Cancer esophagus Karachi 1995-2002: epidemiology, risk factors and trends

To study the trends of cancer esophagus in Karachi South during 1995-2002 and identify risk factors. Incident esophageal cancer cases recorded at the Karachi Cancer Registry for Karachi South, during 1st January 1995 to 31st December 2003 were reviewed. For maximum completion of data, incident cases registered from 1st January 1995 to 31st December 2002 were included for final analyses. The Age Standardized Incidence Rates [ASIRs] of cancer esophagus in Karachi South for males were 6.5/100,000 [1995-1997] and 6.4/100,000 [1998-2002]. In females the observed rates were 7.0/100,000 [1995-1997] and 8.6/100,000 [1998-2002]. In the moderately high incidence, cancer esophagus zone of Karachi, the ASIRs in males remained stable during the last decade, but in females, an upward trend was observed suggesting a progressively higher exposure to risk factors in the latter. The potential risk factors in Karachi are use of all forms of tobacco, areca nut, infrequent consumption of raw fruits and vegetables and diet deficiencies. There is a necessity to actively control the proven risk factors and address the existence of other risk factors. The primary recommended strategy for the control of cancer esophagus would therefore be legislation against tobacco and areca nut in Pakistan and public health education. The risk factors of cancer esophagus identified in this article need to be further confirmed

Breast diseases: a histopathological analysis of 3279 cases at a tertiary care center in Pakistan

To know the frequency of breast diseases in Pakistani females. A retrospective analysis of 3279 breast specimens received over a period of 4 years [1993-1996] at the department of pathology, the Aga Khan University Hospital. Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or >2 cms. in 93% of cases and 40% of them showed 3 or >3 positive lymph nodes. Grade I tumours were 11.38%, grade II 59.17% and grade III tumours 29.47%. Correlation of grade with lymph node metastases [3 or >3+ve nodes] showed 15 cases [1.53%] of grade I, 178 cases [18.25%] of grade II and 68[6.97%] cases of grade III tumours. This study shows that in Pakistani females, the most commonly encountered lesion in carcinoma of the breast followed by the benign lesions such as fibro adenoma, fibrocystic disease and others. Breast carcinoma occurs at a younger age group with predominance of high-grade lesions and with frequent lymph node metastasis

Management of children with acute respiratory infections [ARI] by general practitioners in Multan - an observational study

A knowledge, attitude and practices [K.A.P.] survey was conducted among doctors working as general practitioners [GP] in Multan, for diagnosis and management of acute respiratory infections [ARI] in children under five years of age. GPs in Multan were not familiar with national ARI control programme and rational drug use guidelines. They rarely asked about symptoms describing severity of disease while taking patient histories and did not look for signs of severe pneumonia during physical examinations. Most patients diagnosed as URTI [upper respiratory tract infection] received oral antibiotics and those with pneumonia received injectable antibiotics. Other drugs prescribed included cough syrups, antihistamines and antipyretics. The average number of drugs prescribed per patient was 3.4. The doctors were deficient in providing home care advice for sick children to the caretakers. Average time spent by doctors on each patient was two minutes and twenty-three seconds. A combination of biomedical and social factors help to perpetuate this irrational prescribing behaviour of the GPs. Continuing education programmes for doctors in general practice about ARI management in children and rational use of drugs and health education of the public may improve the current prescribing practices

Classification and immunophenotyping of acute leukemias: a prospective study

Over a period of 3-1/2 years, 86 cases of acute leukemia were analyzed by immunohistochemical [IHC] means on ficoll separated cytospin preparations of peripheral blood and/or bone marrow samples. Antibodies included in the panel were specific against Tdt, HLA-DR, CD19/CD20/CD22, CALLA [CD10], CD2, CD11C as well as against Ig heavy chains. Of 86 cases analyzed, 48 cases were of ALL, [25 of common pre-B ALL, 15 of pre-B/NULL and 8 of T ALL phenotype], twenty-four [24] out of 86 cases were of non-lymphoblastic [AML/AMML] type. In six cases, there was suggestion of a mixed lineage, while in 8 cases there was inconclusive diagnosis. Mean age was lower in common ALL sub-set of ALL as compared to pre-B/NULL group [i.e., 8 vs 12 years], while in non-lymphoblastic group it was 36 years. T cell phenotype was invariably seen in young adults, who usually presented with a mediastinal mass

Immunohistochemical estrogen receptor determination in human breast carcinoma: correlation with histologic differentiation and age of the patients

An immunohistochemical assay for the measurement of estrogen neceptor [ER] has been evaluated on 290 consecutive human breast biopsy and mastectomy specimens in the year 1992 at the Aga Khan University Hospital laboratories. Immunohistochemical localization of estrogen receptor on frozen/paraffin section was scored in a semi-quantitative fashion incorporating both the intensify and the distribution of specific staining. Histologic grading of the tumour was performed according to Bloom's method. In this study, 21% of the tumours were estrogen receptor negative, 15% were weak positive, 25% intermediate positive and 39% strong positive. Fifty percent of the well differentiated tumours showed strong ER positivity against 27% of the poorly differentiated tumours. Seventy eight percent of all negative estrogen receptors were in patients younger than 50 years of age [pre-menopausal group], while 52% of strong estrogen receptor positivity was observed in patients older than 50 years [post-menopausal]. This study demonstrated the value of immunohistochemical method to determine the ER status in patients with advanced breast cancer