Evaluation of Outcomes of Mucinous Ovarian Cancer Treated at a Tertiary Care Cancer Hospital in Pakistan.

Syed Abdul Mannan HamdaniObjective To evaluate the clinicopathological features and survival outcomes of mucinous ovarian cancer (MOC) patients in an Asian population. Study Design Descriptive observational study. Place and Duration of Study Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from January 2001 to December 2016. Methods Data of MOC were evaluated for demographics, tumor stage, clinical characteristics, tumor markers, treatment modalities, and outcomes from electronic Hospital Information System. Results Nine-hundred patients with primary ovarian cancer were reviewed, out of which 94 patients (10.4%) had MOC. The median age was 36 ± 12.4 years. The most common presentation was abdominal distension 51 (54.3%), while the rest presented with abdominal pain and irregular menstruation. Using FIGO (The International Federation of Gynecology and Obstetrics) staging, 72 (76.6%) had stage I, 3 (3.2%) stage II, stage III in 12 (12.8%), and 7 (7.4%) had stage IV disease. The majority of patients 75 (79.8%) had early-stage (stage I/II), while 19 (20.2%) presented with advanced-stage (III & IV). The median follow-up duration was 52 months (range 1-199 months). Among patients with early-stage (I&II), 3- and 5-year progression-free survival (PFS) was 95%, while for advanced stage (III&IV), PFS was 16% and 8%, respectively. The overall survival (OS) in early-stage I&II was 97%, while for advanced stages III & IV, the OS was 26%. Conclusion MOC is a challenging and rare subtype of ovarian cancer requiring special attention and recognition. Most patients treated at our center presented with early stages and had excellent outcomes, while advanced-stage disease had dismal results.

S-Fertilizer (Elemental Sulfur) Improves the Phytoextraction of Cadmium through Solanum nigrum L.

Soil contamination with toxic heavy metals [such as cadmium (Cd)] is becoming a serious global problem due to the rapid development of the social economy. This study was carried out to assess the beneficial role of two different kinds of (S)-fertilizer in the phytoremediation of Cd contaminated soil through Solanum nigrum L. Gypsum (Gyp) and Elemental sulfur (ES) was applied alone and in combination with different ratios (0, 100:0, 0:100, 50:50 mg kg-1) accompanied by different Cd levels (0, 25, 50 mg kg-1). After seventy days of sowing, plants were harvested for determination of growth, physiological characteristics, oxidants and antioxidants, along with Cd uptake from different parts of the plant. Cd toxicity significantly inhibited growth, physiology and plant defence systems, and also increased Cd uptake in the roots and shoots of Solanum nigrum L. The application of Gyp 100 mg kg-1 boosted plant growth and physiology along with oxidants and antioxidants activity as compared to ES 100 mg kg-1 alone, and combine application of GYP+ES 50 + 50 mg kg-1. The application of ES 100 mg kg-1 showed an effective approach to decreasing Cd uptake as compared to Gyp 100 mg kg-1. Overall results showed that the combined application of GYP+ES 50 + 50 mg kg-1 significantly enhanced the phytoremediation potential of S. nigrum in Cd contaminated soil. Thus, it is highly recommended to apply the combined application of GYP+ES for phytoremediation of Cd contaminated soil.

Phosphorus Fertilizers Enhance the Phytoextraction of Cadmium through Solanum nigrum L.

Cadmium (Cd) toxicity strongly influences plants growth and seed germination in crop plants. This pot trial had aimed evaluate the benefits of two different kinds of phosphorus (P)-fertilizer in the phytoremediation of Cd by Solanum nigrum L. The current pot experiment was conducted to evaluate the role of P-fertilizers in phytoremediation of Cd by Solanum nigrum L. Single superphosphate (SSP) contain 7 to 9% P and Di-ammonium Phosphate (DAP) contain 46% P had been applied in single and combine form in soil with different ratios (0:0, 100:0, 0:100, 50:50%) accompanied by diverse Cd levels (0, 25, 50 mg kg-1). Three weeks seeding were transferred into pots, and plants had been harvested afterward seventy days of growth in the pots. Significantly inhibited plant growth was observed in shoots and roots of Cd contaminated plants. Cadmium stress had stimulated oxidative stress in subjected plants. However, supplementation of P-fertilizers in an optimum manner significantly increased plant biomass along with enhancing antioxidants enzymatic activities and inhibiting oxidative stress. Maximum plant-growth had been noted in SSP + DAP supplemented plants in contrast to single SSP, DAP supplemented plants. Higher Cd concentrations observed in SSP + DAP supplemented plants over single treatment. It has been concluded that combination of SSP + DAP might be a better option to improve growth as well as uptake capacity of Solanum nigrum L. under Cd stress. However, a field study is recommended for detailed future investigations.

Chromium-resistant Staphylococcus aureus alleviates chromium toxicity by developing synergistic relationships with zinc oxide nanoparticles in wheat.

Chromium (Cr) is a toxic heavy metal that contaminates soil and water resources after its discharge from different industries. It can act as carcinogen and mutagen for biological systems. Microbe-assisted phytoremediation is one of the most emergent and environment friendly technique used for detoxification of Cr from Cr-contaminated soils. In this study, wheat as a test crop was grown under varying stress levels (0, 50, 100 and 200 mg/kg) of Cr in a pot experiment under a complete randomized design. Alleviative role of Staphylococcus aureus strain K1 was assessed by applying as a treatment in different combinations of zinc oxide nanoparticles (0, 50, 100 mg/L). Growth and yield attributes data presented nurturing impact of bacterial inoculation and ZnO NPs in improvement of wheat defense system by decreasing Cr toxicity. Increase in chlorophyll and carotenoids contents, antioxidant enzymes (SOD, POD, APX, CAT) activities and nutrient uptake also confirmed the mitigative potential of bacterial inoculation when applied solely or in combination with ZnO NPs. The Cr accumulation in different parts of plant was significantly reduced with the application of NPs and S. aureus strain K1. Taken together, the results showed that combined application of Staphylococcus aureus strain K1 and ZnO NPs detoxifies the effects of Cr on wheat plants and boosts its growth, physiology and defense system.

N-Fertilizer (Urea) Enhances the Phytoextraction of Cadmium through Solanum nigrum L.

Heavy metal contamination is currently a major environmental concern, as most agricultural land is being polluted from municipal discharge. Among various other pollutants, cadmium (Cd), one of the most harmful heavy metals, enters into the food chain through the irrigation of crops with an industrial effluent. In the present study, a pot experiment was designed to assess the effect of different nitrogen (N)-fertilizer forms in the phytoremediation of Cd through Solanum nigrum L. Two types of N fertilizers (NH4NO3 and urea) were applied to the soil in different ratios (0:0, 100:0, 0:100, and 50:50 of NH4NO3 and urea, individually) along with different Cd levels (0, 25, and 50 mg kg-1). The plants were harvested 70 days after sowing the seeds in pots. Cadmium contamination significantly inhibited the growth of leaves and roots of S. nigrum plants. Cadmium contamination also induced oxidative stress; however, the application of N-fertilizers increased the plant biomass by inhibiting oxidative stress and enhancing antioxidants' enzymatic activities. The greatest plant growth was observed in the urea-treated plants compared with the NH4NO3-treated plants. In addition, urea-fed plants also accumulated higher Cd concentrations than NH4NO3-fed plants. It is concluded that urea is helpful for better growth of S. nigrum under Cd stress. Thus, an optimum concentration of N-fertilizers might be effective in the phytoremediation of heavy metals through S. nigrum.

Ovarian dermoid cyst presenting with unusual complaint of hair coming out of the anal orifice - A case report.

Dermoid cyst of the ovary is a common benign condition. It is usually asymptomatic but can present with pain, mass, hormone related symptoms or paraneoplastic syndrome. Hair is a common morphological component of the dermoid cyst; however, it rarely manifests as a presenting complain. We report a case, who presented with the complaints of hair coming out through her anal orifice for a year. Ultrasound and computed tomography scan revealed a dermoid cyst of the right ovary adherent to the rectum. Surgical removal showed hair coming out of the cyst. Primary repair of the defect in rectal wall was performed which resulted in resolution of the symptoms.

Frequency and causes of anemia in Lymphoma patients.

OBJECTIVE: Purpose of this study was to find out frequency of anemia and its causes in newly diagnosed treatment naive lymphoma patients. METHODS: We retrospectively studied all lymphoma patients (> 18 years age) diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, from January 2016 till January 2017. The data was collected from electronic Hospital Information System. Descriptive statistics were done by using summary measures for categorical variables as well as continuous variables. RESULTS: Out of a total 408 patients, 272 were males and 136 females. Median age of patients was 33 years (18-76). Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL) were the diagnosis in 201 and 134 patients respectively; rest of the patients had low grade lymphomas. Anemia was present in 184 (45%) patients. Anemia of chronic disease was the commonest cause of anemia and was present in 61 (33.1%) patients. Remaining patients had anemia secondary to marrow involvement 50(27.17%); iron deficiency anemia, Vitamin B-12 deficiency anemia and hemolytic anemia were the causes in 7.6, 1.6%, % and 0.54% respectively. CONCLUSION: Anemia is a common feature in newly diagnosed lymphoma patients with anemia of chronic disease as the commonest cause. It is more frequent in patients with higher stages of lymphoma especially when bone marrow is involved by lymphoma. Since anemia is an important adverse prognostic factor for the outcome of lymphoma patients, work up for anemia prior to initiation of chemotherapy should be done in every lymphoma patient in order to help improve the management of these patients.

Excision of the Gluteal Cleft Pilonidal Sinus, Its Track, and the Sudoriferous Gland Area En-bloc with Primary Repair in the Management of this Disease.

Introduction Pilonidal disease is a common disease mostly affecting young males with a significant reduction in their working capabilities, hence, ideal and simple management of this disease is very important. Our study objective was to assess the recurrence rate of pilonidal sinus disease in patients with a complete excision of the pilonidal sinus, its track, and the sudoriferous gland area en-bloc with primary repair. Methods This descriptive study was conducted at Al-Noor Surgery, Chakwal, Pakistan, from February 2015 to July 2017. All patients who presented with acute and chronic pilonidal disease in the natal cleft, irrespective of age and gender, were included. We excluded from the study patients who had asymptomatic or recurrent pilonidal disease, previous pilonidal surgery, patients belonging to American Society of Anesthesiologists (ASA) Class III or above, immunodeficient patients, patients having bleeding disorders, patients on chemotherapy, and those diagnosed with comorbidities, e.g., anemia, tuberculosis, diabetes, and liver disease. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, US). Results During the study period, a total of one 112 patients were included. The male-to-female ratio was 55:1. The most common age group was the 21-25 age group. Chronic pilonidal disease was the most common presentation. Mean operative time was 22.09±3.65 minutes. There were no complications like bleeding, hematoma, edema, infection, and wound dehiscence. There was no recurrence in the six months follow-up. Hospital stay was 3.13±0.62 hours. Conclusion Simple excision of acute and chronic pilonidal sinus, its track, and the linked sudoriferous gland area en-bloc, followed by primary repair, is an effective approach to deal with this pathology.

Clinical case seminar: Riedel's thyroiditis: report of a case complicated by spontaneous hypoparathyroidism, recurrent laryngeal nerve injury, and Horner's syndrome.

A 42-yr-old woman presented with hyperthyroidism and a large, firm, irregular goiter. Within a few weeks she became hypothyroid. Five months later she developed increasingly severe neck pain and compressive symptoms. The goiter had become rock hard. A fine needle aspiration biopsy showed features of chronic thyroiditis and fibrosis. She partially responded to a course of glucocorticoids. Tamoxifen was added, with marked improvement in goiter size and pain. Both medications were tapered off. Two months later the patient experienced paresthesias of the fingertips, perioral numbness, and a seizure. She was found to have spontaneous primary hypoparathyroidism. Three months later the patient became hoarse and experienced difficulty in breathing. She was found to have a massively enlarged thyroid with compression of the right internal jugular vein and encasement of the right carotid artery as well as tracheal narrowing. She also had right vocal cord paralysis due to recurrent laryngeal nerve involvement. Because of airway compromise, an emergency isthmusectomy was performed, and the patient was given a postoperative course of glucocorticoids with gradual improvement. Postoperative diagnosis was Riedel's thyroiditis. Two months later she presented with near-syncope and was found to have bradycardia, hypotension, and right Horner's syndrome, presumably due to compression of the right carotid sheath. She was given i.v. glucocorticoids and tamoxifen. Six months later and 18 months after her initial presentation, the patient is doing remarkably well. Her goiter has regressed by more than 50%, and she no longer has any pain or difficulty breathing. She remains a little hoarse and has persistent hypothyroidism and hypoparathyroidism. She is taking prednisone (5 mg, this is being tapered very slowly) and tamoxifen (20 mg) daily. This case illustrates the protean manifestations of Riedel's thyroiditis, a rare but fascinating disease. The epidemiology of this disease, its pathophysiology and complications, and the roles of surgery and medical therapy are reviewed.