Selenium and mercury concentrations in biological samples from patients with COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic disease affecting multiple organs. Furthermore, viral infection depletes several trace elements and promotes complex biochemical reactions in the body. Smoking has been linked to the incidence of COVID-19 and associated mortality, and it may impact clinical effects, viral and bacterial conversion, and treatment outcomes. OBJECTIVES: To study the relationship between severe acute respiratory syndrome coronavirus type 2 and the elemental concentrations of selenium (Se) and mercury (Hg) in biological samples from smokers and nonsmokers infected with the virus and in healthy individuals. METHOD: We evaluated changes in the concentrations of essential (Se) and toxic (Hg) elements in biological samples (blood, nasal fluid, saliva, sputum, serum, and scalp hair) collected from male smokers and nonsmokers (aged 29-59 years) infected with COVID-19 and from healthy men in the same age group. The patients lived in different cities in Sindh Province, Pakistan. The Se and Hg concentrations were determined using atomic absorption spectrophotometry. RESULTS: Se concentrations in all types of biological samples from smokers and nonsmokers with COVID-19 were lower than those of healthy smokers and nonsmokers. Hg concentrations were elevated in both smokers and nonsmokers with COVID-19. CONCLUSIONS: In the current study, persons infected with COVID-19 had higher concentrations of toxic Hg, which could cause physiological disorders, and low concentrations of essential Se, which can also cause weakness. COVID-19 infection showed positive correlations with levels of mercury and selenium. Thus, additional clinical and experimental investigations are essential.

Relation of External Beam Radiotherapy Dose with Subclinical Hypothyroidism in Patients undergoing Adjuvant Neck Radiation after Surgery for Squamous Cell Carcinoma of Head and Neck.

The objective of this study was to find out the radiation dose relationship with subclinical hypothyroidism in the postoperative head and neck squamous cell carcinoma patients, who underwent adjuvant neck external beam radiotherapy. It was a prospective cohort study done between June 2018 and January 2020. One hundred patients, who were fulfilling the criteria of histological proven postoperative head and neck squamous cell carcinoma (SCC) of AJCC 2018 stage I to III, were enrolled. Patients were irradiated for 50 Gy to the bilateral lower neck on a linear accelerator. A CT scan face and neck with contrast along with T3, T4, and TSH was done before and after 4 weeks of chemoradiotherapy. All the patients were kept on surveillance for every three months for one year with the above-mentioned CT scan and thyroid function test. Ten patients (10%) had received radiation dose less than 30 Gy to the thyroid gland, while 90 patients (90%) had received radiation dose >30 Gy to thyroid gland. After one year of completion of treatment, 27.8% patients (n = 25) developed subclinical hypothyroidism among those patients (n = 90), who received radiation dose more than 30 Gy to thyroid gland. None of the patients had subclinical hypothyroidism among those patients (n =10), who received radiation dose below 30 Gy to thyroid gland (p= 0.062). Key Words: Head and neck cancer, Neck radiotherapy, Subclinical hypothyroidism.

Vestibular schwannoma: an unusual post radiotherapy response.

Vestibular schwannoma is a relatively uncommon tumor. Although, it is benign but locally expansile and spreads to damage the adjacent structures. Treatment strategy includes surgery, Stereotactic Radiosurgery (SRS) either by standard or hypofractionated protocols. Due to its benign nature, radiation therapy cannot remove the tumor completely, instead radiation therapy halts the growth of vestibular schwannoma and inactivates this benign tumor. Response of radiation in the form of tumor shrinkage is seen 2 - 2.5 years after the radiations. We report a case of vestibular Schwannoma in which residual tumor of 3.1 cm size following subtotal resection was irradiated of the dose of 54 Gy in 30 equal fractions on 3-Dimensional Conformal Radiation Therapy (3-DCRT). A follow-up CT scan brain after 2 months of radiotherapy showed complete disappearance of the disease categorized as complete response. This is an unusual phenomenon and is likely due to the very rarely seen malignant transformation or presence of malignant component in this benign tumor.

Diagnostic accuracy of high resolution MR imaging in local staging of bladder tumors.

OBJECTIVE: To determine the diagnostic accuracy of high-resolution MR imaging done at 1.5T in distinguishing bladder-restricted tumor from non-bladder-restricted tumor and compare the mean short axis dimension of metastatic pelvic lymph nodes with benign pelvic lymph nodes. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from March 2008 to July 2011. METHODOLOGY: Patients with bladder cancer were enrolled. Based on pathologic T-staging following radical cystectomy, patients were assigned to one of two groups. Patients with stage T1 and T2 disease were assigned to the bladder-restricted tumor (BRT) group and those with stage T3 and T4 disease to the non-bladder-restricted tumor (NBRT). High-resolution unenhanced MR imaging done prior to cystectomy was reviewed retrospectively (1.5 T MRI unit; GE Healthcare). Results from MR imaging-based categorization were compared with pathology reports to fulfill the objective. Mean short-axis diameter of largest visible lymph nodes in patients with nodal metastasis was compared with mean short-axis diameter of largest visible lymph nodes in patients with benign lymph nodes. RESULTS: The accuracy of MRI in differentiating distinguishing bladder-restricted tumor from non-bladder-restricted tumor was 67.72%. The mean short axis diameter of metastatic lymph nodes was greater than that of non-metastatic lymph nodes, i.e., 7.4 mm and 5.4 mm respectively. CONCLUSION: Conventional high resolution 1.5T MRI does not appear to offer advantage over imaging done at low field strength scanners.

Gastrointestinal stromal tumor with skeletal muscle, adrenal and cardiac metastases: an unusual occurrence.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the bowel. It most commonly arises in the stomach, followed by the small intestine, colorectum and the esophagus. It usually spreads to the liver or the peritoneum, with bone and lung metastases being infrequent. Here, we present a case report of GIST behaving in a bizarre way. The patient presented with skeletal muscle metastasis and was initially misdiagnosed as leiomyosarcoma. On follow-up, he developed adrenal metastasis, and later, cardiac metastasis. None of the above unusual sites has previously been reported in literature to our knowledge.

Reliability of MRI in measuring tongue tumour thickness: a 1.5T study.

BACKGROUND: Tongue tumour thickness has been shown to have a correlation with neck nodal metastasis and hence patient survival. Current AJCC guidelines recommend inclusion of tongue tumour thickness measurement in routine radiologic staging. Several studies have attempted to define the accuracy of MRI in measuring tongue tumour thickness. The aim of our study was to compare tongue tumour thickness measured at T2-weighted and STIR sequences with histologic tongue tumour thickness. METHODS: Twenty-eight consecutive patients of tongue cancer who had undergone glossectomy were selected retrospectively. Tumours were measured in both STIR axial and T2-weighted coronal images and compared with histologic tumour thickness on resected specimens. Pearson's analysis was performed to determine the degree of correlation. Paired samples t-test was also used for comparison of mean tumour thicknesses measured on MRI with mean histologic tumour thickness. RESULTS: Pearson correlation analysis showed good correlation of tumour thickness measured on MRI with actual histologic tumour thickness (R=0.876). CONCLUSION: MRI provides a satisfactory prediction of tongue tumour thickness which in turn can be used todetermine the need for elective neck dissection in these patients.

Modification and implementation of NCCN guidelines on non-small cell lung cancer in the Middle East and North Africa region.

A lung cancer committee from the Middle East and North Africa (MENA) region was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Non-Small Cell Lung Cancer to create a platform for standard care in the region. The committee comprised different experts in thoracic oncology from the region, including the disciplines of medical and clinical oncology, radiation oncology, thoracic surgery, pulmonary medicine, radiology, and pathology. The committee reviewed version 2 of the 2009 NCCN Guidelines on Non-Small Cell Lung Cancer and identified recommendations requiring modification for the region using published evidence and relevant experience. These suggested modifications were discussed among the group and with a United States-based NCCN expert for approval. The recommended modifications, with justification and references, were categorized based on the NCCN Guidelines flow. This article describes these recommended modifications. The process of adapting the first NCCN-based guidelines in the region is a step toward helping to improve lung cancer care in the region and encouraging networking and collaboration.

Modification and implementation of NCCN guidelines on hepatobiliary cancers in the Middle East and North Africa region.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Hepatobiliary Cancers address hepatocellular cancer, cancer of the gallbladder, extrahepatic cholangiocarcinoma, and intrahepatic cholangiocarcinoma. Hepatocellular cancer incidence is higher in the Middle East and North Africa (MENA) region than in the West, and hepatitis B and C infections are particularly important; the incidence of gallbladder cancer is among the highest in the world. Regional problems include delay in diagnosis, shortage of trained staff, and insufficient liver transplant facilities. Furthermore, costs associated with molecular and targeted therapies are an increasing concern. A committee was formed, consisting of leading specialists and decision-makers from the region, with each member being tasked to suggest modifications to the existing guidelines based on review of the literature and consultations with local colleagues. This committee met as a group, and then continued to discuss and debate the suggested modifications electronically. Several recommendations were finalized after vigorous debate. The final approved recommendations were then presented in April 2009 to the chair of the NCCN Hepatobiliary Cancers Panel for onward transmission and approval. This project represents an effort to modify and implement the NCCN Guidelines on Hepatobiliary Cancers in the MENA region, while taking into consideration local differences in patient and disease characteristics. The hope is that this will form the basis of future local, regional, and international cooperation in guideline development and research.

Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan.

BACKGROUND AND OBJECTIVE: Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan. METHODS AND DESIGN: A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied as no definitive data was available regarding the number of registered interns and nurses at each center. RESULTS: Of all the interviews conducted, 1.8% did not know cervical cancer as a disease. Only 23.3% of the respondents were aware that cervical cancer is the most common cause of gynecological cancers and 26% knew it is second in rank in mortality. Seventy-eight percent were aware that infection is the most common cause of cervical cancer, of these 62% said that virus is the cause and 61% of the respondents knew that the virus is Human Papilloma Virus (HPV). Majority recognized that it is sexually transmitted but only a minority (41%) knew that it can be detected by PCR. Only 26% of the study population was aware of one or more risk factors. Thirty seven percent recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine. CONCLUSION: This study serves to highlight that the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer. Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease.

Impact of bacille Calmette-Guérin vaccination on neuroradiological manifestations of pediatric tuberculous meningitis.

The authors conducted this study to identify whether bacille Calmette-Guérin (BCG) vaccination leads to an altered spectrum of neuroimaging findings outcome in pediatric patients with tuberculous meningitis. This retrospective study was conducted through chart review and review of computed tomography (CT) scans and magnetic resonance imaging (MRI) of patients with confirmed central nervous system tuberculosis from the year 1992 to 2005, at a large tertiary care hospital in Karachi, Pakistan. A total of 108 pediatric patients with tuberculous meningitis were included in the analysis. Of the 108 patients, 63 (58.3%) were male and 45 (41.7%) had received bacille Calmette-Guérin vaccination. There was no difference in terms of severity of clinical presentation and outcome between vaccinated and unvaccinated group. There were no significant differences in CT or MRI findings between the 2 groups except for tuberculomas on MRI, which were significantly higher in the non-bacille Calmette-Guérin vaccinated group (52.2% vs 22.7%, P = .042). Bacille Calmette-Guérin vaccination appears to translate into less tuberculoma formation on MRI.

Klippel-Trenaunay syndrome.

Klippel-Trenaunay Syndrome (KTS) is a rare, congenital, vascular disorder affecting one or more limbs. Originally, it was defined as a triad including port wine stain, varicose veins and bony and soft tissue hypertrophy. We present a case of a 20-year-old female who walked with a limp. Because of swelling of right leg she was sent for Doppler study which picked up dilated arteries and increased blood flow velocity. The impression of KTS was further strengthened by unique nuclear medicine and radiological findings.

Third world issues in breast cancer detection.

OBJECTIVE: To determine the statistics for age, distributions of the type of mammography, ultrasonic evaluation, laterality, assessment category, risk factors, and financial status, amongst females undergoing mammography. METHODS: A descriptive review of consecutive records of women undergoing mammography during Janurary and February 2005 at a tertiary care cancer facility, the Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan. RESULTS: Of a total of 87 patients, only 12 had attended the hospital for mammographic screening. These 12 females could financially afford the cost of their images. The median age of all the females at the time of mammography was 47 years and the mode was 40 years. Of the total, 40 and 32 patients were found in assessment categories 1 and 2 respectively. Only 19 females underwent bilateral mammography whereas forty were evaluated further by ultrasound imaging. Sixteen women had family history of breast cancer among their first degree relatives, twenty eight gave history of Hormone Replacement Therapy and fifty could afford their entire imaging expenses. CONCLUSION: Most patients received their first mammograms when they already had clearly palpable disease. This was partly be due to economic reasons and mainly because of low level of awareness.