Sero-negative celiac disease with dermatitis herpetiformes: a case report

Introduction:We report a case of sero-negative celiac disease in Pakistan. Case Presentation: A 20-year-old female presented with papulovesicular rash for 15 years, diarrhea for 8 years, spasms of hands and twitching of face for 4-5 months. She had mild anemia, low vitamin-D3 and serum calcium. On exclusion of other causes of malabsorption, anti-tissue transglutaminase antibodies (immunoglobulin-A & immunoglobulin-G), anti-endomysial antibodies, total immunoglobulin-A levels and skin biopsy were performed, which were normal. Intestinal biopsy revealed subtotal villous atrophy. Patient was prescribed gluten-free diet, to which she responded with alleviation of symptoms. Conclusions: Negative serology should not rule out celiac disease, intestinal biopsy should be performed if there is strong clinical suspicion

Comparative efficacy of phosphate solubilizing bacteria and synthetic phosphate fertilizers on the growth of wheat

Wheat is recognized as one of the most important dietary elements due to its high nutritious content and thus, has become greatest food option all over the world. Phosphorus (P) being major plant food nutrient plays a vital role multiple functions of plant growth and development. The current study was carried out to compare the performance of phosphate solubilizing bacteria (PSB) as bio-fertilizer with commercially available phosphate fertilizers on wheat crop. The trial was designed in randomized complete block (RCB) replicated thrice. 6 different sources of phosphate fertilizers (Di-ammonium phosphate as DAP, Nitrophos as NP, Single super phosphate as SSP, Restore as PSB, Marathon as PSB, Nitrogen (N2) fixing bacteria as PSB) followed by control were evaluated for agronomic, physiological and quality attributes of wheat. The results showed that most of the qualitative traits were significantly influenced by different treatments. However, application of N2 fixing bacteria was more significant in all treatments. Highest total viable count of colony-forming units (14.63×106 at 3-WAS & 17.70×106 after harvest CFU g-1), maximum tillers’ count (337 m-2), grains’ count (45.57 spike-1), grain yield (2714.3 kg ha-1), LAI (0.67 & 1.16 at 56 & 112 DAS), CGR (13.59 g day-1 m-2), photosynthesis rate (26.13 µ mol m-2 sec-1) and flag leaf sugar content (0.24%) were recorded on account of using N2-fixing bacteria applied as PSB. Moreover, NPK content in shoot, grain as well as uptake of NPK by grain were also received as highest in the same treatment. Based on research findings, it is concluded that application of N2-fixing bacteria as PSB (7.5 kg ha-1) might be increasing wheat production in Dera Ismail Khan and other areas of similar environment in Pakistan

CLINICAL PRESENTATION AND LIFESTYLE RELATED RISK FACTORS OF BREAST CANCER AMONG DIFFERENT AGE AND ETHNIC GROUPS

Breast cancer (BC) is one of the most frequent and leading cause of malignancies in females globally. In Pakistan, breast cancer is most frequently found in younger individuals and late stage presentation is the key feature for clinical diagnosis. Numbers of genetic factors are reported to be significantly associated with the manifestation of breast cancer. A number of factors including gender, age, genetic predisposition, familial vertical history, ethnicity and life style eventually leading to the development of the cancer. Therefore, we identified the role of biochemical characteristics of all participants in the development of breast cancer. 50 breast cancer patients were enrolled in this study. A written informed consent was taken from each of the patients prior to data collection through questionnaire. People belonging to different ethnic groups: Pashtoon was found to be the highest noteworthy figure of breast cancer patients with an overall of 14 (28%) followed by Afghani ethnic group with 7 (14%), Baloch 15 (30%), Hazara 8 (16%), Punjabi 3 (6%) and Sindhi 3 (6%). Key words: Breast cancer, Ethnic groups, Cenar Hospital, Balochistan

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Heritability Estimates for Some Growth Traits of Dhatti Camel Breed in Tharparkar

Purposed study was conducted using 12 sire”s 232 offspring. The parameters were studied birth weight, body weight, weight at 6 month, average daily gain to 6 month, yearling weight, total weight gain from 6 month and average daily gain from 6 month till one year. The results for heritability estimates were analyzed using the variance with unequal subclass numbers by using the data of 12 parental half sib groups. The average numbers of offspring were ranged per sire 3 to 84 with mean of 16.4. The effect of sire was observed significantly higher (P≤.0) in said traits. While the results of heritability estimates were observed low to moderate for birth weight, birth weight at 6 month, average daily gain to 6month, yearling weight, total weight, weight gain to 6 month and average daily gain from six month to 1 year respectively. The results for correlation estimates between these traits were positive and high for bwt with TG6 month and bwt at 6 month with and 6 month to 1 year. It is concluded that values for heritability and correlation were observed in range of other farm animal, while for the better production and higher values selection process is advisable for these traits

Implementation evaluation of a medical student-led intervention to enhance students\u27 engagement with research: Findings and lessons learned

Introduction: Medical colleges globally have student organizations that serve to enable students\u27 involvement in research. However, details of their approach and activities are seldom published to serve as learning for student organizations in other settings. The Student Research Forum (SRF), a student organization based at a private medical school in Pakistan aims to facilitate students in acquiring research skills. Following the observation of a downward trajectory of student initiative and interest, SRF leadership restructured the organization and improve its impact. This study describes the development and implementation evaluation of the interventions.Methodology: The operational framework was revised using the Theory of Change by the core group. Major interventions included enhanced social media and outreach coordination, research workshops, journal clubs, and mentorship to increase research output, mentorship opportunities, and knowledge of medical research; ultimately improving quality in research. The outcomes generated over the course of the study\u27s duration from July 2019 to September 2021 were analyzed using the process metrics of reach, adoption, and efficacy.Results: As a result of the interventions, SRF expanded its reach by conducting a total of 41 events during the duration of the study, facilitated by social media growth on each of SRF\u27s online platforms, with a 300% increase in followers on Facebook, and a nationwide network of 91 student ambassadors. An annual workshop series taught research skills to more than 3800 participants. Students leading their own events, SRF featuring international speakers, and the abstracts submitted to SRF\u27s annual conference, along with the conference\u27s reach of 10,000 students, are seen as improvements in the ToC-informed interventions\u27 adoption. The efficacy of the interventions manifested as the REACH program allocated 56 research projects to vetted applicants.Conclusion: The applied interventions have accelerated SRF\u27s progress towards achieving its long-term outcome of increased quality in research as translated by increased research output quantity, mentorship, and knowledge of medical research. Further evaluation is required to assess the success of the ToC. As SRF continues to grow, a continued analysis of the implementation outcomes is imperative to gauge its effectiveness