Background: Postoperative pulmonary complications (PPCs) are a common concern in patients undergoing thoracic or abdominal surgery, contributing to increased morbidity, extended hospital stays, and elevated healthcare costs. Early initiation of chest physiotherapy (CPT) has been proposed as a strategy to reduce the incidence of PPCs by enhancing respiratory function through various techniques, such as deep breathing exercises, incentive spirometry, and airway clearance. Materials and Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search was performed across multiple databases, including PubMed, Cochrane Library, Embase, and Scopus, to identify studies assessing the effectiveness of early CPT in reducing PPCs. Studies were screened and selected based on predetermined inclusion criteria focusing on adults undergoing thoracic or abdominal surgery who received CPT within the first 24–48 hours postoperatively. Data extraction and quality assessments were conducted using standardized tools to evaluate study bias and reliability. Results: The review included 12 studies, comprising randomized controlled trials and observational studies. Most studies demonstrated that early CPT significantly reduces the incidence of PPCs, such as atelectasis and pneumonia, and improves lung function. However, the degree of effectiveness varied based on the CPT techniques and timing. Some studies highlighted reductions in hospital stay and ICU admissions, underscoring CPT's potential for improving overall surgical outcomes. Conclusion: Chest physiotherapy after induction of surgery seems to be an efficient method for the prevention of postoperative pulmonary complications in patients who underwent thoracic and abdominal surgery. The results provide evidence for integrating CPT into the postoperative care pathways but the differences in CPT application imply that individualized strategies should be used depending on the patient characteristics and types of surgery. More work needs to be done to support such gains and fine-tune CPT procedure.
Kegiatan penelitian dilakukan di Pusat Penelitian Kelapa Sawit, Marihat, Sumatera Utara mulai dari bulan Februari sampai Juli 2011. Tujuan utama dari penelitian ini adalah untuk meningkatkan pengetahuan, keterampilan, pengalaman tentang produksi benih dan untuk penelitian viabilitas benih berdasarkan tempat benih dalam tandan buah kelapa sawit. Data primer diperoleh dengan dua hal, berpartisipasi dalam empat Divisi SUS-BHT (Satuan Usaha Strategis - Bahan Tanaman) seperti Breeding, Pohon Induk, Produksi Benih dan Quality Control. Yang kedua adalah program penelitian tentang kelayakan tetrazolium dan uji benih berkecambah berdasarkan tempat benih dalam tandan buah. Pengolahan tandan bibit kelapa sawit terdiri dari memotong, fermentasi, membelah buah, mengupas, mematahkan dormansi, dan mengecambahkan. Kesimpulan dari penelitian ini adalah bagian terbaik untuk membuat benih yang baik adalah di bagian tengah tandan buah.
Myeloid Elf-1 like factor (MEF) is one of the Ets transcription factors known to regulate cell proliferation and differentiation. A previous report has shown that osteoblast-specific MEF transgenic mice (Col1a1-MEF TG mice) have low bone mass but high bone marrow adiposity. In the present study, we explored a previously unappreciated mechanism whereby MEF promotes adipogenesis in bone marrow. An adipogenic colony-forming unit assay showed that bone marrow cells derived from Col1a1-MEF TG mice had a higher adipogenic differentiation potential compared to those from wild-type. The levels of adipogenic marker genes expression in 3T3L1 cells were higher when co-cultured with Col1a1-MEF TG bone marrow cells than with wild-type cells. MC3T3-E1 preosteoblasts transfected with MEF secreted higher levels of 15-deoxy-delta (12, 14)-prostaglandin J(2), a potent endogenous ligand of peroxisome proliferator-activated receptor γ (PPARγ), under adipogenic conditions. MEF overexpression increased the adipogenic marker genes expression including PPARγ and lipid droplet accumulation in MC3T3-E1 preosteoblasts and 3T3L1 preadipocytes. Endogenous MEF expression levels increased as adipocyte differentiation proceeded. Knockdown of MEF by siRNA suppressed expression levels of adipogenic marker genes including PPARγ. MEF directly bound to the MEF binding element on the mouse PPARγ promoter, transactivating promoter activity. Immunohistochemical staining of tibia sections demonstrated that bone lining cells and bone marrow cells express higher levels of PPARγ protein in Col1a1-MEF TG mice than in wild-type mice. These results suggest that MEF transactivates PPARγ expression, which, in turn, enhances adipogenic differentiation. Furthermore, MEF overexpressing osteoblasts secrete higher levels of adipogenic factors, creating a marrow microenvironment that favors adipogenesis.
Tumor necrosis factor alpha (TNFα) is a multifunctional cytokine that is elevated in inflammatory diseases such as atherosclerosis, diabetes and rheumatoid arthritis. Recent evidence has suggested that β2 adrenergic receptor(β2AR) activation in osteoblasts suppresses osteogenic activity. In the present study, we explored whether TNFα modulates βAR expression in osteoblastic cells and whether this regulation is associated with the inhibition of osteoblast differentiation by TNFα. In the experiments, we used C2C12 cells, MC3T3- E1 cells and primary cultured mouse bone marrow stromal cells. Among the three subtypes of βAR, β2 and β3AR were found in our analysis to be upregulated by TNFα. Moreover, isoproterenol-induced cAMP production was observed to be significantly enhanced in TNFα-primed C2C12 cells, indicating that TNFα enhances β2AR signaling in osteoblasts. TNFα was further found in C2C12 cells to suppress bone morphogenetic protein 2-induced alkaline phosphatase (ALP) activity and the expression of osteogenic marker genes including Runx2, ALP and osteocalcin. Propranolol, a β2AR antagonist, attenuated this TNFα suppression of osteogenic differentiation. TNFα increased the expression of receptor activator of NF-κB ligand (RANKL), an essential osteoclastogenic factor, in C2C12 cells which was again blocked by propranolol. In summary, our data show that TNFα increases β2AR expression in osteoblasts and that a blockade of β2AR attenuates the suppression of osteogenic differentiation and stimulation of RANKL expression by TNFα. These findings imply that a crosstalk between TNFα and β2AR signaling pathways might occur in osteoblasts to modulate their function.
Objective:To assess parents’ attitude toward EPI(Expanded program on Immunization) in three Tertiary Care Hospitals ofKarachiMaterials and Methods:This cross sectional hospital based study was conducted at three tertiary care hospitals of Karachi,PNS SHIFA Hospital, Jinnah Postgraduate Medical Center (JPMC) and Liaquat National Hospital (LNH) from a period of 20thJuly to 20th September, 2015. A structured questionnaire based interview was conducted on150 parents of children less than 5year of age visiting for vaccination at these three tertiary care hospitals.Data was analyzed using SPSS version 23.Results:A total of 150 parents were interviewed, out of which 93 (62.0%) parents vaccinated their child immediately after birth,148(98.7%) parents considered EPI as beneficial for their child’s health, 113 (75.3%) parents were found to be aware of thecomplete vaccination schedule, 56(37.3%)parents had appropriate knowledge regarding vaccines and diseases enlisted on theEPI card, 139 (92.7%) parents kept the record of vaccination schedule, 143(95.3 %) parents didn’t ignored vaccination due toincreased number of children and 21(14%)parents had fear regarding vaccination program.Conclusion:Parent’s attitude toward EPI was positive. However, knowledge about vaccines and diseases and vaccines enlistedon EPI card was low.
Objective: To evaluate the role of artificial tear treatment on central corneal thickness in patients with dry eyes coming to a tertiary care eye hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Tertiary Care Eye Center, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Nov 2022. Methodology: The study included central corneal thickness of 210 eyes (n=210) of 110 patients with dry eye disease measured before and after treatment with continuous use of artificial tear drops one month apart, patients were diagnosed on the presence of symptoms such as burning, dryness, pain, irritation, grittiness followed by slit lamp examination for marginal tear meniscus(<0.25mm) or absent, tear film BUT of <10 seconds , Schrimer test 2 of <6mm after 5 minutes and ocular surface staining score of >1 with fluorescein. Central corneal thickness was measured using corneal topography (Galleli G6 Ziemer). Results: A total of two hundred and twenty eyes of 110 individuals having dry eyes were included in our study. Median CCT before treatment with artificial tears was 522(75)µm while median CCT after 1 month treatment with artificial tears was 547(22.25)µm this showed a percentage increase of 3.79% in central corneal thickness after one month treatment with artificial tears (p-value <0.001) therefore treatment with artificial tears was significantly associated with an increase in central corneal thickness in dry eye disease. Conclusion: Central corneal thickness is substantially related to dry eyes.
Background: Triple positive breast cancer expresses the human epidermal growth factor receptor (Her 2 neu), estrogen and progesterone receptor. It is well known that Her 2 neu expression is associated with a more aggressive subtype of breast cancer and is associated with reduced mortality. It has less response to hormonal therapy. Neoadjuvant chemotherapy and targeted therapy have become the new standard of treating Her 2 expressive or Triple positive breast cancer. Introduction: Triple positive breast cancer is a subtype of breast cancer having expression of Estrogen receptors, progesterone and Her 2 neu receptors. The current standard of this in localized disease (stage I, II and III) includes neo adjuvant targeted along with chemotherapy. The response rate of different regimens in neo adjuvant settings varies widely. Choosing of neo adjuvant treatment depends on patient performance status, comorbidities and socio-economic status. Objective: To find the percentage of size reduction in triple positive breast cancer, in neo adjuvant Chemotherapy and targeted agents and assess for pathological complete response rates. Study Design: Case report and its systematic review. Methodology: Got the patient data with informed consent from patients treated at Khyber Teaching hospital Peshawar, and compared with the data already published in PubMed library, Google scholar. Up to date chemotherapy protocols have been followed as advised in the national comprehensive care network (NCCN). Extensive Literature search has been mentioned with sophisticated drugs and under trials regimen with referencing done. Results: Her 2 expressive disease or triple positive breast cancer is one of the aggressive histological subtypes and its treatment is one of the most costly treatments due to the involvement of the targeted therapy against Her 2 neu receptors. In our case we had a very huge left breast cancer which was Her 2 neu positive. She received neo adjuvant chemotherapy along with Herceptin and perjeta, to which the cancer had responded very well, and down staged the disease from in operable to make it operable and the patient underwent surgery followed by adjuvant radiation therapy and Hormonal as well as chemotherapy and targeted therapies as received in neo adjuvant setting. As per the different trials the pathologic complete responses (p CR) have been found to be different like Neosphere the pCR was 46%, TRYPHAENA showed pCR rates in all treatment arms ranging from 57% to 66%, ACOSOG (p CR= 55%), NSABP (p CR= 49%), GBG (p CR= 45%), DAPHNE (p CR= 56.7%), ADAPT (p CR= 40%), PAMEL (p CR= 30%), GEPARSEPTO (p CR= 60%). In targeted agents Trustuzumab DM TDM 1, PERTUZUMAB showed 43.6% (95% CI, 33-52%) overall response rate, DHP regimen in CLEOPTRA shows PFS of 18 months and median OS of 57 months. Trastuzumab Deruxtecan and DS-8201 showed 59.5% (95%CI, 49.7–68.7) over all response rate, The PFS was 19.4 months (95%CI, 14.1–not reached), 24.6 months (95%CI 23.1 months-not reached) of median OS. ARX788 showed PFS of 17 months if use as monoclonal agent in met breast Cancer. Neratinib showed PFS of 22.2 weeks if used trustuzumab if no trustuzumab than 39 week PFS and OR rate of 24% if previously trustuzumab used if no trustuzumab used than ORR of 54 %. Pyrotinib and poziotinib showing PFS of 14.1 months, ORR of 27%, PFS of 4 months (95% CI, 3.0-4.4) respectively. CDK4/6 inhibitors showed no objective response if used as a mono therapy Monarch Her trial showed ORR (35.4% vs. 22.8% with chemotherapy plus trastuzumab) and median PFS with the endocrine/targeted therapy triplet (8.3 vs. 5.7 months; HR = 0.673, 95%CI, 0.451–1.003; p = 0.0253) but no significant response difference with no chemo arm and and PI3K Inhibitors Llike Alpelisib with TDM 1 shows response in pre-treated HER2-positive patients, an ORR of 43% and a median PFS of 8.1 months (95%CI 3.9–10.8) were reported. In the BOLERO-3 trial, the combination of everolimus with trastuzumab and vinorelbine was evaluated in patients with trastuzumab-resistant ABC, and a small but statistically significant benefit in PFS was reported: median PFS 7.0 vs. 5.78 months (HR = 0.78; 95%CI, 0.65–0.95; p = 0.0067). Margetuximab plus chemotherapy generated handsome amount of 24% relative risk reduction in the hazard of progression vs trastuzumab plus chemotherapy, median OS was 21.6 months with margetuximab vs 19.8 months with trastuzumab, and the final analysis of OS will be reported. Conclusion: The results of all the trials have been discussed briefly along with a case report to signify the treatment in aggressive type of breast cancer. The treatment has been standardized, for tumors of size less than 2 cm shall undergo upfront surgery, followed by adjuvant treatment. If it is pathologically T1 with no nodal metastasis then the patient is advised to receive HP for 12 cycles as per Tolaney study, but if it is p T2 or N+ than the patient will be treated by chemotherapy along with HP for 12 cycles as per Aphinity trial. Those patients having tumor size greater than 2 cm or having nodal metastasis shall receive neo adjuvant chemotherapy and targeted therapy followed by surgery. Adjuvant treatment is based on the final histology of pCR than HP for one year as per Aphinity trial. If no p CR then the patient is advised to receive radiation therapy along with Trastuzumab emtansine (TDM-1) for one year as per Katheriene trial or shall receive HP for 6-12 cycles followed by Neratinib for one year as per Extenet trial.
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