Objective: To find out the association of physical activity, dietary habits and factors associated with depression among medical students of Sindh, Pakistan, during the coronavirus disease 2019 (COVID-19) pandemic. Methods: An online cross-sectional study was conducted between June and August, 2020, on medical students from three medical institutions of Sindh, Pakistan. The study comprised three structured questionnaires related to demographic details, physical activity, dietary and sleep habits, COVID-19 pandemic-associated factors and patient health questionnaire, PHQ-9. A total of 864 students completed the questionnaires and participated in the study. The data was analysed on SPSS version 23. Results: Our study showed that 244 (28.2%) medical students had mild depression, 192 (22.2%) had moderate depression, 80 (9.3%) had moderately severe depression and 80 (9.3%) had severe depression during the COVID-19 pandemic. Out of 864 students, 268 (31%) had no depression. Socioeconomic status, body mass index (BMI), chronic disease/comorbidity, addiction and non-medical prescription drug use were found to be statistically significant predictors of depression among medical students. On multilogistic regression analysis, physical activity, social media/app use and sleeping habits during COVID-19 were associated with depression (p-value < 0.05). Conclusion: The COVID-19 pandemic adversely affected physical activity and sleeping habits in association with depression among medical students. Promoting healthy eating habits, adequate physical activity, and a healthy lifestyle, particularly among students during lockdowns, is a critical component of coping with mental stress and depression. The findings of this study will aid in future research and campaign design in preparation for future pandemics and lockdowns.

Breast cancer (BC) continues to be a significant global challenge due to drug resistance and severe side effects. The increasing prevalence is alarming, requiring new therapeutic approaches to address these challenges. At this point, Extracellular vesicles (EVs), specifically small endosome-released nanometer-sized EVs (SEVs) or exosomes, have been explored by literature as potential theranostics. Therefore, this review aims to highlight the therapeutic potential of exosomes in BC, focusing on their advantages in drug delivery and their ability to mitigate metastasis. Following the review, we identified exosomes' potential in combination therapies, serving as miRNA carriers and contributing to improved anti-tumor effects. This is evident in clinical trials investigating exosomes in BC, which have shown their ability to boost chemotherapy efficacy by delivering drugs like paclitaxel (PTX) and doxorubicin (DOX). However, the translation of EVs into BC therapy is hindered by various challenges. These challenges include the heterogeneity of EVs, the selection of the appropriate parent cell, the loading procedures, and determining the optimal administration routes. Despite the promising therapeutic potential of EVs, these obstacles must be addressed to realize their benefits in BC treatment.

Background: Pre-eclampsia is a hypertensive pregnancy disorder accompanied by proteinuria. Serum Lactate Dehydrogenase (LDH) is a biochemical marker that reflects the severity and progression of pre-eclampsia. Methods: A cross-sectional study was conducted at the Liaquat University of Medical and Health Sciences (LUMHS). One hundred pre-eclamptic women were enrolled and categorized into mild (n=30) and severe pre-eclamptic groups (n=70) to ascertain the function of LDH as a prognostic marker and to assess its association with severity and gestational age in pre-eclamptic women. Results: The significant differences in mean concentrations of LDH between mild and severe preeclamptic women (p-value <0.0001) and early and late-onset pre-eclamptic women (p-value=0.049) were found. Significant differences were also found in the LDH range between mild and severe preeclamptic women presented with late-onset pre-eclampsia (p-value= 0.004). Statistically significant differences (p-value= 0.019) in the levels of LDH were found with systolic blood pressure and proteinuria (p-value= 0.048). Conclusion: LDH is the prognostic marker representing the severity of pre-eclampsia. An increased level of LDH directs adequate monitoring and management; and by early detection of preeclampsia, serious consequences and complications may be prevented.

Background: Preeclampsia is multi-systemic hypertensive pregnancy disorder accompanied by proteinuria. Objectives: To determine the frequency of different presentations of preeclampsia in tertiary care hospital and find out its risk factors. Materials and Methods: The present study was hospital-based cross-sectional study and conducted from 1st August 2015 to 31st July 2016 in Gynaecology and Obstetrics Department, Liaquat University of Medical and Health Sciences (LUMHS), Hyderabad after ethical approval. A total of 112 pre-eclamptic women were enrolled during the study period by non-probability consecutive sampling. Patients were divided on the basis of their presentations into mild preeclampsia, severe preeclampsia, antepartum eclampsia, intrapartum eclampsia, HELLP syndrome, postpartum preeclampsia, postpartum eclampsia and atypical preeclampsia/eclampsia. All the sociodemographic factors and clinical variables were noted. Frequency and percentage were calculated for categorical variable and mean/standard deviation (SD) for continuous variables. Results: Of the 112 preeclamptic women, 54.5% were admitted with antepartum eclampsia, 12.5% with severe preeclampsia, 8.9% with atypical preeclampsia/eclampsia, 8% with mild preeclampsia, 8% with postpartum eclampsia, 3.6% with HELLP syndrome, 2.7% with intrapartum eclampsia and 1.8% with postpartum preeclampsia. Overall, majority of the patients were primigravida (57%), had gestational age >34 weeks at presentation (58.9%) and < 7 antenatal visits (88.3%) during their pregnancy. Overall 17.8% had previous bad obstetrical events, 11.6% had previous history of preeclampsia and 64.3% had consanguineous marriages. Conclusion: Different presentations of preeclampsia may help obstetricians to rule out high- risk pregnancies and provide antenatal care to patients earlier to prevent complications to both mother and fetus.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder influenced by genetic and environmental factors. This study examined the specific gene variants, dopamine transporter 1 (DAT1) rs6350, dopamine receptor D3 (DRD3) rs6280, dopamine receptor D2 (DRD2) rs6277, and catechol-O-methyltransferase (COMT) rs4633, in relation to ADHD among Pakistani children by exploring the potential gene-gene and gene-environment interactions. A total of 100 cases of ADHD and 100 healthy children were recruited. The tetra-primer amplification refractory mutation system (ARMS) assays were designed for genotyping the selected variants in both groups, and their association with ADHD was determined in different genetic models. Gene-gene and gene-environmental interactions were determined by the multifactor dimensionality reduction (MDR) method. The DAT1 rs6350 SNV AA genotype showed a significantly increased risk for ADHD in the codominant and recessive models. Conversely, the AG genotype demonstrated a protective factor for ADHD in the codominant and overdominant models. The DRD3 rs6280 T allele exhibited a decreased risk for ADHD, and the TT genotype showed a reduced risk in the recessive and log-additive models. No association between the DRD2 rs6277 and COMT rs4633 SNVs with ADHD was found in our population. The MDR analysis of the best three-fold interaction model showed redundancy between DAT1 rs6350 and DRD3 rs6280; however, the risk was increased with the gender variable, which showed a weak synergistic interaction with these SNVs. Genes associated with dopaminergic neurotransmission may contribute to the occurrence of ADHD. Furthermore, gene-gene and gene-environmental interactions may increase ADHD susceptibility.

Background: Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for improving prognosis and reducing morbidity and mortality. The purpose of this study was to investigate the diagnostic accuracy of confocal laser endomicroscopy (CLE) in detecting upper gastrointestinal premalignant and early malignant lesions in high-risk patients, as well as diagnosing patients with inconclusive white light endoscopy (WLE) and histopathology results.Methods: It was a cross-sectional study that included ninety (n = 90) high-risk patients with inconclusive diagnoses of upper gastrointestinal lesions on WLE and WLE-based biopsy histopathology. These patients underwent CLE, and the definitive diagnosis was confirmed using CLE and CLE-target biopsy histopathology. Diagnostic accuracy was determined by comparing the sensitivity, specificity, predictive values, and accuracy between the procedures. Result: The mean patient age was 47.43 ± 11.18 years. CLE and target biopsy confirmed that 30 (33.3%) patients had normal histology, while 60 (66.7%) patients were diagnosed with gastritis, gastric intestinal metaplasia, high-grade dysplasia, adenocarcinoma, Barrett’s esophagus, and squamous cell carcinoma of the esophagus. The results of CLE were superior to those of WLE in terms of diagnostic parameters. Additionally, CLE demonstrated nearly similar results in sensitivity (98.33%), specificity (100%), positive predictive value (100%), negative predictive value (96.77%), and accuracy (98.89%) when compared to CLE-target biopsy. Conclusion: CLE showed higher diagnostic accuracy in differentiating normal, premalignant and malignant lesions. It effectively diagnosed patients who initially had inconclusive WLE and/or biopsy results. Furthermore, early detection of upper gastrointestinal premalignant or malignant lesions may improve prognosis and reduce morbidity and mortality.