Introduction Many classification system and mental health act in many country attempted to define mental illness but mental health perse has not been defined.Some unaddressed question like ” what is diseased in mental illness, what do you treat or set right by treatment, how the psychiatrist say that a pateint is improved and describe or define mental health” are addressed. Objectives Working concept for professionals of all allied clinical disciplines. Enable them to understand mental illness and mental health in a uniform and consistent way. Enable all MHP to speak the same language, without room for personal bias. Avoid misconceptions and reduce the stigma with mental illness Methods We divided spectrum of mental health into M entally Healthy, Not Healthy, Unhealthy and ill . Based on two dimension: 1. impact on self and 2. Impact on other. Awareness of ones own self, ability to relate well with other and ones own actions are useful to self as well as others are the three arms of mental health. Results A presentation was given to psychiatrist & allied sciences professional & members from judicairy, technolocrats, industrialist and educationist. Interaction was recorded and analysed, people even gave their responses comments and suggestions by mail and writing. Conclusions Mind is defined as a functional concept consists of Mood Thought and Intellect which is nicely amalgamated in a synchronised manner which always function in unison and the constituents cannot function in isolation. The three arms of the mental health are used to develop a tool to measure the same. All details will be discussed during the presentation. Disclosure No significant relationships.
Background: Transfer of embryos at the blastocyst stage is one of the best approaches for achieving a higher success rate in In vitro fertilization (IVF) treatment as it demonstrates an improved uterine and embryonic synchrony at implantation. Despite novel biochemical and genetic markers proposed for the prediction of embryo viability in recent years, the conventional morphological grading of blastocysts remains the classical way of selection in routine practice. This study aims to investigate the association between the morphological features of blastocysts and pregnancy outcomes. Methods: This prospective study included women undergoing single or double frozen blastocyst transfers following their autologous cycles in a period between October 2020 and September 2021. The morphological grades (A-good, B-average, and C-poor) of inner cell mass (ICM) and trophectoderm (TE) of blastocysts with known implantation were compared to assess their predictive potential of pregnancy outcome. It was further explored by measuring the relationship between the two variables using logistic regression and receiver operating characteristic (ROC) analysis. Results: A total of 1,972 women underwent frozen embryo transfer (FET) cycles with a total of 3,786 blastocysts. Known implantation data (KID) from 2,060 blastocysts of 1,153 patients were subjected to statistical analysis, the rest were excluded. Implantation rates (IR) from transfer of ICM/TE grades AA, AB, BA, BB were observed as 48.5%, 39.4%, 23.4% and 25% respectively. There was a significantly higher IR observed in blastocysts with ICM grade A (p < 0.001) than those with B irrespective of their TE scores. The analysis of the interaction between the two characteristics confirmed the superiority of ICM over TE as a predictor of the outcome. The rank biserial correlation value for ICM was also greater compared to that of TE (0.11 vs 0.05). Conclusion: This study confirms that the morphology of ICM of the blastocyst is a stronger predictor of implantation and clinical pregnancy than that of TE and can be utilized as a biomarker of viability.
Zika virus is a member of the Flaviviridae family and genus Flavivirus, which has a phylogenetic relationship with spondweni virus. It spreads to humans through a mosquito bite. To identify potential inhibitors for the Zika virus with biosafety, we selected natural antiviral compounds isolated from plant sources and screened against NS3 helicase of the Zika virus. The enzymatic activity of the NS3 helicase is associated with the C-terminal region and is concerned with RNA synthesis and genome replication. It serves as a crucial target for the Zika virus. We carried out molecular docking for the target NS3 helicase against the selected 25 phytochemicals using AutoDock Vina software. Among the 25 plant compounds, we identified NS3 helicase-ellagic acid (-9.9 kcal/mol), NS3 helicase-hypericin (-9.8 kcal/mol), and NS3 helicase-pentagalloylglucose (-9.5 kcal/mol) as the best binding affinity compounds based on their binding energies. To understand the stability of these complexes, molecular dynamic simulations were executed and the trajectory analysis exposed that the NS3 helicase-ellagic acid complex possesses greater stability than the other two complexes such as NS3 helicase-hypericin and NS3 helicase-pentagalloylglucose. The ADMET property prediction of these compounds resulted in nontoxicity and noncarcinogenicity.
Purpose of Review Menopause is a multifaceted biological and psychosomatic health disorder induced by the reduction and cessation of ovarian physiology and reproductive hormones such as estrogen, progesterone, follicular stimulating hormone (FSH), and luteinizing hormone (LH). This literature review aimed to synthesize the results of published studies on factors associated with symptoms in women during the transition of menopause and the Siddha way of management. All appropriate preclinical and clinical research data were analyzed in electronic databases like Pubmed, Scopus, and olden Siddha medical literature. Recent Findings Nearly two-thirds of women have subjective cognitive difficulties, commonly identified to be difficulty in memory, attention, processing speed, verbal fluency, and motor skills during their menopausal transition. According to Siddha literature, vadha and pitha dosha produces the menopausal phase disorders. During menopause, symptoms like sleeplessness, nervousness, hot flushes, irritability, irregular menstrual cycle, urinary tract infections, incontinence, and osteoporosis are disturbing the women’s day to day activity. Scientific research strongly evidences that Siddha medicinal herbs and polyherbal preparations serve as an innovative platform for the search of drugs from alternate sources. Phytoestrogen containing herbs like soya, black gram, asparagus, and herbal antioxidants turmeric, green tea, bringaraj, and licorice gives a lot of relief to the menopausal women. Regular yoga postures, meditations, pranayamam, and Surya Namaskaram also support the women to get relieved from cognitive impairments. Summary Based on the evidence of the present investigation, it was concluded that medicinal herbs and ther kayakalpa practices of Siddha medicines are alleviating the problems of menopause without any harmful effects.
In India, Cardiovascular Disease (CVD) is one of the major reasons for death. The age-standard CVD death rate in India is 272 per 100,000 individuals based on Global Burden of Disease Study. In the proposed work, risk of heart failure is predicted based on arterial stiffness indices parameters from carotid artery image. This study was carried out in South Indian population in and around Chennai. Carotid artery image was taken using ultrasound machine for 165 subjects (55 normal, 55 CVD and 55 diabetic). From the carotid artery images, arterial stiffness indices parameters such as stiffness index, elastic modulus, distensibility, and compliance are measured for predicting the risk of heart failure. Biochemical parameters such as HDL, LDL, total cholesterol, fasting blood sugar, and postprandial blood sugar are also recorded for the 165 subjects. Estimated Framingham Risk Score (FRS) is based on biochemical parameters, systolic blood pressure and diastolic blood pressure, and smoking. FRS is 10-year risk score prediction for analyzing the risk of heart failure. All these parameters are analyzed using biostatistical methods, machine learning methods, and deep learning methods to determine the risk of heart failure. Results show that Pearson’s correlation gives significant results with p < 0.01 for biochemical parameters and FRS score. The performance was also determined by comparing various classification techniques in machine learning such as Naïve Bayes, K-Nearest neighbor, Random Forest, Support vector machine (SVM), and multilayer perceptron. Results show that multilayer perceptron and SVM produce good results in four different models. Further analysis is performed by extracting the features of M-mode carotid artery images using transfer learning techniques such as ResNet50 and InceptionV3. The results show the highest accuracy of 99% and 98% are achieved using ResNet50 and InceptionV3, respectively for normal and CVD subjects. Relative risk analysis are also performed using SPSS software for stiffness index and elastic modulus with FRS and the results are tabulated.KeywordsCardiovascular diseaseArterial stiffnessElastic modulusStiffness indexDistensibilityCompliance
Background This retrospective study was conducted to analyze the temporal trends, predictors, and impact of disseminated intravascular coagulation (DIC) on outcomes among septicemic patients using a nationally representative database. Methods We derived data from the National Inpatient Sample (NIS) for the years 2008-2017 for adult hospitalizations due to sepsis. The primary outcomes were in-hospital mortality and discharge to facility. The Cochran-Armitage test and multivariable survey logistic regression models were used to analyze the data. Results Out of 12,820,000 hospitalizations due to sepsis, 153,181 (1.18%) were complicated by DIC. The incidence of DIC decreased from 2008 to 2017. In multivariable regression analysis, demographics and comorbidities were associated with higher odds of DIC. During the study period, in-hospital mortality among patients with sepsis decreased, but the attributable risk percent of in-hospital mortality due to DIC increased. We observed similar trends for discharge to facility; however, the adjusted odds of discharge to facility due to DIC remained stable over the study period. Conclusion Although the incidence of sepsis complicated by DIC decreased, the attributable in-hospital mortality rate due to DIC increased during the study period. We identified several predictors associated with the development of DIC in sepsis, some of which are potentially modifiable.
A 14-year-old girl presented with gradually progressive breathlessness for 3 weeks. On evaluation, it was found that she had left ventricular hypertrophy and nonprogressive R wave in ECG. An echocardiogram revealed aortic stenosis and severe left ventricular dysfunction.Computed Tomography (CT) imaging showed aortic annulus calcifications causing aortic stenosis. Over three years she had gradually developed asymptomatic cutaneous swellings over the small and large joints of the extremities suggestive of tuberous xanthomas. Skin biopsy revealed scattered foamy macrophages in the upper dermis and cholesterol clefts. Her lipid profile showed raised total cholesterol and low-density lipoprotein levels. With the above clinical, histological, and laboratory findings she was diagnosed as a case of familial homozygous hypercholesterolemia with tuberous xanthomas and cardiac failure. She was started on statins, ezetimibe, and other anti-failure measures. We present this case for its rarity. Early diagnosis of this condition based on skin findings, could have prevented cardiac failure by initiating early appropriate treatment.
Aim The aim of this study was to compare the extent of analgesia in terms of duration of analgesia and requirement of postoperative analgesics with preemptive analgesia and transversus abdominis plane (TAP) block in patients undergoing inguinal hernioplasty. Materials and Methods Ninety male patients aged between 18 and 65 years of American Society of Anesthesiologists grades I and II undergoing open inguinal hernioplasty were randomly allocated to three comparable groups of 30 each. Control group (group C) received normal saline; preemptive group (group P) received inj. paracetamol, inj. diclofenac, and inj. Lignocaine; and TAP group (group T) received TAP block with 20 mL of 0.25% bupivacaine at the end of surgery. Parameters recorded were verbal numerical rating scale (VNRS) at rest at 4, 12, 24, and 48 hours and VNRS on movement at 12, 24, and 48 hours; heart rate and mean arterial pressure at 0, 4, 12, and 48 hours; time for first analgesic request; and total doses of analgesics consumed at 24 hours. Results Demographic data were comparable. VNRS on movement and number of doses of analgesics consumed at 24 hours were statistically less in group T (4.80 ± .761 hours); time for first request of analgesia was longer and this group had better patient satisfaction scores compared with other groups. Conclusion Both groups P and T provided better VNRS scores compared with group C. TAP block provided better VNRS scores on movement at 24 hours, lesser analgesic requirement, and better patient satisfaction score compared with other groups.
Introduction Cervical spondylotic myelopathy (CSM) describes a neurological deficit related to the spinal cord due to the changes in the facet joints and discs of the cervical spine as a result of degeneration. Diagnosis is mainly dependent on imaging. Diffusion tensor tractography (DTT), being a non-invasive technique, shows better sensitivity when compared to the conventional T2WI sequence in the early detection of cervical spondylotic myelopathy (CSM). The objective was to determine the diagnostic accuracy of the apparent diffusion coefficient (ADC) in predicting high T2 signals in CSM. Methods A prospective observational study was done on 47 subjects aged between 25 and 70 years, referred to the department of radiology with clinical and imaging evidence of CSM in a tertiary care institute in Chennai. Nurick classification system was used to assess severity clinically. Diffusion-weighted imaging and DTT were done with 1.5 Tesla MRI. The primary outcome variable was a high T2 signal. Mean fractional anisotropy (FA) at the stenotic level and ADC value at a stenotic level were considered explanatory variables. The sensitivity, specificity, predictive values, and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. P-value <0.05 was considered statistically significant. SPSS version 22 (IBM Inc., Armonk, New York) was used for statistical analysis. Results The mean age was 48.26 ± 10.28 years. The majority (72.34%) were males, the majority (42.55%) had a Nurick score of two, and 25.53% had a Nurick score of one. Twenty-six (55.32%) reported a high T2 signal, 36 (76.60%) had elevated ADC, and 11 (23.40 %) had no elevated ADC. There was a statistically significant difference in mean FA and ADC values across groups categorized as non-stenotic level and stenotic level (p-value <0.05). The ADC value had a moderately high sensitivity (76.92%) and low specificity (23.81%) in predicting high T2 signals with a diagnostic accuracy of 53.19%. Conclusion DTI parameters at stenotic level (ADC and FA values) in patients with cervical spondylosis help in the early detection of cervical cord compressive myelopathy prior to the appearance of T2 signal changes in conventional MRI, thereby improving clinical outcome and patient management.
The second wave of the COVID-19 pandemic left the Indian healthcare system overwhelmed. The severity of a third wave will depend on the success of the vaccination drive; however, even with a safe and effective COVID-19 vaccine, hesitancy can be an obstacle to achieving high levels of coverage. Our study aims to estimate the population’s acceptance of the COVID-19 vaccine in an Indian district. A pilot community-based cross-sectional study was conducted from March-May 2021. The data was collected from eight primary health centres in Tamil Nadu. The eligible study participants were interviewed using a self-constructed questionnaire. A total of 3,130 individuals responded to the survey. Multinomial logistic regression was performed to assess the factors influencing COVID-19 vaccine hesitancy and refusal. Results of our study showed that 46% percent (n = 1432) of the respondents would accept the COVID-19 vaccine if available. Acceptance for the COVID-19 vaccine was higher among males (54%), individuals aged 18-24years (62%), those with higher education (77%), having the higher income (73%), and employed (51%). Individuals with no education (OR: 2.799, 95% CI = 1.103–7.108), and low income (OR: OR: 10.299, 95% CI: 4.879–21.741), were significant predictors of vaccine hesitancy (p < 0.05). Living in urban residence (OR: 0.699, 95% CI = 0.55–0.888) and age between 18 to 25 years (OR: 0.549, 95% CI = 0.309–0.977) were protective factor of COVID-19 vaccine hesitancy. While individuals in the age group 25-54years (OR = 1.601, 95%CI = 1.086–2.359), fewer education (OR = 4.8, 95% CI = 2.448–9.412,), low income (OR = 2.628, 95% CI = 1.777–3.887) and unemployment (OR = 1.351, 95% CI = 1.06–1.722) had high odds of refusing the COVID-19 vaccine. Concerns and suspicions about the safety of the COVID-19 vaccine (63%) was the major reasons causing hesitancy towards the COVID-19 vaccine The public health authorities and government need to design, develop and implement targeted interventions to enhance awareness about COVID-19 vaccines, and barriers and enablers to vaccine acceptance among individuals across diverse settings. Emphasis on involving local and religious leaders, ASHA workers, community healthcare workers, Anganwadi workers, and auxiliary nurse midwives can help to overcome context-specific barriers in areas of low COVID-19 vaccine acceptance, especially in rural settings.
Background and objective Brachial plexus injuries more commonly affect the younger generation who constitute the productive workforce. The patients who sustain avulsion injuries of the brachial plexus are more often involved in high-velocity accidents. The avulsion injuries are surgically managed by nerve transfers. This study aimed to evaluate the demography of brachial plexus avulsion injuries. Materials and methods This retrospective study was conducted in January 2013 and included 21 patients treated from January 2007 to December 2011. Results Of the 21 patients, 20 were male and the most commonly affected patients were in the age group of 21-30 years. The mean age of the affected patients was 27.24 years. Six of the patients had pan palsy (C5-8 and T1), nine had C5-7 injury, and six had C5-6 injury. Twenty patients underwent spinal accessory to suprascapular nerve transfer, nine patients underwent ulnar nerve fascicle to nerve to biceps branch transfer, and one patient underwent intercostal nerve to musculocutaneous nerve transfer. Of note, 40% of the patients regained more than M3 power for abduction and external rotation of the shoulder, and 30% of the patients regained more than M3 power for elbow function. Conclusions Road traffic accidents are the most common cause of brachial plexus injuries. Nerve transfers for shoulder and elbow function play a significant role in improving the function of the upper extremity.
Background: Dry eye disorder is a disease mainly due to the tear insufficiency which results in eye discomfort and disturbances in vision. Dry eye also affects the ocular dimensions, especially corneal thickness. Central corneal thickness (CCT) assessment plays an important role in refractive surgeries and in the pre-operative assessment of other ocular surgeries. Aims and Objectives: This study aims to assess the effect of dry eye disease (DED) on CCT with age- and gender-matched controls. Materials and Methods: One hundred and four subjects (52 cases and 52 controls) who attended SRM Medical College and Hospital ophthalmology outpatient department were included in the study. DED was diagnosed with DEQS questionnaire, slit-lamp examination, TFBUT, and Schirmer’s test. Pachymetry was used for measuring the CCT of all subjects. Student “t”-test was used to determine the significance of difference between two means. P
Introduction: Spinal anaesthesia is the preferred anaesthetic technique for fractures of the hip and femur. Ultrasound-guided Fascia Iliaca Compartment Block (FICB) provides more intense analgesia which can prolong the duration of postoperative analgesia and also mitigate the pain encountered while positioning for spinal anaesthesia. Aim: To evaluate the efficacy of ultrasound-guided pre-emptive FICB in hip and femur fracture surgeries. Materials and Methods: This randomised, double-blinded, control study was conducted between May 2019 to December 2019, at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Total 66 patients scheduled for hip and femur fracture surgeries under spinal anaesthesia were randomly divided into two groups i.e, group A received Ultrasound-Guided (UG) FICB preoperatively and group B received no block. All the patients received fentanyl 1 mcg/kg intravenous (i.v.) 15 min before spinal anaesthesia. The Anaesthesiologist performing spinal anaesthesia graded the score of positioning as 0 as not satisfactory, 1 as satisfactory, 2 as good, 3 as optimal. The time for the first request for analgesia, consumption of analgesics and Visual Analog Scale (VAS) scores for 24 hours postoperatively and any adverse effects were compared between the two groups. Student’s t-test was used to compare continuous data and unpaired t-test for categorical data. Results: The time for the first request for analgesia was 671.52±66.73 min in group A and 480.3±57.65 min in group B and was statistically significant (p-value
Introduction: Iron deficiency is the most frequent cause of nutritional anaemia. Evaluation of parameters like serum ferritin and iron is critically important for evaluation of the iron status of patients and diagnosis of Iron Deficiency Anaemia (IDA). But in inflammatory disorders, ferritin concentration may be normal or increased due to the acute phase response, resulting in inaccurate interpretation of the iron status. Similarly, the serum Iron levels may be high in cases of thalassaemia with combined iron deficiency. Reticulocyte Haemoglobin equivalent (RET-He) which correlates to the iron content in reticulocytes is effective, convenient and provides useful information for the immediate diagnosis and treatment of iron deficient states. Aim: The aim of this study was to evaluate the diagnostic performance of RET-He level by comparing it with the iron status of the patients. Materials and Methods: This cross-sectional study was done in Department of Pathology at Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, from December 2020 to November 2021. The complete blood count, RET-He, serum iron and serum ferritin levels of 406 patients with microcytic hypochromic anaemia and dimorphic anaemia were reviewed and RET-He levels were compared with the serum iron and ferritin levels. The p-value was calculated using Statistical Package for Social Sciences (SPSS) IBM software version 28.0. The sensitivity of RET-He and serum ferritin levels in evaluating iron deficiency were calculated. Results: Low RET-He was observed in 394 cases, low serum iron in 401 cases and reduced serum ferritin in 376 cases. Twenty one of 34 cases of IDA with concomitant inflammation showed low RET-He and serum iron, despite normal to high serum ferritin levels. Five cases of iron deficiency with concomitant Haemoglobin defect also showed low RET-He levels and serum ferritin, whereas the serum iron was raised. Low RET-He was observed in 17 cases of dual deficiency anaemia i.e., iron deficiency along with vitamin B12/folate deficiency. Conclusion: It was concluded that measurement of the reticulocyte haemoglobin content provides useful information for the diagnosis, treatment and monitoring of iron deficient states.
SAtellite-based Marine Process Understanding, Development, Research and Applications (SAMUDRA) for blue economy, a technology development program of the Space Applications Centre, is an umbrella program covering research and applications geared toward physical and biological oceanography making use of current and future satellite observations for developing the nation’s blue economy. The main motivation behind this project was to develop satellite and numerical model-based information and value-added products and to demonstrate the implementation of developed applications for operational requirements. The program also aimed at improving existing methodologies for various applications by utilizing space-based inputs. Several field campaigns with the use of NavIC-enabled instruments and NABHMITRA were conducted for measuring biophysical parameters and validation of developed applications in the coastal regions. One of the key aspects of this project was development of web-based customized tools/dissemination system for providing the information to the end users. Some of the key/notable achievements of SAMUDRA were development of a portal OceanEye (tailor-made web-portal for Shipping Corporation of India), storm-surge/inundation system, oil-spill trajectory modeling, level-next potential fishing zone algorithm and rip current alert system.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characterises illness anxiety disorder (IAD) as the preoccupation with having or acquiring a serious illness in the absence of somatic symptoms (or, if present, symptoms that are only mild in severity). DSM-5 includes illness anxiety disorder in the category called somatic symptom and related disorders, characterised by prominent somatic concerns, distress, and impaired functioning. More often than in psychiatric settings, individuals with illness anxiety disorder are encountered in primary care and specialist medical settings. Despite negative laboratory results, the benign course of the alleged disease over time, and adequate reassurances from specialists, their conviction of being ill persists. Illness anxiety preoccupations are heterogeneous, and the degree of insight is variable. Their illness-related preoccupation interferes with their relationships with family, friends, and coworkers. They are frequently addicted to internet searches about their feared illness, inferring the worst from the information (or false information) they uncover. Patients with illness anxiety disorder often have comorbid psychopathology, especially anxiety and depressive disorders. Typically, illness anxiety disorder is chronic. Physical symptoms are absent or mild and frequently represent a misinterpretation of normal bodily sensations. This case report presents the case of a patient diagnosed with IAD by a psychiatrist. The patient had been seen by his primary care physician and therapist for three years without any improvement in his symptoms before he was referred to a psychiatrist. After undergoing a partial thyroidectomy in 2018, this patient has been experiencing increasing symptoms of recurrent anxiety/fear consistent with IAD, despite extensive medical examinations that have consistently revealed normal results.
Replicating the naturalistic biomechanical milieu of cells is a primary requisite to uncover the fundamental life processes. The native milieu is significantly not replicated in the two-dimensional (2D) cell cultures. Alternatively, the current three-dimensional (3D) culture techniques can replicate the properties of extracellular matrix (ECM), though the recreation of the original microenvironment is challenging. The organization of cells in a 3D manner contributes to better insight about the tumorigenesis mechanism of the in vitro cancer models. Gene expression studies are susceptible to alterations in their microenvironment. Physiological interactions among neighboring cells also contribute to gene expression, which is highly replicable with minor modifications in 3D cultures. 3D cell culture provides a useful platform for identifying the biological characteristics of tumor cells, particularly in the drug sensitivity area of translational medicine. It promises to be a bridge between traditional 2D culture and animal experiments and is of great importance for further research in tumor biology. The new imaging technology and the implementation of standard protocols can address the barriers interfering with the live cell observation in a natural 3D physiological environment.
A 41-year-old premenopausal woman presented to the outpatient department with a diagnosis of invasive lobular carcinoma. She noticed a lump a year back but did not seek medical attention due to many socio-cultural factors prevalent in Pakistan that prevent her from seeking medical attention earlier. She came in for a check-up after increasing in size of the lump. The bilateral mammogram showed large areas of asymmetrical density in the left upper quadrant. It was followed by an ultrasound-guided biopsy which confirmed the diagnosis of invasive lobular carcinoma. Due to stage 3, it was recommended to have CT and an MRI of the breast to assess the extent of the disease. Tissue immunohistochemistry was also requested, which came back as ER-positive, PR-positive, and HER2/neu negative. MRI of the breast revealed a 4.2 x 3.3cm heterogeneously enhancing asymmetric mass-like enhancement area within the left breast outer quadrant with an adjacent spiculated nodular lesion measuring 2.2 cm. CT chest/abdomen/pelvis with contrast showed left breast with minimal parenchymal asymmetry and a small 9 mm node seen in the left axilla. There was no evidence of metastasis. The patient was started on neoadjuvant therapy to minimize systemic disease, followed by mastectomy. This case highlights socio-cultural factors prevalent in Pakistan that lead to delays in the diagnosis and treatment of invasive lobular carcinoma. The outcome had been better if the patient sought medical attention sooner at an earlier stage. We also propose strategies to raise awareness in Pakistan for the timely diagnosis and treatment of breast cancer.
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