Cd20 Expression and Effects on Outcome of Relapsed/ Refractory Diffuse Large B Cell Lymphoma after Treatment with Rituximab

Introduction: Down regulation of CD20 expression has been reported in diffuse large B cell lymphoma (DLBCL)). Therefore, it is important to determine whether chemotherapy with rituximab induces CD20 down regulation and effects survival. Objectives: To determine the incidence of down regulation of CD20 expression in relapsed DLBCL after treatment with rituximab and to compare outcomes and assess pattern of relapse between CD20 negative and CD20 positive cases. Methodology: We retrospectively reviewed patients with relapsed DLBCL who received rituximab in the first line setting at Aga Khan University Hospital between January 2007 and December 2014. Data were recorded on predesigned questionnaires, with variables including demographics, details regarding date of diagnosis and relapse, histology, staging, international prognostic index, treatment and outcomes at initial diagnosis and at relapse. The Chi square test was applied to determine statistical significance between categorical variables. Survival curves were generated by the Kaplan–Meier method. Results: A total of 54 patients with relapsed DLBCL were included in our study, 38 (70 %) males and 16(30%) females. Some 23 (43%) patients were at stage IV at the time of diagnosis and 34 (63%) had B symptoms. The most frequent R-IPI at diagnosis was II in 24 (44%) patients. Only 6 (11%) did not show CD20 expression on re-biopsy for relapsed/refractory disease, 2 with CD20 negative DLBCL responding to second line chemotherapy. A complete response after salvage chemotherapy was noted in 16 (29.6%) cases with relapsed/refractory DLBCL. Seven (13%) patients underwent an autologous bone marrow transplant as consolidation after second line treatment. Median overall survival was 18 months in CD20 positive vs. 13 months in CD20 negative patients. Conclusion: This study demonstrated that a small percentage of patients treated with rituximab lose their CD20 expression at the time of relapse. However, it is unclear whether this is associated with an inferior outcome

Preliminary radiological result after establishment of hospital-based trauma registry in level-1 trauma hospital in developing country setting, prospective cohort study

Introduction: Injuries are the second most common cause of disability, the fifth most common cause of healthy years of life lost per 1000 people and unfortunately 90% of mortality takes place in low-to middle-income countries. Trauma registries guide policymakers and health care providers in decision making in terms of resource allocation as well as enhancing trauma care outcomes. Furthermore data from these registries inform policy makers to decrease the rate of death and disability occurring as a result of injuries. We present our experience in setting up an orthopedic trauma registry and the first short term follow-up of radiological outcomes.Materials and Methodology: Our study is a non-funded, non-commercial, prospective cohort study that was registered at Research Registry. The primary objectives of our study included assessing pattern of injuries in patients with upper and lower limb skeletal trauma presenting to our tertiary care academic university hospital and their respective outcomes. Data was collected by the musculoskeletal service line team members supervised by an experienced research associate and trauma consultants. The work has been reported in line with the STROCSS criteria.Results: A total of 177 patients were included in this analysis, of whom 101 (57.1%) patients had lower limb fractures, 64(36.1%) patients ad upper limb fractures and 12 (6.8%) patients had both upper and lower limbs involved. A total of 189 upper and lower limb fracture cases were recorded. 176 patients (93.1%) underwent surgeries and 13(6.9%) were managed nonoperatively. Roentgenographic outcomes were assessed using radiological criteria for each bone fractured.Conclusion: Establishing a trauma registry assists in identification of the pattern of injuries presenting to the hospital which helps in priority setting, care management and planning. This continuous audit of outcomes in turn, plays a significant role in quality improvement

Correlation of TP53 overexpression and clinical parameters with five-year survival in oral squamous cell carcinoma patients

Abstract Introduction TP53 mutation and overexpression have been correlated with poor survival in many cancers including oral squamous cell carcinoma (OSCC). We aim to understand the role of TP53 overexpression in OSCC in our population and correlate it with five-year survival to test its viability as a prognostic marker for OSCC patients. Materials and methods Patients with biopsy proven OSCC at Aga Khan University Hospital from January 2000 to January 2008 were recruited. Immunohistochemistry was used to establish TP53 status and the results were published. Following up on these patients, five-year data were collected and correlated with TP53 status and other clinicopathologic parameters. Results Overexpression of TP53 was not significantly associated with five-year survival (hazard ratio [HR]: 1.543; 95% CI: 0.911-2.612; p = 0.107). Conclusion Although we had proven statistical relevance when correlated with overall survival in our previous study, we were unable to extend the same relevance to TP53 overexpression when it comes to five-year survival

Hernia of morgagni presenting as constipation in a 65-year-old male

Hernia of Morgagni is congenital defects in the diaphragm. They are mostly asymptomatic and present with vague symptoms when they do so. A high index of suspicion is required for timely diagnose of this condition. Here we present the case of a 65-year-old male patient presented to our institute with constipation for the past six months. Chest radiology raised the suspicion of a hernia which was further confirmed by contrast studies. Laparotomy was done and the hernia sac identified, colon and greater omentum reduced and defect repaired. He was discharged in stable condition and was doing well on follow-up

Management of penetrating injury to thoracic inlet and lower neck with retained foreign body using video assisted thoracoscopic surgery

Penetrating neck and chest injuries are a common form of occupational injuries. We hereby report a unique case in which a metallic rod had penetrated the left chest and neck of a plastic factory worker. The patient was vitally stable when he presented to Emergency Room. Chest X-ray was performed and the patient was rushed to the operating room. VATS (video assisted thoracoscopic surgery) and neck dissection was done for retrieval of the metallic rod. On table, endoscopy was also done to rule out injury to oesophagus. No injury to vital structures was found and the subsequent recovery was uneventful

The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs). Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis. Results: The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = 0.11 and P = .004). A BL criterion value greater than 0 mV predicted a significant shunt ratio (Qp/Qs \u3e or = 1.5) (odds ratio, 4.8; 95% confidence interval, 1.3, 18.1; P = or \u3c.0001) with a sensitivity of 0.68 and specificity of 0.65. Conclusion: Our results indicate that there is limited utility of the BL criterion at detecting right ventricular volume overload, although a BL criterion value greater than 0 mV being used to identify patients with significant intracardiac shunts yielded a sensitivity of 0.68 and specificity of 0.65

Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression.Results: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these ‘bounced-back’ LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital.Conclusion: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and ‘bouncing back.’ This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences

Composite model predictive control for the boost converter and two-phase interleaved boost converter

This article compares the conventional model predictive control (MPC) and active disturbance rejection control (ADRC) with a novel MPADRC technique for controlling a non-minimum phase behavior in the DC–DC boost converter. The control of the boost converter is challenging as it is nonlinear, and it shows non-minimum phase behavior in a continuous conduction mode (CCM). Moreover, in this article, the comparison is presented for the boost converter and the two-phase interleaved boost converter using MPC and ADRC, and the effectiveness of the interleaving technique is shown. Finally, it is proved that the interleaving method has much more efficiency and less output ripple than the simple boost converter. To conclude, a novel technique has been introduced that combines both the techniques, that is, MPC and ADRC, in the outer and inner loop with a boost converter, respectively, and the response is clearly the best when compared to the said techniques individually. The overall impact of this technique includes the advantages of both the techniques, that is, the use of MPC allows us to optimize the current value by predicting the future values, and the use of ADRC ensures that the disturbance factor is well tackled and cancels the effect caused by all the disturbances including ignored quantities as well

Revitalizando o Conforto: projeto de um Sistema HVAC com Eficiência Energética para o Auditório Universitário

Nowadays, thermal comfort is becoming a major problem for people due to increasing global warming and climatic changes, but it can be resolved by the concept of Heating, Ventilation, and Air Conditioning (HVAC) systems. The purpose of HVAC is to provide occupants with a comfort zone so that they can feel comfortable according to their thermal comfort. The core objective of this study is to design and propose an HVAC system as per actual design conditions for the University Auditorium located in Karachi, Pakistan. A direct Expansion (DX – Type) system is installed in the Auditorium that has exceeded the lifespan of twenty years, refrigerant R-22 which is currently being used has been obsolete due to its high GWP (Global Warming Potential) and ODP (Ozone Depletion Potential) values which are 1810 and 0.05 respectively. To achieve the objective of this study, two approaches are employed. Cooling Load Temperature Difference (CLTD) method & Hourly Analysis Program (HAP) software. The cooling load calculated from the CLTD method is 202 kW equivalent to 57.5 Ton of Refrigeration (TR). On the other side, the cooling load calculated from HAP software is 192.8 kW equivalent to 55 TR. By considering the calculated cooling load for the University Auditorium, two different HVAC systems are proposed, based on Water cooled and Air-cooled Vapor Compression Cycle. After this study, engineers will be able to design an HVAC system for any facility as per design conditions. Also, they can propose different cost-effective and energy-efficient HVAC systems for that particular space.Hoy en día, el confort térmico se está convirtiendo en un gran problema para las personas debido al aumento del calentamiento global y los cambios climáticos, pero puede ser resuelto por el concepto de sistemas de Calefacción, Ventilación y Aire Acondicionado (HVAC). El objetivo de HVAC es proporcionar a los ocupantes una zona de confort para que puedan sentirse cómodos de acuerdo con su confort térmico. El objetivo central de este estudio es diseñar y proponer un sistema HVAC según las condiciones de diseño reales para el Auditorio Universitario ubicado en Karachi, Pakistán. En el Auditorio se encuentra instalado un sistema de Expansión Directa (Tipo DX) que ha superado la vida útil de veinte años, el refrigerante R-22 que se utiliza actualmente ha quedado obsoleto por su alto GWP (Global Warming Potential) y ODP (Ozone Depletion Potencial) valores que son 1810 y 0.05 respectivamente. Para lograr el objetivo de este estudio, se emplean dos enfoques. Método de diferencia de temperatura de carga de enfriamiento (CLTD) y software de programa de análisis por hora (HAP). La carga de refrigeración calculada a partir del método CLTD es de 202 kW equivalente a 57,5 Toneladas de Refrigeración (TR). Por otro lado, la carga de refrigeración calculada a partir del software HAP es de 192,8 kW equivalente a 55 TR. Al considerar la carga de enfriamiento calculada para el Auditorio Universitario, se proponen dos sistemas HVAC diferentes, basados en el ciclo de compresión de vapor enfriado por agua y enfriado por aire. Después de este estudio, los ingenieros podrán diseñar un sistema HVAC para cualquier instalación según las condiciones de diseño. Además, pueden proponer diferentes sistemas HVAC rentables y energéticamente eficientes para ese espacio en particular.Hoje em dia, o conforto térmico está a tornar-se um grande problema para as pessoas devido ao aumento do aquecimento global e às alterações climáticas, mas pode ser resolvido pelo conceito de sistemas de Aquecimento, Ventilação e Ar Condicionado (HVAC). O objetivo do HVAC é proporcionar aos ocupantes uma zona de conforto para que se sintam confortáveis de acordo com o seu conforto térmico. O objetivo principal deste estudo é projetar e propor um sistema HVAC de acordo com as condições reais de projeto para o Auditório Universitário localizado em Karachi, Paquistão. No Auditório está instalado um sistema de Expansão Direta (Tipo DX) que ultrapassou sua vida útil de vinte anos. O refrigerante R-22 atualmente utilizado tornou-se obsoleto devido ao seu alto GWP (Potencial de Aquecimento Global) e ODP (Depleção de Ozônio). Potencial) valores que são 1810 e 0,05 respectivamente. Para atingir o objetivo deste estudo, duas abordagens são utilizadas. Método de diferença de temperatura de carga de resfriamento (CLTD) e software de programa de análise horária (HAP). A carga de resfriamento calculada a partir do método CLTD é de 202 kW equivalente a 57,5 toneladas de refrigeração (TR). Por outro lado, a carga de refrigeração calculada a partir do software HAP é de 192,8 kW equivalente a 55 TR. Ao considerar a carga de refrigeração calculada para o Auditório Universitário, são propostos dois sistemas HVAC diferentes, baseados no ciclo de compressão de vapor refrigerado a água e arrefecido a ar. Após este estudo, os engenheiros serão capazes de projetar um sistema HVAC para qualquer instalação com base nas condições de projeto. Além disso, eles podem propor diferentes sistemas HVAC econômicos e energeticamente eficientes para esse espaço específico