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[en] Mediastinal radiotherapy (RT), especially when combined with bleomycin, may result in substantial pulmonary morbidity and mortality. The use of modern RT techniques like intensity-modulated radiotherapy (IMRT) is gaining interest to spare organs at risk. We evaluated 27 patients who underwent RT for Hodgkin’s lymphoma between 2009 and 2013 at our institution. For each patient, three different treatment plans for a 30-Gy involved-field RT (IFRT) were created (anterior-posterior-posterior-anterior setup [APPA], 5‑field IMRT, and 7‑field IMRT) and analyzed concerning their inherent “normal tissue complication probability” (NTCP) for pneumonitis and secondary pulmonary malignancy. The comparison of different radiation techniques showed a significant difference in favor of standard APPA (p < 0.01). The risk of lung toxicity was significantly higher in plans using 7‑field IMRT than in plans using 5‑field IMRT. The absolute juxtaposition showed an increase in risk for radiation pneumonitis of 1% for plans using 5‑field IMRT over APPA according to QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) parameters (Burman: 0.15%) and 2.6% when using 7‑field IMRT over APPA (Burman: 0.7%) as well as 1.6% when using 7‑field IMRT over 5‑field IMRT (Burman: 0.6%). Further analysis showed an increase in risk for secondary pulmonary malignancies to be statistically significant (p < 0.01); mean induction probability for pulmonary malignoma was 0.1% higher in plans using 5‑field IMRT than APPA and 0.19% higher in plans using 7‑field IMRT than APPA as well as 0.09% higher in plans using 7‑field IMRT than 5‑field IMRT. During a median follow-up period of 65 months (95% confidence interval: 53.8–76.2 months), only one patient developed radiation-induced pneumonitis. No secondary pulmonary malignancies have been detected to date. Radiation-induced lung toxicity is rare after treatment for Hodgkin lymphoma but may be influenced significantly by the RT technique used. In this study, APPA RT plans demonstrated a decrease in potential radiation pneumonitis and pulmonary malignancies. Biological planning using NTCP may have the potential to define personalized RT strategies.
[en] Background: Acute respiratory illness caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) involved the whole globe within no time. Various studies published globally have shown variable severity of disease and mortality. The objective of our study was to describe clinical and epidemiological characteristics of the disease in our setup. Methods: in this descriptive case series, individuals with signs and symptoms of Coronavirus disease-19 (COVID- 19) and asymptomatic patients with history of close contact to confirmed COVID-19 patients were considered for SARS-CoV-2 Polymerase chain reaction (PCR) assay. Epidemiological and clinical features of only PCR positive cases were recorded. Data regarding hospitalization status, exposure to known COVID-19 patients, clinical feature and clinical outcome of patients was collected and interpreted. Results: A total of 266 patients were found to be SARS-CoV 2 PCR positive which were included in the study. Mean age of patients was 39.45±31.9 years and majority of the patients in our study were male, i.e., 238 (89.5%). Most common clinical features among COVID- 19 symptomatic patients were fever and dry cough followed by myalgias and sore throat. Eighteen (7%) out of 266 died in our setup. Time duration of viral shedding after initial positive PCR varied between 11 days to up to more than 55 days. Conclusions: Coronavirus disease-19 (COVID-19) can present with wide range of clinical spectrum and disease can be life threatening. Severity of disease, requirement of ICU care and mortality were directly related to age of the patient and underlying comorbidities. Rigorous precautionary measures are of utmost importance particularly in this high-risk population. (author)
[en] The novel coronavirus was emerged from China Wuhan city and spread around the globe within a few days. COVID-19 is rapidly transmitted from one human to another, and it is also a highly pathogenic infection. Genetic analysis confirmed that SARS-CoV 2 is phenotypically related to SARS-CoV; therefore, the possible reservoir for SARS-CoV 2 could be bats. According to WHO more than 20 million individuals infected with SARS-CoV 2 while more than 700,000 peoples lost their lives due to COVID-19 as of 13th August 2020. Up-till now, there is no anti-viral therapy or vaccines available for the treatment and prevention of COVID-19. Although dexamethasone and tocilizumab help in reducing mortality among critical patient infected with COVID-19 However, China, Brazil and USA have developed vaccines which is currently under trial phase. Still, up-till now, there is no clinically approved treatment regimen available against COVID-19. (author)
[en] Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections.” We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis. A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89–0.97) and pooled specificity was 0.91 (95% CI 0.54–0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69–1.00) and 0.93 (95%CI 0.64–0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88–0.99) and 0.99 (95%CI 0.13–1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies. FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans.
[en] This study was aimed to evaluate the effects of feeding frequency on growth performance, antioxidant status and immunity of juvenile red swamp crayfish Procambarus clarkia (average weight: 3.01±0.02 g). Crayfish were randomly assigned to one of five feeding frequencies (1,2,3,4 and 5 times/day, F1, F2, F3, F4 and F5) following the same ration size for 60 days. After the feeding trial, fish were challenged with white spot syndrome virus (WSSV) and cumulative mortality was recorded for the next 4 days. The results showed that the weight gain rate (WGR) of crayfish tended to increase initially and then decrease as feeding frequency increased. The WGR in F3 were significantly higher than those fed 1, 4 and 5 times/ day (P<0.05). The highest serum lysozyme (LZM), lowest catalase (CAT) and malondialdehyde (MDA) were observed in crayfish fed 3 times/day. However, there were no significant differences in cortisol, glucose (Glu), and superoxide dismutase (SOD) among all groups (P>0.05). The cumulative mortality in F3 was significantly lower than that of the other groups at d4 after challenge (P<0.05). In conclusion, both low and high feeding frequencies could cause stress of juvenile Procambarus clarkia and the optimal feeding frequency to enhance growth and immunity of this species at juvenile stage is 3 times/day. (author)
[en] Objective: To determine the prevalence of patterns of CKD-MBD in dialysis patients at a tertiary care hospital and analyze its relationship with various socio demographic factors. Study Design: Analytical cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jul 2017 to Dec 2017. Methodology: The sample population comprised of 100 patients undergoing hemodialysis and blood samples of calcium, phosphate, alkaline phosphatase and intact PTH were obtained from these patients. CKD-MBD was classified on the basis of biochemical abnormalities and their relationship with age, gender, marital status, smoking history, dialysis count per week, dialysis duration was assessed. Results: Out of 82 patients consisting of 62 males and 20 females, the mean age was 49.8 ± 16 years, 68% of dialysis patients had biochemical abnormalities of which 73% showing high turn over bone disease and 26.8% showing low turnover bone disease (adynamic and osteomalacia). After applying the logistic regression we found that age, gender, dialysis vintage and other socio-demograhic factors had no significant association with the CKD-MBD subtypes. Conclusion: Biochemical abnormalities although common in dialysis patients but the sturdy interconnection between them is still shrouded in disputation. Special consideration should be remunerated to the dialysis population with different spectrum of CKD-MBD as propitious management can procrastinate the progression of CKD and eventually paring down the cardiovascular morbidity and mortality. (author)
[en] Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0–2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.
[en] Contagious caprine pleuropneumonia (CCPP) caused by Mycoplasma capricolum subsp. capripneumoniae (Mccp) is a highly contagious and deadly disease of small ruminants, especially goats. It is an economically important disease, causing high morbidity and mortality in goats. More recently Mccp Pakistan strain has been identified and isolated by our laboratory. Alarmingly, antimicrobials in animals are inappropriately using and resultantly leading to antimicrobial resistance (AMR) including mycoplasmas, which are causing serious infections in ruminants. Since the growth curve of our local strain and its susceptibility to commonly using antimicrobials is unknown. Therefore, this study was aimed to evaluate the growth curve and susceptibility of Mccp against commercially available quinolones in Pakistan by broth microdilution method. Quinolones including moxifloxacin, levofloxacin, ciprofloxacin, and enrofloxacin were selected for in vitro susceptibility of Mccp Pakistan strain. The concentration for each drug was measured distantly depending on high concentration available in the market and was then used in various concentrations ranges from higher to lower i.e. moxifloxacin 80-0.156 µg/ml, levofloxacin 250-0.488 µg/ml, ciprofloxacin and enrofloxacin 50-0.097 µg/ml. The resultant effective antimicrobial by minimum inhibitory concentration (MIC) and minimum mycoplasmacidal concentration (MMC) value was ciprofloxacin having lowest MIC and MMC value (0.390 µg/ml and 0.781 µg/ml), respectively. It was concluded that ciprofloxacin had best mycoplasmacidal and mycoplasmastatic activities among tested chemotherapeutics agents against Mccp. Ciprofloxacin could be more effective antimicrobial in field against Mccp infection in goat. (author)
[en] Objective: To analyze the outcome of repair of aortic valve disease associated with various types of ventricular septal defect. Methods: In a retrospective observational study design, data of seventy-two patients of ventricular septal defect (VSD) associated with aortic valve prolapse (AVP) and aortic regurgitation (AR) who was operated in Punjab Institute of cardiology from May 2016 to April 2020 was collected. Depending on presence of AR, all patients were divided in four groups. Group-I (VSD and AVP but no AR) had fifteen patients. Only VSD was closed in this group. Group-II (VSD and Mild AR) had forty patients, only VSD was closed in this group as well. Group-III (VSD and Moderate AR) had ten patients, VSD closure and aortic valve repair was done. Group-IV (VSD and severe AR) had seven patients. Aortic valve was repaired in five patients and replaced (AVR) in two patients along with VSD closure. Associated anomalies were addressed as well. Results: Group-I: Twelve out of fifteen patients (80%) showed no post-operative AR. While two patients (13.3%) showed Trace AR. Single patient (6.6%) showed mild AR. There results were unchanged after mean follow up of 36 months. Group-II: Eight out of forty patients (20%) had no AR, while eight (20%) had trace AR. Twenty-three (57.5%) patients had mild AR. Single (2.5%) patient had moderate AR. After follow up of 24 months the patient with moderate AR progressed to severe AR. We are planning to do Aortic Valve Replacement (AVR) in this case. Rest of cases showed no progression of disease. Group-III: Two out of ten patients (20%) had no AR, four (40%) had trace AR, while four (40%) had mild AR. Mean follow up was 42 months (2.5 years). Neither trace nor mild AR progressed to severe or moderate AR. Group-IV: Among seven patients, five underwent repair while two had AVR. Out of five patients who underwent aortic valve repair, four patients (57.1%) were declared mild AR, while severe AR was converted to moderate AR in single patient (14.28%). Mean follow up was 18 months. The moderate AR patient has progressed to severe AR for last six months and we are planning to do AVR in this patient. Postoperative echo of patients with AVR showed adequately functioning aortic valve with AVPG mean 10 mmHg and 15 mm Hg respectively, with no residual AR. Conclusions: Aortic regurgitation associated with VSD is a congenital lesion with continuously active aortic valve disease resulting in significant morbidity and mortality. Early diagnosis, effective treatment and meticulous follow up decelerate and in most cases arrest the disease process. (author)
[en] Objective: To describe the short-term results of mini-gastric bypass (MGB), the complications in patients who underwent mini-gastric bypass surgery (MGB), and evaluate the value of the neutrophil to lymphocyte ratio (NLR) in predicting complications at an early stage. Study Design: A descriptive, analytical study. Place and Duration of Study: Elazığ Medical Park Hospital, Elazığ, Turkey from January, 2016 to July 2019. Methodology: Data of patients who had undergone MGB for morbid obesity at the Department of Surgery, Medical Park Hospital, Elazığ, Turkey from January 2016 to July 2019 were retrospectively evaluated. Demographic characteristics, preoperative body weight, body mass index (BMI), weight change after surgery, and postoperative complications were evaluated. The collected data were statistically analysed. The Kolmogorov-Smirnov and Shapiro-Wilk tests were used to evaluate the data distribution. Results: A total of 95 patients were included in the study. The median preoperative BMI was 40.7 kg/m2 (40.2–42.5), the median NLR was 2.1 (1.5–2.8), and the median length of hospital stay was 4.0 (3.0–4.0) days. In univariate analysis, age, gender, preoperative baseline BMI or preoperative NLR were not statistically significant related to the presence of postoperative complications. There was a statistically significant difference in BMI, depending on different measurement times during the follow-up period (p< 0.001). Conclusion: MGB is an effective procedure in obesity and diabetes surgery. Complications with high morbidity and mortality might be seen, although at low rates. Although NLR’s efficacy is low in predicting MGB complications, it may be a useful parameter in a large series. (author)