Rationalizing Optimal Timing for Adjuvant Hormone Therapy for Patients with Breast Cancer: Impact on Limited Resource Countries

Modern day cancer chemotherapy is complex and involves multiple drugs given either sequentially or concurrently, as an adjuvant or neo-adjuvant. Besides the concentration of the drug, timing, duration and sequencing of individual drugs in combination with other similar agents play a vital role in the final therapeutic outcome. This study constitutes an exhaustive overview of current knowledge of timing and sequencing, specifically of Tamoxifen, based on tumor’s hormone receptor status, as part of a comprehensive treatment plan. It has become apparent that inappropriate timing or sequencing can be detrimental. On the other hand, appropriate timing and sequencing of Tamoxifen, based on breast cancer cell-biology, pharmacokinetics and pharmacodynamics of drugs, the body’s homeostatic response to drugs;surgery and radiation, yield huge benefit for locoregional control, long-term survival and reducing complications in patients with breast cancer. Conclusion: A rational plan for use of Tamoxifen has been recommended, based on this study;for optimal therapeutic benefit. It has also been suggested that in receptor “unknown cases”, it is beneficial to prescribe Tamoxifen, since 75% of breast cancers are likely to be estrogen receptor positive and side effects can be minimized with planned vigilance.

Anaortic Off-Pump Complete Arterial Revascularization Using Composite LIMA RIMA Y Sequential 5 Grafts in a Patient with Triple Vessel Disease Performed in a Low Resource Country: A Case Report

The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report, a patient presented with TVD has been managed with anaortic off-pump complete arterial revascularization (OPCABG) by using composite LIMA RIMA Y Sequential 5 grafts to achieve complete arterial revascularization successfully. This type of operative procedure is technically difficult in a resource poor country like Bangladesh. However, this has been done by a group of young cardiac surgeon. During follow up, the patient is in a good condition.

Frequency of otitis media with effusion among children aged 1-5 years presenting to immunization center of tertiary care hospitals,Rawalpindi

Objective:We conducted this study to assess the etiopathogenic relation of otitis media with effusion(OME)in a group of children aged 1-5 years among the local population of Rawalpindi.Methods:This was a cross-sectional retrospective study.Study was conducted among the children presenting to the immunization center of three tertiary care hospitals of Rawalpindi.Otitis media was assessed by clinical examination and tympanometry from August 2019 to January 2020.Multi-factor regression analysis was then applied to recognize the statistical significance and association of various risk factors to OME.Results:Out of 400 children enrolled in this study,108(27.0%)had OME,out of which 65(60.2%)were males and 30(27.8%)were of age group 2-3 years.Multivariable regression analysis of risk factors associated with OME showed it was strongly associated with snoring(P<0.001),last year symptoms(attack of ear aches with hearing loss[P=0.002]),drugs(URTI antibiotics[P=0.026],All 3 drugs[P=0.013]).Conclusions:We found out that OME is a common disease which if not identified or treated timely can lead to other hard to cure health problems.Control of its etiopathogenic factors can play a major role in its prevention.