Introduction Primary care interval is the time duration from a patient's first presentation to the final diagnosis. Ewing's sarcoma is a rare small round blue cell bone tumor originating from neuroectoderm and undifferentiated neuroepithelial cells, having an annual incidence of approximately one case per million in the United States. In this study, we analyzed the age pattern among patients diagnosed with Ewing's sarcoma undergoing management, along with associated features including involved site, regional lymphadenopathy, and distant metastasis at the time of presentation and their correlation with the primary care interval. Methods This is a cross-sectional study carried out at the Oncology department of a Tertiary Care Government Hospital in Karachi, Pakistan. The duration of our study was from January 2020 to December 2020. During this period, all patients with proven diagnosis of Ewing's sarcoma between ages 10 years and 65 years were included in the study. All the participants of the study were divided into groups, based on the age and site of the tumor. Results A total of 895 cases of bone cancer were reported. Among these, 147 cases (16.4%) had Ewing's sarcoma. Of these patients, 88 were male (60%) while 59 (40%) were female. The mean age of patients was 18.9 ± 3.2 years. Ewing's sarcoma most commonly occurred during 15 to 20 years of age. The most common region involved was lower limb (n=76, 52%) followed by upper limb (n=63, 43%) followed by pelvis (n=8, 5.4%). Conclusion The peak time for the occurrence of Ewing's sarcoma is from 15 years to 20 years of age. Regional painful swelling is the most common presenting feature in our study population. Factors causing a prolonged primary care interval include early age of onset, non-specific clinical presentation, and insufficient knowledge of the primary care physician, which results in poor prognosis. Hence, it is important to consider Ewing's sarcoma as a differential on the first presentation especially in the high-risk age group.
A 19-year female, diagnosed case of CD for eight years and GD for five years, presented at the Emergency Department with history of persistent jaundice for two months. There was also history of chronic diarrhea, fatigue and shortness of breath on exertion. She was receiving carbimazole, 10 mg, BID, and was admittedly non-compliant to both a gluten-free diet (GFD) and the medications. She had completely stopped taking the medications for six weeks at the time of presentation. On examination, the patient was hemodynamically stable, jaundiced and anemic. She had thin coarse hair, fine tremor, exophthalmos (Figure 1), a positive lid lag, Von Graefe's and lid retraction signs. Fluid thrill and shifting dullness were also present. There were also patches of hypo-pigmented skin in the hands, forearms and legs, consistent with vitiligo. Initial laboratory tests showed hemoglobin (Hb) of 8.8 g/dL, mean corpuscular volume (MCV), 85.5 fL, platelets, 68 x109/L, and white blood cell count (WBC) of 9.2 x109/L.
Primary squamous cell carcinoma (SCC) is a rare entity that usually arises from the malignant transformation of a mature cystic teratoma, an endometrioma, or a Brenner tumor. The de novo occurrence of the pure variety in the absence of a prior lesion is the rarest type, and it arises from the metaplasia of the surface epithelium of the ovary. Because of its rarity, a definitive treatment protocol for treatment is not yet available. We present a case of pure primary SCC of the ovary that was managed by surgery followed by chemotherapy.
ObjectiveChikungunya is a viral disease characterized by severe arthralgia, fever, rash, muscle pain, and neurological symptoms. Warm and humid weather, poor sanitary conditions, and improper water storage and disposal can lead to an uncontrolled outbreak of the Chikungunya virus in South Asia. Because a vaccine against the Chikungunya virus has not yet been developed, we must rely on appropriate awareness and suitable preventive measures to prevent its spread. A review of the literature shows that knowledge of the Chikungunya virus among medical students in Karachi is scarce. Because medical students are future medical practitioners, they should be adequately aware of this growing issue.Materials and methodsWe performed a single-center, cross-sectional study at the Jinnah Sindh Medical University in Karachi, Pakistan, in which 200 students were assessed on their knowledge of the Chikungunya virus and fever via a structured questionnaire.ResultsA total of 200 students participated in the study. The mean age of the study participants was 20 ± 1 years. Only 50% of the study participants had an adequate knowledge score related to the Chikungunya virus and fever. We found that 43% had an average knowledge, and 7% had poor knowledge. The study also revealed a strong association between year of study and knowledge score (p=0.003); those in the higher age group had more knowledge (p=0.014).ConclusionA low percentage of medical students have sufficient knowledge about Chikungunya virus and fever, which is alarming because Pakistan has recently faced a severe epidemic of Chikungunya virus fever and is a country prone to further outbreaks. Multiple training programs and lectures are necessary to prepare and educate medical students about both basic and clinical knowledge of Chikungunya.
Objective: To assess the frequency of lymphedema of the arm and forearm after complete axillary lymph node dissection in patients with breast cancer at one year of follow-up and see its association with body mass index among breast cancer patients presenting at a tertiary care hospital in Karachi. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from Apr 2019 to 2020. Methodology: One sixty-eight females of age 25-80 years who underwent complete axillary lymph node dissection for breast cancer were included in the study. A breast surgeon performed the axillary lymph node dissection with more than five years of experience. The patients were followed for one year post-operatively to determine the occurrence of lymphedema. All the demographic details and clinic-pathological findings were reported in the predesigned proforma. Results: About 168 females (97.6%) out of 172 have undergone complete axillary lymph node dissection. Lymphedema was the most common complication among them (38.1%). Common side effect observed after axillary lymph node dissection was pain (66.1%), followed by heaviness (59.5%), firmness/tightness (46.4%) and numbness. The patients with Body mass index ≥ 25 kg/m2, right arm involved, exposure to radiotherapy and moderately differentiated tumour (grade-2) had a significantly higher occurrence of lymphedema (p<0.05). Conclusion: Lymphedema is higher among breast cancer survivors during the first postoperative year. The risk of lymphedema can be reduced by avoiding potential factors like obesity and carefully selecting patients for postoperative radiotherapy.
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