Household costs of breast cancer morbidity: An empirical assessment from Pakistan

PURPOSE

Health care costs attributable to breast cancer are substantial. In countries with high poverty, lack of public health infrastructure and low availability of health insurance, the economic burden of disease does not accrue solely to health care, but also on patients and their families. This study was conducted to explore the cost burden (i.e. direct medical costs, direct non-medical costs and indirect non-medical costs) incurred by breast cancer patients and their families over diagnosis and treatment.

METHODS

Data was collected from 200 breast cancer patients at two hospitals in Lahore, provincial capital of Punjab, Pakistan, by employing purposive sampling technique. Costs were aggregated into three categories and compared with each other as per their weightage.

RESULTS

The study found that direct medical care (US$ 1262.18/ Local currency (PKR) 129,717) is the largest expense, followed by direct non-medical (US$ 310.88 / PKR 31,950) and indirect non-medical costs (US$ 273.38 / PKR 28,096).

CONCLUSIONS

The results of this study provide rich insight into the financial burden borne by households of breast cancer patients and suggest policy implications.

Effects of Breastfeeding on the Baby and on Its Immune System

Human milk is a very complex fluid with a number of components and multiple functions. New functions are continually being identified. It is clear that human milk can affect the immune system of the breasfed infant. This results both in enhanced vaccine responses and, at times, down-regulation of other immune reactivities, such as transplant rejection and the risk of developing certain immunologic diseases, such as type I diabetes. Breastfeeding presumably gives the infant the possibility for an optimal immune response by providing good nutrition, including a decreased risk of vitamin A deficiency. The control of the intestinal flora and the anti-inflammatory effects of maternal milk also increase the possibilities for an adequate immune response in the infant. Further study is needed of the roles of idiotypic and anti-idiotypic antibodies, growth factors, cytokines, and various anti-inflammatory factors in the maternal milk in the infant's host defence.

Laparoscopic inguinal hernia repair: a rare case of colonic mesh migration

Inguinal hernia repair can be performed via either an open or laparoscopic technique. Use of a mesh to repair the abdominal wall defect is now common practice, leading to a reduction in hernia recurrence but also associated with a number of complications. We report a rare case of a 49-year old man who presented 3 years after laparoscopic hernia repair with right-sided abdominal pain and loose stools. Colonoscopy and computed tomography revealed a mesh and fixation devices within the lumen of the caecum and ascending colon. The mesh was successfully excised with primary closure of the bowel defect. This case highlights the importance of recognising mesh migration as a complication of hernia repair, a phenomenon which can lead to serious morbidity. We suggest that patients should be informed of this risk during the consent process, while further research is needed to investigate how this occurrence can be prevented.

Comparison among Different Culture Media for the Detection of Dermatophytes

Dermatophytes are a group of closely related fungi that have the capacity of invading the keratinized tissue of human to produce infections known as dermatophytosis which is commonly referred to as ringworm. Other than routine microscopy, different culture media are available for the detection of dermatophytes from patient's specimen. This cross sectional study was designed to evaluate the outcome of three different culture media and microscopy for the detection of dermatophytes from clinical samples. Skin, hair and nail samples from 84 clinically suspected cases of dermatophytosis who attended at OPD of Dermatology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2014 to June 2015 were screened by direct microscopic examination using potassium hydroxide (KOH) mount. All the samples were inoculated for culture in Sabouraud's Dextrose Agar (SDA), Dermatophytes Test medium (DTM) and Sabouraud's Cycloheximide Chloramphenicol Agar (SCCA). The percentage of samples positive by microscopy was 37.5%, whereas the rate of positivity by culture was 47.6% which showed that culture was more sensitive than microscopy for the diagnosis of dermatophytosis. The efficiency of SDA and SCCA was found to be almost equal. There was no statistically significant difference between SDA and DTM in primary isolation of dermatophytes, though isolation rate was slightly higher in DTM. Though direct examination by microscopy is an efficient screening technique, culture should be done for accurate diagnosis. As DTM is easy to evaluate even without handling the growth of culture in the laboratory, it is recommended to use as screening medium for the detection of dermatophytes.

Saline conditions alter morpho-physiological intensification in purslane (Portulaca oleracea l.)

In this study, primary investigations of selected cultivar of purslane named as Tall Green under articular salinity stress were evaluated to understand the basic concept of different mechanisms of physiological attributes which will play an important role for molecular and proteomic level research. The evaluation of morphological and physiological attributes under 0 mM (without salt addition) 100 mM and 200 mM salt stress changed dramatically. The results showed high salt stress at 200 mM significantly decreasing the morphological attributes and performance of leaves, stems, and roots. At moderate salt stress levels, 100 mM, the ratio of Fv/Fm slightly increased compared to high stress. In addition, salt stress significantly decreased the total chlorophyll content (chl a+b) at 200 mM. The relative water content percentage was high at 0 mM. Moreover, the electrolyte leakage (EL) significantly increased with increasing salinity stress compared to control 0 mM.

A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery

Spontaneous splanchnic artery rupture is associated with up to 70% mortality. Affected vessels are often aneurysmal, secondary to atherosclerosis. We report, to our knowledge, the only case of spontaneous rupture of a branch of the left colic artery and the right gastric artery, possibly secondary to vasculitis.

Measurement of Ascaris lumbricoides IgG antibody, associated risk factors and identification of serum biochemical parameters as biomarkers of pathogenicity: among patients with gastrointestinal complains in Pakistan

Soil transmitted helminths are causing significant morbidity worldwide and the most common infection is Ascaris lumbricoides in developing countries. The present study aimed to determine the immuno-epidemiological status of ascariasis among patients with gastrointestinal complaints and to identify the associated risk factors and eventual changes in serum biochemical parameters to reflect its pathogenicity. This study was conducted on 700 respondents aged between 5-45 years. A total of 356 patients participated in an enzymelinked immunosorbent assay (ELISA) study to determine anti-Ascaris IgG levels and biochemical parameters. The overall seroprevalence was 58.4%, with 100% sensitivity and 84.4% specificity of the assay. The infection was highest among the 21-28 year age group (14.0%), and ascariasis was found to be not significantly (P>0.05) different between the age groups. The results showed that the risk of ascariasis was significantly (P<0.05) increased in individuals who had no contact with soil (OR=4.6, 95% CI: 1.9-10.8), eating unwashed vegetables one month prior to the study (OR=2.7, 95% CI: 1.4-5.2), eating mixed food (OR=2.4, 95% CI: 1.2-4.7), drinking pressure pump water (OR=3.4, 95% CI: 1.9-6.1), and those who had no complain of vomiting (OR=3.1, 95% CI: 1.6-5.8) and nausea (OR=1.9, 95% CI: 1.1-3.2). The results showed significantly (P<0.05) elevated level of serum alanine aminotransferase, alkaline phosphatase, serum cholesterol, total protein and globulin in anti-Ascaris IgG positive cases than the control group. The study concluded that patients who visited health care centres with gastrointestinal complain were at higher risk of ascariasis as compared to other diseases. In conclusion epidemiological studies are needed to establish baseline data for public health authorities in order to plan and implement health education programs to reduce the impact of the disease.

Soft-tissue evidence of head injury in infants and young children: is CT head examination justified?

AIM

To determine whether it is justified to undertake a computed tomography (CT) examination of the head in children under 1 year of age who present with a bruise, swelling, or laceration of >5 cm following head injury in children presenting to a paediatric accident and emergency (A&E) department in the northwest of England. Further aims were to determine whether there was any justification for performing a CT head examination for children with soft-tissue injuries measuring <5 cm, or for children >1 year with evidence of soft-tissue injury, but without any other concerning feature.

MATERIALS AND METHODS

Children <3 years of age presenting with soft-tissue evidence of head injury between May 2011 and Oct 2014 and who subsequently underwent head CT were retrospectively identified from radiology requests. The CT images and clinical notes were used to identify those with skull fracture or intracranial haemorrhage and to determine whether the child was subsequently admitted or discharged from A&E.

RESULTS

Eighty-five CT head examinations met the criteria for inclusion. Of these, 45 examinations demonstrated skull fractures and four examinations identified intracranial haemorrhage. Thirty-eight requests included soft-tissue evidence of head injury as the sole reason indicated for CT head examination. Of these, 22 examinations demonstrated skull fractures and one examination identified intracranial haemorrhage.

CONCLUSION

Soft-tissue evidence of head injury as the sole reason for CT head examination appears to be justified in the present patient population. Furthermore, this study suggests that CT head examination should also be considered for children with soft-tissue injuries of <5 cm and for children aged between 1 and 3 years if identification of a skull fracture would alter the child's management.