Outcome of adult patients with acute lymphoblastic leukaemia receiving the MRC UKALL XII protocol: a tertiary care centre experience

Introduction:Acute lymphoblastic leukaemia (ALL) is a heterogeneous group of lymphoid neoplasm resulting from the proliferation of malignant lymphoid cells. We aimed to study the outcome of adult Patients with ALL receiving the Medical Research Council UKALL XII protocol. Methods: This was a retrospective study conducted at Aga Khan University Hospital from January 2001 to December 2008. The medical records of all adult Patients were reviewed and analysed for clinical, morphological and immunological features at presentation and impact on treatment outcomes. Multivariate analysis and survival studies were performed using Kaplan-Meier statistics. Results: The total number of Patients was 54, with a male to female ratio of 3.4:1 and a median age of 28 years. Common presenting symptoms were fever (n is 49) and bleeding (n is 14). 38 Patients had haemoglobin less than 10 gms/dl, 21 had white blood cell (WBC) count of 50 x 10E9/L or more, and 35 had lactate dehyrogenase more than 1,000 IU. Morphologically, FAB-L2 was the commonest subtype, with 38 Patients with B-ALL and eight with T-ALL. Multivariate analysis showed that age above 30 years, male gender, WBC count above 50 x 10E9/L and T-ALL subtype were independent risk factors for poor survival. 46 (85 percent) Patients achieved complete remission. The median survival was 12.3 months. At the end of five years, 16 Patients were alive, two were alive with disease and 14 were in complete remission. Conclusion: Overall survival and relapse rates in our study were comparable to those reported internationally

Oxidation-Reduction Characteristics of Chlorophenols in an Aprotic Medium

Eighteen chlorophenols, containing from one to five chlorine atoms on the benzene ring at various positions, have been studied by cyclic voltammetric methods to evaluate their oxidation-reduction characteristics in an aprotic medium. The compounds were dissolved in dimethylsulfoxide containing 0.10 M tetrabutylammonium perchlorate as the supporting electrolyte and were then both oxidized and reduced on a glassy carbon electrode. The results indicate that phenols oxidize in a one-step process to phenoxium ion which dimerizes to quinone ether. The ether can be reduced back to phenol in a two-step reduction process. The oxidation potential of the chlorophenols varies with the number and the position of the chlorine substitution. It may also have a relationship with the toxicity of the compound. The main purpose of this study is to understand low chlorophenols, classified as environmental pollutants for their toxicity and carcinogenicity, are oxidized by cytochrome P450 in the metabolic activation process in living systems

Income diversification and income inequality : household responses to the 2013 floods in Pakistan

In this paper we investigate the economic response of rural households to the 2013 floods in Pakistan. The case study illustrates the important roles of labor supply adjustments and income diversification in coping with climate-related risks. Using detailed household panel data that were collected before and after the 2013 floods, we find that the exposure to flood results in lower participation in farm activities. The overall effects are decreased diversification in the sources of income and ambiguous reduction in inequality which is associated with overall declines in incomes. These changes could be locked in if affected households do not have sufficient assets to resume farming. The results suggest intervention points for public policy, related to labor mobility and access to capital

Performance Evaluation of Centralized Reconfigurable Transmitting Power Scheme in Wireless Network-on-chip

Network-on-chip (NoC) is an on-chip communication network that allows parallel communication among all cores to improve inter-core performance. Wireless NoC (WiNoC) introduces long-range and high bandwidth radio frequency (RF) interconnects that can possibly reduce the multi-hop communication of the planar metal interconnects in conventional NoC platforms. In WiNoC, RF transceivers account for a significant power consumption, particularly its transmitter, out of its total communication energy. This paper evaluates the energy and latency performance of a closed loop power management mechanism which enables transmitting power reconfiguration in WiNoC based on number of erroneous received packets. The scheme achieves significant energy savings with limited performance degradation and insignificant impact on throughput

Revisiting Copenhagen climate mitigation targets

Many economies set climate mitigation targets for 2020 at the 2009 15th Conference of the Parties conference of the United Nations Framework Convention on Climate Change in Copenhagen. Yet no retrospective review of the implementation and actual mitigation associated with these targets has materialized. Here we track the national CO2 emissions from both territory and consumption (trade adjusted) perspectives to assess socioeconomic factors affecting changes in emissions. Among the 34 countries analysed, 12 failed to meet their targets (among them Portugal, Spain and Japan) and 7 achieved the target for territorial emissions, albeit with carbon leakage through international trade to meet domestic demand while increasing emissions in other countries. Key factors in meeting targets were intensity reduction of energy and the improvement of the energy mix. However, many countries efforts fell short of their latest nationally determined contributions. Timely tracking and review of mitigation efforts are critical for meeting the Paris Agreement targets

Intracranial chordoma presenting as acute hemorrhage in a child: Case report and literature review

BACKGROUND: Chordomas are rare, slow-growing malignant neoplasms derived from remnants of the embryological notochord. Pediatric cases comprise only 5% of all chordomas, but more than half of the reported pediatric chordomas are intracranial. For patients of all ages, intracranial chordomas typically present with symptoms such as headaches and progressive neurological deficits occurring over several weeks to many years as they compress or invade local structures. There are only reports of these tumors presenting acutely with intracranial hemorrhage in adult patients. CASE DESCRIPTION: A 10-year-old boy presented with acute onset of headache, emesis, and diplopia. Head computed tomography and magnetic resonance imaging of brain were suspicious for a hemorrhagic mass located in the left petroclival region, compressing the ventral pons. The mass was surgically resected and demonstrated acute intratumoral hemorrhage. Pathologic examination was consistent with chordoma. CONCLUSION: There are few previous reports of petroclival chordomas causing acute intracranial hemorrhage. To the authors' knowledge, this is the first case of a petroclival chordoma presenting as acute intracranial hemorrhage in a pediatric patient. Although uncommon, it is important to consider chordoma when evaluating a patient of any age presenting with a hemorrhagic lesion of the clivus

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review & revise’ experience

Background: We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review & revise’ which is a key strategy to minimise antibiotic overuse in hospitals. Methods: In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study. Results: Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions. Conclusions: This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review & revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received