Illustration of association between change in prostate-specific antigen (PSA) values and time to tumor status after treatment for prostate cancer patients: a joint modelling approach.

BACKGROUND: Prostate cancer (PCa) is the most prevalent tumor in men, and Prostate-Specific Antigen (PSA) serves as the primary marker for diagnosis, recurrence, and disease-free status. PSA levels post-treatment guide physicians in gauging disease progression and tumor status (low or high). Clinical follow-up relies on monitoring PSA over time, forming the basis for dynamic prediction. Our study proposes a joint model of longitudinal PSA and time to tumor shrinkage, incorporating baseline variables. The research aims to assess tumor status post-treatment for dynamic prediction, utilizing joint assessment of PSA measurements and time to tumor status. METHODS: We propose a joint model for longitudinal PSA and time to tumor shrinkage, taking into account baseline BMI and post-treatment factors, including external beam radiation therapy (EBRT), androgen deprivation therapy (ADT), prostatectomy, and various combinations of these interventions. The model employs a mixed-effect sub-model for longitudinal PSA and an event time sub-model for tumor shrinkage. RESULTS: Results emphasize the significance of baseline factors in understanding the relationship between PSA trajectories and tumor status. Patients with low tumor status consistently exhibit low PSA values, decreasing exponentially within one month post-treatment. The correlation between PSA levels and tumor shrinkage is evident, with the considered factors proving to be significant in both sub-models. CONCLUSIONS: Compared to other treatment options, ADT is the most effective in achieving a low tumor status, as evidenced by a decrease in PSA levels after months of treatment. Patients with an increased BMI were more likely to attain a low tumor status. The research enhances dynamic prediction for PCa patients, utilizing joint analysis of PSA and time to tumor shrinkage post-treatment. The developed model facilitates more effective and personalized decision-making in PCa care.

Model Selection and Identification of Osteoporosis Risk Factors in Women to Improve Their Healthcare.

Osteoporosis is characterized by low bone mineral density leading to enhanced bone fragility and a consequent increase in fracture risk. The focus of this case-control study was to identify significant socioeconomic risk factors of osteoporosis in Pakistani women and examine how the risk increases for different levels of risk factors. A case-control study was conducted from November 2018 to August 2019 in two main hospitals in Faisalabad, Pakistan. Multiple logistic regression was used to explore the significant risk factors of osteoporosis and how the risk increases in cases (cases = 120) as compared to the control group (controls = 120) in the presence of these risk factors. The mean age ± standard deviation for cases and controls was 59.62 ± 10.75 and 54.27 ± 10.09, respectively. The minimum and maximum ages were 36 and 80 years, respectively. In addition to age, bone fracture, family history, regular physical activity, family size, use of meat, type of birth, breastfeeding, premature menopause, loss of appetite, and use of anticoagulants were significant risk factors with p-values less than 0.05. The risk prediction model with significant risk factors was a good fit with a p-value of 0.28, corresponding to the Hosmer-Lemeshow test value (χ2 = 9.78). This parsimonious model with Cox-Snell R2 = 0.50 (with a maximum value = 0.75) and Nagelkerke R2 = 0.66 showed an AUC of 0.924 as compared to the full model with all risk factors under study that exhibited an AUC of 0.949.

Synthesis, classification and properties of hydrogels: their applications in drug delivery and agriculture.

Absorbent polymers or hydrogel polymer materials have an enhanced water retention capacity and are widely used in agriculture and medicine. The controlled release of bioactive molecules (especially drug proteins) by hydrogels and the encapsulation of living cells are some of the active areas of drug discovery research. Hydrogel-based delivery systems may result in a therapeutically advantageous outcome for drug delivery. They can provide various sequential therapeutic agents including macromolecular drugs, small molecule drugs, and cells to control the release of molecules. Due to their controllable degradability, ability to protect unstable drugs from degradation and flexible physical properties, hydrogels can be used as a platform in which various chemical and physical interactions with encapsulated drugs for controlled release in the system can be studied. Practically, hydrogels that possess biodegradable properties have aroused greater interest in drug delivery systems. The original three-dimensional structure gets broken down into non-toxic substances, thus confirming the excellent biocompatibility of the gel. Chemical crosslinking is a resource-rich method for forming hydrogels with excellent mechanical strength. But in some cases the crosslinker used in the synthesis of the hydrogels may cause some toxicity. However, the physically cross-linked hydrogel preparative method is an alternative solution to overcome the toxicity of cross-linkers. Hydrogels that are responsive to stimuli formed from various natural and synthetic polymers can show significant changes in their properties under external stimuli such as temperature, pH, light, ion changes, and redox potential. Stimulus-responsive hydrogels have a wider range of applications in biomedicine including drug delivery, gene delivery and tissue regeneration. Stimulus-responsive hydrogels loaded with multiple drugs show controlled and sustained drug release and can act as drug carriers. By integrating stimulus-responsive hydrogels, such as those with improved thermal responsiveness, pH responsiveness and dual responsiveness, into textile materials, advanced functions can be imparted to the textile materials, thereby improving the moisture and water retention performance, environmental responsiveness, aesthetic appeal, display and comfort of textiles. This review explores the stimuli-responsive hydrogels in drug delivery systems and examines super adsorbent hydrogels and their application in the field of agriculture.

Fatty acid profile and effect of fish fermented silage on digestive enzymes in Labeo rohita / Perfil de ácidos graxos e efeito de peixe fermentado em silagem de enzimas digestivas em Labeo rohita

Due to inconsistency in demand and supply of fishmeal there is immense need of alternate protein sources. Present project was therefore designed to replace costly fishmeal (FM) with low-priced fermented fish silage (FFS) in fish feed. Fermented fish silage was prepared by fermentation process using Lacto bacillus bacteria and its fatty acid profile and effect on digestive system of Labeo rohita was investigated. Lipid contents were isolated by Soxhlet apparatus and recorded as 6.23 ± 1.23 g/100g of fermented fish silage (FFS). Fatty acid profile of extracted Lipids was determined by gas liquid chromatography (GLC), sufficient amount of unsaturated fatty acids were found with pattern mono unsaturated fatty acids (MUFA) > saturated fatty acids (SFA) >poly unsaturated fatty acids (PUFA). Three treatment diets containing 100% silage (T1), 75% silage (T2) and 50% silage (T3) were prepared by mixing it with soybean meal (SBM) and rice bran as co-ingredients while fermented fish silage was replaced by fishmeal in control diet (T0). The experiment was conducted in glass aquaria in triplicate. Fish growth parameters were recorded fortnightly while physicochemical parameters of water were recorded on daily basis. After completion of feeding trial, three fish were randomly dissected to excise out their intestines and determine activity for protease, amylase and lipase enzymes. Non-significant differences (P<0.05) were recorded in growth parameters and enzymatic activity among all diets except lipase enzyme. Deceptively, it can be concluded that FFS has reasonable concentration of nutrients and unsaturated fatty acids so it can successfully replace fishmeal in fish diets.

Devido à diferença na procura e na oferta de farinha de peixe há imensa necessidade de qualquer membro suplente da fonte de proteína. Tão presente projeto foi projetada para substituir a dispendiosa farinha de peixe (FM) com barato peixe fermentado de ensilagem (FFS) em alimentos para peixes. FFS foi preparado pelo processo de fermentação usando Lactobacillus bactérias e seu perfil de ácidos graxos e efeito sobre o sistema digestivo de Labeo rohita foi investigado. Conteúdo lipídico foram isoladas pelo aparelho de Soxhlet e registadas como 6,23 ± 1,23 g/100g de FFS. Perfil de ácidos graxos extraídos de lipídios foi determinada por cromatografia líquida de gás (GLC). Quantidade suficiente de ácidos graxos insaturados foram encontrados com padrão MUFA > SFA > AGPI. Tratamento de três dietas contendo silagem de 100% (T1), 75% silagem (T2) e 50% silagem (T3) foram preparados misturando com farinha de soja (SBM) e farelo de arroz como co ingredientes enquanto FFS foi substituído pela FM na dieta controle (T0). O experimento foi conduzido em aquários de vidro em triplicado. O Crescimento dos peixes foram anotados os parâmetros quinzenal enquanto parâmetros físico-químicos de água foram registradas diariamente. Após a conclusão do teste de alimentação, três peixes foram aleatoriamente dissecada a impostos especiais de consumo os seus intestinos e determinar a atividade de protease, enzimas amilase e lipase. As variações não significativas (P<0,05) foi registrada em parâmetros de crescimento e atividade enzimática entre as dietas exceto enzima lipase mostrou diferença significativa entre as dietas de tratamento. Aparentemente, é possível concluir que a concentração razoável de FFS tem nutrientes e ácidos graxos insaturados de modo que ela possa substituir com êxito a farinha de peixe na dieta de peixes.

Multi-response optimization of rhamnolipid production using grey rational analysis in Taguchi method.

The present paper envisages the multi-response optimization of certain process parameters like total sugars concentration, C/N ratio and incubation time on rhamnolipid yield, surface tension reduction, biomass formation and substrate utilization, in rhamnolipid production by a Pseudomonas aeruginosa mutant strain grown on clarified blackstrap molasses, under L9 orthogonal array in Taguchi design. The results have been analyzed by using grey relational analysis for the identification of an optimum level of process parameters. The validity of the results was checked though confirmation experiment, under grey relational analysis. Subsequently, the rhamnolipid yield improved from 1.45 to 1.50 g/L, substrate utilization reduced from 26 to 14% (w/v) and lesser biomass was formed. Moreover, the volumetric productivity of the process improved from 0.0086 to 0.0208 g/L/h by 142%. Furthermore, using analysis of variance method, significant contributions of process parameters were determined.

Prognostic value of normal exercise Tc-99m Sestamibi myocardial perfusion imaging in Karachi, Pakistan.

OBJECTIVE: To ascertain the hard event rate in local population with normal myocardial perfusion. METHODS: The study, which was conducted from August 2006 to January 2007, included 300 patients with normal exercise myocardial perfusion scan (MPS). Patients were categorized according to their pre-test probabilities for CAD. Patients with low pre-test probability for CAD were 136 and ranked in group A, while group B constituted 164 patients who had intermediate to high pre-test probability. RESULTS: During a follow-up of mean duration of 27 +/- 3 months, an overall hard cardiac event rate of 1.02% was noted. However, a statistically non-significant difference between the survival rates of low and high pre-test probability groups was also observed. CONCLUSION: The study demonstrated good prognosis for patients with normal exercise myocardial perfusion scan.

Assessing adriamycin-induced early cardiotoxicity by estimating left ventricular ejection fraction using technetium-99m multiple-gated acquisition scan and echocardiography.

BACKGROUND: Adriamycin cardiotoxicity begins with the first dose of therapy. The insult may be subclinical initially, but with continued treatment can result in clinical congestive heart failure. Therefore, a study for the detection of early cardiotoxicity of adriamycin by left ventricular ejection fraction (LVEF) estimation using technetium (Tc)-99m multiple-gated acquisition (MUGA) scan and echocardiography (ECHO) was conducted. METHODS: LVEF was assessed in 42 patients with different cancers, advised to receive adriamycin (average received dose = 95.2 ± 6.82 mg/cycle, protocol dose = 65 ± 10 mg/m) in each of six cycles. The percentage of LVEF (%LVEF) was determined as a baseline after every successive cycle, simultaneously, by a Tc-99m MUGA scan (reference method) and ECHO. RESULTS: A significant decline of 12.17 ± 5.01 and 9.26 ± 4.82 (P < 0.001) in %LVEF was noted at the end of adriamycin therapy, estimated by a Tc-99m MUGA scan and ECHO respectively. Thirteen of 42 (31%) and six of 42 (14%) patients developed protocol-defined cardiotoxicity, determined by a Tc-99m MUGA scan and ECHO, respectively. The incidence of cardiotoxicity was 2.4, 2.4, 4.8, 16, and 31.2% at the median cumulative adriamycin dose of 210, 380, 450 , 550 , and 615 mg/m, respectively. CONCLUSION: Subclinical adriamycin cardiotoxicity was detectable from the third cycle and if not detected earlier continued therapy may progress to severe and irreversible cardiotoxicity. A decline of 5% or more of %LVEF instead of 10% should be considered as a significant marker of subclinical cardiotoxicity. A Tc-99m MUGA scan is more sensitive than ECHO for the estimation of subtle changes in %LVEF. Ideally, %LVEF must be determined at baseline and after every cycle, and if not possible then preferably from the third cycle onwards.

Nephrotoxicity of CDDP assessed estimating glomerular filtration rate with 99mTc-DTPA plasma sample method.

OBJECTIVE: To assess early nephrotoxicity of CDDP (Cis-diamminedichloroplatinum) manifested by a decline in the glomerular filtration rate (GFR) estimated by plasma two sample clearance method (PSC 2) after 99mTc-DTPA injection. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Nuclear Medicine, Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi, from September 2004 to January 2005. METHODOLOGY: The renal function was assessed on 36 patients suffering from different types of cancer and receiving CDDP in doses of (3) 50 mg/m(2) before and after in each of six CDDP cycles. The GFR was determined by PSC 2 method after 99mTc-DTPA injection). A paired sample t-test was used for comparison of the mean value with significance at p < 0.01. RESULTS: There were (28 males and 8 females; age range being 16-68 years) The average decline in GFR baseline to the end of sixth cycles was 43.86 ml/min/1.73m(2) (p=0.000) as estimated by PSC 2 method. There was a significant fall of average 9.36 ml/min/1.73m(2) (p < 0.01) in GFR as observed in each cycle of CDDP estimated by the PSC 2 method. In the initial four cycles, CDDP produced a major nephrotoxic effect of average 10.27 ml/min/1.73m(2) (p < 0.01) fall in GFR. This then gradually declined to a plateau of an average decline in GFR of 7.76 and 7.31 ml/min/1.73m(2) (p=0.000) after the 5th and 6th cycle respectively. CONCLUSION: CDDP produced an early nephrotoxicity which was manifested by a significant decline in GFR in each cycle. Tc-99m PSC 2 method for GFR estimation should be used periodically for the early detection of nephrotoxicity induced by CDDP.

Diagnostic accuracy of Tc-99m-MIBI for breast carcinoma in correlation with mammography and sonography.

OBJECTIVE: To evaluate the accuracy of 99mTc-MIBI scintimammography (SMM) in differentiating malignant breast cancer from benign breast mass and in detecting axillary lymph node metastasis in comparison with mammography and ultrasonography. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: At the Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN), Karachi, from December 2006 to May 2007. METHODOLOGY: A total of 28 patients (both with breast lumps or/and axillary masses) included were in the study. They underwent clinical examination, mammography and ultrasound imaging followed by planar SMM using a single head detector. All subjects received a 740-1110 MBq bolus injection of 99mTc-Sestamibi. 5-10 minutes and 1 hour delayed images were acquired after the injection. SMM scans were considered positive when there was focal area of increased radiotracer uptake. Qualitative (visual) as well as quantitative evaluation of scans was done and compared with ultrasound and mammography, taking histopathology as Gold standard. Sensitivity, specificity, negative and positive predictive values (NPV and PPV respectively) were determined. RESULTS: There were 22 patients presenting with breast lesions (20 palpable, 2 non-palpable) and 6 patients with axillary lump. Scintimammography accurately predicted malignant lesions in the breast (sensitivity 93.3%, specificity. 71.4%, PPV 87.5%, NPV 83.3%, overall accuracy 86.4%) as well as in patients with axillary metastasis (sensitivity 100%, specificity 66%, PPV 75%, NPV 100%, accuracy 83%). A combination of scintimammography with any other imaging modality provides better results than a single test to detect breast cancer. CONCLUSION: SMM has good diagnostic accuracy in the detection of breast cancer as well as in axillary metastasis in association with mammography and ultrasound.

Institution-based cancer incidence in a local population in Pakistan: nine year data analysis.

At present no national level of cancer registry program exists in Pakistan and the data available from different sources, necessary for incidence, prevalence, morbidity/mortality, and etiological assessment of cancer and cancer control programs, are from hospital or institutional databases. Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) is a comprehensive healthcare facility for diagnosis, treatment and research of all cancers. This is a retrospective analysis of the cancer patients of both genders of all age groups to determine frequencies of different cancers presented to this Institute from 1st January 2000 to 31 December 2008. A total of 16,351 cancer patients were registered at KIRAN during the nine year period. Male cancers accounted for 48.1% and female cancers 51.8%. Some 558 (3.4%) were in children (0-15 years). The mean ages at presentation for males and females were 50-/+9.6 and 47-/+7.4 years respectively. In males the five most frequent malignancies were head and neck (32.6%), lung (15%), gastrointestinal tract (GIT) (6.9%), lymphoma (6.1%), and bone and soft tissue (4.9%). In females breast cancer was the most common cancer accounting for 38.2% followed by head and neck (15.1%), cervical (5.5%), ovarian (4.9%) and GIT cancer (4.9%) respectively. Cancer prevalence in different age groups with respect to gender and the epidemiologies of most common cancers with reference to our cultural and environmental factors and dietary habits are also discussed. Overall cancer incidence in nine years in this tertiary care cancer institution showed that head and neck cancers in males and breast cancers in females are most common, at rates almost highest in Asia. Mean age and male to female ratio in all other cancers are essentially comparable to other developing countries.

Tc-99m-methoxy isobutyl isonitrile scintimammography: imaging postexcision biopsy for residual and multifocal breast tumor.

OBJECTIVES: The interpretation of mammogram in a postsurgical breast can be extremely complex and difficult because masses, calcifications, and architectural distortion can mimic cancer. Scintimammography has been proposed because it is not affected by these morphological changes and can potentially be used in patients after excision biopsy to assess any residual tumor, other foci of disease (multifocal disease). MATERIALS AND METHODS: The population comprised of 21 patients (mean age: 47.80 years, median age: 50 years, and age range: 26-77 years) evaluated for suspected residual breast cancer after excision biopsy. All patients received a 740-1000 MBq bolus IV injection of Tc-99m-methoxy isobutyl isonitrile (MIBI) preferably in pedal vein. At 5-10 min after injection, planar images were obtained in prone lateral and supine anterior positions using dual head gamma camera. MIBI uptake was scored as follows: 1 - as normal uptake (compared with contralateral side), 2 - focal low-intense uptake (equivocal), and 3 - focal high-intense uptake (positive). All patients had histopathology for tissue diagnosis. RESULTS: Of the 21 patients evaluated, scintimammography planar was found true positive in 13 and true negative in six. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92.85, 85.71, 92.85, 85.71, and 90.47%, respectively (P<0.001). Scintimammography detected 2/2 multifocal disease. CONCLUSION: In patients after excision biopsy, scintimammography with Tc-99m-MIBI is valuable in assessing residual or multifocal disease. Scintimammography has high positive predictive value and may influence planning further management.

Chest wall recurrence of breast cancer demonstrated on 99mTc-MIBI scintimammography.

BACKGROUND: The mastectomy site is usually assessed by clinical examination and ultrasonography for recurrence of breast cancer, although post-surgical and radiotherapy changes limit the accuracy of these methods. MRI has been used successfully but it remains an expensive modality and may not be readily available. Scintimammography is an alternative method which has the advantage of not being affected by post-operative morphological changes. AIM: To evaluate the usefulness of planar Tc-MIBI scintimammography and supine Tc-MIBI SPECT in the detection of chest wall recurrence post-mastectomy. METHODS: The study population comprised of 26 patients (mean age, 47.15 years; median age 47 years; age range, 22-77 years) with suspected chest wall recurrence of breast cancer on clinical examination. All patients received a 740-1000 MBq bolus i.v. injection of Tc-MIBI preferably in the pedal vein. At 5-10 min post-injection planar images were obtained in the prone lateral and supine anterior positions using a double-head gamma camera. After planar imaging supine SPECT was performed (64 projections, 64x64 matrix, 30 s.frame). MIBI uptake was scored as follows: 1 = normal uptake (compared with contralateral side); 2 = focal low uptake (equivocal); and 3 = focal high uptake (positive). All patients underwent excision biopsy or FNAC for tissue diagnosis. FNAC was considered sufficient if unequivocally positive. RESULTS: For the 26 patients, planar scintimammography was found true positive in 14 and true negative in seven. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78%, 87.5%, 93%, 64% and 81%, respectively (P<0.001). SPECT showed a significantly higher overall sensitivity than planar imaging (89% vs. 78%; P<0.001). SPECT and planar imaging showed the same specificity (87.5%). SPECT showed a significantly higher negative predictive value and accuracy than planar imaging (78% vs. 64% and 88% vs. 81%, respectively; P<0.05). CONCLUSION: Scintimammography is a reliable diagnostic tool and appears accurate in the detection of chest wall recurrence. SPECT shows high positive predictive value and aids in the diagnosis of the chest wall recurrence with greater confidence.

Significance of prostate specific antigen in prostate cancer patients and in non cancerous prostatic disease patients.

OBJECTIVE: To evaluate the significance of prostate specific antigent (PSA) and scan in prostate cancer patients and in non cancerous prostatic disease patients. METHODS: The study was carried out in Radioimmunoassay (RIA) lab, KIRAN Hospital, Karachi during 2002 to 2006. A total of 149 serum samples were collected in which 93 samples were biopsy positive prostate cancer patients referred to KIRAN hospital for treatment. The other 56 samples were collected from patients having other prostatic diseases and advised PSA tests by physicians and urologists from 'The Lab' Karachi. The PSA (total) was measured by immunoradiometric assay (IRMA) in which two monoclonal antibodies against two different epitopes of PSA molecules were used. The results were correlated with bone scan and age of the patients. RESULTS: A total of 149 patient samples were analyzed in which 93 were from biopsy positive prostate cancer patients and 56 from patients having other prostatic diseases. Out of 93 prostate cancer patients sample, 74 (79.6%) had elevated PSA level (>4 ng/ml) and 19 (20.4%) had PSA within normal range (<4 ng/ml). Among 74 elevated PSA level cases, 48 (64.8%) had a positive bone scan and 26 (35.2%) had negative bone scan. Minimum age recorded was 40 years (Mean age 66.4 +/- 9.1 years). In fifty six (56) serum samples which were collected from 'The Lab' and having other prostatic diseases, 49 (87.5%) had PSA within normal range (< or =4 ng/ml). CONCLUSION: Prostate specific antigen has a significant role for the diagnosis of prostate cancer (and has a significant correlation with bone scan). Immunoradiometric assay has a sensitivity of 79.5% and specificity of 87.5% for prostate cancer.

Role of 99mTc-MIBI scintimammography and X-ray mammography in the diagnosis of locoregional recurrence of breast cancer.

OBJECTIVE: To evaluate the utility of Tc- MIBI scintimammography in the loco-regional recurrence of breast cancer and its comparison with mammography. METHODS: The study population comprised of 33 subjects (mean age, 44.9 +/- 14.1 years); evaluated for suspected loco-regional recurrence of breast cancer on clinical examination. All subjects received a 740-1000 MBq bolus IV injection of 99mTc-MIBI preferably in pedal vein. At 5-10 min and 60-90 min post injection planar images were obtained in prone lateral and supine anterior position using double head gamma camera. MIBI uptake was scored as follows: 1: as normal uptake (compared with contralateral side); 2: focal low intense uptake (equivocal); 3: focal high intense uptake (positive). Mammography was performed by two standard views of cranio-caudal and mediolateral oblique in 26 patients. All patients had either excision biopsy or fine needle aspiration cytology (FNAC) for tissue diagnosis. RESULTS: Out of 33 patients, 21 had confirmed as recurrence on hiostopathology/cytology. Scintimammography was found true positive in 18 and true negative in 11 patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85.7%, 91.7%, 94.7%, 78.6% and 87.8% respectively. In comparison, mammography was true positive in 9 and true negative in 6 patients with sensitivity of 52.9%, specificity, 66.7%, PPV 75%, NPV 42.9% and accuracy 57.7%. CONCLUSION: Scintimammography has better diagnostic accuracy than mammography in the detection of loco-regional recurrence of breast cancer.

Assessment of viable myocardium by nitrate augmented 99mTc MIBI myocardial perfusion imaging.

OBJECTIVE: To determine the efficacy of 99mTcMIBI with nitrate administration for the detection of viable myocardium in patients with MI. METHODS: Thirty-five patients (31 men, 4 women; mean age 51.91 +/- 8.86 years, median = 50) with previous history of myocardial infarction (with mean duration of 11.50 +/- 11.4, median =4 months after MI) were included in the study. All patients underwent baseline rest and Nitroglycerine 99mTcMIBI myocardial perfusion imaging (2 day protocol). Fifteen out of 34 patients were also submitted for rest and redistribution TI-201 imaging (3 day protocol). The data were reconstructed in transaxial slices and then reoriented into short, vertical long and horizontal long axis slices. The images were divided into seven different segments for qualitative as well as semi quantitative analysis. The images were interpreted by two independent observers. The segments with tracer activity of more than 55% as compared to maximum, were considered as viable. RESULTS: In the baseline study with 99mTcMIBI, 168/245 (68.57%) were viable segments and these were increased to 197 (80.40%) in the Nitrate MIBI study (p = 0.001 vs. baseline). Total 21 (60%) out of 35 patients demonstrated viable myocardium. The concordance for viable segments detection between Nitroglycerine MIBI and redistribution TI-201 imaging was found in 100 out of 105 segments (95.24%) for 15 patients, with significant kappa = 0.746 +/- 0.079 SE. CONCLUSION: The data suggest that use of nitrate augmented 99mTcMIBI protocol in Cardiac SPECT imaging results in improved detection of viable but hypoperfused segments and achieves results similar to those from standard TI-201 rest and redistribution protocol.

A randomized clinical trial comparing 50mCi and 100mCi of iodine-131 for ablation of differentiated thyroid cancers.

OBJECTIVE: To compare the efficacy of low (50 mCi) and high dose (100 mCi) Iodine-131 in ablation of differentiated thyroid cancer remnants. METHODS: Baseline serum thyroglobulin (sTg), thyroglobulin antibody (Tg Ab) and diagnostic whole body iodine scan with 2 mCi of I-131 were performed in each individual. After 6 months serum Tg, Tg Ab (of-thyroxin) and WB iodine scan with 10 mCi of I-131 were done to assess the efficacy of the low and high dose of I-131. Iodine ablative therapy (IAT) was considered successful (complete ablation) if the I-131 whole body scan was negative and sTg level was undetectable. In case of positive scan and/or sTg level detectable the patient was considered as unsuccessfully/partially ablated. RESULTS: In group A, (high dose) successful IAT was seen in 12/20 (60%) patients. Of these 5/7 (71%) had follicular Carcinoma on histopathology and 7/13 (54%) had papillary Ca. In group B, (low dose) successful IAT was seen in 8/20 (40%) patients, out of which 3/10 (30%) had follicular Carcinoma on histopathology and had successful IAT. 5/10 (50%) patients with papillary Carcinoma had successful IAT. As far as histopathology is concerned, in group A, response to high dose I-131 was better in follicular type than papillary type. Whereas in group B, response to low dose I-131 was better in patients with papillary type than follicular. CONCLUSION: 100 mCi of radioactive Iodine-131 (I-131) is a more effective therapeutic dose than 50 mCi (I-131) in the treatment of differentiated thyroid cancer remnants. Furthermore, follicular Carcinoma respond better to 100 mCi I-131 than 50 mCi while papillary Carcinoma showed an almost equal response to both.

Serum leptin level in hypothyroid males.

OBJECTIVE: To determine the correlation of serum leptin with thyroid hormones in primary hypothyroid male patients and euthyroid lean and obese control subjects. DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Atomic Energy Medical Center, JPMC, Karachi, from 2001 to 2003. SUBJECTS AND METHODS: In this study, three male groups were included. Those were 21 newly-diagnosed, untreated hypothyroid male patients (BMI, 25.12+/-2.31), 24 age and BMI matched euthyroid lean male subjects (BMI, 24.01+/-1.97) and 27 euthyroid obese male subjects (BMI, 33.02+/-2.67). Patients were selected from the thyroid OPD of Atomic Energy Medical Centre, JPMC, Karachi, while healthy, age and BMI matched euthyroid (lean and obese) were selected from general population after checking their thyroid profile. Patients and control subjects suffering from diabetes or other endocrinal diseases and taking thyroxin or steroid were excluded from the study. Serum leptin was measured by ELISA and FT4, FT3 and TSH were measured by radioimmunoassay (RIA), triacylglycerol (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) by kit method, low density lipoprotein cholesterol (LDL-C) was calculated by the Friedwald s formula, and fasting blood sugar (FBS) by glucose oxidase method. RESULTS: The mean +/- SEM values of leptin in male hypothyroid patients were 10.71+/-2.5 ng/ml, 8.27+/-1.91 in control group and 21.34+/-3.4 ng/ml in obese group, respectively. No significant difference was found in serum leptin levels between hypothyroid patients and their age, BMI matched control group, while obese control group had significantly higher values of leptin (<0.05). There was no significant correlation of leptin found with T4, T3, and TSH in hypothyroid patients and lean and obese control subjects. Triacylglycerol (TG, p < 0.005), total cholesterol (TC, p < 0.005) and low density lipoprotein cholesterol (LDL-C, p < 0.05) were significantly higher in hypothyroid patients as compared to control groups. This study observed that serum leptin level was significantly correlated with the BMI (r = 0.732, p < 0.005, r = 0.783, p < 0.005, r = 0.653, p < 0.005), in normal lean, obese and hypothyroid male patients respectively. CONCLUSION: The results of this study suggest that there is no correlation between serum leptin and thyroid hormones in hypothyroid patients as well as in euthyroid subjects. Serum leptin is directly related with BMI.

Risk factors for breast cancer in Pakistani women aged less than 45 years.

BACKGROUND: There has been an increase in the incidence of breast cancer in previously low-risk Asian countries. It is important to identify the risk factors for Asian women, as little information currently exists for this population. AIM: The objective of the study was to determine risk factors for breast cancer among Pakistani women. SUBJECTS AND METHODS: 498 cases younger than 45 years were interviewed from 1 July 1997 to 31 December 1998 at two major cancer hospitals. Age-matched population-based controls were selected from two cities and two villages to represent urban and rural areas. For the variables under study, cases and controls were compared by t-test. Conditional multiple logistic regression models were applied to the data set. RESULTS: Women with BMI >or= 30, with a family history of breast cancer and who were parous were at increased risk. Among parous women risk factors included BMI >or= 30, being in a consanguineous marriage, later age at menarche, later age at first full-term pregnancy, high parity and a history of abortion. CONCLUSION: The risk factors identified for Pakistani women below 45 years were similar to those observed in other studies. However, obesity in pre-menopausal women and late menarche were not protective and consanguinity was identified as a risk.