Aims/IntroductionTo compare the prevalence of metabolic syndrome (MS) using the modified National Cholesterol Education Program Adult Treatment Plan III (NCEP) and the International Diabetes Federation (IDF) definitions and, using both definitions, determine and compare the association of MS, prediabetes, type 2 diabetes, hypertension (HTN) and cardiovascular disease risk (CVD).Materials and MethodsA total of 2,293 randomly selected participants (aged ≥20 years) in a rural community in Bangladesh were investigated in a population-based cross-sectional study. Sociodemographic and anthropometric characteristics, blood pressure, blood glucose, and lipid profiles were studied. Age-adjusted data for MS and cardiometabolic risk factors were assessed, and their relationships were examined.ResultsThe age-adjusted prevalence of MS was 30.7% (males 30.5%; females 30.5%) using the NCEP definition, and 24.5% (males 19.2%, females 27.5%) using the IDF definition. The prevalence of MS using the NCEP definition was also higher in study participants with prediabetes, type 2 diabetes, HTN and CVD risk. The agreement rate between both definitions was 92% (k = 0.80). The NCEP definition had a stronger association with type 2 diabetes and HTN (odds ratio 12.4 vs 5.2; odds ratio 7.0 vs 4.7, respectively) than the IDF definition. However, the odds ratios for prediabetes and CVD risk were not significantly different.ConclusionsThe prevalence of MS was higher using the NCEP definition, and was more strongly associated with prediabetes, type 2 diabetes, HTN and CVD in this Bangladeshi population.

Objective:To report experience with borderline ovarian tumors (BOTs) in a developing country like Pakistan with limited resources and weak database of health system.Methods:Patients with BOTs managed at Shaukat Khanum Cancer hospital, Lahore, Pakistan from 2004 to 2014 were included and reviewed retrospectively. Data was recorded on histopathological types, age, CA-125, stage of disease, treatment modalities and outcomes.Results:Eighty-six patients with BOT were included with a median age of 35 years. Forty-two (49%) patients had serous BOTs and 43 (50%) had mucinous BOTs, while one (1%) had mixed type. Using FIGO staging, 80 patients had stage I; two patients had IIA, IIB and stage III each. Median follow-up time was 31.5 months. All patients had primary surgery. Seventy (81%) patients underwent complete surgical resection of tumor. Forty-three (50%) patients had fertility preserving surgery. Seventy-three (85%) patients remained in remission. Recurrent disease was observed in 13 (15%) patients. Median time to recurrence was 22 months. On further analysis, age above forty years, late stage at diagnosis and incomplete surgery were significantly associated with invasive recurrence.Conclusion:Despite a low malignant potential, relapses may occur in patients above forty years of age, incomplete surgery and staging information and advanced stage at presentation. Fertility sparing surgery should be considered in young patients. Complete excision of tumor and prolonged follow-up are advised because recurrence and transformation to invasive carcinoma may occur.

The human epidermal growth factor receptor 2 (HER2), previously called HER2/Neu or ERBB-2, belongs to the epidermal growth factor receptor (EGFR) family. These receptors are crucial for the activation of sub-cellular signal transduction pathways controlling epithelial cell growth and differentiation and possibly angiogenesis. 1 About 15-30% of all invasive breast cancers are HER2positive (overexpressing). 2,3 Several studies have suggested that HER2-positive tumors are associated with aggressive disease, poor prognosis and have a higher risk of relapse than HER2-negative cancers. [4][5][6][7] Addition of trastuzumab to adjuvant chemotherapy results in durable survival benefits for patients with HER2-positive breast cancer. This was shown in the combined analysis of the North Central Cancer Treatment Group (NCCTG) N9831 trial and the National Adjuvant Breast and Bowel Project (NSABP) B-31 clinical trials. 8 With a median on-study time of 8.4 years, the addition of trastuzumab resulted in a 37% improvement in the overall survival (OS) and a 40% improvement in disease-free survival. The first data for neoadjuvant trastuzumab came from a single centre, randomised study, which showed almost double pCR. 9 The patients who achieved pCR after neoadjuvant treatment have a better long-term outcome. 10,12 In a meta-analysis of 36 trials enrolling nearly 5800 patients with HER2-positive disease receiving neoadjuvant therapy, those who achieved a pCR (including breast and axilla) had superior event-free survival (EFS) and OS compared with those who did not. 11 Consequently, increasing the rate of pCR became the endpoint of neoadjuvant trials with the expectation of translation into improved survival. Based on these results, FDA has given accelerated approval to drugs in neoadjuvant setting. 11,13 Limited data is available regarding response of trastuzumab in Pakistani population, as majority of the patient population cannot get it due to cost issues.

Objective: Our aim was to identify factors favoring long term survival in patients presenting with stage IV epithelial ovarian cancer.Methods: We did retrospective analysis of thirty patients with stage IV epithelial ovarian cancer diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan from 2006 to 2013. Patient’s demographics, clinical data and histopathology were abstracted from cancer registry department of our hospital. Chi-square test was used to find the association between clinic-pathological variables and long term survival. Result: All patients received chemotherapy and surgery as per ovarian cancer guidelines. Of the thirty patients, eleven patients survived greater than four years median survival was recorded as thirty five months. Absence of co-morbidities and good performance status indicated good results of therapy however did not have statistically significant impact on survival. Higher CA-125 at presentation i.e.>1000(normal range : <21 U/ml), response to initial chemotherapy, interval cytoreductive surgery and complete response after induction therapy were significantly associated with long term survival (P<0.05).Conclusion: Prognosis of patients presenting with stage IV epithelial ovarian cancer remains poor. Very high values of CA-125 (>1000) at presentation, response to initial chemotherapy, interval surgical resection and complete remission after induction therapy, appear to be significant prognostic factors for long term survival. Further studies exploring molecular profiling and immunological factors are warranted.

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