Year 2021, Volume 37 - Issue 2

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Retinoblastoma (Rb) represents a primary pediatric cancer, which if left untreated can invade to the nervous system that primarily occurs due to loss of the RB1 gene. Several clinically available therapies are used for the management of risk factors associated with Rb including chemotherapy, brachytherapy, external beam radiotherapy etc. However, each treatment has its own side effects.To meet with the best approach in order to minimize these side effects, novel targeted therapies have been developed that inhibit tumor in an angiogenic-dependent manner. This review provides the insights about some targets and the pharmaceuticals with their possible mechanism of action that targets angiogenesis and induces apoptosis. The targets include activation of p53 via controlling mouse double minute homolog 2, survivin, and thrombospondin-1. Entities described in this review include 5-aminoimidazole-4-carboxamide ribonucleotide, niclosamide, bevacizumab, aflibercept, genistein and quercetin and their potential in treating Rb. Also, the signaling pathways that are affected in response to these drugs like activated protein kinase pathway, Wnt/β-catenin pathway, vascular endothelial growth factor and its receptors has also been discussed.

Transcatheter arterial chemoembolization (TACE) is considered as a major method to treat hepatocellular carcinoma (HCC). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been used to treat patients with advanced HCC. This case report documents the safety, efficacy, and feasibility of TACE and laparoscopic ALPPS to treat the unresectable HCC of the right liver with right intra-hepatic metastasis in a male patient. Percutaneous and trans-femoral artery TACE was performed preoperatively, and the ALPPS stage-I at the 4th week and stage-II after 14 days was carried out. Postoperative outcome was assessed after 180 days of follow-up. It is concluded that preoperative TACE and laparoscopic ALPPS offer a fine treatment alternative to the patients with insufficient residual liver volume and relatively-advanced and extensive HCC.

Background and Objective: Obesity leads to multiple complications that in turn increase mortality worldwide. There is a rapid rise in obesity in the last decade, especially among physicians. The objective of this study was to find out the frequency and relationship of obesity with socio-economic factors among faculty of a local medical college in Lahore, Pakistan.
Methods: A descriptive cross-sectional study was conducted on 162 medical and paramedical staff of Fatima Memorial College of Medicine and Dentistry, Lahore for a duration of 7 months from February 2019 to August 2019. Data were collected by filling the questionnaires and standard tools were used for height and weight measurement. Overweight/obesity was defined as a body mass index of ≥25 kg/m2.
Results: In this study, out of 86 males and 76 females, the majority of the respondents were between the ages of 21 and 35 years. Seventy three (45.1%) and thirty (18.5%) respondents were overweight and obese, respectively. Out of a total 162 subjects, 38 (24%) were hypertensive and 18 (11%) were suffering from diabetes. There was a statistically significant association of obesity with age (p < 0.05), marital status (p < 0.001), family history of obesity (p < 0.001), and smoking (p < 0.05).
Conclusion: Risk factors like age, marital status, family history of obesity, and smoking have a strong correlation with obesity in faculty members of a medical school.

Background and Objective: Ongoing research suggests that cytochrome P4501A1 (CYP1A1) 3801T > C polymorphism may be correlated with human male infertility but the reported results are conflicting. Hence, this case-control study was conducted in Algerian population to determine the frequency of this polymorphism and its relationship to male infertility.
Methods: This study included 173 subjects grouped into two categories: controls (84) and patients (89) with abnormal semen analysis parameters. Genomic DNA from the patients and controls was extracted and PCR-restriction fragment length polymorphism was used to genotype the 3801T > C CYP1A1 polymorphism.
Results: In the control group, the frequency of homozygous wild-type TT, heterozygous TC, and mutant homozygous CC genotypes of the CYP1A1 T > C polymorphism was 84.52%, 13.10%, and 2.38%, respectively, while infertile men had 77.53%, 20.22%, and 2.25%, respectively. There was no correlation between the 3801T > C CYP1A1 variant and male infertility. Furthermore, the rs4646903 C allele was not a risk factor in the dominant genetic model.
Conclusion: The 3801T > C polymorphism cannot be considered as a risk factor for male infertility in Algerian population. Our results need to be validated and confirmed through prospective studies with a larger number of patients.

Background and Objective: Opioid medications used to be the key method for the pain management after spine surgery; most of the opioids may cause many adverse reactions. The purpose of this research was to observe the role of dexmedetomidine combined with butorphanol in the pain management of patients after posterior spinal surgery.
Methods: This research was conducted in the First Hospital Affiliated to Jinzhou Medical University, China from May 2018 to January 2019. Sixty patients who underwent posterior spinal surgery were equally divided into two groups randomly: Group B who received butorphanol 0.125 mg/kg and Group DB who received dexmedetomidine (DEX) 0.1 μg/kg/hour plus butorphanol 0.125 mg/kg. The patient-controlled analgesia was conducted to deliver a bolus dose of 0.5 ml. followed by an infusion of 2 ml/hour and a lockout time of 15 minutes. Heart rate, mean arterial pressure, respiration rate, pulse oxygen saturation, visual analog scale score (VAS), and Ramsay sedation score were recorded as follows: 1 hour (T1), 2 hours (T2), 6 hours (T3), 12 hours (T4), and 24 hours (T5) post‑surgery. The total number of buttons pressing of patient controlled intravenous analgesia (PCIA) and supplementary analgesic agents was observed and adverse drug reactions and total rate of patient satisfaction were evaluated statistically.
Results: VAS scores at different intervals in DB group were significantly lower compared with the B group after surgery; while the score of Ramsay sedation was remarkably higher in DB group. The total number of buttons pressing of PCIA was less than that of the B group and the frequency of nausea was notably lower in DB group (p < 0.05). The total rate of satisfaction with analgesia in DB group was higher after surgery.
Conclusion: DEX could enhance the analgesic effect of butorphanol after posterior spinal surgery with lesser adverse reactions

Background and Objective: Dental caries is one of the most prevalent diseases among children around the world. It has a complex aetiology and different factors like sugar intake, brushing habits, body mass index, and socio-economic status may play a significant role. Apart from dental pain, caries affects children’s over all body functions, body growth, and pose a financial burden on families. The objective of the study was to determine the association between sugar intake and dental decay among local paediatric population.
Methods: This cross-sectional study was conducted at the Ibn-e-Sina Hospital Multan, Pakistan from July, 2019 to December, 2019. Data were collected on a specifically designed questionnaire. A total of 540 participants of age range between 5 and 12 years were selected for this study after taking consent from their parents. The data were analysed using statistical tests of significance.
Results: Female children were predominantly affected as compared to males (56.7% vs. 43.3%) caries was seen more frequently in children brushing teeth once than those doing it twice (p = 0.01). Children taking cariogenic food between meals and 2 hours before sleep showed a significant association with caries development (p = 0.02; p = 0.01). Primary teeth were affected more (74.18%) than the secondary teeth (11.92%).
Conclusion: Irregular brushing habits and frequency and timing of cariogenic food intake are the leading causes of caries in children from local population.

Background and Objective: The guidelines on the factors to determine whether a patient with concomitant stroke and hip fracture is a good candidate for surgical hip repair are still debatable. This study was carried out to investigate the relationship between the management of acute hip fracture and the recovery of neurological function and prognosis in patients with concomitant acute cerebral infarction.

Methods: Thirty patients with acute cerebral infarction combined with acute hip fracture, who were hospitalized and did not accept surgical treatment, and matched 60 cases as control group having acute cerebral infarction without hip fracture admitted in the same period were selected. The neurological function recovery, hospitalization period, 6 months recovery rate, frequency of complications, and 1 year mortality rate between the groups were compared.

Results: Compared with common acute cerebral infarction patients, the NIH Stroke Scale/Score of acute cerebral infarction group with hip fracture was higher (7.2 ± 5.4 vs. 5.6 ± 4.3, p = 0.034). The hospitalization period was prolonged (16.1 ± 8.9 vs. 12.2 ± 5.3, p = 0.041), and 6 months recovery rate was lower (26.7% vs. 53.3%, p = 0.016), the frequency of pulmonary infection and lower extremity deep vein thrombosis was higher (30% vs. 11.7%, p = 0.03; 6.7% vs. 0, p = 0.043). The 1-year mortality rate in patients with combined hip fracture was higher than in patients with cerebral infarction only.

Conclusion: Acute cerebral infarction combined with hip fracture lead to worse neurological recovery, prolonged hospitalization period, increased complications, decreased patient prognosis, and increased 1 year mortality. Surgical treatment of hip fracture with concomitant acute cerebral infarction may improve the prognosis of patients. According to the statistics of neurological function and mortality after 1 year of follow-up, the prognosis of patients with Modified Rankin Scale below 3 was considered good.

Background and Objective: Inguinal hernia is one of the most common type of hernia affecting both genders. New surgical interventions to repair hernia are being developed for the better outcome of patients by reducing the operative time and postoperative complications. The objective of this study was to compare the prolene sutures and skin staples for mesh fixation in inguinal hernioplasty with mean operative time and post-operative pain as outcome determinants.

Methods: This randomized controlled trial was conducted in the Department of General Surgery, DHQ Teaching Hospital, Sahiwal Medical College, Pakistan from January 1st, 2019 to December 31st, 2019. A total of 180 patients admitted for hernioplasty were recruited after institutional ethical approval. The study participants were randomized into group A and B. Mesh fixation was done by using prolene suture in group A, while skin staples were used in group B. The duration of procedure and post-operative pain after 1 week was noted using visual analogue scoring system. The comparison between groups was done through independent sample t-test. p-value < 0.05 was considered to be statistically significant.

Results: Mean age of the patients in group A and B was 39.21 ± 11 years and 40.16 ± 5.72 years respectively. The mean operative time was 52.15 ± 9.78 minutes in group A and 36.92 ± 3.95 minutes in group B (p = 0.000). Post-operative pain after 1 week was reported in 26.7% cases in group A while it was seen in only 10% cases in group B (p = 0.004).

Conclusion: The outcome determinants of mean operative time and postoperative pain after inguinal hernioplasty were better achieved in cases treated by skin staples as compared to prolene sutures.

Background and Objective: Ribavirin (RBV), due to its mutagenic property, exerts cytotoxic effects on the testicular seminiferous tubules and its interstitium in various experimental animals. However, no study was done on the morphology of testicular capsule. Therefore, the present experimental study is designed to observe the transient effects of RBV in different doses on the testicular capsule thickness in albino rats.
Methods: A total of 72 sexually mature adult male albino rats were divided into four groups: A (control) and, B, C, D where RBV was administered intraperitoneally for 5 days in different doses (20, 100, and 200 mg/kg body weight, respectively). Group received distilled water intraperitoneally. Each group was further divided into three subgroups according to three sacrificial time points that were 20th, 40th, and 60th day from the last exposure to drug. Randomly selected rats from each group were sacrificed on every time point. Histological slides were prepared and changes were observed microscopically.
Results: On 20th sacrificial day, the increase in the thickness of capsules was seen in all groups with subcapsular edema in comparison to control group (p < 0.001). After discontinuation of drug, histological evidence of recovery in the form of decrease in the thickness of capsule with decrease in subcapsular edema were observed in low dose groups on 40th and 60th sacrificial days as compared to high dose groups which showed late recovery on both time points (p < 0.001).
Conclusion: The testicular capsular thickening induced by RBV is reversible after cessation of treatment.

Background and Objective: Sharp force injuries (SFI), inflicted by cutting or stabbing, result in variable outcome depending upon the nature and site of the injury. This study evaluated the cases of SFIs and their outcome with reference to the time of presentation, demographic data, wounded organs, and surgical procedure performed.
Methods: This retrospective study analyzed the clinical data of 20 patients who presented with sharp force injury (knife stabbing and penetrating abdominal trauma) and were admitted between April 2015 and November 2016. The management and outcome of patients were recorded.
Results: All patients in this study were male and aged between 21 and 30 years. Knife stabbing was the only mechanism of injury in all cases. Colon (50%) was the commonest organ injured followed by intestine (40%) and liver (30%). Mortality rate was 10%. There were two cases with negative laparotomy (10%). Wound sepsis (10%) was the commonest complication.
Conclusions: SFI involving abdominal area are managed either conservatively or with primary repair and laparotomy to save internal organs. Early presentation and prompt management leads to reduced chances of complications and mortality.