To determine the factors responsible for diagnostic delay of breast cancer among women

Background: Breast cancer is the most common cancer among women throughout the world. Early diagnosis of this cancer is important for its early treatment and favorable outcome. The diagnostic pathway is divided into patient, doctor and system interval. This study will look into the reasons for delay in diagnosis

Objectives: To determine the frequency of diagnostic delay [patient, doctor and system delay] of breast cancer among adult women [>/= 18 years] and factors responsible for it. Study design, settings and duration: Hospital based cross-sectional study conducted at Oncology/ Radiotherapy unit of Jinnah Post Graduate Medical Centre. Karachi from February 2015 to December 2015

Subjects and Methods: Adult women [2 18 years] diagnosed with breast cancer and reporting at Oncology/Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi were enrolled. Convenient sampling was used, sample size was 288 women with breast cancer. Variables included age strata, socio-demographic characteristics, age at menarche, parity and breast feeding history [if applicable], intervals of diagnostic pathway [patient, doctor and system] and reasons of delay. Questionnaire based instrument was used for data collection. SPSS version 16 was used for data analysis and descriptive frequencies

Results: The mean age of the patients was 42 years [range 21-80 years]. Breast lump was the main presenting symptom [90%,]. Complete physical and breast examination was performed by health care provider in 97% cases. Median patient, doctor and system interval was 90, 45 and 35 days respectively. Median diagnostic pathway [patient+ doctor+ system] was 165 days [5.5 months] and ranged from 2- 405 days [13.5 months]. It was further found that after confirmation of the diagnosis, median interval to report to oncology/radiotherapy unit was 18 months. First consultation with the health care provider was delayed due to carelessness in 57%, due to financial reasons in 55%, due to fear of cancer in 23% and due to time constraints to visit hospital by the family members in 13% cases. Univariate regression analysis showed that late presentation to first health care provider by the patient [patient interval] was mostly seen in women having children who were less educated [illiterate/primary] without any ethnic group being specific. Univariate regression analysis showed that delay in reporting to oncology/radiotherapy unit was seen in women without any ethnic group been specific and those having children. Multivariate regression analysis showed that delay in reporting to oncology/radiotherapy units was mostly seen in women aged between 18-25 years who had children and belonged to either Sindhi, Baluchi or Pushto origin

Conclusion: Delay in the diagnosis of breast cancer among adult women attending the tertiary care public sector hospital as not due to doctor or system interval but was due to fear of cancer. Policy statement: Awareness campaigns should be used to communicate to women folks that breast cancer is curable if diagnosed and treated early

effects of new polyherbal Unani formulation AJMAL06 on serum creatinine level in chronic renal failure

This study was conducted to evaluate the efficacy of Unani Ajmal06, an herbal formulation for management of chronic renal failure [CRF]. The therapeutic evaluations of three different formulations such as Itrifal Kashneezi, Jawarsih Zarooni Sada medicines were conducted on number 35 CRF patients clinically diagnosed cases of chronic kidney failure. It was found that herbal coded Ajmal06 was effective for the treatment of CRF in 70% of the patients treated. SPSS tests on sign and symptoms indicated the efficacy of Ajmal06 in lowering serum creatinine level in 70% of patients of chronic renal failure. In clinical response of BUN exhibited 75% of patients improved where as in case of fatigue [70%], edema [90%], leg pain [76%] improved these types of conditions with significant p value

Acute lower respiratory tract infection; therapeutic role of zinc in patients

ABSTRACT: Zinc is an essential rnicronutrient with catalytic role in over a hundred specific metabolic enzymes in human metabolism regulates the expression of the metallothionein gene, apoptosis and synaptic signaling and needed for many aspects of immune system. Thus the zinc 'supplementation in patients with acute lower respiratory tract infections might have potential benefits

Objectives: To evaluate the efficacy of zinc supplementation in patients with acute lower respiratory tract infections. Study design: Quasi experimental study. Setting: Study was conducted in the pediatrics department Independent hospital Faisalabad; the indoor patients meeting the inclusion criteria from 26[th] January to 25[th] July 2013 were included in study

Material and methods: 100 children meeting the inclusion criteria were included in the study which were divided into two groups with random allocation i.e. Group A [Odd number] and Group B [Even number]. Group A was given zinc supplementation 20mg of elemental zinc for 14 days. Along with antimicrobials, oxygen and antipyretics for fever while 50 children in Group B were given with antimicrobials. Oxygen and antipyretics for fever without zinc

Results: Baseline clinical parameters were comparable in both groups at admission. Outcome measures considered were duration of fever, tachypneoa, chest indrawings and total duration of hospital admission. Effect of zinc supplementation is significant with p-value of less than 0.05 for duration of tachypnoea and chest indrawings and total duration of hospital admission while result showed p-value equal to 0.05 that is just significant for duration of fever

Phototherapy; frequency of hypocalcemia in neonates undergoing in Tertiary Care Hospital in Faisalabad

Hyperbilirubinemia is the most common abnormal physical finding in first few weeks of lif and its most common management is phototherapy. Amongst other common complications a less known complication of phototherapy is hypocalcemia

Objectives: to study the incidence of phototherapy induced hypocalcemia in neonates and to have a comparison between preterm and term neonates

Study design: descriptive cross-sectional study

Setting: paediatric Unit II DHQ Hospital Faisalabad, which is a tertiary care centre for all kind of patients

Duration of study with dates: six months from 1-11-2012 to 30-04-2013

Methods: 196 neonates with hyperbilirubinemia full term / preterm neonates admitted in pediatric DHQ hospital faislabad were selected. Inclusion criteria. 1] Hyperbilirubinemia. 2] No hypocalcemia on admission. 3] Received phototherapy for hyperbilirubinemia. Serum Calcium levels were measured in all neonates before and 48 hours after receiving phototherapy. Incidence of hypocalcemia among all neonates was calculated as an absolute percentage and the sample population was also divided into preterm / full term neonates to evaluate the incidence of hypocalcemia in these two groups individually

RESULTS: mean serum calcium in neonates was 7.5+- 1.5 mg / dl .16.84% of neonates were found to have calcium level below the cut off value. 33 out of 196 developed hypocalcemia after phototherapy and out of these 54% were preterm and 45% were term neonates < P-value [0.01]>

Conclusion: phototherapy induces hypocalcemia in neonates more so in preterm neonates

Impact: consideration for additional calcium supplementation should be undertaken in all neonates undergoing phototherapy and further randomized trials need to be done with these concerns

Chronic renal failure in children; etiology and clinical presentation

Chronic renal failure is defined as progressive and irreversible loss of renal functions that gradually progress to end-stage renal disease. The etiology of chronic renal failure in childhood correlates closely with the age of patient at the time when the renal failure is first detected. The aim was to assess the underlying causes and risk factors of chronic renal failure and to identify the clinical presentation of chronic renal failure in children reporting at Allied Hospital Faisalabad. It was a cross sectional study. The study was done in a period of one year starting from March 20th, 2007 to March 20, 2008. The study was done in the Department of Pediatrics medicine Allied Hospital Faisalabad. CRF was defined as glomerular filtration rate less than 25% of the normal for that age and sex. Patients of either sex ranging from 6 months to 15 years fulfilling the inclusion criteria were included in this study. Sampling technique was non-probability convenience sampling. In addition to clinical evaluation, they were investigated to find out the underline causes. Out of 40 patients of CRF males were [n-28], females were [n-12], with male to female ratio of 2.3:1. Mean age of males was 7.36+ 3.98 and females was 8.96+ 2.65. Etiological factors found in 34[85%] patients included congenital malformations [9-22.5%] urolithiasis [8-20%] reflux nephropathy [6-15%] glomerulopathies [3-7.5%] neurogenic bladder [2-5%] strictures [1-2.5%] and miscellaneous [5-20.5%] Etiology was unknown in 6 patients [15%]. Failure to thrive 77%, Respiratory distress 75%, Pallor 75%, Fever 75%, Headache 67%, Vomiting 63%, Edema 50%, and Anorexia 42% were the most common clinical features at presentation

Bronchiolitis; role of oral salbutamol administration for providing symptomatic relief in children

To determine the efficacy of oral salbutamol administration for symptomatic relief in children less than two years of age with acute mild bronchiolitis. Interventional study. Outpatient department of Department of Pediatrics, independent university hospital, Faisalabad, Pakistan, from October 2010 to March 2011. 160 children less than two years of age diagnosed clinically as acute mild bronchiolitis with comparable baseline parameters [age, weight, duration of present illness] were included in the study. They were randomly placed in two groups, Salbutamol Group [SG] [n=80] Placebo Group [PG] [n =80] and were followed daily for first 3 days, then on day 5 and day 7 in outpatient department. Oral salbutamol was administered [0.1 mg/kg/dose] three times daily for 7 days or till complete resolution of illness, whichever came earlier. Time for resolution of illness [ROI] was primary outcome variable whereas time for resolution of cough, coryza, breathlessness, wheeze, achievement of normal feeding and sleep patterns and salbutamol adverse effects were secondary outcome variables. Mean duration of resolution of illness [ROI] was similar in both groups. [6.1 +/- 0.75] days in the salbutamol group and [6.0 +/- 0.80] days in placebo group [p=0.53]. There was no significant resolution time difference of secondary outcome variables between the two study groups. Cough [SG 4.1[0.70, PG 4.1]0.68, P=0.68] Coryza [SG 4.3[ 0.59, PG 4.2] 0.62, P=0.14] Wheeze and Breathlessness [SG 3.8[0.60, PG 3.8]0.63, p=0.24] Sleep [SG 4.5[0.40, PG 4.4]0.55, p=0.19] Feeding [SG 4.3[0.59, PG 4.2]0.62, P= 0.14]. Salbutamol adverse effects [tremors, irritability] were observed in 13 [16.25%] children in salbutamol group. Oral salbutamol administration is not superior to placebo in providing symptomatic relief in children with acute mild bronchiolitis

Acute bronchiolitis in children; epidemiologic and clinical features

To study the epidemiological and clinical features of acute bronchiolitis in children < 2 years of age with mild to moderate acute bronchiolitis. Outpatient department of Department of Pediatrics, independent university hospital, Faisalabad, Pakistan, from October 2010 to March 2011. 200 children diagnosed clinically with mild or moderate acute bronchiolitis were included in the study using convenient sampling technique. Epidemiologic variables of interest included age, gestational age at birth, sex, weight, breastfed or not, parental or caregiver tobacco smoking and socioeconomic status. Clinical variables of interest included cough, fever, breathlessness, wheeze, Rhonchi, feeding and sleep pattern and severity of disease. Predominant age group was between 2 to 12 months [76.5%] with mean age of 7.6 +/- 4.7. 95.5% of children were full term at birth. Male predominance with male to female ratio of 1.4:1 was noted. Mean weight was 7.2 +/- 1.8 kg. Predominantly mixed feeding pattern [45%] was observed. Most of the parents/caregivers [70%] were nonsmokers. Majority of children [81.5%] belonged to families with poor socioeconomic status. Results of clinical variables revealed Cough [100%], breathlessness [69.5%], audible wheeze [59.5%] and rhonchi on chest auscultation [100%], disturbed sleep [80%] and decreased oral feeding [78%]. Majority of children [79.5%] were afebrile. Mild acute bronchiolitis [73.5%] was predominant as compared to moderate acute bronchiolitis [26.5%]. Acute bronchiolitis is more prevalent in children <1 year of age with male predominance and in children from families with poor socioeconomic status. Mild form of acute bronchiolitis is more common. A relative lack of fever along with cough, breathlessness, wheeze and/or rhonchi are major presenting clinical features of acute bronchiolitis

Dental carries frequency in children of age 6 to 12 in different communities of Faisalabad

Dental disease is prevalent among young children, particularly those from lower socioeconomic populations; however few preschool-aged children ever visit a dentist. Dental caries is a common childhood disease. To observe the frequency of dental caries particularly focusing on effects of regular brushing habits with fluoride tooth paste on dental caries in children of different communities of Faisalabad. Cross sectional study. Setting Four communities of Faisalabad located at: Punjab Medical College Colony, Youngwala, Agricultural University Colony, People Colony No.2. Six months from 01 -07-2009 to 31-12-2009. Total 379 patients were included in this study. Dental caries status was recorded after complete intraoral examination of selected children. Sample of drinking water was taken from each patient and fluoride level was measured in Laboratory. Mean age of the children was observed 8.8 +/- 1.8 years. When socioeconomic status of studied population was considered majority i.e. 150 children [39.6%] was from higher socioeconomic class, 139 children [36.7%] were from middle class and 90 children [23.7%] from lower socioeconomic class. As for as sources of drinking water is concerned 132 children [34.9%] using ground water, 113 children [29.8%] canal water, 83 children [21.9%] filtered water and 51 children [13.4%] mineral water and level of fluoride in drinking water, [sources ground water, canal, filter water and mineral water is < 0.7 PPM which is suboptimal for caries protection]. Regular brushing with fluoride containing tooth paste were very effective in preventing dental caries. Dental health services should focus primarily on the prevention of dental caries

Down's syndrome; congenital heart disease in children, an experience in Faisalabad Pakistan

To evaluate the various types of congenital heart defects and to determine their frequency in children with Down's syndrome. Descriptive study. Department of Pediatrics, Independent University Hospital Faisal Abad Pakistan, from January 2010 to December 2012. 93 children between the ages of day 1 to 12 years, diagnosed clinically as Down's syndrome based on its characteristic phenotypic appearance, were included in the study. A detailed history, physical examination and evaluation of cardiovascular status [including Chest x-ray, Electrocardiogram and Echocardiography] were performed in each Down's syndrome case. Variables of interest included age, sex, maternal age at birth and type and frequency of congenital heart disease. Congenital heart disease was present in 48 [51.62%] children out of 93 children with Down's syndrome. Congenital cardiac defects in order of predominant type and their frequency included Ventricular septal defect [29, 60.4%], Atrioventricular septal defect [14, 29.1%], Atrial septal defect [2, 4.1%], Patent ductus arteriosis [2, 4.1%] and Tetralogy of Fallots [1, 2%]. 68 [73.2%] Down's syndrome children [n=93] presented during their first year of life with mean age of 7 +/- 4 months. Male predominance was observed in both with and without congenital heart disease Down's syndrome children [male: female 1.7:1 and 2.5:1 respectively]. Mean maternal age at birth was 27 +/- 2 years. Congenital heart disease [CHD] is frequently associated with Down's syndrome [DS]. Ventricular septal defects and atrioventricular septal defects are the most common forms of CHDs in DS children of our region. Their earlier presentation [in infancy] and significant contribution to the morbidity and mortality of DS children warrants early diagnosis of DS and mandatory screening of all DS children for associated CHDs

Gated MIBI myocardial spect showing balanced ischemia and global hypokinesia in patient having thrombus in basal segment of dominant circumflex system blocking both left anterior descending and circumflex artery

Myocardial perfusion imaging [MPI] is a powerful diagnostic and prognostic tool for evaluating coronary artery disease [CAD]. Gating myocardial perfusion gives important diagnostic and prognostic information. This 43 years old patient was referred for cardiac scan. Exercise stress test showed > 2mm horizontal ST segment depression. Cardiac scan was normal except for left ventricular cavity dilatation on stress images. Gated images showed global hypokinesia and increased end-diastolic volume. Patient was suspected to have balanced ischemia and was referred for Angiography. Angiography showed total occlusion with no flow in proximal Left Anterior Descending Artery and distal circumflex artery. It is very important to evaluate symptomatic patients and patients with risk factors carefully with normal myocardial perfusion scan

Dual phase MIBI scintigraphy in diagnosis of parathyroid adenoma followed by ultrasound guided percutaneous alcoholic ablation

Primary Hyperparathyroidism [HPT] is an inappropriate hyper secretion of parathyroid hormone [PTH]. Primary HPT is caused by parathyroid adenoma in 80-85% of patients. Clinical manifestations are kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. Ultrasonography is widely used in suspected cases for localization of parathyroid adenoma. There is considerable intra-observer variation and it is difficult for ultrasound alone to differentiate parathyroid lesion form that of thyroid. Dual phase Tc-99m MIBI scinitigraphy for detection of parathyroid adenomas has sensitivity and specificity values ranging from 82% to 100% and from 89% to 100%, respectively. Percutaneous ethanol injection for parathyroid glands can be applied effectively in selected cases when surgery is unadvisable either for technical reasons e.g., recurrence of hyperplastic glands in the neck after subtotal surgery or intrathyroideal parathyroid tumors or the poor clinical state of the patient

Bone stress injuries in the army cadets of Pakistan Military Academy

Bone stress injuries are common among army cadets during training period and these injuries give rise to morbidity and loss of training hours. Some cadets with stress fractures re-join their duties while some are kept out of services resulting in attrition and economic loss. A retrospective analysis of bone stress injuries of one hundred and twenty cadets between June 2006 and Dec 2007 was conducted from the case documents available at Institute of Nuclear Medicine, Oncology and Radiotherapy [INOR] Abbottabad. The occurrence of stress fractures among cadets at Pakistan Military Academy, presenting with exercise induced pain was 68.3% amongst these cadets. Seventy fours percent f the fractures were labelled grade-I. High grade fractures were confined to tibia. Tibia was the commonest site of stress fractures in both sexes, accounting for about 73% of all stress fractures. Fifty percent of these patients were labelled as having shin splints and 3% as thigh splints. Most of the stress injuries were confined to the tibia. The referral was considered early as most of the stress injuries were of low grade

Parathyroid carcinoma

Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism and these tumors are usually hyper-functioning as compared to other malignant endocrine tumors. Surgery is the only effective primary treatment. We report a patient, who presented with pathological fracture of femur, hypercalcemia, bilateral renal stones, markedly raised Parathormone levels and palpable mass in the neck. Parathyroid adenoma was initially diagnosed and localized at left lower gland by Sestamibi scan and ultrasonography. She underwent surgery and enlarged parathyroid gland was removed. Intra operatively there was no evidence of local invasion or lymph nodes involvement but biopsy report suggested malignancy