Publications by authors named "Muhammad Abu Bakar"

54 Publications

Incidence of acute kidney injury and assessment of its associated risk factors in patients undergoing transarterial chemoembolisation for hepatocellular carcinoma.

J Pak Med Assoc 2022 Jun;72(6):1057-1060

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Objective: To determine the incidence of acute kidney injury in intermediate stage hepatocellular carcinoma patients undergoing trans-arterial chemoembolisation, and to analyse various causative factors.

Methods: The retrospective study was conducted at the Shaukat Khanum Cancer Memorial Hospital, Lahore, Pakistan,, and comprised data from January 2012 to December 2015 of adult patients of either gender with intermediate stage hepatocellular carcinoma and undergoing trans-arterial chemoembolisation with Child-Pugh score A. Outcomes were measured in the form of development of acute kidney injury, and its causative factors. Data was analysed using SPSS 20.

Results: Of the 133 patients, 90(67.6%) were male. The overall mean age of the sample was 59±8.4 years (range: 26-86 years). Of these, 19(14%) developed acute kidney injury. Higher alpha-fetoprotein levels and lower albumin levels were found to be the significant causative factors (p<0.05).

Conclusions: The incidence of trans-arterial chemoembolisation-related acute kidney injury was 14%. Higher baseline alpha-fetoprotein and lower baseline albumin levels were found to be the significant risk factors.
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http://dx.doi.org/10.47391/JPMA.1286DOI Listing
June 2022

Efficacy of Radioiodine Therapy in Patients With Primary Hyperthyroidism: An Institutional Review From Pakistan.

Cureus 2022 May 14;14(5):e24992. Epub 2022 May 14.

Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background Radioactive iodine (RAI) is the treatment of choice for most patients with primary hyperthyroidism. The most common etiologies of hyperthyroidism are Graves' disease (GD), toxic adenoma (TA), and toxic multinodular goiter (TMNG). A single dose of RAI is usually sufficient to cure hyperthyroidism. The aim of this study was to assess the effectiveness of RAI therapy for patients diagnosed with primary hyperthyroidism. Methods and materials Patients diagnosed with hyperthyroidism who received RAI therapy between 2008 and 2018 were included in the study. The data was acquired from the hospital's electronic medical record system. Following the RAI treatment, a cure was defined as the development of euthyroidism or hypothyroidism after a single fixed-dose without antithyroid medication within one year of RAI therapy. In addition, a simple logistics regression model was used to identify the prognostic factors that may lead to better outcomes. Results A total of 112 patients diagnosed with hyperthyroidism with a mean age of 47 ± 14 were included in this study. The majority of the patients were female, 79 (70.5%). Within one year of RAI therapy, 84 (75%) patients achieved a cure that is either hypothyroid or euthyroid status. RAI dose was higher in responsive patients (18.50 ± 4.10 millicurie [mCi] versus 16.50 ± 4.10 mCi) than in non-responsive patients. The mean RAI doses were 16.05 ± 2.99 mCi in GD, 19.81 ± 4.40 mCi in TMNG, and 20.50 ± 3.30 mCi in TA, with a statistically significant p-value of 0.001. In the univariable logistic regression model, RAI dose was a significant prognostic factor of the responsive group (OR: 1.15, CI [1.01-1.31], p-value 0.03). Conclusion Our data presented that RAI therapy is effective for primary hyperthyroidism. We achieved remission with a single fixed-dose in the majority of patients. Most of our patients were cured within three months of RAI therapy. In addition, the RAI dose was higher in the responsive group as compared to the non-responsive group.
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http://dx.doi.org/10.7759/cureus.24992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191269PMC
May 2022

Review of Perioperative Care Pathway for Children With Renal Tumors.

Cureus 2022 May 11;14(5):e24928. Epub 2022 May 11.

Biostatistics and Epidemiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.

Introduction Wilms tumor is the most common (90%) renal tumor in children. With the recent advances survival rate approaches 90%. This study was designed to identify factors associated with early recovery and hospital discharge, a step forward in the future development of early recovery after surgery (ERAS) protocol in children.  Methods A retrospective cohort study was conducted from May 2020 to February 2022 among children up to the age of 18-years with a diagnosis of primary malignant renal tumors who underwent radical nephrectomy. Baseline parameters (preoperative), intraoperative, and postoperative components were analyzed. A univariable and multivariable logistic regression model was used to identify the factors leading to early discharge. The data were entered into SPSS version 20 (IBM Inc., Armonk, USA), and a p-value ≤0.05 was statistically significant. Results A total of 44 patients with malignant renal tumors were managed with a mean age at diagnosis of 4.06±3.00 years. Twenty-six (59.1%) were male and 18 (40.9%) were female. All the patients received neoadjuvant chemotherapy. Wilms tumor was the most common pathology found in 41 (93.1%) patients; 19 (43.0 %) had stage I, 21 (47.7%) stage II, and four (9.1%) stage III disease. Thirty-four (77.3%) patients had a nasogastric tube placed postoperatively. Median blood loss (BL) was 40 ml (range: 5-250), and the median operative time was two hours (range: 1-4). The median postoperative day to mobilization was one day (range: 1-3), to clear liquids was two days (range: 1-3), and advanced to regular diet was three days (range: 2-5). The median postoperative day of discharge (from surgery to discharge) was four days (range: 2-7), with 31 (70.5%) patients discharged early. Conclusion Our findings indicate that early removal of tube, mobilization, and re-feedings were significantly associated with the early hospital discharge, while the other analyzed factors were not statistically significant. Furthermore, our findings are important in the future development and implementation of ERAS protocol in pediatric oncological resections.
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http://dx.doi.org/10.7759/cureus.24928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187842PMC
May 2022

Survival outcomes of unilateral retinoblastoma based on pathological risk stratification-experience at a tertiary care centre in Pakistan.

Ecancermedicalscience 2022 1;16:1360. Epub 2022 Mar 1.

Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A, Johar Town, Lahore 54782, Pakistan.

Retinoblastoma (RB) is the most common childhood intraocular malignancy. In high-income countries over the past decade, upfront enucleation for unilateral RB is least favoured due to other alternatives that can help in globe preservation, but in low-middle income countries it is still the preferred option due to lack of resources and expertise. The treatment of RB after enucleation is tailored based on the histopathological risk features, as adjuvant chemotherapy with high-risk features reduces the risk of metastasis. The aim of our study was to analyse the survival outcomes of adjuvant therapy based on histopathological risk stratification in patients who underwent upfront enucleation for unilateral RB with advanced disease. A retrospective study was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. A total 113 patients (aged 3 months till 16 years) diagnosed with unilateral RB who had upfront enucleation from July 2009 till January 2019 were included in this study. The mean age of diagnosis was 37.4 months (±24.5) and male-to-female ratio of 1.3:1. The most common clinical presentation was leukocoria (74.3%). Patients who underwent enucleation had advanced disease; group D present in 62.8% followed by group E (32.7%). Histopathology revealed high-risk features in 29 patients (25.7%) and intermediate risk in 54 patients (47.8%). Disease progression and relapse was seen in patients with high-risk histopathological features. The 4-year over-all survival and EFS observed for this cohort was 74% and 71%. Awareness about the early symptoms among the general population and health care personnel at a nationwide level is needed to facilitate early detection and lessen disease related morbidity and mortality.
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http://dx.doi.org/10.3332/ecancer.2022.1360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9085156PMC
March 2022

Metabarcoding of Parasitic Wasp, (Nixon) (Hymenoptera: Braconidae) That Parasitizing Bagworm, Walker (Lepidoptera: Psychidae).

Trop Life Sci Res 2022 Mar 31;33(1):23-42. Epub 2022 Mar 31.

Centre for Insect Systematics, Department of Biological Science and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia.

Microbiome studies of the parasitoid wasp, (Nixon) (Hymenoptera, Braconidae) are important because has potential as a biological control agent to suppress the pest, Walker (Lepidoptera, Psychidae). Three field populations of parasitic wasps with different Integrated Pest Management (IPM) practices to control collected from Perak state (Tapah) and Johor state (Yong Peng and Batu Pahat districts) in Peninsular Malaysia were studied. Bacterial community composition and structure were analysed using α and β diversity metrics. Proteobacteria (83.31%) and Bacteroidetes (6.80%) were the most dominant phyla, whereas unknown family from order Rhizobiales was the most abundant family found in all populations followed by Pseudomonadaceae. Family Micrococcaceae was absent in Tapah. Rhizobiales gen. sp. and sp. were abundant in all populations. Pearson's correlation analysis showed the strongest correlation between individuals of Batu Pahat and Yong Peng ( = 0.89827, < 0.05), followed by Tapah and Yong Peng with = 0.75358, < 0.05 and Batu Pahat and Tapah ( = 0.69552, < 0.05). We hypothesise that low diversity and richness in Tapah might be due to direct and indirect effect of insecticides application. This preliminary data was the first study to do inventory of the microbiomes in the gut of the .
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http://dx.doi.org/10.21315/tlsr2022.33.1.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128653PMC
March 2022

Safety and efficacy of Sinopharm vaccine (BBIBP-CorV) in elderly population of Faisalabad district of Pakistan.

Postgrad Med J 2022 May 4. Epub 2022 May 4.

Department of Respiratory Medicine, Portiuncula Hospital Ballinasloe, Ballinasloe, Ireland.

Introduction: The first case of novel SARS-COV-2 (COVID-19) in Pakistan was detected on 26 February 2020. Pharmacological and non-pharmacological strategies have been tried to lessen the mortality and morbidity burden. Various vaccines have been approved. The Drug Regulatory Authority of Pakistan gave emergency approval for Sinopharm (BBIBP-CorV) COVID-19 vaccine in December 2021. The phase 3 trial of BBIBP-CorV included only 612 participants aged 60 years and above. The primary aim of this study was to assess the safety and efficacy of BBIBPP-CorV (Sinopharm) vaccine within the Pakistani adult population aged 60 or above. The study was carried out in the Faisalabad district of Pakistan.

Methods: A test negative case-control study design was used to assess safety and efficacy of BBIBP-CorV in individuals aged 60 and above against symptomatic infection, hospitalisations and mortality due to SARS-CoV-2 among vaccinated and unvaccinated individuals. ORs were calculated using logistic regression model at 95% CI. ORs were used to calculate the vaccine efficacy (VE) by using the following formula.VE= (1-OR) ×100.

Results: 3426 individuals with symptoms of COVID-19 were PCR tested between 5 May 2021 and 31 July 2021. The results showed that Sinopharm vaccine 14 days after the second dose was efficient in reducing the risk of symptomatic COVID-19 infection, hospitalisations and mortality by 94.3%, 60.5% and 98.6%, respectively, among vaccinated individuals with a significant p value of 0.001.

Conclusion: Our study showed that BBIBP-CorV vaccine is highly effective in preventing infection, hospitalisations and mortality due to COVID-19.
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http://dx.doi.org/10.1136/postgradmedj-2022-141649DOI Listing
May 2022

Ecological risks of heavy metals on surficial sediment of Nijhum Dweep (Island), an important biodiversity area of Bangladesh.

Mar Pollut Bull 2022 Jun 28;179:113688. Epub 2022 Apr 28.

Department of Oceanography, Noakhali Science and Technology University, Noakhali 3814, Bangladesh; University of South Bohemia in Ceske Budejovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Research Institute of Fish Culture and Hydrobiology, Zatisi 728/II, 389 25 Vodnany, Czech Republic.

Ten surficial sediment samples (up to a depth of 3 cm) were randomly collected during the pre-monsoon and analyzed for nine heavy metals using an atomic absorption spectrophotometer (AAS) to assess the distribution, contamination levels, and potential sources of heavy metals. The particle size distribution of the sediments was also investigated using a laser particle size analyzer. The mean concentration (mg/kg) of the analyzed metals followed a decreasing order of Fe (4706.24) > Mn (95.20) > Cu (36.97) > Zn (20.65) > Ni (9.26) > Cr (7.20) > Pb (5.63) > Co (5.52) > Cd (0.29). Surficial sediment of the Island was low to moderately contaminated by Cd and, to a laser extent by Cu in terms of enrichment factor (EF), geo-accumulation index (Igeo), and contamination factor. Ecologically, the Nijhum Dweep area was at low to moderate risk, where Cd was the most potential ecological risk factor. The Pearson correlation analysis revealed a significant positive correlation among Cr, Pb, Zn, Mn, Cd, Fe, Co, Ni, and silt particles, whereas a negative correlation with sand particles. No correlation was found with Cu and other metals except clay particles.
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http://dx.doi.org/10.1016/j.marpolbul.2022.113688DOI Listing
June 2022

Outcomes of Uretero-ileal Anastomosis in Bladder Cancer Cystectomies: Bricker vs. Wallace 1.

Cureus 2022 Mar 2;14(3):e22782. Epub 2022 Mar 2.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background The two commonly used methods for uretero-ileal anastomosis (UIA) during radical cystectomy for muscle-invasive bladder cancer (MIBC) are the Bricker and Wallace 1 techniques. Published data on the incidence of strictures at anastomotic sites is limited. This study compares both anastomotic techniques in terms of uretero-ileal stricture (UIS) rates and the factors that govern it in the patient group. Material and methods Records of all patients presenting with bladder cancer who underwent radical cystectomy at the department of uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) Lahore, Pakistan, from January 1, 2009, to December 31, 2018, were reviewed retrospectively, and all adult patients aged >18 years out of them were selected for the study. Results With a total of 116 patients, the mean age was 54.37 ± 11.16 and a male majority (83.6%). Urinary diversion using ileal conduit was performed in 70 (60.3%) patients and the rest of them i.e. 46 (39.7%) had neobladder formation. Amongst them, uretero-ileal anastomosis was constructed via Bricker and Wallace 1 in 73 (62.9%) patients and 43 (37.1%) patients respectively. Pelvic radiotherapy was received by 13 (11.2%) patients. Anastomotic stricture developed in 19 (16.4%) cases. A relatively similar proportion of stricture rate was found in Bricker and Wallace 1 technique (10% vs 13%). Body mass index (BMI) was found to be significantly higher in patients who developed UIS. Incidence of stricture formation was more on the left than right side i.e. 12 (63.2%) vs five (26.3%) while two (10.5%) patients developed bilateral strictures. Conclusion No significant difference in stricture formation was noted between Bricker and Wallace 1 technique. High BMI and anastomotic leaks were the contributory factors for this complication during our experience.
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http://dx.doi.org/10.7759/cureus.22782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976153PMC
March 2022

Frequency of CD34 and CD10 Expression in Adolescent and Young Adult Patients Having Precursor B-cell Acute Lymphoblastic Leukemia and Its Correlation With Clinical Outcomes: A Single-Center Study.

Cureus 2022 Jan 15;14(1):e21261. Epub 2022 Jan 15.

Biostatistics and Epidemiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background: The clinical outcomes of CD34 and CD10 antigens expression in adolescent and young adult (AYA) precursor B-cell acute lymphoblastic leukemia (pre-B-ALL) is not still well established. In the present study, we analyzed the laboratory characteristics and clinical outcomes of 123 AYA pre-B-ALL patients in order to evaluate the possible clinical significance of these markers.

Materials And Methods: In the current study clinical data of 123 consecutive AYA pre-B-ALL patients aged 18-39 years old, enrolled in adult hematology-oncology unit from December 2014 to April 2019 was analyzed. Patient clinical outcome was calculated as overall survival and disease-free survival.

Results: Overall, 76.4% of patients showed CD34 expression and CD10 expression was found in 90.2%. CD34 and CD10 expression was associated with higher total leucocyte count, increased peripheral blood blast percentage, and decreased platelet count. Overall survival and disease-free survival were both significantly better in CD34 negative and CD10 negative patients compared to their CD34 positive and CD10 positive counterparts.

Interpretation And Conclusion: Expressions of CD34 and CD10 are adverse prognostic factors in AYA pre-B-ALL patients and the presence of these antigens influences the clinical outcome of these patients.
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http://dx.doi.org/10.7759/cureus.21261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8842122PMC
January 2022

Achieving Complete Radiological and Bio-Chemical Response as a Predictor of Long-Term Survival in Stage IV Epithelial Ovarian Cancer.

Cureus 2021 Nov 29;13(11):e20017. Epub 2021 Nov 29.

Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Objective Epithelial ovarian cancer (EOC) is common among ovarian cancers. The majority of existing literature shows combined data of stage III and stage IV. Therefore, we aimed to look for whether achieving complete radiological and biochemical response after initial treatment of stage IV epithelial ovarian cancer as a predictor of long-term survival in the Pakistani population. Methods A cross-sectional study was conducted of patients with stage IV epithelial ovarian cancer diagnosed and treated from 2006-2013 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Overall survival was defined as the number of months between patients' diagnosis at the hospital and any cause of death or last follow-up date. Kaplan Meier curve was used to report the overall survival. The log-rank test was used to distinguish the survival difference in complete and no complete response. P-value <0.05 was considered statistically significant. Result A total of fifty patients of stage IV epithelial ovarian carcinoma, with a mean age of 53 ± 2 received neoadjuvant chemotherapy and suitable patients underwent interval-debulking surgery. Among these fifty patients, twenty-one (42%) patients who achieved complete radiological and biochemical response had a median survival of greater than five years. Patients without co-morbidities (46%) and having good performance status (52%) showed better results of the treatment. Patients' tolerance to chemotherapy with good response and fit enough to undergo interval-debulking surgery, achieving complete radiological and biochemical response after initial induction therapy were significantly associated with long-term survival (P<0.05). Conclusion Outcomes of patients who present with stage IV EOC remains dismal. Patients who achieved complete radiological and biochemical response after neoadjuvant chemotherapy and interval-debulking surgery was significantly associated with long-term survival.
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http://dx.doi.org/10.7759/cureus.20017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716327PMC
November 2021

Elucidating the Etiologies of 18F-fluorodeoxyglucose-Avid Mediastinal Lymph Nodes Among Cancer Patients in a Tuberculosis-Endemic Region Using Endobronchial Ultrasound.

Cureus 2021 Nov 7;13(11):e19339. Epub 2021 Nov 7.

Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background Non-malignant conditions, including infections (such as tuberculosis [TB]), can mimic malignancy with regards to their uptake of 18F-fluorodeoxyglucose (F-FDG) tracer utilized for positron emission tomography-computed tomography (PET-CT) scan, as part of the diagnostic and staging workup of cancer patients. This poses a diagnostic challenge, for which tissue sampling is decisive. In this study, we aimed to determine the underlying etiologies of F-FDG-avid mediastinal lymph nodes among cancer patients in a TB-endemic demographic using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and the respective sensitivity and specificity of PET-CT and EBUS in diagnosing malignancy. Methodology In this retrospective cross-sectional study, we analyzed the data of all cancer patients with F-FDG-avid mediastinal lymphadenopathy on diagnostic PET imaging, who later underwent EBUS-TBNA between July 2013 and December 2018 at our center. Logistic regression analysis was used to determine the relative risk of lymph node characteristics with malignant TBNA cytology, based on which a risk stratification model was formulated. Results A total of 178 patients were included in this study, comprising predominantly males (60.7%). The primary malignancy was lung cancer in 33 (18.5%) patients, while 145 (81.5%) had non-lung cancer. A total of 214 F-FDG lymph nodes were sampled, out of which TBNA revealed malignant cytology in only 44 (20.6%). The final diagnosis was malignancy, TB, and sarcoidosis in 42 (23.6%), 16 (9%), and 12 (6.7%) patients, respectively. Among the remaining, 98 (55%) patients were determined to have only reactive lymphadenopathy, of which 24 (24.5%) had nodal anthracosis, while TBNA was inadequate for the diagnosis in 10 (5.6%) patients. An increased risk of malignancy was associated with the size of lymph node [odds ratio (OR): 1.58 (confidence interval (CI): 1.19, 2.11; p = 0.001], the standard uptake value (SUV) of the lymph node on PET-CT [OR: 1.30 (CI: 1.15, 1.45); p = 0.001], and with primary lung malignancy [OR: 4.44 (CI: 1.96, 10.06); p = 0.001]. At an SUV cut-off value of 6.0, PET-CT had the sensitivity, specificity, positive predictive value, and negative predictive value of 73%, 70%, 49.3%, and 91.8%, respectively, for diagnosing malignancy, while the same for EBUS was estimated to be 93.3%, 100%, 100%, and 97%, respectively. Conclusions In addition to TB, benign etiologies including nodal anthracosis and sarcoidosis predominate as causes of F-FDG-avid mediastinal lymphadenopathy in cancer patients of a TB-endemic demographic. The predictable risk of malignancy on PET imaging increases with nodal size, SUV, and lung primary malignancy; however, EBUS clearly demonstrates a higher sensitivity.
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http://dx.doi.org/10.7759/cureus.19339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651531PMC
November 2021

A rare case of sinonasal solitary fibrous tumour in a patient with concurrent papillary thyroid carcinoma: A case report.

Ann Med Surg (Lond) 2021 Dec 10;72:103032. Epub 2021 Nov 10.

Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

Introduction And Importance: A solitary fibrous tumour (SFT) is a rare neoplasm that commonly arises in the pleura and can occur in other extrathoracic sites. Extrapleural SFT, particularly in the sinonasal cavity, is extremely rare. There are no definite diagnostic criteria for sinonasal SFT as it is rare. Histologic analysis with immunohistochemistry plays an important role in diagnosing SFT.

Case Presentation: We report herein a case of SFT of the sinonasal cavity, which later spread to the oral cavity in a 67-year-old male with underlying papillary thyroid carcinoma (PTC) stage IV. He complained of recurrent epistaxis from a mass in his left nasal cavity for two weeks. The mass grew bigger, and spread to the oral cavity, causing dysphagia and upper airway obstruction. Tracheostomy was done under local anaesthesia and a biopsy of the mass was taken to rule out metastasis from the PTC. However, histopathological examination revealed a mesenchymal tumour of fibroblastic type, consistent with an SFT. He was planned for surgical resection of the tumour. However, he refused the operation and was lost to follow-up.

Clinical Discussion: We describe the clinical presentation of this rare tumour of the sinonasal and oral cavity, including upper airway obstruction, and the importance of immunohistochemical markers such as CD34 and BCL-2 in diagnosing SFT. Complete resection of the tumour is the definitive treatment for SFT.

Conclusion: SFT of the sinonasal and oral cavity is extremely rare. Upper airway obstruction may occur due to the location of the tumour in the airway region. Immunohistochemistry is crucial to distinguish this tumour from other mesenchymal tumours.
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http://dx.doi.org/10.1016/j.amsu.2021.103032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609029PMC
December 2021

Effectiveness of Different Soft Acaricides against Honey Bee Ectoparasitic Mite (Acari: Varroidae).

Insects 2021 Nov 17;12(11). Epub 2021 Nov 17.

Guangdong Key Laboratory of Animal Conservation and Resource Utilization, Guangdong Public Laboratory of Wild Animal Conservation and Utilization, Institute of Zoology, Guangdong Academy of Sciences, Guangzhou 510260, China.

Honey bees () are essential for their products-honey, royal jelly, pollen, propolis and beeswax. They are also indispensable because they support ecosystems with their pollination services. However, the production and functions of honey bees are hindered by the arthropod pest , which attacks bees through its feeding activities. Efforts to control varroa mites have been made through the development of various synthetic pesticide groups, but have had limited success because the mites developed resistance and some of these pesticides are harmful to bees. Branded pesticides are rarely used in Pakistan, as beekeepers utilize acaricides from unknown sources. There is a need to create awareness of available naturally occurring acaricides that may serve as an alternative to synthetic acaricides. Although some naturally occurring compounds are considered toxic to the environment, the soft acaricides oxalic acid, thymol, and formic acid 65% are usually safe for honey bee colonies and beekeepers, when handled appropriately. The current study investigated the effectiveness of formic acid (10, 15, and 20 mL/hive), oxalic acid (4.2, 3.2, and 2.1%/hive), and thymol (6, 4, and 2 g/hive) in controlling mite infestation. The results indicated that all treatments significantly reduced the mite population ( < 0.05). The average efficacies of oxalic acid at 3.2% (94.84% ± 0.34) and 4.2% (92.68% ± 0.37) were significantly higher than those of the other treatments. The lowest efficacy was recorded in formic acid 65% at 10 mL (54.13%). Overall, the results indicated that soft acaricides-such as oxalic acid at 3.2% and 4.2% concentrations-are very effective at controlling varroa mites and can be used in broodless conditions without side effects.
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http://dx.doi.org/10.3390/insects12111032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624935PMC
November 2021

Insights into the nutritional properties and microbiome diversity in sweet and sour yogurt manufactured in Bangladesh.

Sci Rep 2021 11 22;11(1):22667. Epub 2021 Nov 22.

Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chattogram, 4331, Bangladesh.

Yogurt is one of the most frequently consumed dairy products for nutritional benefits. Although yogurt is enriched with probiotics, it is susceptible to spoilage because of the presence of pathogenic microbes. Spoiled yogurt if consumed can cause food-borne diseases. This study aimed to assess the nutritional composition and microbiome diversity in yogurt manufactured in Bangladesh. Microbial diversity was analyzed through high-throughput sequencing of bacterial 16S rRNA gene and fungal internal transcribed spacer (ITS) region. From nutritional analysis, significantly (P < 0.05) higher pH, fat, moisture, total solid and solid-non-fat contents (%) were observed in sweet yogurt. Following the classification of Illumina sequences, 84.86% and 72.14% of reads were assigned to bacterial and fungal genera, respectively, with significantly higher taxonomic richness in sour yogurt prepared from buffalo. A significant difference in bacterial (P = 0.001) and fungal (P = 0.013) diversity between sweet and sour yogurt was recorded. A total of 76 bacterial and 70 fungal genera were detected across these samples which were mostly represented by Firmicutes (92.89%) and Ascomycota (98%) phyla, respectively. This is the first study that accentuates nutritional profiles and microbiome diversity of Bangladeshi yogurt which are crucial in determining both active and passive health effects of yogurt consumption in individuals.
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http://dx.doi.org/10.1038/s41598-021-01852-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608820PMC
November 2021

Clinical Practice for Venous Thromboembolism Prophylaxis in Patients Undergoing Oncological Surgeries.

Cureus 2021 Jul 25;13(7):e16627. Epub 2021 Jul 25.

Biostatistics and Epidemiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Objective To determine the proportion of patients receiving venous thromboembolism (VTE) prophylaxis after oncological surgeries as per the hospital standards and its comparison with the international guidelines. Methodology In the month of September 2019, all patients after elective oncological surgeries were reviewed for VTE prophylaxis administration and education. Results were shared with the department of surgery and Hospital Quality and Patient Safety Department. Education was provided to the relevant staff and hospital policy for VTE prophylaxis was revised followed by a loop audit which was done in October 2020. The primary endpoint was to compare the proportion of patients receiving prophylaxis as per the hospital guidelines. Results Total 425 patients were included in this audit (209 in September 2019 and 216 in October 2020). Compliance with mechanical prophylaxis increased from 84.7 % to 98.6% and pharmacological prophylaxis improved from 39.7% (n=83) to 73.1% (n=158). Adherence to local protocols enhanced significantly from 1.9% (n=4) to 56.4% (n=122). The main cause of non-compliance was lack of risk assessment for VTE. Conclusion VTE prophylaxis can be improved by setting protocols in accordance with the international guidelines and local protocols. This can prevent significant morbidity and mortality in surgical patients as well as hospital costs.
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http://dx.doi.org/10.7759/cureus.16627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384387PMC
July 2021

Sarcoidosis: epidemiology, characteristics, and outcomes over 10 years - a single-center study in Pakistan.

Expert Rev Respir Med 2022 01 17;16(1):133-143. Epub 2021 Aug 17.

Pulmonology & Critical Care Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.

Background: Sarcoidosis is a multisystem granulomatous inflammatory disease which remains under-diagnosed in a tuberculosis endemic region such as Pakistan.

Rationale: To determine the distribution, clinical characteristics, diagnostic and treatment modalities and the disease course in the Pakistani population.

Methods: A cross-sectional review of sarcoidosis patients from Jan-1,2010 to Dec-31,2019 was done. Multivariable logistic and cox-regression models were used to identify the independent risk-factors associated with disease relapse. Kaplan-Meier curves were used to assess the DFS.

Results: 222 patients, with mean age 44 ± 12 years, predominantly females (57.7%) and mean BMI 29 ± 6 were diagnosed sarcoidosis. Significant co-morbidities affected 36.5%, 90% were nonsmokers, and 50.3% belonged to moderate SES. Total 178 (80.2%) were symptomatic with 115 (51.8%) having multi-organ involvement. Stage-I radiological disease was predominant (52.5%). Histopathological diagnosis was obtained in 161 (72.5%) patients. Out of 113 mediastinal lymph-nodes, NNGI was present in 99, with highest yield in Station-07 (68.6%). Treatment was instituted in 108/178 (60.7%) symptomatic patients with steroids alone and in 26 (14.6%) with S+IS, with better clinical and radiological response duration in patients receiving steroid monotherapy (p-values=0.01 and 0.001,respectively, along with overall higher survival time (p-value = 0.04). Risk factors identified for relapse included high SES (AOR5.52;95%CI(1.10-28.40),0.04), steroid monotherapy (AOR0.22; 95%CI(0.10-0.87),0.03), symptomatic response after one year (AOR3.40; 95%CI(1.02-11.10),0.04), and radiological response duration (AOR1.10; 95%CI(1.05-1.20),0.04).

Conclusion: Sarcoidosis is a dynamic disease with a variable clinical and geographical spectrum but good overall prognosis.
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http://dx.doi.org/10.1080/17476348.2021.1924062DOI Listing
January 2022

Ex-situ catalytic pyrolysis of chicken litter for bio-oil production: Experiment and characterization.

J Environ Manage 2021 Nov 31;297:113407. Epub 2021 Jul 31.

Faculty of Integrated Technologies, Universiti Brunei Darussalam, Tungku Link, Gadong, BE1410, Brunei Darussalam. Electronic address:

The depletion of fossil fuels has been a greater concern to the world due to the demand for energy that tremendously increasing with urbanization and population growth. For sustainable development, power industries are trying to find suitable substitute of petroleum fuel which is environment friendly and economically feasible. The biomass such as the production of bio-oil from chicken litter could be a possible alternative source of energy. The conversion of the feedstock was conducted through a catalytic pyrolysis process in an ex-situ fixed bed reactor heated at 500 °C with a heating rate of 50 °C/min. Proximate, ultimate, and calorific analysis of the feedstock was studied using TGA/DTG analysis, CHNS, and bomb calorimeter, respectively. GCMS and py-GCMS experiments on the bio-oil showed that the HHV of the feedstock was 16.01 MJ/kg. The addition of catalyst improved the quality of the bio-oil yield. The presence of dolomite and ZMS-5 catalyst enhances the phenols and aromatic content, respectively. Biomass to catalyst (B/C) ratio increased the oil production from 43.6g to 51.9g for dolomite and 43.6g-47.1g for ZMS-5 with the B/C ration of 20g:3g. Elevating the B/C ratio increases the pyrolytic liquid yield with greater influence on the furanic compound.
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http://dx.doi.org/10.1016/j.jenvman.2021.113407DOI Listing
November 2021

Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors.

Front Oncol 2021 20;11:655634. Epub 2021 May 20.

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Background: Cancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan.

Patients And Methods: We did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher's exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality.

Results: Seventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (=0.01). We identified two independent risk factors associated with death, ICU admission (=0.007) and D-dimer (=0.003).

Conclusion: Pakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.
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http://dx.doi.org/10.3389/fonc.2021.655634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173078PMC
May 2021

Expression of cornulin in tongue squamous cell carcinoma.

Ecancermedicalscience 2021 4;15:1197. Epub 2021 Mar 4.

Institute of Cancer Therapeutics, University of Bradford, Tumbling Hill Street Bradford, BD7 1BD, United Kingdom.

The aim of the study is to identify cornulin (CRNN) protein expression associated with advancement of tongue squamous cell carcinoma (TSCC). A comparison of addictive (containing potential carcinogens) versus non-addiction causative agents was expected to allow detection of differences in CRNN expression associated with TSCC. Bespoke tissue microarrays (TMAs) were prepared and immunohistochemistry (IHC) performed to determine the changes in CRNN expression in epithelial cells of node-negative (pN-), node-positive (pN+) TSCC and non-cancer patients' oral tissues. TMAs were validated by performing IHC on whole diagnostic tissues. Chi-square test or Fisher's-exact tests were used to establish significant expression differences. Analogous analyses were performed for biomarkers previously associated with TSCC, namely collagen I alpha 2 (COL1A2) and decorin (DCN) to compare the significance of CRNN. Keratinisation and its level (low, extensive) were studied in relation to CRNN so that the extent of squamous differentiation could better be assessed. IHC immunoreactive score (IRS) clustered the patients based on weak/moderate (Low (IRS ≤ +3)) or strong (High (IRS ≥ +4)) expression groups. A low expression was observed in a larger number of patients in control proteins COL1A2 (77.3%), DCN (87.5%) and target protein CRNN (52.3%), respectively. Low CRNN expression was observed in TSCC where nodes were involved (pN+: mean 1.4 ± 2.1) ( = 0.248). Keratinisation (%) was low (0% ≤ 50%) in 42.2% and extensive (1% ≥ 50.0%) in 57.8% patients. In conclusion, our study suggested that Low CRNN expression was associated with grade and lymph node metastasis in TSCC. CRNN expression is independent of addiction, however potentially carcinogenic addictive substances might be aiding in the disease progression.
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http://dx.doi.org/10.3332/ecancer.2021.1197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043688PMC
March 2021

Correction to: Prognostic outcomes of treatment naïve oral tongue squamous cell carcinoma (OTSCC): a comprehensive analysis of 14 years.

Eur Arch Otorhinolaryngol 2021 Aug;278(8):3055

Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.

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http://dx.doi.org/10.1007/s00405-021-06617-8DOI Listing
August 2021

Forkhead box P3 and indoleamine 2,3-dioxygenase co-expression in Pakistani triple negative breast cancer patients.

World J Clin Oncol 2020 Dec;11(12):1018-1028

Department of Basic Science Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab 54000, Pakistan.

Background: Forkhead box P3 (FOXP3) is a specific marker for immunosuppressive regulatory T (T-reg) cells. T-regs and an immunosuppressive enzyme, indoleamine 2,3-dioxygenase (IDO), are associated with advanced disease in cancer.

Aim: To evaluate the co-expression of FOXP3 and IDO in triple negative breast cancer (TNBC) with respect to hormone-positive breast cancer patients from Pakistan.

Methods: Immunohistochemistry was performed to analyze the expression of FOXP3, IDO, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor on tissues of breast cancer patients ( = 100): Hormone-positive breast cancer ( = 51) and TNBC ( = 49). A total of 100 patients were characterized as FOXP3 negative positive and further categorized based on low, medium, and high IDO expression score. Univariate and multivariate logistic regression models were used.

Results: Out of 100 breast tumors, 25% expressed FOXP3 positive T-regs. A significant co-expression of FOXP3 and IDO was observed among patients with TNBC ( = 0.01) compared to those with hormone-positive breast cancer. Two variables were identified as significant independent risk factors for FOXP3 positive: IDO expression high (adjusted odds ratio (AOR) 5.90; 95% confidence interval (CI): 1.22-28.64; = 0.03) and TNBC (AOR 2.80; 95%CI: 0.96-7.95; = 0.05).

Conclusion: Our data showed that FOXP3 positive cells might be associated with high expression of IDO in TNBC patients. FOXP3 and IDO co-expression may also suggest its involvement in disease, and evaluation of FOXP3 and IDO expression in TNBC patients may offer a new therapeutic option.
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http://dx.doi.org/10.5306/wjco.v11.i12.1018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769718PMC
December 2020

Predicting the survival in patients with malignant pleural effusion undergoing indwelling pleural catheter insertion.

Ann Thorac Med 2020 Oct-Dec;15(4):223-229. Epub 2020 Oct 10.

Royal Blackburn Teaching Hospital, East Lancashire Hospitals, NHS Trust, England, UK.

Context: Malignant pleural effusion (MPE) is a common comorbid condition in advanced malignancies with variable survival.

Aims: The aim of this study was to predict the survival in patients with MPE undergoing indwelling pleural catheter (IPC) insertion.

Settings And Design: This was a cross-sectional study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Methods: One hundred and ten patients with MPE who underwent IPC insertion from January 2011 to December 2019 were reviewed. Kaplan-Meier method was used to determine the overall survival (OS) of the patient's cohort with respect to LENT score.

Statistical Analysis Used: The IBM SPSS version 20 was used for statistical analysis.

Results: We retrospectively reviewed 110 patients who underwent IPC insertion for MPE, with a mean age of 49 ± 15 years. 76 (69.1%) patients were females, of which majority 59 (53.6%) had a primary diagnosis of breast cancer. The LENT score was used for risk stratification, and Kaplan-Meier survival curves were used to predict the OS. The proportion of patients with low-risk LENT score had 91%, 58%, and 29% survival, the moderate-risk group had 76%, 52%, and 14% survival, and in the high-risk group, 61%, 15%, and 0% patients survived at 1, 3, and 6 months, respectively. In addition, there was a statistically significant survival difference ( = 0.05) in patients who received chemotherapy pre- and post-IPC insertion.

Conclusions: LENT score seems to be an easy and attainable tool, capable of predicting the survival of the patients with MPE quite accurately. It can be helpful in palliating the symptoms of patients with advanced malignancies by modifying the treatment strategies.
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http://dx.doi.org/10.4103/atm.ATM_289_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720744PMC
October 2020

Prognostic outcomes of treatment naïve oral tongue squamous cell carcinoma (OTSCC): a comprehensive analysis of 14 years.

Eur Arch Otorhinolaryngol 2021 Aug 25;278(8):3045-3053. Epub 2020 Nov 25.

Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.

Objectives: To analyze the factors predicting survival outcomes in treatment naïve oral tongue squamous cell carcinoma (OTSCC).

Materials And Methods: A comprehensive review of 531 oral tongue carcinoma patients treated with upfront surgery followed by adjuvant radiotherapy or chemoradiotherapy was conducted from 2004-2018.

Results: The mean age of presentation was 53 years (11-86) with a male to female ratio of 1.3:1. The associated risk factors were smoking (21%), betel nut (16%), naswar (9%) and alcohol (1%). Most of the cases were either well (45.1%) or moderately (46.2%) differentiated. Surgery was performed in 164 patients alone while 368 were treated with surgery in combination with adjuvant modalities. Overall (OS) and disease free survival (DFS) were 66 and 71%, respectively, with a median follow up of 2.5 years. Cox regression analysis showed nodal positivity, increased depth of invasion (DOI) and higher lymph node ratio (LNR) as significant prognosticators impacting OS and DSS.

Conclusion: Nodal volume, DOI and LNR are the most consistent predictors of poor outcome in OTSCC. Nodal positivity, depth of invasion > 5 mm and lymph node ratio > 0.04 adversely affect OS and DSS.
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http://dx.doi.org/10.1007/s00405-020-06482-xDOI Listing
August 2021

Secretory Carcinoma Of Salivary Gland: A Clincopathological Analysis.

J Ayub Med Coll Abbottabad 2020 Oct-Dec;32(4):481-486

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Background: Secretory carcinoma of the salivary gland (SC) is a new entity that harbours a specific ETV6 gene rearrangement. The clinical behaviour of this tumour is not well-known as it is a relatively new entity but it is generally considered as a tumour of low malignant potential. The objective of the study was to find out the frequency of ETV6 translocation in cases diagnosed based on histology and immunohistochemistry, to study morphological features and immunohistochemical findings of our cases and to determine the survival and disease-free status of our patients.

Methods: Twenty-five diagnosed cases of SC were retrieved from the archives of SKMCH and RC. Diagnosis was made primarily based on morphology and immunohistochemistry. Immunohistochemistry includes S100, p63, mammaglobin, DOG 1, GCDFP-15, TTF-1, GATA3, SMA, AMA, and AR. The diagnosis was further confirmed by molecular testing, i.e., Fluorescence in situ hybridization (FISH) studies to observe specific ETV6 gene break. Follow up of the patients was done by developing a questionnaire. Statistical analysis of the data was done using SPSS-23.0.

Results: The mean age of diagnosis was 41±17.4 and the male to female ratio was 1.5:15. The mean size of the tumour was 45.48±27.35. The most common site of the tumour was parotid gland (60%). On morphology, SC showed a wide range of morphological patterns, most common being the tubular, microcystic, intraductal, and papillary. Immunohistochemical stains mammaglobin (22/22), GCDFP-15(15/15) and GATA3 (10/10) showed 100% positive result. However, all cases were negative for p63 (0/18) and DOG 1(0/11). ETV6 break was seen in 17/17 cases (100%). The mean disease-free survival was 75 months and the overall survival was 51.90±2.80 months.

Conclusions: This study highlights the presence of specific molecular alteration in all cases, which were diagnosed based on morphology and immunohistochemistry.
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January 2021

Toxicity Profile of Procarbazine Lomustine and Vincristine Chemotherapy in Low-Grade Glioma - Retrospective Review.

Cureus 2020 Oct 20;12(10):e11070. Epub 2020 Oct 20.

Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.

Background The role of Procarbazine Lomustine and Vincristine (PCV) chemotherapy is already established in terms of improving survival in low-grade glioma (LGG). This improved survival has led to the increasing administration of PCV to LGG patients over the past years. However, like other chemotherapies, serious hematological and non-hematological toxicities may occur. The purpose of this study was to evaluate the toxicity profile of PCV and its clinical relevance in our practice.  Materials and Methods We reviewed 63 patients of LGG retrospectively who received chemotherapy PCV between January 2015 and January 2018 at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore. Results Significant hematological toxicity as grade 3 anemia, thrombocytopenia, and neutropenia occurred in 19%, 27%, and 46% respectively with PCV. Other toxicities such as neurotoxicity, vomiting and derangement of liver enzymes occurred in 3.2%, 19%, and 19% respectively. Patients who were on concurrent anticonvulsants had no increase in PCV toxicity. Survival was not impacted by hematological toxicities up to grade 3. Conclusion PCV chemotherapy is associated with major hematological, hepatic, and clinical toxicities (vomiting, constipation, and neuropathy). Hematological toxicities influenced the course of treatment in terms of delays and interruptions.
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http://dx.doi.org/10.7759/cureus.11070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676953PMC
October 2020

Comparison of Outcomes Between Radical Radiotherapy and Radical Cystectomy in Muscle Invasive Bladder Cancer in a Cancer Specialized Unit of a Developing Country.

Cureus 2020 Aug 26;12(8):e10057. Epub 2020 Aug 26.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Introduction Radical cystectomy (RC) is the current standard of care for treating muscle-invasive bladder cancer (MIBC), however bladder preservation by offering radical radiotherapy (RT) is gaining interest for improving the quality of life while maintaining a reasonable oncological outcome. In this study, we have compared outcomes of the two treatment options. Materials and methods This is a 10-year retrospective cohort study that included all patients who were treated for histologically proven muscle-invasive bladder cancer in the department of uro-oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre from January 2005 to January 2015. Data was analysed using Statistical Product and Service Solutions (SPSS), version 21 (IBM Corp., Armonk, NY). The primary end point of our study was to calculate the three- and five-year disease-free survival (DFS) and overall survival (OS). Results A total of 230 patients were included in the study with male gender predominating (88%). The mean and standard deviation for age was 58.32+11.128. Radical cystectomy was performed in 119 patients while 111 received RT. Clinically, 34% had stage 2 disease, while 66 % had stage 3 cancer. The median follow-up duration was 41 months (range: 2-155). During follow-up 57.4% of patients showed no recurrence. Local recurrence was found in 9.6% patients and distant metastasis in 32.2%. The three-year DFS of RC was 63% and that of RT was 57% while the five-year DFS for RC and RT were 60% and 49%, respectively (p=0.196). The three-year OS of RC was 64% and that for RT was 58%. On further analysis the five-year OS of RC was 53% and that for RT was 50% (p=0.98). Upon stage-based comparisons, we found no statistically significant difference between the three- and five-year DFS and OS of stage 2 and stage 3 when treated with either modality. Conclusion Most studies favor RC and consider it as the gold standard treatment for muscle-invasive bladder tumor treatment. The current study reveals that bladder preservation approach by chemo radiotherapy is a viable treatment option, having comparable oncological outcomes with patients receiving radical cystectomy, and can be offered to patients having muscle-invasive urothelial bladder cancer.
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http://dx.doi.org/10.7759/cureus.10057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520399PMC
August 2020

Oncological Outcomes of Non-Urothelial Bladder Cancers in a Specialized Cancer Hospital of a Developing Country.

Cureus 2020 Aug 23;12(8):e9957. Epub 2020 Aug 23.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background Non-urothelial bladder cancers (NUBCs) constitute only 5% of all bladder cancers. Because of the scarcity of data, no standardized treatment can be offered to these patients. Surgical treatment can be offered to patients with localized disease; however, generally, the prognosis is unfavorable. Methodology Patients with histology-proven NUBC presenting to the Department of Uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan, from January 2002 to July 2017 were identified and assessed retrospectively. Results A total of 20 patients with a median presenting age of 52 years (range: 34-87 years) were identified. Clinically, T3 was the commonest stage of presentation, i.e., in 11 (55%), whereas 1 (7.1%) patient had metastatic disease. Four types of NUBCs were identified: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and inflammatory myofibroblastic tumor. Most of the patients with adenocarcinoma were offered surgical treatment in the form of either partial (64.3%) or radical (28.6%) cystectomy. Two patients with small cell carcinoma and two of the three patients with SCC could only be offered palliative chemotherapy. During a median follow-up of 40 months, 14 (70%) patients developed disease progression or recurrence. All these patients succumbed to their disease during a median period of 37.5 months (range: 5-84 months). Furthermore, three- and five-year disease-free survival was 60% and 51%, respectively, and overall survival was 65% and 31%, respectively. Conclusions NUBC is a rare but aggressive disease that presents at an advanced stage in many cases. Treatment protocols are not uniform; therefore, further collaborative research is needed to improve survival outcomes.
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http://dx.doi.org/10.7759/cureus.9957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510515PMC
August 2020

Locally Advanced Oral Tongue Cancer: Is Organ Preservation a Safe Option in Resource-Limited High-Volume Setting?

Ann Maxillofac Surg 2020 Jan-Jun;10(1):158-163. Epub 2020 Jun 8.

Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Background: Oral tongue is found to be the most common intraoral subsite with worse prognosis despite the use of multimodality treatments. Extensive resections have resulted in loss of form and function of tongue in advanced tumors. The objective of the study was to analyze the role of induction chemotherapy (IC) in intermediate to advanced staged oral tongue cancer for organ preservation and survival outcome in a developing country.

Materials And Methods: The records of oral tongue cancer patients treated from 2007 to 2016 were retrospectively analyzed.

Results: Eighty-one oral tongue cancer patients with advanced stage were treated using induction arm in 10 years. The median follow-up was 24 months with 3- and 5-year survival of 77% and 58%, respectively. IC has an overall response in 87% of the patients at primary site. The chemotherapy has completely resolved the nodal disease in 17% of the patients, but 23% of the patients had failed to respond. Only 21% of the patients received reconstruction using local or regional flaps.

Conclusion: IC has shown encouraging results in advanced staged oral tongue cancers with function preservation and improved survival outcome in less privileged high-volume centers.
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http://dx.doi.org/10.4103/ams.ams_166_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433937PMC
June 2020

Pyrolysis of solid waste residues from Lemon Myrtle essential oils extraction for bio-oil production.

Bioresour Technol 2020 Dec 28;318:123913. Epub 2020 Jul 28.

School of Environmental Engineering, University of Seoul, Seoul 02504, Republic of Korea. Electronic address:

Solid waste residues from the extraction of essential oils are projected to increase and need to be treated appropriately. Valorization of waste via pyrolysis can generate value-added products, such as chemicals and energy. The characterization of lemon myrtle residues (LMR) highlights their suitability for pyrolysis, with high volatile matter and low ash content. Thermogravimetric analysis/derivative thermogravimetric revealed the maximum pyrolytic degradation of LMR at 335 °C. The pyrolysis of LMR for bio-oil production was conducted in a fixed-bed reactor within a temperature range of 350-550 °C. Gas chromatography-mass spectrometry showed that the bio-oil contained abundant amounts of acetic acid, phenol, 3-methyl-1,2-cyclopentanedione, 1,2-benzenediol, guaiacol, 2-furanmethanol, and methyl dodecanoate. An increase in pyrolysis temperature led to a decrease in organic acid and ketones from 18.09% to 8.95% and 11.99% to 8.75%, respectively. In contrast, guaiacols and anhydrosugars increased from 24.23% to 30.05% and from 3.57% to 7.98%, respectively.
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http://dx.doi.org/10.1016/j.biortech.2020.123913DOI Listing
December 2020

Indications and clinical outcomes of indwelling pleural catheter placement in patients with malignant pleural effusion in a cancer setting hospital.

Clin Respir J 2020 Nov 28;14(11):1040-1049. Epub 2020 Aug 28.

Fellow of College of Chest Physicians, Member Royal College of Physicians Ireland, Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan.

Background: The placement of indwelling pleural catheters (IPC) is an effective outpatient approach for the management of malignant pleural effusions (MPE).

Aims: The indications and outcome of IPC in patients with MPE. Risk stratifications, prevention and management of IPC-related complications.

Methods: We retrospectively reviewed the clinical data of patients with MPE who underwent IPC insertion from July 2011 to July 2019. The multivariable logistic regression model was used to identify the independent risk factors associated with IPC infection and the Kaplan-Meier method to determine the overall survival.

Results: A total of 102 patients underwent IPC insertion during the stipulated period and the mean age was 50.49 ± 14.36 years. Seventy-one (69.6%) were females. The indications were Trap Lung in 38 (37.3%), failed talc pleurodesis in 28 (27.5%) and as a primary intervention in 36 (35.3%). The infection rate was 25.5%, of which 65.4% patients had nosocomial infections. Post-IPC overall median survival time was 9.0 ± 2.50 weeks with highest in patients with trap lung (18 ± 1.50 weeks). In multivariable analysis, following variables were identified as a significant independent risk factor for IPC infection: Multiloculated MPE (AOR 2.80; 95%CI (1.00-9.93), 0.04), trap lung (AOR 7.57; 95%CI (1.39-41.25), 0.01), febrile neutropenia (FN) (AOR 28.55; 95%CI (4.23-19.74), 0.001), IPC domiciliary education (AOR 0.18; 95%CI (0.05-0.66), 0.001) and length of hospital stay (AOR 1.16; 95%CI (1.01-1.33), 0.03).

Conclusion: IPC insertion is an effective management for MPE with reasonable survival benefits. Infection is the most common complication, of which mostly are nosocomial infections with higher incidence in multiloculated effusions, trap lung, FN and with lack of domiciliary IPC care education.
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http://dx.doi.org/10.1111/crj.13239DOI Listing
November 2020
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