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* Context.--In recent years, several reporting systems have been developed by national and international cytopathology organizations to standardize the evaluation of specific cytopathology specimen types. Objective.--To assess the current implementation rates, implementation methods, and barriers to implementation of commonly used nongynecologic reporting systems in cytopathology laboratories. Design.--Data were analyzed from a survey developed by the College of American Pathologists Cytopathology Committee and distributed to participants in the College of American Pathologists Nongynecologic Cytopathology Education Program mailing. Results.--Nongynecologic reporting systems with the highest rate of adoption were the Bethesda System for Reporting Thyroid Cytopathology, 2nd edition (74.1%; 552 of 745); the Paris System for Reporting Urinary Cytology (53.9%; 397 of 736); and the Milan System for Reporting Salivary Gland Cytopathology (29.1%; 200 of 688). The most common reason given for not adopting a reporting system was satisfaction with a laboratory's current system. Implementation varied among laboratories with regard to which stakeholders were involved in deciding to implement a system and the amount of education provided during the implementation process. Conclusions.--The implementation of nongynecologic reporting systems in cytopathology laboratories was highly variable., A shared language and framework of understanding are central components to the effective and safe practice of medicine. Although cytopathology shares some of the same language as histopathology, cytopathology specimens [...]

Background Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial. Methods and findings This parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c [greater than or equal to]8% and systolic BP [greater than or equal to]140 mm Hg and/or LDL-cholesterol [greater than or equal to]130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c Conclusions In urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes. Trial registration ClinicalTrials.gov NCT01212328., Author(s): Mohammed K. Ali 1,2, Kavita Singh 3,4, Dimple Kondal 5, Raji Devarajan 4, Shivani A. Patel 1,2,6, V. Usha Menon 7, Premlata K. Varthakavi 8, Vijay Vishwanathan 9, Mala [...]

The link between psychological strain and suicidal ideation is well embedded in literature, however, the underlying mechanism is rarely explored. Therefore, this study aimed to examine the relationship between psychological strain, suicidal ideation, rumination, and depression among Pakistani young adults during the Covid-19 outbreak. In addition, it will also try to determine the mediating role of ruminative subtypes and depression in the relationship between psychological strain and suicidal ideation. The sample consists of 400 university students (83 males and 289 females) with the age range from 18 to 30 years (M = 22.25, SD = 2.40). Psychological strain scale, Suicidal Ideation Scale, Beck Depression Inventory, and Ruminative Response Scale were administered to the participants. Results indicated a significant and positive association between the study variables. Psychological strain positively influenced suicidal ideation both directly, and indirectly via brooding and depression. Both variables were found to be serially mediated by the brooding subtype of rumination and depression and not with the reflective subtype. Strain theory of suicide and response style theory also postulated important insights regarding the association of these variables in young adults, among which, strain is serially related to first brooding and then depression, which is eventually related to suicidal ideation. The present study makes a significant contribution to the literature by providing a unique conceptual and theoretical framework to identify suicide at the ideation level before it proceeds to behavior during this unprecedented time of the pandemic outbreak., Author(s): Noor Ul Ain Muneeb [sup.1] , Sumara Masood Ul Hassan [sup.1] Author Affiliations: (1) grid.412117.0, 0000 0001 2234 2376, Department of Behavioral Sciences, S3H, National University of Science and [...]

A simple trivalent silver complex ([Ag(HIO.sub.6).sub.2].sup.5-) and sulfuric acid chemiluminescence (CL) reaction is established for cetirizine dihydrochloride determination in dosage form pharmaceuticals using flow injection technique. The possible CL reaction mechanism and enhancing influence of cetirizine are described based on spectrophotometric, spectrofluorimetric and CL spectra. The optimum experimental variables of the CL reaction were: 1.0 x 10.sup.-4 M silver(III) complex, 5.0 x 10.sup.-3 M H.sub.2SO.sub.4, 1.0 x 10.sup.-3 M KOH, 5.0 mL/min flow rate and 180 [micro]L sample volume. The relative CL intensity was linear in the range of 0.1-20 mg/L (R.sup.2 = 0.9999, n = 7) with a limit of detection of 0.03 mg/L (S/N = 3), relative standard deviation of 1.6-3.4%, and injection frequency of 230/h. The suggested method has been successfully applied to monitor cetirizine concentration in various tablets and verified by the reported HPLC-UV approach that produces a recovery rate of 91.8-106%., Author(s): Muhammad Moazzam [sup.1] , Muhammad Asghar [sup.1] , Mohammad Yaqoob [sup.1] , Samar Ali [sup.1] , Masood Ahmad Siddiqui [sup.1] Author Affiliations: (1) grid.413062.2, 0000 0000 9152 1776, Department [...]

Background BRCA1 and BRCA2 (BRCA1/2) are the most frequently investigated genes among Caucasian pancreatic cancer patients, whereas limited reports are available among Asians. We aimed to investigate the prevalence of BRCA1/2 germline variants in Pakistani pancreatic cancer patients. Methods One hundred and fifty unselected and prospectively enrolled pancreatic cancer patients were comprehensively screened for BRCA1/2 germline variants using denaturing high-performance liquid chromatography and high-resolution melting analyses, followed by DNA sequencing of the variant fragments. The novel variants were analyzed for their pathogenic effect using in-silico tools. Potentially functional variants were further screened in 200 cancer-free controls. Results Protein truncating variant was detected in BRCA2 only, with a prevalence of 0.7% (1/150). A frameshift BRCA2 variant (p.Asp946Ilefs*14) was identified in a 71-year-old male patient of Pathan ethnicity, with a family history of abdominal cancer. Additionally, we found a novel variant in BRCA2 (p.Glu2650Gln), two previously reported variants in BRCA1 (p.Thr293Ser) and BRCA2 (p.Ile2296Leu) and a recurrent nonsense variant in BRCA2 (p.Lys3326Ter). These variants were classified as variants of uncertain significance (VUS). It is noteworthy that none of these VUS carriers had a family history of pancreatic or other cancers. Conclusions In this first study, BRCA1/2 pathogenic variant is identified with a low frequency in pancreatic cancer patients from Pakistan. Comprehensive multigene panel testing is recommended in the Pakistani pancreatic cancer patients to enhance genetic understanding in this population. Keywords: BRCA1, BRCA2, Germline variants, Pancreatic cancer, Pakistan, Author(s): Noor Muhammad[sup.1,2], Ayesha Azeem[sup.1], Shumaila Arif[sup.1], Humaira Naeemi[sup.1], Iqra Masood[sup.3], Usman Hassan[sup.4], Bushra Ijaz[sup.2], Faisal Hanif[sup.5,6], Aamir Ali Syed[sup.5], Muhammed Aasim Yusuf[sup.7] and Muhammad Usman Rashid[sup.1] Background Pancreatic cancer [...]