Background: The triple-negative tumor is a high-risk tumor as a targeted therapy to these proteins is not possible with this type of cancer. Objective: To investigate the prognostic factors that can help in treatment selection in the triple-negative phenotype breast tumors Study design: A cross-sectional study Place and duration: This study was conducted at People's University of Medical and Health Sciences Nawabshah from Nov 2021 to Nov 2022 Methodology: The present study examined numerous cases of invasive carcinoma of the breast. The patients visited for follow-up for a long time and they were examined by tissue microarray. The series was stained through concurrent immune-histochemical prognostic panels. This was done to specify the subgroups of different types of breast cancer and for the identification of prognostic markers as well as the aggressive behavior of the tumors. Results: In the beginning, a total of 280 cases were included in the study, out of which 45 (16.07%) patients had triple-negative breast cancer. Most of these cancers were grade 3 carcinomas. A strong association was seen with pushing margins, development of recurrence, large size, poorer Nottingham Prognostic Index, and distant metastasis. Moreover, the association was also seen with loss of expression of E-cadherin and androgen receptors, basal phenotype, p53, EGFR, and P-cadherin. The size of the tumor, androgen receptors, and lymph node staging were the most valuable prognostic markers. Androgen receptor and size had prognostic significance in the tumor subgroup with lymph node-positive tumors. On the other hand, the basal phenotype was the only prognostic marker in the subgroup with lymph node-negative tumors. Some other parameters considered in the present study are histological grade, size of the tumor, age of the patient, and vascular invasion. Conclusion: The most significant markers identified were basal phenotype and androgen receptor. Also, tumor size and the status of the lymph node are quite significant in low-risk and high-risk patients while selecting surgical or non-surgical treatment for the triple-negative tumors Keywords: Triple-negative, breast tumor, prognostic markers, androgen receptors

Objective: To analyse the effects of stretching the muscles of the shoulder before surgery on the functionality of the shoulder after the surgery of mastectomy Study design: An analytical cross-sectional study Place and Duration: This study was conducted at Bibi Asifa Bhutto Dental College SMBB Medical University CMC Teaching Hospital Larkana from January 2022 to June 2022. Methodology: All the patients included in the study had mastectomy. The participants were randomized to control groups and treatment groups. The participants in the treatment group were gone through static stretching with a range of motion. The control group did not undergo any stretching preoperatively and was given standard postoperative care. The Numeric Pain Rating Scale (NPRS), Groningen Activity Restriction Scale (GARS), and Universal Goniometer (UG) were used for the collection of the data on the first and third postoperative days. The data was analyzed in the IBM SPSS version 26. Results: A total of 20 patients were included in the study. Overall10 patients were allocated to the treatment group and 10 were allocated to the control group. The mean age of the patients was 47±11.86 years. A significant difference in the functionality, range of motion, pain, and Groningen Activity Restriction Scale scores for daily activities was seen in the treatment group (p<0.05)compared to the control group (p>0.05). However, the difference was not significant in external rotation and Groningen Activity Restriction Scale scores (p>0.05). Conclusion: Shoulder stretching before surgery is not only safe, but it is also effective in the reduction of functional restriction and pain after the mastectomy surgery. Keywords: Shoulder stretching, Pre-operative stretching, Mastectomy, Post-op shoulder function

Objective: To find out the laproscopic cholecystectomy outcomes association with operational findings in rural area of district Sanghar, Sindh, Pakistan. Methods: This longitudinal and interventional study was conducted in a private hospital of Tando Adam District Sanghar the rural area of Sindh, Pakistan from March 2013 to October 2019. Patients above 15 years of age from both genders were taken by using convenient sampling technique, having symptomatic gallstones, favorable or unfavorable anatomical conditions, acute and chronic cholecystitis. Patients with dilated common bile duct (>8 mm in diameter), jaundice, mass at porta hepatis and uncorrectable coagulopathy were excluded. SPSS-22 was used for the statistical analysis. Results: This study included 28(13.9%) males and 173(86.1%) females. Mostly participants fall between the age of 30 to 39 years 65(32.3%). Significant association (p-value< 0.05) was found between the operational findings of the participants and there outcomes. Conclusion: Most of the participants were female. Majority fall between the age range of 30 to 39 years. Many of them stayed in the hospital for up to 24 hours. Significant association was found between the operational findings of the participants and there outcomes. Keywords: Laparoscopic cholecystectomy, Outcomes, Gall stones, operational findings

To find out the laproscopic cholecystectomy outcomes association with duration of hospital stay in rural area of district Sanghar, Sindh, Pakistan. Methods: This longitudinal and interventional study was conducted in a private hospital of Tando Adam District Sanghar the rural area of Sindh, Pakistan from March 2013 to October 2019. Patients above 15 years of age from both genders were taken by using convenient sampling technique, having symptomatic gallstones, favorable or unfavorable anatomical conditions, acute and chronic cholecystitis. Patients with dilated common bile duct (>8 mm in diameter), jaundice, mass at porta hepatis and uncorrectable coagulopathy were excluded. SPSS-22 was used for the statistical analysis. Results: This study included 28(13.9%) males and 173(86.1%) females. Mostly participants fall between the age of 30 to 39 years 65(32.3%). 146(72.6%) participants stayed in the hospital for up to 24 hours.  Non-significant association (p-value> 0.05) was found between the duration of the hospital stay and outcome of laparoscopic cholecystectomy. Conclusion:  Non-significant association was observed between duration of the hospital stay and outcome of laparoscopic cholecystectomy