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Background: Stress in medical students is a global concern. Stress disturbs the sympathovagal balance and affects heart rate variability, a sign of healthy cardiovascular homeostasis. Various strategies have been used globally to combat stress and its effects. Aim: To determine how blowing balloon exercise modulatesheart rate variability (HRV) in stressed medical students. Methodology: A pretest-posttest quasi-experimental study wasconducted among stressed medical students at Islamic international medical college Rawalpindi Pakistan. Sixty students diagnosed with moderate stress were enrolled based on Depression Anxiety Stress Scale (DASS) Proforma. The study population was selected by simple random sampling via the balloting method among the stressed medical students. Study participants underwent a supervised blowing balloon exercise.Before and after a supervised blowing balloon exercise, the participants' pulmonary function tests, electrocardiograms, and DASS scores were measured. Participants' ECGs and pulmonary function tests were recorded viaPower lab (A.D. Instruments, model yam 4/25T, South Wales, Australia). Results: Blowing balloon exercise resulted in a significant reduction of DASS score (p

Background: Head and neck carcinoma is the malignant lesions which develops on lips, oral cavity, nasal mucosa, paranasal sinuses, inside or outside the throat or parotid glands. Magnetic resonance imaging can be a good alternative to invasive procedures for detection of metastatic disease in cases of head and neck tumors. Objective: To evaluate diagnostic accuracy of magnetic resonance imaging in detecting metastasis in neck nodes of oral squamous cell carcinoma with reference to postoperative neck histopathology. Study Design: Cross sectional study Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Mayo Hospital Lahore from 1st January 2014 to 30th June 2014. Methodology: Eighty seven patients with biopsy proven squamous cell carcinoma of orofacial origin were enrolled who had single malignant tumor at the time of diagnosis. Results: The mean age of the patients was 50.44±12.44 years. There were 58 (66.67%) males and 29 (33.33%) females. In terms of sensitivity, specificity, and diagnostic accuracy, magnetic resonance imaging was 94.12%, 61.11%, and 80.46% respectively taking histopathology as gold standard. Conclusion: For the detection of cervical nodal metastases in oral squamous cell carcinoma, MRI is a useful and trustworthy method with a high sensitivity and specificity, especially when compared to postoperative neck histopathology. Keywords: Histopathology, Carcinoma, Magnetic resonance imaging (MRI),Metastasis

Objective: The objective of this study was to assess liver cirrhosis with special reference to thyroid function. Study Design: The study was a cross-sectional one. Setting: Research was conducted at Department of Medicine, Shaikh Zayed Hospital, Lahore from August 2022 to January 2023. Material and Methods: In this study, 115 patients with cirrhosis who were both male and female and between the ages of 20 and 70 were included. These patients underwent thyroid function tests. Each patient provided written informed consent. Results: The average patient's age was 51.78±9.17 years old, and their ages ranged from 35 to 70. The vast majority of patients (n=119, or 55.6%) were between the ages of 53 and 70. Patients included 71 males (61.73% of the total) and 44 females (38.8%). The average duration of illness was 23.78 ±10.05 months, although it may be as little as 8 months. A total of 34 patients (29.56%) were classified as Child Class-B, while 81 patients (70.43%) were classified as Child Class-C. The range of serum TSH was from 3.5 to 5.8 uIU/ml (mean 4.32±0.43 uIU/ml), while the range of serum fT3 was from 1.2 to 2.9 pg/ml (mean 1.87± 0.38 pg/ml). The average serum fT4 concentration was 1.68 pg/ml (standard deviation = 0.47). Practical Implication: Especially in low and middle income countries, there is a lack of consistent data on the impact of cirrhosis on thyroid function and the association of thyroid hormone levels in patients with cirrhosis. In order to better understand the medical picture of cirrhosis of the liver and its relationship to thyroid function, the current investigation was carried out at a tertiary care center. Conclusion: Liver cirrhosis patients had lower mean blood levels of fT3 and fT4. However, the mean serum TSH level was higher in this group of individuals. It was shown to be significantly higher in patients with more advanced liver disease, but not to differ significantly by age, gender, or disease duration. Keywords: Thyroid Function, Liver Cirrhosis, Child-Pugh Classification

Background: Bottle feeding affects the hard tissues of babies in a negative manner. Overall health of infants is also affected by regular bottle feeding. It also results in development of certain harmful habits and increasing use of pacifiers when bottle feeding exceeds 0-6 months. Many detrimental changes occur in the dental tissues of infants due to bottle feeding. Infant feeding practices are an important factor influencing malocclusion in deciduous dentition, which can have long-lasting negative outcomes on oral health-related quality of life. Objective: To assess the awareness in mothers regarding bottle feeding and its adverse dental effects in babies and to find out the general feeding pattern among mothers. Study Design: Descriptive cross sectional study. Study Duration: Study was conducted on feeding mothers in Lahore during a period from November 2020 to February 2021. Methodology: In this study 350 mothers participated. The inclusion criteria consisted of women having at least 1 baby less than 2 years of age. Questionnaire was printed in English and Urdu and filled by mothers. Prior to the actual data collection process at non-sampled Kebeles, the questionnaire was pre-tested on 5% of the sample size, and adjustments were made as necessary. The short questionnaire was collected on same day. Data was analyzed using SPSS version 23 (IBM SPSS Statistics, version 23, USA). Chi square test was used to compare frequencies amongst groups. A p value of

BACKGROUND: Hypomobility of the cervicothoracic (CT) junction has been suggested neck discomfort as one of its causes.There are, however, few trials that have contrasted the impact of CT junction mobilisation against a successful neck pain intervention. The treatment of distant spinal segments using thoracic spine manipulation is non-specific and is founded on the notion of interregional reliance.Recent studies have examined the usefulness of segment-specific spinal mobilisation in the cervical spine, although no firm findings could be drawn from earlier research. The aforementioned factors call for research into the effectiveness of a particular CT junction mobilisation vs a general thoracic manipulation intervention in neck discomfort. MATERIAL AND METHODS: Participants in a randomised clinical trial with mechanical neck soreness and Cervicothoracic junction dysfunction were randomly assigned to the mid-thoracic (T3-T6) manipulation group or the C7-T1 stage Maitland mobilisation group. The results of the cervical flexion, extension, facet flexion, and rotation degrees of movement (ROM) before and after the intervention have been measured the use of a cervical range of motion (CROM) device. The severity of self-stated ache become measured using the numerical pain score scale (NPRS). After the intervention, a one-way ANCOVA was used to evaluate the outcomes. RESULTS: For the study, 48 individuals have been enrolled, with a median age of 36.Forty eight±12.Forty eight for the thoracic manipulation organization and 34.25± 12.24 for the CT junction organization. After treatment, there were no discernible differences in cervical variety of movement (ROM) or self-said ache depth among thegroups (p-value = 0.07, 0.96, 003, 0.Forty, 0.30, 0.31 for flexion, extension, bilateralside bending, and rotation, respectively), nor in neck pain depth (p = 0.67). The cervical ROM and pain, however, extensively stepped forward in both businesses whilst in comparison within-institution, pre- and post. CONCLUSION: This preliminary investigation showed that thoracic manipulation had the same effects on the outcomes of cervical range of motion and neck discomfort as level-specific Cervicothoracic mobilisation in patients with non-specific neck pain when it was compared to remote mid-thoracic manipulation. KEYWORDS: Cervicothoracic Mobilization, Thoracic manipulation, Non-specific neck pain, ROM, mechanical neck pain

Objective: To compare the conventional surgical turbinoplasty versus microdebrider assisted turbinoplasty in cases of inferior turbinate hypertrophy. Design of the Study: It was a cross-sectional survey. Place and Duration of Study: This study was carried at the Department of ENT Nishtar Medical University and Hospital, Multan from January 2022 to June 2022. Patients and Methods: Patients with hypertrophy of the inferior turbinates, the most common cause of nasal obstruction, were split into two groups of 30. The size of the inferior turbinates was classified as Grade I if they took up less than a third of the nasal cavity, Grade II if they took up more than a third but less than half, and Grade III if they took up more than half. Each group had either a standard partial inferior turbinectomy or a turbinoplasty with the help of a microdebrider. Visual evaluation was used to categorise blood loss during and after surgery. Patients were checked on at 1, 2, 4, and 6 months after surgery. Relief from symptoms and the occurrence of problems such crusting and synechiae formation were evaluated. Results of the Study: Both groups showed comparable significant improvements in nasal blockage. Most patients in the CPIT group experienced intraoperative blood loss of grade II (66.66%) or grade III (10%). When the packs were taken off, 60% of patients experienced grade I blood loss, 36.66% experienced grade II blood loss, and 3% experienced grade III blood loss after surgery. Most patients (46%) and surgeons (40%) in the MAT group experienced grade II or higher intraoperative blood loss. The majority of patients' postoperative blood loss was classified as grade I. Six months later, 6.66 percent of the CPIT group had acquired crusting, and 6.66 percent had developed synechiae. Those that received MAT did not have these problems. Practical implication: The choice of surgical procedure is up to the surgeon's attitude and experience due to the lack of agreement regarding their efficacy. That’s why we compared the effectiveness of these treatment methods for turbinate reduction in order to provide evidence to evaluate the results of the several surgical techniques in local population. Conclusion: According to the findings, both surgical approaches are effective in addressing nasal blockage. Complications are less likely to occur with microdebrider-assisted inferior turbinoplasty since the mucosa and nasal physiology are preserved. Keywords: Microdebrider assisted inferior turbinoplasty, Hypertrophied inferior turbinate, Conventional partial inferior turbinectomy

Objective: "The current study aims to assess the proportion of newborns that sleep well and investigates the awareness and comprehension of SIDS and its associated risk factors among mothers of infants in Al Najaf Provence". Methodology: In order to accomplish the study's goals, a descriptive cross-sectional study was used throughout. The study took place between November 2021 and February 2022. a Non-Probability (Purposive Sample) of 100 moms who arrived with infants (under 1 year old) at the Hospital for Maternity and Children and the primary healthcare facilities in Al-Najaf Provence. Results: The study's findings revealed that (49%) of newborns were found to be sleeping on their sides, (37%) were found to be dozing off, and (14%) were found to be sleeping on their prone backs. Participants as a whole (60%) stated that (40%) child doctors were the main information source they used to learn about SIDS. Conclusion: In our study, women had limited understanding about sudden infant death syndrome, and a substantial percentage of them were unaware that smoking exposure during pregnancy and after delivery had been linked to an elevated risk of SIDS. In our study, a large percentage of moms were unaware that giving their babies pacifiers while they slept reduced the risk of SIDS. Keywords: knowledge, mother, sudden infant death syndrome.

Introduction: Diabetes mellitus is a significant precursor of CAD. Patients hospitalised for suspected myocardial infarction had type 2 diabetes at higher rates than the general population, increasing the likelihood of cardiovascular complications. Hospitalized individuals with CAD have a worse prognosis if they also have diabetes mellitus. Objective: With this study, we want to quantify the prevalence of unrecognised diabetes mellitus among Acute Coronary Syndrome patients at a tertiary care hospital in Lahore. Study design: Cross sectional study Setting: Department of Cardiology, Bahria Town Hospital, Lahore Duration: Six months (09-2018 to 03-2019) Data collection procedure: One hundred forty patients who fulfilled the study's inclusion and exclusion criteria were included. Using a standardised questionnaire, we were able to collect information such as age, gender, and type of ACS (STEMI, Non-STEMI, or unstable angina). Diabetes was diagnosed by measuring fasting blood sugar and haemoglobin A1c in a serum sample of 3 cc. It was noted that untreated diabetes mellitus was present. Results: There were 110(78.6%) males and 30(21.4%) females in our study. The mean age of patients was 57.08±12.72 years. The mean height was 171.95±14.37 cm, mean weight was 80.70±11.23 kg and mean BMI was 26.89±3.64. There were 63(45%) patients with family history of diabetes. There were 60(42.9%) patients with Non-STEMI, 52(37.1%) with STEMI and 28(20%) with unstable angina. The mean HbA1c of the patients was 6.11±0.86. There were 10(7.1%) patients with undiagnosed Diabetes mellitus. Conclusion: 7 percent of ACS patients have diabetes mellitus that has not been diagnosed. Keywords: Undiagnosed Diabetes Mellitus, Acute Coronary Syndrome, type 2 diabetes, family history, STEMI

Aim: To assess the association between the severity of retinopathy and HbA1c status in patients with diabetes mellitus. Study design: A Cross-sectional study. Place and duration: In the department of Ophthalmology, Al Shifa Trust Eye Hospital, Rawalpindi for six-months duration from December 2020 to May 2021. Methods: The study included 120 patients of both sexes with type I and type II diabetes, aged 35-80 years. Full ophthalmology examination was carried out including the slit lamp examination, best visual acuity correction, fundus examination and Goldman applanation tonometry. The diabetic retinopathy is graded from Grade 0-Grade V. Results: Of the 120 cases, 58 (49%) were male and 52 (51%) were female. 60 ± 2.4 years was the mean age of patients with 35-80 years of age range for men and 40-75 years for women. Figure 1 is a bar graph showing the severity of diabetic retinopathy. Grade-I diabetic retinopathy was seen in 45(37.5%) patients and Grade-V was noted in 5%. The good control of glycemia was seen in 38 patients and 20.8% had Grade III glycemic control. The worst glycemic control was seen in patients with Grade-IV diabetic retinopathy having 11.8 of HbA1c. Conclusions: This analysis found that severe diabetic retinopathy was seen in patients with poor control of glycemia in comparison to patients with better diabetes control. There is a direct relationship between the severity of diabetic retinopathy and levels of HbA1c levels. Keywords: Diabetic retinopathy, Vitreous hemorrhage, HbA1C, Proliferative diabetic retinopathy, Non-proliferative diabetic retinopathy.

Background: Treatment of either physical or mental illnesses is not as effective if the knowledge and awareness of the patient is inadequate. Study design: Descriptive study. Methodology: A total number of 240 students through convenient sampling who responded to the questionnaire. The ethical approval was obtained from review ethical committee, after completing and submitting the research proposal. The research instrument for data collection was, “structured questionnaire” developed by using 2 scales, the mental health literacy scale (MHLS) and modified scale. Data was analyzed by SPSS version 23. Chi-square test was applied for categorical variables to find the differences in knowledge and practices by dental professionals with p-value ≤0.05 as significant. Results: Almost 86.7% of students were able to identify major depressive disorder.8.3% thought such disorders are punishment by God, 38.3% of students considered mental illness as inherited trait. According to 47.5% treatment of mental illness caused addiction, 37.1% were unsure and 15.4% disagreed. Practical Implication: This study helped researchers in exploring role of multiple factors in changing mental health literacy and how it can help in reducing those barriers and promoting mental health literacy in students. This also added to local literature regarding mental health. Conclusion: It was concluded that mental illness needs recognition and awareness campaigns for mental health literacy needs to be conducted. Keywords: Mental Health, Knowledge, Awareness, Attitude and Individual Performance.

Objective: To assess the knowledge and practices regarding safe urinary catheterization among health care workers Study Design: It was a Cross sectional observational study. Methodology: Ninety two health care workers were interviewed in two hospitals from April 2022 to July 2022. A questionnaire was designed about individual and departmental practices of urinary catheterization, including the practice of hand hygiene, wearing gloves, maintaining a sterile barrier and using a non-touch gentle insertion technique and post insertion catheter care. Results: Fifty respondents were doctors, while 42 were paramedics. Hand washing and using sterile gloves were reported by 67.3% and 91.2% respectively. 71.7% cleaned the area with antiseptic but only 56.5% practiced appropriate method. 67.3% had a separate sterile catheterization tray. 68.5% respondents inserted the catheter without touching its tip. Other safety measures including arrangement of prefilled syringe for inflation of balloon (89.1%), clear visualization of urethral meatus (90%), gentle insertion (84.7%), confirmation of urine flow (86.9%), and holding the catheter in place while balloon inflation (82.6%) were variably practiced. 61.9% had mistakenly passed the catheter into vagina instead of urethra at some occasion in life. 83.6% thought it necessary to hang the urine bag on bed side for safe care, but more than 84% frequently found the urine bags on the floor in their wards. Conclusion: Safe urinary catheterization practices need to be improved. Units must develop set protocols to reduce the incidence of catheter associated morbidity. This can be achieved by continuous training and audit within the department. Keywords: urinary catheter, urinary tract infection, patient safety.

Background and Aim: Thyroid hormones play a significant role in physiology of normal reproductive system. Thyroid dysfunction is extremely common in women and effect certain metabolic process and menstrual irregularities. The present study aimed to assess the menstrual pattern of reproductive age group women and their association with thyroid dysfunction. Methodology: This cross-sectional study was carried out on 140 women with menstrual irregularities who were assessed for thyroid dysfunction in the Department of Obstetrics and Gynecology outpatient Department of Sindh Government Hospital Karachi, January 2021 to December 2021. All the reproductive age group women between (15-45 years) with menstrual irregularities were enrolled. Women with a history of thyroid dysfunction and taking anti-thyroid drugs were excluded from the study. Individual age, thyroid hormones level, and type of menstrual irregularities were recorded. ELISA technique was used for the determination of thyroid hormones. Thyroid stimulating hormone (TSH) levels, serum free triiodothyronine (T3), and free thyroxine (T4) were used for the assessment of thyroid dysfunction. SPSS version 25 was used for data analysis. Results: The overall mean age of the study population was 27.8 ± 5.3 years with an age range from 15 years to 45 years. The age-wise distribution of patients were as follows; 15-25 years n=67, (47.8%), 26-35 years n=46 (32.9%), and 36-45 years n=27 (19.3%). The prevalence of thyroid dysfunction was 22% (n=31). The clinical presentations of menstrual patterns were as follows; Irregular menstruation 66.4% (n=93), Oligomenorrhea 4.3% (n=6), Menorrhagia 15.7% (n=22), Polymenorrhea 7.9% (n=11), and Metropathia 6.4% (n=9). Of the total 31 thyroid dysfunction women, the incidence of normal, hypothyroidism and hyperthyroidism was 82 (58.6%), 12 (38.7%) and 1 (1.4%) respectively. The median TSH level was 2 mIU/L IQR (1.0-4.0). The mean level of T3 and T4 was 2.83±1.13 pg/ml and 1.38±1.1 ng/dl respectively. Conclusion: The present study found that hypothyroidism is the most prevalent thyroid dysfunction among women of reproductive age with different menstrual irregularities. The most common clinical presentation was menorrhagia, polymenorrhea, and oligomenorrhea.. Hence the thyroid function evaluation should be mandatory in cases of DUB to detect thyroid dysfunction so the cases have to evaluated for further medical help Keywords: Menstrual Pattern, Reproductive age group women, Thyroid dysfunction

Introduction: Community acquired pneumonia (CAP) and diabetes mellitus (DM) are common medical conditions which lead to increased morbidity, mortality and high hospitalization rates. Objective: To determine the outcome and predictors of community acquired pneumonia in patients with diabetes mellitus. Methodology: This study was hospital based descriptive case series carried out at the department of Medicine Hayatabad Medical Complex, Peshawar for duration of six months from December 2020 to June 2021. 150 patients were included in this study. All the information’s including name, age, sex, co-morbidity were recorded in pre-designed questionnaire. Data entry and analysis were done through Statistical package for social sciences (SPSS) verion20.0. Results: Based on distribution of predictors, total leukocytes count greater than 12000 or less than 4000 was observed in 37(24.7%) patients, FBS equal to or greater than 126mg/d1 and RBS equal to or greater than 200mg/d1 was observed in 20(13.3%) patients, HbAl c greater than 6.5% was observed in 32(21.3%) patients, blood urea greater than 40mg/d1 in 15(10.0%) patients, serum creatinine greater than 1.2mg,/d1 in 20(13.3%) patients while serum sodium less than 130mEq/L was observed in 26(17.3%) patients. Based on outcomes, expired, survived and prolonged stay in hospital was observed in 67(44.7%), 48(32.0%) and 35(23.3%) patients respectively. Conclusion: Our study concludes that diabetic patients with community acquired pneumonia have unique clinical features. The major predictors of diabetic patients with community acquired pneumonia were total leukocytes count, FBS, RBS, HbAl c, blood urea, serum creatinine and serum sodium. High mortality rate was observed in our study. Keywords: Community acquired pneumonia; Diabetes mellitus, Mortlity

Aim: To access the difference between the mean thickness of the retinal nerve fiber layer (RNFL) in myopic eyes (down to -6.00 D) and the normal eye. Study Design: An Observational and Descriptive study. Place duration: In the department of Ophthalmology, Al Shifa Trust Eye Hospital, Rawalpindi for six-months duration from June 2020 to November 2020. Methods: In this study, the mean comparison of RNFL among 70 myopic eyes (down to -6.00 D) and 70 normal eyes of the same age was done. 15-45 years was the patients’ age range. A comprehensive eye exam was performed and thickness of RNFL was evaluated by optical coherence tomography. Data analysis was done with t-test for independent samples using SPSS 21.0; p

Introduction:Urinary Incontinence (UI)the complaint of any involuntary leakage of urine-is common in women that increases with age and may decrease quality of life Objective:The main objective of the study is to find the urinary incontinence (UI) and related quality of life among elderly men.Material and methods: This cross-sectional study was conducted at Urology Poonch Medical College Rawalakot Azad KashmirDuring May to September 2021. The study included 109 elderly patients aged 65 years and older. Informed consent was obtained from all patients and the study protocol was approved by the local ethics committee of our institution. The patients were assessed sequentially based on their presentation to the physical medicine and rehabilitation outpatient clinic Results: The study included 109 elderly patients and mean age of patients was 73.98 ± 7.88 years. Of the study group, 40.4% had UI and 59.6% did not have UI. The difference between the two groups with respect to mean age was not statistically significant (p = 0.093). Practical implication: UI is coomon among older men so this study will helps us to improve the quality of life. Conclusion: It is concluded that UI is common among older men and is associated with worse QoL. Health care professionals should discuss UI with older men. Keywords: Quality of life, UI, Health care, WHO, Individuals, Population

Background: Women who have had abortions are almost immediately pregnant-risk, low post-abortion family planning usage perceived to be one of the primary and significant factors that cause of induced abortion and spontaneous abortion. The aim of the study was to determine the factors in which the women accept post-abortion contraceptive methods among abortion care service patients in our hospital. Study Design: It was a cross-sectional study conducted in the Obstetrics and Gynecology Department of Riphah International hospital, Islamabad, for six month duration from March 2022 to August 2022. Methods: 125 out of 150 participant (abortion clients) selected by sampling technique were interviewed in Mayo hospital, Lahore. We analyzed dependent and independent variables. Data analysis was done statistically by SPSS 20 version. Results: This study included 150 participants who had a first trimester abortion between the study periods, 25 participants in this study were not willing to participate in the study, ultimately the responding rate of 83%. Among the 125 participants 92% were within the age group 21-39. The maximum participants were Muslim 92% and 8% non-Muslim. The maximum participants were married 96% and 4% unmarried. Most of the participants had only received the educational status 76%. This study indicate the strong relationship between women age 21-39 with the high usage of post-abortion contraceptive 92% as compared to >40 years. The participants in our study were used 85% contraceptive method. Conclusion: Our finding shows that providing appropriate medical advice and contraceptive counseling services can increase contraceptive acceptance. Keywords: Post-abortion contraceptive, family planning, contraceptive counseling services.

Aim: To see the comparative effectiveness of Conventional physiotherapy with kinesio Taping and Conventional physiotherapy alone to reduce pain and increase Range of Motion (ROM) in patients with non-specific low back pain. Methodology: The study design was Randomized controlled trail. Non-probability Temporal method sampling technique was used. Sample size was 36. The data was collected from Department of Physiotherapy Mayo Hospital Lahore. Written informed contest was taken from each patients taking part in this prior to performing any examination. Patients with non-specific low back pain were divided randomly into two groups. In ‘group A’ Conventional physiotherapy with Kinesio Taping was applied while in ‘group B’ only conventional physiotherapy was applied. The patients were divided into two groups using a computer-generated list. Both groups will receive conventional therapy, which will remain same throughout the study. The conventional therapy will include back isometrics and hot pack for 15 minutes. Group A will receive conventional therapy and Kinesio Taping while group B will receive only conventional therapy. Treatment frequency will be thrice a week. The duration of treatment was be 2 weeks in both groups. Each patient's informed consent was obtained before Performa was filled out. The Roland Morris Disability Questionnaire and the Visual Analogue Scale (VAS) were both utilized for scoring. Results: Kinesio Taping with Traditional Physical Therapy technique is more effective in improving ROM and reducing disability as compared to only Traditional Physical Therapy technique. Patients in group A showed marked improvement as compared to group B. Conclusion: it was concluded that conventional physiotherapy with Kinesio Taping is more effective than Conventional physiotherapy alone for the treatment of low back pain. Conventional physiotherapy with Kinesio Taping not only decrease pain but also improves function and flexibility of spine. Key words: Non-specific low back pain, Kinesio-taping, Traditional physical therapy, RCT, Rehabilitation

Introduction: Engagement of fetal head is usually regarded as a phenomenon of labor in nullipara. It commonly occurs during the last few weeks in nullipara, in majority by 38 weeks or even during the first stage of labor. The aim of this study was to determine the outcome of unengaged fetal head at term in nullipara. Materials And Methods: This study was conducted at obstetrics and gynecology unit, tertiary care teaching hospital, Peshawar. This was a descriptive cross-sectional study which was conducted during 12th Jan 2021 to 10th April 2022, in which a total of 111 patients were included in the study using 16.89% proportion of caesarean section¸95% confidence level and 7% margin of error under WHO software for sample size determination. Results: In this study, patients were in age range 19-35 years and heights of the patients were 140-160cm. Among 111 patients, normal vaginal delivery occurred in 71.71% patients, instrumental delivery in 10.8% and 18.2% patients underwent low segment caesarean section. Total number of nullipara with unengaged head were divided into four groups based on fetal head station in early labor. Total number of nullipare in each group of which 30.6% were free head, 43.2% at -3 station group, 21.62%-2 station group and 45% in -1 group Practical implication in nulliparous patients a high station at the onset of labour is not necessarily an omnious finding, even though the incidence of arrest disorders are higher when station is -3,or floating ,obstetricians can still be optimistic towards vaginal delivery. Conclusions: Nullipara with unengaged head at term during labors should be regarded with suspicion and as such should be regarded with apprehension in labor. Dysfunctional labor occurs in only small proportion of patients with unengaged head. It is concluded that the incidence of active surgical intervention in nullipara with unengaged fetal head at term is quite high. Keywords: Primigravidae, engagement of head, delivery, LSCS, Head station.

Objective: To determine the lipid profile abnormalities among diabetes patients presented at tertiary care Hospital. Methods: This cross-sectionals study was done at medicine out patient’s department (OPD) at Muhammad Medical College Mirpur-Khas, from September 2020 to September 2021. Patients of type II diabetes mellitus, presented at medicine OPD, aged more than 40 years, diabetes duration more than three years and both genders were included. A five ml blood sample was obtained in fasting from each case and sent to the Hospital laboratory to assess the HbA1c and lipid profile. All the data was collected via a structured study proforma, and the analysis was done using SPSS version 20. RESULTS: In this study, 67 known diabetic patients were studied to observe the frequency of lipid profile abnormalities. Patient’s mean age was 51.64+10.32 years, mean BMI was 25.20+3.23 kg/m2 and mean Hba1c was 7.84+2.94%. Males were in majority 61.2% and females were 38.8%. Out of all 56.7% patients had lipid profile abnormalities. There was a positive correlation between hba1c and triglyceride level and a significant positive correlation between hba1c and total cholesterol level (r = 0.431, p = 0.001). Frequency of lipid profile abnormalities was statistically insignificant according to gender and duration of disease (p=>0.05). Conclusion: Lipid profile abnormalities were observed to be highly frequent among patients with type II diabetes mellitus. The early identification and treatment of dyslipidemia in individuals with DM seems to be a significant aspect of lowering the risk of DM-related morbidity and mortality. Keywords: Diabetes type II, lipid profile, Hba1c

Objective: The primary goal of this study is to evaluate the rates of death from coronavirus infection among healthcare personnel against those in the general population. Study Design: Comparative study Place and Duration: This study was conducted at Benazir Bhutu Hospital Rawalpindi during the period from July, 2022 to September, 2022. Methods: 135 coronavirus-infected individuals of both genders were studied. Patients were aged 20–65 years. All patients gave written consent for baseline data on age, sex, body mass index, socioeconomic status, and domicile. Patients were symptomatic and asymptomatic. Among 135 cases, 65 were health workers in group I and 70 were general population in group II. Mortality among both groups were compared. ICU hospitalization, ventilation, and death were compared between groups. SPSS 22.0 analyzed all data. Results: There were 35 males in group I with mean age 26.13±10.72 years and in group II 40 were males with mean age 45.6±5.27 years. We found that number of died patients were higher in group II 9 (12.9%) as compared to group I 3 (4.6%). Older age, heart disease, diabetes mellitus and lack of personal protective equipment (PPE) were the most common reasons of died coronavirus patients. Conclusion: The results of this study indicate that older age, heart disease, and diabetes are independently associated with a higher risk of death and a greater severity of pandemic disease among the general public than they are among health care professionals. Keywords: General Population, Ventilation, Mortality, Coronavirus, Health workers

Objective: The purpose of this study was to ascertain the prevalence of silent cardiac ischemia in diabetic patients with type II diabetes. Study Design: Cross-sectional Place and Duration: This study was conducted at Fazaia Medical College, Islamabad from January, 2022 to June, 2022. Methods: Total 115 patients of type-II diabetes mellitus were presented in this study. After taking a thorough medical history, the patient had electrocardiography (ECG) both before and after exercise tolerance testing. This was done in addition to recording their height, blood pressure, weight, and fasting blood sugar levels (ETT). Changes in the electrocardiogram were analysed, and the patient was classified as having silent cardiac ischemia or not depending on the results of the ECG. SPSS 22.0 was used to analyze all data. Results: There were 75 (65.2%) males and 40 (34.8%) females in this study. The mean age was 51.13± 10.29 years and had mean BMI 26.7±8.44 kg/m2. Mean fasting blood sugar was 171±22 mg/dl. Frequency of hypertension was found in 47 (40.9%) cases and 38 (33.04%) patients were smokers. We found that 50 (43.5%) cases had silent cardia ischemia. There was a strong correlation between silent cardiac ischemia and factors such as increasing age, prolonged duration of diabetes mellitus, a smoking history, a history of hypertension, and an increased body mass index (p-value 0.05). Conclusion: We observed that silent cardiac is quite frequent in our population, which necessitates immediate measures to diagnose this issue early for the sake of improved results in the future. Keywords: Type II diabetes mellitus, BMI, Silent cardiac ischemia, Hypertension

Hypertensive disorders in gestation are categorized as hypertension in pregnancy, chronic hypertension, eclampsia and pre-eclampsia. The World Health Organization states: “There are 529,000 maternal deaths annually worldwide due to pre-eclampsia and eclampsia. This study will help in determining pregnancy outcomes in early vs late-onset pr-eclampsia. Aim: To access the pregnancy outcomes of early and late onset pre-eclampsia. Study Design: A retrospective, descriptive and cross-sectional study Place and Duration: In the Obstetrics and Gynecology department of Allama Iqbal Memorial Teaching Hospital Sialkot and Islamic International Medical College, Rawalpindi for one-year duration form January 2021 to December 2021. Methods: A total 130 were admitted to the gynae ward with pre-diagnosis of pre-eclampsia were included. The cut-off value of the early and late onset PE was thirty-four weeks. Pre-eclampsia analysed < 34 weeks was labeled as early-onset pre-eclampsia and if diagnosed after 34 weeks will be labeled as late-onset pre-eclampsia. Obstetric and perinatal outcomes were assessed with version 21 of the Social Sciences Statistical Package. Results: A total 130 were admitted to the gynae ward with pre-diagnosis of pre-eclampsia were included. The severe pre-eclampsia was observed in 48(36.9%) pregnant women and 82 women (63.1%) had no symptoms of severe pre-eclampsia. In 38 (29.2%) cases; early-onset pre-eclampsia was detected and late-onset PE in 92 (70.7%) cases. The rate of severe PE in early-onset PE has been documented in 22 (57.8%) of 38 cases, and severe PE has been reported in late-onset PE in 29 (31.5%) of 92 cases. Adverse maternal outcomes occurred in 20 cases, including 7 cases of placenta abruptio and 3 cases of eclampsia with seizure disorders. Conclusions: The results indicate that in addition to intensive fetal monitoring in women with early-onset pre-eclampsia, attention should be paid to neurological, cardiopulmonary, and haematological parameters. Keywords: late onset, early onset; pregnancy outcome and preeclampsia.

Objectives: The main objective of the study is to find the Incidence of superficial and deep surgical site infections in post cardiac surgery patients with pre-op HBA1C ≥ 7 % compared to those having pre-op HBAIC < 7%. Material and methods: This cross-sectional study was conducted in Armed forces institute of cardiology AFIC /NIHD Rawalpindi during 1st October 2022 to 30 November 2022. Data was collected with the permission of ethical committee of hospital. All the patients who met the inclusion and exclusion criteria were selected for the study. As a routine practice at the cardiac surgery outpatient clinic of our hospital, HbA1c levels of diabetic patients are examined along with other routine examinations approximately 7–10 days before the surgery. Results: The data was collected from 354 patients of age range was 58.98 ± 4.56 years. According to analysis that was performed to investigate the mortality predictivity, age, gender, input ejection fraction, HbA1c levels and preoperative albumin levels were found to be associated with mortality. In the group with HbA1c≥7, the ejection fraction was lower (p=0.027) and mortality was higher (p=0.008). Practical Implications: Increased level of HbA1c>7 in cardiac surgery patients is considered to be the increased incidence of SSI. Conclusion: Increased level of HbA1c>7 in cardiac surgery is considered to be the increased incidence of SSI. We also found that good peri-operative control of RBS associated with decreased rate of SSI after cardiac surgery. Keywords: Cardiac, HbA1c, Diabetic, Surgery, Ejection fraction

Objective: The purpose of this study is to identify the prevalence of iron deficiency anaemia (IDA) in helicobacter pylori-infected patients. Study Design: Prospective/cross-sectional study Place and Duration: This study was conducted at Benazir Bhutu Hospital Rawalpindi during the period from July, 2022 to September, 2022. Methods: Total 105 patients of Helicobacter pylori infection, who ranged in age from 18 to 65 years included. All patients gave their informed written consent after being asked about their age, sex, body mass index, level of education, and place of residence. Blood samples from the subjects were analysed to determine their levels of serum iron, transferrin saturation, ferritin, and total iron-binding capacity. H. pylori infection can be found by histopathology, stool antigen testing, a fast urease test, or a urea breath test. The entire data set was analyzed using SPSS 24.0. Results: Among all there were majority females. Majority of the patients were illiterate and were from rural areas. 60 (57.1%) had poor socio-economic status. Mean Hemoglobin level was 12.1±0.6 (g/dl) mean serum iron level was 49.8 ±10.33(ug/dl) and mean serum ferritin level was 121.7±42.87 (ng per ml).Frequency of iron deficiency anemia was found in 43 (40.95%) patients. Among 43 cases of IDA, majority of the patients had age >35 years. Conclusion: In this research, we found that patients with helicobacter pylori infection, the majority of whom were adult female patients, had a considerably greater frequency of iron deficiency anaemia. Keywords: Prevalence, H.pylori infection, Iron Deficiency Anemia (IDA), Females

Objectives: The main objective of the study is to find the comparison of CKMB, Lactate levels and ejection fraction with warm and cold cardioplegia on first post OP day in elective CABG cases. Material and methods: This cross sectional study was conducted in Armed forces institute of cardiology AFIC /NIHD Rawalpindi during 1st October 2022 to 30th November 2022. Data was collected with the permission of ethical committee of hospital. The study variables were included level of troponin I during intraoperative and post-operative period, time taken for cardiac standstill, CKMB, Lactate levels and ejection fraction with warm and cold cardioplegia, post-operative improvement in ejection fraction, number of days in ICU. Results: The data was collected from 100 patients. There was no statistically significant difference between the two groups as regards bypass and cross clamp times. Mean age of group I patients was 61.3 ± 12.5 years and for group II patients was 67.4 ± 10.4 years. P value of serum lactate level is

Background: Coronary Artery Diseases (CAD) are among the major causes of global morbidity, mortality and disability. P-selectin, being an adhesion molecule, is found in platelet granules and endothelial cells and plays a vital role in inter-platelet aggregation as well as migration of leukocytes into the vascular wall Objective: The objective of present study was to determine the level of sP Selectin in patients with CAD and compare it with healthy controls in Pakistani population. Moreover, association of CAD with p-selectin levels and other demographic variables were to BE assessed. Correlation of p-selectin levels and gender was also to be assessed. Materials and Methods: It is a cross sectional, analytical study including 60 CAD patients and 60 controls (with ages between 40-60 years, both genders). sP Selectin levels were determined by ELISA. Results: Mean P Selectin serum level in patients was 414.27±216.48 ng/ml with control group mean P Selectin level of 510.88±257.26 ng/ml. Mean P Selectin serum level in males was 438.215 ± 201.54 ng/ml with control group mean P Selectin level of 499.119 ± 290.02 ng/ml. Conclusions: sP Selection levels are higher in control group with a significant difference which can be due to use of antiplatelet drugs. CAD was positively associated with BMI, positive family history, smoking history and history of hypertension. Females had significantly higher p-selectin levels than males. More studies are needed with bigger sample size in our population Key Words: Coronary Artery Disease (CAD), sP Selectin

The aim of this study was to compare between different methods in identifying Helicobacter pylori in saliva, oral swabs and biopsy specimens obtained from patients’ chronic gastritis and peptic ulcer disease. Methods: A total of 100 tissue biopsy, saliva and oral swab samples were collected and tested for identification of H. pylori using urease test, culture media and PCR for detection of 16sRNA and virulence CagA and VagA genes. Results: It was found that the biopsy results in all methods have high percentage 85% with the exception of CagA gene that gave a high percentage 71% in saliva samples, there were 82.05% urease positive using saliva sample and 43.59% using swab sample, 59.65% positive saliva culture and 38,60% positive swab culture, regarding 16sRNA, there were 70.59% saliva sample positive and 43,53% positive swab sample. H pylori detection by cag A gene of saliva in comparison with biopsy was 87.50% and of oral swab 41.67%, however by VagA gene the result of saliva was 31.25% and of oral swab was 16.67%. Conclusion: All detection method that done by using biopsy sample more accurate and give reliable result. Saliva sample using in detection H.pylori is attractive for use in population based prevalence surveys for H. pylori infection. Keywords: H. pylori, saliva, oral swab ,16SrRNA, VacA,GagA

Objective: This comparative study was conducted to investigate the knowledge and practice of correct postural biomechanical awareness among male and female paramedical staff during patient transfer. Methods: Data was collected from Surgical, Orthopedic, Emergency, Operation Theater, Gynae & Labor wards of 20 different hospitals and institutes of Lahore i.e. Services Hospital, Jinnah Hospital, UOL Teaching Hospital, Gulab Devi Hospital, Mayo Hospital, Bajwah Hospital, Iqra Medical Complex, Gosha e Shifa Hospital, Farooq Hospital, Fatima Memorial Hospital, Hajrah Hospital, Ganga Ram Hospital, Life Care Hospital, General Hospital, Hameed Latif, Wapda Hospital, Najam Hospital, PSRD Hospital, Children Hospital, Rescue 1122 (EMS=Emergency Medical Services). Data was collected from these paramedics including Ward boys, Nurses, Midwives and EMS. A comparative cross-sectional survey was conducted and 210 members were studied. A well-structured questionnaire(1) based on Thurston scale “yes” and “no” was used, which was filled by both gender paramedics working in these settings. All participants were chosen via simple random sampling. Results: Results were divided in three domains. First assessed demographics, second assessed knowledge while Third domain assessed the practice of knowledge by the participants. Results were represented in Graphs, Tables and Cross Tabulations. Data was analyzed on SPSS (version 20). First domain showed that participants are usually from lower class and least from middle class, second domain determines that female participants have good knowledge in contrast to third domain that showed that male participants have good practice. Conclusion: Valid Conclusion showed that both gender participants should increase both knowledge as well as practice of Correct postural biomechanics. Keywords: Body mechanics, Knowledge, Practice, Paramedical staff, male and female, Lahore, Pakistan.

Objective: To assess the impact of antenatal anemia on maternal and perinatal outcome. Design of the study: Prospective Cohort study Place of Study: was conducted at antenatal clinic of Creek General Hospital, United Medical and Dental College, Karachi, Pakistan. Methodology: One hundred and thirty-five singleton anemic pregnant women who satisfied the inclusion criteria were included in the study. Enrolled patients were analyzed in detail, sociodemographic and obstetric characteristics recorded and followed till delivery after their informed consent. Haemoglobin estimation was done at first visit & anaemia was graded according to WHO criteria and statistical analysis were done. Results: The study population included 135 antenatal anemic women. Mean ± SD of maternal age was 25.8±5.12 years. Mild anemia was found in 31.1%, moderate in 59.2% and 9.6% women were diagnosed with severe anemia. Anemia was diagnosed in 1.5% of antenatal women in 1st trimester, 54.8% in 2nd trimester and 43.7% in 3rd trimester. Majority of patients were booked (87.4%), out of them 25.9% were diagnosed with mild anemia, 55.6% with moderate and 5.9% were severely anemic, while 12.59% were non-booked of those 5.2% were diagnosed with mild, 3.7 % with moderate and severe anemia each (p-value=0.003%). Maternal complications in antenatal and postnatal period included Preterm labour (13.33%), Pregnancy induced hypertension/ Pre-eclampsia (8.88%), Gestational diabetes mellitus (7.40%), oligohydramnios (11.85%) , antepartum hemorrhage (5.92%) and Postpartum hemorrhage (5.18%). 50.37% of pregnant women delivered vaginally while in 49.62 % abdominal delivery was conducted (Emergency-37 %, Elective -12.6%). Regarding Neonatal outcomes, Low Birth weight was found in 80% of cases which was highly significant, 20.7% were delivered by mildly anemic, 52.6% by moderately and 6.7% by severely anemic mothers (p value- 0.009). NICU admission within the first week of birth was needed in 47.40%, Still Birth (0.74%), Low APGAR scores (20.74%) and unfortunately two Neonatal Deaths occurred as well (1.48%). Conclusion: Antenatal anemia is still a prevalent public health issue in developing countries. Provided that anemia is a straightforward predictor of poor maternal and fetal outcome, intensive prophylactic strategies to be implemented for timely diagnosis and management. The authorities should play their active role in refining policies to remediate the principal risk factors, provision of basic health care, reinforce proper antenatal care, maintain regular availability of iron and supplements for correction of anemia and other nutritional deficiencies. Keywords: Anemia, Maternal and fetal outcome, Obstetric

Objective: To determine the diameter of abdominal aorta at T12 vertebral level by the use of Multidetector Computer Tomography Angiography (MDCTA). Study Design: It is a Cross-sectional study. Place and Duration of Study: This study was executed in Ziauddin University (Hospital) Clifton campus Karachi, at Radiology Department, from March 2017 to August 2017. Materials and Methods: Total 160 individuals were enrolled, 75 (46.9%) were females and 85 (53.1%) were males who do not have any abdominal and arterial or venous problems, approach to Radiology Department, for Abdominal 3D Computed Tomography Angiography. Patients who were enrolled in current study were referred to department of Radiology for different indications like adrenal and renal pathologies altered bowel habits and abdominal aches. In current study abdominal aortic dimension (diameter) was analyzed at T12 vertebral levels in both sexes. The SPSS version used in current study was 20 for statistical analysis. Pearson correlation was applied to check the relationship between variables, Independent sample T test was applied. P-value is less than or equal to 0.05 was considered significant. Result: The results of current study revealed that the mean diameter of the abdominal aorta, measured at T12 vertebral level was 20.402±2.54 mm in total 160 individuals. It was observed that male having diameter with 21.47±2.25 and female have 19.18±2.31mm. It clearly showed that male having greater diameter with highly significant values P=0.001. it was also found that there was a high positive correlation was evident in between diameter of abdominal aorta & age with highly significant difference P=0.001 and r =0.713. This correlation showed that as the age increases the thickness of abdominal aorta also increases. Conclusion: It is the first study conducted in Pakistan on detection of abdominal aortic diameter at T12 vertebral level by Multidetector computed tomography angiography. The current study showed that male having greater aortic diameter than in females it also revealed that the age have a great impact on the diameter of abdominal aorta. Keywords: Multidetector computed tomography, aorta, abdominal, heart, tunica Intima.

Background: In many developing countries including Pakistan maternal morbidity and mortality is still high. Knowledge of danger signs of Obstetrics during pregnancy is the first essential step for the timely referral. This study therefore, aims to fill this gap by assessing the current level of knowledge and associated factors of pregnant women living in low socioeconomic areas of Karachi Aim: The aim of the study is to assess the knowledge of pregnant women with low socio-economic status about the obstetric danger signs. Study Design: A cross-sectional study. Place and Duration: Community based medical centers of Gadap Town Karachi, from October 2020 to October 2021. Methods: A total of 300 pregnant women gave their consent and took part in the study. Data was collected in local language by interview and a pre-designed, tested questionnaire was used, which included the socio-demographic profile, number of births, prenatal care visits, and pregnant women knowledge of danger signs during pregnancy, and in the postpartum period. Socio-economic status was assessed in accordance with the modified international classification. Results: Knowledge of at least one danger sign varied from a total of 300 pregnant women consented and took part in this study. Most of them are in the age group of 21-34 years 138(46%) and over 92 (30.7%) were above thirty years, followed by the age group of 18-20 year 70(23.3%) and then >35 years (27%). Most of the pregnant women (62.3%) have completed the primary Level education. The majority of the surveyed population is housewives and semiskilled workers. Conclusions: Our study has shown that there is little knowledge of the danger signs of pregnancy among pregnant women. Also, most subjects are unaware of obstetric danger signs. Based on this study, we suggest that planned strategies are needed to increase women's awareness of obstetric danger signs. Raising awareness of the key signs of danger, creating and promoting mechanisms of generating income should be carried out on a continuous basis in the health facility and in the environment, as it prepares women and their families to make appropriate, quick and effective decisions and actions in the event of symptoms of obstetric emergency. Keywords: Obstetric danger signs, pregnancy Antenatal and postpartum period

Objective: The aim of this study is to compare the efficacy of oral ondansetron with oral domperidone in reducing vomiting in children with acute diarrhea. Study Design: Randomized control trial Place and Duration:The study was conducted atChildren Medical Center (CMC) / Dr Habibun Nabi Children Hospital, Airport Road Mingora Swat and Paediatrics department of Central Park Teaching Hospital, Lahore during the period fromJanuary 2020 to September 2020. Methods: Total one hundred and fifty children with ages 1-7 years were presented in this study. Children had diarrhea and vomiting from the last 24-48 hours. Informed written consent was taken from guardians for detailed demographics age, sex, weight, height and residency were calculated. Children were equally split into two groups. Group A received 0.15 mg/kg oral ondansetron with 75 children and group B received 0.5 mg/kg oral domperidone with 75 patients. Post treatment blockage of vomiting was observed after 12-24 hours. SPSS 24.0 version was used to analyze all data. Results: Majority of the patients were males 45 (60%) in group A and 42 (56%) in group B while rest were females 30 (40%) in group A and 33 (44%) in group B. Mean age of the patients in group A was 4.3 ±2.17 years and in group B mean age was 3.08±6.88 years. Mean weight of the patients were 15.07±8.23 kg and 15.02±3.09 kg in group A and B respectively. In group A mean height was 98.07±11.14 cm and in group B mean height was 97.67±18.24 cm. After 12 hours vomiting stopped in group A was 61 (81.3%) and 54 (72%) patients in group B. Efficacy after 24 hours were significantly higher among patients of group A in 69 (92%) children as compared to group B in 60 (80%) cases with p value < 0.05. Conclusion: In this study we concluded that for reducing vomiting in children with acute diarrhea use of oral ondansetron was effective and useful as compared to oral domperidone. Keywords: Acute Diarrhea, Ondansetron, Domperidone, Vomiting

Background: Corona virus disease is caused by SARS-CoV-2. This pandemic has affected over 200 countries. Most of the patients are asymptomatic. The disease is usually mild but in approximately 14% of patients it worsens to severe respiratory impairment and admission to ICU. Different tests in laboratories have been used to assess severity and prognosis of severely sick Covid-19 patients in addition to clinical and radiological findings. Aim: To study pattern of Hs- CRP, Ferritin and D-Dimers in Covid-19 patients admitted in Mayo Hospital/ KEMU Duration: June 2020 to October, 2020. Methods: It was a descriptive study conducted in Central Diagnostic Laboratory (CDL) of Mayo Hospital/ KEMU, Lahore on 1474 Covid-19 patients. All samples of the Covid-19 patients sent to CDL of Mayo hospital/ KEMU Lahore for D-Dimers, Hs CRP and Ferritin levels were included in the study. The results and other relevant information were recorded on proforma. The collected data was analyzed by SPSS 23.Quantitative variables like age was presented as mean ± SD. Qualitative variables like gender, single, double or triple parameter abnormalities were presented as frequency and percentage. Results: Out of total 1474, 958(65%) samples were of male and 516(35%) were of female patients. Mean age± SD was50.6±4.2 years. The percentage of abnormal Hs CRP, D Dimers and ferritin was 1386(94%), 1312(89%) and 1135(77%) respectively. The mean±SD value for HsCRP, D-Dimers and ferritin was 56.8±16.9mg/L, 4.4±1.5µg/ml FEU and 770±180 ng/ml respectively. The patients having 3, 2 and 1 abnormal parameter were 988(67%), 456(31%) and 29(2%). Conclusion: Males were more affected with Covid-19 as compared to females. HsCRP is the most frequently raised biomarker in Covid-19 patients and both inflammatory (HsCRP and Ferritin) and coagulopathy marker (D Dimers) were raised in severely sick Covid-19 patients. Keywords: D Dimers, Ferritin, Hs CRP, Covid-19 patients.

Introduction: Postpartum haemorrhage is one of the leading causes of maternal mortality. Maternal Mortality globally is estimated as 599.00 deaths per year, a ratio of 400 maternal deaths per 10,000 live births. The aim of this study was to compare the effectiveness of oxytocin and misoprostol in prevention of primary post-partum haemorrhage Material and Method: It was Randomized Controlled Trial, which was conducted in the department of Obstetrics and Gynaecology, Hospital, Peshawar, between 14th March 2020 to 22 April 2022). The sample size was 100(50 in each group) Using 4% of PPH in misoprostol group, 24% of PPH in oxytocin group, 95% confidence level and 90% power of test under WHO software for sample size determination. Results: A total of 100 patients of primary post-partum haemorrhage were observed, which were divided in two equal groups A & B. Patients in Group A were managed with misoprostol while patients in group B will be subjected to oxytocin. Gravida wise distribution shows that out of 50 patients 22(44%) were gravid less than or equal to one,18(36) patient have 2-5 and 10(20%) were more than 5 while group B contains 25(50%) less than or equal to one, 17(34%) patients 2-5 and 8(16%) have gravid more than 5. Gravida distribution among the groups was insignificant with p-value=0.802. Average age was 27.82 years+4.56SD with range of 20-36 years. Group A contained 13(26%) patients in less than or equal to 25 years, 30(60%) patients 26-35 years and 7(14%) patients having ages of more than 35 years. While group B contained 18(36%) patients in less than or equal to 25 years, 28(56%) in 26-35 years and 4(8%) patients with age more than 35 years. The age distribution among the group was also insignificant with p-value 0.429. Efficacy wise distribution was significant with p-value = 0.021. Group A showed 47(94%) efficacy while non-effective in 3(6%) patients. Similarly, Group B showed 39 (78%) efficacy while non effective in 11(22%) patients. The misoprostol has greater efficacy than oxytocin. Age wise distribution of drug-efficacy shows that efficacy was almost same in all age groups. The patients having less than or equal to 25 years of age have shown efficacy in 12(92.3%) patients while 1(7.7%) patients being non-effective. Patients with 26-35 years of age have shown efficacy in 28(93.3%) of patients and 2(6.7%) have shown no efficacy. Similarly, 7(100%) patients have shown efficacy and no patients have no efficacy, with age more than 36 years of age. The same pattern was followed in group B, although age wise efficacy was insignificant in both the groups with p-value=0.765 and 0.987 respectively. The prevention of PPH, particularly in resource poor settings, where PPH is the leading cause of maternal mortality The enormity of postpartum haemorrhage and the limitations in the use of oxytocin for the adequate preventive therapy were the basic rationales behind this study. Secondarily, our cultural setups of home deliveries have a marked role in grave morbidity as well as lack a consensus protocol for the choice of adequate preventive treatment of haemorrhage. Keeping in view the above mentioned factors, this study was conducted to compare the effectiveness of the per rectal misoprostol medication to the intramuscular oxytocin to control the blood loss as adequate preventive therapy. Conclusion: Misoprostol is more effective as compared to oxytocin in prevention of primary postpartum hemorrhage. Keywords: Primary Postpartum haemorrhage, Cervical tears, Vaginal tears, oxytocin, Misoprostol, efficacy

Background: Bipolar disorder (BD), being a psychiatric condition, is defined as mood swing that alternates between mania, hypomania, and depression. Studies have been conducted globally to assess lipid profile for bipolar disorder with varying results. No such studies have been conducted in Pakistan. Therefore, present study was designed to assess total cholesterol and triglycerides in clinically diagnosed bipolar disorder. Materials and methods: One hundred and twelve blood samples were collected of diagnosed bipolar patients visiting Sheikh Zayd Hospital (SZH) and Punjab Institute of Mental Health (PIMH) Lahore. Total Cholesterol (TC) and Triglycerides (TG), were estimated using standard biochemical methods Results: Results obtained were statistically analyzed using SPSS. A total of 112 bipolar patients, 48 (58.5%) were manic, 26 (31.7%) were depressive, 8 (9.8%) were euthymic. The mean Cholesterol level (191.01±40.67 mg/dl),in bipolar group ( manic, depressive and euthymic) were statistically significant as compared to control group with p-value 0.026. The mean TG level (163.01±89.08 mg/dl), in bipolar and control groups were statistically insignificant with p-value 0.609. Conclusions: The present study suggests that TC level is raised in depressive patients. TG levels were same in bipolar and control groups. Keywords: Bipolar Disorder, Lipid Profile, Total Cholesterol, Triglyceride.

Background: Infertility is defined as the inability to conceive after one to two years of unprotected intercourse. It is of two types primary infertility and secondary infertility Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting 5%–10% of reproductive age women. To compare the efficacy of metformin plus clomiphene and clomiphene alone in the treatment of primary infertility due to polycystic ovary syndrome in obese women Materials And Methods: It was Randomized Controlled Trial, which was conducted in the department of Obstetrics and Gynaecology, Hospital, Peshawar, between 30th May 2019 to 8th January 2022) Sample size will be 380 in each group using P 1 = 15%, P 2 = 22% and power of 80% and 95% confidence interval under WHO Software for sample size determination. Results: A total of 380 patients in each group were observed. Average age of the patients was 26.60 years+ 3.99SD with range of 19-35 years. Group A showed 88(23.2%) efficacies. Similarly Group B showed 68 (17.9%) efficacies. Efficacy was significant in both the groups with p-value=0.044. Conclusion: Metformin plus clomiphene is more efficacious than clomiphene alone in the treatment of primary infertility due to polycystic ovary syndrome in obese women. Keywords: Efficacy, metformin, clomiphene, polycystic ovary syndrome, primary infertility

Background: One of the leading cancers worldwide is the hepatocellular carcinoma, ranked as the 6th most common cancers. Aim: To evaluate the co-relation between BCLC staging of HCC and alpha fetoprotein levels. Study design: Cross-sectional study. Methodology: Patients (n=90) of either gender irrespective of age who were diagnosed with hepatocellular carcinoma were included into the study. Clinical examination was performed and findings were noted. Eastern cooperative oncology group ECOG scoring system was used to identify the functional performance status of the patients. Hepatocellular carcinoma staging was done using the BCLC scoring system. Complete blood counts, Liver function tests (LFTS), INR, alpha fetoprotein levels, viral serology for hepatits and ultrasonography of abdomen were performed for all the patients. Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: Mean AFP levels were 400.7±305.4 IU/ml with a range of 8.50- 1015 IU/ml. 3(3.3%) patients were in BCLC stage 0, 23(25.6%) were in stage A, 33(36.7%) in stage B, 15(16.7%) in stage C and 16 (17.8%) in stage D. Results showed significant positive correlation between BCLC staging and AFP levels (r=o.834, p=0.001). Conclusion: It was concluded that Hep C followed by Hep B was the main cause of HCC. AFP has a significant diagnostic and prognostic value with positive co-relation with HCC. Keywords: Alpha-Fetoprotein, BCLC Staging, HCC and Liver Disease.

Background: Psychological health affects numerous physiological processes of the body. The psychological well-being of pregnant women is a global concern. Aim: To compare the blood glucose level (random) in normal versus stress, depression and anxiety among pregnant women (Trimester wise) in district Hyderabad. Methods: A cross-sectional study (survey-based) was conducted in a fixed time frame. The pregnant women were randomly selected and segregated into three groups (trimester wise). The sample size (n) was 123. Random blood glucose level was measured by using the check UC-1001. Stress, anxiety and depression were analyzed by using a valid questionnaire DASS-21. Student t-test was employed as appropriate. Data is shown as mean±standard deviation. Results: Blood glucose level was observed significantly higher (P-value: 0.0004, 0.009 and 0.046) in stressed women (137.82 ±28.94, 142.60 ±40.34 and 126.82 ±35.92) as compared to normal (107.6 ±18.01, 115.05 ± 18.68 and 105.53 ±21.56). Similarly, the blood glucose level was observed higher (P- values: 0.043, 0.065 and 0.078 in depressed women (128.62 ±29.85, 136.79 ±37.10 and 122.44 ±33.41) as compared to normal (105.62 ±13.71, 112.22 ±24.60 and 101.22 ±18.66). An elevated blood glucose level (P-value in First, Second and Third trimester was 0.230, 0.065 and 0.900 respectively) was observed in those who were suffering from Anxiety (125.63 ±29.27, 136.79 ±37.10 and 121.81 ±32.36) as compared to those whose blood glucose level is normal (107.25 ±17.85, 112.22 ±24.61 and 123.66 ±37.04). Conclusion: An elevated blood glucose level was observed in all three trimesters in stressed, depressed and anxious pregnant women. Keywords: Anxiety, Depression, Stress, Blood Glucose. Trimester

Objective: The purpose of this study was to examine the types of fractures sustained and damage patterns among bike trauma patients who were sent to the emergency department. Study design: Retrospective study Place and duration of study: Department of Orthopedic, Khyber Teaching Hospital Peshawar, From September, 2021 to February, 2022. Methods: In this study, 170 patients of motorcycle accidents were taken to investigate the factors associated with the accidents. The collected data included the demographic variables, fractures experienced, patterns of injury, time of accident, types of accident and the possible causes of accidents. Detailed demographics of enrolled cases included age, sex, BMI and localities were recorded after taking informed written consent. Data analysis was performed in SPSS-21.0. Results : A total of 170 patients of motorcycle accidents were conducted to study in which 119 (70%) were males and the rest 51 (30%) were females. The mean age of the patients was 29.6 years. The most common type of accident was car-bike collision that of 65.1%. Most of the deaths were occurred due to the head injury that accounted for 51.1%. The significant association of age, sex, ignorance of safety measures and types of roads with motorcycle accidents was shown in the multiple logistic regression analysis. Conclusion: Motorcycle accidents caused severe life threatening injuries to the patients. Rate of mortality was high among the patients with head injury. Males were more affected by the accidents as they were more in numbers. Accidents were more occurred in the population with age category of 18-27 years. Therefore, significant safety measures can reduce the risks of motorcycle accidents. Keywords: multiple injuries, motorcycle accidents, mortality.

Objective: To determine the prevalence of traumatic injuries to the anterior teeth among 7 to 14 year-old school children. Design: It was a cross-sectional study. Study Settings: This study was done in 10 Government & Private High Schools of Lahore, Pakistan from November 2021 to April 2022. Material and Methods: There were a total of 2230 students between the ages of 7 and 14 participated in the study. Oral examinations and structured questionnaires were used to gather data, which included socioeconomic factors. Results: Total 11.3 percent of the permanent anterior teeth in the current study had TDI. It was found that there is a considerable gender difference in the incidence of dental trauma, with more boys than girls experiencing it. Fall-related injuries accounted for the majority of TDI cases (68.5 percent), then sports (11.2 percent). The permanent maxillary central incisors were frequently broken, with enamel-related fractures being the most frequently reported. The most frequent injury noted was an enamel fracture. Conclusion: Children of school age had a moderate prevalence of TDI, and it was advised that regular oral health education programmes about the causes and techniques of avoiding TDI be implemented. Keywords: Traumatic Dental Injuries, Prevalence, School Children, Anterior Teeth

Introduction: Chronic kidney disease is the most important public health issue affecting about 10% of the world adult population. Objective: To assess the frequency of Hepatitis C Virus in chronic kidney disease patients on regular hemodialysis at tertiary care hospital, Peshawar Methodology: This was descriptive cross sectional study, carried out at the Medicine department, Hayatabad Medical Complex, Peshawar for one year duration from December 2020 to December 2021. A total of 211 patients were observed in our study. All the data was statistically analyzed by using SPSS 23. Results: In our study, there were 140 (66.4%) male patients while female patients were 71(33.6%). Based on duration of illness, 149(70.6%) patients were in illness duration of 1-2 years while 62(29.4%) patients were observed in illness duration of more than 2 years (Table 1). The overall frequency of Hepatitis C virus was 68(32.2%) in patients with chronic kidney disease on regular hemodialysis Conclusion: In hospitalized CKD patients, the occurrence of hepatitis C ELISA antibody is considerably higher. To avoid hepatitis C infection spread, rigorous global infection control strategies must be applied in nephrology units. More research is required to evaluate whether detecting and treating hepatitis C in CKD patients reduces death rates or delays advancement to end-stage renal disease. Key words Hepatitis C Virus; Chronic kidney disease; Hemodialysis