Patient delay in breast cancer diagnosis in two hospitals in Karachi, Pakistan: Preventive and life-saving measures needed

Purpose: Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.Methods: Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.Results: The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months.Conclusion: Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer

EVALUATION OF OIL BASED AVIAN INFLUENZA VACCINE (H5NI) PREPARED WITH DIFFERENT CONCENTRATIONS OF ADJUVANT

Bird flu vaccine from H5N1 strain of avian influenza virus was prepared with two concentrations of adjuvant (Montanide ISA 70MVG). Two vaccines (I and II) were prepared containing 50 and 60% Montanide, respectively. Immune response of both the vaccines as single, as well as booster, dose was evaluated in layer birds through haemagglutination inhibition test. Single dose of both vaccines showed poor immune response, while booster dose gave better response with both the vaccines. However, the vaccine prepared with 60% Montanide provided better immune response compared with the vaccine containing 50% montanide

A multicenter case control study of association of vitamin D with breast cancer among women in Karachi, Pakistan

Background: The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan. Methods: A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information was collected on sociodemographic history, history of vitamin D supplementation, past medical and obstetrical history, family history of breast cancer, sun exposure history, histopathology reports and anthropometric measurement and venous blood was collected to measure serum 25-hydroxyvitamin D (25(OH)D) concentration. Results: Compared to patients with sufficient serum vitamin D (\u3e30 ng/ml), women with serum vitamin D deficiency (\u3c20ng/ml), had a higher risk of breast cancer (OR = 1.65, 95%CI: 1.10, 2.50). Women with history of vitamin D supplementation one year prior to enrollment, had significant protective effect against breast cancer (OR = 0.32, 95% CI: 0.24, 0.43). Conclusions and Recommendation: Serum vitamin D deficiency was associated with increased risk of breast cancer, while vitamin D supplementation was associated with decreased risk of breast cancer. In Pakistani women, where vitamin D deficiency is common, raising and maintaining serum vitamin D at population level is a safe and affordable strategy. It may play a role in reducing the incidence of both vitamin D deficiency and breast cancer, particularly among poor women where the breast cancer mortality is highest due to limited resources for early detection, diagnosis, and treatment. The effects of vitamin D with regard to breast cancer risk in Karachi Pakistan should be further evaluated

The double burden of malnutrition and associated factors among south Asian adolescents: Findings from the global school-based student health survey

The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12-15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associated with adolescent malnutrition were: age, hygiene behaviours, social support, sedentary behaviour, and tobacco use. A substantial proportion of stunting, thinness and overweight was found among school-going South Asian adolescents, indicating that the double burden of malnutrition is present in this population. Future research should seek to further understand the relationship between all forms of malnutrition and its associated factors in the adolescent population

Detection of BCR-ABL kinase domain mutations in CD34+ cells from newly diagnosed chronic phase CML patients and their association with imatinib resistance

BCR-ABL kinase domain (KD) mutations, the most common cause of imatinib resistance, are infrequently detected in newly diagnosed chronic-phase chronic myeloid leukemia (CP-CML) patients. Recent studies indicate pre-existing mutations (PEMs) can be detected in a higher percentage of CML patients using CD34+ stem/progenitor cells, and these mutations may correlate with imatinib resistance. We investigated KD mutations in CD34+ stem cells from 100 CP-CML patients by multiplex ASO-PCR and sequencing ASO-PCR products at the time of diagnosis. PEMs were detected in 32/100 patients and included F311L, M351T, and T315I. After a median follow-up of 30 months (range 8-48), all patients with PEMs exhibited imatinib resistance. Of 68 patients without PEMs, 24 developed imatinib resistance. Mutations were detected in 21 of these patients by ASO-PCR and KD sequencing. All 32 patients with PEMs had the same mutations. In imatinib-resistant patients without PEMs, we detected F311L, M351T, Y253F, and T315I mutations. All imatinib-resistant patients without T315I and Y253F mutations responded to imatinib dose escalation. In conclusion, BCR-ABL PEMs can be detected in a substantial number of CP-CML patients when investigated using CD34+ stem/progenitor cells. These mutations are associated with imatinib resistance, and mutation testing using CD34+ cells may facilitate improved, patient-tailored treatment

Adolescent undernutrition in South Asia : a scoping review protocol

Introduction: The aim of the protocol is to present the methodology of a scoping review that aims to synthesise up-to-date evidence on adolescent undernutrition in South Asia. Methods and analysis: The proposed scoping review will be guided by Arksey and O’Malley’s framework and the Joanna Briggs Institute Reviewers’ Manual. The scoping review question, eligibility criteria and search strategy will be based on the Population, Concept and Context strategy. We will conduct the search in electronic bibliographic databases (Medline (OVID), Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, Scopus) as well as various grey literature sources in order to synthesise and present the findings with descriptive statistics and a narrative description of both quantitative and qualitative evidence. Ethics and dissemination: This study protocol does not require ethical approval. This protocol will accurately describe the proposed scoping review that will map the evidence on adolescent undernutrition in South Asia. The proposed review aims to gather published and unpublished literature to inform policy and healthcare organisations as well as identify future research priorities in South Asia

Adolescent undernutrition in south Asia: A scoping review

Undernutrition is a growing public health challenge affecting growth and development during adolescence in many low- and middle-income countries. This scoping review maps the evidence on adolescent undernutrition (stunting, thinness and micronutrient deficiencies) in South Asia and highlights gaps in knowledge. Using Arksey and O\u27Malley\u27s framework and the Joanna Briggs Institute Reviewers\u27 Manual, the search included electronic bibliographic databases (Medline (OVID), Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, and Scopus) as well as various grey literature sources published up to March 2019. In total, 131 publications met the inclusion criteria of this review. All the included evidence used quantitative data and 115 publications used a cross-sectional design. Nearly 70% (n=86) of the included publications were conducted in India. Prevalence of undernutrition was reported based on different growth references and cut-offs. Evidence is divided into publications that included an intervention component (n=12) and publications that did not include an intervention component (n=116), and presented in a narrative synthesis. This scoping review provides a wide range of publications on adolescent undernutrition in South Asia and identifies future research priorities in the field

Improving Growth and Productivity of Oleiferous Brassicas under Changing Environment: Significance of Nitrogen and Sulphur Nutrition, and Underlying Mechanisms

Mineral nutrients are the integral part of the agricultural systems. Among important plant nutrients, nitrogen (N) and sulphur (S) are known essential elements for growth, development, and various physiological functions in plants. Oleiferous brassicas (rapeseed and mustard) require higher amounts of S in addition to N for optimum growth and yield. Therefore, balancing S-N fertilization, optimization of nutrient replenishment, minimization of nutrient losses to the environment, and the concept of coordination in action between S and N could be a significant strategy for improvement of growth and productivity of oleiferous brassicas. Additionally, positive interaction between S and N has been reported to be beneficial for various aspects of oilseed brassicas. The current paper updates readers on the significance of N and S for the improvement of plant growth, development, and productivity in detail. In addition, S-N nutrition-mediated control of major plant antioxidant defense system components involved in the removal and/or metabolism of stress-induced/generated reactive oxygen species in plants (hence, the control of plant growth, development, and productivity) has been overviewed

Sustained release of drug loaded nanofibers for wound dressing applications

479-485Global burden of chronic wounds has increased drasticallyas they are vulnerable to bacterial infections that causes inflammation, thereby leads to a delay in the healing process. Furthermore, wound care and dressing industry is subjected to a global market of $30.4 billion by 2024. Our work entails fabrication of polymeric electrospun nanofibers loaded with different concentration of the amoxicillin (AMX) antibiotic. Biodegradable and biocompatible poly (vinyl) alcohol (PVA)/poly(meth)(methacrylate)(PMMA) polymerswere blended with different AMX concentration (100, 150, 200 and 250 mg) and fabricated by electrospinning technique. Morphology, structural properties and drug release from electrospun nanofibers depend on the different concentrations of drug incorporated in PVA:PMMA blend of polymer. Furthermore, these studies revealed drug-excipient compatibility and drug encapsulation within the nanofiber. In-vitro release study showed the AMX release time from PVA: PMMA: AMX was extended up to 7 days for AMX-250 with an initial burst release of 70% and further sustained drug release. Electrospun nanofibers of PVA:PMMA:AMX showed greater zone of inhibition of S. aureus as 2.1±0.4 cm for 100-AMX, 2.3±0.5 cm for 150-AMX, 2.4±0.1 for 200-AMX and 3.4±0.3 cm for 250-AMX. These results demonstrate that AMX retains the anti-bacterial activity and hence can be used as a potential wound dressing candidate