ADVERSE FETOMATERNAL OUTCOME IN TWIN PREGNANCY IN WOMEN OF ADVANCED AGE.

Background; Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources which translate into insufficient care during pregnancy and delivery.  Due to inherent biological factors, twin pregnancies have increased rates of obstetric and perinatal complications such as preeclampsia, post-partum haemorrhage and preterm birth, which are known risk factors for maternal and perinatal mortality. Objective; To determine the frequency of adverse fetomaternal outcome in twin pregnancy in women of advanced age. Material and methods: A total of 181 patients with dichorionic diamniotic twin pregnancy on ultrasound having gestational age more than 24 weeks were taken in this cross-sectional study. Demographic information of patients (name, age, weight) was taken. Informed consent was taken from each patient, ensuring confidentiality and fact that there is no risk involved to the patient while taking part in this study. An obstetrical ultrasonography was done to confirm twin pregnancy. Blood samples were taken from all patients for assessment of anemia. Patients were followed up until pregnancy outcome. Results; Mean age of these study cases was noted to be 34.35 ± 2.41 years. Mean gestational age of our study cases was 34.67 ± 2.25 weeks. Mean BMI of our study cases was noted to be 22.45 ± 1.67 kg/m2 (with minimum BMI was 19.4 kg/m2 and maximum BMI was 32 kg/m2) and obesity was present in 27 (14.9 %) of our study cases. Of these 181 study cases, 126 (69.6%) delivered vaginally while 55 (30.4%) had to undergo cesarean section delivery. Mean hemoglobin level was noted to 8.67 ± 1.40 g/dl while anemia was seen in 126 (69.6%) of these study cases. Preterm labor was observed in 144 (79.6%), abruptio placentae in 19 (10.5%) and low birth weight in 123 (68 %) of our study cases. Conclusion; Twin pregnancy is associated with high risk of perinatal and pregnancy outcomes. There was higher frequency of anemia, cesarean section deliveries, preterm births and low birth weight babies in our study. There is a need for specialised prenatal care to reduce complications and adverse outcome in multiple pregnancies, and the need for ongoing social and medical care beyond the prenatal and perinatal periods to improve perinatal outcomes in these patients. Keywords; Preterm labor, anemia, twin pregnancy

The Retention of Generation Y Employees in Pakistan

The retention of employees belonging to generation Y is a problematic issue. Therefore, this paper aims to investigate how compensation package, working environment, growth opportunities and frequent feedback aff ect the retention of generation Y employees. The questionnaire used in the study was adapted from the previous literature. The sample size for the study was 250 and the questionnaire was administered to respondents from selected business organizations. The results indicate that working environment, growth opportunities and frequent feedback tend to enhance the retention of generation Y employees. However, no signifi cant association was found between compensation package and the retention of generation Y employees. The fi ndings of the study need to be carefully analyzed in view of its limitations. The data was gathered from a small sample of business organizations operating in Karachi, Pakistan and selected variables were used. Future studies may investigate the retention of generation Y employees by evaluating a larger sample of business organizations in Pakistan.Keywords: Compensation package, working environment, growth opportunities, frequent feedback, retention of generation Y employees

Epidemiology and Risk Factor Analysis of Fasciolosis in Buffaloes in District Bagh, Azad Kashmir, Pakistan

Fasciolosis is a cosmopolitan parasitic disorder cause great economic decline in cattle and buffaloes in terms of poor carcasses quality decrease in meat and milk production, malfunctioning of livers and weight loss. This research work was carried out in district Bagh, Azad Jammu and Kashmir, Pakistan, extending from December 2016 to May 2017. During this study 200 fecal sample from Buffaloes (Bablus bubalis) of the study area were collected, it was found that 40 percent fecal samples contain eggs of Fasciola hepatica and 60 percent fecal samples were negative. Liver samples of slaughtered buffaloes were also examined during study period and it was found that 74 samples have faciola, out of 200 samples, so 37 per cent samples contain F. hepatica and 63 per cent buffaloes liver samples were negative. It was observed that 19.25% animals of the area have parasites in their body, which are causing economic losses to the owners, in the form of less production of milk and meat and more mortality among the livestock and damages to farmers

Traffic Related Air Pollution Exposure Effect on Circulating White Blood Cell Counts in Healthy Individuals

During this short term study a total of 110 samples were collected from the selected individuals of study area. This study was aimed to count the White blood cells in the blood samples of individuals, who were mostly exposed to exhaust fumes (air pollution), like traffic constables, cooks and shopkeepers. For this purpose blood samples were taken into an evacuee container having anticoagulant Ethylene diamine tetra-acetic acid (EDTA) so to prevent coagulation of blood, for the count of WBCs, heamocyto-meter was used. During the study the body mass index and blood pressure was also measured by digital blood pressure measuring apparatus. Samples were observed under the microscope. It was found that 15% (13,133±2544.081) sampled individuals had increased WBCs and 85% (7821±1482.76) normal WBCs. In female samples 50% (11900±2151.27) were observed with above range of WBCs and other 50% (8540±844.39) with normal range of WBCs count, non-had WBCs count lower than the normal WBCs. Mostly had normal and few had above the range. One way ANOVA has been used to analyze connection of exposure to air pollution with counts of circulating white blood cells

Uloga prijeoperacijskog karcinoembrijskog antigena u recidiviranju resektabilnog kolorektalnog karcinoma

In colorectal carcinoma, carcinoembryonic antigen (CEA) is a recommended marker for surveillance after curative resection. The aim of the present study was to determine the association of preoperative CEA with recurrence of colorectal carcinoma in our population. The study included 55 patients with all operable stages of colorectal adenocarcinoma treated during the 2012-2014 period, evaluated retrospectively and followed-up for recurrence for 2 years. Data on the baseline (preoperative) CEA levels were retrieved from patient files. On data analysis, SPSS 16.0 was used. In patients with normal preoperative CEA, the rate of recurrence was significantly low (p=0.008) and the likelihood of no recurrence 1.55-fold greater as compared to patients with raised initial CEA levels (p=0.028). In patients with raised preoperative CEA, the risk of recurrence was 5.26-fold greater as compared to those with normal CEA levels (p=0.028). A significant weak positive correlation (rs=0.297) was found between raised CEA and recurrence. A highly significant (p=0.002) moderate positive correlation was recorded in patients aged <50 and moderate positive correlation of borderline significance in males (rs=0.324, p=0.058). Sensitivity was 94.4% and specificity 32.4% in predicting recurrence. Accordingly, preoperative elevated CEA showed a significant weak positive correlation with recurrence while normal preoperative CEA moderately decreased the likelihood of recurrence.U kolorektalnom karcinomu preporuča se karcinoembrijski antigen (CEA) kao biljeg u praćenju bolesnika nakon resekcije karcinoma. Cilj ovoga istraživanja bio je utvrditi udruženost prijeoperacijske razine CEA s recidiviranjem kolorektalnog karcinoma u našoj populaciji. U istraživanje je bilo uključeno 55 bolesnika sa svim operabilnim stadijima kolorektalnog adenokarcinoma liječenih u razdoblju od 2012. do 2014. godine. Bolesnici su retrospektivno procijenjeni i praćeni zbog recidiva tijekom dvije godine. Podaci o bazalnim (prijeoperacijskim) razinama CEA preuzeti su iz medicinske dokumentacije bolesnika. Analiza podataka provedena je pomoću SPSS 16.0. Kod bolesnika s normalnom prijeoperacijskom razinom CEA stopa recidiva bila je značajno niža (p=0,008), a vjerojatnost izostanka recidiva 1,55 puta veća u usporedbi s bolesnicima s povišenim početnim razinama CEA (p=0,028). Kod bolesnika s povišenim prijeoperacijskim razinama CEA rizik od recidiva bio je 5,26 puta veći u usporedbi s onim u bolesnika s normalnim razinama CEA (p=0,028). Značajna slabo pozitivna korelacija (rs=0,297) utvrđena je između povišene razine CEA i recidiva. Visoko značajna (p=0,002) umjereno pozitivna korelacija zabilježena je u bolesnika mlađih od 50 godina te umjereno pozitivna korelacija granične značajnosti kod muškaraca (rs=0,324, p=0,058). Utvrđena je osjetljivost od 94,4% i specifičnost od 32,4% u predviđanju recidiva. Dakle, povišena prijeopearcijska razina CEA pokazala je značajnu slabo pozitivnu korelaciju s recidivima, dok je normalna prijeoperacijska razina CEA umjereno snizila vjerojatnost recidiva

Kernel Context Recommender System (KCR): A Scalable Context-Aware Recommender System Algorithm

Recommender systems are intelligent data mining applications that deal with the issue of information overload significantly. The available literature discusses several methodologies to generate recommendations and proposes different techniques in accordance with users’ needs. The majority of the work in the recommender system domain focuses on increasing the recommendation accuracy by employing several proposed approaches where the main motive remains to maximize the accuracy of recommendations while ignoring other design objectives, such as a user’s an item’s context. The biggest challenge for a recommender system is to produce meaningful recommendations by using contextual user-item rating information. A context is a vast term that may consider various aspects; for example, a user’s social circle, time, mood, location, weather, company, day type, an item’s genre, location, and language. Typically, the rating behavior of users varies under different contexts. From this line of research, we have proposed a new algorithm, namely Kernel Context Recommender System, which is a flexible, fast, and accurate kernel mapping framework that recognizes the importance of context and incorporates the contextual information using kernel trick while making predictions. We have benchmarked our proposed algorithm with pre- and post-filtering approaches as they have been the favorite approaches in the literature to solve the context-aware recommendation problem. Our experiments reveal that considering the contextual information can increase the performance of a system and provide better, relevant, and meaningful results on various evaluation metrics

Artificial Intelligence (AI) in Pharmacy: An Overview of Innovations

Artificial Intelligence (AI) emerged as an intervention for data and number-related problems. This breakthrough has led to several technological advancements in virtually all fields from engineering to architecture, education, accounting, business, health, and so on. AI has come a long way in healthcare, having played significant roles in data and information storage and management – such as patient medical histories, medicine stocks, sale records, and so on; automated machines; software and computer applications like diagnostic tools such as MRI radiation technology, CT diagnosis and many more have all been created to aid and simplify healthcare measures. Inarguably, AI has revolutionized healthcare to be more effective and efficient and the pharmacy sector is not left out. During the past few years, a considerable amount of increasing interest in the uses of AI technology has been identified for analyzing as well as interpreting some important fields of pharmacy like drug discovery, dosage form designing, polypharmacology, and hospital pharmacy. Given the growing importance of AI, we wanted to create a comprehensive report which helps every practicing pharmacist understand the biggest breakthroughs which are assisted by the deployment of this field

Enhancement of Cytotoxicity of Enediyne Compounds by Hyperthermia: Effects of Various Metal Complexes on Tumor Cells

Enediyne natural products are a class of compounds that were recognized for their potential as chemotherapeutic agents many years ago, but found to be highly cytotoxic due to their propensity for low thermal activation. Bergman cyclization of the enediyne moiety produces a diradical intermediate, and may subsequently induce DNA damage and account for the extreme cytotoxicity. While difficulties in controlling the thermal cyclization reaction have limited the clinical use of cyclic enediynes, we have previously shown that enediyne activity, and thus toxicity at physiological temperatures can be modulated by metallation of acyclic enediynes. Furthermore, the cytotoxicity of "metalloenediynes" can be potentiated by hyperthermia. In this study, we characterized a suite of novel metallated enediyne motifs that usually induced little or no cytotoxicity when two different human cancer cell lines were treated with the compounds at 37°C, but showed a significant enhancement of cytotoxicity after cells were exposed to moderate hyperthermia during drug treatment. Cultured U-1 melanoma or MDA-231 breast cancer cells were treated with various concentrations of Cu, Fe and Zn complexes of the enediyne (Z)-N,N'-bis[1-pyridyl-2-yl-meth-(E)-ylidene]octa-4-ene-2,6-diyne-1,8-diamine (PyED) and clonogenic survival was assessed to determine the effects of the drugs at 37°C and 42.5°C. Toxicity at 37°C varied for each compound, but hyperthermia potentiated the cytotoxicity of each compound in both cell lines. Cytotoxicity was concentration-, time- and temperature-dependent. Heating cells during drug treatment resulted in enhanced apoptosis, but the role of cell cycle perturbation in the response of the cells to the drugs was less clear. Lastly, we showed that hyperthermia enhanced the number of DNA double-strand breaks (DSBs) induced by the compounds, and inhibited their repair after drug treatment. Thus, thermal enhancement of cytotoxicity may be due, at least in part, to the propensity of the enediyne moiety to induce DSBs, and/or a reduction in DSB repair efficiency. We propose that "tuning" of metalloenediyne toxicity through better-controlled reactivity could have potential clinical utility, since we envision that such compounds could be administered systemically as relatively non-toxic agents, but cytotoxicity could be enhanced in, and confined to a tumor volume when subjected to localized heating

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

FREQUENCY OF M. TUBERCULOSIS DETECTION IN CSF OF PATIENTS WITH SUSPECTED TUBERCULOUS MENINGITIS

Background; The annual incidence of tuberculous meningitis (TM) is unknown. TM is a disease that still often results in residual sequelae, and has a mortality rate ranging between 15 and 51%. Experience of countries such as Pakistan where drug-resistant tuberculosis and TM are prevalent is important. Objective:  To determine the frequency of M. Tuberculosis detection in CSF of patients with suspected tuberculous meningitis at a tertiary care hospital. Materials and Methods; A total of 95 patients were included in this descriptive study. The demographic data like age, sex, height, weight, monthly family income and address of the patients was collected. Cases of TBM fulfilling inclusion and exclusion criteria were included in the study. CSF was collected after consent, through lumbar puncture (LP) done by the post graduate trainee (author or colleagues) under aseptic measures and was sent to the designated hospital laboratory for GeneXpert MTB/Rif assay and report was assessed for M. tuberculosis detection. Data was collected and entered in SPSS and analyzed. Results; total of 95 patients with tuberculous meningitis meeting inclusion criteria of our study were included in this study. Of these 95 study cases, 37 (38.9%) were male patients while 58 (61.1%) were female patients. Mean age of our study cases was 26.62 ± 5.94 years. Of these 95 study cases, 49 (51.6%) were from rural areas and 46 (48.4%) belonged to the urban areas while 62 (65.3%) were from poor families. Seventeen (17.9%) had diabetes and 25 (26.3%) were having history of hypertension. Mean weight of our study cases was 56.16 ± 10.27 kilograms and 66 (69.5%) had up to 60 kilograms of weight. Mycobacterium tuberculous was noted in 49 (51.6%) of our study cases. Conclusion; High frequency of Mycobacterium tuberculosis was observed in our study in cerebrospinal fluid (CSF) of suspected patients of tuberculosis meningitis using genexpert MTB/RIF assay. Mycobacterium tuberculosis was significantly associated with age, socioeconomic status, diabetes and hypertension. Keywords; Tuberculous meningitis, Mycobacterium TB, Genexpert