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Abstract Background Prostate cancer is the second most common malignancy in men, and its incidence is increasing which is attributed to increased screening programs. The treatment options of intermediate and high risk prostate cancer include radical prostatectomy, radiotherapy and androgen deprivation therapy. Hypofractionated radiotherapy is becoming more popular lately due to better understanding of the radiobiology of prostate cancer and favorable logistics. Objective To compare the toxicity and efficacy of hypofractionated versus conventional fractionation external beam radiotherapy in patients with intermediate and high risk localized prostate cancer treated in Shaukat Khanum Memorial Hospital and Research Center, Lahore (SKMCH & RC). Methodology We retrospectively conducted this study on histopathologically confirmed 114 patients with prostate adenocarcinoma who underwent treatment from January 2013 till December 2018. These patients were treated with radical radiotherapy along with hormonal therapy as per indication. Data was collected from electronic hospital system and analyzed by SPSS version 23. Results 114 patients were selected according to the inclusion criteria. Mean age was 68 years (61–75). 88% of patients had stage III-IVA disease at the time of diagnosis. Mean PSA and GS was 33 ± 39 SD and 7 ± 0.9 SD respectively. 89% (n = 102) received radiotherapy with 69% of patients receiving dose of 60 Gy in 20 fractions. Among patients who received hypofractionated dose, 86% (n = 61) of them were categorized as high risk and 14% (n = 10) were intermediate risk, whereas among conventional group 90% (n = 28) were high risk patients and 10% (n = 3) were of intermediate risk. In hypofractionated dose group, 14% (n = 10) developed grade 2 proctitis and 8% (n = 6) developed grade 2 cystitis, in contrast to conventional dose group in which only 3 patients (5%) developed grade 2 GI toxicity and 2 patients (2.9%) had grade 2 GU toxicity. However, these toxicities and their grade were clinically insignificant when compared with the dose groups (p = 0.11). 5 year overall survival for hypofractionated radiotherapy versus conventional dose was 100% and 90% respectively with 95% Cl and p value of 0.3 (clinically insignificant), whereas 5 year disease free survival was 100% and 75% for hypofractionation versus conventional EBRT respectively with 95% CI and p value of 0.04 (clinically significant). Conclusion Hypofractionated radiotherapy in patients with intermediate and high risk localized prostate cancer has better disease free survival at the expense of higher risk for proctitis and cystitis but no difference in overall survival as compared to conventional dose of radiation.

This article discusses problems and potential solutions for improving radiation oncology care in Pakistan.

In the cognate nephrology literature, a few recent publications from major academic centers in the United States have suggested that the incidence of contrast nephropathy was exaggerated and overstated. These investigators have concluded that intravenous contrast material administration was not associated with an increased risk of acute kidney injury (AKI), emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. As a contrarian opinion, we first describe a clear cut case of contrast-nephropathy resulting in AKI requiring hemodialysis treatment managed in the Renal Unit of the Mayo Clinic Health System, Northwestern Wisconsin, in the Spring of 2017. We subsequently revisit the overwhelming evidence-base in the English literature that supports the enormous impact of contrast-nephropathy as a clinical syndrome. We finally posit that these recent repudiations of the existence and significance of contrast-nephropathy as a significant clinical entity represent an overreach in statistical expertise. There is no basis for a requiem song over contrast-nephropathy.

Mass poisonings with diethylene glycol (DEG) usually ingested as an unintended component of pharmaceutical preparations have occurred in Nigeria, especially affecting children with nearly 100% mortality outcomes. Clearly, the unavailability of Specialty Toxicology laboratory testing facilities translates to non-diagnosis and therefore inappropriate management of these patients with resulting poor outcomes. In this case analysis, while utilizing a case report involving intentional DEG intoxication that we managed at the Mayo Clinic Health System in North-Western Wisconsin, we have demonstrated the utility of serial values of commonly available blood test parameters including serum bicarbonate and anion gap, blood ABG pH and CO2 values, together with the use of serum osmolality gap as surrogates to expedite early and appropriate treatment of such cases even in the absence of Toxicology confirmation of DEG as the poisoning agent. Based on the experience gained from this case report, we strongly recommend that the responsible governments in resource-challenged countries must ensure that these laboratory surrogate indices, at the minimum, become available in the hospitals. This would improve outcomes in general.

The frequency of hospital-acquired acute kidney injury has been increasing in recent years. It is associated with higher patient mortality, increased length of stay, increased cost of hospitalization and potentially is linked with an increased risk of developing chronic kidney disease and end-stage renal disease over time. Decreased renal perfusion, nephrotoxic medications, surgery, and radiographic contrast media remain the most common causes of hospital-acquired acute kidney injury. We present some recent cases of hospital-acquired acute kidney injury managed in the Renal Unit, Mayo Clinic Health System, Eau Claire, WI, USA and make a strong case for more preventative nephrology practices to mitigate, if not eliminate, the scourge of hospital-acquired acute kidney injury.