2-[6-Thioxo-5-(2,4,6-trimethyl­phen­yl)-1,3,5-thia­diazinan-3-yl]acetic acid

In the mol­ecule of the title compound, C14H18N2O2S2, the 1,3,5-thia­diazinane-2-thione ring adopts an envelope conformation with one of the N atoms at the flap position. The plane throught the five co-planar atoms of the heterocycle is oriented at a dihedral angle of 80.59 (8)° with respect to the aromatic ring. In the crystal structure, weak inter­molecular O—H⋯S inter­actions link the mol­ecules into chains along the b axis

Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol)

Background: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). Methods: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30–60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. Discussion: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. Trial registration: ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018

Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain

Objective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement. Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ≤3) was considered after 12 months. Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value < 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement. Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF

Revisiting the concept of waqf : its maintenance, issues and challenges

Philanthropic endowment or wqaf represents a form of long lasting charity with potential profits or benefits meant for the spiritual and economical improvement of the society. This study attempts to revisit the concept of waqf by analysing its literal and technical meanings, its legitimacy in the light of the Qur’an and Sunnah. It also analysis some classical and contemporary views pertaining its conceptualization and traces its origin in the Islamic heritage. Istibdal, exchange of the waqf property, as a means of viability of waqf property and its relevant challenges are also dealt with. This paper is based on library research and use qualitative method. Having analysed, the relevant data the authors arrived at the conclusion that future efforts need to be made to develop the concept of waqf based on maqasid shari’ah while in tandem need to develop a universal and comprehensive vision of shari’ah based on its objectives. Both concepts must be revisited, reviewed, and revised to restore the dynamism of the concept of waqf hence, making it an effective tool for alleviation of the poverty and the distribution of wealth among the different sections of the society in equitable manner

Revisiting the concept of waqf: its maintenance, issues and challenges

Philanthropic endowment or wqaf represents a form of long lasting charity with potential profits or benefits meant for the spiritual and economical improvement of the society. This study attempts to revisit the concept of waqf by analysing its literal and technical meanings, its legitimacy in the light of the Qur’an and Sunnah. It also analysis some classical and contemporary views pertaining its conceptualization and traces its origin in the Islamic heritage. Istibdal, exchange of the waqf property, as a means of viability of waqf property and its relevant challenges are also dealt with. This paper is based on library research and use qualitative method. Having analysed, the relevant data the authors arrived at the conclusion that future efforts need to be made to develop the concept of waqf based on maqasid shari’ah while in tandem need to develop a universal and comprehensive vision of shari’ah based on its objectives. Both concepts must be revisited, reviewed, and revised to restore the dynamism of the concept of waqf hence, making it an effective tool for alleviation of the poverty and the distribution of wealth among the different sections of the society in equitable manner

Diabetes conversation map - A novel tool for diabetes management self-efficacy among type 2 diabetes patients in Pakistan: A randomized controlled trial

Background: This study aimed to measure the effect of diabetes education using the novel method of diabetes conversation map (DCM) as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan.Methods: A parallel arm randomized controlled trial among patients with type 2 diabetes aged 30-60 years, with HbA1c \u3e 7%, diagnosed for at least 5 yrs., was conducted at the national institute of diabetes and endocrinology in Karachi, Pakistan. A total 123 type 2 diabetes patients were randomized into DCM (n = 62) or RC (n = 61). Four weekly diabetes control sessions of 40 min each using the DCM or RC was provided. DMSE was measured using a validated Urdu language DMSE tool at baseline and after three months of the randomization. Change in DMSE and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment was compared.Results: Baseline characteristics except HbA1c were similar between the two arms. After 3 months of enrollment, there was no change in the DMSE score in the RC arm however, significant increase in DMSE score was noted in the DCM arm (P = \u3c 0.001). The average difference (95% confidence interval) in DMSE score between the DCM and RC arm was 33.7(27.3, 40.0; p = \u3c 0.001) after 3 months of the enrollment. Difference in HbA1c within groups was not significant.Conclusions: DCM significantly improved DMSE among type 2 diabetes patients in a developing country setting like Pakistan. Healthcare workers caring for type 2 diabetes patients need to be trained on DCM to effectively utilize this novel tool for educating diabetes patients.Trial registration: This trial was prospectively registered. ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018

3-Benzyl-5-butyl-1,3,5-thia­diazinane-2-thione

In the title compound, C14H20N2S2, the 1,3,5-thia­diazinane-2-thione ring adopts an envelope conformation. The S=C bond length is 1.6776 (15) Å, whereas the S—C bond lengths are 1.7470 (15) and 1.8479 (17) Å. The intramolecular C—H⋯S hydrogen bond between the thione and the benzyl units along with the C—H⋯π interaction between the butyl group and the centroid of the benzene ring may be effective in stabilizing the molecule

Awareness and Knowledge on Epilepsy Among Undergraduate Medical Students in Pakistan

Background:  Epilepsy is a common neurological disorder which affects millions of people throughout the world. However, it has been discovered that there is a great degree of ignorance regarding the science of epilepsy among the general masses as well as the populace of medical students.  Studies have been conducted whose results have shown that, there has been fabrication regarding the clinical presentation & treatment of epilepsy among the common man. Numerous appear to link epilepsy to evil spirits and possession that can be healed by spiritual treatments by certain specialists given the designations of ‘demonologists’,’ paranormal investigators’ or ‘mystics’. In such circumstances, medical students can prove to be a major source to educate the society at large. Therefore, it is crucial that their knowledge & attitude towards epilepsy is accurate and thus, must be evaluated at an early stage in their medical career, so that these future physicians may play a pivotal role in the public awareness of epilepsy.  Method:  This study was conducted in Pakistan, at a Government sector medical college, namely, Karachi Medical and Dental College. This is a cross-sectional study. Data was collected between October to December of the year 2014. 270 medical students were given the KAP (knowledge, attitude & practice) form of epilepsy to fill out. The software used to interpret and tabulate the results was SPSS v.16 for Windows. The chi-square test was employed to determine the proportion of knowledge of epilepsy among medical students. The p-value calculated was equal to 0.05.   Findings:  In this study, 270 medical students were recruited, of which 90 were males (33.3%) where as 180 were females (66.6%). The ages of the student participants were within the range of 18 to 24 years. The analysis of our study demonstrates that: 85.1% of the medical students consider epilepsy to be a neurological disorder; 6.66% believe epilepsy is an infectious disease; 4.44% believe it to be a hereditary disease, whereas, 3.7% of the students reckon it is a psychiatric illness. Generalized tonic clonic seizures was deemed to be the most common form of epilepsy (25.5%) with complex partial seizures being the least common form(1.85%) , as well as relatively unknown by the students.             It was discovered through this study that, students were much less acquainted with the knowledge regarding the treatment of the disorder: multiple drug therapy was considered as the treatment by 56.66% of the students, spiritual treatment by 3.7%, spiritual treatment with medication by 20%, surgical treatment by 17.4% & 2.22% deemed epilepsy as a self limiting disease.  Conclusion:  It has been observed with this survey that the medical students of Pakistan are well aware of the knowledge of epilepsy and it being a medical condition. However, the students need to be educated early on in their training to be physicians, about certain aspects and details of the neurological disorder, for instance, the appropriate treatment of epilepsy, where their knowledge is lacking

Effect of Plant Growth Hormones on Shoot and Root Regeneration in Rose under In Vitro Conditions

Background: Rose is a commercially important shrub. This research aimed to observe the influence of different plant growth hormones on development of shoots and roots of Rosa Indica L. in tissue culture.Methods: Various concentrations of N6-Benzylaminopurine (BAP), 1-Naphthaleneacetic acid (NAA), Indole-3-acetic acid (IAA), and Indole-3-butyric acid (IBA) were used in the study. The different concentrations of BAP (2.00, 3.00, and 4.00 mg l-1) and IAA (2.00 and 3.00 mg l-1) were tested for shoot induction. While varying concentrations of IAA and IBA were analyzed for root proliferation.Results: The results of the study indicated that the fastest shoot initiation (17.77 days), the highest number of shoots bottle-1 (3.55), the maximum shoot length (4.72 cm), and the utmost number of leaves bottle-1 (53.67) were observed on MS media containing 3.00 mg l-1 BAP, 3.00 mg l-1 IAA, and 30 g l-1 sugar, while the highest number of shoots bottle-1 were produced under MS + 2.00 mg l-1 BAP + 3.00 mg l-1 IAA + 30 g l-1 sugar. Regarding root induction, the maximum number of roots (4.67) and root length (2.60 cm) were observed under half strength MS media supplemented with 30 g l-1 sugar.Conclusion: The study suggested that MS media containing 3.00 mg l-1 BAP and IAA could be used for tissue culturing rose plants. For root induction, half-strength MS media, along with sugar, could be used. The study gives an insight into potential media compositions for the propagation of rose. The suggested media can have promising uses in commercial multiplication of this important plant.Keywords: Rose; Tissue culture; Micropropagation; MS media; Shoot developmen

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe