• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.759-765
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• 2016

Background: Breast cancer is the most frequent cancer of women in Pakistan with the majority presenting with stage III or IV lesionsat initial diagnosis. Patient and health system related factors are well known determinants of delay in presentation and diagnosis. Additionally, breast cancer being a heterogeneous disease, the various molecular subtypes featuring different aggressiveness also need to be considered. The present study evaluated the association of stage at initial diagnosis of breast cancer with these two factors in local women at a tertiary level health care facility in Lahore, Pakistan. Materials and Methods: Patient and tumor features were recorded separately during diagnostic workup in Breast Clinics at INMOL and at Services Hospital, Lahore. Data were entered in MS Excel and analyzed by descriptive statistics and Chi-Square test. Results: Among the 261 patients, 64% were staged as late breast cancer (LBC), the mean age was 46.8 with standard deviation of 13 years. Some 92% had invasive ductal carcinoma (IDC), 61% had luminal types (LT) of non-aggressive tumor while 39% had the non-luminal types (NLT) of of HER2-enriched or basal aggressive tumors. While 70% of patients presented within one year of symptomatic disease (early report group "ERG"), 30% reported after a mean delay of 4 years with a standard deviation of 3.75 years. The stage distribution among ERG patients was not statistically different from those reporting late (P=0.123). Statistically larger proportion of patients with NLT presented as LBC as compared to the LT (P =0.034). Among the ERG, statistically different stage distribution of disease was observed for the NLT versus LT (P=0.047). Among those presenting late, this difference was insignificant (P=0.416). Conclusions: Breast cancer is a distinct disease in Pakistan with a high frequency of aggressive molecular types affecting younger women, with the majority presenting as LBC. Association of NLT with higher stage at diagnosis is statistically significant whereas time delay in diagnosis is not. Further research is required to define the risk profile and features in local patients. The burden of LBC can be reduced by promoting breast health awareness and by establishing easily accessible dedicated breast care set ups in the hospitals.

• Archives of Reconstructive Microsurgery
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• v.19 no.1
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• pp.1-6
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• 2010

Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from $1.5{\times}1.5{\times}0.5$ cm to $11.0{\times}10.0{\times}6.0$ cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.4
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• pp.1317-1320
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• 2012

Biliary tract cancers, broadly described as malignancies that arise from the biliary tract epithelia, are usually divided into two major clinical phenotypes: cholangiocarcinoma and gallbladder cancer, differing in etiopathogenesis, risk factors, and perhaps molecular and genetic signatures. Atypical symptoms and lack of tumor biomarkers make it difficult to diagnose in early stages. At the time of presentation, few patients are candidates for potentially curative surgical resection. We here assessed and compared features of a total of 150 cases divided into extra- and intrahepatic cholangiocarcinomas and gallbladder cancers (GBC). Althought there were no significant differences in serum tumour marker levels, GBC patients had the poorest prognosis. Furthermore, gallbladder cancer respond poorly to chemotherapy or radiation therapy and approximately half of untreated patients died within 10 months. Therefore, treatment for patients with gallbladder cancer is still in challenge. Outcomes and survival of these patients had improved little over the past three decades - a period in which new successful treatments have greatly contributed to the prolonged patient survival for many other cancers.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3253-3256
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• 2015

Background: Chronic hepatitis B virus (HBV) infection related hepatocellular carcinoma (HCC) is a major health problem in the Asia-Pacific region including Thailand. Several factors have been proposed as contributing to hepatocarcinogenesis. This study was aimed to investigate the impact of CYP2C19 genotypic polymorphism in HCC related to chronic HBV infection in Thailand. Materials and Methods: A cross-sectional study was performed between April 2014 and January 2015. Chronic HBV patients with HCC (n=50) and without HCC (n=50) were included. Clinical information and blood samples of all patients were collected. The CYP2C19 genotype was determined by polymerase chain reaction-restriction fragment length polymorphism method, and was classified as rapid metabolizer (RM), intermediate metabolizer (IM) or poor metabolizer (PM). Results: The CYP2C19 genotype frequencies of RM, IM and PM in HBV patients were found to be 19/50 (38%), 25/50 (50%) and 6/50 (12%), respectively. The CYP2C19 genotype frequencies of RM, IM and PM in HBV with HCC patients were 21/50 (42%), 25/50 (50%) and 4/50 (8%), respectively. The distribution of CYP2C19 genotype was not different between patients with and without HCC. Interestingly, among HBV with HCC patients, the RM genotype of CYP2C19 tended to increase risk of aggressive manifestation (OR=2.89, 95%CI=0.76-11.25, P-value=0.07), compared with non RM genotype carriers. Conclusions: CYP2C19 genotype IM was the most common genotype in Thai patients with chronic HBV infection. In addition, genotype RM could be an associated factor for aggressive presentation in HCC related to chronic HBV infection.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.14
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• pp.257-287
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• 2000

Many problems and complaints have been caused by applying the UCP to the standby credit. To solve the problem, International Standby Practices were established. ISP and UCP are similar in that both of them generally regulate the transaction of credit. However, when the ISP is compared with the UCP, the following features are found : 1. In the UCP, when Force Majeure such as acts of God or strikes cause temporary work stoppage, the expiration date cannot be extended. In the ISP, the expiration date can be extended to 30 days afte the place for presentation re-opens for business in the same situation. 2. The UCP does not specify who the issuer of a document must be because there can be many issuers of documents. In the ISP, it is specified that all required documents are to be issued by the beneficiary. 3. In the UCP, compliance between presented documents is required. In the ISP, a discrepancy between presented documents is allowed. 4. In the UCP, if drawings and/or shipments are required by a credit to be made in instalments, and a required drawing/instalment is not made, the credit ceases to be available for any subsequent instalment. In ISP, there is no loss of effect and no influence on the right of beneficiaries, even in the same situation. 5. In the UCP, multiple transfers are not permitted, but partial transfers are. ISP states just the opposite. Multiple transfers are permitted, but partial transfers are not. 6 The UCP obligate each bank (issuer, confirming and nominated bank) to complete their review within a 'reasonable time' but not more than seven banking days. In the ISP, less than three business days is deemed to be not unreasonable and more than seven days is deemed to be unreasonable. 7. ISP, unlike UCP, recognizes that issuers and confirmers may spread their risk through syndication and participation of standby credits. However, the thing to remember is that the ISP should be reviewed carefully before application. If necessary, a partial addition or modifications can be made. Usually, the best advantage of the ISP is given to the issuers. A positive use of the ISP can be made by issuers but, applicants should consider using the UCP to the their rights and duties.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.934-940
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• 1995

Small cell lung cancer(SCLC) is frequently associated with paraneoplastic syndromes, which occur in approximately 20% of patients at presentation. Clinical Cushing's syndrome secondary to ectopic ACTH production is uncommon, occurring in approximately 5% of all SCLC patients. However, biochemical evidence of hypercortisolism can be detected in up to 50% of patients. Patients with Cushing's syndrome from ectopic ACTH production show hypertension, weakness, hyperglycemia, and hypokalemic metabolic alkalosis, but differ from patients with classic Cushing's disease in that symptoms develop more rapidly. Ectopic ACTH production is associated with a poor response to chemotherapy, short survival, and a high risk of treatment-related complications. We report a case of Cushing's syndrome associated with ectopic corticotropin production in 59-year-old male patient with extensive stage of SCLC.

• Journal of The Korean Ophthalmological Society
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• v.59 no.11
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• pp.1091-1096
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• 2018

Purpose: We report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle-closure crisis (AACC). Case summary: A 76-year-old female visited our clinic because of a 1-day history of ocular pain and vision loss in both eyes. The visual acuity was 0.02 in both eyes and her intraocular pressure (IOP) was 52 mmHg in the right eye (RE) and 50 mmHg in the left eye (LE). She had corneal edema and a shallow anterior chamber in both eyes, with 4 mm fixed dilated pupils. After decreasing the IOP with intravenous mannitol, laser iridotomy was performed. However, 2 days later, visual acuity was further reduced to finger counting at 10 cm RE and at 50 cm LE, and her optic disc was swollen. Bilateral NAION following AACC was diagnosed. One month later, visual acuity slightly improved to 0.02 RE and 0.04 LE, and the optic disc edema resolved. A small cup-disc ratio, optic disc pallor, and atrophy were observed. Humphrey visual fields demonstrated superior and inferior altitudial visual field defects in the LE, and almost total scotoma in the RE. Conclusions: AACC can be a predisposing factor for NAION, so the relative afferent pupillary defect, papilledema, and presentation of other risk factors are important clues to a diagnosis of NAION.

• Asian Spine Journal
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• v.12 no.6
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• pp.1043-1052
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• 2018

Study Design: Level III retrospective cross-sectional study. Purpose: To define and characterize the presentation, symptom duration, and patient/surgical risk factors associated with 'post-decompressive neuropathy (PDN).' Overview of Literature: PDN is characterized by lower extremity radicular pain that is 'different' from pre-surgical radiculopathy or claudication pain. Although it is a common constellation of postoperative symptoms, PDN is incompletely characterized and poorly understood. We hypothesize that PDN is caused by an intraoperative neuropraxic event and may develop early (within 30 days following the procedure) or late (after 30 days following the procedure) within the postoperative period. Methods: Patients who consented to undergo lumbar laminectomy with or without an instrumented fusion for degenerative lumbar spine disease were followed up prospectively from July 2013 to December 2014. Relevant data were extracted from the charts of the eligible patients. Patient demographics and surgical factors were identified. Patients completed postoperative questionnaires 3 weeks, 3 months, 6 months, and 1 year postoperatively. Questions were designed to characterize the postoperative pain that differed from preoperative pain. A diagnosis of PDN was established if the patient exhibited the following characteristics: pain different from preoperative pain, leg pain worse than back pain, a non-dermatomal pain pattern, and nocturnal pain that often disrupted sleep. A Visual Analog Scale was used to monitor the pain, and patients documented the effectiveness of the prescribed pain management modalities. Patients for whom more than one follow-up survey was missed were excluded from analysis. Results: Of the 164 eligible patients, 118 (72.0%) completed at least one follow-up survey at each time interval. Of these eligible patients, 91 (77.1%) described symptoms consistent with PDN. Additionally, 75 patients (82.4%) described early-onset symptoms, whereas 16 reported symptoms consistent with late-onset PDN. Significantly more female patients reported PDN symptoms (87% vs. 69%, p=0.03). Patients with both early and late development of PDN described their leg pain as an intermittent, constant, burning, sharp/stabbing, or dull ache. Early PDN was categorized more commonly as a dull ache than late-onset PDN (60% vs. 31%, p=0.052); however, the difference did not reach statistical significance. Opioids were significantly more effective for patients with early-onset PDN than for those with late-onset PDN (85% vs. 44%, p=0.001). Gabapentin was most commonly prescribed to patients who cited no resolution of symptoms (70% vs. 31%, p=0.003). Time to symptom resolution ranged from within 1 month to 1 year. Patients' symptoms were considered unresolved if symptoms persisted for more than 1 year postoperatively. In total, 81% of the patients with early-onset PDN reported complete symptom resolution 1 year postoperatively compared with 63% of patients with late-onset PDN (p=0.11). Conclusions: PDN is a discrete postoperative pain phenomenon that occurred in 77% of the patients who underwent lumbar laminectomy with or without instrumented fusion. Attention must be paid to the constellation and natural history of symptoms unique to PDN to effectively manage a self-limiting postoperative issue.

• The Journal of the Convergence on Culture Technology
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• v.8 no.1
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• pp.507-512
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• 2022

The subjects of the study are the sedimentary rock slope of the Mesozoic Gyeongsang Supergroup, which has a high risk of failure. The rocks of the slope shall be sandstone, siltstone and dacite, and discontinuities shall develop beddings, shear joints, extension joints, and dacite dyke boundary planes. The type and scale of failure varies depending on the type of rock and the strike/dip of the discontinuities, but the planar failure prevails. Based on the face-mapping data, SMR, physical and mechanical testing of rocks, the critical equilibrium analysis, all representative sections required a countermeasure method because the acceptable safety factor during dry and rainy seasons were far below Fs=1.5 and Fs=1.2. After applying the countermeasure method, both the dry and wet conditions of the slope exceeded the allowable safety factor. In particular, the face-mapping data of the slope-face, the geological cross-sections of several representative sections perpendicular to the slope-face, and the critical equilibrium analysis and the presentation of countermeasure methods that have been reviewed based on them are expected to be reasonable tools for the slope stability.

• Journal of agricultural medicine and community health
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• v.47 no.2
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• pp.109-120
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• 2022

Objectives: The purpose of this study was to identify the effectiveness of COVID-19 vaccinations on deaths of the COVID-19 cases in some elderly long-term care facilities (LTCF) in Gwangju Metropolitan City. Methods: The study subjects were 659 COVID-19 cases in residents of 7 elderly LTCF, Gwangju, from 21 Dec. 2021 to 28 Jan. 2022. The used variables were confirmed dates for COVID-19, demographic characteristics, co-morbidities, presentation of symptoms, death and vaccination related characteristics including type of vaccine, doses and dates. Vaccination status were classified as not vaccinated, partially and fully vaccinated. The associations of vaccination status and deaths of COVID-19 cases were tested by chi-square test and multiple logistic regression analysis. Results: The rates of not vaccinated, partially vaccinated and fully vaccinated were 19.4%, 10.2% and 70.4%, respectively. The mortality rate of the cases was 6.4%. The death rate by vaccination status was 16.4% in not vaccinated, 15.4% in partially vaccinated and 2.6% in fully vaccinated, showing a statistically significant difference. The adjusted odds ratios (ORs) (95% confidence intervals, CIs) of death compared to fully vaccinated were 7.64 (3.87-16.34) in non-vaccinated, and 6.97 (3.44-14.14) in partially vaccinated. Conclusions: COVID-19 vaccination seems to work effectively in preventing deaths of COVID-19 cases of elderly LTCF residents. This finding support that fully vaccinations in high risk group such as elderly LTCF residents is very important for one of strategies of COVID-19 management.