PROGNOSIS OF BREAST CANCER IN VERY YOUNG AGE (LESS THAN 30 YEARS)

Purpose: Breast cancer diagnosed at a younger age has aggressive biology being triple negative and high grade and is associated with poor prognosis.Materials and Methods: Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 were reviewed. Data were extracted from the cancer registry department of the institute. Demographics studied were the age at diagnosis, gender, pregnancy or lactation association, family history of breast cancer, histopathological diagnosis, and stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, and survival. Results: A total of 121 patients with age 30 years or less were included. An only a single patient was male. The age range was from 20 to 30 years; bilateral involvement was seen in a single patient. Almost half 50.4% (n = 61) patients had locally advanced disease at presentation. Pregnancy/lactation-associated breast cancer was seen in 29.8% (n = 36). The most common stage was Stage III (52.1%) and Stage II (33.9%). Invasive ductal carcinoma was the most common histology 94.2% (n = 114) of patients; triple negative was the most common molecular subtype present in 46.3% (n = 56). Chemotherapy was received by 92.6% (n = 112), 88.4% (n = 107) patients received radiation therapy. Modi ed radical mastectomy was performed in 57% (n = 69), breast conservation surgery in 35.5% (n = 43), follow- up period was 5 years, local recurrence was observed in 12.4% (n = 15) and cancer related deaths were 42.1% (n = 51). Conclusions: Breast cancer in very young has very aggressive tumour biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy. Key words: Breast cancer, pregnancy-associated aggressive tumour biology, triplenegative, young

PRIMARY BILATERAL BREAST LYMPHOMA: A REVIEW OF LITERATURE AND REPORT OF FOUR CASES FROM A SINGLE CENTRE

Primary breast lymphoma is a rare entity and carries poor prognosis, bilateral breast lymphoma is even rarer and carries worst prognosis. Bilateral breast lymphoma is a rare disease and lacks treatment. Out of the 2766 cases of non- Hodgkin’s lymphoma registered at our institute from 1994 to 2013, 31 cases of breast lymphoma were found, of which four cases had bilateral involvement. In this review, we describe clinical presentation, histopathological subtypes, treatment administered and outcome of those four cases retrospectively. All patients were female with a median age of 31 years (range 24–64 years). Three patients were diagnosed with diffuse large B-cell lymphoma and mucosa associated lymphoid tissue lymphoma detected in one patient. Chemotherapy remained the main treatment modality and surgery (excision biopsy) was reserved for diagnostic purpose only, none of the patients received radiation therapy. Key words: Breast lymphoma, histopathological subtypes, palliation

COMPARISON OF MAMMOGRAPHY AND ULTRASOUND COMBINED VERSUS ULTRASOUND ALONE IN EARLY EVALUATION OF SYMPTOMATIC BREAST CANCERS IN PAKISTAN

Purpose: The purpose of this study was to detect diagnostic accuracy of mammography and ultrasound combined versus ultrasound alone in early evaluation of symptomatic breast lesions.Materials and Methods: All new patients who presented to the breast clinic with symptomatic breast lesions, during the year 2012, were included in the study. A total of 695 patients were registered. Their clinical findings, mammogram, ultrasound and histopathology were reviewed.Results: Mammogram and ultrasound combined detected 693 (99.71%) lesions in total. Mammogram failed to detect lesions in 1.43% of patients, whereas the failure rate of ultrasound was 0.43%. The incidence of microcalcifications on mammogram was 19.13%.Conclusion: Ultrasound is a useful tool in the initial evaluation of symptomatic breasts. For places such as Pakistan where mammogram is not available at every centre, ultrasound can be used as an effective alternative for the assessment of symptomatic breast lesions.Key words: Breast cancer, mammography, ultrasoun

Prevalence of dry eye among paramedical students of Teerthankar Mahaveer University, Moradabad, Uttar Pradesh

Background: The prevalence of dry eye is 32% in India which is higher than global prevalence. Dry eye is not a disease but a symptom complex occurring as a deficiency and abnormalities of the tear film. Dry eye infection (DED) is perhaps the most pervasive visual sickness on the planet. The point of our investigation was to acquire the pooled pervasiveness of DED in students and investigate its expected relates. Methods: It was a cross-sectional questionnaire-based qualitative and observational study was conducted among the students of the paramedical college of Teerthankar Mahaveer university. The pre-validated questionnaire was divided into three main sections involving the demographic data including the information about gender, age, students studying stream in the second section the questions about general health and question related to dryness in the eye. Results: Out of a total of 40 participants, 65% (26) were male and 35% (35) were female with the average age of the participants was 21.40 with the average age 21.40. During day how often feeling dryness for this we got the responses of 15% (06) for never, 82.50% (33) for some time and 2.50% (01). Further we have assessed the about dryness in their eyes by presenting the question During day how often feeling dryness for this we got the responses of 15% (06) for never, 82.50% (33) for some time and 2.50% (01). Concussions: The finding that dry eye symptoms are particularly common in young adults is concerning, and warrants further study.

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Association Between Structural Empowerment and Nurses Outcomes Among the Public Hospitals of Lahore, Pakistan

Purpose: The purpose of the study was to determine the effect of Structural Empowerment on nursing outcome (Job Satisfaction). The aim of the study was to maintain an empowering work environment that enhances job satisfaction and nurses’ retention and also for the better organizational outcome.Method: A descriptive cross-sectional study was performed to determine the effect of empowering work environment on nursing outcome. A convenient sampling technique was used for the purpose to collect data from respondents.  Job satisfaction was measured on Job Diagnostic Survey Questionnaire a five item Likert scale adapted from (Hackman & Oldham, 1975). Structural empowerment is measured on work effectiveness questionnaire adapted from (Lschinger, 2001). Result: The main findings of the study are that Structural empowerment has a significance positive influence on nursing job satisfaction. In future broad study is recommended to explore the relationship between structural empowerment and job satisfaction further study is required to further elaborate the effect of work environment on nursing outcome.Conclusion: The study concluded that mostly nurses are satisfied with their job due to empowered work environment. Those nurses who are working in empowered environment are satisfied with their job as compare to those nurses who are working in lack of empowered work environment. Structural empowerment is considering as one of the important factor for the nurse’s job satisfaction their retention and better organizational outcome. Key terms: work Environment, Structural Empowerment, and Job satisfaction DOI: 10.7176/JHMN/115-01 Publication date: April 30th 202

Detection of Anthracnose Disease in Chili Using IOT and Field Data

Internet of thing IoT introduced various opportunities for novel applications, which are utilized in agriculture and many more. In the world, Chilli is very significant plant due to its huge ingesting. Chilli has many medicinal properties and using in many foods in Pakistan. Anthracnose produced through Colletotrichum spp. consumes stayed one of the greatest vital viruses of Chilli and in worldwide which can cause in crop victims of up to 50%. Chilli can also decrease the danger of tumor by avoiding chemicals from mandatory to chromosome and decrease calorie consumption through growing thermogenesis. Traditionally, the findings and usageof the insecticide are more frequently complete in the fields but this procedure is more time-intense, risky, and not accurate method in most of the time. The main focus of this effort is to grow a system to detect disease detection using internet of thing IoT on thebases of epidemiology of anthracnose disease in chill to Enhancement of production. Controller collect data from field sensors and send to cloud sever and use of k-nearest neighbor (KNN) classifier for analysis the accurate results. The research is very important in terms to increase the production of agriculture system in Pakistan. The system will identify the diseases in the earlier time and categorize anthracnose disease and send information to the farmers to safe their crops

PROGNOSIS OF BREAST CANCER IN VERY YOUNG AGE (LESS THAN 30 YEARS)

Purpose: Breast cancer diagnosed at a younger age has aggressive biology being triple negative and high grade and is associated with poor prognosis.Materials and Methods: Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 were reviewed. Data were extracted from the cancer registry department of the institute. Demographics studied were the age at diagnosis, gender, pregnancy or lactation association, family history of breast cancer, histopathological diagnosis, and stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, and survival. Results: A total of 121 patients with age 30 years or less were included. An only a single patient was male. The age range was from 20 to 30 years; bilateral involvement was seen in a single patient. Almost half 50.4% (n = 61) patients had locally advanced disease at presentation. Pregnancy/lactation-associated breast cancer was seen in 29.8% (n = 36). The most common stage was Stage III (52.1%) and Stage II (33.9%). Invasive ductal carcinoma was the most common histology 94.2% (n = 114) of patients; triple negative was the most common molecular subtype present in 46.3% (n = 56). Chemotherapy was received by 92.6% (n = 112), 88.4% (n = 107) patients received radiation therapy. Modi ed radical mastectomy was performed in 57% (n = 69), breast conservation surgery in 35.5% (n = 43), follow- up period was 5 years, local recurrence was observed in 12.4% (n = 15) and cancer related deaths were 42.1% (n = 51). Conclusions: Breast cancer in very young has very aggressive tumour biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy. Key words: Breast cancer, pregnancy-associated aggressive tumour biology, triplenegative, young

Mastalgia: Risk Factors and Treatment Strategies Used at Two Breast Clinics in Pakistan

Background: Mastalgia is one of the commonest symptoms of breast disorder and a major cause of anxiety amongst women. The aim of this study was to determine the risk factors associated with the onset and severity of mastalgia, their association with various breast disorders, and response to strategies used for its treatment.Material and Methods: This prospective descriptive study was carried out at Combined Military Hospitals (CMH) of Rawalpindi and Thall over a period of six months from January to July 2017. Women presenting to breast surgery clinic with complaints of breast pain, heaviness, and tenderness were included in the study. Patients were initially evaluated at the time of presentation, treatment was initiated, followed by re-evaluation after six months. A multiple logistic regression model was used to determine association of mastalgia with various conditions and their effect on severity of mastalgia.Results: A total of 93 women presented to the breast clinics during this period. Cyclical mastalgia was noted in 39.8% women while 60.2% had non-cyclical mastalgia. In 41.9% patients no underlying pathology was noted, 49.5% patients had benign disorders while 8.6% had malignancy. Increased BMI (P = .002) and lack of exercise (P = .01) were associated with onset of mastalgia while use of oral contraceptive pills (P < .001) was associated with low risk of mastalgia. Of all the patients, 45.1% responded to measures like reassurance, dietary and lifestyle modifications while 54.9% were treated with pharmacological therapy. Those diagnosed having underlying malignant disorder were treated according to the type and stage of malignancy.Conclusions: Various factors affect the onset and severity of mastalgia and different treatment strategies can be used to alleviate the symptoms. Hence, complete and thorough evaluation of the patients presenting with mastalgia should be carried out to rule out any underlying pathology