Syed Ather Hussain

Awareness of breast cancer warning signs and screening methods among female residents of Pokhara valley, Nepal.

BACKGROUND Breast cancer is the second most common cancer in the world and by far the most frequent cancer among women. OBJECTIVE The present study was undertaken to assess the awareness of breast cancer warning signs and screening methods among the women of Pokhara valley, Nepal. MATERIALS AND METHODS A cross-sectional questionnaire survey was carried out in a community setting with the female population. The questionnaire was administered in face-to-face interviews by trained research assistants. RESULTS Nepalese women demonstrated poor awareness of warning signs like a breast lump, lump under the armpit, bleeding or discharge from the nipple, pulling of the nipple, changes in the position of the nipple, nipple rash, redness of the breast skin, changes in the size of the breast or nipple, changes in the shape of the breast or nipple, pain in the breast or armpit, and dimpling of the breast skin. While 100% of nurses were aware about breast self- examination (BSE), mammography and warning signs of breast cancer. Levels of knowledge were significantly poorer in women with other occupations. Graduates were more aware about BSE, mammogram and warning signs of breast cancer compared to those with other educational levels. CONCLUSIONS The findings indicated that the level of awareness of breast cancer, including knowledge of warning signs and BSE, is sub-optimal among Nepalese women.

Suicidal ideation among medical students of Pakistan: A cross-sectional study

Few studies have investigated suicidal ideation among medical students in the developing world. We found only one report on suicidal ideation among medical students in Pakistan published in the year 2005. The present cross-sectional survey on suicidal ideation conducted in July 2013 involved 331 medical students of Dow University of Health Sciences, Karachi, Pakistan. In the past one year, suicidal ideation was found in 118 (35.6%) students. Forty-six (13.9%) of all the students had made a plan in their life time to commit suicide while 16 (4.8%) of the 331 students tried to commit suicide at some point of time in their life. More females than males pondered suicide while first year medical students formed the majority of those with suicidal ideation. The single greatest risk factor predisposing to suicidal ideation was substance abuse. This was followed jointly by parental neglect and previous psychiatric disorder. Campaigns against substance abuse and counseling of vulnerable students will help in eradicating suicidal intent.

The Spectrum of Genetic Mutations in Breast Cancer

Breast cancer is the most common malignancy in women around the world. About one in 12 women in the West develop breast cancer at some point in life. It is estimated that 5%-10% of all breast cancer cases in women are linked to hereditary susceptibility due to mutations in autosomal dominant genes. The two key players associated with high breast cancer risk are mutations in BRCA 1 and BRCA 2. Another highly important mutation can occur in TP53 resulting in a triple negative breast cancer. However, the great majority of breast cancer cases are not related to a mutated gene of high penetrance, but to genes of low penetrance such as CHEK2, CDH1, NBS1, RAD50, BRIP1 and PALB2, which are frequently mutated in the general population. In this review, we discuss the entire spectrum of mutations which are associated with breast cancer.

Parents in Pakistan arrested for polio vaccine refusal: a necessary step?

Pakistan’s vaccination drive against polio has encountered many adversities in the past few years. The vaccination drive received hostility from militant groups when it was used as cover to spy on Taliban hideouts. In retaliation, extremist groups have killed about 60 polio vaccine workers, which further hindered progress of the vaccine drive. Additionally, some in the general population have misconceptions about the vaccine. Until now, the government has not taken a hard line, which is necessary to control this issue. On March 2, 2015, police in Khyber– Pakhtunkhwa province, Pakistan, arrested more than 450 parents after they refused to vaccinate their children against polio virus because of some religious fears and myths associated with vaccination (such as sterilisation). The parents later signed an agreement to cooperate in administration of the polio vaccine to their children. The police felt the need to intervene because the number of polio cases in the province had increased by 96% in the previous year. In Khyber–Pakhtunkhwa She previously received paclitaxel, trastuzumab, plus pertuzumab, and lapatinib plus capecitabine regimens. She started taking ado-trastuzumab emtansine (T-DM1) at 3·6 mg/kg every 3 weeks. After five cycles of treatment, she developed severe desquamation of her palms and soles with oral mucositis. Additionally, she had characteristic yellow–orange discolouration of her palms (fi gure). Laboratory examin ations showed no abnormalities in whole blood cell count, lipid profile, aspartate aminotransferase and alanine aminotransferase, blood urea nitrogen and creatinine, total bilirubin, direct and indirect bilirubin. The diagnosis was carotenoderma with hand-foot syndrome. A

Endosulfan poisoning: An overview

Endosulfan, an organochlorine (OC) insecticide, is a widely used agricultural pesticide, despite its life threatening toxic effects. In this review, the pharmacokinetics of endosulfan, mechanism of endosulfan toxicity, clinical presentations and management, histopathological findings, and toxicological analysis are described, in addition to its environmental toxicity. The toxic effects of endosulfan can affect many organs and systems presenting in a wide array of signs and symptoms. Although termed a restricted OC-classed pesticide, it continues to be used, especially in the developing world, owing to its beneficial effects on agriculture. Several cases of endosulfan poisoning have been reported from different regions of the world. Whether accidental or intentional, endosulfan ingestion proves to be fatal unless immediate, aggressive treatment is initiated. Management is mainly supportive as no antidote exists for endosulfan poisoning as yet. The use of endosulfan needs to be strictly regulated and eventually banned worldwide altogether to lower the current morbidity and mortality resulting from this pesticide. Additionally, monitoring biological samples, using non-invasive techniques such as breast milk sampling, can provide an effective method of observing the elimination of this environmentally persistent organic pollutant from the general population.

The airplane crash in the French Alps: A preventable tragedy.

The crash of Germanwings Flight 9525 in the French Alps resulted in the death of all 150 people who were onboard including the crew (Brown et al., 2015). The co-pilot who was in his late twenties, was in-charge at the time of the crash and has been accused of deliberately bringing down the plane. This accusation gained credibility when a cockpit voice recording came into light in which the other pilot can be heard knocking angrily on the locked cockpit door, protesting to be let back in (Bukszpan, 2015). The copilot had admitted to the airline training school back in 2009 that he had experienced a severe episode of depression (Brown et al., 2015). More recently, he had been visiting a neuropsychologist who had declared him unfit for work due to his psychological issues. This tragic incident raises questions about the effectiveness of the psychological screening methods currently employed to recruit pilots. German pilots are bound by the guidelines laid down by the European Aviation Safety Agency (Bukszpan, 2015). These guidelines state that individuals should not have any prior psychiatric illness which might hinder the pilot from fulfilling his duties and that all individuals should go through psychological screening before they can be deemed fit. These guidelines go on to state that individuals with an established history of schizophrenia, schizotypal or delusional disorder will be regarded unfit (Bukszpan, 2015). Although airlines may have certain protocols in place to assess the mental health of an applicant, these protocols depend immensely on applicants volunteering information on their own regarding their psychiatric illnesses. According to the Federal Aviation Administration guidelines followed in the United States, doctors are not expected to conduct a formal psychiatric evaluation of the applicant but instead should assess the mental health of the applicant by reviewing medical histories and through dialog (Mendoza, 2015). Since mental health issues are the basis for the refusal of an aviation license, applicants may find it beneficial to omit their psychiatric illnesses. Although the co-pilot in this case did mention a depressive episode in the past, he was not suffering from depression at the time of enrollment and was capable of flying a

PARP inhibitors: current status and implications for anticancer therapeutics.

Poly(ADP-ribose) polymerases (PARPs) comprise of a large family of 17 proteins encoded by various genes which participate in genome maintenance, apoptosis, inflammatory responses and the regulation of gene expression programs. PARP inhibitors, as therapeutic agents, come into play acting on both PARP 1 and PARP 2. These drugs seem to target tumor cells in a moment of vulnerability when they are undergoing DNA repair. In the past few years this class of anti-cancer drug has been discovered to show a promising niche in the clinic.

Gastrointestinal causes of sudden unexpected death: A review

Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.

Breaking your heart—A review on CPR-related injuries

&NA; Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra‐abdominal injuries. This review discusses the risk factors and prevalence of CPR‐related injuries. Highlights:CPR, although lifesaving, may be associated with significant injuries.CPR is associated with a wide range of injuries, from the head and neck down to the abdomen and pelvis.Appropriate technique and position of chest compression may help prevent some CPR‐related injuries.CPR‐related injuries should be considered in all patients who do not improve despite correction of the cause of arrest

Telepsychiatry in Pakistan after natural disasters

Despite recent advances, access to mental health care is still restricted in some low-income and middle-income countries because of limited availability of health facilities in rural areas, reluctance to seek psychiatric help because of cultural considerations, and other factors. Therefore, there is an urgent need for innovative methods to deliver mental health services, particularly in remote areas. Telepsychiatry, which includes the use of video-based conferencing to deliver mental health services, has vast potential to bridge this gap. In Pakistan, where about 160 000 people experience mental health problems, and 34% of population is aff ected by anxiety and depression, telepsychiatry can ensure that high-risk patients receive timely help. Recently, telepsychiatry was used to treat post-traumatic stress disorder (PTSD) in a rural setting in northern Pakistan. The village of Charun Oveer experienced two consecutive natural disasters in 2015; it was hit by fl oods in March, followed by an earthquake measuring 7·5 on the Richter scale in October, which demolished 89 of the 140 houses in the region. Unsurprisingly, many people experienced psychological disturbances. Since the closest health-care facility was situated 3 h away by road, telepsychiatry was the only viable option for providing sustainable psychological and psychiatric treatment. The required facilities were set up by the medical corps arm of Karachi Relief Trust, an organisation specialising in disaster relief, headed by Dr Naseer Mehmood and Dr Nuzhat Faruqui. It was assisted by mental health experts who volunteered for the project. They diagnosed PTSD and other disorders among survivors, who reported a variety of symptoms including insomnia, nightmares, and fl ashbacks, using a quality of life scale. One of the authors (MHU) volunteered in the project and witnessed it fi rst-hand. Initially, two community-based sessions were held in which 160 people attended, with 60 men in one session and 100 women in the other session. The people of the village allowed the team to conduct all activities at the local community spiritual centre. These were a combination of visual, oral, and interactive sessions aimed at destigmatising and spreading awareness regarding mental health problems among the local population. After the initial sessions, translators were employed to further engage the local villagers. The villagers were taught breathing exercises, and art and music therapy was introduced at the community spiritual centre in the village. Additionally, 18 community members were given intense three-day training sessions as mental health workers; obtaining histories and screening the community members for anxiety, depression, and PTSD only. 500 adults were screened and 57 were diagnosed with symptoms of PTSD or depression. These were then shortlisted for the telepsychiatry sessions, and each patient was given a prearranged hour-long appointment with a trained psychiatrist at least once a week. The intervention was delivered to the patients in this manner for the following ten months after which the project came to a close. Outcomes for the project are not available as yet. While concrete evidence regarding effi cacy of telepsychiatry is still being assessed, it is definitely beneficial when in-person interaction between doctor and patient cannot occur. Telepsychiatry has great potential to deliver eff ective help to those who are isolated from expert mental health care, thereby reducing the treatment gap.