Oral Squamous Cell Carcinoma Clinico-pathological features in relation to Tumor Stage; AJCC 2018 perspective.

Objective: To investigate the association between clinicopathological findings and tumor stage according to AJCC 2018 guidelines in patients suffering from Oral squamous cell carcinoma (OSCC). Methods: A descriptive study was conducted from January 2019 to January 2020 at King Edward Medical University and University of Health Sciences on a total of 49 patients enrolled after obtaining written informed consent. Clinical and radiographic findings were recorded. Pathological reporting was done using AJCC 2018 cancer staging guidelines. Association between clinicopathological features with tumor stage and grade was assessed using Chi-square and Kruskal-Wallis test. Result: Mean age of the patients was 46.1 ± 10.6 years. Most of the tumors were of well differentiated type (49%) and moderately differentiated (40.8%) with predominant clinical stage III in 42.9% & IV in 44.9 % and primary tumor stage pT2 28.6% & pT3 36.7%. Significant difference was seen for primary tumor stage in relation to age, gender, depth of invasion, primary site, and size of tumor (p < 0.01). For clinical stages, significant difference was observed in the age, gender, size of tumor, nodal metastasis, and anatomical tumor site (p < 0.01). Conclusion: Application of 8th Edition AJCC guidelines identifies the importance of the latest classification with strong association of latest stage criteria with age, gender, site of primary tumor, tumor thickness, depth of invasion, nodal metastasis and size of largest lymph node involved, and Level of Lymph node involved (level III & V) in a subset of patients from a developing country.

Expression of p53 Protein in Prostate Carcinoma and its Correlation with Gleason Grade.

OBJECTIVES: To determine the correlation of p53 expression with Gleason score in prostate cancer. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Pathology, Fatima Memorial Hospital, Lahore; from January 2014 to August 2016. METHODOLOGY: Thirty-seven samples of prostate carcinoma were graded using Gleason grading system. p53 expression was detected through routine immunohistochemical staining protocols and assessed semi-quantitatively using four-point scale score. The collected data was analysed statistically using Pearson's correlation coefficient.   Results: Out of a sample of 37, high grade tumours were observed in 21 (57%) cases, making them the most prevalent type; while, p53 positive nuclear staining was observed in 26 (70%) cases. Within the high grade tumours, strong positive p53 expression was observed in 8 (38%) tumours; while, overexpression of p53 protein was seen in 7 (33%) cases. In contrast, overexpression of p53 was absent in low grade tumours. CONCLUSION: A statistically significant correlation was observed between p53 positive expression and high Gleason grade. Key Words: Prostate cancer, Immunohistochemistry, p53 protein, Gleason score.

An effective and doable interventional strategy to enhance vaccination coverage - are we ready to change?

OBJECTIVE: To evaluate the effect of patient reminder calls on improvement of routine vaccination coverage. METHODS: This prospective, interventional study was conducted at Rawal Institute of Health Sciences, Islamabad, Pakistan, from December 2014 to August 2016, and comprised babies enrolled at the time of 1st vaccination. Babies who were given bacillus Calmette-Guérin, oral polio vaccine were included. Mobile phone numbers of parents were noted. The 1st reminder call was given after 7 days if a baby did not report on the scheduled date. Similarly, 2nd and 3rd reminder calls were made after waiting for 7 days each time in case of non-reporting. Record of reporting and reminder calls was reviewed daily till all the enrolled babies crossed 15 months of age (scheduled time for 2nd dose of measles) plus 4 weeks. RESULTS: A total of 150 babies were enrolled at the time of 1st vaccination. Reporting without call within 01 week of scheduled date ranged from 52(34.66%) to 99(66%) for different vaccines. The 1st reminder call showed maximum improvement in reporting rate. The range of vaccination rate reached from 91(60.66%) to 132(88%). The 2nd call improved coverage rate range from 108(71.99%) to 140(93.33%). The 3rd call improved coverage rate from 113(75.32%) to 144(96%). Overall coverage rate achieved ranged from 112.5(75%) to 144(96%). CONCLUSIONS: Patient reminder calls showed significant effect in improvement of vaccination coverage rate of all antigens.

Comparison of standard versus double dose of amoxicillin in the treatment of non-severe pneumonia in children aged 2-59 months: a multi-centre, double blind, randomised controlled trial in Pakistan.

INTRODUCTION: WHO pneumonia case management guidelines recommend oral amoxicillin as first line treatment for non-severe pneumonia. Increasing treatment failure rates have been reported over a period of time, which could possibly be due to increasing minimum inhibitory concentrations of Streptococcus pneumoniae and Haemophilus influenzae for amoxicillin. Microbiological data show that this resistance can be overcome by increasing amoxicillin dosage. Based on this data, we examined whether we can improve the clinical outcome in non-severe pneumonia by doubling the dose of amoxicillin. METHODS: A double blind randomised controlled trial was conducted in the outpatient departments of four large hospitals in Pakistan. Children aged 2-59 months with non-severe pneumonia were randomised to receive either standard (45 mg/kg/day) or double dose (90 mg/kg/day) oral amoxicillin for 3 days and then followed up for 14 days. Final outcome was treatment failure by day 5. RESULTS: From September 2003 to June 2004, 876 children completed the study. 437 were randomised to standard and 439 to double dose oral amoxicillin. 20 (4.5%) children in the standard and 25 (5.7%) in the double dose group had therapy failure by day 5. Including the relapses, by day 14 there were 26 (5.9%) cumulative therapy failures with standard and 35 (7.9%) with double dose amoxicillin. These differences were not statistically significant (p = 0.55 and p = 0.29, respectively). CONCLUSION: Clinical outcome in children aged 2-59 months with non-severe pneumonia is the same with standard and double dose oral amoxicillin. Non-severe pneumonia can be treated effectively and safely with a 3 day course of a standard dose.