Pattern, frequency and factors associated with inappropriate high dosing in chronic kidney disease patients at a tertiary care hospital in Pakistan.

BACKGROUND: Patients with chronic kidney diseases (CKD) are susceptible to the toxic drug effects if given unadjusted doses. Although Pakistan harbors a high burden of CKD patients, there is limited information available on the frequency, pattern and factors associated with unadjusted drug doses among CKD patients. METHODS: This cross-sectional study conducted at Sandeman Provincial Hospital, Quetta included 303 non-dialysis ambulatory CKD patients (glomerular filtration rate < 60 ml/min/1.73m2). The patients' data were collected through a purpose designed data collection form. The appropriateness of doses was checked against the renal drug handbook-2018, Kidney Disease Improving Global Outcomes guidelines, British National Formulary-2022, and manufacturer leaflets. Data were analysed by SPSS 23 and multiple binary logistic regression analysis was used to assess the factors associated with receiving inappropriate high doses. A p-value < 0.05 was considered statistically significant. RESULTS: The patients received a total of 2265 prescription lines, with a median of eight different drugs per patient (interquartile range: 6-9 drugs). A total of 34.5% (783/2265) drugs required dose adjustment. Of these, doses were not adjusted for 56.1% (440) drugs in 162 (53.4%) patients. The most common pharmacological class of drugs requiring dose adjustment were antibiotics (79.1%), followed by antidiabetics (59.2%), diuretics (57.0%), angiotensin converting enzyme inhibitors (56.9%), beta blockers (56.9%), analgesics (56.0%), angiotensin receptor blockers (55.2%), domperidone (53.9%) and antihyperlipidmics (46.1%). Patient's age of 41-60 (OR = 5.76) and > 60 years (OR = 9.49), hypertension (OR = 2.68), diabetes mellitus (OR = 3.47) and cardiovascular diseases (OR = 2.82) had statistically significant association (p-value < 0.05) with inappropriate high doses. CONCLUSION: The high frequency of inappropriate high doses suggests an important quality gap in medication dosing for patients with ND-CKD at the study site. Special attention should be paid to the drugs and patients with identified risk factors for receiving inappropriate high doses.

Dual solutions of magnetized radiative flow of Casson Nanofluid over a stretching/shrinking cylinder: Stability analysis.

The enhanced thermal efficiency exhibited by Casson nanofluids offers significant practical applications across various industrial and engineering sectors. This study focuses on the mathematical investigation of the steady magnetohydrodynamic (MHD) boundary layer flow of Casson nanofluid through a stretched/shrinking cylinder, taking into account the effects of suction and thermal radiation. The governing partial differential equations (PDEs) have been subjected to a similarity transformation, resulting in a set of nonlinear ordinary differential equations (ODEs). These ODEs were solved numerically utilizing the code of bvp4c in the software of Matlab which offers high accuracy (4th order). The employed nanofluid model incorporates the effects of Brownian motion and thermophoresis. The present study illustrates the graphical depictions of the impacts of different governing parameters, namely Hartmann (M) number, curvature (γ) parameter, Brownian motion (Nb) parameter, mass suction (S) parameter, thermal radiation (Rd) parameter, and thermophoresis (Nt) parameter, on heat transfer, flow, and mass transfer characteristics. Comprehensive determination and visual presentation of the coefficient of skin friction, local Nusselt number, and local Sherwood number were conducted for a range of estimates of applied parameters. Based on our examination, it has been determined that dual similarity solutions are present within a specific range of mass suction parameters. The relationship between the Casson parameter and various fluid dynamic properties, such as skin friction coefficient, heat transfer rate, and mass transfer rates, has been found to exhibit a decreasing trend. Furthermore, the stability analysis discovered that the first solution exhibits linear stability, whereas the second solution displays linear instability. Additionally, the motivation behind this study is to enhance industrial performance through the optimization of thermal power generation systems, thereby increasing their overall efficiency.

Magnetized mixed convection hybrid nanofluid with effect of heat generation/absorption and velocity slip condition.

Through a vertically shrinking sheet, a two-dimensional magnetic nanofluid is numerically analyzed for convection, heat generation and absorption, and the slip velocity effect. In this research, Al2O3-Cu/water composite nanofluid is studied, where water is deemed the base liquid and copper (Cu) and alumina (Al2O3) are the solid nanoparticles. Modern composite nanofluids improve heat transfer efficiency. Using the Tiwari-Das model, the current study examines the effects of the solid volume fraction of copper, heat generation/absorption, MHD, mixed convection, and velocity slip parameters on velocity and temperature distributions. Introducing exponential similarity variables converts nonlinear partial differential equations (PDEs) to ordinary differential equations (ODEs). MATLAB bvp4c solver is used to solve ODEs. Results showed dual solutions for suction with 0%-10% copper nanoparticles and 1%-500% heat generation/absorption. As copper (Cu) solid volume percentage increases from 0% to 10%, reduced skin friction f ″ ( 0 ) boosts in the first solution but falls in the second. When Cu is added to both solutions, heat transport - θ ' ( 0 ) decreases. As heat generation/absorption increases 1%-500%, - θ ' ( 0 ) decreases in both solutions. In conclusion, solution dichotomy exists when suction parameter S ≥ S c i in assisting flow case, while no fluid flow is possible when S < S c i .

Dual solutions of unsteady flow of copper-alumina/water based hybrid nanofluid with acute magnetic force and slip condition.

Suspending particles of tiny solid in a fluid used to transport energy can enhance its thermal conductivity and heat transport properties. Our main goal of this examination is to study the radiative unsteady two-dimensional (2D) flow on a continuously diminishing, horizontal sheet. with suction for the hybrid water-based nanofluid and an aligned field of magnetic, including the combined suction, magnetic, and velocity slip conditions effect. The Tiwari & Das model of nanofluid equations is used, which takes into consideration the solid volume percentage. Equations of similarity are derived by employing the transformations of similarity, and the associated equations have been simplified numerically by employing the bvp4c method in MATLAB software for a variety of values of the nanoparticle volume fraction, the unsteadiness, and the wall mass suction in water. It is discovered that, within the given the unsteadiness parameter range, two solutions exist. Moreover, it is found that the fluid velocity slows down in 1st solution as volume fraction of copper nanoparticles rises but speeds up in the second solution at first before slowing down again. Using a temporal stability analysis, it is found that only one of the dual branches is stable over the long run, while the other is unstable.

The EMBRACE web service collection.

The EMBRACE (European Model for Bioinformatics Research and Community Education) web service collection is the culmination of a 5-year project that set out to investigate issues involved in developing and deploying web services for use in the life sciences. The project concluded that in order for web services to achieve widespread adoption, standards must be defined for the choice of web service technology, for semantically annotating both service function and the data exchanged, and a mechanism for discovering services must be provided. Building on this, the project developed: EDAM, an ontology for describing life science web services; BioXSD, a schema for exchanging data between services; and a centralized registry (http://www.embraceregistry.net) that collects together around 1000 services developed by the consortium partners. This article presents the current status of the collection and its associated recommendations and standards definitions.

Darcy-Forchheimer Magnetized Nanofluid flow along with Heating and Dissipation Effects over a Shrinking Exponential Sheet with Stability Analysis.

Nanoparticles have presented various hurdles to the scientific community during the past decade. The nanoparticles dispersed in diverse base fluids can alter the properties of fluid flow and heat transmission. In the current examination, a mathematical model for the 2D magnetohydrodynamic (MHD) Darcy-Forchheimer nanofluid flow across an exponentially contracting sheet is presented. In this mathematical model, the effects of viscous dissipation, joule heating, first-order velocity, and thermal slip conditions are also examined. Using similarity transformations, a system of partial differential equations (PDEs) is converted into a set of ordinary differential equations (ODEs). The problem is quantitatively solved using the three-step Lobatto-three formula. This research studied the effects of the dimensionlessness, magnetic field, ratio of rates, porosity, Eckert number, Prandtl number, and coefficient of inertia characteristics on fluid flow. Multiple solutions were observed. In the first solution, the increased magnetic field, porosity parameter, slip effect, and volume percentage of the copper parameters reduce the velocity field along the η-direction. In the second solution, the magnetic field, porosity parameter, slip effect, and volume percentage of the copper parameters increase the η-direction velocity field. For engineering purposes, the graphs show the impacts of factors on the Nusselt number and skin friction. Finally, the stability analysis was performed to determine which solution was the more stable of the two.

Effect of Thermal Radiation on Three-Dimensional Magnetized Rotating Flow of a Hybrid Nanofluid.

The effect of thermal radiation on the three-dimensional magnetized rotating flow of a hybrid nanofluid has been numerically investigated. Enhancing heat transmission is a contemporary engineering challenge in a range of sectors, including heat exchangers, electronics, chemical and biological reactors, and medical detectors. The main goal of the current study is to investigate the effect of magnetic parameter, solid volume fraction of copper, Eckert number, and radiation parameter on velocity and temperature distributions, and the consequence of solid volume fraction on declined skin friction and heat transfer against suction and a stretching/shrinking surface. A hybrid nanofluid is a contemporary type of nanofluid that is used to increase heat transfer performance. A linear similarity variable is−applied to convert the governing partial differential equations (PDEs) into corresponding ordinary differential equations (ODEs). Using the three-stage Labatto III-A method included in the MATLAB software's bvp4c solver, the ODE system is solved numerically. In certain ranges of involved parameters, two solutions are received. The temperature profile θη upsurges in both solutions with growing values of EC and Rd. Moreover, the conclusion is that solution duality exists when the suction parameter S≥Sci, while no flow of fluid is possible when S

Thermal stable properties of solid hybrid nanoparticles for mixed convection flow with slip features.

Following to improved thermal impact of hybrid nanomaterials, wide range applications of such materials is observed in the thermal engineering, extrusion systems, solar energy, power generation, heat transfer devices etc. The hybrid nanofluid is a modified form of nanofluid which is beneficial for improving energy transfer efficiency. In current analysis, the solid nanoparticles aluminium ([Formula: see text]) and copper ([Formula: see text]) have been mixed with water to produce a new hybrid nanofluid. The investigation of a steady two-dimensional mixed convection boundary layer flow of the resultant hybrid nanofluid on a vertical exponential shrunk surface in the existence of porous, magnetic, thermal radiation, velocity, and thermal slip conditions is carried out. Exponential similarity variables are adopted to transform the nonlinear partial differential equation into a system of ordinary differential equations which has been then solved by employing the shooting method in Maple software. The obtained numerical results such as coefficient of skin friction [Formula: see text], heat transfer rate [Formula: see text], velocity [Formula: see text] and temperature [Formula: see text] distributions are presented in the form of different graphs. The results revealed that duality exists in solution when the suction parameter [Formula: see text] in assisting flow case. Due to non-uniqueness of solutions, a temporal stability analysis needs to be performed and the result indicates that the upper branch is stable and realizable compared to the lower branch.

Association of the 9p21.3 locus with risk of first-ever myocardial infarction in Pakistanis: case-control study in South Asia and updated meta-analysis of Europeans.

OBJECTIVE: To examine variants at the 9p21 locus in a case-control study of acute myocardial infarction (MI) in Pakistanis and to perform an updated meta-analysis of published studies in people of European ancestry. METHODS AND RESULTS: A total of 1851 patients with first-ever confirmed MI and 1903 controls were genotyped for 89 tagging single-nucleotide polymorphisms at locus 9p21, including the lead variant (rs1333049) identified by the Wellcome Trust Case Control Consortium. Minor allele frequencies and extent of linkage disequilibrium observed in Pakistanis were broadly similar to those seen in Europeans. In the Pakistani study, 6 variants were associated with MI (P<10(-2)) in the initial sample set, and in an additional 741 cases and 674 controls in whom further genotyping was performed for these variants. For Pakistanis, the odds ratio for MI was 1.13 (95% CI, 1.05 to 1.22; P=2 x 10(-3)) for each copy of the C allele at rs1333049. In comparison, a meta-analysis of studies in Europeans yielded an odds ratio of 1.31 (95% CI, 1.26 to 1.37) for the same variant (P=1 x 10(-3) for heterogeneity). Meta-analyses of 23 variants, in up to 38,250 cases and 84,820 controls generally yielded higher values in Europeans than in Pakistanis. CONCLUSIONS: To our knowledge, this study provides the first demonstration that variants at the 9p21 locus are significantly associated with MI risk in Pakistanis. However, association signals at this locus were weaker in Pakistanis than those in European studies.

Quit smoking for life--social marketing strategy for youth: a case for Pakistan.

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth.

Dual similarity solutions of MHD stagnation point flow of Casson fluid with effect of thermal radiation and viscous dissipation: stability analysis.

In this paper, the rate of heat transfer of the steady MHD stagnation point flow of Casson fluid on the shrinking/stretching surface has been investigated with the effect of thermal radiation and viscous dissipation. The governing partial differential equations are first transformed into the ordinary (similarity) differential equations. The obtained system of equations is converted from boundary value problems (BVPs) to initial value problems (IVPs) with the help of the shooting method which then solved by the RK method with help of maple software. Furthermore, the three-stage Labatto III-A method is applied to perform stability analysis with the help of a bvp4c solver in MATLAB. Current outcomes contradict numerically with published results and found inastounding agreements. The results reveal that there exist dual solutions in both shrinking and stretching surfaces. Furthermore, the temperature increases when thermal radiation, Eckert number, and magnetic number are increased. Signs of the smallest eigenvalue reveal that only the first solution is stable and can be realizable physically.

The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia.

The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30-80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a 12-lead electrocardiogram. A range of biological samples has been collected and stored, including DNA, plasma, serum and whole blood. During its next stage, the study aims to expand recruitment to achieve a total of about 20,000 cases and about 20,000 controls, and, in subsets of participants, to enrich the resource by collection of monocytes, establishment of lymphoblastoid cell lines, and by resurveying participants. Measurements in progress include profiling of candidate biochemical factors, assay of 45,000 variants in 2,100 candidate genes, and a genomewide association scan of over 650,000 genetic markers. We have established a large epidemiological resource for CHD in South Asia. In parallel with its further expansion and enrichment, the PROMIS resource will be systematically harvested to help identify and evaluate genetic and other determinants of MI in South Asia. Findings from this study should advance scientific understanding and inform regionally appropriate disease prevention and control strategies.

Quadruple solutions of mixed convection flow of magnetohydrodynamic nanofluid over exponentially vertical shrinking and stretching surfaces: Stability analysis.

BACKGROUND AND OBJECTIVE: The last two and half decades are witnessed a great surge in the use convective fluids for enhancement of heat transfer of minerals ethylene glycol, oil and water due to their numerous applications in the industrial segments including chemical production, microelectronics, power generation, transportation, and air-conditioning. For this purpose, different procedures were applied to upgrade the thermal conductivity of common fluid but could not. Further, Choi and Eastman in 1995 introduced nanofluid which has good thermal properties as compared to common fluids. After that, it can be seen that researchers, mathematicians, and scientists tried to understand the principles of nanofluids and how to implicate them in many different practical applications. In this work, the Buongiorno model has been considered for nanofluid. One of the prime objectives is to consider all possible multiple solutions of the model because these solutions cannot be seen experimentally. METHODS: The governing equations of fluid flow have been transformed in the form of ordinary differential equations. These equations have been solved by two methods namely, shooting method and three-stage Lobatto IIIa formula. RESULTS: The effects of different parameters on temperature, velocity, concentration profiles, skin friction coefficient, Sherwood number, and reduced Nusselt number were obtained and presented graphically. It was noticed that four solutions existed at definite ranges of the parameters for high suction over both surfaces for the first time. The results of the stability analysis revealed that only the first solution is more stable and possess physical reliability compared to the remaining solutions. CONCLUSION: The graphs also indicated that the fluid velocity decreases as the thermophoresis parameter increases but the opposite behavior observed for both temperature and concentration profiles in the first solution. Furthermore, it was detected that the concentration profile declined at the higher values of the Brownian motion parameter.

Analysis of dual solution for MHD flow of Williamson fluid with slippage.

This study investigates the numerical solutions of MHD boundary layer and heat transfer of the Williamson fluid flow on the exponentially vertical shrinking sheet, having variable thickness and thermal conductivity under effects of the velocity and thermal slip parameters. It is also assumed that shrinking/stretching velocity, as well as the wall temperature, has the exponential function form. In this study, the continuity, momentum and energy equations with buoyancy parameter and Hartmann number are incorporated especially in the Williamson fluid flow case. Similarity transformation variables have been employed to formulate the ordinary differential equations (ODEs) from partial differential equations (PDEs). The resultant ODEs are solved by shooting method with Runge Kutta of fourth order method in Maple software. The effects of the different applied non-dimensional physical parameters on the boundary layer and heat transfer flow problems are presented in graphs. The effects of Williamson parameter, Prandtl number, and slip parameters on velocity and temperature profiles have been thoroughly demonstrated and discussed. The numerical results show that the buoyancy force and the slip parameters contribute to the occurrence of the dual solutions on the boundary layer and heat transfer flow problems. Furthermore, the stability analysis suggests that the first solution is stable and physically possible.

Mathematical analysis of magnetohydrodynamic (MHD) flow of micropolar nanofluid under buoyancy effects past a vertical shrinking surface: dual solutions.

In this paper, we explore dual solutions of MHD flow, heat and mass transfer of micropolar nanofluid over a linear vertical shrinking surface with buoyancy effects, which was not considered in the previous works. The governing fluid flow equations of this problem are transformed into nonlinear boundary value problems (BVPs) of ordinary differential equations (ODEs) by applying similarity variables. The resultant BVPs are converted into initial value problems (IVPs) by using shooting method which then resolved by employing Runge Kutta of order four. The impacts of the governing parameters, such as suction parameter, material parameter, Richardson number, magnetic parameter, Prandtl number, thermophoresis and Brownian motion parameters on velocity, angular velocity, temperature, and concentration are illustrated graphically. The results indicate that the existence of a range of dual solutions and no-solutions. When Richardson number ( δ ) is increased, the reduction of the velocity of micropolar nanofluid has occurred in the second solution. The stability analysis on dual solutions, however, reveals that only the first solution is stable.

Fabrication of calixarene-grafted magnetic nanocomposite for the effective removal of lead(II) from aqueous solution.

Magnetic nanocomposites adorned with calixarene were successfully prepared by immobilizing diethanolamine functionalized p-tert-butylcalix[4]arene (DEA-Calix) onto silica-coated magnetic nanoparticles (MNPs). The synthesis, surface morphology, purity, elemental composition and thermal stability of newly prepared nanocomposites were analyzed using FT-IR spectroscopy, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDX), X-ray diffractometer (XRD), thermal gravimetric analysis (TGA) and vibrating sample magnetometer (VSM). Magnetic solid-phase adsorption (MSPA) was employed to explore the adsorption behavior of DEA-Calix-MNPs towards Pb(II) from water samples prior to its flame atomic absorption spectrometric analysis. The essential analytical factors governing the adsorption efficiency such as solution pH, mass of adsorbent, concentration and contact time have been investigated and optimized. The results depict that DEA-Calix-MNPs has excellent adsorption efficiency 97% (at pH 5.5) with high adsorption capacity of 51.81 mg g-1 for Pb(II) adsorption. Additionally, kinetic and equilibrium studies suggested that Pb(II) adsorption process follows a pseudo-second-order model and Langmuir isotherms, respectively. Real sample analysis also confirmed field applicability of the new DEA-Calix-MNPs adsorbent.

Frequency and comparative analysis of hapatitis D in petients seeking treatment for hepatitis B.

OBJECTIVE: To find the frequency of hepatitis 'D' in patients of hepatitis 'B' seeking treatment and to compare clinical and biochemical features in patients harboring HDV with those who are not. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Medical Unit-IV, Civil Hospital Karachi, Medical Unit-VI and Surgical Unit-VII, Lyari General Hospital, Dow University of Health Sciences, Karachi; from July 2003 to June 2005. PATIENTS AND METHODS: HBsAg positive patients seeking treatment were enrolled in the study. Anti-HDV was done in all. Patients were split into two groups according to their anti-HDV status into HDV positive and HDV negative groups. Liver biochemistries and viral profile for HCV, anti-HBc IgM and HBeAg were done and compared between the two groups. RESULTS: A total of 246 patients were selected. HDV was positive in 66 (26.8%) patients. No significant difference was observed in the frequency and stages of cirrhosis between the two groups while significant differences were observed in the mean SGPT (95% CI: -381.09 to -110.74; P = 0.001) and albumin levels (95% CI: 1.87 to 7.73; P = 0.007) and in the frequency of HBeAg (P = 0.001), anti-HBc IgM (P = 0.02) and HBV DNA (P<0.001). CONCLUSION: HDV infection was common in patients with HBV in this cohort of patients. All patients of HBV should be screened for HDV before treatment decision for the former is taken.

Correlation between clinical endoscopic and histological findings at esophago-gastric junction in patients of gastroesophageal reflux disease.

OBJECTIVE: To determine the correlation between the clinical, endoscopic and histological findings in patients of GERD. DESIGN: An observational, cross-sectional study. PLACE AND DURATION OF STUDY: Lyari General Hospital, Dow University of Health Sciences from November 2003 to October 2004. PATIENTS AND METHODS: Patients complaining of heartburn and/or acid regurgitation at least twice per week for at least 3 months were inducted in the study. Presence of clinical symptoms of epigastric pain, retrosternal burning, and reflux were recorded. Patients were subjected to esophagogastroduodenoscopy and four biopsies were taken from esophago-gastric junction. Correlation/regression analysis was done on clinical, endoscopic and histological findings. RESULTS: A total of 196 patients were selected and endoscopically examined. Most common grade given by patients to epigastic pain was grade-4 (42.9%), retrosternal burning as grade-4 (41.8%) and reflux grade-5 (36.7%). There was significant correlation between the clinical severity of epigastric pain with endoscopic findings (p = 0.002) and reflux (p = 0.0) but no correlation was observed with histological findings (p = 0.19). Out of 109 (55.6%) patients who had normal mucosa on endoscopy but on histology 70 (35.7%) of them had inflammation. Grading of endoscopic and histological findings showed significant correlation with each other (p = 0.0). CONCLUSION: Endoscopic negative GERD is common; severity of clinical symptoms does not correlate [corrected] with endoscopic findings while histopathological findings correlate with those of endoscopic findings [corrected]

Retinoblastoma in Karachi, Pakistan.

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1(st)January 1998 to 31(st) December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, 34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years (95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents'and children'emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation for surviving retinoblastoma patients.

Effects of immobilization on thickness of superficial zone of articular cartilage of patella in rats.

BACKGROUND: Articular cartilage normally functions as a load-bearing resistant material in joints. Patella is composed of hyaline cartilage and spongy bone. Chondrocytes form only 1-5% volume of the articular cartilage. They receive their nutrition by diffusion through the matrix. The alteration in articular cartilage become apparent following immobilization, from 4 to 6 weeks. Until now, focus of research has been the whole cartilage. Zonal changes have not been studied in detail. Since superficial zone bears maximum load and is the first zone to come in contact, the present study was designed to determine changes in thickness on immobilization and remobilization in superficial zone after dividing it into proximal, central, and distal segments. MATERIALS AND METHODS: Forty male rats belonging to Sprague Dawley strain were divided into two groups. Group 1 (n=20) subdivided into an experimental subgroup of 10 rats that were immobilized in plaster of Paris (POP) for 4 weeks and a control subgroup of 10 that were not immobilized. Group 2 (n=20) subdivided into an experimental subgroup of 10 rats that were immobilized for 4 weeks and remobilized for next 4 weeks and a control subgroup of 10 animals that were not immobilized. At the end of the experimental period, the knee joint was dissected and was cut in sagittal plane. The section was fixed in 10% formalin for 48 hours. Specimen was decalcified using ethylenediaminetetraacetic acid (EDTA). The paraffin blocks of 7 µm sections were cut and stained by H and E stain for routine histology and Alcian blue stain and Mallory Trichrome for fine structural microscopy. The zones were named as superficial transitional, radial, and hypertrophic according to the shape of cells present in each zone. The superficial zone was divided into superior part, central, and inferior parts. These parts were labeled as central, proximal, and distal segments. The calibrated stage micrometer was used to calibrate the ocular micrometer under objectives of different power. The ocular micrometer was placed inside the ocular lens. It was calibrated with the stage micrometer under objective lenses of different power. The number of divisions of ocular covering each zone was calculated. These divisions were converted into micrometer and the actual thickness was calculated. RESULTS: The significant decrease in thickness of superficial zone in proximal, central and distal segment was observed in experimental group in comparison to control group. When the experimental subgroup of group 2 was compared with experimental subgroup of group 1 (group immobilized for 4 weeks), no significant reversal was seen in superficial zone and instead significant decrease was observed in distal segment. Fibrous connective tissue was increased adjacent to superficial zone. CONCLUSION: Each segment of superficial zone behaves differentially on immobilization and remobilization. Perhaps a much longer duration of remobilization is required to reverse changes of immobilization in articular cartilage and plays a significant role in knee joint movements.