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The primary objective of this study was to determine post-treatment variations in the hematological profile of stage 2 breast cancer patients and investigate the influence of disease stage and treatment pattern on these changes. The secondary objective was to evaluate the role of post-treatment hemoglobin as a predictor of disease-free survival. MethodsThis prospective, observational study included 177 stage 2, female, breast cancer patients. Treatment included surgery, chemotherapy, radiotherapy, and hormonal (antiestrogen) therapy. Patients were divided into treatment groups based on their histopathological features. Laboratory investigations, including hemoglobin and complete blood count, were carried out twice, first, at the initial cancer diagnosis and, second, eight weeks after completion of radiotherapy. The patients were followed for a period of four years and their disease-free survival was calculated.

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Background Heavy menstrual bleeding (HMB) is a common clinical finding in patients with uterine leiomyomas that can negatively impact their quality of life. Recently, a novel oral GnRH-antagonist (elagolix) has emerged as a possible therapeutic agent for this ailment. Herein data was pooled from clinical trials assessing the safety and efficacy of elagolix with and without add-back therapy. Main text PubMed and Cochrane library were systematically searched for RCTs that measured the efficacy and safety of elagolix for the treatment of uterine fibroid-associated HMB. All safety and efficacy endpoints were compared between elagolix-alone, elagolix w/add-back therapy, and placebo. The primary efficacy endpoint was defined as the number of women who achieved menstrual blood loss (MBL) < 80 ml and a reduction in MBL from baseline of > 50% at the end of treatment. Secondary outcomes assessed included change in hemoglobin levels, incidence suppression of bleeding and amenorrhea, and the incidence of adverse events. The random effects model was used to pool data, and heterogeneity was assessed using I2. Our search identified 4 clinical trials meeting our PICO criteria, with a total of 916 patients. Analysis of the primary outcome revealed that elagolix-alone was the most effective treatment compared to both placebo (LOR = 3.47, CI = 3.03–3.91, p = 0.000, I2 = 0.0%) and add-back therapy (LOR = 0.64, CI = 0.12–1.16, p = 0.016, I2 = 43.1%). Furthermore, both elagolix groups (irrespective of add-back therapy) observed a significant improvement in post-treatment hemoglobin levels as compared to the placebo group (elagolix-alone vs PBO: LOR = 1.44, CI = 0.66–2.22, I2 = 66.0%, p = 0.000; elagolix-w/add-back therapy vs PBO: LOR = 1.22, CI = 0.78–1.66, I2 = 0.0%, p = 0.000). Concerning safety, while elagolix without add-back therapy had the highest overall incidence of adverse effects (elagolix-alone vs placebo LOR = 0.84, CI = 0.48–1.20, I2 = 7.8%, p = 0.000; elagolix-alone vs elagolix-w/add-back LOR = 0.68, CI = 0.09–1.26, p = 0.024, I2 = 64.6%), the incidence of serious (life threatening) adverse events between all 3 treatment groups was not statistically different. The inclusion of add-back therapy with elagolix made the treatment noticeably safer (elagolix-w/add-back vs placebo: LOR = 0.19, CI = − 0.10 to 0.48, I2 = 0.0%, p = 0.194) without seriously compromising its efficacy. Conclusion High-quality evidence from 4 trials suggests that elagolix is an effective treatment for leiomyoma-associated HMB, with a marked improvement in all efficacy endpoints. Furthermore, the inclusion of add-back therapy in the treatment regimen should be considered as it mitigates the hypoestrogenic effects of elagolix.

Madam, Irritable bowel syndrome (IBS) is a common gastrointestinal(GI) disorder, with a prevalence of approximately 11% worldwide and 13.3% in Pakistan.1-2 Symptoms of this disease are usually nonspecific, including bloating, abdominal discomfort with defecation, and change in bowel habits, resulting in most patients going without seeking treatment.2 Those who sought treatment did so due to a decreased quality of life (QoL) and higher anxiety, rather than increased severity of symptoms.2 Although the disease mortality is extremely low, studies have reported a strong association between depression (prevalence=38-100%) and decreased QoL in IBS patients.3 Moreover, IBS predisposes patients to a host of psychological disorders in addition to depression, which significantly impede treatment and lower QoL. As the disease pathophysiology remains largely unclear, treatment is focused mainly towards symptomatic relief and management.3 In addition to the available allopathic remedies, peppermint oil (PO) has emerged as a popular herbal alternative in recent years, and its efficacy and safety have been investigated by multiple studies. A meta-analysis by Hawrelak et al. showed that PO was a significant improvement over placebo in alleviating abdominal pain (RR= 2.154, CI=1.56-2.94) and global symptoms of IBS (RR = 1.95, CI=1.46-2.62).4 PO is generally a safe treatment with few adverse effects; namely heartburn and perianal burning. Compared to other treatments such as tricyclic antidepressants and alosetron, it has a significantly higher benefit-to-harm ratio (25:1) second only to Rifaximin, and a small therapeutic dose (0.2mlx3-6 times/day).4 L-menthol, the primary active ingredient in PO, acts primarily as a calcium-channel antagonist in smooth muscles.5 Additionally, other compounds in PO, including menthone, menthyl acetate, isomenthone, etc contributed independently to its therapeutic effect via numerous mechanisms of action (MoA). These MoAs included but were not limited to antinociception via transient-receptor potential channels, GI histaminergic and cholinergic receptor modulation, serotonergic antagonism, and antiinflammatory effects.5 In countries like Pakistan where herbal medicines are often more popular than their allopathic counterparts, POs fit right in as an effective, alternative treatment that is scientifically proven. It can potentially serve as a valuable asset for IBS treatment in areas where access to medicine is limited, or where cost becomes an issue. These factors in association with its proven efficacy and lack of side effects merit its prescription by physicians as an alternative remedy for the treatment of IBS. Continuous...