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The central importance of the biopsychosocial model of chronic disease is increasingly recognised in the management of long-term conditions (LTC), which are often associated with chronic pain, fatigue and disability. Despite the physical and mental health impact, 'struggle' to maintain self-efficacy, gap in effective transition to adult pathways and long term consequences of poor disease control and lifestyle choices in young people with LTCs, innovation in this age range is rarely reported in generic journals. This paper explores the feasibility and acceptability of health coaching with young service users to increase engagement and self-management, achieved through multidisciplinary team (MDT) training in Adolescent Rheumatology.

Abstract Background Gestational Trophoblastic Neoplasia (GTN) is a disease of the reproductive age group with an incidence rate of

Objective: To determine the association of estrogen and progesterone receptor expression with the clinical and histological findings of endometrial cancer. Study Design: Prospective observational study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi between Sep 2017 to Oct 2019. Methodology: A total of 130 patients were diagnosed with endometrial carcinoma. Data from patient files were collected regarding tumour histology, grade, stage, tumour receptor expression, and the clinical characteristics: parity, menopausal status. The receptor expression profile was documented for each patient. Data were analyzed using SPSS version 25. The association between ER/PR expression categories and clinical/histological features were explored using the chi-square test. Results: The estrogen and progesterone receptor expressions were significantly associated with low-grade (Grade I and II) tumours and with Stage I and Stage II endometrial carcinoma with p

Objective: To identify smokeless tobacco as a risk factor in the development of head and neck cancers and to assess the role of ethnicity in the use of smokeless tobacco in developing head and neck cancers. Study Design: Case-control study. Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Dec 2018 to Jun 2019. Methodology: Three hundred patients, aged 18-85 years of either gender were included in the study. Cases were the patients visiting Oncology OPD with biopsy-proven head and neck cancers (HNCs). Controls were patients presenting at the same hospital for a routine checkup. We interviewed participants by using a pre-designed proforma. Results: The mean age of the cases and controls were reported as 49.26±13.51 years and 40.12±14.89 years, respectively. Majority of the participants were consuming pan (37.0%), gutka (22.6%), tobacco (21.3%), betel nut (19.6%), naswar (12.0%) and mainpuri (9.0%). The participants who consumed tobacco (OR:2.95), gutka (OR:2.39), mainpuri (OR:4.89), pan (OR:2.06) and betel nut (OR:2.28) were times more likely to develop HNCs than those who did not consume tobacco, gutka, mainpuri, pan and betel nut (p

Objective: To assess efficacy of elecrtonic vacuum aspiration in evacuation of retained product of conception with intravenous analgesia. Study Design: A prospective observational study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan to Jun 2018. Methodology: All patients who were intended to undergo Electronic Vacuum Aspiration due to retained products of conception, early fetal demise, septic induced abortions and molar (all upto 12 weeks of gestation) were enrolled in this study after obtaining informed consent. Outcome measures of study were efficacy (defined as completeness of the evacuation procedure confirmed by ultrasound), occurrence of complications like uterine perforation, excessive bleeding >200ml and sepsis (diagnosed clinically or biochemically). Results: A total of 1080 patients underwent Electronic Vacuum Aspiration during the study period. Complete evacuation was achieved in 1026 (95%) cases. Four (200ml. Conclusion: Electronic vacuum aspiration is a safe and efficacious method of uterine evacuation. It does not require special equipment. It is easy to learn and is readily available as well as cost effective. Hence it’s a very lucrative alternative to manual vacuum aspiration using I pass or medical termination of pregnancy in resource poor settings.

Objective: To determine the prevalence of histological subtypes of breast cancer and its association with age, molecular subtype, menopausal status, parity, obesity and tumor grade. Study Design: Prospective, observational study. Place and Duration of Study: The current study was conducted at Oncology Ward-4, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from Apr 2018 to Sep 2019. Methodology: Non-probability convenience technique was used for the sample selection. All patients with diagnosed breast cancer presenting at Oncology ward, Jinnah Postgraduate Medical Center were included in the study. Cases with a non-confirmed diagnosis of breast cancer or those with unknown histological subtype were excluded from the study. Statistical package for Social Sciences (SPSS version 25) was used to analyze the data. Chi-Square test was used to find the association of histological subtypes with age, molecular subtype, menopausal status, parity, obesity, grade of tumor among breast cancer patients. Results: A total of 553 cases of breast cancer patients were reviewed in the study. The mean age of participants was 46.75 ± 10.852 years. We found a frequency of 91.3% of Invasive Ductal Carcinoma (not otherwise specified) among women in our setting. The other rare types of cancer included invasive lobular carcinoma 2%, metaplastic 1.4%, and invasive micropapillary carcinoma 1%. Invasive ductal carcinoma (not otherwise specified). Invasive lobular carcinoma were significantly associated with luminal A type disease (p

Objective: To determine the association of ABO blood groups with clinicopathological factors among gastric cancer patients. Study type, settings & duration: This cross-sectional study conducted at the Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi from January 2019 to March 2020. Methodology: All the patients with confirmed diagnosis of gastric cancer of age from 15-90 years and of either gender were included in the study on the basis of convenience sampling. Type of ABO blood group was identified from laboratory and from blood transfusion section of the hospital. The socio-demographic and clinicopathological data was also recorded on pre-designed proforma. SPSS version 23 was used to analyse data. Results: The mean age of the study sample was 48.31±12.36 years (range: 19-85 years). Out of 144 gastric cancer patients, 51 patients had A type 35.4%, 45 had type B 31.3%, 40 had type O 27.8% and 8 had AB type of blood (5.6%). There was statistically significant association between ABO blood type grade and stage of tumour (p =0.013) and (p =0.05) respectively. Conclusion: Blood group A is the most common blood group found in patients with gastric tumour. Pathologically well differentiated tumour grade is most common grade seen in blood group O, whereas tumour stage III is observed in blood group type B.

India has altered its military stratagem under the Modi government from nuclear deterrence to offensive defence. The constant use of offensive defence in the milieu of deliberate political aggression against Pakistan and victimization of the Muslim community in India is making Indian military doctrine a hostage of hyper-nationalistic politics of Hindutva. Since its rise to power, the BJP government has conflated anti-Muslim and anti-Pakistan approaches. Pakistan remains a crucial factor in its domestic, diplomatic, and foreign policy rhetoric. The internal discord and surge of violence against the Muslim population, as evident by 2020-riots in north-eastern New Delhi, are indicative of vigorous reforming of the national identity of India dominated by Hindutva ideology. Therefore, this paper addresses Hindu nationalism, which arose as a political ideology and caused an insecure environment for Indian Muslims while becoming precarious for Pakistan. It infers that Hindu nationalism, along with its assimilation approach towards minorities, is gradually asserting exclusionary conception of a state where cultural and political centrality of Hindutva has become a core theme. Bibliography Entry Shahzad, Aisha, Sadia Mahmood Falki, and Asma Sana Bilal. 2021. "Transformation of Indian Nationalism and ‘Otherization’ of Muslims in India." Margalla Papers 25 (1): 48-58.

The foreign policy of Pakistan as a part of South Asian milieu and one of the significant Muslim states always remained characterized by the various regional and global restrains which not only made it vulnerable to the external pressures but also substantially affected its strategic choices. Currently, Pakistan is facing multiple internal and external constraints ranging from its domestic economic problems to continuing with CPEC as a real game-changer strategy at the operational level while not upsetting the US. The prime focus of this study is to have an insight intodiplomatic coercion faced by Pakistan and its consequences on her foreign policy decisions. As Indian-centric approach throughout history left limited options for policy-makers. This research examines why Pakistan is being challenged about strategic choices in response to vigorous Indian attempts to isolating her in the international arena. This analytical and descriptive research would possibly recommend the recent foreign policy measures by Pakistan regarding its external dynamics of politics. Bibliography Entry Elharathi, Milad, Sadia Mahmood Falki, and Aisha Shahzad. 2020. "Strategic Autonomy or Isolation: An Analysis of Major Dynamics of Pakistan’s Foreign Policy." Margalla Papers 24 (1): 112-121.

Background: It has been shown that rates of ambulatory follow-up after traumatic injury are not optimal, but the association with insurance status has not been studied. Aims: To describe trauma patient characteristics associated with completed follow-up after hospitalization and to compare relative rates of healthcare utilization across payor types. Setting and Design: Single institution retrospective cohort study. Materials and Methods: We compared patient demographics and healthcare utilization behavior after discharge among trauma patients between April 1, 2005 and April 1, 2010. Our primary outcome of interest was outpatient provider contact within 2 months of discharge. Statistical Analysis: Multivariate logistic regression was used to determine the association between characteristics including insurance status and subsequent ambulatory and acute care. Results: We reviewed the records of 2906 sequential trauma patients. Patients with Medicaid and those without insurance were significantly less likely to complete scheduled outpatient follow-up within 2 months, compared to those with private insurance (Medicaid, OR 0.67, 95% CI 0.51-0.88; uninsured, OR 0.29, 95% CI 0.23-0.36). Uninsured and Medicaid patients were twice as likely as privately insured patients to visit the Emergency Department (ED) for any reason after discharge (uninsured patients (Medicaid, OR 2.6, 95% CI 1.50-4.53; uninsured, OR 2.10, 94% CI 1.31-3.36). Conclusion: We found marked differences between patients in scheduled outpatient follow-up and ED utilization after injury associated with insurance status; however, Medicaid seemed to obviate some of this disparity. Medicaid expansion may improve outpatient follow-up and affect patient outcome disparities after injury.