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Brain metastasis in gastric cancer (GC) patients is a rare phenomenon that is associated with adverse clinical outcomes and poor survival rates. We conducted a retrospective cohort study to investigate the incidence, risk factors and prognostic factors of brain metastasis in GC patients. Data on sociodemographic and tumor characteristics of GC patients from 2010 to 2019 was extracted from the Surveillance, Epidemiology and End-Results (SEER) database. Descriptive statistics, multivariable logistic and Cox regression were applied on SPSS. Kaplan-Meier-Survival curves and ROC curves were constructed. A total of 59,231 GC patients, aged 66.65 ± 13.410 years were included. Brain metastasis was reported in 368 (0.62%) patients. On logistic regression, the risk of brain metastasis was significantly greater in males, patients aged < 60 years and patients having concurrent bone and lung metastasis. High grade and high N stage were significant risk factors for development of brain metastasis. Patients who had undergone surgery for the primary tumor were at reduced risk for brain metastasis (adjusted odds ratio 0.210, 95% CI 0.131-0.337). The median OS was 3 months in patients with brain metastasis and 17 months in patients without brain metastasis (p < 0.05). On Cox regression, Grade IV tumors and primary antral tumors were significant predictable parameters for poor prognosis. Overall Survival (OS) and Cancer-Specific Survival (CSS) were prolonged in patients who had undergone surgery. Brain metastasis in gastric cancer is associated with significantly worse survival. Employing large-scale screening for high-risk patients holds a promising impact to improve survival rates, but it must be accurately balanced with a comprehensive understanding of clinicopathological aspects for accurate diagnosis and treatment.

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Introduction Cardiovascular diseases are an important cause of mortality in Pakistan. Developing nations like Pakistan with poor literacy rates and the majority of the population living in rural areas seem to be insufficient in their knowledge of symptoms. A study indicated that about half of the cardiac deaths occur within one hour of onset of symptoms, thus it is necessary to have adequate knowledge of symptoms to identify the sufferer and to pursue medical services as early as possible. The aim of our study was to assess the knowledge of ischemic heart disease (IHD) symptoms in the population and to investigate the relationship of age, gender, socio-economic status, education, and occupation with knowledge. Materials and Methods This was a descriptive cross-sectional study carried out in the Holy Family Hospital, Rawalpindi, Pakistan over a period of four months from May 2018 to August 2018. The study population comprised of people visiting the hospital. Individuals aged 18 and above were included while medical professionals were excluded. An interviewer-assisted semi-structured questionnaire was used as the data collection tool. After taking consent, 225 participants were asked about their demographic profile and to enlist as many symptoms of IHD as possible. Reference was made to the seven typical symptoms of IHD as recognized by the World Health Organization (WHO). Statistical Package for Social Sciences (SPSS), v23.0 (IBM SPSS Statistics, Armonk, NY) was used for the analysis. Independent samples t-test and one-way ANOVA test were applied; p ≤ 0.05 was considered significant.  Results Out of the seven symptoms endorsed by WHO, chest pain was most frequently identified (42%), followed by pain in the arm (23%), diaphoresis (19%), weakness and fainting (16%), dyspnea (15%), paleness (8%), and sickness and vomiting (5%). Mean score, out of seven symptoms, was 1.28 ± 1.19. Among the total participants, 34% could not enlist any symptom. Participants with higher education, skilled workers, and those having relatives who suffered from IHD showed significantly higher knowledge about IHD symptoms. Conclusions The study showed a paucity of knowledge about IHD symptoms among the participants. Hence it provides grounds for future awareness campaigns to educate the masses.

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BACKGROUND: Hepatitis is a major public health problem in Pakistan due to its strong association with liver failure and hepatocellular carcinoma. In Pakistan, conventional interferon therapy along with Ribavirin is favoured especially in Government funded programs for treatment of Hepatitis C, over the more expensive Pegylated Interferon and Ribavirin combination therapy as recommended by Pakistan society of Gastroenterology and GI endoscopy due to its favourable results observed in genotype 3 which is the dominant genotype of this region. Objective of our study was to assess the virological responses with standard interferon therapy and to determine the predictive values of early virological response (EVR) for Sustained Virological Response (SVR) in chronic hepatitis C patients treated with standard interferon therapy. METHODS: A cross sectional study was conducted on patients with chronic hepatitis C having received standard interferon and ribavirin therapy for six months. EVR and SVR were noted for analysis. Positive and negative predictive values of EVR on SVR were calculated. RESULTS: Out of the total sample (N = 3075), 1946 (63.3%) patients were tested for EVR. 1386 (71.2%) were positive while 560 (28.8%) were negative while 516 (16.8%) were tested for SVR. Two hundred and eighty-five (55.2%) were positive while 231 (44.8%) were negative. EVR and SVR tested were n=117. Positive predictive value of EVR on SVR was 67.1% and negative predictive value was 65.8%. Statistically significant association between EVR and SVR was determined with Chi square statistic of 11.8 (p-value < 0.0001). CONCLUSION: EVR is a good predictor of response of patients to standard interferon and ribavirin therapy. In the absence of an EVR, it seems imperative to stop further treatment. Virlogical responses with conventional interferon therapy are comparable to those of pegylated interferon therapy so adoption of conventional INF therapy is justified in terms of its cost effectiveness especially in resource constrained nations like Pakistan.

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Acute ischaemic stroke is a major cause of neurological morbidity and mortality across the globe. Recent advances in past two decades have made complete reversal of life threatening stroke a reality. The judicious use of intravenous and intraarterial thrombolysis in acute ischaemic stroke has saved countless lives. The use of thrombolytic therapy in Pakistan in acute stroke is still miniscule. Very limited literature is available from Pakistan on the use of intravenous thrombolysis. Intraarterial thrombolysis has been used only in few patients and there are no published reports of that from Pakistan. We present the case of a young man who came within 1 hour of stroke onset with a large right middle cerebral artery infarct resulting in severe neurological deficit. An urgent cerebral angiography showed complete occlusion of right internal carotid artery at its bifurcation. Successful intraarterial thrombolysis was performed with excellent clinical outcome. To our knowledge this is the first report of use of intraarterial thrombolysis in acute stroke from Pakistan.

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