Skin Metastasis in Breast Cancer Patients; a Case Series

Introduction: Breast cancer is the most common malignancy in women. It frequently metastasizes to bones, lungs and liver. Although rare, skin metastasis may also take place. It may also be the presenting feature of initial or recurrent breast cancer. The assessment of recurrent metastatic disease involving skin after mastectomy can be challenging because of the benign-appearing clinical presentation. The purpose of this caseseries was to explore the clinical and radiological presentation of skin metastasis in patients of breast cancer. Materials and Methods: This is a retrospective case series of breast cancer patients with skin lesions on chest and abdomen at the time of initial presentation, or post-treatment such as, after mastectomy or breast conservation therapy; who underwent various radiological investigations including mammography, ultrasoundscan, computed tomography (CT) scan and magnetic resonance imaging from 1 May 2018 to 30 September 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Results: A total of eightcases were identified, out of which seven were females. The most common presentation consisted of the presence of metastatic nodules which were seen in 62.5% (five out of eight) of the patients. Other features consisted of erythematous or plaque-like skin thickening on clinical examination, increased density with indistinct margins seen on a mammogram and diffuse oedematous changes in the skin with small irregular mass or infiltration into subcutaneous tissues were visualised on ultrasound and CT studies. Conclusion: Skin metastasis from breast cancer most commonly presents as nodules, although rarely they may present as plaques or diffuse skin thickening. Awareness of diverse manifestations of skin metastasis is of utmost importance in early diagnosis and management

Imaging Characteristics of Breast Lymphoma; a Case Series

Introduction: Breast involvement by lymphoma is rare. It can occur as a primary breast tumour or as an extranodal manifestation of the systemic disease. The imaging features of breast lymphoma (BL) arenot characteristic. Biopsy is necessary for diagnosis due to non-specific imaging features. Materials and Methods: A retrospective electronic medical chart review was conducted of patients diagnosed with lymphomaof breast that underwent diagnostic radiological procedures (including mammography, ultrasound breast, computed tomography (CT) scan and positron emission tomography (PET/CT) scan from 1 July 2018 to 31 March 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Results: Four patients were identified. On mammogram, the most common finding consisted of the presence of high-density masses with circumscribed or indistinct margins. On ultrasound, hypoechoic masses and indistinct diffuse infiltrative patterns were observed. PET/CT and CT were helpful in detecting extramammary sites of disease and for classifying the disease into primary or secondary BL. Conclusion: The early diagnosis of the BL is important. The radiologists should include lymphoma in the differential diagnosis when there is the absence of microcalcifications or spiculated margins on mammography and ultrasound

IMPACT OF INDUSTRY SPECIFIC VARIABLES ON THE DIVIDEND POLICY OF OIL AND GAS SECTOR IN PAKISTAN

Dividends act as a pathway to attract investments andpetroleum industry of Pakistan has remained an important element in economic progress. Therefore, this research investigates the impact of corporate tax, financial leverage and sales growth on dividend payout ratio of oil & gas sector companies in Pakistan. Secondary data of 10 companies for 12 years have been incorporated. Hypotheses have been tested using fixed effects regression technique which was confirmed through Hausman specification test. Empirical findings reveal that corporate tax and sales growth have insignificant positive impacts, whereas financial leverage has an insignificant negative impact on the dividend payout ratio. The study concludes that decisions about dividend payouts should be made by considering other variables

Estimation of D-dimer Level among Sudanese Women under Contraceptive Pill

Contraceptives are intentional prevention of conception through the use of various devices sexual practices, chemicals, drugs or surgical procedures become a contraceptive if its purpose is to prevent a woman from becoming pregnant. This is a cross sectional study conducted at ALnow Hospital Khartoum, Sudan,  the study aimed to estimate D.dimer levels among Sudanese women take contraceptive pill.    50 Women uses contraceptive pill used as a cases and 50 apparently health women were used as a control. Three   ml of venous blood samples were collected from each subject in 3.8% tri-sodium citrate (9:1 vol/vol) for D-dimer analysis.  The study revealed that was clearly significant increase in D.dimer in women take oral contraceptive pill (p.value 0.000), also the study concluded that D-dimer level was increased in users oral contraceptive Sudanese women,  that is increase the coagubility of the blood  and might be become as a risk factor.   Keywords: Contraceptive pills, D.dimer, coagubility

Ectopic Acromegaly Secondary to Bronchial Tumor; a Case Report of Rare Occurrence.

Introduction: Acromegaly is caused due to the unregulated and sustained overproduction of growth hormone (GH). The majority of the cases are caused by autonomous secretion of GH from anterior pituitary tumors. Nonetheless, in less than 1 % of the cases, the cause of autonomous secretion is secondary to ectopic growth hormone-releasing hormone (GHRH) production. Bronchial carcinoids are the most common cause of ectopic GHRH production. Case description:  A 32-year-old female presented to the clinic with a history of cough, hemoptysis, and undocumented weight loss for four years. Initial workup showed a large right main stem endobronchial mass. Transbronchial biopsy of the mass revealed a grade I neuroendocrine tumor (NET). During NET workup, a large sellar mass was incidentally found on cross-sectional imaging. The hormonal profile revealed markedly elevated insulin-like growth factor -1 (IGF-1) and mildly raised prolactin. The MRI Brain study revealed pituitary macroadenoma measuring 2 cm x 1.2 cm x 1.5 cm. The patient underwent bronchial carcinoid tumor resection, which led to normalization of serum IGF-1 and growth hormone response to an oral glucose tolerance test. Subsequent MRI brain revealed complete resolution of previously noted sellar mass. Practical implications:  This case highlights the importance of differentiating acromegaly secondary to pituitary adenoma and ectopic acromegaly. This case emphasizes the importance of keeping rare entities in the differential while assessing patients with pituitary macroadenoma

Impressions and attitudes of adult residents of Karachi towards a possible public health insurance scheme

Objective: To gauge the general population\u27s knowledge and attitude towards a possible public health insurance scheme.Methods: This descriptive, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from April to May 2015, and comprised permanent residents of the city. Convenience sampling was used. Data was collected via questionnaires. SPSS 22 was used for data analysis.Results: There were 340 participants in the study with an overall mean age of 32.9±12.4 years. Besides, 159(46.8%) participants were aware of the concept of medical insurance while the correct definition was identified by 160(50.5%) respondents. Overall, 256(75.3%) participants were willing to join a theoretical public health insurance scheme. Of all the respondents, 107(31.5%) had faced a catastrophic event in the past and consequently were more willing to join. Of those unsure or not willing to join, 33(37.9%) respondents identified lack of trust in government programmes as the main reason for their choice.CONCLUSIONS: A large majority of adults had a favourable attitude towards the implementation of a possible public health insurance scheme

Infections in patients with multiple myeloma treated with conventional chemotherapy: A single-center, 10-year experience in Pakistan

Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality.Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period.Method and results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients.Conclusion: Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy

Effectiveness of 10-valent pneumococcal conjugate vaccine against vaccine-type invasive pneumococcal disease in Pakistan

Objective: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan.Methods: A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) was determined through serial multiplex PCR. For each case, at least five controls were enrolled from children hospitalized at the same institution, matched for age, district, and season.Results: Of 92 IPD patients enrolled during July 2013 to March 2017, 24 (26.0%) had disease caused by vaccine serotypes. Most case (87.5% of 24) and control (66.4% of 134) children had not received any PCV10 doses. The estimated effectiveness of PCV10 against vaccine-type IPD was 72.7% (95% confidence interval (CI) -7.2% to 92.6%) with at least one dose, 78.8% (95% CI -11.9% to 96.0%) for at least two doses, and 81.9% (95% CI -55.7% to 97.9%) for all three doses of vaccine.Conclusion: The vaccine effectiveness point estimates for PCV10 were high and increased with increasing number of doses. However, vaccine effectiveness estimates did not reach statistical significance, possibly due to low power. The findings indicate the likely impact of vaccine in reducing the burden of vaccine-type IPD if vaccine uptake can be improved

Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors). Methods Various data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population. Results Globally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)). Conclusions There was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.publishedVersio

The Habitable Exoplanet Observatory (HabEx) Mission Concept Study Final Report

The Habitable Exoplanet Observatory, or HabEx, has been designed to be the Great Observatory of the 2030s. For the first time in human history, technologies have matured sufficiently to enable an affordable space-based telescope mission capable of discovering and characterizing Earthlike planets orbiting nearby bright sunlike stars in order to search for signs of habitability and biosignatures. Such a mission can also be equipped with instrumentation that will enable broad and exciting general astrophysics and planetary science not possible from current or planned facilities. HabEx is a space telescope with unique imaging and multi-object spectroscopic capabilities at wavelengths ranging from ultraviolet (UV) to near-IR. These capabilities allow for a broad suite of compelling science that cuts across the entire NASA astrophysics portfolio. HabEx has three primary science goals: (1) Seek out nearby worlds and explore their habitability; (2) Map out nearby planetary systems and understand the diversity of the worlds they contain; (3) Enable new explorations of astrophysical systems from our own solar system to external galaxies by extending our reach in the UV through near-IR. This Great Observatory science will be selected through a competed GO program, and will account for about 50% of the HabEx primary mission. The preferred HabEx architecture is a 4m, monolithic, off-axis telescope that is diffraction-limited at 0.4 microns and is in an L2 orbit. HabEx employs two starlight suppression systems: a coronagraph and a starshade, each with their own dedicated instrument