Xylazine, the new “zombie drug” is a veterinary medicine utilized for anesthesia, sedation, muscle relaxation and pain relief, to facilitate the approach of medical examinations, X rays, minor superficial surgeries, and any other painful manipulative procedure across a variety of species. Xylazine use as an adulterant among other drugs of abuse like heroin and fentanyl was first reported in Puerto Rico in 2006. Over time it has made its way to illicit drug trades, implicated in xylazine-positive overdose deaths. It acts as an ‘Alpha 2 Adrenergic Agonist’ and accelerates the activation of ‘inhibitory neurons’ in CNS. Owing to its inhibitory effects, prolonged duration of action and easy accessibility, xylazine serves widely as a recreational drug. Its long-drawn abuse aggravates toxic effects including hypotension, necrotic skin lesion, respiratory and CNS depression and cardiac arrest. Xylazine, a veterinary tranquilizer, not approved for human use by the FDA has emerged as a new drug of abuse on the streets. Multiple studies suggest a high rise in xylazine associated overdose deaths especially in the United States due to its endemic region of Puerto Rico, where it is widely and easily available. FDA has issued a high alert highlighting rise in “zombie drug” abuse. Awareness of xylazine and its fatal outcomes among public is of immense importance in preventing its abuse.

Key Clinical Message Significant atypical neurologic signs have also been recorded in COVID‐19 individuals, along with a variety of other extra‐pulmonary indications. The COVID‐19 virus is neuro‐invasive and holds significant potential to produce some unconventional neurologic manifestations

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997–2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%–91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Dry eye disease (DED) or keratoconjunctivitis sicca (KCS) is a multifactorial disease that classically develops due to the hyperosmolarity of the tear film. Categorically divided into two types, based on decreased production and increased evaporation of the tear film, DED begins with a spectrum of nonspecific symptoms like pruritus, redness, burning and discomfort, progressively leading to stringy mucus eye discharge, photophobia, twitching, visual fluctuations, and punctate epithelial lesions. This disease has numerous treatment options, including medications, artificial tear inducers, and surgical manoeuvres that prevent water loss from the tear film. However, each of these treatment options has its limitations. The Food and Drug Administration (FDA) has approved another intervention, Meibo (perfluorohexyloctane), as a choice of management for dry eye disease. With its shielding action on the ocular surface, Meibo (perfluorohexyloctane) reduces desiccation stress-induced ocular damage, making it highly specific for treating DED. Available in an eye drop formulation of perfluorohexyloctane (PFHO), these drops can reduce saline evaporation by up to 80%. The methods we used for this analysis are literature searches from PubMed, Medline and Google Scholar. This study aims to scour varying differentials of DED, its aetiology, general interventions, the latest refinements, and clinical efficacy, safety, and trials associated with Meibo (perfluorohexyloctane) in the management of DED.

BACKGROUND:Virtual multidisciplinary team meetings (VMDTM) provide a standard of care that is not limited by physical distance or social restrictions. And so, when the COVID-19 pandemic imposed irrefutable social restrictions and made in-person meetings impossible, many hospitals switched to the VMDTMs. Although the pandemic might have highlighted the ease of VMDTMs, these virtual meetings have existed over the past decade, albeit less in importance. Despite their recent importance, no review has previously assessed the feasibility of VMDTMs through the eyes of the participants, the barriers participants face, nor their comparison with the in-person format. We undertook this scoping review to map existing literature and assess the perspectives of VMDTM participants. MATERIAL AND METHODS:We searched MEDLINE, Embase, CINAHL, and Google Scholar from inception till July 1st, 2023 to select studies that evaluated the perspectives of participants of VMDTMs regarding the core components that make up a VMDMT. Four authors, independently, extracted data from all included studies. Two authors separated data into major themes and sub-themes. RESULTS:We identified six core, intrinsic aspects of a VMDTM that are essential to its structure: (1) organization, (2) case discussion and decision-making, (3) teamwork and communication, (4) training and education, (5) technology, and (6) patient-related aspect. VMDTMs have a high overall satisfaction rating amongst participants. The preference, however, is for a hybrid model of multidisciplinary teams. VMDTMs offer support to isolated physicians, help address complex cases, and offer information that may not be available elsewhere. The periodical nature of VMDTMs is appropriate for their consideration as CMEs. Adequate technology is paramount to the sustenance of the format. CONCLUSION:VMDTMs are efficient and offer a multidisciplinary consensus without geographical limitations. Despite certain technical and social limitations, VMDTM participants are highly satisfied with the format, although the preference lies with a hybrid model.

Breast cancer (BC) is the leading cause of cancer mortality in Pakistan and other South Asian countries. Recent statistics indicate an increased risk of BC incidence and mortality among women in this region. Many factors have been associated with increased mortality from this disease including late detection due to inadequate knowledge of screening, and financial constraints due to which many women do not undergo screening tests. Other causes that have led to the deterioration of the disease status among females include a lack of public knowledge of BC's symptoms and misconceptions taking root from cultural reasons. This situation has called into question the effectiveness of BC awareness campaigns, as they may not have achieved the desired results that were originally envisioned. In this paper, we highlight the shortcomings of the awareness campaigns in Pakistan: lack of BC knowledge, financial constraints, and inaccessible healthcare facilities; and suggest alternatives for reducing breast cancer incidence and mortality.

Multiple sclerosis (MS) is a chronic systemic autoimmune disorder characterized by plaques of demyelination, autoimmune inflammation, and astrocytic gliosis. The primary cells involved in the pathophysiology of MS are T cells. However, B cells have recently been implicated in the pathophysiology of the disease. Therefore, researchers have been exploring B cell therapy as an alternative treatment option for MS. B cell therapy is based on the targeted depletion of CD20-positive B cells. Rituximab, ocrelizumab, and ofatumumab are anti-CD20 antibodies already approved. Briumvi, the fourth type of anti-CD20 antibody was approved by FDA in December 2022, for the treatment of relapsing types of MS, including relapsing-remitting multiple sclerosis, active secondary progressive multiple sclerosis, and clinically isolated syndromes after the drug was tested in two randomized, double-blind, phase III, ULTIMATE I, and II trials which compared Briumvi (ublituximab) with Aubiago (teriflunomide). Ublituximab was found to have a much lower annual relapse rate in the ULTIMATE II trials than teriflunomide. Briumvi is a chimeric recombinant IgG1 monoclonal antibody directed against human CD20 with potential antineoplastic activity. Its mechanism of action involves several distinct processes that collectively lead to the depletion of B cells and suppression of the immune response. The primary mode of action of Briumvi is its high-affinity binding to CD20. Infusion-related reactions are the most common side effects encountered following intravenous administration of ublituximab.

Background: A converging epidemic of Latent tuberculosis infection (LTBI) is observed over past two decades. LTBI is a state of persistent immune stimulation by Mycobacterium tuberculosis but with no active clinical manifestation. Also, there has been as increasing trend for incidence of cardiovascular problems in patients suffering from latent TB infection. Reportedly, the risk of coronary artery disease spikes up to 1.52 times in patient with latent TB infection. Considering the fact that cardiovascular diseases account to be leading cause of death globally, we found a dire need to investigate the role of Latent TB infection in producing coronary artery disease and unveil this unconventional relationship. Purpose: We aim to conduct a meta-analysis to evaluate Latent TB infection as a predictor for coronary artery disease (CAD). Methods: A systemic search was conducted on electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 24th June 2022. Studies meeting predefined inclusion criteria underwent statistical analysis on Review Manager 5.4.1. We calculated odds ratio (OR) with 95% confidence intervals (CI) and graphically represented it through fixed-effect forest plot. Heterogeneity of I2>75% and p-value of p < 0.05 was considered to be significant. Results: Pooled analysis of four selected studies showed that patient with Latent TB infection significantly developed Coronary Artery Disease (OR = 2.15 [1.48, 3.12]; p < 0.0001; I2 = 0%) Conclusions: Latent TB infection can be a potential useful predictor for Coronary Artery Disease. However, there is need for further investigation on a greater number of studies before this can truly become clear.

Objectives: Cardiovascular disease (CVDs) is the leading cause of deaths globally. Apart from traditional risks, multiple indigenous factors are implicated to impact disease courses. Lifestyle factors distinct to South Asians may predispose to disease or serve a protective effect. Our study objective was to determine the Relationship of lifestyle and dietary habits of South-east Asian (Pakistani) population with cardiovascular diseases. Methodology: A case-control study was conducted from April to October 2021 in a two-thousand bedded university teaching hospital in Karachi, Pakistan. Out of 400 participants, 189 were cases with a documented cardiovascular event and 211 were controls. Participants >18 years were included whereas pregnant females and patients with congenital heart defects were excluded. A structured questionnaire was designed and implemented, and anthropometrics were recorded. Chi-square test, independent sample t-test and multivariate analysis were utilized via SPSSv23. P-value <0.05 was considered significant. Results: From 400 participants, 189 cases and 211 controls were identified. 53.4% of the people consuming open spices had CVDs while 46.6% did not. While only 37% of people using home cooked spices had CVDs with an OR= 0.51(0.3-0.84, 95% CI, p=0.08). Our results showed an inverse or no relationship of high BMI with CVDs. No statistically significant results were observed of diabetes and hypertension with CVDs. Conclusion: Based on our results, home grounded condiments have a protective effects on CVD than open spices. With reference to CVD, poor lifestyle habits and anthropometric profiles of our controls indicate a need for urgent preventive measures at population level.