Regular exercise plays an essential role in maintaining healthy neurocognitive function and central nervous system (CNS) immuno-metabolism in the aging CNS. Physical activity decreases the risk of developing Alzheimer's Disease (AD), is associated with better AD prognosis, and positively affects cognitive function in AD patients. Skeletal muscle is an important secretory organ, communicating proteotoxic and metabolic stress to distant tissues, including the CNS, through the secretion of bioactive molecules collectively known as myokines. Skeletal muscle undergoes significant physical and metabolic remodeling during exercise, including alterations in myokine expression profiles. This suggests that changes in myokine and myometabolite secretion may underlie the well-documented benefits of exercise in AD. However, to date, very few studies have focused on specific alterations in skeletal muscle-originating secreted factors and their potential neuroprotective effects in AD. In this review, we discuss exercise therapy for AD prevention and intervention, and propose the use of circulating myokines as novel therapeutic tools for modifying AD progression.

Background: Patients with chronic liver disease are immunocompromised and prone to different opportunistic infections. Fungal infections in patients admitted with liver cirrhosis are not rare and they may increase mortality and morbidity of these patients. Aims of the study is to determine the mortality and its risk factors associated with fungal infections in patients with chronic liver disease.Methods: In this retrospective study, patients admitted with chronic liver disease during the last four years on this hospital were studied for diagnosed fungal infections. A matched control group of cirrhosis patients with a ratio of 1:2 admitted without fungal infections was also studied and mortality was compared between the two groups.Results: Seventy admitted patients of liver cirrhosis with microbial and histopathological evidence of fungal infection were found while 140 patients of the control group had no evidence of fungal infection. Hepatitis C virus infection was the major cause of cirrhosis (65%) and most of the patients were in child class C(63%). Urinary tract infection, esophageal candidiasis, and mucormycosis were major fungal infections. Mortality was much higher in the fungal infections group (34.3%) as compared to the non-infectious group (16%). On multivariate analysis, high WBCs count, hypo-albuminemia and high creatinine levels were the worst factors affecting mortality.Conclusions: Fungal infections are a significant cause of morbidity and mortality in patients with decompensated cirrhosis. Advanced cirrhosis, renal insufficiency, and leucocytosis are independent predictors of fatal outcome in these patients.

Many modifications have been introduced in the field of medical education in recent past with a shift from didactic to more student focused teaching strategies. Modular study system for final year MBBS students was introduced in the subject of Obstetrics and Gynecology in 2018 session. Objectives: To determine the students′ perception about modular teaching and various instructional strategies through feedback in the subject of Obstetrics and Gynecology at undergraduate level. Study Design: Cross sectional study. Setting: University Medical and Dental College, Faisalabad. Period: 1st January to 30th October 2018. Material & Methods: Eight modules were designed in the subject of obstetrics and gynecology for final year MBBS students. In order to ascertain the quality of teaching and to monitor the effectiveness of teaching methodologies, feedback was obtained.  A written questionnaire was designed to collect feedback. Interpretation of collected data was performed on SPSS 20. Results: Total 136 students participated in study by giving back properly filled questionnaire. Modular teaching was appreciated as an effective method by 93.4% students. Case based teaching, small group sessions and problem based learning were considered most favored teaching methods (97.7%, 97.1% and 94.85%) respectively by the students. Conclusion: Modular teaching was found to be an interesting and a useful teaching - learning experience by majority of students. Almost all students showed positive acceptance for various teaching methods. Students’ feedback was also useful in identifying course components that need improvement so that appropriate measures can be made to improve the overall quality and effectiveness of the course in future.

Objective: To find out the frequency of major categories of stroke (i.e. cerebral infarction, intracerebral hemorrhage and sub-arachnoid hemorrhage) Design: A descriptive study. Place & Duration of Study:Medical unit III Allied Hospital Faisalabad from January 2005 to June 2005. Patients and Methods: 112 patients wereenrolled after taking verbal consent. After complete physical examination and investigations a sample size of 100patients was calculated using 5% level of significant and margin of error as 5%. Results: This study revealed frequencydistribution of various categories of stroke as cerebral infarction 62 cases (62%), cerebral haemorrhage 30 cases (30%)and sub-arachnoid haemorrhage 8 cases (8%) out of 100 cases in total. Conclusion: Intra-cerebral bleed has got ahigher trend in Asia than in western countries and is more common in female gender while cerebral infarction is morecommon in males and its frequency although the highest among the major categories of stroke in Asia but relativelyless as compared to that in western countries.

Background: To find out the causes of Acute Kidney Injury (AKI) in population.Methods: A total of 150 patients were enrolled from medical, surgical, gynecology and obstetrics units of Allied Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. History, physical examination and investigations were recorded on specially designed proforma. Patients were evaluated to find out the etiologies of AKI. All patients were subjected to urine analysis, complete blood count, blood biochemistry (urea, creatinine, electrolytes, uric acid, calcium and phosphorus) and ultrasound scan of the abdomen and pelvis. Renal biopsy, immunological assays, such as hepatitis B surface antigen, anti-hepatitis C virus antibody, complements level, antinuclear antibody, anti-double-stranded DNA, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody were performed in selected cases.Results: Male (36%) and female (64%). Pre-renal AKI was most common and was reported in 80 patients (53.33%). Intrinsic Renal azotemia in 56 patients (37.33%). Post renal azotemia in 14 patients (9.33%). Among 80 patients of prerenal AKI, hemorrhage in 45(56.25%), gastroenteritis in 16(20%), sepsis in 8(10%), cardiac diseases in 4(5%), hepatorenal syndrome in 3 (3.75%), peritonitis in 2 (2.50%) and burns in 2(2.50%) were the main causes of Pre-renal AKI. Among 56 patients of intrinsic renal AKI, 40(71.4%) had acute tubular necrosis (ATN), 12(21.4%) with multifactorial causes and 4(7.14%) were found to have glomerulonephritis. Among 14 patients of post renal AKI, 6(42.9%) were having calculi, 6(42.9%) were to have enlarged prostate and 2(4.3%) were having stricture urethra. In this study, contribution of obstetrical, medical and surgical etiologies were recorded as 40%, 36% and 20% respectively.Conclusions: In contrast to study reported from neighbouring country, this study shows rather increase in pregnancy related AKI.