Three new carbazole alkaloids and biological activities of Murraya koenigii.

Three new carbazole alkaloids, mukoenigatin (1), bikoeniquinonine (2) and murrayadinal (3), were isolated from the aerial parts of Murraya koenigii, along with mukeonine-B (4). Their molecular structures were determined on the basis of spectral analysis including UV, IR, MS, and 2D NMR spectroscopy. The antimicrobial activity of different fractions of plant extract was also determined.

Comparative anti-glycation and α-glucosidase inhibition studies of microbial transformed compounds of dydrogesterone.

Anti-glycation and α-glucosidase inhibition activities of microbial transformed compounds of dydrogesterone (1); 20R-hydroxy-9ß,10αa-pregna-4,6-diene-3-one (2), 17ß-hydroxy-9ß,10α-androsta-4,6-diene-3-one (3) and 9ß,10α-androsta-4,6-diene-3,17-dione (4) were evaluated. Compounds 1 and 4 showed potent α-glucosidase inhibitory activities, while 2 and 3 were found to be weak inhibitors, whereas anti-glycation activities of 1-4 were not observed.

Outcomes of Acute Promyelocytic Leukaemia in Paediatric Patients: Insights from a Low-Middle-Income Country.

OBJECTIVE: To describe the prognostic variables and course of paediatric acute promyelocytic leukaemia (APL) in Pakistan. STUDY DESIGN: Cohort study. Place and Duration of the Study: Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan, from January 2012 to December 2022. METHODOLOGY: Patients aged 1-15 years, clinically confirmed APL with promyelocytic leukaemia- retinoic acid receptor alpha (PML-RARA) were enrolled. Initial admission included a thorough examination, recording demographic and clinical data, reporting time, prior treatment, and socioeconomic status. Statistical analysis used SPSS 25.0, with significance at p <0.05. RESULTS: This study included 50 cases of APL. Out of which, 32 (64%) were males and 18 (34%) were females. The mean age at diagnosis was 7.02 ± 3.86 years. Pallor (96%) and fever (88%) were common presentations. The average white blood cell count was 28.70 ± 35.39 x109/L. Treatment protocols include 48% International Consortium for Childhood (ICC)-APL, and 52% arsenic trioxide (ATO). High-risk cases were 54%. Neutropenic fever and differentiation syndrome were common induction complications. Delays over one month increased induction deaths (6.7 to 35%, p = 0.011), reducing disease-free survival (DFS), (76.7 to 35%, p = 0.001), and overall survival (OS), (80 to 45%, p = 0.007). After 40.90 ± 45.19 months' follow-up, 10-year OS and DFS were 66.0% and 60.0%, respectively. The best OS and DFS, at 80%, were observed in standard-risk cases treated with ATO. CONCLUSION: Neutropenic fever and bleeding were the primary causes of mortality in paediatric APL induction. Treatment delay was a key prognostic factor. ATO-based therapy offered safer, improved DFS, and OS suitable for primary healthcare settings. KEY WORDS: Acute promyelocytic leukaemia, Chemotherapy, Neutropenic fever.

Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years' Experience From a Low- and Middle-Income Country.

PURPOSE: Acute lymphoblastic leukemia (ALL) represents around 70% of pediatric leukemia. In high-income countries, the 5-year survival is above 90%, but survival in low- and middle-income countries is inferior. This study documents the treatment outcome and prognostic factors of pediatric ALL in Pakistan. MATERIALS AND METHODS: In this prospective cohort study, all newly diagnosed patients with ALL/lymphoblastic lymphoma from age 1 to 16 years enrolled between January 1, 2012, and December 31, 2021, were included. The treatment was based on the standard arm of the UKALL2011 protocol. RESULTS: Data from 945 patients with ALL, including 597 males (63.2%), were analyzed. The mean age at diagnosis was 5.73 ± 3.51 years. Pallor was the commonest presentation in 95.2% followed by fever in 84.2% of patients. The mean WBC count was 56.6 ± 103.4 × 109/L. Neutropenic fever followed by myopathy was the most common complication during induction. In univariate analysis, the high WBC count (P ≤ 0.001), intensive chemotherapy (P ≤ 0.001), malnutrition (P = .007), poor response to induction chemotherapy (P = .001), delayed presentation (P = .004), and use of steroids before chemotherapy (P = .023) significantly adversely affected overall survival (OS). The delayed presentation was the most significant prognostic factor in the multivariate analysis (P ≤ .002). After a median follow-up of 54.64 ± 33.80 months, the 5-year OS and disease-free survival (DFS) were 69.9% and 67.8%, respectively. CONCLUSION: In this largest cohort of childhood ALL from Pakistan, a high WBC count, malnutrition, delayed presentation, previous steroids use, intensive chemotherapy, and poor response to the induction chemotherapy were associated with decreased OS and DFS rates.

Measuring education sector resilience in the face of flood disasters in Pakistan: an index-based approach.

School resilience is characterized as risk management techniques to build a safe environment for students. Recognizing the need of building disaster resilience for the education sector, this study is aimed at assessing flood disaster resilience of elementary schools in four extremely vulnerable districts of Khyber Pakhtunkhwa province of Pakistan. This paper established the assessment tool by incorporating climate resilience indices and 16 tasks of the Hyogo Framework for action designed for the education sector. It discusses four dimensions: physical conditions of elementary schools, human resources, institutional issues, and external relationships, each with three parameters and five variables. The data were obtained for 60 variables from 20 randomly selected elementary schools. Indicators of resilience were identified, and an index-based approach was used to get the composite values of the four dimensions of resilience. Correlations between the dimensions, components, and indicators were also checked in the current study. Results show that schools in Nowshera, followed by Charsadda, Peshawar, and Dera Ismail Khan, are the most resilient to flood disasters. For all 12 parameters under 4 dimensions, the relative resilience of study districts is the same. The findings further indicated that there is a strong correlation between the pairs of human resources and institutional issues as well as institutional issues and external relationships that can also enhance human resources and external relationships. Furthermore, institutional issues are also correlated with external relationships and human resources, which indicate that there is a triangular relationship among human resources, institutional issues, and external relationships. The findings would encourage policymakers and practitioners to develop an effective plan to improve the resilience of schools using the overall resilience situation. In short, education sector disaster resilience can be achieved by integrated planning and implementation approach. In this respect, disaster managers, public and private education sectors, school staff, students, and parents need to establish synergies to devise a comprehensive plan of action to enhance disaster education.

Hypogylcemic activity of aqueous extract of some indigenous plants.

Pakistan is rich in medicinally important plants and has an ancient herbal treatment methods. Our work is based on the study of some indigenous plants which show inhibitory effect of glucose utilization, and are in use as hypoglycemic agent in traditional system of medicine. Gymnema sylvestre, Momordica charantia and Eugenia jumbolana have been shown to possess hypoglycemic activity of varying degree. The results in three different media revealed that, hypoglycemic activity is more prominent in neutral and basic media as compared to acidic medium.