Glioblastoma remains the most common primary brain tumor after the age of 40years. Maximal safe surgery followed by adjuvant chemoradiotherapy has remained the standard treatment for glioblastoma (GBM). But recurrence is an inevitable event in the natural history of GBM with most patients experiencing it after 6-9months of primary treatment. Recurrent GBM poses great challenge to manage with no well-defined management protocols. The challenge starts from differentiating radiation necrosis from true local progression. A fine balance needs to be maintained on improving survival and assuring a better quality of life. Treatment options are limited and ranges from re-excision, re-irradiation, systemic chemotherapy or a combination of these. Re-excision and re-irradiation must be attempted in selected patients and has been shown to improve survival outcomes. To facilitate the management of GBM recurrences, a treatment algorithm is proposed.

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government policy have been endorsed in vitamin A deficiency causation 5-9 and the vitamin A deficiency prevalence is diagnosed using clinical or biochemical parameters. 1 This condition can cause xeropthalmia, anemia and liable to lead infection and risk of growth retardation and death in severe condition. 1,10,11

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208.80 ± 26.32 min, 198.20 ± 21.92 min, and 210.00 ± 26.58

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Background: Water quality impacts the performance of the hospitals and leads to drastic health service deterioration affecting infection control programs, along with safety of the patients and staff. Good quality water is an essential prerequisite to ensure optimal patient care, and the well-being of the staff and visitors in a hospital environment. Objectives was to study the current water supply and treatment system in the cancer hospital. Also, to carryout root cause analysis of the causes of episodes of diarrhoea amongst patients and staff and to identify the source of infection and suggest improvement in the existing system to prevent recurrence.Methods: There were 25 reported cases of diarrhoea and other gastrointestinal symptoms between May 12 and June 2 2017, allegedly due to water contamination occurring in admitted patients and staff of a tertiary care cancer hospital in north India. This was reported to Hospital Administration, which prompted an epidemiological investigation.Results: Formation of Biofilms on the plastic taps was found to be the main reason for contamination of water.Conclusions: It was very clear that deposition of biofilm within the plastic taps was the main reason of diarrhea among the patients.

Objective: To analyze the frequency and sites of bone erosion on computerized tomograghy scan in Allergic Fungal Rhinosinustis in Pakistan. Study Design: Retrospective observational study. Place and Duration of Study: Department of ENT, Combined Military Hospital Lahore, Malir Karachi and Rawalpindi, from Jan 2010 to Dec 2019. Methodology: Total 230 cases of Allergic Fungal Rhinosinusitis were screened, out of which 85 patients having bone erosions on computerized tomograpghy scan were included in the study. Bone erosion in different paranasal sinuses and their sub sites were evaluated. Depending upon the number of bone erosion, patients were divided into three categories as mild, moderate and severe. Those having erosion at a single site were labelled as mild, those with two sub sites of erosion as moderate and those with more than two subsites of erosion were labelled as severe cases. Results: Detailed evaluation of computerized tomography scan of paranasal sinuses revealed bone erosion in 85/230 (36.9%) cases. Mean affected age was 23.96 ± 12.71 years. There were 52 (61.1%) males and 33 (38.9%) females. Ethmoid sinus was the most commonly involved sinus to have bone erosions 55 (38.19%) followed by maxillary sinus 38 (26.38%) then sphenoid sinus 27 (18.75%) and lastly frontal sinus 24 (16.6%). Out of 85 patients 48 (56.1%) were having mild, 22 (25.8%) moderate and 15 (17.6%) had severe disease. Conclusion: Allergic Fungal Rhinosinusitis has high frequency of bone erosion. Computerized tomography scan is an important and effective investigation in finding these bony erosions and ethmoid sinus is the.....