Comparison of clinico-pathological characteristics and survival of recurrent ovarian cancer patients on seven different chemo-protocols

Despite the growing prevalence of ovarian cancer (OC) in Pakistan, no literature evidence exists regarding its clinic-pathological characteristics, survival and compliance of patients with recurrent ovarian cancer and various chemo-protocols. An observational study was conducted by enrolling 251 recurrent OC patients on 7 different chemo-protocols, from a specialized cancer care hospital, Lahore, Pakistan, using convenient judgmental sampling. The study was conducted for a period of 6 months. Most of the patients were between 18 and 70 years of age, with IIIC FIGO stage and papillary serous histological grade. As per RECIST, improved partial response (PR) (63.3 %) and complete response (CR) (52.1 %) was observed in the CP (carboplatin + paclitaxel) arm, substantiated by improved median progression free survival (PFS) and overall survival (OS) in CP and CD (carboplatin + docetaxel) arms, respectively, yet with no significant differences in survival curves, PFS (p = 0.12) and OS (p = 0.22). Interestingly, the highest and the lowest patient non-compliance were observed in CG (carboplatin + gemcitabine) (81.6 %) and paclitaxel (4.5 %) arms, resp. As per the hazard model for survival, topotecan showed significant association with the therapy related events/deaths compared to other protocols. These data suggest that CP regimen exhibited improved clinical efficacy and decreased toxicity related non-compliance in recurrent ovarian cancer patients of Lahore

To Study the Histomorphological Changes in Cerebellar Purkinje Cells after Exposure to Fine Particulate Matter in C57BL/6J Mice

Objective: To study the histomorphological changes in cerebellar Purkinje cells after exposure to fine particulate matter in C57BL/6J mice. Study Design: Laboratory based experimental study. Place and Duration of Study: The study was conducted in the Anatomy department of the Army Medical College, Rawalpindi, from 15 June to 15 September 2020, in coordination with the Military Hospital, Rawalpindi, and the National Institute of Health (NIH), Islamabad. Materials and Methods: Thirty male and female C57BL/6 mice, 8 weeks of age, weighing 37± 2 gm were obtained from NIH, Islamabad. The animals were divided in two groups, 15 mice in each group (8 male and 7 female) Group A were marked as control, received regular diet and water ad libitum. Group B (experimental group) received dynamic inhalation of 3mg/m³ fine particles (soot) through air circulation for 6h/d for 12 weeks, in plastic cabin measuring 2x2x2 feet fitted with two small fans for evenly distribution of Particulate Matter. After exposure period, the animals were sacrificed. After sectioning the tissue and staining, the microscopic analysis was carried out. Purkinje cell margins were evaluated. Number of Purkinje cells and changes in Purkinje cell size were noted. Data was collected, analyzed with the statistical package for social sciences version 23. A p value ≤ 0.05 was considered significant. Result: The Purkinje cell margins were observed to become irregular and corrugated in the experimental groups B when compared with control group A. The number and size of Purkinje cells also showed difference when compared to the control group A. Conclusion: The present study concluded that fine particulate matter induces changes in histomorphological features of mice cerebellar tissue including Purkinje cells

A DFT study on secondary reaction pathways in the acid-catalysed Beckmann rearrangement of cyclohexanone oxime in aprotic solvent

Non-availability of competent supervisory staff, a focus on improving performance indicators rather than clinical guidance, and lack of a functional referral system, collectively create an environment that is non-conducive for improving patient care while also contributing to the isolation of physicians. Applying a systems thinking approach and using measles and tuberculosis as case examples, the study examined human advice-seeking behavior of primary health care (PHC) physicians in a rural district of Pakistan including the degree to which the existing PHC system supports their access to human advice. Findings underscore the need for a functional information system comprising context-sensitive knowledge management

BREAST CANCER: EARLY DETECTION INITIATIVE IN PAKISTAN

Female breast cancer is currently the most prevalent cancer worldwide, with estimated global figures of 2.3 million new cases (11.7% of all cancer) in 2020. It is the 5th leading cause of cancer-related mortality worldwide, 685,000 deaths.1,2 Exact cause of the breast cancer is not known however, genetic factors like BRCA 1, 2 & p 53 gene mutations play an important role. Other risk factors include female gender, growing age, high estrogen exposure, obesity, lack of exercise, stress, early menarche and late menopause etc.3 Magnitude of the breast cancer patients in Pakistan is undetermined due to absence of the central registry.4 However, an estimated 90,000 women are diagnosed every year with breast cancer in Pakistan out of which 40,000 die every year.5 It’s said that every 9th woman is at risk of breast cancer in Pakistan, nevertheless, being a woman, every woman is at risk.5,6 Recently activities initiated by the first lady, national & international organizations and civil society to raise the awareness about self-examination and early detection in Pakistan has highlighted the importance of this health problem to the masses. Pakistan Atomic energy commission (PAEC) is the prime stakeholder of the cancer care in Pakistan. PAEC cancer registry report 2018-2019 encompassed the data of cancer patients from all over Pakistan including & Afghan refugees. According to this report, breast cancer was the most common cancer (8,816- 23% and 9,827- 24% cases during 2018 & 2019 respectively) among female of Pakistan. Most common age of reporting of the cancer remained 49 years, compare to 62 years in USA.7 The high-risk group was 40-69 years of age, comprising of about 90% of the breast cancer. According to this data every two out of five females were diagnosed with breast cancer in Pakistan. Highest number of breast cancer patients were seen in Punjab (49% in 2018 & 50% in 2019) and Islamabad (45% in 2018 & 46% in 2019), reasons may include urban life, enhanced awareness and availability of the diagnostic facilities in these areas. Rest of the breast cancer statistics include: Sindh (34.6% in 2018 & 34.0% in 2019), KP (31.1% in 2018 & 34.0% in 2019), Baluchistan (28.8% in 2018 & 30.7% in 2019), Jammu and Kashmir (34.1% in 2018 & 35.0% in 2019), Gilgit Baltistan (25.0% in 2018 & 19.2% in 2019) and Afghanistan (29.2% in 2018 & 34.4% in 2019).  According to the data, since 2015, out of 41,673 total breast cancer patients, 939 (2.2%) males mostly from the Pukhtoon ethnicity suffered. This is in contrast to the world data of less than 1%. Majority of the patients presented with advanced stages of the breast cancer (61% and 63% of total cases were in stage III/ IV during the year 2018 & 2019 respectively).8 Breast cancer is still considered a taboo in the conservative society of Pakistan, where female population stands 109,315,131.9,10 Despite the fact that the World Health Organization Global Breast Cancer Initiative (GBCI) has set the target to reduce 2% breast cancer related deaths per year worldwide, Pakistan lacks breast cancer control program.1,11 There is a lack of infrastructure and service providers in the endeavors of early detection and referral, especially at the primary health care levels.   Breast cancer early detection initiative model in KP Pakistan in the early phase of establishment of the breast cancer Control model, conducted a distinctive situational analysis during 2021, by the breast cancer subcommittee of the Khyber Pakhtunkhwa province (KP) of Pakistan. It was found that there are only eleven mammography machines for 35.5 million population of KP in contrast to seventy Mammogram machines per million population in developed country like USA.12  Chemotherapy services are available in nine facilities, whereas Radio therapy services are available in only seven facilities of KP.13 Provincial Assembly of KP passed a resolution unanimously on 7th July 2020 and a proposal has been approved for the KP ADP budget of 2022-23 as the flagship program of the “Breast cancer early detection initiative” to enhance the capacity of the province for early detection through availability of the specialized ultrasound, Mammograms and biopsy at the seven divisions of KP in addition to project implementation unit at the Provincial capital. Public Health Association KP with the vision to promote Public health and influence health policies, was the prime non-governmental organization, to start the struggle for breast cancer control program in the province, was joined by PAEC and other high profile health professionals. This model should be adopted by the rest of the provinces to reduce deaths among female of Pakistan.  Future preventive strategies should include further strengthening of the early detection initiative. Beside good planning, implementation and referral mechanisms, addition of cancer registry, genetic testing and screening, continuous research, targeted advocacy activities, social mobilization to promote self and clinical examination will help to decrease morbidity and mortality associated with the breast cancer

Serum Prolactin as an Early Biomarker for Detection of Gestational Diabetes Mellitus-An Experience at CMH Quetta

Objective: To determine the association between elevated serum prolactin and the development of gestational diabetes mellitus in the first trimester. Study Design: Prospective longitudinal study. Place and Duration of Study: Pathology Department, Combined Military Hospital, Quetta Pakistan, from Apr 2021 to Mar 2022. Methodology: One hundred and twenty-one patients had a measurement of serum prolactin in the first trimester, along with an oral glucose tolerance test in the second and third trimester, at the Pathology Department Combined Military Hospital Quetta Pakistan. Results: In the study group, serum prolactin levels were raised in 51(42.1%) patients in the first trimester. A total of 44(36.3%) patients with raised serum prolactin had impaired oral glucose tolerance tests. A significant association was found between raised serum prolactin and subsequent development of gestational diabetes mellitus in pregnant females. Conclusion: Serum prolactin can be an important biomarker for early diagnosis and monitoring of gestational diabetes mellitus

Correlation between maternal and neonatal blood Vitamin D level; A cross sectional study of 416 participants visiting a tertiary care hospital in Pakistan

In Pakistan there is limited evidence for the levels and relationship of 25 (OH) Vitamin D [25(OH)D] status in pregnant women and their newborns while the association between maternal 25(OH)D and newborn anthropometric measurements remains unexplored. Sociodemographic data was collected from 213 pregnant mothers during their visit to a tertiary care hospital at the time of childbirth. Anthropometric measurements were performed on all mothers and their newborns and blood samples collected from both for 25(OH)D levels. Participants were classified into two groups according to their 25(OH)D status: Sufficient (25(OH)D ≥50nmol/l) and Deficient (25(OH)D 0.05). Our study shows a high prevalence of 25(OH)D deficiency in pregnant women and their newborns and a strong positive association between maternal and newborn 25(OH)D levels. Findings of this study indicate the importance of maintaining sufficient 25(OH)D levels during pregnancy

Security lies in obedience - Voices of young women of a slum in Pakistan

<p>Abstract</p> <p>Background</p> <p>Existing literature shows that young people, especially women, have poor knowledge about sexuality and reproductive health. Many of the difficulties young women experience are related to beliefs and expectations in society making them more vulnerable to reproductive ill health. The objective of this study was to explore how young women living in a slum in Islamabad are prepared for marriage and how they understand and perceive their transition to marriage and the start of sexual and childbearing activity.</p> <p>Methods</p> <p>Twenty qualitative interviews and three focus group discussions were conducted with young women residing in a slum of Islamabad. Content analysis was used to explore how the participants represented and explained their situation and how decisions about their marriage were made.</p> <p>Results</p> <p>The main theme identified was <it>security lies in obedience</it>. The two sub-themes contributing to the main theme were <it>socialization into submissiveness </it>and <it>transition into adulthood in silence</it>. The theme and the sub-themes illustrate the situation of young women in a poor setting in Pakistan.</p> <p>Conclusion</p> <p>The study demonstrates how, in a culture of silence around sexuality, young women's socialization into submissiveness lays the foundation for the lack of control over the future reproductive health that they experience.</p

Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review

Background and Hypothesis People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. Study Design We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Study Results The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02–3.19). The methodological quality of studies evidence was relatively low. Conclusions The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects

"Who am I? Where am I?" Experiences of married young women in a slum in Islamabad, Pakistan

Background: According to the cultural tradition in Pakistan, young women belonging to poor families should marry shortly after menarche. However, existing data show that young people, especially women, are not prepared for sexual life and have poor knowledge about sexuality and reproductive health. Many of the difficulties young women experience are related to beliefs and expectations in the society related to their reproductive roles making them more vulnerable to reproductive ill health. Aim: The study explores the preparedness of young women for married life (communicating with spouse, initiation of sexual activity and child bearing) and ability to negotiate in marriage with spouse on number of children to have and on contraceptive use. Methods: In order to obtain an in-depth understanding of young women’s lives qualitative and quantitative approaches were used. Three qualitative studies using narrative and content analysis were carried out in a slum setting in the outskirts of Islamabad city in Pakistan. Married young women (I), unmarried young women (II) and parents (III) were selected with the help of a community worker. Young married women were interviewed three times at different occasions. Narrative structuring was used to explore how the participants represented their situation. In addition twenty qualitative interviews and three focus group discussions were conducted with young unmarried women (II). Twenty-five parents participated in four gender specific focus group discussions (III). Content analysis was used for analysis of study II and III. For the quantitative study (IV), a subset of 1803 married young women aged 15-24 years was drawn from a nationally representative adolescent and youth survey conducted in Pakistan in 2001-2002 by the Population Council. Regression models were used for analysing the following outcomes: reported agreement with spouse on the number of children to have, current use of contraceptives, intention to use contraceptives in the future and the time elapsed between marriage and the first contraceptive use. Key co-variates of interest were variables that measure the involvement of young women in their marriage as having a say in selection of spouse, mobility outside the household, social role and decision making in their homes. Results: The main theme in all the qualitative studies was ‘socialisation of young women into submissiveness’. For the married young women two themes were identified a) submissive-accepting and b) submissive-victims. The married young women who belonged to the accepting group lived under compromised conditions but described themselves as satisfied with their situation. Women belonging to the victimized group experienced physical and verbal abuse for their inability to cope with the duties of a wife, caretaker of the home and bearer of children. Their situation was compounded by the power dynamics within the household (I). For the unmarried young women the main theme identified was security lies in obedience. The two sub-themes contributing to the main theme were socialisation into submissiveness and transition into adulthood in silence (II). The theme and the sub-themes illustrate the situation of young women in a poor setting in Pakistan. The main theme identified in the study with the parents was ‘Good parents’ strive to raise ‘innocent daughters’. The three sub-themes contributing to the main theme were: a daughter - a responsibility and a burden, social and sexual innocence and parents’ roles in the preparation for marriage. The theme and the sub-themes illustrate how the parents saw themselves as responsible for raising ‘innocent daughters’ and arranging good marriages (III). The quantitative study on the married young women showed that having a say in the selection of spouse at the time of marriage was significantly associated with agreeing with spouse over the number of children to have, intention to use contraceptives and the time between marriage and first contraceptive use. These relationships existed after controlling for education, socioeconomic status, mobility outside of house and decision making in the home (IV). Conclusions: In a culture of silence around sexuality, young women’s socialisation into submissiveness lays the foundation for the lack of control over their future reproductive health (I and II). The parents realised, though, that bringing up daughters for marriage requires not only obedience, but also building confidence and knowledge during their childhood (III). Women who had decision making freedom in their parental home carried this ability with them into marriage in their new home and were better able to negotiate about their fertility (IV). Knowledge about reproductive life could prepare young women better for the future life and give them more control of their fertility. Innovative interventions targeting women need to challenge current societal norms of womanhood to promote the upbringing of confident and knowledgeable young women