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Quinoa (Chenopodium quinoa Willd.) is a newly introduced crop in Pakistan. We evaluated the antifungal efficacy of root extracts of 4-quinoa varieties (PI 596293, Ames 13730, Ames 13737 and PI 634919) against the most harmful soil inhabiting fungal pathogen Macrophomina phaseolina (Tassi) Goid. Methanolic root extracts (1 to 5 %) of these varieties reduced the fungal biomass by 33-70 %. Due to its higher antifungal activity, Ames 13737 variety was selected for further studies and fractionated with 4-organic solvents (n-hexane, chloroform, ethyl acetate and n-butanol) based on their increased polarities. All concentrations of chloroform and the lowest concentration of n-butanol (1.562 mg mL-1 ) completely inhibited the pathogen growth. These fractions were further subjected to GC-MS analysis that revealed the presence of 7-antifungal phytoconstituents (decane; undecane; oleic acid; benzene, 1,2,3-trimethyl; cycloheptasiloxane, tetradecamethyl-; cyclohexasiloxane, dodecamethyl- and 9-octadecanoic acid (Z)-, methyl ester). This study concluded that chloroform and n-butanol fractions of root extract of quinoa possess strong antifungal potential against M. phaseolina. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial peptide LL-37 is produced in response to active vitamin D and produces immunomodulatory effects and inhibits Mycobacterium tuberculosis replication in vitro. To date, no such clinical studies have been conducted to show relationship between 25hydroxyvitamin D and drug resistant tuberculosis patients in Pakistan. Objective: This study was conducted to find the association between insufficiencies of vitamin D with Cathelicidin LL-37 in drug-resistant tuberculosis patients and compare them with the control group. Methodology: Newly diagnosed drug-resistant TB patients and healthy controls ages 15-50 years old (mean 27.17, SD ± 10.37 years) were enrolled. Plasma LL-37 and serum 25 (OH) D levels were measured by ELISA technique in 46 patients and 94 controls. Results: There was a significant difference (p-value <.001) in the level of Vitamin D in both case and control group. Vitamin D insufficiency prevalence was 57.8% and 42.2% with the mean baseline concentrations of 34.39ng/mL (SD ± 15.28) and 39.41ng/mL (SD ± 18.28) in cases and control respectively. In the mean serum concentrations 52.95ng/mL (SD ± 19.67) and 39.00ng/mL (SD ± 18.02) of LL-37 in cases and control respectively, there was a significant difference of P-value <.001 was found. However, concentrations of vitamin D did not associate with serum LL-37 concentrations (p-value>0.05). Conclusion: Cathelicidine LL-37 is a potential biomarker of TB disease. However, the relationship between vitamin D & LL-37 requires further studies in TB patients. [ABSTRACT FROM AUTHOR]

This study was carried out to analyze the phytochemical profile of Euphorbia prostrata Aiton through GC-MS and identification of possible antifungal, antibacterial and other pesticidal compounds through literature survey. Whole plant material of the weed was collected from Lahore, Pakistan and shade dried followed by two-week extraction in ethyl acetate. The filtrates were analyzed by GC-MS that showed the presence of 19 compounds. The major compound in the extract was 9,19-cyclolanost-24-en-3-ol, (3β)- (24.62%) followed by 9,19-cyclolanostan-3-ol, 24-methylene-, (3β)- (19.51%) and γ-sitosterol (12.51%). Other compounds were phytol (8.11%), n-hexadecanoic acid (6.15%), 9,12,15-octadecatrienoic acid, (Z,Z,Z)- (4.90%), neophytadiene (4.88%), cyclohexane, 1,3,5-triphenyl- (3.71%), hexadecanoic acid, ethyl ester (3.04%), phenol, 2,2'-methylenebis[6-(1,1-dimethylethyl)-4-methyl- (2.42%), octadecanoic acid, ethyl ester (2.24%), octacosane (2.11%), 1-heptacosanol (1.71%), stigmasta-5,24(28)-dien-3-ol, (3β,24Z)- (1.71%), 9,12,15-octadecatrienoic acid, ethyl ester, (Z,Z,Z)- (1.29%), oxirane, hexadecyl- (1.21), 9,12- octadecadienoic acid (Z,Z)- (1.05%), Z-8-methyl-9-tetradecenoic acid (1.01%), and 9-octadecyne (0.76%). Literature survey revealed that eight compounds possess antibacterial, antifungal, nematicidal and/or insecticidal properties. Most of the pesticidal compounds were antibacterial in nature. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) still remain a global public health problem. TB is deadly disease caused by a bacterium named Mycobacterium tuberculosis (MTB). Now a day TB is resurgence in the form of drug resistant TB (DR-TB). In order to improve adherence to anti-TB treatment, the World Health Organization (WHO) promotes the use of directly observed therapy (DOT), in which patients undertake medications under the direct observation of a health care provider. Objectives: The present study was conducted with the aim to find out treatment outcome of 11 months STR treatment for MDR-TB patients atPMDTLRH. Results: This study was conducted fromJuly 2017 to March 2020. In this study only those patients were enrolled who were eligible for newly assigned 11 months short treatment of MDR-TB. All those patients who were achieved final outcomes at time of this final draft were included in this study. The numbers of such patients were 109. Mean age of study cases was 19.544 with standard deviation ±15.947. Majority of study cases (56.0%) were females. For study purpose, study cases were divided into four different groups, of which most of the cases belonged to the age group form 45 years to 64 years of age. About 77.1% of these cases achieved successful treatment outcome and remaining 22.9% of study cases achieved unsuccessful treatment outcome. Conclusion: The findings of the current study have several clear implications for TB control efforts. In light of these findings, it could be concluded that to reduce DR-TB transmission in the community, improvement of treatment outcomes, via ensuring adherence, paying special attention to poor and patient having very far residency form the treatment site. Treatment adherence made better by offering a short, highly effective treatment regimen for MDRTB because of the main challenge in achieving the successful treatment outcome is the large number of pills that patients must ingest every day. This study also concluded that with the experience and dedicated team it is very easy to achieve best success rate for any type of treatment. [ABSTRACT FROM AUTHOR]

Background: Resistance to the first-line drugs is a major issue in tuberculosis (TB) control. Globally 20% of previously treated TB cases have been reported to have multi-drug resistant tuberculosis (MDR-TB). Pakistan is among the top high TB burden countries with an annual incidence of 270 per 100,000 and estimated to have more than 13000 MDR-TB cases. In the province of Khyber Pakhtunkhwa (KPK) the annual incidence of TB is around 55,000 out of which around 5% are retreatment cases. So a survey was needed to determine prevalence of MDR-TB in KPK. Objectives: Objective of the present study is to find out the prevalence of MDR-TB among previously treated (Category II) pulmonary tuberculosis patients in the province of Khyber Pakhtunkhwa, Pakistan. Methodology: A total of 131 cultures positive retreatment patients were included in this cross sectional study. Drug susceptibility testing with Isoniazid, Rifampicin, Streptomycin, Ethambutol and Pyrazinamide were performed with standard technique. Results: Of the 131 patients, 54 (41.2%) showed resistance to one or more drugs. Resistance with isoniazid and rifampicin [MRD-TB] was seen in 20 patients (15.3%). Resistance to streptomycin was highest (31.3%), followed by isoniazid (26.0%). Conclusion: The result of this study showed prevalence of drug resistance of 41.2% and MDR-TB of 15.3% with the first line ATT among retreatment cases of pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Smokeless tobacco denotes tobacco-containing products that are consumed without combustion by different methods like inhaling through the nose, sucking, or chewing. It has been estimated that there are 17 million smokeless tobacco users in Pakistan and the most frequently used forms of smokeless tobacco are Paan, Naswar, and Gutka. Naswar accounts for 60% of the total tobacco consumed in Peshawar, the capital city of Khyber Pakhtunkhwa. The levels of carcinogenic tobacco-specific nitrosamines in Naswar are higher than several smokeless tobacco products in the world. Evidence indicates that both globally and in Pakistan, smokeless tobacco control has almost always remained a neglected area compared to smoking control. The authors recently conducted a mixed-methods research study on smokeless tobacco control in Pakistan (STOP), focusing on Naswar and its supply chain in the Khyber Pakhtunkwa province of Pakistan. In this study, discussions with 38 points of sale and exclusive Naswar vendors, it was found that there was a clear agreement among the participants to support a ban on the sale of Naswar to minors, and similarly, they opposed illicit trade of these products. The participants partially agreed on the content disclosure of Naswar, its advertisement, and promotion. Mass media campaigns, group educations, and the use of special brochures or posters are recommended for the improvement of awareness and compliance among vendors. [ABSTRACT FROM AUTHOR]

Blue mold, Lemon, Penicillium italicum, Pakistan, First report Keywords: Blue mold; First report; Lemon; Penicillium italicum; Pakistan EN Blue mold First report Lemon Penicillium italicum Pakistan 845 846 2 06/01/22 20220501 NES 220501 Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s42161-022-01050-0. [Extracted from the article]

Keywords: Decay; Garlic clove; Molecular characteristics; Penicillium cirinum; Pakistan EN Decay Garlic clove Molecular characteristics Penicillium cirinum Pakistan 337 337 1 03/16/23 20230201 NES 230201 In July 2017, garlic ( I Allium sativum i L.) cloves with greyish green sporulation were observed during storage in Sahiwal and Lahore, Pakistan. Decay symptoms similar to those of original specimens were observed after 5 days on the inoculated cloves while cloves in control remained symptomless. [Extracted from the article]

Background: Multi-drug resistant tuberculosis (MDR-TB) is a major public health problem especially in developing countries. World Health Organization (WHO) recommends use of Xpert MTB/RIF assay to simultaneously detecting Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. The primary objective of this study was to determine the frequency of MDR-TB in patients suspected to have drug resistance in Khyber Pakhtunkhwa. The frequency of probes for various rpoB gene mutations using Xpert MTB/RIF assay within 81 bp RRDR (Rifampicin Resistance Determining Region) was the secondary objective.Methods: A total of 2391 specimens, received at Programmatic Management of Drug Resistant TB (PMDT) Unit, Lady Reading Hospital (LRH) Peshawar, Pakistan, between October 2011 and December 2014, were analyzed by Xpert MTB/RIF test. MTB positive with rifampicin resistance were further analyzed to first line anti-mycobacterial drug susceptibility testing (DST) using middle brook 7H10 medium. The data was analyzed using statistical software; SPSS version 18.Results: Out of 2391 specimens, 1408 (59 %) were found positive for MTB and among them, 408 (29 %) showed rifampicin-resistance with four different rpoB gene mutations within 81 bp RRDR. The frequency of various probes among RIF-resistant isolates was observed as: probe E, in 314 out of 408 isolates; B, 44 out of 408; A, 5 out of 408; D, 34 out of 408; and probe C was observed among 6 out of 408 RIF-resistant isolates. The probe A&B and E&D mutation combination was found in only 1 isolate in each case, while B&D mutation combination was detected among 3 out of 408 RIF-resistant isolates.Conclusions: Hence, it is concluded from our study on a selected population, 29 % of patients had MDR-TB. Probe E related mutations (also known as codon 531and 533) were the most common rpoB genetic mutation [314 (77 %)], acknowledged by Xpert MTB/RIF assay. Least mutation was detected within the sequence 511 (1.2 %). [ABSTRACT FROM AUTHOR]

Background: Drug resistant tuberculosis (DR-TB) is a major public health problem in developing countries such as Pakistan. Objective: The current study was conducted to assess the frequency of drug resistant tuberculosis including multi drug resistance (MDR- TB) as well as risk factors for development of DR-TB, in Punjab, Pakistan. Methodology: Drug susceptibility testing (DST) was performed, using proportion method, for 2367 culture positive Mycobacterium tuberculosis (MTB) cases that were enrolled from January 2012 to December 2013 in the province of Punjab, Pakistan, against first-line anti-tuberculosis drugs. The data was analyzed using statistical software; SPSS version 18. Results: Out of 2367 isolates, 273 (11.5%) were resistant to at least one anti-TB drug, while 221 (9.3%) showed MDR- TB. Risk factors for development of MDR-TB were early age (ranges between 10–25 years) and previously treated TB patients. Conclusion: DR-TB is a considerable problem in Pakistan. Major risk factors are previous history of TB treatment and younger age group. It emphasizes the need for effective TB control Program in the country. [ABSTRACT FROM AUTHOR]

The present study was carried out to explore the causal organism of dieback of Eucalyptus citriodora Hook in different areas of Punjab, Pakistan. Diseased samples of E. citriodora suffering from dieback were collected during January to March 2010. Purple to reddish spots were observed on leaf of this tree. Pathogen was isolated on malt extract agar medium. Isolated fungus was identified as Alternaria alternata (Fr.) Keissl. The isolated fungus was inoculated on E. citriodora leaves. The same fungus was re-isolated from the artificially inoculated diseased leaves that confirms A. alternata as causal agent of dieback in E. citriodora in Pakistan. [ABSTRACT FROM AUTHOR]

Keywords: Blue mold; First report; Tomato; Pakistan; Penicillium echinulatum EN Blue mold First report Tomato Pakistan Penicillium echinulatum 1143 1143 1 08/23/22 20220801 NES 220801 Supplementary information The online version contains supplementary material available at https://doi.org/10.1007/s42161-022-01110-5. Blue mold, First report, Tomato, Pakistan, Penicillium echinulatum. [Extracted from the article]

Rumex dentatus L. is a very common weed of wheat (Triticum aestivum L.) in Pakistan. Present laboratory and pot trials were carried out to evaluate metabolites of Drechslera holmii, Drechslera biseptata and Drechslera australiensis as natural herbicides against R. dentatus. Fungal metabolites were prepared in M1D medium. In laboratory bioassays, original and 50% diluted metabolites of different Drechslera spp. significantly reduced seed germination, shoot biomass and root biomass of R. dentatus seedlings by 5-56%, 15-83% and 68-88%, and that of wheat seedlings by 8-20%, 16-38% and 28-38%, respectively. Metabolites of D. biseptata and D. australiensis exhibited greater herbicidal activity than metabolites of D. holmii. In foliar spray repeated pot trials, original metabolites of the three Drechslera spp. significantly reduced shoot biomass of one- and two-week old plants of R. dentatus by 54-60% and 27-46%, respectively. By contrast, the effect of metabolites of all the three Drechslera spp. was non-significant on growth of wheat plants. Metabolites of D. australiensis showed the highest herbicidal activity in pot trials. It is concluded that metabolites of Pakistani Drechslera spp. possess herbicidal potential. [ABSTRACT FROM AUTHOR]

Background Multiple drugs therapies may be the potential source of drug-drug interactions that can result in alteration of therapeutic response and/or increase untoward effects of many drugs. Objective To identify the frequency and levels of potential drug-drug interactions (pDDIs) in internal medicine wards and their association with patients' age, gender, length of hospital stay and number of prescribed medications; and to describe management of frequently identified major or moderate pDDIs. Setting Internal medicine wards of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. Method Micromedex Drug-Reax system was used to screen patient's profiles for pDDIs. Logistic regression was applied to determine the odds ratio for specific risk factors of pDDIs i.e., age, gender, hospital-stay and number of medications. Main outcome measure Overall prevalence and prevalence of contraindicated, major, moderate and minor pDDIs; levels of pDDIs; frequently identified major or moderate interactions; and odds ratios for risk factors. Results Total, 188 interacting drug-combinations were identified that contributed to 675 pDDIs. Of 400 patients, 52.8 % patients were presented with at least one pDDI (overall prevalence), 21.3 % with at least one major-pDDI, and 44.3 % with at least one moderate-pDDI. Of 675 pDDIs, most were of moderate (63.6 %) or major severity (23 %); good (61.2 %) or fair (25.5 %) type of scientific evidence; and delayed onset (50.2 %). Most frequently identified major or moderate interactions resulted in 45.3 % of all pDDIs. Their potential adverse outcomes included hepatotoxicity, bleeding, ototoxicity, nephrotoxicity, hypoglycemia, hyperglycemia, risk of thrombosis, hypotension, cardiac arrhythmias and reduction in therapeutic-effectiveness. There was significant association of the occurrence of pDDIs with patients' age of 60 years or more (OR = 2.1; 95 % CI = 1.3-3.3; p = 0.003), hospital stay of 6 days or longer (OR = 2.6; 95 % CI = 1.5-4.5; p = 0.001), and seven or more number of prescribed medications (OR = 5.9; 95 % CI = 3.6-9.6; p < 0.001). Conclusion The present study has recorded a high prevalence of pDDIs in internal medicine wards. Patients with old age, longer hospital stay and increased number of prescribed medications were at higher risk. [ABSTRACT FROM AUTHOR]

A study was carried out at the Institute of Mycology and Plant Pathology, University of Punjab, Lahore, Pakistan during 2007 to investigate the phytotoxic effects of an alien weed Parthenium hysterophorus L. in comparison with two native Asteraceous weed species viz. Ageratum conyzoides L. and Sonchus oleraceous L. on mungbean (Vigna radiata L. Wilczek) germination and growth. The highest concentration of Parthenium leaf extract (15% w/v) reduced mungbean germination by 26 percent as compared to 11 and zero percent reduction due to same extract concentration of S. oleraceous and A. conyzoides, respectively. Shoot length of mungbean seedlings was reduced by 17-52 percent and 23-52 percent, and shoot biomass by 26-36 percent and 2.4-58 percent due to various extract concentrations of parthenium and A. conyzoides, respectively. Shoot length was stimulated by extract of S. oleraceous. In general, extracts of all three test weed species stimulated the root growth of mungbean. The results conclude that aqueous extracts of alien weed Parthenium exhibited more phytotoxic effects on germination of mungbean as did by two test native weed species belonging to same family. [ABSTRACT FROM AUTHOR]

Parthenium weed (Parthenium hysterophorus L.) is an alien invasive weed of neotropical origin spreading rapidly in Punjab and North West frontier provinces of Pakistan. The present study was carried out to investigate the distribution of parthenium and its allelopathic effects against maize in comparison to native associated asteraceous weed species growing in wastelands district of Lahore. Survey revealed that parthenium weed is becoming a dominant part of local wasteland flora with the highest values of relative density and frequency as compare to other asteraceous weeds. Different concentrations of selected weed extracts failed to decline the germination of maize except higher (15%) concentration of S. arvensis that resulted in reduction of 28% in germination rate as compared to the control. Data recorded on shoot length of maize reflected that the lower concentrations of C. arvense significantly suppressed the shoot length and biomass of maize. Shoot biomass of maize was again significantly reduced even at lower concentrations of A. conyzoides and C. arvense. Interestingly, Inula sp. extracts at all test concentrations resulted in an increased biomass of maize. Root length and biomass appeared to be most sensitive part of maize and retarded significantly in response to different concentrations of extracts of all the test species except for Inula sp. [ABSTRACT FROM AUTHOR]

A study was conducted at the Institute of Mycology and Plant Pathology, University of Punjab, Quaid-e-Azam Campus, Lahore, Pakistan during 2008. Herbicidal activity of aqueous extracts of two medicinal plants of family Solanaceae viz. Withania somnifera Dunal and Datura alba Nees was evaluated against Rumex dentatus L., one of the most problematic weeds of wheat in Pakistan. Aqueous extracts of root and shoot of both test medicinal plant species resulted in pronounced suppression in germination as well as seedling growth of target weed species. However, variability in herbicidal potential of different types of employed extracts was evident. Germination was comparatively less susceptible while root growth in R. dentatus was highly susceptible to all aqueous extracts. Application of aqueous extracts caused 68 percent reduction in germination, 62 percent in shoot length, 96 percent in root length and 68 percent in seedling biomass. [ABSTRACT FROM AUTHOR]

The author reflects on the 25-year existence of Journal of Postgraduate Medical Institute (JPMI) in Peshawar, Pakistan. The author mentions that JPMI's parent institution Postgraduate Medical Institute (PGMI) was established in August 1984 by Dean Professor Jamil Ahmed and Governor General Fazal Haq. The author notes that the purpose of publishing the journal is to build a forum through which the scientific work being done in the medical institutions is highlighted.

The author reflects on the global threat for the emergence of multidrug resistant tuberculosis (MDR-TB) in Pakistan. The author is critical on the challenges for the implementation of DOTS Plus strategies which include laboratory, treatment and logistic support. It concludes that the highest priority of the government is to prevent the MDR through effective DOTS.

Purpose: To identify the frequency, levels and predictors of potential drug-drug interactions (pDDIs) in a pediatrics ward of a teaching hospital in Pakistan. Methods: Medication profiles of 400 pediatric patients were evaluated for pDDIs using Micromedex Drug-Reax® software. Logistic regression was used to identify association of pDDIs with hospital-stay, patient's gender, and number of medications. Results: In total, 86 interacting drug-combinations resulting in 260 pDDIs were identified. Overall, 25.8 % patients were exposed to at least one pDDI regardless of severity-type, 10.7 % to at least one majorpDDI, 15.2 % to at least one moderate-pDDI, and 12.5 % to at least one minor-pDDI. Of 260 pDDIs, most were of moderate severity (41.5 %) followed by minor (35.4 %) and major severity (21.9 %); good (76.9 %) or fair (16.5 %) type of scientific evidence; and delayed onset (46.5 %). Some widespread major or moderate interactions included rifampin + pyrazinamide (14 cases), phenobarbital + diazepam (14), dexamethasone + rifampin (8), amikacin + furosemide (7), furosemide + captopril (7), dexamethasone + phenobarbital (6), phenobarbital + divalproex sodium (6), isoniazid + rifampin (5) amikacin + ibuprofen (5), digoxin + furosemide (4), and acetaminophen + phenytoin sodium (4). There was significant association of the occurrence of pDDIs with five or more prescribed medications (p < 0.001). Conclusion: PDDIs are less prevalent in the pediatrics ward of the hospital studied. Most of the interactions were of moderate severity. Patients with increased number of prescribed medications were more exposed to these interactions. [ABSTRACT FROM AUTHOR]

Purpose: To identify the prevalence of potential drug-drug interactions (pDDIs) in a psychiatric ward, their levels and association with risk factors. Methods: This study was conducted in the psychiatric ward of Ayub Teaching Hospital, Abbottabad, Pakistan. Medical records of 415 patients were retrospectively reviewed for pDDIs using Micromedex Drug-Reax software. Logistic regression was applied to determine association of pDDIs with age, gender, hospital stay and number of drugs. Results: In our study, we identified total number of 825 pDDIs of 126 types, with median number of 1 pDDIs per patient. Overall 64.8 % of the patients had at least one pDDI; 27.2 % at least one major pDDI; and 58.5 % patients at least one moderate pDDI. Among 825 identified pDDIs, most were of moderate (75.6 %) or major (20.8 %) severity, good (66.4 %) or fair (29 %) type of scientific evidence; and delayed onset (71 %). The most frequent major and moderate pDDIs included haloperidol + procyclidine (127 cases), haloperidol + olanzapine (49), haloperidol + promethazine (47), haloperidol + fluphenazine (41), diazepam + divalproex sodium (40), haloperidol + trihexyphenidyl (37), lorazepam + divalproex sodium (34), fluphenazine + procyclidine (33) and olanzapine + divalproex sodium (32). There was significant association of occurrence of pDDIs with hospital stay of 7 days or longer (p = 0.005) and taking 7 or more drugs (p < 0.001). Conclusion: A high prevalence of pDDIs in the psychiatric ward was recorded, a majority of which were of moderate severity. Patients with long hospital stay and increased number of drugs were more exposed to pDDIs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate various types of lung malignancies diagnosed through bronchoscopy, and their presentations. Methodology: This descriptive study was based in a tertiary care chest facility in Peshawar. Duration of the study was from June 2005 - June 2009. The material was obtained from the bronchoscopy record in the chest clinic. All the patients bronchoscoped from June 2005 - June 2009 were studied for their outcome. Result: This study included 425 patients, 306 (72%) were males and 235 (55.3%) of patients were between 31-60 years age. Ninety two (21.6%) patients were diagnosed with lung cancer; of which 73 (79.5%) patients were males and 19 (20.5%) were females. Sixty five (70.7%) of the 92 patients initially presented with shadow on the Chest radiograph, 9 (9.80%) patients had superior vena caval obstruction, 8 (8.70%) patients presented with lung collapse, 6 (6.52%) with haemoptysis, and 4 (4.35%) patients with hoarseness of voice. Forty three (46.7%) patients were diagnosed with squamous cell carcinoma, 29 (31.5%) with adenocarcinoma, 17 (18.5%) with small cell type carcinoma and 3 (3.30%) patients had large cell type carcinoma. Fifty four (58.7%) patients of the 92 were smokers or had a history of smoking, Anthracosis was found in 45 (10.6%) patients out of all the 425 patients. Conclusion: Commonest type of lung cancer in this study was squamous cell (46.7%) followed by adenocarcinoma (31.5%) and small cell carcinoma (18.5%). Squamous cell carcinoma was strongly associated with cigerrete smoking as compared to adenocarcinoma in this study. [ABSTRACT FROM AUTHOR]

Introduction: South Asia is home to more than 300 million smokeless tobacco (ST) users. Bangladesh, India and Pakistan as signatories to the Framework Convention for Tobacco Control (FCTC) have developed policies aimed at curbing the use of tobacco. The objective of this study is to assess the compliance of ST point-of-sale (POS) vendors and the supply chain with the articles of the FCTC and specifically with national tobacco control laws. We also aim to assess disparities in compliance with tobacco control laws between ST and smoked tobacco products., Methods and Analysis: The study will be carried out at two sites each in Bangladesh, India and Pakistan. We will conduct a sequential mixed-methods study with five components: (1) mapping of ST POS, (2) analyses of ST samples packaging, (3) observation, (4) survey interviews of POS and (5) in-depth interviews with wholesale dealers/suppliers/manufacturers of ST. We aim to conduct at least 300 POS survey interviews and observations, and 6-10 in-depth interviews in each of the three countries. Data collection will be done by trained data collectors. The main statistical analysis will report the frequencies and proportions of shops that comply with the FCTC and local tobacco control policies, and provide a 95% CI of these estimates. The qualitative in-depth interview data will be analysed using the framework approach. The findings will be connected, each component informing the focus and/or design of the next component., Ethics and Dissemination: Ethical approvals for the study have been received from the Health Sciences Research Governance Committee at the University of York, UK. In-country approvals were taken from the National Bioethics Committee in Pakistan, the Bangladesh Medical Research Council and the Indian Medical Research Council. Our results will be disseminated via scientific conferences, peer-reviewed research publications and press releases., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Objective: To identify and explore medical students' perceptions about their academic failure., Methods: The qualitative study was conducted at Shifa College of Medicine, Islamabad, Pakistan, from December 2016 to January 2017, and comprised medical students. Two focus group discussions and 5 semi-structured interviews were conducted with students who had obtained <50% marks in their first professional examinations. Key words and important points in the written text were highlighted, coded, themed and categorised. Data was analysed manually., Results: There were 22 students in the two focus group discussions; 13(59%) males and 9(41%) females. Of the 5 interviewees, 3(60%) were males and 2(40%) were females. Variable factors related to failure ranged from curriculum, assessment, environment, educators and personal factors to issues relating to stress and time management, learning resources, financial support, living away from home, poor attendance, peer pressure during small group discussions and indoctrination by parents., Conclusions: Both personal and environmental factors were found to be affecting academic performance of medical students.

Objective: To determine if there was any significant difference in scores of students who acquired knowledge through team-based learning (TBL) versus those who learned through small group discussion (SGD)., Study Design: Quasi-experimental cross-over study., Place and Duration of Study: Shifa College of Medicine, Islamabad, from March to December 2015., Methodology: All students of second year MBBS were assigned to either TBL or SGD, based on non-probability sampling, for 8 themes in a five-week module. The groups were flipped after 4 themes. TBL format recommended by the AMEE guide No: 65 was followed. The impact of both learning methods was assessed by comparing end-of-module written examination scores of the two groups through independent sample t-test. SPSS version 23 was used for data analysis. A p-value of <0.05 was considered statistically significant., Results: End-of-module written examination scores showed there was no significant difference in student academic performance when they studied with TBL or SGD in themes 1-4 (TBL 61.90 ±13.01 versus SGD 59.65 ±11.56, p=0.41). However, for themes 5-8 there was a significant difference in scores (TBL 65.36 ±11.62 versus SGD 59.92 ±10.65, p=0.03) A trend towards higher scores was observed in content learned with TBL in all eight themes., Conclusion: TBL is equally effective as an instructional method as SGD. However, it could not be established that it results in significant improvement in learning.

Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about prevalence, management, and risk factors for adverse drug reactions (ADRs) in MDR-TB patients in Pakistan. To evaluate occurrence, management, and risk factors for ADRs in MDR-TB patients, and its impact on treatment outcomes, this observational cohort study was conducted at programmatic management unit for drug resistant TB of Lady Reading Hospital Peshawar, Pakistan. A total of 181 MDR-TB patients enrolled at the study site from January 1, 2012 to February 28, 2013 were included. Patients with drug resistant TB other than MDR-TB, transferred out patients and those who were still on treatment at the end of study duration (January 31, 2015) were excluded. Patients were followed until treatment outcomes were reported. ADRs were determined by laboratory data and/or clinical criteria. SPSS 16 was used for data analysis. A total of 131 patients (72.4%) experienced at least 1 ADR. Gastrointestinal disturbance was the most commonly observed adverse event (42%), followed by psychiatric disturbance (29.3%), arthralgia (24.3%), and ototoxicity (21%). Potentially life-threatening ADRs, such as nephrotoxicity (2.7%) and hypokalemia (2.8%) were relatively less prevalent. Owing to ADRs, treatment regimen was modified in 20 (11%) patients. On multivariate analysis, the only risk factor for ADRs was baseline body weight ≥ 40 kg (OR = 2.321, P-value = 0.013). ADRs neither led to permanent discontinuation of treatment nor adversely affected treatment outcomes. Adverse effects were prevalent in current cohort, but caused minimal modification of treatment regimen, and did not negatively impact treatment outcomes. Patient with baseline body weight ≥ 40 kg should be closely monitored.

To evaluate the predictive value of time to sputum culture conversion (SCC) in predicting cure and factors associated with time to SCC and cure in multidrug-resistant tuberculosis (MDR-TB) patients, a retrospective study was conducted at programmatic management unit of drug resistant tuberculosis (TB), Peshawar. A total of 428 pulmonary MDR-TB patients enrolled at the study site from January 1, 2012 to August 31, 2014 were followed until treatment outcome was recorded. Survival analysis using Cox proportional hazards model and multivariate binary logistic regression were, respectively, used to identify factors associated with time to SCC and cure. A P value < 0.05 was considered statistically significant. Overall, 90.9% patients achieved SCC, and 76.9% were cured. Previous use of second-line drugs (SLDs) (hazard ratio [HR] = 0.637; 95% confidence interval [CI] = 0.429-0.947), ofloxacin resistance (HR = 0.656; 95% CI = 0.522-0.825) and lung cavitation (HR = 0.744; 95% CI = 0.595-0.931) were significantly associated with time to SCC. In predicting cure, sensitivities of SCC at 2, 4, and 6 months were 64.1% (95% CI = 58.69-69.32), 93.0% (95% CI = 89.69-95.52), and 97.6% (95% CI = 95.27-98.94), respectively, whereas specificities were 67.7% (95% CI = 57.53-76.73), 51.5% (95% CI = 41.25-61.68), and 44.4% (95% CI = 34.45-54.78), respectively. Furthermore, patients' age of 41-60 (odds ratio [OR] = 0.202; 95% CI = 0.067-0.605) and > 60 years (OR = 0.051; 95% CI = 0.011-0.224), body weight > 40 kg (OR = 2.950; 95% CI = 1.462-5.952), previous SLD use (OR = 0.277; 95% CI = 0.097-0.789), lung cavitation (OR = 0.196; 95% CI = 0.103-0.371) and ofloxacin resistance (OR = 0.386; 95% CI = 0.198-0.749) were significantly associated with cure. Association of SCC with cure was substantially stronger at 6 months (OR = 32.10; 95% CI = 14.34-71.85) than at 4 months (OR = 14.13; 95% CI = 7.92-25.21). However in predicting treatment outcomes, the combined sensitivity and specificity of SCC at 4 months was comparable to SCC at 6 months. Patients with risk factors for delayed SCC were also at high risk of unsuccessful outcomes.

Background: Fluoroquinolones are the backbone of multidrug resistant tuberculosis treatment regimens. Despite the high burden of multidrug resistant tuberculosis in the country, little is known about drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance among multidrug resistant tuberculosis patients from Pakistan., Objective: To evaluate drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients., Methods: This was a cross-sectional study conducted at a programmatic management unit of drug resistant tuberculosis, Lady Reading Hospital Peshawar, Pakistan. Two hundred and forty-three newly diagnosed multidrug resistant tuberculosis patients consecutively enrolled for treatment at study site from January 1, 2012 to July 28, 2013 were included in the study. A standardized data collection form was used to collect patients' socio-demographic, microbiological, and clinical data. SPSS 16 was used for data analysis., Results: High degree of drug resistance (median 5 drugs, range 2-8) was observed. High proportion of patients was resistant to all five first-line anti-tuberculosis drugs (62.6%), and more than half were resistant to second line drugs (55.1%). The majority of the patients were ofloxacin resistant (52.7%). Upon multivariate analysis previous tuberculosis treatment at private (OR=1.953, p=0.034) and public private mix (OR=2.824, p=0.046) sectors were predictors of ofloxacin resistance., Conclusion: The high degree of drug resistance observed, particularly to fluoroquinolones, is alarming. We recommend the adoption of more restrictive policies to control non-prescription sale of fluoroquinolones, its rational use by physicians, and training doctors in both private and public-private mix sectors to prevent further increase in fluoroquinolones resistant Mycobacterium tuberculosis strains., (Copyright © 2015 Elsevier Editora Ltda. All rights reserved.)

Background: Various studies have reported culture conversion at two months as a predictor of successful treatment outcome in multidrug-resistant tuberculosis (MDR-TB)., Objectives: The present study was conducted with the aim to evaluate the rate and predictors of culture conversion at two months in MDR-TB patients., Methods: All confirmed pulmonary MDR-TB patients enrolled for treatment at Lady Reading Hospital Peshawar, Pakistan from 1 January to 31 December 2012 and met the inclusion criteria were reviewed retrospectively. Rate and predictors of culture conversion at two months were evaluated., Results: Eighty seven (53.4%) out of 163 patients achieved culture conversion at two months. In a multivariate analysis lung cavitation at baseline chest X-ray (P = 0.006, OR = 0.349), resistance to ofloxacin (P = 0.041, OR = 0.193) and streptomycin (P = 0.017, OR = 0.295) had statistically significant (P<0.05) negative association with culture conversion at two months., Conclusion: A reasonable proportion of patients achieved culture conversion at two months. Factors negatively associated with culture conversion at two months can be easily identified either before diagnosis or early in the course of MDR-TB treatment. This may help in better care of individual patients by identifying them early and treating them vigorously.

Rumex dentatus L. is a problematic weed of wheat. Bioassay-directed isolation of culture filtrates of a plant pathogenic fungus Drechslera australiensis gave holadysenterine as the main herbicidal constituent against this weed of wheat. Leaf disc bioassay showed that herbicidal activity of holadysenterine was comparable to that of synthetic herbicide 2,4-D. This is the first report of this herbicidal compound from the genus Drechslera.

Few recent comparative data exist on smoking habits in the Middle East and North Africa (MENA) region. The objective of this analysis was to evaluate smoking patterns in a large general population sample of individuals aged ≥ 40 years in ten countries in the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A random sample of 457,258 telephone numbers was generated and called. This identified 65,154 eligible subjects, of whom 62,086 agreed to participate. A screening questionnaire was administered to each participant, which included six questions relating to cigarette consumption and waterpipe use. The age- and gender-adjusted proportion of respondents reporting current or past smoking of cigarettes or waterpipes was 31.2% [95% CI: 30.9-31.6%]. This proportion was significantly higher (p < 0.001) in men (48.0%) than in women (13.8%), but no relevant differences were observed between age groups. Smoking rates were in general lowest in the Maghreb countries and Pakistan and highest in the Eastern Mediterranean countries, ranging from 15.3% in Morocco to 53.9% in Lebanon. Consumption rates were 28.8% [28.4-29.2%] for cigarette smoking and 3.5% [3.4-3.6%] for waterpipe use. Use of waterpipes was most frequent in Saudi Arabia (8.5% of respondents) but remained low in the Maghreb countries (< 1.5%). Cumulative cigarette exposure was high, with a mean number of pack · years smoked of 18.5 ± 20.5 for women and 29.1 ± 26.2 for men. In conclusion, smoking is a major health issue in the MENA region., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Five flavonoids, namely (-)-epicatechin-3-O-β-glucopyranoside (1), 5-hydroxy-3-(4-hydroxylphenyl)pyrano[3,2-g]chromene-4(8H)-one (2), 6-(p-hydroxybenzyl)taxifolin-7-O-β-D-glucoside (tricuspid) (3), quercetin-3-O-α-glucopyranosyl-(1 → 2)-β-D-glucopyranoside (4) and (-)-epicatechin(2-(3,4-dihydroxyphenyl)-3,4-dihydro-2H-chromene-3,5,7-triol (5), were isolated from the leaves of mango (Mangifera indica L.). Antifungal activity of these compounds was evaluated against five fungal species, namely Alternaria alternata (Fr.) Keissler, Aspergillus fumigatus Fresenius, Aspergillus niger van Tieghem, Macrophomina phaseolina (Tassi) Goid. and Penicillium citrii. Six concentrations, namely 100, 300, 500, 700, 900 and 1000 ppm of each of the five flavonoids were employed by means of the poisoned medium technique. All concentrations of the five test flavonoids significantly suppressed fungal growth. However, the specificity of different test compounds was evident against different fungal species. In general, antifungal activity of the flavonoids was gradually increased by increasing their concentrations. The highest concentration (of 1000 ppm) of compounds 1-5 reduced the growth of different target fungal species by 63-97%, 56-96%, 76-99%, 76-98% and 82-96%, respectively.

Objective: To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi., Study Design: Cross-sectional study., Place and Duration of Study: Multicentric study involving various TB clinics and treatment centres of Karachi between April to December 2005., Methodology: The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method., Results: Fifteen (11.5%) samples in 130 eligible patients showed primary resistance to one or more drugs. Ten (7.6%) of the isolates tested were resistant to a single drug, none were resistant to 2 drugs, 4 (3.0%) to 3 drugs and 1 (0.76%) to 4 drugs while 1 (0.76%) to all 5 first line agents. Resistance to streptomycin (10 microg/ml) was seen in 8 (6.1%), isoniazid (1microg/ml) in 12 (9.2%), Rifampicin (5 microg/ml) in 4 (3.0%), ethambutol (10 microg/ml) in 1 (0.76%) and pyrazinamide in 6 (4.6%) samples. Primary Multi-Drug Resistance (PMDR) was found in 2 (1.5%) patients. (Isoniazid 1 microg/ml, rifampicin 5 microg/ml with or without other drugs)., Conclusion: In the studied patients, primary drug resistance to at least one anti-tuberculosis drug was 11.5%. It requires an efficiently working anti-tuberculosis programme to prevent escalation including resistance.

Objective: To assess the prevalence of Primary drug resistance to Antituberculous drugs in NWFP METHOD: A cross-sectional prevalence study was undertaken to evaluate the prevalence of drug resistance among new TB patients, using a non-probability convenience sampling methodology. Sample size was calculated according to the population and WHO's estimated incidence of smear positive tuberculosis in the province/country. Sputum samples were obtained from 122 newly diagnosed patients of pulmonary tuberculosis from centres in Peshawar and Abbotabad in NWFP., Results: Sensitivities were performed by proportion method which showed the following resistance values in 118 eligible patients: 15 (12.7%) samples showed primary resistance to one or more drugs. 8 (6.4%) isolates were resistant to a single drug, 2 (1.6%) were resistant to 2 drugs, 4 (3.2%) to 3 drugs, 1 (0.8%) to 4 drugs while none to all 5 first line agents. Resistance to Streptomycin (10 microg/ml) was seen in 7 (5.9%), Isoniazid (1 microg/ml) in 10 (8.4%), Rifampicin (5 microg/ml) in 3 (2.5%), Ethambutol (10 microg/ml) in 2 (1.6%) and Pyrazinamide in 6 (5.0%) samples. Primary Multidrug resistance was 2.5%., Conclusion: This study suggests that prevalence of MDR amongst untreated patients in NWFP is 2.5%, which is a cause of concern and should be addressed through effective TB control programmes with DOTS strategy.