Vitamin D serves as a precursor to the potent steroid hormone calcitriol, which has widespread actions throughout the body. Calcitriol regulates numerous cellular pathways that could have a role in determining cancer risk and prognosis. Low Vitamin D levels have been implicated in numerous disease processes including fracture risk, falls, cardiovascular disease, hypertension, diabetes mellitus, and cancers. Metabolite of 1, 25-dihydroxyvitamin D3 (1,25[OH]2D3) regulates numerous genes that control gut physiology and homeostasis. 1,25(OH)2D3 serves various functions such as maintaining the integrity of epithelial barrier and absorption of calcium and phosphate, and the host's defense against pathogens, and the inflammatory response by several types of secretory and immune cells. Although epidemiological data remain inconsistent, and randomized control trials in humans do not yet exist to conclusively support a beneficial role for Vitamin D, results from some correlating studies strongly suggest that Vitamin D deficiency increases the risk of developing cancer and that avoiding deficiency and adding Vitamin D supplements might be an economical and safe way to reduce cancer incidence and improve cancer prognosis and outcome. The present review highlights the role of Vitamin D in cancer of the gastrointestinal tract including esophagus, gastric (stomach), liver, pancreas, and colon.

Mucormycosis of the mandible (MOM) is a rare fungal infection, and only 23 cases had been reported during the last 50 years worldwide, from seven different countries. Most of the cases were reported in India (n=8, 34%), followed by the United States (n=5, 22%). It is usually associated with an immunocompromised state and generally occurs after tooth extraction. Radiographically, it presents with the characteristic sign of osteomyelitis. Most of the previous case reports/series on MOM described successful outcomes with the resection of the involved segment. However, our experience in managing these cases was quite different and it was observed that resection is seldom required. It was seen that MOM rarely causes cortical perforation. One of the probable reasons is the thicker cortical bone and well-confined boundary of the mandible. Another reason could be the fulminating nature of the disease that leads it to rapidly spread in less resistant medullary bone before perforating cortical bone. During surgery, a clear line was seen separating necrotic medullary bone from healthy cortical bone. The thicker cortical bone of the mandible was found to be resistant to fungal invasion; however, the medullary bone was rapidly invaded. Therefore, the healthy cortical bone could be saved. The preservation of the cortical parts thus helps in maintaining the continuity of the bone. Surgical curettage of necrotic medullary bone is usually the optimal method to manage MOM affecting the mandibular body or ramus region.

Objective: To investigate the level of self-efficacy and disability in patients with rheumatoid arthritis (RA) and to examine the relationship of patient self-efficacy and disability with age and disease duration. Methods: A cross-sectional survey was conducted at the department of rheumatology in JPMC, Karachi from June to November 2017. Patients who had RA as main disease, age above fifteen years, disease duration of three months or above and cognitively able to answer the questionnaires were consecutively included. Self-efficacy was measured by Arthritis Self-Efficacy Scale (ASES) and disability assessed by Health Assessment Questionnaire. The relationship between ASES and disability, age and disease duration were examined using Spearman's rho test. Statistical analysis was undertaken using SPSS for Windows, version 22. Results: Of 100 RA patients, 32% had average self-efficacy. Whereas moderate to severe disability existed in 59% of the patients. A spearman's correlation showed that arthritis self-efficacy was strongly correlated with disability (r= -0.751, p= <.0001), moderately with disease duration (r= -0.359, p= <0.0001) and weakly with age (r= -0.284, p= 0.004) whereas disability had direct moderate correlation with age and disease duration (r= 0.396, p= <0.0001 and r= 0.423, p= <0.0001, respectively). Conclusion:This cross-sectional survey concluded that average self-efficacy and moderate to severe disability exist in RA patients. Enhancing the patient's self-efficacy should be an essential part of a total treatment program of RA so that disability, treatment cost and visits to health care system could be reduced.

Plantar fasciitis (PF) is one of the most common musculoskeletal complain of the foot affecting a huge population. However there is a scarcity of evidence regarding treatment efficacy, therefore this trial aimed to compare the efficacy of Kinesiotaping (KT) vs. Ultrasound Therapy (UT) in the management of pain and physical functioning of foot/ankle in patients with PF. Methodology: Two arms, parallel-group design RCT was conducted on PF patients. Participants aged between 25-60 years, having symptoms of PF for at least 6 months, presenting with unilat-eral and/or bilateral heel pain were included. However, patients with fractures, dislocations, or open wounds around ankle/soles and patients allergic to taping were excluded. 30 patients were randomly divided into group A (KTG=15): received KT and group B (UTG=15): received Ultra-sound Therapy (UT). Both the groups also received cold pack with stretching exercises. Treat-ment was provided on an alternate days for 30 minutes to each group for two weeks. Visual An-alogue Scale (VAS) was used to determine pain and Foot/Ankle disability index (FADI) was used to assess foot and ankle functioning. Readings were taken pre and post intervention. Results and discussion: The mean pain score before treatment was 8.00 but after treatment was reduced to 1.13, in KTG. However, in UTG mean pain score before treatment was 9.13 and after treatment reduced to 4.20. The mean FADI score before treatment was 52.80 but after treatment decreased to 11.46 in KTG. However, in UTG the mean score of FADI before treatment was 58.53 and after treatment, it was decreased to 39.46. Conclusion: The results concluded that KT and UT both are effective techniques for reducing pa-in and improving ankle/foot physical functioning in patients with PF. However, KT was found to be more effective than UT. Keywords: Foot/ankle disability index, Plantar Fasciitis, Pain, Kinesiotaping, Therapeutic ultrasound

Hyperlipidaemia is an condition that increases the chance of coronary heart disease (CHD) and atherosclerotic disease (ASHD) in blood vessels. Hyperlipidaemia occurs in response to smoking, obesity, sedentary lifestyle, and other risk factors to extend CHD. Cardiovascular disease (CVD) is the reason for death. Hyperlipidaemia is divided into two broad classifications: Primary (familial) and Secondary (acquired). Primary hyperlipidemia has been generated by hereditary defects and climatic factors or by undisclosed mechanisms. Secondary hyperlipidemia concern to the metabolic disorders linked with the diabetes mellitus, liver complication, thyroid, and kidney complications. Hyperlipidemia also refers to as elevated levels of lipids within the blood. Circulating lipid are carried in lipoproteins that transport the lipids to varied tissues for energy use, lipid deposition, hormone production, and steroid formation. The lipoprotein consists of esterified and unesterified cholesterol, triglycerides, phospholipids, and protein. The general public who have hyperlipidemia experience no symptoms. Hyperlipidemia is most oftenly correlated with high-fat diets, a stationary lifestyle, obesity and diabetes mellitus. Four different classes of cholesterol-lowering drugs namely, statins, niacin, resins, and fibrates are available to treat hyperlipidemia; however, statins are now considered to be the first line therapy. The preventable causes of hyperlipidemia can include: Smoking, Being overweight, Physical inactivity, Steroid use, Alcohol consumption & Diet high in saturated fat, & cholesterol such as cheese, meat, fried & processed foods and egg yolk. The treatment of hyperlipidemia includes statins, bile acid sequestrants, fibric acids, niacin, and cholesterol absorption inhibitors. There are some of the novel drugs which are selected for the treatment of hyperlipidemia which includes: Evolocumab, Alirocumab, Bempedoic acid, Lomitapide, Evinacumab, and Sebelipase alfa.