Shaukat Khanum Memorial Cancer Hospital Research Articles

Trends in typhoid fever during the COVID-19 pandemic in Pakistan.

Pakistan has been experiencing an extensively drug-resistant (XDR) outbreak of typhoid for some years. We sought to evaluate how the COVID-19 pandemic impacted typhoid epidemiology in Pakistan, from the beginning of the pandemic in 2020 through the end of 2022, and the reduction of COVID-19 cases. We compared national public COVID-19 data with retrospectively obtained patient data of confirmed S. Typhi isolates between January 2019 and December 2022 from Shaukat Khanum Memorial Cancer Hospital and Research Centre and the hospital's extended network of laboratory collection centers across Pakistan. We observed that during the early onset of the COVID-19 pandemic and COVID-19 peaks, typhoid positivity generally decreased. This suggests that restrictions and non-pharmaceutical interventions that limited social interactions and promoted good sanitation and hygiene practices had a positive secondary effect on typhoid. This led to an overall yearly decrease in typhoid positivity between 2019 to 2021. However, the percentage of S. Typhi cases isolated that were ceftriaxone-resistant continued to increase, suggesting the continued dominance of XDR typhoid in Pakistan. In 2022, with the alleviation of pandemic restrictions, we observed increased typhoid positivity and COVID-19 and typhoid positivity started to follow similar trends. Given the continued presence of COVID-19 along with XDR typhoid in Pakistan, it will be imperative to use differential testing to ensure that the epidemiology of each reported is accurate, the spread of each it contained, and that antibiotics are not misused. The use of approved vaccinations will lessen the burden of both diseases.

Frequency of Small Bowel Perforation among Neonates Presented with Pneumoperitoneum: A Cross Sectional Study

Background: Neonatal pneumoperitoneum, characterized by the presence of free gas within the peritoneal cavity, is a critical condition often signaling intestinal perforation. While necrotizing enterocolitis (NEC) has been predominantly associated with this condition, various other etiologies contributing to neonatal intestinal perforations necessitate further exploration. The management of such conditions, particularly in resource-limited settings, remains a challenge, often resulting in significant morbidity and mortality. Objective: This study aims to investigate the frequency of small bowel perforation among neonates presenting with pneumoperitoneum and to examine the association between neonatal weight and the occurrence of small bowel perforation. Methods: A cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from July 2023 to December 2023. Seventy neonates aged 5 to 25 days presenting with radiological evidence of pneumoperitoneum were included. Demographic details were collected, and the infants underwent primary peritoneal drainage followed by exploratory laparotomy if necessary. Data analysis was performed using SPSS version 25, employing Chi-Square tests for categorical variables, with a significance level set at p < 0.05. Results: Of the 70 neonates, 20 (28.6%) were diagnosed with small bowel perforation. A significant association was found between small bowel perforation and neonatal weight; 13 (65%) of the perforation cases were among neonates weighing less than 2.5 kg (p = 0.0001). The overall mortality rate observed was 35%, with 20 neonates succumbing shortly after peritoneal drain insertion due to sepsis. Conclusion: Small bowel perforation is a significant complication in neonates with pneumoperitoneum, with a higher incidence observed in those with lower birth weights. This study highlights the critical need for immediate diagnosis and intervention in such cases, particularly in under-resourced settings, to improve outcomes.

A Deeper Depth of Response After Salvage Therapy Improves Outcomes of Autologous Stem Cell Transplantation in Relapsed Lymphoma and the Feasibility of Non-controlled Rate Freezing of Peripheral Blood Stem Cells.

Background High-dose chemotherapy followed by autologous stem cell transplantation is considered a standard treatment approach for patients with relapsed Hodgkin's lymphoma (HL) and non-Hodgkin lymphoma (NHL). The goal of autologous stem cell transplant in relapsed lymphoma is to achieve long-term disease control, i.e., cure, in contrast to disorders like multiple myeloma, where it only prolongs the duration of remission, progression-free survival, and improves the quality of life. Published outcomes of high-dose therapy and ASCT and the impact of different factors affecting survival in low- to middle-income countries are very limited. Our study analyzed all the autologous stem cell transplants performed in our center over a six-year period to ascertain engraftment, responses, outcomes, and variables that may have impacted transplant outcomes. Methods We conducted a retrospective study including 76 patients from January 2015 to December 2020. Data were retrieved from electronic medical records at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Results Out of a total of 82 autologous transplant patients, 76 were eligible for the study, out of which 50 (66%) had HLand 26 (34%) had NHL. The median age was 29 years (range 18-53) and 29 years (range 20-45) for HL and NHL, respectively. The male-to-female ratio was 5:2 and 4:1 for HL and NHL, respectively. The majority had advanced-stage disease, 85% in HL and 75% in NHL. The minimum cell dose infused was 2.5 million CD34+ cells/kg. Median days to platelets and ANC engraftment were 14 and 11 days, respectively. The 30-day transplant-related mortality was 8.9% and 7.4% in HL and NHL, respectively. The 100-day mortality was 15.2% and 11% in HL and NHL, respectively. The two-year disease-free survival (DFS) and overall survival (OS) were 83% and 83%, respectively, in HL patients. The two-year DFS and OS were 78% and 85%, respectively, in NHL patients. Conclusion High-dose therapy and autologous stem cell transplantation in low- to middle-income countries are limited to relatively younger patients, potentially curative conditions such as lymphoma, and predominantly after achieving a complete response to salvage therapy due to limited resources. Due to these factors, our study shows excellent response rates and survival outcomes compared to internationally published data. Engraftment was also excellent and comparable to published data despite the non-controlled rate freezing of peripheral blood stem cells.

Community Outreach and Engagement in Cancer Research Through a Biobank Clinic at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.

Cancer's increasing prevalence across the globe emphasizes the urgency for continued research, prevention, and accessible healthcare to mitigate its impact on individuals and communities. While there have been significant advances made towards controlling cancermorbidity and mortality in recent decades, Pakistan continues to experience a markedly elevated burden of the disease. With this study, we aim to raise awareness about biobank research within the cancer patient community, fostering participation and collaboration to advance the fight against cancer through vital research contributions. In October 2022, we initiated the biobank clinic at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC). Here, patients underwent screening and received invitations to voluntarily participate in biobank research. During these interactions, we engaged patients in discussions about the significance of biobank research, addressed their concerns, and encouraged their participation in advancing our research endeavors. Two-sample independent t-tests were performed to compare the mean number of participants in pre-clinic and post-clinic cohorts. This research involved a total of 958 participants, with 312 participants enrolled before the clinic and 646 participants enrolled after the clinic. We have observed a noticeable increase in the participation of cancer patients in our research endeavors since the inception of the biobank clinic (p-value<0.001). Over an 11-month time frame, we scheduled appointments for 759 patients, and out of those, 656 patients availed themselves to visit the clinic. Impressively, we achieved the enrollment of 646 patients into the clinic, reflecting an exceptional consent rate of 98.47% for their active involvement in our research initiatives. This underscores our commitment to conducting comprehensive discussions and providing thorough explanations regarding the ethical and procedural aspects of our research. Biobank clinic plays a pivotal role in raising cancer awareness and fostering research participation, especially in regions with limited healthcare infrastructure and lower literacy rates. It emerges as a community-engagement model that aligns research with local needs, ensuring its relevance and benefit to the population.

Preventive analgesia with oral tramadol and pregabalin for post-operative pain in breast surgical patients

Background &amp; objective: Preventive analgesia is implied before the actual surgical insult occurs and it is aimed to reduce the neuro-humoral changes associated with surgical induced pain. Different methods have been used by the anesthesiologists for this purpose. We studied the effect of pre-emptive oral tramadol 50 mg and pregabalin 100 mg on post-operative pain, the requirement of rescue analgesics and the stay in post-anesthesia care unit (PACU) in breast cancer surgery patients.&#x0D; Methodology: A randomized double blinded, placebo-controlled trial, was conducted in the Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan) after ethical approval by the hospital Scientific Review Committee and Institutional Review Board. Atotal of 30 patients, undergoing breast cancer surgery, were enrolled and randomly divided into two groups. Group A (study group) patients were given tramadol 50 mg and pregabalin 100 mg orally, and Group B (control group) received two soda mint tablets orally 30 min prior to induction of anesthesia. Standard monitoring was done and routine general anesthesia was administered with intubation. After recovery, Visual Analog Scale (VAS) scores and time to rescue analgesia, total morphine consumption, were recorded. Data was analyzed using SPSS v.20. P &lt; 0.05 was considered significant.&#x0D; Results: The mean ages in Group A and B were 36.67 ± 9.50 y and 41.80 ± 12.43 y (P = 0.236). The differences in intra-operative morphine and rescue morphine use in both groups were not significant (P = 0.139 and 0.293, The rescue analgesic use and VAS scores in PACU were significantly different in both groups (P = 0.005 and P = 0.022, respectively). Total PACU stay in Group A was 79.33 ± 26.31 min and in Group B was 96.67 ± 34.98 min (P = 0.281). Tramadol use in the ward was not statistically equivalent (P = 0.300). Mean post-operative rescue morphine was 0.2 ± 0.775 mg/kg in control group as compared to placebo group was 1.4 ± 1.682 mg/kg, which was statistically significant (P = 0.02). VAS scores in PACU in both groups showed statistically differences, e.g., 1.33 ± 1.1 vs 2.70 ± 1.60 (P = 0.01). PACU stay time was also higher in the control group.&#x0D; Conclusion: The use of pre-emptive analgesia with oral tramadol 50 mg and pregabalin 100 mg 30 min before the surgery can reduce the requirement of peri operative opioid use, achieve better pain control and early recovery.&#x0D; Abbreviations: BMI- Basal Metabolic Rate; PACU- Post-Anesthesia Care Unit; PONV- Postoperative Nausea and Vomiting; VAS- Visual Analog Scale&#x0D; Key words: Analgesia, Preventive; Cancer Surgery; Opioids; Post-Anesthesia Care Unit; Pregabalin; Tramadol&#x0D; Citation: Usman A, Mehdi SR, Khan AA. Preventive analgesia with oral tramadol and pregabalin for post-operative pain in breast surgical patients. Anaesth. pain intensive care 2024;28(1):81−84; DOI: 10.35975/apic.v28i1.2374&#x0D; Received: November 17, 2021; Reviewed: September 24, 2022; Accepted: July 06, 2023

Toward interpretable and generalized mitosis detection in digital pathology using deep learning.

The mitotic activity index is an important prognostic factor in the diagnosis of cancer. The task of mitosis detection is difficult as the nuclei are microscopic in size and partially labeled, and there are many more non-mitotic nuclei compared to mitotic ones. In this paper, we highlight the challenges of current mitosis detection pipelines and propose a method to tackle these challenges. Our proposed methodology is inspired from recent research on deep learning and an extensive analysis on the dataset and training pipeline. We first used the MiDoG'22 dataset for training, validation, and testing. We then tested the methodology without fine-tuning on the TUPAC'16 dataset and on a real-time case from Shaukat Khanum Memorial Cancer Hospital and Research Centre. Our methodology has shown promising results both quantitatively and qualitatively. Quantitatively, our methodology achieved an F1-score of 0.87 on the MiDoG'22 dataset and an F1-score of 0.83 on the TUPAC dataset. Qualitatively, our methodology is generalizable and interpretable across various datasets and clinical settings. In this paper, we highlight the challenges of current mitosis detection pipelines and propose a method that can accurately predict mitotic nuclei. We illustrate the accuracy, generalizability, and interpretability of our approach across various datasets and clinical settings. Our methodology can speed up the adoption of computer-aided digital pathology in clinical settings.

Correlation of intra operative specimen imaging with final histopathology in breast conserving surgery for breast cancer.

To determine the effectiveness of specimen mammography in breast conserving surgery cases with respect to reduction in margin positivity rate, and to see whether the rate of secondary surgeries is decreased by intra-operative excision based on specimen mammography evaluation. The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2018 to December 2019 related to all female breast cancer patients who underwent mastectomy or breast conserving surgery with the involvement of specimen mammography. Sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography were calculated. Data was analysed using SPSS 20. Of the 226 patients initially assessed, 65(28.7%) were excluded, and the final sample comprised 161(71.2%) women with mean age 46.71±10.47 years. The sensitivity, specificity, positive predictive value and negative predictive value of specimen mammography for the sample were 65.8%, 80.8%, 54% and 87.3%, respectively. Performing specimen mammography for intra-operative margin assessment in 12 patients was likely to spare one patient from re-excision. Intra-operative specimen mammography was found to be a reliable tool for assessing margin status.

Expression of PD-L1 clones (22C3 and 28-8) in hepatocellular carcinoma: a tertiary cancer care hospital experience

BackgroundHepatocellular carcinoma (HCC) is a highly aggressive and rapidly progressing form of cancer with a poor prognosis. Recent advances in the management of HCC focused on the novel immunotherapeutic modalities for patients with advanced disease. PD-L1 has emerged as a promising immunotherapeutic approach for HCC. The evaluation of PD-L1 expression aids in identifying patients who can derive maximum benefits from these therapies. This study aims to examine and compare the expression of PD-L1 using two clones (22C3 and 28-8) in HCC patients.MethodsForty-six patients with HCC were selected between 2005 and 2022 from the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan. The patients' formalin-fixed paraffin-embedded (FFPE) tissue samples were retrieved from the department of pathology to conduct immunohistochemical analysis. Moreover, the clinicopathological data of these patients were gathered from the hospital information system (HIS). To assess the relationship between variables, bivariate analysis was carried out using either the chi-square test or Fisher exact test when necessary.ResultsAmong the 46 tissue specimens analyzed, the presence of clone 22C3 was detected in 20 HCC patients, with 10 patients showing high expression (21.7%) and another 10 patients showing low expression (21.7%). 22C3 expression was not observed in 26 patients (56.5%). On the other hand, clone 28-8 was expressed in 10 patients, all of whom exhibited low expression (21.7%), while no expression of clone 28-8 was observed in 36 patients (78.3%). An association was found between the expression of 22C3 and 28-8 PD-L1 clones (p-value 0.01). Furthermore, upon closer examination, it was revealed that 12 cases exhibited positive results for 22C3 but negative results for 28-8. Interestingly, two cases displayed positive results for 28-8 but negative results for 22C3.ConclusionWe obserevd that the PD-L1 clones, 22C3 and 28-8, are comparable. If PD-L1 expression using 22C3 is negative, considering the use of 28-8 for evaluating expression in HCC patients may be beneficial. However, further validation in a larger cohort is necessary.

Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan

Objective: This study examined the levels of Post-Traumatic Stress Disorder (PTSD) in pediatric cancer caregivers and the impact of spirituality on PTSD in Pakistan. Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Oncology, Shaukat Khanum Memorial Cancer Hospital &amp; Research Centre, Peshawar, Northwest General Hospital &amp; Research Centre, Peshawar in Khyber Pakhtunkhwa (KPK), Pakistan Institute of Medical Sciences, Islamabad and Quaid-e-Azam International Hospital in Islamabad, Pakistan from January 2023 to March 2023.Methods: The study comprised 153 Caregivers of pediatric cancer patients aged One month –12 Years using convenience sampling. The PTSD Checklist-Civilian Version (PCL-C) and Caregiver's Spirituality Scale (CSS-10) were used to collect data. Results: Results of the study found that 81 caregivers (52.94%) had high PTSD, and 96 (62.74%) had high spirituality. Females reported higher PTSD and spirituality than guys. Graduates have more PTSD and spirituality than illiterates and matriculate. PTSD and spirituality had a negative Pearson's Correlation Coefficient. Conclusion: The study emphasizes spirituality as a caregiver's mental health protector. Healthcare practitioners caring for pediatric cancer patients can use the findings to lessen PTSD symptoms by targeting caregivers' spiritual needs. Convenience sampling and self-report measurements decrease generalizability. Future study is needed to investigate the association between PTSD and spirituality in caregivers of pediatric cancer patients.How to cite this: Bashir N, Ain Q, Karim N, Niazi H, Khan MI, Asghar AK. Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan. Life and Science. 2024; 5(1): 33-40. doi: http://doi.org/10.37185/LnS.1.1.440

Clinicopathological Features and Treatment Outcomes of Male Breast Cancer in Pakistani Population: A 10-Year Retrospective Cross-Sectional Study.

Male breast cancer (MBC) accounts for 1% of global breast cancer cases. On account of its rarity, very few prospective clinical trials have been carried out on MBC. Pakistan has the highest incidence of breast cancer in Asia, but very limited data are available on MBC. The objective is to determine the clinicopathological characteristics and treatment patterns of MBC in Pakistani population. This is a retrospective cross-sectional study. A retrospective cross-sectional study carried out using the cancer database of Shaukat Khanum Memorial Cancer Hospital & Research Center. Men with a histologically proven breast cancer, stage 0 to III disease and requiring surgical intervention were included. The Kaplan-Meier curve and log-rank test were used for survival analysis. Sixty-eight patients with MBC were included with a median age at diagnosis of 55 years. Most patients were stage II (47.1%). Invasive ductal carcinoma (IDC) was the commonest type (89.7%). Estrogen receptor (ER), progesterone receptor (PR), and Her-2 receptor positivity were 92.6%, 86.8%, and 32.4%, respectively. Mastectomy was performed in 95.6% of the cases. Neoadjuvant and adjuvant chemotherapy was administered in 25 (36.8%) and 26 (38.2%) patients, respectively. Fifty-five (80.9%) patients received adjuvant radiotherapy. Most of the patients (89.7%) received tamoxifen. The 5-year overall and disease-free survival was 88.2% and 80.9%, respectively. Patients receiving neoadjuvant chemotherapy had a better overall and disease-free survival (P = .025). Male breast cancer occurs at a relatively earlier age in Pakistani population as compared with Western men. Mastectomy is the preferred surgical option for MBC on account of the advanced disease and delayed presentation. Neoadjuvant chemotherapy has a statistically significant effect on overall and disease-free survival, but in spite of these benefits, it remains underutilized.

Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience.

Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS. We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods. A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines. Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.

Azithromycin susceptibility testing for salmonella enterica isolates: Comparing disk diffusion results with MIC gradient strips

Background: Enteric fever remains an imperative public health problem in developing countries. After the emergence of cephalosporin resistance in Salmonella enterica subsp. enterica serovar Typhi, azithromycin is increasingly being used for oral treatment of enteric fever. Reports of sporadic azithromycin resistance have been reported across the country, additionally, misuse of azithromycin during the COVID-19 pandemic has concerns regarding emerging azithromycin resistance. This study evaluated the reliability of the disc diffusion method as a screening test for detecting azithromycin resistance by comparing it with the minimum inhibitory concentrations (MIC) gradient strip results, in 231 typhoidal salmonellae. Material and Methods: This prospective study was conducted in the Section of microbiology of the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore from March 2022 to March 2023. Isolates recovered from blood cultures of patients, suffering from enteric fever were selected. Azithromycin susceptibility testing was performed both by disk diffusion and as well as gradient strips and their results were compared. Results: Among typhoidal salmonellae, a significant portion consisted of extensively drug resistant Salmonella Typhi (61.9%). Only one XDR S. Typhi was found to be resistant to azithromycin both by disk diffusion method and MIC gradient strip method, with a MIC value of 64µg/ml. The study found no discrepancy between the disk diffusion and gradient strip methods. Conclusion: The current study found no discordance between disk diffusion and gradient strip test methods for evaluating azithromycin susceptibility among typhoidal salmonellae. Keywords: Azithromycin, disk diffusion testing, enteric fever, Minimum inhibitory concentration, Salmonella Typhi

Expression of NKX2.2 in Non-Ewing Tumors With Round Cell Morphology.

Background Round cell sarcomas pose diagnostic challenges due to overlapping histopathological features, necessitating precise immunohistochemical markers for accurate categorization. NKX2.2 has emerged as a sensitive diagnostic tool, particularly in Ewing sarcoma. This study extends this understanding to various round-cell sarcomas, shedding light on the potential diagnostic utility of NKX2.2 beyond its established role. The nuanced exploration of NKX2.2 expression aims to enhance diagnostic strategies, prognostic assessments, and therapeutic developments in the landscape of sarcoma research. Methodology Cases were retrieved from the surgical pathology and consultation files of Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. Representative hematoxylin and eosin-stained slides of six different types of already confirmed tumors, including lymphoblastic lymphoma, neuroblastoma, rhabdomyosarcoma, synovial sarcoma, Wilms tumor, and Ewing sarcoma, were reviewed by a panel of pathologists. Immunohistochemistry, utilizing a rabbit anti-NKX2.2 monoclonal antibody, was performed on formalin-fixed paraffin-embedded tissue sections. The presence of NKX2.2 was defined as moderate or high nuclear immunoreactivity in at least 5% of cells. Results The histopathological examination revealed characteristic features in each sarcoma subtype, aligning with established diagnostic criteria. In Lymphoblastic lymphoma, T-cell lineage was confirmed through TdT expression, while the atypical finding of focal NKX 2.2 expression hinted at genetic diversity. Neuroblastoma exhibited the expected salt and pepper chromatin pattern, with NKX 2.2 expression raising questions about its prognostic significance. Rhabdomyosarcoma presented primitive cells expressing desmin, and NKX 2.2 focal expression echoed previous subtype-associated studies. Synovial sarcoma displayed both monophasic and biphasic growth patterns and TLE1 expression, with NKX 2.2 variation suggesting tumor heterogeneity. In Wilms tumor, the characteristic WT1 expression was observed, while NKX2.2's absence reaffirmed its irrelevance in this context. Ewing sarcoma displayed the anticipated homogenous cell population, strong NKX2.2 expression, and CD99 positivity across various sites. Furthermore, age and gender impact on this range of sarcomas found no significant relation with an expression of NKX2.2. Conclusion In conclusion, the diverse expression profiles of diagnostic markers discovered in this study, particularly the atypical expression of NKX2.2 beyond its established role in Ewing sarcoma, signify a significant advancement. This unique finding accentuates the potential diagnostic importance of NKX2.2 in various sarcomas, presenting a novel dimension to our understanding of these malignancies.

Survival Analysis and Correlates with Molecular Epidemiology: 10-Year Retrospective Series of High-Grade Glioma in Pakistan.

High-grade gliomas are malignant, recurring primary central nervous system (CNS) tumors requiring extensive postoperative chemotherapy and radiation treatment. Isocitrate dehydrogenase (IDH), 1p19q, and ATRX mutations significantly influence survival and response to chemotherapy, as seen in many extensive studies from the Global North. This study aims to report data from the local region regarding progression-free survival and overall survival in light of molecular characteristics. A 10-year retrospective series was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, with 285 patients presenting from 2008 to 2018. Prospective follow-up data was collected, and complete molecular profiles were available for patients presenting from 2010 onwards. Survival analysis was conducted through the Kaplan-Meier method, with log-rank reported. 70.53% (201) of patients were male, with a mean age at diagnosis of 43.33 ± 15.1 years. 265 patients within the cohort completed postoperative radiotherapy, while 141 patients underwent chemotherapy (procarbazine, lomustine, and vincristine, or temozolomide). Mean survival, in months, within the cohort was as follows: glioblastoma (14.1), anaplastic astrocytoma (27.5), and anaplastic oligodendroglioma (39.8). Survival curves showed a lower survival for IDH wild-type (P < 0.0001), ATRX mutated (P = 0.029), and 1p19q non-deleted (P = 0.008) tumors from Pakistan. Our findings quantified long-term survival outcomes for high-grade glioma from Pakistan, analyzing the various treatment patterns. Of particular importance, molecular sub-classification significantly predicted survival outcomes for IDH, ATRX, and 1p19 co-deletion mutations. Expanding brain tumor epidemiology will benefit assessing the efficacy of regional oncological centers and establishing standards of care.

Invasive fungal infection by saprochaeta capitata in an immunocompromised child- a case report from cancer hospital in Pakistan

Saprochaeta Capitata is an emerging fungus known to cause life-threatening infections in immunocompromised patients. Here, we describe the case of a 4-year-old male child seen in Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, after obtaining informed consent from the parents. He had Pre-B ALL (acute lymphoblastic leukaemia) and contracted this infection during induction chemotherapy. With the use of dual antifungals, he was able to survive this otherwise fatal fungal infection. Keywords: Saprochaeta capitata, invasive fungal infection, dual antifungal therapy, immunocompromised.

Neuroendocrine Breast Carcinoma: a Case Series

Neuroendocrine breast carcinoma (NEBC) is histologically a rare type of invasive breast cancer. It constitutes only 0.2–0.5% of all invasive breast cancers. In this case series, we are presenting five cases having primary neuroendocrine breast cancers that had been reported at a high-volume cancer centre in Pakistan. In this study, neuroendocrine breast cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre Peshawar were evaluated. We had retrospectively collected information on demographic characteristics of our patients, physical examination, radiological findings, surgical procedures with their outcomes, histopathological and immuno-histochemical characteristics, systemic adjuvant/neoadjuvant therapy and follow-up.

Positivity Rate of Universal PCR Screening for COVID-19 Pre-Endoscopy and its Impact on Diagnosis and Management of New Cancer Patients at a Cancer Centre in Pakistan

Objective: To determine the positivity rate of COVID-19 on pre-procedure screening and its impact on diagnosis and management of new cancer patients. Study Design: Cross-sectional study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan, from Sep 2020 to Aug 2021. Methodology: Data was retrospectively collected from electronic medical records of the patients, including their age, gender, PCR test result, date of first visit to the gastroenterology clinic, date of multidisciplinary team meeting and any adverse event reported due to delay in endoscopy procedure. Results: A total of 1273 patients underwent endoscopy procedures in the study period. Fifty-two patients were found to be COVID-positive (4.1%), and only one was symptomatic. The percentage of positivity in newly diagnosed 22 cancer patients was 1.72%. Of 52 patients, 31 were male (59.61%), and 21 were female (40.39%). Only 1 patient was presented with abdominal pain and revealed concealed perforation. No other adverse event was reported in any patient, and no new imaging was required before discussion in a multidisciplinary team meeting. Conclusion: The hospital policy of COVID PCR test 48 hours before the endoscopy procedure effectively isolates the asymptomatic positive COVID-19 patients. The two-week delay due to COVID-PCR positivity in newly diagnosed cancer patients was not associated with any adverse event, and no new imaging was required.

ROLE OF GATA3 AND STAT6 IMMUNOHISTOCHEMISTRY IN CLASSIC HODGKIN LYMPHOMA (CHL) AND NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA (NLPHL)

Objective: The purpose of our study is to investigate the utility of immunohistochemical expression of GATA3 and STAT6 in differentiating Classic Hodgkin Lymphoma (CHL) from Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL). Material and Methods: We approached database of Shaukat Khanum Memorial Cancer Hospital and Research Centre and selected a total of 79 CHLs and 15 NLPHLs diagnosed either on Trucut biopsy or excision biopsy diagnosed during the time 2020-2021. One slide from each of these 94 cases was stained with GATA3 and STAT6 independently and pattern of staining (either nuclear or cytoplasmic or dual nuclear and cytoplasmic) was accessed. Results: 75/79(95%) cases of CHL were positive for GATA3 staining [60/79(75.9%) cases showed nuclear GATA3 staining, 15/79(18.9%) cases showed both nuclear and cytoplasmic staining] and 4/79(5%) CHL cases were negative for GATA3. 15/15(100%) cases of NLPHL were negative for GATA3[12/15(80%) cases showed no staining and 3/15(20%) cases showed only cytoplasmic blush]. 65/79(82%) cases of CHL were positive for STAT6[17/79(21.5%) cases showed nuclear STAT6 expression, 48/79(60.7%) cases showed both nuclear and cytoplasmic staining], and 14/79(18%) cases of CHL were negative for STAT6 expression [8/79(10%) cases showed only cytoplasmic staining and 6/79(8%) showed neither nuclear nor cytoplasmic staining]. 14/15(93.3%) cases of NLPHL were negative for STAT6[5/79(33.3%) cases showed only cytoplasmic staining and 9/15(60%) cases showed no staining] and 1/15(6.7%) case of NLPHL was positive for STAT6[showed nuclear STAT6 staining]. Conclusion: Nuclear staining of GATA3 and STAT6 either alone or in combination with cytoplasmic staining can be used to differentiate CHL from NLPHL. GATA3 effectively excludes NLPHL with 100% negative predictive value. Keywords: GATA3, STAT6, Classic Hodgkin lymphoma, Nodular lymphocyte predominant Hodgkin lymphoma

Cancer incidence in Khyber Pakhtunkhwa, Pakistan, 2020

BackgroundTo present the population-based cancer statistics for Khyber Pakhtunkhwa (KP), Pakistan, an incidence study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan, in 2023.MethodsRecords from various centres on new cancers diagnosed among residents of KP between January and December 2020 were gathered. Both active and passive methods of data collection were applied, and the information was saved in a central repository at SKMCH&RC. The incidence rates were computed by age group and sex and presented per 100,000 population.ResultsAmong children (0–14 years), the Age-Standardised Incidence Rate (ASIR) was 4.0 in girls and 6.1 in boys, and haematologic malignancies were more prevalent; in adolescents (15–19 years), the ASIR was 7.7 in females, 9.4 in males, and bone tumours, haematologic malignancies, and neurological cancers were prominent; in adult females (> / = 20 years), the ASIR was 84.9, and cancers of the breast, digestive system, and reproductive organs were predominant; and adult males, the ASIR was 73.0, and cancers of the gastrointestinal tract, lip/oral cavity/pharynx, prostate, and Non-Hodgkin Lymphoma (NHL) were common.ConclusionsIt is crucial to investigate the aetiology of these diseases at the community level because dietary elements, infectious diseases, and tobacco use all appear to be significant contributors. Prospective studies could play a key role in highlighting the factors linked to these diseases. Therefore, cancer registration must continue in conjunction with the exploration of risk factors.

Developing an Allogeneic Hematopoietic Progenitor Cell Transplant Service in a Resource-Limited Country: Challenges and Outcomes.

Introduction Allogeneic stem cell transplant has curative potential for many hematological disorders. Building an allogeneic hematopoietic progenitor cell transplant (HPCT) unit requires huge investment, infrastructure, equipment, medical supplies, and training of health care professionals. The key objective of this study is to share our experience of developing an allogeneic HPCT service at our tertiary care cancer hospital in a low-middle-income country. In addition, this study presents the outcomes of the first 30 allogeneic HPCTs done at our center. Methods This retrospective observational study included adult patients 18 years old or older with hematological malignancies who underwent allogeneic HPCT between July 2019 and April 2023 at Shaukat Khanum Memorial Cancer Hospital and Research Centre. Result Of the 30 patients, 24 underwent matched sibling donor (MSD) transplants in which a myeloablative-conditioning regimen (MAC) was used in 19, and a reduced conditioning regimen (RIC) was used in one. Of the six haploidentical-related donor transplants, four received MAC, and two received RIC. The median recipient age at HPCT was 23 and 21 years for MSD and Haplo-related donor transplants, respectively. The median follow-up duration was 12 months (Range: 10 days - 33 months). The overall survival rate at one yearwas 71.3% among all allogeneic stem cell transplant patients, whereas the disease-free survival rate at one yearwas 63.7%. In the acute lymphoblastic leukemia group, the disease-free survival rate at one year post allograft was 51.5%, while in the acute myeloid leukemia group, it was 78.7%. Conclusion This study demonstrates the successful development of an allogeneic bone marrow transplant unit at our hospital despite significant financial constraints. This has allowed us to provide a potentially curative and life-saving treatment to a substantial number of cancer patients. The bone marrow transplant outcomes of this study are comparable to those reported by international bone marrow transplant registries.