Background: Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period. Methods: We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0. Results: Among 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester. Conclusion: Successful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.

Inflammatory bowel disease-associated colorectal cancers (IBD-CRC) are associated with a higher mortality than sporadic colorectal cancers. The poorly defined molecular pathogenesis of IBD-CRCs limits development of effective prevention, detection, and treatment strategies. We aimed to identify biomarkers using whole-exome sequencing of IBD-CRCs to guide individualized management. Whole-exome sequencing was performed on 34 formalin-fixed paraffin-embedded primary IBD-CRCs and 31 matched normal lymph nodes. Computational methods were used to identify somatic point mutations, small insertions and deletions, mutational signatures, and somatic copy number alterations. Mismatch repair status was examined. Hypermutation was observed in 27% of IBD-CRCs. All hypermutated cancers were from the proximal colon; all but one of the cancers with hypermutation had defective mismatch repair or somatic mutations in the proofreading domain of DNA Hypermutated IBD-CRCs had increased numbers of predicted neo-epitopes, which could be exploited using immunotherapy. We identified six distinct mutation signatures in IBD-CRCs, three of which corresponded to known mechanisms of mutagenesis. Driver genes were also identified. IBD-CRCs should be evaluated for hypermutation and defective mismatch repair to identify patients with a higher neo-epitope load who may benefit from immunotherapies. Prospective trials are required to determine whether IHC to detect loss of MLH1 expression in dysplastic colonic tissue could identify patients at increased risk of developing IBD-CRC. We identified mutations in genes in IBD-CRCs with hypermutation that might be targeted therapeutically. These approaches would complement and individualize surveillance and treatment programs. .

Chinese fir (Cunninghamia lanceolata (Lamb) Hook) is a commercially valuable timber species that is widely planted in southern China and accounts for 6.1% of the global plantation forests. However, appropriate planting density that ensures high plantation productivity is largely unexplored in this species. The aim of the study was to examine tree growth, biomass production, and its allocation among different organs in relation to initial planting density, and to examine whether planting density has an impact on root development. Mortality, diameter at breast height and tree-height of all trees were determined and measured in wider (2.36 × 2.36 m), intermediate (1.83 × 1.83 m) and narrow (1.44 × 1.44 m) spacing with stand density of 1450 trees ha−1, 2460 trees ha−1 and 3950 trees ha−1, respectively. In each stand, three plots of 20 × 20 m at a distance of 500 m were delineated as the sampling unit. Biomass was determined by destructive sampling of trees in each stand and developing allometric equations. Root morphological traits and their spatial distribution were also determined by carefully excavating the root systems. The results showed an increase in diameter of trees with decreasing stand density while tree height was independent of stand density. Biomass production of individual trees was significantly (p < 0.05) less in high-density stand (32.35 ± 2.98 kg tree−1) compared to low-density stand (44.72 ± 4.96 kg tree−1) and intermediate-density stand (61.35 ± 4.78 kg tree−1) while stand biomass production differed significantly in the order of intermediate (67.63 ± 5.14 t ha−1) > high (57.08 ± 3.13 t ha−1) > low (27.39 ± 3.42 t ha−1) stand density. Both average root length and root volume were significantly (p < 0.05) lower in the high-density stand than stands with low and intermediate density. Analysis of spatial distribution of root systems revealed no overlap between roots of neighboring trees in the competition zone in low-density stand, a subtle overlap in the intermediate density stand and larger overlap in the high-density stand. It can be concluded that better growth and biomass production in intermediate density stand could be explained by better root structural development coupled with minimal competition with understory vegetation and between trees; thus intermediate stand density can be optimal for sustaining long-term productivity and may reduce the management cost in the early phase of the plantation.

Intercropping is one of the most widely used agroforestry techniques, reducing the harmful impacts of external inputs such as fertilizers. It also controls soil erosion, increases soil nutrients availability, and reduces weed growth. In this study, the intercropping of peanut (Arachishypogaea L.) was done with tea plants (Camellia oleifera), and it was compared with the mono-cropping of tea and peanut. Soil health and fertility were examined by analyzing the variability in soil enzymatic activity and soil nutrients availability at different soil depths (0–10 cm, 10–20 cm, 20–30 cm, and 30–40 cm). Results showed that the peanut–tea intercropping considerably impacted the soil organic carbon (SOC), soil nutrient availability, and soil enzymatic responses at different soil depths. The activity of protease, sucrase, and acid phosphatase was higher in intercropping, while the activity of urease and catalase was higher in peanut monoculture. In intercropping, total phosphorus (TP) was 14.2%, 34.2%, 77.7%, 61.9%; total potassium (TK) was 13.4%, 20%, 27.4%, 20%; available phosphorus (AP) was 52.9%, 26.56%, 61.1%; 146.15% and available potassium (AK) was 11.1%, 43.06%, 46.79% higher than the mono-cropping of tea in respective soil layers. Additionally, available nitrogen (AN) was 51.78%, 5.92%, and 15.32% lower in the 10–20 cm, 20–30 cm, and 30–40 cm layers of the intercropping system than in the mono-cropping system of peanut. Moreover, the soil enzymatic activity was significantly correlated with SOC and total nitrogen (TN) content across all soil depths and cropping systems. The depth and path analysis effect revealed that SOC directly affected sucrase, protease, urease, and catalase enzymes in an intercropping system. It was concluded that an increase in the soil enzymatic activity in the intercropping pattern improved the reaction rate at which organic matter decomposed and released nutrients into the soil environment. Enzyme activity in the decomposition process plays a vital role in forest soil morphology and function. For efficient land use in the cropping system, it is necessary to develop coherent agroforestry practices. The results in this study revealed that intercropping certainly enhance soil nutrients status and positively impacts soil conservation.

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It is known that forest management practices and land use affect soil quality worldwide. This study was conducted to assess the potential effects of stand density on soil quality in Chinese fir plantations. Low-(1,450 trees/ha with 2.36 × 2.36 m spacing), intermediate-(2,460 trees/ha with 1.83 × 1.83 m spacing), and high-density (3,950 trees/ha with 1.44 × 1.44 m spacing) stands in a 10-year-old Chinese fir monoculture plantation were examined, and different soil quality indicators were measured. The results indicated that stand density affected nitrogen (N), phosphorous (P), and magnesium (Mg) content, whereas potassium (K) and calcium (Ca) were not affected. Total N and total P contents were higher in the low-density stands, whereas total Mg was higher in the intermediate-density stands. Available N was higher in the low-density stands, whereas available P was higher in the intermediatedensity stands. No significant difference was observed in the contents of available K, total K, and total Ca among all densities. Soil organic matter was significantly higher in the intermediate-density stand than in the high-and low-density stands. Soil bulk density increased from the surface layer to the 40-60 cm soil layer. Soil pH was lowest in the surface layer of soils of all three densities and increased from the 0-20 cm layer to the 20-40 cm layer; however, it decreased from the 20-40 cm layer to the 40-60 cm layer. Soil pH differed significantly between soils of different densities but remained within an optimum range (4.1-4.5) for Chinese fir plantations. Soil moisture content was significantly higher in the high-density stand than the other stands. The observed effects of stand density on soil quality may be useful for policy makers and forest managers to implement improved forest conservation practices for preserving soil quality and stand production.

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Background and Objective: GLP-one receptor agonists are amongst the unique antidiabetes medications that have significant metabolic and cardiovascular benefits in addition to glucose lowering effect. To best of our knowledge, there is no published data on efficacy of liraglutide use among Pakistani population.Our objective was to ascertain the efficacy of liraglutide use among type two diabetes patients. Methods: This retrospective study was conducted at the Endocrinology Clinics of Aga Khan University Hospital (AKUH) Karachi, Pakistan during the period from July 01, 2016 to 30th June, 2017. Liraglutide was prescribed to 68 obese type two diabetes patients with uncontrolled diabetes taking more than one oral medication ± insulin. Starting dose of Liraglutide was 0.6 mg, which was increased to 1.2 mg after 1-2 weeks with further increment to 1.8 mg/day based on tolerance and individual patient preference. Dose of other diabetes medications was adjusted according to clinical judgment whereas Dipeptidyl peptidase-4 (DPP-4) inhibitors were discontinued. Results: Mean age of cohort was 55 years (SD=10.94 years) with median body mass index of 36.45 kg/m2 and majority (57.35%) were on a dose of 1.2 mg of Liraglutide per day. Median HbA1c reduced to 7.50% and 7.40% at three months and six months respectively vs 8.45% at baseline. Mean reduction in weight after three month was two kilograms and at six months, it was 1.38 kilograms respectively. Conclusion: Liraglutide as add on therapy demonstrated favourable HbA1c and weight reduction in obese uncontrolled type two Diabetes Pakistani subjects. doi: https://doi.org/10.12669/pjms.36.3.358 How to cite this:Rashid MO, Jabeen S, Khoja A, Islam N. Efficacy of Liraglutide in clinical practice: Single centre experience. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.358 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.