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Background: The COVID-19 (Coronavirus Disease of 2019) virus has affected millions of people around the world, and it is likely to induce mental health issues in those who have never had one before, as well as worsen the condition of those who already have. Objective: To determine the effect of COVID-19 on mental health and quality of life. Methodology: The non-probability convenient sampling strategy was utilized in this cross-sectional research. A sample of 300 Males and Female with age above 30 who have gone through COVID-19 and recovered before one month or more are included in the study. All patients who already had cognitive issues even before COVID-19 were excluded from the study. The study variables were measured using the MMSE (mental health) and WHOQOL-BREF (quality of life). Results: The results revealed that 128 participants (43%) of the respondents were male and 172 participants (57%) were female. The findings showed that 32 people were with normal mental health, 100 were with mild and 36 were with moderate mental health between the ages of 30-39. 52 people were with normal mental health, 24 were with mild and no one was with moderate mental health between the ages of 40-49. 4 people were with normal mental health, 4 were with mild and 24 were moderate mental health between the ages of 50-59. 12 people were with normal mental health with, 4 were with mild and no one was with moderate mental health between the ages of 60-69. The results also showed that there was a significant association between mental health and quality of life. chi-square test of independence showed significant association between mental health and quality of life with ꭓ2 (N = 300) = 600.0, p = .000. The findings showed that people with normal mental health had very good quality of life, people with mild mental health have poor quality of life and people with moderate mental health have very poor quality of life. Conclusion: It was concluded from the study that COVID-19 has badly effected mental health and quality of life of the patients suffered from coronavirus. Keywords: COVID-19, Mental Health, Quality of Life, Mental State Examination, Chi-Square

Background: The analysis of superficial lymphadenopathy in the cervical, axillary, and inguinal regions is vital in planning therapy for patients. Elastography is a technique currently being used for the evaluation of lymph nodes by means of evaluating tissue elasticity. In medical practice, shear wave-based and strain elastography techniques are being utilized. Strain elastography can be used to assess types of elasticity. Colors inside and around the nodes are estimated in the first place and then a 4-5 scale scoring system is used to score them visually. The present study aimed to assess the diagnostic accuracy of elastography in distinction between malignant and benign lymph nodes of the neck and head region, taking histopathology as the gold standard. Methods: This study was carried out on ninety-six (96) patients of either gender with lymph nodes in the head and neck region admitted to Children Hospital and University of Child Health Sciences Lahore and Mardan Medical Complex. Patients with proven histopathology and gone through surgery in the head and neck region were excluded from the study. Each patient was subjected to the high-resolution elastography with a 7.5 MHz linear array probe. A consultant radiologist performed the elastography in the presence of the researcher and noted the lymph node types. The histopathology report was compared with the findings of elastography. Results: High-resolution elastography was conducted on each patient enrolled in this study and their results were categorized into two distinct groups’ namely positive elastography and negative elastography. In the positive group, malignant lymph node diagnoses were supported in 51 patients by elastography. Out of which 46 were true positive cases and 5 were false-positive cases with no malignant histopathology. Similarly, in elastography, negative patients, only 3 cases were false negative and 42 cases were true negative. The overall diagnostic precision, specificity, negative predictive value, positive predictive value, and sensitivity of elastography was found to be 92%, 89.10%, 92.80%, 89.40%, and 94%, respectively, in order to differentiate malignant lymph nodes from benign lymph nodes in the neck and head region, taking histopathology as the gold standard. Conclusions: The present study demonstrated that elastography is a favorable and invasive technique for the diagnosis and differentiation of malignant lymph nodes from benign lymph nodes with high diagnostic accuracy. It may help in selecting surgical procedures for lymph nodes in the neck and head region. Keywords: Elastography, Sensitivity, Malignant Lymph Nodes.

Aim: To find the consequences of trunk exercises in addition to the traditional physiotherapy practices for trunk control, mobility, and balance in hemiparetic cerebral palsy children. Methods: Forty children withhemiparetic cerebral palsy of 10-14 years (without gender discrimination), were included in this randomized controlled trial. Both groups received a conventional physical therapy program, whilethe study group additionally received trunk exercises. Participants were re-evaluated after three months of treatment by using the Trunk Impairment Scale (TIS) for assessment of trunk control, Pediatric Berg Balance Scale (PBS) for balance assessments, and the dynamic gait index scale (DGI) for walking mobility function. Results:The Mann Whitney ‘U’ test was used to measure the difference between the 2 groups while Wilcoxon test was used to measure the difference within the group.Results were demonstrated as mean and standard deviations for pre and post-treatmentscores of variables TIS, PBS, and DGI.Comparison of outcome measures of each group before treatment specified no substantial differences. While, comparison of outcome measures after the treatmentwith traditional physiotherapy along with trunk exercises revealed noteworthy increase in the aptitude to maintain trunk stability, balance, and walking mobility function in study group A (p

Introduction: In recent years, laparoscopy's role in treating benign gallbladder and biliary tract diseases has been well confirmed. Objective: The main objective of the study is to find the scope of laparoscopic cholecystectomy in patient with history of previous upper abdominal surgery. Material and methods: This retrospective study was conducted in khyber medical center Peshawar during June 2022 to December 2022. An informed consent was obtained from each patient included in the study. The primary outcomes of the current study involves incidence rate of intraoperative biliary injury and the secondary outcome of the study includes postoperative strictures, bile leaks, hernia, infections, postoperative need for reoperation or drainage. Results: A total of 316 cholecystectomies were performed. Out of these 28 were performed with other hepatobiliary or bariatric operations. The remaining subjects 288, out of which 212 did not show severe cholecystitis and the remaining 76 had severe cholecystitis. 51 patients with severe cholecystitis had LC and 22 were treated with LSC out of those 3 went through open cholecystectomy and were excluded from the study. Practical Implication: This study will helps us in hospitals in Laparoscopic cholecystectomy because it’s a safe method and procedure. Conclusion: It is concluded that Laparoscopic cholecystectomy is a feasible and safe treatment for symptomatic gallstone disease in selected patients with previous upper abdominal surgery history. Keywords: Laparoscopic cholecystectomy, Procedure, Patients, Abdominal

Background: Human being recognition is significant for a variety of purposes, including for the humanitarian and sentimental needs for others, for relatives as well as for the court before rendering a decision. In forensic radiology, the radiographic tests and procedures that are relevant to the law or the courts are performed, interpreted, and then reported. Comparing radiography to three-dimensional (3D) cone beam computed tomography, radiography has the benefits of being more widely available, having a lower radiation dose, and having a lower cast. The systemic change in size or shape between individuals of varying sexes belonging to the same species is known as sexual dimorphism. Sexual dimorphism is reflected by different species' maxillary sinuses. The first paranasal sinus to develop in utero at the age of 10 weeks are the maxillary sinuses, which are two air-filled cavities found in the maxillary bone. They are the largest of the paranasal sinuses. Bones like the pelvis, skull, and femur are used in radiology to identify gender. Maxillary sinuses can be utilized for identification in mass tragedies like aero plane accidents, war, explosions, burnt, decomposing remains, and other calamities. In these situations, all the bones suffer severe damage, but the sinuses are left undamaged. Aim and objective: This research used digital radiography to identify gender based on the morphology of the maxillary sinus. Materials and Methods: From the radiographs (A.P view) of 128 subjects ( 64 males and 64 females), the morphometric characteristics of the maxillary sinus were assessed using microdicom software. Results: The right maxillary sinus average height and width in males was 28.15mm and 25.04mm whereas, in females it 22.39mm and 22.54mm respectively and was found statistically highly significant. Likewise, the left maxillary sinus average height and width in males was 28.91mm and 25.33mm and in females it was 22.39mm and 20.81mm respectively and was statistically highly significant. Conclusion: It was concluded from my study that the anteroposterior (AP) view of digital radiographs can be used to detect the gender based on the height and width of the maxillary sinuses. Keywords: Forensic radiography, maxillary sinus, sexual dimorphism, gender determination mass disaster.

Background: Bio-mechanical changes during pregnancy impose postural deviation, its leading sacroiliac joint pain, or this pain increase with advancing pregnancy or interface the daily activities or sleep. Aim: To determine the prevalence of sacroiliac joint pain. Methods: This Cross sectional study was conducted at Kannan Physiotherapy and Spine Clinic Lahore, Pakistan. Convenient sampling non-probability sampling method was used, PGQ questionnaire or clinical tests are used to diagnose the sacroiliac joint pain. Results: Total pregnant women are 196, There sum of all activity or sum value divided by 75 or multiply by 100, mean 37.30; std. deviation 18.239; minimum 0; maximum 85.(the population of 1000 pregnant women were considered of which 196(19.6%) said they feel pain while 804(80.4%) said they didn’t feel pain or pain increase with trimester. Conclusion: The study concluded that pregnant women are at mild to moderate rate of developing sacroiliac joint pain due to repetitive bad posture or heavy weight during pregnancy. Keywords: Pregnancy, Sacroiliac joint pain, Pelvic girdle questionnaire, clinical test.

Background and Aim: Diabetic mellitus is an epidemic health issue causing almost twice the mortality compared to non-diabetic. Diabetes and non-diabetics with acute myocardial infarction were compared for in-hospital mortality and complications. Material and Methods: This comparative cross-sectional study was conducted on 264 successive diabetic and non-diabetic patients in the Department of Cardiology Pakistan Institute of Medical Sciences Islamabad with study duration of 6 months. All the acute myocardial infarction patients with ST-elevation were admitted and treated with thrombolytic agent such as streptokinase. Patients were categorized into two groups: 1) Diabetic patients 2). Non-diabetic patients. All the patients of either gender with age ranges from 15 years to 80 years and having chest pain for >30 minutes and

Introduction: Acute kidney injury (AKI) is a common complication that can occur after invasive cardiac procedures. This condition can cause significant morbidity and mortality, especially in high-risk patients, such as those with preexisting renal dysfunction. Objectives: The main objective of the study is to find the association of radial artery access with reduced incidence of acute kidney injury. Material and methods: The study is conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar. This is a tertiary care center that provides cardiac care services to a large population of the Khyber Pakhtunkhwa province of Pakistan. The center has state-of-the-art facilities and a team of experienced cardiologists and cardiac surgeons who perform a variety of cardiac procedures, including PCI and CABG. Results: Based on a study of 300 patients undergoing cardiac catheterization, there was a significant association between the use of radial artery access and reduced incidence of acute kidney injury (AKI). The study found that 20% of patients who underwent femoral artery access developed AKI, compared to only 10% of patients who underwent radial artery access. This indicates that radial artery access may be a safer option for cardiac catheterization procedures, as it may help reduce the risk of AKI in patients. Conclusion: In conclusion, the present study provides evidence that radial artery access is associated with a lower incidence of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI).

Background and Aim: Ischemic mitral regurgitation (IMR) is the most prevalent complication following myocardial infarction (MI) and coronary artery disease. Acute or chronic MI can lead to IMR resulting from an abnormality in regional wall motion or dysfunction of papillary muscles in a territory with structurally normal mitral valve leaflets, coronary artery disease and chordae tendineae. The present study aimed to determine the incidence of ischemic mitral regurgitation in ST elevation myocardial infarction and its impact on hospital course. Material and Methods: This cross-sectional study was conducted on 164 myocardial infarction patients in the Department of Cardiology of Pakistan Institute Medical Sciences Hospital, Islamabad over a time period of 6 months. Institute research and ethical committee approved the study protocol. Patients with prior mitral surgery, heart failure, previous myocardial infarction, and mitral valve disorders were excluded. Demographic detail, echocardiographic parameters, and myocardial complications were recorded. Other parameters such as Killip class, in-hospital mortality, and MI territory with respect to electrocardiographic changes were recorded. Data analysis was carried out in SPSS version 26. Results: Of the total 164 MI patients, there were 114 (69.5%) male and 50 (30.5%) females. The overall mean age was 58.62±8.62 years. The incidence of IMR was 106 (64.6%), out of which the prevalence of mild, moderate, and severe MR were 86 (81.1%), 12 (11.3%), and 8 (7.6%) respectively. No significant association was found between the presence of IMR and other parameters such as diabetes, smoking, hypertension, gender, and BMI. There was a significant association between triglyceride and serum LDL-cholesterol levels with IMR presence. On comparing the IMR and no MR cases, left ventricular ejection fraction reduced but pulmonary arterial pressure increased in IMR groups. Conclusion: The present study found that the prevalence of IMR was 64.6% among MI patients and approximately half of the patients who suffer from IMR after having an AMI experience complications as a result of it. A proper treatment decision depends on assessing the severity of the MR in relation to AMI complications. Keywords: Ischemic mitral regurgitation, Myocardial infarction, ST elevation

Objective: To evaluate the relation between balloon size and outcome of patients undergoing pulmonary valvuloplasty. Study Design: A quasi-experimental study. Place and Duration: Pediatric Cardiology Department of Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan from January 2021 to June 2022. Methodology: Children of both genders aged less than 15 years having severe pulmonary stenosis and who underwent pulmonary valvuloplasty during the study period were analyzed. After 24 hours post procedure, echocardiography was done to see echo gradient across pulmonary valve, tricuspid regurgitation, pulmonary regurgitation, right ventricular dysfunction or pericardial effusion. Procedure was considered successful if the residual gradient across pulmonary valve was < 40 mmHg, pulmonary regurgitation < moderate and patients had no major complications. Results: In a total of 75 children, 42 (56.3%) were male. The mean age was 6.24 ± 4.81 years. Cyanosis was observed in 10 (13.3%) children while there was right ventricular dysfunction in 6 (8.0%) children. The pulmonary valvuloplasty procedure was successful in 53 (70.6%) cases while in remaining 22 (29.4%) cases, the procedure was partially successful because of infundibular obstruction. We observed that the degree of pulmonary regurgitation was greater when annulus- balloon ratio was 1.3 or more than that (p

Heavy metals poisoning of soil and water has resulted from industrial expansion in Lahore, Pakistan, creating a significant environmental hazard. As a result, monitoring the contamination of soil and water around industrial sites is critical. The fact that higher concentrations of heavy metals have a negative influence on both plants and human life and this cannot be ignored. Higher heavy metal concentrations have a direct impact on human health due to their presence in drinking water. Consumable plants and vegetables cultivated in these polluted areas may collect higher concentrations of heavy metals from soil and water via the phytoremediation process. Its worth mentioning that the accumulation of toxic metals in edible plants and vegetables also has a direct negative impact on human and animal health. The purpose of this study is to find the heavy metals concentration in the soil and ground water in the Lahore area. Five industrial zones were evaluated for water and soil throughout the research period of December 2021 to January 2022 (pre-monsoon). pH and heavy metals content measurements were performed on the collected soil and water samples. We discovered that the water had a higher pH and that the soil was heavily contaminated with significantly higher concentrations of toxic heavy metals. According to the research, there is a gangrenous influence of pollution caused by industrial waste and the surrounding environment on soil and water resources, which affects living creatures. Keywords: Environmental Pollution, Heavy Metal, Pollution, Water pollution, Soil pollution

Objective: Cardiopulmonary bypass in cardiac surgery is often associated with metabolic changes. So, we conducted this study in order to find the supremacy between two risk factors base excess and hyperlactatemia in early prediction of morbidity and mortality in ICU after cardiac surgery. Material and Methods: Intraoperative data of total of 100 patients who had cardiac surgery was recorded. Intraoperative and postoperative data of base excess and lactate levels were recorded at 1st, 6th, 12th and 24th hour in ICU. Two perioperative groups for B.E(Group 1 B.E < +/-2.5 mmol: Group 2 B.E >+/- 2.5 mmol) and lactate (Group 1 Lactate < 3 mmol: Group 2 Lactate>mmol ) were created, Two post-operative groups for B.E(Group 1 B.E < +/-5.0 mmol: Group 2 B.E >+/- 5.0 mmol) and lactate( Group 1 Lactate 5mmol )were created to find their correlation with early postoperative complications. Results: In our study ICU morbidity and mortality was more related to the lactate and base excess values in the early 24 hours. Progressive Hyperlactatemia and constant negative base excess values were both significantly associated with ICU complications. In the CPB period subgroup negative base excess was more superior in predicting ICU prognosis than Lactate. (P-value 0.001) similarly patients divided in subgroup BE >+/- 5mmol/l had demonstrated superiority in making such prediction. Both CPB (0.013) and X.C (0.036) time were associated independently with ICU prognosis. .Longer ventilation times were also associated with bad ICU prognosis. Conclusion: Our study found negative base excess values in the early postoperative period to be superior in predicting ICU morbidity and mortality when studied at subgroup level both peri-operatively and postoperatively.

Background: Ectopic pregnancy is a lethal condition and a gynecological emergency. It is associated with maternal morbidity and mortality with pregnancy loss. The incidence of ectopic pregnancy is increasing worldwide. The diagnosis of the ectopic pregnancy can be difficult without the suspicion of the condition. It is confused with the pelvic inflammatory disease and miscarriage. Objective: This study may help on formulating a guiding principle on the diagnosis and management of Ectopic pregnancies in this area. In this research the frequency of clinical presentations and factors responsible for ectopic pregnancy are determined. Methodology: This is a cross-sectional based study. This study was conducted at the Obstetricians and gynecology department of Murshid Hospital and health care Center Karachi. The 125 women diagnosed with ectopic pregnancy for the duration of six months from July 2021 to December 2021were included. Patients were examined for outcome variables (abdominal pain, vaginal bleeding, history of infertility, use of IUCD and previous ectopic pregnancy) noted in predesigned performa. Results: - The women mean age was 9m31 ± 6.6 years. There were 96 (78.4%) women observed with abdominal pain and 72 (57.6%) women with vaginal bleeding in which some of them had both clinical presentations. History of fertility 34 (27.2%), use of intrauterine contraceptive device 58 (46.4%) and previous ectopic pregnancy 33 (26.4%) were responsible for ectopic pregnancy. Conclusion: Majority of the patients attended the hospital were in acute condition. They were diagnosed with classical features of ruptured ectopic pregnancy. The most common clinical features were use of IUD, infertility history, and previous ectopic pregnancy. . For reducing the morbidity and mortality rates associated with the ectopic pregnancy the early diagnosis of the tubal rupture is an essential factor. Keywords: Ectopic pregnancy, vaginal bleeding, intrauterine contraceptive device

Objective: To inquire the oral cancer awareness among general medical and general dental professionalsand their knowledge of early detection and prevention of oral squamous cell carcinoma. Study design: cross sectional study Place and duration of study: Oral and maxillofacial surgery Department King Edward Medical University from 5th November 2019 to 5th February 2020. Methodology: A questionnaire was given to dental and medical practitioners and their responses were included in the results. This study was done in three months’ period from 5th November 2019 to 5th February 2020 after ethical approval from institutional review board. Results:The questions were given back by 57 general medical practitioners and by 40 general dental practitioners, producing return rates of 38% GMPs and 26.66% GDPs respectively. The questions were answered by 93 GMPs and by 110 GDPs producing rates of 62% GMPs and 73.33% GDPs respectively. Conclusion: Patients suffering from oral pathologies often go to their general medical practitioner and dental practitioners. The number of patientsof squamous cell carcinoma of oral cavity are rising in the Pakistan, hence general medical and general dental practitioners need to play significant role. This study talks mainly about the on the need for improvement in awareness about oral squamous cell carcinoma. Keywords: oral cancer, awareness, risk factors

Objective: To determine the prevalence of hypothyroidism among children with β-thalassemia major. Study Design: Cross-sectional study. Place and Duration of the Study: The Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, Bahawal-Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from 1st January 2021 to 31st December 2021. Methodology: A total of 125 children of both genders (2 to 18 years) with diagnosis of β-thalassemia major were analyzed. Two ml blood sample under strict aseptic conditions was obtained from every study participant and sent to Institutional Pathological Laboratory for thyroid-stimulating hormone (TSH), T3, and T4. Results: In a total of 125 children with β-thalassemia major, 78 (62.4%) were male. Overall, mean age was 8.57±4.75 years while 57 (45.6%) children were aged between 6 to 10 years. Residential status of 84 (67.2%) children was rural. Parental consanguineous marriages were reported in 91 (72.8%) patients. Mean TSH, T3 and T4 levels were calculated to be 3.27±1.38 pmol/L, 4.71±0.75 pmol/L and 11.80±2.38 pmol/L respectively. Hypothyroidism was noticed in 38 (30.4%) children. Conclusion: Prevalence of hypothyroidism in children with β-thalassemia major was high. Early identification and management of hypothyroidism in β-thalassemia major may improve overall quality of life among these affected children Keywords: Β-thalassemia major, hypothyroidism, thyroid-stimulating hormone.

Objective: The objective of study was to determine the efficacy after endoscopic dilatation in patients of corrosive intake. Study Design: It was descriptive case series Setting: Research was conducted at Medical Unit-III, Services Hospital, Lahore. Duration: Duration of study was 6 months from 1st November 2016 to 30th April 2017. Material and Methods: This study involved 150 patients of age 18-65 years with corrosive intake and dysphagia score ≥ 2. A written informed consent was taken from each patient. Results: Total 150 patients were added in the study. Out of these, 118 patients (78.7%) were females while 32 (21.3%) were males. The age of patient ranged from 18 to 48 years with a mean of 26.72 ±5.61. One hundred thirty two patients (88 %) showed improvement in dysphagia while 18 patients (12 %) did not show any improvement. Efficacy calculated by chi- square test which showed p-value of .000 (statistically significant) Conclusion: 150 patients with dysphagia score ≥ 2 were added in study and dilated with Savary-Gilliard dilator. 132 patients showed improvement in dysphagia with p-value of .ooo (statistically significant).

Objective: To determine the frequency of impaired glucose tolerance in women with polycystic ovary syndrome (PCOS). Study Design: Cross-sectional study Place and Duration: Department of Obstetrics and Gynaecology, Unit-I, ShaheedMohtarma Benazir Bhutto Medical University of Medical Sciences, Larkana. Study was carried out over a period of six months from 23rd March 2018 to 22nd September 2018. Subjects and Methods: A total of 120 patients were recruited in this study. 75g oral glucose tolerance test was performed. The 2ml blood sample was obtained by using BD syringe. Those patients having whole blood glucose value >140-200mg/dl were labeled as having impaired glucose tolerance test. Results: Mean age of the patients was 24.6±6.4 years. Mean BMI 28.5±2.8 kg/m2. Out of 120 cases, 69 patients (57.5%) were married while remaining 51 patients (42.5%) were unmarried. Out of 69 married patients, 24 (34.8%) were primigravida and 45 (65.2%) were multigravida. Mean duration of PCOS was 1.6±0.8 year. Frequency of IGT was observed in 20 patients (16.7%). Symptoms were as follows: Oligomenorrhea 58 (48.3%), hyper-androgenium 29 (24.2%) and increased ovarian volume 33 (27.5%). Stratification with regard to age, BMI, marital status, parity, duration of PCOS and symptoms was also carried out. Conclusion: Women with PCOS are at a high risk for the development of IGT (16.7%) and subsequently Type 2 DM. While managing the hirsutism and menstrual irregularities, metabolic evaluation of the patient should be done. Keywords: Polycystic ovarian syndrome, Impaired glucose tolerance, Androgen excess

Objective: The aim of current study was to find out the factors causing Acute Kidney Injury (AKI) in the postoperative period of cardiac surgery. This prospective study, Peri-operative Anemia, Urine Output, gender, need for Intra-operative blood transfusion were analyzed for association of AKI. Material and Method: The study was conducted at Cardiac Center, QAMC Bahawalpur from January, 2019 to June, 2021. A total of 180 patients who underwent cardiopulmonary bypass for IHD and Valve surgery were studied. CPB hemoglobin levels, Blood Transfusion in OR, Gender specificity, Peri-operative urine output (Group1 UO 4ml/kg/hr) were correlated to establish their relationship in causing post-operative Acute Kidney Injury. The patients were divided into two groups one who had Acute Kidney Injury other who don’t. Results: Acute kidney injury developed in 20 out of 180 patients, current study showed insignificant relation between CPB time, X clamp time, Gender, Surgery type, MAP and Postoperative Acute Kidney Injury. Acute Kidney Injury was more associated with diabetes, need of blood transfusion, perioperative hemofiltration and reduced urine output. Conclusion: Current study showed that Acute Kidney injury is an avoidable complication if hemoglobin levels are kept above 8-9 gm/dl to ensure proper oxygen supply and need of Intraoperative hemofiltration and BT is reduced by reducing circuit length thus hemodilution and found a urine output less than 4 ml/kg/hr during cardiopulmonary bypass carries major risk for AKI. Keywords: AKI Acute Kidney injury CPB Cardiopulmonary bypass UO urine output MAP Mean Arterial Pressure

Objective: Adults with neck-of-femur fractures will be compared between two and three cannulated screws for fixation in this study. Study Design: Comparative/Experimental study Place and Duration: Orthopaedics and Trauma Department of Bacha Khan Medical College, Mardan and the department of Orthopaedics, Gambat Institutes of Medical and Science, Sindh during the period from April 2021 to September 2021 Methods: There were 90 patients of both genders had garden type fractures of neck of femur with ages 15-55years were included. Age, gender, and the reason of the fracture were among the variables collected after patients provided written consent. Patients were equally segregated into two groups. Group I had 45 patients and received cannulated screws fixation and in group II 45 patients received three cannulated screws fixation. Post treatment radiological union was assessed and compared at the 14th week. We used SPSS 23.0 to analyze complete data. Results: There were majority males 75 (83.3%) and only 15 (16.7%) females in this study. Most common cause of fracture was road accidents found in 65 (72.2%) cases followed by falling from height in 18 (20%) cases and sports in 7 (7.8%) cases. In group I mean age of the patients was 34.9±7.16 years and had mean BMI 23.6±3.22 kg/m2 while in group II mean age was 35.2±3.61 years with mean BMI 24.2±2.19 kg/m2. Mean union time in group I was 9.1±3.16 weeks and in group II mean time was 13.3±4.14 weeks. Frequency of radiological union in group I was higher among 43 (95.6%) cases as compared to group II in 37 (82.2%) cases. Overall success rate of radiological union was found among 88.9% cases. Conclusion: We concluded in this study that two cannulated screws fixation was effective and useful as compared to three cannulated screws fixation in the management of fracture of neck of femur in terms of less radiological union time and higher number of success rate among all cases. Keywords: Fracture Neck of Femur, Two Cannulated Screws Fixation, Three Cannulated Screws Fixation, Radiological Outcome

Objective: To find out the analysis of transfusion transmitted infections (TTIs) in β-thalassemia patients at a tertiary care hospital of South Punjab, Pakistan. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, “Bahawal Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from February January 2020 to December 2021. Methodology: Patients of blood transfusion-dependent 𝛽-thalassaemia of both genders and aged 5 to 12 years were analyzed. Blood was collected from patients aseptically and serum separated in Eppendorf tubes and stored at –200C. Screening for hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis and human immunodeficiency virus (HIV) were performed through Chemiluminescence Immunoassay (CLIA) technique. Results: In a total of 1212 patients, 745 (61.5%) were male. Overall, mean age was calculated to be 8.7±4.6 years while 874 (72.1%) patients were below 10 years of age. There were 866 (71.5%) patients who belonged to rural areas of residence. Parental consanguineous marriages were reported in 951 (78.5%) cases. There were 205 (16.9%) patients who were found to have TTIs. Out of these 205 patients, 169 (13.9%) were having HCV, 11 (0.9%) HBV, 20 (1.7%) syphilis whereas HIV was noted in 5 (0.4%) patients. Conclusion: Prevalence of TTIs was found to be high among multi-transfused patients of β-thalassemia. Most common types of TTIs were HCV which is consistent to what has previously been reported in the local literature. Identification of HIV in 0.5% cases in the present study is pointing towards disturbing development regarding spread of HIV in our region. Keywords: β-thalassemia, blood transfusion, hepatitis C, hepatitis B, human immunodeficiency virus.

Aim: To investigate the relationship between narcissism and body image with Instagram usage. Methodology: This cross-sectional research study was conducted in three Universities of Lahore; The university of Lahore, University of Management and Technology, and University of Central Punjab. 200 university students were taken including 100 females and 100 males. age, gender. Narcissistic Personality Inventory-16, Body appreciation Scale-2 (BAS-2), Motive for Instagram use were employed, their age, education, birth order, economic status and student’s qualification were used. Results: The results showed that there was a positive significant relationship between narcissism and body image. More results also revealed a positive relationship regarding narcissism and the usage of Instagram. Conclusion: Narcissism and body image are correlated that means the individuals who have narcissist features, they mentor themselves and have self-image, self-concept, self-perception and outer appearance in their mind and they spend more time on Instagram and are more concerned about their physical appearance. Keywords: Narcissism, Body image, Instagram usage

Background: Pancreatic cancer is a fatal disease with high mortality rate. Imaging has a significant and decisive interplay in the diagnosis process and in staging of the patients with carcinoma. Thus MRI detection of linear metastasis in patients with pancreatic carcinoma is of great importance. Objective: The purpose of the study was to find out the diagnostic accuracy of MRI in the detection of linear metastasis in patients with pancreatic carcinoma Methodology: Systematic literature search was conducted by the help of following search engines: Google scholar, PubMed, NCBI, Medline and Medscape databases from 1999 up to 2020 for names or pancreatic carcinoma, MRI, diagnostic accuracy of MRI in carcinoma, management of motion artifact in MRI, RADAR sequence for motion compensation in MRI. Only those studies were included in this review study which showed the role MRI detection in the patients with pancreatic carcinoma. Total 33 studies were selected and evaluated for the current study. All data extracted from them was further analyzed through meta-analysis. Results: According to literature MRI detection technique is responsible in the detection of linear metastasis in pancreatic carcinoma. The diagnostic accuracy of the test was high with four out of five studies indicating diagnostic accuracy greater than 90%. Moreover, the sensitivity and specificity of the technique is high i.e. above 0.80 and 0.78 respectively. Thus MRI stands as the significant and accurate marker for the detection of metastasis especially in the case of pancreatic adenocarcinoma. Conclusion: The reviewed literature indicated that MRI possesses high diagnostic accuracy for detection of pancreatic carcinoma. The sensitivity and specificity of MRI was also high. The results indicated that the use of MRI may help in early detection of Pancreatic Cancer. Key words: Pancreatic carcinoma, Linear metastasis, Magnetic Resonance Imaging

Aim: To investigate the etiology, gender distribution and presenting complaints associated with zygomatic fractures Method: This cross sectional study was done in Oral and Maxillofacial Surgery Department of King Edward Medical University from April to D3ecember 2019. Patient data was collected from OPD and analysed with SPSS. Results: We analyzed the data of 162 patients with zygomatic bone fracture. Out of this 148 were male and 14 were females. There were bilateral cases, more affecting right side of face and affecting left side of face. The most common etiology was road traffic accident followed by interpersonal violence and occupational injuries. When we consider presenting complaints 87 patients came with difficulty in chewing, 45 with limited mouth opening, 23 with depressed malar eminence and only 7 patients with nerve paraesthesia. Conclusion: Considering the geographic and cultural indices of the evaluated population, it can be concluded that the patients gender and trauma causes significantly affect the prevalence of zygomatic bone fracture Keywords: Zygomatic bone, nerve paraesthesia, limited mouth opening

Aim : To evaluate tranexamic acid effect on quality of surgery. Design: Double-blind study, Prospective and randomized Place & time of study: June 2020 to may 2021Allama iqbal memorial trust hospital Gujranwala. Methods: Two groups of candidates were made. The saline was administered to the control group whereas tranexamic acid was administered as 0.01g/kg in a bolus form, before surgical incision to tranexamic acid group. On a 10-point scale, grading of surgical field, primary hemorrhage and satisfaction of surgeon Results: As far as operating surgeon satisfaction is concerned, noteworthy improvement was witnessed and evaluation of surgery in case of control individuals group as compared to in case of test individual group in the tranexamic acid individuals group was estimated against the control members of group. Conclusion: tranexamic acid was given in dosage of 0.01g/kg of before surgical incision showed improved in a great way in surgical field during repairing of cleft palate operation. Keywords: tranexamic acid surgical field, pediatric, palatoplasty satisfaction, cleft palate

Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P>0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P>0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction

Objective: The aim of this study is to determine the outcomes of using two ring hybrid ilizarov fixator for the management of proximal tibial fractures in adult patients. Study Design: Descriptive Study Place and Duration: Methods: There were 60 patients of both genders were presented in this study. Patients were aged between 25-65 years. Informed written consent was taken from all the patients for detailed demographics age, sex, body mass index and cause of fracture. All the patients had proximal tibial fractures were included, type of fractures were assessed by schatzker technique. Outcomes were assessed by using Rasmussen score in terms of excellent, good and fair. Radiological outcome was measured by fracture healing on radiography. Student t-test and chi square test was used. SPSS 24.0 was used to analyze all of the data. Results: There were 45 (75%) patients were males and 15 (25%) were female patients. Mean age of the patients was 42.3±7.43 years with mean BMI 25.07±6.29 kg/m2. Falling was the most common cause of fracture found in 33 (55%), followed by road traffic accidents in 17 (28.3%) and 10 (16.7%) fractures by assault. Majority of the patients were schatzker type VI fractures 34 (56.7%) followed by schatzker type V fractures in 11 (18.3%), metaphyseal fractures found in 8 (13.3%) cases and proximalone third shaft fractures in 7 (11.7%) cases. Mean surgery time was 4.2±6.17 hours and mean union time of fractures was 19.8±6.61 weeks. According to Rasmussen score 39 (65%) cases showed excellent results with knee flexion more than 90 degree, good results found in 17 (28.3%) patients and fair results in 4 (6.7%) cases. Pin tract infection was the most common complication found in 12 (20%) cases, followed by compartment syndrome in 4 (6.7%) and delayed union in 3 (5%). No any poor outcome was assessed in this study. Conclusion: We concluded in this study that the use of two ring hybrid ilizarov fixator in the management of proximal tibial fractures were effective and useful in terms of excellent and good outcomes of knee flexion. The ilizarov approach allowed for early definitive treatment with a low rate of complications and a favourable clinical outcome. Keywords: Proximal Tibial fracture, Ilizarov Fixator, Shatzker, Rasmussen score, Outcomes

Osteoporosis is a significant and prevalent consequence of cirrhosis due to its detrimental influence on quality of life through persistent pain and immobility. Additionally, its significant morbidity necessitates early detection and treatment. BD is most frequently encountered in the elderly, smokers, postmenopausal women, alcoholics, malnourished individuals, and those with cholestatic liver disease. The prevalence of osteoporosis has been observed to range between 12--55% in patients with cirrhosis. Patients with primary biliary cirrhosis (PBC) have a higher prevalence due to persistent cholestasis and female gender. Prior to orthotopic liver transplantation, about 60% of cases with PBC and primary sclerosing cholangitis (PSC) have osteoporosis. It is critical to diagnose and treat osteoporosis prior to liver transplantation because of deterioration in early months i.e. 6—12 after transplantation. This resulted in much fractures due to trauma i.e. 25—35%. This osteoporosis may be due to toxic effect of immune compromised therapy after transplantation. Keywords: Role of calcium, cirrhosis, vitamin D

Objective: To evaluated serum ferritin levels in children having beta-thalassemia major with iron-overload treated with deferasirox. Study Design: A prospective open-label observational study. Place and Duration of the Study: The Outpatient Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, “Bahawal Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from February 2020 to January 2021. Material and Methods: Children aged 2 to 17 years with diagnosis of β-thalassemia major having chronic iron overload (serum ferritin > 1000 ng/ml) and 2 or more blood transfusions per month were included. Demographic information like gender, age, and residential status, contact number along with assessment of hepatitis serology, HIV status, electrocardiogram and ophthalmic findings were noted on a pre-designed proforma specially designed for this study. Deferasirox was initiated in a dose of 20 mg/kg/day and was adjusted at 3-months interval. Serum ferritin levels were measured at baseline, 3-months, 6-months, 9-months and 12-months. Results: In a total of 40 children, there were 23 (57.5%) male. Overall, mean age was calculated to be 9.1+4.2 years. Residential status of 28 (70.0%) children was rural. Mothers of 27 (67.5%) children were illiterate. At baseline, mean serum ferritin level was noted to be 4137+2319 ng/ml. Significant reduction in mean serum ferritin levels during the course of this study was found with the use of deferasirox as mean serum ferritin levels reduced significantly from baseline to 3-months, 6-months, 9-months and at 12-months as 3637+2119 ng/ml, 4081+2050 ng/ml, 4346+2349 ng/ml, 3252+2464 ng/ml and 2188+1195 ng/ml respectively (p

Aim: to explore the mandibular bone fractures in elderly patients with reference to etiology of trauma. Methodology: This was a descriptive study conducted in the department of Oral and Maxillofacial Surgery KEMU/ Mayo Hospital Lahore. Elderly patients (age 60-100years) with mandibular bone fractures. Results: Aetiology of trauma leading to mandibular fractures was as follows; there were 79(65.83%) cases of RTA, 32(26.66%) falls, 4(3.33%) assaults and there were only 3(2.5%) cases of industrial injury. Conclusion: To conclude, this study depicts that road traffic accidents were the predominant cause of injury in the studied age group. Elderly patients need more care and attention, especially after traumatic incidents and lead to financial burden in hospitals Keywords: Maxillofacial trauma, Elderly population, Mandibular injuries, Elderly fractures

Objective: To determine results of treating supracondylar fracture of the humerus in children using percutaneous cross pinning versus two lateral pinning. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, King Abdullah Teaching Hospital Mansehra from 1st November 2020 to 30th April 2021 Methodology: Eighty four patients of both genders were enrolled. Baseline demographic details of patient’s age, sex and body mass index were recorded after taking consent. Patients aged between 2-14years were included. Children with supracondylar humerus fractures were enrolled and divided equally into 2-groups. Group I had 42 patients and received percutaneous cross pinning technique and group II had 42 patients underwent lateral pinning. Radiological and functional results were assessed by Flynn’s criteria among both groups and frequency of complications was also observed. Results: There were 50 (59.5%) males (25 in each group) and 34 (40.5%) were females (17 in each group. Mean age of the patients in group I was 5.14±9.88 years and in group II mean age was 6.14±8.35 years. Sports 60 (71.43%) was the most common cause of fracture followed by traffic accidents 17 (20.24%) and the rest were 7 (8.3%) fall from the height. Mean surgical time in group I was 30.42±6.09 minutes while in group II mean time was 34.24±2.16 minutes. Mean radiation time in group I was 3.98±9.44 sec and in group II radiation time was 2.11±1.1sec. According Flynn’s criteria excellent results in group I were found in 25 (59.5%) cases, good results in 12 (28.6%) and fair results found in 5 (11.9%) while in group II excellent results were found in23 (54.8%), good results in 15 (35.7%) and fair results in 4 (9.5%). Significantly no difference in outcomes was observed among both groups. Conclusion: Both methods of treatment of supracondylar fractures of humerus are safe and successful however less operative and high time of radiation in cross percutaneous pinning compared to two lateral pinning has been found. Keywords: Percutaneous cross pinning, Two lateral pinning, Supracondylar humerus fracture