Cancer incidence in Khyber Pakhtunkhwa, Pakistan, 2020.

BACKGROUND: To present the population-based cancer statistics for Khyber Pakhtunkhwa (KP), Pakistan, an incidence study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan, in 2023. METHODS: Records from various centres on new cancers diagnosed among residents of KP between January and December 2020 were gathered. Both active and passive methods of data collection were applied, and the information was saved in a central repository at SKMCH&RC. The incidence rates were computed by age group and sex and presented per 100,000 population. RESULTS: Among children (0-14 years), the Age-Standardised Incidence Rate (ASIR) was 4.0 in girls and 6.1 in boys, and haematologic malignancies were more prevalent; in adolescents (15-19 years), the ASIR was 7.7 in females, 9.4 in males, and bone tumours, haematologic malignancies, and neurological cancers were prominent; in adult females (> / = 20 years), the ASIR was 84.9, and cancers of the breast, digestive system, and reproductive organs were predominant; and adult males, the ASIR was 73.0, and cancers of the gastrointestinal tract, lip/oral cavity/pharynx, prostate, and Non-Hodgkin Lymphoma (NHL) were common. CONCLUSIONS: It is crucial to investigate the aetiology of these diseases at the community level because dietary elements, infectious diseases, and tobacco use all appear to be significant contributors. Prospective studies could play a key role in highlighting the factors linked to these diseases. Therefore, cancer registration must continue in conjunction with the exploration of risk factors.

Frequency of Dengue Virus Serotype 1 in Lahore by In-house assay.

Dengue is an important systemic viral infection that is caused by the dengue virus. Ribonucleic acid (RNA) from dengue NS1 positive samples, collected randomly during dengue epidemic from October 2016 to October 2017 at Chugtai Lab, was extracted for nucleic acid. Both the detection and serotyping of dengue samples were performed using real-time PCR on Rotor Gene Q. From the 70 NS1 positive samples, 57 (81.4%) samples were confirmed to be positive for dengue virus RNA, while the remaining 13 (18.6%) were negative. Serotype 1 (DEN-1) was verified among all samples by in-house assay and using commercial kit FTD (Fast Track Diagnostics) dengue differentiation; it was concluded that our in-house assay is in 100% concordance with commercial kit. Serotype 2 (DEN-2) and serotype 3 (DEN-3) have been documented in Pakistan since 1994. But recent detection of serotype 1 in Pakistan is indicative of more severe dengue haemorrhagic fever in future due to reinfection.

Reference Interval of Serum Gastrin 17 (G-17) for Healthy Population: A Non-Invasive Screening Biomarker for Gastric Disorders.

OBJECTIVE: To analyse fasting serum concentrations of G-17 in healthy individuals to establish the reference intervals (RIs) in the Pakistani population. STUDY DESIGN: Cross-sectional, observational study. Place and Duration of the Study: Department of Clinical Chemistry and Immunology, Chughtai Institute of Pathology, Lahore, Pakistan, from October to December 2022. METHODOLOGY: Fasting serum samples from one hundred and twenty healthy individuals between the age of 18-65 years were collected according to the CLSI recommendations after taking written informed consent. Samples were analysed on the auto-analyser for the quantitative measurement of serum G-17 by sandwich chemiluminescence immunoassay. Kolmogorov-Smirnov test was applied to check normality. A p-value of <0.05 was considered significant; 2.5th and 97.5th percentiles were computed using the formula 0.025 (n+1) and 0.0975 (n+1), respectively. RESULTS: Of the 120 samples, 74 were obtained from male patients and 46 from females. The mean age was 30.2 ±10.36 years. The histogram revealed a non-parametric distribution of the data. The established reference intervals by the rank-based method were 2.31 pg/mL and 49.36 pg/mL which corresponds to 2.5th and 97.5th percentiles, respectively. These were markedly different from the Chinese reference ranges. CONCLUSION: Ethnic and geographic variations affect the trends of RIs of Serum G-17. There is a need to establish its population-specific RIs for G-17, so it can be used as a non-invasive option in identifying patients requiring invasive endoscopic intervention. KEY WORDS: Gastrin, Atrophic Gastritis, Biomarker, Reference values.

Highly Sensitive and Ultrafast Liquid Chromatography-tandem Mass Spectrometry Internal Standard Method for Determination of Alpha-Tocopherol in Serum and Application of Validated Method on Patient Serum Samples in Pakistan.

OBJECTIVE: To optimize and validate a specific, sensitive and fast liquid Chromatography coupled to triple quadrupole Mass Spectrometric (LC-MS / MS) technique for accurate detection of serum α-tocopherol (Vitamin E) levels. STUDY DESIGN: An experimental based study. PLACE AND DURATION OF STUDY: The Clinical and Forensic Toxicology section of Chughtai Lab, Jail Road Lahore, from April to September 2022. METHODOLOGY: Methanol was used to deproteinize serum samples. The chromatographic separation was achieved using an Agilent Infinity-Lab Poroshell 120EC-C18 column, Agilent 6470 LC-MS/MS (equipped with an Electron Spray Ionization source) in gradient elution mode using 0.1% LCMS grade formic acid in water and LCMS-grade methanol as mobile phases. Hexa-deuterated α-tocopherol was employed as internal standard to minimise matrix interferences. RESULTS: The retention time of α-tocopherol was 3.0 ± 0.1 minutes. The linear concentrations obtained were ranged from 0.05-2 mg/dL with ≥0.985% coefficient of linearity. Detection and lower quantification limits determined were 0.025mg/dL and 0.05mg/dL, respectively. Recovery ranged from 96.5 to 99.8% and ionization suppression was -15.2% and -15.9% at high and low concentrations of α-tocopherol in serum. Intra-day and inter-day coefficient variation values were 4.2-4.9% and 5.0-5.9%, respectively. CONCLUSION: An efficient and reliable tandem mass spectrometric technique for vitamin E analysis in serum was optimized, validated, and applied to 80 patient samples. This method has usefulness in clinical application for the accurate determination of vitamin E without potential matrix interferences. KEY WORDS: Vitamin E, LC-MS/MS, Tocopherol, Internal standard, Validation.

Cancer in Faisalabad and Nankana Sahib, Pakistan: 2017-2019; An Observational Study.

Introduction: The Punjab Cancer Registry's catchment area includes the districts of Faisalabad and Nankana Sahib. It is an observational and descriptive study that covers the 3 years from 2017 to 2019, evaluating the distribution of cancer in these two districts. Material and Methods: Data on incident cancer cases diagnosed between 2017 and 2019 among residents of Faisalabad and Nankana Sahib in Pakistan, reported by the participating centres of the Registry, were reviewed retrospectively. Figures and proportions for adults, children and adolescents were computed. Results: During 2017 and 2019, 5678 cases were reported from Faisalabad and 390 from Nankana Sahib, with over 50% seen in females. In both districts combined, among adult females, cancers of the breast, reproductive system, and hepatobiliary system were commonly diagnosed, while cancer of the lip/oral cavity/pharynx, hepatobiliary system and non-Hodgkin lymphoma were the leading diagnoses among adult males. In children and young adults (0-19 years), acute lymphoblastic leukaemia, Hodgkin lymphoma and non-Hodgkin lymphoma were the most common diagnoses. Conclusion: The cancer distribution reported from Faisalabad and Nankana Sahib is of utmost importance. However, the underreporting of cancer cases cannot be ruled out. More input from the collaborators is needed to ensure the completeness of cancer surveillance in the region.

Seroconversion in Newly Diagnosed Cases of Coronavirus Disease.

OBJECTIVE: To determine the percentage of seroconverted real time reverse transcriptase polymerase chain reaction (RT-PCR) positive coronavirus disease (COVID-19) cases at different days post-symptom onset; and also find the agreement of chemiluminescence assay used for total antibody detection using RT-PCR as a reference method. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Chughtai Institute of Pathology from April to May 2020. METHODOLOGY: Fifty pre-pandemic samples (healthy population) and 75 COVID-19 patients were included in the study. RT-PCR confirmed COVID-19 patients were divided into 3 equal groups (25 each), according to the days of symptom onset. The samples were analysed using electro-chemiluminescence as assay principle. Positive and negative agreement of COVID-19 antibodies was calculated using EP evaluator to find out the sensitivity of chemiluminescence assay for total antibody detection. The results were analysed using SPSS version 23.0. RESULTS: All the pre-pandemic samples tested were negative for antibodies with a negative agreement of 100%. Total agreement at day 7 post-symptom onset was 84%; whereas, it was 94% at day 14 and increased rapidly to 100% at day 21 post-symptom onset. At day 7 post-symptom onset, 68% of patients were seroconverted; and this percentage was 88% and 100% at day 14 and 21 post-symptom onset, respectively. CONCLUSION: Pre-pandemic samples were non-reactive for COVID-19 antibodies and seroconversion started within the first week post-virus exposure. There was 100% concordance between RT-PCR result and antibody positivity 21 days post-symptom onset. Key Words: COVID-19, SARS CoV-2, Seroconversion, Chemiluminescence.

Frequency of COVID-19 IgG Antibodies among Special Police Squad Lahore, Pakistan.

OBJECTIVE: To find out the sero-prevalence of COVID-19 IgG antibodies among policemen performing duties at high risk areas of Lahore, Pakistan. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: Chughtai Lab Lahore from 20th to 30th May 2020. METHODOLOGY: One hundred and fifty-four young policemen (mean age 27.1 ±3.8 years) were included in the study after written consent. Squad officers who had any sign of acute respiratory infection were excluded from the study. The participants were asked to fill a questionnaire regarding nature of exposure with the infected cases, kind of personal protective equipment they are provided with and living arrangements. Three ml of blood samples were collected from the participants and immediately sent to the lab for analysis. COVID-19 IgG antibodies were analysed using chemiluminescence immunoassay method on Architect Ci8200 (Abbott). SPSS 23.0 was used for data analysis. RESULTS: All participants were males and mean age was 27.1 ±3.8 years. Out of 154 squad members, 24 were reactive for COVID-19 IgG antibodies and performing duties at the areas of high virus exposure. None of COVID-19 IgG reactive cases exhibited symptoms and most of them performed duties at high risk areas with only masks provided as personal protective equipment. Only 10% of the participants who were exposed to confirmed cases of COVID-19 were found to have anti-COVID IgG. CONCLUSION: COVID-19 IgG antibody reactive cases may not show any symptoms. Police force is at high risk of exposure. Serosurveys can help to find the spread of infection in the community and aid in planning healthcare strategies. Key Words: COVID-19, SARS CoV-2, Seroprevalence, Pandemic, Asymptomatic cases.

Cancer Epidemiology in Lahore, Pakistan - 2010-2015.

OBJECTIVE: To study the cancer incidence rates in Lahore, which has an estimated annual population count of 10.3 million. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Data on new cancer cases diagnosed between 2010 and 2015, among the residents of Lahore district, Pakistan, was reviewed retrospectively in 2015-2017. METHODOLOGY: Nineteen collaborating centres of the population-based Punjab Cancer Registry (PCR), representing both the government and private sectors, reported their cases to the coordinating office located within the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC). The age-standardised incidence rates (ASIR) per 100,000 population, over a six-year period, were computed. Sixteen 5-year age groups were created beginning from 0-4 to 70-74 years, followed by 75+ years. Graphs on the five-year age-specific incidence rates by gender, were also generated. RESULTS: Between 2010 and 2015, 33,028 new malignancies were recorded in Lahore, with the crude average annual incidence rate being 53.1. In adults, the highest ASIRs were noted for cancers of the breast (77.3) among females and of prostate (11.4) in men. Age-specific incidence rates for female breast cancer showed an upward trend at the age of 20 years, reaching a figure of 160 at the age of 55 years. Among males, the rates for prostate cancer started to increase at the age of 55 years and reached a peak of 93 at 75 years. CONCLUSION: These results warrant expanding cancer registration in the region and sharing statistics with policy-makers to establish hospitals accordingly to manage cancer, along with exploring various risk factors within the population.