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Integrative oncology aims to coordinate the delivery of conventional medicine and evidence-supported complementary and alternative medicine (CAM) to patients receiving cancer care. This field developed out of an increased interest in CAM usage among cancer patients. However, CAM use among medically underserved cancer patients remains to be well characterized. We evaluated CAM awareness as well as prevalence and characteristics of CAM use in 170 consecutive, medically underserved cancer patients presenting to a large, academic, inner-city cancer clinic, using a survey tool. Fifty-three participants declined participation and 17 survey results were incomplete. Therefore, 100 survey results were included in the final analysis. There were 65 males and 35 females in the survey with a mean age of 64.2 years. About 98% of the respondents were African American while 2% identified themselves as Hispanic. About 45% of patients had metastatic cancer, 24% had early-stage disease while 31% of patients were not aware of the stage of their cancer. About 55% patients had elementary school or lower level of education while only 16% had a college degree or higher. About 92% of respondents were unemployed. Some knowledge of CAM was reported by 22% of patients, while CAM use was reported in only 16% of patients. Female sex and college degree were significantly associated with CAM use. The most commonly used CAM modality was meditation (56%), followed by herbal remedies (31%), yoga (31%), and acupuncture (12%). Among CAM users, a majority used multiple CAM therapies. All users reported benefit from CAM use. Emotional wellbeing was the most common benefit followed by improvement in treatment related adverse effects, chemotherapy related symptoms, pain, and sleep. Even though the majority of our surveyed patients never used CAM, 90% of non-users were interested in gaining more information about the various CAM options and exploring its use and potential benefits. The majority (70%) wanted their primary oncologist to provide information about CAM options and discuss its safety and potential complementary benefit in management of their cancer and associated symptoms.

Objective: Cirrhotic patients commonly undergo screening endoscopy for the existence of esophageal varices. The use of this invasive procedure which is expensive, poorly tolerable and generally not acceptable for the patients is increasing due to increasing number of patients with chronic liver disease and their enriched survival. In this study, our aim is to identify clinical, biochemical, and ultrasonography parameters which might noninvasively predict the presence of esophageal varices and risk of bleeding in patients with liver cirrhosis. Material and Methods: Total 150 Patientsof chronic liver disease admitted in ward-5, JPMC (Sep 2011-Feb 2012 with a complaint of hematemesis or melena were included in the study. Platelet counts of 75,000 to 150,000/µL was defined as grade 1 thrombocytopenia, 50,000 to <75,000/µL as grade II, 25,000 to <50,000/µL as grade III and below 25,000/µL as grade IV. The normal range for the INR is 0.8-1.2. Portal vein size of 1.2 cm or above was taken as dilated. Spleen of >13 cm was considered as enlarged in our study. Results: Out of 72 patients of variceal bleed 69 (46%) were males and 81(54%) were females. Thrombocytopenia was present in 64 (88%) patients with mean platelet count of 85.86/µL (±69.79). Deranged coagulation profile was present in 56 (77%) cases with mean INR of 1.63 (±0.5). Portal vein diameter (PVD) of >1.2 cm was found in 46(63.8%) of patients with mean PVD of 1.22(±0.3023) and splenic size of >13 cm was reported in 54 (75%) cases with mean splenic diameter of 14.5 cm (±2.39). Conclusion: Thrombocytopenia, deranged coagulation profile, large splenic size, and dilated portal vein strongly predict the risk of variceal bleeding.

Objective: To find out the risk factors for developing Hepatic Encephalopathy in patients suffering from Chronic liver disease.Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder that is caused by liver damage.  In its pathology, alterations in normal brain function are associated with an increase in blood ammonia, benzodiazepine like substances, products of neurotoxic fatty acids, and other gut derived toxins, which gain access to the brain as a result of liver dysfunction. Study Design: Hospital based descriptive, cross sectional study. Setting: Medical Unit 1, Ward- 5, Jinnah Post Graduate Medical Centre, Karachi.Duration:  July 2013 to December 2013Patients and Methods: About 150 patients admitted in medical unit 1 with a diagnosis of chronic liver disease in a state of hepatic encephalopathy were included in this study. Patients suffering from viral or bacterial encephalitis, stroke, brain tumor, Wernicke’s encephalopathy were excluded from the study.Results and Observations: There were 96 (64%) female and 54 (36%) were male patients. Mean age of the patients was 52.45 (±12.271) years. 80 (53.33%) patients were having constipation. Infection was found in 55 (36.66%) cases. Upper GI Bleed was present in 51 (34%) patients. 44 (29.33%) patients had moderate to severe electrolyte imbalance as the cause. Constipation alone was the cause in 11.33% of cases. More than one factor was found to be responsible in around 56% of patients while in 6.6% of cases none of these precipitating factors was isolated.Conclusion: Constipation is the commonest cause of hepatic encephalopathy followed by infection, upper GI bleed and electrolyte imbalance.DOI: http://dx.doi.org/10.3126/ajms.v6i2.11099Asian Journal of Medical Sciences Vol.6(2) 2015 36-43

Objective: To find out the changes in lipid metabolism among patients suffering from chronic liver disease secondary to hepatitis C. Study Design: Hospital based observational study. Setting: Medical Unit-I, Ward-5, Jinnah Postgraduate Medical Centre, Karachi. Duration: July 2013 to December 2013. Patients and Methods: About 110 patients admitted in Medical Unit-I with a diagnosis of chronic liver disease were included in the study. Patients suffering from DM, HTN, CKD were excluded from the study. Fasting lipid profile was done in all cases. Results and Observations: There were 44 (40%) male and 66 (60%) female patients. Mean age of the patients was 50.18 (±11.7) years. Total cholesterol was decreased in 76 (69.09%) patients. Normal range was present in 34 (30.91%) patients. None of the patient had hypercholesterolemia. Serum triglyceride levels were low in 14 (12.72%) patients, normal in 82 (74.54%), borderline high in 7 (6.36%) and hypertriglyceridemia was seen in 7 (6.36%). HDL-c was below normal in 26 (23.63%) cases, normal in 78 (70.91%), and high in 6 (5.45%). LDL was near optimal/above optimal in only 5 (4.5%) patients. Mean TC/HDL ratio was 2.53 (±1.02). Mean LDL/HDL ratio was 1.23 (±0.73). Mean TC of HCV +ve patients was 130.5 mg/dl as compared to that of HCV -ve patients which was 82.85 mg/dl (P-value: 0.011). Mean TGs of HCV +ve group was 151.5 mg/dl while that of HCV -ve was 79.9 mg/dl (P-value: 0.025). Mean HDL & LDL levels were 43.67 mg/dl and 39.78 mg/dl in HCV group while 34.83 mg/dl & 64.67 mg/dl in the other group with P-value of 0.026 and 0.081 respectively. Conclusion: When it comes to its relationship with lipid metabolism, HCV is a remarkable virus. Its interaction with lipoproteins and its ability to induce massive steatosis are quite unique and idiosyncratic. Despite of causing hepatic steatosis, How to cite this paper: Arisar, F.A.Q.,