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Background: To evaluate the effect of Tamoxifen on plasma lipid profile in breast cancer patients presenting at tertiary care hospitals. Methods: It was a longitudinal study conducted at the Department of Oncology of Jinnah Postgraduate Medical Center from December 2018 to November 2019. Eighty-eight females aged 26-66 years diagnosed with breast cancer were included in the study using a non-probability consecutive sampling technique. Detailed gynaecological and clinical investigations and detailed history were taken. The blood samples of all the patients were collected and the plasma lipid profile was measured before initiation of Tamoxifen treatment and three- and six-months post-treatment at the clinical laboratory. The plasma lipid profile includes the measurement of Total cholesterol (mg/dl), Triglyceride(mg/dl), High-density Lipoprotein (mg/dl) & Low-density Lipoprotein (mg/dl). SPSS version 23 was used to analyse data. Results: After treatment, there was a significant reduction in serum cholesterol & Low-density Lipoprotein level by 20.54 mg/dl & 16.46 mg/dl at 3 months (p<0.05), moreover there was a significant increase in Triglyceride by 22.14 at 3 months (p<0.05). No significant difference was observed in High density lipoprotein level at 3 months after using Tamoxifen. At 6 months there was a significant reduction in serum cholesterol and low-density lipoprotein by 32.29mg/dl and 24.11 mg/dl at 6 months (p<0.05), moreover there was a significant increase in Triglyceride level by 42.19 mg/dl at 6 months (p<0.05). No significant difference was observed in High-density lipoprotein level at 6 months after using Tamoxifen. Conclusion: Total cholesterol and Low-density Lipoprotein levels showed significant reduction over the period of six months from the baseline with the use of Tamoxifen. Hence Tamoxifen should be considered to have an added advantage on lipid metabolism and therefore, can reduce the risk of cardiovascular events. [ABSTRACT FROM AUTHOR]

Objective: To assess the correlation between tumor size and stage of tumor among BMI categories in females presenting with breast cancer at a tertiary care hospital of Karachi. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Nov 2018 to Dec 2019. Methodology: One eighty-seven women presenting with histologically proven breast carcinoma of age more than 20 years were included. Body Mass Index was estimated by dividing weight in kilogram with height in meter square (BMI=Weight/Height kg/m²). The data regarding histological type and grade, stage of tumor, tumor size, lymph node status, hormone receptor status and menopausal status were also collected. Results: On comparing body mass index categories with clinic-pathological factors; menopausal status, ER status, PR status, HER 2/Neu status and lymph node status showed statistically significant difference between groups (p<0.05). Underweight patients showed very strong correlation between stage and tumor size (r=0.894), whereas obese (r=0.678) and normal weight (r=0.676) females showed strong correlation between stage and tumor size. Conclusion: In conclusion, the present study reveals that body mass index is significantly associated with menopausal status, ER status, PR status, HER 2/Neu status and lymph node status. Though obesity is a modifiable factor which carries risk of developing fatal diseases, data relevant to obesity and breast cancer outcomes is still erratic. We further recommend more indepth study in this context. [ABSTRACT FROM AUTHOR]

Objectives: To find the association of breastfeeding and the risk of breast cancer in our population. Study Design: Case-control study. Place and Duration of Study: Oncology Ward-4 at Jinnah Postgraduate Medical Center, Karachi Pakistan, from Jun 2018 to Jun 2019. Methodology: All patients with diagnosed Breast Cancer visiting the outpatient department were enrolled in this study. Controls were randomly selected from the community. Demographic characteristics, reproductive history, breastfeeding pattern, and hormonal status of cancer were collected from all participants. Results: Among patients who had a positive history of breastfeeding were three times more likely to develop breast cancer than those with no history of breastfeeding [Odds Ratio 3.315 (95% Confidence Interval: 2.094-5.249)]. 69.7% of participants in our study breastfed for more than 2 years. There was also a weak inverse association between lactation amenorrhea and breast cancer risk. Women who experienced lactation amenorrhea had only half the risk of women who did not experience lactation amenorrhea [Odds Ratio 0.685 (95% of Confidence Interval: 0.397-1.182)]. Conclusion: There was a negative relationship between breast cancer and breastfeeding. Further research should explore the genetic and cultural differences and the risk of breast cancer. [ABSTRACT FROM AUTHOR]

Objective: To see the type and frequency of lymphomas. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Medical Oncology at Jinnah Postgraduate Medical Centre, Karachi from Jan 2019 to Dec 2019. Methodology: Total of 150 patients with histopathological diagnoses of lymphoma of 17 to 71 years of age of either gender were included in the study using non-probability consecutive sampling technique. Prior to initiation of study ethics review committee has approved the study (NO.F.2-81-IRB/2019-GENL/10261/JPMC). The data regarding lymphoma type, histology, stage of disease, site, involvement of bone marrow, presence of B-symptoms were recorded. Results: Majority of the patients were male i.e., (n=104, 69.3%) with the mean age of 45.29±17.76 years. Non-Hodgkin's Lymphoma presented as the most common type of lymphoma i.e., (n=107, 71.3%) whereas Hodgkin's lymphoma (HL) contributed for (n=43, 28.7%) cases. Assessment of clinicopathological features of lymphomas revealed that (n=58, 38.7%) cases had bone marrow involvement. B-symptoms appeared in (n=102, 68%) cases, (n=61, 40.7%) cases were stage IV and the most common site were Neck lymph nodes (n=82, 58.3%), followed by abdomen (n=20, 13.3%). There was statistically significant difference between type of lymphoma with respect to age (p=0.001) and gender(p=0.015) Conclusion: Among lymphomas the most common type of lymphoma was Non-Hodgkin's Lymphoma, most common in patients >45 years of age showing relationship of its occurence with age and DLBCL is major subtype and among Hodgkin's lymphoma Classical type is the predominant type Epidemiologic characteristics and distribution of the disease varies with geographical region, racial & environmental factors. [ABSTRACT FROM AUTHOR]

Objective: To see the association between dietary habits in the development of oesophageal carcinoma. Study Design: Case control study. Place and Duration of Study: Department of Medical Oncology at Jinnah Postgraduate Medical Centre, Karachi Pakistan, from Feb 2019 to Dec 2019. Methodology: Patients from age 15-80 years of either gender were included in the study. All the patients presenting to hospital OPD with histopathologically confirmed of oesophagus carcinoma were included. Controls were the healthy attendants coming at the same hospital. The data was collected through pre-designed questionnaire. Results: Total of 173 cases and 173 controls were included in the study. The mean age of the cases and controls were reported as 48.07±14.13 years and 48.86±15.32 years. After adjusting odds in multivariate analysis family history of cancer (OR=3.76; 95% CI: 1.76-7.90, p<0.05), the consumption of chicken (OR=5.22; 95% CI: 3.01-9.056, p<0.05), red meat (OR=5.06; 95% CI: 2.70-9.46, p<0.05) & smoked food (OR=3.36; 95% CI: 1.76-6.44, p<0.05) more than three times per week remained positively associated with oesophagus carcinoma. Conclusion: The study showed association between consumption of chicken, red meat, hot drinks & smoked food with oesophageal carcinoma. [ABSTRACT FROM AUTHOR]

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. Conclusion: This study indicated that Tamoxifen has a significant correlation with the increase in weight in hormone receptor-positive breast cancer patients in our population. [ABSTRACT FROM AUTHOR]

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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background: Acute myeloid leukaemia (AML) is malignant neoplasms of myeloid cells categorized by clonal expansion of hematopoietic blasts of myeloid lineage in peripheral blood and bone marrow. The aim of current study is to identify the common cytogenetic abnormalities in AML patients presenting at a tertiary care hospital of Pakistan. Methods: It was a cross-sectional study conducted at the department of Medical oncology of the Jinnah Postgraduate Medical Center, Karachi from Jun 2017- Jan 2019. The non-probability consecutive sampling technique was used to select patients. Total 92 cases of AML of age 15–55 years of either gender were included in the study. The detection of cytogenetic abnormality was done on the bone marrow biopsy. The cytogenetic abnormalities were classified into the three cytogenetic risk groups as favourable, intermediate and unfavourable. For analysis of data SPSS 23 version was used. Results: The cytogenetic abnormalities were detected in 34 (37%) of the AML patients while 58 (63%) patients had normal cytogenetic. Thirty-two females (34.8%) had a normal cytogenetic (46; XX), and 15 females (16.3%) had various cytogenetic abnormalities. Twenty-six males (28.3%) had normal cytogenetic (46; XY) and 19 males (20.7%) had various cytogenetic abnormalities. Most of the patients were in intermediate risk group (67.4%), followed by favourable (17.4%) and unfavourable risk group (15.2%). The most frequent chromosomal abnormalities observed were complex cytogenetic which was detected in 5 AML patients. Conclusion: In the present study cytogenetic abnormalities were found in 37% of AML patients. Sixty-seven of the AML patients were in intermediate risk group and five patients had complex cytogenetic. Hence the cytogenetic analysis provides significant information regarding prognosis of AML patients and the cytogenetic abnormalities are less than international literature. [ABSTRACT FROM AUTHOR]

Chronic idiopathic urticaria (CIU) is a disease with significant impact on the quality of life owing to its morbidity and relative high prevalence. Omalizumab is a recombinant monoclonal antibody against IgE that inhibits binding of IgE to FcεRI on the cell surface of mast cells. Its role has been thoroughly studied in asthma. We present a case series focusing on the role of subcutaneous omalizumab in the treatment of CIU along with its safety profile in terms of immediate and late side effects. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effect of Tamoxifen on plasma lipid profile in breast cancer patients presenting at tertiary care hospitals., Methods: It was a longitudinal study conducted at the Department of Oncology of Jinnah Postgraduate Medical Center from December 2018 to November 2019. Eighty-eight females aged 26-66 years diagnosed with breast cancer were included in the study using a non-probability consecutive sampling technique. Detailed gynaecological and clinical investigations and detailed history were taken. The blood samples of all the patients were collected and the plasma lipid profile was measured before initiation of Tamoxifen treatment and three- and six-months post-treatment at the clinical laboratory. The plasma lipid profile includes the measurement of Total cholesterol (mg/dl), Triglyceride(mg/dl), High-density Lipoprotein (mg/dl) & Low-density Lipoprotein (mg/dl). SPSS version 23 was used to analyse data., Results: After treatment, there was a significant reduction in serum cholesterol & Low-density Lipoprotein level by 20.54 mg/dl & 16.46 mg/dl at 3 months (p<0.05), moreover there was a significant increase in Triglyceride by 22.14 at 3 months (p<0.05). No significant difference was observed in High density lipoprotein level at 3 months after using Tamoxifen. At 6 months there was a significant reduction in serum cholesterol and low-density lipoprotein by 32.29mg/dl and 24.11 mg/dl at 6 months (p<0.05), moreover there was a significant increase in Triglyceride level by 42.19 mg/dl at 6 months (p<0.05). No significant difference was observed in High-density lipoprotein level at 6 months after using Tamoxifen., Conclusions: Total cholesterol and Low-density Lipoprotein levels showed significant reduction over the period of six months from the baseline with the use of Tamoxifen. Hence Tamoxifen should be considered to have an added advantage on lipid metabolism and therefore, can reduce the risk of cardiovascular events.