Myths and Misconceptions of Breast Cancer in the Pakistani Population

Background Breast cancer is one of the most prevalent types of cancer in the female population. The cultural diversity, religious beliefs, myths, and misinformation regarding the disease contribute to diagnostic delays and enhanced burden on the healthcare system. This study aimed to ascertain the extent of knowledge and prevalence of erroneous beliefs and misconceptions regarding breast cancer among Pakistani women belonging to diverse socioeconomic and educational backgrounds. Methodology This cross-sectional study was performed in a tertiary care hospital in Karachi, Pakistan. A total of 350 women were enrolled in the study as a representative female population, and 300 participants were included who met the inclusion criteria. Participants were conveniently interviewed using a pre-piloted questionnaire designed to assess the prevalent myths and misconceptions about breast cancer. The data were analyzed by SPSS version 23 (IBM Corp., Armonk, NY, USA) using descriptive statistics. Results The study findings point to a significant prevalence of erroneous beliefs and a lack of accurate information on breast cancer. The mean age of the participants was 20.8 ± 10.4 years. The majority of the participants belonged to a middle socioeconomic status (70%) and were undergraduates (61.4%). The participants' friends and family members were the most frequent sources of information regarding breast cancer. The most common myth was "breast-feeding offers immunity to breast cancer completely" (76.6%), followed by "breast cancer spreads after biopsy" (63.8%). Participants also believed that breast tissue biopsy can lead to the spread of cancer (63.4%) and that faith healers and alternative medicine can cure breast cancer (47.5%). One-third (33.3%) of the participants considered all lumps to be breast cancer; however, approximately half (41.6%) of the participants thought that only painful lumps were associated with breast cancer. A significant number of participants believed breast cancer to be a result of God's curse (31.4%) or evil eye (38.7%). Conclusions The findings suggest a critical need for community-based breast health education initiatives that take into account Pakistani women's distinctive cultural and societal attitudes and work to dispel common misconceptions about the condition.

Exploring the impact of the COVID-19 pandemic on provision of cardiology services: a scoping review

The coronavirus disease-19 (COVID-19) pandemic has forced hospitals to prioritize COVID-19 patients, restrict resources, and cancel all non-urgent elective cardiac procedures. Clinical visits have only been facilitated for emergency purposes. Fewer patients have been admitted to the hospital for both ST-segment elevation myocardial infarctions (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI) and a profound decrease in heart failure services has been reported. A similar reduction in the patient presentation is seen for ischemic heart disease, decompensated heart failure, and endocarditis. Cardiovascular services, including catheterization, primary percutaneous coronary intervention (PPCI), cardiac investigations such as electrocardiograms (ECGs), exercise tolerance test (ETT), dobutamine stress test, computed tomography (CT) angiography, transesophageal echocardiography (TOE) have been reported to have declined and performed on a priority basis. The long-term implications of this decline have been discussed with major concerns of severe cardiac complications and vulnerabilities in cardiac patients. The pandemic has also had psychological impacts on patients causing them to avoid seeking medical help. This review discusses the effects of the COVID-19 pandemic on the provision of various cardiology services and aims to provide strategies to restore cardiovascular services including structural changes in the hospital to make up for the reduced staff personnel, the use of personal protective equipment in healthcare workers, and provides alternatives for high-risk cardiac imaging, cardiac interventions, and procedures. Implementation of the triage system, risk assessment scores, and telemedicine services in patients and their adaptation to the cardiovascular department have been discussed.

Pharyngeal-cervical-brachial variant of Guillain-Barré syndrome: a case report of a rare complication following Dengue-Chikungunya co-infection

Pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré Syndrome (GBS) is characterized by weakness in cervicobrachial and oropharyngeal region, together with areflexia of upper limbs. Being an uncommon variant, it is often misdiagnosed as other neurological conditions resembling GBS. Although most of the cases occur as a post-infectious complication, no reports describing its development following dengue-chikungunya co-infection have been documented. A young female presented with a progressive history of swallowing difficulty, bilateral arm weakness and neck weakness. Three weeks earlier, she was presented with clinical features corresponding to dengue and was symptomatically treated. Currently, hypotonia and decreased muscle strength were observed in both upper limbs and neck. Detailed investigation revealed the presence of Immunoglobulin M (IgM) antibodies against dengue antigen (NS 1) and Chikungunya virus (CHIKV), confirming the possibility of previous dengue-chikungunya co-infection. Nerve conduction studies and electromyography of upper limbs pointed towards findings consistent with the early stages of acute motor demyelinating and possible axonal neuropathy. The detection of antiganglioside antibodies (anti-GT1a antibodies), confirmed the diagnosis of the pharyngeal-cervical-brachial variant of GBS. A five days treatment of intravenous immunoglobulin (IVIG) along with physical rehabilitation was started which led to significant improvement and the patient was discharged after 15 days. PCB is an unfamiliar variant of GBS for many clinicians. Diagnosis can be made by a thorough history, clinical examination and investigations that can rule out other potential causes of cervicobrachial and oropharyngeal weakness. It also necessitates careful monitoring and followups after mono- and co-arboviral infections to prevent any debilitating neurological complications.

New-onset restless leg syndrome in a COVID-19 patient: a case report with literature review

Restless leg syndrome (RLS) is a sleep disorder characterized by the sudden urge to move the lower limbs during periods of rest accompanied by an unpleasant sensation like tingling or burning in the legs. Often, this urge is partially relieved by the movement of legs. However, it causes disturbance of sleep leading to daytime fatigue. Herein, we present an unusual case of new-onset of restless leg syndrome in a COVID-19 infected patient who presented three weeks after an uncomplicated delivery via caesarean section. The patient was managed with sleep hygiene measures, oral iron and vitamin C tablets apart from general COVID-19 management medications, subsequently leading to significant improvements. Here we have discussed possible associated factors, pathophysiological mechanisms and management of RLS in the case of COVID infected individuals.

Patterns of Peripheral Nerve and Tendon Injury in Hand Trauma Patients in a Tertiary Care Hospital of Pakistan

Introduction

Traumatic injury to peripheral nerves is a major medical problem worldwide. Moreover, injury to the hand and wrist can lead to extreme morbidity and disable the injured for life. In this study, we highlight the most commonly damaged nerves and tendons that get ruptured in different types of hand trauma patients. No recent study has been done to document the etiologies and quantify the patterns of nerve and tendon involvement in hand injuries to the best of our knowledge.

Methodology

This was a cross-sectional study conducted at the largest trauma center in the city and the Plastic and Reconstructive Surgery ward of Civil Hospital, Karachi. A convenient sampling of 200 patients was done with the help of a preformed, well-structured questionnaire. Patients whose hand was injured solely were included in the study and those with the involvement of the whole limb or other parts of the body were excluded.

Results

We found that most males between the ages of 11 and 20 years presented predominantly with right-hand injury while working with machines. Nerve injury proved to be a rare occurrence. However, combined nerve injury of the ulnar, median, and radial nerve was seen in poly digit trauma. The median nerve was the most commonly damaged nerve in poly digit trauma. Among the tendon injuries, the incidence of combined tendon injury was the greatest. The flexor digitorum superficialis was the most common tendon injured overall.

Conclusion

This study significantly states that tendons are frequently injured in hand accidents. Plastic surgeons must also be aware of optimal nerve repair and reconstruction techniques to limit the physical disabilities and economic burden arising from nerve injury of the dominant hand.

Spontaneous pneumomediastinum and subcutaneous emphysema in a non-intubated COVID-19 patient: a case report

The development of spontaneous pneumomediastinum and subcutaneous emphysema are few of the rare clinical manifestations observed in coronavirus disease-19 (COVID-19) patients which are yet to be fully understood. Most cases of spontaneous pneumomediastinum arise due to factors causing high intra-alveolar pressure. Herein, we report a case of a COVID-19 positive elderly male, who presented with spontaneous pneumomediastinum and subcutaneous emphysema unrelated to high-pressure ventilatory measures, detected on chest computed tomography (CT). Despite acute medical care, the patient progressed towards a more serious clinical course. Male gender and diffuse alveolar damage caused by COVID-19 seems to be the most relevant association in this case. However, we have enlightened other possible pathological mechanisms and their association with severity index of COVID-19.

Neuroendocrine Tumour Of Unknown Primary Origin: Unusual Case Of Metastatic Hepatic Foci In A Female Patient

Under the banner of cancers of unknown primary origin (CUPs), neuroendocrine tumours account for less than five percent of the neoplasms. The clinical manifestations and management depend upon the tumour's grade and differentiation and its site of growth. At times, despite of aggressive search for primary origin, cancer remains hidden. Herein, we present a case of a middle-aged woman who presented to our tertiary set-up with complaints of abdominal pain and distension. After a series of radiologic and interventional investigations including positron emission tomography with liver biopsy and immunohistochemical analysis, a diagnosis of the welldifferentiated neuroendocrine tumour was made, located in the right lobe of the liver. However, the primary origin could not be identified. The patient was managed with trans-arterial chemoembolization (TACE) followed by hepatic resection and was followed biennially afterwards. In our case, hepatic metastasis was treated with chemoembolization and stagedresection and provided a good prognosis to the patient. Our case is unique as only a few case reports have been published with following presentation and documentation of efficacious treatment is needed to contribute to the literature. Proper trials with exteriorization of bowel and radiological imaging is necessary to stage the primary tumour, even if end result is in vain. This will help to further improve the prognosis.

Intensive Care Units of a Tertiary Care Hospital: A Detailed Study of Patient Symptomatology

Introduction Nosocomial infection (NI) is a factor of considerable significance in determining the morbidity and mortality of patients admitted to the intensive care units (ICUs). Our aim was to study the frequencies of various symptoms that might emerge due to nosocomial infection (NI) among ICU patients. Materials and methods This was a cross-sectional study conducted in intensive care units of General Medicine, General Surgery and Paediatric wards in Ruth M. Pfau Civil Hospital Karachi, Pakistan, using well-structured questionnaire created after a thorough literature study. Patients who had an ICU admission for more than five days but less than two weeks were set as the inclusion criteria. The remaining patients were excluded from the study.  Results Among the patients who developed gastrointestinal disturbances while in the intensive units, loss of appetite had the highest ratio in the paediatric ICU, whereas vomiting was most prevalent in the surgical ICU and weight loss was the most recurring symptom in the medical ICU. With regard to the respiratory and cardiovascular symptoms, dyspnea stood out in medicine ICU while fatigue was the most evident symptom amidst the paediatrics and surgical ICU patients. Insomnia was the most common neuropsychiatric symptom in the surgical and paediatric ICUs. Insomnia also paralleled tremors frequently in the medical ICU. Conclusion Infections in patients under intensive care in a tertiary care setup are not restricted to a specific type but present variously, as indicated by the type of symptoms the patients develop during their stay.

Knowledge, attitude and beliefs about malaria in a tribal area of Bastar district (Madhya Pradesh)

A sample survey of K.A.P. about malaria was carried out among sample of 359 inhabitants selected by random sampling in a tribal area of Baster district, which is a hyper-endemic area of the disease, predominantly by P.falciparum infection and understanding about the problem of malaria was poor, only about 50% (ranging from 30% to 60%) of the respondents were aware about cause and signs and symptoms of malaria, breeding & resting habit of mosquito, usefulness of insecticidal spray and ill effect of mud plastering following residual spraying. Proper health education and community involvement are, therefore, necessary to achieve control of malaria in the locality.