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BACKGROUND: CD10 and CD15 expression has been reported in several tumors. Whether CD10 and CD15 have a role in colorectal mucinous and signet ring adenocarcinoma (MSA) tumorigenesis is not yet known. OBJECTIVE: We aimed to investigate the role of CD10 and CD15 expression in mucinous colorectal adenoma-carcinoma sequence (ACS) and determine if there is any clinical and prognostic significance associated with their expression. METHODS: Seventy-five cases of colorectal MSA, and 9 cases of adenoma samples were collected. Manual TMA blocks were constructed and immunohistochemistry for CD10 and CD15 was done. RESULTS: Compared to adenomas, CD15 expression was significantly higher in MSA (p= 0.002), in contrast to CD10 expression. CD15 positivity was significantly associated with microsatellite stable (MSS) tumors (p= 0.018). The association between CD10 positivity and fungating tumor growth showed marginal significance. Unlike CD10, CD15 positivity showed significant association with overall survival of colorectal MSA patients. CONCLUSIONS: CD15 expression seems to have a role in mucinous colorectal ACS, with significant impact on the survival of MSA patients. Further studies are suggested to identify any genetic alterations that may underlie a potential association with disease progression.

Background Studies have shown that the incidence of atrial fibrillation (AF) in cancer is most likely due to the presence of inflammatory markers. The purpose of our study is to determine the association of AF with different cancer subtypes and its impact on in‐hospital outcomes. Methods Data were obtained from the National Inpatient Sample database between 2005 and 2015. Patients with various cancers and AF were studied. ICD‐9‐CM codes were utilized to verify variables. Patients were divided into three age groups: Group 1 (age 80 years). Statistical analysis was performed using Pearson chi‐square and binary logistic regression analysis to determine the association of individual cancers with AF. Results The prevalence of AF was 14.6% among total study patients (n = 46 030 380). After adjusting for confounding variables through multivariate regression analysis, AF showed significant association in Group 1 with lung cancer (odds ratio, OR = 1.92), multiple myeloma (OR = 1.59), non‐Hodgkin lymphoma (OR = 1.55), respiratory cancer (OR = 1.55), prostate cancer (OR = 1.20), leukemia (OR = 1.12), and Hodgkin's lymphoma (OR = 1.03). In Group 2, the association of AF with multiple myeloma (1.21), lung cancer (OR = 1.15), Hodgkin lymphoma (OR = 1.15), non‐Hodgkin lymphoma (OR = 1.12), respiratory cancer (OR = 1.08), prostate cancer (OR = 1.06), leukemia (OR = 1.14), and colon cancer (OR = 1.01) were significant. In Group 3, AF showed significant association with non‐Hodgkin lymphoma (OR = 1.06), prostate (OR = 1.03), leukemia (OR = 1.03), Hodgkin's lymphoma (OR = 1.02), multiple myeloma (OR = 1.01), colon cancer (OR = 1.01), and breast cancer (OR = 1.01). The highest mortality was found in lung cancer in age 80. Conclusion In patients age 80 years, it has significant association with non‐Hodgkin lymphoma and prostate cancer. In patients age 80 years, increased mortality was seen in those with AF and prostate cancer. Twitter Abstract In age, Our study found that in age 80 was seen in prostate cancer

Objective: To determine the surgical outcome in patients with peritonitis at tertiary care Hospital. Materials and Methods: This descriptive case series study was conducted in general surgery department of Peoples Medical Collage Hospital, Nawabshah (SBA). Study duration was two year from August 2014 to July 2016. All the patients aged more than 12 years and of both genders were included. Surgical management was done in all of the study subjects. Abdominal cavity was produced with midline incisions using grid iron as per investigations and clinical evaluation; the quantity and quality of intra-abdominal exudates were measured. Intestinal contents and pus were removed from peritoneal cavity with suction as well as by manual mopping, and full lavage was carried out with 3-5 liters of normal saline to all parts of the abdominal cavity. All the demographic data including clinical presentation and surgical outcome in terms of post-operative complications, Hospital stay and mortality were recorded via study proforma. Results: A total of 100 cases of peritonitis 75% patients were male and 25% patients were female. The mean age of patients was 36.21+12.32 years. Acute generalized abdominal pain was in all cases, followed by fever 91.0%, vomiting 66.0%, constipation 69.0% and 2.0% patients complained of passing blood per rectum. Generalized abdominal tenderness, including rebound tenderness 90%, abdominal rigidity 83%, dehydration 88%, abdominal distention 85%, absent gut sound 70%, shifting dullness was elicited in 64% of cases and jaundice in 1.0% of cases. According to post-operative complications 20.0% patients developed Septicemia and Fecal fistula, 40.0% had wound Infection only, 9.0% patients developed wound infection and septicemia, 4.0% patients developed septicemia without any wound infection. Most of the patients had prolonged Hospital stay and overall mortality rate was 16%. Conclusion: Surgical outcome of the peritonitis resulted poor in those cases who came late and there was huge contamination of peritoneal cavity when operated, these patients developed post-operative complications i.e. wound infection, septicemia, faecal fistula and there hospital stay was longer.

Objective: To find out the prevalence of antibodies against cytomegalovirus and their association with adverse pregnancy outcome in women, at Isra University Hospital Hyderabad. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology & Obstetrics, Isra University Hospital (IUH) Hyderabad, from Jan to Jun 2018. Methodology: Cytomegalovirus IgM and IgG antibodies in 305 women of reproductive age group were measured using the Enzyme Linked Fluorescent Assaysystem kit. Results: The combined positivity of anti cytomegalovirus IgG and IgM antibodies was 93 (30.40%). About 37 (37.37%) and 28 (34.14%) women were found to be seropositive for cytomegalovirus antibodies who had history of spontaneous miscarriage and recurrent miscarriages respectively. Conclusion: Higher association of seropositivity for cytomegalovirus IgM and IgG with bad obstetrical history and low economy was found.

Background The association between atrial fibrillation (Afib) and sinus and AV nodal dysfunction has previously been reported. However, no data are available regarding the association between Afib and bundle branch block (BBB). Methods Patient data were obtained from the Nationwide Inpatient Sample (NIS) database between years 2009 and 2015. Patients with a diagnosis of Afib and BBB were identified using validated International Classification of Diseases, 9th revision, and Clinical Modification (ICD‐9‐CM) codes. Statistical analysis using the chi‐square test and multivariate linear regression analysis were performed to determine the association between Afib and BBB. Results The total number of patients with BBB was 3,116,204 (1.5%). Patients with BBB had a mean age of 73.5 ± 13.5 years, 53.6% were males, 39.1% belonged to the age group ≥80 years, and 72.9% were Caucasians. The prevalence of Afib was higher in the BBB group, as compared to the non‐BBB group (29% vs 11.8%, p value, This study demonstrates that prevalence of Afib is higher in patients with BBB than without BBB. Cost are higher for Afib patients with BBB, compared to those without BBB, with no significant increase in mortality or length of stay.

A highly infectious outbreak of Coronavirus disease (COVID-19) caused by a new coronavirus - Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) was first officially reported in December 2019 inWuhan, China which spread rapidly worldwide infecting millions of people in many countries. Although most of infected patients are asymptomatic or develop mild symptoms that usually recover with good prognosis, 10-20% of infected people especially old age and those with underlying medical co-morbidity conditions, develops severe disease with multiple organ failure, primarily respiratory failure and death. SARS-CoV-2 infection shares similar genetics, pathogenic, epidemiological and clinical features with two other viruses belonging to same coronavirus family that have caused serious infections over the last two decades i.e SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) and MERS-CoV (Middle East Respiratory Syndrome Coronavirus) and pathogenesis and immune changes observed in these infections can be applied to this new pandemic in order to learn the imperative role of the immune system during the course of coronavirus infections and possible use of immunomodulatory intervention and immunosuppressive drugs in management of severe patients. As the immunopathogenesis of SARSCoV- 2 infection is still not clear and understanding this underlying mechanism which leads to severe form of disease is important for identifying effective treatment for critically ill patients, this article reviews the immunopathogenic changes observed in SARS-CoV-2 infection and identify the possible mechanisms by which it induces immune changes including cytokine storm, in order to provide a reference for the early clinical identification and management of severe form of COVID-19 infection. Keywords: COVID-19, SARS-CoV-2, Pathogenesis, Cytokine storm.

Percutaneous Coronary Intervention (PCI) is widely recognized as an effective treatment for Acute Coronary Syndrome (ACS). Inspite of advances in equipment and experience of interventional cardiologist, still there are rare complications occurred [1]. Iatrogenic injury of the aortic valve leaflet is a rare. Aortic insufficiency (AI) after a PCI suggests an iatrogenic valve injury. Aortic leaflet injury is not common but possible complication of PCI. Because of the serious consequences, it should be mentioned in the informed consent. Aortic repair of iatrogenic injury is possible, and it can be performed with excellent clinical and functional midterm results. So, Aortic valve replacement (AVR) is the last option [2].

Background: On 8 March, 2020, the Saudi Ministry of Education announced the closure of schools and universities around the Kingdom to control the spread of the coronavirus disease 2019 (COVID-19) as preventive and precautionary measures. On 18 March, 2020, Almaarefa University started the distance learning method for all students, including clinical medical students. This study aimed to assess the anxiety of college students with regard to the distance learning method in Almaarefa University during the COVID-19 pandemic. Methods: This study is a descriptive cross-sectional study. We distributed a closed-ended questionnaire to 149 students of Almaarefa University. The assessment of anxiety was carried out using the Generalized Anxiety Disorder 7-item (GAD-7) Scale. Results: One hundred and forty-nine students responded to an online questionnaire. The anxiety level, using GAD-7 Scale, was found to be moderate in 36.2%, mild in 32.2%, severe in 22.8%, and normal in 8.7%. Clinical phase students had the highest level of anxiety than basic science students and interns. The adaptive coping strategies used by students during COVID-19 were watching shows and movies (70.7%), sports and exercise (49.3%), cooking (48%), drawing (21.3%), developing new skills (38%), and attending educational webinars (36%). Conclusion: The anxiety levels of the 149 students of Almaarefa University were assessed via the GAD-7 Scale, which found that the highest level was the moderate level, followed by mild, severe, and normal levels. The adaptive coping strategies used by students during COVID-19 were mostly watching shows and movies, sports and exercise, and cooking. Future studies with a bigger sample size assessing the depression score are recommended.

Since the landmark paper from Loop et al. in 1986, the use of the left internal mammary artery (LIMA) for revascularization of the left anterior descending (LAD) artery is the standard of care in coronary artery disease. As such, the successful harvest of the LIMA is critical to the outcome of coronary artery bypass grafting. Described is the approach to harvesting a skeletonized LIMA; the decision between skeletonized and pedicled mammary harvest is beyond the scope of this technical chapter, but a surgeon should never hesitate to use either technique depending on their level of comfort or expertise. Skeletonized is associated with reduced incidence of sternal wound complications and medastinitis and is the preferred approach for patients undergoing bilateral internal mammary artery grafting.

Immune check point inhibitors (ICPIs) are a new class of anti-neoplastic agents being increasingly used by oncologists to treat various malignancies. These drugs have been associated with varied side effects and have a nephrotoxic potential. Many cases of ICPI induced acute kidney injury are increasingly being reported. Their use in CKD patients on dialysis as well as in kidney transplant recipients is associated with various challenges. This review discusses the use of ICPIs in CKD, dialysis and renal transplant patients and their nephrotoxic potential

In emergency situation, each and every second is important in saving a human’s life. The idea of this project is to use the each second protectively to save person. Now a days many life’s are being expired before the person reaches the hospital in ambulance or life is lost to lack of basic information about the condition of the patient and the delay caused due to this. In this project we have structure a protocol which could save every delays and save the life early. This project severs the delays caused by the more of basic information about the patient and delay caused by the ambulance at the traffic signals. The main theme of this project is that when the patient is in ambulance in emergency condition the ambulance should reach the hospital atmost fast and to send each and every least information and condition about the patient to for the priority arrangements for the treatment. It consists of two sections: the basic information and condition of patient is collected in the ambulance by the means IOT (Internet of Things) and make it available to hospital before ambulance reaches the hospital. The second path is control of traffic lights from the ambulance and makes free for its path automatically. This project is to save the time of major late time aspects in more efficient and financial manner and save the life.

Aims and objectives: The control of pulmonary tuberculosis (PTB) mainly depends upon prompt diagnosis and effective treatment which can be hindered by co-infections affecting organs like gastrointestinal system and liver involved in drug bioavailability and metabolism. Among those, Helicobacter pylori (H. pylori) causes chronic gastritis leading to peptic ulcer and related gastric malignancies and liver malfunctions induced by Hepatitis C virus (HCV) co-infections increase the risk of anti-tuberculosis drug-induced hepatotoxicity. The rates of Hepatitis C virus and Helicobacter pylori infections seem to increase day by day in pulmonary tuberculosis patients which need proper investigation followed by timely control and prevention form disease. Methods: The hospital-based study was performed in the area of Southern Punjab, Pakistan. The Tehsil Headquarter hospital in the area, where the study was conducted contained TB Clinic. Inclusion and exclusion criteria of suspected patients of pulmonary tuberculosis included in the study. A total of 132 subjects were screened for PTB, HCV and H. pylori infections for finding the role of co-infection. The positive PTB subjects were screened for HCV and H. pylori infections. Both infections (H. pylori and HCV) were also found among TB patients. Results: A total of 52.27% were positive for PTB in which 50.72% and 17.39% cases were found in H. pylori and HCV infections respectively. H. pylori had increased rate of infection among PTB cases when compared with that of non-TB cases. HCV was also found to be associated with PTB when compared with non-TB cases. Non-significant gender and age-based differences were present, among study population. Among all PTB patients, HCV and H. pylori coinfections were also found in 5.8% patients in current study. Conclusions: Our study showed a high prevalence of HCV and H. pylori infections among PTB patients, which suggest that PTB patients must be screened for the two infections which might be helpful in the control of further complications during the treatment of PTB.

Glaucoma an optic neuropathy is a caused by progressive retinal ganglion cell (RGC) loss associated with characteristic structural changes in the optic nerve and retinal nerve fiber layer (RNFL).Glaucoma induced damage causes the retinal ganglion cells loss that can result in functional loss and decrease in vision of patient . Measurement of intraocular pressure by Tonometery, characteristics of the optic nerve head changes and associated visual field loss are used for diagnosis of Glaucoma. Objectives: To determine the diagnostic accuracy of Optical Coherence Tomography in detection of glaucoma taking perimetry as gold standard. Study Design: Cross sectional (validation). Period: Six months from 17-02-2014 to 16-08-2014. Material and Method: Regarding the Inclusion Criteria patients of glaucoma suspects that meet the criteria mentioned in operational definition of either gender with age range between 35- 60 years were included while patients having refractive errors, hazy media, pupil size less than 4mm after dilation were not included in this study. Also patients with history diabetes mellitus, refractive or retinal surgery were also excluded. All the data was entered and analyzed by using SPSS V-16. Results: A total of 100 patients were included in this study during the study period .Majority of the patients were between 35-45 years of age and minimum patients were 56- 60 years old. Mean age of the patients was 47.10±8.02 years. Males and females were 50 (50%). At OCT glaucoma was present in 71 patients while at perimetry glaucoma was present in 69 patients .Sensitivity, specificity and diagnostic accuracy of OCT was 92.7%, 77.4%, 88.0%, respectively .Positive predictive value and negative predictive value of OCT was 90.1% and 82.7%, respectively. Discussion: Regarding the pathogenesis of Glaucoma induced damage is due to result of retinal ganglion cell (RGC) death with progressive loss of axons located in the retinal nerve fiber layer (RNFL). Many clinical studies showed that optic nerve head (ONH) damage and thinning of the RNFL occur earlier than the appearance of Glaucoma induced visual field defects; Conclusion: In conclusion, glaucoma suspects undergoing the OCT can be assessed for the presence of glaucoma based purely on the results of the OCT.

Rag pickers are marginalized section of our society. India grappling the problem of shelter particularly in the urban societies besides other socio economic problems likes other Asian countries. Children living and working on streets are bound to adopt substandard life style due to lack of basic facilities. As results their quality of life includes physical health, social and psychological functioning severely destabilized and tends to develop sense of insecurity, hopelessness, depression, anxiety etc. Therefore, the study was conducted on the adolescents engaged in rag picking on the streets of Delhi to measure their quality of life and its impact on future perspective thinking. For that purpose sixty rag pickers were taken incidentally from different localities of Delhi. The participants of were male and between the age range of 12 - 18 engaged in rag picking. Sixty adolescents not engaged in rag picking and living with the parents were also taken from the same locality. WHOQOL-BREF and Beck hopelessness scales (BHS) were administered on both the groups of participants to assess their quality of life and sense of hopelessness. The finding suggested that rag picker adolescents were found suffering from significantly poor quality of life as well as higher degree of hopelessness. Findings further indicated negative relationship between quality of life and sense of hopelessness. The living conditions and quality of life of such population appear to be miserable as they usually tolerate constant hunger and suffers from malnourishment, which make them vulnerable to health related problems. For the sake of survival, adolescents working on street and perform variety of jobs including the collection of plastic, aluminium, paper, and anything else that can be resold. Sometime they are also found to be engaged in begging. Their poor quality of life expose them too many health related risk and derive them to be involved in illegal activities like drug trafficking, organ trades, prostitution and slavery especially in metropolitan cities. Such type of situations makes their life complex which in turn develops many psychological problems such as anxiety, psychological trauma, alienation, and feeling of hopelessness as a result they become psychologically vulnerable as well. Psychologically, these children are deprived of love, affection and family's sympathy. As far as quality of life is concerned it is defined in many ways and its measurement and incorporation into scientific study is not steady or easy. The World Health Organization defines Quality of Life as 'The individual's perception of his or her position in life, within the cultural context and value system he/she lives in, and in relation to his or her goals, expectations parameters and social relations. Every culture has different factors affecting quality of life and measures psychological, physical, social as well as economic well-being of the individuals. The general concept of quality of life was basically overlapping with the traditional concepts of health and functional status. An ideal health assessment, therefore, would include a measure of the person's physical health, a measure of physical, social and psychological functioning, and a measure of quality of life. Poverty is one of the most serious social concerns across the world today. Among the poor, the most vulnerable section of the society is people living on the streets. Whether they are gangs of street youth or panhandling drifters, no society is unaffected by the social problem of homelessness. The existing literature on street children or adolescents strongly suggests that there are many problems associated with life without a home. Studies have shown that homelessness is also associated with behaviour problem in

The technical merit of the proposed method is using multiple techniques that fused in each processing part of filtering, segmentation, and features. The originality is to select the best technique depending on some measurements for implementation. Aiming for better enhancement of selected MRI of AlKindy Hospital Patients, as case study, to get efficient diagnose process is the purpose of the current technique using MATLAB that include smoothing, segmentation, feature extraction and classification. The method uses two filters (Median and Slantlet) and two segmentation methods are used (K-mean cluster and Morphological operation) and the area size is used in feature extraction. The experimental results classification is indicating that 50% of the used images are medium cases of brain tumor and 10% low stage both can be treated, while 40% is of high cases of brain tumor reflected that the treatment is difficult.

Purpose: The aim of the study was to evaluate the link between subclinical hypothyroidism (SCH) and erectile dysfunction (ED). Materials and Methods: Seventy-two male patients aged 23–41 years with SCH compared with 25 healthy matched subjects were recruited, and they were divided into Group A: healthy controls (n = 25), Group B: patients with SCH with ED (n = 43), and Group C: patients with SCH without ED (n = 29). Thyroid function test and hormonal assay included total testosterone (TT), sex hormone-binding globulin, free androgen index, and prolactin (PRL) were measured; erectile function was assessed by the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Results: Free triiodothyronine serum level and thyroid uptake were lower in patients with SCH with ED (240.31 ± 23.85 pg/dL) as compared with patients with SCH without ED or the controls (P = 0.008 and P = 0.004, respectively). Thyroid-stimulating hormone (TSH) serum levels differed significantly; they were normal in the control group (2.86 ± 1.86 mIU/L), higher in patients with SCH with ED (12.41 ± 4.73 mIU/L), and relatively low in patients with SCH without ED (7.32 ± 4.81 mIU/L) (P = 0.001). TT serum level was low in patients with SCH with ED as compared with the controls, but this level was high in patients with SCH without ED as compared with those with SCH with ED (P = 0.001). PRL serum level was high in patients with SCH with or without ED as compared with the controls (P = 0.001). IIEF-5 score was low in patients with SCH with ED (11.73 ± 5.79) as compared with the controls (P = 0.001, 95% confidence interval [CI] = 14.3985–7.8215) or patients with SCH without ED (P = 0.001, 95% CI = 13.1152–6.7448). Conclusion: SCH-induced ED is related to the elevated PRL and reduced TT and TSH serum levels more than 10 mIU/L. Furthermore, the high TSH serum level was linked with the low IIEF-5 scores; therefore, the severity of SCH is correlated with the severity of ED.

Vitiligo is a chronic acquired disease of pigmentation disorder. Melanocytes damage and hypopigmentation relate to the induction of oxidative and autoimmune disorders. Different previous studies illustrated the possible role of statins in the treatment of different types of vitiligo. Therefore, objective of this study was to elucidate the role of statins in the management of vitiligo. In general, an endeavor of this study article was to present a mini-review regarding the potential therapeutic effect of statins in the therapy of vitiligo. Results of the present study illustrated that statins inhibit the production of interferon gamma, expression of major histocompatibily complex, and T-cells activation in patients with active vitiligo. Statins have significant anti-inflammatory and immune-modulating activates in different modalities of vitiligo. Statins, have a potential effect against oxidative stress through the activation of anti-oxidant capacity and reduction of ROS in human melanocytes by upregulation of nuclear erythroid 2-related factor in the melanocytes. Statins improve melanogenesis in melanocytes though increasing tyrosinase mRNA production and augment the stimulatory effect of α-melanocyte-stimulating hormone from the pituitary gland on the melanocytes. Finally, statins therapy may produce significant inhibition of inflammatory reactions through the inhibition of chemokines. In conclusion, this study highlighted the potential role of statins in the treatment of vitiligo either systemic or localized through significant suppressions of oxidative stress, autoimmunity, and inflammatory reactions. Bidirectional effects of statins on oxidative and autoimmunity/inflammatory pathway making it as a novel therapy for vitiligo.

To assess the incidence of corneal haze following surface ablation in (PRK) in high myopic patients (≥6D). METHODS: In this prospective clinical study, 25 patients with high myopia (≥6D) that is 50 eyes in total, underwent photorefractive keratectomy by Schwind Amaris 500E laser machine. At the initial presentation, each patient underwent a detailed clinical evaluation that included recording of medical history, detailed ocular history, Snellen visual acuity testing, and thorough anterior segment by slit-lamp bio-microscopy and posterior segment examination with indirect ophthalmoscopy were done. Corneal topography and pachymetry were also done. The patient is followed up at 1week to observe for re-epithelialization and then at 1, 3 and 6 months for observation of haze under slit-lamp examinamination. RESULTS: In our study of 25 patients, that is 50 eyes in total were divided into 3 groups depending upon the spherical equivalence. Group 1 between 6.00-7.00D, group 2 between 7.00-8.00D, and in group 3 more than 8D (≥8.00D). Over 6months period of follow up a significant haze was noted as the patient’s refractive error increased. Out of 50 eyes, 11 eyes (84.6%) with spherical equivalence of 6.00-7.00D (group 1) had grade 0, 8 eyes (66.6%) with spherical equivalence of 7.00-8.00D (group 2) had grade 0, and 6 eyes (24%) with spherical equivalence ≥8.00D (group 3) had grade 0. Thus, the results show that there has been a significant decrease in the eyes with no corneal haze as the refractive error increased. Eyes with grade 1 haze in group1 were 2 (15.3%), group 2 were 3 (25%), and group 3 were 7 (28%). These results showed that the incidence of grade 1 haze increased with increase in spherical equivalence. Eyes with grade 2 haze in group 1 were 0 (0%), group 2 were 1 (8.3%), group 3 were 10 (40%). Thus, it is seen that grade 2 haze was not noted in eyes with spherical equivalence between 6.00-7.00D, but were noted with increase in the refractive error. Eyes with grade 3 haze in group 1 and 2 were 0, and group 3 were 2 (8%). Thus, the results show that as the refractive error of increases the incidence of haze and the degree of haze increases. The p value 6D), thus compromising the post-operative visual acuity. 2. With the use of intra-operative 0.02% Mitomycin-C (MMC) and post-operative topical corticosteroids, thus modifying the healing process and decreasing the incidence of haze in high myopic patients. 3. Thus, concluding that PRK can be an effective procedure in treating high myopic patient.

The effects of benidipine on oxidative stress and myocardial apoptosis were assessed in isoproterenol (ISO)-induced myocardial infarction (MI) in wistar rats.Animals were pretreated with benidipine (1, 3, 10 μg/kg/day Body weight) intravenously for a period of 28 days. After pretreatment, ISO (85 mg/kg Body weight, subcutaneous) was injected in rats at an interval of 24 h to induce MI. Myocardial oxidative stress, cardiac biomarkers, apoptosis, inflammatory mediators, and ultrastructural architecture of the cardiac tissue were assessed in ISO-induced MI in rats.Significant variation in the level of TBA, antioxidant enzymes (GSH, CAT, SOD, GPx, GRx, GST) in myocardium, cardiac biomarkers (CK-MB, LDH) in serum, Caspase-3, C-reactive protein (CRP), and alteration in ultrastructural architecture of cardiac tissue confirmed the cardiotoxicity induced by ISO. Pretreatment with benidipine preserved the lipid peroxide and antioxidant enzymes, and furthermore showed maintained levels of myocardial biomarker, CRP and caspase-3. Ultrastructure architecture of cardiac tissue was also found to be well preserved.The present study suggested cardioprotective effect of benidipine which may possibly be due to its antioxidant activity and antiapoptotic nature.

Background: Pancytopenia is an important hematological problem encounteredin our day-to-day clinical practice. The aim of our study was to evaluate clinical features andetiological pattern of pancytopenia at tertiary care settings in Abbottabad. Methods: Thisprospective study was conducted at Northern Institue of Medical Sciences (NIMS) and AyubTeaching Hospital Abbottabad from 25th August 2009 to 31st July 2010. A total of 85 patientsfulfilling the criteria of pancytopenia were randomly selected by time-based sampling.Pancytopenia was diagnosed by anemia (hemoglobin ≤ 10.0g/dl), leucopenia (WBC ≤ 4.0×109/L)and thrombocytopenia (platelets ≤ 150×109/L). All data has been entered and analyzed by SPSSversion 10.0. Results: Out of 85 patients, 62(72.94%) were males and 23(27.05%) females withM to F ratio of 2.69:1. The mean age (±SD) of males was 30.20±15.42 years, while that of females35.12±16.31 years (p=0.20). Among clinical features, anemia and generalized weakness werethe commonest (97.64%), followed by shortness of breath (88.23%). Majority 54(63.52%) hadnon-malignant disorders responsible for pancytopenia. Overall, the most common cause ofpancytopenia was aplastic anemia noted in 30(35.29%) cases, followed by megaloblastic anemia15(17.64%) and hypersplenism in 13(15.29%). Conclusions: On conclusion, aplastic anemiawas the most common cause of pancytopenia in our study predominantly affecting young adultmales. It

Bacterial vaginosis (BV) is an ecological disorder of the vaginal microbiota that affects millions of women annually, and is associated with numerous adverse health outcomes including pre-term birth and the acquisition of sexually transmitted infections. This study aimed to compare between the different methods (Amsel's, Nugent's, Spiegel's and PAP smears) of BV diagnosis. The results revealed that from the 100 patients It was observed that 48 (48 %) were BV positive, they met three or four of Amsel's criteria . 56(56%) were diagnosed with BV and 45(45%) had normal vaginal flora based on Nugents' score . comparison between Nugent's score and Amsel's criteria for diagnosis of BV showed a sensitivity 81% and specificity 75% . when diagnosis bacterial vaginosis by Spiegel's criteria observed that 24 (24 %) of the 100 cases, were BV positive while 76 (76 %) cases were BV negative while 57 (57 %) cases were BV negative by using pap smear including presence of Bacterail vaginosis with Trichomonas & candida 16 (16%) , Bacterail vaginosis with Trichomonas 20(20%) and Bacterail vaginosis only 7 (7%) in BV positive cases. The comparison between Nugent's score and Pap smears for diagnosis of BV had a sensitivity of 62% and a specificity of 81% .

Background: Metabolic syndrome (MetS) is a growing worldwide health problem. However, there is yet no effective therapy for MetS. The present work investigated the effect of liraglutide, a synthetic glucagon-like peptide-1 and vitamin E on fructose-induced MetS in rats. Summary: Liraglutide (0.3 mg/kg/day) and vitamin E (100 mg/kg/day) were administered either alone or in combination with high fructose-fed male rats for 6 weeks. Fructose-fed rats developed metabolic disorders assessed by visceral fat index, serum glucose, serum insulin, homeostasis model assessment-insulin resistance and serum lipids profile and hepatic disorders assessed by liver index, serum alanine aminotransferase and aspartate aminotransferase and steatohepatitis in histopathology. This study showed that liraglutide, vitamin E and their combination significantly ameliorated the fructose-induced metabolic and hepatic disorders. Key Messages: These results indicate a potential therapeutic benefit of liraglutide and vitamin E combination in prevention of MetS. Their protective effects might rely on their antioxidant effects as well as on the inhibition of tumor necrosis factor-α.

A total of 856 diabetic patients were evaluated for pharmacotherapy-based problems like for possible drug interactions, adverse drug reactions, and other mismatches, if any. Poor correlation between the advised insulin therapy and patients' fasting blood glucose levels (12%, n=103) was observed. To most of the patients (41.66%, n = 357), insulin therapy was advised in combination with glucocorticoides, thiazides diuretics, and propranolol. Prescribing beta blocker (propranolol) with insulin is contraindicated. The higher incidence of diabetic foot patients was in the mean age of 57±3.4 years that was controlled with combination therapy of insulin and oral antidiabetics (63.0%, n=516). 11.1% of the treated patients could not take the prescribed therapy due to poor acceptance of insulin therapy due to its syringe needle prick. 41.66% risks of potential drug interactions, 7.93% adverse drug reactions, and 6.6% mismatches were recorded, as per the international approved algorithm, for managing a diabetes mellitus that reflects poor health care system. All these events necessitate for coordinating with other health professionals to make the therapy safer in the better interest of the patients. It is concluded that in practice prescribing pattern carries more risks for patients. It is imperative to improve the practice of pharmacotherapeutics rather than to practice in routine.

Background Peritoneal dissemination of ovarian tumors is a major prognostic parameter in ovarian malignancies. Analysis of peritoneal washing cytology serves as a useful predictor of ovarian surface involvement and peritoneal metastasis even in the absence of clinical omental spread. The aim of the current study is to correlate peritoneal cytology with various histologic features of ovarian cancers in our setup. Methods A total of 60 cases of ovarian tumors were included in the study that underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omental and lymph node sampling during 2009 till 2014 at the Liaquat National Hospital, Karachi. Any free abdominal fluid was aspirated at the time of surgery. In the absence of free fluid, peritoneal washing was done with 50–100 ml of normal saline. Four cytospin preparations were done along with a cell block preparation. Correlation of peritoneal cytology with various histologic parameters was performed. Results Out of the 60 cases of ovarian tumors involved in the study, 56 were surface epithelial tumors, 2 germ cell tumors, and 2 metastatic carcinomas. The mean tumor size was 9.6 cm. Capsular invasion was seen in 61 % of the cases, and omental metastasis in 51 % of the cases. Serous carcinoma was found to have a significantly higher frequency of positive peritoneal cytology (76.9 %) compared to endometrioid and mucinous carcinomas (44 and 25 %, respectively). A significant positive correlation was seen between positive peritoneal cytology and capsular invasion and omental metastasis with a p value of

Association studies of interleukin-6 (IL-6) -174G>C polymorphism and chronic obstructive pulmonary disease (COPD) have yielded inconsistent results, possibly because single studies often lack sufficient statistical power. A comprehensive search was performed in the PubMed, Embase, Elsevier, Web of Science databases, Wanfang, and the Chinese National Knowledge Infrastructure (CNKI) databases for published studies investigating the associations between IL-6 -174G>C polymorphism and COPD. Odds ratios (OR) and 95% confidence intervals (95%CI) were used to assess the possible associations. Seven studies with a total of 2701 subjects were included in this meta-analysis. A significantly increased risk was detected in the C allele of the IL-6 -174G>C in Caucasians (C vs G: OR = 1.16, 95%CI = 1.03-1.30; CC+GC vs GG: OR = 1.21, 95%CI = 1.02-1.42; CC vs GG: OR = 1.32, 95%CI = 1.03-1.70). This meta-analysis suggests that the C allele of the IL-6 -174G>C might act as a COPD risk factor in Caucasians. Further well-designed case-control studies with larger sample sizes are needed to confirm these conclusions.

Preoperative chemotherapy in patients with primary breast cancer treated with anthracyclines and taxanes results in high response rates, allowing breast conserving surgery (BCS) in patients primarily not suitable for this procedure. Pathological responses are important prognostic parameters for progression free and overall survival. We questioned the impact of histologic type invasive ductal carcinoma (IDC) versus invasive lobular carcinoma (ILC) on response to primary chemotherapy. 161 patients with breast cancer received preoperative chemotherapy consisted of epidoxorubicin 75 mg/m2 and docetaxel 75 mg/m2 administered in combination with granulocyte-colony stimulating factor (G-CSF) on days 3–10 (ED + G). Pathological complete response (pCR), biological markers and type of surgery as well as progression free and overall survival were compared between IDC and ILC. Out of 161 patients, 124 patients presented with IDC and 37 with ILC. Patients with ILC were less likely to have a pCR (3% vs. 20%, P

Fulvestrant (Faslodex) is a new oestrogen receptor (ER) antagonist with no agonist effects. This report describes the experience of a single centre including 126 postmenopausal women with advanced breast cancer (ABC) in a fulvestrant Compassionate Use Programme. All patients had previously received endocrine treatment for early or ABC. Patients received fulvestrant as first(n = 7), second- (n = 51), third- (n = 50) or fourth-line endocrine therapy (n = 18) for ABC (median duration of treatment: 4 months [range 3–27 + months], follow-up: 13 months [range 1–38 + months]). Twelve patients had partial responses (PR) and 43 patients experienced stable disease (SD) P6 months (objective response rate: 9.5%; clinical benefit [CB] rate: 43.6%). Ten of 12 patients with a PR had HER2-negative tumours, and 9/12 had ER-positive and progesterone receptor (PgR)-positive disease (two patients had unknown HER2 status and one had unknown ER and PgR status). Nine of the 18 patients with HER2-positive tumours experienced CB with fulvestrant. Although CB rates were similar when fulvestrant was given as first- to fourth-line endocrine treatment, the proportion of those experiencing CB who had a PR appeared to decrease when fulvestrant was used later in the sequence. Fulvestrant was well tolerated; six patients experienced adverse events (all grade I/II). These data demonstrate that fulvestrant is an effective and well-tolerated therapy for patients with ABC progressing on prior therapies. 2005 Elsevier Ltd. All rights reserved.

The objective of this pilot trial was to evaluate the safety and activity profile of epidoxorubicin, docetaxel and oral capecitabine plus pegfilgrastim (TEX+P) as preoperative first-line treatment for patients with breast cancer. Eleven consecutive patients were enrolled in this prospective clinical pilot trial. Preoperative treatment consisted of epidoxorubicin [75 mg/m2 body surface area (BSA)] and docetaxel (75 mg/m2 BSA) administered sequentially on day 1 in combination with oral capecitabine 2000 mg/m2 daily divided into two doses on days 1-14 of each 3-week treatment cycle. Pegfilgrastim 6 mg fixed dose was administered s.c. on day 2 of every treatment cycle. Patients received a total of 58 cycles (median 6 cycles, range 1-6) of this therapeutic regimen. Outpatient TEX+P was well tolerated. No WHO grade IV toxicity was observed. A pathological major response to this preoperative therapy regimen could be demonstrated in eight of nine evaluable patients leading to breast-conserving surgery in seven of nine evaluable patients. We conclude that outpatient TEX+P is safe in the neoadjuvant treatment of patients with primary breast cancer. Thus, this regimen can be considered for further clinical trials.

PURPOSE: Preoperative chemotherapy in patients with primary breast cancer results in high response rates, allowing breast-conserving surgery in patients primarily not suitable for this procedure. Tumors of patients with histologically proven breast cancer that fail to respond to preoperative chemotherapy are thought to be chemotherapy resistant. We questioned this hypothesis and treated 13 patients who did not respond to preoperative anthracycline-containing first-line treatment. PATIENTS AND METHODS: Eight patients received a combination therapy consisting of epidoxorubicin and docetaxel as neoadjuvant first-line treatment and were treated with CMF as preoperative second-line chemotherapy. The other five patients did not respond to first-line FEC and were given paclitaxel or docetaxel as second-line treatment. RESULTS: A major response to treatment was observed in 10 of 13 patients (77%) during preoperative second-line therapy: one patient (8%) achieved pathological complete response (pCR) and nine patients (69%) partial response (PR). Three patients (23%) had stable disease (SD), and no patient had progressive disease (PD). Eight patients (62%) could undergo breast-conserving surgery. CONCLUSIONS: We conclude that it is possible to achieve objective responses including pCR with potentially non-cross-resistant neoadjuvant second-line therapy, leading to breast-conserving surgery in a high proportion of patients. Thus, preoperative second-line chemotherapy appears to be justified when breast conservation is an important treatment goal and may have potential in improved tailoring of neoadjuvant treatments.

Immunocompromised patients are susceptible to many pathogens, including those that are predominantly problems in veterinary medicine. We report a case of a 42-yr-old white male who presented 19 months post-cadaveric renal transplant (for IgA nephropathy) with a 5 d history of nausea, vomiting, abdominal cramping and diarrhea. Admission chest X-ray revealed a suspicious mass lesion in the left lower lobe. Computed tomography (CT) guided biopsy of the lesion showed a large zone of CD68 +ve histiocytes in a non-caseating granuloma. Gram stain revealed multiple gram-positive rods within the histiocytes, which were eventually identified as R. equi. After 4 months of therapy with fluoroquinolones (Avelox) and Azithromycin a repeat CT showed complete resolution of the lesion. We reviewed the literature with special focus on the clinical features, challenges in diagnosis, and treatment of this rare infection (especially in the transplant patients who are also on immunosuppressive therapy).

This prospective trial aimed to evaluate the therapeutic effects and systemic toxicities of capecitabine monotherapy and capecitabine treatment combined with biological response modifiers in patients with metastatic renal cell carcinoma. Fifty-four patients suffering from metastatic renal cell carcinoma progressing under first-, second- or third-line treatment entered the trial. Capecitabine was given orally at a dose of 2500 mg/m2 daily divided into two doses for 14 days, followed by a 7-day rest in the monotherapy as well as in the combination treatment. This schedule was repeated in 3-week cycles. The combination therapy consisted of capecitabine and an immunotherapy treatment, which consisted either of interferon (IFN)-gamma1b (100 mg/day) administered consecutively 5 times weekly during weeks 1 and 2, and recombinant interleukin (IL)-2 (4.5 MU/day) administered on 4 consecutive days during weeks 3 and 4, every 6 weeks, or IFN-alpha (6 MioIE/day) administered 3 times a week. Fifty-two patients are now evaluable for response and 54 patients for toxicity. We observed a partial response to treatment in five patients (9.6%), minor response in five patients (9.6%), stable disease in 32 patients (61.6%) and only 10 patients (19.2%) showed continued disease progression despite treatment. Outpatient capecitabine was well tolerated. We did not observe any WHO grade IV toxicities. We conclude that capecitabine monotherapy and capecitabine treatment in combination with biological response modifiers appear to be effective regimens with favorable toxicity profiles in patients with advanced renal cell carcinoma. Capecitabine monotherapy seems to be superior than the combination treatment because of its easier application form.

Heart related problems are the major health issues for the human. Almost 1 in every 4 death is mainly due to the heart problems. Most of the people death due to heart problems is due to poor monitoring.To address this issue this project has been designed. The main aim of this project is to measure the heart rate of an elderly people and to alert the care taker when the heart rate is abnormal. The innovation done in this project is measuring the force of the heartbeat at the wrist and thereby measuring the heart rate. The component used to measure this heart rate is FSR(Force Sensitive Resistor).This device can be implemented by means of wrist watch or wrist band. It also monitors the heart rate of the people for 24 hours

Seeds of the Mucuna pruriens plant, now known to contain L-DOPA, have long been used for the treatment of Parkinson's disease patients in ancient Eastern Indian ethnotherapeutics. Following validation of the intrastraital 6-OHDA injection with amphetamine in the parkinsonian rat model, the animals were fed synthetic L-DOPA (125 or 250 mg/kg) or Mucuna pruriens endocarp (MPE, 2.5 or 5.0 g/kg) mixed with rat chow (n =6, for each dose and drug). Controls received no drug. An additional dose of L-DOPA or MPE in the same doses plus carbidopa (50 mg/kg) were administered via gavage (controls received only carbidopa 50 mg/kg) 1 h prior to testing with rotometer. Contralateral rotation (to the side of the 6-OHDA lesion) (CLR) was recorded for 240 min as a measure of antiparkinsonian activity. Results indicated that dose for dose, MPE showed twice the antiparkinsonian activity compared with synthetic L-DOPA in inducing CLR in the parkinsonian animal model. This study suggests that MPE may contain unidentified antiparkinsonian compounds in addition to L-DOPA, or it may have adjuvants that enhance the efficacy of L-DOPA. © 1997 John Wiley & Sons, Ltd.

Glycyrrhizic acid (GA), a triterpenoid saponin glycoside from the roots and rhizomes of licorice is used in traditional and modern medicine for the treatment of numerous medical conditions including skin diseases and beauty care product. In the present study, we investigated the effect of GA against ultraviolet B (UVB) irradiation-induced photoaging in human dermal fibroblasts (HDFs) and its possible mechanism of action. HDFs were subjected to photoaging by sub-toxic dose of UVB (10 mj/cm(2)) irradiation. Cell viability, matrix metalloproteinase 1 (MMP1), pro-collagen 1, cellular and nuclear morphology, cell cycle, intracellular reactive oxygen species (ROS), caspase 3 and hyaluronidase inhibition assays were performed. Western blotting was used to evaluate the expression of NF-kappa B (NF-κB) and cytochrome-C proteins. GA treatment significantly inhibited photoaging. It achieved this by reducing ROS, NF-κB, cytochrome c, caspase 3 levels and inhibiting hyaluronidase enzyme. The main mechanism seems to be, most likely by blocking MMP1 activation by modulating NF-κB signaling. These findings may be useful for development of natural and safe photoprotective agents against UVB irradiation.

Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin and is often associated with autoimmune diseases. A 3-year-old healthy Omani child presented for evaluation of asymptomatic hard nodule on the left upper eyelid. Pathological examination identified the mass as subepidermal calcified nodule. The patient had no history of trauma or metabolic disturbances. Serum levels of calcium and phosphate were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for eye lid mass.

Background At many centres tumour markers are used to detect disease recurrence and to monitor response to therapy in patients with advanced disease, although the real value of serial observation of marker levels remains disputed. In this study, we evaluated the prognostic value of tumour markers for predicting response (partial response [PR], stable disease [SD] ≥ 6 months), de novo disease progression (PD) and secondary PD in patients receiving fulvestrant ('Faslodex') 250 mg/month for the treatment of metastatic breast cancer (MBC). Methods Changes in cancer antigen 15–3 (CA 15-3) and carcinoembryonic antigen (CEA) were prospectively monitored (monthly) and were also evaluated for the 3 months preceding secondary PD. Data from 67 patients with previously treated MBC participating in a Compassionate Use Programme were analysed. Results In patients with a PR (n = 7 [10.4%]), a non-significant increase in CA 15-3 occurred during the first 6 months of treatment; CEA was significantly reduced (P = 0.0165). In patients with SD ≥ 6 months (n = 28 [41.8%]), both CA 15-3 (P < 0.0001) and CEA (P = 0.0399) levels increased significantly after 6 months treatment. In those experiencing de novo PD (n = 32 [47.8%]), CA 15-3 increased significantly (P < 0.0001) after 4 months; CEA also increased significantly (P = 0.0002) during the same time period. Both CA 15-3 (P < 0.0001) and CEA (P < 0.0001) increased significantly in the 3 months preceding secondary PD. Conclusion CA 15-3 increases in patients progressing on fulvestrant but may also increase in those experiencing clinical benefit; this should not be taken as a sign of PD without verification. Overall, both CA 15-3 and CEA appear to be poor prognostic markers for determining progression in patients receiving fulvestrant.

We evaluated Darbepoetin alpha (Aranesp; Amgen), a novel erythropoietic protein, in patients who developed anemia while receiving chemotherapy. Seventy-five patients (median age 62 years, range 40-81 years) undergoing different cancer chemotherapy regimens were treated with darbepoetin alpha. Therapy was started if hemoglobin (Hb) levels fell below 10 g/dl or if symptomatic anemia developed. Treatment effect was evaluated after 4 weeks, 8 weeks and at the end of therapy (up to 12 weeks). If no increase in Hb was seen after 4 weeks, the dose of darbepoetin alpha was increased to 300 microg. Patients were questioned about fatigue and any change during treatment, with evaluation according to a four-point scale, where 0 = no fatigue and 3 = severe fatigue. We observed a treatment response in 54 of 75 patients (72%). Dose escalation was necessary in 30 of 75 patients (40%) and blood transfusions were required in 13 of 75 patients (17.3%). Response was observed in 32 of 43 patients (74.4%) who had a baseline Hb10 g/dl and in 22 of 32 (68.8%) patients who had a baseline Hbor =10 g/dl. At baseline, 60 of 75 patients (93.3%) reported fatigue of grade 2 or 3, but at the end of the 12-week follow-up period, only 26 of 68 patients (38.3%) reported fatigue at these levels. We conclude that darbepoetin alpha is a highly effective and well-tolerated drug in the treatment of chemotherapy-associated anemia. Patients benefited both in terms of Hb levels and control of chemotherapy-related symptoms.

Introduction: We evaluated the efficacy of oral vinorelbine (OV) (Navelbine oral® Boeringer-Ingelheim Austria) in patients with advanced breast cancer as first-line therapy or after progressing under earlier line chemotherapies alone or in combination with trastuzumab (T). Patients and methods: Seventy-eight patients [median age: 63.5 years (y), range (r): 38–84 years] were included into this trial. Patients with her-2/neu positive tumours received a combination of OV and T. Treatment effect was evaluated every three cycles and treatment continued until progression. OV was administered in a dose of 60 mg/m2 on day 1 and 8, q = 21 days, and no dose escalation to 80 mg/m2 was performed. Results: We observed a complete response in 5.9% of patients, partial remission in 22.1%, stable disease (SD) > 6 months in 33.8%, SD < 6 months in 2.9%, and progression despite treatment in 35.3%, respectively. Time to progression was 6 months (range 1–23+). The main toxicities consisted of nausea/vomiting (N/V) and neutropenia. Grade IV neutropenia was found in 5 patients (6.4%), grade III in 6 patients (7.7%) and grade I and II in 11.5%. We did not find any grade IV N/V in our patients, however, grade III N/V was observed in 3.8%. No other grade III and IV toxicities were reported. Conclusion: OV appears to be effective in the treatment of advanced breast cancer at the dose and schedule chosen. It is well tolerated, effective, and the oral formulation is an advantage for the patients as well as for the nursing staff.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

More than 850 patients’ medication history forms were evaluated, retrospectively, for possible irrationalities in the prescribing pattern of antibiotics for management of hospitalized diabetic foot cases. Primary anti-diabetic therapy included insulin, oral anti-diabetic, or combination of both. Supportive therapy included antibiotics for diabetic foot cases and other physical measures like routine wound dressings and washing. Antibiotic therapy was analyzed based on the reported medical literature. It was deduced that in addition to other supportive measures advised for the management of diabetic foot, the antibiotic therapy for management of diabetic foot (n=410) was in the order of ceftriaxone (83.3%) > co-amoxiclav (36.66%) > clindamycin and cipros oxacin (26.66%) > cefuroxime and levos oxacin (10.0%) > clarithromycin and cefoperazone / sulbactam, cephradine and fusidic acid (6.6%) > cefotaxime sodium and oxytetracyclin (3.33%). Placing ceftriaxone as a Þ rst choice (83.3%) in the antibiotic therapy carries no logic as ceftriaxone has low activity against reported higher incidence (85 %) of gram-positive organisms such as Staphylococcus aureus and streptococcus species. Prescribing irrationality of antibiotics is a global phenomenon that shall be addressed right from the medical/pharmacy schools levels. Key words : Antibiotic, ceftriaxone and co-amoxiclav, diabetes mellitus, diabetic foot, mean age.

730 Background: Tumor markers are often used to monitor response to therapy in patients with metastatic breast cancer (MBC) and a surge in tumor markers after 3 months of treatment may be a sign of de novo disease progression (PD). Here we evaluated the prognostic value of tumor markers at predicting response and secondary progression during fulvestrant (‘Faslodex’) therapy. Methods: Patients with MBC were treated with fulvestrant 250 mg/month as part of a Compassionate Use Program. Changes in cancer antigen 15–3 (CA 15–3) and carcinoembryonal antigen (CEA) were prospectively monitored on a monthly basis in patients experiencing a partial response (PR), stable disease (SD) ≥6 months and de novo PD. Levels of these markers were also retrospectively evaluated for the 3 months preceding secondary progression in patients who had previously experienced clinical benefit (CB) with fulvestrant. Results: Tumor markers were monitored in 67 patients; seven patients (10.4%) had a PR, 28 patients (41.8%) had SD ≥6 mon...

8206 Background: Neutropenia is common in patients with cancer who receive myelosuppressive chemotherapy (CT) and contributes to therapy induced morbidity and mortality. In regimens with known high...

708 Background: FUL is an estrogen receptor (ER) antagonist for the treatment of postmenopausal women with hormone-dependent advanced breast cancer (ABC). Our pilot study evaluated the efficacy and safety of FUL in premenopausal women with hormone-sensitive ABC rendered postmenopausal with continuous GOS treatment. Methods: This prospective trial included 14 patients (pts) with ER and/or progesterone receptor-positive ABC. 2 pts were human epidermal growth factor receptor 2-positive (HER2+). Pts received at least 3 doses of FUL 250 mg i.m. q 4 weeks and continued to receive GOS 3.6 mg sc q 4 weeks until disease progression or intolerability. Tumor assessment and evaluation of time to disease progression (TTP) occurred every 3 cycles. Results: 14 pts (median age 41 years, range 28–49) were included in this evaluation. 1 pt received GOS + FUL as 1st-line therapy, 7 as 2nd-, 5 as 3rd-, and 1 as 4th-line treatment, respectively. 11 pts (78.6%) had received adjuvant chemotherapy and 8 pts (57.1%) adjuvant endo...

626 Background: Oral vinorelbine (OV) is a new formulation of well known iv vinorelbine (V). We evaluated the effect of this drug in patients (pts) with advanced breast cancer (ABC) as first line chemotherapy (CT) or beyond first line alone or in combination with trastuzumab (T). Methods: 53 pts (median age: 60 years, range : 38–83) suffering from ABC were treated with OV. 1st line: 24 (45.3%), 2nd line: 18 (34%), 3rd line: 9 (17%), 4th line 1 (1.9%), 5th line: 1 (1.9%). 26 pts underwent prior adjuvant CT (49%), and 34 (64.2%) received prior hormone therapy. Her2-Status was evaluated in all pts. Those positive received a combination of OV and T. 23 pts (43.4%) had bones/soft tissue metastases, 9 (17%) had visceral metastases and 21 (39.6%) had both. The effect of OV was evaluated with CT-scans after three months (m), and treatment was continued until progression. OV was administered at a dose of 60 mg/m2 on day 1 and 8, q 21 days. Results: 25 pts in the OV group are now available for response. We observed...