Clinical profile and outcomes of adult oncological patients presenting to the emergency department of a tertiary care hospital.

OBJECTIVE: To determine the clinical presentations, diagnosis, and outcomes of oncological patients presenting to the emergency department of a tertiary care hospital. METHODS: The single-centre, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, from January 1 to December 31, 2018, and comprised all adult patients with diagnosed solid or haematological malignancy. Demographical and clinical data was recorded from medical record files. The immediate outcomes were reported as hospitalisation or discharge from the emergency department. Data was analysed using SPSS 20. RESULTS: Of the 320 patients, 167(52.2%) were females. Overall, 214(66.9) patients were aged 35-64 years. Most of the patients had solid organ malignancy 276(86.2%), with the most common being breast carcinoma 60(18.8%). Among haematological malignancies, B-cell lymphoma 32(10%) was the most common. The most common symptoms at presentation were vomiting 78(24.4%), fever 77(24.1%), and generalised weakness 66(20.6%). Of the total, 240(75%) patients were admitted and 80(25%) were discharged. The most common discharge diagnosis was chemotherapy-induced vomiting, followed by febrile neutropenia and malignant hypercalcaemia. There were 26(10.8%) deaths among the in-patients. CONCLUSIONS: Cancer patients presented to the emergency department with diverse signs and symptoms. It is essential for physicians in the emergency department to be familiar with their presentations in order to initiate prompt and timely management plans for better clinical outcomes.

Genome-wide analysis of blood lipid metabolites in over 5000 South Asians reveals biological insights at cardiometabolic disease loci.

BACKGROUND: Genetic, lifestyle, and environmental factors can lead to perturbations in circulating lipid levels and increase the risk of cardiovascular and metabolic diseases. However, how changes in individual lipid species contribute to disease risk is often unclear. Moreover, little is known about the role of lipids on cardiovascular disease in Pakistan, a population historically underrepresented in cardiovascular studies. METHODS: We characterised the genetic architecture of the human blood lipidome in 5662 hospital controls from the Pakistan Risk of Myocardial Infarction Study (PROMIS) and 13,814 healthy British blood donors from the INTERVAL study. We applied a candidate causal gene prioritisation tool to link the genetic variants associated with each lipid to the most likely causal genes, and Gaussian Graphical Modelling network analysis to identify and illustrate relationships between lipids and genetic loci. RESULTS: We identified 253 genetic associations with 181 lipids measured using direct infusion high-resolution mass spectrometry in PROMIS, and 502 genetic associations with 244 lipids in INTERVAL. Our analyses revealed new biological insights at genetic loci associated with cardiometabolic diseases, including novel lipid associations at the LPL, MBOAT7, LIPC, APOE-C1-C2-C4, SGPP1, and SPTLC3 loci. CONCLUSIONS: Our findings, generated using a distinctive lipidomics platform in an understudied South Asian population, strengthen and expand the knowledge base of the genetic determinants of lipids and their association with cardiometabolic disease-related loci.