Relationship between the levels of Serum Thyroid Hormones and the Risk of Breast Cancer

Breast cancer is still one of the leading causes of cancer death in women, but there has been a sustained decline in mortality rates over the last decades the relationship between breast cancer and thyroid diseases is controversial many works have been done in past also. The relation between autoimmune and non-autoimmune thyroid diseases has been investigated in patients with breast cancer and age-matched control individuals without breast or thyroid disease. Determination of serum thyroid hormone and antibody levels was done in 100 breast cancer patients and 75 control individuals. The mean values for thyroid hormones and anti-thyroid peroxidase antibodies were significantly higher in breast cancer patients than in control individuals. Our results indicate an increased prevalence of autoimmune and non-autoimmune thyroid diseases in breast cancer patients. Keywords: breast, cancer, autoimmune thyroid diseases

Comparison of Cerebrospinal Fluid Leakage in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma with and without Sellar Floor Reconstruction

Objectives:  This study aimed to compare CSF leak in endoscopic endonasal TSS of pituitary adenoma with and without reconstruction of the sellar floor with no intraoperative CSF leakage. Materials and Methods:  It was a randomized controlled trial of 116 patients of both genders diagnosed case of pituitary adenoma who underwent endoscopic endonasal TSS over 1 year. The cases were randomized into 2 groups. In Group A endoscopic endonasal TSS and the sellar floor, reconstruction was done while in Group B only endoscopic endonasal transsphenoidal surgery was done without reconstruction. Results:  The patient’s mean age in group A was 40.7 ± 9.56 years, and in group, B was 41.9 ± 10.5 years. The gender distribution, for group A, males and females were 29 each (50%) and in group B, the males were 36 (62%) and females were 22 (38%). There were 52 (89.7%) cases of macroadenoma and 6 (10.3%) cases of microadenoma in each group. On the 1st postoperative day, CSF leakage was noted in 2 (3.4%) patients of group A, and CSF leakage was observed in 2 (3.4%) patients of group B. Results revealed no difference in CSF leakage between both groups. There were minor nasal complications in both groups. Conclusion:  There is an equal chance of success with endoscopic endonasal transsphenoidal surgery (TSS) of pituitary adenoma with and without reconstruction of the sellar floor, concerning post-operative CSF leak, in patients who have no intraoperative CSF leak which enlarges the pool of options for treatment

Outcomes of Acromegaly Patients Treated with Sandostatin LAR after Surgical Excision of Pituitary Adenoma

Objectives:  An observational study to evaluate the outcomes of Acromegaly patients treated in the department of Neurosurgery III, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan. Materials and Methods:  This study was the analysis of a case series of 20 patients (mean age: 30 years) of both genders with acromegaly due to macroadenoma who had endonasal excision and postoperative treatment with Sandostatin LAR. Results:  This study consisted of a total of 20 patients out of which 11 (55%) were male and 9 (45%) were female. All 20 Patients (100%) had a headache as their main symptom and 13 patients (65%) had visual field deterioration. 19 patients (95%) had complete resection of the tumor whereas 1 (5%) had a subtotal resection. After surgery and treatment growth hormone levels improved in 19 patients (95%) and remained elevated in 1 patient (5%), IGF-1 (Insulin-like growth factor – 1) levels improved in all 20 (100%) patients. Following consecutive octreotide injections vision of 11 patients (84%) out of 13 improved and in 2 (16%) patients, it remained the same as of Preoperative status whereas Headache improved in all 20 (100%) of the patients. None of the patients had any complications related to the procedure or the injection of octreotide LAR. Conclusion:  Acromegaly due to macroadenoma responds well to treatment with octreotide LAR after endonasal resection in terms of hormonal levels and symptoms of the patients. It is a safe treatment with very less side effects and complications

Manipulation of Plant Growth Regulators on Phytochemical Constituents and DNA Protection Potential of the Medicinal Plant Arnebia benthamii

Arnebia benthamii of the family Boraginaceae is a critically endangered nonendemic plant of the Kashmir Himalayas and is used to treat a number of human diseases. The current study was based on developing an in vitro micropropagation protocol vis-à-vis induction of various secondary metabolites under in vitro conditions for the possible biological activity. A tissue culture protocol was developed for A. benthamii for the first time in the Himalayan region using varied combinations and proper media formulations, including various adjuvants: Murashige and Skoog (MS) media, growth hormones, sugars, agar, and so forth. The influence of different media combinations was estimated, and the MS + thidiazuron (TDZ) + indole 3-acetic acid (IAA) combination favors a higher regeneration potential. The higher amounts of chemical constituents were also recorded on the same treatment. The in vitro plant samples also showed a noteworthy effect of scavenging of hydroxyl radicals vis-à-vis protection from oxidative DNA damage. The in vitro raised plants are good candidates for the development of antioxidant molecules

A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm:a multi-centre randomised controlled trial

Background: Self-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. Methods: This was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016). Results: We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (− 3.6 (− 4.9, − 2.4)), depression (− 7.1 (− 8.7, − 5.4)), hopelessness (− 2.6 (− 3.4, − 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention. Conclusions: Suicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration

A culturally adapted manual-assisted problem-solving intervention (CMAP) for adults with a history of self-harm: a multi-centre randomised controlled trial

BackgroundSelf-harm is an important predictor of a suicide death. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm.MethodsThis was a rater-blind, multicenter randomised controlled trial. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. Patients presenting after a self-harm episode (n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms; CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The trial is registered on ClinicalTrials.gov. NCT02742922 (April 2016).ResultsWe screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm (n = 440) and E-TAU arm (N = 461). The number of self-harm repetitions for CMAP plus E-TAU was lower (n = 17) compared to the E-TAU arm (n = 23) at 12-month post-randomisation, but the difference was not statistically significant (p = 0.407). There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (− 3.6 (− 4.9, − 2.4)), depression (− 7.1 (− 8.7, − 5.4)), hopelessness (− 2.6 (− 3.4, − 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The effect was sustained at 12-month follow-up for all the outcomes except for suicidal ideation and hopelessness. On suicidal ideation and hopelessness, participants in the intervention arm scored lower compared to the E-TAU arm but the difference was not statistically significant, though the participants in both arms were in low-risk category at 12-month follow-up. The improvement in both arms is explained by the established role of enhanced care in suicide prevention.ConclusionsSuicidal ideation is considered an important target for the prevention of suicide, therefore, CMAP intervention should be considered for inclusion in the self-harm and suicide prevention guidelines. Given the improvement in the E-TAU arm, the potential use of brief interventions such as regular contact requires further exploration