IntroductionThalassemia is a common genetic disorder worldwide, also occurring frequently in Karachi, Pakistan. Beta (β)-thalassemia major patients need repeated transfusions which cause iron overload. Patients are treated with chelating agents to reduce the high serum ferritin level and to decrease morbidity and mortality due to increased iron levels. This combined therapy also leads to some complications. One of them is the sensorineural hearing loss (SNHL). To date, no data is available in Pakistan regarding SNHL among major β-thalassemia patients on chelating therapy. MethodsA cross-sectional study was performed in collaboration with the Thalassemia Center and Dr. Ruth Pfau at the Department of Ear, Nose, and Throat, Civil Hospital, Karachi, Pakistan. The variable to detect hearing was pure tone air and bone conduction thresholds at the frequencies of 250 - 4,000 Hz. Clinical data, such as chelating agent dose, duration, and hearing status, were recorded. Demographic characteristics, like age, gender, height, and weight, were noted. The hemoglobin and serum ferritin levels of the subjects were also included.ResultsForty-five percent of cases of thalassemia were suffering from SNHL. In the right ear, the Pearson correlation of chelating agent dose (mg) with SNHL was mildly positive and statistically significant (r = 0.261, p < 0.001), (r = 0.337, p < 0.001), (r = 0.198, p = 0.005), and (r = 0.207, p = 0.003) at the frequencies of 250, 500, 1,000, and 2,000 Hz, respectively, and the Pearson correlation of chelating agent used (in months) with SNHL was mildly positive and statistically significant (r = 0.232, p = 0.001), and (r = 0.301, p < 0.001) at frequencies 250 to 500 Hz, respectively. In the left ear, the Pearson correlation of chelating agent dose (mg) with SNHL was mildly positive and statistically significant, (r = 0.191, p = 0.007), (r = 0.202, p = 0.004), (r = 0.297, p < 0.001), (r = 0.183, p = 0.010) and (r = 0.221, p = 0.002) at frequencies 250, 500, 1,000, 2,000, and 4,000 Hz, respectively, and Pearson correlation of chelating agent used (months) with SNHL was mildly positive and statistically significant only at the frequency of 2,000 Hz (r = 140, p = 0.049). ConclusionChelation therapy and regular blood transfusions, apart from prolonging the life of thalassemic patients, also leads to some complications. With this survey, it was concluded that almost half of the patients had normal hearing, while the other half had sensorineural hearing loss after the use of deferasirox. It is inferred that the incidence of SNHL is not only dose-related but the duration of use of a chelating agent is also a contributing factor.

Introduction While computed tomography (CT) guided lung biopsy has been standard in histological diagnosis of pulmonary lesions, its use is limited to the interventional radiologists only. Ultrasound (US) guided biopsy of pulmonary lesions, which can be performed in-clinic by the pulmonologists only, is becoming a more popular technique. It also has the edge of real-time techniques, multi-planar imaging, and no radiation exposure to the patients. Methods This is a retrospective review of all the patients presenting with pleural-based lung lesions who underwent US-guided biopsy for diagnosis in the Department of Pulmonology, Liaquat University of Medical and Health Sciences Hospital, Hyderabad, Pakistan from 1 st January 2013 till 31 st December 2017. The diagnostic yield, sensitivity, specificity, and accuracy of US-guided biopsies were evaluated for diagnoses of peripheral lung malignancies. Results Ultrasound-guided biopsies for lung lesions has a diagnostic yield of 88.3%, sensitivity of 95.80%, and specificity of 90% with an accuracy of 95.35%. Pneumothorax as an immediate complication was seen only in 1.5% cases. Conclusion US-guided biopsies are a much safer diagnostic alternative to CT-guided biopsy for lung lesions and have high diagnostic yield. It doesn’t require special radiological interventionists, can be performed at patients' bedsides, and the equipment is not as expensive.

Introduction Maintenance therapy of asthma has a crucial role in keeping the disease dormant and preventing frequent acute exacerbations. Asthma control may be achieved by inhaled corticosteroids (ICS) and/or long-acting beta-agonists (LABA). Leukotriene receptor antagonist-montelukast-may be added as an add-on to ICS/LABA or may also be given in monotherapy. The aim of this study was to evaluate the role of montelukast monotherapy as asthma control and its impact on the quality of life of these patients. Methods In this prospective, open-label, interventional study, montelukast 10 mg once daily was given to patients with mild to moderate persistent asthma for four weeks. Quality of life (QOL) was assessed on the Asthma Quality of Life Questionnaire-Standard (AQLQ-S) questionnaire. Asthma control was assessed on the Asthma Control Test (ACT). Data was entered and analyzed using SPSS version 23.0. Results On AQLQ-S, overall QOL improved with one month of montelukast therapy significantly. On sub-scales, except for emotional function, all other three sub-scales including symptoms, activity limitation, and environmental function improved significantly. Asthma control score also significantly improved with one month of montelukast therapy. Conclusion Montelukast has an effective role in asthma control and improvement of QOL in patients with mild to moderate persistent asthma.

Headaches due to migraine are the second leading cause of disability in the world. Migraine can be classified as episodic migraine (EM) and chronic migraine (CM). The course of the disease starts from an aura followed by 4-72 hours of bouts of throbbing, mostly unilateral headache associated with nausea, photo/phonophobia with/without neurological deficit. The pathophysiology of migraine remains debatable and many drugs are used to help control migraine attacks with little or no benefit. However, patient compliance remains a reason for over and underdosing of these medications. The calcitonin gene-related peptide (CGRP), a vasoactive peptide is known to contribute to the disease course. Much work is done on antagonizing the receptor or the molecule itself. For this purpose, genetically engineered monoclonal antibodies are being utilized for long-term reduction in morbidity and prevention of migraine headaches. The four to name are: galcanezumab, fremanezumab, eptinezumab, and erenumab. The purpose of this review is to shed light on the use of these monoclonal antibodies, completed and recruiting trials, and the role of these medications in the prevention of not only EM and CM but also in medication overuse headaches.