Koetjapic acid: unveiling its potential as a saviour in the realm of biological and medicinal properties, with a focus on anticancer mechanism of action

Scientists have been compelled to search for alternative treatments due to the increasing prevalence of chemoresistance as well as the agonising and distressing side effects of both chemotherapy and radiation. Plant extracts have been exploited to treat various medical conditions for ages. Considering this fact, the main focus of various recent studies that are being conducted to find new and potent anticancer drugs involves the identification and utilisation of potential therapeutic chemicals present in plant extracts. Koetjapic acid (KJA), which belongs to the family of triterpenes, is primarily isolated from Sandoricum koetjape. Ongoing investigations into its therapeutic applications have revealed its tendency to impede the growth and proliferation of cancer cells. Koetjapic acid activates the intrinsic apoptotic pathway and promotes the death of cancer cells. Moreover, it inhibits angiogenesis and the dissemination of tumour (metastasis) by targeting the VEGF signalling cascade. Therefore, this study aims to elucidate the underlying mechanism of anticancer activity of koetjapic acid, providing significant insight into the compound's potential as an anticancer agent.

Possible prognostic impact of PKCι genetic variants in prostate cancer

BACKGROUND

Single nucleotide polymorphisms (SNPs) have been linked with prostate cancer (PCa) and have shown potential as prognostic markers for advanced stages. Loss of function mutations in PKCι have been linked with increased risk of malignancy by enhancing tumor cell motility and invasion. We have evaluated the impact of two coding region SNPs on the PKCι gene (PRKCI) and their prognostic potential.

METHODS

Genotypic association of non-synonymous PKCι SNPs rs1197750201 and rs1199520604 with PCa was determined through tetra-ARMS PCR. PKCι was docked with interacting partner Par-6 to determine the effect of these variants on PKCι binding capabilities. Molecular dynamic simulations of PKCι docked with Par-6 were performed to determine variant effects on PKCι protein interactions. The possible impact of changes in PKCι protein interactions on epithelial cell polarity was hypothesized.

RESULTS

PKCι rs1199520604 mutant genotype TT showed association with PCa (p = 0.0055), while rs1197750201 mutant genotype AA also showed significant association with PCa (P = 0.0006). The binding interaction of PKCι with Par-6 was altered for both variants, with changes in Van der Waals energy and electrostatic energy of docked structures.

CONCLUSION

Genotypic analysis of two non-synonymous PKCι variants in association with PCa prognosis was performed. Both variants in the PB1 domain showed potential as a prognostic marker for PCa. In silico analysis of the effect of the variants on PKCι protein interactions indicated they may be involved in PCa progression through aberration of epithelial cell polarity pathways.

Assessment of phytoremediation potential of native plant species naturally growing in a heavy metal-polluted industrial soils

Abstract The present study was carried out in Hayat Abad Industrial Estate located in Peshawar to assess the levels of cadmium (Cd) that were present in the soil as well as the plant parts (Roots and shoots). To evaluate the phytoremediation potential of the plants different factors i.e. Bioconcentration Factor (BCF), Translocation Factor (TF), and Bioaccumulation Coefficient were determined. These plants were grown in their native habitats (BAC). We have analysed, cadmium concentration from soil which are collected from 50 different locations ranged from 11.54 mg/Kg (the lowest) to 89.80 mg/Kg (highest). The maximum concentration (89.80 mg/Kg) of cadmium was found in HIE-ST-16L Marble City and HIE-ST-7 Bryon Pharma (88.51 mg/Kg) while its minimum concentration (12.47 mg/Kg) were detected in the soil of Site (HIE-ST-14L Royal PVC Pipe) and (11.54 mg/Kg) at the site (HIE-ST-11 Aries Pharma). Most plant species showed huge potential for plant based approaches like phyto-extraction and phytoremediation. They also showed the potential for phyto-stabilization as well. Based on the concentration of cadmium the most efficient plants for phytoextraction were Cnicus benedictus, Parthenium hysterophorus, Verbesina encelioides, Conyza canadensis, Xanthium strumarium, Chenopodium album, Amaranthus viridis, Chenopodiastrum murale, Prosopis juliflora, Convolvulus arvensis, Stellaria media, Arenaria serpyllifolia, Cerastium dichotomum, Chrozophora tinctoria, Mirabilis jalapa, Medicago polymorpha, Lathyrus aphaca, Dalbergia sissoo, Melilotus indicus and Anagallis arvensis. The cadmium heavy metals in the examined soil were effectively removed by these plant species. Cerastium dichotomum, and Chenopodium murale were reported to be effective in phyto-stabilizing Cd based on concentrations of selected metals in roots and BCFs, TFs, and BACs values.

Exploring the prognostic significance of PKCε variants in cervical cancer

BACKGROUND

Protein Kinase C-epsilon (PKCε) is a member of the novel subfamily of PKCs (nPKCs) that plays a role in cancer development. Studies have revealed that its elevated expression levels are associated with cervical cancer. Previously, we identified pathogenic variations in its different domains through various bioinformatics tools and molecular dynamic simulation. In the present study, the aim was to find the association of its variants rs1553369874 and rs1345511001 with cervical cancer and to determine the influence of these variants on the protein-protein interactions of PKCε, which can lead towards cancer development and poor survival rates.

METHODS

The association of the variants with cervical cancer and its clinicopathological features was determined through genotyping analysis. Odds ratio and relative risk along with Fisher exact test were calculated to evaluate variants significance and disease risk. Protein-protein docking was performed and docked complexes were subjected to molecular dynamics simulation to gauge the variants impact on PKCε's molecular interactions.

RESULTS

This study revealed that genetic variants rs1553369874 and rs1345511001 were associated with cervical cancer. Smad3 interacts with PKCε and this interaction promotes cervical cancer angiogenesis; therefore, Smad3 was selected for protein-protein docking. The analysis revealed PKCε variants promoted aberrant interactions with Smad3 that might lead to the activation of oncogenic pathways. The data obtained from this study suggested the prognostic significance of PRKCE gene variants rs1553369874 and rs1345511001.

CONCLUSION

Through further in vitro and in vivo validation, these variants can be used at the clinical level as novel prognostic markers and therapeutic targets against cervical cancer.

Exploring the therapeutic and anti-tumor properties of morusin: a review of recent advances

Morusin is a natural product that has been isolated from the bark of Morus alba, a species of mulberry tree. It belongs to the flavonoid family of chemicals, which is abundantly present in the plant world and is recognized for its wide range of biological activities. Morusin has a number of biological characteristics, including anti-inflammatory, anti-microbial, neuro-protective, and antioxidant capabilities. Morusin has exhibited anti-tumor properties in many different forms of cancer, including breast, prostate, gastric, hepatocarcinoma, glioblastoma, and pancreatic cancer. Potential of morusin as an alternative treatment method for resistant malignancies needs to be explored in animal models in order to move toward clinical trials. In the recent years several novel findings regarding the therapeutic potential of morusin have been made. This aim of this review is to provide an overview of the present understanding of morusin's beneficial effects on human health as well as provide a comprehensive and up-to-date discussion of morusin's anti-cancer properties with a special focus on in vitro and in vivo studies. This review will aid future research on the creation of polyphenolic medicines in the prenylflavone family, for the management and treatment of cancers.

Ursolic acid: a natural modulator of signaling networks in different cancers

Incidence rate of cancer is estimated to increase by 40% in 2030. Furthermore, the development of resistance against currently available treatment strategies has contributed to the cancer-associated mortality. Scientists are now looking for the solutions that could help prevent the disease occurrence and could provide a pain-free treatment alternative for cancers. Therefore, efforts are now put to find a potent natural compound that could sever this purpose. Ursolic acid (UA), a triterpene acid, has potential to inhibit the tumor progression and induce sensitization to conventional treatment drugs has been documented. Though, UA is a hydrophobic compound therefore it is usually chemically modified to increase its bioavailability prior to administration. However, a thorough literature indicating its mechanism of action and limitations for its use at clinical level was not reviewed. Therefore, the current study was designed to highlight the potential mechanism of UA, its anti-cancer properties, and potential applications as therapeutic compound. This endeavour is a valuable contribution in understanding the hurdles preventing the translation of its potential at clinical level and provides foundations to design new studies that could help enhance its bioavailability and anti-cancer potential for various cancers.

Comparative effectiveness of EDTA and citric acid assisted phytoremediation of Ni contaminated soil by using canola (Brassica napus)

Phytoremediation is an ecofriendly technique to clean heavy metals from contaminated soil by the use of high biomass producing plant species. Chelators can help to improve this biological technique by increasing metal solubility. Therefore, a pot experiment was conducted to determine the effect of the chelators EDTA and citric acid (CA) in phytoremediation of Ni contaminated soil by using Brassica napus (canola). Two cultivars of B. napus, Con-II (tolerant) and Oscar (sensitive), were selected after screening and exposed to NiSO4 at 30 ppm at the time of sowing. CA (10 mM) and EDTA (1.5 mM) were applied either alone or in combination with each other after two weeks of Ni treatments. Different parameters like morpho-physiological and biochemical data were recorded after 15 days of chelate application. The results highlighted the successful use of chelating agents (CA and EDTA) not only to ameliorate Ni stress but also to enhance Ni accumulation which is prerequisite for phytoremediation. The basal application of 10 mMCA and 1.5 mM EDTA concentration proved to be effective for the growth of plants. The combination of chelating agents failed to show any synergistic effects.

Attitudes and access of Irish general surgery trainees to robotic surgical training

Background

Although the use of robotic-assisted surgery is now mainstream for procedures such as robotic prostatectomy and hysterectomy, its role in general surgery is less well established. Access to training in robotics for general surgery trainees in the Republic of Ireland is variable. Further, there are no data on specific attitudes of Irish trainees toward the role of robotics. We aimed to establish attitudes of Irish general surgery trainees toward the perceived utility of robotic surgery as well as access and satisfaction with training.

Methods

A survey was disseminated to trainees in the Republic of Ireland enrolled in a General Surgery training scheme via email and social media. Data collected included stage of training, intended subspecialty, interest in developing robotic skills, previous exposure to robotic surgery, satisfaction with current access to robotic training, and opinion on formally incorporating training in robotics into the general surgery curriculum.

Results

The response rate was 53.8%. Of these, 83% reported interest in training in robotics and 66% anticipated using the technology regularly in consultant practice. Previous exposure to robotic-assisted surgery was significantly predictive of interest in developing the skillset (P = .014). More than 71% of trainees reported that they were not satisfied with access to robotic training. Of those satisfied with access, 40% felt there was a role for incorporating robotic training into the curriculum compared to 68% of those dissatisfied.

Conclusion

Irish general surgery trainees perceive robotic-assisted surgery to be highly relevant to their future practice. There is an unmet need to provide additional training in the skillset.

•

Irish general surgery trainees perceive robotic surgery (RS) to be highly relevant to their future practice.

•

Access to training in RS is limited, and the majority of trainees desire more access to RS training.

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Most trainees feel that there is a role for incorporating RS training into the curriculum.

PRKCE non-coding variants influence on transcription as well as translation of its gene

Untranslated regions of the gene play a crucial role in gene expression regulation at mRNA and protein levels. Mutations at UTRs impact expression by altering transcription factor binding, transcriptional/translational efficacy, miRNA-mediated gene regulation, mRNA secondary structure, ribosomal translocation, and stability. PKCε, a serine/threonine kinase, is aberrantly expressed in numerous diseases such as cardiovascular disorders, neurological disorders, and cancers; its probable cause is unknown. Therefore, in the current study, the influence of PRKCE 5'-and 3'UTR variants was explored for their potential impact on its transcription and translation through several bioinformatics approaches. UTR variants data was obtained through different databases and initially evaluated for their regulatory function. Variants with regulatory function were then studied for their effect on PRKCE binding with transcription factors (TF) and miRNAs, as well as their impact on mRNA secondary structure. Study outcomes indicated the regulatory function of 73 5'UTR and 17 3'UTR variants out of 376. 5'UTR variants introduced AP1 binding sites and promoted the PRKCE transcription. Four 3'UTR variants introduced a circular secondary structure, increasing PRKCE translational efficacy. A region in 5'UTR position 45,651,564 to 45,651,644 was found where variants readily influenced the miRNA-PRKCE mRNA binding. The study further highlighted a PKCε-regulated feedback loop mechanism that induces the activity of TFs, promoting its gene transcription. The study provides foundations for experimentation to understand these variants' role in diseases. These variants can also serve as the genetic markers for different diseases' diagnoses after validation at the cell and population levels.

Is health a priority among decision-makers of Pakistan? Evidence from Parliamentary questions screening

OBJECTIVES

The objectives of the study were to assess the interest of Pakistani parliamentarians in health issues, including the comparison of interest by gender, to determine the relation of health issues raised in the parliament with national health priorities set by Pakistan's Health Ministry and to assess the nature of health questions.

STUDY DESIGN

Cross-sectional study.

METHODS

We assessed the Pakistani parliamentarians' interest and importance given to the country's health problems by retrospectively counting parliamentary health-related questions raised on the floor of the house from 2012 to 2016. Categorical variables and themes were created and identified respectively based on questions' contents and analyzed in SAS v9.4.

RESULTS

A total of 25,496 questions were asked in the parliament, out of which 408 (1.60%) were related to health issues seeking basic information and policies. An even smaller proportion (1.31%) of the questions were related to national health priorities. Despite a low ratio of female to male members (1:4), females asked five times more questions about health than their male counterparts.

CONCLUSIONS

The members of parliament asked a low percentage of questions about health compared to other affairs in the country. It could, therefore, be assumed that they have low interest in health issues of the country, and this might be one of the reasons for the challenging state of health in the country. However, female members asked the majority of questions about health issues and could, therefore, play a vital role in improving the dismal state of the country's health.

Encapsulated benzoic acid supplementation in broiler diets influences gut bacterial composition and activity

1. The present study investigated the effects of encapsulated benzoic acid (BA) supplementation in broiler feed on performance and gastrointestinal microbiota. 2. Eighty broilers were randomly divided into two groups. Birds in the control group were fed on maize-soybean-based diets. Birds in the treatment group were provided the same diet supplemented with 2 g/kg BA encapsulated in a vegetable oil matrix. 3. At the end of the trial (d 35), pH, bacterial composition and metabolites were determined in the crop, jejunum, ileum and caecum. 4. Growth performance variables and pH were not significantly different. 5. BA concentration decreased rapidly in the proximal gut. However, the treatment diet showed higher BA in the crop, jejunum, ileum and caecum. 6. Total lactate in the crop and D-lactate in the jejunum was higher in the BA treated group. Caecal total and branched chain fatty acids were decreased due to the treatment. 7. Lactobacilli populations were significantly altered by BA supplementation. A trend for increased lactobacilli was observed in the crop, while it became significant in the jejunum and ileum. Lactobacillus species responded differently to the treatment. Four of 5 measured Lactobacillus species, particularly in the ileum, followed the course observed for total lactobacilli; only Lactobacillus salivarius was not modified. 8. Correlation analysis showed that BA modified the intestinal microbiota. Lactobacilli correlated negatively to all studied clostridial clusters and enterobacteria. Clostridial clusters IV and XIVa were significantly increased in the jejunum, whereas only clostridial cluster XIVa was increased in the caecum. 9. Encapsulated BA modified the intestinal microbiota which can lead to the conclusion, that the main beneficial mode of action of BA in the gut appears to be the enhancement of lactic acid bacteria, which in turn may act as a vanguard against pathogens.

Effect of feed grinding methods with and without expansion on prececal and total tract mineral digestibility as well as on interior and exterior egg quality in laying hens

The grinding of cereals by various milling methods as well as thermal treatment of feed may influence mineral digestibility and egg quality. The present study investigated the effect of feed produced by disc mill (D) and wedge-shaped disc mill (WSD), as mash (M) or expandate (E) on apparent ileal absorption (AIA) and apparent total digestibility (ATD) of calcium, phosphorus, magnesium, zinc, manganese, copper and iron, as well as on egg quality in laying hens. A total of 192 hens (Lohmann Brown) aged 19 wk, were assigned using a randomized design with a 2 × 2 factorial arrangement. Four experimental diets were offered ad libitum. Eggs were analyzed for weight, shape index, area, shell weight per unit surface area, yolk color, air cell, blood spot, Haugh unit, albumen and yolk measures (index, weight, height, width and length), shell measures (surface area, stability, density, thickness and membrane weight), as well as percent contents of albumen, yolk, shell, and shell membrane. The ATD for phosphorus, manganese, and copper was higher in WSD compared with D treatment (P = 0.028, P = 0.028 and P = 0.016, respectively). The interaction between milling methods and thermal treatment influenced ATD of copper (P = 0.033), which was higher in WSD+M group (41.0 ± 20.2) compared with D+E group (-3.21 ± 25.1), whereas no differences were observed for D+M (1.90 ± 37.8) and WSD+E (8.02 ± 36.2) groups. Egg stability tended to be higher in E compared with M treatment (P = 0.055). Albumen weight, percentage albumen weight, and albumen: yolk were higher and percentage yolk weight was lower in D compared with WSD treatment (P = 0.043, P = 0.027, P = 0.024, and P = 0.041, respectively). Number of blood spots was higher in E than M treatment (P = 0.053). In conclusion, use of a wedge-shaped disc mill resulted in higher ATD for phosphorus, manganese, and copper than use of a disc mill; however, digestibility for majority of minerals as well as egg quality parameters was comparable. Therefore, feed produced by either disc mill or wedge-shaped disc mill as mash or expandate may be used for laying hens without negative effects on egg quality.

Implication of milling methods, thermal treatment, and particle size of feed in layers on mineral digestibility and retention of minerals in egg contents

Feed production with different milling methods, thermal treatment, and particle size may influence mineral digestibility and retention in eggs. The present study investigated the impact of roller (R) and hammer (H) mills, mash (M) and expandate (E) with fine (F) and coarse (C) particle sizes, on apparent ileal absorption (AIA) and apparent total digestibility (ATD) and retention of calcium, phosphorus, magnesium, zinc, manganese, copper and iron in yolk, albumen, and shell. A total of 384 hens (Lohmann Brown), 19 weeks old, were assigned using a randomized design with a 2×2×2 factorial arrangement. Eight experimental diets were offered ad libitum during the whole experimental period and one week before for diet adaption. The AIA of magnesium, zinc, copper, and iron was higher in treatment R in comparison with treatment H (P<0.01, P≤0.03, P<0.01 and P<0.01, respectively). The AIA of magnesium was higher in treatment M than treatment E (P<0.01). The AIA of magnesium was higher in treatment C in comparison with treatment F (P≤0.05) due to particle size. The ATD of copper and iron was higher in treatment R than treatment H (P<0.01 and P≤0.03, respectively). The ATD was higher for phosphorus and lower for iron in treatment F than treatment C (P≤0.05 and P≤0.02. respectively). The copper concentration in yolk and albumen was higher in treatment C than treatment F (P<0.01 and P≤0.03, respectively). Besides a few overall interactions, the AIA and ATD of copper and manganese were lower in H+M group than R+M group (P≤0.05). The ATD of iron was higher in the M+C group compared to the M+F group (P<0.01), whereas the albumen zinc concentration was higher in the E+C group than E+F group (P < 0.01). In conclusion, the feed produced by hammer mill had negative effects on AIA and ATD for trace elements in particular, but mineral concentrations in egg contents were mostly comparable for all treatments. Therefore, milling methods, thermal treatment, and particle sizes used in the present study can be used for layer feed formulation without negatively affecting egg quality.

Open anterior hip dislocation in a young adult with exposed femoral head and no neurovascular damage

ABSTRACT

Anterior hip dislocation is common in younger adults and is the result of severe, high energy trauma such as high-velocity motor vehicle accidents or falls from great heights. A similar mechanism of injury would cause a femur neck fracture in older patients. Of these, open anterior hip dislocations are extremely rare and are usually associated with other soft tissue and bony injuries. We report a case of an open anterior hip dislocation with normal neurovascular status in a third world setting.

KEY WORDS

trauma, open anterior, dislocation, hip, femoral head, osteonecrosis.

Protecting the right to health of internally displaced mothers and children: the imperative of inter-cluster coordination for translating best practices into effective participatory action

Substantive progress has been achieved in advancing emergency response interventions during disasters including assistance of internally displaced persons (IDPs). Explicit operational technical guidelines and management strategies have been successfully applied through the "cluster approach". In 2008-09 armed conflict in several districts of the Khyber Pakhtunkhwa (KP) province and the Federally Administered Tribal Areas (FATA) of Pakistan resulted in over 2.7 million IDPs. This report describes the response by the Pakistan government, assisted by the hosting populations and humanitarian partners, to deal with the crisis using the cluster approach to ensure the health protection of the IDPs, particularly mothers and children.

Rapid confirmation of tuberculous meningitis in children by liquid culture media

BACKGROUND

Tuberculous meningitis (TBM) is an important and serious complication of tuberculosis (TB) related to high morbidity and mortality. Childhood TBM is a diagnostic dilemma as the clinical features are non-specific and cerebrospinal fluid (CSF) mycobacterial count is low. The diagnosis is made mostly on clinical grounds, CSF analysis and radiological findings and treatment is initiated before the culture results arrive. These non-specific rapid diagnostic tools may be misleading resulting in over diagnosis or misdiagnosis. The conventional way of establishing a definitive diagnosis of TBM is by solid-medium culture that requires 4-7 weeks which may often lead to injudicious exposure to hazards associated with anti-tuberculous therapy (ATT).

METHODS

This study was carried out at the Microbiology department of University Of Health Sciences Lahore. The aim of this study was to assess the reliability of clinical features and CSF analysis in diagnosing childhood TBM by utilizing BACTEC Mycobacterial Growth Indicator Tube (MGIT) 960 system as a rapid confirmatory tool. It was an observational study that included 100 CSF samples from suspected paediatric TBM cases. After carrying out the biochemical and cytological analysis the samples were subjected to Ziehl-Neelsen (ZN) staining and inoculated onto MGIT 960 system. The culture growths were tested for sensitivity to first line ATT.

RESULTS

Of the 100 samples inoculated, only 14 yielded a growth, thus emphasizing unreliability of clinical criteria to diagnose TBM. CSF biochemistry was found insignificant for the diagnosis of TBM (p = 2.260). The CSF cytology, however, was found significant for diagnosing TBM (p = 0.001).

CONCLUSIONS

The study showed that BACTEC MGIT 960 can be effectively used as a rapid diagnostic tool for the diagnosis of extra pulmonary tuberculosis.

Pakistan human resources for health assessment, 2009

Pakistan faces a human resources for health (HRH) crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis.

Launching the first postgraduate diploma in medical entomology and disease vector control in Pakistan

The Health Services Academy has launched a 12-month postgraduate diploma course in medical entomology and disease vector control. The objective is to create a core of experts trained to prevent and control vector-borne diseases. The course is a response to the serious health and socioeconomic burden caused by a number of vector-borne diseases in Pakistan. The persistence, emergence and re-emergence of these diseases is mainly attributed to the scarcity of trained vector-control experts. The training course attempts to fill the gap in trained manpower and thus reduce the morbidity and mortality due to these diseases, resulting in incremental gains to public health. This paper aims to outline the steps taken to establish the course and the perceived challenges to be addressed in order to sustain its future implementation.

Implementing the district health system in the framework of primary health care in Pakistan: can the evolving reforms enhance the pace towards the millennium development goals?

There is growing renewed trust in primary health care as the best approach for ensuring equity in the delivery of essential health services. However, Pakistan with one of the most widely spread district health system networks in the region, has not delivered at the expected capacity. A series of health system reform agendas are now stipulated which include the promulgation of an essential health service package, public private partnerships and a people-centred focus. Nevertheless, success of these reforms will hinge on the ability of the three tiers of the government and other stakeholders to work together to improve the overall performance of the district health system. This paper provides an overview of the district health system infrastructure and organization of primary health care services in Pakistan, the evolving governance pattern and the operational significance and merit of health system pillars for effective service implementation.

The value of preoperative axillary ultrasound staging in the management of early breast cancer

Abstract #1023

Background: The prognosis of breast cancer is strongly associated with the presence of metastatic disease in the axillary lymph nodes at the time of diagnosis. Sentinel lymph node biopsy (SLNB) is the current standard of care for staging a clinically negative axilla in early breast cancer. Approximately 25% of women with early stage breast cancer undergoing SLNB are node positive and require completion axillary lymph node dissection (ALND). Ultrasound guided fine needle aspiration cytology (FNAC) of axillary lymph nodes is a minimally invasive technique that can be used preoperatively to stage the axilla in breast cancer patients, reducing the number of operative procedures required for staging and local control of disease. Aim: To determine the sensitivity and specificity of ultrasound guided axillary FNAC to detect positive axillary lymph nodes in breast cancer patients and to determine the number of patients who avoided unnecessary SLNB. Methods: Newly diagnosed invasive breast cancer patients were prospectively followed from January 2007 to June 2008. Patients with stage IV breast cancer, clinically node positive disease and patients who did not proceed to surgery were excluded. Criteria for a suspicious sonographic axillary node included diffuse cortical thickening &gt;3mm, focal nodular cortical thickening and a mass-like appearance with loss of the fatty hilum. Results: 133 patients who met the inclusion criteria were diagnosed with invasive breast cancer between January 2007 and June 2008. Median age was 60 [21-87]. 49 patients had T1 tumours, 77 patients had T2, and 7 patients had T3 tumours. 126 (95%) patients had axillary ultrasounds, 44 ( 35%) of which showed abnormal axillary lymph nodes. 38 ( 86%) of these 44 patients proceeded to ultrasound guided axillary FNAC and 27 (71%) of these were positive for malignant cells. All patients with positive axillary nodal FNAC underwent axillary clearance and all had positive nodes on final histopathology. The median number of positive nodes was 2, range was 1 to 21. 26 (20%) patients avoided unnecessary SLNB. 82 patients had a negative axillary ultrasound and 27 of these had axillary node positive disease. The median number of positive nodes was 1, the range was 1 to 8.&#x2028; &#x2028; Conclusion: Ultrasound guided axillary FNAC has a high specificity and positive predictive value in radiologically suspicious nodes. A positive FNAC allows definitive treatment of the axilla in radiological node positive patients and avoids the unnecessary step of SLNB.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1023.

Focal non-typhoidal Salmonella infections from a single center in Malaysia

A retrospective review of patients with focal non-typhoidal Salmonella (NTS) infection was performed to determine its features and outcome. All patients with focal NTS infection admitted to the University of Malaya Medical Center, Malaysia, from 1993 to 2002 were studied. More than half (58%) of the 35 cases (54% male, median age 39 years, range 1.5 months to 79 years) were immunocompromized or had chronic medical conditions. One-third of the patients (34%) had superficial infections (lymphadenitis or subcutaneous tissue infection) and all recovered with antimicrobial therapy alone. Deep infections (66%) noted were: meningitis (9%), osteomyelitis or arthritis (26%), abscesses of the gastrointestinal tract or adjacent organs (20%), and others (11%). Deep infections were more likely to occur in the extremes of age (<6 months or >60 years, p< 0.04), associated with adverse outcomes with an overall mortality rate of 9%, or required major surgery (15%).

Oral zinc supplementation in pregnant women and its effect on birth weight: a randomised controlled trial

Pakistan lies in a zinc deficient area where oral zinc supplementation has been advocated for various reasons. A double blind, randomised case-control study was carried out on pregnant women to evaluate the effects of oral zinc supplementation on the weights of newborns. No significant difference was found in the birth weights between the cases supplemented with 20 mg elemental zinc and controls receiving oral placebos (p=0.57).

Prescription and dispensing practices in public sector health facilities in Pakistan: survey report

OBJECTIVES

To gather information on existing prescription practices, dispensing practices and patient satisfaction in government health services of the NWFP, Baluchistan and Punjab province.

METHODS

A cross sectional study design was used for this purpose. Ten health care facilities were selected from each province keeping appropriate representation from first level health facilities, district health facilities and tertiary care hospital. Analysis of selected indicators was carried out on the basis of provinces, health facilities, gender and different age groups.

RESULTS

Documentation of 914 responses was completed from three provinces. Almost equal distribution of encounters was maintained representing different health facilities. Forty seven percent of encounters involved children under 15 years of age. Female patients comprised of 56% and the mean age of the entire sample was 26 years. The mean dispensing time was only 38 seconds, the mean consultation time was 1.79 minutes and the average number of drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being dispensed from the facility. More than half of the prescriptions contained antibiotics and 15% of patients were prescribed with injectables. Only half of the patients expressed satisfaction with their visit to health facility.

CONCLUSIONS

Like many other developing countries, prescription and dispensing practices are not satisfactory in public sector health facilities of Pakistan. Appropriate and workable solutions need to be developed and implemented in the country to improve systems. Regular audits and qualitative studies should become part of the effort.

Suicidal feelings run high among mothers in refugee camps: a cross-sectional survey

OBJECTIVE

To study levels of mental distress in a sample of Afghan mothers caring for children in two refugee camps in North West Frontier Province (NWFP) of Pakistan.

METHOD

Cross-sectional survey of 297 consecutive mothers with young children, attending primary care centres, using a psychiatric screening instrument, the Self-Reporting Questionnaire (SRQ-20).

RESULTS

One hundred and six (36%) of women in the sample screened positive for a common mental disorder. Ninety-six (91%) of those screening positive had had suicidal thoughts in the previous month, and nine (8%) rated suicidal feeling as their topmost concern.

CONCLUSION

There is a high prevalence and severity of mental distress in Afghan mothers caring for young children in refugee camps. This may have serious long-term effects on the psychological and physical development of their children.

Recurrent abdominal pain and Helicobacter pylori infection in children

Recurrent chronic upper abdominal pain is a common problem in children and it has been associated with Helicobacter Pylori gastritis.

AIMS AND OBJECTIVES

We under took this study, to find out the prevalence of Helicobacter pylori gastritis in children with recurrent chronic upper abdominal pain, in our set up.

MATERIAL AND METHODS

This was prospective study carried out at KRL Hospital, Islamabad. Forty three children with chronic recurrent upper abdominal pain (age 3 to 14 years), underwent diagnostic gastroscopy and antral biopsies with histopathology, over a period of one year. Another 42 children of the same age group were taken as control group. Fifteen patients, who tested positive for H. pylori were tested for IgG antibodies in whole blood and compared with 15 patients having negative histology for H. pylori.

RESULTS

Thirty two (75%) children tested positive for H. pylori, in the test group, as compared to 17 (40%) histological positives in the control group (P = < 0.1). The patients who were tested for IgG antibodies showed that this test has 93% sensitivity, 60% specificity and a negative predictive value of 90% as compared to histological identification.

CONCLUSION

Recurrent chronic upper abdominal pain in children, in our population has a significant association with Helicobacter pylori gastritis. Testing of IgG antibodies for H. pylori in whole blood can be used as initial, non invasive screening test for this organism.

Iron deficiency anaemia: continuous versus intermittent treatment in anaemic children

Iron deficiency anaemia is a common disorder among paediatric population. Traditionally, oral iron is given for treatment on daily basis. We undertook this study to compare the results of intermittent with continuous oral iron therapy in children. The study was conducted at Combined Military Hospital (CMH), Lahore. Children (aged 1 to 6) with iron deficiency anaemia (Hb 11 g/dl) were allocated at random into two groups, A (n = 27) and B (n = 28). The mean Hb of group A, before treatment, was 8.56 (+/- 1.51) g/dl and that of group B was 8.32 (+/- 1.68) g/dl. Group A was given daily oral dosage of 6 mg/kg of elementAL iron whereas group B was given the same dosage of iron but only 3 days a week. After 2 months of treatment the Hb of group A rose to a mean of 11.06 (+/- 0.72) g/dl and that of group B was increased to 11.3 (+/- 0.90) g/dl, respectively. The difference, in the rise of Hb of two groups, was not statistically significant. It was concluded that in our sample of population, the results of intermittent and continuous oral iron therapy, for iron deficiency anaemia in children aged 1 to 6 years, were identical.

Glucose ingestion and whole blood ionized calcium and magnesium in the third trimester of pregnancy

OBJECTIVE

To test the hypothesis that glucose ingestion leads to a decrease in plasma ionized calcium (iCa) and ionized magnesium (iMg) during the third trimester of pregnancy.

METHODS

We studied 54 women who underwent a 50 g glucose challenge test (GCT) and 27 women who underwent a 3-hour 100 g glucose tolerance test (GTT) because of an abnormal GCT. Plasma glucose was measured with an automated chemistry analyzer, while whole blood iCa and iMg were measured using an ion-selective electrode.

RESULTS

The 1-hour plasma glucose post-GCT correlated inversely with whole blood iCa (r = -0.322, p = 0.027). The 3-hour plasma glucose GTT revealed a similar, but not statistically significant, decrease in blood iCa (r = -0.378, p = 0.356). The combined 1-hour peak plasma glucose during GTT and GCT correlated inversely with iCa (r = -0.376, p = 0.001), but not with iMg (r = 0.050, p = 0.737). Using multiple regression with iCa as the dependent variable and plasma glucose and glucose dose (50 or 100 g) as independent variables, both plasma glucose and glucose dose were inversely correlated with iCa (R2 = 0.45, p < 0.001).

CONCLUSION

We conclude that in pregnancy, induced hyperglycemia correlates with a drop in blood iCa concentrations; however a 100 g glucose load leads to a lesser iCa decrease than a 50 g load.

Blood lead levels in preschool children in Rawalpindi

Blood lead levels were determined in preschool children residing in Urban areas of Rawalpindi city. Of 92 (50 males and 42 females) children aged one to 5 years were included in the study. Blood lead levels ranged from 7 micrograms/dl to 34 micrograms/dl (mean 18.8 micrograms/dl). The mean lead levels were slightly higher in males (20.3 micrograms/dl) than in females (17.2 micrograms/dl) and over 90% children had lead levels above the acceptable limit of 10 micrograms/dl. Use of leaded petrol, contaminated surma, leaded paints and pica in children are common in our country and may lead to increased lead levels and appropriate measures should be taken to control this trend.

Prevalence and pattern of HIV infection in Karachi

Two thousand seven hundred and seventy six subjects comprising 844 high risk and 1932 low risk group were screened for HIV antibodies by ELISA and western blot. Eight subjects from high risk group were HIV positive. They included three prisoners, two sexually promiscuous, two seafarers and one recipient of blood. The highest prevalence of the infection was found in sexually promiscuous group (5.40% +/- 7.40) followed by prisoners (1.64% +/- 1.87), multitransfused patients (1.0% +/- 1.96) and seafarers (0.66% +/- 0.93). No case of HIV infection was found in low risk population group, however, one pregnant women had p24 and p55 antibodies on western blot.

AIDS and HIV associated disorders in Karachi

In a seroepidemiological study for the prevalence of HIV infection in Pakistan, individuals from different groups were tested for HIV antibodies using ELISA. Positive results were confirmed by western blot. Out of 413 individuals screened four were found positive by ELISA, of these three were confirmed by western blot. Two cases were foreign nationals visiting Pakistan, one of them died of full blown AIDS, the other did not show any AIDS related condition. The third case was a Pakistani national who presented with full blown AIDS with toxoplasmosis. To our knowledge this is the first case of full blown AIDS reported in a Pakistani national. The fourth case was an asymptomatic promiscuous lady who could not be traced further. Blood transfusions abroad and sexual contacts were responsible for HIV infection in these cases.

Human immunodeficiency virus-associated disorders in Pakistan

We have documented evidence of the human immunodeficiency virus (HIV) infection in four individuals including a blood donor and three members of a family (husband, wife, and a child) in Karachi, Pakistan. Our data indicate that HIV has been transmitted to the wife of the seropositive male, a drug abuser, in the recent past and that she has passed the virus to her newborn child perinatally/transplacentally. The two seropositive males (blood donor and drug abuser) were diagnosed clinically as having persistent generalized lymphadenopathy, an AIDS-related condition (ARC), and the child presented with developmental disorders and neurologic manifestations. This is the first report of AIDS/ARC cases from Pakistan that can be directly related to HIV infection and its heterosexual transmission.