Clinico-histopathological study of gonadal and extragonadal teratomas in tertiary care centre

Background: Teratomas are quite often seen in the gonadal region. As compared to gonadal teratoma extragonadal teratomas are very rare. They can be mature, immature, malignant or mixed germ cell tumor. Many a times they are missed clinically because of their rare locations that include retroperitoneum, sacrococcygeal, mediastinum, thyroid, eye, ear, and mesentery. In such locations the list of clinical differentials is long and it is difficult for the clinicians to make an accurate clinical diagnosis. Aims of the study were: to identify the different locations of extragonadal teratoma, to know the histological types of teratoma in different location, and to correlate histopathological diagnosis and clinico-radiological diagnosis. Methods: It is an observational descriptive study of histopathologically proven teratomas over a span of 2 years from July 2021 to July 2023. Results: Out of total 35 cases of teratomas, we had received 14 cases of extragonadal teratomas. The most common sites being sacrococcygeal region. They were most common in the paediatrics age group and most common sex involvement was of male. Conclusions: While interpreting the histopathological findings, a high index of suspicion for teratomas needs to be kept even if the site is not a gonadal location. Simple excision is a cure for this condition or else it may transform to malignancy

Significance of Tumor Marker CA15-3 in Metastatic Breast Cancer

Secondary spread of cancer to bones is commonest and frequent phenomenon and enhances the need of special care for sufferers. Bone metastases mostly are the first complication of different variety of cancers which increase the need of care and expensive facilities. Blood dissemination is another common route, might be due to the venous drainage from visceral organs directly into the axial bones. CA 15-3 is a mucinous tumor markers derived from MUC1 gene, provides better guide line about the treatment, recurrence and prognosis. Aim: Aim of the study was to signify the role of tumor marker CA15-3 in metastatic breast cancer. Methods: Hundred females of breast cancer (any age) with different stages of breast cancer with and without bone metastasis were tested for their serum level of CA 15-3 (biomarker of breast cancer). Bone scan was done to check the secondary metastasis to bones. Intravenous dye Ttechnicium 99 MDP has been used. Serum levels of ca15-3 were measured with the help of Gama Counter with computerized system and IRMA kit (Immunoradiometric Assay) by IMMUNOTECH. Ultrasound of whole abdomen and X ray/CT scan were used to detect liver and pulmonary metastasis respectively. Results: Results indicate a high statistical significant relationship between bone metastasis and elevated levels of tumor marker CA 15-3 in breast cancer patients. Elevated levels of tumor marker CA 15-3 is strongly correlated with positive bone scan. An elevated level of tumor marker CA 15-3 is also correlated with positive pulmonary metastasis CA 15-3 is highly sensitive to detect bone metastasis and also sensitive to detect pulmonary metastasis. A lesser extent of high CA 15-3 serum levels is determinant of liver metastasis. Bone scan is essential tool to detect bone metastasis but need assistance of chemical biomarkers. Conclusions: CA 15-3 as a tumor marker proved a help full determinant of tumor burden in metastatic breast cancer. Its significance is more to detect bone metastasis than to pulmonary and then to liver metastasis. Future studies upon CA15-3 in association with imaging techniques and other organ related specific tumor markers to detect specific metastasis or overall body tumor burden will be blessing for patients and physicians

The dire need for improved management of chronic kidney disease – associated hypertension in Pakistan

Chronic Kidney Disease (CKD) refers to various kidney disorders ranging from mild to severe chronic kidney failure. Because of its escalating incidence and mortality rates, CKD is a serious public health concern in Pakistan. According to a study published in 2018, the overall prevalence of CKD among Pakistani adults was 21.2%, the highest in South Asia. (1) Although there are numerous risk factors for CKD, such as diabetes, cardiovascular disease, smoking, obesity, and genetics, hypertension poses the most serious threat, as the global prevalence of CKD-associated hypertension is between 60 – 90%. (2) In most people with CKD, proteinuria is observed in conjunction with hypertension. (3) As per the Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations, ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) are the preferred treatment choices for diabetic kidney disease and non-diabetic kidney disease patients with proteinuria. In 2013, a cross-sectional study conducted in Karachi, Pakistan, revealed that only 46.1% of General Practitioners opted for ACE inhibitors and ARBs as primary treatment for hypertension and proteinuria associated with CKD. (4) A randomized crossover trial conducted in March 2021 compared  candesartan’s antihypertensive and antiproteinuric effects and the newest ARB, azilsartan medoxomil. The study results revealed that azilsartan (20 mg daily) treatment significantly decreased proteinuria and blood pressure without a noticeable increase in side effects than candesartan (8 mg daily) in patients with CKD who required antihypertensive drugs. (5) Considering the high prevalence of CKD in Pakistan, doctors must follow KDOQI guidelines and prescribe ARBs as the primary therapeutic agents for hypertensive patients with CKD. Azilsartan, the most recent ARB, has been proven to have the most potent antihypertensive and antiproteinuric benefits with the fewest side effects. (5) Therefore, physicians should encourage CKD patients to use azilsartan instead of candesartan and other classes of ARBs.       Furthermore, improved screening techniques for CKD must be introduced and implemented so that doctors can manage the disease more effectively before it progresses into its final stages. Such screening tests would also help to improve blood pressure control among patients recognized to have CKD. Therefore, Pakistan’s public health sector should ensure the implementation of Kidney Disease Improving Global Outcomes (KDIGO) criteria to screen and manage CKD and CKD-associated hypertension and diabetes. Lastly, there is a dire need for awareness programs to educate general health practitioners regarding CKD management and the benefits of timely referral to a nephrologist

Frequency and predictors of non-adherence to lifestyle modifications and medications after coronary artery bypass grafting: A cross-sectional study

Background: Non-adherence to dietary recommendations, exercise and prescribed drug regimens, in coronary heart disease (CHD) patients following coronary artery bypass grafting (CABG), is a major health care issue worldwide. Aims and objectives: The primary objective of this study was to investigate the frequency and predictors of non-adherence to lifestyle changes and medication among CHD patients after undergoing CABG surgery. Method: The sample of this cross sectional descriptive study was 265 patients who underwent isolated primary CABG. Participants who met the eligibility criteria were provided with a pre-coded questionnaire 4 weeks or more after surgery. Adherence was assessed on the basis of patient's self-report. Significance of results was analyzed using Chi square test. Results: Roughly half of the patients were non-adherent to dietary recommendations (n = 120, 45.3%) and exercise (n = 109, 41.1%) while about one third (n = 69, 26%) were non-adherent to prescribed medications. Unwillingness to adopt a new lifestyle and more than one social gathering per week, were found to be statistically significant predictors of non-adherence to diet (p-values < 0.001). Reluctance to follow exercise regimen, busy schedule, and fear that exercise will aggravate heart issues were commonly reported as reasons for non-compliance to exercise. As for non-adherence to medication, forgetfulness, affordability of drugs and too many medications to take were important predictors. Conclusion: Non-adherence to lifestyle modifications and medication is an emerging problem worldwide. It is essential for medical health professionals to discuss these predictors and address them individually. Our findings highlight the need for a healthy physician and patient relationship

Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial

BACKGROUND: Cardiopulmonary bypass is associated with systemic inflammatory response. Steroids suppress this response, although the therapeutic evidence remains controversial. We hypothesised that intravenous steroids in children undergoing open-heart surgery would decrease inflammation leading to better early post-operative outcomes. We conducted a randomised controlledtrial to evaluate the trends in the levels of immunomodulators and their effects on clinical parameters. OBJECTIVE: To assess the effects of intravenous steroids on early post-operative inflammatory markers and clinical parameters in children undergoing open-heart surgery. MATERIALS AND METHODS: A randomised controlled trial involving 152 patients, from one month up to 18 years of age, who underwent open-heart surgery for congenital heart disease from April 2010-2012 was carried out. Patients were randomised and administered either three scheduled intravenous pulse doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at four time intervals and serum levels of inflammatory cytokines - Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha - were measured. Clinical parameters were also assessed. RESULTS: Blood cytokine levels were compared between the dexamethasone (n=65) and placebo (n=64) groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively (p CONCLUSION: Dexamethasone caused quantitative suppression of Interleukin-6 and increased Interleukin-10 activation, contributing to reduced immunopathology, but it did not translate into clinical benefit in the short term

Impact of Drain Placement on Postoperative Complications after Thyroidectomy for Substernal Goiter

Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter