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Objectives: To evaluate the effect of immediate breast reconstruction with mastectomy in the local population. METHODS: The quasi-experimental, control study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised patient data from April 2017 to December 2020, of breast cancer patients who underwent mastectomy with or without immediate breast reconstruction. Those who underwent mastectomy were labelled as control group A, while patients with immediate breast reconstruction were labelled as intervention group B. Data was analysed using SPSS 20. RESULTS: Of the 66 patients, 33(50%) were in each of the 2 groups. Group B had significantly more patients aged <40 years than group A (p=0.01), more patients with graduate-level education (p=0.04), and more patients who were either unmarried or divorced (p=0.05) than group A. Group B patients had higher mean scores for satisfaction with breasts (p=0.001) and psychosocial wellbeing (p=0.001) than those in in group A. Mean scores for adverse effects of radiotherapy were significantly higher in group B than in group A (p=0.04). CONCLUSIONS: Better health-related outcomes were reported by patients who underwent immediate breast reconstruction with mastectomy.

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Objectives: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Intra-operative specimen mammography was found to be a reliable tool for assessing margin status.

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The study aims to determine histamine efficacy on hematologic values in experimental animal model, under physiological and pathological conditions after inducing diphenhydramine-formulated nasal nano-gel/nano-emulgel in comparison with conventional nasal spray regime. In this study, we conducted experiment on New Zealand white male rabbits to prove our hypothesis that nasal diphenhydramine nano-gel and nano-emulgel can penetrate the nasal mucosa faster to show drug response and subside histaminic symptoms than market nasal spray (as reference). Blood samples from 48 New Zealand white male rabbits, under both experimental conditions (physiological and pathological) divided into four groups for each (n = 6) were investigated after inducing each dosage form intranasally. Hematologic parameters (WBCs, RBCs, HGB, PLTs, lymphocytes, monocytes, eosinophils, granulocyte counts) were analyzed in whole blood samples, collected at different time intervals. ANOVA and completely randomized design (CRD) were applied for statistical analysis. Histopathologically, nasal tissues of all groups were analyzed to see intramucosal surface changes. Data of descriptive statistics of hematological parameters analyzed at confidence level 95% showed that under physiological condition, hematological parameters of all groups were lying in normal range, whereas under pathological condition, low values of all hematological parameters were observed in all groups due to allergenic condition. The groups B (allergenic rabbits treated with formulated diphenhydramine nasal nano-gel) and C (allergenic rabbits treated with formulated diphenhydramine nasal nano-emulgel) have shown good changes in the treatment of allergenic rabbits as compared to group D (allergenic rabbits treated with formulated diphenhydramine nasal spray). The completely randomized ANOVA and Tukey HSD all-pairwise comparison tests of hematological parameters were applied that showed all groups in both studies were significantly different from each other. It was observed after histopathological study of nasal membrane tissues that change in mucosa has occurred due to the passage of drug. In summary, hematological profile and histopathological study have demonstrated the comparable results with conventional diphenhydramine nasal spray and formulated diphenhydramine nasal nano-gel/nano-emulgel which can exhibit considerable drug delivery dosage forms in the management of allergic rhinitis in animal model.

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OBJECTIVE: To determine false negative rate, negative predictive value and the factors predicting false negativity of pre-treatment axillary ultrasound. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data from January 2019 to December 2020 of patients with normal lymph nodes on ultrasound, tumour stages T1, T2 or T3 having invasive cancer who underwent sentinel lymph node biopsy. Ultrasound findings were compared with the biopsy results, dividing the sample into false negative group A and true negative group B. Clinical, radiological, histopathological parameters and therapeutic strategies were compared between the two groups. Data was analysed using SPSS 20. RESULTS: Of the 781 patients with mean age 49.39±11.51 years, 154(19.7%) were in group A and 627(80.2%) were in group B, with negative predictive value of 80.2%. Initial tumour size, histopathology, tumour grade, receptors, timing of chemotherapy, and type of surgery has significant difference between the groups (p<0.05). Multivariate analysis showed larger, high-grade, progesterone receptor negative and human epidermal growth factor receptor 2 positive tumours were significantly associated with lower false negative rate on axillary ultrasound (p<0.05). CONCLUSIONS: Axillary ultrasound was found to be effective in ruling out axillary nodal disease, especially in patients with high-burden axillary disease, aggressive tumour biology, larger tumour size and higher timour grade.

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This study was to formulate Aloevera extract loaded emulsion (O/W) based gels, by using various concentrations of rose oil, olive oil and Lemon oil as natural penetration enhancers for transdermal effect to treat skin problems. By using RSM, Aloevera emulgels were formulated and then optimized. Stability studies, physico-chemical characteristics, spreadability, skin protection factor, thermal analysis, FTIR, antimicrobial activity, in vitro drug release study (at 37ºC with 100 rpm for 180 minute in release medium at pH 5.5) and in vivo skin evaluation tests were performed. The results were then statistically analyzed. Among all formulations, G12 has shown maximum 93.53% Aloevera release at higher concentration of Olive oil with decreased concentration of Rose oil and Lemon oil. Analysis of variance (ANOVA) was conducted to evaluate the results exhibited independent variables have remarkable effects on dependent variables. Contour plot is also drawn to express the response between independent and dependent variables. All formulations have followed Korsmeyer-Peppas kinetic model. In summary, the combination of penetration enhancers in Aloevera emulgel can be successfully utilized for treatment of mild-moderate acne vulgaris and other skin problems, as optimized emulgel has shown good permeability, prolonged residence time on skin surface and proved good anti-microbial activity.

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INTRODUCTION AND IMPORTANCE: Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly. CASE PRESENTATION: A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered. CLINICAL DISCUSSION: Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis. The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins. CONCLUSION: Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.

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OBJECTIVE: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. RESULTS: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). CONCLUSION: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome.

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