Prevelance of Epigastric pain in patients taking oral NSAIDS alone versus those taking combination of NSAIDs and misoprostol

                                                                   ABSTRACTObjective:                  This study was done to study degree of relationship between epigastric pain due to gastritis and consumption of NSAIDs.Design:This was observational type of study.Duration and time:This study was conducted at Mayo Hospital Lahore in General Outdoor patient department from july 2017 to December 2017.Method:Every patient taking oral NSAIDs or combination of oral NSAIDs and misoprostol twice daily from last two months was included in our study. Written consent form was signed by each patient to be part of study. A questionnaire was made to ask about symptoms of patient. The date obtained was analysed using Microsoft excel and spss.Results:A total of 153 patients were included in our study. Patients taking only oral NSAIDs were 97(63.39%) whereas those taking combination of Oral NSAIDs and Misoprostol were 56 (36.60%).Among the patients who were taking oral NSAIDs alone 73(75.25%) developed epigastric pain whereas remaining 24( 24.74%) did not develop any such symptom. Out of the patients taking combination NSAIDs+ misoprostol only 11 (19.64%)  developed epigastric pain others did not.Conclusion: Using NSAIDs can cause gastritis and thus should not be prescribed alone. Our study has very well established role of Misoprostol in protection of gastric mucosa against harmful affects of NSAIDs

Comparison of Molecular and Phenotypic Methods for the Detection and Characterization of Carbapenem Resistant Enterobacteriaceae

In recent years, there has been a rapid dissemination of carbapenem resistant Enterobacteriaceae (CRE). This study aimed to compare phenotypic and molecular methods for detection and characterization of CRE isolates at a large tertiary care hospital in Saudi Arabia. This study was carried out between January 2011 and November 2013 at the King Khalid University Hospital (KKUH) in Saudi Arabia. Determination of presence of extended-spectrum beta-lactamases (ESBL) and carbapenem resistance was in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Phenotypic classification was done by the MASTDISCSTM ID inhibitor combination disk method. Genotypic characterization of ESBL and carbapenemase genes was performed by the Check-MDR CT102. Diversilab rep-PCR was used for the determination of clonal relationship. Of the 883 ESBL-positive Enterobacteriaceae detected during the study period, 14 (1.6%) isolates were carbapenem resistant. Both the molecular genotypic characterization and phenotypic testing were in agreement in the detection of all 8 metalo-beta-lactamases (MBL) producing isolates. Of these 8 MBL-producers, 5 were positive for blaNDM gene and 3 were positive for blaVIM gene. Molecular method identified additional blaOXA gene isolates while MASTDISCSTM ID detected one AmpC producer isolate. Both methods agreed in identifying 2 carbapenem resistant isolates which were negative for carbapenemase genes. Diversilab rep-PCR analysis of the 9 Klebsiella pneumoniae isolates revealed polyclonal distribution into eight clusters. MASTDISCSTM ID is a reliable simple cheap phenotypic method for detection of majority of carbapenemase genes with the exception of the blaOXA gene. We recommend to use such method in the clinical laboratory

STRUKTUR KOMUNITAS LAMUN DI PULAU KELAPA DAN KELAPA DUA, KEPULAUAN SERIBU, JAKARTA

Struktur komunitas lamun di pulau Kelapa dan Kelapa Dua, kepulauan Seribu, Jakarta telah dilakukan untuk mengetahui keanekaragaman, kerapatan, dan penutupan jenis. Lamun diambil dari tahun 2016 s/d 2018 dengan menggunakan metode transek kuadrat dengan 3 kali ulangan. Lamun yang ditemukan sebanyak 5 jenis, diantaranya yaitu Cymodocea rotundata, Thalassia hemprichii, Cymodocea serrulata, Halophila ovalis dan Halophila minoris yang memiliki indeks keanekaragaman H’ = 1 ? H’ ? 3 yaitu pada kisaran 1,767-6,031. Persen penutupan lamun pada kurun waktu tiga tahun secara berurutan yaitu 57,96%, 54,72% dan 66,24% untuk pulau Kelapa Dua, sedangkan pada pulau Kelapa yaitu 27,72%, 37,26% dan 68,4%. Kerapatan tertinggi di pulau Kelapa yang mengalami peningkatan setiap tahunnya sampai mencapai 250,889 Ind/m2, sedangkan pada stasiun pulau Kelapa Dua dalam kurun waktu tiga tahun berfluktuasi dimana pada tahun terakhir mengalami penuruan dari 228,5 Ind/m2 menjadi 207,33 Ind/m2. Keanekaragaman lamun yang didapatkan berkategori sedang dengan persentasi penutupan di kedua lokasi setiap tahunnya yakni >50%.Kata kunci:    Lamun, struktur komunitas, persentase penutupa

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

A comprehensive plan to implement evidence based medicine curriculum in undergraduate program

Ziauddin Medical College was among the first medical colleges in Pakistan which has introduced integrated curriculum for M.B.B.S Program with concentration on teaching organ systems in preclinical years. There is considerable integration within the disciplines of Basic Health Sciences and Community Health Sciences, and limited integration of Clinical Sciences. Curriculum also have well structured Clinical clerkship program which provides students with good clinical exposure for Patient management. In year 2010, one additional “Clinical Skills Rotation” was added in clinical clerkship programme to provide additional procedural, communication and Evidence based medicine skills to students in their early clinical exposure. After successful implementation of EBM in 3rd year clerkship program me we are proposing a comprehensive plan of evidence based medicine curriculum in all 5 years of MBBS. EBM curriculum is presented here as a model and how it can be integrated into a medical curriculum. Salient features of comprehensive plan Role and Problem identification of EBM in medical curriculum, Needs assessment Goals and Objectives of EBM Educational strategies Resources and personals requirement Faculty resistance. Ethical issues Users of curriculum. Evaluation and feedback. Assessment plan Dissemination. Curriculum maintenance and enhancement of EBM curriculum. Results: of the pilot project of 2 weeks 3rdyear M.B.B.S EBM program and details of the whole model of EBM Curriculum will be presented in the conference. 1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. 1996. Evidence based medicine: what it is and what it isn\u27t. BMJ 312: 71–2 [3]. 2. Kligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, et al. Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med. 2004 Jun;79(6):521-31. 3. Med Educ Online. 2009 Sep 20;14:15. 4. Tamim HM, Ferwana M, Al Banyan E, Al Alwan I, Hajeer AH. Integration of evidence based medicine into a medical curriculum:Med Educ Online. 2009; 14: 15. 5. Nicholson LJ, Warde CM, Boker JR. Faculty training in evidence-based medicine: improving evidence acquisition and critical appraisal. J Contin Educ Health Prof. 2007 Winter;27(1):28-33. 6. BMC Med Educ. 2010 Aug 19;10:58. 7. Ilic D, Forbes K.Undergraduate medical student perceptions and use of Evidence Based Medicine: a qualitative study.BMC Med Educ. 2010; 10: 58 8. Harden, RM, Susette Sowden, and WR Dunn. Educational strategies in curriculum development: the SPICES model. Medical Education 18.4 (1984): 284-297. 9. Turner, Jim L, and Robert Boice. Coping with resistance to facult

A rare case of cerebral phaeohyphomycosis caused by Fonsecaea species in a renal transplant patient

Cerebral phaeohyphomycosis (CP) is a serious form of phaeohyphomycosis. We report a case of CP caused by Fonsecaea species in a 66-year-old immunocompromised renal transplant recipient female. Craniotomy was performed on an irregularly enhancing right cerebellar hemisphere lesion and abscess and tissue samples collected for microbiological and histological evaluation, showing fungal elements and Fonsecaea species was isolated. Antifungal treatment with voriconazole &amp; liposomal amphotericin B was initiated with a temporary improvement in the patient's condition. Deep vein thrombosis jeopardized patient's prognosis. Despite aggressive surgical and medical intervention, our patient succumbed to the disease. Historically, CP has been linked with fatality rates as high as 65 %, despite surgical intervention and systemic antifungal medication

Frequencies and clinical characteristics of common fusion oncogenes in core-binding factor Acute Myeloid Leukemia from Lahore Pakistan

Background: Acute myeloid leukemia (AML) is one of the most common blood cancers among adults. Genetic abnormalities associated with core-binding factor AML (CBF-AML) help in accurate diagnosis and prognostic stratification, and therefore help in clinical management of the disease. No studies have been carried out about frequencies of genetic abnormalities of CBF-AML and their association with clinical parameters in Lahore region of Pakistan. Therefore, objective of this study was to carry out genetic and characterization of CBF-AML.    Methods: The blood samples were collected along with clinical data AML patients from different hospitals of Lahore Pakistan July 2010 to Dec. 2020. RNA was extracted and RT-PCR was employed to detect CBF-AML -associated fusion oncogenes (AML1-ETO and CBFB-MYH11). Data was analyzed using SPSS version 25.Results: Frequencies of AML1-ETO and CBFB-MYH11 were 13.6% and 11.4%, respectively. AML1-ETO had significant association with FAB subtype AML-M2, occupational exposure to chemical solvents and exposure to petrol products. One the other hand, CBFB-MYH11 was significantly associated with splenomegaly, FAB subtype AML-M4 patients and insecticides exposure.Conclusions: Our results show that overall frequencies AML1-ETO and CBFB-MYH11 and hence CBF-AML is comparable to other ethnic groups. Correlation of specific genetic abnormalities with exposures to chemicals indicates a strong interplay between AML genetics and pollutants.   This study will help not only in differential diagnosis and prognostic stratification of AML in Pakistan, but it also opens new windows to better understand biology of AML in correlation with environmental exposure.Keywords: Acute Myeloid Leukemia; Genetic abnormalities; Core-binding factor leukemia, Prognostic stratification; environmental exposure

Novel IoT-Based Plant Monitoring System

The Internet of Things (IoT) plays a vital role in improving cultivation methods for greenhouses and providing farmers/landowners with the relevant information to make decisions for optimal yields. This paper presents an intelligent system, based on the IoT concept that remotely provides users with information related to the temperature, humidity, and soil moisture intensity for the monitoring of plant conditions. The Android application is designed for the users to monitor plant health parameters and manage the timing and frequency of water sprinkling. The sensors collect the readings and transfer them to the Blynk app using the ESP8266 Wi-Fi module. Based on the critical condition of the plant, the user can control the solenoid valve via an Android application to maintain the healthy state of the plant