Breast cancer is a prevailing disease worldwide that requires effective and rational therapy. For this purpose the use of various treatment modalities should be optimized according to the stage of disease and the risk: benefit ratio of the therapeutic agents employed in the patients. Although the therapies involved provide reduction in morbidity and mortality rates, monitoring is required to combat the resulting adverse drug reactions. This review would be helpful for healthcare professionals to address the multi factorial disease in accordance with its occurrence thereby providing rationalized therapy to the patients. Keywords: Breast cancer; Chemotherapy; Endocrine therapy; Adjuvant therapy IntroductionBreast cancer has increased universally [1,2] and is considered as the second chief mortality cause in women. Among top five cancers in Americans, it is the third fatal cancer [3] while it is also the most prevalent cancer in Asians [4]. Since breast cancer is a very diverse ailment [5] it has several indicators [6] associated to typical features of tissues, therapeutic evaluation and reaction to therapy [7]. Improvements in the diagnosis and management of breast cancer have yielded drop in mortality frequency, but it varies widely between diverse geographic areas [8,9]. For early and locally advanced breast carcinoma, the intention of treatment is cure while for metastasis, it is improvement in clinical presentation of disease and quality of life. Various approaches are employed for breast cancer management like surgery, radiation treatment, endocrine treatment and chemotherapy [10]. The management of breast cancer is discussed as follows since the disease requires proper monitoring and optimized treatment schedules in the patients. The incidence and risk factors of breast cancer vary geographically; also patients respond to the provided treatment differently, therefore, rationalized therapy in individual cases according to the stage of the disease is essential. General treatment recommendations according to Breast cancer stagingThe staging of breast cancer is one of the most consistent prognostic signs that provide valuable confirmation about the current status of cancer identification and its therapy. The staging of breast cancer involves tumor size (T 1-4), association of lymph nodes (N 1-3) and existence of distant metastases (M 0-1).In stage 0, lumpectomy alone can be employed for Ductal Carcinoma in Situ (<0.5cm diameter) but for larger lesions, it is used with adjuvant radiation therapy. Extensive Ductal Carcinoma in Situ (i.e. involving two or more quadrants of the breast) requires mastectomy; adjuvant Tamoxifen therapy is considered in all patients [11].According to existing practice for Stage I and II, after considering axillary lymph node status, lumpectomy and radiation therapy are used in patients with stage I or II breast cancer; this has displayed equivalent effects for total mastectomy and for lumpectomy followed by radiation therapy with 5 and 8 year disease-free and overall survival ra...

Purpose: To highlight the prevalence and severity of depression among undergraduate students in public and private universities in Karachi, Pakistan. Methods: In this cross-sectional study a total of 408 undergraduate students from both public and private universities in Karachi, Pakistan completed Zung Self-Rating Depression Scale (SDS) questionnaire to appraise the presence and extent of depression among the participants. Their sociodemographic characteristics such as age, gender and course of study as well as drug use data were also collected and analyzed. Results: Depression prevalence was 53.43 % (38.07 % for males and 61.00 % for females). A significant disparity in the prevalence of depression across ethnicity was observed. Less than 50 % (n = 163) of the students were satisfied with their duration of degree course work while 111 (27.20 %) participants were not sure about this. The intensity of depression increased with declining satisfaction level (Gamma = 0.264, p = 0.001) which affected the performance and results of students during their studies. A majority of the participants (89 %, n = 358) of our study have never used medicines to alter their mood. Conclusion: The findings of this study highlight the importance of understanding the unique strains and mental health effect of university education on undergraduate students, especially female students.

The aim of this study was to determine the attitude of pharmacists and non-pharmacists in Karachi towards the use of non-prescription medicines. A cross-sectional survey was conducted from August 2012 to October 2012 among pharmacist and non-pharmacists. Data was analyzed and results were compared using Chi-square test with the help of statistical software package (SPSS version 19). Overall prevalence of self-medication was found to be 81.28%. Factors like busy life schedule (27.58%), previous experience of medicine (20.68%) and better drug information (20.86%), contributed differently in promoting self medication to pharmacists, whereas busy life schedule (45%), was one of the major factor of self medication among non pharmacist. The major clinical conditions in which self medication was observed in the pharmacists were flu (36.9%), pain (27.59%), fever (25.86%), diarrhea (24.14%) and headache (22.07%), whereas in the non pharmacists, the main conditions were headache (55.71%), diarrhea (53.33%), fever (35.71%) and flu (35.24%). Self-medication was commonly observed both in pharmacist (62.08%) and non pharmacist (71.43%) in Karachi, but there was a significant increase in non pharmacist ( 2 =4.756, p<0.05). In order to control this prevailing problem, legislation are to be made by the government especially to implement and facilitate the prescription system, conducting awareness programs and restricting drug advertisements for public.

Breast cancer is a commonly diagnosed neoplastic ailment in females particularly near menopause. This ailment signifies a substantial health problem as it has influenced a large number of women. Several risk factors are associated with breast cancer that cannot be altered, but certain can be modified. The existence of risk factors of breast carcinoma does not mean that cancer is unavoidable; numerous females having risk factors not ever developed the disease. The risk factors aid in identifying the females who may get help at maximum from screening or other precautionary measures. It is noteworthy that breast carcinoma can also ensue in females with no recognizable risk factors. The augmented occurrence of breast cancer worldwide revealed by several epidemiological investigations indicates the need of aiming multidirectional investigations so as to ascertain risk factors linked with the incidence of this disease.

Objective: To appraise the use of various fast foods in different age groups among males and females and study its drift in Pakistani population. Method: The study was conducted from February to June 2013 in Karachi, Pakistan on a structured questionnaire. A total of n=489 individuals participated in this study among which n= 222 were males and n= 267 were females whose ages were grouped as <18 years, 18-40 years and >40 years. Fast food was categorized as fries, burgers, rolls, chicken broast and pizza whereas fibrous and vegetable diet included all vegetables in this study. Different types of diseases i.e. diabetes, asthma, hypertension, allergy, GI disorders and skin infections were also enquired about from the respondents consuming fast food. Result: The diet comprising fast food is high in energy and energy density. Fast food consumption has been reported to go along with large amounts of soft drinks which not only augments the weight of the individuals but also put them at danger to different kinds of ailments. In our study, both the genders were reported to take fast food on weekly basis, highest consumed in the age group of 18-40 years. Most popular fast food consumed among the females (n=63) was fries + burger and that in males (n=69) was more than one type of fast food. The consumption of cold drinks with fast food was seen more in males (n=105) than in females (n=90) and mostly in the age group of 18-40 years (males n=72 and females n=45). The consumption of fast food more than one time was observed more in the males. Both the genders belonged to age group of 18-40 years who exercised regularly. The frequency of use of fibrous/vegetable diet was higher in females (n=90) as compared to the male gender (n=117) in the age group of 18-40 years (p=0.033, χ 2 = 8.706). It was observed that the increase in weight was more in females under 18 years of age and more in males of age 18-40 years. It was also found that overall (n=72) males and (n=81) females were suffering from various diseases and yet were consuming fast food. Conclusion: Frequent fast food consumption may contribute to weight gain and with a sedentary life style can put the individuals at stake of different kinds of diseases and high health burden. Knowledge regarding healthy diet and healthy life style can contribute towards a society of people with better productivity and economy.