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Objective: The aim of this study was to assess the prescribing patterns and frequency of use of various drug classes in patients with rheumatoid arthritis in a teaching hospital in Islamabad, Pakistan. Study Design: Descriptive Cross Sectional study. Setting: Medical Outpatient Department of HBS General Hospital, Islamabad. Period: August 2018 to March 2019. Material & Methods: Patients of rheumatoid arthritis were included in the study using non-probability consecutive sampling technique. Socio-demographic details and medication history was collected on pre-designed proforma. Data was analyzed using SPSS version 22. Results: A total of 112 patients were included in the study.108 patients (96.4%) were using disease modifying anti-rheumatic drugs. The most prescribed medication in the patients was methotrexate (n=82, 73%). One disease modifying anti-rheumatic drugs with a steroid was the preferred combination (n=32, 28%). Non-steroidal anti-inflammatory drugs (21%) and steroids (20%) were the other major drug classes among the total medications prescribed. Only one patient included in the study was using biologics. Conclusion: Conventional disease modifying anti-rheumatic drugs in combination with steroids and non-steroidal anti-inflammatory drugs are the preferred therapy in patients of Rheumatoid arthritis in local settings. Methotrexate is the most commonly used disease modifying anti-rheumatic drugs. The use of biological agents remains low as compared to the developed world owing to their high cost.

Objective: Despite its broad etiology, preterm labor has been firmly linked to inflammatory/infectious processes. However, very few cases of preterm birth are preceded by acute signs and symptoms of clinical infection. Many studies have found neutrophil-to-lymphocyte ratio and red blood cell distribution width to be elevated in cases of subclinical infections. We performed a retrospective study to compare the levels of these two markers in preterm vs. term births. Material and methods: Patient information was obtained retrospectively. Preterm and term birth patients were captured from our database during a three-year period. Neutrophil-to-lymphocyte ratio and red blood cell distribution width in the first trimester and on admission to labor and delivery was obtained. A sample size of 130 per group was required to find a 20% difference with 80% power (standard deviation=3.2). p-values less than 0.05 were considered significant. Results: The preterm birth group contained 137 patients with an average gestational age of 32.4 ± 4.1 weeks and the term birth group included 145 patients with an average gestational age of 39.2 ± 1.1 weeks. The neutrophilto- lymphocyte ratio at the time of delivery was found to be higher in the preterm birth group (5.9 ± 5.1 vs. 4.6 ± 3.2, p=0.007). Red blood cell distribution width at delivery did not differ between groups (13.6 ± 0.9, 13.9 ± 1.8, p=0.09). Subgroup analysis of preterm patients with preterm premature rupture of membranes (n=52) or gestational age

Cognitive decline is a debilitating manifestation of disease progression in Parkinson's disease. We aimed to develop a clinical-genetic score to predict global cognitive impairment in patients with the disease.In this longitudinal analysis, we built a prediction algorithm for global cognitive impairment (defined as Mini Mental State Examination [MMSE] ≤25) using data from nine cohorts of patients with Parkinson's disease from North America and Europe assessed between 1986 and 2016. Candidate predictors of cognitive decline were selected through a backward eliminated Cox's proportional hazards analysis using the Akaike's information criterion. These were used to compute the multivariable predictor on the basis of data from six cohorts included in a discovery population. Independent replication was attained in patients from a further three independent longitudinal cohorts. The predictive score was rebuilt and retested in 10 000 training and test sets randomly generated from the entire study population.3200 patients with Parkinson's disease who were longitudinally assessed with 27 022 study visits between 1986 and 2016 in nine cohorts from North America and Europe were assessed for eligibility. 235 patients with MMSE ≤25 at baseline and 135 whose first study visit occurred more than 12 years from disease onset were excluded. The discovery population comprised 1350 patients (after further exclusion of 334 with missing covariates) from six longitudinal cohorts with 5165 longitudinal visits over 12·8 years (median 2·8, IQR 1·6-4·6). Age at onset, baseline MMSE, years of education, motor exam score, sex, depression, and β-glucocerebrosidase (GBA) mutation status were included in the prediction model. The replication population comprised 1132 patients (further excluding 14 patients with missing covariates) from three longitudinal cohorts with 19 127 follow-up visits over 8·6 years (median 6·5, IQR 4·1-7·2). The cognitive risk score predicted cognitive impairment within 10 years of disease onset with an area under the curve (AUC) of more than 0·85 in both the discovery (95% CI 0·82-0·90) and replication (95% CI 0·78-0·91) populations. Patients scoring in the highest quartile for cognitive risk score had an increased hazard for global cognitive impairment compared with those in the lowest quartile (hazard ratio 18·4 [95% CI 9·4-36·1]). Dementia or disabling cognitive impairment was predicted with an AUC of 0·88 (95% CI 0·79-0·94) and a negative predictive value of 0·92 (95% 0·88-0·95) at the predefined cutoff of 0·196. Performance was stable in 10 000 randomly resampled subsets.Our predictive algorithm provides a potential test for future cognitive health or impairment in patients with Parkinson's disease. This model could improve trials of cognitive interventions and inform on prognosis.National Institutes of Health, US Department of Defense.

Summary Background Cognitive decline is a debilitating manifestation of disease progression in Parkinson's disease. We aimed to develop a clinical–genetic score to predict global cognitive impairment in patients with the disease. Methods In this longitudinal analysis, we built a prediction algorithm for global cognitive impairment (defined as Mini Mental State Examination [MMSE] ≤25) using data from nine cohorts of patients with Parkinson's disease from North America and Europe assessed between 1986 and 2016. Candidate predictors of cognitive decline were selected through a backward eliminated Cox's proportional hazards analysis using the Akaike's information criterion. These were used to compute the multivariable predictor on the basis of data from six cohorts included in a discovery population. Independent replication was attained in patients from a further three independent longitudinal cohorts. The predictive score was rebuilt and retested in 10 000 training and test sets randomly generated from the entire study population. Findings 3200 patients with Parkinson's disease who were longitudinally assessed with 27 022 study visits between 1986 and 2016 in nine cohorts from North America and Europe were assessed for eligibility. 235 patients with MMSE ≤25 at baseline and 135 whose first study visit occurred more than 12 years from disease onset were excluded. The discovery population comprised 1350 patients (after further exclusion of 334 with missing covariates) from six longitudinal cohorts with 5165 longitudinal visits over 12·8 years (median 2·8, IQR 1·6–4·6). Age at onset, baseline MMSE, years of education, motor exam score, sex, depression, and β-glucocerebrosidase ( GBA ) mutation status were included in the prediction model. The replication population comprised 1132 patients (further excluding 14 patients with missing covariates) from three longitudinal cohorts with 19 127 follow-up visits over 8·6 years (median 6·5, IQR 4·1–7·2). The cognitive risk score predicted cognitive impairment within 10 years of disease onset with an area under the curve (AUC) of more than 0·85 in both the discovery (95% CI 0·82–0·90) and replication (95% CI 0·78–0·91) populations. Patients scoring in the highest quartile for cognitive risk score had an increased hazard for global cognitive impairment compared with those in the lowest quartile (hazard ratio 18·4 [95% CI 9·4–36·1]). Dementia or disabling cognitive impairment was predicted with an AUC of 0·88 (95% CI 0·79–0·94) and a negative predictive value of 0·92 (95% 0·88–0·95) at the predefined cutoff of 0·196. Performance was stable in 10 000 randomly resampled subsets. Interpretation Our predictive algorithm provides a potential test for future cognitive health or impairment in patients with Parkinson's disease. This model could improve trials of cognitive interventions and inform on prognosis. Funding National Institutes of Health, US Department of Defense.

Underwater environment predisposes a diver to high blood pressure. Although neurologic manifestation after a diving episode are considered to be decompressive illness unless otherwise proved, all medical emergencies are to be considered. Incidence of ICH amongst divers while working underwater is rare and yet to be reviewed in diving literature. We present a 48 year old, exdinerwith C/o Rt. hemiparesis post-dine. NCCT and MRI demonstrated acute intracranial haemorrhage. He was managed conservatively.

The coralline algal genus Jania Lamouroux (tribe Janieae, subfamily Corallinoideae, family Corallinaceae) contains six species on southern Australian coasts: J. micrarthrodia Lamouroux, J. pulchella (Harvey) comb. nov., J. pusilla (Sonder) Yendo, J. verrucosa Lamouroux, and two new species, J. minuta and J. parva. These species are segregated primarily on vegetative characters pertaining to fronds, intergenicula, branching, medullary organisation, and substrate preference, with reproductive features used in some cases. Four of the species are, as far as known, endemic to southern Australia: J. minuta, J. pawa, J. pulchella, and J. pusilla. Jania minuta and J. rnicrarthrodia have evolved a unique short-segmented morphology, with intergenicula containing only one or two tiers of medullary cells each. Jania micrarthrodia is a common and conspicuous epiphyte and variable in morphology depending on degree of water movement. In J. minuta, tetrasporangia are replaced by unusual sporangia, each comprised of a large two-nucleate cell, bracketed by small, uninucleate apical and basal cells. This species also forms distinctive multicellular propagules. Jania parva has delicate fronds with dichotomies that tend to diverge widely; only bisporangial and gametangial plants have been found. Jania pulchella has two types of intergenicula, 'janioid' intergenicula which in fertile plants contain conceptacles, and basal compressed and lobed 'cheilosporoid' intergenicula; it is transferred from Cheilosporum pulchellum Harvey. Jania pusilla is usually epiphytic on Cystophora spp., and has small fronds with broad intergenicula. Jania verrucosa, the most robust species, forms dense tufts on low intertidal rocks in southern Australia and in other subtropical or temperate regions.

OF THE NUMEROUS marine and brackish-water species of Vaucheria, only one, V. dichotoma (L.) Ag. (May, 1938) has as yet been recorded in the flora of Australia. While vegetative material of other species can be found, the absence of sex organs generally renders it impossible to identify the material precisely. In 1953 and 1954, fruiting material belonging to a species which is as yet unknown elsewhere was collected by H. B. S. Womersley. It is apparently related to V. litorea Hofm. and Agardh, which is known from the coasts of northern Europe and the United States. It is smaller in nearly every dimension, however, and has other peculiarities, particularly the absence of a reflexed oogonium, which separates it from that species as well as from the other species of the section Piloboloideae, to which it belongs.

The experimental High-Beta Stellarator programme at Garching (1969-1978) is reviewed, emphasis being placed on the key results. These results may be useful as benchmarks for some of the new stellarator concepts under discussion at present.

In spite of the large number of specific names attributable to Haliptilon, based on specimens collected in southern Australia in the 1800s, only one species, Haliptilon roseurn (Lamarck) Garbary & Johansen, can be recognised. This species is both common on rocks and epiphytic on a variety of marine plants. H. roseurn is unique in the genus in that the fronds often produce determinate adventitious branchlets from axial intergenicula already bearing distichous branchlets. It is a morphologically variable species, depending largely on its habitat. Vegetative and reproductive characters show that Haliptilon is closely related to Jania, and more remote from Corallina. Haliptilon roseum may superficially resemble Corallina officinalis but characters of intergenicular anatomy (especially medullary tiers), branching and size allow it to be readily distinguished.

Twenty-six species of Polysiphonia are recognized from the coast of southern Australia. Their relationships are discussed, their distribution outlined and ecological notes are given. Characters found to be satisfactory for species delimitation include the number of pericentral cells. presence or absence and degree of cortication, whether or not rhizoids are cut off from the parent pericentral cells, the origin of lateral branches near apices (whether from the basal cell of trichoblasts or independent of them), the habit of the thallus, and dimensions and proportions of the thallus and segments of the branches. The presence and frequency of trichoblasts (or scar cells) may be characteristic but can vary with activity of growth of the thallus in some species. Cystocarps offer few characters, though the degree of enlargement of the ostiolar cells may be useful in some species. In male plants, satisfactory characters are whether the spermatangial branch replaces the whole trichoblast or only one basal furcation, and the presence or not of sterile apical cells. The form of the tetrasporangial branchlets and arrangement of tetrasporangia are often useful. Of the 26 species, 17 belong to subgenus Oligosiphonia and nine to subgenus Polysiphonia. Four species (P. scopulorum, P. subtilissima, P. sertularioides and P. brodiaei) are species of widespread distribution, the last-named possibly spread by shipping. One species (P. pungens) is known from the Pacific Coast of Canada and now from the State of Victoria. Some 17 species appear to be restricted to southern Australia, including I1 species newly described (P. haplodasyae, P. shepherdii, P. brevisegmenta, P. amphibolis, P.perriniae. P.propagulqera, P. australiensis, P. abscissoides, P. teges, P. constricta and P. adamsiae). Two species (P. decipiens, P. isogona) occur in southern Australia, New Zealand, and possibly subantarctic regions, while two others (P. abscissoides, P. adamsiae) occur both in New Zealand and in southern Tasmania. One species (P. haplodasyae) is a very small species apparently confined to its host Haplodasya. It appears that P. mollis has been recorded incorrectly from various other countries, and clearly much more critical study of the species of Polysiphonia is needed, especially of early species described from the Mediterranean and West Indies.

Gametes from four forms of Hormosira banksii(f. banksii, f. gracilis, f, sieberi and f.pumila) from the coast at Victor Harbor and Aldinga, in South Australia, cross-fertilize readily in all combinations and the zygotes develop into healthy germlings. Nearly all developed to the first vesicle stage and a few were successfully cultured to plants 24 cm high with many vesicles. The larger plants had immature but typical conceptacles but did not become fertile before loss at 15 months. The above taxa are considered to be at subspecific levels.

Fifteen species of Ceramium are recognized from the coast of southern Australia, and their distri- bution and ecology are outlined. Two species (C. rubrum and C. flaccidum) are of widespread distribution in other parts of the world, but the remaining species appear to be largely confined to southern Australia. The species are separated mainly on the development of the nodal cortication from the ring of periaxial cells at the upper end of each axial cell; other useful taxonomic features are the dimensions of the filaments, the branching pattern, and the arrangement of the tetrasporangia. The pattern of cortical development at the nodes is usually readily followed after aniline blue staining and mounting in corn syrup, since slight contraction of the cells in this process renders the pit-connections visible. Each periaxial cell typically cuts off two cells both acropetally and basipetally and in most species these branch further in a similar pattern; in some species three cells may occasionally be cut off, and in one species (C. flaccidum) only one cell is cut off basipetally. In a few species no cells (or only odd ones) are cut off basipetally, and in many species cortical development is greater acropetally than basipetally. The margin of the nodal cortication (whether straight through synchronous cell development or irregular) may be characteristic of certain species. A variation giving a distinctive pattern in a few species is where the periaxial cells cut off one or two pseudoperiaxial cells which interpose in the periaxial ring (e.g. C. shepherdii, C. australe and C. macilentum). In many species the cortical development is limited and soon reaches a stage which is then consistent throughout the thallus. In some species (e.g. C. tasmanicum) an extending cortex later develops which may largely or completely close the internodal space; in fully corticated species (C. rubrum and C. pusillum) the cortex extends from an early stage and maintains complete cover of the axial cell. Heavily corticated species usually have an outer cortex of small cells lying outside the larger inner cortical cells. Gland cells may be characteristic of certain species but are usually variable in frequency and not always present. The nature of the branch apices, while characteristic in some species, depends on the activity of the apical growth. Carposporophytes and spermatangial plants provide little help in taxonomic distinctions. VThe European species C. gracillimum sensu Harvey is now recognized as a very widely distributed species distinct from C. gracillimum Kuetzing. The oldest name is apparently C. flaccidum (Kuetzing) Ardissone, for which there are many synonyms. It is characterized by the formation of only a single cell basipetally from each of the periaxial cells and also by having unicellular rhizoids; the single basipetal cell may produce one or two further cells and commonly itself divides into 2-4 cells.