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Background: Tyrosine kinase inhibitors (TKI’s) revolutionized the treatment of chronic myeloid leukemia (CML). Aim: To compare the efficacy and safety between two Tyrosine Kinase Inhibitors among Pakistani population. Study Design: Randomized control trial. Methodology: Patients (n=124) were enrolled through simple random sampling. Prognostic scores were calculated for each patient. The institutional ethics committee of HFH approved this study protocol. Written informed consent was taken. Patients were randomly assigned to nilotinib 600 mg or imatinib 400 mg. The first analysis was done at 12 months of treatment. The second analysis was conducted after patients completed 24 months of therapy with TKIs. A consent form was signed by the participant before taking data. The basic end point was the rate of complete cytogenetic response (CCyR; 0% Ph+ metaphases by cytogenetics) at 12 months. Data was evaluated by using SPSS version 23. Chi-square test was applied with p-value of less than 0.05 was considered significant. Results: Nilotinib proved superior over imatinib in achieving complete cytogenetic response (94% vs 79%) with significant p-value. Both drugs showed similar risk profile to those from other international studies. Conclusion: It was concluded that Nilotinib proved clear benefit over imatinib in achieving higher rates of cytogenetic response in our study. The risk of events was comparable with imatinib and nilotinib; but each one showed different kinds of adverse events. Keywords: Chronic Myeloid Leukemia, Tyrosine Kinase Inhibitors and Cytogenetic Response.

Background: Chromosomal translocation is a common cause among hematological malignancies thus. a different diagnostic and treatment approach is required in these cases. Aim: To determine frequencies and clinic-hematological features of different hematological malignancies among patients. Methodology: It was a descriptive cross sectional study. Patients (n=284) with hematological malignancy were enrolled from total 1080 bone marrow biopsies. Detailed history, clinical examination and hematological parameters were recorded at time of presentation. Bone marrow aspiration and trephine biopsy were done as per the clinical indication. Data was evaluated by using SPSS version 23. Chi-square test was applied with p-value of less than 0.05 was considered significant. Results: The study showed the high percentage of hematological malignancies (24%) were observed among enrolled patients with CML being the commonest cancer among them. Practical Implication: This study established the clinic-hematological correlation and provided study based suggestions for better diagnosis and treatment of hematological malignancies while using bone marrow microscopic examination as an important diagnostic tool. Conclusion: It was concluded that acute leukemias were common in younger age whereas chronic leukemias and lymphoproliferative disorders in more advanced ages. Keywords: Hematological Malignancies, Bone Marrow Examination and Diagnosis.

The issue with the overlapping clinical symptoms from an electronic cigarette (e-cigarette) or vaping product use-associated lung injury (EVALI) and coronavirus disease 2019 (COVID-19) sometimes leads to incorrect diagnosis and, consequently, wrong treatment regimen. The purpose of this review is to study the burden of vaping-associated health consequences on the diagnosis and treatment of COVID-19 in young adults and adolescents with a misconception of e-cigarettes as a safer alternative to smoking. The online reference databases, including PubMed, Google Scholar, Web of Science, Medline, and Centers for Disease Control and Prevention (CDC), were used in the literature search, as we analyzed the complexity of timely diagnosis and treatment in the current COVID-19 era with the use of e-cigarettes. This study briefly describes the dysbiosis of the oral microbiome in e-cigarette users that could potentially aggravate the COVID-19 symptoms and lead to the complexity of timely diagnosis and treatment. Additionally, the patient case reports with a history of vaping and symptoms similar to COVID-19 disease are reviewed.

Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection causes life-threatening respiratory illness, which has caused significant mortality and morbidity around the globe. Coronavirus disease 2019 (COVID-19) causes mild respiratory illness in most infected individuals; however, in some patients it may progress to sepsis, acute respiratory distress syndrome (ARDS), cytokine release syndrome (CRS), and multiorgan dysfunction (MODS), which results in intensive care unit (ICU) admissions and increased fatalities. Recent evidence shows that most of these comorbidities associated with COVID-19 infection are associated with dysregulation of the host immune response. Vitamins C and D have been shown to regulate immune response by decreasing the proinflammatory cytokine release from immune cells and inducing proliferation of other immune cells to robustly fight infection. This review critically evaluates the current literature on vitamins C and D in modulating an immune response in different diseases and their potential therapeutic effects in preventing complications in COVID-19 infection.

Background: Management of temporary ileostomy cases is very important considering the outcomes. Objective: The purpose of the present study was to observe the surgical complications of temporary ileostomy patients. Methodology: This prospective cohort study was conducted in the Department of Surgery at Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh over a period of six months from July, 2011 to December, 2011. All patients who had undergone temporary ileostomy after admission were selected as the study population. Patients with temporary ileostomy at any age in both male and female were included in this study. The surgical complications like prolapse, retraction, stenosis, necrosis, skin excoriation, parastomal hernia, bleeding and wound infection were recorded. Result: A total number of 100 patients were selected for observation and management of complications of temporary ileostomy. Their ages ranging from 15 to 65 years with mean age 33.9±11.92 years. Complications were developed in majority cases of cases (52.0%). Several systemic complications were recorded like electrolytes imbalance (31%), hypoproteinaemia (14%), RTI (6%) and significant weight loss (4%). Skin excoriation was the more frequent local complication developed in 32 (32%) patients. However, 36 patients developed laparotomy wound related complication. Conclusion: In conclusion high frequency of complications are found among the temporary ileostomy patients. Journal of Current and Advance Medical Research, January 2021;8(1):65-69

Introduction: Neo adjuvant chemotherapy is increasingly being employed in breast cancer to reduce tumour size & down stage axilla. To reduce false negative rates in axillary lymph nodes after down staging with chemotherapy and to improve axillary conservation ultrasound guided clips were placed in involved axillary lymph nodes prior to commencement of NACT. The study aimed at whether preoperative lymph node clipping had any benefit in identification of lymph node after NACT.Methods: This is a single centre study of 55 patients (Mean age 53 years) with invasive breast cancer with biopsy proven involved lymph nodes (T1-3 N1) who underwent ultrasound guided axillary marker clip insertion before start of NACT. If Post chemotherapy imaging showed normal lymph nodes patients underwent SLNB with additional Lymph Nodes sampled to achieve a total of 4 lymph nodes. All sampled nodes were x rayed at the time of surgery to identify marker clip.Results: We had no procedure related complications with insertion of marker clip in any patients. The median number of nodes was 4.0. Average lymph nodes retrieved was 4.9. SLNB was identified in 47/55 patients (85.5%). Median number of sentinel nodes was 3.0 (Range 1-7) Marker was identified in 41/55 patients (74.5%) 30 (54.5%) patients had marker in sentinel node and 11 (20%) patients had marker in non-sentinel node. Histologically clip was reported in 21 (51.2%) patients. Overall pathological complete response (pCr) in axilla was seen 31/55 (56.45%). Tumours with Her2 over expression showed pCr in axilla 83% n=19/23 while triple negative tumours showed pCr in axilla 64% n=9/14. Er+ Her2- tumours showed low pCr rate 16.7% n=3/18. Completion axillary clearance was performed in 14/24 patients and 10/24 received radiotherapy to axilla.Conclusions: Clips in axillary lymph nodes are safe & relatively easy to deploy without any increased morbidity. Our clip identification rate (74.5%) co relates with other well-known publications (Caudel et al 80%, Z1071-76%). Our study findings validate that clip placement improves the identification of involved lymph nodes and hence improve the accuracy of limited axillary dissection in staging axilla. Citation Format: Mohammad Bilal Elahi, Raouef Ahmed Bichoo, Kartikae Grover, Eiman Khalifa, Naila Bint Ihsan, Peter J Kneeshaw, Brendan Paul Wooler, Dorin Dumitru, Ronjabati Roychaudhury, Ayesha Rahman, Tapan Kumar Mahapatra. Clipping of involved axillary lymph nodes before Neo adjuvant chemotherapy may improve in identification rates & staging of axilla in breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-55.

Plectranthus amboinicus is widely recognized as a potential source of antimicrobial compounds due to the presence of bioactive components (essential oils) secreted by the glandular trichomes borne on the leaves. As such, an understanding of the effect of leaf development on the production of these essential oils (EOs) is of crucial importance to its medicinal applications. The current study represents the first comparative investigation of the effect of different stages of leaf development (lag, log, and stationary phase) upon the yield and bioactivity of phytochemicals produced. The effects of leaf extracts on the antimicrobial activity, cell surface hydrophobicity, biofilm formation, and motility of P. aeruginosa and Staphylococcus aureus were evaluated. Cryo-scanning electron microscopy was used to record the abundance and distribution of both glandular and non-glandular trichomes during leaf development. Gas chromatography-mass spectrometry analysis revealed that the potent phytochemical thymol is present primarily in log (30.28%) and stationary phase (20.89%) extracts. Log phase extracts showed the lowest minimum inhibitory concentration (25 mg/ml) when compared to other phases of development. Stationary phase extracts were shown to exhibit the highest biofilm dispersal activity against P. aeruginosa (80%), and log phase extracts against biofilms of S. aureus (59%). Log phase extracts showed the highest biofilm inhibitory activity against P. aeruginosa (66%) and S. aureus (63%). In conclusion, log phase leaf extracts of P. amboinicus exhibited a multimodal mechanism of action by displaying antimicrobial, antibiofilm activities and reducing the motility and hydrophobicity, which are important virulence factors in P. aeruginosa and S. aureus pathogenesis.

Background: Esophageal cancer is one of the most serious gastrointestinal cancer worldwide, owing to its rapid development and fatal prognoses in most cases. There is a paucity of published data regarding esophageal cancer the study area in particular. This study was conducted to describe the endoscopic and clinicopathological patterns of esophageal cancer in this part of the world. The study provides baseline local data for future comparison. Objectives: The present study is done to highlight the increasing incidence of oesophageal cancer in the population. Methods: Detailed informations were obtained in each cases according to protocol. Complete history was taken either from patient or accompanying attendants. Thorough clinical examination was done. Relevant investigation reports were collected. All the informations were recorded according to fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using SPSS version 19. Results: Among the 50 cases, mean age was 52.92(±10.60) years, minimum age was 30 years and maximum age was 80 years. Maximum 76% were male and 24% were female, male: female ratio was 3.17:1. Socio-economic status of the study population, majority 48% were of lower middle class and 40% were of lower class. Common clinical presentations were dysphagia, regurgitation, significant weight loss and nausea and vomiting which were 100%, 96%, 80% and 14% respectively. Common personal history were smoking, white tobacco chewing, betel nut, betel leaf and alcohol consumption which were 66%, 20%, 92%,92% and 10% respectively. Anatomical site of oesophageal cancer, 48% were middle and lower third oesophageal cancer each. Histopathological type of oesophageal cancer, majority 56% were squamous cell carcinoma of different grades and 40% were adenocarcinoma of different grades. Common clinical staging (TNM) of the oesophageal cancer, T2 disease was 58% followed by T3, 26% and T1, 6%. Considering nodal status most of the cases were NO, 60% with Ni, 24% and N2, 16%. Regarding metastasis, only 18% cases had evidence of metastasis. Regarding treatment options of the esophageal cancer, majority 76% were selected for operative procedure, 10% for chemotherapy, 2% for radiotherapy and the rest of 12% for palliation. Conclusion: In conclusion, common clinical presentations of oesophageal cancer were dysphagia, regurgitation, significant weight loss and nausea and vomiting. Predominant personal history were smoking, white tobacco chewing, betel nut, betel leaf and alcohol consumption. Most of the oesophageal cancers were middle and lower third. Majority of oesophageal cancers were squamous cell carcinoma of different grades. Regarding TNM staging most of the oesophageal cancers were T2 disease. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 69-76

COVID-19 has caused significant morbidity and mortality around the world. However, it has been noticed that case-fatality rates have been significantly higher in Europe and North America compared to the Asia, Middle East and Africa. This could be due to several factors which include average age of the population, testing and tracing facilities, social distancing measures and difference in immunogenic response to SARS-COV-2. In this report, we have discussed the factors which may affect a population to develop herd immunity against COVID-19. We have hypothesized here that frequent prior exposure to other coronaviruses in Asian population might impart partial immunity to COVID-19. This may be the reason for significant lower number of case fatalities seen in this region compared to the west. We, therefore, propose molecular immunological studies to correlate prior exposure to coronaviruses with disease severity. This will help us to develop therapeutic targets to treat severe infection with COVID-19.

Background: "Portsmouth" modification of POSSUM (P-POSSUM) scoring system used to assess mortality in general surgical patients and “Colorectal” Cr-POSSUM scoring system used for mortality assessment for colorectal patient. Objective: The purpose of the present study was to estimate the validity of the P-POSSUM (Portsmouth-POSSUM) and Cr-POSSUM (Colorectal-POSSUM) score in predicting the risk of mortality in colorectal cancer patient. Methodology: This was single centre clinical trial was carried out in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2013 to April 2014 for a period of six (06) months. Patients of both sex who got admitted in the surgery in-patient department for elective colorectal cancer operations were selected as study population. Both the P-POSSUM and Cr-POSSUM, physiological score, operative score, predicted mortality rate were calculated using an online POSSUM calculator. Based on both P-POSSUM and Cr-POSSUM Scoring, patients were categorized into three risk groups. Then a comparative analysis was performed between the observed and the predicted values as well as the Observed/Predicted ratio (O:P) in all the risk groups. Results: A total of 50 patients with the median age of 50 (ranging 20 to 72) years were studied. 30 days overall observed mortality was 3(6%) patients. The mean P-POSSUM and C-POSSUM physiological scores were 32.49±2.08 and 13.92±1.30 respectively. However, the operative score was 11.59±1.46 and 8.12±0.24 in P-POSSUM and C-POSSUM respectively. The overall mortality predicted by the P-POSSUM model was 5 patients (19.33±2.87) and mortality predicted by the Cr-POSSUM model was 4 patients (20.66±4.09). Conclusion: In conclusion both model accurately predicted the risk of postoperative death. Cr-POSSUM provided a better fit to observed results than P-POSSUM. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 118-123

Background: Acute appendicitis is one of the important causes of emergency surgeries. Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. Complete blood count is the primary investigation for any inflammatory condition. Total WBC count and neutrophil percentage are widely used biomarkers to diagnose acute appendicitis. Mean platelet volume (MPV) is an emerging biomarker that has been considered to be affected by inflammatory burden. MPV value is also estimated during complete blood count. This study may help to reveal the change of MPV in acute appendicitis. Study design: This was a prospective observational type of study. Study setting and period: The study was carried out in the Surgery In-patient Department of Dhaka Medical College Hospital, Dhaka from 15-11-2013 till 15-04-2014. Materials: A total of 150 patients of both sex aged 15-65 years who got admitted in the surgery department for acute appendicitis were selected. Pediatric patients (aged less than 14years), patients with co morbid illness like ischemic heart disease, inflammatory bowel disease, general peritonitis and the patients having lack of necessary investigations were excluded from the study. Methods: The variables like total WBC count, neutrophil percentage, platelet count and mean platelet volume (MPV) of all 150 selected patients were noted after admission by doing complete blood count and compared with normal value. The appendix samples obtained after surgery were sent for histopathological confirmation and reports were collected. Results: A total of 150 patients with the mean age of 25.72 (ranging 15-65) years were studied. Among them 93(62%) were male and 57(38%) were female. Mean MPV value was 11.7 ± 0.183 fL (p value 0.02). 122 patients have increased MPV value (81.33%). Among them 113 were eventually diagnosed as acute appendicitis. Negative exploration rate was 14%.Negative exploration was less among MPV raised patients (7.38%). Whereas negative exploration was more among normal MPV patients (21.42%).Total WBC count and neutriphil percentage are important biomarkers to diagnose acute appendicitis which is accepted. However this study revealed MPV value is an important biomarker in acute appendicitis also which is statistically significant and can reduce negative exploration. Conclusion: In this study mean platelet volume increases in acute appendicitis. MPV can be used as a biomarker in diagnosis of acute appendicitis. Journal of Surgical Sciences (2018) Vol. 22 (2) : 83-88

Background: Peptic ulcer perforation management is still an enigma. Though the overall incidence has been reduced worldwide due to wide use of anti-ulcerants, still it is not uncommon. But there is a debate regarding its conservative management over surgical management. Objective: To determine whether surgery could be avoided in selected patients with perforated peptic ulcer disease Methods: This study was conducted in the department of Surgery of Sir Salimullah Medical College and Mitford Hospital during the period from 1st March 2016 to 31st August 2016. After approval from the institutional ethics committee, 30 patients of suspected perforated peptic ulcer disease were successively assigned in this study on clinical and radiological basis. All were given non-operative regimen up to 24 hours. Then they were closely monitored to see improvement of clinical condition or development of any complication. Non-operative treatment was abandoned if the patient failed to improve or deteriorated within 24 hours of non-operative treatment. The data were collected by active participation of patients’ interview in preformed data collection sheet. Results: The data analysis of 30 patients yielded that most of them (86.67%) recovered well after receiving non-operative management, whereas only 4 patients (13.33%) showed no progression and were treated by laparotomy. 73.08% patients with uneventful outcome left the hospital within 10 days of admission and the others were a little late to leave. Conclusion: Patients with perforated peptic ulcer disease can be effectively treated by conservative approach in properly selected cases by proper monitoring under strict supervision of an experienced consultant. Journal of Surgical Sciences (2018) Vol. 22 (2) : 95-98