Benefits of physical activity on reproductive health functions among polycystic ovarian syndrome women: a systematic review.

BACKGROUND: Polycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately 6-26%, affecting 105 million people worldwide. This systematic review aimed to synthesize the evidence on the effects of physical activity on reproductive health functions among PCOS women. METHODS: The systematic review includes randomization-controlled trials (RCTs) on physical exercise and reproductive functions among women with PCOS. Studies in the English language published between January 2010 and December 2022 were identified via PubMed. A combination of medical subject headings in terms of physical activity, exercise, menstrual cycle, hyperandrogenism, reproductive hormone, hirsutism, and PCOS was used. RESULTS: Overall, seven RCTs were included in this systematic review. The studies investigated interventions of physical activity of any intensity and volume and measured reproductive functions and hormonal and menstrual improvement. The inclusion of physical activity alone or in combination with other therapeutic interventions improved reproductive outcomes. CONCLUSION: The reproductive functions of women with PCOS can be improved with physical activity. Furthermore, physical activity can also reduce infertility, as well as social and psychological stress among women. PROSPERO SYSTEMATIC REVIEW REGISTRATION: CRD42020213732.

Establishment of institutional diagnostic reference level for Computed Tomography dose on 160 slicer Computed Tomography scan at Lady Reading Hospital Peshawar.

OBJECTIVE: To set institutional diagnostic reference level for computed tomography of multiple anatomical regions using dose length product as dosimeter parameter and to compare results with international diagnostic reference level. Method: The retrospective study was conducted at the Radiology Unit of Lady Reading Hospital, Peshawar, Pakistan, and comprised dose data of patients who underwent computed tomography from June 1 to August 31, 2018. The mean, 25th, 50th and 75th percentile of dose distribution of common computed tomography examinations was calculated and compared with other established diagnostic reference levels. Data was analysed using SPSS 20. RESULTS: Of the 1001 scans, 143(14.2%) related to brain, 275(27.5%) abdomen-pelvis, 133(13.3%) kidney-ureter-bladder, 186(18.58%) thorax, 85(8.49%) triphasic, 126(12.58%) musculoskeletal, and 53(5.29%) cardiac. Institutional diagnostic reference levels for the computed tomography unit was established as 50th percentile of dose length product for different regions brain 339, abdomen-pelvis 298, thorax 165, kidney-ureter-bladder 302, triphasic 633, musculoskeletal 366 and cardiac 403. Both 50th and 75th percentile values of dose length product for each individual body region was lower than international Diagnostic reference levels. CONCLUSIONS: The diagnostic reference level will be used in routine computed tomography practice at the institution, and will act as the baseline for developing the national diagnostic reference levels.

Observed and predicted precipitation variability across Pakistan with special focus on winter and pre-monsoon precipitation.

This study utilises ground, satellite and model data to investigate the observed and future precipitation changes in Pakistan. Pakistan Meteorological Department's (PMD) monthly precipitation data set along with the Tropical Rainfall Measuring Mission (TRMM) monthly dataset TRMM_3B43 (0.25° × 0.25° resolution) and European Centre for Medium-Range Weather Forecasts's (ECMWF) monthly reanalysis product ERA5 have been used to evaluate rainfall trends over the climatic zones of Pakistan through Mann-Kendall test, Sen's slope estimator and innovative trend analysis for the time period 1978-2018. Community Climate System Model (CCSM4) projections have been employed to explore the projected changes in precipitation until 2099. Furthermore, TRMM and CCSM4 projections have been correlated and validated using root mean square error (RMSE) and mean bias error (MBE). There is a good correlation between TRMM and PMD ground observation at all stations of the country for all seasons, with correlation coefficient values ranging from 0.89 (November) to 0.97 (July and August). However, ERA5 monthly precipitation tends to overestimate rainfall in the winter months. The study shows a decreasing trend in winter precipitation in all zones of the country with a significant decrease over western mountains, i.e. zone C of the country. During 2008-2018, a sharp decrease in winter precipitation is observed as compared to the baseline value of 1978-2007 in all climatic zones. Rainy days have also shown a decrease in winter and pre-monsoon seasons. There seems to be a shift in precipitation from winter towards pre-monsoon season as pre-monsoon precipitation in the last 11 years increased in all zones except for zone C. Coherently, there is a decrease in an area affected by winter precipitation and an increase in area for pre-monsoon precipitation. Future precipitation estimates from the CCSM4 model for RCP 4.5 and RCP 8.5 overestimate precipitation in most parts of the country for the first 9 observed years (2010-2018) and predict a rise in precipitation by 2099 which is more pronounced in the northern and western Pakistan while a decrease is predicted for the plains of the country, which might have negative consequences for agriculture.

Frequency Of Non-Diabetic Renal Disease In Type 2 Diabetes Mellitus Patients Undergoing Renal Biopsy.

BACKGROUND: Diabetes mellitus has become a major emerging health concern. Its burden, estimated to be 451 million in 2017, has been projected to rise to 693 million by 2045. This will bring a rise in the prevalence of its associated complications. There is a wide spectrum of non-diabetic renal disease (NDRD) known to be present in diabetic patients with variable prevalence. However, the majority of diabetes mellitus (DM) patients with renal disease are yet not biopsied and the diagnosis of diabetic nephropathy (DN) is presumed on clinical grounds. METHODS: It is a retrospective cross-sectional study. We selected a total of 126 cases of renal biopsies with a history of type 2 diabetes mellitus. Demographic data was collected from the medical records and pathology reports while all cases were evaluated by reviewing the archived slides. RESULTS: Patients were categorized into group 1 with isolated NDRD, group 2 showing NDRD mixed with DN and group 3 with isolated DN. Thirty-four (27%) cases had isolated NDRD (group 1), 14 (11%) had NDRD mixed with DN and 78 (62%) patients had isolated DN. NDRD, either alone or in combination with DN, was found to be present in 48 patients with an overall prevalence of 38%. CONCLUSION: Our study concludes that NDRD is frequent in type 2 diabetes mellitus patients. Renal biopsy remains the key diagnostic tool in such cases, providing crucial information for proper management of the underlying pathology.

Diagnostic Utility of BCOR Antibody in Clear Cell Sarcomas of Kidney.

Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the second most common renal pediatric renal malignancy after Wilms tumor. It exhibits a heterogeneous morphology, with overlapping features with its close differentials, which results in diagnostic challenges. There was no specific immunohistochemical marker in the past, to help in this regard. BCOR antibody has recently been suggested to be helpful in the differential diagnosis. We aim to study the utility of the BCOR antibody in the diagnosis of CCSK. Methods. We selected a total of 27 cases of CCSK (n = 12), Wilms tumor (n = 12), and congenital mesoblastic nephroma (n = 3). All cases were evaluated for the extent and intensity of nuclear labeling for BCOR antibody by immunohistochemistry (IHC). Results. We found that BCOR IHC was positive in 11 out of 12 cases with diffuse and strong staining in 8 of the cases. None of the cases of Wilms tumor and congenital mesoblastic nephroma were positive. Only 2 cases of Wilms tumor showed minimal and weak staining in <5% of cells. Conclusion. Diffuse and strong nuclear staining for the BCOR antibody is highly specific for CCSK among common pediatric renal malignancies. Our study confirms that BCOR IHC is a good IHC marker for the diagnosis of CCSK.

Assessment of Potential Drug-Drug Interactions in Hospitalized Cardiac Patients of a Secondary Care Hospital in the United Arab Emirates.

OBJECTIVE: To identify the types, severity, and documentation grades of potential drug-drug interactions (pDDIs) and to identify the predictors of pDDIs among hospitalized cardiac patients. METHODS: This was a cross-sectional study. All the patients who were admitted for >24 h in a cardiology ward of a general hospital of the United Arab Emirates and prescribed with cardiac medications were included. The occurrence of any pDDI between cardiac medications and other coprescribed medications was identified using Micromedex database 2.0® and graded and documented based on the severity and documentation. FINDINGS: A total of 842 pDDIs were identified in 155 patients. The overall relevant frequency for the occurrence of pDDIs was found to be 87.74%. A total of 79 pairs of pDDIs were identified. Among identified pDDIs, 41.33% and 56.65% were major and moderate severity type, respectively, whereas 12.32% were excellent and 36.81% were good documentation grade. The majority of pDDIs were between aspirin-bisoprolol (11.64%). Patients taking more than seven drugs (odds ratio [OR] = 9.90; 95% confidence interval [CI]: 2.28-42.99), polypharmacy (OR = 3.86; 95% CI: 0.93-16.08), and number of medical conditions (OR 0.25; 95% CI: 0.09-0.68) were significant predictors of pDDIs. CONCLUSION: The study fosters the importance of regular and close monitoring for pDDIs among cardiac patients. Thus, multicenter interventional studies are required to determine the exact nature and types of pDDIs in the local population.

Wellens' syndrome: a close call.

We describe a case of a middle-aged man who presented to the emergency department with typical anginal chest pains and found to have new, deeply inverted T-waves on ECG consistent with Wellens' syndrome. Similar to the description by Wellens et al, a critical 99% stenosis of the proximal left anterior descending artery was indeed confirmed by coronary angiography and successfully treated with drug-eluting stent. It is very important that physicians recognise this ECG finding as a harbinger of a serious cardiovascular condition and the necessity for an early invasive cardiac catheterisation.

Juvenile rheumatoid arthritis.

OBJECTIVE: To determine the spectrum of clinical presentation, laboratory parameters and drug therapy in patients with Juvenile Rheumatoid Arthritis (JRA). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Children's Hospital and The Institute of Child Health, Lahore, from October 2008 to October 2011. METHODOLOGY: All patients who fulfilled the American College of Rheumatology criteria for JRA were enrolled. Their clinical features, investigations done and treatment received for JRA were noted. Statistical analysis of data was done on SPSS version 16.0 for obtaining descriptive statistics. RESULTS: Out of 185 patients, 50.3% (n = 93) were females; 54% (n = 100) were between 10 - 15 years of age. Polyarthritis was found in 71.9% (n = 133) followed by oligoarthritis (22.7%, n = 42) and systemic onset disease (5.4%, n = 10). Morning stiffness (78%) and fever (68%) were the most common clinical presentations. All patients with systemic onset disease had fever (n = 10) followed by skin rash, hepatosplenomegaly and lymphadenopathy. Uveitis was found in 2 patients, and both belonged to the oligoarticular group. Rheumatoid factor was found in 10.27% (n = 19) of all patients. All patients were given non-steroidal anti-inflammatory drugs (NSAIDs). Disease modifying agents (methotrexate) were given to 43.8% (n = 81). Steroids were used in 61% (n = 113) of patients either with NSAIDs alone or NSAIDs plus methotrexate. CONCLUSION: Disease profile of JRA at the study centre showed that polyarthritis is the commonest type. Recognition of subtypes will help in planning the management of these patients.