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Epilepsy is a neurological disorder involving a number of disease syndromes with a complex etiology. A properly matched antiseizure drug (ASD) gives remission in up to 70% of patients. Nevertheless, there is still a group of about 30% of patients suffering from drug-resistant epilepsy. Consequently, the development of new more effective and/or safer ASDs is still an unmet clinical need. Thus, our current studies were focused on the structural optimization/modifications of one of the leading compounds, KA-11, aiming at the improvement of its antiseizure activity. As a result, we designed and synthesized two close analogs with highly pronounced drug-like physicochemical properties according to in silico predictions, namely KA-228 and KA-232, which were subsequently tested in a panel of animal seizure models, i.e., MES, 6 Hz (32 mA), scPTZ and ivPTZ. Among these compounds, KA-232, which was designed as a water-soluble salt, was distinctly more effective than KA-228 and assured similar antiseizure protection as its chemical prototype KA-11. With the aim of a more detailed characterization of both new molecules, in vitro binding tests were performed to evaluate the potential mechanisms of action. Furthermore, KA-232 was also evaluated in several ADME-Tox studies, and the results obtained strongly supported its drug-like potential. The proposed chemical modification of KA-11 enabled the identification of new pharmacologically active chemotypes, particularly water-soluble KA-232, which, despite the lack of better efficacy than the leading compound, may be used as a chemical prototype for the development of new ASDs, as well as substances potentially active in other neurological or neurodegenerative conditions.

Background: In both emerging and wealthy nations, the epidemic of overweight and obesity has exploded in the last several decades, becoming a huge public health concern. Objective: To estimate the frequency of overweight and obesity and its important determinants among the adult population of Selected Districts of Khyber Pakhtunkhwa Pakistan Methods: A descriptive cross sectional study was conducted by the Department of Community Medicine, Saidu Medical College, Swat Khyber Pakhtunkhwa Pakistan; from January to April 2022. A total of 410 adults were selected and a structured questionnaire was used to collect relevant information. Results: Results showed that 67.07% had age above 30 years; 72.44% were males, 37.32% were illiterate; 51.95% had monthly income less than 25000/ PKR; 54.39% were married; and 26.34% had family history of overweight and obesity. Moreover, 52.93% had sedentary life; 37.56% watch television; and 15.85% & 17.80% had diabetes mellitus & hypertension respectively. Furthermore, 26.34% prefer carbohydrates; and 44.15$ prefer soft drinks. 63.66% and 58.05% didn’t prefer vegetables and fruits respectively. Conclusions: It was concluded that prevalence of overweight and obesity showed moderate to high frequency among adults, and showed relationship was age, gender, marital status, tobacco smoking, dietary habits, and social habits. Thus effective educational, behavioral and social strategies are needed to prevent and control overweight and obesity in the population. Keywords: Prevalence, Determinants, Developing, Adults, Obesity, Overweight, Pakistan

In the last decade, a better understanding of the molecular pathogenesis of B-cell non-Hodgkin lymphomas has resulted in the development of novel targeted therapies, such as small molecule inhibitors of select kinases in the B-cell receptor pathway, antibody–drug conjugates, and small molecules that target a variety of proteins (eg, CD-19, EZH2, and XPO-1–mediated nuclear export). Anti-CD19 CAR T-cell therapy, first approved for relapsed/refractory (R/R) diffuse large B-cell lymphoma, has also emerged as a novel treatment option for R/R follicular lymphoma and mantle cell lymphoma. These NCCN Guideline Insights highlight the new targeted therapy options included in the NCCN Guidelines for B-Cell Lymphomas for the treatment of R/R disease.

Background Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) is a front-line treatment for patients with aggressive B-cell lymphomas. Bcl-2 is associated with chemoresistance due to BCL2 gene rearrangement or protein overexpression and is antagonised by venetoclax. We aimed to assess the safety of venetoclax with dose-adjusted EPOCH-R as initial therapy in aggressive B-cell lymphoma. Methods We conducted a single-arm, phase 1 study across seven treatment centres in the USA. Eligible patients were aged 18-80 years with histologically confirmed, previously untreated diffuse large B-cell lymphoma, transformed indolent non-Hodgkin lymphoma, high-grade B-cell lymphoma with double-hit or not otherwise specified, or primary mediastinal B-cell lymphoma, with Ann Arbor stage II-IV and Eastern Cooperative Oncology Group performance status of 0-2. Participants received six cycles of oral venetoclax 400 mg, 600 mg, or 800 mg once daily for 10 days per cycle with dose-adjusted EPOCH-R (one cycle every 3 weeks; baseline doses were intravenous rituximab 375 mg/m2 on day 1, intravenous etoposide 50 mg/m2 on days 1-4, oral prednisone 60 mg/m2 twice daily on days 1-5, intravenous vincristine 0·4 mg/m2 on days 1-4, intravenous cyclophosphamide 750 mg/m2 on day 5, and intravenous doxorubicin 10 mg/m2 on days 1-4). A subsequent cohort received venetoclax 600 mg once daily for 5 days per cycle. The primary endpoints were the maximum tolerated dose, dose-limiting toxicities, and the recommended phase 2 dose of venetoclax. Analyses were done per protocol. This trial is registered with ClinicalTrials.gov, NCT03036904, and enrolment is now closed. Findings Between Feb 3, 2017, and June 4, 2019, 34 patients were assessed for eligibility, and 30 were enrolled and received venetoclax with dose-adjusted EPOCH-R. The median patient age was 64·0 years (IQR 51·6-69·4). The maximum tolerated dose was 800 mg for 10 days and the established recommended phase 2 dose was 600 mg for 5 days due to tolerability for treatment duration. One (3%) of 30 patients had a dose-limiting toxicity in cycle one (grade 4 thrombocytopenia with 800 mg dose). The most common grade 3-4 adverse events were cytopenias (28 [93%] of 30 patients); febrile neutropenia occurred in 19 (63%) patients. Grade 3-4 non-haematological adverse events included hypophosphataemia (n=10), hypokalaemia (n=7), and hyperglycaemia (n=5). Serious adverse events included infection (n=7) and gastrointestinal toxicities including abdominal pain (n=3), colonic perforation (n=1), and small intestinal obstruction (n=1). There was one treatment-related death (sepsis). Overall response rate was 96·7% (95% CI 82·8-99·9); 28 (93·3% [77·9-99·2]) of 30 patients had complete response and one (3·3% [0·1-17·2]) had a partial response. Interpretation Venetoclax with dose-adjusted EPOCH-R showed an acceptable safety profile at the recommended phase 2 dose and had encouraging preliminary activity in this population at high risk of adverse outcomes, and is worthy of further study. The combination is being investigated in Alliance 051701 (NCT03984448). Funding Genentech.

Moyamoya angiopathy (MMA) related cerebral perfusion deficits or infarctions might influence quality of life (QoL). This study examines preoperative QoL in adult patients with MMA and correlates these with findings obtained via diagnostic imaging. Sixty-seven adult Moyamoya patients underwent preoperative neuropsychological testing including questionnaires to determine QoL, as well as psychiatric and depressive symptoms. The results were checked for correlation with territorial hypoperfusions seen in H215O PET with acetazolamide (ACZ) challenge (cerebrovascular reserve) and infarction patterns observed in MRI. Each vascular territory was analyzed separately and correlated with QoL. Physical role function was restricted in 41.0% of cases and emotional role function in 34.4% of cases (SF-36). Obsessive–compulsive disorder (39.3%) (SCL-90-R), psychoticism (34.4%) (SCL-90-R), and depression (32.7%) (BDI-II) were also very common. Psychoticism was significantly more frequent in cases where perfusion deficits in PET CT were observed in both MCA territories (left p = 0.0124, right p = 0.0145) and infarctions in MRI were present in the right MCA territory (p = 0.0232). Depression was significantly associated with infarctions in the right MCA territory (SCL-90-R p = 0.0174, BDI-II p = 0.0246). Women were affected more frequently by depression (BDI-II, p = 0.0234). Physical role function impairment was significantly associated with perfusion deficits in the left MCA territory (p = 0.0178) and infarctions in the right MCA territory (p = 0.0428). MMA leads to impairments in different areas of QoL. Approximately one-third of all adult MMA patients suffered from depression, with women being most affected. In addition to depression, presence of executive dysfunctions and mental disorders such as psychoticism, obsessive–compulsive disorder, and impaired physical and emotional role function affected QoL. These patients showed significantly more often infarctions and perfusion deficits in the right MCA territory. Long-term studies with follow-up results are necessary to clarify a possible beneficial impact of early surgical revascularization on QoL and depression in adult MMA patients.

Camellia sinensis L. leaves composed of different concentrations of mineral contents play a vital role in human nutrition and health. In this study, locally processed three different green tea varieties i.e. P3, P5 and P9 were used for mineral content determination at National Tea and High Value Crops Research Institute (NTHRI), Shinkiari, Mansehra, Pakistan. Atomic absorption spectrophotometer, flame photometer and Kjehldal apparatus were used for the determination of mineral concentration in all the collected tea samples. Mineral composition of tea samples were identified in the following quantity order: high level of nitrogen (37300 to 41380 mg/L), calcium (515.6 to 522.1 mg/L) and phosphorus (742 to 1220 mg/L) were observed in all tea samples compared to other minerals. Cobalt (Co), molybdenum (Mo), sodium (Na), zinc (Zn), nickel (Ni) and copper (Cu) were highest in P3, while least amount was identified in P5, variety. On the contrary, calcium (Ca), potassium (K) and lead (Pb) contents were maximum in P5, while minimum were in P3. This study revealed that the levels of mineral elements in different varieties of green tea vary from the permissible level but the monitoring of their levels in tea plant is obligatory for future risk measurements.

Platelet aggregation contributes to the pathogenesis of cardiovascular diseases. After activation it leads to dense granule secretion and 5-HT release. The question arises; how platelet aggregation is endogenously controlled during blood circulation. In preliminary studies, we observed that human platelets aggregate more rapidly when suspended in buffer as compared to those suspended in plasma (PRP). These observations point to the presence of an endogenous substance that may inhibit arachidonic acid- induced platelet aggregation. An analysis of plasma Cohn fractions demonstrated that most of the plasma inhibitory activity was associated with albumin-rich and α-globulin rich protein fractions. The identity of plasma endogenous inhibitors of platelet aggregation (EIPA) was established by affinity chromatography on Cibacron Blue F3G-A for specific removal of albumin. The association of α-globulins to EIPA activity was recognized as due to haptoglobin by affinity chromatography on a column of hemoglobin-sepharose. In addition, we also found that the distribution of EIPA activity varies according to sex and physiological state. These findings reveal that EIPA may act by modulation of arachidonic acid metabolism or sequestering the fatty acid substrate.

Background: Agriculture is one of the most dangerous occupations, with high incidence and prevalence of occupational health problems; and farmers are exposed to a too many occupational hazards. Objective: This study was conducted to assess the frequency of occupational health problems among the local farmers of Swat, Peshawar and Kohat Districts Khyber Pakhtunkhwa Pakistan Methodology: After ethical approval; a cross sectional study was conducted among the selected districts of Khyber Pakhtunkhwa; Pakistan. Total of n=325 farmers were assessed regarding the occupational health problems. The famers were selected through convenience sampling technique, based on 95% confidence interval, with 5% precision. A structured open ended questionnaire was used in which farmers were asked regarding the occupational health problems. SPSS version 26.0 was used for data entry and analysis. Finally the result was presented in form of tables. Results: Results showed that 32% were literate; 51.38% had monthly income less than 30000/ PKR; 39.08% had farming for more than 10 years; and 68% were not following personnel protective equipments. Moreover, 38.77% had asthma/COPD; 44.62% had disturbed sleep; 26.77% had hearing loss; 42.15% had eye redness and discharge problems; 64.92% had body ache/ and backache; and 26.77% had history of injuries and falls. Conclusions: It was concluded that farmers revealed a huge list of medical health problems. Moreover, health problems showed relationship with age, educational level, working experience, and compliance of personnel protective equipments and thus occupational education and occupational training strategies were needed to reduce health impacts among farmers. Keywords: Food Contamination, Knowledge, Attitude, Practice, Food Handlers, Kohat

Background: Dental caries is a global public health problem, and affects 60-90% of children; and has relationship with social; dietary; and behavioral factors. The main objective of this study was to assess the frequency and risk factors of dental caries among children of District Nowshera Pakistan. Methods: A descriptive cross sectional study was conducted in District Nowshera, in which a total of n=295 children were examined regarding presence of dental caries, from January to April 2022. A structured questionnaire was used to collect data regarding determinants of dental caries and its risk factors from parents. Data was analyzed by SPSS and results were presented in form of tables. Results: The results showed that 60.68% of children had dental caries. Approximately, 54.92% were male; 64.41% had age < 5 years; 42.03% were working mothers; and 53.56% were form rural setup. Moreover; 46.78% use toothbrush; 26.78% use fluoride toothpaste; 73.56% were breastfed; 20.0% were bottle fed; and 83.39% had night feeding. Furthermore; 29.49% children preferred high caloric food intake; 32.88% prefer sugars in food; and 47.80% added sugar during bottle feeding of their children. Conclusions: It was concluded that dental caries showed moderate to high frequency among children; and showed strong relationship family income, body mass index, parent’s education level; and job status of parents. Moreover, frequency of tooth-brushing, fluoride tooth-paste, and sugar preference showed association with dental caries and thus social, dietary and health promotion strategies were needed to reduce prevalence and complications of dental caries. Keywords: Dental Caries, Toothbrush, Fluoride; Caloric Diet; Bottle Feedings; Nowshera, Pakistan

The objective of this study was to assess the frequency and risk factors of dental caries among adults in District Kohat and Nowshera Khyber Pakhtunkhwa Pakistan. Methods: After taking ethical approval, a descriptive cross sectional study was conducted in District Kohat and Nowshera, in which a total of n=435 adults were assessed and examined for dental caries, from November 2021 to March 2022. A structured questionnaire was used to collect data regarding dental caries and its risk factors. Moreover, relevant tooth brushing, and dietary information was also collected. Data was analyzed by SPSS and results were presented in form of tables. Results: The results showed that 23.68% of adults had dental caries. Approximately, 57.70% of adults are of age between 30-60 years; 25.06% had monthly income less than 25000/PKR per month; 14.02% were illiterate, and 40.92% were overweight and obese. Moreover, 52.64% had compliance to daily tooth-brushing; 49.66% used fluoride tooth paste; 41.15% and 58.85% prefer sugar and sweet beverages respectively. Furthermore, 21.84% had poor oral hygiene; 14.94% had routine dental examinations; and 49.21% & 32.41% prefer vegetables and fruits. Conclusions: Concluded that dental caries showed moderate prevalence among adults and revealed relationship with age; monthly income, body mass index, and literacy level. Moreover, frequency of tooth-brushing, fluoride tooth-paste, oral hygiene status and sweet preference showed association with dental caries and thus comprehensive preventive and health promotion strategies were needed to overcome dental caries among adults. Keywords: Dental Caries, Toothbrush, Fluoride, Monthly Income, Sugar, Sweet beverages, Nowshera

Purpose Patients with Moyamoya Angiopathy (MMA) require hemodynamic evaluation to assess the risk of stroke. Assessment of cerebral blood flow with [15O]water PET and acetazolamide challenge is the diagnostic standard for the evaluation of the cerebral perfusion reserve (CPR). Estimation of the cerebrovascular reactivity (CVR) by use of breath-hold-triggered fMRI (bh-fMRI) as an index of CPR has been proposed as a reliable and more readily available approach. Recent findings suggest the use of resting-state fMRI (rs-fMRI) which requires minimum patient compliance. The aim of this study was to compare rs-fMRI to bh-fMRI and [15O]water PET in patients with MMA. Methods Patients with MMA underwent rs-fMRI and bh-fMRI in the same MRI session. Maps of the CVR gained by both modalities were compared retrospectively by calculating the correlation between the mean CVR of 12 volumes of interest. Additionally, the rs-maps of a subgroup of patients were compared to CPR-maps gained by [15O]water PET. Results The comparison of the rs-maps and the bh-maps of 24 patients revealed a good correlation (Pearson’s r = 0.71 ± 0.13; preoperative patients: Pearson’s r = 0.71 ± 0.17; postoperative patients: Pearson’s r = 0.71 ± 0.11). The comparison of 7 rs-fMRI data sets to the corresponding [15O]water PET data sets also revealed a high level of agreement (Pearson’s r = 0.80 ± 0.19). Conclusion The present analysis indicates that rs-fMRI might be a promising non-invasive method with almost no patient cooperation needed to evaluate the CVR. Further prospective studies are required.

Background and Aim: Dysmenorrhea is one of the most common gynecological disorders in the world. The current study aims to know the prevalence of dysmenorrhea and its management practices among adolescent girls. The study also aim to assess predictors of dysmenorrhea treatment options. Materials and Methods: This institutional-based cross-sectional study was carried out at Obstetrics & Gynaecology department of Mardan Women Hospital, Sheikh Maltoon Town Mardan and Jinnah International Hospital, Abbottabad from June 2020 to November 2020. Pretested self-administrated and a semi-structured questionnaire was used for data collection from volunteer adolescent girls to take part in this study. The outcome and exposure variables association was evaluated through a multi regression model and chi-square test. Dysmenorrhea risk was reported by taking the odds ratio at a confidence interval of 95%. SPSS version 20 was used for data analysis and statistical significance was considered at p

Background: Epilepsy drug therapy advancements have resulted in an increasing number of childbearing age well-controlled epileptic women. It is not surprising then, that the impact of pregnancy on the progression of epilepsy has sparked renewed interest. Aim: The aim of current study was to evaluate the frequency of fits or seizure in pregnant women with previously controlled epilepsy. Materials and Methods: This cross-sectional study was carried out on 98 pregnancies of 84 epileptic women during the period between August 2019 and August 2021in the department of neurology and gynaecology of Ayub Teaching Hospital, Abbottabad. All the pregnant women with less than three verified epileptic fits, pregnancy ended with abortion and incomplete seizure or fit frequency were excluded. All the patients were referred to Gynaecology and Neurology department for early pregnancy and planning by a neurologist and gynaecologist. Data analysis was done with SPSS version 23 with p

Objective: To find the frequency of depression, anxiety and stress among Gynae residents during covid pandemic. Methodology: This Cross-sectional survey was carried out in different Teaching Hospitals of Khyber Pakhtunkhwa during the period of six months i.e from August 2020 to January 2021. After the ethical approval from the research community, data was collected from Post Graduate Gynae Residents of Teaching Hospitals. Sample size for the study was 405 participants. Depression, anxiety and gross scale shorten version DASS-21 containing 21 items was standard research to use in study i.e. depression, anxiety and stress was identified on the basis of their cutoff scores i.e. normal scores were ≥10, ≥8 and ≥15 for depression, anxiety and stress respectively. Result: In depression, 136 (34%) participants were normal followed by moderate level having frequency 121 (30.25%). In the anxiety category, 116 (29%) participants were normal followed by moderate level having frequency 101 (25.5). In the category of stress, 179 (44.75%) participants were normal followed by mild levels having frequency 106 (26.50%). Only COVID positive status was statistically significant with depression, anxiety and stress as their P-valve was 0.02 less than 0.05. Conclusion: Considerable number of post graduate Gynae trainees working in different tertiary care hospitals have varying degrees of depression, anxiety and stress due to COVID-19 pandemic. Keywords: COVID-19, Pandemic, Post graduate, Psychological impact, Trainee doctors, Gynae residents, Mental health, Obstetrics, Gynaecology.

A facile and low-cost pseudo successive ionic layer adsorption and reaction technique was used to deposit cadmium sulfide quantum dots (CdS QDs) on hierarchical nanoflower NiO to form an effective and intimate NiO/CdS p-n heterojunction system. The synthesized hierarchical p-n heterojunctions demonstrated effective photocatalytic activity due to the enhanced separation and transport of photogenerated charge carriers compared to standalone NiO. The dye degradation efficiency of optimized CdS QDs that form p-n heterojunctions was examined by rhodamine B and methylene blue dyes under UV-vis irradiation. The improved photocatalytic performance can be accredited to a large morphological surface, and the successful deposition of CdS QDs to form an active p-n junction for efficient charge separation and migration. The morphological, structural, optical, charge transfer and photocatalytic characteristics of synthesized hierarchical p-n junction photocatalyst were studied by scanning electron microscopy, UV-visible absorbance, X-ray diffraction, photoluminescence spectroscopy, electrochemical spectroscopy, and Fourier transform infrared spectra. Additionally, scavenging experiments were performed to find out the energetic species taking part in dye-degradation, and a rational reaction mechanism has been proposed.

Patients with Moyamoya Angiopathy (MMA) require hemodynamic assessment to evaluate the risk of stroke. Hemodynamic evaluation by use of breath-hold-triggered fMRI (bh-fMRI) was proposed as a readily available alternative to the diagnostic standard [bh-fMRI data sets of 22 patients with MMA were evaluated without and with voxel-wise delay correction within different shift ranges and compared to the corresponding [The study revealed a high mean cross-correlation (r = 0.79, p 0.001) between bh-fMRI and [Voxel-wise delay correction, in particular with shift ranges with high cutoff, should be used critically as it can lead to false-negative results in regions with impaired CVR and a lower correlation to the diagnostic standard [

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

PURPOSE Lenalidomide combined with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (R2CHOP) in untreated diffuse large B-cell lymphoma (DLBCL) has shown promising activity, particularly in the activated B-cell–like (ABC) subtype. Eastern Cooperative Oncology Group (ECOG)-ACRIN trial E1412 was a randomized phase II study comparing R2CHOP versus R-CHOP in untreated DLBCL. PATIENTS AND METHODS Patients with newly diagnosed DLBCL, stage II bulky-IV disease, International Prognostic Index (IPI) ≥ 2, and ECOG performance status ≤ 2 were eligible and randomly assigned 1:1 to R2CHOP versus R-CHOP for six cycles. Tumors were analyzed using the NanoString Lymph2Cx for cell of origin. The primary end point was progression-free survival (PFS) in all patients with the co-primary end point of PFS in ABC-DLBCL. Secondary end points included overall response rate (ORR), complete response (CR) rate, and overall survival (OS). RESULTS Three hundred forty-nine patients were enrolled; 280 patients (145 R2CHOP and 135 R-CHOP) were evaluable: 94 were ABC-DLBCL, 122 germinal center B-cell–like-DLBCL, 18 unclassifiable, and 46 unknowns. Baseline characteristics were well-balanced between arms, and the median age was 66 (range, 24-92); 70% of patients had stage IV disease; 34%, 43%, and 24% had IPI 2, 3, and 4 or 5, respectively. Myelosuppression was more common in the R2CHOP arm. The ORR and CR rate were 92% and 68% in R-CHOP and 97% ( P = .06) and 73% ( P = .43) in the R2CHOP arm, respectively. The median follow-up was 3.0 years; R2CHOP was associated with a 34% reduction in risk of progression or death versus R-CHOP (hazard ratio [HR], 0.66 95% CI, 0.43 to 1.01) and 3-year PFS of 73% versus 61%, one-sided P = .03, and an improvement in OS (83% and 75% at 3 years; HR, 0.67; one-sided P = .05). The PFS HR for R2CHOP was 0.67 for ABC-DLBCL, one-sided P = .1. CONCLUSION In this signal-seeking study, the addition of lenalidomide to R-CHOP (R2CHOP) improved outcomes in newly diagnosed DLBCL including patients with ABC-DLBCL.

PURPOSE Burkitt lymphoma (BL) has unique biology and clinical course but lacks a standardized prognostic model. We developed and validated a novel prognostic index specific for BL to aid risk stratification, interpretation of clinical trials, and targeted development of novel treatment approaches. METHODS We derived the BL International Prognostic Index (BL-IPI) from a real-world data set of adult patients with BL treated with immunochemotherapy in the United States between 2009 and 2018, identifying candidate variables that showed the strongest prognostic association with progression-free survival (PFS). The index was validated in an external data set of patients treated in Europe, Canada, and Australia between 2004 and 2019. RESULTS In the derivation cohort of 633 patients with BL, age ≥ 40 years, performance status ≥ 2, serum lactate dehydrogenase > 3× upper limit of normal, and CNS involvement were selected as equally weighted factors with an independent prognostic value. The resulting BL-IPI identified groups with low (zero risk factors, 18% of patients), intermediate (one factor, 36% of patients), and high risk (≥ 2 factors, 46% of patients) with 3-year PFS estimates of 92%, 72%, and 53%, respectively, and 3-year overall survival estimates of 96%, 76%, and 59%, respectively. The index discriminated outcomes regardless of HIV status, stage, or first-line chemotherapy regimen. Patient characteristics, relative size of the BL-IPI groupings, and outcome discrimination were consistent in the validation cohort of 457 patients, with 3-year PFS estimates of 96%, 82%, and 63% for low-, intermediate-, and high-risk BL-IPI, respectively. CONCLUSION The BL-IPI provides robust discrimination of survival in adult BL, suitable for use as prognostication and stratification in trials. The high-risk group has suboptimal outcomes with standard therapy and should be considered for innovative treatment approaches.

In this study, the frequency and temperature dependent dielectric relaxation and electrical conduction mechanisms in NiAl2O4 spinel oxide ceramic have been explored in a frequency range of 50 − 10 × 10 6 Hz over a measured temperature from 163–283 K. The polycrystalline NiAl2O4 was synthesized via solid state reaction route and sintered at 1000 °C. The room temperature x-ray powder diffraction pattern confirmed the formation of NiAl2O4 spinel phase with Fd3m space group. The surface morphology of the sample was investigated by scanning electron microscopy and chemical properties by Fourier transform infrared spectroscopic analysis. Complex impedance studies revealed the presence of relaxation time distribution and charge carriers were found to be thermally activated. The Nyquist plots exhibited depressed semicircles and their fitting by an equivalent circuit model with configuration (RGCG)(RGBCGB) resolved the contributions of grains and grain-boundaries to the electrical transport properties of the material. Electrical conductivity analysis followed the Jonscher’s power law behavior and the frequency exponent suggested small polaron hopping as the governing transport mechanism in NiAl2O4 spinel oxide. Non-Debye type nature of dielectric relaxation was confirmed by the complex modulus analysis whereas dielectric constant and tangent loss analysis verified that the hopping mechanism was thermally activated.

Purpose The purpose of this paper is to outline the development and piloting of a training intervention for social care staff that uses a capable environments framework to improve the quality of staff support. Design/methodology/approach A single case study was used to evaluate changes in the quality of staff support and in levels of engagement and challenging behaviour for one of the individuals supported. Findings The case study demonstrates the usefulness of the capable environments framework as a model for training and development of support planning. Staff provided more positive interaction and support to the individual, who displayed increased participation in activities and reductions in the occurrence and episodic severity of challenging behaviour. Originality/value Capable environments is a systematic, theoretically-driven approach, which is focussed on the quality of support design and provision for people with intellectual disability. The use of such a framework as an intervention assists staff in the provision of effective personalised supports, a foundation for positive behaviour support.

Central nervous system (CNS) involvement in Burkitt lymphoma (BL) poses a major therapeutic challenge, and the relative ability of contemporary regimens to treat CNS involvement remains uncertain. We described prognostic significance of CNS involvement and incidence of CNS recurrence/progression after contemporary immunochemotherapy using real-world clinicopathologic data on adults with BL diagnosed between 2009 and 2018 across 30 US institutions. We examined associations between baseline CNS involvement, patient characteristics, complete response (CR) rates, and survival. We also examined risk factors for CNS recurrence. Nineteen percent (120/641) of patients (age 18-88 years) had CNS involvement. It was independently associated with HIV infection, poor performance status, involvement of ≥2 extranodal sites, or bone marrow involvement. First-line regimen selection was unaffected by CNS involvement (P=0.93). Patients with CNS disease had significantly lower rates of CR (59% versus 77% without; P

Background and Purpose: Hemodynamic evaluation of moyamoya patients is crucial to decide the treatment strategy. Recently, CO2-triggered BOLD MRI has been shown to be a promising tool for the hemodynamic evaluation of moyamoya patients. However, the longitudinal reliability of this technique in follow-up examinations is unknown. This study aims to analyze longitudinal follow-up data of CO2-triggered BOLD MRI to prove the reliability of this technique for long-term control examinations in moyamoya patients. Methods: Longitudinal CO2 BOLD MRI follow-up examinations of moyamoya patients with and without surgical revascularization have been analyzed for all 6 vascular territories retrospectively. If revascularization was performed, any directly (by the disease or the bypass) or indirectly (due to change of collateral flow after revascularization) affected territory was excluded based on angiography findings (group 1). In patients without surgical revascularization between the MRI examinations, all territories were analyzed (group 2). Results: Eighteen moyamoya patients with 39 CO2 BOLD MRI examinations fulfilled the inclusion criteria. The median follow-up between the 2 examinations was 12 months (range 4–29 months). For 106 vascular territories analyzed in group 1, the intraclass correlation coefficient was 0.784, p < 0.001, and for group 2 (84 territories), it was 0.899, p < 0.001. Within the total follow-up duration of 140 patient months, none of the patients experienced a new stroke. Conclusions: CO2 BOLD MRI is a promising tool for mid- and long-term follow-up examinations of cerebral hemodynamics in moyamoya patients. Systematic prospective evaluation is required prior to making it a routine examination.

Background and aim; Reflex changes, distal motor, and sensory involvement are the primary manifestations of secondary sciatica. Sciatica can be diagnosed with a dural mobility test due to pain sensitivity of dura nerve roots and their sleeves. The present study aimed to determine the frequency of sciatica in women after normal vaginal delivery in the lithotomy positions. Materials and Methods: This cross-sectional study was carried out on 56 pregnant women with sciatica from March 2020 to February 2021 at Neurology and Gynaecology departments of Ayub Teaching Hospital, Abbottabad. A conventional sampling technique was used for sample and data collection. Ethical approval and consent were taken from all the individuals who met the inclusive criteria. All the pregnant women of age 25-45 years old with multigravida, primigravidas and neuropathy were enrolled in this study. All the women below or above 325-45 years and who had trauma and surgical intervention before conception were excluded. Symptom-based proforma was used for demographic and baseline characterization. SPSS version 20 was used for statistical data analysis. Results: According to the data of 56 multigravida pregnant women, sciatic nerve compression, and involvement during pregnancy in multigravida women. The mean age of all the women was 35.6 ± 5.73 with an age range between 25 years and 45 years. Sciatica mostly occurs in pregnancy 3rd trimester. The muscles weakness, mild function loss, increased weight, bad posture, and poor economic status are sciatica complications. The prevalence of mild muscle weakness, moderate weakness, and severe weakness were 23 (41%), 25 (44.72%) and 8 (14.28%) respectively. The mild function loss or weakness was 39 (70.51%) while moderate muscle weakness was 17 (29.49%). Conclusion: The present study found that in pregnant multigravida women, the commonly involved nerves are the sciatic nerve and median. Compression neuropathies are common in the third trimester of pregnancy. Compression neuropathies are caused by an increase in weight during pregnancy (above 55 kg), a low socioeconomic status, and poor posture. Keywords: Compression neuropathies, Sciatica, Multigravida

Background and Aim: The most common entrapment neuropathy is carpal tunnel syndrome (CTS). Carpal tunnel syndrome is caused by median nerve compression at the wrist joint. Idiopathic carpal tunnel syndrome is the most common cause. Among the other physiologic causes of carpal tunnel syndrome (wrist trauma, diabetes, hypothyroidism, rheumatoid arthritis, occupation, contraception, and pregnancy), pregnancy is the most common. The objective of the present study was to determine the frequency of local treatment in carpal tunnel syndrome during pregnancy. Materials and Methods: This cross-sectional study was carried out on 45 pregnant women with carpal tunnel syndrome in the departments of Neurology and Gynaecology, Ayub Teaching Hospital, Abbottabad from May 2020 to April 2021. Individuals who met the inclusioncriteria were enrolled in this study. Ethical approval and consent forms were taken from the participants. All the patients were treated with local treatment (dexamethasone acetate 4 mg and lidocaine 0.5 ml) under the carpal tunnel syndrome. Before and after 3 weeks of local injection, median nerve electro physiologic parameters through sensory nerve conduction velocity (SNCV), sensory latency (DSL), pain intensity (visual analog scale or VAS) and distal motor latency (DML) were all noted. Results: The mean age of the patients was 29± 5.3 years while mean weight gain was 13.2 ± 4.9 kg. The third trimester was the mostfrequent pregnancy trimester with carpal tunnel syndrome. Before and after 3weeks, the average pain score of injected dexamethasone acetate was 8.65 ±0.89 and 4.29 ± 0.74 respectively (p-value < 0.005). Additionally, the median nerve SNCV transcarpalwas 32.9 ±7.1 and 25.1 ± 7.2 m/s (p-value = 0.001); while DSL median nerve was4.87±0.81 ms and 4.1±0.62. Lastly, the DML of the median nerve before and after 3weeks of local treatment was 5.2±1.03 and 4.69±0.54 ms respectively. Conclusion: Pain intensity and electrophysiological factors were considerablyimproved after local treatment dexamethasone acetate injection. Encouraging results have been offered for carpal tunnel syndrome with minimum invasive treatment in pregnant women. Keywords: Carpal tunnel syndrome, Pain intensity, local treatment

This study was undertaken to estimate the antioxidant activity and total tannin content of Moringa olifera Lam. (Moringa) leaves and find a suitable extraction condition for maximum yield. Two types of solvent and three different extraction times and temperatures were experimented for extraction. Moringa leaves were oven-dried and powdered to determine the antioxidant activity in terms of total phenolic content (TPC), ferric reducing antioxidant power (FRAP), and DPPH radical scavenging activity and total tannin content. The maximum TPC value noted in methanol extract, and it ranges from 6.46 ± 0.34 g to 3.91±0.19 g gallic acid equivalent (GAE)/100g dry sample (DM). The FRAP values varied from 211.6 ± 3.75 to 344.13 ± 3.26 mg ascorbic acid equivalent (AAE)/100g DM and 166.67 ± 2.90 to 224.93 ± 1.94 mg AAE/100g DM, for methanol and ethanol extract, respectively. The DPPH radical scavenging activity ranged from 46.32 ± 1.07 to 58.09 ± 0.92% for methanol extract and 56.76 ± 1.48% to 69.72 ± 1.15% for ethanol extract. The total tannin content varied from 6.84 ± 0.05 to 10.22 ± 1.11 mg GAE/100 g dry sample and 6.77 ± 0.08 to 9.23 ± 0.51 mg GAE/ 100g DMfor methanol and ethanol extract, respectively. The highest antioxidant yield for methanol and ethanol extract of Moringa leaves differed for various conditions. Overall, Moringa leaves showed excellent antioxidant properties that can be commercially and domestically used.

Background. BL is a rare, high-grade B-cell lymphoma that is often studied in trials with small sample sizes. Historical definitions of "low-risk BL" vary between studies, use arbitrary cutoffs for lactate dehydrogenase (LDH), and identify a small favorable group, leaving >80-90% of patients (pts) in an undifferentiated "high-risk" category. A validated prognostic index will help compare study cohorts and better define good-prognosis pts for whom reduced treatment would be appropriate vs a poor-prognosis group in need of new approaches. Herein, we constructed and validated a simplified prognostic model for BL applicable to diverse clinical settings across the world. Methods. We derived the BL-IPI from a large real-world evidence cohort of US adults treated for BL in 2009-2018 (Evens A, Blood 2020). Progression-free survival (PFS) from diagnosis until BL recurrence, progression, death, or censoring was the primary outcome. We first determined the best prognostic cutoffs for age, LDH (normalized to local upper limit normal, ULN), hemoglobin (Hgb), and albumin. Independent risk factors were ascertained by forward stepwise selection into Cox regression from candidate variables: age, sex, HIV+ status, ECOG performance status (PS) ≥2, advanced stage (3/4), involvement of >1 extranodal site, bone marrow, central nervous system (CNS), values of LDH, Hgb, and albumin. Derivation models used multiple imputation to mitigate bias from missing data and reported hazard ratios (HR) with 95% confidence interval (CI). BL-IPI groups, defined by inspection of survival curves, were compared using log-rank test for trend. We validated performance of the BL-IPI in an external retrospective dataset of BL pts treated contemporaneously in centers from the United Kingdom, Scandinavia, Canada, and Australia. Results. Characteristics of pts in the derivation (N= 633) and validation (N=457) cohorts are shown in the Table. Age ≥40 years (yr), LDH >3xULN, Hgb 3xULN, low Hgb, and low albumin were associated with inferior PFS in univariate tests. In the multivariable model age ≥40 yr, LDH >3xULN, PS ≥2, and CNS involvement were selected as 4 independent prognostic factors; adding stage did not enhance the model. The model was simplified to 3 groups with 0 (low risk; 18% of pts), 1 (intermediate risk; 36% of pts; HR=3.14; 95%CI, 1.61-6.14), or 2-4 factors (high risk; 46% of pts; HR=6.52; 95%CI, 3.48-12.20; Fig A) with 3 yr PFS of 92%, 72%, and 53%, respectively (P Among pts with stage III/IV (historically classified as "high-risk" and constituting 78% of all pts in the cohort), the BL-IPI further discriminated subgroups with 3 yr PFS of 87%, 71%, and 52%, respectively (P In the international validation cohort, fewer pts had CNS involvement; most received CODOX-M/IVAC+R; and PFS/OS estimates at 3 yr were higher. BL-IPI categories were of similar size (low-risk 15%, intermediate-risk 35%, high-risk 50%), and provided similar risk discrimination (Harrell's C=.65 in both datasets). PFS at 3 yr was 96%, 82%, and 63%, respectively (P Conclusions. BL-IPI is a novel prognostic index specific to BL, which was validated to allow for simplified stratification and comparison of risk distribution in geographically diverse cohorts. The index identified a low-risk group with PFS >90-95%, which could be targeted with future strategies for treatment de-escalation. Conversely, only about 55-60% of pts in the high-risk group achieved cure with currently available immunochemotherapy. Disclosures Olszewski: Spectrum Pharmaceuticals: Research Funding; Genentech, Inc.: Research Funding; TG Therapeutics: Research Funding; Adaptive Biotechnologies: Research Funding. Jakobsen:Takeda: Honoraria. Collins:ADC Therapeutics: Consultancy, Honoraria; Celleron: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Speakers Bureau; Amgen: Research Funding; BeiGene: Consultancy; BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau; MSD: Consultancy, Honoraria, Research Funding; Taekda: Consultancy, Honoraria, Other: travel, accommodations, expenses, Speakers Bureau; Roche: Consultancy, Honoraria, Other: travel, accommodations, expenses , Speakers Bureau; Pfizer: Honoraria; Celgene: Research Funding. Cwynarski:Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support; Atara: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; KITE: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Speakers Bureau; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Speakers Bureau; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Speakers Bureau. Bachanova:Incyte: Research Funding; Karyopharma: Membership on an entity's Board of Directors or advisory committees; BMS: Research Funding; FATE: Research Funding; Kite: Membership on an entity's Board of Directors or advisory committees; Gamida Cell: Membership on an entity's Board of Directors or advisory committees, Research Funding. Danilov:Abbvie: Consultancy; BeiGene: Consultancy; Nurix: Consultancy; Celgene: Consultancy; Gilead Sciences: Research Funding; Takeda Oncology: Research Funding; Pharmacyclics: Consultancy; Bayer Oncology: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; TG Therapeutics: Consultancy; Astra Zeneca: Consultancy, Research Funding; Verastem Oncology: Consultancy, Research Funding; Karyopharm: Consultancy; Aptose Biosciences: Research Funding; Bristol-Myers Squibb: Research Funding; Rigel Pharmaceuticals: Consultancy. Diefenbach:Trillium: Research Funding; Millenium/Takeda: Research Funding; MEI: Research Funding; Merck: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Genentech, Inc.: Consultancy, Research Funding; Incyte: Research Funding; LAM Therapeutics: Research Funding; Denovo: Research Funding. Epperla:Pharmacyclics: Honoraria; Verastem Oncology: Speakers Bureau. Farooq:Kite, a Gilead Company: Honoraria. Feldman:Pfizer: Research Funding; Portola: Research Funding; Janssen: Speakers Bureau; AstraZeneca: Consultancy; Cell Medica: Research Funding; Seattle Genetics, Inc.: Consultancy, Honoraria, Other: Travel expenses, Research Funding, Speakers Bureau; Viracta: Research Funding; Trillium: Research Funding; Rhizen: Research Funding; Corvus: Research Funding; BMS: Consultancy, Honoraria, Research Funding; Kite: Honoraria, Other: Travel expenses, Speakers Bureau; Celgene: Honoraria, Research Funding; Takeda: Honoraria, Other: Travel expenses; Amgen: Research Funding; Pharmacyclics: Honoraria, Other, Speakers Bureau; Abbvie: Honoraria; Bayer: Consultancy, Honoraria; Eisai: Research Funding; Kyowa Kirin: Consultancy, Research Funding. Gerrie:AbbVie: Consultancy, Honoraria, Research Funding; Astrazeneca: Consultancy, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Roche: Research Funding; Sandoz: Consultancy. Jagadeesh:Regeneron: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Debiopharm Group: Research Funding; MEI Pharma: Research Funding; Verastem: Membership on an entity's Board of Directors or advisory committees. Kamdar:BMS: Consultancy; Abbvie: Consultancy; Karyopharm: Consultancy; Celgene: Consultancy; AstraZeneca: Consultancy; Pharmacyclics: Consultancy; Seattle Genetics: Speakers Bureau. Karmali:Takeda: Research Funding; AstraZeneca: Speakers Bureau; BeiGene: Speakers Bureau; Karyopharm: Honoraria; BMS/Celgene/Juno: Honoraria, Other, Research Funding, Speakers Bureau; Gilead/Kite: Honoraria, Other, Research Funding, Speakers Bureau. Khan:Seattle Genetics: Research Funding; Janssen: Honoraria; Pharmacyclics: Honoraria; Bristol Myers Squibb: Research Funding; Celgene: Research Funding. Klein:Takeda: Membership on an entity's Board of Directors or advisory committees. Lossos:Verastem: Consultancy, Honoraria; Stanford University: Patents & Royalties; Seattle Genetics: Consultancy, Other; Janssen Biotech: Honoraria; NCI: Research Funding; Janssen Scientific: Consultancy, Other. Lunning:ADC Therapeutics: Consultancy; Legend: Consultancy; Acrotech: Consultancy; AstraZeneca: Consultancy, Honoraria; Aeratech: Consultancy, Honoraria; Beigene: Consultancy, Honoraria; Verastem: Consultancy, Honoraria; TG Therapeutics: Research Funding; Novartis: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Curis: Research Funding; Bristol Meyers Squibb: Consultancy, Honoraria, Research Funding. Martin:I-MAB: Consultancy; Celgene: Consultancy; Teneobio: Consultancy; Karyopharm: Consultancy, Research Funding; Janssen: Consultancy; Sandoz: Consultancy; Bayer: Consultancy; Beigene: Consultancy; Cellectar: Consultancy; Incyte: Consultancy; Kite: Consultancy; Morphosys: Consultancy; Regeneron: Consultancy. Martinex-Calle:Abbvie: Other: Travel grant. Naik:Celgene: Other: advisory board; Sanofi: Other: advisory board. Palmisiano:Genentech: Research Funding; AbbVie: Research Funding. Phillips:Beigene: Honoraria; Roche: Research Funding. Phillips:Seattle Genetics: Consultancy; Incyte: Consultancy, Other: travel expenses; AstraZeneca: Consultancy; Karyopharm: Consultancy; Beigene: Consultancy; Bayer: Consultancy, Research Funding; BMS: Consultancy; Pharmacyclics: Consultancy; Abbvie: Consultancy, Research Funding; Cardinal Health: Consultancy. Portell:Roche/Genentech: Consultancy, Research Funding; Infinity: Research Funding; Bayer: Consultancy; Amgen: Consultancy; TG Therapeutics: Research Funding; AbbVie: Research Funding; Pharmacyclics: Consultancy; Janssen: Consultancy; Kite: Consultancy, Research Funding; Acerta/AstraZeneca: Research Funding; Xencor: Research Funding; BeiGene: Consultancy, Research Funding. Reddy:Celgene: Consultancy; BMS: Consultancy, Research Funding; Genentech: Research Funding; Abbvie: Consultancy; KITE Pharma: Consultancy. Yazdy:Abbvie: Consultancy; Genentech: Research Funding; Octapharma: Consultancy; Bayer: Honoraria. Smith:Bristol Meyers Squibb: Research Funding; Ayala: Research Funding; Seattle Genetics: Research Funding; Portola: Research Funding; Pharmacyclics: Research Funding; Merck: Research Funding; Incyte: Research Funding; Ignyta: Research Funding; Genentech: Research Funding; De Novo Biopharma: Research Funding; AstraZeneca: Consultancy; Millenium/Takeda: Consultancy; Beigene: Consultancy; Bayer: Research Funding; AstraZeneca: Research Funding; Acerta Pharma BV: Research Funding; Karyopharm: Consultancy. Cheah:Celgene, F. Hoffmann-La Roche, Abbvie, MSD: Research Funding; Celgene, F. Hoffmann-La Roche, MSD, Janssen, Gilead, Ascentage Pharma, Acerta, Loxo Oncology, TG therapeutics: Honoraria. El-Galaly:F. Hoffmann-La Roche: Current Employment, Other: Support of parent study and funding of editorial support. Evens:Research To Practice: Honoraria, Speakers Bureau; Mylteni: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Merck: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy, Honoraria, Research Funding; MorphoSys: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria.

To preoperatively assess the neurodevelopment of a predominantly white population of children with moyamoya angiopathy (MMA).Assessments of 40 children with MMA (24 females, 16 males; mean age 6y 11mo, range 20mo-16y) included tests for non-verbal IQ and fine motor skills, and questionnaires on quality of life, behaviour, and executive functions. The Paediatric Stroke Outcome Measure (PSOM) score was evaluated by a paediatric neurologist.Children with MMA had significantly lower non-verbal IQ scores (mean IQ 92.1, SD 19.6, p=0.015) and fine motor skills (z-score -1.84, p=0.004) than population norms. Patients with posterior cerebral artery (PCA) involvement had poorer non-verbal IQ scores than those without (79.6, SD 24.6 vs 95.2, SD 17.2, p=0.042). Higher PSOM scores were related to lower non-verbal IQ scores (Spearman's rank correlation coefficient -0.43, p=0.006), while the presence of stroke, bilaterality, disease versus syndrome, and age at diagnosis had no significant effect on non-verbal IQ. Quality of life, behaviour, and executive functions were in the typically developing range.Children with MMA are more likely to manifest intellectual and fine motor skill impairment before surgical intervention. PCA involvement is an additional risk factor for lower non-verbal IQ.Children with moyamoya angiopathy have intellectual and fine motor skill impairment before surgical intervention. Posterior cerebral artery involvement and higher Paediatric Stroke Outcome Measure scores may predict poorer performance.

The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.

We conducted a phase I/II multicenter trial using six cycles of brentuximab vedotin (BV) in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) for treatment of patients with CD30-positive B-cell lymphomas. Thirty-one patients were evaluable for toxicity and 29 for efficacy including 22 with primary mediastinal B-cell lymphoma, five with diffuse large B-cell lymphoma, and two with gray zone lymphoma. There were no treatmentrelated deaths; 32% of patients had non-hematologic grade 3/4 toxicities. The overall response rate was 100% (95% confidence interval [95% CI]: 88-100) with 86% (95% CI: 68-96) of patients achieving complete response at the end of systemic treatment. Consolidative radiation following end-of-treatment response assessment was permissible and used in 52% of all patients including 59% of the patients with primary mediastinal B-cell lymphoma. With a median follow-up of 30 months, the 2- year progression-free survival and overall survival rates were 85% (95% CI: 66-94) and 100%, respectively. In the cohort with primary mediastinal B-cell lymphoma, the 2-year progression-free survival rate was 86% (95% CI: 62-95). In summary, BV-R-CHP with or without consolidative radiation is a feasible and active frontline regimen for CD30-positive Bcell lymphomas (ClinicalTrials.gov identifier: NCT01994850).

Acute otitis media, acute bacterial rhinosinusitis, and community-acquired pneumonia are major drivers of pediatric antibiotic consumption. With many available options and the added challenges of navigating antibiotic allergies and de-escalating from intravenous treatment for children requiring hospitalization, prescribing for these relatively simple infections can be a source of confusion and error. The purpose of this article is to evaluate the pharmacokinetic and pharmacodynamic properties of antibiotics commonly prescribed for these disease states, and to specifically compare antipneumococcal activity between oral beta-lactams.

INTRODUCTION: The role of free radicals is well established as a crucial component of the immune system. AIM: To assess the perception of dental practitioners of Northern and Central India regarding the role of antioxidants in oral health. MATERIALS AND METHOD: A pre-tested and pre-validated online questionnaire was distributed among various dental practitioners in Northern and Central India which consisted of dichotomous responses. Descriptive statistics were used to summarize the data, followed by the Chi square test to check significant differences between the responses. Correlation between responses were analysed through the Spearman’s rank correlation. Statistical analysis was done using Statistical Package for Social Sciences version 20 (SPSS 20). RESULTS: A statistically significant difference was observed among the genders, with females 126 (43.7%) having lesser knowledge than males 162(56.3%) regarding the use of antioxidants in their clinical practice. High knowledge scores were observed in 288 (69.2%) dental professionals. Postgraduates were found to have (p=0.05) a higher level of knowledge as compared to graduates. CONCLUSION: The use of antioxidants in dentistry should be increased through the conduction of various CDE programmes. workshops and evidence-based practice guidelines.

Prophylaxis is commonly used to prevent central nervous sy stem (CNS) relapse in diffuse large B-cell lymphoma (DLBCL), with no clear standard of care. We retrospectively evaluated 1162 adult patients across 21 US academic centers with DLBCL or similar histologies who received single-route CNS prophylaxis as part of frontline therapy between 2013 and 2019. Prophylaxis was administered intrathecally(IT) in 894 (77%) and using systemic high-dose methotrexate (HD-MTX) in 236 (20%); 32 patients (3%) switched route due to toxicity and were assessed separately. By CNS-International Prognostic Index (IPI), 18% were considered low-risk, 51% moderate, and 30% high. Double-hit lymphoma (DHL) was confirmed in 243 of 866 evaluable patients (21%). Sixty-four patients (5.7%) had CNS relapse after median 7.1 months from diagnosis, including 15 of 64 (23%) within the first 6 months. There was no significant difference in CNS relapse between IT and HD-MTX recipients (5.4% vs 6.8%, P = .4), including after propensity score matching to account for differences between respective recipient groups. Weighting by CNS-IPI, expected vs observed CNS relapse rates were nearly identical (5.8% vs 5.7%). Testicular involvement was associated with high risk of CNS relapse (11.3%) despite most having lower CNS-IPI scores. DHL did not significantly predict for CNS relapse after single-route prophylaxis, including with adjustment for treatment regimen and other factors. This large study of CNS prophylaxis recipients with DLBCL found no significant difference in CNS relapse rates between routes of administration. Relapse rates among high-risk subgroups remain elevated, and reconsideration of prophylaxis strategies in DLBCL is of critical need.

The current research focused on the super capacitive behavior of organic conducting polymer, i.e., polypyrrole (PPy) and its composites with gum arabic (GA) prepared via inverse emulsion polymerization. The synthesized composites material was analyzed by different analytical techniques, such as UV-visible, FTIR, TGA, XRD, and SEM. The UV-Vis and FTIR spectroscopy clearly show the successful insertion of GA into PPy matrix. The TGA analysis shows high thermal stability for composites than pure PPy. The XRD and SEM analysis show the crystalline and amorphous structures and overall morphology of the composites is more compact and mesoporous as compared to the pure PPy. The electrochemical properties of modified solid state supercapacitors established on pure polypyrrole (PPy), polypyrrole/gum arabic (PPy/GA) based composites were investigated through cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS) and galvanostatic charge–discharge (GCD). The specific capacitance of the PPy modified gold electrode is impressive (~168 F/g). The specific capacitance of PPy/GA 1 electrode has been increased to 368 F/g with a high energy density and power density (~73 Wh/kg), and (~599 W/kg) respectively.

Objective: The main objective of this study is to determine the prevalence of migraine in pregnant women presented with severe headache. Study Design: Retrospective study Place and Duration: Study was conducted at department of Neurology Ayub Teaching Hospital, Abbottabad for duration of eighteen months(from August 2019 to February 2021). Methods: 120 pregnant women with ages 18-45 years were presented in this study. Patients’ detailed demographics including age, body mass index and gestational age was recorded after taking informed written consent. Patients with severe headache were enrolled and International Classification of Headache Disorders-II criteria were used for diagnosis of migraine. Trimester of pregnancy were assessed in terms of 1st, second and third. Complete date was analyzed by SPSS 20.version. Results: Mean age of the patients was 32.16±6.44 years with mean BMI 25.07±2.44 kg/m2. Most of the patients 70 (58.3%) were from third trimester. Gestational age of the pregnant women was 22.64±11.03 weeks. 75 (62.5%) were from urban areas and mostly had low socio-economic status 80 (66.7%). 45 (37.5%) women were educated. 50 (41.7%) cases diagnosed migraine, 35 (29.17%) cases had tension type headache (TTH) while the rest were showed only severe headache among pregnant women. Most common symptom was nausea 24 (48%), followed by vomiting 16 (32%) and sensitivity to light was found in 10 (20%) women. Conclusion: In this study, we concluded with the prevalent condition for pregnant women of migraine and headache-related impairment. Migraine and headache during pregnancy are critical for diagnosis and treatment. Keywords: Headache, Pregnancy, Migraine, Prevalence

An in-situ chemical oxidative method was used to effectively synthesize a promising supercapacitor material based on PPy/ZrO2 composites. The synthesized materials were characterized by different analytical techniques, such as UV/visible (UV/Vis) spectroscopy, Fourier-transform infra-red spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). The inclusion of ZrO2 into the PPy matrix was verified by vibrational spectra and structural analyses. The (TGA) results showed that incorporating ZrO2 into the polymeric matrix improved its thermal stability. In addition, the electrochemical properties of the synthesizedmaterials were investigated byusing cyclic voltammetry (CV) and galvanostatic charge/discharge (GCD). The PPy/ZrO2 composite demonstrated excellent super capacitive performance, and high specific capacity of 337.83 F/g, with an exceedingly high energy density of 187.68 Wh/kg at a power density of 1000 W/kg. The composite materials maintain good stability after 1000 charge and discharge cycles, with 85% capacitance retention. The PPy/ZrO2 possesses a high capacitance, an attractive micro-morphology, and a simple synthesis method. The findings indicate that the PPy/ZrO2 composite could be a promising electrode material for high-performance supercapacitor applications.