Efficacy and safety of ormeloxifene in the management of dysfunctional uterine bleeding

Background: The term dysfunctional uterine bleeding (DUB) is used for abnormal uterine bleeding occurring in the absence of identifiable pathology. A number of drugs are available for management of DUB- nonsteroidal anti-inflammatory drugs, tranexamic acid, ethamsylate, hormones like Oral contraceptives progestins etc. The present study was done to determine the efficacy and safety of ormeloxifene in the management of DUB.Methods: This prospective clinical study involved 50 cases with DUB who were treated with ormeloxifene 60 mg tablet twice a week for first 12 weeks and the once a week for next 12 weeks. They were followed after 6 months of therapy. The outcome was studied by assessment of menstrual blood loss by PBAC score, Hb level in g/dl, endometrial thickness in mm, relief of dysmenorrheal and any side effects of drugs.Results: The median PBAC score was significantly reduced from 316 to 52 after 6 months of therapy. The mean Hb concentration was significantly increased from 7.8 g/dl to 9.1 g/dl at 6 months of therapy. The mean endometrial thickness was reduced from 10 mm to 7.9 mm after 6 months of therapy. 66% of women showed marked subjective improvement in symptoms. Amenorrhea was the main side effect (12%).Conclusions: Ormeloxifene has significant effect in reducing endometrial thickness, decreasing the amount of menstrual blood loss, reducing dysmenorrhea and thereby improving the general condition of the patient. It is definitely a better alternative to hysterectomy in women who wish to avoid surgeries and maintain their reproductive functions

An empirical investigation of the effectiveness and robustness of asset pricing models in Australia : A thesis submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy at Lincoln University

With a plethora of asset pricing models, it is hard to determine: Which model is relatively better than other models in successfully explaining the returns of the capital assets in an equity market? and if any of the previously documented asset pricing models can effectively perform during pre-crisis, crisis, and post-crisis periods and is robust to test-assets' (portfolios) specifications? The main objective of this research is to find answers to the above mentioned overarching questions in the Australian context, but the inquest into the effectiveness of asset pricing models comes with other challenges, e.g. the aggregational level of returns to analyse, test-portfolios’ style, sorting and level of diversification, and these discrepancies produce inconsistent results. The literature on asset pricing in the Australian context produces such inconsistent results that it is challenging to find a consensus, and the few instances where we find some level of consensus, in terms of superiority of one model over another model, it is hard to say if that superiority sustains across different sub-sets of test assets (portfolios) or different economic conditions (e.g. pre-crisis, during the crisis, and post-crisis periods). This study addresses the issue by examining the representativeness and robustness of the CAPM of Sharpe (1964), the three-factor model of Fama and French (1993), the four-factor model of Carhart (1997) five-factor model of Fama and French (2015) and the momentum augmented six-factor model across 73 varied style portfolios of different diversification levels during the periods of the pre-Dotcom crisis of 2001, during the Dotcom Crisis, the pre-Global Financial crisis of 2008-09, during the Global Financial crisis and the post Global Financial crisis. Following Barillas and Shanken (2016) we conducted the test on various subsets of asset returns to better identify a model’s effectiveness and robustness and, following Lewellen, Nagel, and Shanken (2010), we expanded the set of test portfolios beyond size-B/M portfolios and formed univariate and multi-variate style-based portfolios with a variety of portfolio sorting techniques and levels of diversification. We did not find evidence in support of a single model being effective and robust to the study period, e.g. sample period and sub-sample periods, and they are also affected by the style or characteristics of the portfolios, portfolio formation techniques and level of diversification. However, the three-factor model performed relatively better than other candidate models across single-sorted diversified portfolios. The GRS test of Gibbons, Ross, and Shanken (1989) rejects all candidate models in completely explaining the variations in the returns of less diversified or concentrated portfolios with an overall insignificant alpha. However, comparing the models in relative terms, there is no consensus of the superiority of any single model over other models, the four-factor and the five-factor models appear to perform relatively better with lowest absolute alpha Sharpe ratios for quad-sorted and quintile-sorted portfolios. It appears that from a practical point of view, these models may not be as successful in completely explaining the variations in the returns of poorly diversified or concentrated portfolios. Our results support the finding of Lewellen et al. (2010) that choice of test-portfolios significantly affects the power of asset pricing models and the findings of Lo (2004) that portfolio formation affects the effectiveness of asset pricing models in explaining returns and also provide evidence in support of Kan, Robotti, and Shanken (2013) that the results of the asset pricing tests depend upon the characteristics used in sorting stocks into portfolios

Hepcidin Antimicrobial Peptide (HAMP) Screening for P.CYS70ARG Variant and Iron Overload in β -Thalassemia Major Patients

Hereditary Hemochromatosis is a rare genetic iron overload disorder characterized by iron accumulation in vital body organs such as the lungs, liver, and pancreas. HAMP mutations are reported as one of the principal sources for the disturbance of iron homeostasis. This study was designed to screen the involvement of p.Cys70Arg HAMP variant in iron overload in the β-thalassemia patients. For the purpose, bioinformatics tools were used for the structural and functional manifestation of mutated protein which revealed 1.93 kcal/mol energy differences between the wild-type and mutated proteins, causing the stability decline. Following that, clinical data was collected for 106 β-thalassemia major (β-TM) patients which showed a higher prevalence of splenectomy, hepatomegaly and ascites. The PCR-RFLPs were performed to screen the HAMP p.Cys70Arg in 27 controls and 106 β-TM patients. Sac ӀӀ restriction enzyme was used to screen genetically affected and ethnically matched control samples but no control was found with HAMP p.Cys70Arg variant. Out of these 106 β-thalassemia patients, eight patients were HCV+ with higher levels of ferritin in blood. HAMP exon 3 Sanger sequencing did not reveal any mutation in these patients conferring iatrogenic hemochromatosis. Future recommendations include sequencing of complete HAMP gene with its three exons in a large sample size

Minhas Majeed Khan, et al. (eds.). China-Pakistan Economic Corridor—A Game Changer. Islamabad, Pakistan: Institute of Strategic Studies Islamabad (ISSI). 2016. iii+164 Pages. Pak Rupees 500.00 (Hardback).

China-Pakistan Economic Corridor—A Game Changer is a collection of essays, written by experts in the fields of International Relations, Political Economy, Current Affairs, and Sino-Pak relations. The book takes its readers on an exuberant journey through the history of Silk Route to the One Belt, One-Road (OBOR) initiative and the political economy of the Sino-Pakistan relations. The book not only underscores the challenges that lie ahead in making the China-Pakistan Economic Corridor (CPEC) a success, but it also presents suggestions for making it a real game changer for development and prosperity of Pakistan, and the entire region. The book highlights the economic and political importance of CPEC by integrating analysis with the latest data. In the first article, Li Xiguang discusses the importance of the OBOR initiative. He asserts that “opening to both the east and the west”, China will become the centre of Central Asia. The idea of OBOR raised by China would not only achieve economic purposes but cultural, religious, and educational exchanges can also be made possible through this project. Historically, Silk Road had its own influence and it helped in shaping the governance and transportation of even the most distant countries and influenced the culture of even the remotest areas. In the past, the area around the CPEC has seen the ascent of the cultural centres of the world. The CPEC, which encompasses countries including Pakistan, Afghanistan, Tajikistan, Kyrgyzstan, Kazakhstan, Turkmenistan, and Iran has once again put China on the central stage. The author feels that China needs to maintain social relationships and political cooperation with these nations. This initiative is shaping a new world order through common destiny, common interests, values, culture, and security

Perception And Attitude Towards COVID-19 Vaccine: A Cross-Sectional Study From Pakistan

ABSTRACT Objective: The aim of this study was to investigate the awareness regarding COVID-19 vaccines and identify the factors underlying refusal. Methodology: A cross-sectional study was carried out amongst the general population from different walk of life regarding awareness and myths about COVID-19 vaccine selected by convenient sampling method. To collect data, we developed an online survey using questionnaires regarding beliefs and myths about vaccination. The study was started in March 2021 after approval from the ethical committee. Survey consisting of several questions was created using google form. The link was shared on different social media applications and participants were requested to fill the questionnaires. Some patients and their attendants who were visiting HIT hospital Taxila for any reason were also included in the study and they were requested to fill the form at the spot. Participants were given a brief summary of the survey and its purpose, as well as the study protocol and a declaration of confidentiality and privacy, before beginning the questionnaire. Data was collected on online server form. Demographic information was noted. They were asked about their registration, vaccination status and their fear regarding vaccine and its complications. They were questioned about myths and misbeliefs about covid 19 vaccine. Post vaccination symptoms, their preference for different types of available vaccine, and need of booster dose were also inquired. Their beliefs regarding effectiveness of vaccine in prevention of covid-19 symptoms and severity and following the SOPs released by health authorities were noted. Results: Total 287 individuals were included in this study. 62% were females and 31% were males. 50% were doctors and 30% were not registered for vaccination. 70% of individuals were vaccinated and 83% were not afraid to get vaccination while 50% of people thought that they will get COVID-19 after vaccination. 35% participants were afraid that they will get allergic reaction post vaccination and 9% thought that COVID-19 is fake i.e., there is no such disease as COVID-19. 82% were aware that they will need vaccine even if they had COVID-19. Only 7% of population thought that COVID-19 will change their DNA. Chi square test was applied to find out statistically significant difference in opinion between three groups i.e., age, gender and academic qualification. Majority of the statistical correlation was found in these questions on the basis of qualification. There was statistically significant difference in opinion depending on academic qualification, health care and  non-health care workers shown by p value less than 0.05. Health care professionals think there is need for new vaccinations for every new variant, there were mild covid symptoms post vaccination and there was need of booster dose every year while others have contrary opinion. Medical students didn’t believe in DNA alteration. Their was also statistically significant difference in opinion between male and female gender. Most female participants believe that there was requirement of new vaccine for every new variant, there were more chances of covid after vaccination and they need booster dose every year to prevent covid while males have opposite opinion. Majority of the post vaccination symptoms were observed in femaleswhile male observed pain on the injection site only Conclusion: Awareness and education of general population regarding safety, efficacy and benefits of covid-19 vaccination is the cornerstone of the path to eradicate this pandemic. Different platform of social, print and electronic media plays a pivotal role in this regard. However, the importance of health authorities, religious scholars, social activists and politicians in creating awareness cannot be denied either. Collectively all these factors attribute towards the COVID free Pakistan. Key Words: COVID-19, vaccine hesitancy, Pakistan, public awareness, myth

Factors responsible for delay in provision of care to suspected COVID-19 patients presenting in surgical emergency and ways to combat it

Introduction: Health care workers are found to be at three times greater risk of getting infected as compared to the general public.  Scientists and doctors all over the world have agreed upon the use of PPE including gloves, masks, head covers, face shields, goggles, and jumpsuits in protection against COVID-19. Materials and Methods: This observational prospective study was conducted in the surgical emergency of Holy Family Hospital, Rawalpindi over a period of 2 months and 21 days. Patients included all those who presented to surgical emergency with suspicion of being positive for COVID-19 and time taken by first-line health care workers in attending them. 157 patients were observed for this purpose and 23 first-line surgeons including general, orthopedic, and neurosurgeons were interviewed regarding their fears and concerns about contracting COVID-19 and infecting their families. Results: It was observed that a surgeon took on an average of 10 minutes (+/-3 minutes) in wearing all the personal protective equipment and a total of 14minutes (+/- 5 minutes) in reaching a patient in the trauma room with symptoms suggestive of COVID-19. This was in contrast to a patient presenting to a trauma room who had no respiratory symptoms or fever, in which case, the patient was seen within 3 minutes (+/- 2 minutes) of presentation to a surgical emergency. Out of 23 surgeons, 15 had reasonably aware of the disease while 7 were knowledgeable up to the mark. 17 surgeons were extremely fearful about contracting the disease and infecting their friends and families. 7 surgeons confessed to avoiding COVID-19 patients and 9 surgeons confessed that they commanded their junior surgeons to see suspected COVID-19 patients in the emergency room. Conclusion: We concluded that delay in attending trauma patients suspected of being positive for COVID-19 was a worrisome problem that needed to be addressed. Numerous local and regional circumstances served as a factor for this delay, most important of which came out to be an inadequate provision of PPE, time consumed in collecting and wearing PPE, fear of the disease, and anxiety provoked due to this fear among surgeons