P value < 0.05.The purpose of this study was to assess the prevalence and factors associated with stunting among under five children in Adama town, Central Ethiopia, 2013. A community based cross sectional study was conducted on 616 parent child pairs of under five children using structured questionnaire and anthropometric measurements. World health organization new growth reference was used to convert height measurements into Z-scores of the height for age indices considering age and sex of the children. Bivariate and multivariate logistic regression analysis were performed at This study revealed that 44.4% of under five children were stunted. The findings showed that a significant positive association between stunting and mother educational status , number of under five children in the house hold , decision making on the use of money only by husband , age of complementary foods started , presence of diarrhea in the last two week . Therefore, this study recommends intervention strategies focusing on encouraging women education, family planning and education on child caring practice Chronic malnutrition is one of the leading global health concern, it is usually measured by stunting. Stunting, a length or height-for-age z score below minus two, is used by world health organization (WHO) as growth reference standard . It is iThe global proportion of stunted children were reduced slowly since 1990, however, in 2013, about 161 million children under 5 years were stunted . In sub-Around 45% of under five children death in the world is due to various forms of malnutrition, from them stunting is a major contributor . Child mStunting occurs due to different dimensional etiology with no single root cause, therefore, the intervention requires variety of ideas and collaboration of different sectors . Past stA community based cross-sectional study was conducted on 616 parent child pairs of under five children in Adama town, Ethiopia from March to April 2013. Adama town is located 99 km south east of the capital city, Addis Ababa. Administratively, Adama town is divided into 14 kebeles. With an estimated 155,349 population with 79,013 (50.8%) males and 76,336 (49.2%) females. Total numbers of under five children were 20,013 with 51.7% boys and 48.3% girls [The sample size was determined using a formula for estimation of single population proportion with the assumption of 95% confidence interval, 5% margin of error, and prevalence of chronic undernutrition in Oromia region at 41.4% , and desMulti stage sampling technique was used to get the required study subjects. First, four kebeles were selected from fourteen kebeles of Adama town using simple random sampling techniques. Second, the total households with under five children were also identified for each selected kebele. Third, the sample size was allocated for study areas of each selected kebele using population proportion technique. Finally, the households (HH) with under five children were identified using simple random sampling techniques. In the presence of more than one child one of them was selected by lottery method.Interviewer administered questionnaires were employed to collect the data. The questionnaires were adapted and modified after reviewing relevant literature’s –12. The Length was measured for children less than 2 years old and height was measured for those 2 years and older. Length was measured in supine position and height was measured in standing position with calibrated wooden length/height measuring board with sliding head bar. All the measurements were made in duplicate and recorded to the nearest 0.1 cm . The heiThe children’s height was converted to the Z-score of height-for-age based on WHO growth reference population. Data was processed using EPi-info version 3.5.4 & WHO Antro version 3.2.2 to convert the nutritional data into Z-score of H/A taking age and sex into consideration then exported to SPSS version 20 for analysis. Descriptive statistics were used to determine the prevalence of stunting and frequencies and percentages were also calculated for all variables. Bivariate and multivariate logistic regression analysis methods were used to identify factors associated with stunting and to account for potential confounding factors.A total of 610 under five children (304 girls and 306 boys) were enrolled in this study, with 99% response rate. Age wise, 19% of the study participants were in 6-11 months age group with the mean age of 23.56 months (± SD 17.54). More than half of the respondents (58.2%) follows Ethiopian Orthodox Christian in religion and 44.4% were from Oromo ethnic group. Majority of (84.4%) the respondents were married and 78.5% of the households were male headed. From the total number of mothers, 54.4% were house wife, 41% were completed elementary school. Regarding the fathers, 37.4% were private organization employee, while 30.7% were secondary school certificate holder. Two hundred thirty six (38.7%) of the respondents had a monthly income between 701 and 1000 ETH birr. Mean family size was 4.4 persons (± SD 1.61) while 17.5% of the households had more than five family size and about 42.6% of the households had more than two under 5 year children  were breastfed and 34.1% of children were exclusively breastfed for only four and less months. Mean duration of exclusive breastfed was 4.3 (± SD 1.97) months and the average duration of breastfed was 14 (± SD 8.83) months. About 29.5% breastfeed children received pre-lacteal foods/fluids and out of them 18.5% fed water. Majority of the children (81.5%) took additional foods/fluids in the past 48 h, out them 275 (45.1%) were started feeding within the age range of 4-6 months. Around 60.5% of children in the age group of 0–4 month were fed by using bottle. Almost all 598 (98%) respondents washed their hands whenever they fed the child, and also 40.3% washed their dishes immediately after use.Majority (77.9%) of the children visited health facility for illness care; whereas 7.7% of the children did not receive any type of vaccine. Around 34.1% of the children had diarrhea in the last 2 weeks, out of them 32.2% having three to four episodes of diarrhea in a year. Three hundred twenty five (53.3%) of the children had fever before 2 weeks of the study period, likewise 39.8% of the children had ARI. Most of the house hold 254 (41.6%) throw the waste disposal in open field, followed by burning (20.6%) and common pit (19.2%) (Table The percentage of children who were stunted (< − 2 SD) was 44.4%, of which 12.8% severely stunted (< − 3 SD). Out of the total children who are stunted, 147 (54.2%) were boys and 124 (20.7%) of the children was in the age group of 6–11 months.In bivariate analysis; the number of under five children, mother educational status, decision making on the use of money, duration of exclusive breastfeeding, pre-lacteal foods/fluids, additional foods in the past 48 h, age of complementary food started, presence of diarrhea and fever in the last 2 weeks had statistically significant association with stunting.Multivariable logistic regression analysis showed that children from household’s decision making on the use of money by only father were more stunted (AOR = 4.43 95% CI 2.51–7.80) than those children found in the household of decision making by both jointly. Stunting was 3.69 times higher among children whose mother was illiterate (AOR = 3.69 95% CI 1.42–9.58) than children whose mother finished higher education. Similarly, the presence of more than two under five children in the household had 2.8 times higher risk for stunting (AOR = 2.8 95% CI 1.77–4.42). Likewise, significantly higher risk of stunting was observed among children who started complementary foods/fluids less than 4 months of age as compared to the other groups (AOR = 7.52 95% CI 3.39–16.68). Children who had diarrhea before 2 weeks of the study period were 1.79 times stunted than children without diarrhea   and withConsidering education of mothers, the present study revealed that stunting was 3.7 times higher among children whose mother was illiterate (AOR = 3.69 95% CI 1.42–9.58) than children whose mother finished higher education. The result was consistent with studies conducted in Vietnam, India and Afghanistan , 17, 19.Higher risk of stunting was observed among children who started complementary foods/fluids less than 4 months of age as compared to the other groups (AOR = 7.52 95% CI 3.39–16.68). On contrary, study done in west Gojam showed that stunting was higher among children who started complementary foods/fluids at the age of greater than 12 months . This diThis study demonstrated that the socio-demographic factors of the child were major determinants for chronic undernutrition. Therefore, this study recommends intervention focusing on encouraging women education, family planning and education on child caring practice may ultimately reduce the prevalence of stunting.Dietary intake data is not included in this study since it needs follow up records.This study only focused on the two main factors of chronic undernutrition (family and child level factors).


The aim of study was to identify risk factors of birth asphyxia among newborns in public hospitals of Central Zone Tigray, Ethiopia 2018.A total of 88 cases and 176 controls were included in the study. Thirty (34.1%) cases and 28 (15.9%) of controls were not able to read and write. Twenty-one (23.9%) cases and 9 (5.1%) controls were had meconium stained on pelvic examination. Multivariable logistic regression analysis showed that maternal illiteracy , low birth weight , preterm , prim parous , antepartum hemorrhage  and meconium stained amniotic fluid  were independent risk factors of birth asphyxia. Birth asphyxia is defined as a failure to initiate, establish and sustain breathing at birth. It can also be defined as placental or pulmonary gas exchange impairment leading to hypoxemia and hypercarbia , 2. BirtA diagnosis of birth asphyxia may be made when a baby has a < 7 Apgar score. Another way of identifying birth asphyxia is checking the acidity of the blood in the umbilical cord. If it is too acidic, it can be a sign that the baby has had a period of oxygen deprivation . A baby Over 130 million infants born every year globally and about four million neonatal deaths occurred each year . NeonataThere are tested risk factors of birth asphyxia in different studies however there are factors which are not tested particularly in our setting . Hence, The study was carried out in public hospitals of Central Zone Tigray, Ethiopia. Data collection for this study was undertaken from January up to February 2018.A facility based unmatched retrospective case–control study design was employed.The source population was all mothers were born their child in central zone, Tigray, Ethiopia.Mothers with their newborns who diagnosis as birth asphyxia.Mothers with their newborns who diagnosis without birth asphyxia.Sample size of the study was calculated using EPI Info software version 7.1.1 with the following parameters for unmatched case control study: confidence level = 95%; power = 80%; odds ratio = 2.53; case to control ratio = 1:2; proportion of controls with exposure 17.7% ; proportSystematic random sampling technique was used to select the study subjects from four public hospitals with every two study subjects for both cases and controls.Birth asphyxiaDependent variableAntepartum factorsIntrapartum factorsFetal factorsIndependent variablesWhen the newborn has at least one of the following signs, not breathing, gasping, < 30 breaths per minute or < 7 APGAR score .When the newborn weight was < 2500 g .When the newborn was born < 37 gestational age .Data was collected using interviewer administered structured questionnaire adapted , observaQuality of the data was assured with properly designed data collection instruments. The enumerators and the supervisors were given training for 5 days on procedures, techniques and ways of collecting the data. Five percent pretest was done at Shul hospital to check consistency of the questioner. The collected data was reviewed and checked for completeness by principal investigator and co-investigators weekly.Data was entered and cleaned using Epi info version 7.1.1. Data was analyzed using SPSS version 22.0 statistical software. Cross tabulation was done among dependent variable and independent variables. Binary logistic regression model was used to determine significant association between birth asphyxia and possible risk factors. Variables which were show statistical significance during bivariate analysis at p-value ≤ 0.25 were entered to multivariable logistic regression. Multivariable logistic regression was done with considering a selected variables of bivariate logistic regression analysis. Data was finally presented and interpreted at p-value < 0.05 being considered as statistically significant.In this study, a total of 88 neonates who had birth asphyxia (cases) with their index mothers and 176 newborns who had no birth asphyxia (controls) with their index mothers were included making a response rate of 100%. Forty-nine (55.7%) of cases and 64 (36.4%) controls were living in rural areas. Regarding to marital status, 75 (85.2%) cases and 166 (94.3%) of controls were married. Forty-seven (53.4%) of cases and 89 (50.6%) of controls were house wives and 30 (34.1%) cases and 28 (15.9%) of controls were not able to read and write (Table Seventy-six (86.4%) cases and 159 (90.3%) controls their mothers were had antenatal care follow up and 11 (12.5%) cases and 6 (3.4%) controls their mothers were had preeclampsia. Two (2.3%) cases and 5 (2.8%) controls their mothers were with the complication of polyhydramnios and 6 (6.8%) cases and 3 (1.7) controls their mothers were had oligohydramnios as a complication. Three (3.4%) cases and 5 (2.8%) controls their mothers were anemic patients and 8 (9.1%) cases and 11 (6.3%) controls their mothers were had maternal infection. Three (3.4%) cases their mothers had experience of having history of smoking and 10 (11.4%) cases and 34 (19.3%) controls had history abortion. Forty-three (48.9%) cases and 64 (36.4%) controls were prim parous parity.Twenty-three 26.1%) cases and 36 (20.5%) controls their mothers were had experience of prolonged labor and 7 (8.0%) cases and 8 (4.5%) controls their mothers were had prolapsed cord as a complication of labor. Sixty-three (71.6%) cases and 135 (76.7%) controls their mothers were delivered spontaneously and 78 (88.6%) cases and 158 (89.8%) controls their mothers were had vertex presentation. Twenty-one (23.9%) cases and 9 (5.1%) controls their mothers were had meconium stained on pelvic examination. Forty-three (48.9%) cases and 19 (10.5%) controls were low birth weight and 49 (55.7%) cases and 40 (22.7%) and controls were preterm ].Parity was significantly associated with birth asphyxia. This study showed that those who were primiparous 3 times higher risk than those who were multiparous to effect birth asphyxia .Antepartum hemorrhage was significantly associated with birth asphyxia. Mothers who had antepartum hemorrhage had 12 times higher risk than those who were not had antepartum hemorrhage to the outcome of birth asphyxia .Status of meconium stained had significant association with the outcome variable of birth asphyxia. Those who had meconium stained were 7.9 times higher risk than were not had meconium stained to birth asphyxia .Preterm babies were 2.2 times higher risk than term developing birth asphyxia . Similarly, the weight of the neonate had also a significant association with birth asphyxia. Low birth weight neonates were 6.9 times higher at risk than normal weight as determinant of birth asphyxia  . This finding is similar with studies conducted in Pakistan and Thailand , 21 presPreterm babies were 2.2 times more likely to be asphyxiated than term babies. This study is in line with a study conducted in Jordan discovered that preterm babies had risk of development birth asphyxia , 22. ThiMeconium stained mothers had a significant association with birth asphyxia. Those who had meconium stained were 7.9 times higher risk than were not had meconium stained to birth asphyxia. This study is in line with other previous study . In healParity had significant association with birth asphyxia. Those who were prim parous 3 times higher risk than those who were multiparous to effect birth asphyxia. This study is consistent with other studies , 24. ThiAntepartum hemorrhage had significant association with birth asphyxia. Mothers who had antepartum hemorrhage had 12 times higher risk than those who were not had antepartum hemorrhage to the outcome of birth asphyxia. This study is in line with studies reported previously . This coBirth asphyxia is one of the worldwide problem of neonates. It arises different complications, if the cases left untreated and leads to death. There are different variables which culprits of birth asphyxia. In this study, maternal illiteracy, prim parous, low birth weight, preterm delivery and meconium stained amniotic fluid were the risk factors of birth asphyxia. Most of these variables are preventable by holistic care of pregnancy, labor and delivery and post-natal care.This study is quantitative; it was better if qualitative approach was also employed to investigate in detail on extra determinant factors of birth asphyxia.The study was done in single one region of Ethiopia. It is difficult to generalize for the whole country with small sample.This study also subjected to recalling bias of mothers when they remembered their previous history.


To compare the evaluations of evaluate levator ani muscle injury (LAMI) by tomographic ultrasound imaging (TUI) and multiplanar (MP) ultrasound in patients with pelvic organ prolapse (POP).This retrospective analysis studied women who underwent International Continence Society POP quantification examination between October 2015 and June 2016. LAMI was assessed by both TUI and MP ultrasounds. Concordance of these two testing results was analyzed. Their correlations with clinical symptoms were also studied.k = 0.71, P < 0.01). Depth of LAMI in the coronal plane demonstrated good agreement with TUI scores . After controlling for age, BMI, and parity, to have clinically significant POP and POP symptoms, the odds ratios (ORs) for the depth of LAMI in the coronal plane were 1.31 (95% CI 1.19–1.44) and 1.25 (95% CI 1.14–1.36), and for TUI scores were 1.72 (95% CI 1.37–2.17) and 1.63 (95% CI 1.31–2.03). Receiver operating characteristic curve analyses showed a cutoff depth of 7 mm of LAMI yielded a sensitivity of 62% and specificity of 80% for POP symptoms.A total of 135 women were included. All the patients with POP had a minimal LAMI depth ≥ 7 mm. Two examinations, TUI and MP, had satisfactory concordance (TUI and MP had satisfactory concordance in detecting LAMI and correlated with clinical symptoms of POP. Pelvic organ prolapse (POP) is a common disorder. Its causes include birth injury, chronic cough, constipation, and prior hysterectomy –4 Women Currently, three- and four-dimensional (3D/4D) ultrasound systems have made anatomical and functional assessment of the levator ani muscle accessible to more patients . The entThe ‘multiplanar’ (MP) mode, also termed ‘x-Planes’ and ‘multiplanes’, which is one of the popular display modes in 3D/4D ultrasonography, can depict cross-sectional planes through the volume in question ,19. For This study was a retrospective analysis in women who visited the clinic for POP or lower urinary tract symptoms at The Second Xiangya Hospital , between October 2015 and June 2016. Ethics approval for this study was granted by the Human Research Ethics Committee of The Second Xiangya Hospital on March 2017.Inclusion criteria were, 1). Patients visited the clinics with symptoms consistent with POP or lower urinary tract symptoms; 2). Between October 2015 and June 2016; 3). Received both TUI and MP ultrasound examinations. Patients without complete clinical and sonographic data were excluded.TM version 10.3 software. All volume analyses were performed by two of the authors, who blinded to all of the clinical data. The most effective (in terms of producing organ descent) Valsalva maneuver was chosen to measure organ descent  and levator hiatal area according to the standardized method described Dietz [All patients underwent a clinical interview with POP examination performed based on the Pelvic Organ Prolapse Quantification System of the International Continence Society (ICS POP-Q). Four-D TLUS was performed by a qualified sonographer. Transperineal ultrasound was performed with the patient supine after bladder emptying using a Voluson 730 or E8 system  equipped with a 4–8-MHz curved array volume transducer that was placed on the perineum in the sagittal direction with an 85° acquisition angle. Volume acquisition was performed at rest and on maximum Valsalva maneuver with pelvic floor muscle contraction (PFMC). At least 3 Valsalva maneuvers and PFMC actions were completed per patient. Post-processing of the ultrasound volume data was performed using 4DViewed Dietz . LAMI wa2 [POP symptoms were defined as a vaginal lump/bulge or a dragging sensation. Significant clinical prolapse was defined as POP stage 2 or higher ,23. Sign2 .The MP mode was used to depict three orthogonal planes: midsagittal; coronal; and axial , were documented on the right and left side each . Of the Levator ani trauma was also assessed using standardized TUI at slice intervals of 2.5 mm . The 6 sEvery patient received tomographic and multiplanar ultrasound examination. Presence of levator ani muscle injury was set as the main outcome of the study.P < 0.05 were considered to be statistically significant.Statistical analysis was performed using SPSS version 17.0 . Cohen's Kappa test was used to examine the test agreement between TUI and MP ultrasounds. Pearson correlation analysis was applied to test the relationship between ultrasound examination and clinical symptoms. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the relationship between LAMI and POP symptoms and signs. Differences with 2 . The mean parity was 2 , with 90% of subjects having had at least one vaginal delivery. The median age at first childbirth was 22 years (interquartile range 20–25 years). Eighty (59%) patients presented with POP symptoms. Ninety-two (69%) presented with lower urinary tract symptoms including leakage, urgency, frequency, nocturia, or voiding dysfunctionThree had undergone hysterectomy.Of the 147 patients with clinical symptoms of POP, 12 were excluded from analysis , leaving valid data for 135 patients. The mean (± SD) age was 48 ±10 years , and the mean body mass index (BMI) was 22.27 kg/mOn clinical assessment, 33 (24%) women were POP stage 0, 23 (19%) were POP stage 1, and 79 (59%) exhibited significant POP . There was a significant cystocele in 63 (47%) patients, uterine prolapse in 49 (36%), vault prolapse in 3 (2%), and rectocele in 40 (30%) patients.2, with 88 (65%) hiatal ballooning.On ultrasound, 83 (62%) patients exhibited significant POP, which was a cystocele in 59 (44%) patients, uterine prolapse in 51 (38%), enterocele in 4 (3%), and a rectocele in 45 (33%) patients. The mean hiatal area on Valsalva was 22.75 cmk = 0.71, P < 0.01).On the ultrasound examination, every patient with POP had a minimal depth of 7 mm for levator ani muscle avulsion. Thus, a depth of ≥ 7 mm was used to determine LAMI. Numbers of patients without LAMI, or with unilateral or bilateral avulsion, were listed in Logistic regression analysis was used to evaluate the association between LAMI and POP signs and symptoms, by controling age, BMI, and parity as potential confounders. In predicting clinically significant POP and POP symptoms, the odds ratios (ORs) for the depth of LAMI in the coronal plane were 1.31 (95% CI 1.19–1.44) and 1.25 (95% CI 1.14–1.36), and for TUI scores were 1.72 (95% CI 1.37–2.17) and 1.63 (95% CI 1.31–2.03).ROC curve analysis was used to test the diagnostic performance of LAMI depthThe AUCs for the depth of LAMI were 0.82 (95% CI 0.75–0.90), 0.79 (95% CI 0.71–0.87), 0.84 (95% CI 0.75–0.89) and 0.77 (95% CI 0.69–0.85) against POP stage 2 or higher, POP symptoms, significant POP on TLUS and hiatal ballooning Figs  and 4. AThe most common morphological abnormality of the levator ani is a unilateral avulsion of the pubovisceral muscle off the pelvic sidewall ,27, whicr = 0.84) between LAMI depth and TUI scores, as well as limited discrepancy (k = 0.71) in determining levator ani muscle avulsion between the MP mode and TUI.TUI with 3D/4D TLUS is currently the most popular validated method to detect LAMI ,13,14. TMP mode enables clinicians to obtain a more accurate evaluation of LAMI using multidimensional visual assessment as well as a numerical data. The midsagittal plane displayed the slice position, which was at the anterior vaginal wall or urethrovaginal septum; the axial plane depicted the morphological characteristics of the levator ani muscle, which encloses the minimal levator hiatus; and the coronal plane revealed the range of LAMI at the insertion. The configuration and limits of LAMI were accurately presented in the orthogonal planes. It appears possible to improve the evaluation of LAMI in orthogonal planes. Regression analysis revealed that LAMI was an independent risk factor for significant POP (OR = 1.31), and ‘major trauma’  was strongly correlated with POP symptoms and signs (OR = 6.13 and 4.88). LAMI in the coronal plane demonstrated excellent performance in predicting significant POP.While our results confirmed the validity of this technique based on clinical and research practice, there were several limitations to this study that should be acknowledged. First, a single slice in the coronal plane cannot account for the entire insertion of levator ani muscle on the inferior pubic ramus. It is possible that our measurements were not exactly performed on the largest LAMI. Second, the volume analysis was performed by experienced operators to ensure the reliability of the measurements. However, the repeatability and practicability of this method need to be tested in further studies.TUI and MP had satisfactory concordance in detecting LAMI and correlated with clinical symptoms of POP. A LAMI with depth ≥ 7mm might be used as the cutoff to determine POP.S1 Data(XLS)Click here for additional data file.


Chemotherapy-induced thrombocytopenia (CIT) is a significant complication of cancer therapy. Data on the optimal management approaches of this morbidity in children and young adults are still limited.The aim of the study is to estimate the frequency and severity of CIT and associated clinically significant bleeding in children and young adults with solid tumours and haematologic malignancies.9/L. For assessing bleeding, WHO scale had been used.For this retrospective, hospital-based study, children (0–18 y) and young adults (19–40 y) with different types of solid tumours and haematologic malignancies who received chemotherapy at the Muratsan Hospital Complex of Yerevan State Medical University were identified from the patients’ database and included in the study . Thrombocytopenia was defined as a decrease of platelet count below <100 × 10p = 0.001). From 430 cycles of chemotherapy, 31 (7.2%) cycles reported to have bleeding events.Overall, the whole group of patients received 430 chemotherapy cycles. During 131 (31.6%) chemotherapy cycles, patients developed CIT. The study revealed a statistically significant inversely proportional correlation between the age and the severity of CIT. Another important finding of the study was that the patients, who previously were exposed to radiation therapy, were more likely to develop CIT, than those who have not received radiation therapy (68% and 28.7%, Our study showed that clinically significant thrombocytopenia and bleeding are quite rare among children and young adults. Younger age and previous exposure to radiation therapy are positively correlated with the severity of thrombocytopenia. Larger studies are needed to investigate these findings. Thrombocytopenia is a frequent complication of cancer therapy, but there is still no consensus among physicians regarding the management of this important problem –3. As a 9/L (in some centres lower or higher thresholds are implemented) or on-demand transfusions, meaning when bleeding occurs [Current recommendations either favour prophylactic platelet transfusions, i.e. when the platelet count drops below 10 × 10g occurs –9. Data g occurs .This retrospective study was conducted at the Clinic of Chemotherapy of Muratsan Hospital Complex of Yerevan State Medical University (Armenia). We reviewed the charts of the patients with solid tumours and haematologic malignancies aged 0–40 years, who were treated at the clinic between 1 January 2008 and 31 December 2015. Patients from 0 to 18 years old formed the cohort of children (54% of entire group), and from 19 to 40 years were considered as young adults. Those patients, who were admitted to the clinic to receive non-cytotoxic treatment were excluded from the study cohort. The final study cohort included 122 patients, who received 430 chemotherapy courses in total. 67 (55%) patients were males. The median age for the entire group was 18 y . 42 (34.4%) patients were in the age group of 0–10 years, 32 (26.2%) patients 11–20 y, 21 (17.2%) patients in 21–30 y group and 27 (22.2%) patients were in the age group of 31–40 years. 91 (75%) patients had a blood cancer and 31 (25%) patients presented with solid tumours. Out of 66 patients in the group of 18 years and younger 14 had solid tumours (21.2%), and in older age group out of 56 patients 17 had solid tumours (30.4%).9/ L, and National Cancer Institute (NCI), USA scale was incorporated for grading: grade 1—75–100 × 109/L, grade 2—50–74 × 109/ L, grade 3—25–49 × 109/L and grade 4—below 25 × 109/L [Thrombocytopenia was considered a decrease of platelet count in peripheral blood below 100 × 10Descriptive statistical methods were incorporated for the statistical analysis of the collected data. For comparing continuous variables ANOVA-univariate, and for categorical variables, chi-square tests were used. Analyses were performed using IBM SPSS Statistics 20.9/L. At diagnosis, only 9% of patients with haematologic malignancies had grade 4 thrombocytopenia and 4% had grade 3 thrombocytopenia. In the solid tumour group, none of the patients were found to have thrombocytopenia at diagnosis.At the admission for the entire study group, the median platelet count was 221 × 10The information about chemotherapy was available for 414 96.3%) out of 430 courses. Thrombocytopenia had been documented during 131 (31.6%) courses; in particular, CIT occurred during chemotherapy courses for acute lymphoblastic leukaemia (ALL) in 54% (42/77), 38.1% (16/42) of Ewing sarcoma chemotherapy courses, 92.3% of germ cell tumours (12/13), 4.8% in Hodgkin lymphoma (8/165) and 42.5% of non-Hodgkin lymphoma (31/73). During chemotherapy cycles for the patients with acute myeloid leukaemia (AML) (five courses), chronic myelomonocytic leukaemia [6.3% out The exact number of platelets was available for 405 (94.2%) courses. Grade 4 thrombocytopenia was documented during 39 courses (9.6%), grade 3 thrombocytopenia during 28 courses (6.9%), grade 2 and grade 1, accordingly in 35 (8.6%) and 29 (7.1%) of courses.p = 0.274).In our cohort, grade 4 thrombocytopenia was more common among males (11.48%), than in females (7.653%), but the statistical analysis could not show significant correlation between patient sex and severity of thrombocytopenia (p < 0.001), as well as age and severity of thrombocytopenia (p < 0.001), i.e. with ageing the incidence and severity of thrombocytopenia was decreasing. Clinically significant thrombocytopenia (grade 3 and grade 4) were more commonly documented in 0–10 and 11–20 age groups than in older age groups: 57.1% of grade 3 and 64.1% of grade 4 thrombocytopenia occurred in 0–10 age group, and 28.6% of grade 3 and 25.6% of grade 4 thrombocytopenia in 11–20 age group. Similar results were also documented in 0–18 and 18–40 age groups, i.e. 78.6% of grade 3 and 89.7% of grade 4 thrombocytopenia occurred in the 0–18 age group (p < 0.001).The study revealed that statistically significant correlation between patients’ age and the incidence of thrombocytopenia (p = 0.001). 21 (68%) out of 31 patients, who previously received radiation therapy, developed CIT. In the group of patients (383 chemotherapy cycles), who didn’t receive radiation therapy previously, CIT was much rarer—28.7% (110 chemotherapy cycles) (p < 0.001). This means that previous exposure to radiation therapy is a risk factor for developing clinically significant CIT.In the analysis, the study revealed statistically significant correlation between the incidence and severity of thrombocytopenia and previous exposure to radiation therapy ( cycles) . In the p = 0.193) between the number of previously received chemotherapy courses and the incidence and severity of resulted thrombocytopenia.Regarding previous exposure to chemotherapy, no statistically significant correlation was noted  courses presented with bleeding. The vast majority of bleeding episodes were documented during the treatment of haematologic malignancies: during 83% of chemotherapy courses for AML patients bleed (five out of six cycles) and 17.5% for ALL (14/80). In solid tumours group, the majority of bleeding episodes were during osteosarcoma treatment .67% of haemorrhages were WHO grade 1, 23% grade 2, 7% were grade 3 and 3% grade 4. The average duration of bleeding was 5.6 days. In the entire cohort, there was only one episode of intracranial bleeding; the outcome was lethal and the patient was an 18 years old female with AML .9/L; seven episodes when the platelets were in the range of 11–20 × 109/L; three cases in the range of 21–30 × 109/L and three cases in the range of 31–50 × 109/L; five cases in the range of 51–75 × 109/L and one case when the platelet number was >100 – 109/L. Clinically significant bleeding was documented in two cases when the platelet count was <10 × 109/L and in one case when the platelet count was in the range of 11–20 × 109/L. With higher platelet numbers, no clinically significant bleeding was noted.During the study, ten cases of bleeding were recorded when the absolute number of platelets was <10 × 10In the entire study cohort, platelet transfusions were performed only during 30 (7%) chemotherapy courses. In average, four small packages of platelets (1–10) were used per person. No post-transfusion complications were recorded with platelet transfusions.Thrombocytopenia is an important and frequent complication of chemotherapy , and many questions still remain open about its management. The aim of our study was to estimate the frequency and features of CIT and associated clinically significant bleeding in children and young adults. As it was shown, at admission of patients with haematologic malignancies (mostly AML and ALL), only 13% had clinically significant thrombocytopenia; in solid tumour patients, none presented with thrombocytopenia on admission.From the clinical point of view, the importance of thrombocytopenia is in associated bleeding. It was previously reported that bleeding occurs more often in haematologic malignancies than in solid tumours, which is explained not only by direct exposure to chemotherapy but also by associated haematopoietic system damage caused by haematologic malignancies –13. In oThe study showed that the frequency of thrombocytopenia and bleeding were in the youngest groups, and with ageing, the incidence was decreasing.An important finding of the study was that in addition to the relationship between patient’s age and severity of thrombocytopenia, previous exposure to radiation therapy was a risk factor for clinically significant thrombocytopenia.Although it is noted that there is no absolutely safe amount of platelets to prevent bleeding , 5, our Our study showed that clinically significant thrombocytopenia and bleeding are quite rare among children and young adults. Younger age and previous exposure to radiation therapy are positively correlated with the severity of thrombocytopenia. Further larger and prospective studies are needed to examine our findings, as well as the approaches for prevention and treatment of CIT.This research work has been completely self-financed by the authors.The authors declare that they have no conflicts of interest.


The role of obesity has been widely studied as a determinant factor of increasing mortality in surgical patients. In this study we aimed to investigate the association of mortality determinants with obesity classification and BMI score in burn patients admitted to a tertiary referral center in Southern Iran. In this retrospective cross-sectional study, medical profiles of burn patients admitted from 2016 to 2017 were obtained from Amiralmomenin Burn Hospital, a tertiary referral burn center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Demographic, and clinical characteristics as well as patient outcomes were recorded to determine prognostic factors in fatal burns based on anthropometric measurements. 2 and hospital stay was 22.28±13.62 days. Overall mortality rate was 24.7% with 25 expired cases. Logistic regression demonstrated significant association of older age, male gender, and greater TBSA with mortality. However, difference in mortality rate in patients with BMI of 25 kg/m2 (27.4%) in comparison to patients with BMI<25 kg/m2 (18%) did not reach statistical significance.Among 101 patients who were enrolled in this study including 73 males and 28 females, mean age was 34.85±12.04 years, total burn surface area (TBSA) was 37.37 (10.50%), BMI was 25.46±5.33 kg/mAlthough patients with higher BMI had increased mortality rate following burn injury, this finding showed no significant association. Further studies with larger samples may be necessary to conclude a causal association between BMI and mortality in burn patients. Obesity was shown to be a determinant factor in increase of all-cause mortalities.7Burn injuries impose a great burden in developing countries.8 is considered as a major risk factor for the rising trend toward chronic diseases in Iran.9 The role of obesity has been studied in numerous medical conditions. Burn patients are also subject to multiple organ damages besides skin injury and may require intensive care. Obese patients undergoing surgical procedures are at greater risk of morbidity and mortality during post-operative period.10 Although a previous study revealed that obesity had negative impact on the outcome of burn patients, using BMI to determine the mortality as an outcome measure too.11The global epidemic of obesity enrolled our population due to alterations in eating habits and life-styles2) is a widely used tool for identification and classification of obesity. According to the World Health Organization (WHO) guideline, an adult individual with a BMI above 30 kg/m2 is considered obese.12 With the growing concern regarding obesity and the large scale of burn injuries in our country, we designed the present study in a retrospective approach to obtain an insight into management challenges of patients with high BMI and identify the determinants of mortality  in this group of patients.Several anthropometric measurements are available for quantification of obesity. Body mass index  and Medical Ethics Committee of Shiraz University of Medical Sciences. After reviewing medical records of eligible burn patients, all data were recorded in data gathering forms. Demographic , anthropometric, and clinical variables including duration of hospital stay, percentage of burn size (TBSA), and outcome  were collected for each patient. TBSA as an indicator of the percentage of burn injured area was determined based on the Lund and Browder chart. BMI cut points were used to divide patients into four subgroups based on the WHO classification of obesity and were depicted in 2)], 43.1 (42.5%) were normal-weight [BMI=18.5-24.9 (kg/m2)], 34.1 (33.6%) were overweight [BMI=25-29.9 (kg/m2)], and 17.1 (16.8%) cases were obese including 10 patients in obese class I category (moderate obesity) [BMI=30.00–34.99 (kg/m2)] and 5 patients in obese class II category (severe obesity) [BMI=35.00-39.99 (kg/m2)]. Patients were predominantly male  and ages ranged from 17 to 60 years with mean and standard deviation (SD) of 34.85±12.04 years. Average burn TBSA was 37.37 and 10.50 (20-60.50), respectively. Minimum duration of hospital stay was 1 day and reached to a maximum of 59 days (22.28±13.62). Fifty-six cases (55.4%) underwent surgery for skin grafting. Considering final outcomes, 76 cases (75.2%) were discharged and the overall mortality rate was 25 (24.7%). Of the total 101 patients in our study, 7.1 (6.9%) were underweight [BMI<18.5 (kg/m2)]. The mean and SD of BMI for the whole group was 25.46±5.33 kg/m2. Only 2 patients were categorized in obese class III (morbid obesity) [BMI=40.00 (kg/m2) in comparison to the female patients (24.9±4.7 kg/m2); however, this difference was not statistically significant. Comparison between patients with BMI less than 25 kg/m2  and those with BMI greater or equal to 25 kg/m2  showed that observed mortality was not significantly higher when patients had BMI greater or equal to 25 kg/m2 (p>0.05). As shown in 2 and 38.72 (21-60) in cases with BMI greater or equal to 25 kg/m2. Nevertheless, this increase in TBSA was not found to be statistically significant (p>0.05). Furthermore, difference in average hospital stay between these 2 groups failed to reach statistical significance (p>0.05). Considering other mortality risk factors, the mean and SD of TBSA was 35.29 (20-60.50) in cases with BMI less than 25 kg/m13 Since the formation of the original concept of BMI, which is now a universally accepted measure to define and classify obesity, it has always been closely associated with statistics of differential mortality rates implying a distinct increase in risks of disability and mortality at levels above its normal cut point.14,15Survival and mortality following burns are influenced by several factors, among them TBSA of burn and patient’s age are the most prominent predictors of outcome.16,17 Our study supports other studies indicating that obesity may affect burn outcome as death rate of patients with BMI=25 (kg/m2) to be higher in comparison to patients with BMI<25 kg/m2, but the difference was not significant. The first study on this context was conducted in 1990 at Parkland Memorial Burn Hospital categorizing patients based on ideal body weight or total weight and not using BMI, highlighted an increased risk of mortality in obese burn patients, especially when patients’ weight was above 120 kg.18In spite of continuous improvement observed in survival of severely burned patients over the last six decades, reports on outcome analytics of patients with different forms of obesity have been scarce. Moreover, obesity was introduced as a contributing factor in morbidity and mortality of burn patients, almost three decades ago and most of the earlier studies on burn and obesity have not classified results based on BMI cut points to determine the shift in risk of mortality.2) showed a higher mortality than expected mortality (57%) and an increased incidence of pulmonary embolism.19 In 2008, a study from the Burns Centre at Washington Hospital by Carpenter et al. assessed a database of 101,450 cases in the national burn database and reported that obese patients were 4.1 times more likely to stay at hospital for more than a week and 2.6 times more likely to die compared with patients who were not described as obese.20In 1992, an investigation by the United States Army Institute of Surgical Research on 7 morbidly obese patients with a mean BMI of 50.8  multiple co-existing and related health disorders that increased the risk of developing all known organ and functional systems diseases, and (ii) higher complications of surgery.25In addition, evaluating the relationship between obesity and functional outcomes in a group of 221 burn patients, Farrell 8,26 Despite the limitations of this study by relatively small sample size and its retrospective method, it provides further insight into the global obesity epidemic in general and its impact on the cohort of patients sustaining large burns. This observation is not only important to minimize the mortality and complications of burns by using optimized burn care given by a specialist team for obese patients, but also to draw attention of strategic public health authorities involved in planning the prevention, management, rehabilitation, and prognosis of burns in this emerging subpopulation of patients.Considering the increasing rate of obesity in Iranian adult population, recently estimated about 21.7%, these patients need to be referred to a burn unit adequately prepared with the equipment and expertise to manage obese patients as they are presented with major problems for the burn team, especially in the areas of wound and general nursing care.


Pulmonary dysfunctions are frequently encountered after tuberculosis treatment in clinical practice. In the present study, the role of interleukin-10 and 13 in a tuberculosis-associated pulmonary dysfunction was investigated.This is a semi-experimental study on 40 patients selected from referral tuberculosis care center in Birjand, Iran, during 2015-2017. The cases with major medical disorders including those with underlying lung disease were excluded from the study. Informed consent was prepared from each patient, and then blood sample was obtained, serum was extracted and refrigerated at -70 C° at the start (time 1), 2 months (time 2) and 6 months (time 3) after onset of treatment for tuberculosis. Spirometry was also performed at time 2. Finally, 24 patients completed the study.Of the 24 patients with the mean age of 60.87±21.50 years in the study, 9 (37%) were males and 15 (62.5%) were females. Abnormal spirometry was observed in 20 (83.3%) subjects at time 2, of whom 12 (60%) were restrictive and 8 (40%) obstructive. The mean changes of interleukin 10 from the start to end of the treatment were 89.00±89.47 (P=1.00), -29.36±40.21 (P=0.02) and 3.70±29.98 (P=0.1) in patients with normal, obstructive and restrictive spirometery, respectively . While in interleukin 10, changes for interleukin-13 were 77.90±145.97, 6.35±133.10 and -13.35±46.66 (P=0.4), respectively.Upregulation of IL-10 during tuberculosis treatment might be considered as a protective factor against lung dysfunction. In patients with obstructive form, there was a marked decrease in interleukin-10. Posttuberculosis pulmonary dysfunction presented as restrictive or obstructive spirometry patterns are frequently reported -4. TwentInterleukin 10 level in the bronchoalveolar lavage (BAL) of patients with idiopathic pulmonary fibrosis (fibrotic with little inflammation) is higher than the patients with other ILD diseases with abundant inflammation . ConversThis is an experimental study on 40 new adult cases (over 12 years old) of pulmonary tuberculosis selected from referral tuberculosis care center in Birjand, Iran, during 2015-2017, regardless of whether TB is primary or secondary. Informed consent to attendance in the study was obtained from all patients. Patients with any underlying disease other than pulmonary tuberculosis and also smokers were excluded from the study. The diagnostic criteria were initially based on clinical and radiologic evidence compatible with pulmonary tuberculosis in the presence of one of the following conditions. Definitive diagnosis was confirmed by culture of sputum or BAL for mycobacterium tuberculosis (MTB) in all cases. Two samples of sputum smear positive for MTBOne sample of sputum smear and one sputum culture positive for MTBOne sample of BAL smear and one BAL culture positive for MTBOne sample of BAL or sputum smear/culture positive for MTB in patients with radiological and clinical findings strongly suggestive of pulmonary tuberculosis Blood sample (5ml) was obtained, serum extracted and refrigerated at -70 C° from eligible patients at times of start (time 1), 2 months (time 2) and 6 months(time 3) after onset of treatment for pulmonary tuberculosis. All patients were treated free of charge based on WHO  protocols for tuberculosis treatment by the referral tuberculosis care center in Birjand, Iran. Every two months, examinations for all patients were done by the pulmonologist during the course of tuberculosis treatment. Treatment response was confirmed at the end of treatment by clinical findings and study of chest radiography, smear and culture of sputum or BAL samples. IL-10 and IL-13 measurements were performed by ELISA method using the INTEGRA 400 device and the Roche Diagnostics Kit, Germany and reported quantitatively. Inter and intra assay coefficient of variation respectively for both interleukin 10 and 13 was <12% and <10%. Spirometry was performed at time 2. Data are recorded and analyzed using SPSS software (Version 23). Shapiro-Wilk test was used to evaluate the normality of the data. Mann-Whitney and Kruskal-Wallis tests were used to compare means in 2 and 3 independent groups with non-normal distribution. We used Friedman test to compare the mean of repeated measures with non-normal distribution. The approval number of the study was IR.BUMS.REC.1395.70 recorded in the Ethics Committee of Birjand University of Medical Sciences, Birjand, Iran. From 40 recruited patients, 24 cases with the mean age of 60.87±21.50 years completed the study. Out of 24 cases, 9 (37.5%) were men and 15(62.5%) were women. Patterns of spirometry were normal, restrictive and obstructive in 4(16.7%), 12(50%) and 8(33.3%) cases, respectively. The mean reduction of IL-10 during treatment in TB patients with obstructive spirometry was -29.36±40.21 (P=0.02). On the contrary, IL-10 was set up in patients with normal spirometry  . Mean chThe prevalence of abnormal spirometry was 83.3% in our study 2 months after starting pulmonary tuberculosis treatment. Meanwhile, the prevalence of post tuberculosis abnormal spirometry reported 74% in Tanzania and 59% in America , 20. TakSerum levels of IL-10 showed significant upregulation in patients with normal and downregulation with obstructive spirometry alongside tuberculosis treatment in our study. IL-10 is known as an anti-inflamatory cytokine and its production in patients with pulmonary infection leads to less inflammation-related lung damages . Since tChanges in IL-13 were not significant during tuberculosis treatment in patients with normal, restrictive or obstructive spirometry in our study. There is not much information about the role of interleukin 13 in patients with tuberculosis and also post tuberculosis complications. It was claimed in a study that expression of IL-13 was upregulated in Indian children with latent TB compared with that in controls . DespiteConclusion: Respiratory dysfunction as a post pulmonary tuberculosis complication is common. IL-10 and IL-13 are two cytokines that undergo changes in the course of tuberculosis and can be raised in pathogenesis of lung dysfunction. It seems that the low levels of interleukin 10 play an essential role in the emergence of tuberculosis related obstructive and also restrictive pulmonary dysfunction.


It has been suggested that apart from tumour and nodal status, a range of patient-related and histopathological factors including lymph node yield and tumour location seems to have prognostic implications in stage I–III colon cancer. We analysed the prognostic implication of lymph node yield and tumour subsite in stage I–III colon cancer.Data on patients with stage I to III adenocarcinoma of the colon and treated by curative resection in the period from 2003 to 2011 were extracted from the Danish Colorectal Cancer Group database, merged with information from the Danish National Patient Register and analysed.p < 0.0001) and from 36.4% (95% CI 29.8–43.0%) (lymph node yield 0–5) to 59.4% (95% CI 56.6–62.2%) (lymph node yield ≥ 18) for patients with stage III disease (p < 0.0001). The 5-year overall survival for tumour side left/right was 59.3% (95% CI 57.9–60.7%)/64.8% (CI 63.4–66.2%) (p < 0.0001). In the seven colonic tumour subsites, the 5-year overall survival ranged from 56.6% (95% CI 51.8–61.4%) at splenic flexure to 65.8% (95% CI 64.5–67.2%) in the sigmoid colon (p < 0.0001). In a cox regression analysis, lymph node yield and tumour side right/left were found to be prognostic factors. Tumours at the hepatic and splenic flexures had an adverse prognostic outcome.A total of 13,766 patients were included in the analysis. The 5-year overall survival ranged from 59.3% (95% CI 55.7–62.9%) (lymph node yield 0–5) to 74.0% (95% CI 71.8–76.2%) (lymph node yield ≥ 18) for patients with stage I–II disease (For stage I–III colon cancer, a lymph node yield beyond the recommended 12 lymph nodes was associated with improved survival. Both subsite in the right colon, as well as subsite in the left colon, turned out with adverse prognostic outcome questioning a simple classification into right-sided and left-sided colon cancer. The TNM Classification of Malignant Tumours (TNM) proposed by the American Joint Committee on Cancer  is the mThe aim of this nationwide study was, based on prospectively collected data from a national cohort of patients with stage I–III radically resected colon cancer, to examine the prognostic implications of patient and tumour-related factors including lymph node yield and tumour subsite and in colon cancer.This nationwide cohort study is a result of data derived from three Danish registers: the Danish Colorectal Cancer Group (DCCG), the Danish Pathology Registry and the Danish National Patient Registry.Patients with a first-time diagnosis of colonic stage I–III adenocarcinoma subjected to curative resection between May 2001 and December 2011 were identified in the DCCG database, described in details elsewhere by this group . BrieflyThe cohort extracted from the DCCG database was merged with data from the Danish National Patient Register, using the unique personal identification number given to all Danish citizens. Confounders possibly associated with survival were extracted from the DCCG database for use in the present study Table . The Dukp value of < 0.05 was defined as the level of significance in all of the analyses.Data were statistically analysed using the IBM SPSS version 22 . The patient characteristics and tumour-related data were described by non-parametric statistics. Overall survival was analysed according to sex, age, acute vs elective surgery, open vs laparoscopic surgery, American Society of Anaesthesiologists (ASA) score, Charlson comorbidity index, blood transfusion, postoperative anastomotic leakage, year of diagnosis, pT category and in four groups defined by the lymph node yield and by the tumour localisation. The localisation of the colon cancer was treated both according to the categorisation into right-sided colon cancer  and left-sided colon cancer  and to the specific subsites of the colon. Moreover, overall survival was analysed for the lymph node yield groups after stratifying for lymph node-positive disease (stage III) versus lymph node-negative disease (stage I to II). Kaplan-Meier plots and log-rank tests were used for survival analysis. The association between sex, age, acute vs elective surgery, open vs laparoscopic surgery, ASA score, Charlson comorbidity index, blood transfusion, postoperative anastomotic leakage, year of diagnosis, T stage and the four groups defined by the lymph node yield and by the tumour localisation was explored using multiple logistic regressions with overall survival as outcome measure and reported as hazard ratios (HR) with 95% confidence intervals (95% CI). Thus, lymph node yield and pT stage at each level of the variable were compared with the preceding one. Since this group has previously described that year of diagnosis was related to the lymph node yield for both colon , most liA number of 13,766 patients  with an R0 resection of UICC stage I–III first-time diagnosis of colonic cancer were available for our analysis. The median age was 70 years (interquartile range (IQR) 62–78), and the median lymph node yield was 15 (IQR 11–22). A number of 5159 (37.5%) patients had lymph node-positive disease (Table p < 0.0001)  . In patients with lymph node-negative (stage I–II) disease, the 5-year overall survival according to the lymph node yield was 59.3% (95% CI 55.7–62.9%) (lymph node yield 0–5), 64.2% (95% CI 61.8–66.6%) (lymph node yield 6–11), 68.2% (95% CI 66.2–70.2%) (lymph node yield 12–17) and 74.0% (95% CI 71.8–76.2%) (lymph node yield ≥ 18), (.2–63.2%.p < 0.0001).The 5-year overall survival in right-sided colon cancer and left-sided colon cancer was 59.3% (95% CI 57.9–60.7%) and 64.8% (95% CI 63.4–66.2%), respectively, (p < 0.0001).The 5-year overall survival for patients with cancer in the sigmoid colon was 65.8% (95% CI 64.5–67.2%), descending colon 63.3% (95% CI 58.5–68.1%), splenic flexure 56.6% (95% CI 51.8–61.4%), transverse colon 57.7% (95% CI 54.3–61.1%), hepatic flexure 57.4% (95% CI 53.8–61.2%), ascending colon 62.4% (95% CI 59.8–65.0%) and caecum 58.6% (95% CI 56.4–60.8%),  has been the standard treatment for stage III colon cancer patients, and since 2009, adjuvant chemotherapy  has been offered for selected stage II high-risk patients in Denmark .Finally, no genetic or biological data were available in our dataset leaving us without the possibility to further qualify the observed differences between the tumour subsites.Our results demonstrate that the total number of lymph nodes harvested is related to survival in stage I–II and III colon cancer. Stage migration might be a part of the explanation for the prognostic implications of a high lymph node yield, but this is only a part of the explanation since we have demonstrated that a lymph node yield beyond the recommended 12 lymph nodes was associated with improved survival in stage I–II and stage III disease. “Good surgery” with correct mesocolic dissection and true central ligations as well as the immunology of the tumour and host could also be a part of the explanation.Even though we found a significant difference in survival in right- vs left-sided colon cancer, our results support that a classification of colon cancer into right-sided and left-sided disease does not represent the entire complexity of this tumour since both subsites in the right colon, as well as subsites in the left colon, turned out with adverse prognostic outcome. Further research should consider whether tumour subsite should be taken into account when the strategies for diagnosis and treatment of colon cancer are decided.


The incidence of Ulcerative colitis (UC) in Asia is increasing but reports on its long-term course are few. The aim of this study was to identify risk factors predictive of extent progression in Asian patients with UC and to evaluate the clinical outcome by longitudinal follow-up.We retrospectively analyzed 518 UC patients without ascending colon involvement at diagnosis who were regularly followed and underwent colonoscopy between 2003 and 2016 in an Asian tertiary referral center. Proximal disease extension and associated risk factors were analyzed.p = 0.01). Proximal disease extension was associated with disease relapse (p = 0.03) and increased use of steroids and immunosuppressive agents (p <  0.01).A total of 91 (17.6%) patients experienced proximal disease extension followed for a median period of 7.5 years. The median time for extent extension was 16.1 months (interquartile range (IQR) 8.3–42.2). The cumulative rate of disease extension was 9.9, 14.9, 19.6, 24.6 and 30.5% at 1,2,3,4 and 5 years after diagnosis. 43 (12.0%) patients with E1/E2 progressed to E3, and 40 (21.9%) with E1 progressed to E2. Of patients diagnosed with E3 involvement limited to the hepatic flexure distally, 8 (13.3%) progressed to pancolitis. Cox regression analysis found that disease extent at diagnosis was the sole predictor of disease extension (odds ratio (OR),1.74, 95% confidence interval (CI) 1.18–2.57, UC is a dynamic disease and that the disease extension in Asians was comparable to that in Caucasians. Proximal disease extension increased the risk of disease flare and treatment intensification. Ulcerative colitis (UC) is a dynamic disease that can progress to involve increasing segments of the colon over time . In popuStudies on the changes in the disease course over time of Asian patients with UC are still lacking giving the rising incidence of UC in Asia . AccordiThe aim of this study was to evaluate the dynamic disease evolution of a large cohort of UC patients from an Asian tertiary center. We also assessed risk factors and long-term outcomes of patients with disease extension.This was a retrospective cohort study of patients with an established diagnosis of UC in the Gastroenterology Department of the First Affiliated Hospital, Sun Yat-sen University (China). We retrieved detailed demographic and clinical information from an Inflammatory Bowel Disease (IBD) registry, which has been prospectively maintained since 2003. The information obtained from the registry included gender, age, date of symptom onset, date of diagnosis, smoking status, disease activity, disease extent at diagnosis and during the course, medication use, and date of colectomy during follow-up. Initial disease activity in the cohort was evaluated using Truelove and Witts’ criteria . The diaThe extent of disease in UC was defined according to the Montreal classification as E1: proctitis , E2: left-sided (to the splenic flexure) or E3: extensive disease (beyond the splenic flexure). Proctitis was defined as disease < 15 cm from the anal verge. Disease extension was defined as a proximal progression endoscopically from the initial extent at diagnosis. Specifically, disease extension was defined limited UC [E1 or E2] at diagnosis with progression to E2 or extensive colitis [E3]. For patients diagnosed with E3 involvement limited to the hepatic flexure distally, disease extension was defined as progression to pancolitis . In cases without investigative colonoscopy procedures before surgery owing to acute complications, disease extent evaluation was based on macroscopic description of the surgical specimen . DiagnosThe treatment regimen in UC during the follow-up period was based on a step-up approach . BrieflyOur patients are followed up every 1–3 months at the outpatient clinic at regular intervals according to their conditions. Of note, the second and subsequent endoscopic assessments were usually planned within 6–12 months intervals by the treating physician to assess the response to therapy. All endoscopic procedures were performed by skilled endoscopists (BLC and YH). Endoscopic severity was evaluated with the Mayo Endoscopic Score .This study protocol (IRB number: 2015–47) was approved by the Clinical Research Ethics Committee of The First Affiliated Hospital of Sun Yat-sen University. There was a waiver of consent in the present retrospective study as this project meets the criteria according to Health & Human Services regulations (45 CFR 46).2 test and the Fisher’s exact test. Univariable Cox regression was used to identify candidate predictors for inclusion in the multivariable model. A criterion of p ≤ 0.10 was used to identify candidate predictors which were further fitted by a forward selection procedure to eliminate non-significant variables. The odds ratios [OR] derived from the Cox’s models are presented with 95% confidence intervals [CIs]. Survival analysis was performed using Kaplan-Meier analysis based on log-rank test. Statistical significance was set at p <  0.05.The statistical analyses were performed with SPSS (version 19) statistical software . The data are given as numbers and percentages or medians and interquartile range (IQR). Comparisons between means were performed using the t- test for independent samples. Categorical variables were compared using the χA total of 632 patients fulfilled the diagnostic criteria for UC and were included in the study. The median follow-up time was 7.5 years (IQR 5.6–8.1 years). Baseline characteristics are shown in Table Of the 632 patients with UC, 458 (72.5%) patients had limited UC E1 or E2), whereas 174 patients were diagnosed with E3 at the time of diagnosis, including 114 patients with involvement proximal to hepatic flexure (pancolitis), and 60 patients with involvement limited to the hepatic flexure distally. One hundred and seventeen (18.5%) patients had skipped periappendiceal lesions. Therefore, we identified risk factors for disease extension and subsequent outcome in 518 cases, after excluding the 114 patients with pancolitis  had disease extension during the follow-up. The median time for any progression of disease extent was 16.1 months (IQR: 8.3–42.2 months). The cumulative rate of disease extension was 9.9, 14.9, 19.6, 24.6 and 30.5% at 1,2,3,4 and 5 years after diagnosis  and E3(p = 0.04)  1.18–2.57, p = 0.01).The cumulative rates of disease progression were 13.1, 44.9 and 59.4% at 1, 5 and 10 years after diagnosis in patients with steroid-dependence, which was significantly higher than patients without steroid-dependence  Fig. . A Cox rp < 0.01,Table p = 0.023, Fig. p = 0.08).In terms of steroid utilization, 47  patients with disease extension had used steroid, compared to 120  patients without disease extension . The cumulative rates of immunosuppressive agents use in patients with disease extension during the first 5 years after diagnosis were 9.6, 20.9, 27.0, 31.0, and 41.9%, compared to that of 6.3, 10.0, 16.0, 17.9 20.4% in patients without disease extension, respectively. As shown in Fig. p < 0.01).Similarly, 36(39.6%) of the 91 extenders initiated immunosuppressive agents compared to 48 patients  without disease extension  extenders underwent colonic resection, compared to 5  in 427 non-extenders. There was no significant difference in the cumulative rate of colectomy between the two groups  of 91 extenders were hospitalized due to severely active UC compared to 26  in non-extenders without significant difference . Altogether, risk factors have been largely inconsistent across studies and better predictors of disease progression are needed.In the present study, we found that only initial disease location had an impact on the risk of extension. Patients with initial E1/2 were at greater risk of extending to pancolitis. Several studies have demonstrated that patients with proctitis are at greater risk to extend to pancolitis . In a reWe also found that UC disease extension was associated with increased therapeutic requirements. Prior studies have examined the relationship between disease extension and subsequent outcomes , 10, 22.In the current study, we failed to demonstrate a direct causal relationship between disease extension and increasing colectomy rates probably due to the relative low rate of colectomy (1.4%). Although our study was conducted in a referral center, the colectomy rate appears to be comparable with that of previous Eastern population-based studies , 24. PreThere were several limitations to our current study. First, our findings should be interpreted carefully due to the retrospective and referral center–based design of our investigation. Further long-term population-based study are required in order to reduce the selection bias. Second, due to the relative low rate of colectomy, we failed to find a relationship between disease extension and increased chance of colectomy. Last but not least, it is unknown whether any treatments or interventions decrease the risk of disease extension. According to our study, none of the medical treatment during follow-up associated with reduced disease extension, future research should investigate treatments or interventions that could prevent disease progression from E1/E2 to E3.UC is a dynamic disease and the proximal disease extension in the Chinese population was comparable to that in Caucasians. Proximal disease extension was associated with a more severe disease course with increased risk of treatment requirement. As the sole independent risk factor, our findings highlight the need of preventing progression in patients with limited UC.


To date, studies on inflammatory breast cancer (IBC) lack comprehensive epidemiological data. We analyzed detailed prospectively collected clinical and epidemiological data from the IBC Registry at The University of Texas MD Anderson Cancer Center.Patients with IBC (n = 248) were consecutively diagnosed and prospectively enrolled between November 2006 and April 2013. All patients were newly diagnosed and at least 18 years old. Secondary IBC was excluded. Overall 160 variables were collected and evaluated including sociodemographics, anthropometrics, tobacco and alcohol consumption, reproductive variables, and family history data.2, irrespective of menopausal status, was observed in 80.2% of all patients, with 82.6% of African Americans being obese. Approximately 42.2% of patients were ever smokers, and 91% reported ever being pregnant. A history of breastfeeding was reported in 54% of patients, with significant differences between ethnic groups in favor of White women (P<0.0001). Other reproductive factors such as use of birth control pills & hormone replacement therapy were also more frequently associated with White women compare to other ethnic groups (P < 0.05). In the multivariate Cox proportional hazard analysis, African American or Hispanic ethnicity, not having breastfed, higher clinical stage, and TNBC subtype were associated with shorter survival.Mean age at diagnosis was 51.6 (±11.5 SD) years, and the majority of patients were White (77.8%). A mean BMI ≥ 25 kg/mOur data suggest that IBC is associated with distinct epidemiological profiles. This information could assist in targeting patients with specific preventive strategies based on their modifiable behavioral patterns. Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer that accounts for 1–3% of breast cancers diagnosed annually in the United States . The disHere we describe the findings of the IBC registry with regard to the epidemiological characteristics associated with diagnosis of IBC as well as their relationship to well known IBC risk factors: specifically, age, ethnicity, and BMI. Identifying risk modifiers could allow the classification of patients with IBC into subgroups with distinct epidemiological and/or behavioral patterns, leading to the development of better preventive strategies.th edition of the AJCC Cancer Staging Manual and the recommendations of the international expert panel on IBC  were reviewed by a breast pathologist. A clinical diagnosis of IBC was defined according to the criteria outlined in the 7l on IBC ,12. ThesPatients had to be at least 18 years old female and presenting with a new diagnosis of IBC. Both newly diagnosed patients who received multidisciplinary therapy at MD Anderson (Cohort 1) and newly diagnosed patients who received part of their treatment in the form of pre-surgical systemic therapy prior to coming to MD Anderson (Cohort 2) were enrolled into the study. Secondary IBC, defined as IBC that occurred after a history of non-IBC or IBC described as “secondary IBC” in the electronic medical record, was excluded. Patients with recurrent IBC or locally advanced breast cancer not meeting the criteria of diagnosis for IBC were also excluded from the analysis.After obtaining a written informed consent, patients completed an epidemiological risk factor questionnaire with detailed sociodemographic characteristics, reproductive history, and family history. Data for analysis were obtained from the questionnaire, MD Anderson’s Patient History Database, and medical records. The variables of interest included age, ethnicity, marital status, tobacco and alcohol use, reproductive history, breast health , oral contraceptive and hormone replacement therapy (HRT) use, family history, and body mass index (BMI). Hormone receptor status was determined using immunohistochemistry (IHC) , 14. HEROutcome measures evaluated for this analysis were pathological complete response (pCR) and overall survival. pCR was defined as absence of invasive residual carcinoma  after completion of neoadjuvant treatment. Overall survival was defined as the period from date of diagnosis to the date of death or to last follow-up (records were assessed on 06/2015). The study was approved by the Institutional Review Board at The University of Texas MD Anderson Cancer Center.P-value of less than 0.05 was considered significant.Statistical analyses were conducted using SAS for Windows (version 9.4). Standard descriptive statistics and frequency tabulation by using SAS’s PROC MEANS and PROC FREQ functions were used to summarize patient characteristics. All variables that were significant in univariate analysis and variables of interest were entered into a multivariate model. A Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals. A Two-hundred sixty-five patients were identified through the IBC registry. Seventeen patients were excluded due to: a diagnosis of secondary IBC (n = 8), recurrent IBC (n = 3), locally advanced breast cancer (n = 1), drop-off the study or refusal to participate in the study (n = 5). A total of 248 patients were included in the final analysis. Cohort 1 patients comprised 73.4% (n = 182) of the study population, while cohort 2 patients comprised the remaining 26.6% (n = 66).Demographic and clinical characteristics for all study participants are presented in 2, with only 19.7% of patients having a BMI ≤ 24.9 kg/m2, while 49.5% were obese (BMI > 30 kg/m2). Approximately 56.5% of obese patients were categorized as class I (BMI 30–34.9 kg/m2), 26.2% were class II (BMI 35–39.9 kg/m2), and 17.2% class III (BMI > 40 kg/m2). Cohort 1 patients were older than cohort 2 patients , had a higher mean BMI with an over-representation of the obese category, and were diagnosed at a later stage of disease.Overall mean BMI was 30.9 kg/mThe majority of patients (57.8%) were never-smokers. Among the ever-smokers, the average number of years smoked was 20 years, with an average of 16.3 cigarettes/day. The mean age of smoking initiation was 19.7 years (range 8–47 years), and the mean age at cessation for those who quit was 37.2 years (range 10–72 years).P = 0.388) and overall BMI (P = 0.759). However, the highest mean BMI was among African Americans , followed by Whites and Hispanics . Approximately 83% of African Americans were obese (BMI ≥ 30 kg/m2) compared with 48.2% and 38.5% of Whites and Hispanics, respectively (P = 0.0059). Among the obese African Americans, 37% were morbidly obese (BMI ≥ 40 kg/m2), compared to 14% and 10% of obese Whites and Hispanics, respectively.Upon comparing the demographic and clinical characteristics of the study participants by ethnicity , we obseP = 0.0047). However, smoking intensity (cigarettes/day) was significantly higher among African Americans than among Whites (P = 0.04). Regular childhood exposure to secondhand smoke was reported in 51.5% of the patients and was significantly different among ethnic groups (P = 0.004), with the lowest exposure among Hispanics. Alcohol consumption was reported among 79% of the population, with the highest frequency among Whites (82%) and the lowest among Hispanics .A significantly higher frequency of ever-smokers was observed among White patients (47.9%) as compared to African Americans or Hispanics . HR status and HER2 status were significantly different among ethnic groups (P = 0.0110). HR+ (ER+/PR+)/HER2- was observed in 35.9% of patients, followed by TNBC (HR-/HER2-) (24.5%), HR-/HER2+ (21.8%), and HR+/HER2+ (16.9%). African Americans had the highest frequency of triple-negative disease (43.5%), followed by Hispanics (34.6%) and Whites (22.3%). White patients had the highest frequency of HR+/HER2+ at 18.1%, and Hispanic patients had the highest frequency of HER2+ (50%).While Whites and Hispanic patients were almost equally represented in stage III disease , African Americans were under-represented in stage III disease (52%) and over-represented in stage IV disease ; edema ; and presence of a lump . Among White and Hispanic patients, the main breast change was redness, while growth/fullness were the main changes in African Americans.Self-discovery through breast exam was reported in 84% of patients. The majority of patients (79%) reported having annual mammograms. Redness was reported by 62.1% of patients, edema/fullness, 48%; skin dimpling/discoloration, 46%; a lump, 26%; and nipple inversion, 16%. Factors significantly associated with redness were age at diagnosis . Thirty-six percent of patients with a lump were diagnosed with stage IIIC disease, as compared to 18.5% and 24.4% with stage IIIB and stage IV, respectively (P = 0.049). The majority of patients presenting with a lump had the TNBC subtype .A breast lump was reported in only 26% of cases, mainly among 39%, 42%, and 22% of African American, Hispanics, and Whites, respectively . The longest delay was among Whites (average 49.9 days), followed by African Americans (37.1 days) and Hispanics (33.8 days). The top reason for the delay was believing the symptoms were not important (47% of patients). Other reasons [in 53% of patients] were: fear, breastfeeding, no time to visit a clinic or lack of insurance. A physician diagnosis of breast cancer was made in 38% of patients, while an initial diagnosis of IBC was made in only 4% and further testing was recommended for 20% of the cases. Patients reported being initially treated with antibiotics in 38% of cases, while 24% reported being misdiagnosed as having breastfeeding-related changes, an allergic reaction, insect bites or cysts.P = 0.005 and P = 0.023).The mean age at menarche was 12.6 years . One hundred and sixty nine patients were postmenopausal, with 44% reporting natural menopause, 34% reporting artificial menopause due to hysterectomy and 20% due to chemotherapy. Hormone Replacement Therapy [HRT] use was reported in 72% of patients . In addition, 74.4% of patients reported using birth control, median duration 7 years . History of birth control/HRT use was highest among Whites (P <0.0001).A history of ever being pregnant was reported in 91% of patients. Overall mean age at first birth of 23.4 ± 5.4 years. Among African Americans, the mean age was 19.4 ± 4.6 years and significantly different from Whites and Hispanics . The average time between pregnancies was 4.2 years (1–13 years).The mean duration between age at menarche and age at first birth was 10.7 ± 5.7 years. The longest duration was among Whites, 11.2 ± 5.5 years, compared to 10.2 ± 6.4 years for Hispanics (P = 0.043) and 6.5 ± 5.1 years for African Americans (P = 0.0003). Interestingly, the longer duration between menarche and first birth was significantly associated with younger age at diagnosis among Whites. The mean age at diagnosis for patients with a mean duration ≤ 11.2 years was 54.2 ± 10.7 years, vs. 49.9 ± 9.9 for those with a duration > 11.2 years (P = 0.009). This association was not seen in Hispanic or African American patients (P <0.0001).The overall mean number of pregnancies was 2.7  which was significantly higher for African Americans  than Whites and Hispanics .A family history of breast cancer in a first-degree relative  was reported in 13% of patients. A family history of breast and/or gynecologic malignancy was present in 21% of patients and was associated with a history of previous cancers [mainly non-melanoma skin cancer]. A history of previous cancers was exclusively seen among Whites . Stratified by tumor subtype, pCR was significantly associated with the HER2+ subtype (P = 0.0004).The pCR rate in stage III IBC patients (n = 138) was 21.7%. When stratified by ethnicity, the lowest pCR rate was associated with African American ethnicity (P = 0.2114). In multivariate Cox proportional hazard analysis, African American or Hispanic ethnicity, not having breastfed, higher clinical stage, and TNBC subtype were associated with shorter survival ; the mean overall survival was 77.6 months (standard error of the mean [SEM] = ± 3.3 months). Age at diagnosis did not significantly affect survival in the overall cohort , followed by HR+/HER2+ (59.4 ± 2.6 months), HR+/HER2- (61.1 ± 3.4 months), and HR-/HER2+ (76.1 ± 3.6 months). The overall survival time was shorter for patients with no history of breastfeeding  than for patients that breastfed . By multivariate analysis  with a mean ± SEM of 84.1 ± 4.0 months. For stage IV patients, the median was 56.7 months (CI = 39.7–NA), and the mean ± SEM was 53.9 ± 3.9 months. Results for survival by subtype are reported in mean days/years since our population breakdown did not allow for stable reporting using the medians. The overall survival time was shortest for HRanalysis , a histoTo our knowledge, this study is one of the largest analysis of a prospectively collected epidemiological dataset for IBC at a single institution. The study design allowed us to comprehensively document and assess the impact of various epidemiological factors in addition to tumor and patient characteristics. We identified epidemiological profiles that were associated with distinct behavioral patterns among ethnic groups with regard to reproductive history, breastfeeding, smoking, and obesity .P < .00001) [P = .01) [Our results suggest a significant association between pregnancy, lactation, and the risk of developing IBC, particularly among different ethnicities. Bonnier et al previously reported a high number of IBC cases in patients presenting with pregnancy-related breast cancer compared to non-pregnant patients with breast cancer  . SimilarP = .01) . MoreoveP = .01) . Women wP = .01) .Both younger age at first birth and multiparity were significantly represented in the African American patients. However, we speculate that shorter period between age at menarche and age at first birth and lack of breastfeeding among this population potentially creates a cancer-prone microenvironment in the breasts , 19. DurChang et al were among the first to report the association between a high BMI and the development of IBC, which, in contrast to the association in non-IBC, is not limited to the postmenopausal subgroup , 24. In White ethnicity was more frequently associated with a history of smoking as well as several reproductive risk factors such as postmenopausal status, breastfeeding, and oral contraceptive and HRT usage. Whites were also more likely to develop hormone-receptor-positive tumors. On the other hand, 83% of African Americans had class III obesity, and African American ethnicity was more frequently associated with triple-negative IBC.The age frequency distribution curve in our analysis confirms previously reported age-specific incidence rates, with peak diagnosis during the fifth decade. This contrasts with non-IBC, which tends to peak 10 years later and is associated with a dip known as Clemmesen's hook that has been attributed to menopause , 10. DueP = 0.007), in whom erythema was the most commonly reported breast change. This is supported by radiological findings where the use of diagnostic MRI was only able to detect a single dominant mass in 38% of cases, while the majority of masses detected were multiple, small, and confluent [From a clinical perspective, 84% of patients reported diagnosis through self-discovery, despite almost 80% having undergone screening mammography. This means of discovery can be attributed to to the frequent absence of a mass in IBC, but also due to its confusion with mastitis. Almost half the women in this study delayed seeking medical attention because they did not believe their symptoms were important. In our study, a breast lump was reported in less than a third of the patients and was least reported in Whites .The main strength of this study lies in the extensive amount of epidemiological data collected from patients upon enrollment. This allowed us to analyze over 160 epidemiological and clinical variables and identify several patient profiles that were distinct in terms of reproductive history, breastfeeding, smoking, and obesity. While by no means conclusive, this descriptive classification suggests that IBC could be linked to different modifiable risk patterns among ethnic groups. This could lead to a better understanding of the heterogeneous etiology of this disease, as well as provides a new paradigm in targeting patients with specific preventive strategies based on their modifiable behavioral patterns.S1 Table(DOCX)Click here for additional data file.


To determine the frequency of subclinical hypothyroidism in local adult obese population.2 were included in the study. Patients on lipid lowering drugs, with renal failure, hepatic failure and already diagnosed cases of thyroid dysfunction were excluded from the study. Thyroid functions were measured for all patients.The study was conducted at Hayatabad Medical Complex, Peshawar, from March, 2017 to August, 2017. All patients aged between 18 and 60 years with BMI of more than 29kg/m2. The mean serum TSH was 3.13±1.10 mIU/L and mean serum thyroxine level was 1.08±0.25ng/dl. Subclinical hypothyroidism was recorded in 15% of the study population.A total of 127 adults were included in the study in a consecutive manner. Mean age was 34.5 + 7.9 years of which 46.5% were male and 53.5% were female. Mean BMI was 32.05±2.06 kg/m2. Further studies are recommended on relationship between thyroid functions and BMI and its effect on cardiovascular functions.Subclinical hypothyroidism is highly prevalent in our population with BMI of more than 29kg/m Obesity, as defined by the BMI, is on the rise globally and in most sex-age groups is more than 30% in United States. Obesity prevalence has not altered much over past 12 years from 1999 to 2010. This trend in obesity prevalence is linear for men while it is not significant for women over this period.1The three major non-communicable diseases (NCDs) with highest mortality rate in Pakistan are cardiovascular diseases; malignancies and chronic respiratory diseases.5Growing evidence suggests association of altered thyroid function and obesity, a lasting state of low grade inflammation. Recent data has revealed leptin, an adipocyte hormone, to be a major factor linking obesity and thyroid autoimmunity.7The prevalence of subclinical hypothyroidism in Pakistani population is 5.4% compared to the prevalence of overt hypothyroidism that is 4.1% and compared to males, females are more affected.12The present study was designed to determine the frequency of subclinical hypothyroidism in local adult obese population. Doing a thorough literature search, we found that very little data exists about the thyroid hormone levels and its dysfunction among local adult obese population. This study will be an attempt to determine the frequency of subclinical hypothyroidism in local obese adult population and the results of this study will be a guideline for devising future research strategies and identifying mechanisms of preventing subclinical hypothyroidism in patients with morbid obesity.2 were included in the study. Patients on lipid lowering drugs, with renal failure, hepatic failure and already diagnosed cases of thyroid dysfunction were excluded.This descriptive cross-sectional study was conducted at Hayatabad Medical Complex, Peshawar from March 2017 to August 2017. It was a. All patients aged between 18 and 60 years with BMI of more than 29kg/mAll subjects were subjected to complete history and clinical examination to exclude effect modifiers. From all the patients, a blood sample was obtained and was sent to hospital laboratory to measure the serum TSH & Thyroxine levels . All the above-mentioned information including name, age, and sex was recorded in a pre-designed proforma and strict exclusion criteria was followed to control confounders and bias in the study results. All the investigations were done form hospital laboratory by single experienced microbiologist having minimum of five years of experience.Data was stored and analyzed in SPSS version 20. Mean and standard deviation (SD) were calculated for quantitative variables like age, serum TSH and thyroxine levels. Frequencies and percentages were calculated for categorical variables like gender and subclinical hypothyroidism. Subclinical hypothyroidism was stratified among age and gender to see the effect modifications. Chi square was used and a value less than 0.05 were considered significant.2 were observed to determine the frequency of subclinical hypothyroidism and results were analyzed.Age distribution among 127 patients was analyzed as; 44(34.6%) patients were <30 years, 45(35.6%) patients were in age range 30-40 years, 38(29.9%) patients were in age range above 40 years. Mean age of the study population was 34.5 ± 7.9 years. Out of 127 patients included in the study, there were 46.5% male and 53.5% female . Mean BMI was 32.05 ± 2.06. BMI was stratified into two classes i.e. BMI between 29.5-32.0kg/m2 and BMI between 32.1-35.5kg/m2.Total of 127 adult participants having a body mass index of more than 29kg/mAll the patients were subjected to measurement of serum TSH and thyroxine levels. The mean serum TSH was 3.13 ± 1.10 mIU/L and mean serum thyroxine level was 1.08 ± 0.25ng/dl. Subclinical hypothyroidism was recorded in 15% of study population. Subclinical hypothyroidism was stratified with regards to age groups, gender and BMI categories.Rising weight gain and obesity is rapidly becoming a grave problem globally20In our study, the mean BMI was 32.05 ± 2.06 with mean TSH was 3.13 ± 1.10 mIU/L and mean serum thyroxine level was 1.08 ± 0.25ng/dl. Hypothyroidism was recorded in 15% of the patients in our study. Like these findings, Michalaki et al.The aberrantly raised TSH levels in obese patients regress after weight loss either by lifestyle modification or surgical intervention.25Thus, by summing up the past studies, two different theories arise showing relationship of thyroid function and obesity:Lack of thyroid hormone leads to weight gain culminating in overt obesity, which in turn predisposes patients to develop autoimmune hypothyroidism.Sometimes, raised TSH in obese patients does not show hypothyroidism but it is the result of weight gain rather than its cause.2. Further studies are recommended on relationship between thyroid functions and BMI and its effect on cardiovascular functions.Subclinical hypothyroidism is highly prevalent in our population with BMI of more than 29kg/mAbdul Sami conceived, designed and did statistical analysis & manuscript writing.Malik Faisal Iftekhar & Muhammad Abdur Rauf did data collection and editing of manuscript.Akhter Sher did review and final approval of manuscript.