Karachi Research Articles

Beneficiaries perceptions on motivation to family planning intervention in a community of Karachi Pakistan

Background: Pakistan is facing a great challenge in planning, implementing, and sustaining family planning and birth control policies. Considering this, one of the community health programs in the outskirts of a community health worked led family planning counselling. The purpose of this research study is to highlight perceptions of the beneficiaries regarding the benefits of the same. Methods: A qualitative descriptive study was undertaken for this investigation using a non-random sampling technique. The sample was chosen from the community population who were part of this intervention, with an inclusion criterion. The data was collected using in-depth interviews from 13 participants in total. Results: The key themes emerged across the interviews: Unfolding myths: Participants’ recognized that using family planning mediums does not mean that there is a medical deficiency outcome to it but a way to prevent large families, societal pressure: Participants shared the issues and cultural taboos attached to the family planning and how it is conceived in their societies, program support: participants shared that having a female lady health worker coming to the home brings in more access to the family planning and benefits: they found that effective and structured family planning is contributing to their enhanced personal life relations, economic gains and social comfort. Conclusions: A community health program model can be one of the outlets the government can collaborate to offer door to door provision, service quality and access to family planning to such communities in need.

Space-borne Air Quality Monitoring of Nitrogen dioxide (NO2) over Karachi and Lahore using Remote Sensing Tools

In this study, we used Sentinel-5P TROPOMI satellite data to examine the NO2 and gas concentrations in the cities of Lahore and Karachi, Pakistan, and to use environmental valuation methods that focus on air quality problems. Furthermore, the causes and main sources of NO2 are discussed with its effect on the environment and the health of humans. This study examines the correlation between the tropospheric NO2 collected from the recently launched Sentinel-5 Precursor, a low-earth-orbit atmospheric mission dedicated to observing air pollution and outfitted with the spectrometer TROPOMI (Tropospheric Monitoring Instrument). The average amount of NO2 that was gathered between May 2018 and May 2022. The results showed higher levels of NO2 concentrations were recorded in both, Karachi and Lahore. The concentrations exceed the WHO standard levels for NO2 in ambient air. The NO2 concentrations in Karachi ranged from 3.0e-6 mol/m2 being the minimum average concentration to 4.0e-1 mol/m2 being the maximum concentration. However, in Lahore, the minimum average value of NO2 was ranging from 4.0e-5 mol/m2 to 5.5e-1 mol/m2 as the maximum average, which was higher than the minimum and maximum values of Karachi. The study also revealed that the NO2 concentrations measured for both cities were higher than the WHO's yearly limit threshold, which is 53 ppb/year. Thus, it was crucial to take action to address this issue before it poses a severe risk to the local people. This study's identification of the key regions with the greatest NO2 concentrations will aid in understanding the significance of satellite data for monitoring NO2 concentration. Thus, the originality of the study lies in the fact that using the example of Karachi and Lahore, the dynamics of the deterioration of the environmental situation was revealed, and the main reasons for what was happening were also established. In this case, an available tool was used - remote sensing tools. The competent authorities can assist this study in managing and regulating the air quality in the most densely populated areas.

Assessment of Karachi as an Urban Heat Island Threat through Remote Sensing and GIS Techniques

The present study aimed to assess the threat of transformation of Karachi into an Urban Heat Island, so, ambit was having calculated temperature, buildup areas, and normalized difference vegetation index through remote sensing and GIS techniques. The Landsat satellite data was used to differentiate the temperature in different years. These images were processed through Envi 4.7, Erdas Imagine, and ArcGIS 10.3.1. The results revealed that the maximum temperature was found up to 30.52, 35.25, 33.60, 46.73 °C; the buildup area was 23, 34, 26, 45 %; the NDVI results showed ranging from 0.224-1, 0.07-0.43, 0.201-1, 0.29-0.7 during this years. The average spatial land use temperature and buildup area increased by 1.03 and 1.9 times from 1990 to 2019. The maximum NDVI was observed during 2019, because of heavy rainfall as a result which supports promoting more greenery. With an increase in the buildup area, a significant change in the temperature of the territory was simultaneously observed. Therefore, this indicates a major task for urban developers extenuating the subsequent urban heat island occurrence. That is, for the first time it is scientifically substantiated and confirmed by the results that when creating a city development plan, it is extremely important to exclude the possibility of the urban heat island occurrence through preliminary studies. The practical value of the study lies in sound recommendations, one of which is the need for future urban development to emphasize urban plantings, including vertical forests to prevent UHI occurrence in the area of Karachi city.

Celiac And Autoimmune Thyroid Disease In Patients With Anti-Gad Positive Type-1 Diabetes Mellitus.

Type-1 diabetes mellitus (T1DM) and autoimmune thyroid disease can occur concomitantly and patients with TIDM have a high risk of other autoimmune conditions like thyroid disease and celiac disease. This study aimed to analyze the association of anti-GAD positive T1DM with anti-thyroid antibodies and celiac disease. This cross-sectional study was conducted at the Department of Paediatric Endocrinology & Diabetes, National Institute of Child Health, Karachi Pakistan from July 2022 to December 2022. A total of 115 children of both genders aged between 1-18 years having known T1DM were analyzed. Children with chronic kidney disease or chronic liver disease were excluded. Those children were also not included whose parents/caregivers did not wish their children to be part of this research. The blood sample of each child was taken in a sterilized container and sent to an institutional laboratory for biochemical investigations. In a total of 115 patients, 67 (58.3%) were female and 48 (41.7%) males. The mean age was 8.87±3.43 (ranging between 1.5-17 years). The mean HbA1c was 11.86±7.31%. It was found that anti-GAD IgG was having signification association with celiac disease (p<0.001). Significant correlation of anti-GAD positive antibodies with Ttg-IgG antibodies (correlation coefficient=0.303, p=0.001), thyroid peroxidase antibodies (correlation coefficient=0.228, p=0.001). High proportions of children with anti-GAD positive T1DM patients were found to have thyroid disorders and celiac disease. A significant correlation was found between anti-GAD positive antibodies, celiac disease and anti-thyroglobulin antibodies.

The Impact of Burnout on the Psychological Well-being of ESL Students in Higher Education Environment

This quantitative study delved into the intricate relationship between language learning and psychological well-being, emphasising its importance in holistic educational approaches, specifically for English as a Second Language (ESL) learners only. The demanding nature of SLA is emphasised as a significant consequence, guiding this exploration within the theoretical framework of Maslach's theory of burnout. The quantitative study involved 207 ESL students, obtained through convenience sampling, in Karachi Pakistan, utilising the Maslach Burnout Inventory-English Student Survey and the Psychological Well-Being Scale to measure burnout and psychological well-being (PWB). The gathered data was analysed using SPSS version 25. The results reveal a significant negative correlation between psychological well-being and burnout, with burnout emerging as a significant negative predictor of students' psychological states. These findings emphasise the need for proactive strategies to address burnout in ESL education, promoting mental health and fostering supportive learning environments. Ultimately, this research contributes a growing body of literature to the field, emphasising the paramount importance of nurturing the well-being of ESL students as they navigate the path to language proficiency in our interconnected global society.

Mediating Role of Leadership Self-Efficacy between Formal Developmental Experiences and Leadership Effectiveness In Pakistani Higher Education Institutions

Effective leadership is a fundamental impetus for achieving organizational success and fostering a motivated, prompt, and high-performing team. The significance of Leadership Effectiveness (LE) has been extensively discussed in literature over the past few years but there hasn't been much empirical research on leadership development in Pakistani higher education. In this quantitative study, the relationship between formal developmental experiences and leadership effectiveness was examined in relation to the mediating role of leadership self-efficacy. A 15-item scale to measure the three research variables was employed in five private sector universities in Karachi city. The sample population included a total of 300 administrative members from higher education institutions including the Dean, Head of Departments, and Departmental Coordinators. Data were analysed using SEM analysis on Smart PLS software. Results of the study indicate the mediating effect of leadership self-efficacy and effectiveness. It was recommended that post-managerial development programs should be encouraged for effective management of teaching-learning processes.

Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan.

Population growth in Pakistan necessitates the implementation of comprehensive family planning (FP) initiatives. The adoption of modern contraceptives, especially long-acting reversible contraceptives (LARC), and permanent family planning methods in the country is challenging and has yet to reach an optimal level. These challenges are deeply rooted in the lack of informed decision-making, as well as demographic and maternal obstetric history. Interventions tailored according to women's needs can address the challenges faced by FP programs. This paper presents the findings of the implementation of a client-centered counseling and facilitation approach in an urban slum in Karachi, Pakistan. Such an approach has the potential to inform women and help them make better decisions regarding their health. In Rehri Goth, a slum located in Karachi, client-centered counseling along with facilitation at the facility was implemented to encourage the adoption of any modern contraceptive methods, with a specific emphasis on promoting the use of LARCs and permanent methods (where needed) among married women of reproductive age (MWRA). This approach was integrated into the existing Maternal, Neonatal, and Child Health (MNCH) services established in 2014. During the routine delivery of services, data were collected on various aspects including demographic characteristics, obstetric history, motivation to adopt LARCs, and reasons for refusal. A total of N = 3079 eligible MWRA received client-centered counseling, and 60.3% accepted modern contraceptive methods after counseling. Furthermore, 32.5% of these MWRA adopted LARCs or permanent methods. Factors explaining reluctance to adopt any method by MWRA despite specialized counselling were: age >25 years (AOR:1.28, 95% CI:1.08-1.51), no formal education (AOR:1.58, 95% CI:1.36-1.89), having no decision making role at household (AOR:1.60, 95% CI:1.36-1.89), the desire of female or male progeny (AOR:1.86, 95% CI:1.59-2.25) and age of youngest alive ≥3 years (AOR:1.50, 95% CI:1.22-1.84). Factors explaining adoption of short-term methods instead of LARCs or permanent method were: being resident in high under-five mortality clusters (AOR:1.56, 95% CI:1.14-2.14), maternal age > 25 years (AOR:1.88, 95% CI: 1.47-2.40), no decision-making role (AOR:11.19, 95% CI:8.74-14.34), no history of abortions (AOR:2.59, 95% CI:1.79-3.75), no female child (AOR:1.85, 95% CI:1.30-2.65) and ≤ 2 children (AOR:1.74, 95% CI:1.08-2.81). Considering the obstacles mothers face when it comes to accessing extended contraception, public health officials can devise effective strategies that empower MWRA to make well-informed and empowered choices regarding their families and reproductive health.

Efficacy Of Intravitreal Bevacizumab in the Treatment of Vitreous Hemorrhage Secondary to Proliferative Diabetic Retinopathy

Objective: To determine the efficacy of intravitreal bevacizumab in the treatment of vitreous hemorrhage secondary to proliferative diabetic retinopathy. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at PNS Shifa Hospital, Karachi Pakistan, from Sep 2018 to Feb 2019. Methodology: The study included 131 patients with proliferative diabetic retinopathy who presented with vitreous hemorrhage. Vitreous hemorrhage was graded into mild-moderate or severe. Patients were randomized into two groups: the bevacizumab group was treated with three intravitreal injections of bevacizumab given on monthly intervals and the control group which was observed. Vitrectomy was performed if the patient had non resolving hemorrhage by four months or developed tractional retinal detachment during study period. Results: Mean age of patients was 51.8±7.4 and 52.6±6.7 in treatment and control group respectively. Percentage of patients with vision of less than 6/60 in treatment group reduced from (58.7%) at baseline to (33%) at 4 months. Patients with mild to moderate VH who were subjected to intravitreal bevacizumab had significantly less chance of undergoing PPV at 4 months (4.76%) as compared with control group (20%). Improvement in visual acuity was also statistically significant at 4 months (p&lt;0.05). Conclusion: Intravitreal bevacizumab can be effective in diabetic retinopathy related mild to moderate vitreous hemorrhage in terms of improving the vision, reducing the rate of requirement for vitrectomy and completing panretinal laser photocoagulation

Community-based seroprevalence of SARS CoV-2 in an urban district of Karachi, Pakistan

Background Antibody-based serological tests which target households and communities can estimate the true extent of infection in a population. It minimizes the biases of facility-based selective testing and generates scientific data on disease transmission through household asymptomatic cases. The objective of this study was to determine the seroprevalence and trend of SARS-CoV-2 in a densely populated urban community of Karachi. Methods Three serial cross-sectional surveys were conducted in November 2020, February 2021, and December 2021 in Karachi’s District East. Households were selected to provide serum samples for Elecsys® immunoassay for the detection of SARS-CoV-2 antibodies. All household members were eligible to participate regardless of age and infection status. Bayesian regression was used to adjust for assay performance and estimate seroprevalence. Results We enrolled 1506 participants from 501 households. In November 2020, adjusted seroprevalence was estimated as 24.0% (95% confidence interval, CI=18.0-31.0), compared to 53.9% (95% CI=45.5-63.2) in February. In December 2021, it increased to 84.9% (95% CI=78.5-92.3). The conditional risk of infection was 41% (95% CI=29.9-51.6), 56.7% (95% CI=50.4–62.6) and 77.8% (95% CI=73.0-81.7) in surveys 4, 5, and 6 respectively. Only 18.7% of participants who had reactive antibodies for COVID-19 were symptomatic. Conclusions An increase in seroprevalence estimates in Karachi’s District East was observed over time. Community-based seroprevalence studies help to estimate the true proportion of the population that has been infected and predicts the spread of the disease in similar settings.

Comparison of Frequency and Types of Anemia in Subclinical Hypothyroidism and Euthyroidism

Objective: To compare the frequency and types of anemia in subclinical hypothyroid and euthyroid patients. Study Design: Comparative cross sectional study. Place and Duration: Department of Medicine, PNS Shifa, Karachi Pakistan, from Jun 2019 to Dec 2019. Methodology: All patients who fulfilled the inclusion criteria and visited Medicine Department, PNS Shifa Karachi were included in the study. After ethical approval and informed written consent patients were divided into two groups, subclinical hypothyroidism group (149 patients) and euthyroid group (148 patients). Blood samples of all included patients were sent for hematocrit, mean cell volume and hemoglobin level to assess the outcome i-e anemia &amp; its different types. Results: A total of 297 patients were included in the study. Amongst the sub clinically hypothyroid patients, anemia wasnoted in 40 patients (26.9%), while in the euthyroid group, it was noted in 23 patients (15.5%). In the subclinical hypothyroidism group, the type of anemia was microcytic in 13 patients (8.7%), macrocytic in 7 patients (4.7%) and normocytic in 20 patients (13.4%); while in the euthyroid group, anemia was microcytic in 7 patients (4.7%), macrocytic in 4patients (2.7%) and normocytic in 12 patients (8.1%). Conclusion: The commonest type of anemia found in sub clinically hypothyroid patients is normocytic normochromic anemia.The frequency of anemia was 26.9% in the subclinical hypothyroid group and 15.5% in the euthyroid group.

Histopathological Types of Ovarian Cancer in Different Age Group of Patients; A Single Institution Experience

Objective: To see the relationship between age and histological types among patients presenting with ovarian cancer at tertiary care hospital, of Karachi Pakistan. Study Design: Cross-sectional study. Place and Duration of study: Department of medical oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan from Mar 2019 to May 2020. Methodology: Three fifty women presenting with confirmed diagnosis of ovarian carcinoma were included irrespective of their age. The information regarding socio-demographics and family history were noted on pre-designed proforma. Pathology reports were obtained from all the patients and information regarding age, stage and histological type were noted. World Health Organization classification was used to classify the histological type of tumours. All data was entered and analyzed using SPSS version 23. Results: The mean age of the study sample was estimated as 44.27±12.7 years ranging from 14-92 years. According to histological type, most of the females had surface epithelial tumors 307(87.71%), followed by sex cord-stromal tumors 20(5.7%) and germ cell tumors tumors 19(5.43%) respectively. The statistically significant difference was observed between age and histological types and subtypes of ovarian cancer (p&lt;0.05). Conclusion: It is concluded that age is an important factor in determining risk of developing different types of ovarian cancers. Serous type of epithelial ovarian cancer is the most common type and commonly present in 4th to 5th decade of life. Germ cell ovarian tumor is second most common type and present in 2nd decade of life.

Hepatitis B &amp; C Among Patients of Non-Hodgkin’s Lymphoma and its Association with Pathological Factors

Objective: To see the frequency of hepatitis B and C virus among patients presenting with non-Hodgkin’s lymphoma and to see its association with pathological factors in Pakistani population. Study Design: Cross sectional study. Place and Duration of the study: Department of Medical oncology, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Jan 2019 to Jan 2020. Methodology: Total 251 patients of age more than 15 years of either gender with proven diagnosis of non-Hodgkin’s Lymphoma were enrolled in the study. The sample of blood (15 ml) of each participants was taken and sent to laboratory for detection of virus. The HBsAg and HCV antibodies were detected using 3rd generation Enzyme-Linked Immunosorbent Assay (ELISA). The cut-off set for HBsAg as 2.0 and for HCV as 1.0 in the laboratory, respectively. The information regarding socio-demographics, comorbidities, risk factors and clinicopathological features were noted on pre-designed proforma. Results: Out of 251 patients with non-Hodgkin’s Lymphoma, 8.8% had hepatitis and 4% had hepatitis B No statistically significant association was found for prevalence of hepatitis B and C with respect to stage (p=0.791 and 0.299), histological type (p=0.165 and 0.398), bone marrow involvement (p=0.692 and 0.163) and site of tumor (p=0.067 and 0.116). Conclusion: The substantial proportion of hepatitis B and C in the current study provides epidemiological evidence that such infection may play a role in NHL growth.

Association Between Level of Expression of Human Epidermal Growth Factor Receptor 2 (Her-2 Neu) And Age Among Breast Cancer Patients

Objective: To determine the association between human epidermal growth factor receptor 2 with age among patients presenting with breast cancer. Study Design: Comparative cross-sectional study. Place and Duration of Study: Medical Oncology Department, Jinnah Postgraduate Medical Centre, Karachi Pakistan, from Aug 2019-Jan 2020. Methodology: Total 194 females of age 20-85 years with confirmed diagnosis of breast cancer were included in the study. The immunohistochemistry was done for the status of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 and the validation of human epidermal growth factor receptor 2 was done by Fluorescent In situ Hybridization technique in each female. Results: The patient’s age was from 24-82 years old with mean age of 46.57±11.45 year. Out of 194, 108 cases had positive progesterone receptor expression (55.7%), 114 had positive estrogen receptor expression (58.8%) and 67 had positive human epidermal growth factor receptor 2 expression (34.5%). The females of age greater 46 years were more likely to be human epidermal growth factor receptor 2 positive as compared to females of age less and equal to 46 years. Conclusion: The results showed that females with age more than 40 years have significant association with human epidermal growth factor receptor 2, whereas age is an independent variable with regards to estrogen receptor and progesterone receptor status.

EGFR-TKI Sensitizing Mutation Rate in Adenocarcinoma of Lung

Objective: To assess EGFR-TKI sensitizing mutation rate in patients having lung adenocarcinoma and its association with smoking status. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi Pakistan from Apr to Dec 2019. Methodology: One eighty-seven patients aged 20-75 years, of either gender presented with confirmed diagnosis of adenocarcinoma of lung were included in the study. The data regarding characteristics of patients such as gender, age, smoking status, ethnicity and religion were recorded on pre-designed proforma. The examination of EGFR mutation in plasma and tissue specimens was done by the Real-Time polymerase chain reaction assays. SPSS version 23 was used to analyze data. Results: Out of 187, 65(34.8%) patients presented with EGFR TKI-sensitizing mutation and among them 48(73.8%) patients had exon 19 deletion and 17(26.2%) patients had exon 21 L858R point mutation. In patients with positive EGFR, 90.8% were never smokers and 9.2% were smokers or ever smokers. The statistically significant relationship was found between EGFR mutation and smoking status (p=0.001). Conclusion: This study showed EGFR-TKI mutation frequency as 34.8% which in contrast to western studies where EGFR mutation is less frequent. Further, never smokers are at greater risk of EGFR mutation.

Association between Histopathologic Type of Ovarian Cancer and Serum CA-125 Level

Objective: to find an association between the serum CA-125 level and the histopathological type of ovarian tumor. Study Design: Cross-sectional study. Place and Duration of Study: Medical Oncology, Jinnah postgraduate Medical Center, Karachi Pakistan from Jan 2018 to Dec 2019. Methodology: This study included 107 patients presenting with epithelial ovarian cancer. In each case, histological type, pathological stage, degree of differentiation and serum CA-125 was evaluated. The association between preoperative CA-125 and histopathological type of tumor were evaluated. Result: About 107 ovarian cancer patients were included. The mean age in our study was 50.80±10.16 years. Raised CA-125 level was found in most of the patients with serous histology 46(56.1%). Conclusion: Serum level CA-125 elevated in most patients with serous histology. A statistically non-significant association was found between raise CA-125 levels and histological types of ovarian cancer.

Association of Dietary Habits in Esophageal Cancer–A Case-Control Study from Pakistan

Objective: To see the association between dietary habits in the development of oesophageal carcinoma. Study Design: Case control study. Place and Duration of Study: Department of Medical Oncology at Jinnah Postgraduate Medical Centre, Karachi Pakistan,from Feb 2019 to Dec 2019. Methodology: Patients from age 15-80 years of either gender were included in the study. All the patients presenting to hospital OPD with histopathologically confirmed of oesophagus carcinoma were included. Controls were the healthy attendants coming at the same hospital. The data was collected through pre-designed questionnaire. Results: Total of 173 cases and 173 controls were included in the study. The mean age of the cases and controls were reported as 48.07±14.13 years and 48.86±15.32 years. After adjusting odds in multivariate analysis family history of cancer (OR=3.76; 95% CI: 1.76-7.90, p&lt;0.05), the consumption of chicken (OR=5.22; 95% CI: 3.01-9.056, p&lt;0.05), red meat (OR=5.06; 95% CI: 2.70- 9.46, p&lt;0.05) &amp; smoked food (OR=3.36; 95% CI: 1.76-6.44, p&lt;0.05) more than three times per week remained positively associated with oesophagus carcinoma. Conclusion: The study showed association between consumption of chicken, red meat, hot drinks &amp; smoked food with oesophageal carcinoma.

Functional Recovery Measurement: Comparing Early Active Mobilization Versus Immobilization after Extensor Tendon Repair in Zones IV to VIII

Objective: To compare the results of early active mobilization versus immobilization in term of rehabilitation after extensor tendon injury in zones IV–VIII. Study Design: Randomized control trial (Clinical Trial no. NCT04221113). Place and Duration of Study: Department of Plastic and Reconstructive Surgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Feb to Jul 2020. Methodology: Patients with extensor tendon injuries of zone IV–VIII were randomly allocated to Treatment Group (early Active Mobilization) and Comparison Group (Immobilization Group) and their total active motion score was observed at fourth, sixth and eighth week. Results: Overall mean age of study participants was 29.48±5.51 years. Half of the patients had single finger injury 25(50%). Most of the study participants presented with injury in zone V 32(64%). The two groups did not differ on basis of age (p=0.879), gender (p=1.00), zone involved (p=0.183) and finger involved (p=0.396). TAM score between the two groups was not significantly different at fourth week (p=0.384), sixth week (p=0.606) and eighth week (p=0.122). The frequency of complications between two groups was not statistically significantly different (p=0.667).Conclusion: The current study was unable to find the significant difference in patients’ outcomes when treated with early active mobilization and immobilization protocol.

Correlation of Percentage of Ki67 with Tumor Grade in Breast Cancer

Objective: To determine the association of Ki67 with tumor grade and other pathological features in patients with breast carcinoma. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medical Oncology of Jinnah Postgraduate Medical Center, Karachi Pakistan, from Jul 2018 to Jul 2019 Methodology: Two hundred and sixty females diagnosed with breast carcinoma of age more than 19 years were included using non-probability consecutive sampling technique. The histologic grade of tumor has been assessed using the classification of the World health organization. Representative sample was selected from each tumor for immune histochemical staining examination including estrogen receptors, progesterone receptors, Her2neu and Ki67. Nuclear expression has been quantitatively documented for Ki67. Results: The mean age of the study sample was noted as 46.93±12.8 years ranging from 20 to 76 years. Of 260 patients, 17 patients (6.5%) had low Ki67 (1-5%), 23 patients (8.8%) had intermediate Ki67 (6-14%) and 220 patients (84.6%) had high Ki67 (≥15%). The significant relationship was found between Ki67 status and age, stage, tumor size, grade, lymph node status, estrogen receptors, progesterone receptors, HER2/Neu and triple negative (p&lt;0.05). Conclusion: Ki67 index is associated with tumor grade and other pathological features such as stage, tumor size, lymph node status, estrogen receptors, progesterone receptors, HER2/Neu and triple negative.

Evaluation and Comparison of the Effects of Low and High Doses of Herbal Medicinal Plant Emblic Myrobalan (AMLA) on Red Cell Parameters of Normal Healthy Rabbits

Objective: To study and compare the effects of low and high doses of Emblic myrobalan (Amla) on the red blood cells hemoglobin (Hb), packed cell volume (PCV) red cell count (RCC), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin Concentration (MCHC) of rabbits. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Pharmacology, and Animal House of Baqai Medical University Karachi Pakistan, from Jul to Aug 2016. Methodology: Twenty-seven male rabbits of 1-2kg body weight were taken and equally divided into 3 groups (group A, B and C). Group A served as control group; group B (Low dose group) was administered Amla at 2g/kg body weight while group C (High dose group) was administered Amla at 4g/kg body weight. Amla was mixed with water and administered orally with syringe for 60 days. Blood samples were drawn via cardiac puncture on day 61 for red cell parameters and reports were analyzed using Statistically Package for Social Sciences (SPSS) version 21. Results: Administration of low dose Amla resulted in significant increase in Hb (0.001) and PCV (0.001) compared to normal while high dose Amla produced significant increase in Hb (0.001), PCV (0.001), MCV (0.043), MCH (0.027) and RCC (0.001). Administration of high dose Amla showed significant improvement in red cell parameters compared to low dose Amla. Conclusions: Amla may be used to improve the red cell hemoglobin in patients of iron deficiency anemia

Zeb-un-Nissa's ‘Between ourselves: a weekly feature for women’: learning to feel in early post-independence Pakistan

AbstractPioneering Pakistani female journalist Zeb-un-Nissa Hamidullah in her ‘Between ourselves: a weekly feature for women’ columns, which appeared in Karachi's English-language daily newspaper Dawn during the late 1940s and early 1950s, encouraged her readers to stretch rather than breach the boundaries in how (educated) Pakistani women—as ‘good wives and wise mothers’—should fulfil their familial (and wider social) responsibilities. Her advice—which often took the form of ‘homespun’ homilies—consistently flagged up the crucial role of women, whose duties included not simply overseeing their children's behaviour but teaching their offspring, through their own emotional responses, how to feel. In their capacity as mothers, women needed to exercise sabr (patience and perseverance) when providing all-important emotional training for future Pakistani citizens who—like the state—were still in the process of being made. Accordingly, this article discusses the spatially defined context in which ‘Between ourselves’ appeared—that is, Dawn itself and the fast-expanding city of Karachi which was rife with uncertainties—before turning to the emotional ‘good practice’ that Hamidullah promoted.