Treatment of Sinonasal Teratocarcinosarcoma: A Systematic Review and Survival Analysis.

BACKGROUND: Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy of the anterior skull base with only 127 cases described in the English literature. Given the rarity of this tumor, new cases and analysis of published reports may assist in future management of SNTCS. OBJECTIVES: 1) Describe findings from a systematic review of all available literature for malignant SNTCS including the clinical presentation, treatment modalities and outcomes. 2) Present two new cases of this rare anterior skull base tumor. 3) Compare treatment outcomes with respect to recurrence and mortality. METHODS: A systematic review of all English literature available in 2 comprehensive databases was conducted by two independent reviewers using PRISMA guidelines. 85 publications were identified. Each case was reviewed for demographics, treatment and survival, and aggregate treatment outcomes were compared using Kaplan-Meier analysis. RESULTS: A total of 64 articles meeting inclusion criteria were reported in the literature between 1977-2018. This represented a total of 127 patients, with a strong male predominance (83%) and mean age of 50 years (range 10-82). Mean follow-up was 21 months. Recurrence rate was 38%, with mean survival at 2 years of 55%. Almost all patients underwent surgery as a primary treatment modality (90%). The majority of cases were treated with multimodal therapy, with 55% receiving surgery and radiation and 20% receiving surgery with adjuvant chemoradiation. Kaplan-Meier analysis demonstrated a significant survival advantage for patients treated with combined therapy compared to surgery alone (p < 0.001) but did not show differences in recurrence (p = 0.085). CONCLUSION: Two-year survival rates for SNTCS are 55%. Multimodality treatment outcomes appear to be superior to surgery alone based on the published data of this rare skull base tumor, although heterogeneity of treatment methods and reporting bias limits the generalizability of these findings.

First report of Chikungunya fever in Rawalpindi, Pakistan.

BACKGROUND: Chikungunya shares many clinical features with dengue fever, but to date, no case has been reported in Rawalpindi and surrounding areas. AIMS: To detect the presence in Rawalpindi of chikungunya masquerading as dengue fever. METHODS: An observational study was conducted at Rawalpindi Medical University from July to December 2017. Patients with clinical features suggestive of dengue fever, but negative for dengue virus NS1 antigen were included and tested at the National Institute of Health Islamabad, Pakistan, for chikungunya using reverse transcription polymerase chain reaction. RESULTS: We tested 129 patients and 28 were positive for chikungunya. There were 17 (60.7%) men and 11 (39.3%) women, with a mean age of 32.53 years (range 16-60 years). All had fever at presentation. Other clinical features at presentation were noted, such as fever, chills, fatigue, headache, myalgia, arthralgia, retro-orbital pain, abdominal pain, nausea, and diarrhoea. No long-term sequelae or bleeding diatheses were seen and there was no mortality reported. CONCLUSIONS: The clinical features observed and investigated confirmed our reporting of the first case of chikungunya in Rawalpindi, Pakistan.

The medicinal plants in the control of tuberculosis: Laboratory study on medicinal plants from the Northern Area of Pakistan.

BACKGROUND: Tuberculosis (TB) ranks as the second leading cause of deaths due to infectious diseases. Although global efforts have been made to control TB, still, this is a serious threat as Mycobacterium tuberculosis (MTB) produced resistance against both the first- and second-line drugs. The increasing incidence of multidrug-resistant, extremely drug resistant, and totally drug-resistant TB worldwide requires extra efforts to search for new anti-TB drugs. MATERIALS AND METHODS: The present study evaluated the antimycobacterial activities of Citrullus colocynthis, Calotropis procera, Ricinus communis, Capparis decidua, and Fagonia cretica plants' extracts against rifampicin-sensitive (H37Rv) and rifampicin-resistant (TMC331) strains of MTB. RESULTS: Out of 44 extracts, 19 extracts were found active against H37Rv sensitive strain. Highest activities were observed in chloroform extract of C. colocynthis (leaves) and n-hexane extract of R. communis (seeds) with minimum inhibitory concentration values of 2.5 mg/ml each. CONCLUSIONS: Results show antimycobacterial potential in some of the fractions of studied plants that may be utilized further for isolation of active compounds and as a possible cure against TB.

What should be the antibiotic prescription protocol for burn patients admitted in the department of burns, plastic and reconstructive surgery.

This is a prospective study with the aim to determine specific patterns of burn wound bacterial colonisation and antimicrobial resistance profiles. There is a high incidence of infections and septicaemia in post-burn patients, which, in turn, are associated with high morbidity and mortality, a fact that compelled us to undertake this study. The study was conducted over a period 11 months, from 1 August 2014 to 30 June 2015, in 50 burn patients admitted in our burn unit. Wound cultures were taken after 72 hours of admission from all the patients, and then, empirical systemic antibiotics were administered. For wound cultures; 1 cubic cm tissue was taken and placed in aerobic and anaerobic culture vials and transported to the microbiology lab under all aseptic precautions as soon as possible. At the time of fever any time after 72 hours of admission, 16 ml of blood was drawn under all aseptic precautions. Both aerobic and anaerobic blood culture vials were filled with 8 ml of blood each and transported to the microbiology lab. The results of culture and sensitivity reports of 50 patients were recorded. The data obtained was analysed using appropriate statistical analytical tests. The most common organism responsible for bacteraemia is Pseudomonas (43%). Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital; Pseudomonas was found 100% resistant to a combination of ampicillin + sulbactum, ceftriaxone and was most often sensitive to imipenem, amikacin and vancomycin. Methicillin-resistant Staphylococcus aureus (MRSA) was also found resistant to commonly used antibiotics like ceftriaxone, ampicillin + sulbactum and ceftazidime + calvulanic acid. Linzolid and vancomycin were effective in 83% and 100% cases, respectively. We conclude that similar institution-specific studies should be conducted, and such studies will be helpful in providing useful guidelines for choosing effective empirical therapy that will have a great impact on the prevention of infection and its complications in burn patients because of bacteraemia.

Diagnosis, Management And Prevention Of Hepatitis C In Pakistan 2017.

AIMS AND OBJECTIVES: Since the advent of direct acting antiviral agents, there is a revolutionary change in the management of HCV infection. Newer drugs with different mechanism of action are being introduced and are expected to be available in coming few months in Pakistan as well. The main purpose of the guideline is to review and induct the latest research in field of HCV infection in Pakistani perspective so that our healthcare professionals can apply the new recommendations in timely and judicial manner. Target groups of guidelines are general physicians treating hepatitis C, hepatologists and gastroenterologists. Other beneficiaries of these guidelines are public health institutions of Pakistan, which provide free treatment to deserving patients under National Hepatitis Prevention and Control Program and Pakistan Bait-ul- Mal Program. METHODOLOGY: These guidelines are based on the review of National consensus practice guidelines: Diagnosis, Management and Prevention of Hepatitis C Pakistan 2009. Published data in National and International Journals searched with the help of Google search and pub med, and 2015-16 guidelines of HCV by AASLD, EASL, APASL and WHO. Local studies are preferably added with references to enhance the Pakistani perspective. Evidence was also taken from published studies. Recommendations have been based upon evidence from national publications on the subject and scientific presentations at national liver meeting as well from experts' personal experience and opinion.

Estrogen receptor, progesterone receptor, and Her 2 Neu positivity and its association with tumour characteristics and menopausal status in a breast cancer cohort from northern Pakistan.

OBJECTIVES: To measure the frequency of estrogen receptor (ER), progesterone receptor (PR), and Her 2 Neu positivity and to study their association with tumour characteristics and menopausal status in a breast cancer cohort from Northern Pakistan. METHODOLOGY: Patients attending NORI with histopathologically proven diagnosis of invasive ductal carcinoma of the breast were included after providing informed consent. Age, menopausal status, and tumour size were recorded. The presence or absence of nodal involvement (including site and number), distant metastases, sites of metastases, skin involvement, chest wall involvement, recurrent disease, and bilateral breast cancer were noted along with ER, PR, and Her 2 Neu status. Mean ± standard deviations were calculated for continuous variables like age. Frequency and percentage were calculated for categorical variables like ER, PR, and Her 2 Neu status. Association of ER, PR, and Her 2 Neu status with menopausal status and tumour-related characteristics were sought employing t test, x(2 )square test, and ANOVA wherever appropriate. P value >0.05 was considered significant. RESULTS: There were 1226 patients included in the study. Mean patient age was 48.04 ± 11.97 years, and 743 (60.6%) patients were premenopausal. ER, PR, and Her 2 Neu were found positive in 763 (62.2%), 738 (60.1%), and 478 (38.9%) patients, respectively. Significant association (P < 0.05) was found between ER, PR positivity, and Her 2 Neu over expression with menopausal status, tumour size, involvement of skin, chest wall and lymph nodes and the presence of distant metastases. However, no significant association was detected between ER, PR, Her 2 Neu and recurrent disease. CONCLUSIONS: The frequency of expression of hormonal receptors in breast cancer patients from Northern Pakistan is the same as reported in the literature although overexpression of Her 2 Neu is a little higher in our population. There is an inverse relationship between hormonal receptors expression and Her 2 Neu expression. Postmenopausal women have a higher incidence of ER and PR positivity and Her 2 Neu negativity. ER and PR negativity and Her 2 Neu positivity are associated with more advanced disease and poor outcome.

Toxic effects of multiple anticancer drugs on skin.

In this study, cutaneous toxicities associated with the administration of chemotherapy in combination are discussed. Rapidly growing cells are the targets of chemotherapy, so the skin, hair follicles, and nail matrix are frequently affected by chemotherapy. Chemotherapy skin reactions are more likely toxic than allergic reactions. There are numerous chemotherapy-induced cutaneous reactions that have been described in the literature. In addition to a variety of miscellaneous reactions, 19 major cutaneous reactions were discussed in current study. This study was designed to evaluate the clinical spectrum of all cutaneous toxicities over two years in hospitalized and ambulatory patients in the Department of Pediatric oncology and to establish probable relationship between the reaction and suspected anticancer protocol with the help of WHO (World Health Organization) Common Toxicity Criteria by Grade. The data on the cutaneous toxicities were analyzed by percentile and ranking method. The minimal (0.8%) cutaneous adverse effects monitored during the study were Petechiae, photosensitivity, pruritus, urticaria, wound-infection, erythema multiforme, hand-foot skin reaction, injection site reaction, dry skin. Alopecia was the single most common (64.3%) adverse effect observed during the study, where as the pigmentary changes were the second most common (18.2%) adverse effect monitored. While these side effects are generally not life threatening, they can be a source of significant distress to patients, especially alopecia.