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Objective: To determine the impact of the information seminar on breast cancer awareness among the medical and nursing students of CMH institute of Medical Sciences (CIMS) Multan Pakistan. Study Design: Prospective Comparative Study. Place and Duration of Study: One-day seminar at CMH Institute of Medical Sciences (CIMS) Multan Pakistan. Methodology: A one-day seminar on breast cancer awareness was arranged at CMH Institute of Medical Sciences Multan Pakistan for 3rd and 4th-year MBBS and 3rd-year BSc Nursing students. A total of 137 participants were recruited. Participants were selected by non-probability consecutive sampling. A validated 13-question questionnaire was designed to assess participants' basic knowledge of breast cancer and breast self-examination (BSE). Results: The mean age of participants was 21.27±0.99 years. 30(21.9%) were males and 107(78.1%) were female students. Before the seminar, approximately half of the students were correct about the demographics and presentation of breast cancer which increased to more than 80% in all avenues post-seminar (p<0.001). The most significant improvement was the correct responses regarding the age at which BSE should begin. Its frequency and correct technique pre-seminar were 75(54.7%), 51(37.2%) and 23(16.8%), which in post-seminar were 98(71.5%), 106(77.4%) and 75(54.7%) respectively (p<0.001). Conclusion: This one-day educational seminar played a significant role in increasing awareness among medical and nursing students. [ABSTRACT FROM AUTHOR]

Objective: To detect the resistant pattern of uropathogens and find the association of different factors with the resistance in the Poonch District of Azad Kashmir. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Shaikh Khalifa Bin Zayed Hospital, Rawalakot, from Mar to Aug 2019. Methodology: Patients having signs and symptoms of urinary tract infection and growth of bacteria on urine culture were included in the study. The antimicrobial susceptibility of the isolates was determined by using the standard, modified Kirby Buer disc diffusion method. Zone sizes were interpreted following Clinical Laboratory Standards Institute (CLSI) 2019 guidelines. Results: 68 culture-positive patients were included in the study, 45 (66%) patients were female. There was a previous history of urinary tract infection in 44 (64.7%) patients, and 52 (76.5%) gave a history of antibiotic use in the last three months. E. coli was the commonest organism isolated, followed by Klebsiella, Proteus and Pseudomonas. All patients were resistant to at least one antibiotic, 48 (72%) isolates were multi-drug resistant. Uropathogens showed the highest resistance to Ampicillin in 67 (98.5%) patients and the lowest resistance to Piperacillin/Tazobactam 2 (3%) patients only. Resistance was significantly higher in patients having a history of recurrent urinary tract infection (p=0.028) and the use of antibiotics in the last three months (p<0.001). Conclusion: Resistance to antimicrobial agents is increasing in community-acquired urinary tract infections. Resistance is significantly higher in patients having a history of recurrent urinary tract infection and the use of antibiotics in the last three months. [ABSTRACT FROM AUTHOR]

We present disseminated intravascular coagulation (DIC) with excessive fibrinolysis (XFL) as an unusual presenting manifestation of metastatic prostate cancer (PC), which was successfully treated with chemotherapy with Docetaxel which not only controlled the disease but also reversed the patient's coagulopathy within seven days effectively. Thus highlighting rare and life-threatening haemorrhagic complications of prostate cancer along with its satisfactory management option. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of the Mentzer index as a screening tool for iron deficiency anaemia, using an iron profile as the gold standard in patients presenting with hypochromic microcytic anaemia. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to May 2022. Methodology: Data was collected from 163 patients with hypochromic microcytic anaemia. Red cell indices were noted for each patient and recorded on a defined proforma. Results: The mean age of the patients was 8.23±3.57 years. 85(52.1%) patients were males and 78(47.9%) were females. Moreover, out of 163 patients, the specificity, sensitivity, negative predictive value, positive predictive value, and diagnostic accuracy of the Mentzer index for the diagnosis of iron deficiency anaemia were 90.1%, 90.1%, 84.6%, 93.8%, and 90.8%, respectively. Conclusion: The cell-count-based indices, especially the Mentzer index, are reliable and available methods for diagnosing iron deficiency anaemia. They have an accurate discrimination ability. [ABSTRACT FROM AUTHOR]

Objective: To discern the relationship of height and weight with body composition in healthy attendants of cancer patients. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Oct to Dec 2022. Methodology: A total of 226 healthy adults aged 19-47 years having similar daily physical activity levels were included. The body composition of study participants was evaluated using a bioelectric impedance analysis (BIA) machine. The weight of all participants was recorded with the help of a weighing machine. The participants' height was measured using a Harp enden Stadiometer and recorded. Results: Our study showed that weight had a significant positive correlation with body fat mass (rs value=0.83), skeletal muscle mass (rs value=0.763), total body water (rs value=0.704), fat-free mass (rs value=0.75) and per cent body fat (rs value 0.716). On the other hand, height had a negative but non-significant association with fat mass (rs value= 0.025) and a negative significant association with per cent body fat (rs value=-0.16). Height had a positive and significant association with fat-free mass (rs value=0.553), total body water (rs value=0.501) and skeletal muscle mass (rs value=0.505). Conclusion: Weight, if used alone, is not a good indicator of obesity or emaciation, and height has a negative association with fat mass. [ABSTRACT FROM AUTHOR]

Objective: To validate a clinical scoring system for defining the severity of ailment that will assist in developing strategies for management prioritisation. Study Design: Cross-sectional analytical study. Place and Duration of Study: Paediatric Department, Combined Military Hospital Lahore, Pakistan, form Jan 2020 to Jul 2021. Methodology: The paediatric patients who reported to the Medical Reception Centre and were admitted to an Inpatient Facility were enrolled. Demographic profile, temperature, oxygen saturation, pulse, respiratory rate, seizures, and sensorium labelled as "TOPRS" score was recorded with "0 - Normal" and "1 - Abnormal" and scores calculated for each patient with the incorporation of systemic inflammatory response and advanced paediatric life support criteria. Results: A total of 300 paediatric patients with an age range of 1-18 years (mean: 3.86±5.43) were included. Of 300 patients, 237(79%) were discharged after improvement, and the mortality rate was 63(21%). A significant association with the mortality rate was deciphered with temperature, oxygen saturation, and respiratory rate variables. In contrast, pulse rate, sensorium, and seizures were concluded to have an insignificant association. Score "0" mortality was associated with the 4.4% mortality, whereas score "5" enumerated an 80% death rate. Conclusion: The TOPRS clinical scoring system has significant value in the diagnosis of mortality and morbidity of paediatric patients and, hence, can assist in early recognition and triage of patients, consequently aiding in the provision of prioriti sation protocols and management in a befitting manner. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of trimodality therapy in patients with muscle invasive carcinoma of the bladder with deranged renal profile. Study Design: Quasi-experimental study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi over 14 months, from Sep 2015 to Nov 2016. Patients and Methods: Forty patients (n=40) having histopathologically confirmed (urothelial) urinary bladder cancer, clinical stage II or III, aged 18 to 80 years, with Eastern Cooperative Oncology Group (ECOG) performance status ≤2 and having deranged renal functions were included in this study. After maximal transurethral resection of bladder tumour (TURBT), they received 4 courses of chemotherapy with mitomycin and 5 fluorouracil, followed by concurrent chemoradiation using same chemotherapy received 50 Grays in 20 fractions. Response was assessed using RECIST criteria. Results: Efficacy; defined in terms of complete and partial response, was observed in 85% (n=34) of patients. Treatment efficacy was better in males as compared to females (90.6% vs. 62.55: p<0.05). Patients with better ECOG-PS (0-1) and early stage (2) responded well to treatment while response was almost same in different age groups, (p>0.05 in all cases). Thirty-seven patients were able to complete the full study protocol, 2 had severe mucositis and hand-foot syndrome while one patient died after septicaemia. Conclusion: Trimodality treatment with TURBT, chemotherapy and chemo-radiation is a feasible option for bladder preservation in muscle invasive bladder cancer patients with compromised renal functions if we use 5-fluorouracil and mitomycin chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of low maternal serum vitamin-D levels with serum vitamin-D levels of their term neonates and higher risk of early onset neonatal sepsis (EOS). Study Design: Prospective observational study. Place and Duration of Study: Neonatal intensive care unit (NICU) of Department of Pediatrics; Combined Military Hospital (CMH) Malir Cantt Karachi, from Apr 2016 to Apr 2017. Material and Methods: Ninety three term neonates with EOS formed the "sepsis group" and equal number (93) of healthy term neonates without sepsis were included in the control group selected as per inclusion criteria. Blood samples of mothers and their neonates were drawn during the first 72 hours after delivery for measurement of serum vitamin-D levels. Results: Mean serum vitamin-D levels were 18.16 ± 8.21 ng/ml and 13.93 ± 13.29 ng/ml in the mothers and their neonates respectively in the sepsis group and were significantly lower (p-value <0.001) than the mean serum vitamin-D levels of 33.35 ± 12.70 ng/ml and 27.92 ± 7.58ng/ml in the mothers and their neonates respectively in the control group. Vitamin-D deficiency was found in significantly higher number of cases in mothers (88.17%) and neonates (82.80%) in sepsis group as compared to 52.69% mothers and 39.78% neonates in control group (p-value<0.001). There were 14 (15.05%) cases of culture proven sepsis in the study group as compared to just 01 (1.08%) case of culture proven sepsis in control group which was statistically significant (p-value<0.001). Conclusion: Lower maternal serum vitamin-D levels are associated with lower serum vitamin-D levels and higher risk of EOS in their term neonates. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic accuracy of the pSOFA score in predicting mortality in critically ill pediatric patients. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Paediatrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, Aug 2021 to Feb 2022. Methodology: We studied 76 critically ill paediatric patients. All patients underwent pSOFA scoring on admission and then at 72 hours post-admission and were followed up till discharge or till mortality occurred. A pSOFA score of >10 was considered a high mortality risk. The two-by-two table was constructed to calculate the sensitivity, specificity and diagnostic accuracy of the pSOFA score in predicting the occurrence of death. Results: The pSOFA score had a sensitivity of 88.9% at Day-0, which improved to 100% by Day-7 in predicting whether mortality occurred. The specificity was 80.6% on Day-0 and 97.0% on Day-7. The diagnostic accuracy of pSOFA in predicting mortality was 81.6% when performed on the day of admission, which increased to 90.8% when calculated on Day 3 and was the highest on Day-7 when it was 97.4%. Conclusion: The pSOFA score has good diagnostic accuracy in predicting the occurrence of mortality in paediatric patients admitted to intensive care, which increases as the length of stay increases. [ABSTRACT FROM AUTHOR]

Sinonasal glomangiopericytoma is a tumor showing similarities to a glomus tumor but is less aggressive with a low malignant potential. The treatment of choice is complete excision followed by a regular long-term surveillance. The role of adjuvant chemotherapy and radiation remains undetermined. Our patient was a 45-year-old man who presented with nasal obstruction. Endoscopic excision showed sinonasal glomangiopericytoma. No adjuvant treatment was offered and patient was advised active surveillance. Patient was on a regular three-monthly follow-up. There was no evidence of disease recurrence after one year. [ABSTRACT FROM AUTHOR]

Objective: To review the validity of the future of health and care of older people (TFHCOP), good death perception criteria in Muslim patients and health care providers in cultural background of Pakistan. Study Design: A mixed method design with qualitative and quantitative components. Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi, from July 2015 to October 2015. Material and Methods: It is a sequential explanatory type of mixed method research. A total of 110 participants were included in the study by non probability convenient sampling technique. A modified questionnaire was used based on the principles of TFHCOP good death definition comprising of 8 questions. This was followed by interviews. For data collection and analysis grounded theory approach was used with constant comparisons and open coding. Descriptive statistics were used to analyze questionnaire responses. For bivariate analysis we used chi-square test. Results: There was a consensus on the principles presented in the modified questionnaire in the two groups studied. Total of three domains measured non-significant difference in patient’s and health care provider’s perspectives. Participants identified four more domains. The first domain was related to faith in Allah Almighty, second domain is about leaving the will for bereaved, third domain was about the concerns to finish unfinished agendas and the fourth domain was related to the importance of family security over treatment or death. Conclusion: Perception of good death by Muslim patients and health care providers in Pakistan is different from that of Western and Arab communities in certain domains like religious beliefs, leaving will for the bereaved, finishing unfinished work and the importance of family concerns. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of the information seminar on breast cancer awareness among the medical and nursing students of CMH institute of Medical Sciences (CIMS) Multan Pakistan. Study Design: Prospective Comparative Study. Place and Duration of Study: One-day seminar at CMH Institute of Medical Sciences (CIMS) Multan Pakistan. Methodology: A one-day seminar on breast cancer awareness was arranged at CMH Institute of Medical Sciences Multan Pakistan for 3rd and 4th-year MBBS and 3rd-year BSc Nursing students. A total of 137 participants were recruited. Participants were selected by non-probability consecutive sampling. A validated 13-question questionnaire was designed to assess participants' basic knowledge of breast cancer and breast self-examination (BSE). Results: The mean age of participants was 21.27±0.99 years. 30(21.9%) were males and 107(78.1%) were female students. Before the seminar, approximately half of the students were correct about the demographics and presentation of breast cancer which increased to more than 80% in all avenues post-seminar (p<0.001). The most significant improvement was the correct responses regarding the age at which BSE should begin. Its frequency and correct technique pre-seminar were 75(54.7%), 51(37.2%) and 23(16.8%), which in post-seminar were 98(71.5%), 106(77.4%) and 75(54.7%) respectively (p<0.001). Conclusion: This one-day educational seminar played a significant role in increasing awareness among medical and nursing students. [ABSTRACT FROM AUTHOR]

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorptiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted osteopenia/osteoporosis in patients included in our study. [ABSTRACT FROM AUTHOR]

Objective: To look for QTc changes associated with Tyrosine Kinase inhibitors and factors related to these changes among patients suffering from cancer. Study Design: Comparative cross-sectional study. Place and Duration of Study: Oncology Department, CMH Rawalpindi Pakistan from Dec 2020 to Apr 2021. Methodology: The study included one hundred and eighty patients with solid or haematological malignancies taking Tyrosine Kinase inhibitors for more than three months. They underwent 12 lead ECGs inside the oncology department. QTc interval was calculated on the ECG of all the patients, and they were evaluated for the presence of prolonged QT interval. Age, gender, duration of Tyrosine Kinase inhibitor use and presence of comorbid illness were correlated with the presence of QTc changes in our study participants. Results: Out of 180 cancer patients using Tyrosine Kinase inhibitors for more than three months included in the study, 96 (53.3%) were male, while 84 (46.7%) were female. One hundred and eighteen (65.5%) had normal QTc intervals, while 62 (34.5%) had prolonged QTc intervals in our study participants. Chi square test revealed that the advanced age of the patient and prolonged use of Tyrosine Kinase inhibitors was statistically significantly associated with QTc prolongation in our study (p-value<0.001). Conclusion: Significant number of cancer patients using Tyrosine Kinase inhibitors had prolonged QTc intervals in our study. Special attention should be paid to cancer patients with advancing age and prolonged use of Tyrosine Kinase inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of serum cholesterol and body mass index with body composition in the healthy Pakistani adults. Study Design: Cross sectional study. Place and Duration of Study: Physiology Department, Army Medical College Rawalpindi/National University of Medical Sciences (NUMS), in collaboration with Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi and Clinical Pathology Laboratory (CPL), Pak-Emirates Military Hospital, Rawalpindi. (Duration to be asked form the authors). Methodology: The total study sample of 100 participants was taken, that comprised of two groups. Group-1 included male participants (n=50) while group-2 included female participants (n=50). The participants were healthy adults of ages 18-60 years having same physical activity background. Body composition of the participants was evaluated by bioelectric impedance analysis machine. Measurement of serum cholesterol was carried out by the Bosh Diagnostic Kit. Body Mass Index (BMI) was determined by the formula. Results: Serum cholesterol was found to be significantly correlated with body fat mass and percent body fat in males (r-value = 0.90 and 0.82, p-value <0.001 and 0.002 respectively) and in females there was significantly positive correlation with the body fat mass (r-value=0.51, p-value 0.007), skeletal muscle mass (r-value = 0.59, p-value 0.005), total body water (r-value=0.67, pvalue 0.006) and fat free mass (r-value=0.47, p-value 0.008). Conclusion: Serum cholesterol and BMI were associated with the body composition in females but with only fat parameters in the males. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dependency on feeding gastrostomy tubes in patients with head and neck cancers treated with radiotherapy alone or concurrent chemo-radiotherapy. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Shaukat Khanum Hospital, Peshawar Pakistan, from Jan and Jul 2022. Methodology: A total of 115 patients with head and neck cancers having no baseline dysphagia and having gastrostomy tubes were included. All had received an equivalent of 60 greys in 30 fractions or more of radiotherapy. Their swallowing was evaluated weekly during radiotherapy and then every 4-6 weeks on post-treatment follow-up. The total time duration of patient dependency on feeding gastrostomy tube after treatment completion was noted for each head and neck cancer subsite. Results: Of a total of 115 patients, 49(43%) of the patients had nasopharyngeal cancers, 22(19%) had laryngeal, 29(24%) oral cavity, 7(6%) hypopharyngeal and 9(8%) had cervical esophageal cancers. Proportion retaining gastrostomy tube for more than six months of treatment was 8.7% (median duration of retention was five months) with hypopharyngeal, nasopharyngeal, oral cavity, and laryngeal cancer were 14%, 9%, 9% and 5%, respectively. Conclusion: The proportion of patients with head and neck cancers requiring more than six months of a gastrostomy tube is 5-14%. Baseline assessment of swallowing and nutrition and prophylactic feeding gastrostomy can avoid treatment interruptions. Longer duration of retention of a gastrostomy tube is associated with poor quality of life in head and neck cancer patients receiving radiation or concurrent chemo-radiation. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic value of red blood cell distribution width and red cell distribution width index in differentiating iron deficiency anaemia and beta-thalassemia trait. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Feb 2022. Methodology: A study population of 110 children with an age limit of 1.5-7 years who reported low haemoglobin was subjected to serum iron and ferritin levels with further evaluation of red cell count, blood morphology, and comparison of mean corpuscular volume. Red cell distribution width was taken from the lab report, whereas Red blood cell distribution width index value was computed for the samples. Results: A total of 110 patients were enrolled in the study. Seventy-five (68.18%) participants were diagnosed with IDA, 26(23.63%) participants were the candidate of PTT. Nine participants were suffering from anaemia of variable etiologies such as chronic ailment and sideroblastic, etc. PTT patients presented with higher RBC counts with a mean of 5.71±1.2 x1012 /l (6.8-8.5 x1012 /l) when compared to IDA participants who deciphered values of 3.5±0.5 (2.6-4.3 x1012 /l). Mean MCV in PTT was 52.2±2.7(50.1-56.8) whereas for IDA were 72.5±1.2(61.2-78.3). In IDA low serum ferritin was recorded 4.02±1.1(2.2-9.2) as compared to mean values of PTT patients. Conclusion: Red cell distribution width index and Red blood cell distribution width are authentic variables and inexpensive modalities in differentiating between iron deficiency anaemia and beta-thalassemia trait with reliability. [ABSTRACT FROM AUTHOR]

Neuroendocrine breast carcinoma (NEBC) is histologically a rare type of invasive breast cancer. It constitutes only 0.2-0.5% of all invasive breast cancers. In this case series, we are presenting five cases having primary neuroendocrine breast cancers that had been reported at a high-volume cancer centre in Pakistan. In this study, neuroendocrine breast cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre Peshawar were evaluated. We had retrospectively collected information on demographic characteristics of our patients, physical examination, radiological findings, surgical procedures with their outcomes, histopathological and immuno-histochemical characteristics, systemic adjuvant/neoadjuvant therapy and follow-up. [ABSTRACT FROM AUTHOR]

The authors stress the need for a cost effective treatment for cancer in the Pakistan Armed Forces. Topics covered include the rise in the cost of treatments as the medical technology advances, the task of the oncology formulary committee formulated at Combined Military Hospital Rawalpindi, and the increase in the number of cancer patients each year.

Objective: To compare oral Montelukast with oral Doxycycline in the treatment of moderate Acne Vulgaris in terms of mean change in acne severity index. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital Rawalpindi, from Mar 2016 to Aug 2016. Methodology: A total of 84 patients were included in the study. They were randomly assigned to group A and B by consecutive non probability sampling technique. Group A was given 100mg Doxycycline with topical 10% benzoyl peroxide and group B was given 5mg Montelukast with topical 10% benzoyl peroxide. Acne severity index (ASI) was calculated at base line and after one month. Mean change in acne severity index was observed for both the groups. Results: Independent sample t-test was used to compare the means. Mean post treatment change in acne severity index of group A was 5.45 ± 1.29 and group B was 1.80 ± .59 respectively (p-value <0.001). On post stratification analysis for age and gender results were consistent. Conclusion: Efficacy of Doxycycline is significantly better in terms of mean change in Acne Severity Index, as compared to Montelukast. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To analyze the factors associated with adverse effects in elderly women receiving chemotherapy for breast cancer. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital (CMH), Rawalpindi Pakistan, from Dec 2020 to Nov 2021. Methodology: This study was conducted on 145 female patients (>65 years) with breast cancer who were taking chemotherapy of any type and had undergone one cycle. All the study participants underwent detailed clinical evaluation by a consultant oncologist to assess the presence of various adverse effects of chemotherapy. In addition, the association of Anthracycline use, >3 months of treatment, low haemoglobin at baseline and abnormal liver functions at baseline were studied with adverse effects in the study participants. Results: The final analysis included one hundred fortyfive elderly female patients with breast cancer receiving chemotherapy. The mean age of the patients was 69.731±8.794 years. 89(61.4%) patients had no adverse effects, while 56(38.6%) had one or more adverse effects during chemotherapy. Anaemia 26(17.9%) was the commonest adverse effect, followed by fatigue 18(12.4%) and abnormal liver function tests 18(12.4%). It was revealed that the use of Anthracyclinebased chemotherapy and long duration of chemotherapy were statistically significantly associated with adverse effects (p-value<0.05) in our study participants. Conclusion: Considerable number of elderly patients with breast cancer undergoing chemotherapy showed the presence of adverse effects. In addition, patients using Anthracyclinebased chemotherapy and taking chemotherapy for more than three months were more at risk of developing adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To study the role of Hydroxyurea in patients suffering from P-thalassemia major. Study Design: Prospective longitudinal study. Place and Duration of Study: Department Paediatrics, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Oct 2020. Methodology: Data from 73 beta-thalassemia major patients was collected using a structured questionnaire containing inquiries about basic socio-demographic details, disease history, laboratory reports and particulars of former treatment regimens. Hydroxyurea was administered, and its effects were noted among the subjects regarding the frequency of transfusion, haemoglobin levels and severity of clinical symptoms. Results: The mean age of study subjects was 9.15±3.99 years, and most study subjects (56.14%) were boys. The preintervention (before administration of Hydroxyurea) levels of Hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and serum ferritin levels were unremarkable when compared to postintervention levels. However, a significant difference was observed in HbF levels. In addition, an encouraging decrease was reported in the self-rated severity (using VAS) of symptoms such as fatigue (p<0.05), weakness (p>0.05), and shortness of breath (p>0.05). In addition, the transfusion interval was significantly reduced (p<0.05). Conclusion: After carefully considering the results, it can be concluded that Hydroxyurea plays a positive role and brings about significant improvement among patients suffering from P-thalassemia major. [ABSTRACT FROM AUTHOR]

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorptiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted osteopenia/osteoporosis in patients included in our study. [ABSTRACT FROM AUTHOR]

Objective: To look for QTc changes associated with Tyrosine Kinase inhibitors and factors related to these changes among patients suffering from cancer. Study Design: Comparative cross-sectional study. Place and Duration of Study: Oncology Department, CMH Rawalpindi Pakistan from Dec 2020 to Apr 2021. Methodology: The study included one hundred and eighty patients with solid or haematological malignancies taking Tyrosine Kinase inhibitors for more than three months. They underwent 12 lead ECGs inside the oncology department. QTc interval was calculated on the ECG of all the patients, and they were evaluated for the presence of prolonged QT interval. Age, gender, duration of Tyrosine Kinase inhibitor use and presence of comorbid illness were correlated with the presence of QTc changes in our study participants. Results: Out of 180 cancer patients using Tyrosine Kinase inhibitors for more than three months included in the study, 96 (53.3%) were male, while 84 (46.7%) were female. One hundred and eighteen (65.5%) had normal QTc intervals, while 62 (34.5%) had prolonged QTc intervals in our study participants. Chi square test revealed that the advanced age of the patient and prolonged use of Tyrosine Kinase inhibitors was statistically significantly associated with QTc prolongation in our study (p-value<0.001). Conclusion: Significant number of cancer patients using Tyrosine Kinase inhibitors had prolonged QTc intervals in our study. Special attention should be paid to cancer patients with advancing age and prolonged use of Tyrosine Kinase inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2-cyanoacrylate treatment. Study Design: Prospective comparative study. Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019. Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted. Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005). Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship of baseline quantitative BCR ABL1 gene percentage and therapeutic response i.e. Early Molecular Response (EMR) at 3 months with first generation Tyrosine kinase inhibitors (Imatinib) in patients with Chronic Myeloid Leukemia (CML) in chronic phase (CP) Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital, Rawalpindi, Pakistan, and Armed Forces Institute of Pathology Rawalpindi, Pakistan from Oct 2017 to Oct 2019. Methodology: One hundred and seventy patients, 18 years of age or older with newly diagnosed Chronic Myeloid Leukemia (CML) in chronic phase (CP) with quantitative baseline BCR-ABL (IS) transcript were included in the study. All enrolled patients were placed on Imatinib therapy (400 mg/day) and Reverse transcription polymerase chain reaction (RT-PCR) for BCR ABL transcript was repeated at 3 months to document EMR (BCR-ABL (IS) <10%). Patients who were in accelerated/blast phase, or already taking any Tyrosine Kinase Inhibitors (TKI) or chemotherapy were excluded from the study Results: In our study 101 (59.4%) patients achieved early molecular response. Out of these 80 (70.8%) patients with BCR-ABL<50% at baseline value showed early molecular response. However, only 21 (36.8%) with BCRABL >50% at baseline achieved early molecular response (p-value <0.001). Conclusion: A significant number of patients achieved early molecular response with Imatinib therapy that had BCR ABL below 50%, however those with baseline BCR ABL >50%, the rate of EMR was comparatively lower. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of adjuvant Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) therapy in neonatal sepsis. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, Mar 2019 to Mar 2020. Methodology: Thirty neonates (15 cases and 15 controls) were randomly selected for this study. The Interventional Group was given GM-CSF and standard-of-care treatment; the Control Group only received standard care. Both groups were followed for the primary outcome (i.e., discharge or death). Secondary outcomes included the effects of GM-CSF on haematological parameters of neonatal sepsis. Results: The mean gestational age of the children was 33.46±2.47 weeks. In the Interventional-Group, 56.7% of the neonates were discharged with the resolution of the sepsis. There was no significant difference concerning the secondary outcome, but the mortality was higher in the neonates among the Control-Group (p-value>0.05). Conclusion: Our study showed no difference in mortality between the Interventional and the Control Groups. The GM-CSF therapy could be used as an adjuvant therapy in neonates with neonatal sepsis to increase the total leukocyte and absolute neutrophil counts. Further studies are needed to holistically chart the clinical benefit of GM-CSF adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety profile of Hasson’s technique of laparoscopic port access in patients undergoing laparoscopic cholecystectomy. Study Design: Cross-sectional study. Place and Duration of Study: Department of general surgery, Combined Military Hospital Lahore, from Oct 2014 to Aug 2018. Methodology: A total of 1037 patients with acute or chronic cholecystitis who were scheduled for laparoscopic cholecystectomy were included. Hasson (open) technique was used to insert first laparoscopy port for creation of pneumoperitoneum. Following laparoscopic cholecystectomy, data of intra-operative and post-operative complications was noted. Patients were followed during hospital stay to evaluate any procedure related injury. Follow-up was done at up-to six months to determine wound infections and formation of umbilical hernia. Results: Mean age of the patients was 44.65 ± 8.98 years. Out of 1037 patients, procedure was simple in 655 (63.16%) patients and complex in 382 (36.83%) patients due to the presence of inflammatory adhesions and anatomic access. There was no intra-abdominal injury, omental injury, vascular injury or gut perforation. Port-site infections were diagnosed in 6 (0.57%) patients during 06 months’ follow-up. Umbilical hernia was diagnosed in only 1 (0.09%) patient. Conclusion: We found that Hasson technique of first laparoscopy port access for creation of pneumoperitoneum was a safe technique with minimum number access related complications. [ABSTRACT FROM AUTHOR]

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 3.75 mg 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, two-tailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Low-density 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. [ABSTRACT FROM AUTHOR]

Objective: To study the role of Hydroxyurea in patients suffering from β-thalassemia major. Study Design: Prospective longitudinal study. Place and Duration of Study: Department Paediatrics, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Oct 2020. Methodology: Data from 73 beta-thalassemia major patients was collected using a structured questionnaire containing inquiries about basic socio-demographic details, disease history, laboratory reports and particulars of former treatment regimens. Hydroxyurea was administered, and its effects were noted among the subjects regarding the frequency of transfusion, haemoglobin levels and severity of clinical symptoms. Results: The mean age of study subjects was 9.15±3.99 years, and most study subjects (56.14%) were boys. The pre-intervention (before administration of Hydroxyurea) levels of Hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and serum ferritin levels were unremarkable when compared to post - intervention levels. However, a significant difference was observed in HbF levels. In addition, an encouraging decrease was reported in the self-rated severity (using VAS) of symptoms such as fatigue (p<0.05), weakness (p>0.05), and shortness of breath (p>0.05). In addition, the transfusion interval was significantly reduced (p<0.05). Conclusion: After carefully considering the results, it can be concluded that Hydroxyurea plays a positive role and brings about significant improvement among patients suffering from β-thalassemia major. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To assess the clinical characteristics of COVID-19 Virus disease in the pediatric population in Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2020 to Jan 2021. Methodology: All children presenting to the department with symptoms consistent with COVID-19 disease were tested for the virus. Patients who tested positive on the PCR were included in the study. Patients with nonconsistent symptoms of COVID-19 and those who tested negative on the PCR were excluded from the study. All clinical data, including the age of the child, the onset of symptoms, the gap between the onset of symptoms and presentation as well as clinical symptoms, were documented on a predefined proforma. Results: A total of 106 patients were enrolled on the study. The mean age of patients was 5.6±2.5 years. The most frequent symptoms were fever (63, 59.6%) and cough (49, 46.2%). There were 3(2.9%) cases with severe or critical illness. The most frequent abnormal laboratory findings were leukopenia (29, 27.4%) and increased creatine kinase (38, 36.0%). Groundglass opacities were observed in the HRCT chest of 17(65.3%) cases, out of 26 children diagnosed with pneumonia. The majority (70, 66%), had a positive exposure history. 88(83%) cases did not abide by the precautionary measures against the COVID-19 disease. Conclusions: The current study indicates that children usually present with mild symptoms but can present as severe diseases, as observed in this study. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the efficacy of hypofractionated external-beam radiotherapy for management of macroscopic hematuria in patients with advanced urinary bladder cancer. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted from December 2014 to May 2015, at the department of oncology Combined Military Hospital Rawalpindi. Material and Methods: Forty patients with macroscopic hematuria grade 2, 3 or 4 associated with advanced stage (III / IV) urothelial urinary bladder cancer unfit for curative treatment, were enrolled. All patients were subjected to hypofractionated radiotherapy (21gray/3fractions). We used Common Toxicity Criteria Adverse Event (CTCAE) Version 4.0 (Hematuria) for grading of macroscopic hematuria before radiotherapy and at day 15 after radiotherapy. Two proformas were designed to get clinical information and grade of hematuria. Results: Thirty four male and 06 female patients of advanced urinary bladder cancer with macroscopic / gross hematuria were included. Mean age was 60.22 ± 5.72 years. Out of these (n=40) 21 patients (52.5%) presented with grade 3, 17 patients (42.5%) presented with grade 4 while 2 patients (5%) presented with grade 2 hematuria. All patients received hypofractionated radiotherapy (21gray/3fractions). Of these (n=40) 27 patients (67.5%) were hematuria free with complete cessation of bleeding, 10 patients (25%) had ⩾1 Grade improvement in gross hematuria) while 3 patients (7.5%) had no improvement in macroscopic hematuria on CTCAE) Version 4.0 (Hematuria). Conclusion: Hypofractionated radiotherapy (21Gray/3Fractions) is an effective treatment modality for palliation of macroscopic / gross hematuria in advanced urinary bladder cancer patients. [ABSTRACT FROM AUTHOR]