Selective Neck Dissection for Node-Positive Oral Cavity Squamous Cell Carcinoma: A Retrospective Cohort Study

Abstract Introduction Selective neck dissection inclinically node-negative neckisconsidered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevailsinnode-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.

Acute Limb Ischemia Due to Cardiac Thromboembolismin a Young Patient without Myocardial Infarction or Cardiomyopathy

Acute limb ischemia secondary to systemic arterial embolism from left ventricular thrombus is a rare life threatening emergency. Peripheral arterial thrombosis superimposed on an atherosclerotic disease or thromboembolism from cardiac or aortic source are the two most common causes of acute limb ischemia. We present a case of a young healthy female who had recurrent admissions with acute lower extremity ischemia secondary to embolism from intra cardiac thrombus diagnosed by bedside doppler and computed angiogram, managed by surgical thromboembolectomy and discharge on anticoagulation.

The Prognosis of Patients with Pregnancy Associated Breast cancer: Retrospective Cohort Study.

Background: Pregnancy associated breast cancer (PABC), diagnosed during pregnancy or one year post-partum, is relatively rare disease and surrounded by controversies about its prognosis and outcome. Methods: This cohort study is a review of retrospectively collected data of patients diagnosed and treated as PABC from 1987 to 2012 at the Aga Khan University Hospital, Pakistan. We identified patients of PABC and compared with non PABC patients matched for age and stage accrued at 1:2 ratios. The outcomes i.e. Overall survival and Disease Free Survival (DFS) were analyzed with Kaplan Meir Curves and Cox Proportional Hazards regression adjusted for matching. Results: We identified 62 patients of PABC, who had more aggressive disease (higher grade and receptor negativity) with higher number of patients who underwent mastectomy. Median overall survival in PABC group was 2.4 years (range: 4 months-8 years) compared to 5.5 years (range: 1.7 years-14 years.) in non PABC group (p-value 0.001). Similarly, the cases with PABC showed inferior DFS (median 1.5yrs) as compared to non PABC (median 3.2 yrs) (p-value= 0.01).Conclusion: PABC has aggressive course with a poor survival as compared to non PABC cases.

Evaluation of student’s perception and behavior towards plagiarism in Pakistani universities / Evaluación de la percepción y el comportamiento de estudiantes hacia el plagio en las universidades paquistaníes / Avaliação da percepção e do comportamento de estudantes para o plágio nas universidades paquistanesas

Background: The prevalence of academic delinquency in universities, predominantly in the form of plagiarism and cheating, is extensively conceded. Objectives: The objective of this study was to evaluate student’s perception and behavior towards plagiarism in Pakistani universities. Methods: This cross-sectional survey was conducted in 6 academic disciplines in 35 universities in Pakistan during 21.02.2011-21.04.2011. Expert interviewers and learned educationists carried out the interviews with the help of a structured questionnaire to evaluate student’s knowledge about plagiarism such as (i) student’s knowledge about HEC policy, (ii) student’s attitude towards plagiarism, (iii) student’s satisfaction towards plagiarism and cheating, and (iv) their views for penalties (What should be the penalties for 1st and 2nd occurrence of plagiarism?) and recorded the responses. Results: This survey was accomplished by 25742 students. The response rate for awareness about HEC policy about plagiarism showed that significantly (p<0.05) low percentage (94 percent of students was unaware of this policy. The attitudes of significantly (p<0.05) high percentage of students towards plagiarism behavior were unacceptable. Significantly (p<0.05) high response rate towards attitudes regarding punishment for plagiarism was warning and report to HOD for first and second occurrence of this cheating, respectively. Conclusions: An extensive lack was found in the understanding of students towards plagiarism across all the universities. It is necessary to achieve balance between factors affecting plagiarism such avoidance, finding and sentence in case of detection.

Antecedentes: La prevalencia de conductas éticas reprobables en las universidades, principalmente en la forma de plagio y engaño, es extensamente reconocida. Objetivos: El objetivo de este estudio fue evaluar la percepción y el comportamiento de los estudiantes hacia el plagio en las universidades paquistaníes. Métodos: Este estudio transversal se llevó a cabo en seis disciplinas académicas en 35 universidades en Pakistán durante 21.02.2011-21.04.2011. Entrevistadores expertos y educadores eruditos llevaron a cabo las entrevistas con la ayuda de un cuestionario estructurado, para evaluar los conocimientos de los estudiantes sobre el plagio: en aspectos como (i) el conocimiento de los estudiantes acerca de la política HEC, (ii) la actitud del estudiante: hacia el plagio, (iii) la satisfacción del estudiante: hacia el plagio y el engaño , y (iv) Sus puntos de vista en materia de sanciones (Qué sanciones debería otorgarse para la primera y segunda ocurrencia de plagio?) se grabaron las respuestas. Resultados: Esta encuesta fue realizado por 25.742 estudiantes. La tasa de respuesta para la conciencia acerca de las políticas HEC sobre el plagio mostraron significativamente (p <0,05) bajo porcentaje (94 por ciento). Los estudiantes no estaban al tanto de esta política. La actitud de rechazo al comportamiento de plagio muestra significativamente (p <0,05) un alto porcentaje. Los estudiantes consideraron que el plagio eran una conducta inaceptable. Significativamente (p <0,05) de alto índice fue la respuesta respecto a qué castigo se debería otorgar por plagio, la respuesta fue: advertencia e informar a HOD para la primera y segunda aparición de este engaño, respectivamente. Conclusiones: Se encontró una extensa falta de comprensión de los estudiantes hacia el plagio en todas las universidades. Es necesario para alcanzar el equilibrio entre los factores que influencian el plagio, lograr detectar la evasión, buscando y sentenciando los casos encontrados.

Antecedentes: A prevalência de condutas éticas reprováveis nas universidades, principalmente sob a forma de plágio e mentira, é extensamente reconhecida. Objetivos: Avaliar a percepção e o comportamento dos estudantes para o plágio nas universidades paquistanesas. Métodos: Este estudo transversal foi levado a cabo em seis disciplinas acadêmicas em 35 universidades no Paquistão de 21-02-2011 até 21-04-2011. Entrevistadores especialistas e educadores eruditos realizaram as entrevistas com a ajuda de um questionário estruturado, para avaliar os conhecimentos dos estudantes sobre o plágio: em aspectos como (i) o conhecimento dos estudantes acerca da política HEC, (ii) a atitude do estudante com relação ao plágio, (iii) a satisfação do estudante para com o plágio e a mentira, e (iv) seus pontos de vista em matéria de sanções (que sanções deveriam ser aplicadas para a primeira e segunda ocorrência de plágio?). Foram gravadas as respostas. Resultados: Esta enquete foi respondida por 25.742 estudantes. A taxa de resposta para a consciência acerca das políticas HEC sobre o plágio mostraram significativa (p<0,05) baixa porcentagem (94 por cento). Os estudantes não estavam a par desta política. A atitude de recusa ao comportamento do plágio mostra significativamente (p<0,05) uma alta porcentagem. Os estudantes consideraram que o plágio era uma conduta inaceitável. Significativamente (p<0,05) de alto índice foi a resposta a respeito do castigo que deveria ser dado ao plágio; a resposta foi: advertência e informar a HOD para o primeiro e segundo aparecimento deste engano, respectivamente. Conclusões: Foi encontrada uma extensa falta de compreensão dos estudantes em relação ao plágio em todas as universidades. É necessário, para alcançar o equilibrio entre os fatores que influenciam o plágio lograr detectar a evasão, buscando e sentenciando os casos encontrados.

Influence of one week education program on the knowledge and approach of pharmacy students towards diabetes mellitus / Influencia del programa una semana de educación en el conocimiento y enfoque de los estudiantes de farmacia hacia la diabetes mellitus / Influência do programa uma semana de educação no conhecimento e enfoque dos estudantes de farmácia para o diabetes mellitus

The objective of this study was to assess the improvement in knowledge and attitude of Pharmacy student towards diabetes by implementing one week long education program. Study design: Study was conducted between April 25, 2011 to April 29, 2011 which engaged the 3rd professional year Pharm. D. students comprising two groups: experimental and control groups. Lectures and visual presentations on diabetic education and practice were conducted for five days. Three surveys were performed on two groups i.e. non intervened control, non- intervened experimental and intervened experimental surveys. Questionnaire was used as survey tool comprising of 46 questions under ten categories. Results: Scores in all diabetic knowledge aspect was increased after education intervention and was significantly (P<0.05) different from that of control group. Conclusion: The marked increase in knowledge about diabetes among pharmacy students illustrates the importance of educational intervention. Educational programs may markedly increase the educational skills, efficiency and confidence of pharmacy students as well as professionals.

El objetivo del estudio fue evaluar cómo mejorar el conocimiento y la actitud de los estudiantes de Farmacia hacia la diabetes, mediante la implementación de un programa de educación de una semana. Diseño: El estudio se realizó entre el 25 y el 29 de abril de 2011, entre estudiantes de 3er año de la carrera de Farmacia, conformados en dos grupos: uno experimental y otro de control. Se llevaron a cabo conferencias y presentaciones visuales en educación y práctica de la diabetes durante cinco días. Tres estudios se realizaron en dos grupos: el grupo control y experimental no intervenido y el de estudio experimental intervenido. Un cuestionario se utilizó como herramienta de estudio con 46 preguntas en diez categorías. Resultados: Las puntuaciones en el conocimiento sobre todo aspecto de la diabetes se incrementó después de la intervención educativa, lo que fue significativo (P <0,05) diferente de la de grupo de control. Conclusión: El marcado aumento en el conocimiento sobre la diabetes entre los estudiantes de farmacia ilustra la importancia de la intervención educativa. Los programas educativos pueden aumentar notablemente la capacidad educativa, la eficiencia y la confianza tanto en los estudiantes de farmacia, así como en los profesionales.

O objetivo do estudo foi avaliar como melhorar o conhecimento e a atitude dos estudantes de Farmácia para o diabetes, mediante a implementação de um programa de educação de uma semana. Projeto: O estudo se realizou entre 25 e 29 de abril de 2011, entre estudantes de 3º ano do curso de Farmácia, conformados em dois grupos: um experimental e outro de controle. Foram levadas a cabo conferências e apresentações visuais em educação e prática do diabetes durante cinco dias. Três estudos foram realizados em dois grupos: o grupo controle e experimental sem intervenção e o grupo de estudo experimental com intervenção. Um questionário foi utilizado como ferramenta de estudo com 46 perguntas em dez categorias. Resultados: As pontuações no conhecimento sobre todo aspecto do diabetes foi incrementado depois da intervenção educativa, o que foi significativamente (P <0,05) diferente das do grupo de controle. Conclusão: O marcado aumento no conhecimento sobre o diabetes entre os estudantes de farmácia ilustra a importância da intervenção educativa. Os programas educativos podem aumentar notavelmente a capacidade educativa, a eficiência e a confiança tanto nos estudantes de farmácia, bem como nos profissionais.

Candidate genes prediction in pakistani families with hearing impairment by using bioinformatic approach / Predição de genes candidatos em famílias paquistanesas com deficiência auditiva utilizando uma abordagem de bioinformática

Multiple factors such as genetic and environmental, are involved in causing hearing impairment (HI). Severe or profound hearing loss affects approximately one in 1000 children worldwide and half of these cases are due to genetic factors. In case of hereditary nonsyndromic HI, approximately 75­80% of cases are involved in autosomal recessive inheritance and 15% of cases involve autosomal dominant inheritance. HI represents extreme genetic heterogeneity. In nonsyndromic deafness, 135 loci have been mapped till now including 77 autosomal recessive genes of which only 29 corresponding nuclear genes have been cloned. This study was designed to apply bioinformatic approach for reducing large number of candidate genes responsible for deafness to a handy number for their mutation analysis. Databases of expressed mouse inner ear genes and the expressed human cochlear genes were used to cross-reference all genes present in particular locus predicting candidate genes for phenotypes of nonsyndromic hereditary HI. These candidate genes are a source of starting point for mutation analysis along with genetic linkage to refine the loci. After characterization, it was observed that KIAA119 and EDN3 are candidate genes for deafness. In present study, there were total 14 loci and two genes KIAA119 and EDN3 were identified as candidate genes in locus 48 and locus 65 respectively. If mutation analysis of the two characterized genes is done, it will not be a comparatively time taking and labor-intensive process as these genes are only two in number.

Diversos fatores, tais como genéticos e ambientais, estão envolvidos na causa da deficiência auditiva (HI). A perda auditiva severa ou profunda afeta aproximadamente uma em cada 1000 crianças em todo o mundo e metade destes casos são devidos a fatores genéticos. Em relação a HI não-sindrômica hereditária, cerca de 75-80% dos casos estão envolvidos na herança autossômica recessiva e 15% dos casos envolvem herança autossômica dominante. HI representa extrema heterogeneidade genética. Em casos de surdez, 135 loci foram mapeados até agora, incluindo 77 genes autossômicos recessivos das quais apenas 29 genes correspondentes nucleares foram clonados. Este estudo foi desenhado para aplicar abordagem de bioinformática a fim de reduzir o grande número de genes candidatos responsáveis pela surdez a um número útil para a análise de mutação. Bases de dados de genes expressos do ouvido interno em camundongos e de genes expressos na cóclea em humanos foram usados para cruzar todos os genes presentes no locus específico prevendo genes candidatos para os fenótipos de HI não sindrômica hereditária. Estes genes candidatos são uma fonte de ponto de partida para a análise de mutação, juntamente com a ligação gênica para refinar os locos. Após a caracterização, verificouse que KIAA119 e EDN3 são genes candidatos para a surdez. No presente estudo, houve um total de 14 locos e dois genes KIAA119 e EDN3 foram identificados como genes candidatos no locus 48 e locus 65, respectivamente. Se a análise de mutação dos dois genes caracterizados for feita, não será um processo comparativamente longo e trabalhoso uma vez que são apenas dois genes.

In vitro-in vivo correlation study on nimesulide loaded hydroxypropylmethylcellulose microparticles / 药学学报

This study involves mathematical simulation model such as in vitro-in vivo correlation (IVIVC) development for various extended release formulations of nimesulide loaded hydroxypropylmethylcellulose (HPMC) microparticles (M1, M2 and M3 containing 1, 2, and 3 g HPMC, respectively and 1 g drug in each) having variable release characteristics. In vitro dissolution data of these formulations were correlated to their relevant in vivo absorption profiles followed by predictability worth analysis of these Level A IVIVC. Nimaran was used as control formulation to validate developed formulations and their respective models. The regression coefficients of IVIVC plots for M1, M2, M3 and Nimaran were 0.834 9, 0.831 2, 0.927 2 and 0.898 1, respectively. The internal prediction error for all formulations was within limits, i.e., < 10%. A good IVIVC was found for controlled release nimesulide loaded HPMC floating M3 microparticles. In other words, this mathematical simulation model is best fit for biowaiver studies which involves study parameters as those adopted for M3 because the value of its IVIVC regression coefficient is the closest to 1 as compared to M1 and M2.

Comparison of bioavailability and pharmacokinetics of diclofenac sodium and diclofenac potassium in normal and dehydrated rabbits / 药学学报

Two different salts of diclofenac, diclofenac sodium and dielofenae potassium, in tablet dosage form were tested for their bioavailability and disposition kinetics in a group of eighteen rabbits in normal and experimentally induced dehydrated conditions with a wash out period of 7 days between both stages of study. Biochemical and physiological parameters were also measured in both normal and dehydrated states. Diclofenac levels in plasma were determined using a validated reversed phase HPLC method. Primary kinetic parameters i.e. AUC0-∞, Cmax, Tmax and other disposition kinetics were obtained with non-compartmental procedure. Biochemical parameters i.e. packed cell volume, plasma glucose and total lipid concentration in dehydrated rabbits increased significantly. Plasma concentration of diclofenac sodium and diclofenac potassium decreased significantly in water deprived rabbits. In comparison, diclofenac potassium in normal and dehydrated state of the same group of rabbits showed a significantly increased plasma concentration when compared with diclofenac sodium.

Leiomyoma of the urinary bladder with bladder stone

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature