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Background: Consuming foods with a low glycemic index can lower blood glucose levels in type 2 diabetics. Different researches came to the conclusion that a person with type 2 diabetes must have some active insulin for the glucose metabolic pathway; as a result, reaching an equilibrium between the intake of carbs and the quantity of active insulin that is present in the biological system may lower blood glucose levels. Aims and Objectives: The aims and objectives of the current study will be to introduce lifestyle medicine awareness in the local population for the management of Diabetes type -2 and to improve the quality of human health. To assess the dietary patterns and nutrient intakes of people with Type 2 Diabetes in our population and evaluate the association between dietary factors and glycemic control in Type 2 Diabetes patients, to provide evidence-based recommendations for healthcare professionals and patients regarding nutrition and diet for diabetes management. Study Design: A Cross-Sectional Clinical Study. Place and Duration: Current study was conducted in medical and surgical units of Ghurki Trust Teaching Hospital from October 2022 to February 2023. Methodology: Total 200 male and female diabetic type-2 were selected for this study and divided them into two different groups. In Group-A 100 male and female individuals were taking daily meal regularly according to provided lifestyle change instructions (lifestyle medicine), while in Group-B 100 male and female individuals were those how were not fallow the provided lifestyle change instructions properly. In both groups only those individuals were considered who are using Metformin as a medicine for the treatment of their diabetes. Statistical analysis: Raw data was analyzed bio-statistically through the SPSS version 2020. Practical Implications: Current research is so informative for diabetic type-2 patients they can control their glucose levels with lifestyle medicine. Results: A total of 200 participants with type-2 diabetes were included in the study. The mean age of the participants was (54.4 ± 5.1, 54.4 ±6.3) years, and 52% were male and 48% female. The mean duration of type-2 diabetes was (10.20 ± 1.10, 10.20 ± 1.10) years, and (750.10 ± 1.10, 750.10 ± 1.10) of the participants were on oral hypoglycemic agents i.e. Metformin. After nutrition and dietetics intervention, there was a statistically significant (p

Objective: This study's goal was evaluate the part magnetic resonance imaging plays in the identification and classification in perianal fistulas to contrast those results with those from surgery. Study Design: Cross Sectional Place & Duration: Study carried out between the periods of January 2022 to Aug 2022 Material & methods: This study was tested on 50 patients in the hospital. Patients who had undergone MRI pelvis with or without contrast study were counted in the current study. Patients who undergone surgery prior or had recurrent perianal illness were not included in the study. Short T1 inversion recovery, T2 weighted (T2W) sagittal, axial, and coronal MRI sequences (STIR), T1W axial, and coronal sequences, and T1W post contrast axial & coronal sequences were all evaluated. Results Reflected: while evaluation by MRI, among 50 patients, 45 which is 90% were man and 5 which is 10% were female gender. In 45 (90%) of the 50 patients overall, postoperative results confirmed perianal fistula. A total of 5(10%) patients had perianal sinus only. The primary tract was found to have a sensitivity and specificity of 97.73% and 83.33%, respectively, whereas the abscess had a sensitivity and specificity of 88.89% and 95.12%. High sensitivity was also acknowledged for accurately locating the internal opening (95.45%), detecting the horseshoeing (90.91%), correctly identifying the secondary ramification (92.86%) with specificity (94.44%). Conclusion: It is found that MRI demonstrated superior performance in evaluating perianal fistula with critical parameters (primary tract and its grading, internal opening, secondary ramification, abscess, horseshoeing). Pre-operative perianal fistula assessment should be correct to prevent problems and recurrence, which will decrease the need for additional surgeries. Practical Implication: As a result of this study, unnecessary radiation and diagnostic time could be avoided in the preoperative assessment of PAF in ano using MRI. It would also help decrease complications and unnecessary surgeries. Keywords: Magnetic Resonance Imaging and Perianal Fistula, perianal sinus, horseshoeing

Background/Objective: Orthopedic patients have a particularly high risk for post-spinal shivering, a typical consequence of spinal anesthesia. Without treatment, shaking may worsen wound pain, increase oxygen use, and impair healing. There have been a number of studies looking at the efficacy of ketamine and other medications for reducing post-spinal shivering. Despite this, there is a dearth of data on more effective and widely available preventive medicines. As a result, the purpose of this research was to evaluate the efficacy of 0.25 mg/kg of Ketamine (K) against 0.5 mg/kg of Tramadol (T) in preventing shivering after spinal anesthesia. Methodology: 200 patients who were to have orthopedic surgery under spinal anesthesia were randomly chosen to participate in this prospective cohort study. Patients who were given a prophylactic dosage of intravenous ketamine prior to spinal anesthesia are referred to as the Ketamine group(n=100), whereas those who were given Tramadol are referred to as the Tramadol group (N=100). During the intraoperative phase, vital signs such as shivering intensity and frequency, blood pressure, heart rate, and axillary body temperature were monitored hourly at 10-minute intervals for a whole hour. Results: There were 87 patients (43%) who had post-spinal shivering; this number was 32 (32%) for those given ketamine and 55(55%) for those given tramadol (p=0.001). With a p-value of 0.000, the incidence of nausea and vomiting was statistically significantly higher in the tramadol group of 82(82%). The ketamine group had significantly more intraoperative sedation than the tramadol group (p 0.007). Conclusion: After spinal anesthesia, low-dose ketamine is more active in lowering the frequency and intensity of shivering. Therefore, we advise patients having orthopedic surgery under spinal anesthesia to take low-dose ketamine beforehand as a preventative measure against post-spinal shivering. Keywords: Ketamine, Tramadol, Shivering, Orthopedic surgery

Objective: To determine the frequency of factors that cause potassium imbalance in patients with postoperative arrhythmias after cardiac Bypass surgery Material and methods: During the time period of 2 November 2018 through 10 January 2020, 100 patients with heart disease receiving open-heart surgery were enrolled in a prospective observational research conducted by the cardiac surgery department at the Punjab Institute of Cardiology in Lahore. Both genders of age 17-70 years were included and patients with cyanotic heart disease congenital heart disease, previous cardiac surgery and urgent CABG were excluded. Results: Our results showed that of 100 patients, 59 (59%) were male and 41 (41%) were female and the mean age was14.243 ± 50.12 years. 6 patients had preexisting renal failure and 9 had postoperative renal failure. Overall potassium imbalance was noted in 39 patients, 33 were hypokalemic and 6 were hyperkalemic and the mean potassium with S.D was 3.95±0.83 and 37 had postoperative arrhythmias out of which 18 (54.5%) were hypokalemic and 2 (33.3%) were hyperkalemic. Preoperative drugs, preexisting renal failure, CPB time, aortic cross clamp time, intraoperative potassium levels, time on ventilation, postoperative urine output, potassium infusion, postoperative renal failure, arrhythmias and total hospital stay were found to be statistically significant. Conclusion: Potassium imbalance post-cardiopulmonary bypass is major factor that may lead to increased risk of postoperative arrhythmias. Keywords: Potassium imbalance, cardiopulmonary bypass, postoperative arrhythmias, renal failure, hypokalemia

Background: Dental implants have reorganized the field of renewing dentistry by providing a greatly successful and authentic surgery option for the patients with missing teeth. Surface characteristics of the implant are very vital for the success of the implant. This greatly affects the osseointegration and long term stability. Study design: It is a prospective study conducted at Lady Reading Hospital, MTI, Peshawar and Altamash Institute of Dental Medicine, Karachi for the duration of one year from December 2021 to November 2022. Material and Methods: The study was done on patients visiting the tertiary care unit for a period of one year. There were 12 male and 13 female patients that participated in the study. The average age of patients was 56 years in case of men and 53 years for women. The data of number of implants was also analyzed and 12 patients went for 2 implants and 13 patients opted for 3 implants. The study was approved by the review and ethical board committee of the hospital. Results: The ISQ score of the patients that had two implants was 68.5±4.3, whereas the patients who went through 3 implants had ISQ score as 72.1±4.5. Those who had molar region implanted had ISQ score 72.1±2.1, while premolar patients had ISQ score as 72.3±3.1. Acid itching group had ISQ score as 68.4±2.4, the LASER group had ISQ score as 73.4±2.4. Conclusion: After the comparison of different implant surfaces used in human edentulous mandibles treatment. It was concluded that the LASER+HA and LASER are the most effective method for implants. These methods accelerates the Osseointegration process. Keywords: Dental implants and edentulous mandibles.

Background: The human lips are the essential structure for speech, facial expression and oral functions like eating, drinking and breathing. The orthodontic treatment is very crucial for the advancement of the facial expression Lip incompetence is a condition in which the lips fail to close adequately leading to negative effects on speech, facial esthetics and oral functions. Study design: It is a retrospective study conducted at WATIM Dental College Rawat, Rawalpindi and Altamash Institute of Dental Medicine, Karachi for the duration of six months from Jan 2022 to June 2022. Material and Methods: The patients were divided into three groups. The patients that did not follow the inclusion criteria were excluded from the study. Group I had patients with competent lips, group II had patients with their lips apart and group III had incompetent lips. There were 45 patients in each group. Results: The length of group I members was 19.8 mm for men and 18.7 mm for women, which was less than group III individuals with 20 mm and 18.9 mm average upper lip length for males and females. Group II patients had a length of 17.5mm for male patients and 16.4 mm for female patients. The P-value was calculated and the results were statistically significant. Conclusion: The length of group I members was 19.8 mm for men and 18.7 mm for women, which was less than group III individuals with 20 mm and 18.9 mm average upper lip length for males and females. Group II patients had a length of 17.5mm for male patients and 16.4 mm for female patients. Keywords: Lip incompetence and competent lips.

Background: The orthodontist and patients prefer the usage of mini-screw anchorage due to its feasibility of insertion and removal, which necessitates minimum patient cooperation, and cost-effectiveness. Aim: The aim of the study is to access the mean perception of pain using a visual analogue scale after placing the mini-screws in orthodontic patients. Methods: Using convenient sampling technique, this cross-sectional study was held at Armed Forces Institute of dentistry, Rawalpindi and Shahida Islam Dental College, Lodhran for six-months duration from July 2022 to December 2022. A total of 80 patients took part in the study. On a 10-millimeter visual analogue scale (VAS), where 10 signifies "the severe pain presumable" and 0 signifies "no pain," they were asked to rate their anticipated level of pain Results: A total of 80 patients were selected for this study with the mean age of 21.1± 2.8. The majority of subjects (60%) were female, and the posterior maxilla (48.8%) and posterior mandible (30%) were mostly implanted with mini-screws. Mostly, patients described pain on the 1st day of mini-screws insertion with mean VAS was 4.10± 1.65 and on 7th day; minimum pain was experienced with VAS of 2.9±1.09. There was a significant variation (p ≤0.01) in the VAS score between the sexes, with women exhibiting a higher VAS score (39 ± 52.7) compared to men (35 ± 47.3). Conclusion: Mini screws can more precisely carry out difficult tooth movements than the traditional anchorage used in standard orthodontic treatment. Keywords: Pain, mini-screws placement, mean pain perception and visual analogue scale.

Background: Estimation of time interval since death is an important aspect of forensic medicine, it is used as an evidence in both civil and criminal cases. There are multiple techniques used worldwide but reaction of pupil to chemical agents is currently the topic of interest. Studies on the role of pilocarpine in estimating the post-mortem interval (PMI) are very limited worldwide so the current study aimed to estimate the time interval since death using pilocarpine eye drops. Methods: An experimental Cross-sectional study was conducted at the department of forensic medicine and toxicology of a tertiary care hospital of Karachi (Autopsy Lab). The diameter of the pupil of each eye was measured using a Vernier caliper. After that 2% pilocarpine eye drops were administered to both eyes. About 10 to 15 minutes was allowed for pupillary reaction. The pupillary diameter was measured again after 25 minutes. The data was analyzed using Statistical Package for Social Science (SPSS) for Windows Version 22. p-value ≤ 0.05 was considered as significant. Results: The mean age of the study participants was 61 ± 13.4 years and reported significant association with the postmortem interval. The mean postmortem interval was 5 hours 42 minutes ± 3 hours 19 minutes. It has been noted that the longest duration of pupillary reaction was 16 hours 2 minutes. There was a strong correlation of postmortem interval with the change in pupillary diameter after pilocarpine drops. Soon after death, in initial 2 hours the change in pupillary diameter after pilocarpine was 98.8% while the percentage of pupillary reaction decreases as long as the time since death. After 16 hours of death there was no change in pupillary diameter after administering pilocarpine drops. Conclusion: It can be concluded that pupillary reaction after pilocarpine eye drops is significantly associated with time interval since death as 98.8% response was recorded in first two hours after death. The longest postmortem interval up to which the pupil can response to eye drop is 16 hours. Keywords: Pilocarpine, Postmortem interval, Pupillary reaction

Background: Amalgam was the material of choice for dental restorations due to its excellent mechanical properties, but the World Health Organization recommended that it should be phased out due to its environmental concerns. Aim: To determine the dental clinicians’ attitude to amalgam use during routine clinical practice in Lahore. Methods: Cross-sectional study was conducted among private practicing dentists in Lahore.Using convenience sampling, 100 proformas were dispersed. The questionnaire included informed consent along with demographic data such as gender and years of practice, 17 questions related to perceptionand practices, and seven questions about knowledge of dental amalgam restorations.Chi-square test was used to determine statistical significance. P value of less than 0.05 was considered significant. Results: Seventy four questionnaires were returned filled by participants.Majority of the participants, 51 (68.9%), performed no amalgam restorations, but those with 10 years or more experience still used the material at their practices. Dentists based on clinical experience were: less than 5 years=14(18.9%), 5-10 years =31(41.9%), and more than 10 years = 29(39.2%). Significant association, p=0.02, was observed between clinical experience of clinicians and the number of amalgam restorations performed weekly in their clinics. Practical implication=Health organizations often debate about amalgam safety and the environmental issues of mercury. After the devastating floods in Sindh, environmental issues are recently raised in Pakistan. Conclusion: According to this research, dental amalgam use within private dental practitioners is definitely on a decline in Lahore. Some senior dental practitioners with 10 years or more of experienceregularly used amalgam as a restorative material. MeSH words: Dental amalgam, General Practice, Dental

Background: As more patients undergo foot and ankle surgery, regional anesthesia's significance in postoperative treatment has grown. Anesthesiologists and pain specialists have adopted regional anesthesia in large numbers. Numerous techniques, such as nerve stimulation, anatomical markers, and ultrasonography, have been used to block the saphenous nerve. Objective: The present study aimed to assess the traditional anatomic landmark-guided approaches in lower limb surgery performed under regional anesthesia with ultrasound-guided ankle blocks in surgical anesthetic methods. Method: This randomized control study is carried out at the hospital. A total of 60 participants with scheduled foot and ankle surgery were randomly divided into two study groups (each n=30), Ultrasound-guided ankle block (USG) and anatomical landmark-guided ankle block (ALG). Results: Recruited participants had a mean age of 50.2± 14.02, with 39 (65%) male and 21( 35%) female. A total of 49 patients (82%) were able to undergo anesthesia successfully, with 26 (86.60%) of those patients belonging to the USG block group and 23 (76.60%) of those patients belonging to the ALG block group undergoing anesthesia successfully (p-value = >0.999). Practical implication: This study will help to comprehend either ultrasound-guided ankle block or anatomical landmark-guided ankle block in foot surgeries give better results. Conclusion: The results of this research indicate that the success rates of the two procedures are statistically insignificantly different; however, the USG ankle block for surgical anesthesia performed under regional anesthetic had a greater success rate than the anatomic landmark-guided technique. Keywords: Foot surgery, USG ankle block, anesthesia, ALG Block, postoperative treatment

Objective: The purpose of study is to establish accuracy of doppler sonography in diagnosis of early cirrhosis in hepatitis C positive patients, which is based on portal vein velocity and resistive index considering Histopathology as a gold level standard Student Design: It was a cross sectional comparative study (validation study). Place & Duration of Study: The student was held in Radiology department of District Headquarter Teaching Hospital Gujranwala from 1st July 2019 to 30th June 2020. Materials and Methods: The calculated sample size was 50 cases of anti-HCV anti bodies positive on their blood test fulfilling the inclusion criteria were examined for color Doppler ultrasound to see direction and average blood flow in the portal vein. All these cases were undergone core biopsy of liver and histopathology carried out. The results of histopathology were taken as superior quality / gold standard. Results: Mean age of the patients was found to be 42.5 years. The frequency of the hepatitis C in the different age group varied. Out of the 50 about 37 patients (74%) show decrease in the portal vein velocity towards lower limits regardless no ultrasonic appearance of the cirrhosis and remaining 13 patients (26%), show normal velocities towards upper limits. According to this study portal vein velocity in early cirrhosis is between 10-16 cm/sec and these initial cirrhotic changes confirmed on core liver biopsy (gold standard). Sensitivity was found to be 94.4%, specificity 78.5%, diagnostic accuracy 90.0%, both the NPV (negative predictive value) and PPV (positive predictive value) are high (NPV: 78.5%). Practical Implication: To best of our knowledge, there is very little information on this research topic in our area. The design of improved medical strategies to handle such situations and the improvement of their management will be made possible by the availability of such evidence. Conclusion: In our study, the maximum patients (38%) were suffering with this disease for more than 7 years but less than 9 years. 74% patients showed a decrease in the portal vein velocity towards the lower limit, and 26% patients showed normal velocity towards the upper limit. Keyword: Portal Vein, Doppler Ultrasound, Anti HCV, Core Liver Biopsy, Histopathology, Hepatitis C

Background: The mandibular symphysis is the bodily carnal part of the mandible that consist of alveolar and cortical bones. The mandibular symphysis has different parts like chin, or mentum that consist of unique features of modern humans. Objective: The study aimed to explore the correlation of lower incisor inclination growth pattern with the symphyseal morphology. Study design: It is a retrospective study conducted at Orthodontic Department, Shahida Islam Dental College, Lodhran and Fatima Jinnah Dental College, Karachi for the duration of six months from February 2022 to July 2022. Material and Methods: The correlation between all parameters was studied by ANOVA and other statistical analysis were also performed. The study approval was taken from the review board and ethical committee of the hospital. A total of 18 patients participated in this study. The patients were classified according to the facial category i.e. long, normal, and short. Class I comprises 8 patients and class III comprises 10 patients. Results: An increased value was observed in the case of class I with vertical growth patterns while the value decreased in the case of class III. Three different types of incisor inclinations were observed that is over jet positive, over jet negative, and edge to edge. Conclusion: From this study, it is predicted that a correlation exists between vertical growth patterns and sagittal growth patterns for the inclination in incisors. The height and width of the symphysis and facial patterns are also related to vertical growth patterns and indirectly affect the inclination of incisors. High angle facials have thin and long symphysis, while low angle facials have thick and short symphysis. Keywords: short symphysis, soft tissue and growth dimension.

Background: Esophageal varices develop as a consequence of portal hypertension in patients with chronic liver disease. Predicting the varices by non-invasive methods at the time of registration is likely to predict the need for prophylactic β blockers or endoscopic variceal ligation in patients with cirrhosis and portal hypertension. Objective: To evaluate the accuracy of combined non-invasive parameters in predicting the presence of esophageal varices in patients with hepatic cirrhosis due to chronic hepatitis C, using the positive predictive value (PPV) as a measure of performance. Methods: In this cross-sectional study conducted in the Department of Medicine, Unit-I, Sir Ganga Ram Hospital, Lahore, 125 patients fulfilling the inclusion criteria were included. Platelet count, Prothrombin Time/International Normalized Ratio (PT/INR) and portal vein diameter was assessed. Upper gastrointestinal endoscopy was done in all patients to check the presence or absence of esophageal varices. Results: Mean age of the patients was 52.52±8.39 years with 64% males. Mean PT was 10.09±3.13, mean INR was 1.75±0.22, mean platelet count was 83.56±13.47 while mean portal vein diameter was 13.79±0.84. In 61 patients (48.8%) esophageal varices were present on endoscopy and in 85 patients (68%) esophageal varices were predicted by combined non-invasive parameters. Positive predictive value of combined non-invasive parameters was 71.7%. Practical implications: Noninvasive predictors can be used as a screening tool to decide need for preventive drug therapy in esophageal varices and thus help reduce the workload and financial burden of routine endoscopies in all cirrhosis patients. Conclusion: The results suggest that combined non-invasive parameters may be a useful tool in the prediction of esophageal varices in patients with hepatic cirrhosis Keywords: Esophageal varices, Non-invasive predictors, Portal hypertension

Lung cancer is considered a disease that is completely happened by smoking; therefore, it is preventable perfectly. Yet, a small percentage of cases is there, possibly as many as 5 to 15%, in which there are other reasons. The risk factors acknowledged for the other groups comprise passive smoking, family history of cancer, occupational expo sure to certain chemicals and ionizing radiation, and diet. Moreover, a fifty samples from the dwelling of lung cancer patients were compared with twenty healthy volunteers. The study aims at identifying the dangers of radon gas in the dwelling of infected patients and the control group, clarifying how it contributes to increasing the risk of lung cancer. To achieve the aim of the study, the researcher used nuclear track detectors CR-39 , baguettes and TASLIMAGE System . Keywords: Lung cancer, CR-39 Detector, Radon gas for dwellings, Iraq.

Background: Obesity is one of the highly emerging chronic disease. It is a major health concern now a days. The BMI of more than 35% of the adults were in the overweight category in 2008 but now the values are reported to be exceeded. The study aimed to assess the relationship between body mass index and chronic periodontitis. Study Design: It is a cross-sectional study with statistical approach, conducted at Karachi medical and dental college, Karachi Material and Methods: The study was conducted on 200 patients visited the dentist department of the hospital. The study was conducted for six month duration from Jan 2022 to June 2022. The ethical and review board of the hospital approved the study. Results: Among 200, 100 specimens belong to the normal weight category, 73 are overweight, and 27 are from the obese category. In each category, all the specimens are from similar age groups, but more males were present in the overweight and obese categories. Complete data analysis of these patients was performed. Then logistic regression analysis was performed, and it was predicted that periodontitis has a direct relation with the body mass index (BMI). About a 17% risk rate increases with an increase in each unit of BMI. Conclusion: This study supports the hypotheses of the association of obesity with periodontal issues. The body mass index is a factor for the assessment of different health risk factors. The body mass index and smoking are linked with periodontal issues. Smokers and obese people specifically young obese have a more critical periodontal state. Keywords: Body mass index and periodontitis.

Background: Maxillary canines are considered as the keystone of mouth. It plays main role in supporting the upper lip and biting and tearing of food. Canines are also called as cuspids, the upper one is second most common teeth. The purpose of this research was to find the pattern and prevalence of the maxillary canine. Study design: It is a retrospective study conducted for the duration of six months from April 2022 to September 2022 at the dental department of Karachi Medical and Dental College, Karachi. Material and Methods: The study was conducted on 200 subjects visited the dental sciences department of the hospital. The patients who willingly participated in the study was included. The CBCT data was collected and sorted for the further use. Results: Out of the 200 subjects, the 96 (48%) males and 104 were females. The left buccal quadrant of impaction was observed in the 21 males and 15 females. The 5 male and 10 female subjects have the both buccal impaction position. The 8 male and 10 female have the both platal position of impaction. The prevalence of subtype l was 55% in the female and 44% in the males. The subtype II was observed in the 44% females and 55% males. There was no case of type IV subtype. The type VII prevalence was also higher in female 66% as compared to males 33%. Conclusion: The maxillary canine impaction is higher in the female as compared to the males. The impaction prevalence is most commonly observed on the left side as compared to the right side. It was also observed that the buccal and palatal impaction are predominant than other impactions. Keywords: cuspids, maxillary canine, palatal impaction

Background & Objective: Neonatal jaundice is common reason for admission in neonatal units requiring further evaluation to prevent adverse neurodevelopmental outcome. Lactate dehydrogenase levels are high in hemolysis. This study was aimed to explore the diagnostic properties of Lactate Dehydrogenase (LDH)in hemolytic causes of neonatal hyperbilirubinemia. Methods: In this observational cross sectional study, prospective data was collected at Neonatology department of The Children’s Hospital and University of Child Health, Lahore fromFebruary 2020 to March 2022. A total of 364 neonates with the diagnosis of indirect hyperbilirubinemia were enrolled through convenient sampling method after excluding the comorbidities and sick neonates.The neonates were categorized into hemolytic and non-hemolytic group and lactate dehydrogenase levels were compared in both the group. Data was analyzed using SPSS version 24 Results: Out of 364 babies, 123 (33.79%) were diagnosed as having hemolytic jaundice while 241 (66.21%) fell in non-hemolytic group. Out of 123 newborns in hemolytic jaundice group, LDH levels of 101 (82.1%) newborns were raised while only 124 (51.5%) newborns in non-hemolytic group (241) had raised LDH (p-value

Background: The strength of one's grip is a good determining factor of their overall muscularity. Grip strength can be utilized in a variety of circumstances to assess and monitor a variety of health-related conditions. Objective: To evaluate the association of hand grip strength with BMI in cardiovascular disease patients. Methodology: An analytical cross sectional study was done on a population basis. A total of 256 patients of cardiovascular diseases were included in this study. Data were collected through purposive sampling technique. A proforma used to get demographic data including name, age, height, weight and occupation. Their BMI was also calculated. Hand grip strength was measured through handheld dynamometer of both hands. Three trials were performed by the patients from both hands. Results: Out of 256 total participants, 133 (52%) were males and 123 (48%) were females. Their mean age was 51.12 (SD = 12.513) and mean BMI was 26.533 (SD = 5.1012). Hand grip strength (HGS) and body mass index (BMI) had a negative and statistically significant association, for dominant hand (pearson’s r = -0.309, p = 0) and for non-dominant hand (pearson’s r = -0.308, p = 0). Mean hand grip strength of dominant hand was 24.677 (SD = 9.0567) and of non-dminant hand was 21.861 (SD = 8.8035). Age and duration of diseases also had a negative and statistically significant association with the hand grip strength of both hands of the patients with p value 0. Conclusion: It was concluded that the BMI had a great impact on HGS. Presence of CVD and the duration of this disease also affect HGS. With increasing age and obesity hand grip strength decreases. Keywords: Body mass index, Hand grip strength, Cardiovascular diseases.

Introduction: Humans are the only known reservoir of polio virus. Polio virus infection in humans can cause a crippling paralysis in a fraction of the infected patients. Due to permanent nature of the paralysis, low mutation rate of the virus, restriction of polio virus to human hosts and overall feasibility of polio eradication, the polio virus became the target of aggressive vaccination campaigns via supplemental polio immunization (SPI) across the world for more than two decades. To determine the level of knowledge about supplementary polio immunization in mothers presenting to pediatric Population. Materials and Methods: This study was conducted in the Pediatric Department, OPD, District General hospital Timergara from 29-04-2021 to 29-7-2022. Through a descriptive, cross-sectional study design, 216 mothers of children aged 0-5 years, accompanying their children to the pediatric OPD, were included in the study through a consecutive manner and interviewed using a structured questionnaire. Results: In this study 216 mothers were included. Mean age of the mothers was 30.97 years. Most mothers had average level of knowledge (48.6%) while 30.6% had poor level of knowledge regarding supplementary polio immunization. Most common religion was Islam (96.3%). Illiteracy was the most common educational status (32.9%) followed by secondary (22.7%) and primary (19.4%) education. Majority (58.8%) of mothers were housewives. Pearson Chi Square test for Level of Knowledge wise stratification of Educational Status of the mother gave a value of 2=45.793 and was significant at p0.05). Finally, the Level of Knowledge wise stratification of Age groups of mothers had 2=2.87 with p=0.94(i.e. >0.05). Conclusion: Level of Knowledge of mothers regarding supplementary polio immunization is significantly associated with maternal educational status Keywords: Polio, supplementary polio immunization, polio drops

Introduction: The nutritional status of the children is satisfactory in Asian countries like Pakistan however the prevalence of malnutrition is observed to decrease because of the various health programs at national and international level in order to improve the health status of growing children. The aim of this study was to assess the prevalence nutritional status and correlation between nutritional status of students and their academic performance of school going children in Timergara. Methodology: This cross sectional study was conducted by administering and filling the questionnaire from 400 children, 200 from private and 200 from public sector schools of ages 6 to 11 years in different public and private sector schools of tehsil Timergara Lower Dir, KPK. Nutritional status of children was calculated by anthropometric method and compared with WHO growth chart. Academic performance was calculated from the percentage of the marks obtained in the last annual exam. Data analysis was done using IBM SPSS 24.0. Results: The prevalence of male gender were 61% and female gender were 39%. The prevalence of stunting, underweight, thin and Overweight+Obese were25.0 %, 17.0%, 7.5 % and 5.0% correspondingly. The low level of educational performance was significantly higher among the stunted (60.0%), underweight (38.2%), thin (33.3%) and Overweight+Obese (10.0%)children than that of the normal children.The low level of educational performance was significantly higher (p < 0.05) among the stunted, underweight and wasted children than that of the normal children. Conclusion: The nutritional status of school going children of Lower Dir, KPK was satisfactory however emphasis on the awareness regarding nutrition must be given. Keywords: Private, Public, School going children, Nutritional status

Aim: To find out association of Serum Thyroid Stimulating Hormone (TSH) and Anti-Thyroid Antibodies (ATA) i.e., anti Tg-Ab & anti TPO-Ab with thyroid carcinoma in thyroid nodule patients presented in Mayo Hospital Lahore. Study design: It was a comparative cross-sectional study. Methods: It wasconducted in Biochemistry Department and Department of Biomedical Sciences KEMU, Lahore from February 2018 to May 2019. Seventy patients were included in the study based on selection criteria and data was recorded on a preformed questionnaire. The study participants were classified into benign (n=36) and malignant categories (n=34) based on histopathological & radiological investigations. Serum levels of TSH and anti- thyroid antibodies (TPO-Ab&Tg-Ab) were measured employing ELISA (Enzyme Linked Immunosorbent Assay) technique. Results: Thyroid nodules were found to be more prevalent in females (n=64, 91.4%). The mean age of the study subjects was 38.46±12.92 years and there was a significant association of older age with thyroid carcinoma (p=0.001). Moreover, Serum TSH, Anti-Tg-Ab and TPO-Ab were higher in malignant than in benign thyroid nodules and were significantly associated with thyroid cancer (p=

Objective: Evaluation of Propofol's effectiveness in preventing post-surgery nausea and vomiting after ENT operations performed under general anesthesia Study design: Observational study Sampling method: lottery system Study Place: Peshawar Methods: 70 patients between age 18-65, having elective ENT surgery under conventional general anesthesia were included in this observational. After the surgical procedure, the patients were given either 10 mg/kg of dexamethasone, or 0.5 mg/kg of propofol intravenously. For 24 hours after surgery, the patients were monitored for any instances of nausea and vomiting. Results: No significant variation in Mean ± S.D of age, gender, BMI, ASA categorization and type of surgery was observed in both dexamethasone and propofol group. A significant variation in surgery duration (p=0.031) and anesthesia time (0.001) was observed in both the groups. PONV was more common in the propofol group (70%) than in the dexamethasone group (40%), particularly in the first six hours after surgery. Practical implication: this study will help to determine the whether propofol is a better choice for preventing post-operative nausea and vomiting. Conclusion: Propofol was less efficient than dexamethasone in preventing PONV, necessitating less rescue antiemetic use. Keywords: ENT, Propofol, nausea, vomiting, post-surgery complication, dexamethasone, effectiveness

Objective: To determine the frequency of various clinical presentations of myocarditis in children visiting to Dr Ruth KM PFAU, Civil Hospital Karachi. Study design: Cross-Sectional Study. Place and duration: Department of Pediatric Medicine, Dr Ruth K.M PFAU Civil Hospital, Karachi, Pakistan from September, 2020, to March, 2021 Methodology: The study covered all patients who visited Karachi's Civil Hospital and met the inclusion criteria. After describing the study's process, hazards, and benefits, informed consent was obtained. The initial ECG, echocardiography, and cardiac enzyme readings were all documented. Stroke, congenital heart disease, sepsis, asthma, pulmonary embolism, cardiomyopathy, gastroenteritis, diabetes mellitus, and renal failure were among the clinical presentations that were noted. The proforma that is supplied at the end was filled out with all the acquired data and used electronically for research. Results: Age was 6.8± 2.1 years on average. A total of 238 (67.6%) of the 352 patients were male, and 114 (32.4%) were female. In patients with myocarditis who presented clinically, renal disease was found in 46 (13.1%), cardiomyopathy in 30, congenital heart disease in 56 (15.9%), stroke in 41 (11.5%), gastroenteritis in 65 (18.5%), diabetes mellitus in 19 (5.4%), sepsis in 32 (9.2%), and asthma in 48 (13.6%) patients, while pulmonary embolism was found in 15 (4.3%) patients. Practical implication There is growing evidence to support the use of tests such as cardiac magnetic resonance imaging and serum N-terminal B-type natriuretic peptide measurements as supplements to clinical diagnosis. These could eventually lessen the need for invasive procedures like endomyocardial biopsy, which is still the gold standard. Conclusion: The most frequent clinical manifestation of myocarditis was gastroenteritis, which was followed by congenital heart disease and asthma. For the purpose of validating the results so far, additional extensive research is advised. Keywords: Clinical Presentation, Myocarditis, Epidemiology, Asthma, Gastroenteritis

Introduction: According to the World Health Organization, 6.1% of the world's population has hearing impairment, making it one of the most common disabilities. Congenital, prenatal, genetic, and environmental factors are among the many causes of hearing impairment. Congenital hearing loss is thought to be mostly caused by consanguinity. Numerous studies, both in the Middle East, where the practice is very common, and in Europe, where it is taboo, show a strong connection between congenital hearing loss and consanguinity. There is virtually little research on hearing loss brought on by consanguinity in the literature. Objective: The find the prevalence of hearing loss in children of parents with consanguineous marriages. Material & Methods: This an observational cross-sectional study. The study had a sample size of 377 subjects. The data was collected from Alam Audiology Clinic and Sir Ganga Ram Hospital for 6 months from January to June, 2022. The data was collected from parents who reported a consanguineous marriage, and the children were taken between the ages of 0.5 years to 5 years, children were test using various audiological intervention, i.e., Pure Tone. Audiometry, Otoacoustic emissions, Auditory Brain-stem Response. The children who were syndromic or had other associated psychological issues were excluded. A Performa was generated inquiring about demographics, nature of consanguinity, other disabilities type of hearing impairment and other risk factors, this was filled out by the parents or the researcher in consultation of the parents. All the parents were informed of the study and their consent was taken. The study data was analyzed using SPSS 21 and frequencies were found out, tables and charts were systematically drawn and their conclusions were drawn. The study followed all ethical parameters. Results: The results showed that out of the 377 participants, 186 were male and 191 were females, children of the age group 2-5 years were the most extensive numbering 323 participants (85.7%). An overwhelming number of children brought for assessment were with congenital hearing loss 286 (75.9%). Very few people reported hearing impairment in their family history. The nature of the cousin marriage shows that most of the participants 78.2% reported that they are first cousins. Most of the children 69% had moderate to severe hearing loss. Practical Implication: The study will show us the impact of consanguineous marriages have on the hearing capacity of their children. The study will highlight consanguineous marriages as a factor in hearing impairment. Keywords: Hearing loss, consanguinity, hearing impairment, hearing impairment.

Objective: To determine the prevalence of coronary artery disease at the NICVD Hospital, Hyderabad. Methods: At the National Institute of Cardiovascular Disease, a teaching hospital in Hyderabad, cross-sectional descriptive research was carried out. Total 130 patients were participated in study and all individuals were adults (18-60 years old) who presented at the general checkup clinic with a history or signs of CAD. A self-administered questionnaire designed for the study. Results: Among 130 patients, the proportions of significant risk factors for CAD were: 70% Hypertension, 36.2% Obesity, 36.2% Family history, and 36.9% diabetes mellitus. Signs and symptoms of the patients were Heart attacks 31.5%, heartburn 68.5%, AOT 36.9%, Chest pain 48.5%, and vomiting 7.7%. 80.8% of patients took chest pain tablets under the tongue. Patients currently smoking was 16.2%. Practical implication:- This study will prove very helpful for physician in managenment of coronary artery disease. Conclusion: Diabetes, hypertension, and high cholesterol are all modifiable risk factors that must be appropriately controlled. The community should place a high value on screening programs that may identify diseases before they develop and on adopting healthy habits. Keywords: Coronary artery Disease, Heart disease, NICVD

Background: The biggest cause of death worldwide is cardiovascular disease (CVD), which accounts for 31% of all fatalities that are officially reported each year. Hyperlipidemia is thought to be a key risk factor for CVD. Due to the lack of symptoms associated with hyperlipidemia, many patients do not feel the need to take medication. Undoubtedly, treating and managing the hypercholesterolemia and other diseases with no symptoms has been difficult for both patients and medical professionals. Methodology: Study was conducted in co-operation of department of Cardiology & Medicine PMC Hospital Nawabshah. 100 patients were registered having hyperlipidemia, included through convenience sampling technique. Two groups were made age from 31-50 years and other age from 51 to 70 years. Drug compliance was measured by using Morisky scale and detailed history by using the pre-formed proforma. Results: Result showed there was compliance of statin therapy in both genders PDC was more than 80%, but in comparison of both groups statin therapy compliance was statistically non-significant p value-0.726. Conclusion: The majority of the participants in this study who had hyperlipidemia adhered to their statin medication. The factors determining compliance revealed good adherence in the high-risk population, especially in people over 50 years old. Keywords: Gender, compliance. Statin therapy. Hyperlipidemia.

Background and Aim: Stroke is defined as the sudden onset of neurological deficits caused by vascular supply disruption to brain-specific region, contributing as a major factor for mortality and morbidity worldwide. Globally, approximately two-thirds cases of stroke are caused by hypertension as a major risk factor. The purpose of the current study was to determine the prevalence of stroke patients with newly diagnosed hypertension admitted to tertiary care hospital. Materials and Methods: This cross-sectional study was carried out on 205 stroke patients admitted to the Department of General Medicine, Benazir Bhutto Hospital and Holy Family Hospital, Rawalpindi from April 2021 to March 2022. Prior to study conduction, ethical approval was taken from the institute research and ethical committee. Written informed consent was obtained from each individual. All the participants underwent physical examination after using antihypertensive medication besides detailed history. Blood pressure was measured using standard mercury Sphygmomanometer. Patient having blood pressure ≥ 140/90 mm Hg was considered as hypertensive after measurement with difference of 10 minutes time span. SPSS version 25 was used for data analysis. Results: The overall mean age was 59.6 ± 8.5 years. Of the total 205 stroke patients, there were 140 (68.3%) males and 65 (31.7%) females. Out of 205 patients, 60.5% were rural and 39.5% were urban. The literacy rate was 63.9%. Family history of smoking, diabetes mellitus (DM), and hypertension (HTN) among study population were found in 83 (40.5%), 76 (37.1%), and 71 (34.4%) respectively. Based on computed tomography presentations, the prevalence of newly diagnosed hypertension (HTN) was 122 (59.5%). Out of 122 newly diagnosed hypertensive stroke patients, the incidence of ischemic stroke and hemorrhagic was 67 (54.9%) and 55 (45.1%) respectively. The mean value of diastolic and systolic blood pressure was 86.32 ± 12.62 and 125.59 ± 19.97 mm of Hg respectively. Conclusion: The present study concluded that the prevalence of newly diagnosed hypertension was found higher among stroke cases. Early diagnosis of hypertension by proper screening and effective treatment can reduce the mortality and morbidity caused by stroke and hypertension. Keywords: Hemorrhage, HTN, Ischemia, Stroke.

Background and Aim: Hemodialysis is a valuable treatment for elderly individuals progressing to chronic kidney disease (CKD). Globally, hemodialysis demand is increasing for elderly individuals as a life-sustaining therapy which might lead to prolonged suffering in geriatric patients. Therefore, the current study aimed to evaluate the outcomes of hemodialysis in elderly diabetic patients. Methodology: This retrospective study was carried out on 64 type 2 diabetic patients admitted to the Dialysis Unit at Social Security Hospital, Multan Road Lahore from January 2021 to April 2022. Ethical approval was taken from the institution research and ethical committee. All the type 2 diabetic patients above 65 years age having CKD on dialysis were included. Patients having disease that require immunosuppressive treatment, history of malignancy, and those who died within three months of initial treatment were excluded. Patient’s survival data and comorbidities such as cognitive, vascular, and autonomy were studied. Other comorbid conditions such as cerebrovascular disease, peripheral vascular disease (PVD), and coronary artery disease (CAD) were reviewed. SPSS version 25 was used for data analysis. Results: Of the total 64 diabetes patients, there were 34 (53.1%) males and 30 (46.9%) females. The overall mean age was 68.9±3.1 years whereas dialysis mean duration was 28±22 months. Cognitive impairment, lost autonomy, and prior cerebrovascular accident had significant association with mortality rate reported as 7.8% per year. The incidence of fistula or graft, depression, dementia, died, and bedridden cases were 39% (n=25), 18.8% (n=12), 15.6% (n=10), 12.5% (n=8), and 14.1% (n=9) respectively. Of the 25 cases of fistula or graft, about 9.5% used catheter. Conclusion: The present study found that mortality rate was 7.8% in elderly (>65 years) diabetes patients. The high mortality risk was substantially related with cognitive disorder, cerebral vascular accident, and lost autonomy. Generally, hemodialysis practice varies with the region’s clinical pattern due to age variation in elderly patients. Keywords: Hemodialysis, Chronic kidney disease, Elderly, Diabetes

Objective: To evaluate the efficacy of oral nifedipine against vaginal micronized progesterone to treat threatened premature labour (24 wks to 36+6 wks). Design : Randomized Controlled Trial. Setting : Obs and Gynae Deptt, Bakhtawar Hospital, Multan. Study Duration : Six months (15-12-20 to 14-6-21) Material and Methods: 126 patients with diagnosis of threatened preterm labour were included in this study. Baseline demographic information of patients (age, gestational age and parity, previous history of preterm labour, smoking, BMI and socioeconomic status) was recorded. In 63 patients oral nifedipine was given for treating threatened premature labour and in remaining 63 patients, progesterone was administered vaginally to prevent preterm labour.Efficacy was noted for both groups on a especially designed proforma. Results: Mean of ages of women included was 28.05±4.49 yrs. Mean GA of patients was 33.54±1.83 weeks. Mean parity was 1.81±1.11. Mean BMI of patients was 24.33±3.33 Kg/m2. Previous history of preterm labour was found in 16 (12.70%). Oral nifedipine was effective in 47 (74.60%) patients & vaginal progesterone was noted successful in 58 (92.10%) patients with p-value of 0.009. Conclusion: Vaginal micronized progesterone is more effective than oral nifedipine for the prevention of threatened preterm labour. More research work is required to ascertain the superiority of vaginal progesterone over nifedipine for the prevention of preterm labour. Keywords: Oral nifedipine, micronized progesterone, preterm labour.

Background: The success of orthodontist treatment lies in the satisfaction and expectation levels of the patients. There is a need to explore factors which determine the expectation and satisfaction levels of the patients. Objective: The study aimed to analyze the satisfaction level and expectations of orthodontic patients with their orthodontic treatment. Study design: This cross-sectional and observational study was conducted at dentistry department of Islamic International Medical and Dental College Islamabad. The duration of the study was six months from Jan 2022 to June 2022. Material and Methods: The 210 patients that visited orthodontic department of the hospital were selected for analysis. Among those 210 patients, there were 170 females and 40 males. The participants were fully aware of the study and written consent was taken from the patients. The satisfaction level was analyzed. It was observed that there were 16% participants that were unsatisfied. There were 176 patients that were satisfied with the orthodontic treatment they were given. There was no significant co-relation found between people of different age groups (p=0.5). The study was carried out to find features like ethics, behavior and the degree of orthodontist that did the treatment. The comparisons of groups with the orthodontic treatment was carried out and the satisfaction of the patients post-treatment. Results: It was observed that 16% participants were unsatisfied it included 7 males and 27 females. Among the 210 patients that participated there were 176 patients that were satisfied with the orthodontic treatment they were given. There was no significant co-relation found between people of different age groups (p=0.5). There were 70% patients that reported that they had no problem during the treatment. And there were 30% patients that felt problems. There were many problems described by the patients. Conclusion: The study reported that majority of the patients significantly met their expectations of the treatment. There was no orthodontic treatment linked factor that had significant association on the satisfaction of the patients. Keywords: Orthodontic patients, satisfaction level and degree of orthodontist.

Objective: This study aimed to report the incidence of dental caries among deaf students of primary school in Lahore Method: This descriptive crossectional study was conducted at 2 private primary schools for deaf students in Lahore. Sample of the study was 150 students who were completely deaf. Data was collected by screening of oral health maintenance of students by two dentists. Chi Square test was used to explore the age wise difference in occurrence of dental caries among deaf students of primary school in Lahore Results: Overall incidence of dental caries is quite high among deaf students of primary school in Lahore (112(74.67%). Results of chi square test revealed no significant difference of incidence of dental caries in terms of age (X2=4.597, P=.204). Conclusion: In Lahore, incidence of dental caries among primary school deaf students is quite high which need to be address. Moreover, age has no significant effect on the incidence of dental caries among primary school deaf students. Keywords: Dental caries, Deaf students, Primary school, Oral health maintenance

Background: A World Health organization estimated show that almost 10 million people effect from TB and almost 1.5 million people died from this disease in 2018. Pakistan is ranked 5th in overall TB burden and ranked 4th in drug resistance development of developing countries. About 510,000 case of TB arise every year in Pakistan and 15000 patients develop drug resistance each year. Drug resistance cause huge mortality rate. It should confirm by using drug susceptibility test before treating the patient for drug resistance and for cure. Objective: To find out the frequency of rifampicin resistance in primary pulmonary tuberculosis patient by using drug susceptibility test.

Objectives: Hygiene practices helps a lot in the prevention of infection among the admitted patients and an important component of infection prevention and patient safety. The aim of this study was to assess the hygiene status of medical and surgical units of selected hospitals in District Nowshera, Swat and Peshawar Districts, Pakistan. Material and Methods: It was a cross-sectional descriptive study, carried out in hospitals of Nowshera, Swat and Peshawar Districts, from August 2021 to February 2022. Data was collected from 60 medical and surgical units. A structured questionnaire was used to collect data, and face-to- face interviews were conducted with healthcare workers and patients. Finally results were presented in form of tables. Results: 64.66% of health care staff practice hand hygiene measures; and most of the surgeons (81.67%) were not satisfied with provided scrubbing materials. 46.67% of patients were satisfied with the prevailing hygiene status; 96.67% with health services. Moreover, 56.67% of patients wash hands before eating; 31.67% of sweepers satisfied with provision of materials, and surgical site infection rate was 13.33%. Furthermore, 63.33% of units collect waste daily; whereas only 18.33% had waste separation. 68.33% had isolation chamber for infectious cases; 36.67% screened patients for HIV/AIDS; and only 11.67% didn’t change fomites on daily basis. Conclusion: It was concluded that the hygiene status of selected hospitals was satisfactory. Moreover, the hygienic status showed strong relationship with type of unit; number of sweepers; waste collection frequency and frequency of fomites change and thus needs strategies to increase awareness and motivation of health care staff with an aim to reduce the incidence of hospital infections. Keywords: Hygiene Status, Infection, Medical, Surgical, Hospital

Objective: To assess the impact of socio-demographic factors on different personality types in individual. Methodology: A Cross-sectional descriptive study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore over a period of 5 months from July to November 2021. Data was collected using a ten-item personality inventory scale (TIPI). The sociodemographic variables included age, gender, marital status, occupation and educational level. All individuals irrespective of their age and gender were included in the study. Individuals with a history of psychiatric illness were excluded from the study. Results: There was a statistically significant difference in conscientiousness personality traits among age groups (p=0.006). Similarly, the difference in the personality trait of agreeableness (p≤0.001), conscientiousness (=0.016), and emotional stability (p=0.007) across gender was statistically significant. There was also a statistically significant difference in the scores of agreeableness among the employed and unemployed individuals (p=0.044). Conclusion: The conscientiousness personality trait score among age groups was the highest for the age group 50 to 59. The personality trait scores of agreeableness, conscientiousness, emotional stability across gender were higher in females in comparison to males. The contrary was true for emotional stability. The score of agreeableness was higher for unemployed individuals in comparison to employed individuals. Keywords: extraversion, agreeableness, conscientiousness, emotional stability, openness to experience, sociodemographic factors.

Aim: To look for effects and graft outcome of Direct Antiviral Agents on Hepatitis C positive Renal Transplant Patients Design: Prospective study Duration & place of study: The study will be conducted in Shaikh Zayed Hospital’s Kidney Transplant Unit, Lahore, and will comprises of consecutive Hepatitis C positive Renal Transplant Recipients from January 2018 to January 2020 Methodology: The Hepatitis C Positive Renal Transplant Recipients will be selected after fulfilling Inclusion and Exclusion Criteria and we will follow the patient for 3 months after initiation of DAA regime. Result: The study included 50 patients average age was 36.1±10.5 years and 32(64%) of them were male and rest were females. Therapy for HCV was 100.0% successful. The total bilirubin levels, hemoglobin, platelet count, serum creatinine and eGFR had no significant change in averages over 12 weeks of treatment. The ALT and AST levels reduced significantly in first 4-week time and then stayed at a level while the ALP levels reduced significantly over all intervals of follow-ups. The albumin levels increased significantly at week 8 and stayed unchanged on week 12 as compared to baseline. The WBC count and blood glucose levels reduced significantly from baseline till end of study. 12th week was compared with baseline, it was observed that among 29 with eGFR >90 at baseline 7(24.1%) had eGFR 60 – 90 and 3(10.3%) had eGFR even less (30 – 60). Conclusion: HCV is a well-recognised risk factor of poor graft survival in kidney transplant patients. In our study it was observed that DAA treatment can resolved HCV infection in kidney Transplant Recipients with significant improvement of liver function without loss of allograft function. Keywords: Hepatitis C, Direct Antiviral Agents, Sustained Virological Response

Aim: To assess the role of transcranial Doppler in patients with severe traumatic brain injury Study design: A cross-sectional study Place and duration: This study was conducted at Mekran Medical college Turbat Pakistan. Methodology: Transcranial Doppler (TCD) was performed on 255 patients with severe traumatic brain injury (TBI) who had a Glasgow Coma Scale of 8 or less on admission. All the patients were on a ventilator. TCD was performed on the first, second, third, and seventh days of the hospital stay. Two out of three of the following were used to define hypoperfusion: 1. A mean velocity of less than 35 cm/sec in the middle cerebral artery 2. The diastolic velocity of the middle cerebral artery is seen to be lesser than 20 cm/sec and 3. A pulsatility index of more than 1.4 was recorded. The following criteria were used to identify vasospasm: mean velocity of the middle cerebral artery more than 120 cm/sec and Landegaarde index greater than 3. The Lindegaard index is the ratio of middle cerebral artery blood flow to internal carotid artery blood flow. Results: The results showed that 141 people (45 percent) had normal readings. Out of the 141 patients, 55 were admitted to a long-term care facility, 43 patients were discharged. Ten of the patients were unconscious or vegetative, and their relatives pleaded for their loved ones to be removed from them. Four people died as a result of brain death, while two others died as a result of injuries. Seventy-two patients (28%) had hypoperfusion, and 71 died, 65 through brain death, 6 from stopping care, and one with mild disability. Vasospasm was present in 69 individuals (27%). Conclusion: Patients with normal measures should have a good chance of survival. Hypoperfusion patients had a bad prognosis. The use of nimodipine in patients with vasospasm should be examined, but further research is needed to determine its safety and effectiveness. TCD is helping to assess early prognosis. Keywords: Prognosis, Transcranial Doppler, traumatic brain injury, hypoperfusion, vasospasm