Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country.

INTRODUCTION: The disease course of head and neck (H&N) cancer can severely impair patients' quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan. METHODS: An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis. RESULTS: A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34). CONCLUSION: The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.

Obstructed inguinal hernia containing ovary with an ovarian cyst: a case report.

A 27-year-old married woman came to the emergency room (ER) with the chief complaint of severe pain in the abdomen for 3 days, which was more pronounced in the right iliac fossa, along with the complaint of multiple episodes of vomiting for the last 6 hours. She also gave a history of swelling in the right inguinal region for last 9 months with the complaint of mild on and off pain in the swelling. On physical examination, diagnosis of obstructed inguinal hernia was made. Ultrasonography (USG) of abdomen was of no use, as it only commented on hernial defect and not on the contents of the hernial sac. An emergency surgery was planned; marsupialisation of ovarian cyst, repositioning of fallopian tube along with ovary and herniorrhaphy was performed without any difficulty.

Effect Of Age, Gender And Type Of Varicosity On The Post-Operative Pain Score After Seven-Day Compression Dressing After Varicose Vein Surgery.

Great saphenous vein insufficiency is linked to 80% of all remarkable lower limb varicosities. A total of 30 patients were enrolled from OPD fulfilling the inclusion criteria after the approval of the hospital's ethical committee. Patients had compression dressing for seven days after surgery. The patients were divided into two groups-Group-A (Compression dressing for two days) and Group-B (Compression dressing for seven days). Stratification of pain score was done against age, gender, and grades of varicose veins, and after dividing into groups t- test was put into use. A p 20 value ≤0.05 was contemplated to be remarkable. Thirty patients with primary varicose vein were enrolled in this study. The mean age of patients was 35.4±9.9 years. Mean pain score in these patients was 2.9±0.8 years. Pain score after seven days of compression dressing after the surgery for varicose veins depend upon the gender, age, and grades of the varicosity of the veins. It is lesser in the females, younger age groups, and in those who had initially lesser severity of the varicose veins.

Spontaneous splenic rupture during dengue fever.

Dengue fever is one of the most frequent arboviral diseases in the world. Dengue is known to cause myocarditis, hepatitis, and neurological illustrations but one of the established presentations is leakage of plasma resulting in circulatory failure. Spontaneous rupture of the spleen is one of the most infrequent but known outcome of dengue fever which has been reported from time to time in literature. We present, here, the case of a 50-year-old patient who developed this condition during dengue fever and was managed in our department successfully. This complication must be kept in mind while treating any case of dengue fever so that it can be avoided or if not then treated timely.

Role of interventional radiology in surgical diseases of breast.

Since the publication of the first imaging-guided wire localisation technique, the art of breast treatments has made great strides. Radiologists like Hall, Frank, Kopans, DeLuca, and Homer were all the pioneers in innovative breast interventional radiology field. Their approaches and gadgets for enhancing surgical outcomes in cases with breast diseases aided progress in the discipline and have withstood the ravages of time. Many of their methods are still in use. We are all standing together at the beginning of a new chapter in medicine. Cost effectiveness, comparative effectiveness studies, and an older population are all causing clinicians to reconsider what they perform. Similarly, we are now united on a global scale. The studies described in the current narrative review relate to multiple nations around the world. Breast cancer is a worldwide health problem. With the expansion of technological advances, as well as the apparent ease of worldwide travel, we must all collaborate to improve the outcome in the battle against breast cancer.

Experience of surgical management of rare cases of choledochal cyst in last five years-tertiary care reflection.

Choledochal Cyst (CC), also known as the biliary cyst, is one of the rare inherited anomalies of intrahepatic and/or extrahepatic biliary system characterised by varying degrees of cystic dilatation of the biliary tract without acute obstruction. The prevalence ranges from 1 in 13,000 people to 1 in 2 million people with preponderance in Asia1, particularly in Japan. Moreover, the presentation also varies in children and adults, and is usually vaguer and non-specific in adults. The prevalence is even lower in males, with female to male ratio being 3:1-4:12. We present here three cases of adult choledochal cysts excised in our surgical unit in the last five years. We discuss the aetiopathogenesis, presentation, diagnosis, surgical treatment, and complications of choledochal cysts based on the available literature. It is crucial to establish a multidisciplinary group of professionals, that comprises paediatric surgeons, pathologists, paediatric gastroenterologists, physiotherapists, nutritionists, oncologists, and radiologists, to get acceptable outcomes in diagnosing and treating children with choledochal cysts.

Post pancreatic surgery complications; surgeon vs interventional interventional radiologists.

Even at high-volume centres, pancreatic resections are linked with a high rate of complications, as well as significant morbidity and mortality. In the management of these occurrences, a multidisciplinary approach is required, and interventional radiology plays an important role in the treatment of patients who develop post-surgical problems. The current review was planned to provide an overview of interventional radiological techniques that can be used to treat various types of problems following pancreatic resection. Percutaneous fluid collection drainage, percutaneous transhepatic biliary operations, artery embolisation, venous interventions, and fistula embolisation are feasible therapeutic alternatives with fewer problems than a re-look surgery. They also have a shorter hospital stay and faster recovery.

The study of frequency of malignancy and its types in surgical jaundice; a tertiary care experience.

OBJECTIVE: To determine the frequency of malignancy and its types in patients presenting with surgical jaundice in a tertiary care setting. METHODS: The cross-sectional study was conducted at the North Surgical Ward, Mayo Hospital, Lahore, Pakistan, from May 8 to November 8, 2020, and comprised patients of either gender with a diagnosis of surgical jaundice made on the basis of history, clinical examination, haematological and biochemical reports and radiological investigations. All patients were managed as per the guidelines for surgical jaundice with injection vitamin K intramuscular, hydration with intravenous fluids, avoidance of constipation by lactulose or neomycin, vitals and urine output monitoring and prophylactic antibiotics. Demographic data as well frequency of malignancy were noted using a predesigned proforma. Data was analysed using SPSS 21. RESULTS: Of the 95 patients, 51(53.7%) were male and 44(46.3%) were female. The overall mean age was 49.96±16.54 years (range: 18-80 years). A total of 19(20%) cases had body mass index <30. Malignancy was identified in 50(52.6%) cases; 14(28%) gallbladder, 4(8%) head of pancreas, 9(18%) peri-ampullary carcinoma, 7(14%) cholangiocarcinoma, 6(12%) Klastkin tumour, 5(10%) hepatocellular carcinoma, and 5(10%) metastatic tumour. CONCLUSIONS: More than half of the surgical jaundice cases had malignancy, gallbladder being the most affected site.

A Holistic Approach to Identify and Classify COVID-19 from Chest Radiographs, ECG, and CT-Scan Images Using ShuffleNet Convolutional Neural Network.

Early and precise COVID-19 identification and analysis are pivotal in reducing the spread of COVID-19. Medical imaging techniques, such as chest X-ray or chest radiographs, computed tomography (CT) scan, and electrocardiogram (ECG) trace images are the most widely known for early discovery and analysis of the coronavirus disease (COVID-19). Deep learning (DL) frameworks for identifying COVID-19 positive patients in the literature are limited to one data format, either ECG or chest radiograph images. Moreover, using several data types to recover abnormal patterns caused by COVID-19 could potentially provide more information and restrict the spread of the virus. This study presents an effective COVID-19 detection and classification approach using the Shufflenet CNN by employing three types of images, i.e., chest radiograph, CT-scan, and ECG-trace images. For this purpose, we performed extensive classification experiments with the proposed approach using each type of image. With the chest radiograph dataset, we performed three classification experiments at different levels of granularity, i.e., binary, three-class, and four-class classifications. In addition, we performed a binary classification experiment with the proposed approach by classifying CT-scan images into COVID-positive and normal. Finally, utilizing the ECG-trace images, we conducted three experiments at different levels of granularity, i.e., binary, three-class, and five-class classifications. We evaluated the proposed approach with the baseline COVID-19 Radiography Database, SARS-CoV-2 CT-scan, and ECG images dataset of cardiac and COVID-19 patients. The average accuracy of 99.98% for COVID-19 detection in the three-class classification scheme using chest radiographs, optimal accuracy of 100% for COVID-19 detection using CT scans, and average accuracy of 99.37% for five-class classification scheme using ECG trace images have proved the efficacy of our proposed method over the contemporary methods. The optimal accuracy of 100% for COVID-19 detection using CT scans and the accuracy gain of 1.54% (in the case of five-class classification using ECG trace images) from the previous approach, which utilized ECG images for the first time, has a major contribution to improving the COVID-19 prediction rate in early stages. Experimental findings demonstrate that the proposed framework outperforms contemporary models. For example, the proposed approach outperforms state-of-the-art DL approaches, such as Squeezenet, Alexnet, and Darknet19, by achieving the accuracy of 99.98 (proposed method), 98.29, 98.50, and 99.67, respectively.

A novel terpenoid glycoside and other bioactive constituents from the seeds of Cichoriumintybus.

Phytochemical investigation of the seeds of Cichorium intybus L (C. intybus) led to isolate n-hexacosane (CI-1), an aliphatic higher ketone, n-nonacosan-3-one (CI-2), two aliphatic acid esters characterized as n-octacosanyl decanoate (CI-3) and n-tricosanyl hexadecanoate (CI-4), two mixed glycerides identified as as glyceryl-1-(hexadec-7- enoyl)-2- tetradecanoyl-3-hexadecanoate (Cl-5) and glyceryl-1- (eicos-9-enoyl)-2,3, bis-eicosanoate (Cl-6), and three e steroidal constituents and their structures were elucidated as as stigmast-5, 22-dien-3ß -ol-21-oic acids (Cl-7), stigmasterol-3ß-d-glucopyranoside (Cl-8) and stigmast-5, 22-dien-3-ß-ol-3-ß-d-glucuronopyranoside (Cl-9). The dry seeds powder was defatted and finally extracted with ethanol by using a maceration method. The ethanol was evaporated near to dryness and silica gel was added to the extract and a slurry with the help of methanol solvent was prepared. The slurry was loaded to the column by using petroleum ether and was eluted with a mixture of chloroform and methanol. A series of test tubes were collected and each test tube with 2 mL eluents was collected. Based on the thin layer chromatography (TLC) the content of nine test tubes were considered as pure compounds. The solvent was evaporated from the test tube at room temperature. All the nine compounds from the column were characterized by using Infrared (IR), Nuclear Magnetic Resonance (NMR) and Mass spectrometry (MS). Eight compounds were previously isolated from the plant and they showed various biological activities. A new compound was isolated for the first time from the plant kingdoms. Based on the chromatographic and spectroscopic analysis the new compound was characterized as stigmasterol carboxylic acid (CI-9). The isolated new compound could be used to treat liver and cardiac diseases.

Antibiotic Antibiogram in Patients With Complicated Urinary Tract Infections in Nephrology Unit of South Waziristan.

Objectives To evaluate the antibiotic antibiogram in patients with complicated urinary tract infections (cUTIs) presenting to a Nephrology unit of South Waziristan. Methods A cross-sectional study was conducted at the Department of Nephrology, Sholam, South Waziristan. The study included all patients who presented with cUTIs and the symptoms included urinary urgency, hematuria, dysuria, suprapubic discomfort, and increased frequency. Those patients with clinical manifestations but are on antibiotics within the past five days were excluded. Results A total of 158 patients were included in the study with 113 (71.5%) females and 45 (28.5%) males. A total of 95 (60%) cases had gram-negative microbes, 47 (30%) had gram-positive cocci, and 16 (10%) had candida infection. In our study, the highly prevalent uropathogenic gram-positive bacteria showed the highest sensitivity to Linezolid, Rifampicin, and Vancomycin. Methicillin-resistant staph aureus was detected in 25% of isolates. All isolates of candida were sensitive to fluconazole. Gram-negative bacteria were highly resistant to ceftazidime, cefepime, ceftriaxone, and ciprofloxacin. Conclusion The development of bacterial resistance against multiple antibiotics is a global crisis that restricts the drug of choice for the treatment of cUTIs. In our study, we showed that overall, E.coli (gram negative) and S. Aureus (gram-positive) showed variable resistance to many antibiotics including ceftazidime, cefepime, piperacillin-tazobactam, ceftriaxone, and clindamycin.

A Robust End-to-End Deep Learning-Based Approach for Effective and Reliable BTD Using MR Images.

Detection of a brain tumor in the early stages is critical for clinical practice and survival rate. Brain tumors arise in multiple shapes, sizes, and features with various treatment options. Tumor detection manually is challenging, time-consuming, and prone to error. Magnetic resonance imaging (MRI) scans are mostly used for tumor detection due to their non-invasive properties and also avoid painful biopsy. MRI scanning of one patient's brain generates many 3D images from multiple directions, making the manual detection of tumors very difficult, error-prone, and time-consuming. Therefore, there is a considerable need for autonomous diagnostics tools to detect brain tumors accurately. In this research, we have presented a novel TumorResnet deep learning (DL) model for brain detection, i.e., binary classification. The TumorResNet model employs 20 convolution layers with a leaky ReLU (LReLU) activation function for feature map activation to compute the most distinctive deep features. Finally, three fully connected classification layers are used to classify brain tumors MRI into normal and tumorous. The performance of the proposed TumorResNet architecture is evaluated on a standard Kaggle brain tumor MRI dataset for brain tumor detection (BTD), which contains brain tumor and normal MR images. The proposed model achieved a good accuracy of 99.33% for BTD. These experimental results, including the cross-dataset setting, validate the superiority of the TumorResNet model over the contemporary frameworks. This study offers an automated BTD method that aids in the early diagnosis of brain cancers. This procedure has a substantial impact on improving treatment options and patient survival.

An outcome of emergency vascular surgery performed by general surgeons; our experience in a university hospital of Pakistan and can they substitute vascular surgeons?

OBJECTIVE: To measure the outcome of emergency vascular surgery performed by general surgeons, and to identify preventable causes of mortality. METHODS: The retrospective study was conducted at the General Surgery Department of Mayo Hospital, King Edward Medical University, Lahore, Pakistan, and comprised data between January 2014 and May 2019 related to cases regardless of age and gender that required emergency vascular surgery after diagnosis by a consultant surgeon at the surgical emergency. The cases were analysed from admission till discharge. Data was analysed using SPSS 20. RESULTS: Of the 135 cases, 127(94%) were males. The overall mean age was 28.8±11.5 years (range: 14-63 years). Mean duration of hospital stay was 11±3.92 days (range: 4-22 days). Three major peripheral arteries injured were brachial 32(38.5%), popliteal 55(40.7%) and femoral 20(20.7%), with more than half with complete transection 75(55.6%). Vascular repairs done were primary anastomosis 45(33.3%), reverse saphenous vein graft 68(50.4%), embolectomy 4(3%) and amputation 18(13.3%). Limb salvage rate and mortality was 101(74.8%) and 6(4.4%), respectively. Complications occurred in 38(28.1%) cases, with 24(18%) wound infections and 9(6.7%) myonecrosis. Factors leading to poor outcome/complications were Glasgow Coma Scale score <12 (p=0.01), referred case (p=0.04), significant bleeding (p=0.004), haemoglobin <9 at presentation (p=0.001), bone fracture (p=0.01), involvement of lower limb (p=0.003) and late presentation (p=0.003). CONCLUSIONS: Late presentation in hospital was the major modifiable factor improvement of which could lead to better outcome, apart from the early and proper surgical intervention.

Psychometric properties of the Urdu version of the EORTC QLQ-H&N35 (European organization for research and treatment of cancer head and neck module) quality of life tool.

BACKGROUND: We translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire's Head and Neck (H&N) Cancer Module (EORTC QLQ-H&N35) and assessed its convergent and discriminant validity by examining correlations of QoL with depression, anxiety, and resilience. METHODS: We translated the EORTC QLQ-H&N35 according to EORTC instructions. Patients at a tertiary care hospital in Pakistan completed a survey consisting of Urdu versions of EORTC QLQ-C30 (core QoL tool), QLQ-H&N35, Hospital Anxiety and Depression Scale, and Wagnild and Young Resilience Scale (RS-14). Content validity, convergent validity, discriminant validity, and reliability (using Cronbach's alpha) of the EORTC QLQ-H&N35 were assessed. RESULTS: Our sample comprised 250 patients with H&N cancer, most commonly oral (82%). The Urdu translations were comprehensible for all patients. The Cronbach alpha for QLQ-H&N35 multi-item domains ranged from 0.75 to 0.98 (acceptable to excellent), barring "Senses Problems", which was less than the generally acceptable level (0.50). The patient-reported content validity index (CVI) scores for relevance and clarity of the Urdu version of the QLQ-H&N35 were 0.93 and 0.92, respectively (both excellent). Our results revealed weak bidirectional correlations of the QLQ-H&N35 with resilience, depression, and anxiety, showing good discriminant validity. A weak-to-moderate but significant negative correlation (r: - 0.185 to - 0.613; p < 0.01) was seen between the QLQ-H&N35 and the global QoL measure of the QLQ-30. CONCLUSION: Our Urdu translation of the EORTC QLQ-H&N35 demonstrated validity comparable to previous studies, with good discriminant construct validity when measured against resilience, depression, and anxiety. An issue of concern is the poor internal consistency of the "Senses Problems" domain. Nevertheless, the Urdu translation produced in this study serves as a valid and reliable measure to measure QoL in H&N cancer in clinical or research settings in Pakistan.

Perceived corporate social responsibility and pro-environmental behaviour: Insights from business schools of Peshawar, Pakistan.

Corporate Social Responsibility (CSR) and environmental sustainability have become urgent concerns for contemporary businesses. This study focuses on the interplay between corporate social responsibility perceptions and pro-environmental behaviour (PEB) in response to experts' call for research on the micro-foundations of corporate social responsibility. In addition, it reveals the mechanism underpinning how perceived CSR shapes pro-environmental behaviour in an understudied developing context. Empirically, a qualitative multiple-case research design is utilised by selecting three business schools from Peshawar, Pakistan. Fourteen semi-structured interviews were conducted with senior management and faculty to collect data. Besides primary data, a qualitative documentary review is used to enhance the research. Data analysis is done through the thematic network technique. Plantation, cleanliness, waste reduction, and energy conservation are the environmental aspects of CSR as regarded by employees. In addition, perceived CSR shapes pro-environmental behaviour via environmental knowledge and awareness, eco-civic sense, environmental values, personality traits, religious perspective, and perceived organisational support for the environment. This study provides original additions to the CSR literature by suggesting eco-civic sensibility and religious perspective as new CSR drivers for pro-environmental conduct. Incorporating stakeholder salience into the context of the present study also advances CSR research. The findings are also valuable for management to make the CSR agenda of business schools more strategic, comprehensive, and centred on the priorities of salient stakeholders.

Intravenous fosphenytoin as treatment for acute exacerbation of trigeminal neuralgia: A prospective systematic study of 15 patients.

INTRODUCTION: Intravenous fosphenytoin is widely used for acute exacerbation of trigeminal neuralgia, however, few studies have investigated this treatment. We aimed to examine the efficacy and side effects of initial intravenous fosphenytoin plus oral tapering of phenytoin for exacerbation of trigeminal neuralgia. METHODS: Consecutive patients with primary trigeminal neuralgia were included in this prospective observational 90-days follow-up study. Data were collected using standardized interviews before, at 24 hours, day 7, 30 and 90 post loading dose. The primary outcome was the proportion of responders defined as a 50% reduction in pain intensity 24 hours post loading dose. RESULTS: We included 15 patients. Nine patients (60%) were responders. Pain intensity 24 hours post loading dose was reduced by 5.00 points on the numerical rating scale (p < 0.001), and at day 7 by 5.5 points (p < 0.001). The most common side effects were hypotension and dizziness. CONCLUSION: Intravenous fosphenytoin relieves trigeminal neuralgia pain in most patients and provides a window for titrating prophylactic trigeminal neuralgia medications or planning neurosurgery. The decision to administer intravenous fosphenytoin should be taken with support from trigeminal neuralgia experts and involves considerations of co-morbidities and other treatment options for acute exacerbation of trigeminal neuralgia.Clinical Trial: Preregistered (ClinicalTrials.gov Identifier: NCT03712254.

Comparison of outcome of compression dressing for two days Vs seven days after varicose surgery.

Incompetence of the great saphenous vein (GSV) is a global issue and the most prevalent cause of chronic venous disease of the leg. Clinical manifestations range from moderate to severe, including tiredness, heaviness, and irritation, as well as hyperpigmentation and leg ulcers. A study was conducted to address this controversy,1 i.e. to determine the outcome of compression dressing after varicose vein surgery in terms of postoperative pain, on the Surgical floor, of Mayo Hospital, Lahore, from October 1, 2020, to April 1, 2021. A total of 60 patients with Primary varicose veins were enrolled in this study, fulfilling the inclusion criteria after obtaining approval from the ethical committee of the hospital. The patients were divided in two groups. Group A wore compression dressing for two days after surgery and Group B wore compression dressing for seven days after surgery. All the patients received 1gm Paracetamol I/V eight hourly followed by tablet Paracetamol 500mg P/O eight hourly. Then the outcome of compression dressing was analysed in the form of mean postoperative pain. The mean pain score was assessed on one week. Data were entered in SSPS v23.0. Stratification of pain score was done against age, gender, and grades of varicose veins. A comparison of the two groups was done by applying a t-test. A p-value of ≤ 0.05 was considered significant. Prescribing compression stockings for longer than two days after Trendelenburg's procedure leads to reduced pain and improved physical function during the first week after treatment.

Effect of sevoflurane versus propofol on neutrophil-to-lymphocyte ratio in healthy individuals: a sub-study of a randomised crossover trial.

Background: Sevoflurane and propofol are commonly used drugs in general anaesthesia. However, their effects on perioperative immune function are incompletely understood. We hypothesised that sevoflurane and propofol differentially affect immune function in healthy individuals. Therefore, we investigated the effect of sevoflurane and propofol on neutrophil-to-lymphocyte ratio before, during, and after general anaesthesia. Methods: In this randomised crossover study, 19 healthy individuals underwent 2 h of general anaesthesia with either propofol or sevoflurane. After 4 weeks, anaesthesia was repeated using the other drug. Blood samples were obtained before, during, 1 h after, and 1 day after anaesthesia. The primary outcome was whole-blood neutrophil-to-lymphocyte ratio, and secondary outcomes were specific white blood cell differential counts. A linear mixed-effects model was used to estimate effect sizes. Results: The neutrophil-to-lymphocyte ratio was higher in the propofol compared with the sevoflurane group during anaesthesia, 2.8 (confidence interval [CI]: 2.3-3.3) vs 1.6 (CI: 1.1-2.1), and 1 day after anaesthesia, 2.6 (CI: 2.1-3.1) vs 1.9 (CI: 1.4-2.4). In all patients, we observed transient lymphopaenia during propofol anaesthesia, 1.1 × 109 cells × L-1 (CI: 0.9-1.4), compared with sevoflurane anaesthesia, 1.9 × 109 cells × L-1 (CI: 1.7-2.1). In addition, neutrophil counts were higher 1 day after propofol anaesthesia, 4.4 × 109 cells × L-1 (CI: 4.0-4.9), compared with sevoflurane anaesthesia, 3.5 × 109 cells × L-1 (CI: 3.1-4.0). We observed no differences in the remaining white blood cell subgroups. Conclusions: In healthy individuals undergoing general anaesthesia without surgery, the neutrophil-to-lymphocyte ratio was affected by the type of hypnotic used. Transient lymphopaenia was observed in all participants during propofol anaesthesia.

Inflammatory mediators as surrogates of malignancy.

Inflammation related to cancer occurs in the cellular vicinity of the tumour and is involved with predictions related to the course of disease and survival prognosis in varioua malignancies. These inflammatory markers affect different phases of tumourigenesis, i.e. carcinogenesis, tumour expansion, lymphovascular invasion, and distant metastasis, and, as a result, tumour cells can activate immune mediators and cells directly and/or chemokines as well as prostaglandins. Numbers of circulating different blood cells, i.e. lymphocytes, platelets, neutrophils and levels of plasma proteins, like C-reactive protein and interleukins that are components of inflammatory responses, are hallmarks of pathways leading to tumourigenesis. Thus, they can provide vital information in stratifying patients according to the risk and precisely targeted clinical care and outcome in malignancies. The current narrartive review was planned to discuss the role of platelet-to-lymphocyte ratio alongside the use of systemic immune inflammation index as the inflammatory mediators of malignancies along with overview of their role in different studies. It was also planned to recommend what the future studies should should aim at, including multiple risk factors, exposures and inflammatory profiles and as well as their combined interactions, for a better understanding of the role of the inflammatory mediators in malignancy.

Extraction, isolation and structural characterization of two triterpenoid glycosides from the fruits of Ficusbengalensis.

Ficus bengalensis (F. bengalensis) is a popular medicinal plant species used extensively in the Ayurveda treatment as hypoglycemic, diuretic, tonic, rheumatism, astringent, and inflammation. The goal of this study is to separate and characterize - compounds from fruits of the selected F. bengalensis. The dried fruits coarse power was defatted with non-polar solvent petroleum ether and then systematically extracted with ethanol by using maceration method for 3 days. The ethanol was evaporated and the prepared extract was separated by several chromatographic methods. After separation, the ethanol extract of F. bengalensis afforded nine compounds including two new triterpenoid glycoside derivatives Compound 1: Bengalensursenyl diglycoside and Compound 2: Ficusbengursenyl diglycoside and other minor known phytochemicals. The chemical structures of these separated phytochemicals were elucidated based on spectroscopic analysis and minor chemical transformations. This paper reports isolation and structure elucidation of compounds 1 and 2. In conclusion, the isolated Compound 1 and Compound 2 could be further investigated for any pharmacological activities. This is the first report in our laboratory on isolation of Compound 1 and Compound 2 from the fruits of F. bengalensis.