The Prognosis of Patients with Pregnancy Associated Breast cancer: Retrospective Cohort Study.

Background: Pregnancy associated breast cancer (PABC), diagnosed during pregnancy or one year post-partum, is relatively rare disease and surrounded by controversies about its prognosis and outcome. Methods: This cohort study is a review of retrospectively collected data of patients diagnosed and treated as PABC from 1987 to 2012 at the Aga Khan University Hospital, Pakistan. We identified patients of PABC and compared with non PABC patients matched for age and stage accrued at 1:2 ratios. The outcomes i.e. Overall survival and Disease Free Survival (DFS) were analyzed with Kaplan Meir Curves and Cox Proportional Hazards regression adjusted for matching. Results: We identified 62 patients of PABC, who had more aggressive disease (higher grade and receptor negativity) with higher number of patients who underwent mastectomy. Median overall survival in PABC group was 2.4 years (range: 4 months-8 years) compared to 5.5 years (range: 1.7 years-14 years.) in non PABC group (p-value 0.001). Similarly, the cases with PABC showed inferior DFS (median 1.5yrs) as compared to non PABC (median 3.2 yrs) (p-value= 0.01).Conclusion: PABC has aggressive course with a poor survival as compared to non PABC cases.

Acute type a aortic dissection: a pathology under diagnosed

To compare the frequency of acute type A aortic dissection with chronic dissections, at two large cardiac surgery centers of the country. Acute type an aortic dissection: a pathology under diagnosed. This study was conducted at Rehman Medical Institute, Peshawar and National Institute of Cardiovascular diseases, Karachi, between January 2001 and January 2007. All patients with type A aortic dissection are studied retrospectively. Patients with aortic aneurysm, undergoing aortic root surgery, were not included in the study. Out of 13 patients who underwent aortic root surgery for various pathologies of the aorta, 9 cases had type A aortic dissection. Eight patients were diagnosed by trans-thoracic and trans-esophageal echocardiography and one patient was diagnosed on contrast enhanced computerized tomography [CT] scan. None of the patients had cardiac catheterization or MRI. Six of the nine dissections were chronic. One patient had Marfan Syndrome. Eight patients were hypertensive. One patient had aortic valve repair with supra coronary tube graft interposition for ascending aortic dissection; while eight patients had aortic root replacement with prosthetic composite grafts. There was one in-hospital death. Post operative echocardiogram of the patient with aortic valve repair, revealed mild aortic regurgitation. Seven of the eight surviving patients are in NYHA class I while one patient is in NYHA class two. Aortic root surgery can be safely performed with results comparable to the published data. Hypertension needs to be controlled to avoid its potentially lethal complications, like aortic dissection

Pharmacotherapy of opiate addiction in Unani medicine

Drug addiction has now become a serious worldwide socio-medical problem. The uses of drugs are more common in our society. Despite massive media campaigns designed to educate the public about the danger of drug addiction, the absolute number of opiate-addicts are increasing day by day. The solution of drug addiction in Unani medicine takes into account the religious, spiritual, moral and social factors, while the Western medicine did not recognize it as a holistic disorder. Therefore, the Western medicine has failed to see it as a coherent phenomenon and hence does not possess any specific and comprehensive pharmaco therapy. The present paper describes the pharmaco therapy of opiate addiction and literature survey on single and compound drugs of Unani medicine employed to cure opiate addiction