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

PLAYERS’ PERCEPTION ABOUT COMMERCIALIZATION OF SPORTS IN ACADEMIC INSTITUTIONS OF PAKISTAN

Commercialization is the way toward presenting another item or creation strategy into trade making it accessible available. The term frequently implies particularly the passageway into the mass market instead of prior specialty markets, however it additionally incorporates a move from the research facility into even constrained trade. The main objectives of the study are to examine the effects of commercialization of sports in academic institutions. The study was quantitative in nature and sample (n=260) for this research was from eight private and public sector universities of Lahore. The data collection tool was questionnaire containing 20 items. Results and data analysis showed that there is no difference among the opinion of male and female (Sig. 0.362) and among different age groups (Sig. 0.791). Overall results showed that there is positive effect of commercialization of sports in academic institutions as commercialization of sports helps players to develop their financial, sympathetic and caring attitude, their financial support, their recognition in society as well as their social support. Commercialization of sports promotes modesty and quality of life in them. Commercialization’s of sports also help to develop their personality with behavior and ethical values and awareness regarding their role in the society. In future recommendations, there should be panel discussions about commercialization of sports should be organized in collaboration of both coaches and athletes, there should be qualified staff for the commercialization, coaching and training of players, sports organizations and government should take necessary steps for the promotion of commercialization of sports at grass root as well as at international level

Prevalence of intestinal metaplasia and dysplasia in infectious and non-infectious chronic gastritis

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age.Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms.Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori) and (4.7% without H. pylori). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%).Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference

Outcomes of high risk Patients with febrile neutropenia at a tertiary care center

Creative Commons Attribution LicenseFever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality incancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status,comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia(FN) are observed in those with documented infection. The objectives of the study were to present available tools forrisk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes. Methods: Thiscross sectional study was conducted on adult culture positive FN patients admitted to the Hematology/Oncologyservice at the Aga Khan University Hospital, Karachi, Pakistan from 1st January 2009 to 31st December 2012. Highriskcriteria were defined as profound neutropenia, short latency from a previous chemotherapy cycle, sepsis orclinically documented infection at presentation, severe co-morbidity and a performance status greater than or equalto 3. All types of organisms in blood culture and the outcomes of the patients were recorded on Proforma. Results:A total of 156 patients with culture-positive febrile neutropenia were identified during the study period. The meanage was 47 years with a slight male predominance of 54%. One hundred and sixteen patients fulfilled the criteria forthe high risk group. Fifty two percent had a single high risk factor and 40 % had two. All patients harbored eithersingle or multiple bacterial organisms including gram positive, gram negative or both types. Some 34% of patientshad gram positive bacteremia, 57 % had gram negative and 9 % were infected with both. Among 73 gram positivecultures 44 % were Staphylococcus species and among 123 gram negative cultures 43 % were E. coli. One hundredand fifteen patients recovered uneventfully and could be discharged. Thirty two patients in the high risk and 9 in thelow risk groups deceased with an overall mortality of 26 %. The mean hospital stays of patients with solid tumors andhematological malignancies were 7.58 and 15.0 days, respectively. Mortality was higher in the latter group, and alsoin high risk patients with both gram positive and negative bacteremia. Conclusion: We emphasize the importance ofrisk stratification and continuous surveillance of the spectrum of locally prevalent pathogens and their susceptibilitypatterns for formulation of therapeutic regimens for febrile neutropenic patients

Construction of Synthetic Intact Human Parathyroid Hormone Gene and Testing the Transformation Efficiency and Expression of it in E. coli strains

 human parathyroid hormone gene (hPTH gene) is responsible for preproparathyroid hormone production (biologically inactive hormone) which further modified to form the biologically active hormone, a synthetic hPTH gene with 289bp which cod for active intact hPTH was constructed by Five long primers by splicing overlap extension PCR (SOE), the gene contain a de generated codon, and have two recognition site of restriction enzymes in both ends of the Gene, and a stop codon. The synthetic hPTH gene was transformed in two E. coli strains DH5? and BL21 (DE3) with transformation efficiency6.6* 106 and 3.4* 106 for both isolatesrespectively. And the transformation of gene was detected by extraction of constructed plasmid and amplification of cloning gene on it, the expression of the cloning gene in the BL21 (DE3) was detected by performing Real Time PCR which gave a Ct value of about (23.46). That makes the synthetic gene suitable for direct expression of human active protein inside the bacterial cells

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

Knowledge, attitude and perceptions of Muslim cancer patients regarding cancer treatment during Ramadan: Results from a tertiary care hospital Karachi

Objective: To assess the knowledge and attitude of Muslim cancer patients regarding cancer treatment during Ramadan.Methods: This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from July to August 2015, and comprised cancer patients. .Adult Muslim cancer patients receiving active oncological treatment or on surveillance were included. Patients on only supportive treatment were excluded. SPSS 19 was used for data analysis.Results: Of the 265 patients, 87(32.8%) were males and 178(67.2%) were females. The overall mean age was 49±13.87 years. Besides, 184(70.9%) patients belonged to the middle class. Breast cancer was the most common cancer 106(40.6%). Overall, 153(57.9%) patients had stage II disease. Further, 201(80%) patients had 0-1 performance status. Moreover, 180(72%) patients were receiving different forms of chemotherapeutic agents. It was found that 113(54.3%) patients sought advice regarding fasting. Most of the patients who observed fast, i.e. 214(81%), had an early stage disease and 19(7.1%) were on hormonal therapy. Patients who did not fast mostly attributed this to fatigue 69(26.3%). Conclusion: Only half of the patients sought advice on fasting and those having early disease more.Conclusions: Only half of the patients sought advice on fasting and those having early disease more frequently observed fast

Efficacy of Insecticides against Fall Armyworm, Spodoptera frugiperda (Lepidoptera, Noctuidae) in Maize

Fall armyworm (FAW), Spodoptera frugiperda (Lepidoptera: Noctuidae) is most destructive specie of genus Spodoptera for several agricultural crops. In Pakistan\u27s Sindh province, the invasive fall armyworm Spodoptera frugiperda was first documented causing serious maize damage in 2019. There is need to develop management strategies against this pest in the country. The current study was conducted to check the toxicity of different insecticides against FAW in maize field. The results showed among tested insecticides, deltamethrin was recorded most toxic insecticide followed by chlorantraniliprole and emamectin benzoate. At 1d days after first spray, least number of larvae were recorded with deltamethrin (0.07 larvae/plant), chlorantraniliprole (0.11d larvae/plant) and emamectin benzoate (0.13 larvae/plant). After three days application of first spray, significantly a minimum number of larvae were recorded with deltamethrin (1.11bcd larvae/plant) chlorantraniliprole (1.13d larvae/plant) and emamectin benzoate (1.17d larvae/plant). The maximum and minimum population of larvae was recorded at 1st day of first spray and 14 days of spray, respectively. The least number of larvae were recorded at 14 days of second spray. At 14 days after 2nd spray, 0.07ab, 0.10e and 0.10de larvae per plant were recorded with deltamethrin, chlorantraniliprole and emamectin benzoate, respectively