Background: Thrombocytopenia is a prominent feature of dengue fever and dengue hemorrhagic fever. Papaya leaves have been used by many patients due to their perceived beneficial effect on platelet count. However, scientific data on this beneficial effect is lacking.Methods: A single centre, single blinded, randomized placebo controlled trial was conducted at the Department of Medicine, Jinnah Hospital Lahore. Adult patients admitted with diagnosis of dengue fever (DF) or dengue hemorrhagic fever (DHF) and platelet counts ≤50 × 109/L were eligible for the study. After obtaining written informed consent participants were randomly assigned to either treatment or control group. 5ml of papaya leaf extract in syrup form was given twice daily for four days to treatment group and placebo solution was given to control group. Platelet counts were checked on daily basis. Outcome was measured in terms of platelet increments from baseline.Results: Thirty-nine (39) patients were enrolled and 28 (72%) were male. 19 (48.7%) patients received papaya leaf extract. Mean baseline platelet counts of treatment and control group were comparable, 36.2 × 109/L and 34.1 × 109/L respectively. Mean platelet counts at the end of treatment were 142.3 × 109/L and 116.5 × 109/L in treatment and control group respectively (p = 0.182). Platelet count normalized (i.e. ≥150 × 109/L) in 9 (47.4%) patients in treatment group and 5 (25%) patients in control group (p = 0.191). Similarly, no significant differences in mean platelet count increments from baseline were found between treatment and control group on day 2 (23.7 × 109/L vs 15.9 × 109/L, p = 0.242), day 3 (42.6 × 109/L vs 35.1 × 109/L, p = 0.424), day 4 (71.6 × 109/L vs 58.4 × 109/L, p = 0.309) and day 5 (106 × 109/L vs 82.3 × 109/L, p = 0.189). No significant adverse event occurred in either group.Conclusion: Papaya leaf extract, in this study, did not show any effect on platelet count in dengue fever.
BackgroundUp to 30% of patients with pancreatic cancer and more than 50% of patients with gastric cancer already have incurable disease, with distressing symptoms of gastric outlet obstruction at the time of presentation which require effective palliation. We decided to test the clinical outcomes of endoscopic stent placement in malignant gastric outlet obstruction.MethodsIn a retrospective single institution-based study, the charts of patients who had self-expandable metal stents placed to alleviate malignant gastric outlet obstruction were reviewed. Charts were reviewed to assess improvement in oral intake according to the Gastric Outlet Obstruction Scoring System (GOOSS), and in order to also evaluate technical success and complications of the procedure.Results69 patients with successful stent placement were retrospectively evaluated. Within 7 and 28 days after stent placement respectively, 85.5% and 80% benefited from stent insertion, with an increase in the GOOSS score of > 1. Resumption of soft or low residue diet (GOOSS 2-3) was achieved in 53.6% at day 7 and in 62% of patients at day 28, respectively. Of the patients achieving a GOOSS score of 2-3, 17.3% remained on a soft or low residue diet at 24 weeks or at last follow up, while 46% died. Stent related adverse events occurred in 10 patients (14%), including stent blockade in 7 and stent migration in 3 patients.ConclusionEndoscopic enteral stenting promptly increases oral intake in the majority of patients with malignant gastric outlet obstruction and is a safe procedure with a low rate of serious complications.
Percutaneous endoscopic gastrostomy tube insertion is a useful means of providing enteral nutrition to patients with swallowing problems. Patients with head and neck cancer who are likely to develop dysphagia should be assessed promptly for PEG tube insertion before the start of radiation. Early recognition and prompt treatment of serious complications can avoid potential fatality associated with PEG tubes.
Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths. This study aimed to determine the survival of patients with HCC at our treatment facility. Methods: We retrospectively studied 278 patients with HCC who were seen between 2007 and 2013. Of these patients, 84.4% had evidence of prior infection with hepatitis C, while 7.8% had markers of hepatitis B infection. Results: Median survival was 24.6 months for transarterial chemoembolization (TACE), 61 months for ablative therapies, and 31.5 months for those undergoing surgical resection. Increasing tumor size, multifocality, advanced Barcelona clinic liver cancer (BCLC) stage, and poor liver function (Child-Pugh class B-C) were significantly associated with worse prognosis; pvalues were 0.002, 0.009, <0.001, and <0.001, respectively. Conclusion: Most patients in our series presented with advanced liver disease, with multifocal tumors and were candidates for palliative treatment only. Public education to minimize hepatitis B and C transmission, screening programs to detect disease at an earlier stage, and the development of specialist liver units and liver transplant programs can bring a change in HCC survival in developing countries.
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