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

current state of poison control centers in Pakistan and the need for capacity building.

Background: Chemical exposure is a major health problem globally. Poison control centers (PCCs) play a leading role both in developed and developing countries in the prevention and control of poisonous chemical exposures. In this study, we aimed to assess the current state of PCCs in Pakistan and highlight capacity building needs in these centers. Methods: A cross-sectional survey of the two registered PCCs was done during August – December 2011. Necessary services of the PCCs were evaluated and the data were recorded on a predesigned checklist. Results: Both PCCs are affiliated to a tertiary care hospital. Clinical services to poisoned patients were available 24 hours a day / 7 days a week. Information on common local products was available to poison center staff. Both centers were involved in undergraduate and post graduate teaching. Telephone poison information service was not available in either of centers. There was a limited capacity for qualitative and analytical toxicology. Common antidotes were available. There were limited surveillance activities to capture toxic risks existing in the community and also a deficiency was observed in chemical disaster planning. Conclusion: PCCs in Pakistan need capacity building for specialized training in toxicology, toxicovigilance, chemical disaster planning, analytical laboratory tests and telephone service for consultation in poisoning cases

Metastatic prostate tumor to testes: Sign of advance disease

Prostate cancer is the second most common cause of mortality for males in the United States. Metastases may be present, typically in the axial skeletal region. To date, few patients have presented with metastases to the testicles. We present the case of an adult male with diagnosed prostate cancer who presented and subsequently diagnosed bilateral testicular metastases. Testicular metastases secondary to diagnosed prostate cancer are very rare. Patients present with these metastases may have unfavorable prognosis. This case demonstrates that prostate cancer may metastasize to rare locations such as the testes, requiring further surgical intervention

The current state of poison control center in Pakistan and the need of capacity building

Context Poison control center plays a leading role both in developed and developing countries in the prevention and control of poisonous exposure. In a developing country, the poison control center may be the only source of information and advice on toxic chemicals because of unavailability of resources such as occupational, food and drug regulatory bodies. Objective In this study, we aim to assess the current state of poison control centers of Pakistan and to highlight gaps in their capacity building needs. Methods Cross-sectional survey of two poison control centers was done during August – December 2011 with the help of standardized tool. Results Both poison control centers were affiliated with tertiary care hospital involved in undergraduate and post graduate teaching. Clinical services were available 24/ 7. Information on common local product was available to poison center staff. Common antidotes were available. Telephonic poison information service to the public was currently not available. There was a limited capacity for qualitative and analytical toxicology. There were limited surveillance activities to capture toxic risk existing in the community and also deficiency was observed in chemical disaster planning. Conclusion Poison control centers in Pakistan need capacity building for specialized training in toxicology. Keywords: toxicology, Emergency, Karachi, Pakista

PENILE CANCER AND OUR EXPERIENCE AT TERTIARY CARE HOSPITAL

Purpose: Penile cancer is a rare malignancy which accounts for <1% of adult male cancers. Phimosis, poor hygiene, smoking and human papillomavirus infection (type 16 and 18) are major risk factors for penile cancer. This analysis is to know the mode of presentation and treatment outcome of penile cancer in our setting.Materials and Methods: We reviewed case notes of all patients who had histologically proven penile cancer from January 2005 to December 2014. Patient’s demographics, predisposing factors, symptoms, type of tumour, treatment and its outcome were analysed using the Statistical Package for the Social sciences 19.Results: A total number of 19 patients who had histologically proven penile cancer were included in the study. Circumcision was done in 16 (84.2%), while 3 (15.8%) were uncircumcised. Most of the patients presented with a lesion 16 (84.2%) and the rest 3 (15.8%) with pain. Patients having delayed presentation by 1 year were 15 (78.9%), 3 (15.8%) after 2 years and one patient (5.3%) after 5 years. Partial and total penectomy were performed in 4 (40%) patients each while wide local excision in 2 (20%) of the patients (n = 10). 4 (30.7%) patients had complication of treatment. The overall 5-year survival was 69.2%.Conclusion: Penile cancer is an aggressive malignancy with generally poor outcome. There is a need of awareness amongst the masses of this cancer to detect the disease at an early stage. There is further need for specialised oncological centre to improve survival rates and outcome.Key words: Circumcision, penectomy, penile cancer, phimosi

Classification of pharynx from MRI using a visual analysis tool to study obstructive sleep apnea

BACKGROUND: Obstructive sleep apnea (OSA) is a chronic sleeping disorder. The analysis of the pharynx and its surrounding tissues can play a vital role in understanding the pathogenesis of OSA. Classification of the pharynx is a crucial step in the analysis of OSA. METHODS: A visual analysis-based classifier is developed to classify the pharynx from MRI datasets. The classification pipeline consists of different stages, including pre-processing to select the initial candidates, extraction of categorical and numerical features to form a multidimensional features space, and a supervised classifier trained by using visual analytics and silhouette coefficient to classify the pharynx. RESULTS: The pharynx is classified automatically and gives an approximately 86% Jaccard coefficient by evaluating the classifier on different MRI datasets. The expert's knowledge can be utilized to select the optimal features and their corresponding weights during the training phase of the classifier. CONCLUSION: The proposed classifier is accurate and more efficient in terms of computational cost. It provides additional insight to better understand the influence of different features individually and collectively. It finds its applications in epidemiological studies where large datasets need to be analyzed

Triple-component nanocomposite films prepared using a casting method: Its potential in drug delivery

The purpose of this study was to fabricate a triple-component nanocomposite system consisting of chitosan, polyethylene glycol (PEG), and drug for assessing the application of chitosan–PEG nanocomposites in drug delivery and also to assess the effect of different molecular weights of PEG on nanocomposite characteristics. The casting/solvent evaporation method was used to prepare chitosan–PEG nanocomposite films incorporating piroxicam-β-cyclodextrin. In order to characterize the morphology and structure of nanocomposites, X-ray diffraction technique, scanning electron microscopy, thermogravimetric analysis, and Fourier transmission infrared spectroscopy were used. Drug content uniformity test, swelling studies, water content, erosion studies, dissolution studies, and anti-inflammatory activity were also performed. The permeation studies across rat skin were also performed on nanocomposite films using Franz diffusion cell. The release behavior of films was found to be sensitive to pH and ionic strength of release medium. The maximum swelling ratio and water content was found in HCl buffer pH 1.2 as compared to acetate buffer of pH 4.5 and phosphate buffer pH 7.4. The release rate constants obtained from kinetic modeling and flux values of ex vivo permeation studies showed that release of piroxicam-β-cyclodextrin increased with an increase in concentration of PEG. The formulation F10 containing 75% concentration of PEG showed the highest swelling ratio (3.42±0.02) in HCl buffer pH 1.2, water content (47.89±1.53%) in HCl buffer pH 1.2, maximum cumulative drug permeation through rat skin (2405.15±10.97 μg/cm2) in phosphate buffer pH 7.4, and in vitro drug release (35.51±0.26%) in sequential pH change mediums, and showed a significantly (p<0.0001) higher anti-inflammatory effect (0.4 cm). It can be concluded from the results that film composition had a particular impact on drug release properties. The different molecular weights of PEG have a strong influence on swelling, drug release, and permeation rate. The developed films can act as successful drug delivery approach for localized drug delivery through the skin. Keywords: anti-inflammatory, chitosan, nanocomposite, permeation, polyethylene glyco

Madurella mycetomatis as an agent of brain abscess: case report and review of literature

Fungal cerebral abscesses are rare and usually seen in immunocompromised individuals. We report a case and review published literature of Madurella mycetomatis as an agent of cerebral abscess. We found contiguous head and neck infections to be the principal cause of cerebral maduromycosis caused by M. mycetomatis. Early recognition of Madurella spp. as the causative agent is essential to avoid cerebral spread