Background: Patients with idiopathic chronic cough and unexplained airflow obstruction in non-smokers have been shown to have an increased prevalence of hypothyroidism and other organ specific autoimmune disorders. Whether patients with hypothyroidism have an increased prevalence of respiratory symptoms is unknown. Methods: The prevalence of respiratory symptoms was assessed in 124 patients with treated hypothyroidism recruited from primary and secondary care, 64 outpatients with inflammatory bowel disease, and 1346 control adults recruited randomly from the electoral register in a case-control study. Respiratory symptoms and smoking history were assessed by a respiratory symptom questionnaire. Results: After adjustment for age, sex and smoking, symptoms of breathlessness and sputum production were more prevalent in both patient populations than in controls (odds ratios for hypothyroidism and inflammatory bowel disease; breathlessness: 3.1 (95% CI 2.1 to 4.6) and 3.4 (95% CI 2.0 to 6.0), respectively; sputum production: 2.7 (95% CI 1.6 to 4.5) and 2.5 (95% CI 1.2 to 5.0), respectively). Cough during the day and night was significantly more prevalent in patients with hypothyroidism (1.8 (95% CI 1.2 to 2.9)) and approached significance in those with inflammatory bowel disease (1.8 (95% CI 1.0 to 3.4)). Wheeze and nocturnal cough were no more prevalent in either disease population than in controls. Conclusion: There is a significantly increased prevalence of respiratory symptoms in patients with hypothyroidism or inflammatory bowel disease compared with controls recruited from the general population. Further work is required to determine whether similar differences are seen in comparison with hospital based controls. These findings support the hypothesis that there is a link between autoimmune hypothyroidism and respiratory disease.

Background: Dietary patterns, which represent the amounts, proportions, variety or combinations of different foods and drinks in the diets, and the frequency with which they are regularly consumed, have been linked to the risk of numerous cancers. However, the association between dietary patterns and breast cancer risk is still unclear.Objective: This systematic review was conducted to investigate and clarify the association between dietary patterns and breast cancer risk by assessing and appraising the literature published to date and evaluating the results of these studies.Design: A broad, general and inclusive electronic literature search was conducted throughout the Google Scholar, and PubMed databases to identify studies written in English and published from 2001 to 2017.Results: 2,215 articles were found and 112 articles were chosen for further review, of which 87 articles were excluded after reviewing the title and abstract of each article. The remaining 25 articles were included in the paper after a full review. Although in most of the articles included in this paper, no overall association was reported between the prudent, Mediterranean or Western dietary patterns and breast cancer risk, it was suggested that a Western or Western-type dietary pattern might increase the risk of breast cancer, and a prudent, Mediterranean and healthy dietary patterns might protect against estrogen receptive-negative tumors, mostly in postmenopausal women. Conclusion:This systematic review provides evidence of an association between dietary patterns and breast cancer risk and highlights the need for further observational and interventional studies.

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Introduction Laparoscopy is as safe and effective as laparotomy for the treatment of ectopic pregnancy, ovarian cysts, dermoid cysts and adnexal torsion. Treatment with laparoscopy results in shorter hospital stay and faster recovery. None of such studies are shown in the literature from Pakistan so the aim is to assess the effectiveness of laparoscopy in the management of adnexal emergencies, over a 4-year period. Methods Patients presenting in the Emergency department of Patel Hospital with suspicion of or diagnosed adnexal pathology from November 2011 till date were evaluated and kept for laparoscopic surgery. A predesigned proforma was completed for each such patient. The observed variables were indication of surgery, haemodynamic status, presence or absence of haemoperitoneum, time from incision till control of bleeding, total duration of surgery and the operative morbidities. The operative morbidities include the amount of blood loss, need for conversion to laparotomy, duration of stay, visceral/vascular injury, and the condition of the patient at 1 week postoperative follow-up. Results The total number of surgeries was 91. Of these, 69 were ectopic pregnancies and 22 were ovarian cyst accidents. Of them 63 were tubal ectopic, three were ruptured ovarian ectopic, two were cornual ectopic, one caesarean scar ectopic, 12 ovarian torsion and ten ruptured ovarian cysts. There was haemoperitoneum in 63 (80%) cases and 55 (70%) of them were haemodynamically unstable. Time taken to achieve haemostasis, on average, was 5.5 minutes in the case of ectopic gestations and 7.5 minutes in the case of ovarian cysts. The mean time taken for the procedure was 70 minutes for ovarian cysts and 55 minutes for ectopic pregnancy. Conclusion Laparoscopy is effective mode of surgery for all sorts of adnexal emergencies.

Hot Flushes or Flashes are a serious problem. They impact significantly on daily life and sleep quality, affecting employment, relationships and quality of life. The only effective treatment for hot flushes is oestrogen which is contraindicated in 75% of breast cancer patients. An estimated 550,000 people now live in the UK with a diagnosis of breast cancer and up to 70% women experience disabling hot flushes which can continue for years after treatment. Studies have shown that up to 50% of patients stop taking their life-saving antioestrogen drugs before 5 years1 quite probably due to unacceptable side-effects On the initiative of the patient advocate members of the NCRI Breast Clinical Studies Group, a Working Party on Symptom Management has been established. Members of the group have a particular interest in hot flushes and include representatives from patients, oncology, psychology, gynaecology, acupuncture and the voluntary not-for-profit sector The Working Party audited current UK clinical practice for hot flushes in cancer with a short questionnaire circulated to the UK Breast Intergroup mailing list (about 800 breast cancer health professionals) and to the Breast Cancer Care Nursing Network (about 850 clinical nurse specialists/breast care nurses). The full results of the questionnaire will be presented Briefly, a small number of people were prescribed hormone replacement therapy or Progesterone (Megestrol acatate), more Clonidine and Gabapentin and many selective serotonin reuptake inhibitors (SSRIs). Although SSRIs have some effect in reducing the intensity of hot flushes, they have significant side effects including sexual dysfunction, in a group of women, many of whom are already suffering sexual problems due to anti-oestrogen drugs or premature menopause. In addition, available treatments (both pharmacological and non-pharmacological) varied across the UK. The majority (95%) of respondents to our questionnaire agreed or strongly agreed that treatment and management of hot flushes is an unmet need. The questionnaire also demonstrated inequality of access to treatment in the UK. An exploration of the US National Cancer Institute and UK clinical trials databases revealed very few studies working in this area. 21 studies in the UK, Europe and the USA since 2006. Most trials investigate non pharmacological approaches and combinations and new versions of existing approaches. There are no agreed guidelines for managing hot flushes after breast cancer, which may limit the access and availability of appropriate interventions. It is clear from our survey that clinicians are left making individual decisions based on personal experience and availability of local services, which has led to a patchy and inequitable position on the management of this troubling problem. There is a need for research to understand the physiology of flushing and to develop and test new interventions to address this intractable problem, which continues to be a cause of considerable distress to many women after breast cancer. 1. Makubate B et al Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality.Br J Cancer. 2013;108:1515-24. This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 10/34/01). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-09.