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Objective: To explore trimodality treatment with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy as an alternative approach to neoadjuvant chemotherapy followed by radical cystectomy, for the treatment of non-metastatic muscle invasive bladder carcinoma. Study Design: Retrospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi Pakistan, from 2006 and 2015. Methodology: A total of 122 patients were evaluated in a retrospective manner. Primary endpoint was overall survival. Patients received four courses of neoadjuvant chemotherapy followed by radical concurrent chemoradiotherapy with Cisplatin as radiation sensitizer. Result: 5-year overall survival was 80 (66%) in this population and a complete response following completion of treatment was seen in 93 (76.3%) patients. Subset analysis showed markedly increased 5-year overall survival of around 104 (85%) in patients having complete response after neoadjuvant chemotherapy. Conclusion: The study concludes that bladder preservation is an acceptable alternative to radical cystectomy in selected population especially among those who had a complete response to the initial four courses of chemotherapy.

Chemotherapy has significantly improved survival of cancer patient, but it has many side effects. About 14-81% of patients receiving chemotherapy experiences oral mucositis. Studies have shown zinc supplements may act as protective agent against oral Mucositis. The aim of study was to explore the preventive role of zinc sulfate in chemotherapy induced mucositis. OBJECTIVES: The objective of the study to evaluate the effectiveness of zinc sulfate in prevention or decreasing severity of chemotherapy induced oral mucositis with chemotherapy regimens having high neutropenic potential. DESIGN:Open label two arms interventional study, with quantitative study design. SETTING: Study was conducted at Medical Oncology Department, Fauji Foundation Hospital, Rawalpindi in 6 months duration. MATERIAL AND METHODS: The patients were enrolled by convenience non-probability sampling technique. They were randomized to interventional arm receiving zinc sulfate plus chemotherapy and no interventional arm receiving only chemotherapy by systematic sampling. MAIN OUTCOME MEASURES: Incidence and severity of mucositis at day 7 and day 14 in interventional and non interventional arm. SAMPLE SIZE: It was two arm study with 50 patients in each arm with total of 100 patients. RESULTS: Chi Square test was applied on the effect of Zinc Sulphate on Mucositis. Mucositis assessed at day 7 & day 14 showed statistically significant difference in Mucositis incidence and severity in number of patients receiving Zinc Sulphate between two arms with p value < 0.00. CONCLUSION: Zinc Sulphate is an effective adjunct used in our study, which not only showed its effectiveness but also proved to be safe drug without any interactions with chemotherapies. Zinc Sulphate significantly reduced the Mucositis. LIMITATIONS: This study only evaluated the effect of zinc Sulphate with single cycle of chemotherapy and did not compare the protective effect of zinc sulphate with other preventive agents.

Background:Tamoxifen acts as a selective estrogen receptor modulator by binding to the estrogenreceptors on mammary epithelium andblockingtheproliferative action of estrogen on mammaryepithelium. In contrast to that it has a weak estrogen agonistic effect on bone, liver and endometrium.Tamoxifen therapy has favorable effects on serum lipid profile by decreasing serum levels of Total cholesterol and low density lipoprotein (LDL), while its effect on high density lipoprotein (HDL) and triglyceride (TG)is still controversial. So this study is to evaluate the effects of tamoxifenTherapy on fasting serum lipid profile in patients with breast cancer. Results: Mean age was 43.56±3.53yrs , most common BMI was 30-34.9. Patient serum TG levels were raised from baseline after 3 months of tamoxifen with p values of (0.000) which was statistically significant while HDL levels were raised but with p value of (0.008 ) which was statistically insignificant. Serum LDL and total cholesterol were reduced from baseline after 3 month with p value of (0.000) and (0.000) respectively. Conclusion: This study concludes that tamoxifen has effects on serum lipid profile by increasing TG levels and lowering TC and LDL levels so this should be in consideration while prescribing tamoxifen to the patients having other risk factors for cardiovascular abnormalities.

Introduction Ki-67 is a nuclear antigen present in the synthesis phase of the cell cycle. Studies have shown that a high value of Ki-67 results in greater response to chemotherapy with higher incidence of complete pathological response, which ultimately results in improved overall survival. Methods and materials The objective of the study was to determine the frequency of high Ki-67 levels in breast cancer patients and to find the correlation of complete pathological response in breast cancer with Ki-67 levels. It is a descriptive case series with a correlational study design done at Fauji Foundation Hospital Rawalpindi. Eighty patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy followed by surgery were recruited. Their Ki-67 levels were determined on trucut biopsy. Pathological response in the post-op sample was correlated with Ki-67 levels. Results The results showed 27 (33%) patients out of the 80 had high Ki-67 values. Among them 17 (63%) had complete pathological response, seven (26%) showed partial pathological response whereas three (11%) had disease progression. In contrast, out of the 53 patients having low Ki-67 values, only nine (17%) had complete pathological response, 31 (58%) showed partial pathological response and 13 (25%) had progressive disease. A Chi-square test was applied which showed significant correlation between Ki-67 and complete pathological response, with a p value of 0.00018. Conclusion Therefore high Ki-67 values in patients with breast cancer correlated well with attainment of complete pathological response. We can incorporate Ki-67 in the initial clinical assessment of breast cancer patients to help predict effectiveness as well as response to chemotherapy.

Background:Tamoxifen acts as a selective estrogen receptor modulator by binding to the estrogenreceptors on mammary epithelium andblockingtheproliferative action of estrogen on mammaryepithelium. In contrast to that it has a weakestrogen agonistic effect on bone, liver and endometrium.Tamoxifen therapy has favorable effects on serum lipid profile by decreasing serum levels of Total cholesterol and low density lipoprotein (LDL), while its effect on high density lipoprotein (HDL) and triglyceride (TG)is still controversial. So this study is to evaluate the effects of tamoxifenTherapy on fasting serum lipid profile in patients with breast cancer. Results:Mean age was 43.56±3.53yrs , most common BMI was 30-34.9. Patient serum TG levels were raised from baseline after 3 months of tamoxifen withp values of (0.000) which was statistically significant while HDL levels were raised but with p value of(0.008 ) which was statistically insignificant. Serum LDL and total cholesterol were reduced from baseline after 3 month with p value of (0.000) and (0.000) respectively. Conclusion:Thisstudy concludes that tamoxifen has effects on serum lipid profile by increasing TG levels and lowering TC and LDL levels so this should be in consideration while prescribing tamoxifen to the patients having other risk factors for cardiovascular abnormalities.

Introduction: Geriatric patients receiving total knee arthroplasty (TKA) are found to have similar postoperative complications, functional scores, and perioperative mortality, as compared to younger patients. Conversely, geriatric patients often have longer lengths of stay. Periarticular injection (PAI) of liposomal bupivacaine (LB) as part of the multimodal pain management strategy is thought to improve recovery, however, mixed comparative efficacy data exists for its use in TKA.2-5. Methods: A retrospective, chart review was conducted at a 287-bed community teaching hospital. Orthopedic surgical patients who received an infiltration with liposomal bupivacaine versus bupivacaine HCl for unilateral TKA were compared. Patients identified in the electronic medical record by Diagnosis Related Group (DRG) 470—major joint replacement or reattachment of lower extremity without major complication or comorbidity codes were utilized. Patients who meet the following criteria were included: age 65 and older who underwent a TKA between 8/1/2018 to 7/31/2019 were discharged to home. Patients who have contraindications or hypersensitivity to bupivacaine formulations or a history of opioid dependence were excluded. The primary outcome is to identify whether patients who received an infiltration with liposomal bupivacaine had a lower total opioid consumption during their hospital stay. Results: A total of 114 patients who had a DRG 470 code and were above the age of 65 years were studied. There was no statistically significant difference in mean total opioid consumption (oral morphine equivalents) between the bupivacaine HCl (n = 25) and liposomal groups (n = 85) respectively, 93.76 versus 83.72 mg; P = .569. In addition, patients in both groups had similar lengths of hospital stay, 2.5 versus 3 days; P = .529 and mean pain scores until discharge 3.7 versus 4.34 on VAS; P = .305. Conclusion: The results of this drug utilization evaluation do not support a strong clinical advantage with local infiltration of liposomal bupivacaine over bupivacaine HCl in geriatric patients undergoing primary TKA surgery at this institution. There was not a statistically significant difference in mean total opioid consumption between the 2 groups. Additionally, the use of non-opioid analgesics, mean pain scores, and hospital lengths of stay were similar in both groups.

Background:According to WHO, breast cancer is the most common cancer in the women worldwide, soearly diagnosis is the best way to reduce its morbidity and mortality. Among various risk factors, the relationship between serum lipid profile and breast cancer is still unclear. Therefore, this study was conducted to evaluate this relationship. Methodology:Prospective, descriptive observational study with a comparative study designconducted at Fauji Foundation Hospital, Rawalpindi between November 2018 to April 2019. Results:140 patients were divided into two groups i.e. cases and controls. Both groups were equally sub divided based on menstrual status. Independent student t-test was applied for comparison between the groups. BMI was significantly higher in the study group as compared to control group (p=0.002). Serum TG and LDL levels were higher in breast cancer patients (p= 0.032 and p=0.07 respectively). Cholesterol level was not statistically different in any group (p= >0.05). Higher HDL levels were seen in pre-menopausal cases (p=0.004) but there was no statistical difference when studied across cases and control groups. Conclusion:As breast cancer is the most common tumor in females, so early diagnosis is the key to reduce its morbidity and mortality. In this study, higher BMI, TG and LDL levels were seen in breast cancer patients as compared to controls. So, it may be concluded that BMI and dyslipidemia have some role in the etiology of breast cancer.

Background:Chemotherapy induced peripheral neuropathy (CIPN) is one of the commonest and disabling side effect of chemotherapy drugs like taxanes , platinum compounds, vinca alkaloids, thalidomide and bortezomib.It often leads to dose reduction and discontinuation of treatment. Many agents like Vitamin E, glutathione, glutamate, acetyl L carnityle have been evaluated for their role in prevention of CIPN without any significant success Hence, CIPN is an important area of research due to lack of effective agent to prevent CIPN. Methodology: Un-blind double arm interventional study Results:Forty patients were distributed in two groups; intervention (vitamin E supplemented n=20) and control (n=20) arms. The TNSn scores were comparable at baseline and immediately after chemotherapy among both groups. However, after 3 months of chemotherapy the mean TNSn was comparatively low in the intervention arm (0.95 versus 1.64) which was not statistically significant. In subset analysis of Paclitaxel-Cisplatin combination chemotherapy subgroup, TNSn scores of two arms immediately post chemotherapy and at 3 months showed maximum difference between the arms (p-value, Conclusions:Our study showed a protective role of vitamin E profoundly in patients receiving single agent paclitaxel followed by paclitaxel and cisplatin regimen where the recovery from CIPN was much better as compared to control arm.

Small bowel obstruction (SBO) secondary to fruit pit impaction is rare. The presence of an ovoid, stony body in the bowel lumen on radiologic imaging in a patient presenting with signs and symptoms of SBO is likely to raise concern for gallstone ileus. We report the case of a 56-year-old man who presented with a 1-day history of intermittent left-sided abdominal pain and nausea associated with a single episode of vomiting. CT scan of the abdomen and pelvis revealed a 3.3 cm impacted stony mass in the terminal ileum resulting in high-grade partial SBO. The mass had a hypodense centre encased within a hyperdense, ridged outer layer. The diagnostic impression was gallstone ileus. The object was removed via enterotomy and was found to be a peach pit.

The paper seeks to offer an explanation for the observed oscillations in the real wages of unskilled labour in Bangladesh. Within the framework of a model of lagged adjustment of expectations, variations in real wages are shown as a function of (I) fluctuations in the rate of inflation, (II) fluctuations in the average product in agriculture, (ELI) variations in the mode of government intervention by way of changes in the minimum wage laws, etc. , and (IV) fluctuations in the state of the economy. Even though real wages are not supposed to show any marked changes in labour surplus economies like Bangladesh, the paper analyses the mechanism through which wages are seen to track inflation and changes in the domain of production in the countryside even in such economies., Internationales Asienforum, Bd. 12 Nr. 2-3 (1981): Internationales Asienforum

Transient control over the atomic potential- energy landscapes of solids could lead to new states of matter and to quantum control of nuclear motion on the timescale of lattice vibrations. Recently developed ultrafast time- resolved diffraction techniques1 combine ultrafast temporal manipulation with atomic- scale spatial resolution and femtosecond temporal resolution. These advances have enabled investigations of photo-induced structural changes in bulk solids that often occur on timescales as short as a few hundred femtoseconds. In contrast, experiments at surfaces and on single atomic layers such as graphene report timescales of structural changes that are orders of magnitude longer. This raises the question of whether the structural response of low-dimensional materials to femtosecond laser excitation is, in general, limited. Here we show that a photo-induced transition from the low- to high-symmetry state of a charge density wave in atomic indium (In) wires supported by a silicon (Si) surface takes place within 350 femtoseconds. The optical excitation breaks and creates In– In bonds, leading to the non-thermal excitation of soft phonon modes, and drives the structural transition in the limit of critically damped nuclear motion through coupling of these soft phonon modes to a manifold of surface and interface phonons that arise from the symmetry breaking at the silicon surface. This finding demonstrates that carefully tuned electronic excitations can create non-equilibrium potential energy surfaces that drive structural dynamics at interfaces in the quantum limit (that is, in a regime in which the nuclear motion is directed and deterministic). This technique could potentially be used to tune the dynamic response of a solid to optical excitation, and has widespread potential application, for example in ultrafast detectors.

The unoccupied electronic structure of quasi-one-dimensional reconstructions of Pb atoms on a Si(557) surface is investigated by means of femtosecond time- and angle-resolved two-photon photoemission. Two distinct unoccupied electronic states are observed at E-EF=3.55 and 3.30 eV, respectively. Density functional theory calculations reveal that these states are spatially located predominantly on the lead wires and that they are energetically degenerated with an energy window of reduced electronic density of states in Si. We further find momentum-averaged lifetimes of 24 and 35 fs of these two states, respectively. The photoemission yield and the population dynamics depend on the electron momentum component perpendicular to the steps of the Si substrate, and the momentum-dependent dynamics cannot be described by means of rate equations. We conclude that momentum- and direction-dependent dephasing of the electronic excitations, likely caused by elastic scattering at the step edges on the vicinal surface, modifies the excited-state population dynamics in this system. © 2015 American Physical Society. DFG/FOR/1700

Learning classifiers from imbalanced or skewed datasets is an important topic, aris- ing very often in practice in classification problems. In such problems, almost all the instances are labeled as one class, while very few instances are labeled as the other class, usually the more important class. Traditional classifiers trying to achieve an accurate performance over a full range of instances are not suitable to deal with imbalance learning tasks. They tend to classify all the data into the majority class, which is usually the less important class. Researchers have already presented many solutions to this problem both on data and algorithmic level. In this thesis a new approach to deal with imbalanced datasets is presented on the data level. This approach is an oversampling technique which involves generating new samples for the minority class by making a random walk in the dataset. The new samples are generated by some Markov Chain Monte Carlo Algorithm. Newly generated samples are then added to existing data set in order to balance the ratio between majority and minority class samples.

Non Hodgkin's Lymphoma (NHL) comprises a group of lymphoproliferative disorders the frequency of which continues to rise. Although many classification systems exist for identifying specific histological subtypes, NHL is generally divided into indolent (low-grade) and aggressive (intermediate- and high-grade) forms. Large B Cell Lymphoma (LBCL) is one of the commonest aggressive NHLs. The aim of this review is to provide a general overview of NHL, its clinically practicable cellular classification, epidemiology and in depth overview of the evolution of treatment of LBCL during the past 5 years. Current guidelines from National Cancer Institute (NCI), USA and National Institute on Clinical Excellence (NICE), UK are mentioned and recommendations according to our own set-up are suggested.

To evaluate the efficacy and toxicity of 1-hour weekly Paclitaxel in metastatic breast cancer along with evaluation of overall survival.A phase II interventional trial.Oncology Department, Combined Military Hospital, Rawalpindi, between August 2001 to July 2003.Thirty-six patients were enrolled in the study. All patients with histologically confirmed and bi-dimensionally measurable metastatic breast cancer who had received previously either chemotherapy or hormone therapy were included in the study. Paclitaxel was administered in 1-hour weekly infusion in a dose of 100 mg/m2 for 12 doses.All patients had received previous chemotherapy with either CAF or CMF. Twenty-five patients had also received hormone therapy, 61% had two or more metastatic sites involved, and lung was the common site of involvement. Complete response was observed in 4 (11.1%) patients, partial response in 14 (38.8%) patients, with an overall response rate of 50.0%. Clinical benefit was 94.4% and median overall survival was 11 months. Treatment was well-tolerated with no grade 3 or 4 toxicity. Common side effects were arthralgias, myalgias and neutropenia.Treatment with 1-hour weekly infusion of Paclitaxel is a well-tolerated chemotherapy with a substantial degree of efficacy in patients with metastatic breast cancer.