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Objective: The objective of the current study is to determine the pattern of dermatological disorders and to find out their connection with different socioeconomically factors among students of the Medical College. Methodology: The Cross sectional observational study was carried out for the period of three months .The research instrument used was the well developed questionnaire. Results: The questionnaire was administered among total 350 students and the most participant age group was the > 22 and that was about 47.4% of the total sample size the more skin complication seen was the acne that was about 59.7%, in addition to this dandruff contributed very heavily to the hair complexities which makes about 35.7% of the sample. Conclusion: Skin infections especially the cosmetic are very common among the Medical students.

Background Aging is the irreversible change in the human physiology which occurs with the passage of time and it becomes very much critical to recommend drugs among the geriatrics patients because their body response is quite different. Objectives The purpose of the current study is to assess and evaluate the potentially inappropriate medications among the geriatric patients at the tertiary care Hospital of Larkana Sindh which is the biggest Hospital in the Northern Part of Sindh. Methods The descriptive cross-sectional study was conducted which included the 500 patients aged more than 60 years. The data was collected from the patients' case charts and the questionnaire distributed among the patients. BEERS′ criteria was used to detect the frequency of chronic disorders in geriatric patients and appraise the polypharmacy. Results The male patients were 42.6% and the female patients were 57.4%. The inappropriate medication use (IMU) was observed among 22.6% patients. Inappropriate antibiotics were seen in 35.39%, Benzodiazepine 28.32%, non-steroidal anti-inflammatory drugs (NSAIDs) 15.04%, cardiovascular system (CVS) drugs 12.39% of patients. Parenteral route of administration was observed in 70.04% of patients. Conclusion Polypharmacy is highly prevalent in the prescriptions of geriatrics patients, due to certain reasons like a chronic disease. Clinical Pharmacist can be better placed to provide his professional activities in this context.

Aims: The present study was designed to identify and assess the severity of azithromycin interactions with other drugs in the outpatient setting in Alkharj. Methodology: A retrospective analysis was performed of azithromycin prescriptions in the outpatient setting in a public hospital in Alkharj in order to determine the incidence of interactions between azithromycin and other medications. Results: There were 182 prescriptions included in the study. There was a major interaction in only 1 prescription (0.55%) and moderate interactions in 15.30% of the prescriptions. So the percentage of overall interactions was about 20.88%. The most common drug interactions in the present study were between azithromycin and salbutamol. Conclusion: It can be concluded that the interactions between azithromycin with other medications were common, but these interactions could lead to irregular heart rhythm and lead to muscle pain and weakness. Adoption of international standard and locally conformable guidelines of antibiotic use can help in avoiding such problems.

Objective: To determine factors that facilitate and are barriers to self-monitoring of blood glucose in type 2 diabetic patients visiting family medicine clinics at a tertiary care teaching hospital Karachi Pakistan. Methods: Approximately 255 patients were consecutively recruited from the clinics during April 2018 to May 2019 at Family Medicine outpatient clinics at the Aga Khan University Hospital. Data on socio-demographic status, facilitators and barriers to SMBG were extracted through a questionnaire, after obtaining an informed written consent. Data was entered and analyzed in SPSS version 19. Results: Among study participants 47.5% were above 50 years and 51.4% were males. About 30.2% of the participants were practicing SMBG at least once a month and 26% were practicing it daily. Fear of complications was the biggest facilitator (80.1%) and being expensive (51.4%) was barrier for SMBG. Over half of the SMBG practicing participants (59.7%) were diagnosed with diabetes for more than 05 years (p: 0.63). Conclusion: Assessment of blood glucose is a critical component of diabetes treatment and management. It can motivate patients to become active participants in their own care. Health care providers should communicate and educate the patients about the advantages of SMBG.

Introduction: Cosmetics are defined by the Saudi Food and Drug Authority as any material or preparation designed to come into contact with various external body parts (epidermis, hair system, nails, lips, and external genital organs) or with the oral cavity's teeth and mucous membranes for a variety of purposes, such as cleansing, perfuming, altering their appearance and/or keeping them in a good condition. Objectives: The objective of the study was to assess the prevalence, level of awareness, and practices regarding cosmetics harmful hazards among Saudi female University Students of Albaha; Saudi Arabia. Methodology: This was a descriptive study intended to assess the prevalence, awareness and practice of Saudi female students of Albaha University. Systematic sampling methods were used to pick from each college, the predetermined sample size was taken, accordingly systematic random sampling was used to recruit 410 female students from medical and none medical colleges. Medical students at the latter level of their study were excluded from the study. Information was gathered using a self-administered questionnaire which was constructed to explore respondents’ awareness and practice toward using cosmetics. Results: A total of 410 respondents were enrolled in the study with a respondent rate of 93.2%, most of the respondents (62.4%) were none medical, and (37.6%) medical students. The prevalence of cosmetics use among our respondents is (97.8%), (82%) of them are between the age of 18 and 20 years and (76.3%) were unmarried. Most of the respondents (77.8%) used cosmetics daily while (20%) used to apply them sometimes or on need. Facial cosmetics, lipstick, and eye make-up as a group is the most commonly used cosmetics (64.9%) followed by skin lightening products (14.4%). 69% have an average level of knowledge concerning cosmetics adverse effects; (23%) have knowledge level and only (8%) having a good level of knowledge. A very significant proportion (37%) had experienced at least one side effect. Irritant contact dermatitis is the most commonly seen adverse effect affecting (38.8%) of the study population; followed by acne (27%) and allergic contact dermatitis (18.4%). Perfumes, deodorants, body lotions and creams by far the most common cosmetics products causing adverse effects (52.4%); followed by Facial cosmetics, lipstick and eye make-up in 143 (34.9%). Conclusion: A high prevalence rate of cosmetic use among Albaha university female students. Unfortunately, only 8% of them have good knowledge about the harmful effects of cosmetics. A very significant proportion was experienced at least one cosmetics-related side effect. This study concludes that cosmetics health-related hazard awareness among our respondents was not satisfactory and therefore needs a special consideration on cosmetic use-related safety concerns through awareness programs to raise their awareness. Recommendation: More researches should be directed to determine levels of knowledge and awareness towards cosmetic usage and its health hazards and safety measures. We recommended that a well-structured health education program should be done including lectures, workshops, campaigns and mass media orientation to increase the awareness level and educate the students about the hazardous effects of commonly used cosmetics.

Background Peripheral neuropathy (PN) is a complaint with often unidentified reasons. Some medicines, including statins therapy, are anticipated to be amongst the reasons for PN. Aims This study intended to assess the association of peripheral neuropathy with statins therapy amongst Type 2 diabetic patients. Methods At Penang General Hospital, 757 cases were categorized into two groups (564 with statins therapy and 193 without statins therapy). The diagnosis of PN was investigated retrospectively for a period of 10 years (2006–2016). Confounding risk factors as age, diabetes period, hypertension, glycemic control, other co-morbidity, and prescriptions were matched. Results About 129 (22.9%) cases from 564 statins users had PN. Only 30 (15.5%) subjects had PN from 193 statins non-users. Chi-square test showed a significant variance among statins treatment cohort and statin-free cohort in the occurrence of PN (P-value: 0.001). Spearman’s investigation presented a positive correlation (r: 0.078, p-value: 0.031) among statins use and PN prevalence. Binary logistic regression was statistically significant for statins therapy as a predictor of peripheral neuropathy incidence (r2: 0.006, p-value: 0.027) amid diabetic patients. The relative risk of peripheral neuropathy connected with statins therapy is (RR: 1.47, 95% CI: 1.02–2.11). The excess relative risk is 47.1%. While the absolute risk (AR) is 7.3% and the number needed to harm (NNH) is 14. Conclusions The study indicated a positive association between peripheral neuropathy and statins utilization. Peripheral neuropathy was higher amongst statins users than the statins-free group.

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute. Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis. Results: The mean age of our cohort was 8.6 years (range 3–15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency >1 month was found to have a statistically significant longer progression-free interval. Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative.

In recent years, reports from developed countries have shown that awake craniotomy has been shown to improve outcomes of surgical resection of brain tumors. However, no such data is available from low- and middle-income countries. We retrospectively reviewed 200 cases of awake craniotomy performed at our center for excision of brain tumors during last 5 years, and assessed clinical outcomes. Data was collected from patients’ medical records, and included demographics, tumor location/histology, clinical complains, and functional status. We used Karnofsky performance scale (KPS) to assess function. Extent of resection was determined on post-operative MRI. Statistical analysis was done using SPSS version 22. Seven attending surgeons performed these cases; however, 168 (84%) surgeries were performed by a single surgeon who is the senior author (SA Enam). Mean age was 39.3 ± 11.9 years and 79% (158) were male. Left frontal lobe was the most common location for tumors (50; 25%). Although 52% (104) patients had malignant neoplasms, seizures were the most common presenting symptom in 63% (126) cases followed by motor deficits in 29% (58). The most common tumors were low grade oligodendroglioma (58; 29%%) followed by glioblastoma (42; 21%). Mean length of hospital stay was 3.15 days ± 1.7 days. Gross total resection was achieved in 82 (41%) patients. New intraoperative neurological complains were seen in 31 (15.5%) patients, however, 22 (11%) of these had recovered by median follow-up of 1.4 months. KPS at last follow-up improved in 92 (46%), remained stable in 94 (47%) and deteriorated in 14 (7%) patients. Although absence of a control group decreases the strength of this, with our large sample size we can safely conclude that AC allows maximum safe excision of brain tumors, and offers a good chance of preserving patients’ functional status, along with adequate extent of resection.

INTRODUCTION In Pakistan, brain tumor epidemiology has been examined in single-centre studies or as part of general cancer registries, which are limited by catchment area, age group, or are not specific to brain tumors. The Pakistan Society of Neuro-Oncology conducted a nationwide study to assess the distribution of brain tumor distribution and associated risk factors. This unfunded study explores data from across Pakistan and serves as a potential model for LMICs to emulate. METHODS A cross-sectional study was designed to include patients diagnosed with brain tumors in major neurosurgical centers in Pakistan retrospectively from January-December 2019. Patients, both alive and deceased, with a radiological diagnosis of a brain tumor were included. Data were recorded on a comprehensive online form from 35 centers, encompassing an estimated 85% of all the brain tumor patients seeking initial treatment by a neurosurgeon from the public and private sectors. Data collection was split into three regions: Sindh and Balochistan; Punjab; and Khyber Pakhtunkhwa and Islamabad. Data collection occurred between August 2020 and January 2021. RESULTS A total of 2750 brain tumor cases were recorded of which 1897 (69%) were diagnosed in the private sector hospitals. MRIs were a more common radiological study compared to CT scans. 2666 surgeries were performed, 174 individuals underwent chemotherapy and 479 underwent radiation therapy; approximately two-thirds of the patients that require adjuvant treatment are not able to receive it. Gliomas were the most common tumor, while pineal tumors were the least common. Findings indicate a low metastasis frequency and few females seeking care. CONCLUSION The study shows that brain tumors are mostly diagnosed and operated on in the private sector; the public sector should be more engaged. The study also highlights that despite inconsistencies in hospital records for brain tumor patients, reliable information can be collected in LMIC settings.

Very little research has been conducted on brain tumor epidemiology in Pakistan and a few studies that do exist provide regional data only. Conducting population based epidemiological studies in low-and-middle income countries (LMICs) like Pakistan can be particularly challenging due to limited resources, poor clinical and research infrastructure, unreliable or incomplete hospital records and a lack of standardization across the health care system. Population-wide studies and registries play an important role in cancer epidemiology and can help identify the current magnitude of cancer burden and its likely future evolution, allowing for better planning of prevention, diagnosis, management, and rehabilitation. This paper describes our experience in designing and conducting Pakistan Brain Tumor Epidemiology Study (PBTES), a first-ever nationwide study carried out to assess the distribution of brain tumors in Pakistan. In addition to the aforementioned obstacles, we were also faced with the global health crisis caused by the COVID-19 pandemic and had to promptly adjust our study accordingly. Other investigators conducting epidemiological studies in LMICs with similarly challenging and constricting settings could benefit from our experiences.

BACKGROUND: To determine factors that facilitate and are barriers to self-monitoring of blood glucose in type 2 diabetic patients visiting family medicine clinics at a tertiary care teaching hospital Karachi Pakistan. METHODS: Approximately 255 patients were consecutively recruited from the clinics during April 2018 to May 2019 at Family Medicine outpatient clinics at the Aga Khan University Hospital. Data on socio-demographic status, facilitators and barriers to SMBG were extracted through a questionnaire, after obtaining an informed written consent. Data was entered and analyzed in SPSS version 19.RESULTS: Among study participants 47.5% were above 50 years and 51.4% were males. About 30.2% of the participants were practicing SMBG at least once a month and 26% were practicing it daily. Fear of complications was the biggest facilitator (80.1%) and being expensive (51.4%) was barrier for SMBG. Over half of the SMBG practicing participants (59.7%) were diagnosed with diabetes for more than 05 years (p: 0.63). CONCLUSION: Assessment of blood glucose is a critical component of diabetes treatment and management. It can motivate patients to become active participants in their own care. Health care providers should communicate and educate the patients about the advantages of SMBG.

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and instrumental technologies is a constant struggle for neurosurgeons in Pakistan, considering the cost-effectiveness. Hence, this results in significant limitations for surgeons to provide the best outcome for their patients. As most Pakistanis (74%) pay out of pocket, measuring cost-effectiveness is extremely crucial. It was found that significant differences in intra-operative and postoperative care existed among various centers. Public sector institutions fared much worse. The role of diagnostics in glioma surgery is severely limited across centers in Pakistan and as such, research and training need to be addressed promptly. In order to achieve success in glioma management, the data in our article demonstrate various facets of health care that need to be addressed simultaneously and swiftly. Surgical access needs to be improved; only then, optimal management of glioma can be accomplished in Pakistan.

Introduction: Multiple primary brain tumors are a rare occurrence that are often accounted for by a complex process of tumorigenesis involving irradiation and possibly the association of residual embryonic tissue turning neoplastic. In this case study, we report a case of coexisting sub ependymoma and oligodendroglioma in a patient. Case: A 32-year-old female was referred to our hospital with a history of seizures for the past 6 months and intact sensorimotor functions. Her Magnetic Resonance Imaging (MRI) revealed a lesion in the parieto-occipital lobe along with perilesional edema which resulted in the effacement of the left lateral ventricle. A second lesion was noted at frontal horn of the right lateral ventricle attached to the septum pellucidum with tiny cystic spaces. The left parieto-occipital lesion (oligodendroglioma) was excised using a supratentorial craniotomy approach and an interhemispheric anterior transcollosal approach was used for debulking the intraventricular tumor (subependymoma). The patient was put on Temozolomide but only took 4 cycles of chemotherapy and refused radiation therapy. She currently has stable disease and is being followed with MRI scans every 6 months. Conclusion: The most commonly reported concomitant tumors are meningioma with glioma followed by schwannoma and pituitary adenoma. The discovery of a second tumor is often done pre-operatively, intraoperatively, years after resection of the first tumor and even during postmortem examinations. We report for the first time, the co-existence of an oligodendroglioma and a sub ependymoma.

Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors. Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015–December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21. Results: Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome. Conclusions: DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature.

Introduction Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic disorder characterized by fibrofatty replacement of right ventricle. Extensive research revealed the involvement of desmosomal, non-desmosomal and modifier genes in the etiology of the ARVC/D. Further, environmental factors with modifier genes influence the severity of the disease. One of the well-known modifier genes is HSP90α polymorphism, which is involved in protein folding and regulation as well as apoptosis etc. Therefore, in this study, an investigation was carried out to find the possible association between HSP90α polymorphism and ARVC/D. Material and methods This study included 240 healthy control samples without any family history of cardiac diseases and 61 ARVC/D patients. Diagnosis of patients was carried out using ECG and 2-D echocardiography, following revised diagnostic criteria: definite, borderline diagnosis and possible diagnosis. Scoring of genotypes was carried out by allelic-specific PCR. Results A statistically significant association was observed between HSP90α polymorphism and ARVC/D. In codominant and overdominant models, ‘C/G’ was found to be risk conferring. Further, in dominant model, ‘C/G’ and ‘G/G’ genotypes were susceptible for ARVC/D. Moreover, ‘G’ allele which was predominant in ARVC/D was found to risk conferring towards ARVC/D. Conclusion These findings suggest that possible role ofHSP90α polymorphism in the etiology of ARVC/D. The ‘G’ allele of HSP90α polymorphism damages the 3-D native conformations, which is required for the interaction between client proteins such as desmosomes, ryanodine receptor-2 and sodium channel leading to mislocalization of these proteins. Furthermore, loss of inhibitory interaction between HSP90α protein and Apaf-1 trigger apoptosis.

Long QT syndrome (LQTS) is a rare primary cardiac electrophysiological disorder with characteristic symptoms of syncope, tachyarrhythmia and torsades-de-pointes. It is the outcome of mutations in genes encoding ion channels that function as voltage regulators. Heat shock protein (HSP) 90 is a molecular chaperone that plays vital roles in a variety of cellular processes, one of which is folding of nascent polypeptide chains into their native forms. The main objective of this study was to screen for HSP90 Q488H (C > G) polymorphism in patients with LQTS and identify its risk towards LQTS manifestation.

INTRODUCTION Global oncology development within LMICs (low- and middle-income countries) requires bridging gaps in healthcare systems. Brain tumor care in Pakistan is currently sparse and concentrated in urban centers. Distance traveled to a hospital dictates a patient’s access to care, neurosurgical access, and continuity of care through adjuvant chemoradiotherapy and primary care providers can be disrupted if patients cannot overcome the barriers due to extensive distances traveled. METHODS Data was collected as part of the Pakistan Brain Tumor Epidemiology Study (PBTES) regarding patients with brain tumors who underwent surgical procedures in 2019 at private and public major neurosurgical centers across Pakistan. Using patient addresses, we used a mapping software to calculate the distance traveled by each patient to the primary hospital. Analysis was done using appropriate statistical methods. RESULTS Out of 2403 patients, the mean distance traveled across the country was 240 km. The longest distance traveled within Pakistan was from Skardu to Karachi (2002 km) for resection of a pituitary adenoma (28 hours via car). Only 48% of patients were able to reach their primary hospital within 50 km. 52% of patients had to travel more than 50 km, and 18% had to travel upwards of 500 km to reach their primary hospital. Additionally, 101 patients traveled to Pakistan from other countries for brain tumor surgery (98 patients from Afghanistan [mean distance traveled: 723.6 km], 3 patients from Syria, Oman, and Sudan). CONCLUSION Prior studies have described a cut-off of 50 km as an acceptable limit for distance from the primary hospital in cancer patients for optimal follow-up and outcomes, which is achieved by only 48% of brain tumor patients in Pakistan. Most patients have poor access to surgical care for brain tumors, further compounded by repeat traveling for follow-ups and chemoradiotherapy.

Pituitary adenomas and Rathke’s cleft cyst with calcification are rarely seen and craniopharyngioma still remains the common sellar suprasellar space occupying lesion with calcification. Presence of calcification is reported in pituitary adenoma in only 0.2% to 8% cases. The pituitary adenoma with calcification is a rare radiological finding and it must be distinguished from other lesions of the pituitary gland as the management and prognosis differs significantly. We report a case of a 29-year-old gentleman presented electively with the complaints of deterioration of vision for four months. CT-scan without contrast examination revealed pituitary adenoma with calcification. The patient underwent transsphenoidal resection and was discharged on third post-operative day. Histopathology confirmed the diagnosis of pituitary adenoma with calcification. Pituitary tumor presenting with evidence of calcification is an infrequent radiological finding and identification of pituitary adenomas with calcifications is essential as it guides towards medical and surgical management of the lesion.

Ever since the 1960s, transsphenoidal surgery has been the modality of choice for treating Cushing's disease. Subsequent visualization of the pituitary fossa and sphenoid sinus may be done either with the operating microscope or with the relatively new endoscope. The endoscope due to its panoramic view allows greater visualization as compared to the operating microscope. It confers greater access to the cavernous sinus, sella, suprasellar, and parasellar regions and accommodates higher magnifications. It is bi-dimensional, however as opposed to the operating microscope that provides a three-dimensional view and allows greater depth perception. This article provides a comprehensive review of the advantages and disadvantages of the endoscope and compares it to the operating microscope. We hope this article will prove useful to both clinicians and academicians alike in their approach and management of Cushing's disease.

Statins have impacts on the metabolism of glucose that might influence the progress of diabetes in non-diabetics or affect glycemic control in patients with existing diabetes. Experimental proof has been contradictory about whether some statins display beneficial properties while others indicate harmful impressions. Some systematic reviews of statins had stated conflicting findings on the concern of glucose metabolism. The current study investigates the published systematic reviews and meta-analyses to combine their results and give a clear situation regarding the influence of statins therapy on glycated hemoglobin (HbA1c). This study has valuable strength points; long follow-up period and big sample size.

Introduction: Drug-drug interaction refers to an altered or impaired responseof drug as a resultant of the other drug’s activity. However, recently advancement in field oftherapeutics has leaded the therapy toward more rational and logical trend in order to improvethe patients’ health with respect to cost effectiveness. Objective: To assess the various levels ofDDIs in Prescriptions at public sector teaching hospital of Hyderabad, Pakistan. Study Designand Settings/Methodology: A descriptive observational questionnaire based study has beenconducted by collecting initially 250 random prescriptions of various patients prescribed withmultiple drugs. Tertiary care hospital OPD and In-patient wards were visited for a period of06 months. The Prescriptions (℞) so collected were analyzed and assessed individually fordrug interactions using Standard drug interaction software i.e.. Lexi-comp’s Lexi-Interact, DrugInformation Handbook, Hansten and Horn’s drug interactions. Results: For this study, a total 250Prescriptions were collected. It was observed that 30 (12%) prescriptions contained with singlemedication, 10 (4%) prescriptions were unreadable, 210 (84%) prescriptions were containedmore than one medication. Moreover, 210 (84%) poly-pharmacy prescriptions focused keenly.Subsequently, 51 (24%) prescriptions ensured the prevalence of DDIs and 159 (76%) were Non-DDIs prescriptions. Similarly, 13 ℞ contained four or more than four drugs, 32 ℞ contained threedrugs and 06 prescriptions contained two drugs correspondingly. Conclusion: It was clearlyconcluded that the most potential reason of DDIs are Poly pharmacy. So it is of utmost needto enhance the health care policies in overall healthcare system in order to antagonize DDIsassociated morbidity and mortality among society.

Alternate furrow irrigation (AFI) is gaining interest as a means of saving water while minimising loss in crop production. Given the potential water savings of AFI, a field experiment was conducted in the Tandojam region of Pakistan by growing okra with AFI and conventional furrow irrigation (CFI) in which every furrow is irrigated. Our results show that total irrigation water applied in the AFI treatment was roughly half (248 ± 2.9 mm) that applied to the CFI treatment (497 ± 1.7 mm). Despite the very significant reduction in irrigation water used with AFI there was a non-significant (p > 0.05) reduction (7.3%) in okra yield. As a result, we also obtained a significantly (p −3 with AFI, which was nearly double the 2.78 ± 0.04 kg m −3 obtained with CFI. While this reduction in yield and/or potential income may appear small, it could be critical to the welfare of individual farmers, who may as a result hesitate to make changes from CFI to AFI if they are worse off than farmers who do not adopt AFI. This situation exists because current water charges are based on crop and land area rather than the volume of water being accessed for irrigation. Transitioning from the current crop and land area based method of charging for water to a volumetric method may require investment in irrigation system changes and may take time to accomplish. These are important lessons for other countries, and particularly developing countries who are trying to improve the environmental, social and economic performance of their irrigated systems. We recommend that further studies be carried out using AFI to determine whether similar water savings and flow-on benefits can be achieved across a wide range of cropping systems in arid and semi-arid environments.

Glioblastoma, also known as glioblastoma multiforme (GBM), is the most common primary brain tumor. Extensive research has been carried out to discover the factors associated with the course and progression of GBM. CD133 is a glycoprotein antigen found in normal and malignant tissues. CD133 has been recognized as a marker for the growth of cancer cells. The association between this tissue marker and GBM is being investigated. The aim of this review was to evaluate the role of CD133 as a tumor marker for the prognosis of GBM.

Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.

Background In a developing country there is a need for development of criteria that can be used for the diagnosis of spinal tuberculosis, which is common in that region. Methods Demographic, clinical, and radiologic features of spinal tuberculosis and spinal epidural tumors have been compared statistically, and inferences have been drawn in terms of P values, sensitivity, specificity, positive predictive values, and negative predictive values. Results A statistically significant relationship was found between spinal tuberculosis and spinal pain, fever, gradually progressive lower limb weakness, contrast-enhancing epidural ± paravertebral lesions, continuous levels affected, spinal deformity, and raised erythrocyte sedimentation rate. Conclusions These relationships were considered the most probable criteria for the diagnosis of spinal tuberculosis.

Background: Male breast cancer accounts for less than 1% of all cancers found in men. It usually presents at a later age and stage as compared to female breast cancer. Treatment strategies are extrapolated from the management of female breast cancer. Our study here looked at 18 patients diagnosed with and treated for male breast cancer at The Aga Khan University Hospital in Pakistan. We compared our findings with the existing data from Asian and Western countries. Materials and Methods: A retrospective study was conducted looking at patients with male breast cancer between January 1986 and December 2009. Patient and disease characteristics were analyzed and 5 year overall survival was calculated using Microsoft Excel and SPSS. Results: The average age at diagnosis was 52 years (38-67 years). Twelve (66.7%) patients had axillary lymphadenopathy. Stage II disease was the most common stage at presentation (9 patients, 50%). Infiltrating ductal carcinoma was seen in 16 patients (88.8%). Seven lesions were positive for both estrogen and progesterone receptors. Sixteen patients had surgery in the form of either modified radical mastectomy or radical mastectomy. Radiation was used in 7 patients in an adjuvant setting. The five year overall survival for stage I, II, III and IV disease was 100% vs 78% vs 50% vs 0%( p

Background: Alzheimer Disease (AD), the most common form of dementia, is a progressive and irreversible neurodegenerative disorder. Promising preventative strategies includes identification of potential modifiable risk factors for AD that could help identify individual who are at risk of AD. This study focuses on identifying biochemical factors associated with non- familial AD. Methods: One hundred and ten individuals which included 55 AD patients and 55 healthy controls were recruited for the study. Patients clinically diagnosed by a neurologist as AD and controls with no clinical or family history of any neurological disease were subjected to Mini-Mental State Examination (MMSE) were evaluated for fourteen relevant biochemical markers using commercial kits. MDR analysis was carried out which is considered a basic machine learning tool for understanding the role of interaction and combination of the factors towards the outcome. PCA is performed to support the MDR interpretation. Through clustering analysis the probably causative factors towards the disease can be identified. Results: MDR analysis revealed that the overall best fit model included 10 factors which had a maximal testing accuracy of 61%, cross-validation consistency of 8/10. PCA analysis has further reduced the factors to Iron, TSAT, HDL, VitB12, FA, and Hcy which are important in disease initiation/progression. Apart from the cases, 9% of the controls who had lower MMSE also had low Iron, TSAT, HDL, VitB12, FA, and high Hcy. Conclusion: As per the results obtained, we would suggest a medical practice where, screening individuals above the age of 55 years with both MMSE and selected biochemical parameters (Iron, TSAT, HDL, VitB12, FA, and Hcy) should be carried out to identify those at risk of developing AD. Higher risk individuals can be suggested for modifications in diet/life style, enhancing certain nutritional components which may constitute promising strategies in postponing, slowing, and/or preventing cognitive decline in AD.

Background Autosomal recessive Long QT syndrome is characterized by prolonged QTc along with congenital bilateral deafness depends on mutations in K + channel genes. A family of a Long QT syndrome proband from India has been identified with novel indel variations. Methods The molecular study of the proband revealed 4 novel indel variations in KCNQ1 . In-silico analysis revealed the intronic variations has led to a change in the secondary structure of mRNA and splice site variations. The exonic variations leads to frameshift mutations. DNA analysis of the available family members revealed a carrier status. Results and Conclusion It is thus predicted that the variations may lead to a change in the position of the splicing enhancer/inhibitor in KCNQ1 leading to the formation of a truncated S2–S3 fragment of KCNQ1 transmembrane protein in cardiac cells as well as epithelial cells of inner ear leading to deafness and aberrant repolarization causing prolonged QTc.

Summary Background An extensive survey on schoolchildren in Kashmir Valley in 1995 showed a high prevalence of goitre, making it imperative to have a relook at our iodine status, 15 years postiodization. Objective To study the total prevalence of goitre and urinary iodine excretion (UIE) in Kashmiri schoolchildren, 15 years postiodization. Design A cross-sectional survey, covering 9576 schoolchildren, aged 5–15 years (5988 in 6–12 year age group) was conducted. Goitres were graded as per WHO/UNICEF/ICCIDD. UIE was measured by the arsenic acid reduction in ceric ions method and was estimated in 208 subsampled children. Results were compared with that of 1995 survey. Results The overall prevalence of goitre in the present study was 38% (95% CI: 34–42) and 37% (95% CI: 32–42) in those aged 6–12 years. No significant difference in prevalence of goitre was observed between boys and girls overall (36% vs 41%. P > 02), nor in the 6–12 year age group (33% vs 40%, P > 01). There was a significant trend of increasing prevalence of goitre with age (P < 0005). UIE ranged from 12 to 397 lg/g.creatinine (median, 104); 11% subjects had UIE of

Access to safe and affordable drinking water for all is an important goal of SDGs (Sustainable Development Goals). Degradation of water quality of coastal aquifers is a major concern throughout the world including the Indus River delta. Looking at the present changing climate scenario, the study was conducted to assess and map the spatial variation in the groundwater quality of district Thatta using GIS (Geographic Information System). The groundwater samples from hundred (100) randomly selected hand pumps of the district were collected such that all union councils of the district were sampled. The water samples were analyzed for different physicochemical parameters, i.e. taste, color, odor, pH, turbidity, EC (Electrical Conductivity), calcium, magnesium, total hardness, chloride, total dissolved solids, and arsenic using standard laboratory techniques. The results of water analysis revealed that 85% of the groundwater samples had TDS (Total Dissolved Solids) concentration beyond the permissible limit described by WHO (World Health Organization). Whereas, all the groundwater samples had chloride concentration beyond permissible limit of 250 mg/l. Analysis for arsenic revealed that only 20% of groundwater samples had a concentration higher than the safe limit of 10 ppb. The study indicated that in most of the areas, the groundwater quality was not as per drinking standards prescribed by WHO, hence was not suitable for drinking purpose. The GIS maps of groundwater quality parameters were prepared using spatial interpolation Kriging tool. These maps provide the visual analysis and interpretation of spatial variability of different groundwater quality parameters, hence are supportive in monitoring and managing the vulnerability of groundwater contamination.

Cranioplasty is a frequently performed procedure in neurosurgery. The pediatric population for this procedure is distinct from the adult one because of the growing skulls and thinner bones of the calvarium. A paucity of data on the outcomes of this procedure in the pediatric population has been identified repeatedly. We conducted a retrospective cohort study to investigate the outcomes in a pediatric population that underwent cranioplasty after craniectomy at our institute in a developing-world country. Our cohort showed no association of complication rate or cosmetic outcomes with the timing of cranioplasty, area of skull defect, type of implant used, or method of storage.

Cardiomyopathies are the sub-acute, chronic disorders of the myocardium that result in cardiac muscle injury thus disrupting the normal contractile function of the heart. HCM and DCM are inflammato...

Long QT Syndrome (LQTS), a disorder of the cardiac repolarization process with prolongation of the QT interval (QTc ≥0.46 seconds), is an ion-channelopathy. Mutations in either KCNQ1 or KCNE1 genes are susceptible to LQTS. Hence, screening of KCNQ1 and KCNE1 genes is taken up to evaluate the genetic correlation of these genes in Long QT patients of Indian origin. A total of 33 Long QT Syndrome patients and 100 healthy subjects were enrolled for the present study. PCR-SSCP protocol was utilised for screening of KCNQ1 and KCNE1 genes followed by In-silico and statistical analysis. The clinical profile of the Long QT syndrome patients in our study revealed a higher percentage of females with the mean age also being higher in females when compared to males. The two variations (S546S and IVS13+36A>G) in KCNQ1 and the S38G polymorphism in KCNE1 gene were identified and their association with Long QT syndrome is being reported for the first time in Indian population. S546S is located in the KCNQ1 C terminus close to this domain and IVS13+36A>G is located in the intronic region in close proximity to the coding region for C-terminal domain; these may therefore affect the functional protein through non-assembly. S38G leads to a substitution of serine to glycine at 38th amino acid position (S38G) in the transmembrane domain of KCNE1. Our study reports compound heterozygosity/genetic compound ofS546S and IVS13+36A>G of KCNQ1 gene. Haplotype frequencies and linkage disequilibrium analysis revealed a significant association between the three biomarkers. Compound heterozygosity of the polymorphisms influence downstream signalling and KCNQ1- KCNE1 interactions.

Apoptosis plays an important role in atherogenesis and rupture of vulnerable plaques in coronary artery disease. FAS and FAS ligand (FASL) induce apoptosis when FAS binds to FAS-L. However sFas blocks apoptosis by binding to FAS and FASL or sFasL. The present study is sought to examine the role of extrinsic apoptotic genes (FAS, FASL) polymorphism and serum levels of FAS, FASL in the pathogenesis and susceptibility to CAD in south Indian population. The study included 300 CAD patients and 300 healthy controls. Lipid profiles, sFas, sFasL were estimated by commercially available kits. FAS -670 G>A, FASL -844 T>C genotypes were analyzed by PCR-RFLP. Secondary structures of pre mRNA were analyzed by the Vienna RNA webserver and gene-gene and gene-environment interactions were determined by MDR analysis. Total cholesterol, triglyceride and LDL levels were significantly high in CAD patients compared to the controls. Molecular analysis revealed that the frequency of the AA genotype of FAS (54% vs 27%) and CC genotypes of FASL (10.3% vs 1.3%) were high in CAD patients compared to controls. Secondary structure analysis of FAS and FASL confirmed our molecular analysis. sFas levels were low while serum sFasL were high in CAD patients. MDR analysis revealed synergistic effects of gene polymorphisms and additive effects of epidemiological factors on risk of CAD. Polymorphisms of FAS (-670 G/A), FASL (-844 T/C) and their circulating levels play an important role in the pathology of CAD.

Nephrotoxicity is an important adverse effect of Amphotericin B, and although risk factors for nephrotoxicity in adults have been investigated, studies examining nephrotoxicity in the pediatric population are scarce. We describe case of 10 year old boy (CALLA - VE B cell ALL) who received conventional Amphotericin-B, but he persisted with hypokalemia.

Sir,We report a case of carpenter's syndrome in a child ofconsanguineous marriage. The child was having cleft lipand turricephaly, polydactyly in both hands, polydactylyand syndactyly in lower limbs. (Fig. 1). The patient wasevaluated with MRI. T1W axial view MRI was showingcortical atrophy, corpus callosum agenesis, and in sagitalview tower shaped skull, and ventricles seem to be singledue to cortical atrophy (Fig. 2). There was no cardiacanomaly on echocardiography.

Heterogeneity in clinical manifestations is a well-known feature in Long QT Syndrome (LQTS). The extent of this phenomenon became evident in families wherein both symptomatic and asymptomatic family members are reported. The study hence warrants genetic testing and/or screening of family members of LQTS probands for risk stratification and prediction.Of the 46 families screened, 18 probands revealed novel variations/compound heterozygosity in the gene/s screened. Families 1–4 revealed probands carrying novel variations in KCNQ1 gene along with compound heterozygosity of risk genotypes of the SCN5A, KCNE1 and NPPA gene/s polymorphisms screened. It was also observed that families- 5, 6 and 7 were typical cases of “anticipation” in which both mother and child were diagnosed with congenital LQTS (cLQTS). Families- 16 and 17 represented aLQTS probands with variations in IKs and INa encoding genes. First degree relatives (FDRs) carrying the same haplotype as the proband were also identified which may help in predictive testing and management of LQTS. Most of the probands exhibiting a family history were found to be genetic compounds which clearly points to the role of cardiac genes and their modifiers in a recessive fashion in LQTS manifestation.