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Cuscuta reflexa is an extensive leafless, parasitic climber that has been used since ancient times for various purposes and as a therapeutic plant in different areas of Pakistan. The phytochemical, antibacterial, antioxidant, and fatty acid investigations were carried out on the leaves, stems, and fruit extracts of C. reflexa. Preliminary phytochemical screening has shown the presence of various phytochemicals such as carbohydrates, protein, amino acids, alkaloids, flavonoids, phenols, glycosides, saponins, tannins, terpenoids, steroids, and phenolic compounds. The percentage variation of some components fluctuated like moisture (6.85-10.34%), ash (5.38-7.83%), acid insoluble ash (0.28-0.71%), water-soluble ash (0.78-0.96%), hexane extractives (1.23-1.91%), alcohol extractives (10.39-12.23%), water extractives (25.34-30.35%), loss on drying (1.16-1.47%) and crude fiber (15.04-18.26%) for leaves, stems, and fruits respectively. The level of free fatty acid was different as follows: leaves (2.37%), stems (2.16%), and fruits (2.94%); a high value of peroxide was observed in stems, followed by leaves and fruits. The iodine and saponification values in leaves, stems, and fruits were found in the range of 105-116 g I2/100 g, and 165-175 mg KOH/g. The antibacterial activity was carried out by the disc diffusion method against gram-positive Staphylococcus aureus and gram-negative Escherichia coli bacteria. It was found that all extracts of the selected plant were most active against E. coli with a zone of inhibition of 4, 4, and 6 at MIC 250 as compared to S. aureus, which showed a zone of inhibition of 3, 4, and 5 at MIC 250 μg/ml. The antioxidant potential of the leaves, stems, and fruit extracts, examined on the basis of their scavenging activity of free radicals, was found to be good. The result of the gas chromatography-mass spectroscopy (GCMS) analysis reveals that linoleic acid (38.10-40.53%) is the most abundant fatty acid of C. reflexa and the smallest amount was found in tricosanoic acid (0.12-0.19%). In general, the isolated compounds were reported to possess anticarcinogenic, antitumor, antimicrobial, and anti-inflammatory properties. It was concluded that C. reflexa has a markedly therapeutic potential to heal wounds and may provide the pharmacological basis for its folk uses. [ABSTRACT FROM AUTHOR]

As a result of climate change and unsustainable land use management in the recent past, droughts have become one of the most devastating climatic hazards whose impacts may prolong from months to years. This study presents analysis of droughts for two major cropping seasons, i.e., Kharif (May–September) and Rabi (October–April), over the Potwar Plateau of Pakistan. The analysis is performed using various datasets viz. observational, reanalysis, and Regional Climate Models (RCMs), for the past (1981–2010) and future (2011–2100) time periods. The following two methods for the identification of dry and wet years, also referred to as drought and wetness, are applied: (1) the percentile rank approach and (2) the drought indices, Standardized Precipitation Index (SPI) and Reconnaissance Drought Index (RDI). Future projections of droughts are investigated using RCM (RegCM4.4 and RCA4) outputs from CORDEX South Asia domain under two Representative Concentration Pathway (RCP) scenarios, RCP4.5 and RCP8.5. Generally, the indices show non-significant decreasing trends of drought severity in the recent past for all cases; however, significant increasing trends are observed for annual (0.006) and Kharif (0.007) cases under RCP4.5 scenario. The analysis of large-scale atmospheric dynamics suggests the significant role of low-level geopotential height anomalies over Tibetan Plateau (northwest of Pakistan) during Kharif (Rabi) season in controlling drought occurrence by transporting moisture from the Bay of Bengal (Arabian Sea). Moreover, composites of vertically integrated moisture transport, moisture flux convergence/divergence, and precipitable water anomalies show their marked contribution in maintaining the drought/wetness conditions over the Potwar region. [ABSTRACT FROM AUTHOR]

We have used the Laser Induced Breakdown Spectroscopic (LIBS) technique to qualitatively identify the naturally existing transparent crystal as a pure quartz (SiO 2 ) by observing its optical emission spectra using a Q-switched Nd:YAG laser, fundamental wavelength at 1064 nm and second harmonic at 532 nm. The spectra were registered using a set of five miniature spectrometers covering the spectral range from 200 nm to 720 nm. The plasma temperature has been calculated in the range from 8500 K to 10,200 K and the electron densities determined from the Stark broadened spectral lines in the range of 1.0 × 10 17 cm − 3 to 6.0 × 10 17 cm − 3 . We report here the full widths at maximum of the spectral lines associated with the 3p4s 3 P 0,1,2 → 3p 2 3 P 0,1,2 , 1 S 0 , 1 D 2 transitions in Si and four multiplets of singly ionized silicon. [ABSTRACT FROM AUTHOR]

Background: The importance of including bioethics in the medical curricula has been recognized globally. Certain countries including Pakistan continue to lag behind although some developments have occurred recently., Objectives: The research aimed to provide a snapshot of bioethics education in undergraduate medical colleges in Karachi, Pakistan. The secondary objectives included identifying factors promoting or inhibiting integration of bioethics into the curriculum., Methods: A two-pronged strategy was used to collect data including a website review of medical colleges, in existence for more than ten years, recognized by the Pakistan Medical and Dental Council (PMDC), the regulating body for undergraduate medical education in Pakistan. The other arm employed in-depth interviews with medical educationists in colleges fulfilling inclusion criteria. Data from the website was analyzed and presented as frequencies. Qualitative data was analyzed using content analysis method which involved coding of transcripts, multiple readings and arriving at subthemes and themes iteratively., Results: Thirteen medical colleges were included for the website review, of which four were from public sector. Three medical colleges used the word "ethics" in their vision and mission statement and four had provided a detailed curriculum for ethics on their website. Thematic framework included four broad themes: 1) Need for Bioethics Education, 2) Current Status of Bioethics Education 3) Challenges in integration of bioethics in medical curriculum and 4) Recommendations for integration of bioethics in the Curriculum. Participants were in agreement that bioethics was important in development of future physicians. Participants identified various challenges, foremost being shortage of trained faculty, lack of institutional buy-in and overcrowded curriculum., Conclusion: The study identified sporadic inclusion of bioethics in undergraduate medical curricula, left to the discretion of individual institutions. Since Karachi is a cosmopolitan city, the findings may reasonably reflect the situation in other parts of the country. While bioethics is recognized as an important field, it will continue to remain an orphan subject in the curricula unless the regulatory and accreditation bodies make it compulsory for institutions to include ethics in their curricula., (© 2024. The Author(s).)

Introduction: Influenza is a serious underestimated viral infection in Pakistan and influenza vaccination and vaccination awareness are low. The current work aimed to develop consensus on influenza epidemiology, prevention, vaccination, and awareness in Pakistan., Methodology: A systematic literature search was conducted to develop recommendations on influenza vaccines in Pakistan. Experts' feedback was incorporated using the modified Delphi method. A three-step process was used, with 18 experts from different specialties from Pakistan who participated in voting rounds to achieve a minimum 75% agreement level., Results: Pakistan has a low-immunization-rate and is susceptible to serious influenza outbreaks and influenza-related complications. Influenza circulates year-round in Pakistan but peaks during January and February. The subtype A/H1N1 is predominant. The experts urged vaccination in all individuals ≥ 6 months of age and with no contraindications. They highlighted special considerations for those with comorbidities and specific conditions. The experts agreed that the inactivated influenza vaccine is safe and efficient in pregnant women, immunocompromised, and comorbid respiratory and cardiovascular patients. Finally, the experts recommended conducting promotional and educational programs to raise awareness on influenza and vaccination., Conclusions: This is the first regional consensus on influenza and influenza vaccination in Pakistan with experts' recommendations to increase influenza vaccination and decrease influenza cases and its associated detrimental effects., Competing Interests: Raeefuddin Ahmed and Tabrez Ali are salaried and full-time employees of Abbott Laboratories (Pakistan) Limited. Uzma Bashir participated in the activity as a subject matter expert with no financial benefits received for the technical support provided, (Copyright (c) 2024 Bushra Jamil, Raeefuddin Ahmed, Uzma Bashir, Shobha Luxmi, Samreen Kulsoom, Saadia Ashraf, Muhammad H Hamid, Fawad Farooq, Ainan Arshad, Altaf Hussain, Tabrez Ali.)

Measurements of radionuclides' activities in air, water, and soil give clues about the anthropogenic activities in the region, and imperative to assess the overall radiological risk for individuals. Such an investigation was carried out to characterize the soil activities in the region hosting a research center, and to calculate the associated elements of radiological risk in terms of radiation doses and hazard indices. The soil samples were collected within the radius of 10 km in local area, Nilore, and analysed for activity using a high-purity germanium (HPGe) gamma spectrometric system. In all samples, only the basic nuclides, contributing to terrestrial activity, i.e., 40  K, 232 Th, 226 Ra, and 137 Cs, were observed within the detectable limits of activity. The distribution of the data set and the correlation between the measured activities were studied with the use of the principal component analysis (PCA). The measured average specific activities of 226 Ra, 232 Th, 40  K, and 137 Cs were 40.65 ± 9.84 Bq/kg, 59.31 ± 16.53 Bq/kg, 528.24 ± 131.18 Bq/kg, and 5.16 ± 4.56 Bq/kg respectively. The corresponding dose rate in air was found to be 76.63 ± 18.39 nGy/h, which is slightly higher than the world median value of 51 nGy/h calculated from concentration of terrestrial radionuclides in soil but falls within the world average value range of outdoor external exposure of 18-93 nGy/h obtained through direct measurement, and therefore not harmful for the living species. The standard hazard indices for all soil samples such as radium equivalent activity ([Formula: see text]), external hazard index (H ex ), and internal hazard index (H in ) were also found within safe limits for the soil to be used as construction of building material. This investigation led to conclusion that the soil activities are consistent with the usual background level of terrestrial activities, and their associated dose rates are well within the safe limits for public., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Modernization produces carbon dioxide (CO 2 ) emissions but is also able to achieve sustainable agriculture growth by introducing the concept of renewable energy into the agriculture sector, and through this process reduce the CO 2 emissions in the country. The main objective of this research is to check the environmental Kuznets curve hypothesis with CO 2 emissions and economic development in renewable energy and agriculture subsectors such as fisheries and crop production in Pakistan. This study covers the time period 1984 to 2020. We have applied the autoregressive distribution lag (ARDL) bound test. The results indicate the existence of long-term association among all variables in the model. The result of co-integration in the short run shows a negative relationship between CO 2 emissions and crop production in the current time period, and it shows a positive correlation with the first lag of CO 2 emission, which means that current crop production reduces the CO 2 emissions by 32% during a year, while in the lag period, it will increase in the short run. In the long run, a 1% increase in crop production will reduce the CO 2 emission by 86%. Renewable energy shows a negative relation with CO 2 emissions in the short run; a 1% increase in renewable energy will reduced the CO 2 by 0.017%. Our results support the existence of the EKC hypothesis for Pakistan. In light of the findings, it is suggested that policy makers should focus more on renewable energy to decrease the level of CO 2 as much as possible. Moreover, the government must provide subsidies for machines used for cropping and give special attention to subsectors such as livestock and fisheries., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

High-risk-human papillomavirus (HR-HPV)-induced cervical cancer is the second most common cause of death among females worldwide. HPV16 is the most prevalent HR-HPV infection worldwide. This study found the genotypic distribution of HR-HPV in the local population and investigated the sequence variations among the E6 and E7 oncogenes of the local HPV16 genotype to the E6 and E7 oncogenes of the foreign HPV16 genotypes and constructed a phylogenetic relationship based on nucleotide sequence comparison among the variants identified in our study along with previously reported isolates that were obtained from different regions of the world. The samples were collected from patients with cervical cancer. Genomic DNA was extracted, and HR-HPV genotypes were determined using real-time PCR. The HPV16 E6 and E7 genes were amplified and sequenced. A HPV16 phylogenetic tree was constructed using the maximum likelihood method with MEGA 7. HPV16 was the most prevalent human papillomavirus (HPV) type identified in the present study. HPV16 isolates belonged to the A1 sublineage of the European branch. Twenty-one nucleotide sequences were included in this analysis. The first, second, and third codon positions are also included. The final dataset included 776 positions., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Drought variability analysis is of utmost concern for planning and efficiently managing water resources and food security in any specific area. In the current study, drought spell occurrence has been investigated in the Balochistan province of Pakistan during the past four decades (1981-2020) using standardized precipitation index (SPI), reconnaissance drought index (RDI), and precipitation deciles (PD) at an annual timescale. Precipitation and temperature data collected from 13 synoptic meteorological stations located in Balochistan were used to calculate the SPI, the RDI, and the PD for calculation of drought severity and duration. Based on these indices, temporal analysis shows adverse impacts of drought spells in Nokkundi during 1991-1993, in Barkhan, Dalbandin, Quetta stations during 1999-2000, whereas Barkhan, Dalbandin, Lasbella, Sibi during 2002-2003, Zhob during 2010-2011, Kalat and Khuzdar during 2014-2015, and Panjgur during 2017-2018. Also, the aridity index for each station was calculated based on the UNEP method shows that major part of Balochistan lies in the arid zone, followed by the hyper-arid in the southwestern part and the semi-arid zones in the northeastern part of the province. SPI and RDI results were found more localized than PD, as PD shows extensive events. Furthermore, principal component analysis shows a significant contribution from all the indices. For SPI, RDI, and PD, the first three principal components have more than 70% share, contributing 73.63%, 74.15%, and 72.30% respectively. By integrating drought patterns, long-term planning, and preparedness to mitigate drought impacts are only possible. The RDI was found more suitable and recommended in case of temperature data availability.

The kidney is the most vulnerable organ in coronavirus disease-2019 (COVID-19) patients besides the lungs, with evidence of acute kidney injury (AKI). We aimed to find the prevalence of AKI among COVID-19 patients and further evaluate the association of between COVID-19 and AKI along with an understanding of mortality. A prospective observational study was conducted among COVID-19 patients admitted to a tertiary care hospital, Hayatabad Medical Complex, between March 2020 and June 2020. Chi-square test was applied for comparative analysis, whereas for predictors of mortality, odds ratios (OR) were calculated using logistic regression. A total of 606 patients with COVID-19 were admitted to the dedicated ward, of which 250 (41.3%) had AKI and 190 (31.4%) died, whereas, patients having AKI presented 62.1% of mortality. Our study revealed a statistically significant association between AKI and mortality (OR = 3.5; P <0.0001). Moreover, we observed a greater risk of deaths among patients with AKI stage I-III i.e., AKI stage I (OR = 2.4; P <0.0001), stage II (OR = 5.5; P = 0.0001), and stage III (OR = 6.6; P<0.0001). Our study reported AKI and associated mortality in a considerable number of patients with COVID-19. AKI patients have significantly higher chances of death versus non-AKI patients. Further, the risk of mortality increases with further deterioration in kidney function, i.e., patients with AKI stage III showed a higher mortality rate compared with stage II and stage I., Competing Interests: None

Objectives: Tuberculosis (TB) is a significant public health concern, and the basis of successful anti-tuberculosis treatment (ATT) rests on the complete eradication of live bacilli from a patient. This study was conducted to detect the live TB bacilli in Lowenstein Jensen culture media among exit cases of TB who were declared successfully treated, either cured or treatment completed., Methods: This cross-sectional study was conducted across Pakistan. Fifty-eight active TB DOTS centers were selected. The sample size of 3355 TB cases were equally distributed in all DOTS facilities. A detailed questionnaire was developed to record the information from TB DOTS and patients. After successful treatment, the sputum was taken from TB cases and examined to detect live bacilli on L-J culture., Results: A total of 3355 TB cases were enrolled in the study. The male to female proportion was 1704(50.9%) and 1651(49.2%). Initially, 1993(59.4%) cases were cured, and 1362(40.6%) were declared as treatment completed cases. At exit, 324(9.65%) cases were again ZN smear-positive, and 328(9.77%) were positive on L-J culture, after being declared successfully treated for TB., Conclusions: To eradicate live TB bacilli, all TB cases should be subjected to L-J culture at the end of ATT., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Violence against Pakistani women occurs at an alarming prevalence that reflects a significant risk to the health of women and families. Understanding violence against women in Pakistan comes with methodological and cultural complexities. Many of the studies examining prevalence and predictors of violence against women tend to utilize convenience samples contributing to the possibility of an inflated prevalence. Due to the patriarchal family structure and cultural context, domestic violence is normalized resulting in extremely low reporting rates. The present study utilizes a sample of ever-married Pakistani women collected across five provinces to shed light on the prevalence and predictors of women that experience domestic violence (emotional or physical abuse). Data were obtained from the 2012-2013 Pakistan Demographic and Health Survey including a large sample of Pakistani women from five provinces (Sindh, Punjab, Balochistan, Khyber Pakhtunkhwa, and Gilgit Baltistan). Binary Linear regressions were conducted to examine how intrinsic variables (age, education, region, urban/rural, type of marital relationship, and wealth) predicted experiencing emotional or physical abuse from one's husband within the past year. Approximately, 20% of women endorsed experiencing physical violence and 28% endorsed experiencing emotional violence. Results found that educational level, wealth, and type of marital relationship were associated with a higher likelihood of experiencing some form of physical or emotional violence. Implications from this study support policy interventions aimed at education within the family, linking women with resources, and continued investment in the education of young women. Interventions would be best targeted in low wealth regions with a special emphasis on rural areas.

Interior settled dust is one of the greatest threats of potentially toxic metal(oid)s (PTMs) exposure to the children, especially in the school environment. Therefore, it is more worthy of having in-depth knowledge of compositional characteristics of school dust. Forty schools were selected of Lahore city for dust sampling. The school dust was analyzed to determine the PTMs (As, Cd, Cr, Cu, Ge, Mo, Ni, Pb, Sb, Sn, Sr, V, and Zn) concentrations using ICP-MS. The morphological characteristics, PTMs speciation, and mineralogy of school dust were examined using SEM with EDS, XPS, and XRD, respectively. Moreover, the geo-accumulation index (I geo ), potential ecological risk index (PERI), and multivariate statistical analysis were employed to assess the pollution levels, ecological risk, and source identification of PTMs, respectively. The I geo indicated a heavily-extreme pollution level of Cd (I geo  = 4.92), moderate-heavy pollution of Zn (I geo  = 3.22), and Pb (I geo  = 2.78), and slight-moderate pollution of Cr (I geo  = 1.62), and Cu (I geo  = 1.53). The ecological risk has been found extremely high for Cd and moderately high for Pb and As, while potential ecological risk found extremely high posed by cumulatively all selected PTMs. Multivariate statistical analysis showed that sources of PTMs comprise of natural processes as well as several anthropogenic processes like vehicular emissions, agricultural and industrial activities. The SEM, XRD, and XPS analyses demonstrated the presence of airborne particles and PTMs containing minerals with several toxic chemical species in school dust. This study can help to develop strategies to reduce school indoor pollution and hence to establish an eco-friendly learning environment for children., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Pathogenic germline mutations in BRCA1/2 constitute the majority of hereditary breast and/or ovarian cancers worldwide. Incidence and mortality rate of breast and ovarian cancers in Pakistani women is high. Thus, to establish the diagnosis for targeted therapy in Pakistan, we conducted Next-generation sequencing-based germline testing for the detection of BRCA1/2 oncogenic variants associated with breast and ovarian cancer subtype., Methods: Peripheral blood of 24 women, diagnosed with breast and epithelial ovarian cancers, was taken from the recruited cases with the consent of performing germline genetic testing. DNA was isolated from the peripheral blood and subjected to indexed BRCA Panel libraries. Targeted NGS was performed for all coding regions and splicing sites of BRCA1 and BRCA2 genes using AmpliSeq for Illumina BRCA Panel and Illumina MiSeq sequencer (placed at AFIP). Analysis of the sequencing results has been done by using Illumina bioinformatics tools., Results: We detected 421 variants having a quality score of 100 in all cases under study. The list of identified variants in BRCA1 and BRCA2 genes was narrowed down after filtering out those which did not pass q30 and those with a minor allele frequency (MAF) > 0.05 based on gnomAD browser. To classify these variants, clinical significance was predicted using external curated databases. As a result, we interpreted (n = 4) 16.7% pathogenic variants in BRCA1 and (n = 6) 25% variants of uncertain significance (VUS) in both genes. Descriptive statistics depicted that the age and BMI of BRCA positive cases are less than BRCA negative cases., Conclusion: Our findings exhibit an initial report for the NGS based cancer genetic testing in Pakistan.  This will enable us to pursue screening and diagnosis of hereditary BRCA mutation utilizing the latest state-of-the-art technique locally available in Pakistan ultimately resulting in targeted cancer therapy.

Objective:  To determine the pattern of histopathology in living-related, kidney transplant recipients (KTRs) from a transplant centre in Khyber Pakhtunkhwa (KPK), Pakistan., Study Design: Descriptive, observational study., Place and Duration of Study: Institute of Kidney Diseases, Peshawar, from August 2008 to July 2018., Methodology: A retrospective review of graft biopsy reports and clinical charts from living-related, kidney transplant recipients was carried out. Allograft biopsies were done for graft dysfunction with no apparent cause. The biopsy pathology was classified according to updated Banff classifications. The descriptive statistics were used to tabulate the results., Results: Out of the 55 biopsies, 51 (92.73%) were from males with mean age of 34.35±9.40 years. Out of 52 percutaneous biopsies, 10 (19.23%) belonged to the normal category. Category 2 (borderline rejection) and 3 (acute/active cellular rejection) were seen in three (5.7%) and one (1.9%) cases, respectively. Interstitial fibrosis/tubular atrophy (Banff Category 5) was observed in 18 (34.62%) cases. Banff Category 6 (others) was seen in 19 (36.5%) cases, in which calcineurin inhibitors (CNI) toxicity was commonest (17 [89.4%] of 19 cases). Mixed lesions were found in 19 (36.5%) cases. Out of the 19 mixed category cases, 12 (63.16%) showed both Category 3 and Category 5 changes with most of the cases showing mild to moderate IF/TA; while one case had severe IF/TA. Three graft nephrectomies were done, one each for recurrent oxalosis, nephroblastoma and fungal infection., Conclusion: Among the studied specimens, mixed lesions were the predominant findings, followed by others (mostly CNI toxicity) and IFTA categories. The frequency of acute/active rejections was low and that of chronic changes higher, in keeping with delayed biopsies. Key Words: Allograft biopsy, Graft dysfunction, Rejection, Kidney.

Background: Pakistan has a high incidence of breast cancer in Asia, where annually 16,232 deaths are reported. There are many exogenous and endogenous risk factors that affect the tumor suppressor genes and oncogenes. The p53 gene is a tumor suppressor gene and it has a role to protect the whole genome from external and internal stresses, which causes damages to the genome., Objective: The aim of the current study was to investigate the p53 gene expression by using the real-time PCR technique in different grades of breast cancer as compared to the normal tissue., Methods: Fresh Modified Radical Mastectomy (MRM) samples (grade1-grade3) were collected from different hospitals of the Lahore. The project was approved by an ethical review committee of Jinnah Hospital, Lahore. And before sampling an informed consent was obtained from patients and clinicians. RNA from fresh biopsies was extracted by Qiagen extraction kit and cDNA was formed. Real time PCR performed by using SYBR green master mix (ABI) and the data was evaluated by using Livak method. Statistical analysis was done by using Microsoft Excel., Results: There was an abnormal gene expression of p53 in all grades of the breast tumors. Non-significant (p>0.05) difference of down and up regulation of p53 in different grades of breast tumor was found. However, as a whole up-regulation was more than down-regulation with significant difference (p<0.0011)., Conclusion: The abnormal expression of p53 shows that there are some genetic and epigenetic factors which are the primal cause of an abnormal gene expression. It is recommended that perform next generation sequencing (NGS) of the gene to find out the mutations causing the abnormal behavior of p53 gene., (© 2020 Sadia H et al.)

We describe the seroprevalence of severe fever with thrombocytopenia syndrome virus (SFTSV) and the association of antibody occurrence with location, sex, and age among the human population in Pakistan. Our results indicate substantial activity of SFTSV and SFTSV-related viruses in this country.

Objective: To determine the prevalence of fungal infections causing nasal polyposis (AFRS-Allergic fungal rhino sinusitis) in the local population., Methods: It is a cross sectional study, carried out from October 2010 to January 2015 on 221 patients in the ENT Department of Abbasi Shaheed Hospital and Karachi Medical & Dental College in collaboration with the microbiology department. This study included patients who had a clinical diagnosis of nasal polyposis with or without fungal infection on the basis of nasoendoscopic examinations. All patients underwent Functional Endoscopic Sinus Surgery (FESS) and the diagnosis of (AFRS-Allergic fungal rhino sinusitis) was considered after histopathological confirmation of eosinophilic mucous containing hyphae. Numerator included the total number of patients who presented to the ENT out-patient clinic of Abbasi Shaheed Hospital suffering from nasal polyposis secondary to fungal infection during the follow-up period of the study. On the other hand, denominator included all the patients who attended the ENT out-patient clinics during the same follow-up period. This determined the period prevalence of fungal infections in nasal polyposis at a tertiary care centre in Karachi., Results: Data was collected, a descriptive analysis was performed and a Computed Tomography (CT) grading was done. On the basis of histopathology, 90 (40.7%) patients were found to have fungal infection., Conclusions: The prevalence of fungal infections was 40.7% (90 patients) in nasal polyposis.

The devastations and damages caused by climate change are apparent across the globe, specifically in the South Asian region where vulnerabilities to climate change among residents are high and climate change adaptation and mitigation awareness are extremely low. Pakistan's low adaptive capacity due to high poverty rate, limited financial resources and shortage of physical resources, and continual extreme climatic events including varying temperature, continual flooding, melting glaciers, saturation of lakes, earthquakes, hurricanes, storms, avalanches, droughts, scarcity of water, pest diseases, human healthcare issues, and seasonal and lifestyle changes have persistently threatened the ecosystem, biodiversity, human communities, animal habitations, forests, lands, and oceans with a potential to cause further damages in the future. The likely effect of climate change on common residents of Pakistan with comparison to the world and their per capita impact of climate change are terribly high with local animal species such as lions, vultures, dolphins, and tortoise facing extinction regardless of generating and contributing diminutively to global GHG emissions. The findings of the review suggested that GHG emissions cause climate change which has impacted agriculture livestock and forestry, weather trends and patterns, food water and energy security, and society of Pakistan. This review is a sectorial evaluation of climate change mitigation and adaption approaches in Pakistan in the aforementioned sectors and its economic costs which were identified to be between 7 to 14 billion USD per annum. The research suggested that governmental interference is essential for sustainable development of the country through strict accountability of resources and regulation implemented in the past for generating state-of-the-art climate policy.

Climate change is a global challenge faced by everyone, but the developing countries are highly vulnerable to variations in the environment. This research focuses on the Punjab province of Pakistan and evaluates the impacts and consequences of climate change on general public at local and divisional level. In order to cope with the impacts of climatic changes at all levels, especially divisional level, raising reliable awareness and dispersing actionable knowledge regarding mitigating and adapting measures is significantly important. Therefore, recognition of information gaps, improvements in the level of alertness, and development of preventive measures in each sector is imperative. The impacts of climate change are observed across the country through gradual increase in temperature, human health issues, pest diseases, droughts, floods, and irregular weather patterns leading to changes in lifestyles, and these issues are likely to continue in the future. The main cause of climate change in Punjab, Pakistan, can be attributed to excessive release of greenhouse gases (GHG) into the atmosphere due to human activities involving inefficient energy usage, rapid urban expansion, improper waste management, industrial development, increasing transportation, agricultural activities, and livestock mismanagement. The findings of this study revealed that transportation sector is the major source of GHG emissions in the country, followed by industrialization and waste, at national, as well as divisional, level. The extent of impacts of climate change at divisional level is distinguishable and displayed a direct relationship with climate, geography, variation of effects, and modes of production in various regions of Punjab. The study strategically investigated all nine divisions of the province for comprehensive understanding of climate change phenomenon, and the results indicated that nearly three-fourths of the respondents have never indulged in taking steps towards climate change mitigation and adaptation. The study adopted a mixed (qualitative and quantitative) approach where the findings can act as set of guidelines for governmental authorities in formulating, assisting in preparation, instructing, and guiding policies for climate change mitigation and adaptation at national, local, and divisional levels. Graphical abstract.

Objective: To investigate the association of oral squamous cell carcinoma with demographic variables and oral health indicators. ., Methods: The observational case-control study was conducted at the Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan, from November, 2015, to August, 2016.Pathologically confirmed patients with oral cancer represented the cases, while The controls were ethnically and linguistically-matched subjects without any oral pathology. Demographical, clinical and pathological data was taken down to assess variables, risk factors, and oral health indicators. Descriptive statistics and logistic regression modelling were employed for data analysis., Results: Of the 551 subjects, 341(62%) were males, and 210(38%) were females. Of the total, 276(50.1%) were cases and 275(49.9%) were controls. The mean age of the cases was 55.0}13.4 years and that of the controls was 52.8}14.9 years (p=0.073). Poor oral hygiene, periodontal diseases, material of toothbrush, and no use of mouthwash were significant predictors of oral cancer (p<0.05 each). Smoking and using smokeless tobacco were also significant variables., Conclusions: Oral health indicators in combination with smoking conferred an increased risk of oral cancer.

This study aims to provide estimates, trends and projections of vision loss burden in Pakistan from 1990 to 2025. Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2017) was used to observe the vision loss burden in terms of prevalence and Years Lived with Disability (YLDs). As of 2017, out of 207.7 million people in Pakistan, an estimated 1.12 million (95% Uncertainty Interval [UI] 1.07-1.19) were blind (Visual Acuity [VA] <3/60), 1.09 million [0.93-1.24] people had severe vision loss (3/60≤VA<6/60) and 6.79 million [6.00-7.74] people had moderate vision loss (6/60≤VA<6/18). Presbyopia was found to be the most common ocular condition that affected an estimated 12.64 million [11.94-13.41] people (crude prevalence 6.08% [5.75-6.45]; 61% female). In terms of age-standardized YLDs rate, Pakistan is ranked fourth among other South Asian countries and twenty-first among other 42 low-middle income countries (classified by World Bank), with 552.98 YLDs [392.98-752.95] per 100,000. Compared with 1990, all-age YLDs count of blindness and vision impairment increased by 55% in 2017, which is the tenth highest increase among major health loss causes (such as dietary iron deficiency, headache disorders, low back pain etc.) in Pakistan. Moreover, our statistics show an increase in vision loss burden by 2025 for which Pakistan needs to make more efforts to encounter the growing burden of eye diseases., Competing Interests: The authors have declared that no competing interests exist.

Background: Organizations flourish with a satisfied workforce. There is little known information on demographic characteristics and motivators for job satisfaction among Pakistani postgraduate trainees in surgery. Job satisfaction is predicted by intrinsic motivators (personal growth and perceived ability to work) and extrinsic motivators (perceived social support). Work family interference/enhancement and job stressors (workload and long working hours) also impacts job satisfaction; predicting overall life satisfaction. This study aims at examining life satisfaction predicted by personal and professional characteristics.., Methods: The postgraduate trainees in the public and private hospitals of Rawalpindi and Islamabad were surveyed using validated measures of life satisfaction, personal growth, perceived social support, perceived ability to work, work family interference/enhancement, job stressors, co-workers support, supervisors support, and job satisfaction from September 15 to December 28, 2017., Results: Personal growth, perceived ability to work, availability of social support, and work family enhancement positively correlate to job and life satisfaction. Work life interference and job stressors negatively relate to job and life satisfaction. Job satisfaction is also partially mediated by intrinsic and extrinsic motivators on life satisfaction, whereas job stressors weakened the relationship between job satisfaction and life satisfaction. Long working hours is negatively related to job satisfaction and life satisfaction., Conclusions: Life satisfaction is predicted by job satisfaction that is characterized intrinsic and extrinsic motivators. Healthcare organizations face challenge of providing reduced working hours, increased salaries, supportive working environment, and increased supervision to enhance the job satisfaction of employees and to improve the functioning of the healthcare environment.

Objective: To determine the correlation of trainee selection scores (TSS) with subsequent performance in anesthesiology trainees at a university hospital., Study Design: Descriptive analytical study., Place and Duration of Study: The Aga Khan University Hospital, Karachi, from August 2016 to January 2017., Methodology: Data were collected on 44 anesthesiology trainees completing their training between 2009 and 2015. TSS consisted of entrance test, final-year medical school scores, and interviews. Assessment included written tests, viva voce, and clinical assessment. Non-parametric Spearman rank correlation coefficient was computed to assess the relationship between scores., Results: Weak correlation was found between TSS and overall assessment scores for first three years of training. Correlation of TSS with clinical component of assessment was weak throughout training, while it was moderately significant with cognitive component of assessment in third and fourth years of training. Correlation between interview scores and cognitive as well as clinical assessment was non-significant. TSS showed weak correlation with success in exit level examination., Conclusion: Correlation between overall TSS and assessment scores was weak for first three years of training, and becoming moderately positive in later years of training. Cognitive component of TSS had moderately positive correlation with cognitive assessment, but not with clinical performance. Anesthesiology training programmes need to strengthen their selection criteria; and development of structured interviews might prove useful. Future research should focus upon identifying most useful traits in selecting high performers in anesthesiology training.

The increasing disparity in healthcare access in Pakistan requires immediate intervention in the form of informed policy and appropriate implementation of such a policy. The implementation of a global surgery framework in Pakistan has the potential to improve healthcare access and parity in rural areas. Benefitting from the lessons learned through previous attempts at implementing centrally planned health programmes, This paper makes the case for a decentralised approach in facilitating the implementation of a Global Surgery framework in Pakistan. The Critical Creative Innovative Thinking (CCIT) forum, established at the Aga Khan University (AKU), Karachi, has an important role to play in this regard. The CCIT forum has demonstrated ability in developing and facilitating multi - disciplinary engagement around topics of biomedicine and healthcare, and in growing such engagements to their commercial value. Hence, the CCIT forum has immense potential in creating a highfunctioning ecosystem around Global Surgery, thereby formulating a dynamic implementation plan - outside of conventional, centrally implemented public policy frameworks.

Objective: International Medical Graduates (IMGs) secured greater than 10% of all general surgery (GS) residency positions in the US during the past decade. The Match process remains competitive, with a significant number of IMGs performing dedicated research before residency application. The impact of such research remains largely unknown. We aimed to provide an objective analysis of the impact of dedicated research time on obtaining a categorical GS residency position., Design: Data for National Resident Matching Program Match results from 2008-2017 was compiled from annual Match lists of the Aga Khan University, Medical College (Karachi, Pakistan). Medical graduates provided this information voluntarily each year. Data was exported to Microsoft Excel and used for descriptive and statistical analysis using SPSS. Candidates were divided into quasi-experimental groups based on their preference for direct application (no-research group, n = 64) or research prior to Match (research group, n = 20)., Results: A total of 84 IMG applicants matched into GS residency positions in the US within the past decade. Amongst these, 18 matched directly into categorical positions while 66 applicants secured preliminary spots. A total of 37 (56%) preliminary candidates eventually secured categorical GS residency positions. Research group applicants had an overall 85% (n = 17) success rate of obtaining a categorical position, while no-research group had a 59% (n = 39) success rate (chi-square test, p = 0.04). Success rate was 69% (n = 38) for male applicants and 57% (n = 17) for female applicants. Median time to a categorical position was 4 years (2-6) for the research group and 3 years (1-6) for the no-research group., Conclusions: Our quasi-experimental study demonstrated a higher success rate for Aga Khan University, Medical College applicants with significant research background in the US, compared to those who did not. Better social integration, enhanced mentorship available during research, overcoming of cultural and linguistic barriers and a perception as better qualified candidate can be some factors contributing to higher success rates., (Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

This study was carried out to study elemental, nutritional, phytochemical and biological evaluation of Hypericum perforatum collected from Swat in 2010. The elemental analysis showed that Ca was highest (5600 μg/g) in leaves and lowest (2500 μg/g) in flowers. The potassium was highest (840 μg/g) in fruit and lowest (80 μg/g) in leaves. Magnesium was highest (260 μg/g) in stem and lowest (200 μg/g) in flowers. Sodium was highest (4900 μg/g) in stem and lowest (4700 μg/g) in leaves and flowers. Copper was highest (26 μg/g) in stem and lowest (10 μg/g) in leaves. Iron was highest (5000 μg/g) in flowers lowest (1200 μg/g) in stem. Zinc was highest (80 μg/g) in flowers and lowest (46 μg/g) in stem. Nickle, cadmium and Cobalt were <5 μg/g for all plant parts. The nutritional analysis showed that the dry matter was in the range of (97.61%) in stem and (96.38%) in leaf, ash (5.43%) in flowers and (1.90%) in stem, crude protein (12.63%) in leaf and (6.15%) in stem, crude fibre (64.74%) in flowers and (13.0%) in leaf, ether extract (10.98%) in fruit and (1.88%) in stem and nitrogen free extract was (65.80%) in leaf and (10.98%) in flower, respectively. Hypericum perforatum did not show cytotoxic, insecticidal and antibacterial activity in vitro at different doses. The % activity was zero% in cytotoxic and insecticidal activities. However, H. perforatum plant parts revealed phytotoxic activity. The phytotoxic activity of leaf and fruit remained same (44.0%) at highest dose (500 μg/ml). The phytochemical screening showed the presence of mucilage, tannins, anthraquinones, saponins, fats and oils and proteins in all parts of the plant. Calcium oxalate was found in all parts except the fruit. Lignin and catechin was found in all parts except the leaf. Cutin was found only in stem and flower while chlorophyll was found only in stem and leaf. In various localities (Shartangaar, Panj Pali and Sharanko) of Swat fresh leaves were used while in Barani and Jaba fresh as well as dried leaves were used as stimulant, in fever, cough, diphtheria and as an anthelmintic only in Shartangaar.

Improving health care quality in a resource constraint environment in an emerging economy that is in a hard-to-reach geographic terrain can become a challenge especially when it has to follow the international standard which AKHS, P envisions to implement across the nation in all of its health facilities. Healthcare of the nation is a responsibility which is shouldered by both the government and the private sector. Private-sector, however, remains under pressure as its resource size is limited and it remains subject to stringent regulation and quality control requirements regardless of whether it is in the remotest corner of the country where proper land routes are either lacking or not safe. This article shares the unique experience of AKHS, P in achieving ISO 9001:2008 International Quality Management System Certification. Particularly at one of the "world's highest valleys -situated at Gilgit Baltistan at an altitude of 13,083 ft. above sea level in Northern Pakistan. The experience was unique in terms of demonstrating and recording how a quality management system can be implemented in one of the most difficult to reach areas where compliance to international quality standards was previously unthinkable.

Aim: To present the epidemiologic data (age, gender, size etc) and histopathologic and immunohistochemical features of cases of rhabdomyosarcoma (RMS) reported in our department., Settings: Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan., Duration: All cases of RMS diagnosed between January 1, 2003 and December 31, 2012 were included in the study., Results: A total of 277 cases were included. Embryonal rhabdomyosarcoma (ERMS) was by far the dominant histologic type (87.4%) followed by alveolar type (ARMS)(9.4%). ERMS was much more common in males (64.0%)and over 65% of cases occurred in the first decade of life (over 90% in the first two decades). Head and neck region was commonest site for ERMS (46.7%), followed by the genitourinary system (16.1%). Over 65% cases of ARMS occurred in the extremities. Over 80% cases of ARMS occurred in the first 3 decades of life. Immunohistochemical staining for Desmin and MyoD1 was positive in 96.7% and 85.4% respectively., Conclusions: The epidemiologic data and microscopic findings in our patients are similar to international published data on rhabdomyosarcoma.

Objective: To determine the clinico-pathological and histological features of Chondroblastoma (CB)., Study Design: Case series., Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2000 to 2013., Methodology: The histological slides of all reported cases of CB were retrieved and reviewed for morphological features. Clinical features were noted from surgical pathology reports. Frequency of features was noted., Results: Sixty one cases of CB were identified. Pain was the most common presenting symptom. The age ranged from 10 to 38 years (mean 20 ± 1.98 years; M: F 2.5:1) with 61% patients in the second decade of life. Forty six cases occurred in long tubular bones; distal femur being most common site. Metaphysis, clavicle, temporal bone and metacarpal were also involved. Histologically, all CBs were composed of round to polygonal cells and scattered osteoclast-type multinucleated giant cells and majority had hemosiderin pigment. Chicken-wire calcifications and coarse calcifications were seen in 85% and 26% of cases respectively. A spindle cell component was seen in 54% of cases. ABC-like areas were seen in 10 cases. Mitosis ranged from 1 to 6/10 HPFs. Recurrence was seen in 2 cases. Recurrent tumor showed similar morphology when compared with the initial tumor., Conclusion: CB is a benign tumor but has potential for recurrence. Males are more affected, second decade is more common and distal femur is most common site. Metaphysis, clavicle, temporal bone and metacarpal were the rare sites of CB. Histological features predictive of recurrence were not separately identified.

Objective: To study the prevalence of Group A beta haemolytic Streptococcus in patients with acute pharyngitis and correlation of Modified Centor Score and Rapid Antigen Detection Test., Methods: The multi-centre, prospective, cross-sectional study was conducted in 8 major cities of Pakistan between June 2012 and February 2013, and comprised patients presenting with acute pharyngitis. The subjects were above 3 years of age presenting to primary care physician with sore throat, temperature over 100.4 degrees F, tonsillar exudates and/or cervical adenopathy (duration of symptoms < 14 days). They were scored using Modified Centor Score and were tested with Rapid Antigen Detection Test for Group A beta haemolytic Streptococcus. SPSS 19 was used for statistical analysis., Results: Of the 5140 patients, 1299 (25.3%) tested positive, for RADT Group A beta haemolytic Streptococcus in acute pharyngitis. There was no significant difference across different age groups (p < 0.08). There was a strong correlation between Modified Centor Score and Rapid Antigen Detection Test results (p < 0.001). Of the patients with positive result, 3 (0.4%) had a Modified Centor Score < or = 0; 23 (1.8%) had score of 1; 152 (11.7%) had score of 2; 511 (39.3%) had score of 3; and 609 (46.9%) had Centor score of > or = 4., Conclusion: The prevalence of Group A beta haemolytic Streptococcus as a cause of acute pharyngitis was 25.3%. Modified Centor Score had a strong positive correlation with Rapid Antigen Detection Test in identifying Group A beta haemolytic Streptococcus as a cause of acute pharyngitis.

Continued advances in the field of histo-pathology (and cyto-pathology) over the past two decades have resulted in dramatic changes in the manner in which these disciplines are now practiced. This is especially true in the setting of a large university hospital where the role of pathologists as clinicians (diagnosticians), undergraduate and postgraduate educators, and researchers has evolved considerably. The world around us has changed significantly during this period bringing about a considerable change in our lifestyles and the way we live. This is the world of the internet and the world-wide web, the world of Google and Wikipedia, of Youtube and Facebook where anyone can obtain any information one desires at the push of a button. The practice of histo (and cyto) pathology has also evolved in line with these changes. For those practicing this discipline in a poor, developing country these changes have been breathtaking. This is an attempt to document these changes as experienced by histo (and cyto) pathologists practicing in the biggest center for Histopathology in Pakistan, a developing country in South Asia with a large (180 million) and ever growing population. The Section of Histopathology, Department of Pathology and Microbiology at the Aga Khan University Hospital (AKUH) in Karachi, Pakistan's largest city has since its inception in the mid-1980s transformed the way histopathology is practiced in Pakistan by incorporating modern methods and rescuing histopathology in Pakistan from the primitive and outdated groove in which it was stuck for decades. It set histopathology in Pakistan firmly on the path of modernity and change which are essential for better patient management and care through accurate and complete diagnosis and more recently prognostic and predictive information as well.

Objective: To assess the frequency of Candida in cases of onychomycosis ata tertiary care facility in an urban area., Methods: The cross-sectional study was carried out from September 2009 to July 2010 at the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. It involved 124 patients, who were clinically diagnosed as cases of onychomycosis with the collaboration of the hospital's Dermatology Department. The specimens were processed for the diagnosis by mycological culture using Sabouraud's dextrose agar at 25 degrees C and at 37 degrees C. Observation for growth was done periodically for 4 weeks; if growth was present, the pathogen was identified by cultural characteristics and microscopy. Descriptive statistics (with frequency and percentage) of the type of fungus and organisms were evaluated., Results: Of the 124 cases, 52 (42%) tested positive and represented the final study sample. Candida was observed in 16 (30.76%) patients., Conclusion: There was high frequency of Candida involvement in clinically diagnosed cases of onychomycosis.

Background: The aim was to investigate the reinfection rate of H. pylori during a follow-up period of 12 months in adults who had undergone eradication therapy., Methods: One hundred-twenty patients; 116 with gastritis, 3 with duodenal ulcer and 1 gastric ulcer, were studied. Their mean age was 41±13 years (range 18-77) and male: female ratio of 2:1. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP). 14C urea breath test (14C-UBT) was performed 4 weeks after the eradication therapy. The successfully treated patients were observed for 12 months with 14C-UBT to assess H. pylori status. If 14C-UBT was negative, it was repeated after every 12 weeks. If 14C-UBT was positive, endoscopy was repeated with biopsies., Result: The eradication therapy was successful in 102(85%) patients. Out of forty-seven H. pylori isolates cultured, clarithromycin sensitivity was present in 30(64%) and amoxicillin in 45(98%), respectively. Follow-up 14C-urea breath tests of all 102 patients who eradicated H. pylori remained negative up to 9 months. However, in 6 patients, the 14C-UBT confirmed recurrence at 12 months. The recurrence rate was 6%., Conclusion: A low rate of recurrence of H. pylori infection was found in patients with dyspeptic symptoms. H. pylori isolates demonstrated a high invitro clarithromycin resistance.

Aim: To present an epidemiological and histological perspective of diseases of the gastrointestinal tract (including liver and biliary tract) at the Section of Histopathology, Department of Pathology, AKUH, Karachi, Pakistan., Materials and Methods: All consecutive endoscopic biopsies and resections between October 1 and December 31, 2012 were included., Results: A total of 2,323 cases were included. Carcinoma was overwhelmingly the commonest diagnosis on esophageal biopsies (69.1%); chronic helicobacter gastritis (45.6%) followed by adenocarcinoma (23.5%) were the commonest diagnoses on gastric biopsies; adenocarcinoma (27.3%) followed by ulcerative colitis (13.1%) were the commonest diagnoses on colonic biopsies; acute appendicitis (59.1%) was the commonest diagnosis on appendicectomy specimens; chronic viral hepatitis (44.8%) followed by hepatocellular carcinoma (23.4%) were the commonest diagnoses on liver biopsies; chronic cholecystitis was the commonest diagnosis (over 89%) on cholecystectomy specimens., Conclusions: Squamous cell carcinoma comprised 88.8% of esophageal cancers. About 67% were in the lower third and 56.5% were moderately differentiated; mean ages 49.8 years for females and 55.8 years for males; 66% cases were from South West Pakistan. Over 67% patients with gastric adenocarcinoma were males; mean ages 59 and 44 years in males and females respectively, about 74% gastric carcinomas were poorly differentiated; and 62.2% were located in the antropyloric region. About 63% patients with colorectal adenocarcinoma were males; mean ages 46.1 and 50.5 years for males and females respectively; tumor grade was moderately differentiated in 54%; over 80% were located in the left colon. In 21.2% appendicectomies, no acute inflammation was found. Acute appendicitis was most common in young people. Hepatitis C (66.3%) was more common than hepatitis B (33.7%); about 78% cases of hepatocellular carcinoma occurred in males; females comprised 76.7% patients with chronic cholecystitis; and 77.8% patients with gall bladder carcinoma. All resection specimens showed advanced cancers. Most cancers occurred after the age of 50 years.

Background: HIV/AIDS is a global problem, South Asia and Africa bearing the maximum burden. The incidence is reported to be rising in Pakistan. It is important to document the prevalence of various risk factors in our population so that appropriate measures could be taken for preventing emergence of new cases. Objectives were to identify the possible etiological factors/high risk behaviour in cases diagnosed as HIV/AIDS presenting at a tertiary care referral centre., Methods: Prospective observational case series carried out over a one year period at HIV/AIDS referral centre at Allama Iqbal Medical College Lahore. Five hundred patients were included who were positive for HIV on screening devices and then confirmed by ELISA. All these patients were referrals from Punjab AIDS control programme (PACP). A detailed history was taken on a pre-designed Performa specially targeted to identify the known risk factors for HIV infection., Results: Five hundred HIV positive subjects diagnosed by screening device and confirmed on ELISA were included in the present study. Three hundred and fourteen (63%) were males and 186 (37%) were females. Mean age was 35 +/- 12 years. Most prevalent risk factor among these patients was sexual transmission followed by intravenous drug abuse, injections from substandard health facilities, and transmission from infected spouse., Conclusion: HIV/AIDS is a preventable disease if the risk factors are avoided. Community awareness for unsafe homo and heterosexual practices and discouraging visits to non qualified health practitioners should be the top priority by PACP apart from controlling the IDUs menace.

Objective: To assess the present waste management system of healthcare facilities (HCFs) attached with Shalamar Hospital, Lahore by applying the 7-S technique of Total Quality Management (TQM) and to find out the outcome after imparting training., Study Design: Interventional quasi-experimental study., Place and Duration of Study: The Shalamar Hospital, Lahore, Punjab, Pakistan, November, 2009 to November, 2010., Methodology: Mckinsey's 7-S, technique of TQM was applied to assess the 220 HCFs from Lahore, Gujranwala and Sheikhupura districts for segregation, collection, transportation and disposal (SCTD) of hospital waste. Direct interview method was applied. Trainings were provided in each institution. After one year action period, the status of four areas of concern was compared before and after training. The parameters studied were segregation, collection, transportation and disposal systems in the 220 HCFs. Each of these were further elaborated by strategy, structure, system, staff, skill, style and stakeholder/shared value factors. Standard error of difference of proportion was applied to assess significance using 95% confidence level., Results: There was marked improvement in all these areas ranging from 20% to 77% following a training program of 3 months. In case of disposal of the waste strategy, structure and system an increase of 60%, 65% and 75% was observed after training., Conclusion: The 7-S technique played a vital role in assessing the hospital waste management system. Training for the healthcare workers played a significant role in healthcare facilities.

The epidemiology of Hodgkin lymphoma (HL) shows a wide geographic variation with regard to age, gender, histological subtypes and their association with Epstein-Barr virus. The proportion of EBV positive cases appears higher in developing than in developed countries. EBV is a common infection in Pakistan due to poor socioeconomic conditions, but reports regarding HL subtypes have been rather selective. Our aims were to establish the relative frequencies of the five subtypes of Hodgkin lymphoma, to determine their associations with Epstein-Barr virus, and finally to establish whether such association follows patterns seen in developing or developed countries. Among 100 cases, the male: female ratio was 4.5:1, with an age range of 4-82 years and an average of 26.6 years. Similar to the subtype distribution in developing countries, mixed cellularity was the commonest 57%, followed by nodular sclerosis 35%, lymphocyte rich 6% and nodular lymphocyte predominant 2%. EBV-LMP1 staining was demonstrated in 41/57 (71%) of the mixed cellularity and the 19/35 (54.2%) of nodular sclerosis subtypes. All 6 cases of lymphocyte rich and 2 cases of nodular lymphocyte predominant were negative for EBV-LMP 1. Speculation about prognostic effects of EBV infection on the course of HL are tempting. Thus the EBV-positive HL could in the future prove to be an excellent candidate for targeted cellular immunotherapy.

Introduction: Cancer ovary is the third most common malignancy diagnosed in women in Karachi, a moderate to high risk region for the disease., Materials and Methods: Three hundred and thirty seven cases of ovarian cancer registered at the Karachi Cancer Registry for the years 1995-2002 were reviewed., Results: The age- standardized incidence rate (ASR) world per 100,000, crude incidence rate per 100,000 (CIR) and frequency of ovarian malignancies in 1995-1997 were 10.9, 5.9 and 6.2% respectively. Corresponding figures for 1998-2002 were 8.1, 5.1 and 4.8%. The mean age at presentation in 1995-1997 was 45.7 years (95%CI 42.9, 48.4; SD∓15.9), range 95 (3 to 98) years and in 1998-2002 it was 45.0 years (95%CI 42.8, 47.3; SD±16.1), range 79 (3 to 82) years. Eleven (3.3%) cases of childhood cancers, 13 (3.9%) adolescent cases, 126 (37.4%) reproductive age (20-44 years) and 187 (55.5%) cases in the 45+ age group were registered. Epithelial malignancies were the most common cancers above the age of 20 years (78.4%), the commonest amongst these was serous adenocarcinoma (33.3%). Germ cell tumors were more common (5.6%) in children and adolescents. Microscopic confirmation was 99.0%. Presentation was of a moderately differentiated (grade 2) malignancy with a regional or distant spread of disease in three fourths of the cases., Conclusions: The incidence of cancer ovary, though stable in Karachi, involves a relatively younger age group with a strong family history in a fourth of the cases. The disease presents at an advanced stage. An ageing population over time may translate into a higher incidence of ovarian cancer. The current incidence of cancer ovary in Karachi is an enigma and belies reproductive protective factors. Studies focused on the genetic risk factors in this population are recommended.

The Section of Histopathology, Aga Khan University is the largest center for histopathology in Pakistan and is the major reporting and referral center for CNS neoplasms in the country. Over the years, a significant increase has been noted in the number of CNS neoplasms reported annually. This increase most likely represents increased number of neurosurgical procedures being performed. A major problem that we face as histopathologists is absence of clinical history or radiological films in a large number of cases.

Background: Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU)., Methods: H. pylori infection established by both rapid urease test and histology were studied. The cagA and vacA allelic status was determined by polymerase chain reaction (PCR). Sequencing of vacA i1 and i2 PCR product was carried out., Results: Two hundred and twenty-four patients were included, 141 (63%) were males with a mean age of 45 +/- 16, range 16-83 years. The virulence marker cagA was associated with GU in 20(63%) (p = 0.04), DU in 23(72%) (p = 0.003) and GC in 29(73%) (p = 0.001) compared to NUD in 51(42%). VacA s1am1 was associated with GU in 23(72%) (p = 0.001), DU in 17(53%) (p < 0.001) and GC in 23(58%) (p = 0.003) compared to NUD in 38(32%) while vacA s1bm1 was also associated with GU in 9(28%) (p = 0.001), DU in 12(37%) (p < 0.001) and GC 11(28%) (p < 0.001) compared to NUD in 13(11%), respectively. The diagnoses of GU in 21(66%), DU in 16(50%), GC in 20(50%) and NUD in 50(42%) were associated with moderately active chronic inflammation. CagA in 55(45%) (p = 0.037), vacA s1am1 in 51(51%) (P < 0.001), s1bm1 in 25(56%) (p = 0.002), s1am2 32(30%) (p < 0.001) and s1bm2 29(69%) (p = 0.004) were also associated with moderately active chronic inflammation., Conclusion: CagA was negative in majority of NUD patients with H. pylori infection. However, cagA was associated with peptic ulcer and GC. VacA allele's s1am1 and s1bm1 were associated with H. pylori associated diseases and inflammation.

Objective: To determine the frequency of three phases of chronic myeloid leukaemia at first presentation., Study Design: Case series., Place and Duration of Study: Department of Oncology, Combined Military Hospital (CMH), Rawalpindi, from June 2006 to December 2007., Methodology: Forty-five patients of either gender with Chronic Myeloid Leukaemia (CML) at their first presentation in outpatient department were included in the study by consecutive sampling technique. All patients were diagnosed on blood complete picture and bone marrow examination including aspiration, trephine and cytogenetics at Armed Forces Institute of Pathology (AFIP). Each phase was defined on the basis of World Health Organization (WHO) criteria., Results: Out of 45, there were 31 (68.9%) male and 14 (31.1%) female patients. The mean age of presentation was 37.9 years. The pattern of presentation revealed 35 (77.8%) in Chronic Phase (CP), 7 (15.5%) in Accelerated Phase (AP) and 3 (6.7%) in Blast Crisis (BC). Philadelphia chromosome was detected in 39 (86.7%) cases on culture method. Splenomegaly was observed in 37 (82.2%) patients. The mean total leukocyte count, platelet count, haemoglobin and marrow blast were 214.3 x 10(9)/L, 551.4 x 10(9)/L, 9.94 g/dl and 9.3% respectively., Conclusion: CML presented at a younger age in the chronic phase.

Introduction: South Asia is an enigma for gastric cancer, a low risk region with a contradictory high prevalence for Helicobacter pylori., Patients and Methods: To examine the demographics, pathology and trends of gastric cancer in Pakistan, epidemiological data of 335 gastric malignancies, registered at Karachi Cancer Registry (KCR) for Karachi South (KS), during 1st January 1995 to 31st December 2002 were reviewed. Trends were studied by categorizing the cases into two time periods '1995-7' and '1998-2002'., Results: Ninety six cases of gastric cancers were registered in the 1995-7 period, 61 in males and 35 in females. In males, the ASR (world), and crude incidence rate (CIR) per 100,000 were 3.9 and 2.3 respectively. In females, the values were 3.0 and 1.5. In the 1998-02 period 239 cases of gastric cancer were registered, 156 cases in males and 83 in females. The ASR and CIR per 100,000 were 6.0 and 3.4 in males and 3.6 and 2.1 in females. An 18% increase was observed in males and 14% in females during the seven year study period. The male to female ratio was 2:1.The mean age of male patients was 51.9 years (95% CI 45.8; 58.1; SD -/+17.9) in 1995-7 and 53.7 years (95% CI 51.6; 55.9; SD -/+14.0) in 1998-02. In females the mean age for the two periods was 48.8 years (95% CI 42.5; 55.0; SD -/+ 18.2) and 48.4 years (95% CI 45.4; 51.5; SD -/+13.9) respectively. Age-specific curves showed a gradual increase in risk from the second until the seventh decade. The majority of the cases presented as poorly or moderately differentiated distal (non-cardia) cancers with a regional spread., Conclusion: Gastric cancers in Karachi fall into the prototype of a low risk developing country pattern. The incidence is increasing, most marked in males above 40 years of age. Larger pathology-based studies are required to comment on the precise morphological sub-types of gastric adenocarcinoma. Etiological studies focused on different strains of H. pylori are required to address the gastric cancer enigma, whilst examining possible protective environmental or genetic factors.

Introduction: Cancer prostate (CaP) is a commonly diagnosed cancer in western men, but there is sparse information about the demographics of this malignancy in Pakistan. The study objective was to provide an overview of CaP in Karachi, Pakistan., Methodology: Epidemiological data of 282 incident CaP cases registered at Karachi Cancer Registry (KCR) during 1st January 1995 to 31st December 2002 were reviewed. Incidence and trends were studied in 2 time periods, 1995-7 and 1998-2002., Results: In 1995-7, CaP accounted for approximately 3.4% of the cancers in males and ranked 8th in hierarchy with an age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 of 6.0 and 2.8 respectively. During 1998-2002, CaP accounted 4.6% of the cancers, ranked 4th with an ASR world and CIR per 100,000 of 10.1 and 4.4. Thus an approximate 60% increase was observed between 1995 and 2002. Mean ages of the patients were 67.0 and 67.4 years. Age-specific curves showed a gradual increase in risk from the fifth decade onwards. A marginal down staging was also observed in period 2, more apparent in the more educated Mohajir and Punjabi ethnicities., Conclusion: Karachi falls into a low risk region for CaP, with a rapidly increasing incidence and a marginal down staging. The probable reasons for the lower incidence are a low life expectancy, lack of availability or accessibility to health care and lack of public awareness. Implementation of CaP screening and public health education is a necessity today. The low incidence of CaP in Pakistan may be an artefact!

Objective: To obtain information about the prevalence of cigarette smoking among a selected sample of university students in Karachi and build our understanding of the determinants of smoking with respect to family smoking, smoking in the home, smoke-free public places, and quit smoking cessation programmes., Methods: Data were collected as a part of a pilot project initiated by Jinnah University Karachi. Participants were 629 university students (432 males and 197 females) aged 18-25 years from ten universities in Karachi. Descriptive statistics and Logistic regression analyses were used to determine the results and conclusions., Results: Thirty-nine per cent of students had smoked a whole cigarette in their life time, whereas 25% had smoked 100 or more cigarettes in their lifetime. Overall, 23% of students (31% male and 6% female) were classified as a current smoker and their mean age and standard deviation of smoking initiation was 17 +/- 2.7 years (17 +/- 2.6) for males and 16 +/- 2.9 females. Sixty-three percent of smokers reported that public places should be smoke-free. Logistic regression analyses adjusted by age and gender suggested that parental and sibling influence and number of close friends and individuals who smoke at home were highly predictive of being a smoker., Conclusion: Findings from this study suggest that student were generally open to smoking cessation treatment and no-smoking restrictions.

Introduction: The objective of the study was to determine the trends of cancer cervix in Karachi South during an eight (1995-2002) year period., Methodology: Cancer cervix cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002., Results: Cancer cervix ranked sixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and CIR of 7.5 and 4.0 per 100,000. Thus between 1995 and 2002, the incidence of cervical cancer registered an approximate 10% increase. The mean age of the cancer cases was 53.3 years (SD 11.6; 95% CI 50.58, 55.96; range 32-85 years) and 50.7 years (SD 11.7; 95% CI 48.8, 52.5; range 51 years) in period 1 and 2 respectively. The morphological components of squamous cell carcinoma and adenocarcinoma remained stable during this period, though a marginally higher component and increasing incidence of adenocarcinoma was observed throughout. A negligible down staging was observed in the 1998-2002 period. Localized malignancy was observed in 30.8% in period 2 as compared to 25.7% in period 1 and the component of carcinoma in situ increased from 0% percent in period 1 to 1.3% in the second period. Despite this two thirds of the cases still presented with a regional or distant spread of disease., Conclusion: Pakistan at present falls into a low risk cancer cervix region. The cause of concern is the steadily increasing incidence especially in the younger birth cohorts, the advanced disease at presentation; insignificant in-situ cancers and no preventive intervention or awareness practices in place.

Nature of presenting symptoms and even signs of disease can lead to a diagnosis that seems routine but is in fact erroneous because a sufficient index of suspicion is not generated in the mind of the physician dealing with the case. A young girl of about 16 years was brought to the Casualty Department, DHQ Hospital Bannu on 12 Sep 2004 with complains of severe vomiting and diarrhoea; the casualty medical officer diagnosed her as a case of acute gastroenteritis.

Introduction: Primary gastrointestinal (GI) malignancies are a rarity in childhood and adolescence, with limited information from Asian populations. This study was conducted with the objective of identifying the existence of malignant GI tumors in the young population of Pakistan and to determine high risk geographical areas of the country., Methodology: Pediatric and adolescence (

Background: To determine in a large series of surgical biopsies, the frequency of various histologic types of primary solid malignant neoplasms in males and females in different age groups., Methods: A retrospective study of 20,000 consecutive surgical biopsies reposted in the section of histopathology, AKU in 2004., Results: Malignant neoplasms are commonest in the fifth and sixth decades of life. The commonest malignant neoplasms in the first decade were Hodgkin's lymphoma and Wilm's tumor in males and females respectively. In the second decade, osteosarcoma in males and Ewing's sarcoma / PNET in females. In the third decade, colorectal adenocarcinoma in males and infiltrating. Ductal carcinoma of breast in females. In the fourth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In the fifth decade squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In sixth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females and in the seventh decade, prostatic adenocarcinoma in males and infiltrating ductal carcinoma of the breast in females. Above age of 70 years, the commonest malignant were again prostatic adenocarcinoma in males and infiltrating ductal carcinoma of breast in females., Conclusion: Malignant neoplasms are commonest in the fourth, fifth and sixth decades of life.

Background: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopsies., Methods: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004., Results: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus., Conclusion: Out of 20,000 biopsies, there were 4616 (23.08%) malignant neoplsms. Carcinoma of oral cavity is very common in our population in both sexes.