An Indirect View of the Fertility Changes in Pakistan

An effort has been made in this paper to arrive at some indirect assessment of the levels of birth rates from the same survey data sources. The basis for this approach is the internal consistency of the relevant data.! Ideally, in a series of repeated surveys the variations ih the estimated yearly rates should be only due to the sampling and non-sampling errors and not due to changes in the numerator or the denominator resulting from variations in the procedures of measurement. In other words, such changes if any, should not result in any erratic variations between the estimates of one series to the other, otherwise they may lead to some erroneous inference about the levels and trends. Let us now have a look at the crude birth and death rates for Pakistan, as reported from different surveys. From Table 1 it is clearly evident that the crude birth rate as reported from yearly repeated surveys (pGE, PGS and PDS series), show erratic up and down movements over the years 1962-65 through 1988, with the level of the rate remaining over 40 [Farooqui and Farooq (1971); Government of Pakistan (1973, 1973a, 1974, 1974a, 1981, 1983, 1983a, 1984, 1984a, 1990)]. The corresponding crude death rates also show year to year variations but in their case a net decline of 4.1 is evident over the same period. Table 1 also shows that the estimates of Crude Birth Rate (CBR) reported by 1975 Pakistan Fertility Survey (PFS), 1984-85 Pakistan Contraceptive Prevalence Survey (PCPS) and 1990-91 Pakistan Demographic and Health Survey (PDHS) show a declining trend [Government of Pakistan (1976, 1986); NIPS (1992»). Moreover the levels of CBR given by these types of one-time surveys are reported to be lower than the rates reported for the nearest years by the series of yearly repeated surveys. Conducted by Pakistan Federal Bureau of Statistics

Fructosamine: an alternative assessment of past glycaemic control in developing countries

Fructosamine assay determines glycaemic control in diabetic patients by measuring glycosylated plasma protein. This study was done to assess the value of fructosamine as an alternative test to HbA1c as a measure of glycaemia. Sixty patients (both insulin dependent diabetes mellitus and non insulin dependent diabetes mellitus) were selected from the diabetic clinic and fasting blood samples were collected for estimation of glucose, HbA1c and fructosamine levels. The results were compared by correlation analysis and major discrepancies/discordance was detected by dividing the results into 3 clinical categories and detecting the cases in which the values fell in opposite clinical categories. Fructosamine correlated well with HbA1c (r = 0.41, p \u3c 0.01) and with fasting blood glucose (r = 0.45 p \u3c 0.01). Major discordance was detected in the results of only 7 patients which can partly be attributed to different periods over which HbA1c and fructosamine reflect average glycaemia. Fructosamine measures glycaemia over the past 2-3 weeks and HbA1c over 8 weeks. As fructosamine assay is relatively inexpensive, reliable and simple to perform; it can be used as an alternative to HbA1c and is particularly suited for developing countries

Breast diseases in males--a morphological review of 150 cases

Objective: This study was carried out to observe the prevalence breast diseases of males in our setup. Method: All cases of male breast disease diagnosed from 1991-97. Results: One hundred and fifty (150) cases of male breast diseases were diagnosed. Age of the patients ranged from 4 to 90 years, with mean age 38.75 years (median = 33 years). Gynecomastia was the most common pathological abnormality of the male breast (58.66%). Most of the patients presented in the 3rd decade of life. Amongst the malignant conditions, infiltrating ductal carcinoma was most prevalent (82%). Most of the patients with malignancy presented in the 5th and 6th decades of life. Conclusion: Gynecomastia was the most prevalent male breast disorder, followed by infiltrating ductal carcinoma. Our findings correspond with that of world literature

Epidermal Growth Factor Receptor (EGFR) as a Prognostic Marker: an Immunohistochemical Study on 315 Consecutive Breast Carcinoma Patients

Objective: To assess the independent and interdependent prognostic value of epidermal growth factor receptor (EGFR) in carcinoma of breast in female population. The Type I family of growth factor receptors includes epidermal growth factor receptor (EGFR also known as EGFRI). Methods: The expression of EGFR protein was analysed immunohistochemically on 315 tumour specimens of infiltrating ductal carcinoma of breast. These patients also had axillary lymph nodes sampling. Results: Overexpression and/or amplification of EGFR was observed in 70 (22.00%) tumours. Eleven (16%) were grade I, 43 (61%) grade II and 16 (23%) grade Ill tumours. Axillary lymph node metastasis had significant correlation with intensified positivity of EGFR (p\u3c 0.05). Significant number of EGFR positive patients developed local recurrence and distant metastases to brain, liver and bone (p\u3c 0.05). EGFR positivity showed significant correlation with the disease free and overall survival (p\u3c 0.05). At a median follow-up of48 (4 years) months in EGFR positive patients, the overall survival was 3.39 years and disease free survival was 2.86 years. EGFR negative tumour patients showed a better survival. In this group the overall survival was 4.62 years and the disease free survival was 4 years. Conclusion: EGFR analysis can be a useful indicator for the selection of patients who are at the high risk, for hormonal therapy decisions and can be useful as a target for new treatment modalities

Central nervous system lymphomas: a histologic and immunophenotypic analysis

Objective: To observe the spectrum of non-Hodkin’s lymphomas involving the central nervous system including morphological subtypes and immunophenotypic status. Setting: Retrospective analysis of eleven years (1986 to 1996) data from surgical pathology files of Department of Pathology. Results: orty-three cases of non-Hodgkin’s lymphomas were diagnosed during the period of eleven years (from 1986 to 1996), all of which were diffuse types. A total of 1177 Central Nervous CNS biopsies were examined, out of which 937 cases were diagnosed as CNS neoplasms, the remaining were non-neoplastic in nature. Among 937 CNS neoplasms, 43 cases (4.6%) were reported as non-Hodgkin’s lymphomas. As most of the cases were outside referrals, the primary or secondary nature of the lymphomatous process could not he assessed. Seventeen cases were intracranial, while 26 cases were spinal in location. Majority of the intracranial Eymphomas were hiopsied from the cereherum (12 cases). Male to female ratio was 1:2. The median age for intracranial lvmphomas was 50 years and for spinal lymphomas 29 years. There were 16 cases (37%) of diffuse large cell lymphomas; 7 cases (16%) of diffuse mixed small and large cell lymphomas; 3 cases (7%) of diffuse large cell immunoblastic lvmphomas; 2 cases (4.6%) of lymphoblastic lymphomas and diffuse small non-cleaved cell lymphomas and one case of small Iyrnphocytic lymphoma and diffuse small cleaved cell Ivmphoma. One case of T cell rich B cell lvmphoma was also diagnosed in the thoracic spine as primary extranodal lymphoma. Eight cases were unclassifiable and in 2 cases the features were suggestive of lymphoma. Immunophenotypic analysis was performed in 20 cases, however, in 2 cases the results were inconclusive. Fifteen cases (83%) showed immunoreactivity for B cell markers and 3 cases showed T cell phenotype out of which one case was lymphoblastic lymphoma. Conclusion: CNS lymphomas were uncommon tumors and comprised 4.6% of the total CNS neoplasms in our study. Moreover, these CNS lymphomas accounted for 2.2% of the total non-Hodgkin’s lvmphomas, including both nodal and extranodal. There was a higher incidence of location of these lymphomas within the spinal cord than brain. Most of the lymphomas were of intermediate or high grade (75%) according to the working phenotype in 84% 3f the lymphomas, in which it was formulation. lmmunophenotypical status revealed B-cell teste

Male breast cancer

Objective: To review cases of male breast cancer.Settings: Histopathology Section, Department of Pathology, The Aga Khan University, Karachi.Method: Fifty one cases of male breast cancer specimens, received during a period of 10 years, routinely processed and stained with Haematoxylin and Eosin were analyzed. Special stains and Immunohistochemistry were used in difficult cases.Results: Male breast cancer affected individuals in the sixth and seventh decades of life with a mean age of 56.2 years. Infiltrating ductal carcinoma (IDC) was the predominant type. Skin involvement was seen in 27.45% of the cases. Breast lump was the most common presenting symptom followed by skin ulceration. At the time of presentation 43.13% patients had a tumour size of more than 3 cm.Conclusion: Male breast cancer is a rare disease. Most of our findings correspond to the published local and international data