OBJECTIVE:To collect and analyse epidemiologic data of all malignancies by age group and gender for the Karachi population to estimate the cancer incidence of 5-years (2017-2021) and identify major risk factors for setting priorities towards cancer control programs. STUDY DESIGN:Observational study. Place and Duration of the Study: Karachi Cancer Registry (KCR) Secretariat, Pakistan Health Research Council (PHRC), JPMC, Karachi, from 2017-2021. METHODOLOGY:Cancer data of seven tertiary care hospitals of Karachi submitted to KCR during the study period were analysed including age, gender, date of first contact, primary site and ICD coding. All the data was cleaned, merged, and analysed. All patients 0-14 years were classified as 'children', all aged 15-19 years were classified as 'adolescents', and those age 20-years and above as 'adults'. Age standardised incidence rates (ASIR) were determined for both genders. RESULTS:During the last five years (2017-2021), a total of 65,886 malignant cases were received. The distributions seen amongst males and females were 33,510 (51%) and 32,376 (49%), respectively with 60,145 (91.3%) tumours found in adults (≥20 years), 4844 (7.3%) in children, and 897 (1.4%) in adolescents. The three most common tumour sites were oral, liver, and colorectal in males; breast, oral and ovary in females; bone, brain and connective tissue in adolescents; and leukaemia, brain and bone in children. The overall ASIR (%) in males was 89.20 for adults, 9.19 for children, and 1.61 for adolescents. The overall ASIR (%) in females was 93.44 for adults, 5.45 for children, and 1.11 for adolescents. CONCLUSION:Oral cancer, a largely preventable cancer is the leading cancer in males while breast cancer is the leading cancer in females followed by oral cancer. In adolescents and children, the incidence closely matches most of the world. KEY WORDS:Karachi, Cancer registry, Oral cancer, Breast cancer, Age-standerdised ratio.

Background:Polycystic ovarian syndrome(PCOS)is a fairly common condition that affects both endocrine and metabolic systems. It affects women of reproductive age of all ethnicity and race. Only a small number of females are diagnosed with it.There is a good percentage of people who are still not diagnosed because of a lack of good diagnostic criteria and varying symptoms among different individuals.Fenugreek is an herb that contains many constituents including Quercetin. It helps in the regulation of steroidogenesis.Material and Methods: Molecular docking of Quercetin with insulin receptor substrate 1, follicle-stimulatinghormone receptor and androgen receptor wasperformed using Autodock4. The ADME (absorption, distribution, metabolism and excretion) properties were calculated by using smile notation in the Swiss ADME web-based tool. The Bioavailability Score was calculated using Mol-inspiration web-based tool.Results: The study shows that Quercetin is having best binding capacity with the androgen receptor and also shows good binding affinity with FSH receptors and Insulin receptors.This indicates Quercetin can have a positive effect on PCOS.Conclusion: We can concludethat Quercetin is helpful for the treatment of PCOS. KeyWords: Quercetin, Polycystic ovarian syndrome, Diabetes mellitus

Objective: To find out the variation of body mass index and peak expiratory flow rate among medical students of Combined Military Hospital, Lahore Medical College, Lahore, Pakistan. Methods: A Cross-sectional study was conducted by undergraduate students of CMH, at CMH Lahore Medical College and Institute of Dentistry in September 2019 after Ethical approval from the Ethical Review Committee of the same institution. There were 138 1st year medical students. Demographic profiles of all the students were taken and height, weight, BMI, PEFR were measured. Participants were classified on the basis of their BMI values. Underweight (BMI<18.5), normal weight (18.5≤ BMI≤ 24.9), overweight (25≤ BM≤ 29.9), and obese (BMI≥ 30). Correlational tests were applied to find out any statistically significant correlations. A p value less than 0.05 was considered significant. Results: The mean BMI in females was 23.16±6.01 corresponding with that of mean PEFR value 325.23±62.30 whereas in males the mean BMI was 22.65±3.11 corresponding with that of mean PEFR value 433.97±101.84. There is a statistically significant variation in PEFR with gender (r=0.540, p=0.001) which can be explained on ethnic backgrounds. Males had a higher PEFR than females. However, there was no significant correlation between BMI and PEFR. Also, gender was not related to BMI. Conclusion: In our study, PEFR is not affected by variation in BMI. However, gender is associated with PEFR. Males have a higher PEFR than females. This can be explained on the basis of ethnicity. BMI is not associated with gender. A large sample size with more accurate calculation of PEFR is needed for better evaluation. Keywords: Obesity and lung function, PEFR and BMI, BMI and gender How to cite: Ijaz F, Hafeez F, Bashir I, Aftab RK, Malik SA.Variation of body mass index and peak expiratory flow rate among medical students of CMH Lahore medical college. J SIMS Esculapio.2021;17(1):100-103

Objective Various studies have been conducted during this pandemic which dealt with prevalence of mental health problems among the HCWs and indicated a strong association between the disease and the pandemic. In this article, we will try to provide a systematic review of the studies done so far in this regard. We also aimed to find out a relationship between COVID-19 related variables and mental health issues of HCWs. Methodology Using keyword search on PubMed, Asian Journal of Psychiatry, and Web of Science electronic databases, we collected original articles, reviews, preprints, and letter to editors, related to our topic. 10 of them were shortlisted. After studying them extensively and intensively, a systemized review is presented in this article. Results Increased levels of anxiety, anger, hesitation, perplexing, and post-traumatic distress are reported during the lockdown due to this pandemic, especially in Pakistan. Health Care Workers are the most psychologically affected with this pandemic. Conclusion The mental states of HCWs should be monitored and a detailed plan should be devised to discuss and resolve the psychological concerns of HCWs. Keywords: COVID-19, Mental Health, Health Care Professionals, Psychological Effects

COVID-19 (coronavirus disease 2019) is a disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). COVID-19 has yielded many reported complications and unusual observations. In this article, we have reviewed one such observation: an association between malaria endemicity and reduced reported COVID-19 fatality. Malaria-endemic regions have a significantly lower reported COVID-19 fatality rate as compared to regions where malaria is non-endemic. Statistical analyses show that there is a strong negative correlation between the reported SARS-CoV-2 fatality and endemicity of malaria. In this review, we have discussed the potential role of CD-147, and potential malaria-induced immunity and polymorphisms in COVID-19 patients. Noteworthy, the results may also be due to underreported cases or due to the economic, political, and environmental differences between the malaria endemic and non-endemic countries. The study of this potential relationship might be of great help in COVID-19 therapy and prevention.

Obesity has been defined as the excessive deposition of fats on the body.It presents a very significant risk to humanity, with debilitating consequences for healthcare systems worldwide.It has multiple effects on the body, including grave consequences on the cardiovascular and respiratory systems.Our project explores the latter.There are multiple studies available in the scientific literature that attempt to explain this phenomenon, all with limited success and conflicting results.This cross-sectional exploration of the topic was done on medical undergraduates to pick up on any correlations between peak expiratory flow rate (PEFR) and the markers of obesity (body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist to hip ratio (WHR)).In general, we found that male participants had sizably higher PEFR values than females (r=0.540,p<0.01).Appropriate BMI is mandatory for the physiologic functioning of the human body.This work also statistically demonstrates a negative overall correlation between lung health and various parameters of obesity.Our work suggests a positive correlation between WHR and PEFR (r=0.325,p<0.01),BMI and PEFR (r=0.573,p=0.02), along with weight and PEFR (r=0.464,p<0.01).Maintaining a BMI and WHR in the normal range is essential for optimal physiological functioning and physical well-being.

What is the matter of creation of human? This question has been addressed since long back in the history from ancient Indian and Egyptian civilizations to the Greeks and until the advent of modern sciences. The answers to this question were varying and led to various ideologies about the paternity of the newborn and the role and importance of women in society. More or less the concept was that the human is formed from the male semen and female menstrual blood where semen is the actual matter of formation and the part of the female is just to nourish and nurture; until it is proved by the modern science that both male and female gametes equally take part in the formation of the embryo. However, the Islamic Holy Scripture, the Quran, and the narrations from Islamic prophet (PBUH) and the descriptions of the Islamic scholars stand in opposition to these concepts and have a stunning correlation with the modern scientific descriptions of the embryology.

Amidst a time when there is the global pandemic of COVID-19 and high levels of stress and anxiety among people, it was pertinent to study if people have modified their health-seeking behavior. A questionnaire-based cross-sectional study was performed in Lahore to assess the change in behaviors of people before and during the pandemic. The results show that the health seeking behavior of the people has changed during the pandemic, resulting in an increased trend of self-medication and a decreased number of people visiting the hospital for their ailments. People preferred private health providers over the government facilities. This might be due to the misinformation, panic, and uncertainties spread by the social media. Governmental health care providers should consider these aspects while addressing the polices related to the pandemic.

Objectives: To estimate the cancer incidence by age group and gender for the population of Karachi Division by analyzing the Karachi Cancer Registry data of 2017-19. Settings: The population of Karachi division is 16.1 million according to national census 2017. ‘Karachi Cancer Registry’ which is a part of ‘National Cancer Registry’ is collecting data from eight major hospitals in Karachi since 2017. For outcome measures, cancer counts and the age standardized incidence rates (ASIR) per 100,000 population were computed for age groups (0–14, 15–19 and ≥20 years), in both genders and all cancer site/type. Methods: The population denominators were based on the population of Karachi division estimated at 16.1 million in the population census, 2017. Counts and age-standardized incidence rates (ASIR) were calculated for each of the three age categories. Results: From Jan 2017 till Dec 2019 a total of 33,309 malignant cases were recorded in KCR database comprising 17,490 (52.5%) females and 15,819 (47.5%) males. ASIRs in age groups 0-14, 15-19 and ≥ 20 years, among female were 11.5, 2.4 and 223.6 and in males were 17.6, 3.2 and 216.7 respectively. The commonest diagnosis in children, adolescent and adults were (1) among females: children; bone (3.12), leukemia (2.09) brain/CNS (1.26); in adolescents: bone (0.78), brain/CNS (0.27), connective and soft tissue (0.11), in adults: breast cancer (76.07), oral cancer (16.68) and ovary (10.89) respectively, and (2) among males: children; bone (4.56), leukemia (2.79) and brain/CNS (1.88); in adolescent; bone (1.19), brain/CNS (0.31) and leukemia (0.21) and in adults: oral cancer (42.83), liver (16.10) and bone (13.37) respectively. Conclusion: Oral Cancer, a largely preventable cancer is the leading cancer in Karachi adult males while in female adults Breast Cancer is the leading cancer followed by Oral Cancer. In children and adolescents Bone, Leukemia and Brain/CNS malignancies are most common.

Objective: To assess the knowledge, awareness and attitudes of medical students towards recently discovered coronavirus disease-19 (COVID-19). Methods: This was a cross sectional study conducted on medical students in CMH Lahore Medical College,(LMC), Institute of Dentistry (IOD). A questionnaire containing demographic information, 14 knowledge and eight attitude items was completed by 384 participants. Results: Overall, >90% people were aware about the etiology, mode of transmission and possible symptoms; however, very few of them knew about the in-depth details. Knowledge score revealed that 80% of participants had sufficient knowledge about coronavirus. MBBS students and nursing Students had significantly better knowledge in comparison with other students. In terms of attitude, >80% of students showed positive attitudes among which the nursing students were dominant. Conclusion: The medical students of CMH LMC showed a satisfactory level of awareness and attitudes towards COVID-19 with an obvious difference with regard to disciplines. More educational efforts with periodic educational interventions are still needed about the current pandemic.

Colorectal cancer, ICD-10 (International Classification of Diseases 10th Revision) categories C18-C21 (cancer of the colon, recto-sigmoid junction, and rectum) is considered among the top ten malignancies globally with a 25 fold variation worldwide (Parkin, 2005). Higher incidence rates are reported for North America, Australia/ New Zealand, Western Europe, and Japan. A lower incidence is reported for Africa and Asia and intermediate rates for southern parts of South America (Parkin DM, 2005). In ‘Cancer Incidence in Five Continents’ (CIV)

INTRODUCTION:This study was conducted to assess the patterns of primary central nervous system (CNS) malignancies in Karachi South (KS), a moderate risk population in Asia.MATERIALS AND METHODS:Data for 321 registered cases were reviewed and analyzed in two periods 1995-1997 (111 cases, 75 (67.6%) male (M); 36 (32.4%) female (F)) and 1998-2002 (210 cases, 124 (59.1%) M; 86 (40.9%) F).RESULTS:Age standardized incidence rate per 100,000, crude incidence rate and relative frequency in 1995-1997 were 3.5, 2.8 and 3.5% (M) and 1.8, 1.6 and 1.7% (F). Corresponding figures for 1998-2002 were 3.3, 2.7 and 2.7% (M) and 3.3, 2.7 and 2.1% (F). Mean age of male and female patients during 1995-1997 was 33.3 years (SD± 20.4) and 30.7 years (SD±19.6). Mean ages for 1998-2002 were 33.2 years (SD±19.5) and 28.7 years (SD±18.5) for males and females respectively. In males, 199 malignancies were reported, 106 (86.9%) cases in the brain, 10 (5.5%) in meninges and 12 (6.0%) in the spinal cord; 122 cases were observed in females, 177 (89%) cases in the brain, 8 (6.6%) each in the meninges and spinal cord. The most common morphology was astrocytoma (72 (36.2%) (M); 40 (32.7%) (F)). Mean age of low grade astrocytoma was 27.8 years (M) and 27.0 years (F); anaplastic astrocytomas, 40.5 years (M), 34.1 years (F) and glioblastoma, 45.7 years (M) and 38.3 years (F). Youngest cases were registered for cerebellum and brain stem.CONCLUSION:The incidence of CNS malignancies is stable in males and gradually increasing in females. Astrocytoma is the commonest morphology; they affect a younger age group and show an age gradient in proportion to tumor grade. The mean age varied by sub-site and histology. Focus should be directed towards the understanding the biological nature and risk factors prevalent in this population.

INTRODUCTIONCancer ovary is the third most common malignancy diagnosed in women in Karachi, a moderate to high risk region for the disease.MATERIALS AND METHODSThree hundred and thirty seven cases of ovarian cancer registered at the Karachi Cancer Registry for the years 1995-2002 were reviewed.RESULTSThe age- standardized incidence rate (ASR) world per 100,000, crude incidence rate per 100,000 (CIR) and frequency of ovarian malignancies in 1995-1997 were 10.9, 5.9 and 6.2% respectively. Corresponding figures for 1998-2002 were 8.1, 5.1 and 4.8%. The mean age at presentation in 1995-1997 was 45.7 years (95%CI 42.9, 48.4; SD∓15.9), range 95 (3 to 98) years and in 1998-2002 it was 45.0 years (95%CI 42.8, 47.3; SD±16.1), range 79 (3 to 82) years. Eleven (3.3%) cases of childhood cancers, 13 (3.9%) adolescent cases, 126 (37.4%) reproductive age (20-44 years) and 187 (55.5%) cases in the 45+ age group were registered. Epithelial malignancies were the most common cancers above the age of 20 years (78.4%), the commonest amongst these was serous adenocarcinoma (33.3%). Germ cell tumors were more common (5.6%) in children and adolescents. Microscopic confirmation was 99.0%. Presentation was of a moderately differentiated (grade 2) malignancy with a regional or distant spread of disease in three fourths of the cases.CONCLUSIONSThe incidence of cancer ovary, though stable in Karachi, involves a relatively younger age group with a strong family history in a fourth of the cases. The disease presents at an advanced stage. An ageing population over time may translate into a higher incidence of ovarian cancer. The current incidence of cancer ovary in Karachi is an enigma and belies reproductive protective factors. Studies focused on the genetic risk factors in this population are recommended.

INTRODUCTION:Karachi falls into a low risk region for colorectal cancer (CRC). The incidence rate is known but detailed epidemiology and pathology data regarding the disease are not available. The aim of this study was to describe CRC with reference to incidence, gender, topographic sub-site, tumor morphology, grade and stage at diagnosis and to determine the trends of incidence.MATERIALS AND METHODS:Four hundred and seventy three cases of colorectal cancer submitted to the Karachi Cancer Registry for Karachi South, years 1995-2002 were reviewed. Cases were analyzed in two time periods (1995-7 and 1998-2002) to facilitate the study of time trends.RESULTS:A total of 151 CRC cases were registered during period one [86 (57%) males; 65 (43%) females] and 322 cases [210 (65%) males; 112 (35%) females] in period two. Age standardized rate (ASR) world per 100,000, crude incidence rate (CIR) and relative frequency in period one were 5.3, 3.2 and 4.1% in males and 5.5, 3.2 and 3.2% in females respectively. Corresponding figures for period two were 7.1, 4.5 and 4.7% for males and 5.2, 2.8 and 2.7% in females. The male, female ratio was equal for colon (1:1). Men had more rectal cancers (2:1) and overall CRC (1.7:1). The mean age of the patients varied with sub-site and gender from 43.7 years to 51.2 years. Cancers of the rectum presented at a relatively earlier age. Less then 5% of the cases were diagnosed in adolescents, 50% above 50 years of age and only 30% above 60 years. The ratio under-40 to above-40 for CRC patients was 0.3, which is much higher than the international average, indicating a younger age group at risk. The first cases were observed in adolescents (15-19 years) and a peak was observed in the seventh decade. Colon to rectum ratio was 1:1 in males and 2:1 in females. Most cases presented with advanced disease, though some down staging was observed in period 2 (1998-2002).CONCLUSION:The current low but increasing incidence (especially in men), the younger age and advanced stage of CRC at diagnosis reflects a low risk, unscreened population. With existing prevalence of high risk factors in Pakistan, the low CRC incidence may be an artifact. There are concerns that an aging population over the next decade and changing lifestyle patterns may translate into a higher CRC incidence. Screening must be considered as part of the health sector planning for the future and include the high risk younger age groups.

INTRODUCTION:Cancer prostate (CaP) is a commonly diagnosed cancer in western men, but there is sparse information about the demographics of this malignancy in Pakistan. The study objective was to provide an overview of CaP in Karachi, Pakistan.METHODOLOGY:Epidemiological data of 282 incident CaP cases registered at Karachi Cancer Registry (KCR) during 1st January 1995 to 31st December 2002 were reviewed. Incidence and trends were studied in 2 time periods, 1995-7 and 1998-2002.RESULTS:In 1995-7, CaP accounted for approximately 3.4% of the cancers in males and ranked 8th in hierarchy with an age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 of 6.0 and 2.8 respectively. During 1998-2002, CaP accounted 4.6% of the cancers, ranked 4th with an ASR world and CIR per 100,000 of 10.1 and 4.4. Thus an approximate 60% increase was observed between 1995 and 2002. Mean ages of the patients were 67.0 and 67.4 years. Age-specific curves showed a gradual increase in risk from the fifth decade onwards. A marginal down staging was also observed in period 2, more apparent in the more educated Mohajir and Punjabi ethnicities.CONCLUSION:Karachi falls into a low risk region for CaP, with a rapidly increasing incidence and a marginal down staging. The probable reasons for the lower incidence are a low life expectancy, lack of availability or accessibility to health care and lack of public awareness. Implementation of CaP screening and public health education is a necessity today. The low incidence of CaP in Pakistan may be an artefact!

Introduction: South Asia is an enigma for gastric cancer, a low risk region with a contradictory high prevalence for Helicobacter pylori. Patients and Methods: To examine the demographics, pathology and trends of gastric cancer in Pakistan, epidemiological data of 335 gastric malignancies, registered at Karachi Cancer Registry (KCR) for Karachi South (KS), during 1st January 1995 to 31st December 2002 were reviewed. Trends were studied by categorizing the cases into two time periods '1995-7' and 1998-2002'. Results: Ninety six cases of gastric cancers were registered in the 1995-7 period, 61 in males and 35 in females. In males, the ASR (world), and crude incidence rate (CIR) per 100,000 were 3.9 and 2.3 respectively. In females, the values were 3.0 and 1.5. In the 1998-02 period 239 cases of gastric cancer were registered, 156 cases in males and 83 in females. The ASR and CIR per 100,000 were 6.0 and 3.4 in males and 3.6 and 2.1 in females. An 18% increase was observed in males and 14% in females during the seven year study period. The male to female ratio was 2:1. The mean age of male patients was 51.9 years [95% CI 45.8; 58.1; SD +/-17.9] in 1995-7 and 53.7 years [95% CI 51.6; 55.9; SD +/-14.0] in 1998-02. In females the mean age for the two periods was 48.8 years [95% CI 42.5; 55.0; SD +/-18.2] and 48.4 years [95% CI 45.4; 51.5; SD +/-13.9] respectively. Age-specific curves showed a gradual increase in risk from the second until the seventh decade. The majority of the cases presented as poorly or moderately differentiated distal (non-cardia) cancers with a regional spread. Conclusion: Gastric cancers in Karachi fall into the prototype of a low risk developing country pattern. The incidence is increasing, most marked in males above 40 years of age. Larger pathology-based studies are required to comment on the precise morphological sub-types of gastric adenocarcinoma. Etiological studies focused on different strains of H. pylori are required to address the gastric cancer enigma, whilst examining possible protective environmental or genetic factors.

Introduction: Primary sarcomas of bone and cartilage (BS) are a group of rare neoplasms, with limited information from Pakistan. The present population-based study was conducted with the objective of examining descriptive epidemiological characteristics of BS in Karachi. Materials and methods: Epidemiological data of 68 BS registered at Karachi Cancer Registry for Karachi South during 1st January 1995 to 31st December 1997 were reviewed. Results: Forty six (66.7%) cases were diagnosed in males and 23 (33.3%) in females. BS accounted for 2.2% and 1.1% of all cancers in males and females, respectively. The age standardized rate (ASR) world per 100,000 was 1.75 in males and 1.00 in females. Microscopic confirmation was 99.0%. The mean age of male and female patients were 26.7 years (SD +/- 17.4) and 24.3 years (SD +/- 16.0) respectively. In males 14 (30.4%) BS were diagnosed in the 0-14 year age group and 23 (50.0%) cases in the below 20 years age group. The distribution in females was 31 (67.4%) and 8 (34.8%) cases, respectively. Approximately half the cases (34.8% males; 47.8% females) were observed in the lower limbs. The most common morphology was osteosarcoma (30.5% males; 43.4% females), followed by Ewing's sarcoma (23.9%) in males and giant cell tumor (13.0%) in females. Age-specific curves showed a gradual increase in risk from the first until the fifth decade in males, and second to fourth decade in females. The age-specific curves were bimodal. In both genders the first peak was observed at 10-14 years but a second peak was observed at 70-74 years in males and 65-69 years in females. The cardinal symptoms that lead to the diagnosis of bone tumors were pain (22 cases; 32.4%) and spontaneous fractures (45 cases; 66.2%). Conclusion: Karachi falls into a high risk region for BS, which were observed in a relatively younger population, with a male predominance and a high frequency of osteosarcoma. The underlying factors for BS in Karachi need to be addressed considering the overwhelming proportion of youngsters at risk and the late presentation.

INTRODUCTION The objective of the study was to determine the trends of cancer cervix in Karachi South during an eight (1995-2002) year period. METHODOLOGY Cancer cervix cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002. RESULTS Cancer cervix ranked sixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and CIR of 7.5 and 4.0 per 100,000. Thus between 1995 and 2002, the incidence of cervical cancer registered an approximate 10% increase. The mean age of the cancer cases was 53.3 years (SD 11.6; 95% CI 50.58, 55.96; range 32-85 years) and 50.7 years (SD 11.7; 95% CI 48.8, 52.5; range 51 years) in period 1 and 2 respectively. The morphological components of squamous cell carcinoma and adenocarcinoma remained stable during this period, though a marginally higher component and increasing incidence of adenocarcinoma was observed throughout. A negligible down staging was observed in the 1998-2002 period. Localized malignancy was observed in 30.8% in period 2 as compared to 25.7% in period 1 and the component of carcinoma in situ increased from 0% percent in period 1 to 1.3% in the second period. Despite this two thirds of the cases still presented with a regional or distant spread of disease. CONCLUSION Pakistan at present falls into a low risk cancer cervix region. The cause of concern is the steadily increasing incidence especially in the younger birth cohorts, the advanced disease at presentation; insignificant in-situ cancers and no preventive intervention or awareness practices in place.

INTRODUCTION:The present study was conducted with the objective of examining epidemiological characteristics of soft tissue sarcomas (STSs) in Karachi.PATIENTS AND METHODS:Epidemiological data of 96 (63 male and 33 female) incident STS cases registered at Karachi Cancer Registry (KCR) for Karachi South (KS), from 1st January 1995 to 31st December 1997, were reviewed.RESULTS:The age standardized rate (ASR) world per 100,000 were 3.3 (2.9%) and 2.1 (1.6%) in males and females, respectively, with mean ages of of 41.4 years (95% CI 35.77-46.97) and 40.2 years (95% CI 31.27-49.03). The age-specific curves showed a gradual increase in risk from the first until the eighth decade in both genders, with the highest peak at 75+ in females and 70-74 years in males. In males, 8 (12.7%) STS cases were diagnosed in the pediatric age group (0-14), 12 (19.1%) in adolescents and young adults (15-24 years), 19 (30.1%) in adults 25-49 years of age and 24 (38.1%) in the 50 years+ age group. In females the respective frequencies were 11%, 26%, 30% and 33%. The most common histological tumor was rhabdomyosarcoma, though the occurrence of the histological subtypes was age-dependent. Rhabdomyosarcomas and Ewing's sarcomas were more frequent in children and adolescents whereas fibrosarcomas, leiomyosarcomas, liposarcomas, malignant fibrous histiocytomas (MFHs) and schwannomas were encountered in the elderly.CONCLUSION:Karachi falls into a high risk region for STS, observed in a relatively younger population, with a male predominance, high frequency of rhabdomyosarcoma and advanced stage at diagnosis. Information on grading and staging remain incomplete for most cases, which negatively affect disease management and survival.

INTRODUCTION:The present study was conducted with the objective of examining descriptive epidemiological and pathological characteristics of cancer cervix in Karachi South, an all urban district population of Karachi, Pakistan.METHODOLOGY:A total of 74 cases of cancer cervix, ICD-10 (International Classification of Diseases 10th Revision) category C53 were registered at the Karachi Cancer Registry, for Karachi South, during a 3 year period, 1st January, 1995 to 31st December 1997.RESULTS:The age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 (5.2, 8.43) and 3.22 (2.49 to 3.96). Cancer cervix accounted for approximately 3.6% of all cancers in females and was the sixth malignancy in hierarchy. The mean age of the cancer cases was 53.27 years [standard deviation (SD) 11.6; 95% confidence interval (CI) 50.58, 55.96; range (R) 32-85 years)]. The distribution by religion was Muslims (90.5%), Christians (8.1%) and Hindus (1.4%). There were no cases reported in Parsees. The frequency distribution by ethnicity was Urdu speaking Mohajirs (20.3%), Punjabis (17.6%), Gujrati speaking Mohajirs (4.1%), memon Mohajirs (8.1%), Sindhis (10.8%), Baluchs (8.1%), Pathans (5.4%) and Afghan migrants (2.7%). The ethnicity was not known in approximately a fourth (23.0%) of the cases. The socio-economic distribution was 27.0% financially deprived class, 24.4% lower middle class and 48.7% upper middle and affluent classes. The majority of the women were married (86.5%); a smaller number were unmarried (2.7%) or widows (10.8%). The age-specific curves showed a gradual increase in risk from the fourth up till the seventh decade, followed by an actual apparent decrease in risk after 64 years of age. The peak incidence was observed in the 60-64 year age group. The morphological categorization was squamous cell carcinoma (86.5%), adenocarcinoma (10.9%) and adenosquamous carcinoma (2.6%). The majority of cases presented with moderately differentiated or grade 2 lesions (45.9%). There were no in-situ cases. Approximately half the cancers (58.1%) had spread regionally and 8.1% to a distant site at the time of diagnosis. Odds ratios (OR) were calculated for socioeconomic residential categories, religion, ethnicity, age groups and education. The OR for socioeconomic residential categories ranged between 0.69 and 2.9 with a marginally higher risk in the lower [OR 2.09 (95% CI .97; 4.49)] and lower middle class [OR 2.08 (95%CI 0.95; 4.58)]. Hindus [OR 1.2 (95% CI 0.18; 2.2)] had a slightly higher risk then the Muslims [OR 0.14 (95% CI 0.17; 1.2)]. A higher risk was also observed for Christians [OR 7.76 (95% CI 1.74; 34.5)].CONCLUSION:The incidence of cervical cancer in Karachi South (1995-97) reflects a low risk population with a late presentation and a high stage disease at presentation. It is suggested that cervical screening if implemented should focus on once a life time methodology involving 36-45 year old women. This should be combined with HPV vaccination for the young and public health education for all. A regular cervical screening program would require mobilization of considerable financial, structural and human resources along with training for personnel. This may burden the already stretched health resources of a developing country.