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Pulse oximeters are widely used in hospitals and homes for measurement of blood oxygen saturation level (SpO 2 ) and heart rate (HR). Concern has been raised regarding a possible bias in obtaining pulse oximeter measurements from different fingertips and the potential effect of skin pigmentation (white, brown, and dark). In this study, we obtained 600 SpO 2 measurements from 20 volunteers using three UK NHS-approved commercial pulse oximeters alongside our custom-developed sensor, and used the Munsell colour system (5YR and 7.5YR cards) to classify the participants' skin pigmentation into three distinct categories (white, brown, and dark). The statistical analysis using ANOVA post hoc tests (Bonferroni correction), a Bland-Altman plot, and a correlation test were then carried out to determine if there was clinical significance in measuring the SpO 2 from different fingertips and to highlight if skin pigmentation affects the accuracy of SpO 2 measurement. The results indicate that although the three commercial pulse oximeters had different means and standard deviations, these differences had no clinical significance.

Objective: To determine the efficacy of preoperative Tranexamic Acid (TXA) in reducing perioperative allogenic blood transfusion frequency in patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS)., Methods: We conducted this placebo controlled double-blinded randomized trial in Orthopaedics & Traumatolgy Division Lady Reading Hospital, Peshawar from 1 st January 2020 to 25 th December 2022. All patients with intertrochanteric hip fractures fulfilling the inclusion criteria were treated with Dynamic Hip Screw (DHS) and were randomly divided into two equal groups. One group was administered single dose IV Tranexamic Acid (TXA) in a dose of 15mg/kg body weight in 100ml of saline while the other group (Placebo) was given 100 ml normal saline preoperatively. Post-operative Hemoglobin was measured on first, second and third day. The frequency of allogenic blood transfusions in the perioperative period was determined in both groups based upon the transfusion trigger (Hemoglobin 9g/dl). Categorical variables were compared with Chi-square test and mean with Independent sample t-test. P value of <0.05 was considered significant., Results: The total number of patients in our trial were 200 which were equally but randomly allocated into TXA group and Placebo group each containing 100 patients. The mean age of the patients in TXA group was 48.16±1.75 years and the age of patients in the Placebo group was 48.35±1.60. The baseline demographic and clinical variables of both groups were identical ( p < 0.05). The average preoperative hemoglobin was 11.5±4.2 g/dl in TXA group and 11.3±2.4g/dl in the Placebo group (p>0.05). The frequency of allogenic blood transfusion was significantly lower ( p <0.05) in TXA group (13%, n=13) than in the Placebo group (41%, n=41)., Conclusion: Tranexamic acid (TXA) significantly reduces the frequency of peri operative allogenic blood transfusion in patients undergoing Dynamic Hip Screw (DHS) for intertrochanteric fractures., (Copyright: © Pakistan Journal of Medical Sciences.)

Reduction in friction ensures fuel economy, control on emissions and durability of components in internal combustion engines. A modern gasoline internal combustion engine was instrumented to determine the friction values at the cam-roller interface considering the effects of surface treatment and engine operating state. A series of tests under different operating speeds and lubricant inlet temperatures were undertaken using both an original surface roller and a Wonder Process Craft (WPC) surface-treated engine roller. The results clearly revealed a substantial reduction in friction magnitude for the WPC surface-treated engine roller in comparison to the original roller while operating under similar conditions, indicating their strong potential for employment in engines. An increase in friction with the rise in temperature was also observed for both types of rollers, whereas increased lubricant entraining velocity due to higher operating speed had the opposite impact. A considerable reduction in frictional drive torque ranging from 8% to 28% was observed by employing the WPC-treated roller in comparison to original/untreated roller at various operating conditions, which signifies the strong potential for employment of WPC surface treatment in the roller/follower valve train engines.

Introduction: Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan., Methods: DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500 cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology., Results and Discussion: Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings., Conclusion: DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To compare long working length distal femoral locking plates with short working length for treating extra-articular distal femur fractures in terms of union and implant failure., Methods: The randomised controlled trial was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from April 28, 2018, to March 10, 2021, and comprised all adult patients of either gender with extra-articular distal femur fractures who were randomised into two groups. Group A was exposed to long working length, while group B had short working length. Patients in both the groups were followed up regularly for one year for the assessment of fracture union and implant failure. Data was analysed using SPSS 22., Results: In the group of the 61 patients, 30(49.2%) were in group A; 24(80%) males and 6(20%) females with overall mean age of 37.9±9.6 years. The remaining 31(50.8%) were in group B; 26(83.8%) males and 5(16.1%) females with overall mean age of 37.2±1 years. The mean working length in group A was 75±5mm and in group B it was 35±9mm. In group A 28(93.3%) fractures healed, while in group B 19(61.2%) fractures achieved union (p=0.01). Non-union was noted in 2(6.6%) patients in group A and 7(22.5%) in group B (p=0.08). Plate breakage was noted in 3(9.6%) patients and screw breakage in 2(6.4%) patients in group B and none in group A (p=0.0001)., Conclusions: Long working length titanium locking plates were found to be better than short working length in achieving fracture union and avoiding implant failure.

In the present study, a method for the determination of residues of the neonicotinoid insecticides thiamethoxam and imidacloprid in the stingless bee Melipona scutellaris Latreille (1811) was optimized through a factorial design, tested using green metrics, and then applied to exposed bees. It combines the extraction with a modified quick, easy, cheap, effective, rugged, and safe method and the determination by liquid chromatography-tandem mass spectrometry analysis. Different parameters such as the mass of the sample, dispersive sorbents, and elution solvents were assessed. Method validation parameters were checked and include sensitivity, specificity, and linearity. The limit of quantification of 0.0025 μg g -1 was obtained for both insecticides, where accuracy was 94%-100% with satisfactory intraday and interday precisions (relative standard deviation <10%). The qualified method was applied to orally and topically exposed bee samples, and the results indicated that it is suitable for the determination and quantification of neonicotinoid pesticide residues in this species. Moreover, green analytical metrics like the National Environmental Methods Index, Eco Scale score, high-performance liquid chromatography with an environmental assessment tool (HPLC-EAT), waste generation, and amount of sample were compared with methods described in the literature involving neonicotinoid analysis in honeybees. As a result, the present study displayed the highest Eco Scale score and HPLC-EAT score and the second smallest amount of sample and waste generated. Thus, the method meets green analytical metrics more than other methods. In this sense, besides the application, the multicriteria decision analysis tool employed suggests that this is a good option as a green analytical method. Environ Toxicol Chem 2022;41:2365-2374. © 2022 SETAC., (© 2022 SETAC.)

The environmental concerns associated with artificially formulated engine oils have forced a shift towards bio-based lubricants. The deposition of hard coatings on engine components and migrating to environmentally friendly green lubricants can help in this regard. Chemically modified forms of vegetable oils, with better low-temperature characteristics and enhanced thermo-oxidative stability, are suitable substitutes to conventional lubricant base oils. The research presented in this manuscript was undertaken to experimentally investigate the wear and friction performance of a possible future generation of an environmentally friendly bio-based lubricant as a potential replacement for conventional engine lubricants. In order to quantify the tribological benefits which can be gained by the deposition of DLC coatings, (an (a-C:H) hydrogenated DLC coating and an (a-C:H:W) tungsten-doped DLC coating) were applied on the cam/tappet interface of a direct acting valve train assembly of an internal combustion engine. The tribological correlation between DLC-coated engine components, lubricant base oils and lubricant additives have been thoroughly investigated in this study using actual engine operating conditions. Two additive-free base oils (polyalphaolefines (PAO) and chemically-modified palm oil (TMP)) and two multi-additive-containing lubricants were used in this investigation. Real-time drive torque was measured to determine the friction force, detailed post-test analysis was performed, which involved the use of a specialized jig to measure camlobe wear. An optical profilometer was used to measure the wear on the tappet, high-resolution scanning electron microscopy was employed to study the wear mechanism and energy-dispersive X-ray spectroscopy was performed on the tested samples to qualitatively access the degradation of the coating. When using additive-free TMP, a low friction coefficient was observed for the cam/tappet interface. The presence of additives further improved the friction characteristics of TMP, resulting in reduced average friction torque values. A tremendous enhancement in wear performance was recorded with a-C:H-coated parts and the coating was able to withstand the test conditions with little or no delamination.

Objectives: To determine the clinical and radiological outcome of proximal femur shaft fractures in school going children treated with locking compression plates (LCP)., Methods: This descriptive study was conducted in Orthopaedic Division Lady Ready Reading Hospital Peshawar from 25 th June 2018 to 25 th September 2020. Children of either gender and age 6 to 12 years old with subtrochanteric and proximal one third femur factures fulfilling the inclusion criteria were enrolled in this study. Open reduction and internal fixation with 4.5 mm narrow locking compression plates (LCP) were done in all. Post operative clinical outcome was evaluated by using Flynn scoring system and graded as excellent, satisfactory and poo results. Radiological assessment of fracture union was done through anteroposterior (AP) and lateral X-ray radiographs., Results: A total of 60 children with mean age 9.01±1.61 SD (range 6 to 12 years) were included in our study. Oblique fractures were present in 23(38.3%) children, spiral in 20(33.3%), transverse in 11(18.3%) and comminuted in 6 (10%) children. The radiological union time was 13.3±1.2 weeks (range 9.4 to 18 weeks). Majority (88.3%, n=53) of children had excellent clinical outcome according to Flynn's scoring system while satisfactory outcome was noted in 7(11.6%) children. No cases of delayed union, mal union, nonunion and implant failure was reported., Conclusion: The results of our study indicated that proximal femoral shaft fractures in school going children treated with locking compression plates had excellent clinical and radiological outcome. We therefore recommend locking compression plate as the implant of choice to fix proximal femoral shaft fractures in school going children., (Copyright: © Pakistan Journal of Medical Sciences.)

In this paper, we have focused on machine learning (ML) feature selection (FS) algorithms for identifying and diagnosing multidrug-resistant (MDR) tuberculosis (TB). MDR-TB is a universal public health problem, and its early detection has been one of the burning issues. The present study has been conducted in the Malakand Division of Khyber Pakhtunkhwa, Pakistan, to further add to the knowledge on the disease and to deal with the issues of identification and early detection of MDR-TB by ML algorithms. These models also identify the most important factors causing MDR-TB infection whose study gives additional insights into the matter. ML algorithms such as random forest, k-nearest neighbors, support vector machine, logistic regression, leaset absolute shrinkage and selection operator (LASSO), artificial neural networks (ANNs), and decision trees are applied to analyse the case-control dataset. This study reveals that close contacts of MDR-TB patients, smoking, depression, previous TB history, improper treatment, and interruption in first-line TB treatment have a great impact on the status of MDR. Accordingly, weight loss, chest pain, hemoptysis, and fatigue are important symptoms. Based on accuracy, sensitivity, and specificity, SVM and RF are the suggested models to be used for patients' classifications., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Mian Haider Ali et al.)

Background: Osmotic pretreatment is an effective processing unit for improving the textural quality of dried fruit and vegetable snacks, whereas nutrition loss and high calorie after impregnation is still a noteworthy shortcoming of sugar-immersed products. Therefore, the use of apple juice concentrate as a clean label solution to improve the qualities of instant controlled pressure drop (DIC)-dried carrot chips was investigated., Results: Apple juice concentrate impregnation substantially enhanced the physical properties of the carrot chips, including hardness (38.28 N), crispness (2.01 mm), porosity (66.72%) and homogeneous microstructure, comparable to chips obtained using sucrose and maltiltol based osmotic solutions. Additionally, compared to the sucrose and maltiltol impregnated chips, a higher retention of carotenoids (302.81 μg g -1 , dry basis), a higher multiplicity of phenolic compounds, stronger antioxidant activities and a superior sensory score were observed in the chips pretreated with apple juice concentrate., Conclusion: Apple juice concentrate could be used as a clean label osmotic solution to enhance the organoleptic attributes and fortify the nutritional properties of DIC-dried carrot snacks. © 2019 Society of Chemical Industry., (© 2019 Society of Chemical Industry.)

Objective: To analyze the contents and format of peer review proforma of Medical journals of Pakistan., Methods: This descriptive study was conducted in the Department of Orthopaedics and Traumatology Lady reading Hospital Peshawar Pakistan from 3 rd August 2018 to 9 th February 2019.An email was sent to the chief editors of all the medical journals listed on the official website (www.pmdc.org.pk) of Pakistan Medical and Dental Council (PM&DC).They were requested to send peer review proformas of their journals. The received proformas were analyzed for major contents and format or style. The proforma had a structured format when each portion of the manuscript i.e, title, abstract, key words, methodology, results, discussion, conclusion and references were individually sectioned for evaluation. Whereas in the unstructured proformas the reviewer was asked to assess the manuscript as a whole., Results: We received 41 proformas via emails. Majority (82.9%) of the proformas were structured while 17% were unstructured. A scoring or rating system for the manuscript was present in 31.7% of the proformas while 43.9% of the proformas were without any scoring system. Guidelines for the peer reviewers were given in 58.5% of the proformas. The peer review policy (closed or open) was mentioned in only 7.3%.About 9.7% of the proformas asked the reviewers to disclose conflict of interests., Conclusion: A spectrum of contents and format of peer review proformas of medical journals were observed. We found structured peer review proforma with a scoring scale comprehensive and more appropriate for peer review.

Objective: To determine the frequency of pin tract infection in external fixator tibia and its effects on the definite fracture fixation and bone healing., Methods: The prospective study was conducted at Lady Reading Hospital, Peshawar, Pakistan, from August 2017 to July 2018, and comprised patients regardless of age and gender with open fracture tibia Gustillo-Anderson type II and type IIIA. Pin tract infection was assessed following the application of locally made external fixation of tibia open fractures. Follow-up was done fortnightly till soft tissue healing, removal of external fixator and definite fracture healing. Pin tract infection was classifiedand treated according to the Checketts-Otterburn classification system. SPSS 20 was used for data analysis., Results: Of the 117 patients, 95(81%) were males and 22(19%) were females with an overall mean age of 24.7±9.35 years. Pin tract infection was documented in 28(23.9%) patients. Minor and major pin tract infections were reported in 27(96.4%) and 1(3.5%) patient respectively. Soft tissues healed in 27(96.4%) cases., Conclusion: External fixator for initial stabilisation of open tibial fractures in all patients is recommended..

Münchausen Syndrome by Proxy (MSBP) is a psychiatric disorder characterised by the adoption of bizarre behavioural-patterns by caregivers in which diseases or disorders are fabricated in individuals, usually children, for purposes which span feelings of superiority derived from deceit of persons deemed superior to the caregiver, or attention seeking. The patient under discussion was a 6 year old male brought to the hospital by his mother with complaints of repetitive and unceasing passing of stones per urethra. Upon inspection of stone specimens brought in by the parents and physical examination, the stones in question were observed to be common stones, with no reason to suggest a urolithiatic origin, leading to the suspicion of MSBP. Further questioning of both the mother and father revealed more information regarding the cause of her child's illness and strongly suggested that the stones were being physically inserted into the child's urethra by the mother--often in the father's absence--after administration of sedative-hynotic drugs.

Ureteral triplication is a rare congenital anomaly of the urinary tract. Since the first description by Warny in 1870, approximately 100 known cases have been reported in the literature, often accompanied by a variety of associated anomalies in contralateral kidney. This report presents a case of ureteral triplication with contralateral duplication and vesicoureteral reflux (VUR) of the upper moiety on the triplicate side. The patient was a 10 year old male who presented with a history of recurrent urinary tract infections and right loin pain. ACT urogram was performed which showed a triplicate right ureter with gross hydroureter of the upper moiety. There was a duplex system present on the left side. The patient underwent right upper pole heminephroureterectomy.

Background: Talipes Equino-Varus (TEV) is one of the most common congenital anomaly. It is managed by various methods, i.e., conservative & surgery. Objective of this study was to determine the efficacy of modified Turco's postero-medical release in children's having congenital TEV., Methods: This descriptive observational study was conducted from June 2004 to June 2008 in the Orthopaedics Unit of Lady Reading Hospital (LRH) Peshawar. The inclusion criteria were children of age 6 months to 3 years of age having moderate and severe club foot. The exclusion criteria were clubfoot secondary to some other disorders such as cerebral palsy, arthrogryphosis multiplex congenita, myelodysplasia or congenital dislocation of the hip. The deformity was treated by modified Turco's one stage release. Follow-up was for one year. Results were graded according to modified McKay rating system., Results: A total 70 patients were included in this study with the age range of 6 months to 3 years with moderate to sever deformity. Thirty-eight, were male (54.2%) and 32 patients (45.72%) were female, twenty three patients (32.85%) had bilateral club foot while the rest of 47 patients (67.15%) had unilateral deformity. Positive family history of club foot was in 10 patients (14.2%). Results were concluded on 52 patients who completed one year follow-up. Excellent results were observed in 34 patients (65.38%), good in 9 patients (17.30%), fair in 2 patients (3.84%), and poor in 7 patients (13.46%)., Conclusion: Children up to three years age with congenital TEV can be successfully treated in almost all the cases by modified Turco's one stage postero-medial release.

Background: Femoral shaft fractures are common in adult population due to vulnerability to road traffic accident and firearm injuries. There are various treatment modalities to treat the femur shaft fracture, i.e., Plating & screws, Intramedullary nailing, External fixator and Interlocking nails. Comminuted fractures due to gun shot injuries are a challenging problem for orthopaedic surgeons. The objective of this study is to evaluate the role of interlocking nailing in the management of femoral fractures due to high velocity gunshot injuries., Methods: This descriptive study was conducted on 68 patients at Orthopaedic unit Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2002 to March 2004. The patients of each gender from age fifteen years onward having femoral shaft fracture due to high velocity gunshot injuries who had not previous surgical intervention were included in the study. The exclusion criteria were intertrochanteric, supracondylar femoral fractures and those who failed the follow-up. All the patients were treated with close or open interlocking nails. The outcome measures were graded excellent, good and poor according to radiological and clinical results. Follow-up was for eighteen months and in some cases up to thirty months., Results: Out of 68 patients 64 (94.12%) were male and 4 (5.88%) were female patients. The age range was from 15 to 65 years (average age of twenty nine years. The close interlocking nails were done in 64 patients (94.12%) and open interlocking nails were done in 4 patients (5.88%). The static interlocking nailing was performed in 58 patients (85.29%) while dynamic interlocking nailing was performed in 10 patients (14.71%). Knee flexion contracture in 5 cases (7.35%) and limb shortening of less than 2 Cm in 2 patients (2.94%). Non-union were in 4 cases (5.88%). Excellent results were in 42 patients (61.76%), good in 18 patients (26.47%) and poor in 8 patients (11.77%)., Conclusion: Interlocking nailing is one of the best options for the management of femoral shaft fractures due to high velocity gunshot injuries.

Background: Infection in orthopedic surgery is a disaster both for the patient and surgeon. Although its incidence has been reduced due to modern theatre facilities and aseptic measures but in developing countries its prevalence is still high. It is better to prevent infection rather than to treat it. The objective of this study is to know the frequency of infection in orthopedic implant surgery in a public hospital and to evaluate the risk factors, causative organism, complications and treatment., Methods: This prospective study was conducted in orthopedic unit-B Ayub Teaching Hospital, Abbottabad, from 1st April 2007 to 30th October 2007. Close fracture cases admitted for internal fixation devices were included. The exclusion criteria were soft tissue surgery, wounds and open fractures needing external fixation devices. The follow up was done for six months., Results: Infection developed in 6 patients (5.76%), out of which superficial and deep infections were 2 (1.92%) and 4 (3.84%) respectively. There were 2 infection cases in each stage of the infection i.e. early, delayed and late. The staphylococcus aureus was the commonest organism, i.e., 3 (50%) out of 6. The age of the patients was more than 60 years in 3 (2.88%) patients, 30 to 60 years in 2 (1.92%) patients and below 30 year in 1 (0.96%) patient. The smoking history was in 2 (1.92%) patients., Conclusion: Infection rate in our study was quite high and needs proper measures to control it because it had great financial burden on patient and on hospital resources and could lead to morbidity and mortality in patients. We could not find significant risk factors in our small sample size study although the infection was relatively more common in patients with advanced age, prolonged surgery time, smoking and skin abrasion at fracture site. Commonest organism was Staphylococcus aureus.

Background: In Children Supracondylar fracture of humerus is one of the most common fractures in first decade of life. There are various treatment modalities for this fracture i.e. Close reduction and casting, open reduction and internal fixation, skeletal traction and Percutaneous Pinning. This study was conducted to know the outcome of Percutaneous Pinning in the management of displaced supracondylar humeral fracture in children and to compare the results with close reduction and castings and published literature., Methods: This descriptive study was conducted in Orthopaedic department of Ayub Teaching Hospital Abbottabad and Lady Reading Hospital, Peshawar from January 2002 till December 2003 on 40 children. Patients included were of either gender with age range from 3 to 12 years with displaced supracondylar fracture presenting within 72 hours of injury. Two treatment modalities were studied for comparison. Cross k-wires fixation through each humeral condyle was done after closed reduction of fracture under image intensifier in general anesthesia. Casting/Backslab was applied after reduction of fracture without image intensifier under anesthesia or analgesia. Out come measures were according to Flynn criteria that are functional and cosmetic factor which is based on loss of elbow motion and carrying angle in degrees respectively., Results: Cross percutaneous pinning gave excellent results in 13 (65%), good outcome in 4 (20%) and poor outcome in 3 (15%) patients. While patients treated with close reduction and casting showed excellent results in 4 patients (20%), good in 8 patients (40%), fair in 2 patients (10%) and poor in 6 patients (30%)., Conclusion: Closed reduction and cross percutaneous pinning for displaced supracondylar humerus fractures in children is safe, cost and time effective method and gives stable fixation with excellent outcome as compared to close reduction and casting.

Bochdalek hernia is a rare condition that usually presents in the neonatal age. Rarely it presents late and is usually misdiagnosed. We came across a Bochdalek hernia, which presented at the age of 15 years and was initially misdiagnosed as pulmonary tuberculosis. The case history, diagnosis and management of this condition along with literature review are presented here.