Independent prescription of medicines and diagnostic test advice by final year medical students in Punjab.

Sale of medicines is not rigorously controlled in Pakistan. Therefore, medical students start prescribing drugs and advising diagnostic tests before they graduate. This cross-sectional study investigated the frequency of independent medical prescription by 180 stratified, randomly selected final year medical students from 3 public medical colleges in Punjab, Pakistan. Data were obtained by self-administered questionnaire. One hundred and twelve students had prescribed medicines independently without any supervision; 38 had performed a physical examination before prescribing; and 74 had advised and 49 interpreted diagnostic tests independently. Forty-four students had administered injectable drugs and one third of these were administered without seeing expiry dates. The most frequently prescribed drugs were nonsteroidal antiinflammatory drugs (92%) and antibiotics (73%). The most frequently advised tests were complete blood cell count, chest X-ray and urine detailed reports. One hundred and twenty-seven participants thought that medical students should not prescribe drugs. There was a significant relationship between gender and household income and prescription practices. Many final year medical students had prescribed drugs and advised diagnostic tests before graduation.

Exploring fractional-order new coupled Korteweg-de Vries system via improved Adomian decomposition method.

This paper aims to extend the applications of the projected fractional improved Adomian Decomposition method (fIADM) to the fractional order new coupled Korteweg-de Vries (cKdV) system. This technique is significantly recognized for its effectiveness in addressing nonlinearities and iteratively handling fractional derivatives. The approximate solutions of the fractional-order new cKdV system are obtained by employing the improved ADM in fractional form. These solutions play a crucial role in designing and optimizing systems in engineering applications where accurate modeling of wave phenomena is essential, including fluid dynamics, plasma physics, nonlinear optics, and other mathematical physics domains. The fractional order new cKdV system, integrating fractional calculus, enhances accuracy in modeling wave interactions compared to the classical cKdV system. Comparison with exact solutions demonstrates the high accuracy and ease of application of the projected method. This proposed technique proves influential in resolving fractional coupled systems encountered in various fields, including engineering and physics. Numerical results obtained using Mathematica software further verify and demonstrate its efficacy.

Systemic AL amyloidosis: current approach and future direction.

Systemic Light chain (AL) amyloidosis is a monoclonal plasma cell proliferative disorder characterized by deposition of amyloidogenic monoclonal light chain fragments causing organ dysfunction. It is a fatal disease and if not diagnosed and treated early can lead to organ failure and potentially death. The renal system along with the cardiovascular system are the most common organs involved but other organs such as gut and liver can be involved as well. The initial evaluation of patients requires confirming the diagnosis with tissue biopsy and staining with Congo red followed by confirmatory typing with mass spectrometry of the Congo red positive tissue. Then establishing the extent of the organs involvement by various staging and biomarkers testing. The treatment options and the tolerability of therapy depend on the disease staging, frailty, and co-morbidities. The autologous hematopoietic cell transplantation (HCT) after high dose melphalan therapy is an effective strategy which is usually done after initial bortezomib induction therapy. Unfortunately, most systemic AL amyloidosis patients are not candidate for HCT due to frailty, old age, multi-organ involvement, renal and heart failure at the time of diagnosis. While it is widely accepted that the patients need to be treated until they achieve complete hematologic response, the maintenance therapy after HCT is not well established in AL amyloidosis. In this review, we report the literature on the latest treatment updates of AL amyloidosis and the ongoing clinical trials highlighting the future treatments.

Management of Adverse Reactions for BCMA-Directed Therapy in Relapsed Multiple Myeloma: A Focused Review.

Anti-B-cell maturation antigen therapies consisting of bispecific antibodies, antibody-drug conjugates, and chimeric antigen receptor T cells have shown promising results in relapsed refractory multiple myeloma (RRMM). However, the severe side effects include cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenia(s), infections, hemophagocytic lymphohistiocytosis, and organ toxicity, which could sometimes be life-threatening. This review focuses on these most common complications post-BCMA therapy. We discussed the risk factors, pathogenesis, clinical features associated with these complications, and how to prevent and treat them. We included four original studies for this focused review. All four agents (idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, belantamab mafodotin) have received FDA approval for adult RRMM patients. We went through the FDA access data packages of the approved agents to outline stepwise management of the complications for better patient outcomes.

The Role of Bispecific Antibodies in Relapsed Refractory Multiple Myeloma: A Systematic Review.

Multiple myeloma is a heterogeneous clonal malignant plasma cell disorder, which remains incurable despite the therapeutic armamentarium's evolution. Bispecific antibodies (BsAbs) can bind simultaneously to the CD3 T-cell receptor and tumor antigen of myeloma cells, causing cell lysis. This systematic review of phase I/II/III clinical trials aimed to analyze the efficacy and safety of BsAbs in relapsed refractory multiple myeloma (RRMM). A thorough literature search was performed using PubMed, Cochrane Library, EMBASE, and major conference abstracts. A total of 18 phase I/II/III studies, including 1283 patients, met the inclusion criteria. Among the B-cell maturation antigen (BCMA)-targeting agents across 13 studies, the overall response rate (ORR) ranged between 25% and 100%, with complete response/stringent complete response (CR/sCR) between 7 and 38%, very good partial response (VGPR) between 5 and 92%, and partial response (PR) between 5 and 14%. Among the non-BCMA-targeting agents across five studies, the ORR ranged between 60 and 100%, with CR/sCR seen in 19-63%, and VGPR in 21-65%. The common adverse events were cytokine release syndrome (17-82%), anemia (5-52%), neutropenia (12-75%), and thrombocytopenia (14-42%). BsAbs have shown promising efficacy against RRMM cohorts with a good safety profile. Upcoming phase II/III trials are much awaited, along with the study of other agents in concert with BsAbs to gauge response.

An Augmented Artificial Intelligence Approach for Chronic Diseases Prediction.

Chronic diseases are increasing in prevalence and mortality worldwide. Early diagnosis has therefore become an important research area to enhance patient survival rates. Several research studies have reported classification approaches for specific disease prediction. In this paper, we propose a novel augmented artificial intelligence approach using an artificial neural network (ANN) with particle swarm optimization (PSO) to predict five prevalent chronic diseases including breast cancer, diabetes, heart attack, hepatitis, and kidney disease. Seven classification algorithms are compared to evaluate the proposed model's prediction performance. The ANN prediction model constructed with a PSO based feature extraction approach outperforms other state-of-the-art classification approaches when evaluated with accuracy. Our proposed approach gave the highest accuracy of 99.67%, with the PSO. However, the classification model's performance is found to depend on the attributes of data used for classification. Our results are compared with various chronic disease datasets and shown to outperform other benchmark approaches. In addition, our optimized ANN processing is shown to require less time compared to random forest (RF), deep learning and support vector machine (SVM) based methods. Our study could play a role for early diagnosis of chronic diseases in hospitals, including through development of online diagnosis systems.

Chondroprotective Effects Of Intra-Articular Hyaluronic Acid And Triamcinolone In Murine Model Of Osteoarthritis.

BACKGROUND: Osteoarthritis is a heterogeneous disease of joints that affects mainly older population. Definitive cure of osteoarthritis is still undiscovered. This study was designed to evaluate and compare the chondroprotective effects of hyaluronic acid and triamcinolone in murine model of osteoarthritis. METHODS: This Laboratory based experimental study was carried out in Pharmacology Department, Army Medical College Rawalpindi, from April-June 2019. Osteoarthritis was induced by medial menisectomy and anterior cruciate ligament resectioning of knee joints of twenty-four rats which were then divided into three groups with eight rats in each. Group I, II and III were named control, hyaluronic acid and triamcinolone groups respectively, which were given intra-articular injections of these drugs once weekly for four consecutive weeks and then gait pattern was scored. Animals were sacrificed thereafter and samples were collected for histopathological analysis. RESULTS: Comparison of gait score of control, hyaluronic acid and triamcinolone groups exhibited a p value of <0.01 while intergroup comparison between group I and II, group I and III and group II and III depicted p-value of <0.001, 0.016 and 0.003 respectively. Likewise, collective histopathological analysis of the three groups showed p-value of <0.01 while intergroup comparison of group I and II, group I and III and group II and III showed p-value of <0.001 for all. CONCLUSIONS: Comparison of control group with treatment groups proved chondroprotective effects of hyaluronic acid and triamcinolone. Additionally, hyaluronic acid proved to provide better chondroprotection as compared to triamcinolone.

COVID-19 infection presenting with acute epiglottitis.

In this case report, we present a novel presentation of acute epiglottitis in a patient with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) who presented to the emergency room in extremis and respiratory failure requiring emergent cricothyrotomy. Epiglottitis has become less common since the introduction and widespread use of the Haemophilus influenzae type B (Hib) vaccine. This reduction in cases has shifted demographics of the disease from the pediatric population towards adults with comorbid conditions. Interestingly there is a high degree of overlap between many of the comorbidities between epiglottitis and COVID-19. The novel severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), also referred to as coronavirus disease 19 (COVID-19), has been reported to affect the gastrointestinal tract and neural tissue and has been implicated in necrotizing encephalitis. We report the first known case of the novel SARS-CoV-2 virus presenting with acute epiglottitis.