Primary Diffuse Large B-Cell Lymphoma of Breast: A Rare Form of Gestational Breast Cancer

Primary diffuse large B cell lymphoma of the breast is an uncommon form of gestational breast cancer and its presentation during pregnancy is challenging. In our case report, a patient presented with a right breast lump during the first trimester of her pregnancy. Biopsy was taken from right breast mass, which was diffuse large b cell lymphoma (DLBCL) double expressive type. She underwent termination of pregnancy and received 6 cycles of multiagent intense chemotherapy along with central nervous system prophylaxis followed by consolidation involved site radiotherapy (ISRT) to breast and axilla after achieving a complete response. Studies suggest no improvement in the outcome of gestational breast cancer with the termination of pregnancy. However, the presentation of primary DLBCL during pregnancy is extremely rare and the decision regarding pregnancy termination is weighted upon a case by case basis. The paucity of data makes our case report a valuable source for the management of DLBCL breast in pregnancy

Tuberculosis among Nomadic Women in Perception of Socio-Economic Status: A case of Sahiwal, Pakistan

Using data from a representative sample of the Nomadic women community, this article evaluates the effect of social and economic factors on tuberculosis disease of nomadic women in district Sahiwal, Pakistan. It also carries out impact of geographical mobilization of nomadic women on their health status. The socio-economic indicators like health education, income and availability of health facilities by government play inevitable role in diminution of tuberculosis. Data collected from 255 nomad women through the snowball sampling technique. Data were analyzed with the help of binary logistic regression model. The finding of the research shows that nomad women do not get proper health care services and have not good information regarding their health. This article makes a valuable contribution to the literature by recommending that there is high need to introduce health care programs and health care services, which may protect the health of nomadic women

Tuberculosis among Nomadic Women in Perception of Socio-Economic Status: A case of Sahiwal, Pakistan

Using data from a representative sample of the Nomadic women community, this article evaluates the effect of social and economic factors on tuberculosis disease of nomadic women in district Sahiwal, Pakistan. It also carries out impact of geographical mobilization of nomadic women on their health status. The socio-economic indicators like health education, income and availability of health facilities by government play inevitable role in diminution of tuberculosis. Data collected from 255 nomad women through the snowball sampling technique. Data were analyzed with the help of binary logistic regression model. The finding of the research shows that nomad women do not get proper health care services and have not good information regarding their health. This article makes a valuable contribution to the literature by recommending that there is high need to introduce health care programs and health care services, which may protect the health of nomadic women

Spatiotemporal analysis of Highly Pathogenic Avian Influenza (H5N1) outbreaks in poultry in Egypt (2006 to 2017)

BACKGROUND: In Egypt, the highly pathogenic avian influenza (HPAI) subtype H5N1 is endemic and possesses a severe impact on the poultry. To provide a better understanding of the distributional characteristics of HPAI H5N1 outbreaks in Egypt, this study aimed to explore the spatiotemporal pattern and identify clusters of HPAI H5N1 outbreaks in Egypt from 2006 to 2017. RESULTS: The Epidemic curve (EC) was constructed through time series analysis; in which six epidemic waves (EWs) were revealed. Outbreaks mainly started in winter peaked in March and ended in summer. However, newly emerged thermostable clades (2.2.1.1 and 2.2.1.2) during the 4th EW enabled the virus to survive and cause infection in warmer months with a clear alteration in the seasonality of the epidemic cycle in the 5th EW. The endemic situation became more complicated by the emergence of new serotypes. As a result, the EC ended up without any specific pattern since the 6th EW to now. The spatial analysis showed that the highest outbreak density was recorded in the Nile Delta considering it as the ‘Hot spot’ region. By the 6th EW, the outbreak extended to include the Nile valley. From spatiotemporal cluster epidemics, clustering in the Delta was a common feature in all EWs with primary clusters consistently detected in the hot-spot region, but the location and size varied with each EW. The highest Relative Risk (RR) regions in an EW were noticed to contain the primary clusters of the next EW and were found to include stopover sites for migratory wild birds. They were in Fayoum, Dakahlia, Qalyobiya, Sharkia, Kafr_Elsheikh, Giza, Behera, Menia, and BeniSuef governorates. Transmission of HPAI H5N1 occurred from one location to another directly resulted in a series of outbreaks forming neighboring secondary clusters. The absence of geographical borders between the governorates in addition to non-restricted movements of poultry and low vaccination and surveillance coverage contributed to the wider spread of infection all over Egypt and to look like one epidemiological unit. CONCLUSION: Our findings can help in better understanding of the characteristics of HPAI H5N1 outbreaks and the distribution of outbreak risk, which can be used for effective disease control strategies. GRAPHICAL ABSTRACT: [Image: see text

Prenatal Diagnosis of Maternal Serum from Mothers Carrying β-thalassemic Fetus

Background Current study focused on discovering protein biomarkers from the maternal serum of β-thalassemic trait mothers carrying the normal fetus and β-thalassemic major fetus. Method Serum samples from β-thalassemic trait mothers carrying major (N=5) and normal fetuses (N=5) were studied. IVS1-5 thalassemia mutation was common among β-thalassemic trait mothers who were carrying homozygous β-thalassemic fetus (IVS1-5/ IVS1-5 mutation) or normal fetus (no mutation). We employed two-dimensional gel electrophoresis and mass spectrometric analysis to explore differentially expressed maternal serum proteins from thalassemia carrier couples having the same β-thalassemia mutation. Western blotting was performed for one of the identified proteins to validate our data. Results Ten proteins were identified in maternal serum of β-thalassemic trait mothers carrying the β-thalassemic major fetus and normal fetus. Among these, Serotransferrin, Haptoglobin, Alpha-1 anti-trypsin (A1AT), Apo-lipoprotein A1, and Fibrinogen-beta chain were found to be up-regulated in mothers carrying major fetuses and are known to be associated with pregnancy-related disorders. The expression of A1AT was validated through western blotting. Conclusion Proteins identified in the current study from maternal serum are reported to contribute to hereditary disorders. We suggest that these can serve as putative screening markers for non-invasive prenatal diagnosis in β-thalassemic pregnancies

High CD44 immunoexpression correlates with poor overall survival: Assessing the role of cancer stem cell markers in oral squamous cell carcinoma patients from the high-risk population of Pakistan

Oral squamous cell carcinoma (OSCC) is a top-ranked cancer in the Pakistani population, and patient survival has remained unchanged at ∼50% for several decades. Recent advances have claimed that a subset of tumour cells, called cancer stem cells (CSCs), are responsible for tumour progression, treatment resistance, and metastasis, which leads to a poor prognosis. This study investigated the impact of CSC markers expression on overall survival (OS) and disease-free survival (DFS) of OSCC patients. Materials and Methods. Immunohistochemistry was used to evaluate CD44, CD133, L1CAM, and SOX2 expression in a well-characterized cohort of 100 Pakistani patients with primary treatment naïve OSCC. The immunoreactivity for each marker was correlated with patient clinicopathologic characteristics, oral cancer risk chewing habits, and survival. The minimum follow-up time for all patients was five years, and survival estimates were calculated using the Kaplan-Meier method and Cox proportional hazards model. Results. In this cohort of 100 patients, there were 57 males and 43 females. The median OS and DFS time durations observed were 64 and 52.5 months, respectively. Positive expression for CD44, CD133, L1CAM, and SOX2 was observed in 33%, 23%, 41%, and 63% of patients. High CD44 expression correlated with decreased OS (P=0.047) but did not influence DFS. However, CD133, L1CAM, and SOX2 had no effect on either OS or DFS. Tonsils, nodal involvement, and AJCC stage were independent predictors of worse OS and DFS both. Conclusion. Of the CSC markers investigated here, only CD44 was a predictor for poor OS. CD44 was also associated with advanced AJCC and T stages. Interestingly, CD133 was significantly lower in patients who habitually consumed oral cancer risk factors

Improving hate speech detection using machine and deep learning techniques: A preliminary study

The increasing use of social media and information sharing has given major benefits to humanity. However, this has also given rise to a variety of challenges including the spreading and sharing of hate speech messages. Thus, to solve this emerging issue in social media, recent studies employed a variety of feature engineering techniques and machine learning or deep learning algorithms to automatically detect the hate speech messages on different datasets. However, most of the studies classify the hate speech related message using existing feature engineering approaches and suffer from the low classification results. This is because, the existing feature engineering approaches suffer from the word order problem and word context problem. In this research, identifying hateful content from latest tweets of twitter and classify them into several categories is studied. The categories identified are; Ethnicity, Nationality, Religion, Gender, Sexual Orientation, Disability and Other. These categories are further classified to identify the targets of hate speech such as Black, White, Asian belongs to Ethnicity and Muslims, Jews, Christians can be classified from Religion Category. An evaluation will be performed among the hateful content identified using deep learning model LSTM and traditional machine learning models which includes Linear SVC, Logistic Regression, Random Forest and Multinomial Nai¨ve Bayes to measure their accuracy and precision and their comparison on the live extracted tweets from twitter which will be used as our test dataset

Attitudes of medical students in Lahore, Pakistan towards the doctor–patient relationship

Background. A good doctor–patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor–patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc. Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1–5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor–patient relationship. PPOS yields a mean score range of 1–6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression. Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05). Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study

Funding Information: COVIP study did not have any funding. Publication of this article was funded by the Priority Research Area qLife under the program “Excellence Initiative – Research University” at the Jagiellonian University in Krakow (06/IDUB/2019/94). Publisher Copyright: © 2022, The Author(s).Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial RegistrationNCT04321265, registered 19 March 2020, https://clinicaltrials.gov.publishersversionpublishe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely