3% of the patients being male while 41.7% were female. The most common presentation was incidental diagnosis (50.3%). Overall5-year survival for cT1a and pT1a RCC was 68% while that for cT1a and pT3a RCC was 100%. There was no significant survival difference among the two groups (P = 0.316). The overall 5-year survival for cT1b and pT1b RCC was 81% while that for cT1b and pT3a was 65%. There was no significant survival difference among the two groups (P = 0.136).Conclusion: We found no survival difference in cT1 RCC who were upstaged to pT3a on histopathology as compared to cT1 RCC-staged pT1 on histopathology.Key words: Clinical T1 stage, pathological T3a stage, radical nephrectomy, renal cell carcinoma, surviva

Anaemia in acute coronary syndrome: a cross-sectional study

Background: Acute coronary syndromes (ACS) are an imbalance between myocardial oxygen supply and demand, and the presence of anaemia further potentiates this imbalance. The burden of anaemia in patients presenting with acute coronary syndromes (ACS) is significant. Anaemia has the potential to worsen myocardial ischemic insult by decreasing the oxygen content of the blood supplied to the jeopardized myocardium. Present study investigates the prevalence of anaemia in ACS patients attending a tertiary health care institute.Methods: A total of 148 patients with ACS were recruited in the study from July 2018 to October 2018 in Multan institute of cardiology, Pakistan. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent. Patient having any other diseases known to cause anaemia were excluded.Results: Mean age of patients was 49 years. Out of 148, 114 (77%) were males and 34(23%) were females. Prevalence of anaemia was 38% in Male and 58.8% in Female. Among Male, 18.8% were microcytic, 4.54% were macrocytic and 77.27% were normocytic. Among Female, 50% were microcytic and 50%% were normocytic. Prevalence of ACS was higher is patients with diabetes and hypertension combined (31%) than in patient with diabetes alone (17.56%) or hypertension alone (21.62%). 13.51% were pure vegetarians  while 78.37% were on mixed diet consisting of vegetables+meat+pulses.Conclusions: Higher incidence of anaemia was reported in subjects having acute coronary syndrome. Incidence of anaemia in STEMI patients was greater than NSTEMI and unstable angina patients. Severe form of acute coronary syndrome i.e. STEMI was associated with higher incidence of anaemia

Impact of diabetes mellitus on nerves

Background: Involvement of the peripheral and autonomic nervous systems is probably the most common complication of diabetes. The main symptoms of diabetic polyneuropathy include negative symptoms (those related to nerve fiber loss or dysfunction) such as numbness and weakness, and positive symptoms (those related to abnormal function of surviving nerve fibers) such as tingling and pain.Methods: This was a cross-sectional study held in diabetic clinic of Nishter hospital, Multan, Pakistan. The study included any diabetic patients showing symptoms of neuropathy.Results: There were total of 140 in this study. This study included 85% of male and 15% of female. Most common symptoms of diabetic neuropathy were pain (70%) and tingling (70%) followed by numbness in 65% of patients. There were 28 patients in 5 years duration of diabetes, 35 people in 6-10 years duration, 21 patients in 11-15 years duration, and 14 patients in 20+ years duration.Conclusions: Neuropathy due to diabetes is crippling especially when pain is the prominent symptoms. Autonomic symptoms like constipation and lightheadedness are discomforting for the patients. The most commonly used screening test is vibrating tuning fork test which is east to perform is clinical setting and is not time consuming. Diabetic patients need to take special care of

Types and clinical presentation of stroke

Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

THE RESEARCH BASED ON THE RELATIONSHIP BETWEEN R&D AND MARKETING UNITS AT ERICSSON TELECOM COMPANY, SWEDEN.

The paper is an extensive review of inter organizational relation. Every organization wants to attain the competitive position in the Global market. The organization is effectively utilizing the R&D, production and marketing units, to develop the innovative products to accomplish the consumer needs.  The need for innovation is growing every day. The innovation success depends on the vital link between R&D, production and Marketing. In this paper concentrated on R&D and Marketing units at Ericsson Telecom Company, because these two units are combined and work together to discover new innovative products according to the customer requirements and to improve their operational excellence. The paper analyzed the relation between the R&D and Marketing departments of Ericsson is Strong or weak by using the factors like communication, decision making, formal and informal mechanism between the two units and also identified the relationship between these two units has it improved during last three years (2006- 2008). Research Methodology: In this dissertation work the authors were taken the interpretative research. The researchers used Primary data and secondary data. The primary data collected by E mail questions to Ericsson's employees and secondary data collected by Journals, Ericsson home page, magazines and library online database etc. Findings: The researchers analyzed the current relationship between R&D and Marketing units at Ericsson Organization. We scrutinized communication, decision making, and formal and informal mechanism are giving positive support and build the strong relationship between two units. The researchers also found few gaps between two units, but the overall relationship between two units were strong. It positively contributes to Ericsson's operational excellence