Clinical characteristics and prognostic analysis of triple-negative breast cancer: single institute experience

Background: Triple-negative breast cancer [TNBC] is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy

Materials and Methods: A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival

Results: In our study, patients were young [median age at presentation, 47 yrs], premenopausal [54%], tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma [90%], histological grade higher than two [90%]. Relapses were early and preferential visceral [32%] and CNS metastasises [11.7%]. 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens [43%], sequential anthracycline and taxane-based regimen [24%] and other regimes like CMF [13%] were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up

Conclusions: Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed

Tobacco chewing and risk of gastric cancer: a case–control study in Yemen

This study aimed to assess the risk factors for gastric cancer in Yemen. A hospital-based case-control study of 70 cases and 140 controls was carried out in Sana'a city between May and October 2014. A structured questionnaire was used to collect information through direct interview. Living in rural areas, tobacco chewing and drinking untreated water were significant risk factors for gastric cancer. Frequent consumption of chicken, cheese, milk, starchy vegetables, cucumber, carrots, leeks, sweet pepper, fruit drinks, legumes and olive oil were associated significantly with decreased risk of gastric cancer. Multiple logistic regression analysis showed that chewing tobacco and frequent consumption of white bread were associated with increased risk of gastric cancer, whereas frequent consumption of chicken, cooked potatoes and fruit drinks had an inverse association. Risk of gastric cancer can be prevented by health education and increasing community awareness

Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale [MMAS-8©] as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency [alpha = 0.70] and moderate split-half reliability [r = 0.65]. Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size [phic = 0.34]. The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries

Platinum-based chemotherapy in metastatic triple negative breast cancer: experience of a tertiary referral centre in India

Experimental data suggest that triple-negative breast cancer [TNBC] may have increased sensitivity to platinum-based chemotherapy but there is lack of relevant clinical data. Clinical outcomes in patients with metastatic TNBC treated with Platinum-based chemotherapy were evaluated in this prospective study. 21 selected patients with metastatic TNBC presenting at GCRI during the study period from 1[st] August 2009 to 31[st] October 2011 formed the study group with median follow up period of 10 months. They were given palliative chemotherapy based upon prior adjuvant chemotherapy along with an additional platinum compound. Response rates, response duration and toxicities of platinum-based chemotherapy were recorded and analyzed. In evaluable TNBC patients, overall response rate and complete clinical response were 72% and 38% with median response duration of four months. Response could not be assessed in three patients due to patient refusal for evaluation, lost to follow up and toxicities. In three TNBC patients after completion of platinum based chemotherapy have early isolated CNS relapse with systemic disease in remission. Haematological adverse effects were febrile neutropenia in 19% of patients, and grade 3-4 neutropenia [9%] thrombocytopenia and anaemia [7%]. The main non-hematological adverse effects reported in the present study were peripheral neuropathy [14%] and severe emesis [9%]. The most common Platinum-based chemotherapy combination was carboplatin and paclitaxel in 11 patients [52%] of evaluable patients. Patients who received this regime have complete response rate, overall response rate and toxicity was 45%, 65% and 10%. TNBC patients with platinum-based chemotherapy have better overall response rates, higher complete clinical response rates, prolonged response duration and acceptable safety profile. The results of the present study need to be confirmed with a larger randomized study with a longer follow up

Liver transplantation in patients with portal vein thrombosis: comparing pre-MELD and MELD era

Portal vein thrombosis [PVT] used to be a relative contraindication for liver transplantation [LT]. This obstacle has been dealt with following the improvement of LT-related techniques. To compare the outcome of adult patients with PVT who underwent LT before and after adopting MELD. We retrospectively searched our database for deceased donor LT recipients who had PVT, were operated between 1990 and 2009, and were 18 years old or more. The outcome of patients operated in pre-MELD era [1990-2001] was then compared with that of those operated in MELD era [2002-2009]. The incidence of patients undergoing LT with PVT has increased from 1.2% [491/40,730] in pre-MELD era to 6% [2540/42,601] in MELD era [p<0.01]. Patients with PVT in MELD era were older [53.6 vs 50.5], had higher calculated MELD [21.3 vs 18.9], shorter length of hospital stay after LT [25 vs 21.7 days], more likely to develop HCC [14.8% vs 0], and more likely to receive DCD allograft [3.9% vs 0.8%]. Donor risk indices were comparable in both groups [1.9 vs 1.9]. The median waiting time before transplantation decreased during MELD era [71 vs 99 days]. Allograft and patients survival was comparable between the two eras. However, allograft and patients survival rates were lower in patients with PVT compared to those without. In Cox regression analysis, PVT was associated with worse allograft [HR=1.3, 95% CI: 1.2-1.4, p<0.001] and patient survival [HR=1.3, 95% CI: 1.2-1.5, p<0.001] compared to non-PVT patients. The incidence of patients with PVT has increased in MELD era without improvement in outcomes. Donor and recipients characteristics changed in MELD era. PVT is still associated with poor outcomes compared to patients without PVT

Acute kidney injury after cardiac surgery in eastern Saudi Arabia

Acute kidney injury is a serious complication after cardiac surgery. This study was conducted to determine the frequency of acute kidney injury and the associated risk factors following cardiac surgery at Dhahran health centre in eastern Saudi Arabia. All patients who underwent cardiac surgery between June 2005 and December 2008 were included. Of 293 patients who fulfilled the criteria and were included in the final analysis, 85 [29.0%] developed acute kidney injury. Using multivariate analysis, the factors significantly associated with acute kidney injury were age, diabetes, preoperative chronic kidney disease and emergent surgery. Mortality associated with acute kidney injury was 10.5% overall and 42.9% when dialysis was required. Acute kidney injury following cardiac surgery is a serious problem among patients in eastern Saudi Arabia. Measures to prevent this complication are essential

Frequency of class II type carious lesions in first permanent molars and their association with pulp

The objective of the present study was to determine the frequency of class II type carious lesions in first permanent molars and its possible association with the pulp when examined clinically and radiographically. Two hundred and forty two subjects were examined in the Dept. of Operative Dentistry, Khyber College of Dentistry, Peshawar for the presence of Class II type carious lesions in the period of two months. This study showed that 62% subjects had a Class II type carious lesion. In the maxilla, unilateral call II carious lesions were 19% and bilateral 2.5%, while in the mandible, unilateral 36.4% and bilateral 4.1% respectively. The occurrence of class II carious lesion was more in females and in mandibular molars. Regarding pulp exposure, a significant relationship was present between clinical and radiographic examination

Position of canine in the maxillary and mandibular arches

To determine the position of canine in the maxillary and mandibular arches. Cross-sectional analytical Setting: Orthodontic department, Karachi Medical and Dental College. The study was completed in 6 months. 200 patients were included in our study out of which females were138. The subjects were selected on non-probable, purposive technique. Inclusion criteria was patients not orthodontically treated previously, having symmetric arches of either sex between 14years and 25years having adult dentition. Patients exhibiting incisal or cuspal attrition, fractures of teeth or ectopically erupted teeth, having mixed dentition, with anomalies of tooth size e.g. micro dontia, macrodontia, peg laterals etc. were excluded. Patients with anomalies of tooth number e.g. hyperdontia, hypodontia were also not included in this study. Position of canine in the arch were determined on the scanned image of the occlusal surface of the patients casts. For both maxillary and mandibular arches, with-in the arch group showed significant values. In our study, the second most frequent position of canine in the maxillary arch was labial [15% of the total sample]. In the mandibular arch the second most position of canine was also labial. [30% of the total sample]. In the maxillary arch, 85% of the casts showed canine with-in the arch [P< .001]. In the mandibular arch, 65% of the casts showed canine with-in the arch [P< .001]. In our study we found the canine with-in the arch in significant number in both maxilla and mandible

Sagittal discrepancy in centric Relation and centric occlusion positions in pretreatment orthodontic patients

To compare the centric relation [CR] - centric occlusion [CO] discrepancy in sagittal [antero-posterior] plane as determined by the differences in overjet. Design: Comparative; cross sectional study. Place and Duration: Orthodontic outpatient department, Karachi Medical and Dental College. The study period was 18 months. Subject And Eighty patients were divided into 3 groups according to Angle's classification. Leaf gauges were employed for muscle deprogramming. Bimanual manipulation technique was used to guide the mandible in centric relation. Softened red modeling wax was used to obtain the centric bite registration. The study caste were trimmed in centric relation using bite registration. Overjet was recorded in centric relation and centric occlusion by dial caliper on castes. A statistically p-value

Surgery for pleuropulmonary tuberculosis

The purpose of our study was to analyze current indications for surgery in pleuropulmonary tuberculosis [TB]. We present our experience with TB patients presenting with indications for surgery between 1998 and 2003. Material and The indications for surgical intervention included 220 cases of empyema, mediastinal lymphadenopathy 48 cases, hemoptysis 25 cases, destroyed lung 24 cases, undiagnosed pleural effusion 24 cases, bronchiectasis 18 cases, cavitary lesion with MDRTB 13 cases and pulmonary aspergilloma 10 cases. Thirteen patients with multidrug-resistant tuberculosis required surgical intervention, although 26 were treated with second line drugs during this period. The techniques utilized included decortication in 152 cases, lobectomy in 62 cases, rib resection for pleural drainage in 50 cases, anterior mediastinotomy in 48 cases, pneumonectomy in 28 cases, open pleural biopsy in 24 cases, and thoracoplasty in 18 cases. In 12 patients [3.1%], two procedures were performed, and in one case, 3 procedures. In 65 cases [17%] there were complications, of which persistent air leakage after decortication and pulmonary resection was the most frequent [n=26]. There was a mortality rate of 2.8% [11 cases]. Conclusions: In our experience, surgery in the treatment of TB is indicated to resolve sequalae or complications, since cases of simple or multidrug-resistant TB can be managed pharmacologically. The morbidity and mortality rates in our series were acceptable

Prevalence of pulmonary tuberculosis in Karachi juvenile jail, Pakistan

Jail inmates may be at increased risk of contracting tuberculosis [TB]. We studied 386 detainees [mean age 17.7 years] in Karachi juvenile jail to determine the prevalence of TB and possible risk factors for contracting TB. We found a 3.9% prevalence of TB among the inmates, significantly higher than the estimated 1.1% prevalence in the general population of Pakistan. Positive family history of TB was a significant risk factor for TB. Poor adherence of previously diagnosed patients to anti-TB treatment was found. Our study highlights the vulnerability of inmates to TB owing to the presence of highly infectious cases, along with environmental conditions such as overcrowding and poor ventilation. This study strongly indicates the need for an effective treatment programme in the jails as well in the general community

Parotid tumours: PIMS experience

Retrospective analysis of eighteen patients presenting with a lump in the parotid region is carried out. Surgery was performed in all cases. Clinically all of them were suspected to have bnign tumour. Superficial parotidectomy with facial nerve exploration and preservation was the procedure of choice and carried out in 13 patients [72%], while pleomorphic adenoma was the commonest tumour [72%]. Results are documented and survey of recent medical literature is presented regarding rationale of various types of surgical procedures for a parotid tumour

Tooth pastes and TV advertisements: a scientific analysis

Few months ago, Ministry of Health, Government of Pakistan sought our opinion concerning the claims made in the T.V. advertisements by various tooth paste manufacturing firms. This gave us the idea of making a scientific study of the problem and we entrusted the task to Dr Qazy Javed Akhtar B.D.S [Peshawar] now working as a lecturer in the Department of pharmacology of the Khyber medical college, Peshawar. He has prepared this article under the guidance and with active help of professor S.A Wahid Shah, Head of the same Department. It is amazing that many dental surgeons know so little about the tooth pastes which they are supposed to recommend to their patients. Readers opinion on this topic will be most welcome