Review of current literature on gestational trophoblastic neoplasia.

BACKGROUND: Gestational Trophoblastic Neoplasia (GTN) is a disease of the reproductive age group with an incidence rate of <1% among all tumors involving the female reproductive tract. It occurs because of aberrant fertilization. Patients are diagnosed early because of aggravated symptoms during pregnancy. Moreover, patients also bleed from the tumor sites, which leads to early presentation. A cure rate of 100% can be achieved with adequate treatment. MAIN BODY: In this literature review, the authors have brought to attention the risk factors, classification, and various treatment options in GTN patients according to their stratification as per the WHO scoring system. Patients are categorized into low and high risk based on the FIGO scoring system. Patients with low risk are treated with single-agent methotrexate or actinomycin-D. Despite the superiority of actinomycin-D in terms of efficacy, methotrexate remains the first choice of therapy in low-risk patients due to its better toxicity profile. Multi-agent chemotherapy with etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine (EMA-CO) leads to complete remission in 93% of high-risk GTN patients. Around 40% of patients with incomplete responses are salvaged with platinum-based multi-agent chemotherapy. Isolated chemo-resistant clones can be salvaged with surgical interventions. CONCLUSION: The mortality in patients with GTN has significantly reduced over time. With adequate multi-disciplinary support, patients with GTN can ultimately be cured and can spend every day healthy reproductive life.

Significance of ca15-3 in carcinoma of the breast with Visceral metastases.

Background: The most common malignancy and second most common cause of death is breast cancer among women. About 2.09 million fatalities from breast cancer happened in 2018. The objective was to evaluate the elevated CA15-3 in breast cancer patients with visceral metastases presenting at the tertiary care hospital of Karachi. Methods: It was a cross-sectional study conducted at the Department of Oncology of Jinnah Postgraduate Medical Center from 15th December 2018 to 15th November 2019. Female patients aged 26-80 years diagnosed with visceral metastatic (defined as metastasis to lung, liver, brain and adrenal glands) breast cancer were included in the study. The diagnosis of breast cancer was confirmed on histopathology whereas the metastatic sites were evaluated using physical examination and imaging. The serum CA15-3 concentration was assessed using assay kits. The serum CA15-3 level of 0-32 U/ml was taken as normal range for all the patients whereas CA15-3 level greater than 32 U/L was considered as elevated CA15-3. SPSS version 23 was used to enter and analyze data. Results: A total of 139 females were included in the study. The mean age & BMI of the patients were reported as 46.5 years & 26.69 kg/m2. In the majority of the patients' metastases were detected in the liver (n=54), 92 in the lungs+ parenchymal disease, 20 in adrenal glands, 12 in pleural effusion and 10 in the brain. Out of 139 patients with visceral metastases, 52(37.4%) had normal CA15-3 level whereas 87 (62.6%) had elevated serum CA15-3 levels (>32 U/L). Conclusion: The serum CA15-3 tumour marker is elevated significantly in visceral metastases and can be used as a prognostic marker in metastatic breast cancer patients.

Exploring Liposomes for Lung Cancer Therapy.

Cancer is referred to as a pleiotropic disease-causing approximately 9.6 million deaths in 2018. Among all cancers, lung cancer was the leading cause of death in 2017, and 12% of fatalities were alone due to lung cancer. The associated risk factors in lung cancer include smoking (80-85%), chronic inflammation in the lungs, COPD, pulmonary fibrosis, environmental and occupational exposure to nickel, arsenic, chromates, etc. Early diagnosed patients' treatment plan includes chemotherapy, immunotherapy, radiotherapy, surgery, and tumor ablation. Many sorts of drug delivery carriers have been used in the past, usually in targeted chemotherapy. Liposomes are spherical shape vesicles containing a lipid bilayer and aqueous core, with potency to encapsulate both hydrophobic and hydrophilic drugs with minimal toxicity. These vesicles have a particle size of 0.02-1000 µm allowing selective passive targeting to the tumor's deeper tissues. Current publications on liposomes highlight their acceptance and best choice among all systems to deliver synthetic and herbal drugs to the lungs. This review focuses on many aspects, which include an in-depth analysis of potential anticancer drugs that have utilized the advantages of liposomes for effective lung carcinomatherapy and devices used to deliver the active agents to the pulmonary tissues. Investigations on ongoing, approved, and failed clinical trials and patents on products related to lung cancer have been highlighted to provide a critical review on the subject.

Lipid Engineered Nanoparticle Therapy for Burn Wound Treatment.

INTRODUCTION: Skin is the largest organ of the human body protecting the underlying organs and tissues from any foreign attack. Any damage caused in the skin may sometimes result in serious consequences within the internal body tissues. Burn is one such issue that damages the layers of the skin and thereby making the skin vulnerable and prone to any foreign matter entering and causing serious diseases. METHODS: An online literature assessment was steered for the lipid nanoparticles, burn wound treatments, and different types of nanoformulation. Appropriate information was taken from different electronic scientific databases such as Web of Science, Elsevier, Science Direct, Springer, PubMed, Google Scholar etc. Additional data was summarized from textbooks, local prints and scripts. RESULTS: Recent innovations and developments in nanotechnology-based drug delivery systems have shown promising results in minimizing the drawbacks associated with conventional therapies. Lipid based nanoparticles possess capabilities to deliver active agents to their target site without the possibility of degradation. Conventional therapy of burn wound is costly and the treatment is long lasting, making the patient uncomfortable. Moreover, it also doesn't yield satisfactory results or narrow effects. Encapsulation of bioactives inside the lipid core protects the active entity from pH and enzymatic degradations. CONCLUSION: This review highlights the drawbacks associated with conventional dosage forms. A lot of consideration is focused on the advancement of nanomaterials using innovative methods in wound care for treating burn wounds with a faster healing effect. This review article highlights recent developments in lipid based nanoformulations for the treatment of burn wound injury.

One Year Disease Free Survival In Acute Myeloid Leukemia Patients After Induction Remission.

BACKGROUND: Diagnostic karyotyping analysis is routinely used in acute myeloid leukaemia (AML) clinics. Categorization of patients into risk stratified groups (favourable, intermediate and unfavourable) according to cytogenetic findings can serve as a valuable independent prognostic factor. The aim of this study was to assess the one-year disease free survival rate in AML patients after induction remission presenting at tertiary care hospital of Karachi. METHODS: It was a longitudinal study conducted at the department of Medical oncology of Jinnah Postgraduate Medical Center, Karachi from Jun 2017-Jan 2019. Ninety-three diagnosed cases of AML of age 15-55 years of either gender were included in the study. All patients received the first cycle of "3+7" regime for induction chemotherapy. This includes Daunorubicin 45 mg/m2 on days 1 to 3 and Cytarabine in a dose of 100 mg/m2 from day 1-7. Marrow response was assessed on the 21th day of induction therapy. If the bone marrow includes lesser than five percent blast cells then it was labelled as complete remission (CR). The patients who achieved CR and normal haematopoiesis were eligible to receive 4 cycles of consolidation therapy with cytarabine 3 mg/m2 every 12 hour on days 1, 3 and 5. Consolidation cycles were monthly administered. All the patients who achieved CR were follow up for the duration of one year for disease free survival. On follow up monthly visits, outcomes were assessed using CBC report and physical examination. RESULTS: After 1 year, out of 72 AML patients, 19 patients remained in complete remission, 5 patients lost to follow up, 3 relapses, 19 showed persistent disease & 28 died during consolidation. According to cytogenetic status, CR was achieved in 6 patients (50%) with favourable cytogenetic, 14 patients (28%) with intermediate cytogenetic and 2 patients (20%) with unfavourable cytogenetic status. The highest median survival time was observed in patients with favourable cytogenetic status as 5.23 months. However, there was no significant difference was observed in survival time with respect to cytogenetic status. CONCLUSIONS: The "3+7" regime of Daunorubicin & Cytarabine is effective in inducing induction remission and increases 1 year survival, however chemotherapy related morality rate was high in unfavourable cytogenetic group.

Medical and Psychosocial Challenges Associated with Breast Cancer Survivorship.

Objective To assess the association between common survivorship issues and characteristics of breast cancer survivors presenting at a tertiary care hospital in Karachi, Pakistan.  Methodology This study was conducted in the medical oncology department of Jinnah Medical Postgraduate Center from March 27, 2019, to September 27, 2019. A number of 257 females of age group 18-90 years who had either completed their treatment or were undergoing treatment at the time were included using non-probability consecutive sampling techniques. Face-to-face interviews were personally conducted by the researcher, and data regarding the socio-demographics and common survivorship issues faced by breast cancer patients were obtained. The data acquired were entered and analyzed using SPSS version 23 (IBM Corp, Armonk, NY). Results The mean age of the breast cancer survivors were 42.58 ± 10.07 years. Of the main challenges, lack of energy received the highest mean score of 3.44 ± 1.26, followed by fatigue and financial issues. Overall the most common survivorship issue were financial issues (81.3%), followed by fatigue (80.9%), cessation of the menstrual cycle (66.1%), weak social support (59.1%), and cosmetic disfigurement (51.8%). Conclusion Breast cancer survivors have various psychological, medical, and social issues and may require unique attention during follow-up visits.

Association Of Weight Change In Breast Cancer Patients Undergoing Tamoxifen Treatment At A Tertiary Care Centre, Sindh, Pakistan.

BACKGROUND: Tamoxifen is a selective oestrogen receptor modulator; in the breast, it decreases the growth and proliferation of breast epithelial cells. We assessed the weight change after Tamoxifen use in breast cancer patients. METHODS: This was a single-centred, prospective, observational cohort study. All patients diagnosed with breast cancer with ER and/or PR positivity were enrolled in the study. Out of these, 90 patients who have been prescribed Tamoxifen treatment either in adjuvant or palliative setting gave their consent to participate. Demographic data, treatment plan, menstrual status, weight, BMI, serum fasting lipid profile, change in diet, and change in physical activity were recorded at the time of diagnosis and then quarterly until 1 year of treatment. RESULTS: A mean age of 42.12±8.5 years was reported, and the mean weight was 62.22±10.6 kg. The majority of the patients, i.e., 68 (75.55%) had advanced tumour stages (III and IV). The study reported that the mean weight of the patients changed significantly at different time intervals during the treatment course (p<0.0005). Moreover, there was an upward trend in weight from the time of starting Tamoxifen to 3-months (62.22±1.51 kg vs 62.88±1.45 kg, respectively). There was a statistically significant increase in weight at 6-month, 9-month, and 12-month of Tamoxifen treatment (63.72±1.46 kg, 64.35±1.42 kg, 65.12±1.44 kg, respectively). Also, most of the patients gained weight as time passed by. CONCLUSIONS: This study indicated that Tamoxifen has a significant correlation with the increase in weight in hormone receptor-positive breast cancer patients in our population.

Testing the limits of contextual constraint: Interactions with word frequency and parafoveal preview during fluent reading.

Contextual constraint is a key factor affecting a word's fixation duration and its likelihood of being fixated during reading. Previous research has generally demonstrated additive effects of predictability and frequency in fixation times. Studies examining the role of parafoveal preview have shown that greater preview benefit is obtained from more predictable and higher frequency words versus less predictable and lower frequency words. In two experiments, we investigated effects of target word predictability, frequency and parafoveal preview. A 3 (Predictability: low, medium, high) × 2 (Frequency: low, high) design was used with Preview (valid, invalid) manipulated between experiments. With valid previews, we found main effects of Predictability and Frequency in both fixation time and fixation probability measures, including an interaction in early fixation measures. With invalid preview, we again found main effects of Predictability and Frequency in fixation times, but no evidence of an interaction. Fixation probability showed a weak Predictability effect and Predictability-Frequency interaction. Predictability interacted with Preview in early fixation time and fixation probability measures. Our findings suggest that high levels of contextual constraint exert an early influence during lexical processing in reading. Results are discussed in terms of models of language processing and eye movement control.