Pathologic complete response in HER2-positive breast cancer patients receiving trastuzumab in neoadjuvant setting

Objective: To compare the pathological complete response in human epidermal growth factor receptor type 2 [HER-2] positive breast cancer patients getting neoadjuvant chemotherapy with or without trastuzumab

Study Design: Retrospective randomised double-arm observational study

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2008 to 2016

Methodology: HER2-positive, lymph node positive, breast cancer patients receiving neoadjuvant chemotherapy [NACT] were retrospectively observed. Patients getting neoadjuvant trastuzumab, fulfilling the inclusion criteria were studied. The comparison group included randomly selected equal number of HER2-positive breast cancer patients having similar tumor characteristics, getting NACT only. Pathological complete response [pCR] was defined as no residual invasive or in situ residual tumor in breast tissue, or in the lymph nodes. One hundred and fifty-six patients were studied. Eighty-nine patients with HER2-positive disease received trastuzumab preoperatively. Sixty-four [n=64] patients received the complete standard dose of neoadjuvant trastuzumab along with chemotherapy. Almost equal number of patients [n=67] with HER2- positive disease were selected by random assortment for the reference group who did not receive trastuzumab before surgery

Results: The pathological complete response of study group was [n=32] 50%, which was 26.1% higher than the reference group [n=16] 23.9%; and this difference was statistically significant with a p-value of 0.002 [<0.05]. The overall pCR was 36.6% [n=48]

Conclusion: Addition of trastuzumab to neoadjuvant chemotherapy doubled the pCR in HER2-positive breast cancer. Targeted therapy should be offered to all eligible patients with HER2-overexpressing breast cancer

Urothelial carcinoma of urinary bladder; immunohistochemical demonstration of COX-2 in correlation with various grades

In spite of the fact that inflammation has been regarded as a localized or generalized defensive component of the body to different types harmful stimuli, there has been becoming confirmation of its strong part in initiation or progression of different ailments particularly related with cancer

Objectives: Aim of this study was to recognize the pattern of expression and level of intensity of COX-2 in different grades of papillary urothelial carcinoma of urinary bladder along with significance of COX 2 in tumerogenesis of urothelial carcinoma of urinary bladder

Period: 1.1.2009 to 31.12.2012

Methods: The marker of COX-2 was investigated by using Immuno- histochemistry

Results: COX 2 was not detected in normal urothelium, but its intensity was expressed as 68% in low grade, 72% in high grade and 80% in invasive urothelial carcinoma

Conclusion: Results of the present study indicate that COX-2 as a component of inflammation play an important role in progression of urinary bladder tumor and encourage use of COX 2 inhibitors as potential antitumor agent

Essential hypertensive patients; comparison of anti-hypertensive effect of candesartan cilexetil and amlodipine

Objective: To compare blood pressure lowering effects of angiotensin II type I receptor blocker candesartan cilexetil in comparison with calcium channel blocker amlodipine in essential hypertensive patients

Study design: Randomized, open-labeled, prospective comparative study

Place and duration: The study was carried out in the department of pharmacology and therapeutics, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi from July 2007 to January 2008

Subjects and methods: In this study [80] newly diagnosed essential hypertensive patients were enrolled and divided into two groups [DR1] and [DR2] respectively. DR1 patients received candesartan 16mg once a day and DR2 patients received Amlodipine 10mg once a day for 3 months duration

Results: The mean systolic blood pressure of DRI was 162.23 on day 0 which decreased to 141.05 on day 90, versus DR2 which decreased from 160.12 on day 0 to 140 on day 90. The mean diastolic blood pressure decreased significantly for DR 1 group from 99.87 mmHg to 87 to 89. mmHg, versus DR2 which decreased from 98.5 to 86.25. All values of blood pressure have been taken in mmHg. The results of this study were observed statistically significant

Conclusions: Candesartan cilexetil is a newer and safer alternative for the treatment of essential hypertensive patients in comparison to conventional antihypertensive treatment

Assessment of health services on relevant primary health care principles in internally displaced people of Pakistan

SPHERE based assessment of internally displaced persons camp was done to assess health services on relevant primary health care principles using a cross-sectional survey in Jalozai Camp, Pakistan. Most of the households [74%, n=87] had access to health education addressing issues to protect and promote their health which was provided at household level [83%, n=72], community level [44%, n=38] and health centre level [13%, n=11]. All the health facilities were culturally and socially acceptable in terms of language, separate waiting rooms, presence of female health providers and language translators. A referral system was in place which provided free transport in [67%, n=2] health facilities to tertiary care hospitals. Health services provided were culturally and socially acceptable and efforts on health education were also appreciable, except that no health education or intervention was done on HIV AIDS. Referral should be made to referral facilities within the districts instead of directly to tertiary care hospitals

Prevalence of cardiovascular diseases and essential hypertension in the desert area of Thar

Globally essential hypertension and cardiovascular diseases are associated with high morbidity and mortality due to unhealthy life styles and lack of preventative measures. In some ethnicities these factors are insignificant due to genetic makeup favoring protection against these diseases. To study the prevalence of risk factors for essential hypertension in the Pakistani population of a desert area of Thar. A random cross sectional study was done from 2002 to 2008 on 276 subjects [126 males, 150 females] in Islamkot-Thar, the desert area of Sindh. Data for anthropometric, demographic, socioeconomic, dietary pattern, basal metabolic index, body fat content, antihypertensive use and psychosocial factors were recorded. Three consecutive readings for blood pressure were taken in 15 minutes. Any systolic blood pressure of over 140mm Hg and diastolic of over 90mm Hg in all 3 readings was taken as hypertension. Study population was divided in hypertensives [patients] and non hypertensives [controls]. Data were analyzed in two steps clinically, descriptively and inferentially using SPSS version 14, first for entire population and second by breaking this population into two sub ethnicities having no consanguinity in them. Hypertension was seen in [10.9%] cases while 88.4% were normotensive. Hypertensive group showed increased association of risk factors e.g. male gender, old age, marriage, moderately high monthly income, lack of exercise, low leisure time activity, prolonged tobacco exposure, parental history, high basal metabolic index profile, intermediate body fat content and stressful job. However, this group showed lack of association of factors like alcohol, extra salt, scarce education and stress. Decrease association with saturated fat was seen as compared to oil [20.7% versus 79.3%]. Subethnicity analysis of the two communities, both having no consanguinity showed one group to be suffering from essential hypertension [17%] and its comorbids like diabetes mellitus [11.4%], asthma [6.5%] and stroke [0.6%] while the other group lacked all these findings. Despite similar coexisting conditions different genetic makeups predispose one subethnicity to normal and the other to hypertensive phenotype. Molecular studies on this population are needed to reconfirm the present clinical conclusion

Frequency of abnormal waist circumference and associated risk factors in healthy adults

To find out the frequency of central obesity and risk factors for obesity based on waist circumference [WC] in healthy volunteers. This descriptive cross-sectional study in terms of data collection and analysis was conducted at Hayatabad Medical Complex [HMC] and Welfare Clinics in Peshawar City, from November 2005 till April 2006 [6 months]. A convenient sample of 1031 healthy volunteers accompanying their patient to Out Patient Department [OPD], Ward at HMC and at welfare clinics in the city were included in the study. A structured interview questionnaire was administered to all participants and their anthropometric measurements taken in standardized way. Out of 1031 individuals [778 males, 253 females] with mean age of 35.75 +/- 13.45 years, the frequency of high waist circumference was 57%, significantly higher in females [89%] compared to males [47%]. It increased with age peaking at 49-58 year age group and declining thereafter. Married subjects [67%], illiterates [69%], housewives [96%], car-owners [61%] and hypertensive subjects had significantly higher frequencies of increased waist circumference. Ethnicity [p=0.45], smoking [p=0.36] and awareness of risks [p=0.91] did not show significant association with frequency of increased waist. There is a very high frequency of increased waist circumference particularly among females. There is progressive increase in waist with increasing age with a decline later in life. There is positive association of increased waist with occupation, educational status, use of cars and married marital status. There is no association of high waist with smoking, awareness or ethnicity

Tracheal injury due to blunt chest trauma: a rare surgical emergency

Tracheal injury is a rare complication of blunt chest trauma. The patients usually present with signs of respiratory distress. Primary repair is the treatment of choice in case of large defects, while small tears can be managed conservatively. Immediate operation is recommended to improve deteriorating pulmonary function. The decrease in mortality and long-term morbidity depends on early diagnosis. We report a case of tracheal injury due to non-penetrating thoracic trauma which was successfully managed with surgery