Effect of vitamins C and E on antioxidant status of breast-cancer patients undergoing chemotherapy.

WHAT IS KNOWN AND OBJECTIVE: Reactive oxygen/nitrogen species generated by antineoplastic agents are prime suspects for the toxic side-effects of acute or chronic chemotherapy. The present study was undertaken to test whether vitamins C and E (VCE) supplementation protect against some of the harmful effects of commonly used anticancer drugs in breast-cancer patients. METHODS: In a randomized 5-month study, the activity of various antioxidant enzymes (superoxide dismutase, catalase, glutathione-S-transferase and glutathione reductase) and the levels of malondialdehyde and reduced glutathione were measured in forty untreated breast-cancer patients (stage II) and compared with those of healthy controls. The degree of DNA damage was also assessed in the peripheral lymphocytes of the patients by alkaline single cell gel electrophoresis. The untreated patients were then randomly assigned to either treatment with chemotherapy alone (5-fluorouracil 500 mg/m(2) i.v. day 1, doxorubicin 50 mg/m(2) i.v. day 1 and cyclophosphamide 500 mg/m(2) i.v. day 1, every 3 weeks for six cycles) or to the same chemotherapy regimen supplemented with VCE (vitamin C 500 mg tablet and vitamin E 400 mg gelatin capsule). On completion of the treatments, both the groups were studied again for the levels of the markers measured prior to treatment. RESULTS AND DISCUSSION: The untreated group showed significantly lower levels of antioxidant enzymes (P < 0·001) and reduced glutathione (P < 0·001), and more extensive lipid peroxidation (P < 0·001) and DNA damage than healthy controls. Similar but less pronounced patterns were observed in the patients receiving chemotherapy alone. The group of patients receiving VCE supplementation had all the marker levels moving towards normal values. Activities of superoxide dismutase, catalase, glutathione-S-transferase and glutathione reductase, and the levels of reduced glutathione were significantly increased (P < 0·01) while, the levels of malondialdehyde and DNA damage were significantly (P < 0·01) reduced in the VCE supplemented group relative to those of patients receiving chemotherapy alone as well as relative to the pretreatment levels. WHAT IS NEW AND CONCLUSION: Co-administration of VCE restored antioxidant status, lowered by the presence of breast-cancer and chemotherapy. DNA damage was also reduced by VCE. The results suggest that VCE should be useful in protecting against chemotherapy-related side-effects and a randomized control trial to evaluate the effectiveness of VCE in breast-cancer patients using clinical outcomes would be appropriate.

Case report of an arteriovenous graft for renal dialysis, with multiple complications treated successfully over 5 years.

INTRODUCTION: Arteriovenous grafts (AVG) is a good alternative when native arteriovenous fistula (AVF) is not possible. However, complications are higher and close surveillance is required for successful salvage intervention. PRESENTATION OF CASE: We present the case of a 35 year old man with a history of a successful Brachio-Axillary AVG performed in his right arm in 2012. He had a background of multiple previous failed attempts of a native AVF formation. He presented in 2014 with symptoms consistent with AVF stenosis. He underwent a successful fistuloplasty and 2 stent insertion. In June 2015 he presented again with re-stenosis and successful fistuloplasty was performed with balloon dilatation. In October 2015 he presented with AVF thrombosis. This was treated with fistuloplasty and thrombolysis. He presented again in August 2016 with a recurrent thrombosis in his AVG and this was again treated with a successful fistuloplasty and thrombolysis on two separate occasions. He then presented in September 2016 with re-stenosis. This was treated with fistuloplasty and 2 stent insertion. He underwent a successful renal transplant during this time and presented again with a sinus discharge in February 2019 when the plan was made for subtotal graft excision. CONCLUSION: Incidence of complications is higher when a graft is used over a native AVF. However, close surveillance and prompt intervention can lead to multiple successful salvage procedures thus prolonging the lifespan of the graft. As in our case we were able to prolong the lifespan of the AVG with multiple successful interventions.

Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital.

We aimed to study the effect of Ramadan fasting on the occurrence of peptic ulcer disease and its complications in patients presenting to the Accident and Emergency Department at Al-Ain hospital, United Arab Emirates (UAE). We retrospectively reviewed patient records over the 10-year period, 1992 to 2002. Of 470 patients treated for peptic ulcer disease, 215 were seen during Ramadan and 255 in the month after Ramadan. The frequency of peptic ulcer disease was higher after Ramadan than during Ramadan but this was not statistically significant. Peptic ulcer disease occurred more frequently in the age group 30-49 years. Peptic ulcer perforation occurred more frequently after Ramadan but the difference was not significant. Regression analysis identified the following variables as predictors of peptic ulcer disease: anorexia, pain, hypertension, smoking, epigastric pain, diabetes and family history.

Evaluation of peritoneal lavage and abdominal paracentesis in cases of blunt abdominal trauma--a study of fifty cases.

Diagnostic peritoneal lavage (DPL) is an accurate technique to diagnose abdominal visceral injury in blunt abdominal trauma. Four-quadrant abdominal paracentesis should be used routinely in all cases of blunt abdominal injuries as a diagnostic tool. The study included 50 cases in whom four-quadrant abdominal paracentesis was done at JN Medical College, Aligarh. There were 13 positive taps, out of which 12 were true positive and one was false positive. In all 37 negative taps DPL was done, out of which 23 had positive lavage, 22 had true positive and one had false negative results. All the patients with true positive peritoneal lavage had intra-abdominal injuries at laparotomy.

Acid base balance in seriously ill surgical cases and its prognostic significance.

Acid base changes are common in surgical patients. The present study was conducted in 50 seriously ill surgical patients over a period of 56 hours. A wide range of pH was observed with 72% observations outside the normal limits. Alkalosis was observed in 44% of total observations while acidosis was noted in 28%. A higher mortality was seen in cases with alkalosis.

Bilateral traumatic rupture of the diaphragm.

A 3.5-year-old girl sustained compression injury leading to isolated bilateral diaphragmatic rupture with extensive herniation of abdominal viscera into the pleuropericardial cavities. Reduction of the hernia and repair of the defects were readily accomplished through a thoraco-abdominal approach with excellent outcome.

Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital

We aimed to study the effect of Ramadan fasting on the occurrence of peptic ulcer disease and its complications in patients presenting to the Accident and Emergency Department at Al-Ain hospital, United Arab Emirates [UAE]. We retrospectively reviewed patient records over the 10-year period, 1992 to 2002. Of 470 patients treated for peptic ulcer disease, 215 were seen during Ramadan and 255 in the month after Ramadan. The frequency of peptic ulcer disease was higher after Ramadan than during Ramadan but this was not statistically significant. Peptic ulcer disease occurred more frequently in the age group 30-49 years. Peptic ulcer perforation occurred more frequently after Ramadan but the difference was not significant. Regression analysis identified the following variables as predictors of peptic ulcer disease: anorexia, pain, hypertension, smoking, epigastric pain, diabetes and family history