Exploring of pyrazinamidase recombinant activity from PZA-sensitive and resistant Mycobacterium tuberculosis expressed in Escherichia coli BL21 (DE3)

The mutations of pncA gene encoding pyrazinamidase/PZase in Mycobacterium tuberculosis are often associated with pyrazinamide/PZA resistance. The H and R1 isolates showed significant phenotypic differences to PZA. The H isolate was PZA sensitive, but R1 was PZA resistant up to 100 ug/ml. The paper reports the pncA profile for both isolates and the activity of their protein expressed in Escherichia coli BL21(DE3). The 0.6 kb of each pncA genes have been subcloned successfully into the 5.4 kb pET30a vector and formed the pET30a-pncA recombinant with a size of 6.0 kb. The pncAR1 profile exhibited base mutations, but not for pncAH against to pncA from the PZA-sensitive M. tuberculosis H37RV published in Genbank ID: 888260. Three mutations were found in pncAR1, ie T41C, G419A, and A535G that subsequently changed amino acids of Cys14Arg, Arg140His and Ser179Gly in its protein level. The mutant PZase R1 that expressed as a 21 kDa protein in E. coli Bl21(DE3) lost 32% of its performance in activating PZA drug to pyrazinoic acid/POA compared to the wild-type PZase H. The mutation in the pncAR1 gene that followed by the decreasing of its PZase activity underlies the emergence of pyrazinamide resistance in the clinical isolate. Structural studies for the R1 mutant PZase protein should be further developed to reveal more precise drug resistance mechanisms and design more effective TB drugs.

Mesoporous bimetallic S-doped nanoparticles prepared via hydrothermal method for enhanced photodegradation of 4-chlorophenol

Magnesium oxides (MgO) have gained shown significant promise for a variety of applications, which can be modified by ions doping. In this study, bimetallic Ag-doped S-MgO nanoparticles were prepared by hydrothermal method and used for photocatalytic degradation of 4-chlorophenl (4-CP). EDX suggested the presence of no impurities, which mainly contained Mg, Ag, and S elements, suggesting that S and Ag were incorporated into the lattice of MgO as a result of successful doping. Estimated bandgap of Ag-doped S-MgO nanoparticles was 3.7 eV, lower than MgO (7.8 eV), but useful to improve optical characteristics and photocatalytic efficiency to degrade 4-CP up to a maximum of 99.60 ± 0.50%. The synergetic parameter during photocatalysis of 4-CP was 6.91, confirming the degradation of 4-CP. Quenching experiments proved the presence of hydroxyl radicals (•OH) and singlet dioxygen (1O2) that were critical in 4-CP degradation. The kinetics rate constant was increased by 24.8% from 0.086 ± 0.004 to 0.108 ± 0.005 min-1 by the addition of sulfate in the reaction medium. The work proposes a new synthetic method for preparing catalysts that are capable of producing in-situ •OH radicals and 1O2 to decompose the organic contaminants.

Plankton diversity and its heavy metal content in Ratai Bay of Pesawaran district, Lampung, Indonesia

Artisanal and small-scale gold mining (ASGM) activity in Way Ratai River produces heavy metal wastes; therefore, further information regarding heavy metal concentrations in the water was needed, especially in plankton samples. Furthermore, the determination of plankton diversity was also carried out in the waters of Way Ratai to determine the bioconcentration factor (BCF). Eight sampling sites were chosen along the river reaching the coast of Way Ratai. The research was conducted in November 2020 and March 2021. Ten heavy metals, Ag, Cd, Co, Cr, Cu, Fe, Mn, Pb, and Zn that are commonly found in mining areas, were determined in the water and plankton samples by using ICP-OES. The results indicated that the highest concentration found was Fe in plankton samples (0.725 mg/L in the river and 1.294 mg/L on the coast). Meanwhile, contents of Cd, Cu, Fe, Mn, and Zn in the river exceeded the predetermined water quality standards, while Ag and Pb metals were not detected. The Cd, Cr, Cu, Pb, and Zn content in seawater also exceeded quality standards. The highest BCF value (12.96) was found for Fe at station G, whereas the lowest BCF value (0.13) was found for Ag at stations G and H.

Advanced oxidation of 4-chlorophenol via combined pulsed light and sulfate radicals methods: Effect of co-existing anions

Pulsed light (PL) technology, which is based on photonic technology involves the application of broadband emission of light with short and high-power pulses is beginning to emerge for the treatment of wastes via advanced oxidation processes (AOP). The present work investigates the efficiency of PL as a light source for persulfate (PS) activation (PL/PS) and 4-chlorophenol)4-CP) degradation, an organic model pollutant. The influencing parameters on 4-CP degradation such as solution pH, reaction time, initial concentration of 4-CP, PS dose, pulse intensity and frequency, and distance from PL source are systematically investigated. With increasing pH from 3 to 9, the 4-CP degradation decreased from 49.79 ± 2.49 to 33.12 ± 1.66%. The 4-CP degradation followed the first order kinetics that was improved with increasing reaction time, PS dose, pulse intensity, frequency of pulse, and decreasing pH, initial 4-CP concentration and distance from the PL source. The presence of sulfate, chloride, and carbonate anions in the solution has the inhibitory effects on 4-CP degradation, while nitrate anion improved the performance of PL/PS system. In addition, presence of humic acid had an inhibitory effect on the PL/PS system, which led to a decrease of reaction rate constant and 4-CP degradation was performed in PL/PS system with OH, SO₄^-, O₂^- and ₁O² radicals. The contributions of OH and SO₄^- radicals were 46% and 51%, respectively for the 4-CP degradation and synergistic effect of PL/PS system showed a significant influence on 4-CP degradation while using a combination of PL and PS, suggesting that PL is an effective activator of PS.

Enhanced removal of humic acid from aqueous solution by combined alternating current electrocoagulation and sulfate radical

Application of alternating current in electrocoagulation and activation of persulfate (AEC-PS) for the effective removal of humic acid (HA) from aqueous solution was evaluated. In order to optimize the removal efficiency HA by the AEC-PS process, several influencing parameters such as pH, reaction time, PS dose, current density (CD), concentration of NaCl, initial concentration of HA, and coexisting cations and anions influence were investigated. From the batch experiments, the highest HA removal efficiency obtained was 99.4 ± 0.5% at pH of 5, reaction time of 25 min, CD of 4.5 mA/cm², PS dose of 200 mg/L, and NaCl concentration of 0.75 g/L for an initial HA concentration of 30 mg/L. When CD increased from 1.25 to 4.5 mA/cm², the HA removal efficiency was improved from 88.8 ± 4.4% to 96.1 ± 1.5%. In addition, the type of coexisting cations and anions exerted a significant role, leading to a reduction in the removal efficiency of HA. To investigate the dominant free activated radical, radical scavengers such as tert-butyl alcohol and ethanol were employed. It was observed that both OH and SO₄^- radicals substantially contributed to the removal of HA, and the contribution of SO₄^- radical was higher than that of OH radical, suggesting that AEC-PS process could serve as a novel and effective treatment technique for the removal of organic matters from aqueous sources.

Adsorption of 4-chlorophenol by magnetized activated carbon from pomegranate husk using dual stage chemical activation

Separation under the influence of magnetic field has been widely explored to tackle environmental issues related to centrifuging and filtration. In this work, activated carbon produced from pomegranate husk (PHAC) using dual stage chemical activation was magnetized with iron salts and used for adsorption of 4-chlorophenol (4CP) from the synthetic wastewater. Adsorption experiments were conducted in batch mode to determine the removal efficiency of magnetized activated carbon pomegranate husk (MPHAC) as a function of initial 4CP concentration, solution pH, MPHAC dose, contact time, ionic strength, and temperature. The rough surface of MPHAC containing pores on the surface had a total pore volume of 0.623 cm³/g with a surface area of 1168 m²/g. The 4CP adsorption was highly dependent on ionic strength, solution pH, and temperature; the equilibrium was reached in 60 min of contact time. Kinetic models and equilibrium isotherms were employed to assess the fitness of adsorption data; results were fitted best with the Liu model giving maximum adsorption capacities of 446.89 ± 20.75 and 183.64 ± 17.85 mg/g for 1 and 2 g/L of MPHAC, respectively. For the investigation of the adsorption kinetics, Avrami fractionary-order model showed the best fit of the experimental data compared to other kinetic models.

Fabrication of activated carbon from pomegranate husk by dual consecutive chemical activation for 4-chlorophenol adsorption

In the present work, the fabrication of activated carbon (AC) from pomegranate husk (PHAC) by dual consecutive activation processes with ZnCl₂ and NaOH as a chemical agent was studied. After that, the synthesized PHAC was used for adsorption of 4-chlorophenol (4CP) as a highly toxic compound for the human health and the environment. Different analytical techniques characterized the synthesized PHAC using ZnCl₂/NaOH. The isotherms of N₂ adsorption and desorption showed that total pore volume (V_total) and specific surface area (S_BET) of PHAC were 0.404 cm³/g and 811.12 m²/g, respectively. The 4CP adsorption by PHAC studies revealed that the highest 4CP removal efficiency was 100% and obtained at 50, 100, and 150 mg/L of 4CP concentration with 2.5 g/L of PHAC. Based on the batch experiments, the highest 4CP removal was achieved at pH 6, 2.5 g/L of PHAC, and contact time of 60 min. The 4CP adsorption data of equilibrium and kinetics were successfully fitted to Langmuir's isotherm and Avrami fractional order.

Solitary circumscribed neuroma of the glans penis. An unusual finding

Palisaded encapsulated neuroma is a rare, benign neural tumor. The involvement of the glans penis is rare; few cases have been reported. We present a 52-year-old man with a five-month course of a solitary painless lesion of the glans penis. Full excision of the nodule was performed. Histopathological and immunohistochemical analyses and examination was consistent with a palisaded encapsulated neuroma. We describe one of a few existing cases of this kind of tumor in the glans penis.

Retention of atenolol from single and binary aqueous solutions by thin film composite nanofiltration membrane: Transport modeling and pore radius estimation

The performance of a polyamide-based thin-film composite nanofiltration (NF) membrane (NF33) was investigated for the retention of atenolol, a pharmaceutical pollutant, from the single and binary aqueous solutions. The effect of pH, applied pressure, feed flux, initial atenolol (ATN) concentration, and different co-existing salts with varying concentrations were studied to test the performance of the membrane. The removal efficiency of ATN increased with increasing solution pH giving the highest retention (70.9 ± 3.1) at pH 9, which was slightly decreased with the increasing initial ATN concentration but increased with increasing applied pressure and feed flux. As per the uncharged solutes rejection concept, the average pore radius of NF membrane for slit-like and cylindrical pore geometries were, respectively 0.169 ± 0.003 and 0.264 ± 0.009 nm. The Spiegler-Kedem model could predict the performance of NF membrane by retaining ATN over the investigated range of feed flux. The calculated reflection coefficient (σ) was close to unity, demonstrating the convective transport. Addition of CaCl₂ as a co-existing salt into the feed showed promoting effect on ATN retention, and its efficiency was lowered by the addition of NaCl and Na₂SO₄ salts. As per the cost analysis, the total annualized cost of treatment by the NF was found to be 0.53 $/m³.

Synergistic degradation of 4-chlorophenol by persulfate and oxalic acid mixture with heterogeneous Fenton like system for wastewater treatment: Adaptive neuro-fuzzy inference systems modeling

The 4-chlorophenol (4-CP) is known to be a highly toxic compound having harmful effects on human health and the environment. Due to adverse effect of 4-CP, a new combination of persulfate (PS) and oxalic acid (OA) with heterogeneous Fenton like (HFL) system was developed and applied for 4-CP degradation as an emerging contaminant from synthetic wastewater. The individual (OA, PS, and HFL) and combined (HFL/OA, HFL/PS, and HFL/OA/PS) systems were investigated under various conditions to synergistic effects verification and determination of degradation mechanism of 4-CP. Compared to individual and combined systems, significant synergetic of 4-CP degradation efficiency was observed by HFL/OA/PS system. The highest 4-CP degradation efficiency by HFL/OA/PS system under optimal conditions (solution pH: 6, H₂O₂ dose: 275 mg/L, goethite dose: 125 mg/L, OA dose: 50 mg/L and PS dose: 100 mg/L) with an initial 4-CP concentration of 30 mg/L was 99.6 ± 4.9% after 35 min reaction time. 4-CP degradation by HFL/OA/PS system was followed with the first-order kinetic. The application of radical scavengers including ethanol (EtOH) and tert-butyl alcohol (TBA) revealed that the SO₄^•- radical was determined as primary produced radical species. The Cl- ions release was measured during degradation reaction at various 4-CP concentrations and indicating the complete 4-CP degradation. The developing of the adaptive neuro-fuzzy inference system (ANFIS) for 4-CP degradation efficiency prediction was revealed. These results show that prediction of 4-CP degradation efficiency using HFL/OA/PS system is possible by the ANFIS model with a high accuracy (R²: 0.98).

Correlation between pre-ramadan glycemic control and subsequent glucose fluctuation during fasting in adolescents with Type 1 diabetes

BACKGROUND

Even though patients with type 1 diabetes mellitus (T1DM) are exempted from fasting, the vast majority elect to fast against the advice of their healthcare providers. We have previously reported the incidence of wide fluctuations in blood glucose (BG) along with "unrecognized" severe hypoglycemia during Ramadan fasting in adolescents with T1DM. This report compares the continuous glucose monitoring (CGM) data during fasting in adolescents with T1DM according to their Pre-Ramadan diabetes control.

METHODS

Children and adolescents with T1DM who intended to fast the month of Ramadan were asked to wear the CGM during fasting for a minimum of 3 days. Hypoglycemia, hyperglycemia, and severe hyperglycemia were identified as BG <70 mg/dL (3.9 mmol/L), BG 201-300 mg/dL (11.2-16.7 mmol/L), or BG >300 mg/dL (16.7 mmol/L) respectively, while normoglycemia was identified as BG 70-200 mg/dL (3.9-11.1 mmol/L). Patients were categorized as well-controlled (Group 1) and poorly controlled (Group 2) if the pre-fasting HbA1C was ≤8% (64 mmol/mol) and >8%, respectively. We compared the mean BG and the percentages of time spent in hypoglycemia, hyperglycemia, and severe hyperglycemia between the two groups using Chi-square (significant difference when P value was <0.05).

RESULTS

A total of 21 patients were enrolled (15 females), age 15 ± 4 years, duration of diabetes 6 ± 3 years, and HbA1C 8.5 ± 1.0% (70 mmol/mol). There were 7 subjects in Group 1, mean HbA1C 7.5 ± 0.4, and 14 subjects in Group 2, mean HbA1C 9.1 ± 0.9. The mean ± SD BG was 174 ± 76 mg/dL versus 199 ± 98, (P < 0.05) in Group 1 and Group 2, respectively. The percentages of hypoglycemia, hyperglycemia, and severe hyperglycemia were significantly higher in Group 2, while there was a higher percentage of normoglycemia in Group 1. The overall durations of hypoglycemia, hyperglycemia, and severe hyperglycemia in Group 2 were longer by 30, 14, and 135%, respectively, than those in Group 1.

CONCLUSIONS

Glycemic control before Ramadan in adolescents with T1 DM appears to correlate with blood glucose profile during Ramadan fasting. Our data suggest that optimal glycemic control before Ramadan may reduce the potential risks associated with fasting and minimize glucose fluctuation.

Effect of some biotic factors on microbially-induced calcite precipitation in cement mortar

Sporosarcina pasteurii, a common soil bacterium has been tested for microbial treatment of cement mortar. The present study also seeks to investigate the effects of growth medium, bacterial concentration and different buffers concerning the preparation of bacterial suspensions on the compressive strength of cement mortar. Two growth media, six different suspensions and two bacterial concentrations were used in the study. The influence of growth medium on calcification efficiency of S. pasteurii was insignificant. Significant improvement in the compressive as well as the tensile strength of cement mortar was observed. Microbial mineral precipitation visualized by Scanning Electron Microscopy (SEM) shows fibrous material that increased the strength of cement mortar. Formation of thin strands of fillers observed through SEM micrographs improves the pore structure, impermeability and thus the compressive as well as the tensile strengths of the cement mortar. The type of substrate and its molarity have a significant influence on the strength of cement mortar.

Separation of Y-chromosome Bearing Ram’s Sperms using an Albumin Gradient Technique and Identification of Embryos by PCR

Several advantages have been suggested for producing sexed sperms including using fewer and genetically superior female animals for replacement.Four hundred active ovaries collected from the slaughter house of Al-shu'alah, the number and type of oocytes, ratios of maturation and fertilization shown that there was a significant difference in the numbers of oocytes (P<0.05) between right and left ovaries. A high recovery rate was obtained of good oocyte (Grade A) 42.35% (432/1020), fair oocyte (Grade B) 37.54% (383/1020) followed by and poor oocyte (Grade C) 17.84% (182/1020). There was a significant difference (P<0.05) between the 3 different grades. grades A and B oocytes, (815/1020) 79.9% of recovered oocytes were cultured. Maturation rate was 86.38% (704/815).Y- Bearing sperms separation applied by using procedure of the modified albumin technique; either one (8%) or two layers (8 and 16%) of BSA (M1, and M2) at 200, 300 or 400 xg, then used for in vitro fertilization.The in vitro fertilization rate observed was 21.8% (132/604) of matured oocytes by choosing universal primers from sequences that are highly conserved in the X and Y chromosomes, sex-specific sequences were successfully amplified in embryonic lysates. Bovine serum albumin sexed sperms result in more percentage of male embryos by using one layer of BSA ( 8%) at 200 × g (M1a) and 300× g (M1b) which were 72.7% and 54.5% respectively, and shows a deviation (p<0.05) from the 50% expected percentage for male and female embryos. While using two layer of BSA (16% and 8% BSA) at the 200 × g (M2a) and at 300× g (M2b) were 81.8% and 63.6% respectively. When we compare the rate of male embryos produced from IVF by sperms isolated by two layers of BSA (M2a, and M2b), moderate results obtained with M2b (63.6%) while the best results were with M2a separation protocol (81.8%).

Quality of life measurement in cancer patients receiving palliative radiotherapy for symptomatic lung cancer: a literature review

Approximately 27% of North American cancer deaths are attributable to cancer of the lung. Many lung cancers are found at an advanced stage, rendering the tumours inoperable and the patients palliative. Common symptoms associated with palliative lung cancer include cough, hemoptysis, and dyspnea, all of which can significantly debilitate and diminish quality of life (QOL). In studies of the effects of cancer therapies, the frequent evaluative endpoints are survival and local control; however, it is imperative that clinical trials with palliative patients also have a QOL focus when a cure is unattainable. We conducted a literature review to investigate the use of QOL instrument tools in trials studying QOL or symptom palliation of primary lung cancer or lung metastases through the use of radiotherapy. We identified forty-three studies: nineteen used a QOL tool, and twenty-four examined symptom palliation without the use of a QOL instrument. The European Organization for Research and Treatment of Cancer (eortc) QLQ-C30 survey was the most commonly used QOL questionnaire (in thirteen of twenty trials). Of those thirteen studies, eight also incorporated the lung-specific QOL survey eortc QLQ-LC13 (or the eortc QLQ-LC17). A second lung-specific survey, the Functional Assessment of Cancer Therapy-Lung (fact-L) was used in only two of the twenty trials. In total, only ten of forty-three trials (23%) used a lung-specific QOL tool, suggesting that QOL was of low priority as an endpoint and that measures created for lung cancer patients are underused. We encourage investigators in future trials to include specific QOL instruments such as the eortc QLQ-LC13 or the fact-L for studies in palliative thoracic radiotherapy because those instruments provide a measure of QOL specific to patients with lung cancer or lung metastases.

Validation of symptom clusters in patients with metastatic bone pain

Purpose

Symptom clusters (scs) are a dynamic construct. They consist of at least 2 or 3 interrelated symptoms that may be a significant predictor of patient morbidity. In a previous study, we identified 2 scs in patients with bone metastases:

These scs may be clinically important in the pain and symptom management of patients with metastatic bone pain. It is therefore important to validate the reported scs to determine if they hold true across similar patient populations.

Patients and Methods

From February to September 2007, our study accrued 52 patients with bone metastases [29 men (56%), 23 women (44%); median age: 68.5 years (range: 39–87 years)] who were referred for palliative radiotherapy (rt). Prostate (31%), breast (29%), and lung (19%) were the most common primary cancer sites. Treatment arms ranged from single to multiple fractions, with most patients receiving a single 8-Gy fraction (77%) or 20 Gy in 5 fractions (21%). The most prevalent sites for rt were spine (42%), hips (17%), and pelvis (14%). Worst pain at the site of rt and functional interference scores were assessed using the Brief Pain Inventory (bpi), a multidimensional pain instrument that uses 11-point numeric rating scales. Patients provided their symptom severity scores on the bpi at baseline and at 4, 8, and 12 weeks post rt. At all time points, a principal component analysis with varimax rotation was performed on 8 items (worst pain and 7 functional interference items) to determine relationships between symptoms before and after rt for bone pain.

Results

Two scs were identified. Cluster 1 included worst pain and interference with general activity, normal work, and walking ability; cluster 2 consisted of interference with mood, sleep, enjoyment of life, and relations with others. Our statistical analysis produced varied results for the 2 clusters found in our previous investigation. These differences may be an indicator for the instability of scs or may be a result of the fewer number of patients accrued in the present validation study.

Conclusions

The scs in our two studies were not identical for patients receiving palliative rt for symptomatic bone metastases. Another sc validation study should be conducted with a larger sample before a conclusion is drawn about the existence of an unstable phenomenon in sc research.

Retrospective analysis of the treatment of psoriasis of the palms and soles

In this retrospective analysis, the effect of currently used treatments in 26 patients with psoriasis of the palms and soles were analyzed. In general, patients are treated initially with topical medications including superpotent topical corticosteroids in combination with calcipotriene ointment or tazarotene gel or both. If satisfactory improvement is not achieved in 4-8 weeks, systemic retinoids are added, formerly etretinate and currently acitretin, except in women of childbearing potential. If the latter regimen is not effective within two months, soak PUVA is added to the regimen of oral retinoids and topical medications. If improvement is inadequate, or if the treatment regimen is not tolerated, methotrexate or cyclosporine have been added in the past. The availability of the excimer laser has recently modified our approach so that this therapy is used in combination with acitretin before soak PUVA. With the availability of biologic agents, methotrexate is avoided because of its hepatotoxicity and bone marrow toxicity and cyclosporine is avoided because of its nephrotoxicity. If oral acitretin plus topical therapy is not adequate to control the disease and the excimer laser is not an option because of its limited availability, alefacept, etanercept and infliximab are added when possible. Other biologic agents are likely to be added to this list in the future.

After radiotherapy, do bone metastases from gastrointestinal cancers show response rates similar to those of bone metastases from other primary cancers?

PURPOSE

Reports investigating whether the response rates to palliative radiation therapy (RT) for painful bone metastases from gastrointestinal (GI) cancers are similar to rates for bone metastases from other primary cancer sites have been limited. The present study evaluated response rates for symptomatic bone metastases from gi cancers after palliative outpatient rt in the Rapid Response Radiotherapy Program (RRRP).

PATIENTS AND METHODS

We identified 69 patients with bone metastases from gi primaries who received palliative rt in the RRRP clinic during 1999-2006. We extracted records for 31 of these patients during 1999-2003 from an RRRP database that used the Edmonton Symptom Assessment Scale (ESAS). Record for the remaining 38 patients during 2003-2006 were extracted from an RRRP database that used the Brief Pain Inventory (BPI). Eligibility criteria for encryption in the two RRRP databases and for collection of patient demographic information (age, sex, primary cancer site, and Karnofsky performance status) were identical. Response rates for this cohort of metastatic gi patients were then compared to rates for 479 patients receiving palliative RT for bone metastases from other primary cancer sites. Pain scores from the ESAS and BPI and data on analgesic consumption were collected at baseline and by telephone follow-up at 4, 8, and 12 weeks after RT for all patients. Complete (CR), partial (PR), and overall (CR+PR) responses were evaluated according to International Consensus Endpoints.

RESULTS

Assessment of the 69 patients with metastatic GI cancers revealed CR, PR, and CR+PR rates of 18%, 42%, and 61% at 4 weeks; 22%, 35%, and 57% at 8 weeks; and 50%, 21%, and 71% at 12 weeks for evaluable patients. The 479 evaluable patients with metastatic cancer from other primary cancer sites had CR, PR, and CR+PR rates of 25%, 27%, and 51% at 4 weeks; 26%, 22%, and 48% at 8 weeks; and 22%, 29%, and 51% at 12 weeks. No statistically significant differences were observed in RT response rates for bone metastases from GI cancers than from other primary cancer sites.

CONCLUSIONS

After palliative RT, bone metastases from gi cancers demonstrate response rates that are similar to rates for metastases from other primary cancer sites. Patients with symptomatic bone metastases from GI malignancies should be referred for palliative RT as readily as patients with osseous metastases from other primary cancer sites.

Symptom clusters in cancer patients with brain metastases

AIM

To explore the presence of symptom clusters in patients with brain metastases.

MATERIALS AND METHODS

Patients with brain metastases referred to an outpatient palliative radiotherapy clinic were asked to rate their symptom distress using the Edmonton Symptom Assessment Scale (ESAS). Baseline demographic data were obtained. To determine interrelationships between symptoms, a principal component analysis with 'varimax rotation' was carried out on the nine ESAS items. Follow-up was carried out by telephone 1, 2, 4, 8 and 12 weeks after radiation.

RESULTS

Between January 1999 and January 2002, 170 patients with brain metastases provided complete baseline data on the ESAS. The most common primary cancer sites were lung, breast and gastrointestinal. Fatigue was the highest scored symptom, followed by a poor sense of well-being, anxiety, drowsiness and poor appetite. The four most prevalent symptoms were fatigue (91.7%), a poor sense of well-being (88.1%), drowsiness (82.2%) and anxiety (82.1%). Three symptom clusters were found at baseline. Cluster 1 included fatigue, drowsiness, shortness of breath and pain. Cluster 2 included anxiety and depression. Cluster 3 included poor appetite, nausea and a poor sense of well-being. Fatigue, nausea, drowsiness and poor appetite showed an overall increase in symptom severity over time; whereas fatigue, drowsiness and poor appetite were experienced to some extent by a greater proportion of patients at week 12 compared with baseline. Symptom clusters emerged in all weeks of follow-up, but consisted of different symptoms in each week.

CONCLUSION

Symptom clusters seemed to exist in patients with brain metastases before and after whole brain radiotherapy. However, different symptoms clustered at various time points. The effectiveness of whole brain radiotherapy in providing palliative relief to patients with brain metastases needs to be explored with regards to symptom clusters.

Medicolegal impact of the new hurt laws in Pakistan

The penal laws in Pakistan went through sweeping reforms in 1979 with intent to bring them in line with the Islamic Jurisprudence. The introduction of these laws repealed the definitions as well as punishments of various types of injuries. Besides that these laws also redefined and reclassified the crime of murder. The laws required that the injuries be identified and documented by an authorized physician. The new classification of injuries and deaths, lack of proper forensic training of the emergency room physicians, performance of medicolegal work by doctors at the earliest stages of their careers and theoretical methods of undergraduate teaching in forensic medicine are matters of concern as they adversely affect the quality of medicolegal work performed in the country. This article gives an overview of the medicolegal system of Pakistan. It also reviews the current laws, their impact on the medical and legal systems of the country and offers some recommendations to correct the existing situation of forensic training and work standards.