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Bibi Kulsoom,1,2 Tahir Sultan Shamsi,1 Nasir Ali Afsar3 1Center of Excellence in Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan; 2Department of Biochemistry, Jinnah Medical and Dental College, Karachi, Pakistan; 3Department of Pharmacology, Jinnah Medical and Dental College, Karachi, Pakistan Purpose: Acute myeloid leukemia patients are commonly treated with cytarabine (Ara-C) and anthracyclines but the sustained remission rate is not very promising. We explored the role of drug-metabolizing enzymes and transporters in the therapeutic response.Patients and methods: Bone marrow and peripheral blood samples of 90 newly diagnosed acute myeloid leukemia patients treated with standard 3+7 regimen were analyzed through real-time PCR for expression of human equilibrative nucleoside transporter 1, deoxycytidine kinase, cytidine deaminase (CDA), deoxycytidine monophosphate deaminase (dCMPD) and topoisomerase IIα (Topo-IIa). The expression of these markers was studied in relationship with good (persistent remission) and poor therapeutic response (relapse/resistance).Results: High Topo-IIa expression in peripheral blood was associated with good response (P=0.006). Relapse was higher among low expressors of Topo-IIa in peripheral blood (OR: 26.25). Bone marrow Topo-IIa expression followed a similar trend but did not reach statistical significance. In contrast, patients with high bone marrow dCMPD expression had poor response (OR: 3; P=0.043). One-year disease-free survival (DFS) was better among those with high bone marrow Topo-IIa (P=0.04) or CDA (P=0.03) expression. High bone marrow Topo-IIa expression also had better DFS at 6 months (P=0.04) and at 12 months (P=0.04).Conclusion: High expression of Topo-IIa in peripheral blood is a favorable indicator of persistent remission, good therapeutic response and DFS. High dCMPD and low CDA expression in bone marrow is associated with poor therapeutic outcome. Keywords: topoisomerase IIα, hENT1, dCMPD, CDA, dCK, survival, AML, antimetabolites, anthracyclines

Bibi Kulsoom,1 Tahir Sultan Shamsi,1 Nasir Ali Afsar,2,3 Zahida Memon,4 Nikhat Ahmed,4 Syed Nazrul Hasnain5 1National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan; 2Jinnah Medical and Dental College, Karachi, Pakistan; 3College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 4Ziauddin University, Karachi, Pakistan; 5Dow International Medical College, Karachi, Pakistan Purpose: Many anticancer drugs induce apoptosis in malignant cells, and resistance to apoptosis could lead to suboptimal or no therapeutic benefit. Two cytoplasmic proteins, B-cell lymphoma protein 2 (Bcl-2)-associated X (Bax) and Bcl-2, act as a promoter and an inhibitor of apoptosis, respectively. Both Bax and Bcl-2 as well as their ratio have been regarded as prognostic markers in various cancers. However, conflicting results have been reported. A clear understanding of apoptosis has also become crucial due to reports about anti-Bcl-2 chemotherapy. We explored the relationship of Bax and Bcl-2 gene expression and their ratio with the therapeutic response in acute myeloid leukemia (AML) patients.Patients and methods: Bone marrow and/or blood samples from 90 AML patients treated with cytarabine and daunorubicin were included. Expression of Bax and Bcl-2 was determined through real-time polymerase chain reaction by using ΔΔCt method of relative expression.Results: Bax and Bcl-2 expression among marrow and blood samples correlated with each other (rs=0.5, p

Bibi Kulsoom,1 Nasir Ali Afsar2 1Department of Biochemistry, 2Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia Background: Contemporary literature suggests that medical education might adversely affect students’ mental health. Alfaisal University in Riyadh, Saudi Arabia is a developing institution; hence, there has been a concern regarding the mental well-being of the students.Objectives: This study was designed to assess the traits of depression, anxiety, and stress among students in relation to potential underlying reasons.Methods: All 575 medical students across the 5 years of study participated by filling out the Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire anonymously twice. Firstly, 2–3 weeks before a major examination (pre-examination), and secondly, during regular classes (post-examination). Correlation was sought regarding sex, year of scholarship, attendance of a premedical university preparatory program (UPP), housing, and smoking. Subjective comments from students were also obtained.Results: A total of 76.8% and 74.9% of students participated in pre- and post-examination groups, respectively. The majority were the children of expatriate workers in Saudi Arabia, and included Arabs, South Asians, and North Americans. Prevalence of depression, anxiety, and stress was high (43%, 63%, and 41%, respectively) which reduced (to 30%, 47%, and 30%, respectively) to some extent after examinations. Saudis and those who had attended UPP had higher DASS-21 scores. Smoking and female sex predicted higher levels of “baseline” depression, anxiety, or stress. The students perceived the curriculum and schedule to be the primary causes of their high DASS-21 scores.Conclusion: The students had high “baseline” traits of depression, anxiety, and stress, and these were higher if an examination was near, especially among Saudis and those who had attended UPP. Smoking and female sex predicted higher levels of “baseline” depression, anxiety, or stress. Students suggested that study burden and a busy schedule were the major reasons for their high DASS-21 scores. Keywords: DASS, examination, medical education, smoking, depression, anxiety, stress

Abstract Alzheimer’s disease (AD) is a neurodegenerative condition that causes cognitive decline, memory loss, and reduced personal autonomy. The pathology of AD involves the aggregation of abnormal brain proteins, specifically beta-amyloid plaques and tau tangles, disrupting neuronal communication and leading to the loss of brain cells. Aducanumab, a monoclonal antibody, demonstrates promise in clinical trials by selectively binding to aggregated amyloid-beta, leading to a notable decrease in plaque burden and potential cognitive benefits. However, regulatory approval for aducanumab remains controversial. Lecanemab and donanemab are recent additions to the AD’s treatment landscape, both targeting aggregated amyloid-beta. Lecanemab shares similarities with aducanumab in its mechanism of action, while donanemab employs a distinct approach by binding to a specific truncated form of amyloid-beta. Positive outcomes have been observed in early-stage clinical trials for both drugs, demonstrating a reduction in amyloid-beta plaques. While aducanumab’s approval offers hope for AD’s treatment, ongoing studies on lecanemab and donanemab are imperative for a comprehensive understanding of their potential in disease modification. Here, we show in this review the potential AD treatments, with a focus on their primary action targeting the reduction of amyloid-beta plaques ultimately giving a broader insight on the topic. The review emphasizes the necessity for long-term efficacy and safety data to assess the overall impact of these drugs on cognitive decline and functional outcomes for future researchers to endeavor. In conclusion, the development of amyloid-beta targeting monoclonal antibodies represents a significant stride in AD’s treatment, demanding further investigation to ascertain their true potential and role in the therapeutic arsenal for this challenging condition.

Objective: To determine the diagnostic accuracy of Anti-Mullerian Hormone in Polycystic ovary syndrome detection, keeping Rotterdam criteria as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi and Rehman Medical Institute, (RMI)Peshawar, Pakistan from Jul 2018 to Jun 2019. Methodology: The study included one hundred and forty clinically suspected patients of polycystic ovary syndrome (PCOS) of 16-45 years of age. Blood samples were analyzed for serum Anti-Mullerian Hormone analysis on Architect ci 8200 System using the Chemiluminescent immunoassay technique. AMH was considered positive for Polycystic ovary syndrome at a threshold of 4.9ng/ml. In addition, AMH's diagnostic accuracy was evaluated, considering the Rotterdam criteria of PCOS as a gold standard. Results: The mean age and mean BMI of the study subjects were 26.73±5.07 years and 30.43±4.83kg/m2, respectively. The mean follicle-stimulating and Luteinizing hormones were 4.34±0.68mIU/ml and 5.24±1.43mIU/ml, respectively. The mean Anti-Mullerian hormone of all patients was 7.79±4.62ng/ml. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), the likelihood ratio of a positive test (LR+) and Likelihood ratio of a Negative Test (LR-) of AntiMullerian hormone were 91.8%, 74.7%, 73.7%, 92.2%, 3.63%, 0.11%, respectively and overall diagnostic accuracy was 82.1%. Conclusion: Anti-Mullerian hormone can effectively determine the existence of Polycystic ovary syndrome among women of reproductive age and serve as a sensitive diagnostic tool for Polycystic ovary syndrome.

The election of Hassan Rouhani in 2013 as the President was hailed as a ‘victory of moderation’ in Iran, signaling the fact that Iran would embrace moderation after the ‘fierce rule’ of Ahmadinejad, former Iranian President. However, a chronic failure of moderates' agenda in Iran during former's tenure has now changed the power distribution in the country leading to conservative faction's win in the 2020 Parliamentary elections. The paper is an attempt to evaluate the election result of 2020 and understand the new power dynamics in Iran. It reviews the performance and policies of President Rouhani as he reaches the last year of his second term and also analyzes the emerging political scenario in the country with challenges to the new Parliament. Additionally, to make a holistic analysis, the paper briefly covers the strong points of Rouhani administration and the plausible policy changes expected from the new parliament. The methodology of the paper is qualitative content analysis.

China-Iran relations have steadily evolved and expanded in the domains of geopolitics, economics and diplomacy since the Iranian revolution. Presently, being increasingly isolated from the world under Donald Trump's maximum pressure campaign, Iran has been further drawn towards China, which, in the long term, can significantly alter the existing regional security architecture of the Persian Gulf. The recent agreements and partnership between the two countries, which is reflected in the Belt and Road Initiative (BRI) as well as the draft 25-year Comprehensive Strategic Partnership (CSP) will pave the way for a long term strategic cooperation between the two countries. In this context, the paper analyzes various factors that have systemically fostered friendly ties between the two countries. The paper also explores historical and contemporary trends that can impact the future of bilateral relations. Further, it evaluates the economic relations between the two countries outlining the trade in the oil sector as well as other sectors. Lastly, the paper examines the plausible challenges to the future of bilateral relations. For this, the paper relies on three variables: the internal dynamics and perception in Iran about its relations with China; the major power-middle power dynamics that can prove to be a barrier in the relations; and the outlook and responses of the regional countries that may scuttle the process of strategizing bilateral relationship.

Objective: To assess the intake of macronutrient and proportion of risk factor of diabetic complication among people with type 2 diabetes and to explore their causal relation. Methodology: A retrospective study conducted on retrieved first visit data of 9563 subjects visiting the study center between 2006 and 2014. Macronutrient intake was assessed using 24-hr recall. Standard protocols were used for demographic, anthropometric measurements and biochemical variable. Statistical analysis was performed using statistical package for social sciences (SPSS) version 20. Result: Out of 9563 subjects, 53.7% were males; mean age, duration of diabetes and body mass index was 51.02 ± 10.99 (yrs), 11.06 ± 8.2 (yrs) and 28.15 ± 5.34 (kg/m2) respectively. Average daily intake of carbohydrate, proteins and fats was 230.6, 68.1 and 66.1 g; and the mean intake of calories was 51.4%, 15.1% and 33.5% respectively. Obesity was found (≥25 kg/m2) 50.6% and overweight (23–24.9 kg/m2) in 34.9%. Women took more calories from fat (p = 0.001), men from protein and carbohydrates (p = 0.001). People>50 years took more fat than

One of the most significant developments of the year 2018 was US President Trump's decision to pull out of the Joint Comprehensive Plan of Action (JCPOA) or Iran Nuclear Deal, a multilateral agreement signed between Iran and China, France, Russia, the United Kingdom, and the United States, plus Germany (P5+1). While the US has withdrawn from the deal and the other signatories to the deal are trying to keep Iran in the deal, Iran sees little return in remaining part of the deal. Hence, there is uncertainty about its survival. To study the future of JCPOA, the paper analyzes the future course of action of Iran, the EU and the US vis-à-vis the deal. It looks at US efforts to scuttle the deal, the internal and external pressures on Iran to abide or abandon the deal, and the EU's attempts to appease the US while keeping Iran in the deal. Furthermore, it looks at the bilateral relations between stakeholders and predicts the consequences of the course of action taken by each stakeholder.

Depending on how Trump administration adjusts to the nuclear deal between Iran and the P5+1, the strategic landscape of Iran could either transform dramatically or slide back to pre-deal status quo ante. Traditionally, Iran aspires for a wider regional role to enhance its stature and assume a regional leadership position. As international politics becomes more complex and interlinked, a resurging Iran, reaching to the outer world, has implications for Pakistan. Critically speaking, Pakistan's relations with Iran are unique in the sense that these could neither be described as strategic partnership nor strategic rivalry; rather the relations have been alternating between strong friendship and competition. Thus, it is important to study and extrapolate Iran and Pakistan relations and also how this relationship could serve the long-term interests of each other in the region. The paper juxtaposes Pakistan-Iran relations in the changing regional balance of power. It looks at Pakistan-Iran relations from two angles: history of the bilateral relations; present issues and concerns that could have an impact on the future contours of the relations; and makes plausible policy recommendations for strengthening bilateral ties.

Objective: To determine the response of cisplatin-based concurrent chemoradiation in stages III and IV head & neck squamous cell cancer and to evaluate frequency of common toxicities. Introduction: Almost 70% of head and neck cancer patients present with locally advanced disease (stage III and IV). Concurrent chemoradiotherapy is the current standard treatment. Cytotoxic cisplatin is the treatment of choice for concomitant chemoradiotherapy. Cisplatin acts as a radiation sensitizer and advances the antitumor efficacy when combined with radiotherapy. Likewise all chemotherapeutic agents also show side effects including mucositis, dermatitis, nausea & diarrhea. Materials & Methods: A descriptive study conducted in Department of Radiotherapy, Karachi Institute of Radiotherapy and Nuclear Medicine from 2010 to 2011. Fractions with 2 Gy per fraction were completed in 7 weeks. Sample size of 85 enrolled. Total dose of radiotherapy was 66 Gy in 33 fractions. Cisplatin of 100 mg /m² on day 1, 22 and 43 were given. Treatment response was determined radiologically at four weeks. Toxicity was assessed weekly during treatment. Results: Mean age was 55.4 (±10.5) years with Male to Female ratio was 1.3: 1. Thirty (41.1%) patients had achieved complete response (CR), 36 (49.3%) patients had partial response (PR). Significant response rate was 90.4%. p-value was significant

In the last decade, there has been a growing interest in cruise missiles in India and Pakistan. A characteristic counterforce weapon with high speed and precision, stealth capabilities and multiple launch platforms, cruise missiles are linked to the preemptive capabilities of a state; an antithesis to mutual vulnerability important to maintain nuclear deterrence. However, like any other weapon, they cannot be neatly described as either weapon for offense for first strike or weapon for defense in second strike. This makes it imperative to study the implications of the cruise missiles of Pakistan and India on strategic stability. The paper is divided into three parts; the first part studies the characteristics of cruise missile and builds a theoretical framework to understand how counterforce systems like cruise missiles impact strategic stability between two states. The second part studies the impact of cruise missiles in South Asia on regional strategic stability from three aspects: deterrence stability, crisis stability and arms race stability. In the third part, the conclusion, it is found that while the dynamics of deterrence stability and crisis stability are not affected by cruise missiles, it proves to be destabilizing for arms race. Cruise missiles in South Asia reinforce the cyclic dynamics of offense and defense, prompting both countries to invest in their security, which on the long run will impinge on deterrence stability and crisis stability between the two countries.

Objective: To determine the response of cisplatin-based concurrent chemoradiation in stages III and IV head & neck squamous cell cancer and to evaluate frequency of common toxicities. Introduction: Almost 70% of head and neck cancer patients present with locally advanced disease (stage III and IV). Concurrent chemoradiotherapy is the current standard treatment. Cytotoxic cisplatin is the treatment of choice for concomitant chemoradiotherapy. Cisplatin acts as a radiation sensitizer and advances the antitumor efficacy when combined with radiotherapy. Likewise all chemotherapeutic agents also show side effects including mucositis, dermatitis, nausea & diarrhea. Materials & Methods: A descriptive study conducted in Department of Radiotherapy, Karachi Institute of Radiotherapy and Nuclear Medicine from 2010 to 2011. Fractions with 2 Gy per fraction were completed in 7 weeks. Sample size of 85 enrolled. Total dose of radiotherapy was 66 Gy in 33 fractions. Cisplatin of 100 mg /m² on day 1, 22 and 43 were given. Treatment response was determined radiologically at four weeks. Toxicity was assessed weekly during treatment. Results: Mean age was 55.4 (±10.5) years with Male to Female ratio was 1.3: 1. Thirty (41.1%) patients had achieved complete response (CR), 36 (49.3%) patients had partial response (PR). Significant response rate was 90.4%. p-value was significant

Allah has sent human being in this world with the designation of caliph. That's why the main purpose of human being is to act upon Allah's orders. Allah says in Quran : I ordered ghost (jin) and human for the worship only . in order to accomplish this goal Allah sent various messengers and prophets who provide guidance to human and deliver Allah's Laws and orders. They also thought human being the pathology and un-pathology of God. The first part of the prophecy was the first world's man Hazrat Adam(A.S). He guides their children on Allah's command according. Even the chain of prophet hood ended on Muhammad (P.B.U.H) with the knowledge of Quran and Sunnah. Quran strongly emphasis and older human that their is only one religion for all mankind. That's why Quran don't emphasis on the believers by various prophets of God. Actually mean of Deen and shariah both mean law form by Allah.Defense is that in Deen. it shows no alternation in religion in various area. Like shariah include the properties of Deen in which way of life could be modified according to the circumstance.This modification could be change only by Allah. or the person to whom it is given the right(Prophet or Messenger).

Sound is an important communication tool for humans that contain information about the surrounding environment. It may signify a danger or a reward for an organism. In humans, the mechanism of sound production and perception is complex and sophisticated. Sound is produced by vibrating body in a medium that contains molecules in the surrounding space. The sound perception starts in the human foetus at around the third trimester where it plays a vital role in organising the foetal brain. This process continues after birth and can be exploited by various endogenous and exogenous factors. Many mechanisms that can modulate hearing process at different levels lead to subclinical or clinical presentation of hearing-related problems. It is important to contemplate the mechanisms underlying sound production, perception and pathogenesis of hearing loss. This will facilitate prescribing a relevant treatment option according to the cause and its underlying mechanism. The current narrative review was planned to focus on sound production, its perception, types of hearing loss and available treatment options vited in relevant literature searched by using Google Scholar and PubMed.

Background: Sub-optimal HDL is a prognostic marker of cardiovascular disease. South Asia has a high prevalence of sub-optimal HDL compared to other parts of the world. Intermittent fasting (IF) is a type of energy restriction which may improve serum HDL and other lipids thereby reducing the risk of cardiovascular diseases. Objective: The aim of the study was to evaluate the effect of IF on lipid profile and HDL-cholesterol in a sample of South Asian adults. Methods: A 6-week quasi-experimental (non-randomized) clinical trial was conducted on participants with low HDL (< 40 mg/dl for men and < 50 mg/dl for women). Participants of the control group were recommended not to change their diet. The intervention group was recommended to fast for ~12 h during day time, three times per week for 6 weeks. Pulse rate, blood pressure, body weight, waist circumference, serum lipid profile, and blood glucose levels were measured at baseline and after 6 weeks. Result: A total of 40 participants were enrolled in the study ( N = 20 in each group), while 35 (20 control and 15 intervention) completed the trial and were included in data analysis of the study. Body measurements, including body weight, BMI and waist circumference, showed significant interaction effects ( p 's < 0.001), indicating that there were larger reductions in the IF group than in the control group. Significant interaction effects were also observed for total ( p = 0.033), HDL ( p = 0.0001), and LDL cholesterol ( p = 0.010) with larger improvements in the IF group. Conclusion: This study suggests that intermittent fasting may protect cardiovascular health by improving the lipid profile and raising the sub-optimal HDL. Intermittent fasting may be adopted as a lifestyle intervention for the prevention, management and treatment of cardiovascular disorders. Clinical Trial Registration: NCT03805776, registered on January 16, 2019, https://clinicaltrials.gov/ct2/show/NCT03805776., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ahmed, Farooq, Siddiqi, Meo, Kulsoom, Laghari, Jamshed and Pasha.)

: Consumption of flavonoid-rich nutraceuticals has been associated with a reduction in coronary events. The present study analyzed the effects of cocoa flavonols on myocardial injury following acute coronary ischemia-reperfusion (I/R). A commercially available cocoa extract was identified by chromatographic mass spectrometry. Nineteen different phenolic compounds were identified and 250 mg of flavan-3-ols (procyanidin) were isolated in 1 g of extract. Oral administration of cocoa extract in incremental doses from 5 mg/kg up to 25 mg/kg daily for 15 days in Sprague Dawley rats ( n = 30) produced a corresponding increase of blood serum polyphenols and become constant after 15 mg/kg. Consequently, the selected dose (15 mg/kg) of cocoa extract was administered orally daily for 15 days in a treated group ( n = 10) and an untreated group served as control ( n = 10). Both groups underwent surgical occlusion of the left anterior descending coronary artery and reperfusion. Cocoa extract treatment significantly reversed membrane peroxidation, nitro-oxidative stress, and decreased inflammatory markers (IL-6 and NF-kB) caused by myocardial I/R injury and enhanced activation of both p-Akt and p-Erk1/2. Daily administration of cocoa extract in rats is protective against myocardial I/R injury and attenuate nitro-oxidative stress, inflammation, and mitigates myocardial apoptosis., Competing Interests: The authors declare no conflict of interest. The producer of cocoa extract has not been informed before, during and after the execution of the study

There is conflicting evidence that MDR1, MRP2 and LRP expression is responsible for chemotherapy resistance. We conducted this study to explore their role in AML therapy outcomes. Bone marrow and peripheral blood samples of 90 AML patients, receiving chemotherapy, were analyzed by real time PCR. Gene expression was calculated by the 2 -ΔΔCt method. The patients who had a persistent remission were labelled 'Good Responder' (GRes) whereas, those with relapse or drug resistance were labelled 'Poor Responders' (PRes). Higher LRP expression in bone marrow, but not in peripheral blood, was positively associated with persistent remission (p = 0.001), GRes (p = 0.002), 1-year overall as well as disease-free survival (p = 0.02 and p = 0.007, respectively). Marrow and blood MDR1 and MRP2 expression did not differ significantly between the above groups. Logistic regression analysis showed that only a diagnosis of acute promyelocytic leukemia (APL; M3) or high marrow LRP expression significantly predicted a favorable therapeutic outcome. This is the first report showing that high bone marrow LRP expression predicts significant favorable therapeutic outcome. Peripheral blood LRP expression as well as marrow and blood MDR1 and MRP2 expression have no predictive value in AML patients treated with standard dose cytarabine and daunorubicin 3+7 regimen.

Objective: To analyse a decade-long pattern of clinical presentation of acute myeloid leukaemia patients and compare it with contemporary data., Methods: The retrospective cohort study was conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, and comprised of medical record of acute myeloid leukaemia patients from March 2006 to October 2016. Data noted age at presentation, gender, medical history, physical examination, blood and bone marrow investigations such as, haemoglobin levels, blood cell count myeloperoxidase activity, periodic acid-Schiff and reticulin staining as well as final diagnosis. Comparison, where possible, was done with contemporary literature. SPSS 19 was used for data analysis., Results: Of the 626 subjects, 248(39.6%) were females and 378(60.4%) males. The overall mean age was 35.3±17.1 years. The most common age group was 15-40 years with 354(56.5%) patients. The most common subtype was acute myeloid leukaemia with maturation 183(33.6%). Myeloperoxidase activity was positive for the majority of the acute myeloid leukaemia patients. Periodic acid-Schiff test, done on only selected patients, was mostly negative. Reticulin staining was positive for 113(65.3%) patients. The most common presenting complaints were fever 266(71.9%) and weakness 168(45.4%). Mean haemoglobin and red blood cell count were 8.3 ± 2.4 g/dL and 2.9 ± 1.2 1012/L, respectively., Conclusions: Acute myeloid leukaemia was found to be a highly variable disease that presented with non-specific signs and symptoms.

Acute myeloid leukaemia (AML) is a group of haematological malignant disorders. Although not a new disease, many studies have been conducted to explore AML etiology, pathogenesis and prognosis at molecular level over the past two decades. A meticulous and continuous review of the available literature is still required to contemplate currently discovered information. We searched Google Scholar and PubMed by using different key word such as: updates in diagnostic criteria of AML, WHO classification of AML, new prognostic factors and risk stratification of AML. Mostly articles are referred from international sources published during last five years. Some older articles were only used when pivotal information required could not be surpassed by newer articles. Initially 50 relevant articles were included which were subsequently reduced to 36 by excluding articles with similar information. In this review an attempt is made to approach the subject in the light of currently available literature.

Background: This study was planned to audit female breast cancers and their chemotherapy in a busy public sector institution. As a case-study, Pakistan provides an opportunity to explore the issue in a low-GDP, low-literacy, populous developing country., Method: Retrospective analysis of the records at Karachi Institute of Radiotherapy and Nuclear Medicine., Results: A total of 3,431 female breast cancer patients presented during 2001-2008, half being <45 years, mostly suffering from infiltrating ductal carcinoma of breast. Further analyzing a subgroup of 183 consecutive patients over six months revealed that only 1.6% were at stage-I, whereas 75% had node-positive disease, including 19.1% with distant metastases. Some 41.6% were either high grade or poorly differentiated. The low grade tumors showed a two-fold likelihood of ER and PR positivity as compared to high grade lesions. 5-Flourouracil, doxorubicin and cyclophosphamide (FAC) constituted the most common chemotherapy. Earlier diagnosis was associated with complete remission. Overall, 33% developed myelotoxicity, more often if age ≥ 45 years (p=0.012), out of which 60% needed active correction. All those patients who did not experience a drop in total leukocyte count (TLC) below 4 x 10⁹/L did not show complete remission., Conclusions: Infiltrating ductal carcinoma of the breast is the most common type. FAC is the most common chemotherapy. Tendency for late diagnosis, metastatic disease, treatment failure as well as leukopenia especially in ≥ 45 years is present. Failure to show leukopenia is suggestive of poor therapeutic outcome.

Objective: To identify frequency of the following markers of atherosclerosis risk: high C-Reactive Protein (CRP) and ratio between serum levels of low density lipoprotein (LDL) and high density lipoprotein (HDL) and to determine the association of high serum CRP levels and LDL:HDL in the patients presenting at NICVD with first myocardial infarction., Methods: This case control study was conducted at National Institute for Cardiovascular Disease (NICVD), in Karachi, comprising of 50 male patients of acute myocardial infarction (without any other co-morbidity) and 50 matching controls., Results: In this study, CRP levels were significantly high (p = 0.003) and serum HDL levels significantly low (p = 0.006) in patients as compared to controls. Serum LDL levels and the ratio of LDL and HDL were not significantly different among the two groups., Conclusion: High serum CRP levels rather than high LDL:HDL are associated with myocardial infarction in the patients presenting at NICVD with first myocardial infarction.