Macroeconomic Determinants of Urbanization in Pakistan

Urbanization refers to the migration of rural people to urban centers in search of better jobs. Urbanization and growth go together; no country has ever reached middle-income status without a significant population shift into cities. Urbanization has strong association with unemployment, economic growth, poverty, infrastructure, crimes, health, socio-economic conditions and education. In 2050, most of the urban population of the world will be concentrated in Asia (52%) and in Africa (21%). A simple and modest model provided reasonable results. Increase in literacy is a decisive factor that has significant impact on increasing urban population. Per capita GDP growth also positively influences the urban population. Age-structure is too an important determinant of migration and urbanization. It is an open secret that generally young persons have gone abroad. Specification and diagnostics test supported the model which reveals appropriateness and statistical soundness of the model. Serious heed is paid to delimitation of cities to make them manageable and governable. Agriculture is provided sufficient resources to discourage migration to cities

Occipital Encephalocele and Review of Literature

Encephalocele is a rare congenital malformation of the central nervous system. It is defined as a congenital herniation of the intracranial compartments through a long defect and contains various rudimentary cerebral tissue components or sometimes only cerebrospinal fluid. They are located at midline of parietal or occipital region when the defect is small. Usually only the meninges herniate and the anomaly is cranial Meningocele or cranium bifidum with Meningocele. We present 47 cases of encephalocele, mostly occipital encephalocele, operated during last 5 years in our hospital at the department of Neurosurgery SZH, RYK. This is a retrospective study.Material and Methods: Between January 2008 and December 2013. Forty seven cases of encephalocele have been treated at our department. They were diagnosed on the basis of clinical findings and CT scan was done in all patients. All patients were operated and diagnosis was confirmed at peroperatively. Demographic, clinical, radiological and operative data were reviewed from hospital charts.Results: The total number of patients was 47, out of which 23 were male and 24 were female. Neurosurgical data of patients with encephalocele over the five years and three months from January 2008 to April 2014 were retrospectively studied. The average age of the patients at the time presentation was 10 months and seven days.Conclusion: Encephalocele is a relatively uncommon neurosurgical entity largely seen in the pediatric population. Treatment of this condition can be rewarding if properly managed early. Occipital, parietal, frontal, and frontonasal types may be approached without opening the cranium, while sincipital and basal encephalocele usually require craniotomy. In this series we present our experience in the operative management of encepha-locele with good outcome and also share our recommendation in technical consideration for surgical approaches

PSYCHOSOCIAL ILLNESS IN CHILDREN WITH THALASSEMIA: A CASE-CONTROL STUDY

INTRODUCTION: Thalassemia is the most common hemolytic autosomal recessive disorder. Pakistan has significant number of thalassemic children .The children with chronic disorders like thalassemia are prone to develop psychosocial illness including depression, anxiety, intellectual and behavioral issues.  OBJECTIVE: To assess the psychosocial illness in children with thalassemia and to compare these problems in children with and without Thalassemia   PLACE & DURATION: The Children’s Hospital and the institute of child health, Multan. From January to September 2021.  STUDY DESIGN: Case-control  MATERIAL AND METHOD:   In this study 50 children with Thalassemia and 50 normal children were enrolled as case & control according to inclusion and exclusion criteria. After approval from institutional ethical committee, detailed history ,Socioeconomic status, educational status of parent and child, age of diagnosis of disease, and whether thalassemia is well controlled or not and complications were noted. A Pediatric Symptom Checklist was used for psychosocial problems in all children. Data was analyzed by using SPSS version 22. Mean and standard deviation for quantitative data, while frequencies and percent for qualitative data was calculated. P-value was calculated by Chi square test. Prevalence ratio (ODDS ratio) with 95%confidence interval of all variables were calculated.  RESULTS: Out of 100 patients 50 were in case group (Thalassemia) and 50 control (non-thalassemic.Male female ratio was 1.2:1. 60 %( n=30) cases, 78 %( n=39) control patients were age ranges between 5 to 10 years. Educational level of parents of 40%(n=20),and 56%(n=28) was below matric,42%(n=21) and 90%(n=45) patients were going to school in case and control group respectively.82%(n=41) patients belonged to low socioeconomical status in each group. Regarding characteristics of thalassemia 74 %( n=37) patients were diagnosed within 1st year of life, while 26 %( n=13) after 1st year.64 %( n=32) had well controlled and 36 %( n=18) poor controlled disease. 20%(n=10) had developed Diabetes mellitus,2%(n=1) heart failure,74%(37) growth failure,76%(n=38) hemolytic facial features and 72%(n=36)skin discoloration. Psychosocial problems were statistically significant in children with Thalassemia as compared to healthy ones (p-value<0.001).Poorly controlled thalassemia and complications of heart and growth failure were found statistically significant risk factors.  CONCLUSION: Psychosocial problems are common in children with thalassemia as compared to healthy ones. So these patients must be referred for detailed psychological evaluation and management along with medical treatment.

Neurosurgical Management of Intracranial Epidermoid

Objective: Epidermoid cyst or cholesteatoma is a congenital slow growing lesion. The objective was to analyze clinical presentation surgery and outcome after surgery.Study Design: Retrospective observational study.Materials and Methods: This study represents a retrospective review of patients treated with epidermoid cyst, during a period of 18 years between 1995 to 2012. It was conducted at the department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan and department of Neurosurgery PGMI / LGH Lahore and department of Neurosurgery AMDC Farooq Hospital, Lahore.Results: The age of our patients ranged from 18 to 40 years, with male predominance. The predominating symptoms were related to the 5th, 7th and 8th cranial nerve and headache. Our study included 10 cases of epidermoid cysts; four of them were in CPA area, two suprasellar region and one was at pineal region. It was not always possible to determine if the signs and symptoms were due to local involvement by the epidermoids, increased intracranial pressure or both. The age of our patients ranged from 18 to 40 years, with male predominance. The retrosigmoid approach was used in 5 patients, ® Frontal craniotomy in 2 cases, Rt interhemispheric transtentorial approach in one patient and sub-temporal approach in one case. Parental portaline approach in 1 case. Total resection of epidermoid cyst was accomplished in 7 cases. To minimize recurrence, the residual epidermoid was carefully coagulated with the aid of microscope and bipolar diathermy without damaging surrounding neurovascular structures.Conclusion: Surgical management of intracranial dermoid has encouraging and good results. Use of endoscope is good adjunct for complete removal of epidermoid from angles and corners of the lesion

Surgical Outcome of Cerebellopontine (CP) Angle Tumors

Objective: The purpose of this study is to evaluate the clinical characteristics and surgical outcome of CP angle tumors.Material and Methods: This is a retrospective study of 10 cases admitted in the Department of Neurosurgery, Shaikh Zayed Hospital, Rahim Yar Khan during the last 8 years. The predominating symptoms here related to the seventh and eighth cranial nerves and headache.Results: Study included 10 cases of CPA Tumour clinical presentation was hearing loss, tinnitus, abnormal bala-nce, headache, facial numbness and buccal numbness, ataxia and trigeminal neuralgia. We had 10 patients, came with above clinical presentations. All cases were operated through retromastoid sub-occipital craniectomy. VP shunt was inserted in 1 case. Histopathology report was four patients vestibular schwanoma three tentorial meni-ngioma, two epidermoid cyst and one patient had choroid plexuses papilloma.Complications: One patient developed meningitis due to cerebrospinal Fluid leakage at operative site. Lumber drain was placed to control leakage and infection was controlled by aggressive treatment. There was no mortality in our study. One patient developed recurrence of epidermoid cyst at the same site after seven and half years. None of the patients developed further cranial nerve deficit as compare to preoperative deficit. The maximum period of follow-up of one patient was seven and half year.Conclusion: It is concluded from this study that the retrosigmoid corridor is the safe surgical approach for CPA tumors. In case of CP angle epidermoid, there was no recurrence symptoms on the immediate follow-up. At ope-ration, the root entry zone of TN should be examined for evidence of additional vascular compressio

Pharmacological evaluation of the hypoglycemic and anti- Alzheimer’s activities of aerial parts of Breynia distachia (Phyllanthaceae)

Purpose: To determine the cytotoxic, bronchorelaxant, spasmolytic, antidiabetic, α-glucosidase, acetylcholinesterase, butyrylcholinesterase, α-chymotrypsin and lipoxygenase inhibitory attributes of methanol and dichloromethane extracts of the aerial parts of Breynia distachia.Methods: The dichloromethane and methanol extracts of the aerial parts of the plant were prepared by maceration. Various ex vivo assays were employed, such as the brine shrimp lethality assay, lipoxygenase inhibitory activity assay, α-glucosidase inhibitory assay and α-chymotrypsin assay, as well as assays to assess the spasmolytic and bronchorelaxant activity. Meanwhile, the hypoglycaemic effect were analysed using an alloxan-induced diabetic model in Wistar albino rats.Results: The methanol extract (aerial) showed significant (p ≤ 0.05) cytotoxicity towards brine shrimp larvae at concentrations of 10, 100 and 1,000 μg/mL, respectively, whereas the dichloromethane extract (aerial) of the plant showed non-significant (p ≥ 0.05) results. The methanol extract (aerial parts) also demonstrated significant (p ≤ 0.05) α-glucosidase inhibitory activity and lipoxygenase inhibitory activity, with IC50 (half-maximal inhibitory concentration) values of 40.37 ± 5.29 μg/mL and 132.9 ± 0.33 μg/mL, respectively, while the dichloromethane extract exhibited significant (p ≤ 0.05) α-glucosidase inhibitory activity, with an IC50 value of 135.43 ± 8.29 μg/mL. An in vivo antidiabetic model showed that the administration of 150 and 300 mg/kg methanol extract of the aerial parts significantly (p ≤ 0.05) lowered the blood glucose level in alloxan-induced diabetic rats compared to control (treated with water).Conclusion: Data from different in vitro and in vivo models suggest that the methanol extract (aerial parts) of B. distachia shows significant cytotoxic, bronchorelaxant, spasmolytic, antidiabetic and anti-Alzheimer’s activity Hence, these findings validate the folkloric use of B. distachia and highlight the need to further explore its medicinal potential and the phytoconstituents responsible for its pharmacological actions

Surgical Management of Tuberous Sclerosis

Tuberous sclerosis is a genetic disorder with incidence of 1 into 6000 birth. It is a multi-systemic disorder. Seizures associated with tuberous sclerosis (TS) can be difficult to control with medical therapy.Objective: To determine the role of surgery for the management of seizures and other symptoms in Tuberous Sclerosis.Material and Method: Four patients with TSC who underwent surgery were admitted in the Department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan and Department of Neurosurgery, PGMI / Lahore General Hospital, Lahore.Results: We admitted 5 cases, 3 males and 2 females. All presenters with seizers other presenting feature were headache and vomiting in all 5 cases, vomiting in 5 cases. All cases were operated were craniotomy and removal of tumour. Surgery were V.P. Shunt was performed in 3 cases. All 5 cases revealed excellent outcome and seizures well controlled with anticonvulsant postoperatively which were poorly controlled preoperatively. All 5 cases were discharged in satisfactory condition within 2 – 3 weeks. Histopathology the histopathology of all 5 cases were subependymal giant cell astrocytoma (SEGA).Outcome: All 5 cases revealed excellent outcome and the seizures were well controlled post-operatively with anticonvulsants. While pre-operative fits, were poorly controlled. All 5 cases were discharged in satisfactory condition with 2 – 3 weeks.Conclusion: The surgery had excellent outcome for tuberous sclerosis provided timely decision is taken to treat the tumor and associated hydrocephalus. Most of these patients will lead ventriculoperitoneal shunt or EVD as an emergency step to save the life

Functional Role of MicroRNAs in Embryogenesis

This book chapter will provide an overview of the functional role of microRNAs (miRNAs) in embryogenesis. A brief introduction to embryogenesis and emphasis on the importance of miRNAs in gene regulation will be provided. The biogenesis and mechanism of action of miRNAs will be discussed in detail with a focus on the importance of miRNA-mRNA interaction in gene regulation. The chapter will then delve into the role of miRNAs in early embryonic development, including their importance in the establishment of the three germ layers, cell proliferation, differentiation, and apoptosis during embryogenesis. The role of miRNAs in organogenesis and tissue differentiation, specifically the formation of specific organs such as the heart, lung, liver, and brain, will also be discussed. The chapter will conclude by examining the dysregulation of miRNAs in embryonic development and disease, including teratogenicity, developmental disorders, and developmental cancer. The chapter will summarize the functional roles of miRNAs in embryogenesis and will offer future perspectives and potential therapeutic applications of miRNAs in embryonic development and disease

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