Role of Volumetric Modulated Arc Technique Radiotherapy in a Rare Case of Intraductal Apocrine Carcinoma of Parotid Gland.

Introduction Apocrine carcinoma, a cancer of sweat glands, is very rare, with a global incidence of 0.0049 to 0.0173 cases per 100,000 persons annually. It is usually found in axilla and anogenital areas. The intraductal apocrine variety of salivary duct carcinoma in the parotid gland is very rare and aggressive and may be due to ectopic sweat glands in the parotid gland duct or metaplastic change of the salivary duct epithelium. It usually presents in an advanced stage. Even though surgery is the standard of care in most head and neck cancers, there are no standard guidelines for the treatment of intraductal apocrine parotid carcinoma, which is different from other head and neck cancers due to its rare incidence, aggressive behavior, and poor prognosis. Case presentation We present a rare case of intraductal apocrine salivary duct carcinoma of the left parotid gland, presented in a locally advanced stage with very high chances of recurrence after surgery, and discuss the role of volumetric modulated arc technique radiotherapy in its management. Conclusion Intraductal apocrine salivary duct carcinoma usually has androgen receptor expression, and lack of expression is associated poor prognosis. Even with complete resection, it has a high recurrence rate. Volumetric modulated arc technique radiotherapy (VMAT) decreases recurrence and increases survival by irradiating the areas more likely of recurrence, with minimal toxicity to surrounding normal tissues.

In vitro strategies for the enhancement of secondary metabolite production in plants: a review.

BACKGROUND: Plants are the prime source of vital secondary metabolites (SMs) which are medicinally important for drug development, and these secondary metabolites are often used by plants in the various important tasks like defense against herbivory, interspecies defenses and against different types of stresses. For humans, these secondary metabolites are important as medicines, pigments, flavorings and drugs. Because most of the pharmaceutical industries are highly dependent on medicinal plants and their extraction, these medicinal plants are getting endangered. MAIN BODY: Plant cell culture technologies are introduced as a viable mechanism for producing and studying SMs of plants. Various types of in vitro strategies (elicitation, hairy root culture system, suspension culture system, etc.) have been considerably used for the improvement of the production of SMs of plants. For the enhancement of SM production, suspension culture and elicitation are mainly used, but hairy root culture and other organ cultures are proved to satisfy the demand of secondary metabolites. Now, it is easy to control and manipulate the pathways that produce the plant secondary metabolites. CONCLUSIONS: Techniques like plant cell, tissue and organ cultures provide a valuable method for the production of medicinally significant SMs. In recent years, most of the in vitro strategies are used due to knowledge and regulation of SM pathway in commercially valuable plants. In future, these things will provide a valuable method to sustain the feasibility of medicinal plants as the renewable sources of medicinally important compounds, and these methods will provide successful production of desired, important, valuable and also unknown compounds.

Environmental determinants and PCOS symptoms severity: a cross-sectional study.

Polycystic Ovary Syndrome is a complicated female disorder worldwide. Researchers conducted a quantitative study to examine multiple environmental determinants contributing to its symptoms severity. Data of 150 PCOS diagnosed women (16 to 45 years) was gathered from private clinics and hospitals of Lahore, Pakistan. Chi-square, spearman's correlation, and linear regression tests were run. Chicken, fast food and spicy food intake were found to be the significant predictors of PCOS severity (F (1, 148) = 6.903, p = 0.01), (F (1, 148) = 11.400, p = 0.001), and (F (1, 148) = 4.525, p = 0.035) respectively. We also found significant relationships of sedentary lifestyle (p = .034) & BMI (p = 0.025) with PCOS symptoms severity. However, relationship of socioeconomic status (SES) was non-significant with the disease severity. These determinants will direct healthcare professionals in proper management and counseling of PCOS women thus improving their life quality.

Illicit sale of controlled drugs at community pharmacy/medical stores of Punjab, Pakistan: A road to demolition of public health.

Sale of controlled drugs without prescription is a burning issue in developing countries like Pakistan. Illicit sale practices lead towards drug abuse and misuse among youngsters and negatively impact the health of youth and economy of any country. Present study aims to highlight the illicit sale practices at community pharmacies/drug stores of Punjab, Pakistan. Study was conducted at community pharmacies/drug stores (n = 200) of Punjab, Pakistan. Sales men at pharmacies/drugs stores were interviewed and then their statements were cross verified by sending fake customers at their community pharmacies to check the extent of illicit sale practices by them. Gathered data was analyzed using SPPS-22. Out of 200 pharmacies, pharmacists were physically present at 5% of pharmacies (n = 200), rest of the 95% pharmacies (n = 190) were being run by non-qualified persons and were found to be engaged in illicit sale practices. Controlled drugs were being provided to customers without prescription, which is a dilemma and need to be addressed for effective policy making. Physical presence of pharmacists at community pharmacies/drug stores is necessary to overcome the illicit sale practices. Effective policy must be developed and implemented by Governmental Authorities to prevent the youth from hazards associated with drug abuse and misuse.

Quantifying satisfaction among pharmacists working in Pharmaceutical Sales or Marketing and its inferential relationship with demographics: A Cross-Sectional analysis in Pakistan.

OBJECTIVES: To quantify satisfaction among pharmacists working in pharmaceutical sales or marketing in Pakistan. METHODS: A cross-sectional study was conducted among pharmacists working in pharmaceutical sales and marketing during August to November, 2019. Satisfaction score of pharmacists was considered satisfied (Score > 2.5) and dissatisfied (Score < 2.5). The maximum and minimum satisfaction score was four and one for each question respectively. RESULTS: A total of 250 questionnaires were distributed and 200 were received back yielding a response rate of 80%. Male respondents dominated the cohort and were more satisfied (2.60 ± 0.47) as compared to females (2.31 ± 0.48) with majority were 18-30 years old and 78% had Pharm. D level of education (2.61 ± 0.47). The mean satisfaction score of participant is 2.51 with standard deviation of 0.49. The 53% of the respondents were dissatisfied with their salaries. The study dependent and independent variables are correlated with each other and significant results were seen between them. The factors associated with dissatisfaction are fear of losing job (2.19 ± 0.88), switch job (2.20 ± 0.77) and health condition (2.09 ± 0.89). Factors associated with satisfaction are positive attitude of doctor (2.91 ± 0.60), doctor consider respectful job holder (2.91 ± 0.61), enjoy work (3.01 ± 0.65), job by choice (3.12 ± 0.67) and progress in job (3.00 ± 0.74). CONCLUSIONS: It was concluded that the respondents were dissatisfied due to number of issues including disturbance in their personal life, lack of promotion and incentives among study participants.

Understanding COVID-19: From Origin to Potential Therapeutics.

Currently, a global pandemic era of public health concerns is going on with the Coronavirus Disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first case of COVID-19 was reported from Wuhan's Huanan seafood market in China late December 2019. Bats, pangolins, and snakes have been nominated as salient carriers of the virus. Thanks to its high pathogenicity, it can cause severe respiratory infections. Fever, dry cough, sore throat, pneumonia, septic shock, and ground-glass opacities are the foremost clinical manifestations of COVID-19. Immunocompromised patients are at high risk for COVID-19 infection and may lead to death. Scientist and government agencies around the globe are putting forward their best efforts and resources for the effective treatment of human coronavirus infections; however, neither vaccines nor antiviral drugs are available for the treatment of human coronaviruses (HCoV) infections such as SARS (severe acute respiratory syndrome), MERS (Middle Eastern respiratory syndrome), and COVID-19. Since the outbreak, a plethora of research and review articles have been published. Moreover, the mass media has bombarded the public with conflicting opinions about the pandemic. There is a dire need for accurate and reliable information concerning this pandemic. In this review, we have compiled the up to date information about the origins, evolution, epidemiology, and pathogenesis of this disease. Moreover, very few reports have addressed the clinical features and current status of treatment for COVID-19; we have adequately addressed these topics in detail in this review. Finally, a detailed account of clinical trials of vaccines and other therapeutics currently in progress has been delineated.

Blend of guar gum and Eudragit shows excellent drug release retarding behavior in sustained release tablets.

The objective of the current study was to compare sustained release behavior of natural and synthetic polymers in matrix tablets of lisinopril and hydrochlorothiazide combination. Guar gum was used as a hydrophilic natural polymer while Eudragit L 100-55 was used as synthetic polymer. Tablets were formulated by direct compression method using different ratios and combinations of both polymers. Various physical tests were performed. After that, in vitro drug release patterns were investigated by performing dissolution in pH 6.8 phosphate buffer. Results indicated that tablets with combination of both guar gum and Eudragit L 100-55 (formulation F10) were having the best drug release retarding behavior. All formulations followed zero order kinetics indicating the drug release was independent of the concentration. Higuchi model revealed drug release by diffusion mechanism while Korsmeyer Peppas model suggested that formulations followed the non-fickian release behavior.

Case of metastatic small cell carcinoma of the oropharynx successfully treated with image-guided volumetric modulated arc therapy (IG-VMAT): pushing the limits of technology to match treatment intent.

Extrapulmonary small cell carcinomas (EPSCC) are a rare subtype of neuroendocrine tumours which have been documented to arise from a multitude of sites and treatment outcomes are disappointing. The most common site involved in the head and neck region is the larynx and the oropharynx as a primary site has been infrequently reported. The patient presented with bilateral neck swelling and an ulcerated lesion was noted in the base of tongue (BOT). A biopsy revealed small cell carcinoma (SCC) and was confirmed with immunohistochemistry. The final diagnosis after workup was SCC of BOT stage IVc. He received induction chemotherapy to which the tumour responded partially, followed by curative intent chemoradiotherapy and adjuvant chemotherapy. The patient achieved a radiological complete response to treatment and almost all treatment-induced toxicities resolved. An aggressive approach to managing EPSCC is possible with modern radiotherapy techniques, with tolerable treatment-induced toxicities.

Early Clinical Outcomes, Patterns of Failure, and Acute Haematologic Toxicity of Image-Guided Volumetric Modulated Arc Therapy (IG-VMAT) in the Definitive Treatment of Locally Advanced Carcinoma Cervix.

PURPOSE: To evaluate clinical outcomes and failure patterns in patients with locally advanced cervical cancer (LACC) treated definitively using image-guided volumetric-modulated arc therapy (IG-VMAT). METHODS AND MATERIALS: This retrospective review included 18 consecutively treated patients with LACC. Treatment consisted of IG-VMAT and concurrent chemotherapy followed by intracavitary radiotherapy. The primary end points were overall survival (OS) and disease-free survival (DFS). Acute haematologic toxicity was evaluated using Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: A total of 16 patients were either stage IIB or IIIB and the median follow-up was 30.5 months (interquartile range: 13-36.25 months). The 2-year DFS was 63.3% (95% confidence interval [CI]: 52.8%-72.4%) and 2-year OS was 72.2% (95% CI: 62.1%-80.5%). There were 7 treatment failures, predominantly in-field. Acute haematologic toxicity was low. CONCLUSIONS: IG-VMAT is associated with favourable outcomes for patients with LACC.

Parachute-Like Mitral Valve Tuberculoma: A Rare Presentation.

There have been anecdotal reports of tuberculous cardiac involvement, mainly in cases of military tuberculosis or immune deficient individuals. The spectrum of clinical presentations of tuberculous cardiac involvements includes incidental detection of single and multiple well-circumscribed tuberculomas, symptomatic obstructive lesions, AV conduction abnormalities, and even sudden death. We present a case of cardiac tuberculoma in an immune-competent person who presented with worsening dyspnea. The unique morphology of this mass posed an imaging challenge that required 4-dimensional (4D) echocardiography and cardiac magnetic resonance (CMR) detail to differentiate the mass from an anterior mitral leaflet (AML) aneurysm. Histological examination after surgical resection confirmed its tuberculous etiology.

Primitive neuroectodermal tumour of the cervix: a rare diagnosis.

A 48-year-old woman presented with symptoms of lower abdominal pain and vaginal discharge for 6 months. Clinical examination and pelvic ultrasound scan suggested a diagnosis of infected Gartner's cyst, for which she underwent vaginal cystectomy. However, histopathology and immunohistochemistry revealed a diagnosis of primitive neuroectodermal tumour of the cervix. Further investigations revealed the stage to be FIGO IIIB, which was inoperable. She received neoadjuvant chemotherapy (vincristine, adriamycin, cyclophosphamide alternating with ifosfamide, cisplatin and etoposide, every 21 days), but the tumour did not respond to treatment and she was started on radiotherapy with definitive intent (55.8 Gray in 31 fractions over 6.2 weeks). A PET-CT performed 2 months after completion of radiotherapy showed complete response, and she is now receiving adjuvant chemotherapy.

Understanding and responsiveness level about cervical cancer and its avoidance among young women of Pakistan.

Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. There are few to no initial symptoms and signs. This study was conducted to assess the awareness level of young Pakistani women about cervical cancer and to educate them about this deadly disease. A detailed questionnaire regarding demographic data and information about cervical cancer was distributed in different cities of Punjab. A total of 873 women took part in this survey and 70.1 percent were totally unaware of this cancer. Only 8.5% of the whole surveyed population knew accurately about cancer of cervix, 7% of the surveyed respondents correctly specified the human papilloma virus as the causative agent. Only 5.2% respondents were able to identify the Pap smear test as a diagnostic measure. Out of all the surveyed population only 4.3% of individuals were found to be vaccinated against this disease and the majority was found from the medical profession. Medical professionals, students, working women, housewives and uneducated individuals took active part in this survey. This study demonstrates a low level of awareness among Pakistani women and a need for an active campaign by media and government to increase understanding as well as introducing measures for improved prevention and treatment of cervical cancer.