Karachi cancer registry (KCR): Age-standardized incidence rate by age-group and gender in a mega city of Pakistan

Objectives: To estimate the cancer incidence by age group and gender for the population of Karachi Division by analyzing the Karachi Cancer Registry data of 2017-19.Settings: The population of Karachi division is 16.1 million according to national census 2017. \u27Karachi Cancer Registry\u27 which is a part of \u27National Cancer Registry\u27 is collecting data from eight major hospitals in Karachi since 2017. For outcome measures, cancer counts and the age standardized incidence rates (ASIR) per 100,000 population were computed for age groups (0-14, 15-19 and ≥20 years), in both genders and all cancer site/type.Methods: The population denominators were based on the population of Karachi division estimated at 16.1 million in the population census, 2017. Counts and age-standardized incidence rates (ASIR) were calculated for each of the three age categories.Results: From Jan 2017 till Dec 2019 a total of 33,309 malignant cases were recorded in KCR database comprising 17,490 (52.5%) females and 15,819 (47.5%) males. ASIRs in age groups 0-14, 15-19 and ≥ 20 years, among female were 11.5, 2.4 and 223.6 and in males were 17.6, 3.2 and 216.7 respectively. The commonest diagnosis in children, adolescent and adults were (1) among females: children; bone (3.12), leukemia (2.09) brain/CNS (1.26); in adolescents: bone (0.78), brain/CNS (0.27), connective and soft tissue (0.11), in adults: breast cancer (76.07), oral cancer (16.68) and ovary (10.89) respectively, and (2) among males: children; bone (4.56), leukemia (2.79) and brain/CNS (1.88); in adolescent; bone (1.19), brain/CNS (0.31) and leukemia (0.21) and in adults: oral cancer (42.83), liver (16.10) and bone (13.37) respectively.Conclusion: Oral Cancer, a largely preventable cancer is the leading cancer in Karachi adult males while in female adults Breast Cancer is the leading cancer followed by Oral Cancer. In children and adolescents Bone, Leukemia and Brain/CNS malignancies are most common.

Prevalence, diversity and disease association of <i>Helicobacter pylori</i> in dyspeptic patients from Pakistan

Introduction: The etiological association of Helicobacter pylori with gastric ulcer (GU), gastric cancer (GC), and duodenal ulcer (DU) is well-known. Understanding the epidemiology of H. pylori facilitates the estimation of disease burden in a certain population. This study presents the diversity of H. pylori genotypes and their association with different clinical outcomes among dyspeptic patients in Pakistan over a period of four years. Methodology: Gastric biopsy samples from a total of 450 dyspeptic individualswere subjected to PCR, genotypingand histology. Results: A total of 201 (45%) cases were found positive for H. pylori. The detection rate was high in GU (91%), DU (86%) and GC (83%) cases compared with those cases who had intact gastric mucosa (18%). Histology revealed the presence of infection in 68% of cases of mild/chronic nonspecific gastritis with others belonging to the GU sequel. cagA gene carriage was observed in 104 (51%) cases or mostly from DU, GU and GC groups, of which 97 were Western type strains while 3 were East-Asian type strains that are rarely observed in South Asia. vacA allelic variant s1am1 was most commonly observed, followed by s1am2, and s1bm1, with direct correlation in diseased cases (gastritis, GU, DU and GC). Prevalent genotypic combinations were s1am1/cagA- in gastritis and s1am1/cagA+ in DU, GU, and GC. Conclusions: Our study indicates the predominant circulation of Western type cagA and vacAs1am1 type H. pylori strains in Pakistan.</br

Feasibility of robotic surgery in a developing country, a public sector perspective

Objective: To assess the clinical feasibility of robotic platform and to calculate cost for sustaining it..Methods: The study was conducted at Sindh Government Qatar Hospital and Civil Hospital Karachi from October 11, 2011, to August 30, 2017. Feasibility was assessed in terms of clinical outcome i.e. surgical complications, duration of stay and readmissions. The cost of doing an individual procedure was calculated along with the projected cost for 150, 200 and 250 cases per year. SPSS 23 was used for data analysis..Results: Of the 119 patients, 45(37.8%) were males and 74(62.2%) were females. Overall mean age was 42.10 -13.40 years (range: 21-80 years. Mean hospital stay was 3.59-3 (range: 1-19 days). Complications occurred in 17(14.3%) patients ranging from wound infection 7(5.9%), bleeding 5(4.2%), intra-abdominal abscess 3(2.5%) and recurrence 2(1.7%). The total cost of robotic platform was Rs320 million with an annual maintenance contract of 10% of the total cost. The mean cost of performing a robotic procedure was Rs.389,263.05-39,249.63 (range: Rs252,823.09- Rs456,842.79)..Conclusions: Robotic surgery was found to be a feasible and viable option. The major hindrance was the cost involved in setting up the system and recurring costs in terms of disposables

Antibiotic resistance and cagA gene correlation: A looming crisis of Helicobacter pylori

AIM: To determine antibiotic resistance of Helicobacter pylori (H. pylori) in Pakistan and its correlation with host and pathogen associated factors