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INTRODUCTION: Male breast cancer is rare and accounts for less than 1% of all breast cancer cases worldwide. METHODS: This retrospective cohort study included all patients of invasive male breast cancer treated with curative intent by a trimodality approach via a multidisciplinary team at an academic university hospital in India between 2009 and 2023. Records were identified from a prospectively maintained database. Clinicopathological parameters, treatment details and survival were recorded and analysed. RESULTS: Thirty-four patients were included. The median (IQR) age was 55(44-63) years. Most patients were overall stage III (74%) and node positive (79%) with Scarff-Bloom-Richardson grade II (50%). Twenty-five patients (73%) were oestrogen receptor (ER) positive. Lymphovascular space invasion (LVSI) and perineural invasion (PNI) were present in 62% and 21% of patients, respectively. The most common chemotherapy timing was adjuvant (53%) followed by neoadjuvant (41%), and the most commonly used regimen consisted of a combination of doxorubicin-cyclophosphamide followed by a taxane (53%). Most (85%) patients underwent a mastectomy, five patients underwent breast conservation. All patients received radiotherapy to a dose of 42.6 Gy in 16 fractions, followed by a tumour bed boost for those undergoing breast conservation. At a median follow-up of 70 months (range 10-159 months), the five and ten-year overall survival was 91% and 58%, and the five-year disease-free survival (DFS) was 67%. The median DFS was 72 months. On univariate analysis, the tumour sub-type (Luminal versus TNBC) significantly predicted DFS (P = 0.03 log-rank). CONCLUSION: Breast cancer in males has a high incidence of node positivity, ER positivity and LVSI. Even with advanced stages at presentation, trimodality therapy in a multidisciplinary setting offers good long-term outcomes.
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Post inflammatory hyperpigmentation (PIH) affects all skin types with a heightened predilection for darker skin tones. Its course is chronic once developed and treatment is often difficult. This systematic review aims to summarize the treatment outcomes for PIH with a focus on skin of colour (SOC) individuals. A literature search was conducted using MEDLINE (from 1946), Embase (from 1974), PubMed, and Cochrane in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Results from 48 studies summarized 1356 SOC individuals. The mean age was 29 years (n = 1036) and 78% were female (n = 786). The ethnic prevalence was 70% Black, 27% Asian, and 3% Latin. Overall, 20% were Fitzpatrick skin type (FST) III, 40% FST IV, 34% FST V, and 6% FST VI. Most cases were precipitated by inflammatory conditions (89%) and localized to the face (83%). The most frequently reported interventions were topical retinoids (22%) and laser therapy (17%). Partial improvement was seen in 85% and 66% of participants, respectively. Laser was the only intervention that offered complete resolution in a subgroup of patients (26%); however, there were reported cases of PIH exacerbation following treatment. Chemical peels (9%) and hydroquinone (7%) were among other treatments with less effective outcomes. PIH and its persistence is a prevalent issue, significantly affecting many affected individuals with darker skin tones. Our results show a lack of robust efficacy across all treatment modalities. There is considerable room for improvement in interventions for at-risk populations.
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BACKGROUND AND OBJECTIVE: Epilepsy is a prevalent neurological disorder that affects a significant number of individuals globally. This condition is associated with a high occurrence of psychiatric comorbidities, which can significantly affect the quality of life of individuals affected. The aim of this study was to investigate the association between antiseizure therapies and the likelihood of psychiatric comorbidities in individuals with epilepsy. METHODOLOGY: Data for this study was gathered from the Neurology referral center in Islamabad, Pakistan. A standardized questionnaire was utilized to gather data from 120 individuals diagnosed with epilepsy. The survey consisted of inquiries regarding the management of seizures, the utilization of anti-seizure medications, and the presence of psychiatric comorbidities. The data was analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The findings indicated that individuals who were using multiple antiseizure medications had a notably higher likelihood of having psychiatric comorbidities in comparison to those who were on mono therapy (p = 0.010). suggests that patients with unsuccessful seizure control are more probable to have psychiatric comorbidities as compared to those with good seizure control (p = 0.029). CONCLUSION: To conclude poor seizure control and poly therapy are associated with increased risk of psychiatric comorbidities.
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Anticonvulsivantes , Epilepsia , Trastornos Mentales , Humanos , Anticonvulsivantes/uso terapéutico , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Epilepsia/psicología , Masculino , Femenino , Adulto , Trastornos Mentales/epidemiología , Trastornos Mentales/tratamiento farmacológico , Adulto Joven , Persona de Mediana Edad , Comorbilidad , Adolescente , Pakistán/epidemiología , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology. METHODS: A systematic review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations. RESULTS: Eighty-five studies were included, representing 1359 cases with mean age 2.4 years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum-like (19%), purpuric/petechial (7%), and Gianotti Crosti-like (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10 days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2 weeks after symptoms, respectively. CONCLUSION: Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.
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Enfermedad de Boca, Mano y Pie , Erupción Variceliforme de Kaposi , Enfermedades de la Uña , Niño , Humanos , Masculino , Preescolar , Femenino , Enfermedad de Boca, Mano y Pie/diagnóstico , Enfermedad de Boca, Mano y Pie/epidemiología , Enfermedades de la Uña/etiología , Filogenia , AciclovirRESUMEN
This study finds out seasonal and monthly variations in Aerosol Optical Depth (AOD) over eastern and western routes of China Pakistan Economic Corridor (CPEC) and the relationship between AOD and meteorological parameters (i.e., temperature, rainfall and wind speed). The Moderate Resolution Imaging Spectroradiometer (MODIS) and Multi-angle Imaging Spectroradiometer (MISR) data was used from the terra satellite for the period of 2000-2016. This study aims to overtake the conventional view of the purpose of using the satellite datasets. This study takes on to the concept that validated satellite data sets rather should be used for the analysis instead of just validation specifically for our study region. Hence, after comparing MODIS AOD with MISR AOD, only MISR AOD dataset is used for further analysis. The results show a decreasing trend of AOD in summer season, a positive relationship between temperature and AOD during winter and spring seasons whereas a positive relationship between wind speed and AOD in winter and spring seasons over eastern and western routes. Periodic analysis of MODIS AOD and MISR AOD depicts May-Aug as the peak period of aerosol concentration over central Pakistan. The inter-annual analysis shows the aerosol trend remained higher during summer season however rainfall shows the washout effect. Eastern route has higher standard deviation and larger values for aerosol prevalence as compared to western route. The trajectory analysis using the HYSPLIT model suggests the bias of air mass trajectory caused deviation in the aerosol trend in the year 2014.
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Contaminantes Atmosféricos , Aerosoles/análisis , Contaminantes Atmosféricos/análisis , China , Monitoreo del Ambiente , PakistánRESUMEN
Development of plant based nanoparticles has many advantages over conventional physico-chemical methods and has various applications in medicine and biology. In present study, zinc oxide (ZnO) nanoparticles (NPs) were synthesized using leaf extracts of two medicinal plants Cassia fistula and Melia azadarach. 0.01 M zinc acetate dihydrate was used as a precursor in leaf extracts of respective plants for NPs synthesis. The structural and optical properties of NPs were investigated by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, scanning electron microscope (SEM), ultraviolet-visible spectrophotometer (UV-Vis) and dynamic light scattering (DLS). The antibacterial potential of ZnO NPs was examined by paper disc diffusion method against two clinical strains of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) based on the zone of inhibition and minimal inhibitory indices (MIC). Change in color of the reaction mixture from brown to white indicated the formation of ZnO NPs. UV peaks at 320 nm and 324 nm, and XRD pattern matching that of JCPDS card for ZnO confirmed the presence of pure ZnO NPs. FTIR further confirmed the presence of bioactive functional groups involved in the reduction of bulk zinc acetate to ZnO NPs. SEM analysis displayed the shape of NPs to be spherical whereas DLS showed their size range from 3 to 68 nm. The C. fistula and M. azadarach mediated ZnO NPs showed strong antimicrobial activity against clinical pathogens compared to standard drugs, suggesting that plant based synthesis of NPs can be an excellent strategy to develop versatile and eco-friendly biomedical products.
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Antibacterianos/química , Cassia/química , Melia/química , Nanopartículas del Metal/química , Extractos Vegetales/química , Hojas de la Planta/química , Óxido de Zinc/química , Antibacterianos/farmacología , Escherichia coli/efectos de los fármacos , Tecnología Química Verde/métodos , Pruebas de Sensibilidad Microbiana/métodos , Tamaño de la Partícula , Extractos Vegetales/farmacología , Staphylococcus aureus/efectos de los fármacosRESUMEN
This study presents detailed analysis of spatiotemporal variations and trend of dust optical properties i.e., Aerosol Optical Depth (AOD) and Angstrom component over Asian desert regions using thirteen years of data (i.e., 2001-2013) retrieved from Aerosol Robotic Network (AERONET), Moderate Resolution Imaging Spectroradiometer (MODIS) and Multi-angle Imaging Spectroradiometer (MISR). These regions include Solar Village, Dunhuang and Dalangzadgad and are considered as origin of desert aerosols in Asia. Mann-Kendall trend test was used to show the trend of AOD. The relationship of AOD with weather parameters and general AOD trend over different wavelengths has also been shown. AOD's trend has been observed significant throughout the year in Solar Village, while in Dunhuang and Dalanzadgad the significant trend has been found only in peak period (March-June). Analysis show high values of AOD and low values of angstrom in Solar Village during peak period. In Chinese desert regions, high values of AOD have been found during peak period and low values in pre-peak period. Significant relationship has been observed between AOD and average temperature in Solar Village and Dalanzadgad whereas rainfall and wind speed showed no significant impact on AOD in all desert regions.
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Clima Desértico , Polvo/análisis , Monitoreo del Ambiente/métodos , Imágenes Satelitales , Aerosoles , Asia , Lluvia , Temperatura , VientoRESUMEN
BACKGROUND: Dengue is becoming more common in Pakistan with its alarming spreading rate. A historical review needs to be carried out to find the root causes of dengue dynamics, the factors responsible for its spread and lastly to formulate future strategies for its control. METHODS: We searched (January, 2015) all the published literature between 1980 and 2014 to determine spread/burden of dengue disease in Pakistan. RESULTS: A total of 81 reports were identified, showing high numbers of dengue cases in 2010, 2011, and 2013. The tendency of dengue to occur in younger than in older age groups was evident throughout the survey period and all four serotypes were recorded, with DENV1 the least common. Most dengue hemorrhagic fever (DHF) cases fell in the 20-45 years age range. High frequencies tended to be observed first in the Southern coastal region characterized by mild winters and humid warm summers and then the disease progressed towards the lowland areas of the Indus plain with cool winters, hot summers and monsoon rainfall. Based on this survey, new risk maps and infection estimates were identified reflecting public health burden imposed by dengue at the national level. CONCLUSIONS: Our study showed that dengue is common in the three provinces of Pakistan, i.e., Khyber Pakhtunkhwa (KP), Punjab and Sindh. Based on the literature review as well as on our study analysis the current expansion of dengue seems multifactorial and may include climate change, virus evolution, and societal factors such as rapid urbanization, population growth and development, socioeconomic factors, as well as global travel and trade. Due to inadequate remedial strategies, effective vector control measures are essential to target the dengue vector mosquito where high levels of human-vector contact occur. The known social, economic, and disease burden of dengue is alarming globally and it is evident that the wider impact of this disease is grossly underestimated. An international multi-sectoral response, outlined in the WHO Global Strategy for Dengue Prevention and Control, 2012-2020, is now essential to reduce the significant influence of this disease in Dengue endemic areas. Overall gaps were identified in knowledge around seroprevalence, dengue incidence, vector control, genotype evolution and age-stratified serotype circulation.
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Dengue/epidemiología , Humanos , Pakistán/epidemiología , Factores de RiesgoRESUMEN
This study is an attempt to find out the factors responsible for sudden dengue outbreak in different cities of Pakistan during 2011. For this purpose, spatio-temporal distribution of dengue in Islamabad, Rawalpindi, Lahore, and Karachi has been taken into account. According to the available data, the factors responsible for this spread includes climate covariates like rainfall, temperature, and wind speed; social covariates like population, and area of locality, and environmental risk factors like drainage pattern and geo-hydrological conditions. Reported dengue cases from localities and Shuttle Radar Topography Mission (SRTM) 90 m digital elevation model (DEM) of study areas have been processed for hotspots, regression model and stream density in the localities of high dengue incidence. The relationship of daily dengue incidence with climate covariates during the months of July-October of the study year is analyzed. Results show that each dry spell of 2-4 days provides suitable conditions for the development and survival of dengue vectors during the wet months of July and August in the areas of high stream density and population. Very few cases have been reported in July while higher number of cases reported in the months of August, September, until late October. Hotspot analysis highlights the areas of high dengue incidence while regression analysis shows the relationship between the population and the areas of localities with the dengue incidence.
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Dengue/epidemiología , Brotes de Enfermedades , Humanos , Incidencia , Análisis de los Mínimos Cuadrados , Pakistán/epidemiología , Densidad de Población , Lluvia , Factores de Riesgo , Ríos , Temperatura , VientoRESUMEN
This study focuses on the dengue transmission in different regions of Pakistan. For this purpose, the data of dengue cases for 2009-2012 from four different cities (Rawalpindi, Islamabad, Lahore, and Karachi) of the country is collected, evaluated, and compiled. To identify the reasons and regions of higher risk of Dengue transmission, land use classification, analysis of climate covariates and drainage patterns was done. Analysis involves processing of SPOT 5 10 m, Landsat TM 30 m data sets, and SRTM 90 m digital elevation models by using remote sensing and GIS techniques. The results are based on the change in urbanization and population density, analysis of temperature, rainfall, and wind speed; calculation of drainage patterns including stream features, flow accumulation, and drainage density of the study areas. Results suggest that the low elevation areas with calm winds and minimum temperatures higher than the normal, rapid increase in unplanned urbanization, low flow accumulation, and higher drainage density areas favor the dengue transmission.