Ethnic predisposition, risk factors and breast cancer presentation; a 10-year data. Single centered prospective cohort study from Karachi.

Background: Breast cancer, a leading cause of mortality among females, has been the center of research for many decades. Work is in progress to advance the research worldwide and in our region. This study is conducted to look into regional ethical predilection/age, clinical presentation/stage, pathological subtypes and risk factors of BC among patients of Karachi, with the aim of proposing a ground in our policy making regarding protocol setting for screening and management of BC patients. Methods: A prospective cohort study started at public Hospital, Karachi from 2010 to 2020.500 females with histo-pathologically proven BC selected. History, clinical examination, radiological and histo-pathological data retrieved; data regarding age, ethnicity, family history, parity, marriage/menopause, stage/lump size/symptoms were filled on pro-forma. Primary outcomes were age, ethnicity, family history, stage/histological type and menopausal status of our cohort while secondary outcomes were parity, marriage, symptoms and lump size/site. Data analyzed using SPSS in ranges and percentages. Results: Among different ethnicities, Makrani were the most affected(34%). Majority were premenopausal females ≤50yrs (78%). Infiltrating ductal carcinoma (88.8%) was the commonest subtype. Family history was positive in few (5.8%). Parity and marital status had no effect on our population. Breast lump (88%) was the commonest presenting symptom and 51% of our patients had the right side involved. Upper outer quadrant (51%) was the most involved quadrant and the majority (46%) were stage II. Conclusions: Age of presentation is around a decade earlier in our region, with women of Makrani descent more prone to develop BC. 2/3rd of patients were premenopausal, with lump breast as primary complaint. Majority of patients presented in stage-II. Results of age and racial predilection in our population suggest us to concentrate future research more on genetic profiling so we incorporate the results to devise population specific protocols with reference to age, presentation, BC type, ethnicity & risk factors.Record submitted retrospectively at ClinicalTrials.govt on 09-07-2022 NCT05458570 .

Association of serum leptin with serum estradiol in relation to breast carcinogenesis: a comparative case-control study between pre- and postmenopausal women

Background/aim: The aims of this study were to observe the interhormonal relationship of serum leptin with serum estradiol and to compare pre- and postmenopausal women for possible implications in breast carcinogenesis. Materials and methods: This comparative case-control study encompasses 175 breast cancer patients and 175 age-, sex-, and BMI- matched healthy controls. For comparison, the subjects were divided into pre- and postmenopausal groups according to their menstrual history. Blood samples were analyzed for serum leptin and serum estradiol by the ELISA method. Results: Higher mean values of serum estrogen and leptin were observed in breast cancer cases among both the pre- and postmenopausal groups. While estimating the association of serum leptin with serum estradiol, a weak positive (r = 0.186) but statistically significant (P = 0.022) correlation was found among the premenopausal subjects, while a moderate positive association (r = 0.556) was found among the postmenopausal subjects, which had high statistical significance (P = 0.001). Furthermore, correlation coefficients (r) of the pre- and postmenopausal groups were compared using Fisher r-to-z transformation and found to have a statistically significant difference (z = 4.03, P = 0.0001). Conclusion: The findings of this study suggest the mitogenic effects of leptin on mammary tissue via augmenting peripheral estrogen production more significantly among postmenopausal subjects. Thus, the therapeutic modulation of leptin may be a potential adjuvant treatment for breast cancer patients with high levels of leptin along with high estrogen concentration as a consequence.

Sporadic Case of Peutz-Jeghers Polyp in a 14-Year Boy.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant hamartomatous polyposis of the gastrointestinal tract, with pigmentation around lips, the buccal mucosa, and anal area. Patients have a strong family history. Patients of PJS present with abdominal pain, blood in stools, and occasionally melena because of polyps, along with classical mucocutaneous pigmentation. Very rarely a sporadic case of Peutz-Jeghers syndrome occurs in early childhood and adolescent. The case of a 14-year boy is reported, who presented with intussussception and bleeding per rectum due to jejunal polyp and a rectal polyp. Intussussception was treated by resection anastomosis due to vascular impairment. Rectal polyp was removed during colonoscopy. There was no family history of Peutz-Jeghers syndrome or polyps but patient had classical mucocutaneous pigmentation of buccal mucosa. Therefore, this case is of sporadic Peutz-Jeghers polyp (PJP), which is a rare disorder.

Serum Adiponectin Level Association with Breast Cancer Risk: Evidence from a Case-Control Study.

BACKGROUND: Adiponectin is a protein, synthesized by adipose tissue, which has a questionable role in breast cancer pathogenesis. This study focused on serum levels of adiponectin among cases and controls, and its possible association with breast cancer risk. MATERIALS AND METHODS: This case-control study covered 175 diagnosed breast cancer patients with positive histopathology from Breast Clinic, surgical unit-1, Civil Hospital, Karachi and 175 healthy controls from various screening programs. Blood samples were obtained after an overnight fast and later analyzed. RESULTS: Fasting blood glucose was significantly raised, while serum adiponectin was significantly decreased in breast cancer cases when compared to control subjects. To find the precise influence of serum adiponectin on the risk of breast cancer, subjects were divided in to quartiles based on serum levels of adiponectin. It is observed that risk of breast cancer decreased with rising quartile. Q2 (25th-50th) had the highest OR=1.76 (CI: 0.93-3.34), Q3 (50th-75th) has OR=0.89 (CI: 0.48-1.64), while subjects in the highest quartile Q4 (>75th) had significantly (p< 0.05) decreased risk of breast cancer having OR=0.06 (CI: 0.02-0.15), when compared to the lowest quartile. CONCLUSIONS: We demonstrated a statistically significant association of elevated serum adiponectin with decreased risk of breast cancer. This signifies a protective role of adiponectin via an intricate mechanism of masking mitogenic growth factors in breast carcinogenesis.

Elevated fasting blood glucose is associated with increased risk of breast cancer: outcome of case-control study conducted in Karachi, Pakistan.

BACKGROUND: There are several validated risk factors for breast cancer. However the legitimacy of elevated fasting blood glucose (FBG) is not well established. This study was designed to assess this parameter as a risk factor for breast cancer among pre- and post-menopausal women. MATERIALS AND METHODS: This case-control study was conducted at Department of Biochemistry, University of Karachi from June 2010 to August 2014. Simple random sampling technique was used to collect data of study subjects comprising 175 diagnosed breast cancer patients with positive histopathology from Breast Clinic, surgical unit-1, Civil Hospital, Karachi and 175 healthy controls from various screening programs. Blood samples were analyzed for FBG and serum insulin. RESULTS: FBG, HOMA-IR, systolic and diastolic blood pressure were significantly raised in breast cancer cases when compared to control subjects. Cases and controls were further categorized in to two groups using cutoff value of 110 mg/dl to distinguish subjects into normal fasting glucose (<110 mg/dl) and having impaired fasting glucose (≥110-≤125 mg/dl) or diabetes (≥126 mg/dl). Odds ratios were found to be 1.57, 2.15 and 1.17 in overall, pre-menopausal and post-menopausal groups, respectively. (all p<0.05). CONCLUSIONS: A statistically significant risk of breast cancer exists in women having elevated fasting blood glucose levels, corresponding to prediabetes and diabetes, among pre and postmenopausal ages, with comparatively greater effects in the premenopausal group.

Non-Hodgkin's lymphoma of the breast presenting as breast abscess during pregnancy.

Primary non-Hodgkin's lymphoma of the breast is an uncommon disease. In all patients with breast lump, primary lymphoma of breast should be considered as it is one of the most easily missed pathology. We report a case of a 22 years old lactating mother who presented with the complaint of a painful swelling in the right breast, noticed during the last trimester of her pregnancy, mimicking breast abscess.

Postoperative use of drain in thyroid lobectomy - a randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan.

BACKGROUND: Thyroidectomy is a common surgical procedure, after which drains are placed routinely. This study aims to assess the benefits of placing postoperative drains, its complications and affects on postoperative stay, in thyroid lobectomy. METHODOLOGY: Randomized Clinical Trial of 60 goitre patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July'11-December'11. Patients were randomly assigned into drain and non drain groups. Patient demographics, labs and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in non drain group it was calculated by ultrasound of neck on first and second post-op days. Data was entered and analyzed on SPSS v16 using Independent T tests. RESULT: The mean total drain output for 2 days in non-drain group was significantly lower 10.67 (±9.072) ml while in drain group was 30.97 (±42.812) ml (p = 0.014). The mean postoperative stay of drain group (79.2 ±15.63 hours) was significantly higher, as compared to mean postoperative stay of non drain group (50.4 ±7.32 hours). Mean Visual Analogue Score (VAS) for pain day 1 (6.2 ±0.997) and day 2 (4.17 ±0.95) in drain group were significantly higher compared to day 1 (2.6 ±1.163) and day 2 (1.3 ±0.877 ) of non drain group. From drain group, 2 patients complained of stridor, dyspnea on Day 1 which subsided by Day 2 and 1 case of voice change, with no such complains in non drain group. No patients from both groups developed seroma, wound infection or hematoma. CONCLUSION: In uncomplicated surgeries especially for lobectomy, use of drain can be omitted.