Treatment of chronic myeloid leukemia in the imatinib era: perspective from a developing country

BACKGROUND: There is paucity of data from developing countries on the efficacy and safety of imatinib mesylate in chronic myeloid leukemia (CML). The primary objective of this study was to document complete and partial cytogenetic responses to imatinib in all phases of CML. Secondary objectives included evaluations of complete hematologic response, safety, time to progression, and survival. METHODS: Two hundred seventy-five patients in all phases of CML who received treatment with imatinib from January 2001 to December 2005 were included in the study. All patients had on bone marrow or BCR-ABL positive in peripheral blood by polymerase chain reaction. RESULTS: After a median follow-up of 18 months, major cytogenetic responses (Ph <35%) in chronic phase (CP), accelerated phase (AP), and blastic phase (BP) were documented in 61%, 57%, and 28% of patients, respectively. A complete cytogenetic response was observed in 39.4%, 35.7%, and 14.3% of patients in CP, AP, and BP, respectively; and a complete hematologic response was observed in 90%, 86%, and 30%, respectively. The median time to progression at 18 months was 91% in CP and 68% in AP. The overall survivals in CP, AP, and BP at 18 months was 92%, 74%, and 38%, respectively. CONCLUSIONS: Impressive hematologic, cytogenetic, and molecular responses to imatinib were observed, similar to the responses reported in patients from Western countries. Patients had good compliance, toxicity was limited, and overall quality of life was improved markedly. The results indicated that the biology of CML is not different in patients from developing countries.     

Early spica cast for fracture shaft of femur in children: the north of Jordan experience

This is a case series study that was conducted to assess the findings and usefulness of early spica in children less than 10 years of age. Forty patients less than 10 years of age with femoral shaft fractures were treated by early hip spica between 2000 and 2005 and were followed up for 6 months. The setting was a public university hospital and a public university-affiliated hospital in the north of Jordan. Ultimate shortening of the affected limb of ≥2 cm was observed in those patients with an overlap between fragments of ≥2 cm in the first post-spica X-ray. One case of significant angulation and no cases of rotation deformities were observed. It is concluded that early spica cast in children under the age of 10 is an effective treatment modality. Only in the presence of overlap of ≥2 cm between fragments in the first post-spica X-ray, there would be a chance of ultimate shortening of the affected limb by ≥2 cm. Children aged ≥6 are more liable to develop leg shortening.     

Prevalence of Comorbid Mental Illness and Drug Use Recorded in General Practice: preliminary findings from the General Practice Research Database

Preliminary analysis of a large UK general practice database was conducted in order to determine the prevalence of mentally ill patients in primary care who are also diagnosed with a drug abuse problem and vice versa. The baseline population was 527,000 of whom 1308 patients (prevalence 0.25%) were diagnosed with a drug abuse problem; 59,359 patients suffered a mental illness (11.26%) between 1993 and 1997. Comorbidity was defined by diagnoses of mental illness and drug abuse at any time between 1993 and 1997 (i.e. not necessarily simultaneously): 621 (0.12%) patients were found to be comorbid according to this definition. Neurosis was the most common condition for both mentally ill and drug-abusing patients. Drug abusers were found to have higher rates of psychosis, schizophrenia, paranoia and personality disorders than those with only a mental illness. However, little difference was observed in the prevalence of these conditions between those classed as drug addicts and non-addicts. These findings show that those regarded as non-dependent suffer from mental illness to the same extent as those who are addicted or dependent on drugs. This raises issues regarding service and treatment provision, as emphasis is usually placed on treating the addicted. Future analysis will concentrate on elucidating the time relationships in order to determine possible patterns of causality.     

Nerve conduction studies and its importance in diagnosis of acute poliomyelitis

Motor nerve conduction velocities was performed on 50 subjects in the pediatric age group. Thirty two patients with acute poliomyelitis and 18 controls. The MNCV was studied in the median nerve in the upper limb and the posterior tibial in the lower limb. The motor nerve conduction velocity in polio patients matched well with the controls, as well as within the accepted standards for normal. The MNCV of the median nerve ranged from 41.8±2.76 m/sec in under 1 year to 44±2.1 m/sec in 3–8 years, in polio patients, while the range in controls varied from 37 to 53 m/sec. Similarly, for the posterior tibial nerve, in polio patients the value of MNCV varied from 38.7±4.9 m/sec to 42.5±3.1 m/sec. In the controls, also the MNCV ranged from 38.5±6.3 m/sec to 48.4±3.42 m/sec. Thus, no delay on the motor nerve conduction velocity was seen. Poliomyelitis is a major problem in developing countries like Pakistan and India, where serological diagnosis is a luxury. The determination of motor nerve conduction velocity provides a quick and easy method of distinguishing poliomyelitis from other motor nerve disorders esp. Guillian Barre syndrome.     

The Disclosure Process and its Impact on South Asian Families with a Child with Severe Intellectual Disabilities

Background Although several research studies have investigated parental experiences of the disclosure process in White families with a child with severe disabilities, little work has focused on the experiences of South Asian families. Materials and methods This study aimed to provide a rich picture of the disclosure experiences of South Asian parents of a child with severe intellectual disabilities, using semi‐structured qualitative interviews with 26 parents over two time points, and structured quantitative interviews with 136 parents. Results Parents reported variable experiences of the disclosure process, with many parents experiencing disclosure in the wrong language for them and most parents reporting little post‐disclosure support. Parents identified good practice in disclosure as prompt disclosure in the appropriate language, with the partner present (where possible), with emotional support as part of the process, with clear and practical information, and linked to post‐disclosure support from a keyworker. Conclusions Good practice in disclosure was also associated with parental understanding of their child, and parents being more likely to mobilize informal and formal supports. The implications of these findings are discussed.     

Nanoimprinted Hybrid Metal-Semiconductor Plasmonic Multilayers with Controlled Surface Nano Architecture for Applications in NIR Detectors

We present a proof of concept for tunable plasmon resonance frequencies in a core shell nano-architectured hybrid metal-semiconductor multilayer structure, with Ag as the active shell and ITO as the dielectric modulation media. Our method relies on the collective change in the dielectric function within the metal semiconductor interface to control the surface. Here we report fabrication and optical spectroscopy studies of large-area, nanostructured, hybrid silver and indium tin oxide (ITO) structures, with feature sizes below 100 nm and a controlled surface architecture. The optical and electrical properties of these core shell electrodes, including the surface plasmon frequency, can be tuned by suitably changing the order and thickness of the dielectric layers. By varying the dimensions of the nanopillars, the surface plasmon wavelength of the nanopillar Ag can be tuned from 650 to 690 nm. Adding layers of ITO to the structure further shifts the resonance wavelength toward the IR region and, depending on the sequence and thickness of the layers within the structure, we show that such structures can be applied in sensing devices including enhancing silicon as a photodetection material.