Limited Wedge Resection of a Duodenal Gist in a Patient with Intermittent Melena

Gastrointestinal Stromal Tumors account for 1% - 2% of all gastrointestinal (GI) tract tumors. Among GISTs, duodenal localization occurs in less than 5% and usually presents with upper GI bleeding. A 45-year-old man presented in the outpatient department with complaints of epigastric discomfort, intermittent melena and undocumented weight loss for the preceding 3 months. Initial upper GI endoscopy showed mild duodenitis and no other upper GI pathology. For unexplained symptoms, a CT Scan was performed which demonstrated a well-defined solid lesion along the second part of the duodenum. An endoscopic ultrasound (EUS)-guided biopsy of a subepithelial lesion at D2 was performed. Immunohistochemistry findings were suggestive of GIST. Wedge resection of the duodenal mass was done. Duodenal GIST should be considered as a differential in cases of GI bleeding when other differentials have been ruled out. Limited resection of duodenal GIST should be considered over pancreaticoduodenectomy, in case of small size tumors.

Long-term Outcomes of Pregnancy-Associated Breast Cancer: A Single Institution Experience

Background: The incidence of pregnancy-associated breast cancer (PABC) is increasing, especially in the developed countries. Herein, we report the long-term outcomes of PABC from a single institution in an Arab country. Methods: Consecutive patients diagnosed to have PABC between 2005 and 2012 at a tertiary referral hospital from a Gulf cooperation council country were the subjects of the study. Long-term outcomes are reported, with a minimum follow-up of 8 years. Results: A total of 16 patients were evaluable for long-term survival analysis. The median age at the time of diagnosis was 31.5 (26-40) years. Nine (56%) patients were multiparous (> 5 previous pregnancies). The mean gestational age at diagnosis was 19.7±7.4 weeks. Immunohistochemistry revealed the following phenotypes: Luminal A 3 (18.8%); HER-2 enriched 8 (50%); triple-negative 5 (31.2%). Three patients underwent modified radical mastectomy as the initial treatment, of which 2 received adjuvant chemotherapy during pregnancy. For patients who received neoadjuvant or palliative chemotherapy, the response rate was 75% (pCR 2; CR 1; PR 6). After a median follow-up of 60 months, median progression-free survival was 36 months (95%CI 24.2 to 47.8), while the overall survival was 59 months (95%CI 31.6 – 86.4). Age, marker status, Ki-67 score, clinical stage and differentiation grade did not affect the PFS or OS on univariate analysis. Conclusions: Fifty percent of the patient with PABC expressed HER-2/neu protein, and 1/3rd had triple-negative disease. The rate of response to chemotherapy, and long-term survival may help to set a benchmark for studies from the region. Larger cohort studies may help to draw firm conclusions.

To Determine the Prevalence of Obesity in Breast Cancer Patients

Background: Breast Cancer is one of the leading causes of death worldwide. Pakistan alone has the highest rate of Breast Cancer than any other Asian country as approximately 90000 new cases are diagnosed every year out of which 40000 dies. Obesity is also a critical public health problem growing with every passing year in Pakistan and worldwide. Research studies are being conducted worldwide regarding the relation between the two problems. Objective: The objective of this study is to determine the prevalence of obesity in breast cancer patients in a tertiary care hospital in Karachi, Pakistan. Methods: BMI is used as a screening tool for overweight and obesity. According to World Health Organization, a body mass index (BMI) over 25 is considered overweight, and over 30 is obese. A retrospective analysis of 262 patients diagnosed with Breast Cancer during 2019 and 2020 was performed. Patients’ hospital records in Oncology were reviewed. The weight in kilograms and height in centimeters of patients were reviewed. Their BMI was calculated and recorded using the SPSS system. Results: The median BMI was 28.25 kg/m2 with an interquartile range of 25.15 - 31.99 kg/m2. Nearly 80% of the study participants had body mass index higher than normal levels (n=203, 77.5%) and out of them approximately half were overweight (n=104, 51.2%) and the remaining were obese (n=99, 48.7%). Conclusion: We conclude from our study that body mass index is positively correlated with breast cancer occurrence and thus the proportion of females having BMI >= 25 was significantly higher among patients.

Clinico Pathological Review of Adnexal Masses in Children and Adolescents at a University Hospital

Background & Objective: The study objective was to review the clinic-pathological characteristics of adnexal masses in the children and adolescent population in our institution. Methods: Retrospective analysis of 178 adolescent patients including neonates, presenting with adnexal masses between January 2000-December 2012, was performed. Results: Records of a total of 178 patients were analyzed. The mean age was 14 years. The most common symptom was abdominal pain noted in 146(82%) patients followed by nausea and vomiting in 28(15.7%) and incidental findings in 19(10.7%). The majority of the ovarian masses were benign. The follicular cyst was the most common histopathological type in 66 patients (37.1%) followed by a hemorrhagic cyst in 40(22.5%), benign teratoma in 21(11.8%), benign serous cyst in 20 patients (11.2%), endometrioma and mucinous cystadenoma in 13 patients (7.3%). The average tumor size observed in the present study was 7.84cms. However, the size varied in different age groups such as 4.27 cm size in neonates, and 7.1 cm in 1-14 years age group, and 8.61 cm in 15-19 years age group with a P-value of 0.009. Out of a total of 178 patients, 46(25.8%) were managed conservatively. However, 90(50.6%) patients underwent ovarian cystectomy, 26(14.6%) were managed by unilateral salpingo-oophorectomy, 10(5.6%) by unilateral oophorectomy. Aspiration and biopsy were done in 6(3.4%) patients. Conclusion: Incidence of adnexal masses increases with age with maximum cases between age 14 and above. Adolescent girls with adnexal masses can have variable presentations however abdominal pain is the most common symptom. Mostly these are benign masses therefore conservative approach for treatment should be adopted.

Improving Cancer Patients Satisfaction with Treatment Process: A Pilot Interventional Approach in a Tertiary Care Hospital in Karachi, Pakistan

Background and Objective: Chemotherapy is one of the treatments of choice worldwide to combat cancer. The complex nature of chemotherapeutic agents results in multiple physiological and psychological issues and if the patient and their caregivers (family) are unaware of these effects, poses additional stress which may result in patient dissatisfaction. This pilot project aimed to provide patients'/families' awareness regarding the process of treatment and subsequently to improve their satisfaction level. Methods: This academic project is a mandatory assignment of clinical practicum course (for the degree of Masters in Nursing Sciences (Aga Khan University School of Nursing & Midwifery). An interventional design was employed for this study. A total of 30 cancer patients, that is 15 in the intervention group and 15 as controls were recruited. The project was initiated as an academic requirement (started in Jan 2015) and last for four months (Apr 2015). Patients planned for their first chemotherapy cycle were selected in both groups. A self-developed questionnaire was used to assess the patient satisfaction level regarding the chemotherapy process before and after the standardized and video-based educational intervention. An independent T-test was used to analyze the data. Results: The overall mean score of patient satisfaction level after the intervention was 18.80; whereas, it was 11.93 for another group. The patient's mean satisfaction level was higher for the intervention group. Conclusion: This study indicates video-based intervention for pre-chemotherapy teaching as an effective educational mode to assist patients throughout the treatment process. It can also facilitate in reducing treatment-related stressors and enhance patients' satisfaction levels.

Is Health a Right or Family’s Property?

We are often geared by the notion that health is an individual right and every individual has equal rights and opportunities for healthcare. However, in Eastern society, the family conquers the right of the individual and decides the treatment modalities. Alongside, healthcare professionals have regulated themselves with the culture of society. Thus, the autonomy of the individual is being compromised. This has enforced us to think about whether "health is an individual's right or a family's property"?