Measurement of natural radioactivity in sand samples collected along the bank of rivers Indus and Kabul in northern Pakistan

Radioactivity is a part of the natural environment. The presence of natural radioactivity in sand and other building materials results in internal and external exposure to the general public. Therefore, it is desirable to determine the concentration of naturally occurring radionuclides, namely (232)Th, (226)Ra and (40)K in sand, bricks and cement which are commonly used as building materials in Pakistan. In this context, sand samples were collected from 18 different locations covering an area of ∼1000 km(2) along the banks of river Indus (Ghazi to Jabba) and river Kabul (Nowshera to Kund) in the northern part of Pakistan, whereas bricks and cement samples were collected from local suppliers of the studied area. In order to measure the specific activities in these samples, a P-type coaxial high-purity germanium-based gamma-ray spectrometer was used. In sand samples, the average specific activities of (226)Ra, (232)Th, and (40)K were found to be 30.5±11.4, 53.2±19.5 and 531±49 Bq kg(-1), whereas in brick samples, specific activities of 30±14, 41±21 and 525±183 Bq kg(-1) were observed, respectively. In cement samples, measured specific activity values were 21±5, 14±3 and 231±30 Bq kg(-1), respectively. Radium equivalent activities were calculated and found to be 143.8±38.6, 124±49.8 and 56.69±7 Bq kg(-1) for sand, brick and cement samples, respectively. The annual mean effective dose for the studied sand samples was found to be 0.40 mSv. External and internal hazard indices were less than unity for all the studied samples. The present results have been compared with those reported in the literature.

Determination of MHC binding peptides and epitopes from non-structural movement (NSm) protein of groundnut bud necrosis virus

Groundnut bud necrosis virus (GBNV) is recognized as one of the most economically important viruses and is known to affect several crops including peanut, potato, tomato and soybean. For managing plant virus diseases, determination of their causal agents' identity at an early stage of crop is a pre-requisite. In the present study, NSm protein of GBNV has been used to predict out MHC binding peptides and epitopes that are highly suitable for antigenicity. Eighteen peptide regions were found to have high affinity. Few of these NSm protein TAP transporters are 126- RRYMHISRL with score 11.638, 125- NRRYMHISR with score 10.280, 46- AIMNKAKTL with score 7.762, 120- PTWNSNRRY with score 7.632 and 171- ASLKDPMCF with score 7.277. The support vector machine (SVM) based approach predicted MHCII-IAb peptide regions, 45- SAIMNKAKT, 151- ASLIDPNKM, 23- PAVKKENNR, 229- PIAAENNTC, (optimal score 0.938); MHCII-IAd peptide regions, 208- YAKGVGFAS, 101- NDSLVGNGN, 55- NGKQYVSSG, 63-GDSSVLGTY, (optimal score 0.852); MHCII-IAg7 peptide regions, 277- LQKAAERLA, 145- SKNNVKASL, 228- TPIAAENNT, 276- SLQKAAERL, (optimal score 1.640); and MHCII- RT1.B peptide regions, 193- TPKQCMQLN, 195- KQCMQLNLT, 246- KVIQSAALI, 166- IISRQASLK, (optimal score 0.800) as binders from NSm protein. The most suitable predicted segments in NSm protein of GBNV virus found in the study are 164- KIIISRQASLKDPMCFIFHLNWS- 186 and 237-CDVVPINRAKVIQSAALIEACKLMIP-262. These two fragments, obtained from non-structural movement protein with average propensity 1.016, are high-efficiency binders and may, therefore be used in cross protection to provide resistance against GBNV and develop GBNV specific antibodies that can be exploited in sero-diagnostics.

Risk factors for extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae acquisition in a neonatal intensive care unit

This study was made to find the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae in neonatal intensive care unit (NICU) and to identify the risk factors associated with the acquisition of these organisms. Risk factors associated with ESBL-producing E. coli and/or K. pneumoniae acquisition status of neonates were assessed. Of 253 neonates admitted, 238 entered the active surveillance system. ESBL-producing K. pneumoniae was responsible for 7 infections and 51 colonizations while ESBL-producing E. coli was responsible for 9 infections and 88 colonizations. Concurrent isolation of both the organisms occurred in 30 neonates. The logistic regression model identified 'length of stay in the NICU' as the single independent risk factor. Imipenem, cefepime and amikacin can be suggested as the drugs of choice in our study.

Negative Estrogen Receptor and HER2 Assays at Core Biopsy of Invasive Cancers Should Be Confirmed in the Surgical Specimens

Background: Management of patients with invasive breast carcinoma is determined by the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in the tumor cells. It is therefore critical to accurately assess ER, PR, and HER2 (ERPRH2) and avoid false-negative results that could lead to withholding of potentially beneficial therapy. Most laboratories, including ours, evaluate ERPRH2 status of invasive carcinoma on core biopsy (CB) material. We also routinely retest the cancer in the surgical specimen (SS) for any marker negative on CB. Our study evaluates discrepancies in ER and HER2 results in CB and SS to determine if repeat testing is necessary.Methods: Retrospective review of the pathology database found 186 invasive carcinomas from 181 patients in which ERPRH2 had been performed on the CB, and negative stains repeated on the SS. For the purpose of this study, immunoperoxidase stains (IHC) were repeated simultaneously on the CB and SS for the marker with discordant result, using the same antibody. Two study pathologists reviewed all IHC. HER2 FISH was performed on the SS for all cases with a discordant HER2 IHC result.Results: The concordance rate between CB and SS results was 97.3% (181/186) and discordant results were found in 5/186 (2.7%) cases (Table 1). Three cases were discordant in ER (including 2 cases that were PR(-) on CB and SS) and two cases were discordant for HER2. Discrepancy was due to intratumoral heterogeneity in 2 cases. The CB sampled the HER2(-) area of the tumor in one case, but staining of a larger section unveiled the positive focus; the positive result was confirmed by amplification of HER2 detected by FISH. The second case was an invasive lobular carcinoma (IL) with mixed classical and histiocytoid morphology; only the classical IL was ER(+), but the CB had sampled the histiocytoid IL. In two other cases the discrepancy resulted from technical error. Both cases had been prospectively interpreted as ER(-) on CB and ER(+) on SS, but repeat IHC for ER showed positive staining in both the CB and SS. The fifth case was HER2 (0/1+) on CB but equivocal (1-2+) in the SS, where a larger portion of tumor was evaluated; the equivocal result led to reflex HER2 FISH with detection of low level HER2 amplification. Relying solely on the CB would have resulted in the misclassification of 2 tumors as triple negative; repeat stains on the SS showed that one was HER2(+) and the other ER(+).Conclusions: Concordance in the ER and HER2 results between CB and SS was high (97.3%), but 2.7% of cases showed discordant findings. Factors associated with discordance included intratumoral heterogeneity tumor, technical error, and equivocal findings. A triple negative profile on CB converted to either ER(+) or HER2(+) after staining on SS in 2 cases (40% of discordant cases and 1.1% of all cases), impacting patient management. Our findings suggest that any ER and/or HER2 negative result obtained at CB should be confirmed on the SS to ensure appropriate patient management.Findings of discordant casesCaseER (%)HER2HER2 FISH CBSSCBSSSS1OOO3+4.42O951+1+N/P3O1001+1+N/P45501+1+N/P590N/P0-1+1-2+2.6N/P- not performed

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6008.

Economical and environmental implications of solid waste compost applications to agricultural fields in Punjab, Pakistan

Application of municipal solid waste compost (MSWC) to agricultural soils is becoming an increasingly important global practice to enhance and sustain soil organic matter (SOM) and fertility levels. Potential risks associated with heavy metals and phosphorus accumulations in surface soils may be minimized with integrated nutrient management strategies that utilize MSWC together with mineral fertilizers. To explore the economic feasibility of MSWC applications, nutrient management plans were developed for rice-wheat and cotton-wheat cropping systems within the Punjab region of Pakistan. Three-year field trials were conducted to measure yields and to determine the economic benefits using three management strategies and two nutrient doses. Management strategies included the application of mineral fertilizers as the sole nutrient source and application of mineral fertilizers in combination with MSWC with and without pesticide/herbicide treatments. Fertilizer doses were either based on standard N, P and K recommendations or on measured site-specific soil plant available phosphorus (PAP) levels. It was found that combining MSWC and mineral fertilizer applications based on site-specific PAP levels with the use of pesticides and herbicides is an economically and environmentally viable management strategy. Results show that incorporation of MSWC improved soil physical properties such as bulk density and penetration resistance. The PAP levels in the surface layer increased by the end of the trials relative to the initial status. No potential risks of heavy metal (Zn, Cd, Cr, Pb and Ni) accumulation were observed. Treatments comprised of MSWC and mineral fertilizer adjusted to site-specific PAP levels and with common pest management showed highest cumulative yields. A basic economic analysis revealed a significantly higher cumulative net profit and value-to-cost ratio (VCR) for all site-specific doses.

Combined persistent Mullerian Duct Syndrome, Transverse Testicular Ectopia and Mosaic Klinefelter's Syndrome

Persistent Mullerian Duct Syndrome (PMDS), a rare form of male pseudohermaphroditism, is characterized by the persistence of Mullerian duct structures (uterus, fallopian tubes and upper two-thirds of vagina) in otherwise normallyvirilized males (Karyotype 46XY). Patients suffering from PMDS present with cryptorchidism, inguinal hernia and infertility. Diagnosis is established when Mullerian duct structures are discovered either during ultrasonography for localization of undescended testis(s), during surgical exploration for cryptorchidism or herniorrhaphy (hernii uteri inguinalis). Presence of both testes on one side of the scrotum is known as Transverse Testicular Ectopia (TTE). Co-existence of PMDS and transverse testicular ectopia in a patient of mosaic Klinefelter's syndrome (Karyotype 46XY/47XXY) is a unique genetic association.

Human placental IGF-I and IGF-II expression: correlating maternal and infant anthropometric variables and micronutrients at birth in the Pakistani population

AIM

To correlate infant birth weight with maternal and infant biometric data, including the expression of placental IGF-I and IGF-II at birth, and levels of serum zinc and ferritin.

METHODS

The data consisted of observations from 89 women from Karachi, Pakistan. Placental and cord blood samples were taken immediately following delivery and were subsequently divided into two groups, small and large for gestational age (SGA and LGA).

RESULTS

The mean birth weight was 2.79 kg; the prevalence of SGA being 13.4% (< or =10th percentile); the prevalence of LGA being 23.6% (> or =90th percentile). Placental IGF-I and IGF-II mRNA expression was greater in the LGA group (p < 0.05). Furthermore, a significant correlation was noted between infant birth weight and maternal anthropometric parameters (p < 0.01). Cord zinc levels were also significantly higher in the LGA group (p < 0.05).

CONCLUSION

Maternal anthropometry, along with placental IGF-I and IGF-II mRNA levels, correlated significantly with infant birth weight suggesting the importance of these growth factors for birth weight outcomes. The higher zinc levels in the LGA group also suggest the importance of this micronutrient in foetal growth. Our results suggest that growth problems have a multifactorial aetiology arising from within the infant rather than due to maternal constraint alone.

Impact of anthropmetric measures on sural nerve conduction in healthy subjects

BACKGROUND

Nerve conduction studies are an invaluable aid to investigate and quantify the physiological activity of peripheral nerves. These include measurement of sensory and motor conduction velocities and latencies of peripheral nerves. These nerve conduction parameters may be affected by anthropometric factors like age, sex, height, weight and BMI. In this observational study the impact of these anthropometric parameters was measured on sensory nerve conduction velocity (SNCV) and sensory latency (SNSL) of sural nerve.

METHOD

Sural nerve conduction studies were conducted in EMG room of Neurology section of Medical Unit 1 at Sir Ganga Ram Hospital, Lahore on Electromyograph by Nihon Kohden MEB-5304K.

RESULTS

After following strict exclusion criteria by careful history and physical examination 25 normal healthy subjects recruited from local population by random sampling technique. The age range was 40-70 years with mean age 47.2 +/- 9.23 years. Gender distribution was 60% females and 40% males. The mean SNCV was found to be 53.16 +/- 5.68 meter per second (m/sec) and mean SNSL was 2.81 +/- 0.45 milliseconds (msec).

CONCLUSION

It was found that the mean sural nerve conduction velocity was higher and the mean sensory latency was shorter in healthy subjects than that of the Western races. Moreover, the SNCV decreases and SNSL increases significantly with age.

Determination of gamma-emitting radionuclides in the inter-tidal sediments off Balochistan (Pakistan) Coast, Arabian Sea

Natural radionuclide contents of 226Ra, 228Ra and (40)K were studied for inter-tidal sediments collected from selected locations off the745 km long Balochistan Coast using HPGe detector based gamma-spectrometry system. The sampling zone extends from the beaches of Sonmiani (near Karachi metropolis) through Jiwani (close to the border of Iran). The natural radioactivity levels detected in various sediment samples range from 14.4 +/- 2.5 to 36.6 +/- 3.8 Bq kg(-1) for 226Ra, 9.8 +/- 1.2 to 35.2 +/- 2.0 Bq kg(-1) for (228)Ra and 144.6 +/- 9.4 to 610.5 +/- 23.9 Bq kg(-1) for (40)K. No artificial radionuclide was detected in any of the marine coastal sediment samples. 137Cs, (60)Co, 106Ru and 144Ce contents in sediment samples were below the limit of detection. The measured radioactivity levels are compared with those reported in the literature for coastal sediments in other parts of the world. The information presented in this paper will serve as the first ever local radioactivity database for the Balochistan/Makran Coastal belt of Pakistan. The presented data will also contribute to the IAEA's, Asia-Pacific Marine Radioactivity Database (ASPAMARD) and the Global Marine Radioactivity Database (GLOMARD).

Gamma-emitting radionuclides in the shallow marine sediments off the Sindh coast, Arabian Sea

Determination of gamma emitting radionuclides in shallow marine sediments off the Sindh coast has been carried out using a gamma spectrometry technique. The activity concentration measured in various sediment samples off the Sindh coast has been found to vary from 15.93 +/- 5.22 to 30.53 +/- 4.70 Bq kg(-1) for 226Ra, from 11.72 +/- 1.22 to 33.94 +/- 1.86 Bq kg(-1) for 228Ra and from 295.22 +/- 32.83 to 748.47 +/- 28.75 Bq kg(-1) for 40K. The calculated mean values of radium equivalent activity, absorbed dose rate and effective dose are 98 Bq kg(-1), 49 nGy h(-1) and 0.06 mSv y(-1), respectively. No artificial radionuclide was detected in the samples measured from the study area. As no data on radioactivity of the coastal environment of Pakistan are available, the data presented here will serve as baseline information on radionuclide concentration in shallow sea sediments off the Sindh coast. The data will also be useful for tracking pollution inventories from unusual radiological events (if any) in the territorial waters of the study area. Further, the information presented will contribute to modelling of a regional radioactivity database from the perspectives of the International Atomic Energy Agency's Asia-Pacific Marine Radioactivity Database and Global Marine Radioactivity Database.

Socioeconomic status and breast cancer survival in Pakistani women

OBJECTIVES

No data is available from developing countries correlating socioeconomic status (SES) with survival in female breast cancer patients. We decided to test the hypotheses whether SES is an independent determinant for disease stage, access to minimal expected treatment (MET) and survival.

METHODS

Two hundred eighty six patients diagnosed with breast cancer were recruited between April 1996 to May 1998. Patients were divided into three groups according to their SES. Prognostic factors analyzed were age, tumor size, nodal status; stage at presentation, estrogen receptor status, time elapsed before diagnosis and access to MET. Disease free survival (DFS) and overall survival (OS) were determined according to the SES of the patients.

RESULTS

Patients were categorized into three socioeconomic groups, high (21%), middle (44%) and low (35%). Mean age of all patients was 46 years, in patients from lower SES mean age was 43 years compared to 50 years in high SES. Mean time elapsed before diagnosis for women from high-income group was 4.3 months versus 10.6 months in low-income group. Early breast cancer was more common in affluent strata, 70% versus 41% in the lower strata. Eighty-nine percent patients received MET from the affluent group compared to only 43% patients in the lower strata. Literacy rate of patients from high SES was 73.7% compared to 15% in the low SES. Five year DFS and OS are 79% and 86% for high income group, 48% and 68% for middle income group and 31%,49% for lower strata which were statistically significant (P=.0001 and P<.0001).

CONCLUSION

In our cohort of patients strong association was noted between low SES and advanced disease, delay in diagnosis, limited access to MET and inferior DFS and OS. The outcome of these patients may be improved by patient education and availability of better health care facilities.

Fission track estimation of uranium concentrations in drinking water from Azad Kashmir, Pakistan

The analysis of uranium in water samples can be very helpful for providing guidelines to the general public regarding necessary remedial measures. A fission-track technique has been applied for the estimation of the uranium concentration in drinking water collected from natural springs of Muzaffarabad and hilly areas of Reshian, Azad Kashmir. The technique involved simultaneous irradiation with thermal neutrons of a sample and a standard in contact with a track detector, and the counting of the fission tracks in the detector from the (n, f) nuclear reaction. Uranium concentrations of the samples were determined by comparing fission-track density with that of a standard of known uranium concentration. Uranium concentration in water samples from the Muzaffarabad and Reshian area varied from 0.03 +/- 0.01 microgL(-1) to 6.67 +/- 0.14 microgL(-1) with an average of 1.36 +/- 0.05 microgL(-1). The observed concentrations of uranium in drinking water were found to be less than the Maximum Acceptable Concentration levels of 9-30 microgL(-1). Thus, the observed values are within safe limits as far as uranium related health hazards are concerned.

Institution based tumor registry from Punjab: five year data based analysis

INTRODUCTION

There are no population based cancer registries in Pakistan except for Karachi Cancer Registry (KCR). No data from Punjab is available in the last decade. We decided to conduct a data base analysis to see the frequencies of different cancers in Punjab.

PATIENTS AND METHODS

A retrospective analysis of 5100 patients presenting to Jinnah Hospital between January 1997 to December 2001 with histological diagnosis of cancer was performed. A tumor registry performa on all patients was filled which included demographic data as age, sex, duration of symptoms and disease stage at presentation. All cancers were coded according to international classification of Disease-oncology (ICD-10) classification.

RESULTS

Male cancers accounted for 47.7% and female cancers 52.2% of the total cases. In males the three most frequent cancers were leukemias, non-Hodgkins lymphoma and lung cancer. In females breast cancer was the most common cancer accounting for 38.5% female followed by ovarian cancer 13.6%.

CONCLUSIONS

Our institution based cancer registry indicates hematological malignancies are the most common cancers in males in Punjab followed by lung and colorectal cancer. In females breast cancer is the commonest cancer followed by ovarian cancer. Gall bladder cancer is relatively more frequent in women while cervical cancer is less commonly observed in our patient population. Despite biases until population based incidences are available, studies like ours may prove beneficial for future health planning and research.

Phase 1 trial of ifosfamide and adriamycin in metastatic breast cancer

OBJECTIVE

A Phase 1 trial was conducted in patients with estrogen negative receptors (ER) or hormone refractory metastatic breast cancer to determine the maximum tolerated dose (MTD) of ifosfamide with a fixed dose of doxorubicin. A secondary objective was to determine the efficacy of the combination in metastatic breast cancer.

METHODS

Fifteen patients were entered in the study in cohorts of three patients at each dose level of ifosfamide. The dose of doxorubicin was fixed at 45 mg/m2. Five different dose levels of ifosfamide were tested ranging from dose level 1 of 1.5 gms/m2 day 1-3 to level V at 2.5 gms/m2 day 1-3.

RESULTS

Dose escalation of ifosfamide was stopped at 2.5 gms/m2. The MTD of ifosfamide was 2.25 gms/m2 day 1-3 in combination with doxorubicin. All patients in the study were assessable for toxicity. Neutropenia and thrombocytopenia were the major dose limiting toxicities. Other toxicities included anemia, confusion and hematuria. Objective responses were documented in 11 of 15 patients (73.3%). Median time to treatment failure (TTF) was 13 months. Median overall survival (OS) was 18 months.

CONCLUSION

The combination of ifosfamide and doxorubicin was a practical well tolerated regimen. There was substantial evidence of clinical activity in this phase I trial. This combination should be further evaluated, as an attractive alternative to taxanes for patients in developing countries where cost effectiveness is important.

Neuroblastic and Schwannian stromal cells of neuroblastoma are derived from a tumoral progenitor cell

The coexistence of neuroblastic and Schwannian stromal (SS) cells in differentiating neuroblastoma (NB), and derivation of Schwannian-like cells from neuroblastic clones in vitro, were accepted previously as evidence of a common pluripotent tumor stem line. This paradigm was challenged when SS cells were suggested to be reactive in nature. The advent of microdissection techniques, PCR-based allelic analysis, and in situ fluorescent cytometry made possible the analysis of pure cell populations in fresh surgical specimens, allowing unequivocal determination of clonal origins of various cell subtypes. To overcome the complexity and heterogeneity of three-dimensional tissue structure, we used: (a) Laser-Capture Microdissection to obtain histologically homogeneous cell subtype populations for allelotype analysis at chromosomes 1p36, 11q23, 14q32, and 17q and study of MYCN copy number; (b) multiparametric analysis by Laser-Scanning Cytometry of morphology, DNA content, and immunophenotype of intact cells from touch imprints; and (c) bicolor fluorescence in situ hybridization on touch imprints from manually microdissected neuroblast and stroma-rich areas. Histologically distinct SS and neuroblastic cells isolated by Laser-Capture Microdissection had the same genetic composition in 27 of 28 NB analyzed by allelic imbalance and gene copy number. In all 20 cases studied by Laser-Scanning Cytometry, SS cells identified by morphology and S-100 immunostaining had identical DNA content and GD2-staining pattern as their neuroblastic counterparts. In 7 cases, fluorescence in situ hybridization demonstrated the same chromosomal makeup for SS and neuroblastic cells. These results provide unequivocal evidence that neuroblastic and SS cells in NB are derived from genetically identical neoplastic cells and support the classical paradigm that NB arises from tumoral cells capable of development along multiple lineages.