Evidence Reversal: An exploratory analysis of randomized controlled trials from the New England Journal of Medicine

BACKGROUND: Evidence Reversal (ER) is the phenomenon whereby new and stronger evidence contradicts previously established evidence. OBJECTIVES: To quantify evidence reversals and to determine characteristics associated with reversibility. METHODS: Original articles from the New England Journal of Medicine (2000 to 2016) were screened for three inclusion criteria: tested a clinical practice; Randomized Controlled Trial design; and tested an established clinical practice. The proportion of RCTs that represented ER was determined. Association of trial characteristics with reversal was explored using logistic regression in order to inform a potential framework of reversibility. RESULTS: In total, 611 RCTs met the inclusion criteria, of which 54% were evidence reversals. Based on variables associated with ER, a reversibility framework was proposed, comprised of eight trial characteristics. CONCLUSION: More than 50% of RCTs published in the NEJM that test established practices are evidence reversals. The characteristics of RCTs that are associated with reversal will inform future research to further understand reversibility

Trade Liberalisation Policies, Intra-regional Trade and Opportunities for Sustainable Agricultural Development

Many of the Near East (NE) countries are currently opening their agricultural markets at three distinct but interacting levels: unilateral liberalisation, regional integration schemes and multilateral trade liberalisation. These changes hold important implications for intra- and extra-regional trade, use of agricultural resources and sustainability of agricultural development in the NE countries. Unilaterally, and since the late 1980s, most countries of the region have liberalised their agriculture sectors by eliminating or reducing input subsidies, removing or reducing guaranteed producer prices, reducing the number of subsidised commodities and liberalising the exchange rate and the trade regime. Most of the implicit and explicit subsidies for agricultural inputs and outputs were withdrawn. However, some of the NE countries were able to continue supporting agriculture mainly for food security reasons. Experiences showed that domestic reform is necessary but not sufficient condition for economic growth.

Using saltland in Pakistan : an Australian connection

Pakistan and Australia have a common enemy in salt. In each country millions of hectares of previously productive land have been affected by salt (or have the potential to become saline) because of inappropriate agricultural development. Since 1989 the Western Australian Department of Agriculture has participated in a research project in Pakistan which involves revegetation of salt land using Australian shrubs. Early results are very promising

Is Chaalia/Pan Masala harmful for health? practices and knowledge of children of schools in Mahmoodabad and Chanesar Goth, Karachi

OBJECTIVE: To determine the practices and knowledge of harmful effects regarding use of Chaalia and Pan Masala in three schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi, Pakistan. METHODS: To achieve the objective a cross-sectional design was used in three government schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi. Students of either gender drawn from these schools fulfilling the inclusion and exclusion criteria were interviewed using a pre-coded structured questionnaire. Along with demographic data, questions regarding frequency of Chaalia and Pan Masala use, practices of this habit in friends and family and place of procurement of these substances, were inquired. Knowledge was assessed about harmful effects and its source of information. In addition, practices in relation to that knowledge were assessed. RESULTS: A total of 370 students were interviewed over a period of six weeks, of which 205 (55.4%) were boys. The ages of the students were between 10 and 15 years. Thirty one percent of the fathers and 62% of the mothers were uneducated. The frequency of use of any brand of Chaalia was found to be 94% and that of Pan Masala was 73.8%. Eighty five percent of them were regular users. A large majority (88%) procured the substances themselves from near their homes. Ninety five percent of the children had friends with the same habits. Eighty four percent were using the substances in full knowledge of their families. Chaalia was considered harmful for health by 96% and Pan Masala by 60%. Good taste was cited as a reason for continuing the habit by 88.5% of the children and use by friends by 57%. Knowledge about established harmful effects was variable. Knowledge about harmful effects was high in both daily and less than daily users . CONCLUSION: The frequency of habits of Chaalia and Pan Masala chewing, by school children in lower socio-economic areas is extremely high. The probable reasons for this high frequency are taste, the widespread use of these substances by family members and friends, low cost and easy availability

Trade Liberalisation Policies, Intra-regional Trade and Opportunities for Sustainable Agricultural Development

Many of the Near East (NE) countries are currently opening their agricultural markets at three distinct but interacting levels: unilateral liberalisation, regional integration schemes and multilateral trade liberalisation. These changes hold important implications for intra- and extra-regional trade, use of agricultural resources and sustainability of agricultural development in the NE countries. Unilaterally, and since the late 1980s, most countries of the region have liberalised their agriculture sectors by eliminating or reducing input subsidies, removing or reducing guaranteed producer prices, reducing the number of subsidised commodities and liberalising the exchange rate and the trade regime. Most of the implicit and explicit subsidies for agricultural inputs and outputs were withdrawn. However, some of the NE countries were able to continue supporting agriculture mainly for food security reasons. Experiences showed that domestic reform is necessary but not sufficient condition for economic growth

Castleman\u27s disease -- a rare disease of lymph nodes

Castleman\u27s disease is a rare disorder of unknown etiology and different clinical manifestations, occurring in young adults (usually prior to age 30 years). In this case report we present one such case who was a 16 years old male with abdominal pain, weight loss, cervical lymph adenopathy and hepatosplenomegaly. Lymph node biopsy revealed hyaline-vascular type of Castleman\u27s disease. He was put on chemotherapy but was lost to follow-up