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Oat (Avena sativa L.) has rich phenolic contents with nutritional and therapeutic health benefits. The objective of the present work was to perform a cell cytotoxicity assay of three South Asian oat cultivars to determine their suppressive effect on intracellular reactive oxygen species (ROS). Oat cultivars were firstly examined for total phenolic content, 1,1-diphenyl-2-picrylhydrazyl (DPPH) scavenging activity, and phenolic acid profiling through HPLC. Total phenolic contents of oat cultivars ranged from 167.57 to 198.41 mg GAE/100 g, and DPPH scavenging activity was IC50 = 18.81 to 13.18 mg/mL. Oat cultivars displayed average content of phenolic acids such as vanillic acid (0.33 µg/g), syringic acid (6.70 µg/g), caffeic acid (4.16 µg/g), ferulic acid (2.06 µg/g), p-coumaric acid (20.22 µg/g), with the highest being gallic acid (74.32 µg/g). Cell cytotoxicity assay of oat polyphenolic extracts revealed that 10 and 15 µg/mL concentrations had non-significant differences when compared with their respective control treatments. Oat extracts suppressed ROS in Caco-2-cells, with or without hydrogen peroxide stimulation from 65.20 - 86.13%, and 56.36 - 79.56% with 10 and 15 µg/mL concentrations, respectively. In conclusion, oat is a rich source of polyphenols which have strong antioxidant behaviour to suppress the ROS activity.

Objective: The aim of this study is to report the clinic-pathological profile of children with TBM and their treatment outcome. Methodology: A retrospective observational study was conducted in the Pediatrics Department over 6 months period. Medical records of children admitted with TBM from November 2017 to May 2018 were reviewed for data collection. Data regarding clinical presentation, laboratory investigations were recorded. Patients were treated with a standard ATT regimen, and their outcome was noted. The study was approved by hospital ethics committee. Data was entered in SPSS for statistical analysis. Results: Females were predominant 39 (55.7%) and age ranged from 4 months to 13 years in this study. Only 28 (42.0%) children were fully vaccinated and had BCG scar presence. Most TBM cases were of stage II 24 (42.8%) or stage III 29 (42.8%). The frequent symptoms were fever 61 (87.1%), rigidity/irritability 35 (50.0%), and seizures 26 (37.1%). WBCs count in CSF was found below 500 in 64 (91.4%) children. There were 55 (78.5%) children with lymphocytosis and 14 (20.0%) with polymorph nuclear cells. A CT scan was suggestive of TBM in 51 (72.8%) children. Only 21 (30.0%) cases had a complete recovery whereas 17 (24.2%) recovered with sequelae and 10 (14.2%) deaths were noted. Conclusion: TBM presents with a poor clinical and pathological state in the advanced stage of the disease, and the therapy outcome is also non-satisfactory with high mortality and sequelae posing constant challenges.

Numerous documented researches have been conducted to evaluate the potential of using different plants and herbs as traditional medicines. Bitter gourd (Momordica charantia) is an agricultural commodity belonging to the plant kingdom and family Cucurbitaceae. Besides having a higher content of calcium and iron, this plant also possesses considerable numbers of vitamins such as B1, B2, B3, and C. These are great sources of some biologically active compounds such as momordicin I, II, and cucurbitacin B. The salutary perceptions have been also emphasized as they are useful in protecting from cardiovascular conditions such as atherosclerosis thereby, regulating the blood cholesterol level in the body. Bitter gourd entire fruit, seeds, and leaves help lower the fat accumulation and also control the impaired antioxidant status. Though this plant could facilitate the balance effect of anti-HIV drugs, the contents of ration amino sugar variate by declined and inclined, observed in lungs, heart, liver, and spleen during diabetes.

The high Employee Turnover Intention (ETO) is a prevalent issue in the contemporary world of business, which is, directly and indirectly affecting organizations. The TC of Pakistan is the fastest-growing sector; however, if Talent Management (TM) is not properly managed, it results in Employee Turnover Intention and reduces Organizational Efficiency (OE). This study is carried out to examine the impact of talent on OE and examine the moderating role of ETO in the Telecommunication sector (TC) of Pakistan. The study is carried out using structured questionnaires as distributed amongst 125 employees of cellular service providers working in franchises, regional offices and business centers operated in Lahore- the second- largest hub of mobile users in Pakistan. Regression and MODGRAPH were used to check the effect of moderating variable, ETO. The findings of the study indicate that managing talent has a significant role in improving OE. In addition, ETO moderates the relationship between TM and OE in the TC of Pakistan.

Mammary Analogue Secretory Carcinoma (MASC) is a rare pathology of the salivary gland, most commonly involving the parotid gland. The objective of this study was to identify the characteristic features of MASC and its treatment outcomes. A retrospective review of 12 patients with histological diagnosis of MASC, who were managed between 2010 to 2019, was carried out at the Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore. Their mean age was 34 (±16) years. There were 9 (75%) male and 3 (25%) female patients. Painless slow growing swelling was the most common presenting symptom. All the patients had undergone surgical excision with or without neck dissection, followed by adjuvant treatment. Of these, six patients had T2 tumours, while four had cervical lymph node metastasis. The mean follow-up period was 23 (±21) months. Local recurrence was seen in one patient. MASC is considered a low-grade tumour with good prognosis which can be treated with curative intent of surgery followed by radiotherapy effectively. Keywords: Mammary analogue secretory carcinoma, Parotid gland, Salivary tumour.

Introduction Squamous cell carcinoma arising at the maxillary sinus is a rare neoplasm, characterized by an aggressive growth pattern and glooming prognosis. The proximity of the maxillary sinus with complex anatomical structures such as the eye, skull base, infratemporal fossa, pterygomaxillary fossa, nasal cavities, and ethmoid sinuses makes the surgical treatment of tumors infiltrating into these structures very challenging. The study's objective was to investigate the prognostic factors of survival and maxillary sinus SCC treatment outcomes. Methods We did a retrospective analysis of patients treated for maxillary sinus SCC at our institution between 2004 -2018. The study included all the patients with histologically proven maxillary sinus SCC treated with curative intent. The medical record of 43 patients was reviewed and utilized for the analysis. The Kaplan-Meier curve calculated five-year overall survival. Results A total of 43 patients were analyzed. At the presentation time, the mean age was 54.56 years (SD ± 11.65). Smoking (n=13, 30.2%) was the common risk factor. 36 (83.7%) patients presented with stage IV disease. Surgery was performed in 16 (37.2%) patients, whereas 27 (62.8%) patients received radiation and chemotherapy. Treatment failure was seen in 35 (81.4%) patients with locoregional recurrence in 30 (85.7%) patients and distant metastases in 5 (14.3%) patients. The five years overall survival in our study was 22%. Loco-regional recurrence and distant metastasis were the significant factors impacting survival (p=0.01). Conclusion Maxillary sinus SCC is rare cancer that is more common in males and usually presents at an advanced stage with a poor outcome. These tumors have a higher rate of treatment failure with a poor prognosis. Locoregional recurrence and distant metastasis adversely impact the overall survival.

The Coronavirus disease 2019 (COVID-19) pandemic has majorly contributed to massive and widespread mortality. Epidemiological data strongly indicates a sex-based disparity in COVID-19 clinical outcomes, with women having lower infection and hospitalisation rates, coupled with better prognosis and lesser mortality. This disparity may be explained by several mechanisms including differences in innate and adaptive immune responses, genetic factors, and an interplay between sex hormones and immune effectors, as well as gender-specific behaviour differences. These pathways, particularly the immunological divergence in response to viral infection, could potentially influence not only COVID-19 pathogenesis and disease course, but also the response to antiviral drugs and vaccines. Furthermore, factors that confer a protective advantage against COVID-19 may be exploited to develop therapeutic strategies to improve clinical outcomes in COVID-19.

Oral squamous cell carcinoma (OSCC) is the most prevalent subtype of head and neck cancers that has a disproportionately high incidence and mortality in developing countries in South-Central Asia, including Pakistan. The standard treatment for OSCC generally consists of surgery combined with radiotherapy or chemotherapy; however, the overall survival rates have not improved, and only ~50% of patients survive the disease. Therefore, identifying and validating new drug targets can provide new therapeutic options for improved treatment and better prognosis for OSCC patients. The present study aimed to develop an organoid model from patient-isolated primary tumour cells and determine their drug sensitivity profile coupled with mutational analysis. New combinations of targeted drugs with synergistic activity in oral cancer cells were identified through high-throughput screening followed by validation of their activity in oral cancer cells in 2D monolayer and 3D organoid cultures. Results indicate a synergistic activity of proteasome (PR-171) and survivin (YM155) inhibitors in all tested patient-derived tumour cells and four oral cancer cell lines. Moreover, chitosan-based nanocapsules harboring these drugs showed therapeutic efficacy comparable to free drug combinations, indicating a potential for efficient and targeted delivery. Next-generation sequencing data identified missense mutations in eleven cancer-related genes that encode BRAF, EGFR, KRAS, NRAS, HRAS, MEK1, PIK3CA, PTEN, NOTCH1, TP53 and TERT. The ongoing research aims to correlate the drug sensitivity data with the mutational profile of patient-derived tumour cells to find novel targets. In conclusion, we have developed 3D organoids from patient-derived primary tumours and utilized them to validate the synergistic combination between screen-identified proteasome and survivin inhibitors. Our preclinical study provides a rationale for further evaluation of the novel drug combination in vivo and in clinical settings. Citation Format: Muhammad Furqan, Iffat Aleem, Muhammad Tahseen, Raza Hussain, Asif Loya, Muhammad Tariq Mahmood, Philippe Gautier, Kevin Myant, Saira Saleem, Amir Faisal. Proteasome and survivin inhibitors synergize to inhibit the growth of oral cancer organoids. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4940.

The basic objective of the empirical study is to identify the influence of organizational learning (OL) and transformational leadership (TL) on knowledge sharing (KS) in banking sector of Pakistan. The above said sector is selected as population of the current research. By using the simple random sampling technique, different branches of private banks and public banks are selected as a sample. 150 questionnaires were distributed to top managers and middle managers. 110 questionnaires were filled by employees and used for analysis. The overall response rate was 73.33%. Different statistical techniques i.e. Pearson’s correlation analysis, multiple regression analysis and reliability analysis are applied on collected data. The results of Pearson’s correlation analysis shows that there is positive relationship between organizational learning (OL), transformational leadership (TL) knowledge sharing (KS). Moreover, regression analysis’s results describe that organizational learning is solid forecaster of knowledge sharing as compare to transformational leadership. From the managerial point of view, the results give clear hint to Pakistan’s banking sector must understand the significance of organizational learning, transformational leadership for the purpose of knowledge sharing. In future researches, data may be collected to other sectors like textile industry, education zone and telecom industry etc. for more simplifying the outcomes and researches may also conducted on some other variables.

Objective To analyse epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma (CMM) in Pakistan; and to compare the results with other studies. Study design Case series. Place and duration of study Shaukat Khaum Memorial Cancer Hospital (SKMCH) from January 1997 to December 2017. Methodology All patients presenting to the study centre with a diagnosis of CMM were included in the study. Non-cutaneous melanoma cases were excluded. Patient demographics, tumor type, and tumor stage were recorded retrospectively. All data were analysed in SPSS and descriptive statistics were determined. Results A total of 169 CMM patients were registered during a 20-year period. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most common clinical subtype was unspecified melanoma (n=154, 91%). The most frequently observed T-stage at presentation was Tx (n=124, 73.4%), followed by T4 (n=23, 13.6%). With regard to body distribution, CM was seen most commonly in the lower limb including hip. Conclusion CMM is a rare disease in Pakistan. However, patients tend to present at a more advanced stage. Identification of risk factors and tumor characteristics is, therefore, of paramount importance in managing these patients. Key Words: Cutaneous malignant melanoma (CMM), Pakistan, Lower middle income country, Stage.

This paper proposes the multipurpose and wirelessly controlled UGV which can move across the surface, detect objects and classify them. It can also monitor and inspect object under interest if detects any undesirable condition then inform corresponding authority for further immediate actions. The Mini Rover-Unmanned Ground Vehicle (UGV) is any piece of mechanized equipment that moves across the surface of the ground and serves as a means for carrying or transporting something, but explicitly does not carry a human being. It will be able to go to places that human cannot reach for the sack of exploration and observation. The UGV operates without an onboard human presence. UGVs are used for the purpose of search and rescue, security and surveillance, terrain and forest monitoring because it is inconvenient, inefficient, dangerous, and sometimes impossible to have a human operator present in such environments. Major problems faced by UGV in natural terrain environment are reliable sensing, route finding, and object detection and identification. We combine a set of sensors and image processing techniques to counter these problems by getting a more extensive perception of the environment.

The basic objective of the empirical study is to identify the influence of organizational socialization (OS) and organizational climate (OC) on knowledge management (KM) among the banking sector of Pakistan. The above said sector is selected as population of the current research. By using the simple random sampling technique, different branches of public banks and private banks are selected as a sample. 270 questionnaires were circulated to top level managers and middle level managers. 240 questionnaires were filled by employees and used for analysis. The overall response rate was 89%. Different statistical techniques i.e. Pearson’s correlation analysis, multiple regression analysis and reliability analysis are applied on collected data. The results of Pearson’s correlation analysis shows that there is positive relationship between organizational climate (OC), organizational socialization (OS), knowledge management (KM), its dimensions i.e. knowledge sharing (KS) and knowledge application (KA). Moreover, regression analysis’s results explain that organizational socialization is strong predictor of knowledge management as compare to organizational climate. From the management point of view, the results give clear clue to Pakistan’s banking sector must understand the importance of organizational socialization, organizational climate for the purpose of knowledge management. In future researches, data may be collected to other sectors like telecom industry, textile industry and education sector etc. for more generalizing the results. Moreover, researches some other variables like social interaction, perceived organizational support, and perceived supervisor support may also be conducted.

The intention of current empirical research is to explore the relationship between transformational leadership, social interaction and knowledge management among banking sector of Pakistan. The said sector is selected as population of the research. With the help of simple random sampling, different branches of public banks and private banks are selected as a sample. 270 questionnaires were circulated to top level and middle level managers. 230 questionnaires were filled by employee and used for analysis. The overall response rate was 85%. Different statistical methods i.e. Reliability analysis, Pearson’s correlation analysis and multiple regression analysis are applied on collected data. The results of Person’s correlation analysis shows that there is positive relationship between transformational leadership, social interaction, knowledge management and its dimensions i.e. knowledge sharing and knowledge application. Moreover, regression analysis’s results explains that social interaction is strong predictor of knowledge management as compare to transformational leadership. From the managerial viewpoint, the results give rational direction to banking sector of Pakistan to understand the significance of knowledge and its management as well.

Drilling practices continue evolving with a global quest for efficiency and an increased focus on the lower total cost of ownership. This leads to equipment/electronic upgrades on rigs and the use of new methodologies or tools in oil and gas well drilling. These have a potential to induce substantially higher loads throughout the string, which can remain invisible to the driller but have consequences on the drill stem product connections. As an original equipment manufacturer (OEM), we have noticed an increase in the number of queries related to connection backoff in the well. We would like to take this educational opportunity to share with the industry, especially younger generations, the most common root causes of loosening and/or backing off a connection down hole and ways to address them. Over decades we have gained experience when dealing with our customers/users who have experienced connection loosening or backing off. We saw that every connection technology, from the API rotary shouldered connection to the premium ultra-high torque connections, could be exposed. Through investigations, rig visits, analysis, and adjustments made to the drilling practice, we have helped numerous players address this effect on land and offshore. As a result, we have identified several causes that can lead to these incidents. Sometimes, basic physical principals can be overlooked. Often, dynamic phenomenon downhole is not captured, thoroughly understood, or ignored until they impose themselves. Finally, the running practice and connection torque management on surface can often be improved. With a minimum of preliminary planning at the time of well design, by embracing best industry practices on the rig floor and by monitoring what is happening, one can greatly reduce the chances of experiencing downhole back-offs and/or be in a position of making better decisions when they occur. This paper discusses, in detail, the likely root causes and offers ways to address these. While it will not completely eliminate the risks, our experiences and related investigations indicate that it will reduce the effect.

Objective This study aimed to estimate the prevalence of pain among treatment-naive patients with oral cancer and to identify the clinical and histopathological characteristics of oral cancer associated with pain occurrence. Materials and methods A retrospective chart review was conducted of patients presenting with biopsy-proven oral cancer between January 2015 and December 2019. Variables, including demographic data, medical history, clinical presentation, and histopathological information, were extracted and analyzed. Appropriate descriptive and analytic statistics were computed. Results Among 1,067 participants, 682(63.9%) were males. The prevalence of pain was 67.5%. It was found to be significantly associated with the duration of symptoms, history of betel or areca nut, squamous cell carcinoma, presence of disease in tongue, palate, and lips, lesion size, clinical nodal involvement, depth of invasion, TNM classification, limited mouth opening, bleeding, and restricted tongue mobility. Logistic regression analysis suggested that pain in oral cancer was positively associated with the occurrence of disease in the tongue and negatively with TNM stage I. Conclusions There is a high prevalence of pain among patients with oral cancer even before the initiation of any therapeutic intervention. Occurrence is significantly higher in patients with the presence of disease in the tongue and among those with TNM stage II or more.

Introduction: A portion of patients with head and neck cancer (HNC)-associated pain may not experience relief in symptoms with non-invasive modalities. A nerve block is a procedure in which a local anesthetic agent is injected along the nerve track to preferentially block sensory transmission. The literature on the effectiveness of nerve blocks in the management of HNC-related pain is limited. The purpose of this study was to determine the effectiveness of nerve blocks in management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders. Materials and Methods: A retrospective chart review of patients who underwent a nerve block or infiltration procedure in the regions of head and neck for management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders in the Orofacial Pain Medicine clinic, Shaukat Khanum Memorial Cancer Hospital and Research Centre, between November 2018 and November 2019 was completed. Information regarding demographics, diagnosis, and pain characteristics was extracted and reviewed. The Fisher-exact test and Mann-Whitney U test were used for analysis between independent and dependent variables. Results: A total of 27 participants were included in the investigation, of which 66.7 % were males. The average pre-procedure pain score was 6.85 ± 2.54. Following intervention, 81.5 % of the participants experienced greater than 75 % relief in pain for longer than 48 hours. The mean immediate post-procedure pain score was 0.26 ± 1.02 and the average duration of relief was 6.10 ± 6.50 weeks. The significant effect of nerve blocks was found to be statistically associated with the concurrent use of amitriptyline (p = 0.017). Conclusion: Nerve blocks, as an adjunctive therapy to pharmacologic treatment, can provide significant relief to patients with breakthrough HNC-associated trigeminal and cervical neuropathic pain disorders. However, the duration of relief experienced by the participants is inconsistent. The beneficial effect of nerve blocks appears to be more common in patients that were concurrently using amitriptyline.

Herein, we report synthesis of a set of benzothiazole-thiourea hybrids with aromatic and aliphatic side chains (BT1 to BT9) using an elegant synthetic strategy. The newly synthesized benzothiazole-thiourea conjugates were subjected to In-vitro tyrosinase inhibition and free radical scavenging activity. Majority of the compounds indicated inhibition considerably improved than the standard; compound (Kojic acid with IC50 = 16.8320 ± 1.1600 µM) BT2 with IC50 = 1.3431 ± 0.0254 µM was found to be the best inhibitor. A non-competitive mode of inhibition of BT2 was disclosed with Ki value of 2.8 µM. In order to study enzyme-inhibitor interactions SAR analysis molecular docking was carried out. The amino groups of thiourea were involved in hydrogen bonding with Glu322 showing the bond length of 1.74 and 2.70 Å, respectively. Moreover, the coupling of π-π was displayed between benzothiazole and benzene rings of His244 and His263, respectively. The outcome of this study might help to develop new inhibitors of melanogenesis, important for cosmetic and food products. Communicated by Ramaswamy H. Sarma

Introduction: First bite syndrome (FBS) is a gustatory-evoked painful condition that is characterized by the onset of severe electric-shock like pain in the periauricular region. In the majority of patients, FBS develops post-operatively. However, in rare instances it may present in a preoperative setting. Case description: Two cases of FBS developing preoperatively secondary to parotid gland tumour are presented. The patients, 54 and 30 years old, presented with complaints of electric-shock like pain localized over the periauricular region. In each case the pain was triggered following first bite of the meal. In both cases, pain lasted for a few seconds and with subsequent bites subsided only to return at the beginning of next meal. Practical implications: Preoperative occurrence of FBS in the absence of a history of trauma or surgery should necessitate a thorough investigation and follow up for an underlying salivary gland tumour.

Sol-gel and solid-state reaction methods were used to synthesize diamond nanoparticles (DNPs) and (DNPs) x /CuTl-1223 (x = 0, 0.25, 0.50, and 1.00 wt.%) nanoparticle-superconductor composites, respectively. Effects of these DNPs on structural, morphological, compositional, and transport properties of CuTl-1223 superconducting phase were investigated by different experimental techniques such as X-ray diffraction (XRD), energy dispersive X-ray (EDX) spectroscopy, scanning electron microscopy (SEM), and resistivity versus temperature (R-T) measurements. The unchanged crystal structure and stoichiometry of host CuTl-1223 superconducting matrix with addition of DNPs gave evidence about the dispersion of nanoparticles at the grain boundaries of the host matrix, which may heal up the inter-granular voids and pores resulting in enhanced inter-grain connectivity. Critical transition temperature T c (0) and hole concentration of CuTl-1223 superconductor were observed to be increased with addition of DNPs up to a certain optimum value (i.e. x = 0.5 wt.%).

Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was

Software Defined Networking (SDN) is platform that support network application more efficiently. SDN is successful because it decoupled the control plane from its data plane. Detachment of these two-planes improved dynamic configuration, controller programmability, centralized and decentralized network. In this study Distributed SDN approach is used to avoid scalability and robustness issue. The SDN controllers can be centralized, also it works on multiple nodes that can be physically distributed. Distributed nodes communicate with each other and improve performance of network to assist data flow. When flow arrives through end devices to any data plane in Distributed SDN, our model will support the data plane to increase controller response time. Also, controller will check, whether data needs to prioritize flow to send locally or globally with the help of Elephant or Mice flow. This model is used to reduces the controller work load, response time and manage quality of services (QoS) between controllers.

A series of symmetrical salicylaldehyde-bishydrazine azo molecules, 5a-5h, have been synthesized, characterized by H-1-NMR and C-13-NMR, and evaluated for their in vitro -glucosidase and -amylase inhibitory activities. All the synthesized compounds efficiently inhibited both enzymes. Compound 5g was the most potent derivative in the series, and powerfully inhibited both -glucosidase and -amylase. The IC50 of 5g against -glucosidase was 0.35917 +/- 0.0189 mu M (standard acarbose IC50 = 6.109 +/- 0.329 mu M), and the IC50 value of 5g against -amylase was 0.4379 +/- 0.0423 mu M (standard acarbose IC50 = 33.178 +/- 2.392 mu M). The Lineweaver-Burk plot indicated that compound 5g is a competitive inhibitor of -glucosidase. The binding interactions of the most active analogues were confirmed through molecular docking studies. Docking studies showed that 5g interacts with the residues Trp690, Asp548, Arg425, and Glu426, which form hydrogen bonds to 5g with distances of 2.05, 2.20, 2.10 and 2.18 angstrom, respectively. All compounds showed high mutagenic and tumorigenic behaviors, and only 5e showed irritant properties. In addition, all the derivatives showed good antioxidant activities. The pharmacokinetic evaluation also revealed promising results

Background: Overview of clinical impact of positron emission tomography-computed tomography (PET-CT) scans in patients with head and neck carcinomas at our center. Methods: Retrospective review of posttreatment 18F-fluorodeoxyglucose (18F-FDG) PET-CT scans in patients with head and neck carcinomas with risk of residual disease. Clinical outcome served as the reference standard. Results: This study included 93 patients (65.6% males, mean age: 48.8 years ± 17.2 standard deviation) with squamous cell carcinoma as most frequent histopathology (91.4%). PET-CT scans were performed on average 6 months posttreatment. Diagnostic accuracy, positive predictive value, and negative predictive value of PET-CT for disease were found to be 88%, 88%, and 92%, respectively. A median follow-up of 24 months was available for 91 patients. Kaplan–Meier curves showed significantly higher disease-free survival with negative PET-CT as compared to positive PET-CT (P = 0.01) and maximum standardized uptake values of

Green energy Internet is a new concept for future power systems based on high-level interconnection among different systems for energy efficient delivery and manage energy resources. Smart grid is one of the core energy management system based on multiple routing and data transferring services for energy management, distribution, pricing, and demand services. The traditional energy networks have suffered from high and complex computing operations and lead to degradation of services and the overall performance of all operations. Software-Defined Networking (SDN) is one of the platform to enhance the flexibility and efficiency by decoupled the control plane from its data plane. A detachment of these two-planes improved dynamic configuration, controller programmability, centralized and decentralized network operations. In this paper, a distributed SDN approach is used to address the scalability and robustness issues and improve the overall energy efficiency in smart grid systems. The SDN controller logically centralized but it works on multiple nodes that physically distributed. Distributed nodes are communicating with each other and improve the network performance to assist data flow. When flow arrives through end devices to any data plane in distributed SDN, the proposed approach supports the data plane to increase the controller response time. Also, the controller checks, whether the data needs to prioritize flow to send it locally or globally with the help of Elephant or Mice flow. The proposed approach is used to reduce the controller workload, response time, and manage Quality of Services (QoS) and enhanced energy efficiency among controllers. This approach also improves the green energy utilization in smart grid systems. The experimental results indicate that the proposed approach is more suitable and feasible for smart grid systems.

Background: The olfactory groove meningioma has always been surgically challenging. The common microscopic surgical procedures exercised involve modification of pterional or sub-frontal approaches with or without orbital osteotomies. However, we believe that orbital osteotomies are not mandatory to achieve gross total resection. Hence, this study was performed to evaluate the surgical outcomes of olfactory groove meningioma with bicoronal sub frontal approach but without orbital osteotomies. Materials and Methods: The study was performed by reviewing the medical charts, neuroimaging data, and follow-up data of 19 patients who were treated micro surgically for olfactory groove meningioma without orbital osteotomies in our department. Mean overall follow up period of our study was 5 years. Statistical analysis was done by means of IBM SPSS Software version 19. Results: Nineteen patients (1 male and 18 female patients, with an age range of 35-67 years; average age of patients' 51±7.5 years) of OGM were managed in our department. All patients were evaluated by MRI Brain with and without Gadolinium, CTA, CT Scan both axial and Coronal sequences. Most common symptom reported was head ache (80%), others include; urinary incontinence (26%), seizures (78%), decreased visual acuity (79%), papilledema (74%), personality changes (68%) and olfactory loss was reported in 57% of the patients. Post-operative complications include; CSF accumulation (5%), hematoma at tumor bed (10%), skin infection (5%) and mild post-operative brain edema (26%). Mortality rate was 5%. During 5 years of follow-up, we recorded one recurrence which was after 26 months and successfully removed in reoperation. Conclusion: Bi-coronal sub frontal approach appears to be an excellent technique for Olfactory Meningioma removal as practiced by most neurosurgeons. Nevertheless, it is not mandatory to carry out orbital osteotomy to acquire optimal surgical outcome as is advocated by some Authors.

Small cell neuroendocrine carcinoma (SCNEC) is a rare disease of nose and paranasal sinuses. In contrast to other regions SCNEC of this region has been reported to be recurrent and locally aggressive. No definite treatment has been established till date because of rarity of this disease. The purpose of this descriptive study is to present the series of 8 cases with SNEC of nose and paranasal sinuses. Retrospective review of 8 patients presenting with Small cell neuroendocrine carcinoma of nose and paranasal sinuses, from January, 2005 to December, 2014 treated at Shaukat Khanum Memorial Cancer HospitalResearch Centre, Lahore was performed to determine the clinical characteristics and outcome of this disease. The subjects were 7 males and 1 female with a mean age of 45±15 years (range 24 to 59 years). Tumours were present in nasal cavity (n=4), ethmoid sinus (n=3) and maxillary sinus (n=1). Almost 50% of patients presented with AJCC stage IV-A. All patients had immunohistochemistry proven diagnosis. All patients (08) received radiotherapy with mean doses 58±Gy (Range 54-66Gy). Surgery was performed in 2 while chemotherapy was administered in 4 patients. Recurrence occurred in 3 patients, one each with loco-regional, distant and both. At a median follow up of 38 months, 5 patients were alive with no evidence of disease. SCNEC is a rare but aggressive neoplasm. Current standard of care varies but multi-modality approach should be the cornerstone in management of SCNEC. Early diagnosis and intervention improve the final outcome.

Introduction Total thyoidectomy has become the oncologic procedure of choice for differentiated thyroid cancers DTC. The aim of the present study was to evaluate the post-operative morbidity rates, in relation to the surgical extent of primary and redo-thyroid surgeries. Patients and Methods A total of 331 adult patients who underwent thyroid gland surgery for a diagnosed DTC were included. 213 patients had a completion thyroidectomy, while 117 received a primary total thyroidectomy. Among the redo surgery group, 108 had surgery on the previously unexplored side of neck only, while 105 had repeat exploration and thyroid resection on the previously operated side as well. Length of hospital stay, post-operative hypocalcaemia, recurrent laryngeal nerve injury and tumour recurrence were used as primary outcome measures. Results Comparing primary versus redo surgery, there was no statistically significant difference between the groups in terms of all four main outcome measures. After controlling for patient's age, T and N stage, length of follow up, and whether or not a neck node dissection was done, the opposite side only redo surgery was associated with a statistically significant shorter hospital stay and lesser risk of persistent hypocalcaemia. Performance of simultaneous neck dissections was found to be associated with longer hospital stay (P ≤ 0.01). Higher initial N stage has a higher likelihood of development of loco regional and metastatic recurrence (P Conclusion Analysis of our data suggest that under uniform conditions of tumour stage, surgeon, demographics and T stage, there is no statistically significant difference in post-operative outcomes between primary or completion total thyroidectomy. However, less extensive surgery is associated with a better perioperative outcome.

Spindle cell carcinoma (SpCC) is a variant of squamous cell carcinoma with biphasic components and more aggressive behaviour. Its rarity and histopathological pattern pose a diagnostic challenge. Early diagnosis and treatment result in a decrease in local and distant metastasis. Case 1 is a 71-year-old female presented with hoarseness of voice and dyspnoea for 2 years without any risk factors. Fibre-optic laryngoscopy (FOL) revealed smooth polyp hanging from anterior two-third of the left vocal cord. Microlaryngoscopic excision revealed SpCC followed by post-operative radiotherapy and is currentlyalive. Case 2 is a 72-year-old male presented with worsening stridor for 2 years post-excision of laryngeal nodule and history of smoking and hookah use for >20 years. He developed dysphonia after a few months with fixed hard level 3 nodes at the right side. FOL showed a polypoid mass extending from the left vocal cord into the supraglottis. Fine-needle aspiration cytology of the neck swelling confirmed the diagnosis of SpCC. Computerised tomography (CT) chest/abdomen showed distant metastasis. Palliative radiotherapy was given, but the patient died after 3 months due to locoregional failure. Case 3 is a 35-year-old male presented with a history of hoarseness for 3 years with no risk factors. FOL showed a 1.2-cm polypoid growth on the right vocal cord. Total laryngectomy was performed and histopathology showed SpCC. Radiotherapy was given and the patient is alive without disease with regular follow-ups. Smoking and alcohol are thought to be the contributing factors causing this disease. Biphasic nature of the tumour requires pathological sampling for diagnostic confirmation. Surgery combined with radiotherapy has a better survival outcome. SpCC is a rare tumour with a tendency for locoregionalrecurrence. Surgery should remain the mainstay of treatment followed by post-operative radiotherapy for a better control.Key words: Larynx, radiotherapy, spindle cell carcinoma

Background: Overview of clinical impact of positron emission tomography-computed tomography (PET-CT) scans in patients with head and neck carcinomas at our center. Methods: Retrospective review of posttreatment 18F-fluorodeoxyglucose (18F-FDG) PET-CT scans in patients with head and neck carcinomas with risk of residual disease. Clinical outcome served as the reference standard. Results: This study included 93 patients (65.6% males, mean age: 48.8 years ± 17.2 standard deviation) with squamous cell carcinoma as most frequent histopathology (91.4%). PET-CT scans were performed on average 6 months posttreatment. Diagnostic accuracy, positive predictive value, and negative predictive value of PET-CT for disease were found to be 88%, 88%, and 92%, respectively. A median follow-up of 24 months was available for 91 patients. Kaplan–Meier curves showed significantly higher disease-free survival with negative PET-CT as compared to positive PET-CT (P = 0.01) and maximum standardized uptake values of

Sulfonamide derivatives serve as an important building blocks in the drug design discovery and development (4D) process. Ciprofloxacin-, sulfadiazine- and amantadine-based sulfonamides were synthesized as potent inhibitors of jack bean urease and free radical scavengers. Molecular diversity was explored and electronic factors were also examined. All 24 synthesized compounds exhibited excellent potential against urease enzyme. Compound 3e (IC50 = 0.081 ± 0.003 µM), 6a (IC50 = 0.0022 ± 0.0002 µM), 9e (IC50 = 0.0250 ± 0.0007 µM) and 12d (IC50 = 0.0266 ± 0.0021 µM) were found to be the lead compounds compared to standard (thiourea, IC50 = 17.814 ± 0.096 µM). Molecular docking studies were performed to delineate the binding affinity of the molecules and a kinetic mechanism of enzyme inhibition was propounded. Compounds 3e, 6a and 12d exhibited a mixed type of inhibition, while derivative 9e revealed a non-competitive mode of inhibition. Compounds 12a, 12b, 12d, 12e and 12f showed excellent radical scavenging potency in comparison to the reference drug vitamin C.

Background: Despite being rare in incidence, malignant tumors of major salivary glands show diverse histological variation. There are limited data on major salivary gland tumor management and outcome from Pakistan. The objective of this study was to share our experience with management of malignant tumors of major salivary glands. Materials and Methods: Patients who received treatment at Shaukat Khanum Cancer Hospital and Research Center from July 2002 to June 2011 with an underlying diagnosis of a major salivary gland malignancy were included. Patient characteristics and treatment modalities were assessed. Local, regional and distant failures were determined. Disease free survival (DFS) and overall survival (OS) were calculated using Kaplan Meier curves and the Log rank test was used to determine statistical significance. Univariate and multivariate analyses were performed using Cox proportional hazard regression. Results: The parotid gland was the primary site of origin in 104 (80%) patients. Mucoepidermoid carcinoma (43%) and adenoid cystic carcinoma (24%) were the most common histological types. Surgery followed by adjuvant radiation remained the mainstay treatment modality with 81 (62%) patients. Nineteen (15%) patients were treated with surgery alone and 30 (23%) patients with locally advanced surgically inoperable tumors received radiation only. Forty one (32%) patients failed the treatment (local 12, regional 11, locoregional 5, distant 13). The expected 5 year DFS and OS were 65% and 74% respectively. On multivariate analysis, grade was the only independent predictor of DFS and nodal involvement was the only independent predictor of overall survival. Conclusions: Employing existing standards of treatment, comparable survival can be achieved in Pakistani population with major salivary gland malignancies as elsehwere in the world.

Concurrent chemo-radiation (CRT) has been established as the standard of care for non-metastatic loco- regionally advanced nasopharyngeal carcinoma (NPC) but recently the addition of induction chemotherapy in the already established regimen has presented an attractive multidisciplinary approach. This retrospective study was carried out to evaluate the efficacy of induction chemotherapy (IC) followed by CRT for the management of loco-regionally advanced NPC. Between July 2005 and September 2010, 99 patients were treated with cisplatin based IC followed by CRT. Induction chemotherapy included a 2 drug combination; intravenous gemcitabine 1000 mg/m2 on day 1 and 8 and cisplatin 75 mg/m2 on day 1 only. Radiotherapy (RT) was given as a phase treatment to a total dose of 70 Gy in 35 fractions. Concurrent cisplatin (75 mg/m2) was administered to all patients on days 1, 22 and 43. All patients were evaluated for tumor response and adverse effects after IC and 6 weeks after the completion of the treatment protocol. Statistical analysis was performed using SPSS version 17 and Kaplan Meier estimates were applied to project survival. Median follow-up duration was 20 months. The 5-year overall survival (OS), loco regional control (LRC) and relapse free survival (RFS) rates were 71%, 73% and 50%respectively. Acute grade 4 toxicity related to induction chemotherapy and concurrent chemo-radiation was 4% and 2% respectively, with only 3 toxicity-related hospital admissions. We conclude that induction gemcitabine and cisplatin followed by chemo-radiation is a safe and effective regimen in management of nasopharyngeal carcinoma, meriting further investigation in randomized clinical trials.

Purpose: Platinum-refractory or relapsed squamous cell carcinoma of the head and neck (SCCHN) is considered to have poor prognosis. Although cetuximab is currently recommended as category 1 in this group of patients, the use of it is hampered in low- and middle-income countries (LMICs) like Pakistan due to nancial constraints. Further, majority of the population of these countries is unable to tolerate toxicity related to other intravenous chemotherapeutic agents due to lower socioeconomic background with poor nutrition status. The aim of this study is to evaluate the response rate and toxicity of oral methotrexate (MTX) in platinum-refractory or relapsed SCCHN. Methods: Between June 2008 and December 2012, 71 patients received palliative oral MTX either due to recurrent or persistent disease. With a median age of 51 years (range 22–75), there were 68% of males and 32% of females. Site distribution was as following; oral cavity 58%, nasopharynx 25%, hypopharynx 7%, paranasal sinuses 6%, larynx 3%, Oropharynx 1%. Patterns of recurrence; local 32%, regional 07%, loco regional 10%, distant 15% and persistent disease in 36% of the patients. All the patients received oral MTX 10 mg once a day, 4 days a week. To contain the possible side effects associated with MTX, folinic acid 15 mg per oral every 6 hourly on day 5 was prescribed. Response assessment was done on two monthly basis. Response, toxicity, mean response time and mean time to progression were determined. Results: Response to MTX was as following; complete response 3%, partial response 4%, stable disease 11% and progressive disease in 82% of the patients respectively. Toxicity related to oral MTX includes neutropenia Grade III in 1% while mucositis Grade III in 10% of the patients, respectively. None of the patient had Grade IV mucositis or haematological toxicity. Treatment was stopped in 13% of the patients due to poor compliance. Mean response time was 4 months (range 1 – 20) and mean time to progression was 5 months (range 1–23). Conclusion: Oral MTX is a simple, cost-effective and well-tolerated regimen to be used on outpatient basis for palliation in platinum refractory or relapsed SCCHN in LMICs and debilitated patients. This treatment merits further evaluation in large-scale clinical trials. Key words: Oral methotrexate, platinum refractory, relapsed squamous cell carcinoma of head and neck

To determine the outcome in patients with early squamous cell carcinoma of oral tongue, and the impact of various prognostic factors on survival.The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised records of patients treated for squamous cell carcinoma of early stage tongue between March 2003 and October 2009. Various factors, including demographics, risk factors, stage, and grade of the tumour were determined. Kaplan Meier curves were plotted to determine the 5-year overall survival, relapse-free survival, local control, regional control, and loco-regional control.A total of 137 patients with early oral tongue tumours were treated. With a median follow-up of 46 months, the overall survival of T1, T2 early tongue tumour was 73% and 64%. The incidence of occult metastasis was 30%. The overall survival for Stage I/II and III/IV was 78% and 50% (p=0.002). Patterns of failures included; local 19 (13%), regional 22 (16%), loco-regional 4 (3%) and distant 5 (4%) respectively. The 5-year local control, regional control, loco-regional control was 86%, 82% and 72%. The only significant predictor of overall survival was clinical and pathological N stage in T1 patients, and surgical procedure, grade, pathological N stage in T2 cases.Treatment of early squamous cell carcinoma of oral tongue effectively achieved local control and disease-free survival. Nodal stage was the most important prognostic factor in terms of survival and recurrence.

Introduction: Large cell neuroendocrine carcinoma is a distinct clinicopathlogical entity which is extremely rare among salivary glands. Fine needle aspiration cytology is a valuable tool in the diagnosis of salivary gland tumors but due to extreme rarity of large cell neuroendocrine carcinoma and high grade cytological features this tumor is usually not in the list of high grade carcinomas differentials. We have documented a case of large cell neuroendocrine carcinoma that was misdiagnosed initially as tuberculous parotitis and later on as large cell high grade carcinoma on fine needle aspiration cytology. Case report: A 45 year old male with a painful lump at right parotid and facial nerve weakness was initially misdiagnosed as tuberculous parotitis and treated with anti-tuberculous therapy. Based on fine needle aspiration cytology, he has been treated as high grade carcinoma of parotid. Radical parotidectomy and neck dissection from level 1-5 was performed to be followed by post-operative radiotherapy. Currently patient is alive without disease and on regular follow up. Conclusion: Due to varied morphological and biological behavior of large cell neuroendocrine carcinoma, early diagnosis seems to be an important prognostic factor. Surgery should be considered as the mainstay of treatment supplemented by postoperative radiotherapy and chemo radiotherapy.

Purpose: Head and neck tumours include tumours of nose, paranasal sinuses, oropharynx, larynx and mouth. Squamous cell carcinoma (SCC) is the most common head and neck malignant tumour which accounts for 90% of head and neck malignant tumours. p21 is an important immunohistochemical marker which has signi cant role in predicting prognosis of head and neck SCC (HNSCC). Increased p21 expression in HNSCC is associated with bad prognosis in terms of increased risk of nodal metastasis, increased rate of recurrence and decreased survival rate. The purpose of this study was to evaluate the expression of p21 in HNSCC with various clinicopathologic and prognostic parametres. Materials and Methods: A total of 110 patients ( n = 110) of HNSCC (oral cavity n = 98 and laryngeal tumours n = 12) were included in the study which were diagnosed and treated between January 2008 and January 2011 at a tertiary care centre in Pakistan. Mean age was 51 years (age range 15–78). 65 (59%) were male and 45 (41%) were female. Tumours were classi ed as p21 positive when ≥10% tumour cells were immunoreactive for p21. p21 expression was noted and correlated with T-stage, nodal metastasis, perineural and depth of invasion, recurrence and 2-year survival rate. Results: Of 110 cases, p21-positive cases were 88 (80%) compared to 22 (20%) negative. T1–T2 tumours with p21 expression were 59 (67.04%) while 17 cases (77.27%) had negative for p21 ( P = 0.44). Amongst T3–T4, 29 cases showed p21 expression (32.96%) while 5 cases (22.73%) were negative ( P = 0.44). Nodal metastasis was seen in 51 cases (57.95%) with p21 positivity as compared to 4 cases (18.8%) with no p21 expression ( P = 0.0015). Perineural invasion was seen in 15 carcinomas (17.04%) having p21 positivity and 1 case (4.54%) with p21 negativity ( P = 0.18). 48 cases (54.54%) had depth of invasion >1 cm with positive p21 as compared to 4 cases (18.18%) without ( P value = 0.0035). 39 cases (44.31%) showed recurrence along with p21 expression while 3 cases (13.63%) showed recurrence without ( P = 0.0076). 2-year survival rate was 56.81% ( n = 88) in p21 positive cases, whereas it was 90.90% ( n = 20) those with negative p21 ( P = 0.0026). Conclusion: Positive p21 expression in HNSCC correlates with intermediate grade, late stage, increased nodal metastasis, tumour recurrence and decreased survival. p21 should be considered as an important prognostic and predictive marker in HNSCC to detect tumours at early stage and to improve therapy and prognosis. Key words: Head and neck squamous cell carcinoma, lymph node metastasis, p21, recurrence, survival rate

IntroductionGiven the high probability of cure, the aims of treatment are cure, laryngeal preservation and good voice quality while making effective use of available resources. In this study we analyze locoregional control (LRC) and survival following hypofractionated radiotherapy in early stage glottic squamous cell carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Center.Materials and methodsBetween October 2003 and June 2009, 87 patients with early glottic squamous cell carcinoma were treated with hypofractionated radiotherapy. All patients were included in the study (M: 94%; F:6%). Median age was 60 years (range: 21-81 years). Sixty-six percent of patients were smokers. AJCC stage was T1 in 95% and T2 in 5% of the patients. Radiotherapy dose was 55 Gy in 20 fractions over 4 weeks. All patients were treated on cobalt-60. Median radiotherapy treatment time was 28 days (range: 23-35 days).ResultsThe LRC rate after primary radiotherapy at 5 years was 91% (95% CI: 88-94%). The 5 years overall and disease-specific survival was 86% (95% CI: 81 and 91%) and 97% (CI 95%: 95 and 99%) respectively. Patients with T1a and T1b disease had LRC rates of 95 and 88% (p = 0.32). The LRC rates for patients with and without anterior commissure involvement at 5 years were 80 and 96% (p = 0.02) respectively.ConclusionHypofractionated radiotherapy 55 Gy in 20 fractions is comparable to conventional fractionation schedules in terms of locoregional control and survival while offering potential for optimizing resources usage.