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Despite significant advancements in developing selective FMS-like tyrosine kinase 3 (FLT3) inhibitors, resistance to treatment is common even on continued therapy. Acquisition of on-target mutations or adaptation to MAPK, JAK2, and ABL signaling pathways drive treatment failure and disease relapse. Although combinatorial targeting of all escape routes in preclinical models demonstrated its efficacy, the clinical application is challenging owing to drug-drug interaction and differing pharmacokinetics of the inhibitors. We reasoned that selective polypharmacological targeting could lead to a durable response with reduced toxicity. A cell-based screening was carried out to identify inhibitors targeting FLT3, RAS-MAPK, BCR-ABL, and JAK2 to target the adaptive resistance observed with FLT3 inhibitors. Here, we show that pluripotin is an equipotent inhibitor of FLT3, BCR-ABL, and JAK2 in addition to inhibiting Ras-GAP and extracellular signal-regulated kinase 1 (ERK1). Structural modeling studies revealed that pluripotin is a type II kinase inhibitor that selectively binds with inactive conformations of FLT3, ABL, and JAK2. Pluripotin showed potent inhibitory activity on both mouse and human cells expressing FLT3ITD, including clinically challenging resistant mutations of the gatekeeper residue, F691L. Likewise, pluripotin suppressed the adaptive resistance conferred by the activation of RAS-MAPK pathways, BCR-ABL, and JAK2 signaling. Treatment with pluripotin curbed the progression of acute myeloid leukemia (AML) in multiple in vivo models including patient-derived primary AML cells in mouse xenotransplants. As a proof of concept, we demonstrate that targeted polypharmacological inhibition of key signaling nodes driving adaptive resistance can provide a durable response.

Menopause is a stage in life in which female periods are stopped, as it is a normal part of ending of your fertile, reproductive years. Objective: To assess the knowledge, attitude and practices regarding menopause among elderly women of Lahore. Methods: A cross sectional study was conducted in the Tertiary Health Care Centers in Lahore, Pakistan. Data were collected by non-probability convenient sampling technique. Inclusion criteria includes all females age between 45 to 60 and above. Whereas the exclusion criteria include non-cooperative individuals, women on any drug therapy. After taking informed written consent, data were collected by using self-structured questionnaire. Results: According to the study, 70% women had prior knowledge of menopause. 60% believe menopause is life-altering. Additionally, 67% believe menopause causes weight gain, 67% believe that food changes assist manage menopause. In addition, 65% practice the lifestyle changes help managing menopause. 44% had mild hot flashes and sweating episodes, 23% had severe symptoms, 45% of women had mild sleep issues. 36% were suffering from mild depression, and 30% had no symptoms. In 29% women had osteoporosis, 46% women have joint pain 25% of women made dietary modification for menopause. Conclusions: The majority of women were aware of menopause and its symptoms because they were educated, but they did not live a healthy lifestyle that included dietary practices and physical activities such as yoga and exercise. Providing menopause management could be a strategy to encourage successful menopausal transition in middle-aged women

Warfarin is the standard of care, and direct oral anticoagulants (DOACs) are a group of newer drugs to prevent stroke in patients with valvular heart disease. The aim of this meta-analysis is to compare the efficacy and safety of DOACs and warfarin in the prevention of stroke in patients with valvular heart disease (VHD). The current meta-analysis was conducted using the standards developed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation. The databases from the Cochrane library, PubMed, and Excerpta Medica database (EMBASE) were used to search for relevant articles without placing restrictions on the year of publication. Outcomes assessed in the current meta-analysis included a number of patients with stroke or systemic embolism, patients having myocardial infarction during the study period, patients with major bleeding events, and patients who died due to any reason. Overall, five studies were included in the current meta-analysis. Direct oral anticoagulants were associated with a lower risk of stroke or systemic embolism in patients with VHD (relative risk (RR): 0.75, 95% confidence interval (C)I: 0.60 to 0.94). The risk of major bleeding events is 31% lower in patients receiving DOAC compared to patients receiving warfarin (RR: 0.69, 95% CI: 0.58 to 0.83). No significant difference was found between the two groups in terms of all-cause mortality and myocardial infarction. The current meta-analysis shows that DOACs were associated with a lower risk of stroke or systemic embolism as compared to warfarin in patients with VHD. Besides this, the risk of major bleeding events was also lower in patients receiving DOACs compared to patients receiving warfarin. No significant differences were reported in terms of myocardial infarction and all-cause mortality between the two groups.

Atrial fibrillation is an irregular heart rhythm, and it is one of the most common cardiac arrhythmias. It is associated with a five times increase in the risk of stroke. Anti-coagulants are prescribed routinely to prevent strokes, especially in patients with atrial fibrillation for many years decreasing the risk of stroke among patients with atrial fibrillation. Non-vitamin K oral anticoagulants especially apixaban and rivaroxaban are frequently used and they are considered to be safe and more effective than warfarin. The aim of this meta-analysis is to compare the efficacy and safety of apixaban and warfarin in preventing stroke among patients with non-valvular arterial fibrillation. The current meta-analysis was conducted using the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search was done using databases, including PubMed, EMBASE, and Cochrane Library, with no restrictions on language and year of publication. The current meta-analysis included randomized control trials and non-randomized control trials (prospective and retrospective cohort studies) comparing the efficacy and safety of apixaban and warfarin in preventing stroke in patients with non-valvular atrial fibrillation. The primary efficacy outcome was stroke or systemic embolism while the primary safety outcome was major bleeding events. Overall, nine articles were included in the current meta-analysis with a pooled sample size of 267998 patients with non-valvular atrial fibrillation. The administration of apixaban was associated with a significant decrease in stroke or systemic embolism (RR: 0.77, 95% CI: 0.67-0.90) and major bleeding events (RR=0.63, 95% CI: 0.58-0.68) as compared to warfarin. However, no significant difference was reported in all-cause mortality (RR=0.80, 95% CI: 0.30-2.14) between the two groups. The current meta-analysis concluded that apixaban, compared to warfarin in patients with non-valvular atrial fibrillation showed a reduction in stroke and systemic embolism. Apixaban has also a better safety profile in terms of reduction in overall major bleeding events.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are oral diabetes medications that enhance the excretion of glucose by preventing the renal proximal tubules from reabsorbing glucose, which lowers glucose levels in plasma. Currently, studies have shown that SGLT2 inhibitors have beneficial impacts on cardiovascular outcomes, but their effect varies between the individual SGLT2 inhibitors. Thus, the current meta-analysis was conducted to compare the efficacy of dapagliflozin and empagliflozin in preventing cardiovascular events in patients with type 2 diabetes. The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A search of studies comparing cardiovascular events between dapagliflozin and empagliflozin in patients with type 2 diabetes published up to 1 July 2022 was done by two reviewers independently on PubMed, Embase and Cumulated Index to Nursing and Allied Health Literature (CINAHIL). The pre-specified primary endpoints were cardiovascular death, stroke, myocardial infarction and heart failure. Overall four studies were included in this meta-analysis. No significant difference was found in the incidence of myocardial infarction (risk ratio (RR)=0.81, 95% confidence interval (CI): 0.60-1.09), heart failure (RR=0.76, 95% CI: 0.56-1.04), cardiovascular mortality (RR=0.46, 95% CI: 0.18-1.20) and stroke (RR=1.07, 95% CI: 0.84-1.38) between dapagliflozin and empagliflozin. Results have shown that the risk of developing stroke, heart failure, myocardial infarction and cardiovascular death were not significantly different in the two groups.

Coronary vessel disease (CVD) is a class of diseases that impacts the blood vessels and heart and is one of the leading causes of disability and death. CVD includes cerebrovascular disease and coronary heart disease, both illnesses of the vessels transporting the oxygenated blood to the brain or heart. Colchicine is an inexpensive and old drug with strong anti-inflammatory effects. Numerous randomized control trials (RCTs) have demonstrated the effectiveness of low-dose colchicine for the prevention of severe cardiovascular events without showing any signs of serious adverse effects within the regime of treatment. In the current meta-analysis, we aim to assess the efficacy and safety of colchicine for secondary cardiovascular outcome prevention among patients with clinically proven CVD. The current meta-analysis was carried out using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PUBMED, Cochrane, and EMBASE databases were used to search for RCTs comparing colchicine and placebos for the prevention of secondary cardiovascular outcomes. The primary efficacy endpoint was mortality due to cardiovascular disease, stroke, urgent coronary revascularization, and myocardial infarction. Secondary efficacy outcomes included death due to all-cause mortality. Seven RCTs were reviewed, with a pooled sample size of 12114, out of which 6099 were randomized to the colchicine group, and 6015 were randomized to the control group. The decrease in cardiovascular events, including myocardial infarction, stroke, urgent coronary revascularization, and cardiac-related death, was significantly lower in patients randomized to colchicine (p-value0.05). The incidence of safety outcomes did not vary significantly different between groups (p0.05). In patients with CVD, compared to standard medical therapy, colchicine significantly decreases the risk of cardiovascular events such as cardiovascular-related death, myocardial infarction, stroke, and urgent coronary revascularizations.

Purpose: The main purpose of this study is to explore those psycho-social factors which are affecting the usage of credit cards in the present day. Furthermore, it is also aimed to investigate the impact of those factors like parental involvement, religiosity, impulsivity, compulsivity, locus of control, social status, customer attitude and financial distress on credit card usage in the context of Pakistan. Design/Methodology/Approach: For the purpose, the questionnaire has developed and distributed among users of credit cards in Bahawalpur region of Pakistan. This research is quantitative in nature and a probability sampling technique has been used to collect data. Moreover, regression analysis is used Findings: The results reveal that parental involvement, compulsivity, and financial distress have a significant impact on credit card usage. However, the study failed to find out any impact of impulsivity, locus of control and religiosity on credit card usage. Similarly, the customer attitude and social status also did not have any impact on usage of credit cards. Implications/Originality/Value: The results of this study extend help to the banks, financial institutions and, particularly, futures researches in the field of digital currency. It is also pertinent to mention that now it is a need of the time to start working and developing new digital banking tools and ways to compete in the digital world.

Purpose: The benefits of Information and Communication Technologies (ICTs) in environmental resource management has been a topic of hot discussion for the policymakers across the world. For the purpose, the government of Pakistan took initiative in 2018 to use technology for the country’s social welfare, financial benefits and to enhance environmental sustainability and named it as “Digital Pakistan Initiative”.Design/Methodology/Approach: For analysis, this study took CO2 emissions as the dependent variable and ICT, FDI inflows, and Trade Openness as independent variables. Data were collected on bimonthly basis from 2004 through 2019, and analyzed employing ARDL approach. Main purpose of the study was to examine the short-run and long-run relationship among carbon emissions and ICT, FDI Inflows and Trade Openness.Findings: The findings show that there exists a short-run relationship among all the variables; however, FDI inflows and trade openness have a significant relationship with CO2 emissions. The results also exhibit that there is no long-run relationship between CO2 emissions, FDI inflows, and Trade openness while ICT has an insignificant long-run relationship with CO2 emissions. With the increase of information and communication, the country’s environmental sustainability is also increased. Implications/Originality/Value: The current study was based on least considered variables and the pioneer in testing the complex relationship through VAR estimation.

Economic growth has been known to foster human development for long term economic stability. The evidence of bi-causality in the human development and economic growth nexus is however limited. This paper builds on the reverse causality between human development and economic growth in context of Pakistan, with the moderating impact of political stability. The study applies OLS and VECM on the data collected from World Bank Database from year 2006 to 2018. Our findings exhibit empirical evidence related to endogenous growth models and a significant causal relationship between human development and economic growth, moderated by political stability. The relationship is further explained by trajectories of happiness, health and income redistribution. Our findings suggest efficient reallocation of resources towards human development to address post pandemic growth concerns.

This paper builds on Capital Asset Pricing Model (CAPM) and its ability to validate market and firm specific risk. The effort is aimed at ascertaining the role of bankruptcy risk in determining the cost of capital in firms and its impact on corporate valuation. We also attempt to replace and analyze disparity of systematic and unsystematic components of risk with bankruptcy and risk of future liquidity. A similar study has recently been carried out in Indian market by Shirur (2013) for checking the validity of beta and cumulative risk measurement for identifying the presence of bankruptcy risk. This research may be the first attempt at analyzing such semantics with data from Pakistan. Therefore, the current study attempts to investigate the role of bankruptcy risk in determining the cost of capital in corporate valuation and the need of segregating systematic risk and unsystematic risk into liquidity risk and bankruptcy risk. The findings of this study suggest that unsystematic risk shall be eluded while investing in a well-diversified portfolio, but after investing in a specific firm, the unsystematic risk needs to be incorporated in total corporate valuation.

This paper aims to examine the differences in financial resilience of Islamic and Conventional Commercial banks with respect to the short term and long-term perspectives to pliability. The selected banks are compared on their resilience quotient exhibited by Liquidity Coverage Ratio (LCR) and Z-Scores. This study evaluates cross country panel data of 157 listed and non-listed licensed Islamic banks located in 22 countries and same number of their conventional commercial counterparts, through a period of 1998 to 2018. The data were collected through BANKSCOPE database and World Bank publications. Ratio analysis and Multiple Regression analysis were applied on data to analyze the extent of resilience of both Islamic and Conventional banks.The findings suggest that there are considerable differences in short term and long term resilience quotient of Islamic and Conventional commercial banks. Where Islamic banks have relatively enervated position than Commercial banks on liquidity frontier, they hold a more resilient position with respect to z-score. ROE and Capital adequacy are two important factors that have a significant impact on bank resilience.This research is different from all past researches with respect to methodological, aeon and acclimatization perspective. Resilience is a relatively new phenomenon adopted from complex adaptive ecosystems and most studies in this area are of theoretical nature. Moreover, the fact that this research has considered not only the long term but also short-term resilience perspective, adds to its overall value and originality.

Savings is potential solution to consume the scarce resources in an efficient way, which helps large scale production, improved productivity of the labor and result in increased economic development. The purpose of this study is to examine how macroeconomic indicators like GDP growth rate, income, inflation rate and interest rate affect gross national savings rate of Pakistan and how political stability influence the relationship between these four macroeconomic indicators and savings rate. Using 10 years macroeconomic data of Pakistan from year 2006-2015, multiple regression analysis technique was run and it was found that all four macroeconomic indicators significantly affects the savings rate. Income appeared to be strongest predictor in causing an increase in the savings rate. Although GDP found to be have an inverse relationship with savings rate. Political stability appeared to be non-significant in influencing the relationship between macroeconomic factors and savings rate.

This study aims to examine the macroeconomic and bank specific predictors of Credit Risk (NPL) and their relevant degree of impact on banks in Pakistan. For bank variables a sample of big 10 banks has been taken from 2009 to 2018. For macro-economic variables sample of 2009 to 2018 has been taken from the world bank. As financial institutions play their role to support industries and alleviate poverty in a country, this study checks the effect of banking variables as well as the economic variables on the credit risk of banks by taking industrial sector growth as a moderator. The study found that NPLs are negatively associated with Lending interest rate, Bank investment, Capital adequacy ratio, Domestic credit to private sector, Financial depth and GDP growth while positively associated with Lending capability, Return on equity, Interest spread and Liquidity Ratio. The moderation effect of Industrial sector growth on the relationship of Lending Capability and NPLs is found to be strengthening the relationship.

Purpose- The purpose of this study is to provide a new obscured aspect of financial working capital in working capital management, and investigate the association between financial and operating working capital with business performance. This paper also examines the interacting effect of net cash flow on this relationship. The current study introduces a modification in cash conversion cycle (CCC) by taking concealed trade advance payments. Design/methodology/approach- This study employs fixed effect regression model, covering a sample of Automobile sector companies, listed at Pakistan Stock Exchange (PSX) for the period of fourteen years from 2005 to 2018. Secondary data is collected from companies’ financial annual reports, PSX website, and Balance sheet analysis of State Bank of Pakistan (SBP). The study is explanatory and deductive in nature. Financial working capital (FWC) and new measure of operating working capital (OWC) i.e. modified cash conversion cycle (mCCC) is introduced & empirically tested with 252 firm-year observations. Findings- The regression results shows, a convex association between OWC & FWC, with business performance, in dearth of internal cash. However, after taking interacting effect of internal availability of cash, only FWC relation has become concave. The result also shows that mCCC provides a more realistic view of OWC. Research limitations/implications- This study has considered, concealed trade prepayments only, further research could include other components in mCCC. Moreover micro, macro factors and status of the economy such as depression or boom may also affect the results of the research. The findings suggest that managers should separately deal operating & financial working capital. Firms’ performance can be enhanced, if Finance Manager Take account internal cash of the firm. In case of deficiency (sufficiency) of it, he should work to decrease (increase) the investment amount in operating working capital (financial working capital). Overall, the results will be helpful to the financial experts and business practitioner in analyzing, and utilization of their resources. Originality/value- This study adds a new dimension in working capital by separating it into operating and financial working capital. The study also offers insights into the new knowledge of extension in CCC, role of concealed advance payments and internal cash flow, for class teachers and business practitioners. It will also describe the new avenues for further research in this field. Key Words: Financial working capital, Operating working capital, Trade advanced payments and modified cash conversion cycle (mCCC).

Purpose__ The research provides an insight in to the most popular debate around the globe about tax compliance. The research focusses on SMEs in premises of Bahawalpur division, Pakistan, by proposing a reliable solution for interstitial gaps existing between tax authorities and compliance behavior of taxpayers. It expands the Fisher model of compliance (1992) and deploys it as a base by adding new variables namely Power of authority, Tax audit and Electronic filing. The data has been statistically analyzed by using SPSS through running test of correlation and regression. Positive correlation and causation were established among variable leads to analysis of data through Ordinary Least Square (OLS), which ratify the role of attitude and perception as moderator in overall relationship. Results show that Power of authority directly influence compliance behavior while other two variables indirectly effects the relationship through moderator, thus nurturing the voluntary behavior of taxpayer. Design/Methodology/Approach___ A research framework has been developed for identifying the effect of different factors which may in boosting up compliance behavior of taxpayers. Quantitative approach was used and data has been collected through Questionnaire from almost 50 SMEs of Bahawalpur Division. Implications___ Policy makers may use the findings of the study to encourage voluntary compliance from the non-tax paying SME. Further study can be expanded by increasing sample size and by gathering detailed information for tax authorities. Originality/Value___ The proposed Model and findings may contribute in paving path for increasing voluntary compliance. Research also emphasize on other factors which should be focused for improvement and could play a crucial role in compliance.

Purpose: The paper aims to access the impact of financial transparency and disclosure on stock market capitalization. The financial transparency and disclosure measure the extent to which the firms have open firm-specific information for the investors. More transparency leads to strong investor protection. Design/methodology: The study has been conducted on the Pakistan Stock Exchange from period 2008 to 2017. Descriptive Statistics, Correlation, and Regression Analysis have been used to find out the impact of the above-mentioned variables on the Stock market Capitalization. Findings: The results support our hypothesis that information disclosure and strength of investor protection has a positive significant impact on market capitalization. Research Limitation: While our study focuses on the significance of information disclosure and transparency, it does not measure the quality and accuracy of the information disclosed. Practical Implication: The results might be of interest to potential investors who will be able to diversify their investment in a way that minimizes risks based on the disclosure practices of the firms. Originality/value: The research contributes to the finance literature by finding out the impact of information disclosure on stock market capitalization in the Pakistan Stock Exchange on recent data.

Introduction Occupational therapists around the world increasingly seek to support the participation of children with disabilities and special educational needs in mainstream education. Contemporary school-based occupational therapy practice is progressing from an individual, impairment focus towards collaborative, universal interventions at the whole class and whole school level. Participation-focused practice and collaboration is particularly important, but uncommon, in low-resource contexts such as Pakistan. Methods This article reports on collaborative action research that developed the role of occupational therapy in inclusive education in Karachi, Pakistan. A research team consisting of occupational therapists and teachers worked with five local primary schools, using the action research cycles of plan–implement–observe–reflect to develop practical strategies, materials and inclusive lesson plans to facilitate the participation of all children in all school-based occupations. Findings Support from school management and interdisciplinary collaboration were crucial for implementing change. In addition, strategies like inclusive lesson planning were found to benefit all children in class. Collaborative action research led to increased professional confidence in the teachers and occupational therapists, and skill development through developing a resource guide, running workshops and presenting at (inter)national conferences. Conclusion Collaborative action research was an effective means to develop the occupational therapy role in inclusive education practices in Pakistan, develop culturally appropriate educational resources, and upskill local therapists and teachers.

This research paper investigates the mediatory effect of Individually Perceived Stress in the direct relationship of high accomplishment work practices and financial performance of Firm. This research narrates different mechanisms and procedure through which work practices enhances firm performance. Cross Sectional research design is opted for data collection purpose. Data is collected from 500 employees of banking industry and analysis of data is done through Confirmatory Factor Analysis and Multiple Regression Analysis. The analysis of collected data shows that Individually Perceived Stress significantly affects the direct relationship of High-Performance Work Practices and Firm Financial Performance. Stress changes the direction of implemented practices in opposite direction due to which resultant results doesn’t match with the desired results. This paper contributes to literature by responding to the long waiting call for explaining importance of stress in high performance work practices and firm performance linkage. This paper also strengthens the literature by adding individual effect of four constructs of High Performance Work Practices. Current research also holds important and valuable implications for governing bodies or managing authorities of institutions.

Desired Objective: Aspire of this study is to uncover the evidences of the usefulness of antiviral medicine typically Sofosbuvir/Ledipasvir for the treatment of Hepatitis C Virus (HCV) infection in children. Study Design: Descriptive and Cross Sectional Duration and Setting: Duration for this study was nine months starting from April, 2018 to March, 2019 and study was conducted in Pediatrics department of the Mayo Hospital Lahore. Methodology: We enrolled patients, who were with diagnostics of positive Hepatitis C Virus (HCV) PCR and were the age of six to fifteen years after conducting and considering the histopathology and some examinations. The strength of the patients was 44 children having mean age of 10.52 years. Male patients were dominating with total of 28 boys and female were 16 girls. Made the Hepatitis C Virus (HCV) genotyping according to the affordability of the patients. Kept all the patients on the one dose of Sofosbuvir/Ledipasvir on daily bases. For the cases of cirrhosis established or INF-experienced, ribavirin added additionally. After four weeks of treatment, LFT and RFT of every patient were taken and after twelve weeks PCR was performed. Treatment was comprised on total 12 weeks and with the extension of 24 weeks for cirrhosis established. For analyzing the collected data, the software used was SPSS v-20. Results: Among all genotypes, genotype-1 was the leading type having 75 percent. 44 patients attained sustained virological response SVR-12 having 90.9 percent and rest four patients got partial virological response having 9.1 percent. Associated Hepatitis B Virus (HBV) was detected in ten patients and these patients were treated Entecavir for the whole period of treatment. All the patients attained sustained virological response SVR-12 with decrease in little of HBV while cases of INF-experienced were responsive with sustained virological response SVR-12 that were 14 patients with 31.8 percent. Conclusion: Oral antiviral (90 Sofosbuvir 400 mg or Ledipasvir 90mg) is effectively useful for the management of Hepatitis C Virus (HCV) infection in children. Keyword: Hepatitis C virus (HCV), Sofosbuvir or Ledipasvir, Pediatrics, Genotype, Antiviral.

Objective: To determine the frequency and severity of peripheral neuropathy in patients with type 2 diabetes mellitus. Study Design: An Experimental Study. Place and Duration: In the Physiology Department of Services Institute of Medical Sciences in collaboration with Medicine Unit II of Services Hospital Lahore for Six months duration from September 2018 to February 2019. Methods: Forty-two subjects with type 2 diabetes at the beginning were randomly selected into the experimental group. Twenty-five patients with age and sex matched were included as controls. Electromyography showed nerve conduction velocities of 2 sensory nerves and 2 motor nerves of upper and lower extremities. Glycemic control was assessed by the presence of fasting plasma glucose and glycosine Hb with the help of a kit. Conclusion: Peripheral neuropathy was 33.33% higher in diabetic men and 16.6% higher in women. Fasting plasma glucose levels showed a significant inverse correlation with sensory conduction of speeds (r = -0.365), sural (r = -0.366) and motor conduction speeds (r = -0.365) (P Conclusion: Nerve conduction rates should be performed regularly. In addition, glycosylated Hb levels should be monitored and controlled regularly so that peripheral neuropathy and disability in these patients can be prevented by appropriate and timely diagnosis and treatment. Key words: Distal peripheral neuropathy, diabetes, glycemic control.

The study is an endeavor to calculate the mobility of wealth across generations. The study is aimed to provide useful insights in the determinants of wealth linked in a manner that enables the calculation of wealth at single point in time (i.e. at the age of the eighteen and at the age of thirty). Pakistan is a developing country with high unemployment rate, slow economic growth, inefficient Zakat system, and increasing poverty rate. Pakistan is facing different problem to achieve the sustainable development goals. The 21th century goals are to eradicate extreme poverty and hunger, insure environmental sustainability, reduce corruption rate, inclusive economy, concentration of wealth, equal distribution of wealth. The proposed framework of intergenerational wealth mobility will help to minimize the poverty, evasion of taxation system, effective and efficient Zakat system as well as reduces the level of money laundering and corruption rates in Pakistan. In a while examine by (Shehzadi, Mohammad and Shah 2012). The significance of the study relates to development of the framework that measures the intergenerational wealth mobility in Pakistan.

Griether’s disease, also known as, Transgrediens et Progrediens Palmoplantar Keratoderma, is an autosomal dominant disorder, clinically characterized by diffuse palmoplantar keratoderma associated with hyperhidrosis and progressive extension of keratoderma to the dorsum of hands and feet, knees, elbows with characteristic involvement of Tendo-Achilles. We report a case of a 9 year old male with typical features of Greither’s disease.

Non-epidermolytic variety of hereditary palmoplantar keratoderma with autosomal dominant inheritance characterised by uniform, thick, yellow hyperkeratosis over palms and soles was first described separately by Thost and Unna and named as Unna-Thost Keratoderma. We present a case of Unna-Thost keratoderma in a 9 year old male child who presented with waxy, thick, yellow palms and soles with fissures and contractures in hands.