Androgen deprivation therapy and cardiovascular risk in patients with prostate cancer

Objective: The objective of this study was to investigate the effects of androgen deprivation therapy [ADT] on risk of subsequent cardiovascular morbidity in men with prostate cancer

Study Design: Quasi experimental study

Place and Duration of Study: Department of oncology Combined Military Hospital Rawalpindi, from Sep 2014 to May 2015

Patients and Methods: Thirty consecutive patients fulfilling inclusion criteria were enrolled. All patients were subjected to medical castration/ androgen deprivation therapy [ADT] with monthly 3.75 mg leuprorelin acetate intramuscular injection until castrate levels of testosterone [<50ng/dL] were achieved. We used Framingham's score for assessment of 10 years cardiovascular risk of individual patient before initiation and after completion of 6 months ADT. Serum lipid profile [fasting], systolic blood pressure, history of smoking, diabetes and antihypertensive medication were recorded. Proforma was designed to get clinical information. A p-value of <0.05 was considered significant. A paired-samples t-test was conducted to compare Framingham cardiovascular risk scores before initiation and after completion of 6 months ADT

Results: We enrolled 30 men with high/intermediate risk localized prostate cancer. Mean age was 63.47 +/- 7.32 years. All patients received 6 months ADT with monthly 3.75mg leuprorelin acetate intramuscular injection. There was a significant difference in Framingham cardiovascular risk scores before [mean +/- sd; 20.95 +/- 7.98] and after [mean +/- sd; 25.72 +/- 6.15] 6 months ADT; t [29] =-4.54, p<0.01, two-tailed. Hence ADT resulted in a significant increase [mean +/- sd; 25.7 +/- 6.15] in 10 years cardiovascular morbidity risk t [29] =-4.54, p<0.01, twotailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Lowdensity lipoprotein [LDL] levels after 6 months ADT [p<0.01, <0.01 and <0.01 respectively] however high density lipoprotein [HDL] remained un-changed [p=0.043] in comparison to pre-ADT values

Conclusion: Androgen deprivation therapy results in significantly increased risk of cardiovascular morbidity in patients with prostate cancer however this relationship between ADT and risk of cardiovascular morbidity may be confounded by unmeasured variables like obesity, atherosclerosis and body mass index [BMI] variations

Causes of male and female sub fertility in the couples who underwent 'In vitro fertilization' at life clinic

Objective:To explore the causes of male and female sub fertility in the couples undergoing 'In Vitro Fertilization' at LIFE clinic

Materials and Methods:In this retrospective, cross-sectional, observational study from Lahore, Pakistan all couples coming for evaluation and treatment for sub-fertility from 1st January to 30th April 2015 at Lahore institute of fertility and endocrinology LIFE with n=344 patients were included Fertility and Endocrinology [LIFE]. Sampling method was non probability consecutive.The data collection instrument was an especially designed Performa. Causes of Sub fertility male and female were studied and data was extracted from the files of LIFE

Results:Out of 344 patients 138[40.1%] had female factors, 122[35.5%] had male factor, 38[11.0%] had combined factors whereas 46[13.4%] had unexplained infertility. Out of 138, 55[39.85%] females had tubal factor, 2[1.45%] had endometriosis, 21[15.22%] had PCO and 60[43.47%] had unexplained causes of sub-fertility. Out of 122 males, 90 [74.4%] had oligospermia/asthenospermia and 32[25.6%] had azoospermia

Conclusion:Tubal factor was a major cause of sub-fertility in females whereas in 2/3 of the females, cause of sub-fertility was not explained.Among the males,oligospermia was the most common cause and was found in 74.4%. Health education about menstrual hygiene should be imparted early in life to prevent Sub-fertility due to infection. Premarital counseling and testing should be made easily available. Andrology should be made part of the Gynecology courses and curricula. Community based Sub-fertility research should be encouraged to assess the disease burden and frequency of preventable causes

Percutaneous image guided cutting needle biopsy of mediastinal masses: diagnostic yield and complications

To evaluate image guided cutting needle biopsy of mediastinal masses for diagnostic yield and complications. This was a descriptive study. Computed Tomography [CT] and ultrasound guided biopsies of mediastinal masses were performed in 30 patients. Tissue core obtained, were preserved in formalin and sent for histological examination. X-ray chest taken for evidence of pneumothorax and mediastinal widening. Hemoptysis, pneumothorax other complication were recorded. Definite histological diagnosis was obtained in all 30 patients. 70% [n=21] were malignant disease and 30% [n=9] were benign pathologies. Sensitivity and specificity, positive and negative predictive values were 100%. Pneumothorax occurred in 7% [n=2] cases. Hemoptysis occurred in 10% [n=3] cases. Chest intubation was not required in cases of pneumothorax. No hemodynamic instability occurred. There was no major complication. Image guided percutaneous transthoracic cutting needle biopsy in mediastinal masses is an accurate procedure for specific histological diagnosis and has a low complication rate

How aware are patients about hepatitis? A KAP [knowledge, attitude and practices] survey of pregnant women

Hepatitis B and C have become major public health problems worldwide. Estimates of prevalence of these diseases in Pakistan range from 5-15% . This places a huge financial burden on the available health resources. Currently available drugs for the treatment of hepatitis are very expensive and achieve eradication of the disease in around 50% of patients. The best strategy for controlling the menace of hepatitis and its complications lies in prevention. Any such plan should focus on public education. Considerable myths and misconceptions abound in the general public about hepatitis especially about the mode of spread and preventive measures

Aims and Objectives: the present study was undertaken to evaluate the knowledge, attitudes and practices regarding hepatitis in a group of pregnant females attending an ante natal clinic

Results: results of this study have demonstrated that the knowledge about hepatitis is not adequate. Almost half of the subjects believed that hepatitis B and C could spread through food and water. Forty percent of the respondents never insisted on sterilization of dental or barber instruments even when they knew that these were important sources of spread of hepatitis. 55% of the respondents were of the opinion that hepatitis B and C was an absolute contraindication to breast feeding. 77% knew that hepatitis B could be prevented by vaccination but only 67% were actually vaccinated. Almost 50% of the respondents believed that vaccination against hepatitis B also prevented hepatitis C. Hepatitis was considered a social stigma by 40% of the respondents

Conclusions: over all the results of this study suggest that more attention needs to be given to providing correct health education to the public. Misconceptions and myths about hepatitis can only be dispelled by adopting a rational health education strategy

Indications and complications of bronchoscopy: an experience of 100 cases in a tertiary care hospital

To enlist the frequency of indications and complications of flexible fibreoptic bronchoscopy in a tertiary care hospital. A total of 100 patients admitted to Chest and medical units of Lady Reading hospital Peshawar who needed bronchoscopy were selected irrespective of their age, sex, occupation. All patients in whom bronchoscopy was indicated were included in the study. After detailed clinical history with thorough physical examination and relevant investigations, Bronchoscopy was performed with Olympus fibreoptic bronchoscope. Relevant data were recorded for analysis. Out of 100 patients, 64 [64%] were male, and 36 [36%] were female. Majority of patients [55%] were above 50 years of age. In 60% patients, there was radiographic abnormality on chest X-ray and C.T scan. In 25 [25%], the indication was unexplained hemoptysis and 2 [2%] patients had hoarseness. Another 13 [13%] patients were bronchos coped to see Acid Fast Bacilli in bronchial wash. These patients were suspected to have Tuberculosis but sputum smears were reported negative on repeated examinations. Complications which occurred in these patients included Pneumothorax [1%], hemorrhage [1%], hypoxemia [4%], Atrial tachycardia [3%], bronchospasm [2%], and post-bronchoscopy fever [2%]. These complications were managed accordingly and all patients recovered without any serious consequences. Most of the indications for Bronchoscopy in this hospital are diagnostic rather than therapeutic. Most common indications include radiographic abnormalities, hemoptysis, hoarseness and for isolation of ABF

Survey of chest specialists and trainees knowledge and practice of TB guidelines

To investigate the fundamental knowledge of TB guidelines and their application in day to day practice by the chest specialists and trainees working in teaching hospitals. A questionnaire-based survey was conducted among the participants of 5th biennial chest conference. The data of 195 doctors was analyzed. 96% of doctors said they were treating their TB patients according to guidelines and categorize their patients for treatment, but only 54% knew the correct number of categories for treatment as recommended by the guidelines. Only 49% knew about the components of DOTS. 85% doctors considered sputum microscopy most important diagnostic test for TB and 61% would use it for monitoring of their patients. 88% would advise sputum AFB culture and sensitivity in suspected cases of suspected drug resistance, 59% doctors would treat MDR TB patients themselves and 33% would refer to specialized centers. 5 declared them incurable. 47% and 30% doctors respectively recommended changes in WHO recommended fixed drug combination FDC during pregnancy and lactation. 58% doctors recommended chemoprophylaxis for tuberculosis in our setting. Overall fundamental knowledge of consultants regarding management of TB was good. Knowledge about DOTS and TB guidelines among all the doctors was average and needs improvement. Management of MDR TB by trainees is alarming in the absence of adequate knowledge and experience

Survey of awareness and management attitudes of chest specialist and trainees towards asthma

The study was aimed at three objectives: i. To know about doctors understanding of pathophysiology of Asthma. ii: To assess the knowledge of treatment of asthma and actual treatment practices by Chest specialists and Postgraduate trainees. iii: To assess the baseline knowledge, attitude and treatment practice in the absence of any local treatment guidelines and then see the effectiveness of the guidelines in changing their practice. A preset questionnaire was distributed among doctors from all over Pakistan, during 5th Biennial Conference on Lung Health in 2002. Each question was followed by a set of answers, of which one was to be tick marked. 66 doctors participated, 14 teaching consultants, 24 chest specialists, 14 postgraduate students, and 14 other doctors. 82% doctors would treat their patients on long-term basis and 18% would treat them acutely. 71% thought asthma was chronic inflammation of the airways whereas 28% thought it was due to bronchoconstriction and mucus plugging. Airways remodeling was considered to be partially or fully reversible by 90% and not reversible by 8%, 2% did not respond. 89% were fully aware of stepwise management of asthma and 11% were little aware. The grading of asthma severity was done by clinical examination 44% and clinical plus spirometery 56%. Inhalers were prescribed always by 35%, frequently by 57% and sometimes by 6%. 78% prescribed steroid inhalers alone or in combination with Beta 2 agonist, whereas 12% used only Beta 2 agonist. 93% would teach inhaler technique by themselves or by trained technician and 7% would leave it to chemists or patients. 88% would check inhaler technique on follow-up visit. 92% used oral drugs with inhalers. The choice of oral drugs varied between steroid [8%], theophylline [28%], Beta 2 agonist [37%], and leukotriene inhibitors [18%], no response [9%]. 47% sometimes and 50% never advised desensitization while 3% recommended it frequently. A significant proportion of doctors lacked a good understanding of pathophysiology of asthma. Although the majority of chest physicians and trainees were fully aware and correctly practiced, a significant number [i.e. one fourth] of doctors were not managing their patients with asthma correctly according to the guidelines

Somking and doctors a survey of trends and attitudes

The aim of this survey was to assess smoking trends and attitude towards smoking in doctors. Out of the total 86 doctors, 61[70.9%] males and 25[29.1%] females, the number of consultants and junior doctors was 21[24.4%] and 65[75.6%]. A total of 24[27.9%] doctors were smokers. Smoking was more popular among males 24[39.3%] and consultants 09[42.8%] than lady doctors [zero] and junior doctors 15[23.0%]. Other substance abuse was found in smokers only, 03[12.5%] among males smokers and zero among females while 01[11.1%] and 02[13.3%] in smoker consultants and junior doctors respectively. Among the smoker doctors 16[55.2%] and among the non-smoker doctors 27[47.4%] would always give their smoking patients a "stop-smoking" advice while the remaining doctors would, either sometimes or not at all, advise their patients to stop smoking. A supplementary question was included in another study, conducted by the same investigator on 275 university students to help assess doctors' contribution in reducing tobacco consumption in the community. The answers were analyzed in this study. Only 25% of the exsmokers gave up smoking on doctors' advice. Thus doctors don't have an accurate perception of smoking related diseases and so not only have high smoking rates but are also contributing insignificantly to reduce smoking in the community

Smoking trends in medical students: Are they influenced by difference in gender and financial status?

Smoking trends in medical students and the influence of gender and financial status difference was studied in a survey in Peshawar. Total study population was 154 with 101[65.6%] males and 53[34.4%] females while 78[50.6%] and 76[49.4%] were regular and self-financed students respectively. The total number of smokers was 49[31.8%]. Out of the male and female students 38[37.6%] and 6[12.8%] were smokers respectively. The number of smokers among regular and self-financed students was 15[19.2%] and 34[44.7%] respectively. Majority of the smokers [74.5%] smoked less than 10 cigarettes / day and only a small minority smoked more than 20 cigarettes/ day. Despite the fact that overall 93.6% students were aware of even passive smoking hazards; still only 74.7% and 69.8% male students would favour a ban on smoking at public placed and on cigarette ads., respectively while the corresponding number of female students was 94.1% and 80.4%, respectively. 15[39.5%] and 6[33.3%] among the male and female students respectively, first smoked during their school life