ASSOCIATION OF POSITIVE FAMILY HISTORY WITH BREAST CANCER IN YOUNG FEMALES WITH BREAST LUMPS.

Background; Breast cancer is most frequently diagnosed cancer in females. It has a major impact on health of women. According to a World Health Organization [WHO] estimate, more than 1.2 million people are diagnosed with breast cancer worldwide every year. This study was conducted to determine the frequency of breast cancer in patients presenting with breast lumps in our population. OBJECTIVE; To determine frequency of breast cancer among young females presenting with breast lumps at a tertiary care hospital. Material and Methods; Consecutive 160 young ladies presenting with breast lumps were taken.  Young females with breast lumps were taken and diagnosed for breast cancer. All the data was entered and analyzed using SPSS-20. Results; Of these 160 study cases, 98 (61.2 %) were un-married female patients while 62 (38.8 %) were married female patients. Mean age of our study cases was 23.23 ± 3.85 years (with minimum age of our study cases was 18 years while maximum age was 32 years). Our study results have indicated that majority of our study cases i.e. 123 (76.9 %) were aged up to 25 years. Mean body mass index of our study cases was 26.23 ± 1.92 kg/m2 and obesity was present in 48 (30.0 %). Mean disease duration was 2.98 ± 2.54 months and 111 (69.4%) had duration of illness up to 3 months. Breast cancer was noted in 40 (25.0%) of our study cases. Conclusion; High frequency of breast cancer was noted in our study among young females presenting with breast lumps. Breast cancer was significantly associated with marital status, increasing age, residential status, socioeconomic status and family history of breast cancer. These findings suggest that females at every age group with breast lumps need specialized care for diagnosis and management. Keywords; Breast Cancer, Breast Lumps, Young Females. DOI: 10.7176/JMPB/54-18 Publication date: April 30th 201

Frequency of puerperal infection with meconium stained amniotic fluid.

Objective: To determine the association of meconium stained amniotic fluid with puerperal infection. Material, place and method: A Cohort Study was conducted from 1stjanuary 2018 to 30th June 2018 in department of obstetrics & gynecology, Nishtar hospital, Multan. A total of 66 women with singleton pregnancy, gestational age 37-41 weeks of any parity undergoing elective caesarean section were eligible in study. Patients with rupture of membranes for more than 6 hours on history, diabetic patients, preterm delivery and post term delivery were excluded. During elective caesarean section, after rupture of membranes women were divided in two equal groups. 33 (50%) patients with meconium stained liquor in exposed group and 33 patients (50%) with clear liquor in un-exposed group were divided. Puerperal infection was noted when temperature of 38°C and higher on any two of first ten days postpartum excluding of first 24 hours. The data was analyzed using statistical analysis program to compare proportions between these two groups. Frequency, percentage and mean ±SD were presented for variables. Chi-square test was applied to compare puerperal infection in both groups taken p ≤0.05 as significant. Results: Age range in this study was from 18 to 35 years with mean age of 28.000± 2.27 years in Exposed Group while 26.212± 3.06 years in Unexposed Group. Mean gestational age was 38.848±1.12 weeks in exposed group while 39.060±1.11 weeks in unexposed group. Puerperal infection was seen in 63.64% patients in exposed Group as compare to 12.1% in unexposed Group (p=0.005). Conclusion: Recognition of the increased risk of infection in women with meconium stained fluid improves the perinatal outcome. Keywords: Meconium stained amniotic fluid, Puerperal infection, Association, cohort study. DOI: 10.7176/JMPB/54-17 Publication date: April 30th 201

Influence of Inclined Chip Angles on Dynamic Contact Angle Variations in Digital Microfluidics

The impact of tilted angles on contact angles of water droplets in digital microfluidics was investigated. Experiments were conducted tilting the chip from 0 to 10 degrees at voltage increments of 50V from 250V to 400V DC. Both advancing and receding contact angles of the water droplets were measured at each angle and voltage combination. As the tilted angle increased from horizontal to 10 degrees, the advancing contact angle generally decreased whereas the receding contact angle increased. This trend held for all tested voltages. The changes were more pronounced at higher tilt angles above 5 degrees. Voltage was also found to influence the contact angles, with both advancing and receding angles decreasing with increasing driving voltage. The results provide insight into how tilted surface angles affect wetting properties in digital microfluidics. By understanding these relationships between contact angles, tilt angles and driving voltages, design parameters like maximum operational tilt angles before droplet pinning or instability can be better determined. The findings may assist in designing and optimizing tilted or three-dimensional digital microfluidic devices and applications

Awareness, use and perceptions about E-cigarettes among adult smokers in Karachi, Pakistan.

OBJECTIVE: To estimate the prevalence of awareness, current use and intention to use of e-cigarettes among adult smokers. METHODS: This cross-sectional survey was carried out at the Aga Khan University Hospital, Karachi, from July to August 2016, and comprised people aged above 18 years who had smoked more than 100 cigarettes in their lifetime. Convenience sampling method was used. A self-administered questionnaire was used to collect data. SPSS 22 was used for data analysis.. RESULTS: Of the 387 participants, 359(92.8%) were male. The overall mean age was 32.4±12.6 years. Moreover, 215(55.5%) respondents belonged to the middle socio-economic class. Besides, 249(64.3%) respondents were aware of e-cigarettes while 39(10.1%) used them, and 81(20.9%) wanted to use them. Socio-economic status was the best predictor for awareness about e-cigarettes (p CONCLUSIONS: The percentage of e-cigarette usage was low despite the higher than expected awareness among the subjects

A Spatially Resolved Single-Cell Genomic Atlas of the Adult Human Breast

The adult human breast is comprised of an intricate network of epithelial ducts and lobules that are embedded in connective and adipose tissue1-3. Although most previous studies have focused on the breast epithelial system4-6, many of the non-epithelial cell types remain understudied. Here we constructed the comprehensive Human Breast Cell Atlas (HBCA) at single-cell and spatial resolution. Our single-cell transcriptomics study profiled 714,331 cells from 126 women, and 117,346 nuclei from 20 women, identifying 12 major cell types and 58 biological cell states. These data reveal abundant perivascular, endothelial and immune cell populations, and highly diverse luminal epithelial cell states. Spatial mapping using four different technologies revealed an unexpectedly rich ecosystem of tissue-resident immune cells, as well as distinct molecular differences between ductal and lobular regions. Collectively, these data provide a reference of the adult normal breast tissue for studying mammary biology and diseases such as breast cancer

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

Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America

Background & Aims Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection