Global uses of traditional herbs for hepatic diseases and other pharmacological actions: A comprehensive review.

Hepatocellular carcinoma (HCC) is the 7th most common cancer and the 3rd leading cause of cancer-related death worldwide. It is resistant to the majority of chemotherapeutics and has a dismal prognosis. Hepatocellular carcinoma is a prevalent complication of chronic liver disease (CLD) in India. Primary liver cancer is the 6th most common cancer worldwide and the 4th most prevalent cause of cancer-related death. In 2018, it affected 841,000 people and caused 782,000 deaths around the world. Thus, research into the tumor cycle and its prevention through suitable herbal (Unani/Ayurvedic) medication is critical for reducing the impact of primary liver cancer. Treatment options for end-stage liver cancer are limited, necessitating costly liver transplantation, which is unavailable in most countries. Here, we present the results of a comprehensive literature survey to determine the benefits of using various herbs with liver protective and antioxidant properties. This information will be useful to researchers working on liver carcinoma and free radical scavenging, both of which are important in curbing potential carcinogens.

Her-2/neu gene overexpression in breast carcinoma and its association with clinicopathological characteristics of the disease.

OBJECTIVE: To assess the frequency of Her-2/neu gene amplification in breast cancer and its association with clinicopathologic characteristics of the disease. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Study was carried out at Surgical Unit I, Holy Family Hospital, Rawalpindi, from January 2005 to December 2006. METHODOLOGY: A total of 50 patients diagnosed of having breast cancer on biopsy of breast lump were included in the study. All patients underwent mastectomy and samples were submitted to AFIP (Armed Forces Institute of Pathology, Rawalpindi) for histopathology and determination of estrogen and progesterone receptors and Her-2/neu gene amplification. Moreover, association of Her-2/neu amplification to other characteristics like tumour size, node involvement, histological grade and presence of estrogen and progesterone receptors were also studied. RESULTS: Out of 50 patients, 18 (36%) were positive for Her-2/neu overexpression. Among the various prognostic factors, age showed a statistically significant relation to Her-2/neu positivity (p=0.001). The Her-2/neu positive cancers were larger in size (mean size of 7.9 +/- 3.615 and 5.4 +/- 1.906 cm in Her-2/neu positive and negative cases respectively; p=0.002). Her-2/neu positive cases had statistically significant relation to number of involved lymph nodes (mean number of 9.9 and 4.4 lymph nodes in Her-2/neu positive and negative cases respectively; p=0.001). Tumour grade and nuclear grade had no statistically significant relation to Her-2/neu status (p=0.19 and 0.434 respectively). Both estrogen and progesterone receptors are inversely related to Her-2/neu positivity (p=0.028 and 0.006 respectively). CONCLUSION: The pathological and clinical characteristics of Her-2/neu positive and negative subsets differ, and Her-2/neu overexpression was associated with other poor prognostic factors of age, tumour size and number of nodes involved. There was an inverse relation of Her-2/neu status and hormone receptor.

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.

Risk of development of chronic kidney disease in patients with type 2 diabetes having metabolic syndrome.

OBJECTIVE: To measure the relation of creatinine clearance in type-2 diabetic patients with different components of metabolic syndrome and to quantify the relationship of frequency of incident CKD with increasing number of metabolic syndrome components while controlling for age, gender and duration of diabetes. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Diabetes Clinic, Fauji Foundation Hospital, Rawalpindi, from January to August 2006. METHODOLOGY: Patients having type-2 Diabetes for more than 5 years were enrolled. Information regarding age, gender, duration of diabetes , type of diabetes, treatment taking, complete fasting lipid profile, fasting blood glucose, Body Mass Index (BMI), 24 hours urinary proteins and creatinine clearance, co-existent risk factors like hypertension and ischemic heart disease was taken. Patients were divided into groups having one to all five metabolic syndrome traits. Progressive increase in the metabolic syndrome traits was compared with decline in creatinine clearance. Pearson correlation test and multiple logistic regression were applied to determine correlation with significance at 'r' and 'p' < 0.05. RESULTS: Out of 104 evaluated female and male patients, 70% had hypertension, ischemic heart disease and a family history of diabetes. While 20% had normal creatinine clearance, 37% had a creatinine clearance between 60-90 ml/min, 19% had a creatinine clearance of 30-59 ml/min, 18% had a creatinine clearance of less than 30 ml/min and 10% were already in stage 5 CKD. The decline in renal function was more severe in subjects evaluated who had a higher number of features of the metabolic syndrome. Age was the only significant determinant of development of CKD (p=0.05). CONCLUSION: The renal function progressively declined with 3 or more features of the metabolic syndrome.

Malignant hypertension in a patient with end of stage renal disease (ESRD) treated by renal transplant.

Control of hypertension is often a problem in the management of end stage renal disease (ESRD). Multiple modalities of treatment are required to prevent cardiovascular and cerebrovascular mortality and morbidity. These include fluid and salt restriction, multidrug regimes and dialysis. We report a case of young 25 years old patient, admitted with chronic renal failure, complicated by malignant and refractory hypertension, not responding to hemodialysis and antihypertensive agent. During stay in hospital, patient also had intracerebral hemorrhage, fits due to uncontrolled hypertension requiring ventilatory support followed. Renal transplant was considered to be the final therapeutic modality. After gradual recovery, a successful live-related renal transplant was performed. As soon as good graft was established, the blood pressure settled and 4 of the 5 antihypertensives were withdrawn. After 2 weeks, patient was discharged in a stable condition with a total stay of about 2 months.

Renal transplant in a patient with augmentation cystoplasty.

A 20 years old girl, had undergone surgery for meningocele six weeks after birth, suffered from neurogenic bladder dysfunction. She underwent an augmentation ileocystoplasty and was trained to perform clean intermittent self catheterization (CISC). After two years she developed renal failure secondary to recurrent urinary tract infections and she was started on chronic hemodialysis. On account of repeated line sepsis, a live related donor renal transplant was performed. About three months after renal transplantation she reported in emergency with an episode of graft rejection secondary to severe infection and later on complicated by leakage of urine from the renal pelvis of the allograft into the peritoneal cavity suggestive of a rent. A percutaneous nephrostomy of the allograft was performed which facilitated healing of the rent in the renal pelvis. The nephrostomy was withdrawn and patient started voiding through urethral catheter and gradually returned to CISC.