5-Fluorouracil-Induced Severe but Reversible Cardiogenic Shock: A Case Report

5-fluorouracil cardiotoxicity is increasingly recognized with variable presentation. We report a patient who developed cardiogenic shock due to high-dose 5-fluorouracil infusion (1,000 mg/m2 every 24 hr for 96 hr). There was no evidence of myocardial necrosis. The patient recovered completely without any residual cardiac dysfunction. The exact cause of 5-fluorouracil toxicity remains to be determined. The case highlights the need for careful monitoring of patients who receive high-dose 5-fluorouracil for the development of cardiotoxicity.

Short-term Impacts of Tillage and Fertilizer Treatments on Soil and Root Borne Nematodes and Maize Yield in a Fine Textured Cambisol

Conservation agriculture (CA) based on the principles of minimum soil disturbance, crop residue retention, and crop rotation has been the focus of intensive research in recent years. A study was carried out to determine the effects of tillage and fertilizer on the population densities of plant-parasitic nematodes in maize. Three tillage regimes, (i) basin planting, (ii) rip line seeding, and (iii) conventional tillage, were combined with four fertilizer regimes: (i) no-fertilizer, (ii) low fertilizer rate, (iii) medium fertilizer rate, and (iv) high fertilizer rate. The experiment was arranged as a split plot in randomized complete block design, replicated three times with tillage as the main plot factor and fertilizer as the sub-plot factor. The study was conducted on fine-textured Cambisol soils at Chinhoyi University of Technology farm, Zimbabwe, over two cropping seasons between December 2014 and April 2016. Eight plant-parasitic nematode genera were observed belonging to five groups based on their feeding sites: (i) sedentary endoparasites ( Meloidogyne and Rotylenchulus ), (ii) migratory endoparasites ( Pratylenchus ), (iii) semi-endoparasites ( Scutelonema and Helicotylenchus ), (iv) ectoparasites ( Xiphinema and Trichodorus ), and (v) algal, lichen or moss feeders ( Tylenchus ). In both cropping seasons, semi-endoparasitic nematodes were double under rip line seeding and triple under basin planting compared to conventional tillage. Basin planting had higher plant-parasitic nematode richness than rip line seeding. Nematode densities did not have a measurable effect on maize grain yield. Maize grain yield was higher in rip line seeding (37%) and planting basins (52%) than conventional tillage during 2014/15 cropping season. On the other hand, during 2015/16 cropping season, maize grain yield was 78% and 113% higher in rip line seeding and basin planting, respectively, compared to conventional tillage. The results show that under the environmental and edaphic conditions of this specific study site, semi-endoparasitic nematodes were higher under rip line seeding and basin planting compared to conventional tillage. The authors conclude that (i) plant-parasitic nematode genera exhibited differential responses to different tillage systems but were not affected by fertilizer application, and (ii) in the present study, maize grain yield response under different tillage and fertilizer regimes was overall not related to nematode population density and composition.

Correlation of ABH blood group antigens secretion with Helicobacter pylori infection in Pakistani patients

OBJECTIVES

A and B blood group antigens are fucosylated carbohydrate present on human erythrocytes and body secretions. Their presence in body secretions depends on the expression of a dominant allele of secretor gene FUT2 and is correlated with susceptibility to various infectious and non-infectious diseases. We investigated the correlation of blood group and ABH antigen secretion with Helicobacter pylori infection and gastroduodenal symptoms and analysed the distribution of babA gene among ABH secretors and non-secretors.

METHODS

Two hundred and ninety patients who underwent gastroduodenal endoscopy during 2011 to 2012 participated. Gastric biopsy, saliva and blood samples were obtained from every patient. Gastric biopsies were subjected to rapid urease test and PCR for the detection of H. pylori and babA gene. Blood grouping and ABH antigens secretions were determined by Lewis blood group phenotyping and haemagglutination inhibition test.

RESULTS

50.34% of patients were ABH antigen secretors and 45.51% non-secretors. Distribution analysis of blood group revealed that 40 blood group B, 67 blood group A 20 blood group O and 19 blood group AB patients secreted ABH antigens in saliva. Fifty-six blood group O, 19 blood group B, 32 blood group A and 17 blood group AB patients were non-secretors. Gastroduodenal complaints were common among non-secretors. Sixty-two percent of patients with a combination of duodenal ulcer and gastro-oesophageal reflux and 54% of patients with gastritis were non-secretors. Of 290 samples, 31.02% were positive for H. pylori. Thirty percent of these tested positive for babA gene; the majority belonged to non-secretor blood group O.

CONCLUSIONS

Our results suggest that the infection of H. pylori is correlated with ABO blood groups and blood group antigens secretion in body fluids.

Effect of saline water on seed germination and early seedling growth of the halophyte quinoa

Salinization is increasing on a global scale, decreasing average yields for most major crop plants. Investigations into salt resistance have, unfortunately, mainly been focused on conventional crops, with few studies screening the potential of available halophytes as new crops. This study has been carried out to investigate the mechanisms used by quinoa, a facultative halophytic species, in order to cope with high salt levels at various stages of its development. Quinoa is regarded as one of the crops that might sustain food security in this century, grown primarily for its edible seeds with their high protein content and unique amino acid composition. Although the species has been described as a facultative halophyte, and its tolerance to salt stress has been investigated, its physiological and molecular responses to seawater (SW) and other salts have not been studied. We evaluated the effects of SW and different salts on seed germination, seedling emergence and the antioxidative pathway of quinoa. Seeds were germinated in Petri dishes and seedlings grown in pots with SW solutions (25, 50, 75 and 100 %) and NaCl, CaCl2, KCl and MgCl2 individually, at the concentrations in which they are present in SW. Our results demonstrated that all salts, at lower concentrations, increased the germination rate but not the germination percentages, compared with control (pure water). Conversely, seedlings were differently affected by treatments in respect to salt type and concentration. Growth parameters affected were root and shoot length, root morphology, fresh and dry weight, and water content. An efficient antioxidant mechanism was present in quinoa, activated by salts during germination and early seedling growth, as shown by the activities of antioxidant enzymes. Total antioxidant capacity was always higher under salt stress than in water. Moreover, osmotic and ionic stress factors had different degrees of influence on germination and development.

Development of an in-house enzyme-linked immunosorbent assay based on surface whole cell antigen for diagnosis of Helicobacter pylori infection in patients with gastroduodenal ulcer disease

Helicobacter pylori (H. pylori) is a causative agent of gastritis, gastroduodenal ulcers and gastric adenocarcinoma. More than 50% world population is colonized by H. pylori, which is closely related to the chronic gastritis and gastric ulcer infection. In this study, a total of 214 gastritis patient's serum samples were screened for anti-H. pylori IgG antibody. A 96-well plate coated with 20 μg/ml antigen and hundred-fold diluted patient's serum was allowed to react. After extensive washing with buffer, 1:2,500 diluted conjugated secondary antibody was added. Later substrate was added to observe positivity by measuring the intensity of color. Statistical analyses were performed, and p value of <0.01 was taken as significant; 84% male patients and 89% female patients, respectively, tested positive for H. pylori, while agewise distribution was 35-45 years males (40%) and 35-55 years females (52%) were found highest number of H. pylori infected patients. In-house ELISA based on surface whole cell antigen (wELISA) showed a sensitivity of 93%, specificity of 100%, accuracy 94% and κ value 0.86 with significant correlation R-0.77020; p < 0.0001. We conclude that H. pylori local isolates surface antigen was satisfactory for diagnosis as different parameters were adjusted according to the local H. pylori isolates. Fluctuations in serum antibody titer predict the variation in an individual's response of the host against H. pylori. In-house wELISA could provide a reliable and a clinically useful method for the diagnosis of H. pylori infection in patients of Karachi, Pakistan.

Prevalence, diversity and disease association of Helicobacter pylori in dyspeptic patients from Pakistan

Introduction: The etiological association of Helicobacter pylori with gastric ulcer (GU), gastric cancer (GC), and duodenal ulcer (DU) is well-known. Understanding the epidemiology of H. pylori facilitates the estimation of disease burden in a certain population. This study presents the diversity of H. pylori genotypes and their association with different clinical outcomes among dyspeptic patients in Pakistan over a period of four years. Methodology: Gastric biopsy samples from a total of 450 dyspeptic individualswere subjected to PCR, genotypingand histology. Results: A total of 201 (45%) cases were found positive for H. pylori. The detection rate was high in GU (91%), DU (86%) and GC (83%) cases compared with those cases who had intact gastric mucosa (18%). Histology revealed the presence of infection in 68% of cases of mild/chronic nonspecific gastritis with others belonging to the GU sequel. cagA gene carriage was observed in 104 (51%) cases or mostly from DU, GU and GC groups, of which 97 were Western type strains while 3 were East-Asian type strains that are rarely observed in South Asia. vacA allelic variant s1am1 was most commonly observed, followed by s1am2, and s1bm1, with direct correlation in diseased cases (gastritis, GU, DU and GC). Prevalent genotypic combinations were s1am1/cagA- in gastritis and s1am1/cagA+ in DU, GU, and GC. Conclusions: Our study indicates the predominant circulation of Western type cagA and vacAs1am1 type H. pylori strains in Pakistan.

Antibiotic resistance and cagA gene correlation: A looming crisis of Helicobacter pylori

AIM: To determine antibiotic resistance of Helicobacter pylori (H. pylori) in Pakistan and its correlation with host and pathogen associated factors.

METHODS: A total of 178 strains of H. pylori were isolated from gastric biopsies of dyspeptic patients. Susceptibility patterns against first and second-line antibiotics were determined and trends of resistance were analyzed in relation to the sampling period, gastric conditions and cagA gene carriage. The effect of cagA gene on the acquisition of resistance was investigated by mutant selection assay.

RESULTS: The observations showed that monoresistant strains were prevalent with rates of 89% for metronidazole, 36% for clarithromycin, 37% for amoxicillin, 18.5% for ofloxacin and 12% for tetracycline. Furthermore, clarithromycin resistance was on the rise from 2005 to 2008 (32% vs 38%, P = 0.004) and it is significantly observed in non ulcerative dyspeptic patients compared to gastritis, gastric ulcer and duodenal ulcer cases (53% vs 20%, 18% and 19%, P = 0.000). On the contrary, metronidazole and ofloxacin resistance were more common in gastritis and gastric ulcer cases. Distribution analysis and frequencies of resistant mutants in vitro correlated with the absence of cagA gene with metronidazole and ofloxacin resistance.

CONCLUSION: The study confirms the alarming levels of antibiotic resistance associated with the degree of gastric inflammation and cagA gene carriage in H. pylori strains.

First organized screening mammography programme in Saudi Arabia: preliminary analysis of pilot round

The aim of this study was to analyse results of the pilot screening round for Al-Qassim Screening Mammography Programme and compare with international standards. Analysis was conducted in the central screening office in Prince Faisal Oncology Centre, which coordinates activities of various screening units. Data were collected during the period 1 January 2007 to 30 June 2008. Organizational and functional information was obtained from policy and procedure manuals of the programme. Out of 9812 eligible women, 1766 (18%) participated and data were available for 1628 (16.6%). The median age of participants was 47 (standard deviation 8.12) years. The low uptake rate (18%) and a high recall rate (31.6%) characterized the pilot screening round. Biopsy rate was 1.5% and cancer detection rate was 0.24%. Many performance indicators in this pilot screening round were not available. Many of the available indicators did not meet international standards.

Endoscopic esophagitis and gastroesophageal flap valve

The authors studied the relationship of endoscopic esophagitis and gastroesophageal flap valve (GEFV) in patients with symptomatic gastroesophageal reflux (GER). On endoscopy, the GEFV was graded as I to IV in 138 patients with acid regurgitation and heartburn relieved by antacids, and in 54 control subjects without symptoms suggestive of GER. Grade of GEFV was correlated with the grade of esophagitis, response to medical treatment, duration of symptoms, obesity, smoking, sex, and age of the patient. Abnormal GEFV (grades III and IV) was more frequent in patients with symptomatic GER, both with and without esophagitis, compared with control subjects (p = 0.000001. p = 0.03). Abnormal GEFV was significantly more common in patients with GER with esophagitis compared with those without (p < 0.00001). There was no significant difference in the distribution of normal and abnormal GEFV in patients with grade I esophagitis. However, grade 2 and grade 3 esophagitis were associated more commonly with an abnormal GEFV (p < 0.00001, p < 0.02 respectively). Hiatal hernia is always associated with an abnormal GEFV. Abnormal GEFV correlated significantly with age (more frequent when older than 40 years). Sex, duration of symptoms (>3 years), response to medical therapy, smoking, and obesity (body mass index > 30 kg/m2) did not correlate significantly with abnormal GEFV. We conclude that endoscopic esophagitis is usually associated with abnormal GEFV. It is more frequent in grades 2 and 3 but not grade 1 esophagitis. It is also encountered more commonly after the age of 40 years.

Cancer in Al-Qassim, Saudi Arabia: A retrospective study (1987-1995)

Regional differences in the pattern of cancer are obvious in Saudi Arabia. From January 1987 to December 1995, 1106 new cases of cancer (642 males, 464 females) were seen at the King Fahd Specialist Hospital in Buraidah, Al-Qassim. Overall, lymphomas, non-Hodgkin's and Hodgkin's disease combined were the most common malignancy seen (15.10%), followed by esophageal carcinoma (7.77%). Thyroid cancer was the most common malignancy among females (12.50%), followed by breast cancer (9.48%). The majority of the patients were in the younger age group (77% were <50 years of age). Among the hematological malignancies, acute lymphoblastic leukemia was the most frequent type (36.23%). Lymphomas were the most common malignancy (66.12%) seen in the pediatric age group (0-14 years), followed by leukemias and brain tumors. The pattern of cancer in Al-Qassim is generally similar to other regions of Saudi Arabia, with few regional variations. prominent among such variations is the high frequency of non-Hodgkin's lymphomas (NHL), esophageal and thyroid carcinomas.

Efficacy of fine-needle capillary biopsy in the assessment of patients with superficial lymphadenopathy

BACKGROUND

Fine-needle aspiration biopsy (FNAB) is an important tool for the cytologic assessment of patients with lymphadenopathy. The nonaspiration method (without the use of a syringe or a handle), or fine-needle capillary biopsy (FNCB), is becoming popular for its ease of learning and use. The authors compared the two techniques of fine-needle biopsy (with and without aspiration) for identifying the cause of superficial lymphadenopathy.

METHODS

Over a 2-year period 50 cytologic examinations were conducted in patients with superficial lymphadenopathy. Both procedures were performed at the same site; the order in which they were performed was determined randomly. Slides were fixed in a similar manner and examined by a cytotechnologist and pathologists blind to the procedure. Scores were tabulated and compared and diagnosis was confirmed by histologic examination.

RESULTS

The best and the average score for the yield of cellular material was higher with FNCB (P < 0.004). Cell preservation also was superior with FNCB (P = 0.00066). However, the failure rate was lower with FNAB (P = 0.7662).

CONCLUSIONS

FNCB of superficial lymph nodes yields adequate cellular material of superior quality, which may be advantageous in certain situations. However, the diagnostic yield does not appear to be significantly increased using this technique.

Symptomatic cardiotoxicity with high-dose 5-fluorouracil infusion: a prospective study

Cardiotoxicity with 5-fluorouracil (5-FU) therapy has been reported to range from asymptomatic EKG abnormalities to fatal myocardial infarction. We report a prospective study in 100 consecutive patients receiving 5-FU infusion in combination with other chemotherapeutic agents or alone for the treatment of different malignancies with the aim of identifying patients who develop symptomatic cardiotoxicity. Patients with a history of cardiac illness, abnormal EKG or cardiac enzyme levels were excluded. Patients were observed during the total period of infusion, daily EKG was performed on asymptomatic patients, those who developed cardiotoxicity were monitored till symptom-free for 24 h. Eight patients developed symptoms suggestive of cardiotoxicity. Pain was the commonest symptom (5/8), followed by palpitation and sweating. Three patients developed EKG abnormalities and 1 went into cardiogenic shock. Time to toxicity ranged from 18 to 30 h (mean 24 +/- 3.7 h) and serial cardiac enzyme levels remained normal in all patients. The symptoms reversed immediately on cessation of the treatment in most of the patients (7/8). Time to recovery ranged from 5 to 60 min (mean 19.28 +/- 19.6 min). There was no recorded death due to toxicity. We conclude that 5-Fu infusion is associated with a significant risk of symptomatic cardiotoxicity. Concomitant chemotherapeutic agents, received by all the affected patients, may have a contributory effect too. Cardiotoxicity seems to be completely reversible, particularly in patients without underlying cardiac disease. The patients should be informed about the symptoms and the condition recognised and managed immediately.

Cancer in Libya--a retrospective study (1981-1985)

Between 1981 and 1985, 1124 patients with histopathologically confirmed malignant disease were registered at the sole oncology clinic of Libya, 664 (59%) were males and 460 (41%) were females. Overall, malignant lymphoma (ML) was the most common cancer (180/1124, 16%), with non-Hodgkin's lymphoma (NHL) being more common (57.2%) than Hodgkin's disease (HD) (42.8%). Considered separately, lung cancer was the most common tumour (22.4%) in males with a male to female ratio among the highest in the world (18.6:1), 85% of our male patients were smokers and more than 50% had been smoking heavily for 20 years or more. Breast cancer was the most frequent tumour (29.8%) of females and the majority of our patients were of a younger age group (72.3% below 50 years). Almost all our patients were multiparous and had breast-fed their babies. Cancer of the cervix uteri was less frequent (4.5%) than ovarian cancer (7.8%). The incidence of colorectal cancer was higher (4.6%) than other African countries. Contrarily the primary tumours of liver (1.9%) and bladder (0.5%) were less frequent. Among the children, aged less than 10 years, the common solid tumours of childhood occurred in the following frequency, ML 31.2%, nervous system 19.2%, Wilm's tumour 16.8% and bone tumours 9.6%.

A 10-year experience of tamoxifen as primary treatment of breast cancer in 100 elderly and frail patients

Between 1977 and 1983 100 elderly women (median 76.3 years) with breast cancer were treated with tamoxifen as primary therapy. The median follow-up is 59 months. Sixty-eight responded (40 CR and 28 PR) with median response durations of 47 months and 26 months respectively. Twenty-two patients had disease stabilization for a median of 15.5 months and 10 had progressive disease. The median time to best response was 13.5 weeks for patients achieving CR and 14 weeks for those with PR. Oestrogen receptor values were obtained in 37 patients of which two patients had no ER detectable. Sixty-seven per cent of ER-unknown patients responded compared with 74% of ER-rich. Likelihood of response did not appear to depend upon T-stage or age. Survival was better than that of an unmatched historical group treated with surgery/radiotherapy and compares favourably with recent reports. Although 35% have died of breast cancer, 25% died of other causes and 22% remained free of recurrence at the time of reporting or at death. Only 11% underwent subsequent mastectomy/lumpectomy and the most frequent subsequent treatments were radiotherapy to the breast (32%) and further hormonal therapies (40%). Tamoxifen is a practical primary therapy of breast cancer in elderly and frail women obviating the need for surgery in a high proportion of cases.

A double-blind randomized cross-over comparison of high-dose prochlorperazine with high-dose metoclopramide for cisplatin-induced emesis

This double-blind randomized cross-over study was conducted to compare the safety and efficacy of high-dose prochlorperazine infusion and dexamethasone (HDPD) with an effective and safe combination of high-dose metoclopramide and dexamethasone (HDMD) in controlling cisplatin-induced emesis. None of the patients entering the study had received any prior chemotherapy. High-dose cisplatin was administered on an inpatient basis. Twenty eligible patients were analyzed based on the assessment made 24 h after the chemotherapy. The parameters compared were severity and duration of nausea and vomiting, severity of retching and side effects. Significantly less vomiting and retching episodes were recorded with HDPD combination. The severity of nausea was also less with this combination. There was no significant difference in the incidence of side effects.

Prognostic factors for survival in soft tissue sarcoma

Between 1975 and 1984, 125 cases of histologically confirmed soft tissue sarcomata (STS) were registered in the Department of Clinical Oncology in Edinburgh. Of these, 100 were eligible for analysis of prognostic factors. The overall 5-year survival rate was 21.5%. Univariate analysis demonstrated that extent of surgery, radical versus palliative or no radiotherapy, mass as a presenting symptom, metastases at presentation, site, histological type, mitotic activity, grade and UICC stage all had a statistically significant effect on survival. Analysis using the proportional hazard regression model was performed on the 87 patients for whom all variables were recorded. When all histological and clinical features and treatment modalities were included in the model then radiotherapy, surgery, necrosis, sex and mitoses were identified as independent prognostic variables. When symptoms and treatment were excluded then the multivariate analysis identified sex and mitotic activity as independent parameters. For the 33 superficial STS with tumour size recorded multivariate analysis revealed size, necrosis and cellularity as independent prognostic variables. For the 31 deep STS histological type, sex, surgery and radiotherapy were identified as independent prognostic parameters.