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Objective: To evaluate comparison of intra-articular injection of Platelet Rich Plasma (PRP) and corticosteroids in patients with Temporo Mandibular Joint Dysfunction syndrome. Methods: This case-control study was conducted at Department of Oral Maxillofacial Surgery in a tertiary care hospital, Karachi. The inclusion criteria was patients with either gender aged from 25-50 years, previously diagnosed with TMJ dysfunctions syndrome not responding to conservative management. Patients with stage 3 & 4 TMD disease and uncontrolled comorbidities were excluded. After takinginformed consent predesigned questionnaire was used to collect information from patients, about their socio demographic and lifestyle-related factors. Based on clinical and radiological data as well as the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), a diagnosis of TMPDS was established. PRP was injected into the upper joint space in the PRP group and triamcinolone in other group. Follow-up was conducted after one-week, one and third-month interval. Respectively evaluation of reduction in symptoms was conducted using VAS pain scoring system and other parameters were measured in millimeters by an unassisted maximum incisal opening method using Vernier Caliper. Data was analysed using SPSS v. 21. P-value > 0.05 was considered significant. Results: Total 16 (66.7 %) were females. Maximum age group which receives treatment was 38 years i.e. 4 (16.7%). Mean age was 32.75 + 5.01 years. It was evident that mouth opening increased significantly along with an increase in lateral protrusive movement from 6mm to 7 mm. Joint tenderness was reduced up to 50%. Although joint clicks slightly increased from 58.3% to 62.5%. When comparing the PRP group to control group, pain score was significantly reduced (p-value:

Abstract Background Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. Objective To estimate the burden of cervical cancer in Pakistan using available data sources. Methods We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. Results A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995–1997 ASIR = 6.81, 1998–2002 ASIR = 7.47, and 2017–2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015–2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. Conclusion The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.

BackgroundOral mucositis is an inflammatory condition of oral cavity which is a common and serious side effect of cancer treatment. Severe oral mucositis compromises basic functions like eating and swallowing causing malnutrition also affecting overall patient's oral health related quality of life. The aim of the study was to find the frequency of oral mucositis in patients with breast cancer during their chemotherapy, the factors associated with oral mucositis & the overall patient's oral health related quality of life.MethodsA cross-sectional study was conducted and a total of 160 women diagnosed with breast cancer, receiving chemotherapy and who had undergone at least one cycle of chemotherapy were recruited from two hospital settings. In-person interviews were done, patients were asked questions about their sociodemographic history, personal habits, oral history and oral findings, breast cancer stage, chemotherapy history and Oral Health Related Quality of Life. Their oral examination was done at the end of the interview to assess presence or absence of oral mucositis, using World Health Organization oral mucositis tool. Oral Health Related Quality of Life was assessed using Oral Health Impact Profile-14 questionnaire.ResultsOur results showed that out of 160 patients 88 (55%) of the breast cancer cases developed oral mucositis during chemotherapy. The mean Oral Health Impact Profile -14 scores in patients with oral mucositis was high 18.36±0.96 showing poor Oral Health Related Quality of Life. Occasional frequency of brushing was significantly associated with oral mucositis (Prevalence ratio:2.26, 95%_CI 1.06-4.84) compared to those patients who brushed once and twice daily. Low level of education showed negative association with oral mucositis (Prevalence ratio:0.52, 95%_CI 0.31-0.88).ConclusionOur study showed significant positive association of occasional brushing with OM and protective association of low level of education with the development of OM. Emphasis should be given to oral hygiene instructions and dental education to cancer patients in oncology clinics with the prescription of mouth washes, gels and toothpaste to patients to decrease OM during chemotherapy.

Abstract Background There are no studies done to evaluate the distribution of mammographic breast density and factors associated with it among Pakistani women. Methods Participants included 477 women, who had received either diagnostic or screening mammography at two hospitals in Karachi Pakistan. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System. In person interviews were conducted using a detailed questionnaire, to assess risk factors of interest, and venous blood was collected to measure serum vitamin D level at the end of the interview. To determine the association of potential factors with mammographic breast density, multivariable polytomous logistic regression was used. Results High-density mammographic breast density (heterogeneously and dense categories) was high and found in 62.4% of women. There was a significant association of both heterogeneously dense and dense breasts with women of a younger age group < 45 years (OR 2.68, 95% CI 1.60–4.49) and (OR 4.83, 95% CI 2.54–9.16) respectively. Women with heterogeneously dense and dense breasts versus fatty and fibroglandular breasts had a higher history of benign breast disease (OR 1.90, 95% CI 1.14–3.17) and (OR 3.61, 95% CI 1.90–6.86) respectively. There was an inverse relationship between breast density and body mass index. Women with dense breasts and heterogeneously dense breasts had lower body mass index (OR 0.94 95% CI 0.90–0.99) and (OR 0.81, 95% CI 0.76–0.87) respectively. There was no association of mammographic breast density with serum vitamin D levels, diet, and breast cancer. Conclusions The findings of a positive association of higher mammographic density with younger age and benign breast disease and a negative association between body mass index and breast density are important findings that need to be considered in developing screening guidelines for the Pakistani population.

Abstract Background Vitamin D deficiency is becoming a serious public health problem, even in sun-drenched cities like Karachi, Pakistan. We investigated the prevalence of vitamin D deficiency and its association with sociodemographic characteristics, anthropometric measures, and lifestyle factors among premenopausal and postmenopausal women (n = 784). Methods Face-to-face interviews were conducted to collect information and serum concentrations of 25-hydroxyvitamin D were measured after the interviews. Results A total of 57% of women were vitamin D deficient with higher vitamin D deficiency found among premenopausal women (64.7%) compared to postmenopausal women (49%). The median serum concentrations of 25-hydroxyvitamin D (IQR) were 16.7 ng/ml (IQR 9.8–30.0). Factors associated with vitamin D deficiency were lower socioeconomic status (OR 2.00; 95% CI 1.15–3.48), younger age with highest vitamin D deficiency found in

PURPOSE Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them. METHODS Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review. RESULTS The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months. CONCLUSION Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

Objective: To determine any relationship of diet with breast cancer risk. Methods: The case-control study was conducted at Aga Khan University Hospital and the Karachi Institute of Radiation and Nuclear Medicine, Karachi, from February 2015 to July 2017, and comprised cases with a confirmed diagnosis of breast cancer and controls. Data was collected using the Alternate Healthy Eating Index 2010, which was modified according to the particular cultural patterns of diet in the Pakistani population. Data was analysed using SPSS 21. Results: Of the 1124 subjects, 374(33.3%) were cases and 750(66.7%) were controls. High intake of grains, both whole and refined including white rice, was associated with breast cancer (odds ratio: 2.53; 95% confidence interval: 1.69-3.79; p

With current situation of increasing burden of cancer in Pakistan, this report reviews studies related to cancer burden and cancer prevention and control in Pakistan. Electronic databases used were PubMed, Medline, EMBASE, the University of Adelaide library & Aga Khan University (AKU) library database, to search for relevant articles on the topic of cancer prevalence and prevention in Pakistan published in English. We conducted a literature search of published epidemiological and clinical studies relating to this topic up to March 1, 2020. It showed that there is a dearth of epidemiological studies in cancer risk factors, prevention and control in our population. Most studies are hospital based with small sample sizes and underpowered. Epidemiological integrated transdisciplinary research is needed to find the actual burden, etiology and feasible prevention strategies of cancer unique to our population with focus on low cost screening methods for early detection of cancers and premalignant lesions in our population. There is an urgent need for a centralized national cancer registry to have combined results of cancer registry from Pakistan Atomic Energy Commission, Karachi Caner Registry, Punjab Cancer Registry and cancer registries from the rest of Pakistan. To have the data of cancer incidence in Pakistan, policy is needed to make cancer incidence as notifiable disease and mandatory. Collaboration is also needed to work with diverse groups like the National Cancer Society of Pakistan (NCSP), National Cancer Control Plan, and Society of Medical Oncology Pakistan to draft and implement plans and strategies for national cancer control programs. It will help mobilize Ministry of Health and policy makers to address the alarming high incidence of different types of cancers in Pakistan.

BACKGROUND:The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan. METHODS:A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information was collected on sociodemographic history, history of vitamin D supplementation, past medical and obstetrical history, family history of breast cancer, sun exposure history, histopathology reports and anthropometric measurement and venous blood was collected to measure serum 25-hydroxyvitamin D (25(OH)D) concentration. RESULTS:Compared to patients with sufficient serum vitamin D (>30 ng/ml), women with serum vitamin D deficiency (

Objective: To identify and compile a list of important epidemiological risk factors of preeclampsia among pregnant women from observational studies. Methods: Review of published case control and cohort studies on risk factors of Preeclampsia (PE) by literature search from 1976 -2010 was conducted. 108 studies were selected using search engines of PubMed and Google Scholar. Findings: Most of the studies were case control studies. The factors identified most often were women with a previous history of preeclampsia, pre-existing diabetes, multiple (twin) pregnancy, nulliparity, family history , raised blood pressure (diastolic ≥ 80 mm Hg) at booking, raised body mass index before pregnancy, or increasing maternal age ≥ 40. In some individual studies the risk is also increased with an interval of 10 years or more since a previous pregnancy, autoimmune disease, renal disease and chronic hypertension. Conclusions: These factors and the underlying evidence base can be used to assess risk at booking so that a suitable surveillance routine to detect preeclampsia can be planned for the rest of the pregnancy.

Objectives: To determine the prevalence of menopause, chronic illnesses and lifestyle of middle aged women in Karachi, Pakistan. Design: A Cross Sectional survey was conducted among women of 40-60 years living in socio-economically different areas of Karachi. Information was gathered on their current menstrual status, age at menopause, body mass index, exercise habits, weekly recall of food consumed and chronic illnesses. These variables were also examined according to the socio economic status of the area where women reside. Results: A total of 1764 women in age group 40-60 years were interviewed. The prevalence of menopausal women in this age group was 39.3 percent (%). The mean age at menopause was 45.2 (±3.8) years. Only seven percent of women were doing some kind of exercise and approximately eighty percent had their Body Mass Index ≥ 23 kg/m2 according to Asian Standard. Approximately 31 percent (%) of women reported eating any type of meat at least four times a week, of these most were from higher income area. Majority consumed meat less than three times a week. Similar pattern was observed for consumption of fruits and milk. Approximately 36 percent (%) of women reported diabetes mellitus, hypertension, cardio vascular heart disease and arthritis. Conclusion: The sedentary life style, obesity and chronic illnesses are highly prevalent and are serious emerging public health problem for 40-60 years old women of Karachi. We recommend that awareness about balanced diet, exercise and healthy eating habits should be inculcated in women early in life, where possible through schools and media. Health policies and public health messages should be formulated according to the various stages of life cycle of women, so that women can prepare themselves for the next stage of life.