National Cancer Registry of Pakistan: First Comprehensive Report of Cancer Statistics 2015-2019.

OBJECTIVE: To compile a comprehensive national cancer registry report of Pakistan by merging and analysing cancer registration data received from major functional cancer registries in various parts of Pakistan. STUDY DESIGN: Observational study. Place and Duration of the Study: Health Research Institute (HRI), National Institutes of Health (NIH), Islamabad, from 2015-2019. METHODOLOGY: Data from major cancer registries which included 'Punjab Cancer Registry (PCR), 'Karachi Cancer Registry (KCR)', 'Pakistan Atomic Energy Commission (PAEC) Cancer Registry', Armed Forces Institute of Pathology (AFIP) Cancer Registry, Nishtar Medical University Hospital Multan (NMH), and Shifa International Hospital, Islamabad (SIH) registries were pooled, cleared, and analysed at HRI. RESULTS: A total of 269,707 cancer cases were analysed. Gender-wise 46.7% were males and 53.61% were females. As per province-wise distribution, 45.13% of cases were from Punjab, 26.83% from Sindh, 16.46% from Khyber Pakhtunkhwa (KP), and 3.52% from Baluchistan. Both genders combined, 'breast cancer' 57633 (21.4%) was the most common cancer. In males, the top-5 cancers in order of frequency/percenatages were 'oral' 14477 (11.6%), 'liver' 8398 (6.73%), colorectal 8024 (6.43%), 'lung' 7547 (6.05%) and 'prostate' 7322 (5.87% cancers). In females, causes of the top-5-cancers included 'breast' 56250 (38.8%), 'ovary' 8823 (6.09%), 'oral' 7195 (4.97%), 'cervix' 6043 (4.17%), and 'colorectal' 4860 (3.36%) cancers. In children 'Leukemia' 1626 (14.50%) and in adolescents 'Bone' 880 (14%) were the leading malignancies. CONCLUSION: Breast cancer is the most common cancer in females touching epidemic proportions while 'oral cancer' which is the leading cancer in males ranks third in frequency in females. Like 'oral cancer' which shows a strong correlation with chewing, other common cancers in Pakistan including liver cancer, lung cancer, and cervical cancer are also largely preventable as showed a strong correlation with hepatitis B and C, smoking, and high-risk human papillomavirus. KEY WORDS: National Cancer Registry, Health Research Institute - NIH, Islamabad, Pakistan.

Maternal and peri-natal outcomes of dengue fever with special emphasis on vertical transmission.

OBJECTIVE: To investigate the maternal and peri-natal outcomes of dengue infection and frequency of dengue immunoglobulin G positivity in pregnant women along with pregnancy outcomes. Method: The observational two-phase study was conducted from 2012 to 2015 in Lahore, Pakistan. In phase 1, pregnant women who had acute dengue fever were prospectively and retrospectively enrolled from 4 tertiary care hospitals. Demographic data, clinical/laboratory parameters and maternal/foetal outcomes were recorded for each subject. In the second phase, normal pregnant women with no current or past history of dengue fever were enrolled from Gynaecology Department of Shaikh Zayed Hospital, Lahore, to determine the frequency of dengue immunoglobulin G positivity and pregnancy outcome. Data was analysed using SPSS 20. RESULTS: Of the 12 subjects in phase 1, 10(83.3%) were prospective cases and 2(16.6%) were retrospective. The overall mean age was 26.3±5.4 years, 7(58.3%) were in 2nd and 5(41.6%) were in 3rd trimester of pregnancy. Among the 4(33.3%) women at gestational age ≥33 weeks, 3(75%) had poor foetal outcome. In the second phase, there were 127 women with a mean age of 27.4±4.3 years. Among them, 38(29.9%) women were in the 2nd and 89(70.1%) were in the 3rd trimester. Dengue immunoglobulin G positivity was found in 65(51.2%) cases, but poor maternal or foetal outcome was not found in such women. CONCLUSIONS: Acute dengue fever at late term resulted in adverse foetal outcomes. Frequency of dengue immunoglobulin G positivity was high among pregnant women, but it was not associated with adverse outcomes.

Prognostic value of five serum markers predicting in-hospital mortality among adults with community acquired pneumonia.

INTRODUCTION: To evaluate the prognostic value of serum markers predicting in-hospital mortality among community acquired pneumonia patients. METHODOLOGY: Total 134 patients admitted in Sir Ganga Ram Hospital Lahore Pakistan during 2014-16 included. Serum markers recorded upon admission included blood urea nitrogen, albumin, creatinine, blood urea nitrogen/albumin ratio and blood urea nitrogen/creatinine ratio. Patients were observed for the incidence of mortality during hospitalization. Comparison between survivors and non-survivors for means by t test; odds ratios by contingency tables; and effectiveness of predictors by receiver operating characteristic curve analyses were assessed. RESULTS: Overall mean age was 50 ± 21 years; males 45.5%; and in-hospital mortality 9.7%. For in-hospital mortality, creatinine ≥ 2.8 mg/dL showed the highest odds (OR = 7.656, 95% CI = 2.281-25.692; p = 0.001); followed by CURB-65 score ≥ 4 (OR = 4.958, 95% CI = 0.418-58.784; p = 0.266); and blood urea nitrogen ≥ 24.7 mg/dL (OR = 3.364, 95% CI = 1.033-10.954; p = 0.062). Serum creatinine was a fair predictor of in-hospital mortality (AUC = 0.721) showed 53.0% sensitivity and 87.0% specificity at cut-off 2.8 mg/dL. Blood urea nitrogen (AUC = 0.691) and blood urea nitrogen/albumin ratio (AUC = 0.675) were poor predictors; whereas albumin (AUC = 0.424) and blood urea nitrogen/creatinine ratio (AUC = 0.403) failed to predict in-hospital mortality. CONCLUSIONS: Among five serum markers, raised serum creatinine was a better predictor of in-hospital mortality in adults with community acquired pneumonia.

Dietary patterns of Pakistani adults and their associations with sociodemographic characteristics-a community based study.

OBJECTIVE: To identify the dietary patterns and understand their association with sociodemographic characteristics among adults. METHODS: The community-based cross-sectional study was conducted in Islamabad, Lahore, Karachi, Peshawar and Quetta cities of Pakistan from March to November 2018, after approval from the National Bioethics Committee, Islamabad, and comprised adults of either gender. Data was collected using the food frequency questionnaire, and dietary patterns were identified using factor analysis. Multivariate regression analysis was used to assess the association of socio-demographic determinants with dietary patterns. Data was analysed using SPSS 21. Parallel Analysis criterion (Eigen values) was determined along with Monte Carlo simulation. RESULTS: Of the 448 subjects, 206(46%) were males and 242(54%) were females. The largest age group was 36-55 years 199(47.4%). Six dietary patterns were identified: "Vegetables", "Fruits", "Mixed Junk and Processed food", "Dairy and Fast food", "Discretionary" and "Fish". Regression analysis showed that those aged 36-55 years had higher scores for vegetables, fruit and fish pattern (p<0.05). Females scored more for vegetables, fish and fruits, and a significantly low score for discretionary diet pattern (p<0.05). Participants with high education level and socioeconomic status had raised scores for discretionary diet items (p<0.05). CONCLUSIONS: Six distinct dietary patterns among Pakistani adults were identified, showing significant association with sociodemographic characteristics.

Pregnancy outcomes with confirmed SARS-CoV-2 infection during first wave: A review.

Maternal and foetal care has become an important concern in the wake of enormous global spread of coronavirus disease-2019 (COVID-19), but there is scarcity of information about maternal and perinatal outcomes. The current review was conducted from March to July 2020. Appropriate and related databases were searched electronically by using terms, like "COVID-19 and pregnancy", "pregnancy outcomes of COVID-19". Pooled analysis of the reviewed studies showed that of the 164 newborns, vertical transmission was noted in 7(2.95%). The most common element 140(84.98%) was caesarean section deliveries. COVID-19 pneumonia developed in almost 54(30.90%) of 175 women. The most common symptom of COVID-19 among women was fever 88(50.77%). Adverse maternal and foetal outcomes were found to be associated with COVID-19 in the form of severe illness, increased rates of caesarean section deliveries and worse birth outcomes. Yet, vertical transmission of COVID-19 infection remains debatable.

Detection of active mycobacterium tuberculosis at 6th month exit among declared successfully treated cases in Pakistan.

OBJECTIVES: Tuberculosis (TB) is a significant public health concern, and the basis of successful anti-tuberculosis treatment (ATT) rests on the complete eradication of live bacilli from a patient. This study was conducted to detect the live TB bacilli in Lowenstein Jensen culture media among exit cases of TB who were declared successfully treated, either cured or treatment completed. METHODS: This cross-sectional study was conducted across Pakistan. Fifty-eight active TB DOTS centers were selected. The sample size of 3355 TB cases were equally distributed in all DOTS facilities. A detailed questionnaire was developed to record the information from TB DOTS and patients. After successful treatment, the sputum was taken from TB cases and examined to detect live bacilli on L-J culture. RESULTS: A total of 3355 TB cases were enrolled in the study. The male to female proportion was 1704(50.9%) and 1651(49.2%). Initially, 1993(59.4%) cases were cured, and 1362(40.6%) were declared as treatment completed cases. At exit, 324(9.65%) cases were again ZN smear-positive, and 328(9.77%) were positive on L-J culture, after being declared successfully treated for TB. CONCLUSIONS: To eradicate live TB bacilli, all TB cases should be subjected to L-J culture at the end of ATT.

Vertical Transmission of SARS-CoV-2 from COVID-19 Infected Pregnant Women: A Review on Intrauterine Transmission.

BACKGROUND: Fetal safety is a major concern with the global spread of COVID-19, but there is scarce information regarding vertical transmission and how it affects the fetus. OBJECTIVE: To assess and summarize the currently available evidence on vertical transmission (probable/confirmed) of SARS-CoV-2 along with fetal outcomes. METHODS: The current review was carried out from March to October 2020. Relevant databases were searched electronically. Pertinent articles were selected according to eligibility criteria and information was compiled. RESULTS: In 16 selected articles there were total 498 COVID-19 infected pregnant women ranging in age between 15 and 45 years. Gestational age at the onset of COVID-19 symptoms ranged from 25-41 weeks. Vertical transmission (probable and confirmed) rate from series was 4.883% (23/471). Of 17 affected newborns (information available), 08 required NICU admission, 04 developed pneumonia and 04 required mechanical ventilation. CONCLUSION: There is probable intrauterine transmission of SARS-CoV-2. Few adverse fetal outcomes are associated with COVID-19.

Effects of antenatal nutrition counselling on dietary practices and nutritional status of pregnant women: A quasi-experimental hospital based study.

OBJECTIVE: To assess the effects of nutrition education intervention on dietary practices and nutritional status of pregnant women. METHODS: In this quasi-experimental study, 215 pregnant women were enrolled from Gynae OPD, Sir Ganga Ram Hospital, Lahore, Pakistan during 2017-18. Dietary practices were assessed using the usual intake form and scoring was done against food guide pyramid. Nutritional status was evaluated by anthropometric measurements and biochemical estimation. In addition to nutrition counselling, each woman was prescribed with supplements commonly used during pregnancy. Dietary habits and nutritional status were reassessed after two months. The women lost to follow up were 21 (9.8%) therefore data obtained from 194 women were subjected to final analysis by using SPSS 20. RESULTS: The age of women ranged between 18 and 38 years. Those who never attended a school were 14.4%; poor 46.0%; and working 3.7%. The comparison between pre- and post-counselling dietary practices showed improvement in the numbers of women taking recommended portions of bread & cereals (79.4% vs. 95.9%, p = <0.001); vegetables (50.5% vs. 64.9%, p = 0.004); milk & dairy products (38.1% vs. 81.4%, p = <0.001); and a reduction in the numbers of women taking recommended portions of meat & bean (100.0% vs. 94.8%, p = 0.002). The frequency of women taking recommended diet as per food guide pyramid improved from 3.1% to 37.1%. Vitamin D status also showed improvement in the numbers of women with normal levels of serum vitamin D (7.1% vs. 33.3%, p = 0.079). CONCLUSIONS: Overall, nutrition counseling showed positive effects on nutritional status of pregnant women. Thus, the nutrition counseling must be an essential part of antenatal care for all pregnant women in the setting.

The relationship of dyspnea and disease severity with anthropometric indicators of malnutrition among patients with chronic obstructive pulmonary disease.

OBJECTIVE: To find the association of dyspnea and disease severity with anthropometric indicators of malnutrition among chronic obstructive pulmonary disease patients. METHODS: The cross-sectional analytical study was carried out at Sir Ganga Ram Hospital, Lahore during October 2013 to December 2014. Total 138 adult patients with severe COPD were enrolled. The severity of disease was measured by global initiative for chronic obstructive lung disease criteria; and dyspnea was assessed by modified medical research council dyspnea scale. Anthropometric indicators of malnutrition such as body mass index (BMI) and mid upper arm circumference (MUAC) were measured to evaluate the nutritional status of COPD patients. Data was analyzed by using Statistical Package for Social Sciences version 20. RESULTS: The mean age of 138 patients was 55±3 years. The frequency of male patients (76.8%) was three-times higher than female patients (23.2%). The overall frequency of underweight patients measured by BMI was 44%, which was increased to 92% undernourished patients by using MUAC. When compared with female patients, the male patients showed lower means of BMI, MUAC, FEV1% and FEV1/FVC ratio. The significant relationship of high grade dyspnea with BMI (p=0.001), and MUAC (p=<0.001) revealed that malnourished COPD patients had more shortness of breathing as compared to normal-weight patients. Similarly, the association of FEV1% with BMI (p=0.001), and MUAC (p=<0.001) showed that malnourished patients had very severe type of COPD than normal-weight patients. CONCLUSION: Dyspnea and severity of disease had significant association with BMI and MUAC among COPD patients. Thus, assessment of nutritional status by measuring BMI and MUAC should be considered to predict the severity of disease among adult COPD patients.

Hypoalbuminemia predicts intensive care need among adult inpatients with community acquired pneumonia: a cross sectional study.

INTRODUCTION: Various scales helped physicians to decide the site of care of pneumonia patients, but had certain limitations. Literature review suggested that serum albumin and B/A ratio predict the site of care but more evidences were required. Therefore, the study was aimed to evaluate the role of serum albumin and B/A ratio in the prediction of intensive care need among patients with community acquired pneumonia. METHODOLOGY: The cross-sectional analytical study enrolled 134 adult inpatients with pneumonia from Sir Ganga Ram Hospital, Lahore, Pakistan during September 2014 to December 2016. Serum albumin, creatinine and urea levels were estimated; and BUN, B/A ratio and CURB-65 scores were calculated to predict the need of ICU. RESULTS: Overall mean age was 50 ± 21 years, and 54.5% patients were females. The patients (19.4%) who required treatment in ICU had significantly lower albumin levels (p = 0.001); elevated BUN levels (p = 0.003), B/A ratio (p = 0.001) and CURB-65 score (p = 0.038); and longer hospital stay (p = 0.002). Hypoalbuminemia showed significant association with the requirement of ICU (OR: 7.956; p = 0.001). The optimal cut-off point of serum albumin to predict ICU need was 3.4 g/dL (50% sensitivity; 89% specificity). Low serum albumin was revealed as a good predictor of requiring treatment in ICU (AUC 0.718). CONCLUSIONS: Hypoalbuminemia was a good predictor of requiring ICU treatment. Elevated B/A ratio and BUN levels showed significant association with ICU need. Serum albumin estimation before hospitalization might be used independently or additional with established criteria to decide the site of care.