This study reports on the immunohistochemical staining for cytokine proteins of 26 epiretinal membranes obtained from eyes undergoing surgery for the treatment of proliferative vitreoretinopathy. All specimens were investigated for the distribution of staining for interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN gamma) and interleukin-2 (IL-2). The results showed that 22 of the membranes (85%) stained for TNF alpha not only intracellularly but also in the extracellular matrix. This contrasts with the findings that only 2 membranes stained for IL-1 alpha and that another 3 were positive for IL-1 beta. Staining for the cytokines IL-6 and IFN gamma was also observed in 9 and 7 membranes respectively. None of the specimens investigated stained with antibodies to IL-2 or control antibodies, and none of three normal retinas stained with any of the antibodies used. Pre-absorption of anti-cytokine antibodies with the corresponding human recombinant cytokines abolished staining of cells and extracellular matrix. The present findings support growing evidence that cytokine-mediated pathways of inflammation are involved in the pathogenesis of proliferative vitreoretinopathy, and draw attention to the possibility that interaction between extracellular matrix-bound cytokine and inflammatory leucocytes or resident cells of the retina may promote the development and perpetuation of this condition.

Background: Aging is the irreversible change in the human physiology which occurs with the passage of time and it becomes very much critical to recommend drugs among the geriatrics patients because their body response is quite different. Objectives: The purpose of the current study is to assess and evaluate the potentially inappropriate medications among the geriatric patients at the tertiary care Hospital of Larkana Sindh which is the biggest Hospital in the Northern Part of Sindh. Methods: The descriptive cross-sectional study was conducted which included the 500 patients aged more than 60 years. The data was collected from the patients' case charts and the questionnaire distributed among the patients. BEERS′ criteria was used to detect the frequency of chronic disorders in geriatric patients and appraise the polypharmacy. Results: The male patients were 42.6% and the female patients were 57.4%. The inappropriate medication use (IMU) was observed among 22.6% patients. Inappropriate antibiotics were seen in 35.39%, Benzodiazepine 28.32%, non-steroidal anti-inflammatory drugs (NSAIDs) 15.04%, cardiovascular system (CVS) drugs 12.39% of patients. Parenteral route of administration was observed in 70.04% of patients. Conclusion: Polypharmacy is highly prevalent in the prescriptions of geriatrics patients, due to certain reasons like a chronic disease. Clinical Pharmacist can be better placed to provide his professional activities in this context.

Objectives. This study aimed to assess and make a pattern of factors causing stroke leading to cerebral haemorrhage in male patients as well as to assess association of demographic characteristics, diet and disease with haemorrhagic stroke in Quetta, Balochistan, Pakistan. Methods. In a cross sectional questionnaire based interviewing study, a questionnaire was designed to access the pattern of factors causing stroke leading to cerebral haemorrhage in male patients. Total 339 cases (adult male who had haemorrhagic stroke) were identified from two government and four private hospitals in Quetta City, Province Balochistan, Pakistan. The study was conducted within the time period of 9 months, from March to November, 2015. The data was piloted and then final data was analysed by using IBM SPSS 22. Results. In demographic characteristic study of patients, majority 219 (64.6%) were among the age group between 51 years and above, 330 (97.3%) were married, majority 186 (54.9%) were having urban residence and 277 (81.7%) were having own residence ownership, 127 (37.5%) were having addiction to smoking and 120 (35.4%) were addicted to tobacco and snuff. 124 (36.6%) were reluctant to mention whether their patients were either smokers or not. Among total 339 patients, majority 284 (83.8%) were not doing physical exercise routinely or if they were recommended by the physician. Among the 339 patients, all 339 (100%) of patients selected the multiple options among all given options (headache, unconscious/loss of consciousness, pain in neck). Conclusions. Demographic characteristics, low level of education, low income, urban residence in combined family setup, married, increased number of children are associated with hemorrhagic stroke. Smoking, tobacco and snuffing may also cause stroke. Lack of physical exercise, past history of stroke, diabetes mellitus, cardiovascular disease, hypertension (personal or family) of any type does not significantly cause stroke but may increase the risk of stroke. The order of events suddenly happened to the hemorrhagic patients are headache, pain in neck, vomiting and finally state of unconsciousness.

depends up on many factors such as: Quality of clinical services provided, availability of medicine, behavior of doctors and other health staff, cost of services, hospital infrastructure, physical comfort, emotional support, and respect for patient preferences [3,4]. Mismatch between patient expectation and the service received is related to decreased satisfaction [5,6]. Therefore, assessing patient perspectives gives them a voice, which can make public health services more responsive to people's needs and expectations [7,8]. customer satisfaction [1,2]. Patients' perceptions about health care systems seem to have been largely ignored by health care managers in developing countries. Patient satisfaction