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Objective: To assess the role of early triage and emergency obstetric care for high-risk pregnancies and their outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2021 to Jun 2022. Methodology: Women with high-risk pregnancies, aged 18-40 years, gestational age >28 weeks, were included. Emergency obstetric care was provided to participants of the study. Maternal outcome was assessed regarding their hospital stay duration, morbidity, mortality and mode of delivery. The fetal outcome was in terms of intra-uterine death (IUD), Early neonatal death (ENND), and live births. Results: The mean age of patients was 28.1±3.49 years. Most of the patients belonged to high-order cesarean section and hypertensive disorders of pregnancy. 94.3% were delivered by cesarean section due to obstetric reasons, and hospital stay was an average of> 72 hours in 57.7 %. Maternal mortality and morbidity were not observed. 99.9% of babies were live births, 0.7% ended into ENND, and one received an IUD. Conclusion: Early triage followed by the provision of emergency obstetric emergency care is recommended in high-risk pregnancies for optimum feto-maternal outcome.

Objective: To find the changing radiological pattern of COVID-19 on HRCT chest in vaccinated patients. Study Design: Observational, cross-sectional study. Place and Duration of Study: Combined Military Hospital, Sialkot Pakistan, from Jan to Feb 2022. Methodology: All patients referred for High-resolution computed tomography (HRCT) chest were included. All participants underwent HRCT chest after recording the demographic data. Computed tomography (CT) images were reviewed by an experienced radiologist for pulmonary involvement and determining the computed tomography severity score, which ranged from 0-40 points. Results: A total of 90 patients were included in the study. The mean age was 35.8±13.2 years. The number of partially vaccinated, fully vaccinated patients, and those with booster doses were 10(11.1%), 62(68.9%) and 18(20%), respectively. Patients with normal or non-specific findings on HRCT were 74(82.2%), and those with findings suggestive of COVID-19 pneumonitis were 16 (17.8%). The mean CT severity score among positive cases was 4.69±8.01, while the most frequent pulmonary finding was ground glass opacities found in 11(68.8%) cases. Conclusion: Vaccination reduces the frequency and severity of pulmonary involvement in cases with breakthrough COVID-19 though the presentation of the disease and pattern of the pulmonary involvement does not show much change.

Objective: To determine the effect of comprehensive campaign for dengue control in Southern Punjab, Pakistan. Study Design: Cross sectional study. Place and Duration of the Study: Station Health Organization Multan and Departments of Pathology, Combined Military Hospital Multan, from Mar 2019 to Dec 2020. Methodology: This study was conducted by implementing a comprehensive campaign by involvement of public health workers in high risk dengue area of Multan. There were five phases of this campaign; awareness, situation analysis, vector surveillance, indoor residual sprays where vector was found and contact tracing of dengue fever cases. The system was developed in 46 Mohallas/localities of Multan. Hot spot for mosquitoes breeding were identified at 15 places. Total of 23 health workers were recruited including 3 female workers. Insecticide spraying was carried out by indoor residual spray pumps & thermal foggers in a cyclic pattern. Results: During 2019, 42 larvae were identified followed by insecticide sprays & follow up visits; 26 cases of dengue fever were diagnosed and treated at CMH Multan in a dedicated dengue ward. Contact tracing was carried out and indoor residual sprays were carried out in 20 houses around residence of these cases. In 2020, 5 larvae were identified followed by sprays & follow up visits; 2 cases of dengue fever were diagnosed and treated. Conclusion: Comprehensive campaign against dengue fever was quite successful to control spread of dengue fever.

Objective: To determine important errors in initial Gram staining of clinical specimens and evaluate the types of Gram-stain errors. Study Design: Cross-sectional study. Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Aug 2018 to Feb 2019. Methodology: Gram staining and culture inoculation of all specimens were performed per recommended guidelines. The Gram stain results on day-0 were compared with the results of the culture on day-2. There was no discrepancy if similar organisms were obtained on culture as on Gram stain. Nevertheless, if the Gram stain and culture results were not similar, it was termed a discrepancy. The consultant microbiologist reviewed all discrepant slides, and if not resolved, possible causes of error were sought, and the results documented. Results: Of the total 300 clinical specimens, errors were observed in the initial gram staining of 29 specimens (9.7%), whereas 271(90.3%) specimens were error-free. Upon evaluating these 29 errors, 11(38.0%) were observer errors which were resolved when reviewed by a consultant microbiologist. 14(48.0%) were technical errors, and 4(14.0%) results were discrepant due to the presence of anaerobic organisms, missed on initial aerobic cultures. Conclusion: The frequency of Gram stain errors in our study (9.7%) is not very high; nevertheless, it can have severe consequences in critical samples from seriously ill patients if wrong empirical antimicrobial treatment is begun based on a wrong initial Gram stain result.

Placenta accrete spectrum (PAS) previously known as morbid adherent placenta, is a complex obstetric complication that has risen exponentially in the last couple of decades. It carries serious fetomaternal risk in terms of morbidity and mortality, also increasing perinatal mortality owing to prematurity. PAS include three variants depending upon the degree of placental penetration, i.e. accrete, increta and percreta. We highlighted the unique diagnostic criteria of the placenta accrete spectrum,which includes the history of incomplete removal of the placenta, with repeated evacuation, persistent vaginal bleeding and ultrasound evidence of retained products of conception.

Objective: To evaluate the clinic-pathological characteristics and their association with biopsy-proven glomerulonephritis in pediatric patients. Study Design: Prospective longitudinal study. Place and Duration of Study: Pediatric Department Nishtar Medical University, Multan Pakistan, from Jan 2014 to Dec 2019. Methodology: During the study, a total of 211 renal biopsy reports of different age groups were studied and analyzed for clinic-pathological features and patterns of direct immunofluorescence. Results: The mean age of 8.6±3.25 years was observed. The most common pathology was focal segmental glomerulo-sclerosis in 86 (40.76) of the patients, followed by mesangio-proliferative glomerulonephritis in 41 (19.43) of the patients. Minimal change disease was seen in 26 (12.32) cases. It was observed that the majority of the patients with diffuse proliferative glomerulonephritis were younger than 11 years old, whereas; 10 (11.2), patients with lupus nephritis, 11 (15.1) and membranous nephropathy, 10 (12.2) were comparatively older. Conclusion: Glomerulonephritis presents a diversified group of diseases with overlapping clinic-pathological features. The present study has reported many significant characteristics which could help diagnose a particular disorder among the pediatric population.

Abstract Objective: To find any association between presbyopia and usage of smart phones in Pakistani Population. Study Design: Prospective cross-sectional study. Place and Duration of Study: University of Health Sciences, Lahore, from Oct 2018 to Jul 2019. Methodology: Approval for this prospective cross-sectional study was obtained before hand from the Institutional Review Committee, University of Health Sciences Lahore. Questionnaire was made through Google docs. Data were assessed by using SPSS version-26. Frequency distributions of different demographic characteristics and those of patients’ history with the use of devices were calculated. Results: Median ± Interquartile of age was 36.50 ± 14 as it was not normally distributed variable. Mostly were males (78.9%). Majority belonged to age group of 41-50 years (44.7%). This study participants were mostly of the education group of masters or higher (>50%). About 35% of the study participants were suffering from presbyopia. Out of 182 participants who were suffering from presbyopia majority were using the glasses for near vision for 1-3 years. When the cross tabulation of using the glasses for near vision was done with the duration of usage of mobile phones and computers then it was seen that the result was found to be statistically significant (p=0.04). Conclusion: The usage of smart phones has significantly raised the prevalence of presbyopia and despite knowing all the ocular side effects of using electronic devices the public is still addicted to it.

Objective: To compare the in-vitro efficacy by determining Minimum Inhibitory Concentration of Vancomycin using the reference Agar Dilution to the E-Strip in Methicillin Resistant Staphylococcus aureus isolates. Study Design: Validation study. Place and Duration of Study: The department of Microbiology Army Medical College/National University of Medical Sciences in collaboration with Pak Emirates Military Hospital Rawalpindi, from Dec 2016 to Dec 2017. Methodology: Non-duplicate 84 isolates of Methicillin resistant Staphylococcus aureus from various clinical specimens were included in the study. All these isolates were screened for susceptibility to glycopeptide by E-strips method (Bio mérieux) as well as Agar Dilution method, using vancomycin concentrations of 0.25, 0.50, 1.00, 2.00, 4.00 and 8.00µgm/ml respectively in two fold serial dilutions. Results: There was an overall agreement on 83 samples by both the methods i.e. 83 were Vancomycin Sensitive Staphylococcus aureus by both methods while one isolate with intermediate resistance to Vancomycin was only detected by Agar Dilution. The sensitivity of the E–strips compared to Agar Dilution was found to be 100%. The positive predictive value was 98.8% with a diagnostic accuracy of 98.8%. Specificity and negative predictive value could not be ascertained for E-strips because of the limitation of the method to detect the Vancomycin Intermediate Staphylococcus aureus isolates. Conclusion: E-strip can be a convenient alternative to the gold standard Agar Dilution but its inability to identify VISA challenges its reliability in determining the Vancomycin resistance in MRSA isolates.

Objective: To know the Awareness, knowledge, attitude of patients towards pandemic and use of PPE, and how they follow the preventive instruction. Study Design: Cross sectional study. Place and Duration of Study: Obs /Gynae department, Combined Military Hospital Lahore, form Mar 2020 to May 2020. Methodology: Five hundred women were recruited from Gynae outpatient department by random sampling technique from mid Mar 2020 to mid of May 2020. All the subjects were interviewed by questionnaire. Results: Results were knowledge and awareness of population towards the spread, and prevention of pandemic of COVID-19. Patients attitude was also assessed towards use of preventive measures like wearing mask, hand wash, social distancing, use of sanitizer and general cleanliness. They were also interviewed about safety of breast feeding, and their knowledge regarding role of telemedicine in this pandemic. Most of patients showed maximum score in knowledge (88.4%) and attitude (90%) up to 3 showing direct relationship of knowledge and practice (attitude). Mean age was 40.4 yrs. Conclusion: Knowledge about pandemic, its cause, how it spreads, has significant impact on awareness and practice of preventive measures in this pandemic period. Target should be education of general population to improve the practices in current pandemics, as well as for future epidemics.

Objective: To show efficacy of 17OH progesterone in prevention of preterm labor in comparison with frequent monitoring. Study Design: Randomized clinical trial. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Attock, from May 2011 to Dec 2011. Methodology: Total 100 patients of high risk preterm delivery were selected from outpatient department. Patients were divided into two groups, fifty patients in group A, who were managed by frequent monitoring only and no treatment used for them. Fifty patients in group B, were given injection Proluton depot prophylactically (17OH progesterone) on weekly basis from 16 weeks of pregnancy till 37 weeks. Women included in study were educated about signs and symptoms of preterm labor, and about the importance of early diagnosis and treatment. The women were followed according to their group assignments until either preterm delivery or 37 weeks. Results: Out of 50 patients, 41 (82%) deliveries in group A were between 32 -36 weeks of pregnancy, there was no delivery at or >37 weeks as compared to group B, in which 14 (28%) deliveries were beyond 37 weeks of gestation. Only 4 (8%) patients in group B, were delivered before 31 weeks of pregnancy as compared to group A in which this number was 9 (18%) (p-value

Objective: To determine the important clinical features at the initial presentation of Hepatocellular carcinoma and the treatments offered thereby. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from Jan 2017 to Dec 2017. Methodology: A total of 157 patients were studied. Their history, examination and relevant investigations were carried out at initial presentation to find all required details including age, gender, etiology of HCC, number and size of hepatic lesions, Child Pugh class, performance status, BCLC scoring, vascular invasion of tumor, lymph nodal involvement and metastasis; at time of diagnosis of hepatocellular carcinoma. Treatment was offered based on all these parameters, as per latest AASLD guidelines. Data were entered in SPSS version 24 for statistical analysis. Results: Of the total 157 patients, 117 (75%) were males and 40 (25%) were females. Mean age was 60.4 ± 8.67 years. Majority of HCC cases (84%) were HCV infected. Performance status was 0 or 1 in 87% cases. Around 52% patients had huge size of lesion, >5cm, at presentation. Child Pugh score was A for 68% patients. BCLC score was B, C or D in 70% cases which implies intermediate or advanced disease where curative treatments could not be performed. TACE was the most frequent treatment offered (33% cases), followed by Sorafenib (29% cases). Conclusion: Hepatocellular carcinoma was found to be on the rise in our setup as a consequence of the huge prevalence of HCV infection. Most patients were males presenting at intermediate or advanced stage disease where curative treatments were not possible.