Non-small cell lung cancer: disease spectrum and management in a tertiary care hospital

Objectives: To review the spectrum of presentation and the surgical management of Non Small Cell Lung Cancer (NSCLC) and the role of various diagnostic modalities in predicting the post-operative stage and the correlation of the post-operative stage with the chances of recurrence.SETTINGS: The Aga Khan University Hospital, Karachi--a tertiary care referral center in Paksitan.Methods: This is a retrospective study of medical records of all the patients who were managed at the Aga Khan University Hospital (AKUH) between 1988 and 1998. The patients with a diagnosis of lung cancer were identified using the ICD-9-CM coding system and the data was analyzed for patients with NSCLC only.Results: A total of 773 patients were admitted with a diagnosis of lung cancer at AKUH over 10 years period. Out of these 21 (2.71%) underwent staging mediastinoscopy and 20 (2.58%) patients underwent exploratory thoracotomy and biopsy without any resection, as the disease was found to be unresectable. Only 18 (2.32%) patients underwent surgical resection. There were 15 males and 3 females and the mean age was 53 years. Mean duration of symptoms was 12 months and cough and haemoptysis were the main presenting symptoms. Most of the tumors were located on the right side. CT scan and mediastinoscopy were mainly used to stage the disease. Complete surgical resection including en-bloc resection of adjacent structures was attempted, when possible. Median follow up was 24 months and the recurrence rate was 39%. There was no significant correlation between post-op stage and recurrence.CONCLUSION: It is concluded that most of the patients present at the advanced stage and resection is possible only in a small number of patients. The size of primary tumor and local extension should not contra-indicate surgery in patients with negative mediastinal nodes and without distant metastasis as it can be performed safely. All pulmonary lesion in the adults must be thoroughly investigated as early diagnosis and complete resection is the only key to cure and long term survival

Acute myocardial infarction: profile and management at a tertiary care hospital in Karachi

Objective: Acute Myocardial Infarction (AMI) is a rising epidemic in developing countries. While studies in the West have established the characteristics and management of AMI patients, comprehensive data reflecting these issues in the Pakistani subjects is scarce. This study examined the profile and management of AMI in patients hospitalized at a tertiary care hospital in Karachi, Pakistan.Methods: Three hundred forty four patients admitted in 1998 with the diagnosis of AMI met our inclusion criteria. Data on presentation, investigations, monitoring and therapy was obtained. Chi-square and t tests were used to analyze the data.Results: Out of 344 patients with AMI, 71% were males; 58% had a Q wave MI. Majority of the patients who presented within 2 hours of symptom onset (36%), had chest pain. Patients with dyspnea and no chest pain were more likely to present after 12 hours of the onset of symptoms. In-house mortality was found to be 10.8%. Low HDL and diabetes was associated with in-hospital complications. Twenty nine percent of patients were given thrombolytic therapy with a mean door-to-needle time of 1 hour 36 minutes; 33% of patients who were eligible of Streptokinase did not receive it. Cardiac catheterization was performed in 28% patients. Echocardiography and Exercise Tolerance Test, both under utilized, were performed in 67% and 16% of patients, respectively. Two hundred sixteen (70%) patients discharged from hospital were contacted via telephone and the 1-year mortality rate among them was 28%.CONCLUSION: The profile and management of AMI was in coherence with earlier, Western studies. Chest pain units need to be established in the Emergency Room. Patients should be risk stratified prior to discharge. Public awareness regarding primary and secondary prevention and symptoms of AMI needs to be increased

Fixed point results of F-rational cyclic contractive mappings on 0-complete partial metric spaces

© 2018 Forum-Editrice Universitaria Udinese SRL. All rights reserved. Wardowski [19] introduced a new concept of contraction which called F-contraction and proved a fixed point theorem on complete metric space. Following this direction of research, in this paper, we introduce an F-rational cyclic contraction on partial metric spaces and we present new fixed point results for such cyclic contraction in 0-complete partial metric spaces. An example is given to illustrate the main result, also an application to integral equation is given to show the usability of our results

3-Ammonio-4-hydroxy­benzoate monohydrate

The title compound, C7H7NO3·H2O, which crystallized as a hydrate, was obtained from an extraction of the plant species Saussurea atkinsonii of the asteraceae family collected from the hilly area (Ayubia) of Pakistan during the flowering season. The dihedral angle between the benzene ring and the carboxyl­ate group is 25.64 (5)°. In the crystal, the packing is consolidated by N—H⋯O and O—H⋯O hydrogen bonds, as well as weak aromatic π–π stacking [centroid–centroid separation = 3.9365 (9) Å] and C=O⋯π inter­actions

Effect of single dose magnesium on arrhythmias in patients undergoing coronary artery bypass surgery

OBJECTIVE: To evaluate the safety and role of prophylactic administration of magnesium in preventing arrhythmias. METHOD: This double blind randomized placebo controlled clinical trial was conducted at Aga Khan University Hospital on coronary artery bypass surgery patients. All patients were connected to holter monitor before induction of anaesthesia and this monitoring continued for 24 hours. Study drug containing either 2-grams of magnesium or normal saline was given after intubation. Levels of serum magnesium was checked preoperatively and then in ICU at 0, 6, 12, and 24 hours. Independent t-test and chi square test were used for analysis. Statistical significance was defined as p-value \u3c 0.05. RESULTS: A total of 104 patients consented to participate in the study, 53 patients were randomly allocated in magnesium (Mg) group and 51 in placebo group. Two (3.77%) patients in magnesium group and five patients (9.8%) in placebo group developed atrial fibrillation. Incidence of ventricular and supraventricular tachycardia was also slightly higher in placebo. Mg level after arrival in CICU (Cardiac Intensive Care Unit) showed mean of 2.1 in magnesium group and 1.6 in placebo group (p = 0.6). CONCLUSION: Low magnesium levels were noticed in the placebo group after cardiopulmonary bypass and although prophylactic administration of magnesium sulphate was relatively safe but significant benefit on prevention of arrhythmias could not be attained

Pharyngitis and sore throat: A review

Pharyngitis is a sore throat caused by inflammation of the back of the throat. It is one of the most common reasons for visits to family physicians. Throat may be scratchy and swallowing can be painful. Usually, a sore throat is the sign of another illness, such as a cold or the flu. In this review article, epidemiology, national perspective, regional perspective, pathogenesis, clinical diagnosis, clinical presentation and causes of pharyngitis was described.Key words: Pharyngitis, sore throat, inflammation

Phenyl N-cyclo­hexyl­carbamate

In the title compound, C13H17NO2, the dihedral angle between the benzene ring and the basal plane of the cyclo­hexyl ring is 49.55 (8)°. In the crystal, mol­ecules are linked by N—H⋯O hydrogen bonds, forming chains propagating in [010]

Some α − ϕ-Fuzzy Cone Contraction Results with Integral Type Application

In this paper, we define α-admissible and α-ϕ-fuzzy cone contraction in fuzzy cone metric space to prove some fixed point theorems. Some related sequences with contraction mappings have been discussed. Ultimately, our theoretical results have been utilized to show the existence of the solution to a nonlinear integral equation. +is application is also illustrative of how fuzzy metric spaces can be used in other integral type operators.Scopu

Comparative study of Internet Protocol

In today's generation, most of today's Internet is using IPv4, Now twenty years old. IPv4 is now uploading with the Problem of meeting growing Internet requirements and it is a shortage of IPv4 addresses, which are necessary for all new the machines added to the Internet.IPv6, fixes a series of problems In IPv4 addresses. It also adds many improvements to IPv4 and provides a better network. IPv6 is expected to gradually replace IPv4, with the two coexisting for several years during a transition period. As the population is increasing day by day, similarly the Internet isAlso growing and expanding more and more and more and more,Government, scientists and universities are looking for new waysTo send information quickly and powerfully The two new InternetsDevelop new and faster technologies to improve research andCommunication, and both projects are expected toEventually improve the current commercial Internet. A big advantage of IPv6 is that it simplifies and solves the problem. The scarcity of IP addresses. In today's Internet technology, Controls in the United States 74% of the 4 million IP addresses, while the amount that China has is equal only to the University California, but its share of 80 million users. This is the main reason Asian countries, especially China, Japan and South Korea, Show interest in IPv6 version technology