Study of diagnostic and prognostic parameters in Breast cancer patients without metastasis

Background: Carcinoma of the breast is the most prevalent cause of mortality from cancer in women aged 40-69 years. The aim of the present study was to examine any alteration in the status of lactate dehydrogenase, ferritin, gamma glutamyl transferase, Platelets, hemoglobin, alkaline phosphatase, aspartate transaminase, alanine transferase and bilirubin in the plasma of breast cancer patients without distant metastasis, to establish their diagnostic and prognostic values.Methods: Current reading describes a study conducted on 50 breast cancer patients from Institute of Nuclear Medicine and Oncology (Lahore). The patients were clinically categorized as stage II (19 patients) and stage III (29 patients) respectively. Most of the patients were diseased with infiltrative ductal carcinoma (48) of the breast. Blood samples of all patients were collected after forty days of chemotherapy course besides 10 healthy subjects.Results: There was a significant rise in LDH (221.48 ± 18.44) and Ferritin (356.46 ± 12.28) levels as compared to control groups. Concentration of GGT (34.12 ± 1.61) was also elevated but not significantly raised. There was no significant rise in ALP (279.27 ± 26.60), AST (49.44 ± 8.510), ALT (33.40 ± 2.83), bilirubin (4.87 ± 3.96), Hb (11.16 ± .299) and platelets (032.54 ± 21.68) levels in comparison to normal control subjects. An elevation of LDH and ferritin levels in cases of carcinoma breast signifies its importance as a biomarker of disease. A serial measurement of these enzymes would have diagnostic and prognostic significance and help treatment decisions.Conclusion: The ferritin along with lactate dehydrogenase can be used as a valuable biomarker for breast cancer diagnosis and prognosis.Keywords: Breast cancer; Prognostic parameters; Treatment; Metastasi

Clinical effectiveness of Carbimazole and Propylthiouracil for Hyperthyroidism in Patients of Punjab, Pakistan

Background: The primary objective of any drug for hyperthyroidism is to control clinical manifestations and maintenance of normal levels of hormonal concentrations. It also targets to prevent the recurrence of disease along with minimizing associated risk factors. In this study, effectiveness of oral anti thyroid agents was checked to normalize altered levels of thyroid hormones due to hyperthyroidism.Methods: The study was comprised of 40 subjects of whom 30 were experiencing hyperthyroidism and were administered anti-hyperthyroid drugs. 10 patients of hyperthyroidism were not taking any medication. Standard dose regimens of carbimazole and propylthiouracil were employed for all 30 hyperthyroid patients under closed monitoring. Physical as well as biochemical analyses of all subjects were done and thyroid profiling was performed for measuring levels of free thyroxine (fT4), free triiodothyronine (fT3), thyroid stimulating hormone (TSH) and antibodies against thyroglobulin (Tg).Results: Thyroid profiles of medicated hyperthyroid patients were compared with the profiles of non-medicated group. Statistical analysis appeared with non-significant values for all four parameters.Conclusion: No significant difference was found between medicated and non-medicated groups. We recommend that combinatorial drugs and new derivatives with better efficacy and fewer side effects should be employed to treat hyperthyroidism

Effects of prophylactic use of brimonidine 0.2% on intraocular pressure after YAG-capsulotomy

Background: Rise in intraocular pressure (IOP) is the commonest complication after YAG posterior capsulotomy. As there are different opinions regarding use of anti-glaucoma therapy before YAG, we compared post-YAG IOP between the patients who had Brimonidine eye drops and those who did not have any anti-glaucoma treatment. Material and methods: It was a prospective study that included patients who had undergone uneventful phacoemulsification with foldable intraocular lens implantation and YAG posterior capsulotomy. One hundred fifty patients were divided into two groups; (a group with prophylactic brimonidine 0.2% eye drops before laser and a group without any anti-glaucoma therapy). Intraocular pressure was checked pre-laser and one hour after laser procedure. Results: Out of 150 patients, 78 were in brimonidine group and 72 in the control group. The mean age of the patients was 60.39 ± 12.98 years. In the brimonidine group, IOP was 12.56 ± 2.38 mm Hg and 12.29 ± 3.64 mm Hg before and after YAG, respectively. In the control group, IOP was 12.24 ± 1.53 mm Hg and 13.38 ± 2.84 mm Hg before and after YAG. Brimonidine 0.2% caused a decrease in IOP, but the post-laser IOP difference between the two groups was not statistically significant. The change in IOP before and after using brimonidine 0.2% was also not statistically significant. Conclusion: Every patient undergoing YAG capsulotomy does not require prophylactic anti-glaucoma therapy. Only the patients prone to high IOP, glaucoma suspects, and diagnosed cases of glaucoma should be given prophylactic treatment

Circulation of Dengue Serotypes in Local Population of District Lahore, Pakistan

Infection with dengue virus (DENV) is considered as serious public health issues internationally as amounted to 2.5 billion people are at infection risk throughout the world. Dengue is now endemic in Pakistan. Till now, no licensed vaccine is available against dengue virus infection. The main purpose of this study was to find out differences in the levels of IgM and IgG on gender basis as well as distribution of dengue serotypes in the local population of district Lahore, Pakistan. Fifteen blood samples including 3 control sample were collected from dengue infected patients and statistical results showed significantly higher mean levels of IgM (1.12 + 0.09) and IgG (2.07 + 0.56) antibodies in patients as compared to control groups for IgM (0.34 + 0.05) and IgG (0.10 + 0.05) antibodies respectively. Statistical results on Gender base showed significantly higher mean levels of IgM (1.10 + 0.19) in males and of IgG (2.27 + 0.74) in females. The enveloped gene of 1.5 kb was successfully amplified through polymerase chain reaction and cloned in ?TZ57R/T. The cloned gene was then confirmed through restriction digestion. Out of 15 dengue samples, only 3 dengue samples were successfully amplified using polymerase chain reaction which all belongs to serotype 2 In future, it may contribute in development of treatment to dengue infection with dengue virus type 2 which is more prevalent in district Lahor

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Effect of anterior chamber depth on the accuracy of different intraocular lens’ formulas

Background and Objectives: Due to the difference in anterior segments among different races, intraocular lens formulas behave differently. Asian eyes have smaller anterior segment dimensions than Caucasian eyes. This study was carried out to evaluate the effect of different values of anterior chamber depth on the accuracy of Sanders, Retzlaff, Kraff/Theoretical (SRK/T), Hill Radial Basis Function (Hill RBF 2), and Barrett Universal II (Barrett U II) formulas.Methods: This was a descriptive observational study. Ninety-six eyes of patients, who underwent phacoemulsification with intraocular lens implantation and ended uneventfully, were included. The patients were divided into two groups based on the anterior chamber depth (ACD). Group 1 had ACD &gt; 3 mm and group 2 had ACD &lt; 3 mm. Intraocular lens (IOL) power with SRK/T was calculated with a built-in formula in IOL Master 500. Barrett Universal II and Hill RBF 2 formulas were calculated using online calculators. Descriptive statistics were calculated for both groups. An independent t-test was applied for group comparison.Results: Comparisons of the mean prediction errors of groups 1 and 2 using three different formulas were not statistically significant (p &gt; 0.05). However, SRK/T had the lowest median prediction error for both groups but the highest percentage of eyes within &plusmn;0.5 D of absolute prediction error (APE) for group 1 and the lowest percentage of eyes within &plusmn;0.5 D of APE for group 2.Conclusion: There was no statistically significant effect of different anterior chamber depths on the accuracy of SRK/T, Barrett U II, and Hill RBF 2. The three formulas behaved similarly with different depths of the anterior chamber. </div

A comparison of SRK/T formula with Hill RBF 2 and Barrett Universal II in the calculation of intraocular lens power

Objective: To compare the accuracy of SRK/T, Barrett Universal II and Hill radial basis activation function-2 formulas in intraocular lens power calculation using different axial lengths. Methods: The retrospective study was conducted at the Lahore General Hospital, Lahore, Pakistan, and comprised data from June to December 2020 of patients who underwent phacoemulsification with non-toric, monofocal intraocular lens implantation. Data was sorted in 3 groups on the basis of axial length; group 1 22-25mm, group 2(>25mm, and group 3 <22mm). Intraocular lens power was calculated using SRK/T with IOL Master, while online calculators were used for Barrett Universal II and Hill radial basis activation function-2 formulas. Data was analysed using SPSS 21. Results: Of the 100 patients, 47(347%) were males and 53(53%) were females. There were 49(49%) diabetics, and 57(57%) were right eyes. There were 77(77%) patients with mean age 62.38+9.5 in group 1, 17(17%) patients with mean age 52.59+12.78 in group 2, and 6(6%) patients with mean age 61.33+7.61 years in group 3. Mean axial length in group 1 was 23.55+0.81mm with anterior chamber depth of 3.1+ 0.37mm. In group 2, mean axial length was 27.54+2.8mm, with anterior chamber depth of 3.4+0.15mm. In group 3, mean axial length was 21.74mm, with anterior chamber depth of 3.14+0.44mm. Mean prediction error of SRK/T versus Barrett Universal II was 0.092+0.041D (p=0.078), SRK/T versus Hill radial basis activation function-2 was 0.066+0.037D (p=0.221) and Barrett Universal versus Hill radial basis activation function-2 was -0.025+0.019D (p=0.553). ---Continu

Sero-prevalence of Human Cytomegalovirus among blood donors in Lahore, Pakistan

Background: Transfusion-transmitted cytomegalovirus (TT-CMV) infection can cause severe illness and even death among immunocompromised patients; therefore, the spread of CMV through blood products should be prevented. To our knowledge, no study has been carried out in Pakistan to determine the seroprevalence of CMV in general population as well as among blood donors. The goal of this study was to determine CMV seropositivity among blood donors at the blood bank of INMOL Hospital, Lahore, Pakistan. Methods: A sero-epidemiological cross-sectional study was conducted. Sera from 91 blood donors were screened for CMV specific IgG antibodies by enzyme-linked immunosorbent assay (ELISA) based kit. Results: The CMV-specific IgG antibodies were detected in 89 blood donors, which gave seroprevalence rate of 97.8%. The statistical analysis of results was done using pearson chi-square test and appeared non-significant with values 0.625 and 0.705 for different age groups and blood groups of donors. Conclusion: Because of high seroprevalence in this study area, an adequate supply of CMV seronegative blood is difficult to maintain. Therefore, we propose that the future strategies for the prevention of post-transfusion CMV infection in recipients should include the transfusion of leukoreduced blood products. Further a prospective study with much greater population can be done to identify major causative risk factors for such highest prevalence rate

Tooth loss in institutionalized coronary heart disease patients of Punjab Institute of Cardiology, Lahore, Pakistan

Objective: To observe frequency and possible association of tooth loss with prevalent coronary heart disease in Pakistani population. Methodology: Angiographically determined coronary heart disease (CHD) patients of Punjab Institute of Cardiology, Lahore, Pakistan, and healthy individuals were enrolled for status of tooth loss. Results: Nine hundred and thirty six CHD patients and 595 healthy subjects with mean age of 51.9 ± 8.4 years were examined. Mean (±SD) tooth loss was significantly (P ⩽ 0.001) higher in cardiac patients (9.8 ± 9.2) than healthy subjects (6.8 ± 6.9) with odds ratio (OR) = 1.543 (95%CI = 1.985–2.851). Tooth loss was significantly (P ⩽ 0.001) associated with CHD males and females and cardiac patients with diabetes and smoking. After adjustment of age, gender, diabetes and smoking, subjects with CHD were more likely to have higher tooth loss. Conclusion: Tooth loss was significantly associated with prevalent CHD independent of classic risk factors of age, gender, smoking and diabetes in this study sample