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Aims: Cancer is a disease that takes lives of thousands of people each year. There are more than 100 different types of cancers known to man. This fatal disease is one of the leading causes of death today. Background: Astrocyte elevated gene-1(AEG-1)/ Metadherin (MTDH) activates multiple oncogenic signaling pathways and leads to different types of cancers. MTDH interacting with staphylococcal nuclease domain containing 1(SND1) supports the survival and growth of mammary epithelial cells under oncogenic conditions. Objective: Silencing MTDH or SND1 individually or disrupting their interaction compromises the tumorigenic potential of tumor-initiating cells. The aim of our present study was to investigate novel interactions of staphylococcal nuclease domain containing 1 (SND1) binding domain of AEG-1/MTDH with different lead compounds through molecular docking approach using MOE software. Methods: Molecular docking was done by docking the ChemBridge database against important residues of MTDH involved in interaction with SND1. After docking the whole ChemBridge database, the top 200 interactive compounds were selected based on docking scores. After applying Lipinski’s rule, all the remaining chosen compounds were studied on the basis of binding affinity, binding energy, docking score and protein-ligand interactions. Finally, 10 compounds showing multiple interactions with different amino acid residues were selected as the top interacting compounds. Results: Three compounds were selected for simulation studies after testing these compounds using topkat toxicity and ADMET studies. The simulation study indicated that compound 32538601 is a lead compound for inhibiting MTDH-SND1 complex formation. Conclusion: These novels, potent inhibitors of MTDH-SND1 complex can ultimately help us in controlling cancer up to some extent.

The goal of this study is to review the overall prevalence, burden, and distribution of the dengue disease in Pakistan from 2000 to 2019. Literature was searched using different search engines like Google scholar, PubMed, etc. providing the keywords “Dengue disease/infection, Dengue virus, DENV, DF/DHF/ DSS Pakistan”. All the published research papers/reports on the dengue virus over the period 2000 to 2019 were studied and selected data were summarized using MS Excel for windows such as total cases, age wise, gender, DENV serotype distribution, total DHF, and DSS patients. The literature providing insufficient data was excluded. The total number of cases reported during 2000-19 were 201,269. The maximum number of cases during the mentioned literature survey period was reported in Khyber Pakhtunkhwa (KP) (23.3%) followed by Punjab (3.8%) and Sindh (1.9%). The majority of dengue-infected cases were reported as Dengue fever (74.4%) followed by DHF (24.1%) and DSS (1.5%). Overall the deaths during the mentioned literature survey were 1082, of which the maximum mortalities were reported from KP (N=248) followed by Punjab (N=220). DENV remains a major public health problem in Pakistan and seems to remain endemic for a long time. The total prevalence of dengue infection is increased accordingly with time from 2000 to 2019. Moreover, all the four serotypes exist in Pakistan with increased mortalities.

The use of natural colorants in modern dye factories is a potential green chemistry idea that should be widely promoted in order to minimize the wool dyeing’s dependency on some hazardous and non-biodegradable synthetic colors. In this study, an effort was undertaken to see if Rheum Emodi (Rhubarb) extract might be used as a natural dye for wool dyeing for the replacement of synthetic dyes. The dyeing of wool fabric was carried out using microwave (MW) rays’ treatment. By combining several mordants, a stunning color pallet of shades of varying hue and tone was created. Comparative evaluation of the effects of various chemical mordants (aluminum salt, iron salt, tannic acid, and cream of tartar) and bio mordants (pomegranate extract, and pine nut hull extract) on the characteristics of dyed wool samples was carried out to choose the best mordant for each application. It was found that MW treated wool fabric using bio mordant shown higher color fastness value of 4/5 to 5 and color strength value of approximately 10 to 20 rather than using metallic mordant. Scanning electron microscopy (SEM) photographs and Fourier transform infrared spectroscopy (FT-IR) analyses revealed the difference between irradiated and un-irradiated wool fabric. The employment of MW rays and bio-mordants in the natural coloring of wool fabric is encouraged due to their biocompatibility and non-toxicity when combined with MW treatment of wool fabric, as well as their high color fastness and color strength performances. As a result, the naturally extracted dyes from rhubarb can be the replacement of synthetic dyes for the coloration of wool fabric in the textile industry due to their environmental issues.

BACKGROUND: This paper focuses on the concept of career construction based on the theory of conservation of resources to understand the overall effect of career capital on career success from both a subjective and objective manner through the mediating effect of perceived employability. OBJECTIVE: This study attempts to explain how different integrated aspects of career capital, including human, social, and psychological (antecedents), influence both subjective career success and objective career success (outcome) through the mediating effect of perceived employability (mediator). METHODS: Time-lagged data of 331 employees from the telehealth medical billing service companies based in Pakistan were analyzed through a structural equation modeling technique using SmartPLS software. RESULTS: The main results confirmed that career capital positively affects perceived employability and career success while perceived employability positively mediates the relationship between career capital and career success. CONCLUSION: This research responded to prior calls by explaining the positive mediating role of perceived employability (as a mediator) in explaining the positive influence of career capital on career success using different various dimensions of career capital and career success. This research included the contextual issues by testing the model in the telehealth sector of Pakistan. The findings suggested that context or occupation matters in the relationship between career capital and career success.

Objective: To estimate the frequency of thrombocytopenia among patients with vivax-positive malaria. Study Design: Cross Sectional Study. Setting: Department of General Medicine Hayatabad Medical Complex Peshawar. Period: May 2022 to November 2022. Material & Methods: Total 140 cohort were observed in this study. Patients were taken as sample according to inclusion and exclusion criteria as per operational definition after the patients' written informed consent. Sociodemographic data was collected on a predesigned questionnaire. History such as febrile illnesses and blood dyscrasias and basic studies and peripheral blood smears were obtained. Results: The results of the study showed the sample has mean age 36 years with SD ± 3.72, of which 70% were men while 30% were women. Thrombocytopenia was observed in 68% of patients. Conclusion: In conclusion, the estimated frequency of thrombocytopenia in vivax malaria was found to be 68%.

Objective: To evaluate articular Cartilage after Knee injuries in young population as predictor of early Osteoarthritis, to pave the much more effective OA preventive measures in young population. Study Design: Descriptive Case Series. Setting: Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Period: 2020 to 2021. Material & Methods: One hundred forty five patients was conducted in Early Osteoarthritis was defined as a diffuse and ill-defined involvement, but originated in the cartilage surrounding a focal lesion, considered to include a maximal involvement of 50% of the cartilage thickness (ICRS Grade II) based on the macroscopic ICRS classification. Articular cartilage evaluation (Chondral lesions and OA) were recorded on set proforma according to ICRS grading system. Results: Mean age was 32 years. Significant risk for early osteoarthritis was 17.9%; female had higher risk for early osteoarthritis as compared to male with p value of 0.03. Correlation between patient’s age and grade of chondral lesion with risk for early Osteoarthritis were significant with p value of 0.00 and .002 respectively. Significant risk for early osteoarthritis was 10.25%, 23.08% and 15.38% respectively for anterior cruciate ligament tear, medial meniscus, and lateral meniscus injury. 42.65% anterior cruciate ligament injuries were associated with concomitant injuries, whereas significant risk for early OA was 17.24% as compared to isolated ACL injuries of 57.35% with significant risk for early OA of 10.25%. Concomitant meniscal and ACL injuries had significant risk for early OA was 23.53%. Conclusion: Arthroscopic evaluation of articular Cartilage damage after Knee injuries is good predictor of early Osteoarthritis in young population.

Objective: To compare early and late oral feeding after ileostomy closure in terms of postoperative anastomotic leakage. Study Design: Randomized Control Trial. Setting: Department of Surgery Unit, Leady Reading Hospital Peshawar. Period: July 2020 to January 2021. Material & Methods: All patients with stoma 226 (113 in each group) were observed. Patients were randomly divided into two categories. In the early postoperative period (within 24 hours of surgery), Group A permitted oral feeding. Group B who preserved "nil by mouth" for up to 72 hours during the post-operative phase. Patients were held null by mouth in the post-operative phase, while intravenous antibiotics and fluids were listed in both groups for up to the duration. In group A within 24 hours and in group B after 72 hours, 30 ml of liquid per hour was started orally. Follow-up was taken after the 7th day post-operative. The frequency of anastomotic leakage between the two groups was assessed and safety was defined based on anastomotic leakage. Results: The mean age in Group A was 42 years SD ± 6.94 for this analysis, while the mean age in Group B was 44 years SD +6.15. In 90 % of patients, more than Group A (early oral feeding) was safe, whereas Group B (late oral feeding) was safe in 86% of anastomotic leakage patients. Conclusion: Our research concludes that early oral feeding is better in terms of anastomotic leaks compared to late oral feeding after ileostomy closure.

Objective: To evaluate the real-world efficacy, safety, and functional outcomes of PRC-063 (multilayer-release methylphenidate) versus lisdexamfetamine (LDX) in ADHD subjects in a phase IV, open-label study. Method: The primary endpoint was the change in the ADHD-DSM-5 Rating Scale (ADHD-5-RS) total score from baseline to Month 4. Secondary endpoints included a non-inferiority comparison between PRC-063 and LDX and measures of functioning and evening behavior. Results: One hundred forty-three pediatric and 112 adult subjects were enrolled. Mean ADHD-5-RS scores (standard deviation) were reduced in pediatric (−16.6 [10.4]) and adult (−14.8 [10.6]) subjects treated with PRC-063 ( p Conclusion: PRC-063 and LDX significantly improved ADHD symptomatology and functioning and were well-tolerated.

Objective: To associate CT severity score with inflammatory markers and to determine outcomes of COVID-19 patients admitted to CMH Lahore. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Mar to Jun 2021. Methodology: Patients of COVID-19 age 18 and above, with a positive RT-PCR, were included in the study Clinical and radiological data of 200 patients was retrieved and analysed from the hospital registry. Results: In the present study, we studied the role of inflammatory markers in predicting the severity of COVID-19. We have compared the levels of LDH, CRP, IL-6 and serum Ferritin between the two groups. LDH (p=0.015), IL-6 (p=0.001) and Ferritin (p=0.001) were significantly different between the two groups, but CRP was not (p=0.811) significant. Conclusion: CT severity score associates well with the COVID-19 clinical severity. Our data suggest that the chest CT scoring system can predict the severity of COVID-19 disease and significantly associates with inflammatory markers.

Displaced Tibiai plateau fractures are complex periarticular injuries. Restoration of the anatomy and internal fixation are key elements for early return to function and better functional outcome. Newer modalities like CT scans has enabled better understanding of these fractures. Posterior approaches were not very common as compared to anteromedial and anterolateral surgical approach. Posterior approach has the advantage of avoiding anterior skin and soft tissues that has been compromised as a result of the fracture; it is also particularly helpful in direct and accurate reduction in certain fracture patterns. This case series highlights the importance of posterior approach to restore the articular surface of complex periarticular proximal Tibial fractures. All displaced tibial plateau fractures with posteromedial fragment were included in the study. Pathological fractures and all open fractures were excluded from this study. ---Continue

Background and Aim: The curve of Spee (COS) is a physiological entity in human dentition. A functional masticatory system necessitates an appropriate occlusal curvature. The primary objective of this investigation was to assess the skeletal and dental parameters in individuals with variation in the depth of curve of Spee. Materials and Methods: A total of 276 patients with pre-treatment lateral cephalograms and dental cast models were investigated in the Orthodontics and Dentofacial Orthopedics Unit of a Tertiary Care Hospital of Mardan, Pakistan from January 2021 to December 2022. Patients with no prior history of orthopedic treatment for functional jaw, prosthodontic treatment, no prior history of cleft lip and palate and cranio-facial disorders were enrolled. Ethical approval was obtained and all the patients were categorized into three groups based on the depth of curve of Spee (COS): Group-I (flat curvature < 2 mm), Group-II (normal curvature 2-3 mm), and Group-III (deep curvature > 3 mm). Lateral cephalometric analysiswas done to measure the four angular and four linear parameters. Molar relation, overbite, COS depth, and overjet were measured based on the occlusal classification. SPSS version 27 was used for data analysis.

There is severe competition among educational institutions in Pakistan's public and private sectors as a result of the country's more dynamic educational environment. Using a descriptive methodology, we investigated the function of situational leaders and examined how the situational leadership style is relevant in Pakistan. We have concluded that educators place a high value on situational leadership because it allows the leader to adjust to the demands of the situation or environment. Situational leaders work and apply strategies in line with the demands of the situation, and they also help create new strategies that are appropriate for the circumstance. However, the most important element of the situational leadership approach is the capacity to adjust and be flexible in a particular scenario. Leadership in a given situation ought to be more able to adapt to both internal and external environmental variables. A leader must establish this equilibrium skillfully and successfully. A leader's ability to adjust to the current situation or scenario and meet the requirements of the team or the situation, rather than their skills, is the basis of this situational leadership style. These situational leaders need to be very adaptable.

Introduction: Diabetics lack potassium and magnesium. (Mg). Hypokalemia and hypomagnesemia cause vasoconstriction and glucose breakdown, so all hypomagnesemia diabetics should take K and Mg daily to prevent diabetic arterial disease. Methodology: 80 types 1 diabetes (T1-DM) patients were analyzed for parameters like K, Mg, Serum, Lipids, and HBA1c. After giving 1.7mg/dL blood Mg patients, 300mg Mg oxide daily for 3 months, the parameters were re-examined. 40 insulin-dependent diabetic men and women averaged 16.79 ± 4.00 years, Mg 2.94.38/dL. 30.3% had hypomagnesemia. Blood magnesium levels are inversely associated with age, diabetes length (P value 0.002) and other parameters and are favourably correlated with mean corpuscular volume, HDL, and platelet counts. Mg supplementation substantially lowered HBA1c. HBA1c started at 09.22%1.98%. Oral K and Mg tablets for three months lower it to 6.77%1.53%. (P0.003). it also lowered LDL, blood lipids, and total cholesterol in hypomagnesemia diabetics. Conclusion: Oral Mg intake in T1-DM patients improves glucose control, atherogenic lipid proportion, and therapeutic lipid component.

During the time of Hazrat Abu Bakr and Hazrat Umar Farooq, the Islamic accounting system had a considerable impact on society. This system is founded on the values of transparency, responsibility, and moral behaviour, which support justice, fairness, and social welfare. In the era of Hazrat Abu Bakr and Hazrat Umar Farooq, the Islamic accounting system was crucial in preserving the social order's economic stability.The system made sure that financial transactions were carried out accurately, honestly, and reliably, which contributed to a rise in public confidence. As a result, a society that was richer and more stable allowed both businesses and people to prosper. The Islamic accounting system's emphasis on responsibility was one of its most notable effects. The Islamic accounting system's emphasis on social welfare had a significant impact as well. This made society more just and egalitarian as everyone had access to basic needs. To sum up, the Islamic accounting system has had a significant influence on society, especially during the time of Hazrat Abu Bakr and Hazrat Umar Farooq.

This study aims to extend the literature on workplace bullying and its impact on knowledge hiding directly and through the mediation of emotional exhaustion and psychological empowerment as a moderator after collecting data from 600 nursing staff working in public and private hospitals in Pakistan. The results revealed the negative impact of workplace bullying (WB) on knowledge sharing directly and partially with the mediation of emotional exhaustion (EE). However, the impact is reduced through the moderating effect of psychological empowerment (PE). The finding of our study has several implications for healthcare institutions or academic leaders and policymakers of organizations.

Purpose This paper aims to examine the effects of perceived desirability for entrepreneurship (PDE) and perceived self-efficacy (PSE) on the entrepreneurial intentions (EI) of business students, with the moderation effect of entrepreneurial knowledge (EK) in the context of the theory of planned behaviour. Design/methodology/approach We used a self-administered survey of 200 students registered in the business schools of Pakistani universities. The causal association between the variables was estimated through SmartPLS by using hierarchal linear modelling. Findings The study findings indicate that PDE and PSE significantly influence EIs. Furthermore, EK significantly strengthens the nexus between PDE and EIs and between PSE and EIs. Those students who had already acquired self-efficacy and exhibited desirability for the business venture were more inclined towards entrepreneurship if they had acquired some EK and vice versa. Research limitations/implications This study reveals that a model of EIs is needed to configure the students’ goals and motivations. Also, using new education programmes will help students acquire new knowledge for business startups. Further implications are also discussed. Originality/value This research fills a gap by using the moderating role of EK on the nexus between PDE, PSE and EIs, which has remained untouched in the educational sector.

Background: Dengue fever is becoming endemic in Pakistan as shown by its increasing prevalence in the summer seasons for almost the last decade. Elevation of liver enzymes indicating underlying liver damage, is a common phenomenon and may be associated with other complications. Objective: To find out the frequency of hepatocellular damage in the patients presenting with dengue fever as evident by elevated liver enzymes.Material and Methods: This was a descriptive study performed in the medical unit of Hayatabad Medical Complex Peshawar Pakistan. Patients were consecutively collected from the wards, outpatients, and emergency department. The patient's collection was from the year 2022 epidemic from 10th Jul to 23rd Oct. Patients with consistent clinical features, were diagnosed on the bases of dengue NS1 test and antibodies titers. Liver enzymes, complete blood counts and ultrasound were performed to find out any evidence of liver damage and plasma leaks as evident by pleural effusion or ascites. Alanine aminotransferase (ALT) of more than 50 U/L was considered as elevated in our study. Patients with elevated liver enzymes due to expected reasons other than dengue fever as per clinical records, were excluded from the study. The patient's data was noted on a preformed Performa for further analysis. Results: We consecutively collected 500 patients for the study. The number of male patients was 59% (n=295) while female patients were 41% (n=205). The age range was 15 to 75 years (mean 45, SD 21.32). The overall frequency of elevated (ALT) was 68.2% (n=341). Stratification of patients according to the ALT level shows that only 13.68% were having an ALT level of more than 300 U/L. The frequency was 45.45% in patients without complications, 91.60% in patients with warning signs, 85.71% in severe dengue and 100% with acute liver failure. Patients with an alanine aminotransferase (ALT) of =>300U/L were having a hospital stay of 5 to 12 days (mean 8.81, SD 2.6) days verses 4 to 9 days (mean 5.8, SD 1.9) in the patients having

The section of mammalian metabolism known as ketogenesis is responsible for creating ketone bodies. In this mechanism, the liver responds to decreased glucose availability by producing the tiny, water-soluble molecules acetoacetate, D-3-hydroxybutyrate, and propanone. While ketone bodies are always present in small amounts in healthy people, dietary changes and some pathological circumstances can raise the concentrations of these substances in living organisms. The systemic effects of ketogenic diet (KD), despite its recent widespread usage, are poorly known and can range from potentially dangerous results to medically advantageous outcomes depending on the situation. Here, we discuss the metabolism and molecular signaling of ketone bodies before relating the biology of ketone bodies to debates about their potential or actual health benefits. According to the findings of this research, a KD can be used as a natural treatment for weight loss in fat individuals. This is a one-of-a-kind research that will follow the effects of a KD for 24 weeks. The patients' lipid, total cholesterol, LDL cholesterol, and glucose levels all decreased significantly, while their HDL cholesterol levels increased significantly. The adverse effects of medications widely used for weight loss in such individuals were not noted in patients on the KD.

We tested job characteristics model (JCM) of Hackman & Oldham (1976) in predicting the organizational citizenship behavior of healthcare sector employees in Pakistan. A cross-sectional design was employed by collected data from the 183 healthcare employees working at three tertiary healthcare centers in twin cities of Rawalpindi and Islamabad. The results of study reported that all the five job characteristics of JCM of Hackman & Oldham (1976) predicted organizational citizenship behavior of healthcare sector employees in Pakistan. The study also presents implications for the theory and practice along with directions for future research. The results of the study could be generalized in other field since data is collected from the health sector however, it is suggested that the study could be replicated with a relatively larger sample size to obtain a larger picture of the relationship between employees; job characteristics and citizenship behavior in Pakistan healthcare institutions.

Background: Hypoadiponectinemia and raised total leukocyte count have been associated with coronary artery disease. The aim of this study was to investigate association of serum adiponectin levels with total leukocyte count in patients of coronary artery disease belonging to Khyber Pakhtunkhwa. Methods: This cross-sectional/analytical study consisted of two groups. Group A contained 100 patients of coronary artery disease while group B contained 100 healthy controls. Consent of the study subjects was obtained, their history was recorded and fasting blood samples were analyzed for serum adiponectin level, total leukocyte count (TLC), serum lipid profile which included serum total cholesterol (T-C), triglyceride level (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Adiponectin level was determined with ELIZA method, TLC was estimated on automated hematology analyzer and lipid profile was determined using enzymatic colorimetric method. SPSS version 21 was used to analyze the data. Results: Subjects with coronary artery disease when compared to healthy subjects showed significantly high level of total leukocyte count (9.26±1.488 vs. 6.37±4.052) and low level of serum adiponectin (4.3±0.80 vs. 9.6±3.69). Moreover, serum lipid profile showed low HDL-C (30.04±9.1 vs. 43.64±7.3) and raised triglyceride (220.1±67.7 vs. 181.86±41.4), total cholesterol (229.3±37.01 vs. 189.4±32.7), and LDL-C (153.78±38.53 vs. 109.16±33.91) levels. Significant negative association of adiponectin with TLC (r -0.826 with p

Objective: To document the frequency of agenesis, position, class and angulation of impacted mandibular third molar teeth in patients aged range between 21-25 years visiting Khyber College of Dentistry using Pell and Gregory and Winter’s classification system. Study Design: Descriptive Cross-Sectional study. Setting: Department of Maxillofacial Surgery and Orthodontics in Khyber College of Dentistry. Period: March to September, 2020. Material & Methods: A total number 390 patients having impacted mandibular third molar were selected using non-probability consecutive sampling technique. All impacted mandibular third molar teeth on panoramic radiographs were reviewed by a single examiner using X-ray viewer to determine agenesis, position, class and angulation of impaction. Results: The mean age of the study participants was 22.89 SD ± 1.41 years and majority of the patients were males (n= 203, 52.1%) and were from the age group 23 years (n= 114, 29.2%). Overall, majority of the impacted third molars both right and left side were Position C (57.5%) followed by Position A (30.75%) and Position B (11.7%).Agenesis were identified in 5.7% of the total sample assessed. Impaction patterns of the third molar was higher among males (52%) compared to females (48%). Most common angulation pattern on both arches was Mesioangular (46.4%) and least common was buccolingual (4.6%). A highly statistical significant difference was identified with chi-square test when angulation pattern was compared with gender. (P < 0.01). Conclusion: In conclusion, this research provides useful data regarding the different pattern of third molars impaction. The most common pattern of impaction on both arches was Position C and Class 3. Mesioangular angulation was identified in maximum number of patients. The results of the current study will help the maxillofacial surgeons in the safe removal of the impacted mandibular third molar specially in the healthcare settings where the resources are limited.

Objectives: To study the spectrum of chronic hepatitis in haemodialysis patients. Study Design: Cross Sectional study. Setting: Kutiyanana Memon Hospital (KMH), A Tertiary Care, Charity Hospital at Karachi, Pakistan. Period: Jun 2015 to May 2020. Material & Methods: During the study period, 87 patients were followed up on and tested for hepatitis B and C virus infection. The patients were included in the study after calculation of sample size and application of inclusion and exclusion criteria. AxSYM, an enzyme-linked immunosorbent assay (ELISA)-based fast immunochromatographic technology, was used to screen the samples (Abbott Laboratories, Abbot Park, IL, USA). Hepatitis B and C prevalence was established, as well as the frequency of different sequelae such cirrhosis, encephalopathy, and hepatocellular cancer. Results: Our sample population was almost evenly split between males and females, with 44 (51%) males and 43 (59%) females. Three of the 43 females tested positive for HBV, whereas 19 (63 %) tested positive for HCV. On the other hand, in males, 11 (37 %) had chronic HCV and 9 (75 %) had Chronic HBV infection, accounting for 34% of the total HBV population. Conclusion: In haemodialysis patients, hepatitis B and C are very common. They are adding to morbidity and mortality of already suffering community. This trend is surrogate marker of suboptimal infection control techniques during dialysis in underdeveloped countries like Pakistan. To protect an already afflicted community from a potentially preventable disease, immediate measures are required for prevention and early diagnosis of chronic hepatitis.

Objective: to know the connection between Sodium intake/urinary Sodium excretion and the tendency to develop hypertension during pregnancy. Study design: Prospective longitudinal study. Place and Duration of Study: Combined Military Hospital Kharian, District Gujrat Pakistan from Jul 2019 to Dec 2020. Methodology: The included population was divided into two equal Groups (Normotensive and hypertensive). Blood pressure was measured at a pre-determined interval starting from the initial prenatal visit before 18 weeks of pregnancy to the 36th week of gestation. Urinary Sodium secretion was determined in 24-hours urine accumulated at three stages between 18 and 36 weeks of gestation. The main outcome actions were the implication of the difference in mean between urinary Sodium and alterations in maternal BP. Results: The mean age of our study population was 32 years ± 6.96 years, and it ranged from 31 to 48 years. The mean urinary sodium was 141.00 ± 24.879, 140.00 ± 29.73 and 139.00±15.17 mEq/day in the normotensive group, which was 142.00 ± 21.90, 143.00 ± 32.03 and 139.00 ± 14.27 mEq/dl in the hypertensive group. In the hypertensive group, systolic Blood pressure was also high with mean systolic BP of 143.00±12.10, 141.00±12.47 and 148.00±16.82 respectively during the three trimesters. As expected, it was normal in the second group. Conclusion: There was no significant association between sodium intake and pregnancy-induced hypertension.

Objective: To determine the exact magnitude of the problem in our setup which will help to develop consensus guidelines with the contribution from various specialists especially obstetric medical specialist. Study Design: Prospective Observational study. Setting: It was conducted on 2448 patients who were ill due to various medical conditions during pregnancy and admitted to PNS Shifa and CMH Kharian. Period: 1st Jun 2019 till 31st May 2021. Material & Methods: Data was collected from the patients in the wards and delivery room and analysed using SPSSV28. Descriptive statistics were applied and means, and frequencies were calculated for different variables. Results: The total number of antenatal admissions was 8775, in which 2488 (28%) were patients. The mean age of our study population was 28 S.D (+ 4.78) years while the mean parity was 4 (S.D + 1.407). Hypertensive disorders were the most common medical disorder followed by haematological and liver disorders. Endocrine disorders were found in 372 (15%) of the study population. A total of 864 (38%) patients in the total study population had haematological abnormalities. Among these, anaemia was the most common haematological abnormality. Regarding respiratory disorders COVID-19 336(14%) was the most common respiratory medical disorder during pregnancy. Conclusions: All medical conditions in pregnancy are common and require a multidisciplinary approach which should be managed by a team involving Obstetric medical specialist.

Background: The SARS-COV-2's spread from continent to the continent has resulted in an increased number of mutations in the viral gene encoding proteins. As a result, mutations in target proteins provide a significant challenge in creating antiviral drugs and vaccines. The present review discussed the COVID-19 epidemiology and the effects of drugs being tested against COVID-19/SARS-COV-2. Dosage of these drugs along with associated challenges was also discussed. Methodology: Systematic review was conducted after a thorough search in the "PubMed, NIH, Elsevier, Scopus, Web of Science, Science Direct, and Google Scholar database. 45 studies on drugs associated with COVID-19 fulfilled the inclusion criteria and were selected for this review. Results: The FDA only accepted the Remdesivir drug against SARS-COV-2, as the hospitalized patients recovered very quickly by taking it. Antiviral EIDD-2801 has been found to make the SARS-COV-2 unable to infect cells by causing genetic modifications in the virus RNA. Similarly, Nitazoxanide appeared beneficial against SARS-COV-2 in a primary intervention and severe conditions (including pregnancy) without undesirable effects on the newborns. Children with mild cases can be handled solely by proper caring. Conclusion: Although Remdesivir and Dexamethasone are recommended in severe cases, clinical trials are ongoing to investigate other possible therapies like MAb and Convalescent Plasma antibodies for COVID-19. Older drugs (usually used to treat other conditions) are also under-tested by researchers to see if they are effective for COVID-19. Further tests are essential to validate whether any of the mentioned above possible therapies would be helpful for COVID-19 treatment.

Objective: To find the association of Child-Pugh’s Class with oesophagal varices and portal hypertensive gastropathy in cirrhotic patients at CMH Lahore. Study Design: Cross sectional study Place and Duration of Study: Department of Gastroenterology and Department of Pathology, Combined Military Hospital Lahore Pakistan, from Feb to May 2021. Methodology: All patients with cirrhosis of the liver, irrespective of aetiology, who underwent upper gastrointestinal endoscopy, were included in the study. Lab data was retrieved from the Pathology Department to calculate Child Pugh’s score. Endoscopic findings of oesophagal varices and portal gastropathy were recorded and their correlation/association with Child-Pugh’s Class was calculated separately by using Pearson’s coefficient. Results: A total of 148 patients were included in the study. Male patients were 90(60.8%) and female were 58(39.2%). The age range was 27-85 years, with the mean of patients being 55.93±13.19 years. Association of Child Pugh’s Class with oesophagal varices and portal hypertensive gastropathy revealed that higher grades of oesophagal varices (Grade-lll) and severe portal hypertensive gastropathy were found in Child Pugh’s Class-B (13.51%, 14.18%) and C (15.54%, 16.2%) as compared to Class- A (4.72 %, 1.35%). Child-Pugh’s Class positively correlates with both oesophagal varices and portal hypertensive gastropathy by Pearson’s coefficient r=0.594 and 0.035, respectively; both have significant p values (p

Objective: To determine if a goal-directed ECG workshop improves ECG interpretation competency and confidence among the house officers in PNS Shifa Hospital. Study Design: Prospective comparative study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan to Dec 2021. Methodology: ECG workshops were conducted for House Officers in batches. The participants were asked to complete a questionnaire testing their ECG interpretation competency before and after the workshop and self-report their confidence level in ECG interpretation. Results: Sixty-eight house officers participated in the workshops and completed the test. There were 41(60.29%) female and 27(39.7%) male participants. The statistics showed significant improvement in ECG competency (p

Objective: To determine gender-based morphological variations in malleus. Method: The cross-sectional descriptive study was conducted at the Ear-Nose-Throat and Radiology departments of a public-sector hospital in Karachi, from January 20 to July 23, 2021, and comprised subjects of either gender aged 10-51 years who had intact ear ossicles. They were divided into equal male and female groups. After history and a thorough examination of the ear, high-resolution computed tomography scan of petrous temporal bone was done. The images were studied for malleus, to measure the parameters of its head width, length and shape of manubrium, and total length of malleus for possible morphological variations along gender lines. Data was analysed using SPSS 23. Results: Of the 50 subjects, 25(50%) were males with mean width of the head 3.04±0.34mm, mean length of manubrium 4.47±0.48mm, and mean total length of malleus 7.76±0.60mm. The corresponding values in 25(50%) females were 3.00±0.28mm, 4.31±0.45mm and 7.41±0.51mm. The total length of malleus between both genders was significantly different (p= 0.031). The shape of manubrium was straight in 10(40%) males and 8(32%) females, and curved in 15(60%) males and 17(68%) females. Conclusion: Width of head, length of manubrium and total length of malleus were different in gender terms, but the total length of malleus was significantly different. Key Words: Ear, Malleus, Computed tomography.

Background: Peripheral artery disease (PAD) is highly prevalent in patients with diabetes mellitus. The ankle-brachial index (ABI) measurement is used to diagnose peripheral arterial disease, and little is known about its prevalence in asymptomatic type 2 Diabetic patients. This study aimed to determine the prevalence of subclinical peripheral artery disease in patients with type II diabetes mellitus. Methodology: It was a descriptive study conducted at the Peshawar Institute of Medical Sciences, from Feb 2022 to Aug 2022. Two hundred sixty-four patients with type II diabetes (for more than three years) with no clinical features of peripheral arterial disease were assessed by measuring ankle brachial pressure index for subclinical peripheral arterial disease. Reading less than 0.9 was positive for peripheral artery disease in the lower limbs. Results: Peripheral Arterial Disease was present in 115 (43.6%) patients and absent in 149 (56.4%) patients. The peripheral artery disease was significantly more in males, those with age greater than 55 years, smokers, and hypertensive patients (p-value ≤ 0.05) but was not associated with the duration of diabetes or BMI of the patient (p-value > 0.05) Conclusion: There was a high prevalence of asymptomatic peripheral artery disease in Type 2 Diabetic patients using ankle-brachial pressure index measurement. Those with ages greater than 55 years, smokers, hypertensive, and males were particularly at higher risk.

Objective: To determine the frequency of malnutrition among T2DM patients in tertiary care. Place and Duration of Study: Departments of Medicine Hayatabad medical complex peshawar Pakistan from jan 2020 to July 2021. Methodology: this Multi-center study conducted in department of medicine hmc hospital Peshawar from jan 2020 to July 2021. total of 130 T2DM patients were assessed for nutritional evaluation with the assistance of a nurse and supporting staff. With the use of a questionnaire and a Subjective Global Assessment form, the data was collected (SGA). With the aid of MS Excel and SPSS, the nutritional risk factors and malnutrition status were determined, and the data was statistically examined. Results: The results of our recent study showed that, of the 130 patients, 62 48% were at intermediate risk of malnutrition and 68/52% were at high risk. Similar to this, 48 individuals had severe malnutrition, while 80 patients were classified as having moderate malnutrition. Obese Class-I, with the greatest risk of malnutrition and the highest frequency of severe malnutrition, has been proven to have the highest incidence among the different BMI categories. 0.920 is the correlation coefficient R2.

Objective: Diabetic foot ulcers and anemia are two typical complications of diabetes. For this reason, we set out to gather data on the prevalence of anemia in persons with and without diabetic foot ulcers (DFUs) of similar ages and sex. Method: The Department of Medicine HMC hospital Peshawar conducted this multi-center study from October 2020 to October 2021 in their interdisciplinary diabetic foot clinic. Those who took part in the study were split into two groups: those with DFUs (the Case group) and those without (the Control group) (people without DFUs). Biochemical and hematological markers, as well as demographic data, were collected from the outset. DFU in the case group was categorized and staged using the UT system. Anemic subjects with other obvious explanations were not included. Controls were recruited from a diabetes clinic that offered presentations during the same time frame. SPSS version 24 was used for the statistical analysis of the data. Results: A total of 80 people were studied, split evenly between the case and control groups regarding age and gender. Men made up the majority of the 60 participants (74%).

Introduction: Persistent hyperglycemia and anomalies in the metabolism of proteins, lipids, and carbohydrates are hallmarks of diabetes mellitus, which is brought on by insufficient insulin synthesis or action. Other associated systemic problems, such dyslipidemia and hypertension, may result from this. Dyslipidemia increases cardiovascular events such persistent high blood pressure by raising serum triglycerides, free fatty acids, and HDL cholesterol and lowering it. This research examined hyperlipidemia. Type 2 diabetics, regardless of hypertension. Objective: to compare T2DM with and without hypertension, the present study evaluated the blood lipid profiles of both groups. Layout of the study An experimental research approach is used, along with a comparative study methodology. Methodology: the multi-center study conducted in department of medicine HMC hospital Peshawar OPDs and Out Door Patients hosted the research. From January 2021 to January 2022, performed lab tests. The Multi center study achieved our aim. The study comprised 100 type 2 diabetics divided into cases and controls. Cases had type 02 diabetes and hypertension, but controls did not. Both groups estimated cholesterol, triglycerides, LDL, and HDL levels. The statistical analysis uses SPSS version 28. Mean values and an independent student T-test were used to compare groups.

Brain tumours are quickly increasing in prevalence all over the world. It causes the deaths of thousands of individuals annually. Misdiagnosis of brain tumours often results in unnecessary treatment, further lowering the survival rate of the affected individuals. Prompt medical diagnosis is crucial to improve the prognosis for patients with brain tumours. Positive advancements in deep and machine learning domains have been made due to repeated achievements in supporting medical practitioners in making correct diagnoses utilizing computer-aided diagnostic tools. Deep convolutional layers are superior to conventional methods at extracting unique characteristics from target regions. In this research, initially, Gabor filter and ResNet50 were applied to accurately extract the important features of brain tumours from the MRI images dataset. Firstly, the extracted features of Gabor and ResNet50 were classified individually through SVM, and secondly, the features from both these techniques were combined and then classified through SVM. The Kaggle MRI dataset for a brain tumour was utilized in this research. It includes 7,023 Images and four classes Glioma, Meningioma, No-Tumor, and Pituitary. The results from every system were outstanding, but the best results were shown by the combined features of Gabor and ResNet50, an advanced hybrid approach with 95.73% accuracy, 95.90% precision, and 95.72% f1 score.

This research presents a low-cost, real-time, reliable, and scalable solution for Structural Health Monitoring.(SHM) using an IoT-based multi-node system. The study's objective is to detect and identify damages timely andweaknesses in civil structures such as bridges, buildings, and dams, which environmental factors, overuse, or natural phenomena may cause. Each sensor node, fabricated using NodeMCU, is equipped with sensors for measuring vibration, shock, tilt, strain, humidity, and temperature. The data collected by multiple sensor nodes is transmitted to Amazon Web Services (AWS) cloud platform via Wi-Fi and analyzed for damage detection and predictive maintenance. The field testing on a pedestrian steel bridge showed over 99% success in data transmission with a frequency of 1 second per reading, resulting in 18,000 readings over 5 hours. With a fabrication cost of $40 per sensor node and scalable AWS resources, the proposed solution is highly scalable and can operate for 15 days without human intervention.

Intelligent transportation systems (ITS) have emerged as the optimal solution to address urban mobility challenges. However, to effectively implement ITS, detailed traffic flow statistics are imperative. Various solutions have been proposed, including intrusive/non-intrusive sensors and compute vision-based solutions. However, these solutions have limitations in the number of measured traffic flow parameters, cost or performance under different traffic conditions. To overcome these limitations, we propose an Internet-of-Video-Things (IoVT) based solution. The sensor node (fabricated using Raspberry Pi Zero W, Pi camera, power bank, and Wi-Fi device) can live-streaming roadside traffic video to a remote Dell server located at our lab with Camlytics (commercially available traffic analysis software) installed. The proposed solution was field tested with a 45-minute live-streamed video of 720p at 25 frames per second. Results show that the proposed solution can measure more traffic flow parameters than intrusive and non-intrusive sensors, with an accuracy of 84.3% for vehicle count and speed estimation. Other parameters were also calculated, such as time/distance headway, spatial/temporal densities, heat maps, and trajectories. Additionally, the proposed solution can count pedestrians with an accuracy of 76.3%.

The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe.This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European BoardCollege of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms.Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract."Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.

Background: Stroke or cerebrovascular accident is the most common cause for disability and third leading cause of mortality worldwide. Stroke not only accounts for leading reason for mortality and morbidity, but also puts a great economic burden on the family as well as on society. Aim: To determine the relationship between blood calcium levels and the severity of patients with acute ischemic stroke presented to the medical department HMC Peshawar. Methodology: From July 2019 to January 2020, the Department of Medicine at the Hayatabad Medical Complex in Peshawar carried out this descriptive (cross-sectional) study. 137 patients fulfilling the inclusion criteria were selected for this study. Appropriate history regarding presenting neurological deficit, occupational and socioeconomic history were taken to dig out the confounding factors. After taking history, appropriate physical examination was performed study the relationship between blood calcium levels and the severity of acute ischemic stroke Results: Out of 137 patients, 71 were males and 66 females with age range of 35-80 years (Mean 56.42 years + 12.44SD). Pearson correlation coefficient shows that severity of stroke and serum calcium have negative correlation of -0.236. Majority of patients in our research sample had ischemic strokes, as evidenced by NIHSS scores of greater than 20, followed by scores of 6–10 individuals. To support the treatment recommendation of hypercalcemia in patient who presented with electrolyte imbalance should be treated early on time to prevent stroke and its severity. Conclusion: Smoking habits of the trial participants were evenly distributed amongst the intervention groups, and they had no impact on the outcome of patients with acute ischemic stroke. Patients with ischemic stroke consistently had lower blood calcium levels than non-diabetic patients with diabetes mellitus. In order to support the treatment advice for hypercalcemia, patients who first presented with electrolyte imbalance should receive therapy as soon as possible in order to reduce the risk of stroke and its severity. Keywords: Ischemic stroke, serum calcium, hypertension, diabetes mellitus.