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Adverse intrauterine environment could serve as an important stimulus for postnatal altered health status and for increased susceptibility to long-term non-communicable diseases (NCDs). The notion is now recognized as the Developmental Origins of Health and Disease (DOHaD), which was first proposed by Sir David Barker. Since then, several scientific disciplines have strived to measure the magnitude of the early fetal programming and later risk of diseases. Pakistan, with striking figures of morbidity and mortality from NCDs, is currently tackling with double burden of diseases and requires planned efforts to counteract the threat of NCDs. Considering the growing needs and available evidences, Pakistan DOHaD Society was officially instigated in September 2016. The Society aims to explicitly address the association of life in utero with future health and disease and to endorse early screening and interventions to reduce the burden of NCDs, mental health issues and learning disorders along the life course. It has shown significant progress toward investigating the influence of adverse in utero environment such as diabetes, maternal under-nutrition and pre-eclampsia on fetal programming under two major research lines, that is, cardiovascular and cerebrovascular programming. The Society has been successful in disseminating its research findings through several esteemed international scientific conferences. Pakistan DOHaD Society encourages scientific community for collaborative research aimed at improving the quality of life during early childhood, adolescence and adulthood through provision of appropriate pre-pregnancy and antenatal interventions targeted to address at-risk in utero conditions.

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BACKGROUND: In South Asia, gender disparity in child mortality is highest in Pakistan. We examined the influence of child gender on household decision regarding health care. METHODS: Prevalence ratios were calculated for 3740 children aged 1-59 months from 92 randomly selected villages of rural Pakistan using a cluster-adjusted log-binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics. RESULTS: There were 25 more girl deaths than boys per 1000 live births (95% CI: 13.9, 48.6) among post-neonates and 38 more among children aged 12-59 months (95% CI: 10.5, 65.5). However, in adjusted analysis, gender was not a significant predictor of illness reporting, visit to health facilities, choice of provider, hospitalization and health expenditure. Significant predictors of health care were child's age, illness characteristics, number of children in the family, household socio-economic status and absence of girls' school in the village. CONCLUSIONS: Differential care seeking for boys and girls is not seen in Thatta despite clear differences in mortality ratios. This calls for more creative research to identify pathways for gender differential in child mortality. Factors identified as influencing child health care and amenable to modification include poverty alleviation and girls' education.

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Pakistan ranks fourth globally in terms of absolute numbers of under-5 deaths. Although several determinants of child deaths have been identified, the possibility of an association between mother's health and under-5 deaths has not been assessed in Pakistan. We compared data on 106 deceased children 0-59 months old with those on 3718 live children, using a cross-sectional survey of 2276 households among 99 randomly selected villages in Thatta, a rural district of Pakistan. We examined the association between self-reported maternal health status and under-5 deaths, using the SUDAAN statistical package to account for cluster sampling technique. Three models for logistic regression analysis were Model-1: demographic factors, Model-2: household socio-economic factors and Model-3: demographic and household socio-economic factors. Mothers of deceased children were 60% more likely to report chronic illnesses than mothers of live children after controlling for child's age, mother's age and type of house (final Model-3 analysis) (adjusted odds ratio [aOR; 95% confidence interval]: 1.6 [1.01, 2.5]). The association of self-reported maternal ill health with under-5 deaths in Thatta suggests the role of maternal health in child survival. Child survival strategies should include screening and treating mothers for common chronic illnesses. This is particularly important in a setting where only a quarter of chronically ill mothers seek care outside the home.

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MR imaging (0.35 and 1.50 T) was used to assess the appearance of the seminal vesicles. The size and signal intensity of normal seminal vesicles vary with the age of the subject. In general, on T2-weighted images, the signal intensity of normal seminal vesicles is lower than that of fat in prepubertal children, similar to or higher than that of fat in adults, and similar to or lower than that of fat in patients older than 70 years of age. Endocrine and radiation therapy will influence the size and signal intensity of the seminal vesicles. The purpose of the essay is to illustrate the spectrum of seminal vesicle disease, including congenital anomalies, inflammation, and neoplastic disease. Although MR imaging is helpful in depicting seminal vesicle abnormalities, it does not allow differentiation of benign from malignant disease, distinction of hemorrhage due to tumor invasion from postbiopsy changes, or distinguishing between glandular obstruction due to tumor infiltration and mechanical compression.

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Twenty-nine patients underwent magnetic resonance (MR) imaging for investigation of müllerian duct anomalies (MDAs). The anomalies evaluated were uterine agenesis (n = 2), uterine hypoplasia (n = 5), unicornuate uterus (n = 5), uterus didelphys (n = 5), bicornuate uterus (n = 10), and septate uterus (n = 2). The MR imaging interpretation was correlated with results of laparotomy (n = 18), hysterosalpingography (HSG) (n = 5), laparoscopy (n = 2), hysteroscopy (n = 1), HSG and laparotomy (n = 2), and HSG and laparoscopy (n = 1). MR imaging enabled correct classification of the anomaly in each patient and identification of coincidental gynecologic disease in 10 patients (34%). MR imaging results influenced clinical treatment in six (24%) of 25 patients referred prospectively. Of particular value was the ability to characterize septal tissue (myometrium versus fibrous tissue), identify the patients in whom the septum of bicornuate uteri had both fibrous and myometrial components, and establish that suspected adnexal lesions were actually components of obstructed MDAs.

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A case of primary non-Hodgkin's lymphoma of the terminal ileum with enterovesical fistula is reported. A 50-year-old Malay man presented with haematuria, dysuria and per-rectal bleeding. Intravenous urogram, double contrast enema and an MDP bone scintigram showed a fistulous communication between the bladder and distal ileum. At laparotomy, a large tumour attaching the terminal ileum to the dome of the bladder was found. Histopathological examination of resected small bowel revealed a diffuse histiocytic non-Hodgkin's lymphoma of the small bowel. The bladder mucosa was shown to be normal.

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An unusual case of syringomyelia secondary to a cauda equina meningioma involving the conus medullaris is described. The tumour was totally removed with decompression of an adjacent cyst and syrinx resulting in resolution of the symptoms and radiological appearance.

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A 29 year old Chinese female who presented with spontaneous purpura, was found to have gross hepatomegaly and thrombocytopenia. The thrombocytopenia responded to steroid therapy but relapsed when the dose of steroid was tapered down. Subsequent investigations revealed that the hepatomegaly was due to a large haemangioma of her liver. For symptomatic hepatic haemangioma, surgical excision is the treatment of choice; this was refused by the patient.

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A rare case of hepatic hydatidosis in non-endemic Malaysia is reported. It is important that clinicians treating the occasional patient be familiar with current diagnostic and therapeutic modalities.

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A five year review of 224 Tc-99m methylene diphosphonate (MDP) scintiscans of 194 patients with proven nasopharyngeal carcinoma revealed evidence of craniofacial asymmetry in 73.7 per cent. In virtually all instances tracer accumulation corresponded to the side of the primary lesion, cervical node enlargement and or cranial nerve dysfunction. It was concluded that the high frequency of asymmetric ipsilateral MDP accumulation about the face may be attributed to one or all of the following; tumour extension into contiguous structures, localised inflammatory or necrotic changes or even tracer uptake by the tumour itself.

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Paraventricular calcification not previously reported in systemic lupus erythematosus was seen in cranial computed tomograms of two patients with this disorder.

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