Breast cancer is the leading cause of morbidity and mortality globally but has an even more significant impact in developing countries. Pakistan has the highest prevalence among Asian countries. A general lack of public awareness regarding the disease often results in late diagnosis and poor treatment outcomes. The literacy rate of the Southern Punjab (Pakistan) is low compared to its Northern part. It is therefore vital that university students and especially medical students develop a sound knowledge about the disease so that they can spread awareness to others who may be less educated. This study therefore considers current knowledge and understanding about the early signs of breast cancer amongst a study group of medical and non-medical university students of the Southern Punjab, Pakistan. A cross-sectional descriptive analysis of the university students was carried out using a self-administered questionnaire to assess their awareness of breast cancer from March to May 2014. A total of 566 students participated in this study, out of which 326 were non-medical and 240 were from a medical discipline. Statistical analysis was carried out using Graph Pad Prism Version 5 with a significance level set at p<0.05. The mean age of the non medical and medical participants was 23 (SD 2.1) and 22 (SD 1.3) years, respectively. Less than 35% students were aware of the early warning signs of the breast cancer development. Knowledge of medical students about risk factors was significantly better than the non medical ones, but on the whole was insufficient. Our study indicated that knowledge regarding breast cancer was generally insufficient amongst the majority of the university students (75% non-medical and 55% medical) of Southern Punjab, Pakistan. This study highlights the need to formulate an awareness campaign and to organize conferences to promote breast cancer awareness among students in this region.

IntroductionOur aim was to study the outcomes and predictors of in-hospital cardiopulmonary resuscitation (CPR) among adult patients at a tertiary care centre in Pakistan.MethodsWe conducted a retrospective chart review of all adult patients (age ≥14 years), who underwent CPR following cardiac arrest, in a tertiary care hospital during a 5-year study period (June 1998 to June 2003). We excluded patients aged 14 years or less, those who were declared dead on arrival and patients with a “do not resuscitate” order. The 1- and 6-month follow-ups of discharged patients were also recorded.ResultsWe found 383 cases of adult in-hospital cardiac arrest that underwent CPR. Pulseless electrical activity was the most common initial rhythm (50%), followed by asystole (30%) and ventricular tachycardia/fibrillation (19%). Return of spontaneous circulation was achieved in 72% of patients with 42% surviving more than 24 h, and 19% survived to discharge from hospital. On follow-up, 14% and 12% were found to be alive at 1 and 6 months, respectively. Multivariable logistic regression identified three independent predictors of better outcome (survival >24 h): non-intubated status [adjusted odds ratio (aOR):3.1, 95% confidence interval (CI):1.6–6.0], location of cardiac arrest in emergency department (aOR: 18.9, 95% CI:7.0–51.0) and shorter duration of CPR (aOR:3.3, 95% CI:1.9–5.5).ConclusionOutcome of CPR following in-hospital cardiac arrest in our setting is better than described in other series. Non-intubated status before arrest, cardiac arrest in the emergency department and shorter duration of CPR were independent predictors of good outcome.

IntroductionOur aim was to determine the characteristics of patients presenting with syncope at a tertiary care hospital in Karachi, Pakistan.MethodsA review of medical records was conducted retrospectively at the Department of Medicine, Aga Khan University Hospital, Karachi. Patients aged 16 and above, admitted from January 2000 to December 2005 with the diagnosis of syncope made by the attending physician were included.ResultsA total of 269 patients were included (75% males, mean age: 57.4 years). Neurogenic (vasovagal) syncope was the most common cause (47%), followed by cardiogenic syncope (18%) and orthostatic syncope (9%). A total of 24% were discharged undiagnosed. Twenty patients (7.4%) did not have any prodrome. Common prodromal symptoms included dizziness (61%), sweating (25%), palpitations (19%), nausea/vomiting (19%) and visual symptoms (17%). The distribution of symptoms according to cause of syncope revealed only breathlessness to be significantly associated with cardiogenic syncope (p = 0.002). Most patients with cardiogenic syncope were aged above 40 (98%, p < 0.001), had coronary artery disease (72%, p < 0.001) and abnormal electrocardiogram at presentation (92%, p < 0.001).ConclusionDespite differences in burden of diseases, our findings were similar to those of published syncope literature. Further studies are needed to develop a protocol to expedite the evaluation and limit the work-up and admission in low-risk patients.

Background: Breast cancer symptoms are often not felt clearly by patients, as a result many patients who come in an advanced stage. This will affect the prognosis and cure rate of the patient. There are several factors that influence the prognosis of breast cancer, including histopathological grade, and classic immunohistochemical markers such as estrogen receptors, progesterone receptors, and HER2. In addition, breast cancer can be 4 main molecular subtypes, namely Luminal A, Luminal B, HER2-Overexpression, and Triple Negative / Basal-Like. Objectives: This study aims to determine the relationship between histopathological grade with the molecular subtypes of breast cancer patients in Haji Adam Malik General Hospital in 2016-2018. Methods: This is analytical cross-sectional research using a consecutive-sampling technique. Data were obtained secondary from the medical records of breast cancer patients at Haji Adam Malik General Hospital in 2016-2018 and then analyzed with the chi-square test. From 1005 cases of breast cancer during the 2016-2018 period, 131 samples were taken in this study. Results: Of the 131 samples, the highest histopathological grade was grade 2 with 53 people  (40.5%), followed by 41 people (31.3%) with grade 3, and 37 people (28.2%) with grade 1. The most molecular subtypes were Luminal A with 38 people (29%), followed by 33 people (25.2%) with Luminal B, 31 people (23.7%) with HER-2 Overexpression, and 29 people (22.1%) with Triple Negative / Basal-like. From the analysis of the chi-square test obtained p value of 0.045. Conclusion: There is a relationship between histopathological grade with molecular subtypes of breast cancer patients. Keywords: breast cancer, histopathological grade, immunohistochemistry, molecular subtypes     Latar Belakang: Gejala-gejala kanker payudara sering tidak dirasakan dengan jelas oleh pasien, akibatnya banyak pasien yang datang dalam keadaan stadium lanjut. Hal ini akan mempengaruhi prognosis dan tingkat kesembuhan pasien. Terdapat beberapa faktor yang mempengaruhi prognosis dari kanker payudara, antara lain grading histopatologi, dan marker imunohistokimia klasik seperti reseptor estrogen, reseptor progesteron, dan HER2. Selain itu, kanker payudara dapat diklasifikasikan menjadi 4 subtipe molekuler utama, yaitu Luminal A, Luminal B, HER2-Overexpression, dan Triple Negative/Basal-Like. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara grading histopatologi dengan subtipe molekuler pasien kanker payudara di RSUP Haji Adam Malik Tahun 2016-2018. Metode: Penelitian ini merupakan penelitian analitik menggunakan desain cross-sectional dengan teknik pengambilan sampel consecutive-sampling. Data diperoleh secara sekunder dari rekam medis pasien kanker payudara di RSUP Haji Adam Malik pada tahun 2016-2018 dan kemudian dianalisis dengan uji chi-square. Dari 1005 kasus kanker payudara selama periode 2016-2018, diambil sampel pada penelitian ini sebanyak 131 buah rekam medis. Hasil: Dari 131 sampel, grading histopatologi terbanyak terdapat pada grade 2 dengan 53 orang (40,5%) , diikuti 41 orang (31,3%) dengan grade 3, dan 37 orang (28,2%) dengan grade 1. Subtipe molekuler terbanyak yaitu Luminal A dengan 38 orang (29%), diikuti 33 orang (25,2%) dengan Luminal B, 31 orang (23,7%) dengan HER-2 Overexpression, dan 29 orang (22,1%) dengan Triple Negative/Basal-like. Dari hasil uji chi-square diperoleh nilai p sebesar 0,045. Kesimpulan: Terdapat hubungan antara grading histopatologi dengan subtipe molekuler pasien kanker payudara. Kata kunci: grading histopatologi, imunohistokimia, kanker payudara, subtipe molekuler

Bioleaching of low-grade secondary copper sulphide ores using different microbial strains is an ecologically safe technology for the recovery of metals in the mineral and mining industry. The purpose of the present study was to analyze the mineral contents of Reko Diq deposits and to assess the dissolution of copper from sulfide ore by an indigenously isolated strain of acidophilic iron-and sulfur-oxidizing bacterium (BSTFe-2) in shake flask experiments. X-ray diffraction (XRD) analysis of the ore sample suggested that it contained 0.81% Cu on dry matter basis and contained chalcocite (Cu 2 S) and covellite (CuS) as main copper minerals. Pyrite (FeS 2 ) was also present as a sulfide mineral. The other minerals detected in the ore matrix were muscovite (a di-octahedral mica mineral), quartz, feldspar (anorthite) and calcite. Quartz (SiO 2 ) was the main silicate mineral present in the sample. Calcite (CaCO 3 ) was found as the main acid-consuming gangue mineral. We observed that about 80-90% of the total Cu content present in the ore matrix was solubilized during 30 days of the leaching process mediated by Acidithiobacillus ferrooxidans at 30ºC. Copper dissolution from ore was found to be directly related to the reaction pH (1.5-1.9). The leaching data obtained from the pulp densities (5, 10 and 20% wt/

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Introduction:Infection with Helicobacter pylori is globally prevalent. It is a chronic infection, standard treatment of which includes two antibiotics, amoxicillin and clarithromycin, plus a proton pump inhibitor used for 1 or 2 weeks. However, owing to increased resistance in our country, definitive eradication of H pylori is difficult.We conducted this study to evaluate the efficacy of a regimen using levofloxacin for successful eradication of H pylori infection. Subject and methods:This is a prospective study conducted at a tertiary care hospital. After informed written consent, all patients with proven H pylori infection (either by biopsy or by stool antigen test) were included in this study on the basis of other inclusion and exclusion criteria. Patients were given levofloxacin-based sequential therapy and stool for H pylori antigen was performed as per protocol to assess the eradication rate (ie, efficacy of levofloxacin-based regimen). Patients were required to fill a Performa for assessment of symptoms. Chi-square test was used for analysis. P < 0.05 was considered as significant.Results: A total of 149 patients with active H pylori infection were included. Out of 149 cases, 80 (53.7%) were male and 69 (46.3%) female. H pylori eradication was successfully achieved in 128 (85.9%) patients, 13 (8.7%) patients remained positive after eradication therapy and 8 (5.4%) patients lost follow up. No serious adverse event was observed. Conclusion:Levofloxacin-based sequential therapy was highly effective (85.9%) against chronic H pylori infection.

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