Metastatic signet ring gastric adenocarcinoma presenting with microangiopathic hemolytic anemia.

Metastatic adenocarcinoma presenting as microangiopathic hemolytic anemia (MAHA) and leukoerythroblastic blood picture is rare. We report three patients who presented with MAHA as the initial symptom of metastatic signet ring cell gastric adenocarcinoma. One patient had past history of gastric ulcer. In all these patients the initial diagnosis was based on peripheral blood smear followed by bone marrow biopsy; upper GI endoscopy showed presence of gastric ulcers with focally scattered neo-plastic signet ring cells on histopathology. All patients died within a week of diagnosis

A Tale of the Ticker; Stock Market Capacity Building Hegemony and Temporal Performance in the Emerging Economies

This paper aims to examine stock market with a capacity building perspective for economic growth, focusing on the factors that enhance stock market capitalization in the long term. This study evaluates cross country series data of 26 emerging countries listed at MSCI index, through a period of 2006 to 2019. The data were collected through World Bank, Pakistan Stock Exchange and SECP database. Vector Error correction model and Multiple Regression analysis were applied on data to analyze the impact of assorted factors on stock market capitalization to GDP as a measure of long term capacity. The findings suggest that political stability and corporate tax rate are two important factors that may have significant impact on stock market capitalization to GDP. This research is different from all past researches with respect to methodological, aeon and acclimatization perspective. Capacity building is a relatively new phenomenon adopted from complex adaptive ecosystems and most studies in this area are of theoretical nature. Moreover, the fact that this research has considered not only the long term but also short-term market capitalization perspective, adds to its overall value and originality

HYPOFRACTIONATED RADIOTHERAPY IN GLIOBLASTOMA MULTIFORME

Purpose: The purpose of this study was to assess the outcomes in glioblastoma patients treated with hypofractionated radiotherapy.Materials and Methods: We reviewed all glioblastoma patients treated at our specialist cancer centre over 7 and a 1⁄2 years using hypofractionated radiotherapy (HRT) postoperatively. The HRT regimen was 48 Gy given at 3 Gy/ fractions in 16 fractions. We calculated overall survival using time to event analyses. Results: A total of 62 patients were identi ed of whom 44 (71%) were male. The median age of these patients was 50 years (range: 20–71 years). Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 47 (76%) and 1 in 15 (24%) patients. 7 (11%) of the patients underwent gross total resection, 52 (83%) had subtotal resection and 3 (5%) had a biopsy only. Response assessment on magnetic resonance imaging at 3-month post-HRT showed that 14 (22%) patients had regression, 21 (34%) were stable and 22 (35%) had a progressive primary tumour. 5 (8%) patients were lost to follow up. With a median follow-up of 7.8 months, the median overall survival was 9 months. Patients with ECOG-0 showed a median survival of 7 months as compared to 6 months for those with ECOG-1. Patients with stable or partial response showed a median overall survival of 8 months in comparison to 6 months for those with progressive disease. There were no signi cant differences in median survival based on the extent of surgery. A Cox multivariate model con rmed signi cant correlation of age and response to radiotherapy with survival. Conclusion: HRT consisting of 48 Gy in 3 weeks can be used for selected glioblastoma patients to reduce the overall treatment time of conventional radiotherapy by 35–40% without apparent increased toxicity or decrement in survival in a low resource environment. Key words: Chemoradiation, glioblastoma, hypofractionated radiotherapy, survival

Phylogenetic analysis of coat protein gene of CYDV-RPV strain from Wheat

Background: Keeping in view the potential damage caused by viruses to production of different crops and possible ‘directed damages’ by manipulated viral attack in/across border collectively make phylogenetic analysis of any attacking viral specie important. Cereal yellow dwarf viruses (CYDV) are highly important viruses in wheat causing significant yield loss.Methods: Double antibody sandwich ELISA and reverse transcription polymerase chain reaction (RT-PCR) was used to detect and confirm the polerovirus i.e. CYDV-rhopalosiphum padi virus (RPV), and unassigned viruses (SGV, RMV) in Punjab and NWFP provinces. The PCR products were inserted into a pGEM®-T easy vector, which then transformed in JM-107 cells of Escherichia coli. Recombinant plasmids were sequenced. Nucleotide and predicted amino acid sequences were aligned, analyzed and compared with other RPV isolates of the family. The nucleotide sequence data were used to make a phylogenetic tree.Results: Sequencing of 600 bp of coat protein gene confirmed the presence of CYDV-RPV strain. Pakistani isolate has close phylogenetic relationship with RPV-Mexcio and RPV-Yolo (USA). They had 99.95% similarity with RPV-Pakistan. The RPV-Aus, RPV-IR, and RPV-Cal (USA) had 99.94% identities with RPV-Pakistan.Conclusion: This work led to a conclusion that there is very low genetic diversity in RPV-Pakistan. Now it is in our future interest to clarify the identity of RPV-PK with more sequencing. The current study may help scientists to formulate appropriate management strategies against CYDV-RPV

Accuracy of diagnosis and relationship with quality of emergency medicine training program

An indicator for emergency room performance is the ability to establish the correct diagnosis within the emergency room over the years. The authors chose to examine the non-congruence of Emergency Room diagnoses to that established after hospital stay for three selected years. A total of 8488 records were reviewed and all disparate diagnosis were recorded and categorized. Retrospective chart reviews were done from July 2008 to February 2009 at the Aga Khan University Hospital, Karachi. A substantial reduction in the percentage of disparate diagnoses was seen over the years from 41% in the initial year to 14% in the last year evaluated. It was concluded that over the years there has been an improvement in the reliability of Emergency Room diagnoses at the Aga Khan University Hospital, Karachi

FPGA IMPLEMENTATION OF ADVANCE ENCRYPTION STANDARD WITH SINGLE KEY

Advanced Encryption Standard (AES), is known as most secured encryption standard now a days. Many researchers have implemented it in different languages like java, C and C++ with different algorithms. Recently the AES 128-bit has been implemented using Verilog on FPGA with equipped key being encrypted along with data input in whole process. In this paper the AES 128-bit encryption and decryption process with key which is only used for data input and is not encrypted throughout the encryption/decryption process. Results are same but our algorithm is slightly faster because only data is encrypted in the process of encryption, thus process time and area is optimized

Perceptions of teachers on government school privatization in Punjab, Pakistan

The educational privatization is the global phenomenon with far-reaching implications, and its impact on teachers in government schools within the context of Punjab, Pakistan, is a subject of dominant importance. Research investigates the effects of privatization upon teachers' job security, salaries, and job satisfaction. Study includes a mixed-methods approach, combining survey data from 430 teachers with in-depth interviews of 25 teachers. The results reveal that educational privatization in Punjab presents uncertainties about teachers' job security and contractual terms, reduces their autonomy and creates financial stress. Thus, on the positive side, teachers experience improvements in resources and teaching environments. However, impact of privatization on the teachers' job satisfaction is complex, with a blend of positive & negative emotions. The study underlines the need for balanced approach in the privatization policies, recognizing the teachers' multifaceted experiences. The policymakers must ensure that teachers' well-being and economic stability are not compromised. Findings donate to understanding of the impact of privatization on teachers in a specific context and call for further research to explore long-term effects and the perspectives of other stakeholders

Teacher Training in Pakistan: Overview of Challenges and their Suggested Solutions

Education is a key component of progress in the present-day world. But this progress cannot be made without efforts of teachers. Therefore, teacher education, in particular teacher training becomes extremely important. In this regard, several trainings programs are initiated and executed across Pakistan but the desired outcomes have not been achieved so far. Hence, this study was conducted to explore the challenges in teacher training in Pakistan and the ways through which these issues can be resolved. The sources for the data of the study were the published studies in the field in the context of Pakistan, national education policy, and other relevant literature. Based on secondary data, the study concludes that the issues with teacher training in Pakistan are administrative as well as faculty related. The findings reveal that the challenges related to policy and planning, poor induction of teachers, lack of resources in teacher training institutions, demotivation among teachers, and unequal distribution of skilled and productive teachers, dual training system and infrequent trainings. These issues can be fixed by fostering encouraging environment, ensuring accountability and merit, providing necessary resources, systematizing professional training programs and their continuation. The findings of this study will, therefore, positively guide policymakers to develop the right and effective policy to improve the standard of teacher education in the country

A Case Report Of A Giant Plunging Ranula In A 25-Year-Old Patient: A case report

Abstract This case report aims to present an unusual case of a plunging ranula that extended to the superior vertebral body of the T4 vertebrae, we will be elaborating on the patient presentation, investigations, diagnosis, and treatment of the lesion, while also talking about the adversities faced while diagnosing and treating the patient. The rarity of this condition and an atypical presentation makes this a difficult case to diagnose and vigilant treatment is needed to prevent any complications associated with the condition and ensure a successful treatment and recovery

Epidemiological Data of Neurological Disorders in Pakistan and Neighboring Countries: A Review

Neurological disorders are the impairments of nervous system and are an important and growing cause of morbidity, mortality, and disability. In addition to health costs, those suffering from these conditions are also frequently victimized of stigmatization and discrimination. Stigmatization further minimizes the patients\u27 access to treatment and social activities. These disorders, therefore, require special attention particularly in developing countries where unfortunately, the burden of these disorders remains largely unrecognized. Moreover, the burden imposed by such chronic neurological conditions in general can be expected to be particularly devastating in poor populations. These conditions are emerging as severe public health concerns in the developing countries due to the facts such as unawareness, Illiteracy, large numbers of people who are untreated, and unavailability of inexpensive but effective interventions. Regrettably, reliable population-based data from developing countries including Pakistan on the epidemiology of neurological disorders are extremely limited. Although, some information on epidemiological aspects of neurological diseases are available from some developing countries (Pakistan, Iran, India, Sri Lanka, Saudi Arabia and China) but disease prevalence and pattern are based on geographical, social, cultural, religious, and ethnic factors. In this review, w e critically analyzed data of 209 studies regarding the burden and prevalence of hypertension, depression, Stroke, Alzheimer\u27s disease (AD), epilepsy, and Parkinson\u27s disease (PD) in Pakistan and neighboring countries