Risk factors for breast cancer for women in Punjab, Pakistan:Results from a case-control study

Over the last three decades an increase in the incidence of breast cancer has been observed in the previously low-risk Asian countries. This study is designed to determine the risk factors of breast cancer for Pakistani women as little information exists in this regard. A case-control study of 564 female breast cancer cases diagnosed at the two cancer hospitals at Lahore (INMOL and SKMCH) during the time period Jan 1, 1998 to Dec 31, 1998 was carried out. Four hundred and forty eight women aged 24-80 years out of 564 cases were complete with respect to defined criteria and were eligible for the study. Population-based controls were selected to match for age of cases in the ratio 1:2. The data were analyzed considering ‘all women’ and then separate analyses were done for ‘premenopausal’ and ‘postmenopausal women’. Women with family history of breast cancer, history of consanguineous marriage, smoking and high BMI (≥28) are at increased risk of breast cancer for all three groups. Early menarche (45 years) was a strong determinant of breast cancer. Higher number of full-term pregnancies (>3) was protective for ‘all women’ and ‘premenopausal women’ but in case of ‘postmenopausal women’ the poor with higher number of pregnancies were significantly protected. Late age at first FTP (>25 years) is a significant risk factor for postmenopausal women

Utilization of intravascular imaging in elective non chronic total occlusion percutaneous intervention and chronic total occlusion percutaneous intervention: Trends in utilization and impact on in-hospital mortality

Objectives: The objectives of this retrospective study include outcomes associated with and without intravascular imaging in cases of elective single vessel (SV) CTO PCI and in non-CTO PCI. Method: We explored the NIS database from October 1, 2015 to December 31, 2018 to identify 317,090 adult admissions with elective SV PCI. Admissions with STEMI and NSTEMI were excluded to identify elective cases only. Using the ICD 10 diagnosis code for CTO, we identified 33,345 admissions that underwent SV CTO PCI. We classified the remaining cases as SV non-CTO PCI. Results: Intravascular imaging was utilized in 2930 (8.8%) cases in CTO PCI group and 23,710 (8.3%) cases in non-CTO PCI groups. The utilization of intravascular imaging (IVUS/OCT) significantly increased in elective SV CTO PCI, 6.4%–11.2%, p-trend<0.001 and non-CTO PCI group, 7.3%–9.0%, p-trend<0.001. There was no significance difference in mortality with and without intravascular imaging (combined IVUS/OCT vs no IVUS/OCT: 1.5% vs 1.3%, p = 0.195) in the CTO PCI group. But, in non-CTO PCI admissions, there was a significantly lower in-hospital mortality when intravascular imaging was used (0.7% vs 0.8%, p = 0.003). The cost of hospitalization was significantly higher when intravascular imaging was used in elective single vessel CTO PCI admissions, combined IVUS/OCT vs no IVUS/OCT: $27,427 vs$21,452, p < 0.001 and non-CTO PCI admissions, combined IVUS/OCT vs no IVUS/OCT: $23,620 vs$20,272, p < 0.001. Conclusions: In conclusion, despite the cost, intravascular imaging use decrease mortality in non-CTO PCI groups but there is no difference in mortality in CTO PCI groups

Hepato-Protective Effects of Delta-Tocotrienol and Alpha-Tocopherol in Patients with Non-Alcoholic Fatty Liver Disease: Regulation of Circulating MicroRNA Expression

MicroRNAs (miRNAs) play a key role in the regulation of genes for normal metabolism in the liver. Dysregulation of miRNAs is involved in the development and progression of non-alcoholic fatty liver disease (NAFLD). We aimed to explore changes in circulating miRNA expression in response to delta-tocotrienol (δT3) and alpha-tocopherol (αTF) supplementation and correlate them with relevant biochemical markers in patients with NAFLD. In total, 100 patients with NAFLD were randomized to either receive δT3 (n = 50) 300 mg or αTF (n = 50) 268 mg twice/day for 48 weeks. Plasma expression of miRNA-122, -21, -103a-2, -421, -375 and -34a were determined at baseline, 24 and 48 weeks of intervention using RT-qPCR. Both δT3 and αTF significantly downregulated expression of miRNA-122, -21, -103a-2, -421, -375 and -34a. Moreover, δT3 was more effective than αTF in reducing expression of miRNA-375 and -34a. A significant correlation was observed between miRNA expression and biochemical markers of hepatic steatosis, insulin resistance (IR), oxidative stress (OS), inflammation and apoptosis. δT3 and αTF exert hepato-protective effects by downregulating miRNAs involved in hepatic steatosis, IR, OS, inflammation and apoptosis in patients with NAFLD. Furthermore, δT3 has more pronounced effects than αTF in reducing miR-375 and miR-34a, which are linked to regulation of inflammation and apoptosis

Correlation between Cholesterol, Triglycerides, Calculated, and Measured Lipoproteins: Whether Calculated Small Density Lipoprotein Fraction Predicts Cardiovascular Risks

Background. Recent literature in lipidology has identified LDL-fractions to be more atherogenic. In this regard, small density LDL-cholesterol (sdLDLc) has been considered to possess more atherogenicity than other LDL-fractions like large buoyant LDL-cholesterol (lbLDLc). Recently, Srisawasdi et al. have developed a method for calculating sdLDLc and lbLDLc based upon a regression equation. Using that in developing world may provide us with a valuable tool for ASCVD risk prediction. Objective. (1) To correlate directly measured and calculated lipid indices with insulin resistance, UACR, glycated hemoglobin, anthropometric indices, and blood pressure. (2) To evaluate these lipid parameters in subjects with or without metabolic syndrome, nephropathy, and hypertension and among various groups based upon glycated hemoglobin results. Design. Cross-sectional study. Place and Duration of Study. From Jan 2016 to 15 April 2017. Subjects and Methods. Finally enrolled subjects (male: 110, female: 122) were evaluated for differences in various lipid parameters, including measured LDL-cholesterol (mLDLc), HDLc and calculated LDL-cholesterol (cLDLc), non-HDLc, sdLDLC, lbLDLC, and their ratio among subjects with or without metabolic syndrome, nephropathy, glycation index, anthropometric indices, and hypertension. Results. Significant but weak correlation was mainly observed between anthropometric indices, insulin resistance, blood pressure, and nephropathy for non-HDLc, sdLDLc, and sdLDLc/lbLDLc. Generally lipid indices were higher among subjects with metabolic syndrome [{sdLDLc: 0.92 + 0.33 versus 0.70 + 0.29 (p 7.0%. Subjects having nephropathy (UACR > 2.4 mg/g) had higher concentration of non-HDLc levels in comparison to sdLDLc [{non-HDLc: 3.68 + 0.59 versus 3.36 + 0.43} (p=0.007), {sdLDLc: 0.83 + 0.27 versus 0.75 + 0.35 (p=NS)}]. Conclusion. Lipid markers including cLDLc and mLDLc are less associated with traditional ASCVD markers than non-HDLc, sdLDLc, and sdLDLc/lbLDLc in predicting metabolic syndrome, nephropathy, glycation status, and hypertension

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population