Transforming breast cancer care: harnessing the power of artificial intelligence and imaging for predicting pathological complete response. a narrative review.

This narrative review explores the transformative potential of Artificial Intelligence (AI) and advanced imaging techniques in predicting Pathological Complete Response (pCR) in Breast Cancer (BC) patients undergoing Neo-Adjuvant Chemotherapy (NACT). Summarizing recent research findings underscores the significant strides made in the accurate assessment of pCR using AI, including deep learning and radiomics. Such AI-driven models offer promise in optimizing clinical decisions, personalizing treatment strategies, and potentially reducing the burden of unnecessary treatments, thereby improving patient outcomes. Furthermore, the review acknowledges the potential of AI to address healthcare disparities in Low- and Middle-Income Countries (LMICs), where accessible and scalable AI solutions may enhance BC management. Collaboration and international efforts are essential to fully unlock the potential of AI in BC care, offering hope for a more equitable and effective approach to treatment worldwide.

The discerning influence of dynamic contrast-enhanced MRI in anticipating molecular subtypes of breast cancer through the artistry of artificial intelligence - a narrative review.

Radio genomics is an exciting new area that uses diagnostic imaging to discover genetic features of diseases. In this review, we carefully examined existing literature to evaluate the role of artificial intelligence (AI) and machine learning (ML) on dynamic contrastenhanced MRI (DCE-MRI) data to distinguish molecular subtypes of breast cancer (BC). Implications to noninvasive assessment of molecular subtype include reduction in procedure risks, tailored treatment approaches, ability to examine entire lesion, follow-up of tumour biology in response to treatment and evaluation of treatment resistance and failure secondary to tumour heterogeneity. Recent studies leverage radiomics and AI on DCE-MRI data for reliable, non-invasive breast cancer subtype classification. This review recognizes the potential of AI to predict the molecular subtypes of breast cancer non-invasively.

Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report.

INTRODUCTION: Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5-2% of all fibroadenomas. PRESENTATION OF CASE: In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan. DISCUSSION: Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases. CONCLUSION: The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.

Future priorities of interns in public and private tertiary care hospitals of a mega city in a developing country.

OBJECTIVE: To determine the future priorities of young medical doctors in tertiary care hospitals in a major urban centre. METHODS: This multi-centre cross-sectional study was conducted at four tertiary care hospitals of Karachi, Pakistan, from January to June 2015, and comprised medical interns. A questionnaire-based survey was conducted. The participants were inquired about their demographics, preferred places and hospitals for training in the future and reason for their choices. Differences in future choice for going abroad between gender, relationship status, household monthly income, etc. were analysed. SPSS 16 was used for data analysis. RESULTS: Of the 308 participants, 228(74%) were females and 80(26%) were males. The overall mean age was 24.56±1.18 years. Moreover, 118(38.3%) participants wanted to go abroad for their postgraduate training. Of them, 46(39%) wished to return to Pakistan after completing the training from abroad. Top five reasons for going abroad included better quality of training 60(50.8%), better environment and facilities 35(29.7%), security and safety 29(24.6%), better career growth 24(20.3%) and fiancé/spouse settled there 18(15.3%). Preference of pursuing postgraduate training abroad outside Pakistan was significantly higher among doctors who were males (p=0.026), had graduated from medical colleges in Karachi (p=0.003), had household monthly income of greater than Rs100,000 (p<0.001) and had an immediate family member abroad (p<0.001). Besides, 190(61.7%) doctors wanted to pursue their training in Pakistan. Of them, 85(44.7%) wished to do their postgraduate training in public sector hospitals while 105(55.3%) had their preference for private hospitals. Main reasons for joining private hospitals included quality of training 40(38.1%), clean environment 25(23.8%), facilities 25(23.8%) and familiarity with environment 25(23.8%). CONCLUSIONS: Almost half of the female doctors were planning not to pursue their careers in the future, whereas half of the male doctors wished to go abroad for training with only one-third among them planning to return.

Lessons learned from a community based intervention to improve injection safety in Pakistan.

BACKGROUND: A national study in 2007 revealed that in Pakistan the prevalence of hepatitis B is 2.5% and for hepatitis C it is 5%. Unsafe injections have been identified as one of the reasons for the spread of these infections. Trained and untrained providers routinely perform unsafe practices primarily for economic reasons i.e. they reuse injection equipment on several patients. The patients, do not question the provider about the need for an injection because of social barriers or whether the syringe is coming from a new sterile packet due to lack of knowledge. The present paper represents an intervention that was developed to empower the community to improve unsafe injection practices in rural Pakistan. METHODS: In a rural district of Pakistan (Tando Allahyar, Sindh) with a population of approximately 630,000 a multipronged approach was used in 2010 (June to December) to improve injection safety. The focus of the intervention was the community, however providers were not precluded. The organization of interventions was also carefully planned. A baseline assessment (n=300) was conducted prior to the intervention. The interventions comprised large scale gatherings of the community (males and females) across the district. Smaller gatherings included teachers, imams of mosques and the training of trained and untrained healthcare providers. The Pakistan Television Network was used to broadcast messages recorded by prominent figures in the local language. The local FM channel and Sunday newspaper were also used to disseminate messages on injection safety. An end of project assessment was carried out in January 2012. The study was ethically reviewed and approved. RESULTS: The interventions resulted in improving misconceptions about transmission of hepatitis B and C. In the baseline assessment (only 9%) of the respondents associated hepatitis B and C with unsafe injections which increased to 78% at the end of project study. In the baseline study 15% of the study participants reported that a new syringe was used for their most recent injection. The post-intervention findings showed an increase to 29% (n=87). CONCLUSION: It is difficult to assess the long-term impact of the intervention but there were several positive indicators. The duration of intervention is the key to achieving a meaningful impact. It has to be at least 18-24 months long.