Frequency of Helicobacter pylori infection using 13C-UBT in asymptomatic individuals of Barakaho, Islamabad, Pakistan

High frequency of Helicobacter (H.) pylori infection has been reported in Pakistan mainly for dyspeptic patients, while the published data is inadequate regarding asymptomatic population. The non-invasive 13C urea breath test (UBT) was used to determine the frequency of H. pylori infection in 516 asymptomatic individuals and to find out its association with gender and age. Overall prevalence was 74.4% (384/516) while 63.5% (113/178) children were positive for 13C-UBT and the percentage increased with age in both the genders with significantly higher prevalence in adolescents (p=0.003) and adults (p < 0.001). Moreover, there was non-significant difference between the prevalence of H. pylori infection in males and females in all age categories. The reported high frequency of H. pylori infection warrants further studies to identify epidemiological and environmental risk factors.     

Sonographic hematoma-guided vs wire-localized lumpectomy for breast cancer: a comparison of margins and volume of resection

HYPOTHESIS: Sonographic hematoma-guided (SHG) lumpectomy achieves better margin clearance with a smaller volume of resection compared with wire-localized (WL) lumpectomy. DESIGN: Retrospective study. SETTING: University Comprehensive Breast Center. PATIENTS: Consecutive patients treated over 6 months at the breast center with stereotactic biopsy-proven cancers that were not visualized on ultrasonography. The SHG and WL techniques were compared. MAIN OUTCOME MEASURES: The matching variables were age, mammographic abnormality, tumor size and type, and lymph node status. The outcome variables were the closest margin of resection, volume of resection, resection index (resection volume divided by tumor volume), and rate of margin revision. RESULTS: Twenty-nine patients had SHG lumpectomy and 34 had WL lumpectomy. The SHG and WL groups were similar in age, mammographic abnormality, tumor size and type, and lymph node status. The median (interquartile range) closest margin was 5.0 (5-8) mm in the SHG group vs 3.5 (1-7) mm in the WL group (P = .01). The median (interquartile range) resection volume was 85.0 (60-128) cm(3) in the SHG group vs 143.4 (54-229) cm(3) in the WL group (P = .048). The median (interquartile range) resection index was 77.1 (51-220) in the SHG group vs 315.9 (89-3025) in the WL group (P = .003). The margin was revised in 1 (3.4%) of the patients who underwent SHG lumpectomy vs 5 (14.7%) of the patients who underwent WL lumpectomy (P = .20). CONCLUSIONS: Sonographic hematoma-guided lumpectomy is superior to WL lumpectomy in obtaining adequate margins while minimizing the volume of resection.     

Superiority of Sonographic Hematoma Guided Resection of Mammogram Only Visible Breast Cancer: Wire Localization Should be an Exception—Not the Rule

Background The goal of breast conservation in cancer treatment is to obtain adequate margins with minimum tissue loss to achieve acceptable oncologic and cosmetic outcome. The standard for resection of breast cancers visible only on mammogram is wire localization (WL), which has a high rate of positive margins. We hypothesized that sonographic hematoma guided (SHG) resection achieves better margin clearance while minimizing volume of resection by more accurate lesion localization. Methods This retrospective study was conducted at the University Comprehensive Breast Center. Consecutive patients over the span of one year, undergoing breast conservation for stereotactic biopsy proven cancers that were not visualized on ultrasound were studied. SHG and WL technique were compared for age, mammographic abnormality, and tumor characteristics. Outcome variables included closest margin of resection, volume of resection, resection index (resection volume/tumor volume), and rate of margin revision. Results Forty-five patients had SHG, while 51 had WL lumpectomy. The SHG and WL groups were similar in age, mammographic abnormality, tumor type, and stage. Median (25th–75th centile) tumor size was larger in SHG group vs WL group [1.2 (1.1–1.3) vs 0.8 (0.4–1.4) cm; P = .009]. Median (25th–75th centile) closest margin in SHG vs WL group was 5.0 (5.0–8.0) vs 4.0 (1.0–10) mm [P = .0041]. Median (25th–75th centile) resection volume in SHG vs WL group was 85.0 (60.0–128.0) vs 142.2 (54.4–229.0) cm³ [P = .0127]. Median (25th–75th centile) resection index in SHG vs WL group was 77.3 (59.3–285.7) vs 337.1 (88.9–3982.2) [P = .0004]. Margin was revised in 2 (4.4%) SHG vs 8 (15.7%) WL patients [P = .0978]. Conclusion Sonographic hematoma guided lumpectomy is superior to wire localization in obtaining adequate margins with minimal volume of resection.     

Mesenteric lipoma leading to small gut strangulation and short gut syndrome

A rare case of mesenteric lipoma was presented to us as acute abdomen. His abdominal x-ray showed dilated small gut. Ultrasonography of abdomen revealed dilated small gut loops and minimal amount of free fluid in the peritoneal cavity. On exploration, most of the small gut was gangrenous and tightly twisted twice around its mesentery that contained a lump which was confirmed as lipoma on histopathology.     

Baseline prevalence of high blood pressure and its predictors in a rural adult population of Bangladesh: Outcome from the application of WHO PEN interventions

This cross‐sectional study estimated the prevalence of high blood pressure (BP) and examined its predictors at baseline following protocol 1 (actions 1 and 2) of World Health Organization (WHO) Package of Essential Noncommunicable Disease (PEN) Interventions in a selected rural area of Bangladesh. A total of 11 145 adults (both sex and age ≥ 18 years) completed both the questionnaire and clinical measurements at the household and community clinics, respectively. We defined high BP as systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg, prehypertension (pre‐HTN) as systolic BP 120–139 mmHg or diastolic BP 80–89 mmHg, and hypertension (HTN) as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg and/or anti‐hypertensive drug intake for the raised BP. The prevalence of high BP was 51.2% (pre‐HTN, 25.3%; HTN, 25.9%). Among them, the proportion of pre‐HTN was higher among men (28.7%) while HTN was higher among women (27.4%). Other than fast food intake (pre‐HTN, OR: 1.110, P = .063) and women sex (HTN, OR: 1.236, P < .001), the pre‐HTN and HTN had higher odds for having same predictors as follows: age ≥ 40 years, family history of HTN, physical inactivity, central obesity, generalized obesity, and diabetes. In conclusion, the application of WHO PEN protocol 1 detected one‐fourth of the rural adult population had pre‐HTN and HTN respectively, and the common significant predictors of those were the age, family history of HTN, physical inactivity, generalized obesity, and diabetes.     

Chemoprevention Indication Score: A user-friendly tool for prevention of breast cancer – Pilot analysis

BackgroundDespite the results of prospective randomized placebo controlled studies, endorsement from various professional societies, and approval by the FDA, the chemoprevention of breast cancer is limited. This is attributable to the perceived risks of complications with tamoxifen. Individualized risk–benefit calculation regarding the use of tamoxifen is burdensome for practical clinical use. We propose a Chemoprevention Indication Score (CIS) that is easy to compute and reliable to identify women suitable for chemoprevention.Material and methodsChart-review of all patients attending a university-based high-risk breast clinic identified the women offered chemoprevention and those who accepted it. Age, Gail risk score, past medical history and physician's reasons for not offering tamoxifen were recorded. CIS was developed weighing risks and benefits of tamoxifen; high, moderate and low indication score categories were defined for recommendation of tamoxifen. CIS was validated by cross-tabulating with the rate of physician recommendation of tamoxifen and by agreement with Gail's risk–benefit index.ResultsBetween 2004 and 2006,105 women attended the high-risk clinic. Median (interquartile) age was 47 (42–53) yrs; 142(90%) were Caucasian. Median (interquartile) Gail score was 2.3 (1.0–3.2). Forty-eight (46%) women were offered tamoxifen while 15(14%) complied. Tamoxifen was offered to 1 of 5(20%) women with low; 32 of 82(39%) women with moderate and 15 of 18(83%) women with high CIS [p = 0.0008]. The McNemar's test for agreement between CIS (<6 vs. ≥6) and Gail's risk–benefit index was significant at p < 0.0001 and Kruskal–Wallis test comparing median Gail's risk–benefit index across CIS was significant at p < 0.0001.ConclusionInability to identify appropriate candidates has been a great barrier towards acceptance of chemoprevention for breast cancer. The CIS can be used for individual risk–benefit analysis for recommendation of breast cancer chemoprevention. However, CIS needs to be validated on a larger scale with methodologically more rigorous studies before proposing generalized use in the community.     

Prevention of nausea and vomiting following breast surgery

BACKGROUND: The purpose of this study was to determine the rate of nausea and vomiting in women following breast surgery (PONV) under general anesthesia (GA), before and after the introduction of a standardized prophylactic anti-emetic (AE) regimen. METHODS: We performed a retrospective review of eligible patients, between July 2001 and March 2003. Patients operated on before September 2002 had standard preoperative care (old cohort [OC]); patients operated on after September 2002 were treated prophylactically with oral dronabinol 5 mg and rectal prochlorperazine 25 mg (new cohort [NC]). Data were collected from hospital records regarding age, diagnosis, comorbid conditions, previous anesthesia history, anesthesia and operative details, episodes PONV, and use of AE. The rate and severity of PONV was calculated for both cohorts. RESULTS: Two hundred forty-two patients were studied: 127 patients in the OC and 115 patients in the NC. The median age was 56 years (range 32 to 65). The rate of nausea and vomiting were significantly better in the patients treated prophylactically with dronabinol and prochlorperazine (59% vs. 15%, P < .0001 and 29% vs. 3%, P < .0001). Twenty patients in the OC were given some prophylactic AE treatment and 12 (60%) of them required further treatment; only 12 of 109 patients (11%) in the NC required further AE treatment (P < .0001). CONCLUSION: PONV is a significant problem in breast surgical patients. Preoperative treatment with dronabinol and prochlorperazine significantly reduced the number and severity of episodes of PONV.