SENTINEL LYMPH NODE SCINTIGRAPHY IN BREAST CARCINOMA- COMPARISON OF TWO VERSUS FOUR INJECTION SITE TECHNIQUE

Purpose: Sentinel lymph node (SLN) is the first regional node that drains lymph from the primary tumour and receives seeding of metastatic cells. Axillary node dissection remains the most reliable predictor of disease outcome. Controversies still exist about several aspects of lymphatic mapping and SLN biopsy for breast cancer, including number of radioisotope injection. The purpose of this study is to evaluate the success rate of different number of injection sites in the detection of SLN in breast cancer.Materials and Methods: A total of 120 consecutive breast cancer patients were divided into two groups. Group A (60 patients) received four intradermal periareolar (ID-PA) injections. Group B (60 patients) received two ID-PA injections.Imaging was carried out at 45 min post-injection. A gamma probe was used to explore the SLNs during surgery.Results: In Group A, 60 females with the mean age of 50.77 years were included in the study. 34 (56%) patients had single SLN. 25 (41.7%) had SLN with the second tier. 1 (1.7%) was negative. Group B included 60 patients (59 females and 1 male) with the mean age of 51.9 years. In 30 (50%) patients, single SLN was detected. 29 (48.3%) had SLN with the second tier. 1 (1.7%) was negative.Conclusion: SLN mapping with two periareolar ID injections carries less radiation dose and less pain as compared to the four injections with equal sensitivity for the visualization of SLNs.Key words: Breast cancer, intradermal injection, sentinel lymph node, Tc99 human serum albumi

Development of methods for the detection of trace amounts of selected carcinogenic and mutagenic amines in water

A great deal of concern exists over the presence of potentially carcinogenic and/or mutagenic substances in drinking water supplies. The general analytical schemes currently applied to water are less suited than specific methods for the detection of certain classes of organic contaminants such as aromatic amines because of their reactivity. We have concentrated our efforts at developing analytical schemes by which we are able to reliably detect, separate, and quantitate trace levels of a number of aromatic and heterocyclic amines. Both liquid and gas chromatographic methods have been developed. The relative strengths and limitations of the methods are discussed. Field evaluations of the final methods were carried out and reported.U.S. Department of the InteriorU.S. Geological SurveyOpe

Impact Of Metacognitive Awareness On Performance Of Students In Chemistry

The impact of metacognitive awareness on students’ performance has been examined in the present study. 900 students of grade X participated in the study.  Metacognitive awareness was measured using inventory, while performance of students was measured with the help of researcher made test in the subject of chemistry.  Results indicated that metacognitive awareness was significantly correlated with the performance of students.  The highly metacognitively aware science students performed well on the test.  Results further indicated that there was no significant difference in the metacognitive awareness of male and female students. &nbsp

The Epidemiological and Clinical Characteristics of 2019 Novel Corona Virus Disease (COVID-19) in Balochistan, Pakistan

Background: The unprecedented outbreak of 2019 novel coronavirus disease (COVID-19) drastically spread worldwide. The study was aimed to articulate the findings of a descriptive and clinical characteristic, also to access the potential risk factors link with the spread of COVID-19. Method: The COVID-19 cases reported through April 30, 2020, were extracted from Balochistan’s COVID-19 Electronic Dashboard. All cases from March to April 2020 were included. The results of the laboratory finding as well as data acquired through COVID-19 Dashboard were cleaned; descriptive exploratory analysis and chi-square were calculated to demonstrate the association using Epi- Info. Results: A total of 1381 patient records extracted and screened. Of these, 1218 suspected cases and 1049 confirmed cases contributed to the analysis. Among confirmed cases, 77% (811) were male. The most affected age group was 60 – 69 years (attack rate 1.90/10,000), mean age was 36 ±17.11 SD with age range 2 months-94 years.  District Quetta 82% (864) and district Pishin 5% (55) remained the epi-center for high attack rates. Among confirmed cases, a total of 14 deaths occurred for an overall Case fatality rate of 1.33%. The epi surge was peaked around March 19, April 5, and April 24, 2020. Among high-risk personals, those who had contact with infected individuals’ showed a high association of 97% (323/333) than without any contact 87% (221/254). Those who had travel history showed a prevalence of 86% (87/101) than in those who did not 59% (60/104) while those admitted in hospital with comorbid conditions showed a prevalence of 70% (26/37) than in those who did not 13% (6/46). Conclusion: COVID-19 epidemic has spread rapidly in the province. A series of multidimensional public health interventions, a cost-effective surveillance system, and the adoption of safe working practice, awareness sessions are necessary to control the COVID-19 outbrea

Analysing Impact of Efficiency, Profitability, and Risk Management on Sustainable Performance of the Pakistani Banks

This conceptual paper aims to create a comprehensive framework for the Pakistani banks by analysing the impact of banks’ efficiency, profitability, and risk management capability on sustainable performance by incorporating most suitable determinants of banks specific internal and macroeconomic and external determinants. Internal determinants such as size of bank, capital ratio, loan intensity, credit risk, financial leverage, operating, return on asset (ROA), age of bank, Z-Score, bank ownership (foreign, domestic and government), and listing is studied and impact on efficiency, profitability, and risk management has been measured. Macroeconomic and external determinants such as Gross Domestic Product (GDP), inflation, interest rate, exchange rate, market capital, Global Financial Crisis, corruption control, and financial action task force (FATF) has been discussed and impact on efficiency, profitability, and risk management has been measured. During the process of research, the strands of reviewing literature show that renowned authors conducted independent studies on efficiency, profitability, and risk management and holistic studies analysing all these variables in one unison study are scarce. Whereas this paper has novelty that combines the impact of efficiency, profitability, and risk management capability on sustainable performance of banks and their corresponding banks’ specific internal and macroeconomic external determinants are researched. This conceptual paper has limitations as it is not empirically tested yet and this paper is based on literature review and suggests empirical testing of this framework through another study. This conceptual paper will contribute in assisting management of banking sector to measure sustainable performance of banks and will be helpful to the investors for making investment decisions for different banks

Drug/bioactive eluting chitosan composite foams for osteochondral tissue engineering

Joint defects associated with a variety of etiologies often extend deep into the subchondral bone leading to functional impairment and joint immobility, and it is a very challenging task to regenerate the bone-cartilage interface offering significant opportunities for biomaterial-based interventions to improve the quality of life of patients. Herein drug-/bioactive-loaded porous tissue scaffolds incorporating nano-hydroxyapatite (nHAp), chitosan (CS) and either hydroxypropyl methylcellulose (HPMC) or Bombyx mori silk fibroin (SF) are fabricated through freeze drying method as subchondral bone substitute. A combination of spectroscopy and microscopy (Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), energy dispersive X-ray (EDX), and X-ray fluorescence (XRF) were used to analyze the structure of the porous biomaterials. The compressive mechanical properties of these scaffolds are biomimetic of cancellous bone tissues and capable of releasing drugs/bioactives (exemplified with triamcinolone acetonide, TA, or transforming growth factor-β1, TGF-β1, respectively) over a period of days. Mouse preosteoblast MC3T3-E1 cells were observed to adhere and proliferate on the tissue scaffolds as confirmed by the cell attachment, live-dead assay and alamarBlue™ assay. Interestingly, RT-qPCR analysis showed that the TA downregulated inflammatory biomarkers and upregulated the bone-specific biomarkers, suggesting such tissue scaffolds have long-term potential for clinical application

A survey of Autism knowledge and attitudes among the healthcare professionals in Lahore, Pakistan

<p>Abstract</p> <p>Background</p> <p>The diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness campaigns.</p> <p>Methods</p> <p>Physicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians (psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed. Demographic information regarding the participants of the survey was also gathered.</p> <p>Results</p> <p>Two hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study. Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups, differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with Physicians (P-value <0.001). Significant misunderstandings of some of the salient features of autism were present in both professional groups.</p> <p>Conclusion</p> <p>Results suggests that current professionals in the field have an unbalanced understanding of autism due to presence of several misconceptions regarding many of the salient features of autism including developmental, cognitive and emotional features. The study has clinical implications and calls for continued education for healthcare professionals across disciplines with regards to Autism in Pakistan.</p

Primary results from the CLEAR study of a novel stent retriever with drop zone technology

Background: Challenges to revascularization of large vessel occlusions (LVOs) persist. Current stent retrievers have limited effectiveness for removing organized thrombi. The NeVa device is a novel stent retriever designed to capture organized thrombi within the scaffold during retrieval. Objective: To evaluate the safety and effectiveness of revascularization of acute LVOs with the NeVa device. Methods: Prospective, international, multicenter, single-arm, Investigational Device Exemption study to evaluate the performance of the NeVa device in recanalizing LVOs including internal carotid artery, M1/M2 middle cerebral artery, and vertebrobasilar arteries, within 8 hours of onset. Primary endpoint was rate of expanded Treatment in Cerebral Ischemia (eTICI) score 2b-3 within 3 NeVa passes, tested for non-inferiority against a performance goal of 72% with a -10% margin. Additional endpoints included first pass success and 90-day modified Rankin Scale (mRS) score 0-2. Primary composite safety endpoint was 90-day mortality and/or 24-hour symptomatic intracranial hemorrhage (sICH). Results: From April 2021 to April 2022, 139 subjects were enrolled at 25 centers. Median National Institutes of Health Stroke Scale (NIHSS) score was 16 (IQR 12-20). In the primary analysis population (n=107), eTICI 2b-3 within 3 NeVa passes occurred in 90.7% (97/107; non-inferiority P<0.0001; post hoc superiority P<0.0001). First pass eTICI 2b-3 was observed in 73.8% (79/107), with first pass eTICI 2b67-3 in 69.2% (74/107) and eTICI 2c-3 in 48.6% (52/107). Median number of passes was 1 (IQR 1-2). Final eTICI 2b-3 rate was 99.1% (106/107); final eTICI 2b67-3 rate was 91.6% (98/107); final eTICI 2c-3 rate was 72.9% (78/107). Good outcome (90-day mRS score 0-2) was seen in 65.1% (69/106). Mortality was 9.4% (13/138) with sICH in 5.0% (7/139). Conclusions: The NeVa device is highly effective and safe for revascularization of LVO strokes and demonstrates superior first pass success compared with a predicate performance goal. Trial registration number: NCT04514562

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer