Gender bias and 'doctor brides'. A social dilemma of medical students in Pakistan.

OBJECTIVE: To assess gender bias, discrimination and bullying at medical schools, and to explore the phenomenon of 'doctor brides'. METHODS: The multicentre survey was conducted at 14 medical education institutions across Pakistan from September 2020 to April 2021, and comprised medical students of either gender at both public-sector and private-sector institutions. The survey questions explored beliefs, experiences and knowledge related to common stereotypes and social issues in medical education, including female role models, work-life balance, gender roles, lack of support from family and faculty, and bullying. Association between gender with survey variables was explored. Data was analysed using SPSS 26. Thematic analysis was used to exploring knowledge around 'doctor-brides'. RESULTS: Of the 377 subjects, 245(65%) were females. The overall mean age was 21.4±1.8 years. There were 211(53.8%) subjects aged 21-23 years, and 368(97.6%) were Muslims. Significantly more women than men were of the opinion that men are encouraged and are more likely to assume leadership roles (p=0.002). More women than males agreed that household chores and work had an impact on speciality choice (p<0.001). Most sexual assault victims were women (p<0.0001), but men generally faced more bullying and hostile behaviour (p=0.014). With regard to women being forced to quit medicine after marriage/childbirth by their in-laws/husbands or change their careers from clinical medicine to preclinical teaching, 99(26.25%) subjects knew first-hand of such cases, while 238(63.12%) had no such experience to share. CONCLUSIONS: Gender bias, discriminatory behaviour and bullying were found to be widely prevalent in medical schools across Pakistan. The general perception of 'doctor brides' needs to be revisited.

Efficacy of azathioprine and methotrexate in patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

The study examined the efficacy of various immunosuppressants in patients with chronic inflammatory demyelinating polyneuropathy. We compared the efficacy of Azathioprine and Methotrexate in the treatment of CIDP. Patients of either gender aged ≥18 years having chronic polyneuropathy progressive for at least 8 weeks having no serum para protein or any genetic abnormality and fulfilling the Koski criteria. To measure the efficacy, Overall Neuropathy Limitation Scale (ONLS) was used. Group 1 was treated with a combination of oral steroids i.e., Prednisolone and Azathioprine while group 2 was treated with a combination of Prednisolone and Methotrexate. ONLS was statistically insignificant in the patient groups (AZA versus MTX) at the beginning of the therapy (from 1-3 months) in both groups. However, in the 4th month, the AZA group performed better than the MTX group. At the 12th month, the mean ONLS score of the patients in the AZA group was 3.69, while the mean ONLS score of the patients in the MTX group was 5.30 (p-value=0.001). We concluded that Azathioprine was more efficacious as compared to Methotrexate in the treatment of CIDP based on ONLS and should be considered as a first-line immunosuppressant in the treatment of CIDP in low-income countries like Pakistan.

Death receptor pathway genes (Caspase and BID) expression analysis in cancerous cells in response to extracts of amla and turmeric.

Plant extracts antiproliferative effects were determined by using mammalian cells along the expression profile of Caspases 3, 8 and the BID gene of the death receptor-induced pathway. Two medicinal plants viz., Turmeric (Curcuma longa) and Amla (Emblica officinalis) extracts were examined for antiproliferative effect through Neutral Red-Dye uptake assay on Vero and MDA-MB 231 cell lines. A reverse transcriptase polymerase chain reaction was used to determine the expression of genes while GAPDH expression was used as an internal control. Expression of BID was up-regulated in methanolic turmeric extract-induced MDA-MB 231 cells while Caspases 3,8 expressions were the same in induced and uninduced MDA-MB 231 cells. Activated BID cleaved into tBID and activated the intrinsic pathway which caused death in methanolic turmeric extract-induced cancerous cells. Ethanolic extracts of turmeric exerted the strongest antiproliferative effects on Vero and methanolic extracts on MDA-MB 231 cells. The morphological studies of cell lines and gene expression analysis of turmeric methanolic extract-treated cells showed activation of apoptosis via converting BID into t-BID (intrinsic pathway) and activating Caspase-3 and Caspase-8 (extrinsic pathway). With the differential cytotoxicity and induction of apoptosis in induced cancer cells in comparison to uninduced cancerous cells, hence turmeric is a natural source of new anti-cancerous compounds.

The need for valproic acid as prophylaxis in neurosurgery patients.

Using anti-epileptic drugs in neurosurgery patients is a routine practice. This controlled trial aimed to assess whether prophylaxis with Valproate in brain surgery patients is justified or not. Group A (n=50; controls) patients received valproic acid postoperatively for three months, while group B (n=50; subjects) received a placebo. Serum valproic acid levels between 50-125g/ml were required. Kendall's Tau was applied to see the correlation between the 'frequency of seizures' between different surgical procedures performed and the extent of manipulations-EOMs. A wireless EMOTIV EPOC device was used to visualize the Electroencephalogram patterns. In controls, 12 patients had one seizure and only two patients had 2 seizures. In the placebo group, 13 patients had one and 4 patients had 2 seizures. The seizure frequency was highest amongst brain tumor patients. An insignificant difference was found between the seizure frequencies of the placebo and control groups. A statistically insignificant correlation was found between seizure frequency and independent variables: surgical procedures and EOM (%). Using an AED or not, the frequency of seizures did not substantially reduce over the postoperative period. If not necessary, the anti-epileptic medication that is frequently provided as a prophylactic against seizures in the post-operative period should not be administered.

The pncA gene mutations of Mycobacterium tuberculosis in multidrug-resistant tuberculosis.

The pncA gene encodes pyrazinamidase enzyme which converts drug pyrazinamide to active form pyrazinoic acid, but mutations in this gene can prevent enzyme activity which leads to pyrazinamide resistance. The cross-sectional study was carried out during 2016-2017 for 12 months. The purpose of the study was to detect mutation at codon 12 and codon 85 in the pncA gene in local multidrug-resistant tuberculosis (MDR-TB) patients by developing a simple molecular test so that disease could be detected timely in the local population. DNA extracted from sputum-cultured samples from MDR-TB patients and subjected to semi-multiplex allele-specific PCR by using self-designed primers against the pncA gene. Among 75 samples, 53 samples were subjected to molecular analysis based on purified DNA quantity and quality. The primers produced 250 and 480 bp fragments, indicating the mutations at codon 12 (aspartate to alanine) and codon 85 (leucine to proline) respectively. MDR-TB was more common in the age group 21-40 years. Fifty-seven percent of samples (n = 30) were found positive for pncA mutations, whereas 43% of samples (n = 23) showed negative results. Thirteen percent of samples (n = 4) had mutations at codon 12 in which aspartate was converted to alanine, and they produced an amplified product of 480 bp. Eighty-seven percent of samples (n = 26) had mutations at codon 85 in which leucine was converted to proline and amplified product size was 250 bp. The mutations were simple nucleotide substitutions. The prevalence of mutations in which leucine was substituted by proline was higher than the mutations in which aspartate was substituted by alanine. A high prevalence of substitution mutation (CTG → CCG; leucine to proline) was detected in MDR-TB cases. Earlier detection of MDR-TB via an effective molecular diagnostic method can control the MDR tuberculosis spread in the population.

Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan.

OBJECTIVE: To identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. METHODS: This prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 2019 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patientnotes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. RESULTS: Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care, monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in 'use of antibiotic prophylaxes'. CONCLUSIONS: Regular audits are needed to monitor and improve patient care.

Post-vaccination (COVID-19) impacts in healthcare personnel.

The COVID-19 pandemic has brought attention back to its spread in medical staff. A survey-based study was conducted to combine general information related to COVID-19 exposures, acceptances, vaccines received, and side effects. The majority (62.3%) of healthcare professionals had acquired COVID-19 infection from hospital environment (51.5%) mainly who treated (64%) COVID-19 patients. 54% healthcare respondents expressed 'high acceptance' towards COVID-19 vaccines. 88% received COVID-19 vaccination. The majority of healthcare personnel received SinoPharm (65%). 82.3% did not acquire COVID-19 post-vaccination. 38% mild side effects were observed from vaccination. Following were the general side-effects: myalgia (18.2%), the feeling of sickness (16%), fever (15.6%), dizziness (7.8%), joint pain (7.4%), chills (4.8%), and flu (4.8%). Following were the common neurological side-effects reported: headache (18.2%), fatigue (16.5%), muscle pain (16%), numbness/tingling (3%), and migraine (2.6%). Nausea and diarrhoea were reported in only 3.5% of respondents. Bad taste was reported in only 3% of respondents. The 1.7% reported rash and itching. The majority of the healthcare professionals did not report significant side effects related to neurological, gastroenterological, skin and oral categories. To assess the vaccines' potential for substantial and long-term or chronic effects, more study with a larger sample size and a longer follow-up time is required.

Clinical and biochemical indicators of disease severity and neurological findings in COVID-19: A study of King Edward Medical University (KEMU), Pakistan.

This study investigated the significance of difference between presence and absence of different neurological findings in COVID-19, in relation with the biochemistry. Various significant correlations in connection with the disease severity and clinical factors were also identified. 351 COVID-19 patients were included. Different laboratory/ clinical findings were investigated. Correlations Kendall's tau and Pearson Chi-Square were applied to find the correlations between severity and clinical findings. The Mann-Whitney Test was applied for a comparison between two types of neurological groups for each biochemistry parameter. Headache was reported in 28% and dizziness in 13% patients. The impaired smell and impaired taste were reported in 28.5% and 36.2% patients, respectively. The muscle pain was present in 39% patients. 80% patients had low lymphocytes & 70% had high neutrophils. 54.5% were found with high ALP. LDH was elevated in 73%. Severity was found significantly correlated with decreased oxygen saturation, age and raised levels of urea, creatinine and LDH. The groups (with/without CNS involvement) were statistically different in ALP, groups (with/without PNS involvement) in WBC, lymphocytes, neutrophils, ALP, urea, creatinine, CK, CKMB and LDH and groups (with/without MSK involvement) in WBC. Oxygen saturation, age, urea, creatinine and LDH are significant indicators of disease severity in COVID-19. The altered levels of different biochemistry can impact the neurological states of COVID-19 patients.

Less disease severity of COVID-19 among smokers: An indication of investigating nicotine as preventive measure.

The study was aimed to mention the epidemiology of smoking in Pakistani COVID-19 infected patients along with the disease severity, oxygen dependency and fatality rate. A cross sectional epidemiological study was carried out on 555 confirmed cases of COVID-19 infection. The median age was 47±16 years. 59% were male and 41% were female. Most of the patients (97.5%) survived, while only 2.5% expired. 25.6% patients required the oxygen. Total 17 (3%) COVID-19 patients with age 20-75 years were identified as smokers. No mortality was observed in smokers. The 1.4% smokers presented with mild disease, 1.2% with moderate disease and 0.4% had severe disease. According to Chi-Square test, there existed an insignificant difference (p-value: 0.38649) between smokers and non-smokers in disease severity levels. Smoking is a precursor for countless diseases, but it behaved differently in COVID-19 infected patients, as its prevalence was significantly low. We found no significant variation of the disease severity among the smokers and non-smokers. Profound experiments should be conducted to recommend whether nicotine can be used as a protective agent to negate COVID-19 infection.

Assessment and prediction of restless leg syndrome (RLS) in patients with diabetes mellitus type II through artificial intelligence (AI).

This study aimed to diagnose the incidence of restless leg syndrome (RLS) in patients with diabetes mellitus (DM) type-2, thorough artificial intelligence based multilayer perceptron (MLP). 300 cases of diabetes mellitus type-2, of age between 18-80 years were included. Point-biserial correlation/Pearson Chi-Square correlations were conducted between RLS and risk factors. We trained a backpropagation MLP via. supervised learning algorithm to predict clinical outcome for RLS. Majority of the patients were having hypertension (63%) and with peripheral neuropathy (69%). Two mostly reported scaled parameters were: 18% 'tiredness' and 14%, 'impact on mood'. A significant correlation was found in RLS with smoking, hypertension and chronic renal failure (CRF). MLP model achieved more than 95% accuracy in predicting the outcome with cross entropy error 0.5%. Following scaled symptomatic variables: 'need/urge to move' (100%) achieved the highest normalized importance, followed by 'relief by moving' (85.7%), 'sleep disturbance' (62%) and 'impact on mood' (51.3%). Artificial intelligence based models can help physicians to identify the pre diagnose RLS, so that active measures can be taken in time to avoid further complications.

Molecular detection of hupB gene of Mycobacterium tuberculosis in young patients with acute lymphoblastic leukemia (ALL) on Chemotherapy.

Cancer chemotherapy can lead to the mycobacterial infections. Tuberculosis has been reported a serious complication in leukemia patients who undergo chemotherapy. The study was focused to find mutations in hupB gene of M. tuberculosis in 50 acute lymphoblastic leukemia (ALL) patients through semi multi complex PCR. A column based DNA isolation method was adopted for DNA isolation. The gene for histone-like protein (hupB [Rv2986c]) of M tuberculosis was amplified to detect two closely related mycobacterial species. Primers M and S (histone like protein HupB) were utilized to generate amplicons of 318 bp and 291 bp for M. tuberculosis and M. bovis, respectively. Out of fifty ALL patients, 21 (42%) were females and 29 (58%) were males. The prevalence of ALL was found higher in males as compared to females. The prevalence of ALL was higher in patients of age group 5-10 years. The results of the amplification showed that, the 318 bp fragment specific for M. tuberculosis was observed in seven samples (14%), while 291 bp fragment specific for M. bovis was not observed in any sample. Children with ALL were found at higher risk for tuberculosis. A risk evaluation of tuberculosis infection must be conducted before managing chemotherapy.

Synthesis and evaluation of solid lipid nanoparticles loaded with bovine serum albumin prepared by different methods.

.We evaluated the effect of different synthesis methods of solid lipid nanoparticles (SLNs) loaded with bovine serum albumin (BSA) on parameters including particle size, polydispersity index, loading capacity and % entrapment efficiency including release study. We investigated the binary fatty acids mixtures for test protein BSA. Different techniques were used as micro emulsion, ultrasound homogenization and double emulsification-evaporation for the BSA loading of SLNs. With the increase in BSA content from 0-10%, indicated an increase in the size and decrease in polydispersity index. The stability of SLNs loaded with BSA was examined by measuring the zeta potential and all formulations were found to be quite stable. Release study and kinetic models were applied to assess BSA release profile from different formulations of SLNs. The particle size of BSA loaded SLNs was reduced to 89.67 ± 4.88 nm when PEG 6000 and Brij were used as 0.25% and 1.5% of total formulation (F5). Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and Fourier-transform infrared spectroscopy (FTIR) indicated the chemical stability of BSA which was used to load SLNs in different formulations. SLNs from the combinations of solid and liquid lipids had enhanced the physicochemical properties and permitted controlled release of BSA for up to 10 days. The study also evaluated the addition of polyethylene glycol which reduced the particles size and enhanced % entrapment efficiency. The release of BSA from SLNs was followed zero order rate kinetics and diffusion-controlled. Different mathematical models, i.e., zero order, first order, Higuchi and Korsmeyer-Peppas models were found best fit to BSA release profile of all formulations of SLNs.

Impacts of intake of bakery food chemicals, degraded water and psychiatric drugs on liver & renal functions of brain tumor patients.

A chemically preserved food has raised mental health issues. Abnormalities in liver and kidney functions have been reported from mentally imbalanced individuals. This study was focused on finding anxiety issues and biochemistry alterations in brain tumor patients and in controls. The levels of liver & kidney enzymes were compared in both groups through Mann-Whitney U test. Kendall's tau-b correlation was conducted to determine that is there any relationship between anxiety levels and biochemistry parameters in both groups. There was more occurrence of severe anxiety levels (58%) in brain tumor patients. There were more mood swings in CG (64%) as compared to BP (48%). Less sleeping pattern was found in CG (42%) as compared to BP (37%). More patients (58%) were having severe anxiety levels as compared to CG (52%). 73% patients were having low levels of alkaline phosphatase (AP). 52% individuals in CG were having low levels of AP. AP was found significantly associated with anxiety levels in brain tumor patients only. A nutrient deprived food from preservation can reduce levels of alkaline phosphatase. This can impact metabolism of necessary minerals for proper brain function. This epidemiological study reports a significant association between anxiety and reduced AP levels.

Polymorphism of Interleukin-10 (IL-10, -1082 G/A) and Interleukin-28B (IL-28B, C/T) In Pediatric Acute Lymphoblastic Leukemia (ALL).

We conducted genotypic analyses of interleukin-10 (IL-10) (-1082 G/A; GG, GA, AA) and interleukin-28B (CC, CT, TT) genes polymorphisms in acute lymphoblastic leukemia (ALL) pediatric patients in descriptive study to evaluate the prevalence of these mutations. In amplification refractory mutation system-PCR (ARMS-PCR), one reaction was carried out for each patient's DNA sample. For IL-28B gene, two forward and two reverse primers specific for C-allele and T-allele were used separately. For human IL-10 gene, two different forward primers specific for A and G alleles were used in combination with common reverse primer. IL-10 gene promoter showed highest frequency (n=29, 58%) of heterozygous (GA) allele, while genotypic analysis of IL-28B gene showed highest frequency (n=28, 56%) of homozygous (CC) allele. The IL-10 (AA) genotype related to its protein's less production in body which may be associated with the least survival of ALL's patients, while IL-28b (CT and TT) genotypes may be associated with less IFNλ3 levels and less life expectancy.

Depression and dementia from hyponatremia in brain cancer patients exposed to frozen food chemicals.

Frozen food chemicals contain neurotoxins which disturb electrolyte levels. Altered electrolyte levels can induce mental illnesses. This study was focused on finding the prevalence of depression, dementia, intake of antidepressants and electrolytic alterations in brain cancer (BC) patients and in control group (CG) who were taking frozen and canned food. The levels of electrolytes were compared in both groups through Mann-Whitney U test. The Odds Ratio (OR) and Relative Risks (RR) were calculated of having a specific occurrence or condition of brain cancer patients vs. controls. Majority (41.42%) patients were from the age group 33-57 years. There were 52% male and 47% female patients. There was more occurrence of dementia (41%) and depression (6%) in patients as compared to CG. 94% patients were found with dementia. 32% patients were having low levels of sodium and 43% were having low levels of potassium. High levels of potassium (26%) were found in CG. 76% patients and 73% controls were taking canned food in moderation. 69% patients and 50% controls were taking frozen food in moderation. The potassium levels (p value: 0.00001) and sodium levels (p value: 0.01468) were found at significant difference in brain cancer patients and control group. Statistically significantly higher odds of outcome (OR>1) and increased relative risks (RR) were reported in dementia, depression and intake of anti-depressants for BC vs. CG. This epidemiological study reports hyponatremia as a significantly different parameter between brain cancer patients and controls. Food's chemicals induce hyponatremia, which can disturb mental states to develop different neurological conditions.

Molecular detection of Isoniazid, Rifampin and Ethambutol resistance to M. tuberculosis and M. bovis in multidrug resistant tuberculosis (MDR-TB) patients in Pakistan.

The various aspects of MDR-TB, type of pathogen, different drug sensitive methods and mutation (s) in specific genes were determined. The histone-like protein (hupB) gene of M. tuberculosis was targeted by using primer sets: N & S and M & S (produced 645 bp & 318 bp fragment respectively). The most significant risk factors were the poverty and male gender of ages 11-25 years. All samples were detected as M. tuberculosis. By Drug Proportion method, the highest percentage (37%) was found resistant to only Rifampin. By MGIT method, the highest percentage (82.2%) was found resistant with the triple combination (Rifampin-RIF + Isoniazid-INH + Ethambutol-EMB) of the drugs. The highest mutations (76.92%) were found in gene rpoB (codon 531) in MDR TB patients. By, MAS-PCR, the highest percentage (34%) were found resistant to combination (INH + RIF) of the drugs. Minimum samples were resistant to RIF and RIF + INH drugs by MGIT, while proportionate results were observed from MAS-PCR and DP. Moreover, by MAS-PCR mutation in gene embB (306) caused EMB resistance (51.64%). We found that M. tuberculosis was the main cause of MDR-TB. Our findings may further be used for an early diagnosis of multi-drug resistant tuberculosis.

Mutations of the human interferon alpha-2b (hIFNα-2b) gene in low-dose natural terrestrial ionizing radiation exposed dwellers.

Natural terrestrial ionizing radiations emerge from uranium deposits and can impact human tissues by affecting DNA bases which constitute genes. Human interferon alpha-2b (hIFNα-2b) gene synthesizes a protein which exhibits anticancerous, immunomodulatory, anti-proliferative and antiviral properties. This research aimed to find out hIFNα-2b gene mutations for those residents who were chronically exposed to low-dose natural terrestrial ionizing radiations. The gene amplifications was done through PCR technique and gene mutations were identified by bioinformatics in order to conclude as to how mutations identified in hIFNα-2b gene sequences will lead to alterations in the hIFNα-2b protein in radiation exposed residents. The range of radiation dose exposure was 0.4383-4.55832 (mSv/y) for the selected radiation exposed locations which were having uranium mineralization. Mutations (24%) in hIFNα-2b gene shows that some of the radiation exposed inhabitants were having a modulated immune response. The CBC (Complete Blood Count) parameters: WBC (White Blood Cells), MCH (Mean Corpuscular Hemoglobin), MCHC (MCH Concentration) and PLT (Platelets) on average were below the normal range in 24% radiation exposed subjects who were having hIFNα-2b gene mutations. Immunomodulation is observed by the mixed trend of either lymphocytosis or lymphopenia and neutropenia or neutrophilia in the exposed population. Thus, a radioactive exposure from uranium can affect the immune system and can induce mutations.

Mutations of the human interferon alpha-2b (hIFN-α2b) gene in occupationally protracted low dose radiation exposed personnel.

Ionizing radiations impact human tissues by affecting the DNA bases which constitute genes. Human interferon alpha 2b gene synthesizes a protein which is an important anticancerous, immunomodulatory, anti-proliferative and antiviral protein. This study was aimed to identify interferon alpha-2b mutations as a consequence of the use of occupational chronic low dose radiation by hospital radiation exposed workers. A molecular analysis was done in which DNAs were extracted from blood samples from radiology, radiotherapy and nuclear medicine workers. The gene was amplified through polymerase chain reaction and further genetic data from sequencing results analyzed by bioinformatics tools in order to determine as to how mutations in interferon alpha 2b sequences will lead to changes in human interferon alpha-2b protein. A total of 41% gene mutations was detected among all radiation exposed workers in which higher percentage (5.4%) of base insertion mutations and 14% frameshift mutations were found in radiology workers. The chronic use of low dose of radiations by occupational workers has a significant correlation with mutational effects on interferon alpha 2b gene, further evident by depressed interferon alpha levels in serum. This can lead to depressed immunity in radiation exposed workers. Hematological profiling of this group also showed hyperimmune response in the form of lymphocytosis.

Machine learning models to predict neuropsychiatric disorders in various brain tumors.

OBJECTIVE: Neuropsychiatric disorders in brain tumor patients are commonly observed. It is difficult to anticipate these disorders in different types of brain tumors. The goal of the study was to see how well machine learning (ML)-based decision algorithms might predict neuropsychiatric problems in different types of brain tumors. METHODS: 145 histopathologically-confirmed primary brain tumors of both gender aged 25-65 years of age, were included for neuropsychiatric assessments. The datasets of brain tumor patients were employed for building the models. Four different decision ML classification trees/models (J48, Random Forest, Random Tree & Hoeffding Tree) with supervised learning were trained, tested, and validated on class labeled data of brain tumor patients. The models were compared in order to determine the best accurate classifier in predicting neuropsychiatric problems in various brain tumors. Following categorical attributes as independent variables (predictors) were included from the data of brain tumor patients: age, gender, depression, dementia, and brain tumor types. With the machine learning decision tree/model techniques, a multi-target classification was performed with classes of neuropsychiatric diseases that were predicted from the selected attributes. RESULTS: 86 percent of patients were depressed, and 55 percent were suffering from dementia. Anger was the most often reported neuropsychiatric condition in brain tumor patients (92.41%), followed by sleep disorders (83%), apathy (80%), and mood swings (76.55%). When compared to other tumor types, glioblastoma patients had a higher rate of depression (20%) and dementia (20.25%). The developed models Random Forest and Random Tree were found successful with an accuracy of up to 94% (10-folds) for the prediction of neuropsychiatric disorders in brain tumor patients. The multiclass target (neuropsychiatric ailments) accuracies were having good measures of precision (0.9-1.0), recall (0.9-1.0), F-measure (0.9-1.0), and ROC area (0.9-1.0) in decision models. CONCLUSION: Random Forest Trees can be used to accurately predict neuropsychiatric illnesses. Based on the model output, the ML-decision trees will aid the physician in pre-diagnosing the mental issue and deciding on the best therapeutic approach to avoid subsequent neuropsychiatric issues in brain tumor patients.

Association of 25-hydroxyvitamin D with hematological profile and anthropometry in patients with glioma.

OBJECTIVE: Gliomas are immune system suppressive tumors, and the role of vitamin D is pivotal in the immune system. This study aimed to observe if there is any significant association between the serum levels of 25-hydroxyvitamin D with hematological indices and anthropometric measurements. METHODS: A total of 75 glioma patients were included, and the information was collected on gender, age group, area, socioeconomic status, intake of vitamin D and calcium in food and supplements, skin color, sunlight exposure, body mass index, and muscle strength. A nonparametric Kendall's tau-b correlation test was performed to find a correlation between 25-hydroxyvitamin D levels and blood counts, body mass index, and muscle strength. RESULTS: The majority of patients (72%) were having low lymphocytes followed by high granulocytes and high white blood cells. The majority were having low levels of both 25-hydroxyvitamin D (84%) and calcium (73%). Patients were mainly from urban areas, and the majority belonged to middle-class families having sedentary lifestyles. The majority of patients were not taking vitamin D supplements. An insufficient amount of sunlight exposure was found in most of them. The majority of the patients were although had normal weight but weak muscle strength (74.6%). An insignificant correlation was found between 25-hydroxyvitamin D levels with the hematological indices or anthropometric measurements in brain tumor patients. CONCLUSION: Vitamin D is a powerful immune modulator, and there is a great need for sufficient amounts of sunlight exposure and vitamin D-enriched diets to prevent cancer.