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This study examines the use of different vaccines and therapies for treating non-small lung cancer. The research is focused on immunotherapy to treat lung cancer that affects a large number of people globally. The research used literature review to gather data, and the results were examined thematically to present the most effective methods for treating this medical issue. The results of the study found that lung cancer can be treated effectively through different immunotherapy techniques.

Background Escitalopram is widely used for the management of the major depressive disorder and generalized anxiety disorder, but there is no to very limited data available regarding efficacy and safety in Pakistani patients. This study was conducted to evaluate the efficacy and safety of escitalopram oral drops to manage the major depressive disorder and generalized anxiety disorder in a local cluster within Pakistan. Methods This prospective multicenter observational study was conducted in the department of psychiatry from August 2018 - August 2019. Eighty-five patients meeting the selection criteria were included in the study. Adolescent, adult, and geriatric patients of either gender with generalized anxiety disorder having Hamilton Anxiety Rating Scale (HAM-A) rate ≥ 10 and major depressive disorder having Montgomery-Asberg Depression Rating Scale (MADRS) rate ≥ 7 or patients with co-morbid generalized anxiety disorder (GAD), major depressive disorder (MDD) were selected for the study. We are reporting patients’ improvement from baseline, response rate, and remission rate. Data analysis is performed by using SPSS version 21 (IBM Inc, Armonk, USA). Results Among enrolled patients, 42 were adolescents, 22 were adults, and 21 were geriatric. The mean age of an adolescent, adult, and geriatric patients was 14.92 ± 2.04, 44.54 ± 12.08, and 64.61 ± 3.16 years, respectively. Among enrolled patients, the mean change in a total score of HAM-A for anxiety and MADRS for depression were -10.04 ± 4.32 and -17.67 ± 14.42, respectively. At the end of the study, the remission rate and response rate for depression were 82 % and 75%, respectively. Similarly, the remission rate and the response for anxiety were 76% and 81%, respectively. Mean HAM-A and MADRS scores were significantly improved for adolescent, adult, and geriatric patients. Adverse events were reported in eight (9.41%) patients with six having gastrointestinal (GI) disturbance and two having to worsen anxiety. All reported adverse events were of mild severity. Conclusion Escitalopram oral drops are found effective and tolerable in reducing both anxiety and depression over the duration of study in all age groups, including adolescents, adults, and geriatrics.

Background In Pakistan, there is a paucity of published clinical data regarding the efficacy of sofosbuvir-velpatasvir in the management of patients with hepatitis C without cirrhosis or with compensated cirrhosis. Methods A prospective, open-label, multicenter, interventional trial was conducted in patients with hepatitis C without cirrhosis or with compensated cirrhosis. Hepatitis C patients without cirrhosis or with compensated cirrhosis were screened, and 133 patients were enrolled in the study. They received sofosbuvir 400 mg plus velpatasvir 100 mg combination once daily for 12 weeks. Patients were followed up for six months after the start of therapy. Hepatitis C viral load was assessed at baseline, at week 12, and after 24 weeks following the start of the treatment. The trial was prospectively registered with the Iranian Registry of Clinical Trials (IRCT) with the identification number IRCT20170614034526N4. Results Among enrolled patients, 79 were male, and 54 were female. Ninety-five (71.4%) patients were without cirrhosis, and 38 had compensated cirrhosis. Patients without cirrhosis had a mean age of 45.90 ±10.99 years, and patients with compensated cirrhosis had a mean age of 52.60 ±12.29 years. As per the intention-to-treat analysis, all patients without cirrhosis and 35 (92.1%) patients with compensated cirrhosis achieved undetectable viral load hepatitis C virus (HCV) ribonucleic acid (RNA) of

Objective: This study was intended to know the efficacy and safety of Sofobuvir in combination with Ribaviran and Peg Interferon on the basis of sustained virological response. Material and Methods: This was a prospective observational multicenter study with the use of non-probability convenient sampling technique. The duration of study was from January 2016 till July 2017. The study was conducted in lady reading hospital. The patients infected with HCV, belonging to both genders, and willing for treatment with standard interferon and Ribavirin were included in the study. The written consent was taken from all the patients with complete confidentiality of the data. HCV was diagnosed by detecting anti-HCV antibodies in serum with the help of Polymerase Chain Reaction (PCR). PCR was done at 12th week after the treatment and was classified as Sustained Virological Response (SVR). The therapy was categorized into dual containing Sofosbuvir and Ribavirin, triple containing Sofosbuvir, Ribavirin and Peg interferon. The dose of sofosbuvir, Ribavirin and Peg Interferon was 400 mg/OD, 1200 mg/OD and 180μcg/OD respectively. All data was entered and analyzed on SPSS version 20. Results: Total 386 patients were selected for the study including 172(45.5%) males and 214(54.5%) females with the male to female ratio of 1:1. They were divided into treatment naïve and experienced group with a frequency of 211(54.6%) and 175(45.4%). The frequency of genotypes of hepatitis C was found to be 4(1.9%), 1(0.5%), 2(0.9%), 1(0.5%), 178(84.3%), 20(9.5%), 3(1.4%) and 2(3.6%) for genotypes 1a, 2, 2a, 2b, 3, 3a, 3b and UT respectively in naïve patients and similarly it was 3(1.7%), 1(0.6%), 4(3.2%), 3(1.7%), 113(64.6), 44(25.2%), 5(2.9%) and 2(1.1%) respectively in experienced group. The overall SVR achieved regardless of the dual and triple therapy in naïve patients was 200(94.7%) and in treatment experienced patients were 144(82.3%). Conclusion: The Sofosbuvir is an effective drug for the achievement of sustained virological response in combination with Ribavirin and Peg Interferon. The uniformity in the high rates of achievement of SVR in dual and triple therapy suggests a powerful efficacy of Sofosbuvir in treating and eliminating the viral load in the patients infected with Hepatitis C Virus. Keywords: Hepatitis C; Sofosbuvir; Sustained virological response

Objective: EXCITE (clinical EXperienCe of amlodIpine and valsarTan in hypErtension) evaluated the real-life effectiveness, safety, and tolerability of single-pill combinations (SPCs) of amlodipine/valsartan (Aml/Val) and amlodipine/valsartan/hydrochlorothiazide (Aml/Val/HCTZ) in patients with hypertension from 13 countries in the Middle East and Asia. Here, we present data from Pakistan. Methods: This was a 26-week observational, multicenter, prospective, open-label study. At week 26, change from baseline in mean sitting systolic (msSBP) and diastolic blood pressure (msDBP) and the proportion of patients achieving BP goal (SBP/DBP Results: A total of 500 patients with hypertension (mean age of 48 years) were prescribed Aml/Val ( n = 471, 94%) or Aml/Val/HCTZ ( n = 29, 6%); 439 (87.8%) patients completed the study. At week 26, the mean BP decreased from 153.4/91.1 mmHg at baseline to 128.9/78.4 mmHg in the Aml/Val cohort (−24.5/−12.7 mmHg; p < 0.0001) and from 171.6/99.3 mmHg at baseline to 127.7/77.4 mmHg (−43.9/−21.9 mmHg; p < 0.0001) in the Aml/Val/HCTZ cohort. BP goals were achieved by 57% and 55.2% of patients in the Aml/Val and Aml/Val/HCTZ cohorts, respectively. A total of 40 (8%) patients reported at least one AE during the study period. Most common AEs included nausea (1.6%), headache (1.2%), vomiting (1.2%), and edema (1.2%). Most patients in Aml/Val cohort and all patients in Aml/Val/HCTZ cohort rated the effectiveness, compliance and tolerability as ‘good’ or ‘very good’. Conclusions: Aml/Val with or without HCTZ in a SPC was effective and well-tolerated for BP reduction in this cohort of patients with hypertension from Pakistan.

Hepatitis-B virus (HBV) infection is a major global health problem. Of the two billion people who have been infected, more than 350 million have chronic hepatitis. It is estimated that 235,000-328,000 people die annually due to liver cirrhosis and hepatocellular carcinoma, we assessed the short term outcomes of treatment with telbivudine in 11 adults aged 14-41 years with HBeAg-positive or HBeAg-negative chronic hepatitis-B (CHB). Treatment of chronic hepatitis-B patients with telbivudine shows 43.1% reduction in serum ALT with no significant adverse effects.

To assess the effect of vildagliptin in comparison to sulphonylurea (SU) on hypoglycaemia in Muslim patients with type 2 diabetes mellitus fasting during Ramadan.VIRTUE was a multicenter, prospective, observational study, which enrolled 244 patients from Pakistan who were re-analysed. All included patients were treated with vildagliptin (n=121) or SU (n=121) as add-on to metformin or as monotherapy for 16 weeks. The primary outcome of interest was to compare the proportion of patients with ≥1 hypoglycaemic event (HE) during fasting between vildagliptin and SU cohort. Changes in HbA1c and body weight and treatment adherence were also measured.Of the 244 patients enrolled, 120 patients in the vildagliptin cohort (99.2%) and 119 patients in the SU cohort (98.3%) completed the study. Patients experiencing at least one HE were fewer with vildagliptin when compared with SUs (5.8% vs. 14.2%; p0.033). The reduction in HbA1c was 0.3% with vildagliptin from a baseline of 7.6% and 0.1% with SU from a baseline of 7.4% (between-treatment difference: -0.1% p0.054). A reduction of 0.3 kg was seen with vildagliptin treatment vs. 0.2 kg weight gain in the SU group. Adverse events were experienced by 15.7% in the vildagliptin cohort and 17.4% in the SU group.The treatment with vildagliptin was associated with fewer hypoglycaemic events compared with SUs and was well tolerated with good glycaemic and weight control in patients with T2DM fasting during Ramadan.

Tariq Saeed,1 Muhammad Nasrullah,2 Adnan Ghafoor,3 Riaz Shahid,4 Nadeem Islam,5 Mohammad Usman Khattak,6 Neeta Maheshwary,7 Ahson Siddiqi,7 Muhammad Athar Khan81Pakistan Telecommunication Company Ltd, Karachi, Pakistan; 2Cavalary Hospital, Gulberg, Lahore, Pakistan; 3Fauji Foundation Hospital, Rawalpindi, Pakistan; 4Dr Riaz Shahid Clinic, Peshawar Cantt, Peshawar, Pakistan; 5Punjab Employs Social Security Institution, Islamabad, Pakistan; 6Medical B Unit, Hayat Abad Medical Complex, Peshawar, Pakistan; 7Novartis Pharma Pakistan, Karachi, Pakistan; 8Department of Medical Education, King Saud bin Abdulaziz University, Riyadh, Kingdom of Saudi ArabiaObjective: Anticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan.Methods: This was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18–65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ≥4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale–Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs.Results: Of the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P

Dry eye disease (DED) is one of the most frequently encountered ocular morbidities. The objective of this study was to assess the performance of sodium hyaluronate eye drop for eight weeks in patients with DED.This was a multi-centre, open-label, uncontrolled clinical trial carried out at different centres of Pakistan, from August 2009 to November 2010. A total of 250 diagnosed patients of Dry Eye who met the inclusion criteria were included in the study. After informed written consent, all patients having at least 2 of the Dry Eye symptoms, and at least 1 of the tests (Tear Film Break-up time (TBUT)or = 10 second, Schirmer's testor = 6 mm/5 min, and positive corneal staining) were enrolled. Tolerability/safety assessments consisted of monitoring and recording of adverse events and physical examinations at baseline, 4th week and 8th week.Out of 250 allocated patients 13 dropped out. The mean age of the patients was 47.6 +/- 13.8 year and out of 237 patients 86 (36.3%) were men and 151 (63.7%) were women. At the initial visit the foreign body sensation was 80%, itching 68%, burning 58%, watering 38%, photophobia 38%, and feeling of dryness was 16%. At the 3rd visit the foreign body sensation decreased to 32%, itching to 32%, burning to 20%, watering to 12%, photophobia to 18%, and feeling of dryness to 14%.Sodium hyaluronate has a beneficial effect on the conjunctival epithelium in a well-defined and homogeneous population of patients with dry eye and can be considered useful for the treatment of dry eye.

Objective: To assess the effectiveness of sodium hyaluronate Eye Gel in Dry Eye Disease (DED) patients Methods: A Multi-center, Open-label, Uncontrolled clinical trial was conducted in different centers of Pakistan. Ten ophthalmologists conducted this study in which 250 diagnosed patients with dry eye disease were enrolled after obtaining a written informed consent. Ten patients were dropped out during the study period. All patients were assessed as per following criteria for enrolling a patient into the study: Tear Film Break – up time (TBUT) ≤ 10 seconds, Schirmer Test – 1 ≤ 6 mm / 5 minutes and Positive Corneal Staining. Tolerability/safety was assessed by the monitoring and recording of all adverse events. The physical examination was done at baseline, 4 th week and 8 th week. Results: The mean age of the patients was 43.4 ±17.8 years and out of 240 patients 117 (48.7%) were males and 123 (51.3%) females. The Mean duration of symptoms was 19.3±23.9. At the initial visit the foreign body sensation was 50.6%, itching 35.9%, burning 50.6%, watering 42.9%, photophobia 25.3% and feeling of dryness in 14.7% of patients. After 4 weeks (2 nd visit), the symptoms were decreased to 47.1% foreign body sensation, 32.4% itching, 48.2% burning, 41.8% watering, 25.3% photophobia and 13.5% feeling of dryness. At the 3 rd visit (after 8 weeks) the frequency of symptoms were: 45.3% foreign body sensation, 30.6% itching, 45.9% burning, 40% watering, 24.7% photophobia and 13.5% feeling of dryness. Conclusion: Sodium Hyaluronate can provide a suitable alternate in the treatment of dry eye disease due to its reported efficacy on foreign body sensation, itching, burning, watering, photophobia and feeling of dryness