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Malnutrition is very common in patients on hemodialysis. Assessing the malnutrition status of haemodialysis patients is important for treatment and better health of the patients. Anthropometric measurements, both parts of anthropometry are used to assess the nutritional status. Objective: To assess the nutritional status of hemodialysis patients. Methods: A cross-sectional study was conducted at Bahria International Hospitals, Lahore and completed within 9 months using the convenient sampling technique. The data were collected through pretested questionnaire from 385 dialysis patients. Data were analyzed in the form of mean, frequencies, percentage and standard deviation with the help of SPSS version 22.0. Results: 50.5 % of the patients had normal body mass index (BMI) and 9.2% had BMI less than 18 which were underweight according to the WHO criteria. The mean and standard deviation of mid upper arm circumference (MUAC), mid arm muscle circumference(MAMC) and skin fold thickness (SFT) were 13.22±6.16, 20.40±4.67 and 1.67±0.54. Biochemical data showed mean and standard deviation of urea, creatinine and albumin were 104.37±38.63, 3.46±7.2716 and 3.46±0.72. Dietary intake included average energy intake i.e. 612.16±243.95, protein intake i.e. 30.61±10.98, fluid i.e. 738.11±223.06, sodium intake i.e. 949.60±578.96 and potassium intake i.e. 918.77±359.52. Conclusions: Most of the patients on haemodialysis were malnourished. These patients need dietary advice, care and monthly routine check-up of biochemical and anthropometric data to prevent from further complications.

Pakistan is under developing country and it has an unpredictable market nature of shareholder-investors observe the company’s performance. This research could help to companies in understanding financial behavior, attitude and investors’ satisfaction in stock trade. Financial behavior is comparatively new subject in Pakistan therefore; this study has examined the financial behavior and attitude of investors. The behavioral finance that has been attempted to understand the positive experiences influences investors’ financial behavior. This study has find out that investor satisfaction is strongest in influence of positive financial behavior of investor and trader in stock trading; positive experience and brokers suggestions are strengthens the investment decision of investors and increases behavior loyalty to prefer over competitor. The main purpose of research to determine the effect of financial behavior on investors’ attitude and behavioral loyalty and investors’ satisfaction to preference over competitor. The research framework links with experiences in stock trade for positive (negative) experiences, attitude and financial behavior is developed. The research framework is measured data from sample of Karachi and Karachi Stock Exchange; the data is analyzed in smart PLS based on PLS-SEM. This study focused on trading experience with company’s active investors and traders in banking industry in Pakistan. The future research could be research in other sectors with inter-related issue of investors and traders (brokers) in stock trade. This is the first study in this research area; this study will be determine the experiences with positive (negative) financial behavior, attitude, satisfaction and behavioral loyalty of investors and traders in stock trade. Therefore, adding in this area of study which will help understanding the investors and traders attitude, preference and financial behavior in financial market.

Objectives: The current lockdown in the country has led to a sedentary lifestyle because of a shift of daily activities online and a fear of contracting the illness leading to isolation inside homes; Hence an expected change in weight of the general population. This study aims to determine the frequency of weight gain and its impact in adults during the current lockdown of COVID-19. Methods: Participants selected from the ages of 18-25 from different universities of Pakistan were sent questionnaires via WhatsApp, posted online using Microsoft Forms. A total of 157 responses were attained. Results: Among the 157 participants the average weight before the lockdown was 61.95 kgs and after the lockdown was 64.99kgs so there was an increase of 3.016 kgs whereas 18.5% of the sample maintained their weight and 37.6% were reported to have lost weight. The results also depict a 1.6% increase in impairment of body image. Conclusion: We concluded that the Lockdown due to the COVID-19 pandemic has caused a gain in the weight and lowered self-esteem with regard to body image of most young adults in Pakistan due to many factors including higher food intake, lack of exercise and also emotional distress. Key words: Obesity, Weight gain, Lockdown, Body Image. How to Cite: Bokhar U, Shoaib U, Tariq S, Khan S.K, Syed F, Amin B, Ijaz F, Aftab R.K. Frequency of weight gain and its impact in adults during lockdown: a cross sectional study. Esculapio.2020;16(04):110-115.

Acute Lymphoblastic Leukemia (ALL) is the most common cancer in childhood. Despite a significantly improved prognosis over the last decade with a 5-years survival rate of ~90%, treatment-related morbidity remains substantial and relapse occurs in 10–15% of patients (1). The most common site of relapse is the bone marrow, but early colonization and subsequent reoccurrence of the disease in the central nervous system (CNS) also occurs. Integrins are a family of cell surface molecules with a longstanding history in cancer cell adherence, migration and metastasis. In chronic lymphoblastic leukemia (CLL), the VLA-4 integrin has been acknowledged as a prognostic marker and mounting evidence indicates that this and other integrins may also play a role in acute leukemia, including ALL. Importantly, integrins engage in anti-apoptotic signaling when binding extracellular molecules that are enriched in the bone marrow and CNS microenvironments. Here, we review the current evidence for a role of integrins in the adherence of ALL cells within the bone marrow and their colonization of the CNS, with particular emphasis on mechanisms adding to cancer cell survival and chemoresistance.

The overall survival of children with acute lymphoblastic leukemia (ALL) has improved markedly over the last decade, yet relapse occurs in about 10–15% of patients [1]. The spread of leukemic blast...

Women with human immunodeficiency virus have higher rates of abnormal cervical and vaginal cytology and, subsequently, of cervical and vaginal cancers. Although professional bodies currently advocate for indefinite cytology screening for women living with human immunodeficiency virus, these recommendations are based on expert opinion, not evidence-based. In the general population, women who have never had an abnormal cytology result can cease screening at age 65 years. This is due to the relatively low incidence of dysplasia in this group and the risk of false-positive results as women age, invasive follow-up testing, and destructive treatments of lesions that are unlikely to progress to cancer. What is unclear, however, is how human immunodeficiency virus-infected women over age 65 years who have no history of abnormal cytology should be screened to maximize benefit while reducing harms of overscreening. This is a crucial question, as women over age 65 years who are living with human immunodeficiency virus comprise a rapidly growing population.To describe the incidence of abnormal cervical and vaginal cytology results in women over the age of 65 years living with human immunodeficiency virus, with the goal of providing evidence for screening recommendations.A retrospective chart review was performed, identifying 69 women who received gynecologic follow-up in a county hospital system in Houston, Texas, between 2000 and 2018 and who met study criteria. Incidence of abnormal cytology after age 65 was determined by analyzing all available cytology results after age 65. Demographic and clinical risk factors, including human immunodeficiency virus-specific clinical risk factors, were analyzed. Matched cervical and vaginal pathology results, if conducted, were also evaluated. Statistical analyses were conducted using Stata 15, including χAmong 69 women with no history of abnormal cervical cytology, 12 (17%) went on to develop abnormal cytology results, including 3 (4%) showing high-grade squamous intraepithelial lesions. The incidence rate was 3.5 cases per 100 woman-years (95% confidence interval, 1.58, 7.81). No demographic or gynecologic characteristics were associated with abnormal cytology. A CD4 count of200 at the time of human immunodeficiency virus diagnosis or at the time of cytology was associated with an abnormal Papanicolaou test result (P.0001, P = .031). Of women with pathology results in the county hospital system (n = 8), 4 (50%) had cervical intraepithelial neoplasia 2+ or vaginal intraepithelial neoplasia 2+. No women developed invasive cancer. However, 50% of women who had an abnormal Papanicolaou test result in the study period were lost to follow-up; outcomes for these patients are unknown.Given the relatively high proportion (4%) of women with high-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia 2+/vaginal intraepithelial neoplasia 2+ during the study period, we agree with current screening recommendations for continued routine Papanicolaou testing after the age of 65 years in women with human immunodeficiency virus. More evidence from larger studies is needed to solidify evidence-based screening recommendations in this unique and growing population.

Study Objective Adnexal torsion (AT) requires urgent surgical intervention to preserve ovarian function. Historically, treatment for AT was oophorectomy because of concerns related to leaving a nonviable ischemic ovary. No published studies support these theoretical concerns and current literature supports conservative management. The aim of this study was to review the institutional outcomes for AT cases, including salvage rates and complications. Design, Setting, Participants, Interventions, and Main Outcome Measures This study was approved by the institutional review board at Baylor College of Medicine. A retrospective chart review on cases of AT from 2007 to 2016 at a single Children's hospital was performed on the basis of International Classification of Diseases, 10th revision and Current Procedural Terminology codes. A standardized chart review form was used in data extraction. Statistical analysis was performed using SAS version 9.4 (SAS Institute). Results Chart review identified 245 torsion cases in 237 patients. The mean age was 12.4 ± 3.29 years. Of the participants, 230 (94%) underwent minimally invasive laparoscopy with ovarian preservation in 233 (95%) of the cases. There were no complications due to detorsion of the affected adnexa. Intraoperatively, the right adnexa was affected in 134 (55%) cases and a lesion was noted in 193 (79%) cases, most commonly paratubal cysts and mature teratomas. The malignancy rate was low, noted only in 4/245 patients at (1.2%). Pediatric gynecology performed most of the cases (n = 214; 87%). Conclusion The findings of our study continue to support the conservative management of patients with AT.

Objectives: To determine adherence to dimensions of physical wellness among medical students of public and private medical colleges in Pakistan. Methods: This cross-sectional study was carried out from January to July 2011 among 820 students of private and public medical colleges in Karachi, Pakistan. Results: Overall, medical students scored low in dimensions of physical wellness. Private medical colleges students were fond of vigorous activities such as aerobics and swimming, whereas public medical colleges students were involved in moderate intensity activities such as walking and use of stairs ( p less than 0.0001). Private students reported to consume more fast food ( p =0.0001), had less sleep ( p =0.0001), but attended regular annual medical checkups ( p =0.009) as compared with their public institute counterparts. Safe practices such as avoidance of tobacco were almost the same. Conclusion: Comprehensive adherence to all dimensions of physical wellness was lacking among medical students. Saudi Med J 2015; Vol. 36 (6): 754-758 doi: 10.15537/smj.2015.6.11108

EBV has been a leading candidate as a trigger for several autoimmune diseases. We describe an antineutrophil cytoplasmic autoantibody (ANCA) -associated systemic vasculitis as the initial presenting illness of AIDS.The patient was diagnosed ANCA -associated systemic vasculitis in the setting of HIV infection because of a high level of ANCA level, crescent glomerulonephritis in pathology, and clinical signs and symptoms compatible with systemic vasculitis. He also had HIV associated lymphadenopathy with scattered. EBV-RNA positive cells and reactive germinal centers.EBV genome was found in reactive lymph nodes and, therefore, may be associated with the immunopathogenesis of vasculitis.

To observe effects of vitamin D levels on pregnancy outcome after intra cytoplasmic sperm injection (ICSI).It was a cross-sectional study conducted in Australian Concept Infertility Medical Center from July 2011 to August 2014. Estimation of 25-hydroxy cholecalciferol (25-OHD) of consented females (252) was done before treatment protocol for ICSI. Results of β hCG performed 14 days after embryo transfer categorized groups; Pregnant with ß hCG more than 25 IU/mL and rest included in non-pregnant group. Both groups were compared by independent sample t-test and Pearson's Chi Square test. Binary Logistic Regression Analysis was used to estimate odds ratio of pregnancy outcome with its predictors including Vitamin D.The mean value of 25-OHD, number of oocytes, fertilized oocytes and endometrial thickness was significantly higher in pregnant women. A significant positive association of 25-OHD with clinical pregnancy and thickness of endometrium was observed. After adjustment with female age and BMI, positive association of vitamin D with endometrial thickness was observed.Deficiency of 25-OHD in females hinders the accomplishment of optimal endometrial thickness required for implantation of embryo after ICSI. The improvement in vitamin D status can thus improve success results in assisted reproductive clinics.

INTRODUCTION:HIV-infected women are 10-11 times more likely to develop abnormal cervical cytology compared with HIV uninfected women, elevating the need for Pap smear surveillance. While guidelines for screening exist for HIV-infected women of reproductive age, there is inadequate data to guide care

Retail health clinics are walk-in clinics located in retail stores or pharmacies that are typically staffed by nurse practitioners or physician assistants. When they entered the marketplace in the early 2000s, retail clinics offered a limited number of services for low-acuity conditions that were paid for out of pocket by the consumer. Over the past decade, business models for these clinics have evolved to accept public and private health insurance, and some are expanding their services to include diagnosis, treatment, and management of chronic conditions. Retail health clinics are one of several methods of health care delivery that challenge the traditional primary care delivery model. The positions and recommendations offered by the American College of Physicians in this paper are intended to establish a framework that underscores patient safety, communication, and collaboration among retail health clinics, physicians, and patients.