With the ameliorated resectability prowess of endoscopic techniques, a myriad of diseases previously treated by major ablative surgeries are now endoscopically curable. Endoscopic submucosal tunnel dissection (ESTD) is a relatively new technique that has diversified endoscopic application. Although ESTD has frequently been used for the resection of esophageal neoplastic lesions, the clinical evidence pertaining to its efficacy in the treatment of circumferential Barrett’s esophagus remains sparse. In this study, we evaluated ESTD as a potential therapeutic technique in patients with Barrett’s esophagus-related high-grade dysplasia. The tunneling strategy helped achieve complete en bloc resection at an increased dissection speed, without any procedural complications. This article illustrates that ESTD can be a feasible, safe, and effective treatment for dysplastic Barrett’s esophagus. Future research should aim to stratify the potential risks and complications associated with this optimization of endoscopic submucosal dissection in patients with superficial esophageal lesions.

Objective: Pulmonary function tests (PFTs) are important for assessing respiratory function in amyotrophic lateral sclerosis (ALS) patients. However, weakness of oral and glottal closure, due to concomitant bulbar dysfunction, may result in unreliable PFT values stemming from leakage of air around the breathing tube and through the glottis. In this study, we assessed whether standard thoracic electrical impedance tomography (EIT) could serve as a surrogate measure for PFTs. Approach: Thoracic EIT was performed simultaneously with standard PFTs on seven ALS patients without clinical bulbar weakness (six men and one woman, mean age of 63 years) and ten healthy volunteers (seven men and three women, mean age of 57 years). A raw impedance metric along with more standard EIT measures were computed and correlated with the normalized forced vital capacity (FVC). Additionally, test/re-test metrics and EIT images were analyzed. Main results: The impedance metric was found to be robust and sensitive to lung activity. We also identified qualitative EIT differences between healthy volunteers and ALS patients, with the ALS images showing greater heterogeneity. Significant correlations with FVC were found for both impedance and EIT metrics in ALS patients (r2 = 0.89) and for the impedance metric only in healthy volunteers (r2 = 0.49). Significance: This suggests that EIT, using our novel impedance metric, has the potential to serve as an alternative technology to standard PFTs for assessing pulmonary function in patients with ALS, offering new metrics of disease status for those with bulbar weakness.

Objectives: Multiple studies are conducted to establish the frequency of electrolyte imbalance outside Pakistan but there is little data available locally. This study was therefore intended to assess the electrolyte imbalance in cancer patients undergoing chemotherapy which can help to reduce the morbidity related to electrolyte imbalance by replacing them appropriately.Methodology: An observational study using non-probability convenient sampling technique was conducted for a year from April 2016 to March 2017 at the Oncology Department of Jinnah Post graduate Medical Center, Karachi after taking the ethical approval from the hospital's Ethical Review Committee. An informed consent was taken from a total of 256 cases diagnosed with various cancers and on an ongoing chemotherapeutic regimen before including them in the study. Age, height, weight, gender, body surface area, type of cancer, chemotherapy protocol, number of days on chemotherapy, electrolyte levels before and after therapy were the variables included. Data was analyzed using the SPSS 20 version. Descriptive statistics of demographic variables was presented as mean, standard deviation and frequency in percentages.Results: 256 patients were included in the study. The mean age of patients was 43.21±12.85 years. 52.7% of the patients showed a reduction in the level of sodium after treatment, followed by 52.2% of the patients showing a reduction in the level of potassium after treatment. 14.8% of the patients presented with reduced chloride levels, with 84.4% of the patients maintaining normal chloride levels before and after treatment. Furthermore, 87.1% of the patients, maintained normal magnesium levels, with 2.7% of the patients presenting with increased magnesium levels after therapy. Conclusion:Our study predicted the significant reduction in the sodium and potassium levels in cancer patients on chemotherapeutic agents. However most of the patients maintained the normal levels of chloride and magnesium.

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