Notes

Perceptions from the Importance of Improve Care Planning In the COVID-19 Pandemic Among Older Adults Coping with Human immunodeficiency virus.
In 2015, Karachi saw its first ever epidemic of severe heatrelated illnesses that resulted in an extraordinary number of hospital admissions, especially in the intensive care, for fatal heat stroke within-hospital mortality of 3.7%.We conducted this study to elucidate the patient-related factors that lead to an increase in hospital admissions with heat-related illnesses in a tertiary care hospital. It was a descriptive case series conducted in the department of medicine at the Aga Khan University in June 2015. A total of 134 patients were admitted with heat-related illnesses of which 76(56.7%) were males. The mean age of the patients was 66 ±14.5 years. Heatstroke was present in 86 (64.2%) patients, followed by heat exhaustion in 48 (35.8%) and in-hospital mortality from heat-related illnesses was 5(3.7%). Hypertension (OR 2(95 % CI 1.0, 3.6) and insufficient sleep or food or water intake (OR 1.7(95 % CI 0.8, 3.8) was associated with severe heat-related illnesses. The effects remained even after adjusting for type and area of residence.Road Traffic Accident (RTA) injuries pose a public health challenge which significantly impacts the human capital development. The Punjab Economic Research Institute (PERI) conducted a study to assess the frequency, causes of trauma injuries, distribution and need and gap analysis of trauma centers in the province of Punjab. For gap/situational analysis, information was extracted through a structured questionnaire from randomly selected 8 District Head Quarters hospitals, 6 Teaching hospitals and 8 independent trauma centers. According to the data of Rescue 1122, 70% of RTA injuries involved the age group 11-40 years. In 295589(63.26%) of the RTA cases the vehicle involved was a motorbike. The major RTA injuries were leg fractures 71699 (16.44%) and head injuries 44738(10.26%). Over speeding 159977(44%) and careless driving 121545 (33.35%) were the major causes of RTAs. Noted was a shortage and mismatch between human resources and equipment in the trauma treatment facilities. Inequality was also found in distribution of trauma care units. Integrated and fully equipped trauma care system along with the establishment of trauma centers in places of high accidents' frequency is recommended. Strict implementation of road traffic safety laws is mandatory.Parkinson's disease is a slowly progressive neurodegenerative disease that commonly affects people aged 60 years and above. So far, no treatment has been shown to halt or slow the progression of the disease and our options are limited to symptomatic management. Levodopa is the most preferred antiparkinsonian medication that provides excellent control of symptoms early in the disease. However, in most patients the response declines over time and complications of motor fluctuations and dyskinesia arise. Other medical therapies play an adjunctive role in the management, as they are not as effective as levodopa. Advanced therapies like deep brain stimulation (DBS) can provide effective control of symptoms in moderate to advanced disease. Deep brain stimulation surgery has recently been started in Pakistan. Masitinib This review provides an overview of deep brain stimulation, its indications, patient selection process and details of surgery, expected benefits and limitations as well as its history and challenges in Pakistan.A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the postoperative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chisquare and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and postsurgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). The study found that pre-surgery wound status could be an indicator for risk of SSI in a post-operative scenario.There exist wide anatomical variations of upper limb. Their implication is perhaps greatest when it comes to failure of arteriovenous fistula (AVF) for chronic haemodialysis. Among arteries of forearm, brachial artery is of note, whose high bifurcation is associated with increased risk of failure. The superficial and accessory variants also cause difficulty for the surgeon. The single unpaired brachial vein and stenosis of cephalic vein compound the difficulties associated with AVF among many others. A thorough understanding of surgeons regarding normal anatomy and diverse variants holds high importance in context of deciding an appropriate site for arteriovenous (AV) anastomosis. Negligence in creation of fistula not only pose a threat to patients of end stage renal disease (ESRD) but also contributes to numerous other complications involving nerves and drug administration.
To investigate the efficacy and safety of targeting cancer metabolic vulnerabilities with specific anticancer agents.

The systematic review and meta-analysis entailed search on PubMed, Embase and Google Scholar databases for cohort-based studies or clinical trials which reported hazard ratio for overall survival and/or median overall survival of patients treated with metabolicallyactive anticancer drugs. Data was analysed using the Number Cruncher Statistical System version 11.

There were 16 studies published between 1989 and 2018 that reported improvement in the overall survival (p=0.05) despite the reported significant heterogeneity across the studies (I2=70%). Exploiting amino acid metabolic vulnerabilities was associated with a favourable prognostic outcome (p=0.05), while targeting glycolysis and nucleic acid synthesis had no significant clinical importance (p>0.05).

There is an urgent need to develop future therapies relying on the synergistic actions of nucleotide biosynthesis, glycolysis and amino acid metabolism.
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