Upper extremity deep venous thrombosis prevalence in the NHS Grampian Medical Ambulatory clinic: diagnostic, therapeutic, and prognostic considerations in oncology patients.

INTRODUCTION: Whilst upper extremity deep vein thromboses (UEDVT) account for approximately 5 to 10% of all cases of DVT, rigorous guidelines regarding diagnosis and management of presenting patients remain to be developed. The association of UEDVT with concurrent asymptomatic pulmonary embolism as well as the first presentation of malignancy deems essential rigorous research and clinical guideline development to ensure optimal patient care. METHODS: This retrospective audit study is the first to provide estimates of UEDVT prevalence in the North-East Deanery main hospital centre, Aberdeen Royal Infirmary (ARI). RESULTS: Of the 605 patients attending the ARI Ambulatory Emergency Care (AEC) clinic with clinical suspicion of UEDVT, 38 (6.2%) had a confirmatory diagnosis. Underlying malignancy, presence of PICC line, and cardiovascular co-morbidities were identified as common confounding factors. Subclavian vein with concurrent extension to primarily the cephalic vein thrombosis was identified as the most commonly thrombosed venous territories. Importantly, oncology patients were found to have poorer survival outcomes following an UEDVT, in comparison to patients with other significant co-morbidities (cardiovascular, chronic renal disease, inflammatory bowel disease): HR 5.814 (95%CI 1.15, 29.25), p 0.012. Lastly, genetic associations were drawn between patient genetic status as tested for other co-morbidities and prothrombotic cellular cascades, suggesting rigorous VTE assessment in patients identified with congenital or acquired mutations, namely, in CALR, JAK, MSH 2/6, MYC, and FXN. CONCLUSIONS: Overall, this study offers the first report of UEDVT presentations in the UK with no restrictions of patient performance status or underlying co-morbidities and provides a rounded clinical picture of patient characteristics, diagnosis, management, and prognostic associations in view of rigorous guideline development.

Burn first aid knowledge and its determinants among general population of Rawalpindi.

OBJECTIVE: To assess the general knowledge and practices related to burn first aid treatment (BFAT) and to examine age, gender, socioeconomic status, education and previous history of exposure to burn (self/family member) as factors influencing burn first aid knowledge among the general population of Rawalpindi. STUDY DESIGN: A cross-sectional, descriptive survey. PLACE AND DURATION OF STUDY: Three major tertiary care hospitals of Rawalpindi, from August 2017 to May 2018. METHODOLOGY: All consenting people ≥ 18 years of age, with or without a prior history of burn, accompanying patients to three major tertiary care centers of Rawalpindi were administered a pre-tested structured questionnaire. The questionnaire was divided into two sections; socio-demographic section and knowledge on BFAT. Those who were illiterate and could not fill the questionnaire were interviewed and their responses were marked by the researchers themselves. Data were analyzed using SPSS version 21. RESULTS: A total of 400 participants comprising 205 (51.3%) males and 195 (48.8%) females with a mean age of 38 ± 10.3 years were included. The majority (58%) were educated up to 12th grade or higher. "Toothpaste" (47.5%) followed by "cool running water" (20.3%) were the two most frequently applied items following a burn injury. Only 8.8% respondents applied cold water for the ideal time duration. Overall, 83% of the participants provided correct answers for 25-50% of the survey questions. Socioeconomic and educational status of the participants had a significant association with burn first aid knowledge. CONCLUSION: A significant limitation of knowledge regarding BFAT was seen among the general population of Rawalpindi.

Monocyte Chemoattractant Protein-1 (MCP-1/CCL2) Levels and Its Association with Renal Allograft Rejection.

BACKGROUND: CCL2 is a chemoattractant for monocytes/macrophages, T cells, and natural killer cells. It is shown to be involved in the immunological responses against renal allograft. This study was conducted to access the role of urinary CCL2 expression in predicting the rejection episodes in renal transplant patients. METHOD: A total of 409 urine samples included in this study. The samples were consisted of (a) biopsy-proven graft rejection (n = 165); (b) non-rejection (n = 93); (c) non-biopsy stable-graft (n = 42), and (d) healthy renal donors (n = 109). The samples were quantified for the CCL2 using the MCP-1/CCL2 ELISA kit. The data were analyzed using the Statistical Package for Social Sciences (SPSS®) and MedCalc® statistical software. RESULTS: Results showed that the CCL2 levels were significantly increased in rejection group when compared with the non-rejection, stable-graft, and control, P < 0.05. The receiver operating curve's characteristics illustrated that the urinary CCL2 level is a good predictor for graft rejection, with an area under the curve of 0.81 ± 0.03 with optimum sensitivity and specificity of 87% and 62%, respectively, at a cut-off value of 198 pg/mL. Kaplan-Meier curve also showed better cumulative rejection-free graft survival time in group with less than 198 pg/mL of CCL2 as compared to those with expression levels of more than 198 pg/mL (30 weeks vs. 3 weeks; log-rank test, P < 0.001). CONCLUSION: In our study, noninvasive investigation of CCL2 levels in urine has showed potential to predict rejection episodes. It is suggested that the CCL2, with others markers, may help in early detection and monitoring of graft rejection episodes.

Regression of hepatocellular carcinoma after treatment with Sofosbuvir - A case report.

Spontaneous regression (SR) of hepatocellular carcinoma (HCC) is a rare event. Several factors have been suggested as the underlying mechanism but the exact pathogenesis is not understood. The role of sofosbuvir in HCC regression has not been established yet. We report here a case of a 59 years old male who developed HCC secondary to chronic HCV infection. He failed treatment with interferon but the tumour regressed completely after treatment of hepatitis C with sofosbuvir and ribavirin for 48 weeks.