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Objective: To determine the severity and outcome of acute hepatitis in dengue patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2022 to Oct 2023. Methodology: The study included 215 confirmed cases of dengue infection. Data included demographic details day of illness, clinical findings, laboratory parameters, duration of hospital stay, and mortality at the 20th day. Patients experiencing dengue complications such as bleeding and shock were monitored. We divided patients into two groups based on ALT levels: mild to moderate hepatitis with ALT levels up to 299 IU/L and severe hepatitis with ALT levels greater than 300 IU/. Results: A total of 215 patients with dengue fever were included in this study, out of which 184(83% were male) and 31(14% were female). Out of the total sample size, 181(86%) of patients had dengue fever, 75(33%) had dengue hemorrhagic fever, and 13(6%) had dengue shock syndrome. The study showed statistically significant differences in terms of bleeding in patients with mild/moderate hepatitis (median=109.50) and severe hepatitis (median=55.92), Z=2.52, p=0.012, r=0.174. Conclusion: This study concluded that severe hepatitis in dengue patients was associated with higher rates of dengue hemorrhagic fever and dengue shock syndrome. Severe hepatitis was also associated with decreased levels of platelets and higher rates of dengue complications like ascites and pleural effusion. It was also associated with a longer hospital stay.

Objective: To determine the diagnostic accuracy of Doppler assessment of hepatic venous waveforms for predicting large esophageal varices in patients with cirrhosis, keeping esophagogastroduodenoscopy as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Rawalpindi Pakistan, from Jan 2021 to Jan 2022. Methodology: According to the Child-Pugh classification, 157 cases of liver cirrhosis were included in this study. With a convex probe operating at 3.5 to 5 MHz, a Doppler ultrasound was executed. If quiet breathing wasn't an option, the spectral waveform was captured at the end of the inhalation phase while holding your breath. This was roughly 3–6 cm from where it connects to the inferior vena cava. All patients underwent an esophagogastroduodenoscopy. Results: In Doppler USG-positive patients, 84 (true positive) developed significant esophageal varices on endoscopy, while 4 (false positive) did not. Among 69 individuals with negative Doppler USG results, six (false negative) had significant esophageal varices on endoscopy, whereas 63 (true negative) did not (p=0.0001). We found that the overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Doppler evaluation of hepatic venous waveforms were 93.33%, 94.0%, 95.45%, 91.30%, and 93.6% for finding large esophageal varices in cirrhotic patients using esophagogastroduodenoscopy as the gold standard. Conclusion: This study proved that using Doppler to look at hepatic vein waveforms is a very sensitive and accurate noninvasive way to tell if someone with cirrhosis will get big esophageal varices.

Objective: To determine the correlation of renal ultrasonographic parameters with serum creatinine levels in patients with chronic kidney disease. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to April 2021. Methodology: One hundred thirteen patients with chronic kidney disease (Stages 1 to 4) were enrolled in a cross-sectional study. Detailed history and examination were carried out. Serum creatinine levels were carried out, and findings were noted. All patients underwent renal ultrasonography evaluation, kidney parameters were assessed, findings were noted, and statistical analysis was performed. Results: The mean age of the patients was 42.96±12.71 years, the duration of Chronic kidney disease was 30.38±14.59 months, the length of the kidneys was 7.15±1.84 cm, the volume of the kidneys was 59.4±12.7 ml, the thickness of the renal cortex was 3.78±1.41 cm, thickness of renal parenchyma was 8.33±1.71 mm and serum creatinine levels were 5.36±2.63. Renal ultrasound parameters negatively correlated {for length of kidneys r=-0.187 (p=0.047), for volume r=-0.133 (p=0.161), for cortical thickness r=-0.285 (p=0.002) and parenchymal thickness r=-0.083 (0.382)} with serum creatinine level and only cortical thickness and length of kidneys had significant correlation with it. Conclusion: Ultrasound assessment is an easy and reliable tool. Measurement of cortical thickness and length of kidneys must be routinely incorporated in the ultrasonographical assessment of patients with Chronic kidney disease.

Objective: To compare the effectiveness of Methotrexate (MTX) versus Cyclosporine (CyA) in the patients of moderate to severe atopic dermatitis (AD) Study Design: Systematic review and Meta-analysis. Methodology: After formulating our research team and PICO question rationally, a search strategy and literature search were carried out as per Cochrane guidelines. Full-text articles were retrieved after title and abstract screening per our inclusion criteria. The whole search process was documented in the form of a PRISMA flow chart. Team members made and filed data extraction sheets, and qualitative data synthesis was performed. Afterwards, a meta-analysis was carried out, involving a total of 03 randomized controlled trials. Revman was used to process the continuous and dichotomous data collected for our outcomes. RoB 2 was used to assess the risk of bias in the included studies. Grade pro-GDT was used to summarize the findings in the table. Results: Pooled results from 3 RCTs showed that CyA in a 2.5mg/kg dose is better than MTX @0.4 mg/kg/week at 12 weeks in AD. At follow-up, MTX maintains better disease control, i.e., until 24 weeks post-treatment. MTX has a better safety profile than CyA. Conclusion: MTX and CyA are both effective drugs for moderate to severe AD, but they have their pros and cons.

Despite improvements in the design of mechanical prosthetic heart valves and regular use of anticoagulation, prosthetic heart valve thrombosis remain the most dreadful complication associated with high mortality. Surgical thrombectomy or valvereplacement is used as a conventional therapy. Medical thrombolysis, on the other hand, is a therapy choice. Present case is of a 26-year old female with Ebstein's irregularity who effectively endured tricuspid prosthetic valve thrombolysis usingintravenous Streptokinase (SK). The outcome of our patient supports that SK can be an adequate therapeutic option for thrombolysis of tricuspid Prosthetic Valve Thrombosis (PVT) in children and adolescents.

Objective: To determine the diagnostic accuracy of lung ultrasound (LUS) in the diagnosis of pneumonia in children using chest x-ray as the gold standard. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Sialkot Pakistan, from Feb to Aug 2021 Methodology: All patients underwent clinical examination, chest radiograph (anterior-posterior view), lung ultrasound and blood sample analysis in the first 24 hours after admission. A pre-specified hospital radiologist carried out a lung ultrasound. The examination was performed with the patient sitting upright or supine. The presence of pneumonia on x-ray and USG were recorded. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasound in the diagnosis of pneumonia by taking chest x-ray as the gold standard was calculated in all the study participants. Results: In this study, 262 patients with clinical features of pneumonia were enrolled. The mean age of the study participants was 3.27±2.344 years. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy and frequency of lung ultrasonography (US) vs chest radiography (CR) in diagnosing pneumonia was 95.28%, 87.5%, 99.59%, 36.84%, 95.04% and 96.95% respectively. Conclusion: Lung ultrasound emerged as a sensitive diagnostic tool to diagnose pneumonia in children. Sensitivity, specificity, positive predictive value, and negative predictive value all favoured the use of this modality to diagnose pneumonia in paediatric patients.

We report a case of successful hybrid device closure of large mid muscular Ventricular Septal Defect (VSD) in an infant for the very first time in Pakistan. Increasing collaboration between pediatric cardiac interventionalists and congenital cardiac surgeons has resulted in introduction of various hybrid procedures in the management of Congenital Heart Diseases (CHD). Advantages of hybrid procedures include complex interventions by using minimally invasive methods, avoidance of cardiopulmonary bypass, shorter procedure and recovery time leading to subsequent decrease in complications. A large VSD in an infant carries an increased risk of morbidity including failure to thrive, congestive cardiac failure, and recurrent respiratory tract infections. Timely and safely the successful perventricular closure of large VSD using hybrid approach is a milestone in the management of VSDs in infants.

Objective: To identify the complications of Transcatheter palliation in Tetralogy of Fallot patients. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Paediatric Cardiology Department, AFIC/NIHD, Rawalpindi Pakistan, from Jul to Dec 2022. Methodology: This Analytical Cross-sectional study was conducted in n=54 patients of Tetralogy of Fallot (TOF) who underwent Transcatheter palliation procedure. Cases were selected by using non-probability consecutive sampling. Patients with isolated pulmonary stenosis, complex congenital heart and Tetralogy of Fallot with pulmonary atresia were excluded from the study. Data was entered and analyzed by using SPSS version-24:00. In descriptive statistics, Mean±SD were calculated for continuous variables while frequency (%) for categorical variables. To find out the association between categorical variables, Chi-square test was used. p-value of

Objective: To look for migraine headaches and associated factors in patients being managed for psoriasis at a tertiary healthcare setup in Rawalpindi, Pakistan. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2021 to Feb 2022. Methodology: One hundred and forty patients of psoriasis being managed at our Dermatology Unit were included in the analysis. All patients were screened with the Migraine Screen Questionnaire (MS-Q), and those having scores equal to or more than four were evaluated by medical specialists, and diagnosis of migraine was established based on the International Classification of Headache Disorders diagnostic criteria for migraine. An association of relevant risk factors was established with migraine among these patients. Results: Out of 140 patients with psoriasis, 75(53.4%) were male, while 65(46.6%) were female. Eighty-five (60.7%) patients had migraine confirmed by clinical criteria, while 55(39.3%) had no migraine. Statistical analysis revealed that more body surface area involvement and longer duration of psoriasis had a statistically significant relationship with migraine among the study participants (p-value

Objectives: To determine the frequency of parasites detected in stool samples of children with symptoms of parasitic infections. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, in collaboration with Paediatrics Department of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2020. Methodology: A Total of 138 stool samples were collected from children who were admitted or presented in the outdoor department and had symptoms of intestinal parasitic infections. Youngsters who had been dewormed within the previous six months or whose samples arrived at the lab more than three hours after the collection were not included. Stool samples were examined visually and by using a saline preparation followed by a method that involved the concentration of formal ether. This was done to determine the different kinds of trophozoites, adult worms, and eggs or cysts that parasites produce. Results: The study found that intestinal parasites were moderately prevalent (26.81%) among the pediatric population, with Giardia lamblia (54.05%) being the most frequent, followed by Entamoeba histolytica (35.14%) and Ascaris lumbricoides (5.41%). Conclusion: It is recommended to guarantee the accessibility of purified drinking water to decrease the incidence of parasitic infections within our populace.

Objective: To compare the antimicrobial efficacy of cefoperazone plus tigecycline versus cefoperzone and their effect on biochemical indices. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pathology, Rehman Medical Institute, Peshawar Pakistan, Nov 2022 to May 2023. Methodology: Patients of either gender with age >20 years having intensive care unit stay of >72 hours having clinical and radiological evidence of hospital acquired respiratory infection were included in the trial. A non-randomized convenience sampling technique was employed. Group CT patients received a combination of cefoperazone-sulbactam plus tigecycline intravenously while Group C participants received only cefoperazone-salbactam. Demographics, inflammatory markers,pathogens, treatment effectivity were recorded. Results: Mean age of participants in Group CT was 57.59±6.08 years as compared to 56.37±6.87 years in Group C. Pseudomonas aeruginosa was the most common pathogen identified in 30(23.8%) patients. CRP, WBC’s and PCT was significantly reduced after antibiotic treatment in both groups with a p-value of

Objective: To check the motivational factors behind the usage of skin lightening creams and users’ awareness in our setup by constructing a validated questionnaire. Study Design: Cross-sectional study. Place and Duration of Study: Outpatient Department of Dermatology, Combined Military Hospital Rawalpindi, from Oct to Nov 2020. Methodology: Two fifty patients who were using skin-lightening creams (SLC) were recruited after the informed consent. Questionnaire was made following seven steps as mentioned in AMEE (Association for Medical Education Europe) guide 87. Data was analyzed by SPSS version 21. Reliability was be checked by Cronbach@. Descriptive statistics of responses including frequencies and percentages were calculated. Exploratory factor analysis of questionnaire was made. Results: Skin lightening cream users had age range from 16-56 years, majority 190 (76%) were females. Out of 158 (63.2%) were married, 180 (72%) well educated and 146 (58.4%) had Fitzpatrick skin type 3-5 predominate. Cronbach alpha of our questionnaire was 0.802. The 5-point likert scale was used to record users’ perceptions in the domains i.e., motivational factors, awareness about product and intentions. Majority, 89 (35.6%) used the product on social media recommendation. Out of 201 (80.4%) developed side effects with telangiectasia and skin thinning being the commonest ones. Out of 88 (35.2%) were using other skin whitening practices besides these creams. Conclusion: False perceptions about fairness and lack of user’s awareness govern the skin lightening practices in our society resulting in increased usage and side effects experienced by users. A mass educational awareness program regarding “skin lightening.........

Objective: To evaluate the outcomes of squint surgery with adjustable sutures in patients with horizontal Strabismus. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan, from Jul 2016 to Jun 2018. Methodology: Adult patients with horizontal Strabismus and co-operative enough were selected for squint surgery with adjustable sutures. Squint surgery was performed under general anaesthesia. The recessed muscle was attached to the insertion site with hang back technique with a bow tie knot if required adjustment (further recession or advancement) was performed on the first post-operative day under topical anaesthesia. Preoperative, pre and post-adjustment and final postoperative orthoptic assessment were recorded. Results: One hundred thirty-two patients were selected for strabismus surgery with adjustable sutures. Eighteen patients (13.6%) had a history of previous strabismus surgery. 75(56.8%) patients required post-operative adjustment of sutures. Orthophoria was achieved in 107(81.1%) and residual exotropia of less than 10pd in 25(18.9%) patients. Desired surgical outcome of orthophoria or the residual squint of less than 10 prism diopters was achieved in 100% of patients. Conclusion: A positive surgical outcome was observed in our patients, and the second surgery for residual or consecutive squint was avoided.

Objective: To determine the diagnostic accuracy of PET/CT in detecting aggressiveness of lymphoma based on sub-uptake keeping bone marrow biopsy as the gold standard. Study Design: Prospective longitudinal study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to Mar 2021. Methodology: One hundred thirty-eight patients of either gender, aged 20 to 80 years who were diagnosed with lymphoma (either Hodgkin’s or non-Hodgkin’s lymphoma) on initial PET/CT scan were enrolled in the study. All patients underwent PET/CT, and 18-FDG SUV was calculated. After obtaining values, all participants underwent bone marrow biopsy to determine the aggressiveness of lymphoma and findings were subjected to statistical analysis. Results: The mean age of the patients was 54.92±16.86, and the mean SUV value was 17.04±8.03. There were 77(55.8%) males and 61(44.2%) females. Hodgkin’s lymphoma was present in 28 (20.3%) patients and non-Hodgkin’s lymphoma in 110(79.7%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of 18 FDG PET/CT SUV were 92%, 92.2%, 93.2%, 90.9% and 92.1%, respectively. Conclusion: 18-FDG PET/CT SUV has high diagnostic accuracy and can detect aggressive lymphomas and further specify the areas for biopsy.

Objectives: To see the effects of Intra-Vitreal Diclofenac injection (IVD) in refractory Diabetic Macular Edema (DME). Study Design: Quasi-experimental study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020. Methodology: Patients included in the study having Clinically Significant Macular Edema (CSME) with Central Macular Thickness (CMT) of more than 300 microns not responding to three consecutive Intravitreal injections of Bevacizumab (IVB).Intravitreal Diclofenac injection (500μg/0.1 ml) was given by the same retina fellow with the same protocol across all patients.Each patient was evaluated based on Central Macular Thickness (CMT) before intravitreal Diclofenac injection and on followup visits one week and one month after injection. Results: A total of 30 patients (30 eyes) were included in the study. Out of these, 11 were females, and 19 were males. The mean age of the patients was 57.87±4.424 years. Mean Central Macular Thickness (CMT) before injection was 439.67±110.45µm, after one week 398.47±110.55µm and 384.87±119.11µm after one month of intra-vitreal Diclofenac injection. Pre and post-injection central macular thickness (µm), which was clinically significant (p-value

Objective: To compare the risk factors with estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status of breast cancer patients. Study Design: Cross sectional comparative study. Place and Duration of Study: This study was carried out in Multidisciplinary Lab-1 of Army Medical College, National University of Medical Sciences, Rawalpindi, in collaboration with Department of Pathology of Army Medical College, NUMS Rawalpindi, from Jan 2019 to Jan 2020. Methodology: A total of 50 individuals including radiologically diagnosed cases of breast cancer with different stages and 10 healthy controls without cancer. Patients with any co-morbidity were excluded. Participant’s sample was collected and subjected to ER, PR and HER2 estimation. Other factors i.e. age, gender, marital status, breast feeding, menopause status, side of the breast affected were all taken into consideration. Results: Patients characteristics showed that the mean age, marital and menopause status were linked with breast cancer. The data showed that hormone receptors i.e., ER (p=0.0001), PR (p=0.0002) and HER2 (p=0.0001) were positive among most of the cancer patients as compared to the healthy subjects without cancer. There were no association found between age and hormone receptors. Marital status, breast feeding, menopause and side of breasts involved also had no association with hormone receptors. Conclusion: No significant association found between risk factors and hormone recpetors status of breast cancer patients in our population.

Objective: To predict the tertiary structure of human interferon alpha/beta receptor 2 protein. Study Design: Structure prediction by using bio informatics tools. Place and Duration of Study: Department of Biochemistry, Swat Medical College (STMC), Saidu Shareef, Swat, Pakistan, from Aug 2019 to Dec 2019. Methodology: All protein sequences of human interferon alpha/beta receptor 2 (isoforma, b and c) (IFNAR-2) were retrieved through the BLAST search (The Basic Local Alignment Search Tool) from available databases ‘NCBI’ (National Centre for Biotechnology Information) and ‘Uni Prot KB’ (The Universal Protein Resource). Sequence alignment was conducted by using Clustal Omega, to get the consensus sequence for IFNAR-2 protein. Consensus protein sequence of human IFNAR-2 was used for the prediction of the three-dimensional structure by employing Swiss-Model Server. Moreover, subcellular localization analysis was also performed by using CELLO2GO program. Results: Structural model of human IFNAR-2 protein was predicted and evaluated by Ramachandran dimension. Cellular localization of tertiary topological domains of the predicted models were revealed probability of localization of IFNAR-2 protein (isoform a, b & c) is highest in the plasma membrane due to the presence of the transmembrane alpha helical regions. Conclusion: This study predicted the tertiary structural dimensions of human IFNAR-2 protein, including the specific topological domains that contribute towards the subcellular compartmentalization and functional characteristics.

Objective: To assess patient and observer reported scar quality after Basal cell carcinoma surgery of face using the Patient and Observer Scar Assessment Scale (POSAS). Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Department, Tertiary Care Hospitals at Multan and Karachi and Plastic Surgery Department, Tertiary Care Hospital Multan, from Apr to Sep 2020. Methodology: Patients with basal cell carcinoma that full filled inclusion and exclusion criteria were enrolled by consecutive sampling technique at Dermatology and Plastic Surgery Department after informed consent. Surgical excision was followed by reconstruction of defect either by direct closure or by rotation or advancement flap. Surgical scar was assessed independently at 8 weeks by POSAS. Data was analyzed with SPSS-23. Results: A total of 27 patients were enrolled in study. There were 11 (37.9%) males and 16 (59.25%) females between ages of 45-70 years. Basal cell carcinoma was located on cheek in 15 (55.5%), nose in 9 (33.3%), temple 2 (7.4%) and forehead 1 (3.7%) cases. Direct closure was performed in 6 (22.2%), rotation flaps in 10 (40.7%), and advancement flaps in 11 (40.7%) cases. Mean score of observer opinion about surgical scar between different surgical techniques was not statistically significant (p=0.191). How-ever, mean score of patient opinion of scar between different surgical techniques was statistically significant (p=0.032). Conclusion: POSAS is a valid tool for scar evaluation by patient and observer-reported scar qualities after Basal cell carcinoma surgery.

Objective: To determine the correlation of 18F-FDG SUV value with bone scintigraphy findings, i.e. uptake of Tc-99m in diagnosed cases of malignancy with sclerotic bone metastasis. Study Design: Prospective longitudinal study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to Mar 2021. Methodology: This study included 30 patients of age 18 to 80 years who had sclerotic bone metastasis as confirmed in histopathology. All patients underwent whole-body PET/CT scanning to evaluate sclerotic bone metastasis and determined 18-FDG SUV after 5MBq/kg body weight of 18-FDG was injected. After two weeks of PET/CT scan, Tc-99m bone scintigraphy was carried out, and SUV of Tc-99m was determined after 20-25mCi technetium-99 methylene disphosphonate was injected, and the correlation was assessed between SUV of 18-FDG and Tc-99m. Results: The mean 18-FDG SUVmax and mean Tc-99m SUVmax, were, 21.31±8.77g/ml and 15.29±6.49g/ml respectively.21(70%) lesions on 18-FDG PET/CT and 8(26.7%) on Tc-99m bone scintigraphy were metastatic in bones. 18-FDG SUV on PET/CET and Tc-99m SUV on bone scintigraphy correlated positively with each other, and this correlation was found to be statistically significant (r=0.491, p=0.006). Conclusion: 18-FDG SUV PET/CT significantly correlated with Tc-99m SUV on bone scintigraphy and helped detect metastatic lesions earlier and modulate treatment response. Keywords: Bone metastasis, Bone scintigraphy, 18-FDG PET/CT, Tc-99m SUV.

We report a technically difficult retrieval of embolized Atrial Septal Defect device from left atrium. Device was captured after multiple attempts using different types of snares and was brought to inferior vena cava without delivery sheath. As we were unable to slenderize the device into short sheath, it was finally retrieved using an unconventional and innovative technique.We emphasize the importance of safe improvised methods during challenging catheterization procedures resulting in successful outcomes.

Pseudoaneurysm of the ascending aorta is a rare but dreadful complication following cardiac surgery and it has more chances of rupturing in elderly females. It occurs as a result of lengthy cardiopulmonary bypass time and associated degenerative changes in old patients. Due to the poor prognosis, early diagnosis and management of this complication is essential. Our case is of a 68-year old female who developed a 44 mm large ascending aortic pseudoaneurysm 7 days after undergoing (coronary artery bypass grafting) CABG for long-standing. (Triple vessel coronary artery disease) TVCAD. The location of the pseudoaneurysm was found to be just above the vein graft to the RCA on (computerized tomography) CT-Aortogram. 2D-Echocardiography showed an Ejection Fraction of 45% and a 22 mm neck of the aneurysmal sac. Trans-catheter device closure was planned and the neck was successfully closed with no residual leak seen on (computerized tomography) CT-Aortogram performed after 3 days. However, she developed cardiac arrest during the device closure and even after successful resuscitation she went into a state of septic shock in the following weeks that did not respond to maximum medical treatment which unfortunately led to her death. A review of 3 similar cases of post-cardiac surgery aortic pseudoaneurysms which were successfully managed via trans-catheter device closure is also discussed. Early diagnosis and interventional treatment of post-cardiac surgery aortic pseudoaneurysms in elderly patients is necessary alongside very careful surgical technique while performing cardiac surgery to minimize the risk of aneurysm formation.

Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of cardiac defects with Lifetech™ Konar-MFO in a Tertiary Cardiac Care Center. Study Design: Descriptive cross-sectional study. Setting and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Mar 2019 to Dec 2021 Methodology: Patients of all ages and both gender undergone transcatheter closure of a cardiac defect with Konar-MFO from Jan 2021 to Dec 2021 were included in the study through non-probability consecutive sampling and approval by the institutional ethical review committee was taken prior to data collection. Data of patients undergone transcatheter closure with Konar-MFO from Mar 2019 to Dec 2020 was extracted retrospectively to assess the immediate and short-term efficacy and safety of the occluder. SPSS version-23 was used for data entry and analysis. Results: A total of 138 patients had transcatheter closure of a cardiac defect with Lifetech™ Konar-MFO during the study period. Case of VSD were 124(89.9%), PDA 9(6.5%), post-operative cases were 4(2.9%) along with 1(0.7%) case of coronary artery fistula (CAF) to the right ventricle. Out of 138 patients, 73(52.9%) were females while 65(47.1%) were males. The mean age was 9.3 ±8.1 years with a range of 6 months to 36 years. Mean fluoroscopy time was 13.68±9.74 min. The procedure was successful in 137(99.27%) cases. The device embolized in 2(1.45%) cases. Conclusion: In selected cases of VSD, PDA and in some post-operative cases the occlusion with Lifetech™ Konar-MFO is safe and efficacious with the added benefits of softness and versatility of the approach.

In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD), atrioventricular septal defect and tetralogy of fallot (TOF) are associated with conduction system injury. Fewer cases are reported describing life threatening complication of late post-operative complete heart block. We are reporting 2 patients who presented with late complete heart block after ventricular septal defect repair and managed by permanent pacemaker placement in AFIC Cath lab.

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

Objective: To compare the efficacy of Intravitreal Bevacizumab in combination with Posterior Subtenon Triamcinolone for treatment of different levels of diabetic macular edema. Study Design: Comparative cross sectional study. Place and Duration of Study: This study was done in Retina Clinic, Al Shifa Trust Eye Hospital, Rawalpindi, from Jul 2017 to Dec 2017. Methodology: Total of fifty-two patients were included in the study which were divided into two groups on the basis of foveal thickness (group 1 = Foveal Thickness 500μm). Results: Both groups were treated with combination of Intra-vitreal Avastin and Posterior Subtenon Triamcinolone. The percentage decrease in foveal thickness after 6 weeks of injection in group 1 was 30.08 ± 13.035% as compared to 38.88 ± 8.883% in group 2 (p=0.006). While the improvement in BCVA in both groups after 6 weeks of injection was same (0.2 ± 0.2 in Log MAR) (p=0.521). Conclusion: It is concluded that the use of Intravitreal Bevacizumab in combination with posterior subtenon triamcinolone for treatment of macular edema is more effective in foveal thickness >500μm as compared to thickness

Objective: To evaluate a novel liquid chromatography tandem mass spectrometry based method for serum 25 hydroxy vitamin D (D2 and D3 metabolites) analysis. Study Design: Cross sectional validation study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Pakistan, from Mar 2019 to Mar 2020. Methodology: Samples were extracted and 25 OH vitamin-D was separated by means of chromatography and finally quantified via mass spectrometer. A quadrupole- tandem mass spectrometer with Electron spray Ionization coupled to high performance liquid chromatography was adopted for detection and quantitation of 25-hydroxyvitamin D2 and D3 in serum. Results: Limit of detection (LOD) was at the level of 2.49 ng/ml and limit of quantitation (LOQ) was estimated to be 3.9 ng/ml for both the metabolites. The correlation coefficient was 0.99. For D3 observed recovery was 98% and 97.5% respectively while for D2 the recovery was calculated to be 97% and 98%. Percentage relative standard deviation (RSD) was 0.8% and 1.3% respectively. This method has an advantage of less matrix effects, minimal cross-reactivity with 24, 25 hydroxy vit D and 25, 26 di-hydroxy vitamin D metabolite than the routinely used antibody-based assays. Conclusion: This LC-MS/MS methodology is sensitive, specific and can quantitate Vitamin D2 and D3 quite efficiently. This method may be employed for vitamin D analysis in clinical laboratories.

Abstract Objective: To determine the frequency of various anatomical cardiac anomalies and variations in children with Tetralogy of Fallot diagnosed by cardiac catheterization. Study Design: Cross sectional study. Place and Duration of Study: Children's Hospital and Institute of Child Health Lahore, from Jan 2010 to Dec 2018. Methodology: All children with tetralogy of fallot underwent standard cine-angiograms after obtaining written consent following basic laboratory workup. Results: Out of 425 patients, 398 completed cardiac catheterization. The median age was 6 years (interquartile range 3.5-9 years). Confluent Branch pulmonary arteries were present in 395 (99%) children. Pulmonary artery abnormalities were detected in 72 (18%) patients. Two hundred and eleven (53%) children had 283 major aortopulmonary collateral arteries with 88 having 2 or more major aortopulmonary collateral arteries. Out of all, 195 (92%) had hemodynamically significant Major aortopulmonary collateral arteries (supplying ≥3 lung segments) with 54 (28%) having small (1.67 mm at origin) caliber. Conclusion: The frequencies of pulmonary artery abnormalities and various anatomic variations missed on echocardiography in the studied population were high. Diagnostic cardiac catheterization is still a relevant invasive diagnostic procedure in children with tetralogy of fallot.

Objective: To review the available literature investigating effectiveness of flipped classroom (FC) in context to teaching of procedural skills in residency in various medical fields especially in dermatology. Study Design: Systematic review. Place and Duration of Study: Flipped classroom meeting out inclusion criteria published in 9 years from 2012 to 2020. Methodology: Flipped classroom meeting out inclusion criteria published in 9 years from 2012 to 2020 were reviewed by the authors and co-authors as per their feasibility and discussion done by video conferencing by mobile software apps. Results: To review of 25 full-text articles. Strategic organization of course material, wise choice of pre-class activities, usage of Virtual learning environment, class time utilization tailored to learners needs, adherence to timelines, proper training of staff and proper evaluation; are required for successful implementation of flipped classroom. Students had positive perceptions about this technique. Conclusion: Flipped classroom is an effective teaching method for procedural skills training in post graduate medical training.

The dental profession is an important segment of human health care services all over the world. Dental schools in Europe and United States have evolved their curriculum to keep abreast with advances in dentistry; like connective tissue biophysics and molecular engineering through an objectively structured and clinically oriented curriculum. However, dental education in our country is still mostly traditional. This article examines the new approaches to teaching and learning in dental schools/colleges that are shaping dental curriculum globally. Articles relating to curricular trends in dental education and advancement in the dental profession published between 2010-2020 were searched in medical search engines. However, few relevant articles published before this period were also consulted. The current trends in dental curricula show new teaching, learning, and assessment methods like small group discussions, case-based learning, competency-based learning, Inquiry-based teaching-learning, and peer-assisted learning. The curricular format is integrated and new innovative assessment techniques like the assessment of multiple systematic reviews (AMSTAR) are being employed. Virtual reality, interdisciplinary teaching, and distributed community models in dental education are being implemented. The emergence of COVID-19 has also affected dental education and as a result, e-learning formats and assessment techniques have become increasingly popular. Dental schools abroad have revamped their curriculum with the advances in newer technologies and research related to dentistry. There is a need to immediately update and redesign the present dental curriculum in our country as well.

Objective: To determine the effect of paired formative assessment on students’ learning. Study Design: Quasi experimental study. Place and Duration of Study: Islamic International Medical College Rawalpindi, from Jan 2018 to Jun 2018. Methodology: A total of 160 students who attended otolaryngology module were included in the study. Randomized allocation was done by computerized software programme and students were divided into 2 groups i.e. experimental (group A) and control group (group B). Later on in group A, pairing of students was done by lottery method. Group A and B were dealt with paired and individual formative assessment respectively. Effectiveness of both methods of learning was calculated on the basis of academic scores obtained in tests consisting of 20 MCQs from predefined and taught syllabus. A p-value were obtained by applying independent sample t-test and considered statistically significant at 0.05. Results: Out of 160 participants, 94 (58.7%) were females and 66 (41.3%) were males. In individual testing phase mean scores of group A was 13.36 ± 2.22 and mean scores of group B was 13.24 ± 2.5 (p 0.861). In paired formative assessment phase, mean scores of group A was 16.70 ± 1.94 (CI 95% 2.16-4.55) and mean of scores of group B was 13.40 ± 2.23 (CI 95% 2.16-4.55) p=0.001. Conclusion: The effectiveness of paired formative assessment. This method provides students a conducive environment to achieve learning objectives.

Objective: To identify the risk factors for the development of stress fractures in this sub population in our country. Study Design: Comparative cross sectional study. Place and Duration of Study: Combined Military Hospital Abbottabad Pakistan, from Jan 2015 to Aug 2017. Methodology: This study was conducted to identify different variables as risk factors for stress fractures in training cadets. We analyzed age, gender, running and sports prior to joining training, duration of marching, daily milk and carbonated drinks consumption, cigarette smoking, serum albumin, calcium and vitamin D levels, calf muscle diameter, leg length discrepancy and tibiofemoral angles. Results: A total of 275 participant included in this study, 140 cases, 51% and 135 controls, 49%. Mean age was 20 years. Two hundred and sixty eight (97%) were males and 7 (3%) were females. Grade-2 stress fracture was the commonest with 63 (45%) cases. Regular daily running prior to joining training p

Objective: To determine the frequency of congenital cardiac lesions in pregnant women reporting for fetal echocardiogram and correlate with obstetrical risk factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: To be conducted at pediatric cardiology and obstetrical unit of AFIC/NIHD and CMH Rawalpindi, from Jan 2009 to Jan 2020. Methodology: Pregnant women referred for fetal echocardiogram from 19-49 years of age were enrolled. Echo was done between 20 to 36 weeks gestation. Primary outcome was the nature of cardiac lesion and gestation at diagnosis. Neonatal scan was done at follow up to confirm cardiac diagnosis. Secondary outcome was obstetrical risk factors which were the reason for referral. This included age consanguinity, family history, previous history of intrauterine death or early neonatal death, maternal and paternal diseases. Data was collected and analyzed n frequencies and percentage. Chi-square was applied for association between variable and p-valve 0.05 was considered significant. Results: A total of n=967 pregnant women referred to outpatient department for fetal echocardiogram. Congenital cardiac lesion were detected in n=83 patients. Majority of patients had CAVSD (1.2%) CCAVB (1.2%) followed by ASD (1.1%) VSD (0.9%) Abnormal heart rate (0.8%) Single ventricle (0.3%). Most significant maternal age group was between 21 to 30 and 30-40 years (43.7 and 46.2%). Only 3% below 20 years and 6.7% above 40 years of age. Most important maternal risk factor was previous off spring 0.5% past family history 0.3% and abnormal obstetrical ultrasound 0.3% Followed by maternal diabetes 0.1% and maternal hypertension 0.1%. The yield of detection of congenital cardiac lesions was 8.3%. Conclusions: Congenital cardiac diseases are the second most common congenital anomaly and huge burden n pediatric population. Timely diagnosis and referral can be lifesaving.

Objective: To compare trans-atrial/Trans-pulmonary and trans-annular/trans-ventricular techniques of surgical correction of tetralogy of fallot. Study Design: Descriptive cross sectional study. Place and Duration of Study: AFIC-NIHD Rawalpindi, from Jan 2005 to Jan 2020. Methodology: Pre-op variables included age, gender, weight, SaO2 and any previous operation (like Modified Blalock Taussig Shunt.) Operative variables were any previous Blalock Taussig Shunts and if present, then their takedown, Cardiopulmonary Bypass Time, Aortic Clamp Time, any Right Ventricle - Pulmonary Artery conduit, Main Pulmonary Artery patch-plasty, Left Pulmonary Artery/ Right Pulmonary Artery patch-plasty, dosage of inotropes and pacing started during weaning off CPB. Post-op variables were mechanical ventilation time (hrs), ventilation time >72 hrs, dosage and duration of inotropes, pacing >24 hrs, renal complications, neurological complications, sepsis, low cardiac output, re-ventilation, tachyarrythmias, any re-opening surgery, mean intensive care unit stay (hrs), overall hospital stay (days) and overall all-cause mortality. Results: A total of 1271 TOF patients were operated. In (38.6%) cases Trans-atrial / Trans-pulmonary approach was used while in 780 (61.3%) correction was done by TAP/TV technique. In both techniques, male patients were 365 (66.4%) vs. 73 (64.1%) females. Mean age was 5 ± 2.3 vs. 4 ± 2.5 years, MPA patch-plasty was 190 ± 5 (38.6%) vs. 780 ± 8 (100%) (p-0.058), RPA/LPA Patch Plasty was 25 ± 6 (5%) vs. 180 ± 10 (23%) (p- 0.025), In ICU, Ventilation hours was 25 ± 8 and 30 ± 12, Ventilation >72 Hrs was 15 (3%) vs. 65 (8.3%) (p-0.015), Inotrope duration >72 Hours was 90 (18.3%) vs. 400 (51.2%) (p-0.338), pacing >24 hours was 30 (6.1%) vs. 150 (19.2%) (p-0.0001), renal complications were 10 (2.3%) vs. 35 (4.4%) (p- 0.285), Neurological complications were 7 (1.4%) vs. 15 (1.9%) (p0.553), Sepsis was 11 (2.2%) vs. 47 (6%) (p-0.33), Low cardiac output was 15 (3%) vs. 66 (8.4%) (p- 1.000), re-ventilation was 10 (2%) vs. 110 (14%) (p- 0.41), Tachy-arrhythmia was 25 (5%) vs. 150 (19.2%) (p- 0.11), re-openings were 19 (3.8%) vs. 65 (8.3%) (p- 0.0003), ICU stay (Hours) was 87 ± 8 vs. 108 ± 10, Mortality was 35 (7.1%) vs. 75 (9.6%) (p-0.094), Mean hospital stay (Days) was 12.2 ± 2.5 vs. 15.8 ± 4.9. Conclusion: Fifteen years’ experience of Tetralogy of fallot corrections at AFIC-NIHD indicates that Trans-atrial / Trans-pulmonary approach is more beneficial to patients due to high survival rate, less morbidity, less hospital stay and an early discharge. This ultimately translates into less financial burden on the patients, hospital, society and the country at large.

After total correction for tetrolgy of fallot (TOF), right ventricle behaves in an unpredictable manner depending on type of right ventricular outflow tract (RVOT) reconstruction and surgical expertise of infundibular muscle resection. We are reporting a 23 years old girl who underwent total correction at two years of age. RVOT was reconstructed with native pericardial patch. Gradually she developed breathlessness and occasional chest pain. Echocardiograghy revealed hugely dilated right ventricle (RV) with gross pulmonary regurgitation and RV dysfunction. Cardiac MRI also calculated right ventricular end systolic volume (RVESV) 57 ml/m2 and right ventricular end diatolic volume (RVEDV) 157ml/m2. We decided to implant transcatheter venus p-valve at pulmonary position. The procedure went successful having competent pulmonary valve and improved RV function. Total fluoro time was 36.4 minutes and total procedural time was two hours. This procedure was done first time in Pakistan with optimal results.

Objective: To measure the level of preparedness of MBBS students to clinical exposure to COVID-19 pandemic. Study Design: Cross-sectional online questionnaire survey. Place and Duration of Study: Physiology Department, Islamic International Medical College, Riphah University, from July to July 2020. Methodology: Medical students from first to final year were included. Data was collected through a validated questionnaire measuring knowledge, attitude and practice of medical students regarding COVID-19. Statistical analysis was done on Microsoft Excel. Frequencies, percentages, mean, and Standard deviation were calculated. Results: A total of 315 students were included in the final analysis. The mean age of the students was 21 3.2. Social media were the main sources of information for 45.5% of the students. The overall level of knowledge of students about COVID-19 was good in 88% and 12% had poor knowledge. The attitude had a mixed response of 55.5% being confident that the disease would be controlled while 93.3% and 87% of the students wanted to help and educate the society. Regarding practice 91% of the students had good practice and used face masks though poor practice were the application of hand sanitizer and going out of home 68%. Conclusion: The level of preparedness of MBBS students before clinical exposure to the COVID-19 Pandemic was satisfactory. The students had good knowledge, a mixed attitude and good practices regarding COVID-19. Gaps in knowledge and the practice which were highlighted need to be addressed by the educational institutes through awareness programs before interaction with the patients is initiated.

Objective: To determine mean renal resistivity index using renal artery Doppler in patients having type 2 diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi, from Jan 2016 to Jul 2016. Methodology: One hundred and fifty patients diagnosed with Type II Diabetes mellitus were included in this study. Renal resistivity index of both the kidneys at the level of segmental arteries was measured through color Doppler system (SSA-580A Toshiba, Japan) equipped with a transducer 3.75 MHz. At least two readings taken each at upper, mid and lower pole and average resistivity index was calculated. HbA1c levels were carried out through standard lab procedures. Results: Mean age of the patients was 54.06 ± 8.27 years. Out of 150 cases, 87 patients (58.0%) were male and 63 patients (42.0%) were female. Mean duration of diabetes was 5.53 ± 2.22 years. Mean HbA1c was 7.58 ± 1.02. Mean renal resistivity index of right kidney was 0.72 ± 0.02, mean renal resistivity index of left kidney was 0.72 ± 0.03 and average of both kidneys’ mean renal resistivity index value was 0.72 ± 0.02. Conclusion: Renal resistivity indices were high in patients with type 2 diabetes. This signifies that renal Doppler ultrasounds may be used as a non-invasive marker to identify patients with diabetes who have high risk of developing early nephropathy and thus may contribute to timely diagnosis and control disease progression.

Objective: To compare the immediate, short term and long term effects of active isolated stretch versus post isometric relaxation on hamstring flexibility in young healthy adults. Study Design: Randomized controlled trial (trail number is NCT04024839). Place and Duration of Study: Islamabad Federal College, in the department of Doctor of Physical Therapy from Jan 2018 to Jul 2018. Methodology: Thirty five students were selected according to inclusion criteria and randomly assigned into two groups by lottery method 17 and 18 in each group respectively. Group A was given post isometric relaxation while group B was active isolated stretch. Age group between 18 to 25 year, male and female students with tight hamstring were included while neurological and orthopedic disorders were excluded. Active Isolated Stretch and Post Isometric Relaxation at baseline, after first and final exercise session were calculated immediately and short term effects while long term effects were calculated after two weeks of final session. Results: Active knee extension score for both hamstring muscles after 1st session showed statistical insignificant improvement for both legs (p=0.20 right and p=0.18 left). Active knee extension score after 2 weeks of exercises gave insignificant improvement in score for both legs (p=0.20 right and p=0.20 left). Similarly, Active Knee Extension score after all sessions showed insignificant improvement for both legs (p=0.49 right and p=0.88 left). There was no significant improvement for Active Knee Extension, lower extremity scale and sit and reach test with p=0.15. There were no differences between the effectiveness of both techniques i.e., Passive Isometric Relaxation and Active Isolated Stretch (p=0.58). Conclusion: Both techniques were equally effective in their immediate, short-term and long term effects on hamstrings flexibility.

Objective: To study the functional and molecular interactions of IFNAR-2 within biological networks Study Design: Computational analysis: STRING software Place and Duration of Study: Department of Biochemistry, HITEC-Institute of Medical Sciences, Taxila Cantt, Pakistan, from Dec 2017 to Jun 2018. Methodology: Protein sequence of IFNAR-2 protein was obtained from ‘National Centre for Biotechnology Information (NCBI)’ database and STRING analysis conducted by applying specific parameters including (1) Text mining (2) Experiments (3) Databases (4) Co-expression (5) Neighborhood (6) Gene fusion and (7) Co-occurrence for identifying protein-protein interactions and molecular associations. Maximum number of interactors was set at 20 and highest confidence level was set at 0.900. Results: Protein-protein interaction analysis translate that human IFNAR-2 protein has high level of interactions with a set of proteins of similar size, drawn from the genome. This set represents a partial biologically connected group of proteins. This information has a potential to set the basis for further experimental investigations in more integrated and biologically linked pathway-oriented perspective that results in more targeted outcomes. Conclusion: Functional and molecular enrichment through STRING analysis revealed that IFNAR-2 protein has strong associations and serves as a key player in antiviral response of immune system.

Objective: To determine the severity and outcome of acute hepatitis in dengue patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2022 to Oct 2023. Methodology: The study included 215 confirmed cases of dengue infection. Data included demographic details day of ilness, clinical findings, laboratory parameters, duration of hospital stay, and mortality at the 20th day. Patients experiencing dengue complications such as bleeding and shock were monitored. We divided patients into two groups based on ALT levels: mild to moderate hepatitis with ALT levels up to 299 IU/L and severe hepatitis with ALT levels greater than 300 IU/. Results: A total of 215 patients with dengue fever were included in this study, out of which 184(83% were male) and 31(14% were female). Out of the total sample size, 181(86%) of patients had dengue fever, 75(33%) had dengue hemorrhagic fever, and 13(6%) had dengue shock syndrome. The study showed statisticaly significant differences in terms of bleeding in patients with mild/moderate hepatitis (median=109.50) and severe hepatitis (median=55.92), Z=2.52, p=0.012, r=0.174. Conclusion: This study concluded that severe hepatitis in dengue patients was associated with higher rates of dengue hemorrhagic fever and dengue shock syndrome. Severe hepatitis was also associated with decreased levels of platelets and higher rates of dengue complications like ascites and pleural effusion. It was also associated with a longer hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Doppler assessment of hepatic venous waveforms for predicting large esophageal varices in patients with cirrhosis, keeping esophagogastroduodenoscopy as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Rawalpindi Pakistan, from Jan 2021 to Jan 2022. Methodology: According to the Child-Pugh classification, 157 cases of liver cirrhosis were included in this study. With a convex probe operating at 3.5 to 5 MHz, a Doppler ultrasound was executed. If quiet breathing wasn't an option, the spectral waveform was captured at the end of the inhalation phase while holding your breath. This was roughly 3-6 cm from where it connects to the inferior vena cava. Al patients underwent an esophagogastroduodenoscopy. Results: In Doppler USG-positive patients, 84 (true positive) developed significant esophageal varices on endoscopy, while 4 (false positive) did not. Among 69 individuals with negative Doppler USG results, six (false negative) had significant esophageal varices on endoscopy, whereas 63 (true negative) did not (p=0.0001). We found that the overal sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Doppler evaluation of hepatic venous waveforms were 93.33%, 94.0%, 95.45%, 91.30%, and 93.6% for finding large esophageal varices in cirrhotic patients using esophagogastroduodenoscopy as the gold standard. Conclusion: This study proved that using Doppler to look at hepatic vein waveforms is a very sensitive and accurate noninvasive way to tel if someone with cirrhosis wil get big esophageal varices. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of success of intralesional vitamin D3 versus cryotherapy for management of patients with plantar warts. Study Design: Quasi experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi, from Aug 2016 to Feb 2017. Methodology: Total 60 patients, fulfilling the selection criteria, were included in the study. The patients were randomly divided in two groups by using lottery method. In group 1, Vitamin D3 was injected into the base of the warts after local anaesthetic agent, prilocaine. In group 2, cryotherapy was done by using a high-intensity regimen of one session every two weeks till 6 weeks. All patients were followed-up in Out-Patient Department (OPD) for 13 weeks. After 13 weeks, condition of warts was assessed. In case of complete resolution of warts, the success was labeled. Results: In this study success rate of intralesional D3 was 63.3% and for cryotherapy success rate was 43.3% (p-value=0.121). Stratification of age and gender did not show any statistically significant difference between success rates of both treatment modalities. However patients with history of shorter duration ranging in between 11-15 days showed significant higher success rate for intralesional vitamin-D3 as compared to cryotherapy. Conclusion: Frequency of success of intralesional vitamin-D3 was more than that of cryotherapy for treating planter warts.

Objective: To determine the protective effect of human milk on development of retinopathy of prematurity (ROP) in preterm babies. Study Design: Observational study. Place and Duration of Study: King Edward Medical University Lahore, Department of pediatrics over a period of 11 months, from Feb 2016 to Dec 2016. Material and Methods: A total 142 preterm babies with birth weight

Objective: To determine the major stresses of house officers, causes of these stress and the coping strategies. Study Design: Descriptive cross sectional study. Place and Duration of Study: Study was conducted in 13 different tertiary care hospitals of Karachi in both government and private sectors from Oct to Nov 2017. Material and Methods: A descriptive cross sectional study with multistage random sampling technique was done in which a self-designed and self-explanatory questionnaire was used. Results were analyzed using statistical package for social sciences (SPSS) version 20. Results: About 300 questionnaires were distributed to interns. From the total, 83.9% participants were female. The mean age of the participants was 24 years. Out of the total respondents, 9.4% participants stated no any significant medical mistake. Issues arising due to lack of knowledge or incompetency leading to mis diagnosis of patients were reported by 20.5% respondents. One of the common mistakes reported was wrong drug administration; either route, dosage or incorrect medicine, committed by about 25.3% of doctors participated. The most reported reason thought to be the underlying cause of mistakes was work overload that was about 36.3%. Conclusion: It can be concluded by the present study that house officers are susceptible to stress which affects their overall work performance and it leads to significant medical mistake due to which patient suffer and because of this pressure it‟s very hard both physically and mentally for a doctor to cope up.

Objective: This study was conducted to explore and compare the level of mental health in all the districts of Gilgit Baltistan (GB). Study Design: Cross-sectional study. Place and Duration of Study: Based at CMH Gilgit, all districts of GB were visited between Mar and Dec 2016. Material and Methods: Data were collected from consenting adults in community setting by administering mental health inventory (MHI). Data were compared with the population mean and inter-district comparisons were performed. Results: A total of 370 (186 males) participants, age ranging from 17 to 80 years (M = 28.54 ± 11.27). Out of these, 240 (64.8%) were married and their education levels ranged from 5 to 16 years of schooling. Males (t=4.5, p

Objective: To determine the frequency of beta thalassemia trait among the asymptomatic healthy individuals. Study Design: Cross sectional study. Place and Duration of Study: This was carried out at Pakistan Air Force (PAF) Hospital Lahore from Jan 2016 to Jun 2017. Patients and Methods: The subjects were both male and female who came from all over Pakistan for central medical board for selection in Pakistan Air Force. Their ages were between 18 and 28 years. Their complete blood counts were measured on Sysmex KX 21 hematology analyzer. Candidates with microcytic hypochromic indices without anaemia were screened for beta thalassemia trait. Haemoglobin (Hb) electrophoresis was done on cellulose acetate paper at alkaline PH. HbA2 estimation was done by measuring the absorbance of elute on spectrophotometer. Beta thalassemia was diagnosed if the subject had HbA2 more than 3.5%. The data was analyzed using statistical package for social sciences (SPSS) software version 17. Results: A total of 2279 individual were enrolled in the study. Among them 2061 (90.4%) were males and 218 (9.6%) were females. Out of 2061 males, 91 (4.41%) were found to have beta thalassemia trait whereas among females only 6 (2.75%) out of 218 had beta thalassemia trait. The overall frequency of beta thalassemia trait was found to be 4.25%. Conclusion: The overall frequency of beta thalassemia trait in our study was found to be 4.25%. Thalassemia screening should be carried out along with normal health screening tests at least once in lifetime.

Objective: The aim of the study is to find out the prevalence of Medical Student Syndrome (MSS) in Pakistan and its association with age, maturity level and the degree of medical knowledge. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The survey was completed in one year, from Jul 2016 to Jul 2017 Material and Methods: A self-designed, self-explanatory questionnaire was used. The link of the questionnaire was disseminated electronically. The data were analyzed by using Statistical Package for Social Sciences (SPSS-22) Results: Total 129 responses were received from the students of different medical colleges/universities of Pakistan. Mean age of the participants was 21.94 years. Among the respondents 43% were males while 57% were females. Maximum participants were from final year. Majority of the respondents that is about 81% reported they had symptoms of the diseases they study, yet 44% pursued and moved forward. Among them 28% of the respondents said that they investigated their felt symptoms further, of which maximum were from 3rd year. Only 43% of the students knew about the Medical Student Syndrome. Some of the respondents, about 22.8% admitted the fact that they used psychiatric medicines either for relaxing or sleep. Conclusion: It can be concluded that medical students are more vulnerable to conditions like Medical student syndrome so there is a need to counsel medical students about the symptoms of MSS as well as to support the students by discussing different techniques to subsist the stress level.