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Objective: To compare Goldmann applanation tonometer, air puff tonometer, and tonopen measured IOP Readings in vitrectomized eyes filled with temponading oils and gasses. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi Pakistan, from Aug 2021 to Feb 2022. Methodology: A total of 50 eyes were included in our study. Intraocular pressure was measured by an experienced ophthalmologist between 10am to 4pm on the 7th postoperative day by three devices, Goldmann applanation tonometer (GAT), air puff tonometer, and tonopen. Pearson's correlation and paired samples t-test was applied to determine correlation and any significant difference between the mean of intraocular pressure measured by three different devices. Results: Out of the 50 people included in study 31(62%) were males and 19(38%) were females. The mean age of study participants was 50.10±11.61 years. Mean intraocular (IOP) pressure measured by the GAT applanation tonometer was 14.59±1.13 mmHg. Mean IOP as calculated by the airpuff tonometer was 15.93±1.88 mmHg, whereas mean IOP as calculated by tonopen was 15.85±1.86 mmHg. All three instrument values showed significant difference as p-value < 0.001. Conclusions: The air puff tonometer overestimates IOP as compared to GAT. Tonopen and air puff tonometer produce IOP measurements that are similar and consistent to each other but not to GAT. [ABSTRACT FROM AUTHOR]

Objective: To determine the agreement between subjective and objective parameters using meibography. Study Design: Cross-sectional observational study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi Pakistan from August 2021 till February 2022. Methodology: 100 patients were included in the study. Non-contact infra-red meibography was performed on each patient. Subjective assessment was done using the four-grade and five-grade scales while objective assessment was done by applying computerized grading. Results: A total of one hundred (n=100) patients participated in the study. Out of total, 60% patients were male and 40% were females, with a mean age 42.25±14.9 years. There was statistically significant difference was seen Session I OII vs Session II OII as p-value <0.001 in Grade-4, Session-I OIII vs Session-II OIII as p-value <0.001 in Grade-5. There was not statistically significant difference seen in Computerized Grading (100-grade scale) as p-value >0.05. Correlations between observers was best with the 5-grade scale followed by the computerized 100-grade scale and 4-grade scale. Conclusions: We found that the reliability of the 5-grade scale was poorer to that of the 4-grade scales. We also concluded that computerized grading offers a better intra and inter-observer assessment. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of successful excision of pterygium on corneal astigmatism and topography. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Feb 2021 to Jul 2021. Methodology: All 52 patients of pterygium who underwent surgical excision of the pterygium during the study period were included. The size of pterygium was measured in millimeters. Pre-operative automated keratometry and corneal topography was done, and changes in astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity were measured postoperatively on the 7th day. Paired sample t-test was applied between pre- and post-operative astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity. Results: The mean age of participants was 42.02±13.3 years, with 22(42.3%) females and 30(57.7%) males. The male to female ratio is 1.36:1. The highest frequency of cases was noted in the age group, 31-50 years (42%), followed by 18-20 years (21%). Pterygium size was 2.25 to 4.10 mm, with a mean of 3.16±0.54mm. Pain and photophobia were noted in 5 cases. Pre- and postoperative comparison of astigmatism and corneal topography revealed a significant reduction in Surface Asymmetry Index and Surface Regularity Index values (p-value<0.001). Uncorrected Visual Acuity (p=0.002) and Best Corrected Visual Acuity also improved significantly after surgery (p=0.006). Conclusions: This study concluded that pterygium excision brings a significant decrease in astigmatism and reversible corneal topography changes. [ABSTRACT FROM AUTHOR]

Objective: To compare the analgesic efficacy of Local Anaesthetic infiltration with Bupivacaine at Trocar site in Laporoscopic Cholecystectomy when injected preoperatively vs postoperatively. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General surgery, Combined Military Hospital, Rawalpindi Pakistan, from May to Nov, 2016. Patients and Methodology: Patients meeting the inclusion criteria were randomly divided into two groups using coin method. Group A received pre-operative injection of Bupivacaine infiltrated at the trocar sites. Patients in Group B received the similar dosage post-operatively. The pain of the patients was assessed post-operatively using Visual Analog Score (VAS) at 6, 12 and 24 hours and compared. Results: A total of 190 patients were equally divided into Group A and B (95 each). The mean age was 46±13.77 years in Group A and 43±14.80 years in Group B.23.68% (n=45) of patients were aged between 12-24 years, 13.15% (n=25) were of 25-36 years, 22.63% (n=43) were aged 37-48 years and 40.52% (n=77) of the patients were between the age of 49-60 years. 75.78% (n=144) of patients were males, while 24.21% (n=46) were females. The Mean±SD VAS post-operative pain scoring Group A and Group B was 4.5±0.04 vs 5.0± 0.40, respectively. The p-value was <0.001and the difference is statically significant. Conclusion: We concluded that the use of pre-operative local anesthesia helps reduce post-operative pain in patients undergoing laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of type 2 diabetes mellitus on plasma N-terminal prohormone B-type natriuretic peptide levels in patients with heart failure and correlate it with glycosylated haemoglobin levels. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology in collaboration with the Department of Cardiology, Combined Military Hospital, Multan Pakistan, from Feb to Sep 2021. Methodology: We assayed plasma NT-pro BNP levels in 194 individuals with established heart failure, (98 non-diabetics, and 96 patients with diabetes). Plasma NT-pro BNP levels were compared between groups in addition, the correlation of glycosylated haemoglobin with plasma NT-pro BNP levels was explored. Results: The mean plasma NT-pro BNP values were higher in patients with diabetes (15826.08 ± 8143.434pg/mL) than in non-diabetics (12534.06±6323.92pg/mL) with a p-value 0.02. When NT-pro BNP was compared there was no significant found difference between the non-diabetic group and the Controlled Diabetes-Group (p-value 0 .882), but it was significantly higher in the Uncontrolled Diabetes-Group (p-value<0.001). A moderate positive association was found between NT-pro BNP and glycosylated haemoglobin (r=0.541, p-value<0.001). Conclusion: Although obesity has an inverse relation with plasma natriuretic peptides level and most patients with diabetes are overweight, the plasma NT-pro BNP is still a very informative tool and holds its significance as a diagnostic and prognosis marker in diabetic patients with heart failure. [ABSTRACT FROM AUTHOR]

Phytophthora infestans is a destructive pathogen in the tropical and the sub-tropical areas of the world. Identification of pathogens is very important to find successful disease control strategies. Here, we isolated and identified P. infestans, as well as, determined the morphological characteristics, on different media. The phenotypic characteristic of the isolates were observed as fluffy cottony growth with striated pattern. The average length of sporangia among the isolates collected during 2017 from potato growing areas of Punjab ranged from 14.94 to 47.89 µm, and mean breadth of sporangia varied from 10.44 0 to 23.67 µm. During 2018, among all districts, isolate Jhg-22 showed the highest length (46.64 µm) and breadth (22.17 µm) followed by Shl-25 (46.59 µm) and breadth (22.61 µm), Oka-24 (46.31 x 21.72 µm) while the lowest value measured by Cht-14 (16.05 x 13.39 µm). The best growth and sporulation of P. infestans revealed on Rye agar media compared with other media, while the minimus growth was observed on carrot agar media across most isolates. Therefore, the determination of morphological characteristics for plant-pathogen may add knowledge of the taxonomic behavior of pathogen. The usage of various growth media is providing a useful pattern of the growth that can be utilized in determining the best possible control of late blight disease. [ABSTRACT FROM AUTHOR]

Tristeza disease is caused by citrus tristeza virus (CTV) expresses salient symptoms like stem pitting, yellowing of leaves, stunted growth of large, small lateral branches and twigs. The study was carried out to quantify the spatial and temporal distribution of CTV disease in major citrus growing areas of Sargodha district (Sargodha, Kot Momin, and Bhalwal). The samples from the declined orchards were collected based on symptomology and confirmed through ELISA. CTV was detected in 3 varieties viz., Kinnow (Citrus reticulate), Mosambi (Citrus sinensis) and Feutrell's early (Citrus reticulate cv feutrell's early). The maximum disease incidence was recorded in Mosambi (90%), followed by Feutral's early (74%) and Kinnow (57%). Mosambi was the most susceptible within the range of OD values (0.82-2.35) followed by Feutrell's early (0.45-0.64) and Kinnow (0.25-0.56). The disease severity was recorded only on Mosambi as it was more affected than Feutral's early and Kinnow. The rating scale to observe the severity of tristeza disease was based on percentage of pits in the 1 sq. inch piece of bark at bud union of infected tree. This rating scale has been developed for the first time to record the tristeza disease severity. The maximum disease severity was recorded in Kot Momin (62%) followed by Bhalwal (56%) and Sargodha (50%). The study concluded that CTV is one of the most promising factors playing role in the citrus decline. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiological pattern, clinical presentation and outcome of patients with proptosis in a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Khyber Teaching Hospital, Peshawar Pakistan, from Jan 2019 to Jun 2020. Methodology: This study was conducted on 60 patients having proptosis. Patients were treated either medically, surgically or both. The demographic profile included age, gender and type of proptosis. The outcome included recovery, re-treatment, referral to the relevant speciality and loss to follow-up, were measured. Results: Out of 60 patients with proptosis, 39 were males, and 21 were female. Fifty-two patients had unilateral, and 8 had bilateral proptosis, with the majority suffering from non-axial proptosis. On aetiology exhibited tumours (45%), infectious (25%), inflammatory (16.6%), vascular (6.66%) and injury (6.66%). The surgical procedure was indicated in 27(45%) patients, while medical treatment was given in 28(46.6%) patients. Five patients (8.4%) received both surgical and medical treatment. Out of 60 patients, 26 patients (46.33%) fully recovered and 11 patients (18.33%) did not recover, 17(28.33%) patients were referred to other specialities for management, and 5(8.3%) patients lost to follow-up. Conclusion: In our study, tumours were the main cause of proptosis, followed by infective and inflammatory causes, with the paediatric age group (<18 years) at more risk. [ABSTRACT FROM AUTHOR]

Objective: To determine the role of Methylprednisolone in managing COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jan to Feb 2021. Methodology: This study was carried out at the Department of Medicine. Medical records of all moderate, severe and critical COVID-19 patients admitted and receiving Methylprednisolone were reviewed. Methylprednisolone was used in all patients at doses 0.-2 mg per kg. Results: A total of 200 cases were included. The most common presenting symptoms were cough (77.5%), fever (67.5%) and shortness of breath (63.5%). Most patients (85%) presented within the first week of their illness. One or more comorbidities were present in 75% of patients. Most common being hypertension in 70(35%) and diabetes mellitus in 63(31.5%). Complications seen in the study were Cytokine release storm 92(46%) and acute respiratory distress syndrome 44(22%). The median time for initiation of corticosteroid therapy was 4 hours (range 1-96 hours). Overall survival (OS) in the study was 83.5%. OS for patients with moderate, severe and critical diseases was 97.8%, 86.2% and 62%, respectively (p<0.001). Conclusion: Corticosteroids are useful in COVID-19-admitted patients and provide excellent survival outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic performance of bone scintigraphy and 18F-NaF-PET/CT in detection of bone metastasis in newly diagnosed high-grade prostate cancer patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology and Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul 2020 to Dec 2022. Methodology: Newly diagnosed high-grade prostate cancer patients with Gleason score ≥8 who underwent bone scintigraphy followed by 18F-NaF-PET/CT (Sodium Fluoride-Positron Emission Tomography/Computerized Tomography) for staging during study duration were included. We compared the diagnostic accuracy of both imaging modalities in detecting bone metastasis using two-point scale scoring system i.e., metastasis present or not present on per patient basis. Results: A total of 45 patients with mean age 69.66±9.38 years and mean Prostatic Surface Antigen level 36.21±65.07 ng/ml were included. 18F-NaF-PET/CT detected bone metastasis in all 25 patients with bone metastasis (100%) compared to 20(80%) by bone scan. 4 patients had false-positive bone scan while 2 had false-positive 18F-NaF-PET/CT scan. Overall 18F-NaF-PET/CT demonstrated a higher sensitivity, specificity, positive predictive value, negative predictive value and accuracy compared to bone scan (100% vs 80%, 90% vs 80%, 92.59% vs 83.33%, 100% vs 76.19%, 95.56% vs 80% respectively). Conclusion: 18F-NaF-PET/CT has better diagnostic performance than bone scintigraphy for the detection of bone metastasis in newly diagnosed high-grade prostate cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the success rate of probing and syringing for congenital nasolacrimal duct obstruction in children under local anaesthesia. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Niazi Medical Dental College, Sargodha Pakistan, from Jul 2018 to Dec 2019. Methodology: Forty-five children were included in the study, of which five had bilateral epiphora. Children of 8-12 months of age were included in this study. Probing and syringing were done under topical local anaesthesia. In this study, special modified straight 25D lacrimal probe cannula was used. Post-operative steroids and antibiotics were given to all the children for two weeks. Results: Forty Children (45 Eyes) of 8-12 months of age (less than one year) were included in this study. Single successful probing was achieved in 40 eyes (88.88%). Probing was repeated in five cases. Repeated successful probing was achieved in 3 eyes (60%) as the remaining two eyes (40%) where success was not achieved had a bone abnormality which needed an ENT examination and further intervention like Dacryocystorhinostomy (DCR) with close intubation. Conclusion: Topical local anaesthesia is a good alternative to general anaesthesia as it is not available, particularly in remote areas of Pakistan. It saves the children from the hazards of general anaesthesia and is a good choice for children who are not fit for general anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: To compare serum small dense low-density lipoprotein cholesterol levels in coronary heart disease (CHD) patients and healthy controls. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, in collaboration with AFIC Rawalpindi from Feb to Dec 2021. Methodology: A total of 220 participants were selected for the study, 120 healthy controls and 100 CHD patients. Fasting blood samples after 12 hours of fast were collected for lipid profile and small dense low-density lipoprotein cholesterol (sdLDL-C) levels. SdLDL-C levels were analyzed by automated, standardized enzymatic assay on Siemens Advia 1800 automated chemistry analyzer using Ex Denka Seiken kits. Results: Among the total participants, 154 (70%) were males, and 66(30%) were females. The median age of all participants was 55(IQR: 52 -56) years, while their median sdLDL-C was 0.93 (IQR: 0.56-1.08) mmol/L. Results showed that small, dense LDL cholesterol serum levels were significantly raised in CHD patients compared to healthy controls (p-value <0.05). Conclusion: The current study showed that patients with CHD had elevated small, dense LDL-C levels compared to the healthy control group. [ABSTRACT FROM AUTHOR]

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME). Study Design: Quasi-Experimental Study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018. Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) >300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient's best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months. Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 pm, 332.81 ± 144.69 pm after one month, 292.81±147.59pm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 pm, 364.52 ± 167.95 pm after one month and 323.37±155.74 pm after six months. Similar results were observed for IOP and BCVA. Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate of goniotomy in terms of reduction in intraocular pressure. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Ophthalmology, at Faisalabad Medical University/Allied Hospital Faisalabad from Apr 2016 to Aug 2017. Methodology: A total of 65 patients were enrolled in our study. The patients with intraocular pressure greater than 21 mm Hg and corneal diameter less than 13 millimetres were included. Intraocular pressure was measured before and four-weeks after goniotomy. Intraocular pressure measurement of less than 21 mm Hg four-weeks after surgery was considered successful. Results: Out of 65 patients, 35 (53.8 %) were male, and 30 (46.2%) were female. The age of patients ranged from 3 months to 33 months, with a mean age of 15.25 ± 7.66 months. Among 65 patients operated for goniotomy, the procedure was found successful in 55 (84.6%) patients, and only 10 (15.4%) patients did not show improvement following goniotomy. The fall in intraocular pressure from baseline to post-operative values of intraocular pressure was statistically significant (p-value < 0.01). Conclusions: Goniotomy is an effective procedure for lowering intraocular pressure in childhood glaucoma patients and can be offered as a primary and initial procedure at an early age. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of real-time Shear Wave Elastography (SWE) in detecting liver cirrhosis among patients suffering from diseases predisposing to it, keeping histopathology as the reference standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, from Jan 2018 to Jul 2018. Methodology: A total of 114 patients were recruited, and relevant history taken from patientsreal-time shear wave elastography (SWE) of the liver was performed, followed by USG guided liver biopsy. Patients having clinically suspected diseases predisposing to hepatic fibrosis were sent to the Radiology department for ultrasound or ultrasound-guided liver biopsy. Elasticity values using sheer waves of 14.9 kPa (2.23m/s) or more was taken as suggestive of cirrhosis. Elastography findings were compared with histopathology findings. Results: Real-time SWE showed high diagnostic accuracy for detecting liver cirrhosis with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 92.86%, 89.66%, 89.66%, 92.86% and 91.23%, respectively. Conclusion: This study concluded that the diagnostic accuracy of RTSW elastography in detecting liver cirrhosis is relatively high. [ABSTRACT FROM AUTHOR]

Rice harvesting is generally done by hand or with a combine harvester. The major challenges include loss of yield and quality during the harvesting process. Rice yield and quality losses may be minimized with the use of a suitable harvesting method. This study aims to evaluate the different paddy harvesting methods in terms of grain losses and head rice yield. This research evaluated the three harvesting methods: a Head-feed harvester (model PRO-588I-G, Kubota, Japan), a Whole-stalk harvester (model 8060, NH, Italy), and manual harvesting. The experiments were carried out on an area of 12,060 m2 with a complete randomized design (CRD) and three replications during the year 2021. The yield-related crop parameters were measured before harvesting. All crop parameters were non-significant except for the productive tiller, filled and unfilled grain, and 1000-grain weight which were significant at p < 0.05. The grain moisture content during harvesting was 21% which was within the recommended range. The effect of harvesting methods on grain losses and head rice yield was highly significant at p < 0.01. Higher grain losses (10.73%) and lower head rice yield (15.40%) were found in the Whole-stalk harvester. Lower grain losses (4.78% and 2.96%) and greater head rice yields (31.73% and 29.73%) were obtained using Head-feed harvesters and manual harvesting, respectively. In conclusion, the Head-feed combine harvesters are found to be a more practical choice for paddy harvesting. [ABSTRACT FROM AUTHOR]

Summary: In present research, photocatalytic degradation of textile wastewater was investigated through the combined effect of ozonation and photocatalysis processes. Catalytic acids in the nano-particle form under moderate reaction conditions were used for the successful disintegration of contaminants in textile wastewater which in turn increases the process efficiency. Moreover, the combined effect of the photocatalytic-ozonation process after secondary treatment of textile wastewater on discharge requirements of zero discharge hazardous chemicals (ZDHC) by Road to Zero was also studied. Different parameters were optimized like ozone flowrate, catalytic concentration, UV light intensity, and reaction time. Results revealed that overall process efficiency is influenced by ozone and reaction time. In contrast, an increased rate of degradation is attributed to the synthesized TiO2 (anatase) in nanoparticle form. The combined ozone-assisted photo-catalytic process showed the COD, BOD, and TSS removal efficiencies of 91.5%, 94%, and 86% at 25 °C temperature and pH 7-9. The results were attained at optimum conditions like reaction time (140 min), Ozone concentration (2 g/hr), TiO2 concentration (2g/L), and UV energy (88 W), respectively. The study demonstrated the efficiency of an integrated process for the degradation of real textile wastewater. Thus, combined photocatalytic and ozonation processes are known to exhibit better responses than individual processes for pollutants removal from textile wastewater. [ABSTRACT FROM AUTHOR]

Objective: To assess whether monitoring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) was a useful, non-invasive method for predicting anaemia in fetuses. Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Radiology, Rawalpindi Pakistan, from Feb and Aug 2022. Methodology: Fifty pregnant women who did not have hydropic babies were included. The peak systolic velocity (PSV) was measured in the middle cerebral artery (MCA). A positive result was determined when the MCA-PSV value exceeded 1.5 multiples of the median (MoM). The blood samples obtained from neonates were forwarded to the hospital laboratory to estimate haemoglobin levels shortly after birth. The outcome of the method (MoM) was observed and subsequently compared with neonatal haemoglobin levels. Results: 60% of neonates were anaemic according to middle MCA-PSV while the haematology laboratory reported 74% of neonates as anaemic according to cut-off haemoglobin of less than 13.5gm/dl. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the MCA-PSV in detecting the anaemia were 93.75%, 61.1%, 81.08%, 84.62%, and 82%, respectively. Conclusion: MCA-PSV Doppler is deemed valuable as a diagnostic technique for fetal anaemia, albeit secondary to the primary approach of neonatal haemoglobin estimation upon birth. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of sino-orbital mucormycosis outcomes in diagnosed patients of COVID-19 and its association with the duration of the disease. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Pak Emirates Military Hospital, Rawalpindi, from Feb to Jul 2021. Methodology: A sample size of 20 was calculated using WHO calculator. Diagnosed patients of COVID-19 who fulfilled the inclusion criteria were selected through consecutive sampling technique. The mode of presentation, in-depth imaging findings, associated co-morbidities and management/follow up details were collected. Results: Total 20 patients were included in study. There were 12 (60%) male and 8 (40%) female. Mean age of patients was 60.4 ± 9.8 years. Outcomes of study were treatment, still of follow up, mortality and mortality with sepsis, survival and exenteration (15%, 15%, 25%, 5%, 25% 15% respectively). Among all the patients, 2(10%) patients showed intraconal and extraconal orbital involvement, 9 (45%) showed left, 8 (40%) showed right and 1(5%) showed both orbits involvement. Outcomes of sino-orbital mucormycosis showed significant association with COVID-19 duration (p=0.03). Conclusion: Sino-Orbital mucormycosis is a common and potentially life-threatening complication of COVID-19. Early initiation of anti-fungal treatment as well as surgical intervention are key to decrease both the mortality and morbidity associated with the disease. [ABSTRACT FROM AUTHOR]

A three year spatial field survey of different insect pests of cotton and leaf curl virus (CLCuV) in relation to weather parameters was conducted in four tehsils viz. Alipur, Jatoi, Kot Addu and Muzaffargarh of district Muzaffargarh (Punjab, Pakistan). In each tehsil pest scouting was conducted in 40-50 spots (five acres each) per week selected randomly starting from 1st June to 30th October each year. Hot spots (pest incidence at and above Economic Threshold level, ETL) for each tehsil were determined weekly, and then the combined infestation was calculated at the district level. The results showed that the weather conditions, during all the three years, had a significant impact on the insect pest abundance. The maximum percentage of whitefly hot spots ranged in line from 8.36-24.14% during three years study period followed by mealybug (6.71-11.79%), jassid (4.56-7.22%), thrips (1.36-6.22%), pink bollworm (0.99-5.42%) and armyworm (2.77-4.23%). The population of dusky cotton bug, spotted bollworm and American bollworm were negligible with 1.22% hot spots of dusky cotton bug and 0.02% of spotted bollworm during 2020. CLCuV hot spots ranged from 15.66-22.74% during 2018-2020. Correlation matrix revealed that population fluctuations of whitefly, mealybug, pink bollworm and armyworm were negatively correlated with maximum and minimum temperature and positively correlated with jassid and thrips. Relative humidity exhibited a positive association with all the insect pests and CLCuV incidence. Multiple regression analysis was used to estimate the combined as well as individual impact of maximum and minimum temperature and relative humidity on population fluctuation of insect pests. The R2 values indicated that maximum and minimum temperature were the most influential factors and played a significant role in the population fluctuation of the studied insect pests as well as CLCuV. The results of the study may be helpful to the pest managers as a pest forecasting tool for initiating management strategies at appropriate time during the cotton season. [ABSTRACT FROM AUTHOR]

Cadmium (Cd) is highly toxic metal which naturally exists in environment in small proportion but continuously increasing due to anthropogenic activities. The rapid increase in population is putting pressure on urbanization, agriculture and industrialization which have resulted in gradual increase in Cd level. It is released from industries as an impurity and pollutes soil, water and air in different ways. High solubility in water increases its mobility in the soil ecosystem. The use of sludge and chemical sprays on crops increase the Cd contamination besides some other heavy metals. Through nutrient cycling, it is taken up from the soil to plants and finally becomes the part of human body which warrants serious health concerns. Cadmium causes mild to severe effects on plants, animals and environmental health. Humans are exposed to cadmium through food, water intake, inhalation (cigarette) and dermal contact which then produces heart disease, kidney failure, lung cancer, orthopedic disease, nervous system failure, low immunity level, mental retardation and growth retardation. Different environmental friendly and low cost biological remedies are used nowadays to control Cd toxicity such as phytoremediation phytostabilisation, rhizofilteration, phytoextraction. This review paper has summarized the impact of Cd on soil, plants and humans and strategies to remove or minimize its toxicity by applying some low cost and environmental friendly techniques. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the immunogenicity and short-term safety of inactivated SARS-CoV-2 Vaccine (Vero Cell), BBIBPCorV (Sinopharm) in our setup. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Sialkot Pakistan, from Feb to Apr 2021. Methodology: A total of 227 health care workers (HCWs) between 18 to 59 years of age were included in the study. Two doses of Inactivated SARS-CoV-2 Vaccine (Vero Cell), BBIBP-CorV were administered to all individuals 21 days apart and they were monitored for any vaccine-related adverse reactions for 7 days after each dose. Neutralizing antibodies (NAbs) in study subjects were detected in three samples i.e. before 1st dose of vaccine, 21 days after 1st dose and 14 days after 2nd dose by Elecsys Anti- SARS-CoV-2 S (Roche Diagnostics). Results: Mean age of individuals in the study was 36.70 ± 18.08 years and most individuals were in the 31-45 years age group. Fatigue and drowsiness were the most common adverse effects experienced by study subjects after 1st and 2nd dose of the vaccine followed by malaise and headache. Only 42 (39%) individuals developed positive neutralizing antibody titers in a sample taken 21 days after 1st dose while all individuals except one (99%) developed positive neutralizing antibody titers in a sample taken 2 weeks after 2nd vaccine dose. Conclusion: Inactivated SARS-CoV-2 Vaccine (Vero Cell), BBIBP-CorV is safe and well-tolerated with very few adverse reactions. Immunogenicity was well achieved as the seroconversion rate was 99% two weeks after 2nd dose of the vaccine. [ABSTRACT FROM AUTHOR]

The following research was designed to evaluate the most appropriate concentration of two different fungicides against the charcoal rot of sunflower caused by Macrophomin phaseolina under greenhouse conditions. The treatments viz. Success, Nativo and Control with the concentrations of 2, 4 and 6mM were used with three replications under completely randomized design in greenhouse conditions. Nativo had given the most significant results in all studied traits as compared to all other treatments at the concentration of 6mM. The results showed that Nativo exhibited the maximum germination % (71.47), seedling length (23.67, 35.00 and 47.33 cm), number of leaves/plant (6.33, 7.67 and 11.33), minimum disease incidence (12.33, 11.12 and 10.13 %), minimum disease severity (26.80, 24.67 and 11.37 %) and maximum plant survival (89.62, 94.35 and 98.37%) at 15, 30 and 45 days after treatment, respectively. The application of Success @ 6mM was also good but lowers than the Nativo. The poor performance and maximum disease incidence and disease severity were recorded from the controlled pots. Among all the treatments the application of Nativo @ 6 mM had given maximum control of charcoal rot. So, it suggested that the application of Nativo @ 6 mM may be best for the control of charcoal rot. [ABSTRACT FROM AUTHOR]

In under two decades, the world has encountered three flare-ups of fatal Coronaviruses, including the ongoing pandemic of Coronavirus Disease 2019 (COVID-19) in China. COVID-19 represented a crisis of worldwide concerns, and cases have been accounted for more than 200 nations/districts that came about in wellbeing, lives, and monetary misfortunes. China's financial development is anticipated to tumble to 5.6% this year, the International Monetary Fund (IMF) anticipated that arrangement venture and expense strategies to execute $3.3 trillion and contributes further $4.5 trillion. IMF conjectures develop from 3.7% of worldwide total national output (GDP) in 2019 to 9.9% in 2020. Gross domestic product proportion anticipated from 3.0% in 2019 to become 10.7% in 2020, the US proportion expected to increment from 5.8-15.7%. There is a desperate requirement for local and universal co-activity to stretch out hands to forestall further spreading of COVID-19. The IMF has reacted to the COVID emergency with exceptional speed and greatness of financial aid. This paper shows the response of the world against COVID-19. How the countries are helping each other to control the spread and discovering the cure of this virus. Asia has survived usefully and also defending the second wave of virus, but on the other hand, the Europe is the most infected region with the highest rate of death. Why Asia is near to win this fight with a stable economy, but the Europe is not, instead of this the economy is going to be crashed. These questions raises to the Economy, Behavior and Policies, of respective Countries. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of Carbamazepine versus Topiramate for the management of trigeminal neuralgia. Study Design: Comparative prospective study. Place and Duration of Study: Oral and Maxillofacial Surgery department, Allied Hospital, Faisalabad Pakistan, from Nov 2017 to Nov 2018. Methodology: A total of 60 patients (30 in each group) were included. Group A was treated with Carbamazepine 100mg TDS and group B with Topiramate 25mg TDS. Visual analogue scale was used to access pain and was calculated at 1st visit (baseline), at 7th day, at 14th day and at 28th day. Results: Out of 60 patients, mean of age was 54.78 ± 8.49 years. Right and left side of the face was involved in 41 (68.3%) and 19 (31.7%) patients respectively. Maxillary branch was involved in 24 (40%) and mandibular branch was involved in 36 (60%) patients. The mean of visual analogue scale after 7 days in group A was 4.53 ± 0.93 and in group B was 7.1 ± 1.07, after 14 days mean of visual analogue scale in group A was 3.7 ± 1.02 and in group B was 4.03 ± 1.27. Mean of visual analogue scale after 28 days in group A was 3.27 ± 1.01 3.93 ± 1.28. The results were statistically significant with p-value of 0.03. Conclusion: Topiramate has comparable efficacy as that of Carbamazepine at dose of 75-100mg with lesser side effects. So Topiramate can be used as first line of treatment in trigeminal neuralgia. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of 1H- magnetic resonance spectroscopy imaging findings in predicting neurodevelopmental abnorma-lities in term neonates having respiratory distress, using clinical neurological examination as reference standard. Study Design: Cross sectional validation study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging (AFIRI), Pak Emirates Military Hospital, Rawalpindi, from Oct 2017 to Apr 2018. Methodology: A total of 86 patients were included in study. All term neonates suspected of hypoxic ischemic encephalopathy (HIE) referred for magnetic resonance spectroscopy (MRS) meeting our inclusion criteria were enrolled for study acquisition after taking informed consent from attendants. Results: Approximately 47 out of 86 patients suspected to have perinatal asphyxia showed raised lactate peaks (resonating at 1.3 ppm) in both watershed and ganglionic regions and at 6 months neurological evaluation showed significantly delayed neurological development and delayed milestones. Seven (8.1%) patients clinically suspected to have birth asphyxia showed no specific detectable spectral spikes at 1.31 ppm. Twenty six (30.2%) patients presenting with delayed cry but no laboratory evidence of birth asphyxia showed no definite evidence of visualization of lactate peaks. Six (6.97%) patients showed normal magnetic resonance spectroscopy who had clinical, biochemical suspicion of systemic ischemic insult and later on showed retarded neurodevelopment at 6 months of age. Conclusion: Magnetic resonance spectroscopy (magnetic resonance spectroscopy) spectra in patients having high documented clinical and biochemical suspicion of transitory birth asphyxia from any cause, acquired at frontal watershed territory and deep grey matter showed a characteristic spectral resonance of lactate peak not demonstrable in normal term infants at aforementioned locations thus signifying cellular brain injury despite no radiological visible parenchymal infarction. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of general and specific endoscopic findings in patients diagnosed with dyspepsia and to determine association of age and gender with organic dyspepsia. Study Design: Cross sectional study. Place and Duration of Study: Gastroenterology department, Combined Military Hospital, Kharian, from Jul to Dec 2018. Methodology: A total of 180 patients participated in the study after being selected through non probability consecutive sampling. Age, gender and history of dysphagia, weight loss, gastrointestinal bleeding, and smoking were recorded. All underwent standard electronic video upper gastrointestinal endoscopy. Abnormal findings of inflammation, narrowing, strictures, furrowing, erosions, ulcers, atrophy, nodularity, polyps, masses and malignancy were recorded. The abnormal findings were presented as frequency and percentages. On the basis of endoscopic findings the sample was divided into two groups of functional (normal endoscopy) and organic dyspepsia. Chi-square test was selected to compare the frequencies of organic and functional dyspepsia with age and gender. Results: Majority 99 (55%) of the patients with dyspepsia had a normal endoscopic finding while in organic dyspepsia, reflux esophagitis 41 (22.8%) was the most common finding followed by gastritis 16 (8.9%), duodenal ulcer 12 (6.7%) and gastric ulcer 9 (5%). Three patients with organic dyspepsia had malignancy. Most common specific findings were non erosive esophagitis 25(30.8%). Age above 40 years and male gender was found to be statistically significantly associated with organic dyspepsia (p<0.01). Conclusion: Majority of the patients with dyspepsia have a normal endoscopic finding. There is a higher incidence of organic dyspepsia in males and in patients above 40 years of age. [ABSTRACT FROM AUTHOR]

Citrus slow decline caused by Tylenchulus semipenetrans deteriorates the quality and quantity of citrus fruit and make it prone for the invasion of other microbes. A survey was carried out for the assessment of nematode population distribution in all 7 Tehsils of district Sargodha (Pakistan) viz: Sargodha, Silanwali, Sahiwal, Shahpur, Bhalwal, Kot Momin and Bhera. Population densities of nematode were assessed in different genera of citrus crop i.e. kinnow, sweet orange, feutral's early, grape fruit and sweet lime, both in healthy and declining orchards. Whitehead and Hemming tray method was used for the isolation of T. semipenetrans which showed that the population was low in declining orchards as compared to the population densities found in healthy orchards. Kinnow was the most infested by nematode with mean population 1161 while sweet orange was the least infested with 595 nematodes, in all localities. Maximum nematode population density in healthy and declining orchards was recorded in Kot Momin that was 2600 and 946 nematodes per 50 ml of soil, respectively. The lowest mean population was recorded in Silanwali with 1200 in healthy and 300 in declining orchards. The assessment of spatial distribution of nematode population would pave foe effective disease management strategies. [ABSTRACT FROM AUTHOR]

Asian citrus greening disease is one of the leading causes of the citrus decline in many parts of the world, including Pakistan. Adequate information about disease incidence is essential for the eradication and controlling measures of disease. In this context, a survey regarding the incidence of citrus green disease (CGD) was recorded in two cultivars Kinnow (Citrus reticulate Blanco) and Mosambi (Citrus sinensis (L.) Osbeck), among significant citrus-growing areas of Sargodha district based on symptoms. Random samples of trees within orchards were scored based on characteristic symptoms like blotchy mottle, lopsided unripe fruits, and aborted seeds were observed. The highest incidence of 26% was recorded in Kot Momin, while the lowest incidence of 4.6% was found in Sahiwal. Among the cultivars, the highest disease incidence in mosambi (C. sinensis) and Kinnow (C. reticulate) was recorded 26% in Kot Momin and 23% in Bhalwal, respectively. Leaves samples were collected from the diseased trees to isolate DNA and to confirm greening pathogen with two primer pairs, which amplified the specific DNA (~1160bp) and ßoperon (~703bp) regions. The present study not only detects the molecular detection of CGD in already identified samples through the iodo-starch test but also provides reliability for quick indexing of disease in the aforesaid field. Moreover, molecular detection also revealed the (standardization) of primers used in previous and current studies. Characteristic symptoms combined with molecular detection would be useful to formulate the management strategies. [ABSTRACT FROM AUTHOR]

Adequate nutrition plays a very important role in mitigating disease damage. Nevertheless, no specific rule exists that how a specific nutrient can alter the severity of the disease. Normally, plants are stressed by different environmental confines may be weakened and susceptible to disease and these include nutrient scarce plants. Tissue contents of potassium, nitrogen, and phosphorus of above parts of the ground of plant in three cultivars of chickpea ('C-44', Bittle-98' and 'Pb-91') after treatment with Bion® (acibenzolar-Smethyl), salicylic acid (SA), potassium hydroxide (KOH) or plant extracts of neem (A. indica A. Juss.), datura (D. metel L.) and garlic (A. sativum L.) were investigated 7 and 14 days after inoculation with Ascochyta rabiei. Elevated nitrogen (2.95%), potassium (1.05%) and potassium (533.00 ppm) contents in the tissues decreased disease severity (79.3%) in cv. C-44. These increases were significant (P = 0.05) after 14 days of inoculation with plant pathogen in plants pretreated with chemicals. There was no significant change in plants treated with the plant extracts except with extracts of A. indica. Chemically increased N, P, and K were highest in cultivar C-44 followed by Pb-91 and Bittle-98. A similar trend was observed with plant extract treated plants, with the greatest effect observed with A. indica extracts. The results indicate that chemicals reported to induce resistance to pathogens may increase mineral contents which prevent the spread of the pathogen. [ABSTRACT FROM AUTHOR]

Planting method is an important aspect of production technology for the maximum resource utilization by crops per unit area. Dry-seeded rice (DSR) is a contemporary resource saving crop establishing technique, which enables farmers to harvest economical rice production. Field study was conducted at Rice Research Institute, Kala Shah Kaku, Pakistan in 2014 and in 2015 to evaluate the different planting methods. Three dry-seeded rice (DSR) planting methods viz. (i) DSR-broadcast, (ii) DSR-drill, (iii) DSR-ridges were compared with the conventional transplanting (TR) method in lines having row to row and plant to plant distance of 22.5cm distance, and farmer transplanting method. Experimental design was randomized complete block, replicated 3 times. Data were recorded on height (cm), tillers m-2, filled and unfilled grains panicle-1, thousand grain weight (g), grain and biomass yield (t ha-1). Grain sterility (%) and harvest index (%) were also calculated. Highest grain yield (5.00 to 5.11 t ha-1) with harvest index (30.00 to 31.50%) and relatively low grain sterility (12.00 to 12.01%) were observed in DSR-ridge and DSR-drill sowing method. Moreover, DSR (i.e. DSR-ridge and -drill) resulted in 104 and 76 % more profit over TR-farmer practice. The study concluded that DSR-ridge and DSR-drill proved to be the best to obtain the maximum paddy yield and net profit. Farmers can adopt these methods to harvest maximum benefit. [ABSTRACT FROM AUTHOR]

Objective: To analyze work related effects on musculoskeletal system in employees reporting to Pakistan Field Hospital level II (PFH lvl II) Star Base, Monrovia, Liberia. Study Design: Cross sectional study. Place and Duration of Study: PFH lvl II, Star Base, Monrovia, Liberia, from Apr to Sep 2017. Methodology: We enrolled 104 patients 30-60 years (years) consecutively, who were given a questionnaire regarding demographic and work related musculoskeletal issues. Type of work is divided into two categories as desk work/computer work and physical. Musculoskeletal issues were divided into head-ache, upper limb/ cervical issues, lower limb/nonspecific back issues and combined upper and lower limb issues. Descriptive statistics were used for variables under study. Pearson Chi square test (X2) and odd’s ratios (OR) were calculated. Results: Our study showed 48 (46%) suffering from Musculoskeletal disorders (MSDs) as compare to 56 (54%) who were symptom free. There were increase in percentage of MSDs with increase in age groups. Desk related issues (58.8%) were more common in 41–50 yrs age whereas manual work related MSDs (72.2%) were predominant in 31–40 yrs group. Gender OR = 14.806, 95% Confidence interval (CI): 3.2-68.3 and obesity (OR = 2.727, 95% CI: 1.0-7.1) showed strong association with work related musculoskeletal disorders (WMSDs). Conclusion: Our study will raise awareness of work related musculoskeletal effects and measures to avoid them. [ABSTRACT FROM AUTHOR]

Objective: To compare mean heart rate reduction in Ivabradine and placebo group in left ventricular failure patients. Study Design: Quasi experimental study. Place and Duration of Study: Study was conducted at Combined Military Hospital, Kharian, from Jul 2018 to Dec 2018. Methodology: Sixty four patients participated in the study. They were randomly divided into two groups of 32 each. One group was given Tab Ivabradine (10 mg twice a day) while second group received a placebo for a period of 4 weeks. After 4 weeks each patient was evaluated and heart rate, systolic and diastolic blood pressure were recorded. Mann-whitney U test selected to compare heart rate and ages of both groups t- test used to compare systolic and diastolic blood pressure among both groups. Chi-square test used to determine the association of heart rate between two groups. A p-value ≤0.05 was considered significant. Results: Median (IQR) heart rate was significantly lower in Ivabradine group 58.3 (4) as compared to placebo 64.1(1) (p<0.01). Systolic blood pressure (132.8 ± 3.6) was significantly lower in ivabradine group as compared to placebo group (137.1 ± 4.5) (p<0.01). Difference in diastolic blood pressure was insignificant in both groups (p= 0.55). There was a significant association between heart rate of 55-60 beats per minute and ivabradine use (p<0.01). Conclusion: Ivabradine is safe and efficative drug in reducing heart rate and systolic blood pressure for patients suffering from left ventricular failure. Early detection and management of left ventricular failure with ivabradine use leads to better prognosis of the disease. [ABSTRACT FROM AUTHOR]

China's economic growth and military modernization have forced the US to shift its focus from the Middle-East to the Asia-Pacific region. The US Pivot to Asia Pacific policy aims to maintain the US hegemony by containing China in this region. This article is an attempt to gauge the responses of those regional countries which are having close economic and political relations with China and the US. It also tries to highlight the factors which increased the US military and diplomatic involvement in the region. This article tries to find the answer of research question that why the US has introduced Asia-Pacific policy and how the regional countries have responded to it. As per the nature of the research, secondary sources have been used to complete this research. Three qualitative approaches such as historical, descriptive and exploratory within the broader framework of post positivist paradigm have been used to find the answer of the research question. This study is conducted under the lens of Hegemonic Stability Theory. This study concludes with the argument that regional countries have shown mixed reactions to the US policy and geo-political competition is likely to grow between the US and China in future. [ABSTRACT FROM AUTHOR]

Paediatric mandible serves as a foundation for future aesthetics and function. Fracture of paediatric mandible institutes asymmetry, occlusal discrepancies and can lead to TMJ ankylosis. Hence paediatric mandibular fractures should be dealt with utmost care. The objective of current study was to record and compare the causes, pattern and management options of mandibular fractures among different age groups of children, reporting to tertiary care centres in Punjab. It was an analytical study carried out from 1st August 2018 to 31st July 2019. The study was carried out on 116 patients who were divided into 2 groups. In group A, 72 patients of age 10 years or less and in group B, 44 patients of age between 11-16 years were included. They were compared for the causes, patterns and management of paediatric mandibular fractures. Paediatric mandibular fractures in both groups have tendency to be bilateral and mostly favourable. Condylar fractures were the most common type of paediatric mandibular fracture. There were statistically significant differences between both groups regarding cause (P=0.043) and management (P=0.02). It was concluded that the causes and management of mandibular fractures change with the age of children. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a dedicated hospital based warfarin clinic assessing patients' knowledge and improving the drug compliance in a tertiary cardiac center of Pakistan. Study Design: Descriptive cross sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology from Jan 2019 to Jul 2019. Methodology: Patients presenting in the anticoagulation clinic using warfarin for different cardiovascular indications from Jan to Jul 2019 were included in the study. Patients were assessed for their underlying cardiovascular condition, their international normalized ratio levels checked using a standard technique. The patients' knowledge about the drug and the degree of compliance was judged by eight-item Morisky Medication Adherence Scale (MMAS-8). The patients were thoroughly counseled and reassessed six months later assessing the improvement in compliance with the warfarin therapy. Results: Total number of 401 patients using warfarin for different cardiovascular diseases were studied. The mean age was 43.3 ± 13.3 years with 218 (54.5%) patients being male. Most of the patient 300 (75%) belonged to the low socio-economic group with average monthly income of

Rice (Oryza sativa L.) is a main staple food in Pakistan, after wheat and is generally cultivated through raising nursery seedlings and transplanting them in puddled soils. Declining surface water, high cost of pumped groundwater, high labor costs, and drudgery in manually transplanted rice (TPR) have motivated researchers to develop alternated technology such as direct seeded rice (DSR). About 30% of total water used in rice cultivation is consumed for puddling of soil (land preparation) and transplanting operations. Physical properties of soils are deteriorating due to continued puddling over the decades, resulting in structural breakdown leads to a compacted layer (the plough plate) that acts as a barrier to the infiltration of water and causes temporary waterlogging, which confines the penetration of roots and growth of a subsequent wheat crop after the harvesting of rice crop. DSR technology helps by eliminating the need for continuous ponding of water and thus lessens water use for rice production, resulting in saving of 15-20% of water over TPR. DSR is also a less labor-intensive and more farmers-friendly, time-saving and cost-effective technology than TPR. The Rice Research Institute, Kala Shah Kaku, has refined the DSR technology and production practices and conducted 20 field demonstrations of DSR with modified seed drills during 2017 in Gujranwala, Hafizabad, Narowal, Sheikhupura, and Sialkot districts. The super basmati rice variety was direct seeded in comparison with manually TPR. The DSR was carried out in well prepared dry seed bed with the help of tractor mounted rice drill. Irrigation was applied immediately after sowing and after 24 hours pendimethline was sprayed as pre-emergence weedicide. The irrigation was repeated about 4-5 days after pre-emergence weedicide application and afterwards about 3-5 days interval till tillering phase and then 5-7 days interval till crop maturity. The overall results indicated that paddy yield was 20% higher under DSR as compared to TPR. Moreover, during 2017 in Punjab Province, Pakistan, more than 2500 farmers cultivated rice using DSR on an area of about 10000 ha and found it more cost effective than manually TPR. Therefore, farmers can opt this technology to harvest maximum benefits. [ABSTRACT FROM AUTHOR]

Pre-treatment of plants with chemical elicitors can induce systemic resistance against plant pathogens and insect herbivores. The plan of the study was to study induction of defense responses and protective effects against Phytophthora infestans (Mont.) de Bary and sucking insect pests of potato (Solanum tuberosum L.) with application of salicylic acid (SA) and β-aminobutyric acid (BABA). Concentration of SA and BABA (2, 4 and 5 mM) were applied to foliage. Application of both resistance inducers suppressed disease development by 54.1% and 67.4%, for SA and BABA, respectively, 5 days after pathogen inoculation. Numbers and size of lesions per plant was reduced by application of SA and BABA. Plants treated with BABA exhibited increased resistance against herbivory by aphids (Myzus persicae Sulzer) (Homoptera: Aphidiae), thrips (Thrips tabaci Lindeman) (Thysanoptera: Thripidae) and whitefly (Bemisia tabaci Gennadius) (Hemiptera: Aleyrodidae) compared to SA treated plants. Potato plants treated with SA and BABA had higher peroxidase and polyphenol oxidase activity than water treated plants. Enzymes produced as result of treatment with elicitors are responsible for protection against late blight and sucking insect pests. The inducers can be used for disease and insect pest's management. [ABSTRACT FROM AUTHOR]

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

Objective: To study the association of anthropometric and biochemical parameters with nonalcoholic fatty liver disease (NAFLD) diagnosed on ultrasonography (USG). Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Pathology, Combined Military Hospital (CMH) Mardan, from Aug 2016 to Jan 2017. Methodology: Study was conducted on 96 individuals 20-65 years enrolled by non-probability consecutive sampling. They were evaluated by taking anthropometric and biochemical parameters to establish association of nonalcoholic fatty liver disease diagnosed on ultrasonography as compared to healthy individuals. Results: Mean age was 28.7 ± 10.3 years in control group as compare to 39.9 ± 10.8 years in nonalcoholic fatty liver disease group. Nonalcoholic fatty liver disease was seen in 17 (28%) females as compared to 44 (72%) males showing strong association of males with the disease (p=0.025). There were 31 (50%), 22 (36%) and 8 (14%) cases in mild, moderate and severe nonalcoholic fatty liver disease categories respectively using ultrasonography. Abdominal circumference, systolic blood pressure and body mass index (BMI) were significantly associated with nonalcoholic fatty liver disease. Whereas, among biochemical parameters serum glucose, alanine aminotransferase (ALT), triglyceride and low density lipoprotein cholesterol (LDL-C) were independent parameters strongly associated with nonalcoholic fatty liver disease. Conclusion: Our study showed that deranged anthropometric along with biochemical parameters was strongly associated with development of nonalcoholic fatty liver disease. [ABSTRACT FROM AUTHOR]

Objectives: To check the performance in the pre-analytical phase of testing in the clinical chemistry laboratory of a reference institute using five key performance indicators and to compare these indicators between the morning and night shifts to ascertain the most probable source of pre-analytical errors. Study Design: Comparative cross-sectional study Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: Defined key performance indicators (KPIs) were observed for a period of six months. The frequency and percentage of each KPI were calculated. Defects per Million were calculated for deriving Six Sigma (σ) values. KPIs were also compared between the morning and night shifts. Results: A total of 272,731 samples were observed in which 2306(0.84%) were found haemolysed (σ=3.5), 604 samples (0.22%) were not received in the Department due to various pre-analytic reasons (σ=4.0), 260 samples (0.09%) were found having insufficient sample volume for analysis (σ=4.5), 181(0.06%) samples were found having improper/ wrong labelling or bar code errors (σ=4.5) and 161(0.05%) samples were delivered in wrong tubes (σ=4.5). KPI-1, KPI-2, and KPI-3 were found to be significantly higher during the night shift than the morning shift. Conclusion: Haemolysed samples and lost-not-received samples were the main causes of pre-analytical errors Key performance indicators aided as an instrument to screen and improve process execution in the laboratory. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of ionizing radiations on trace metal levels in healthcare workers exposed to occupational radiation in a tertiary care health facility. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, in collaboration with the Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from Apr to Oct 2021. Methodology: Healthcare workers (n=45) exposed to occupational radiations were compared with an equal number of Controls in a tertiary care health facility for their trace metal levels. An atomic absorption spectrophotometer (AAS) was used to measure serum zinc (Zn) and copper (Cu) levels. A calorimetric technique was used to measure serum iron (Fe) levels. Results: Mean serum Copper (9.54±2.52 µmol/l) and Zinc (11.78±1.90 µmol/l) concentrations of the Risk-Group were significantly lower than their respective Control-Groups (Copper: 14.76±3.13 µmol/l and Zinc: 14.67±3.01 µmol/l). At the same time, mean serum Iron levels in the Exposed-Group (17.55±3.88 µmol/l) were significantly (p<0.001) higher than the Control-Group (14.41±4.23 µmol). The duration of radiation exposure was inversely proportional to serum Copper (p-value 0.002) and serum Zinc (p<0.001) concentrations, which is statistically significant. At the same time, serum iron level (p-value 0.001) and TIBC (p-value 0.003) increased proportionately with increasing duration exposure, which was also statistically significant. Conclusion: Low-dose ionizing radiation exposure led to a significant decrease in serum Copper and Zinc levels, whereas an increase in serum Iron levels was noted. There was an association of trace metal disturbances with increasing radiation exposure. [ABSTRACT FROM AUTHOR]

A survey on the incidence and severity of late blight (Phytophthora infestans (Mont.) de Bary) of potato was conducted in the major potato growing areas of Punjab viz., Khushab, Sargodha, Sahiwal, Okara, Jhang and Chiniot districts during the cropping seasons of 2016-2017. A total of six districts comprising of three locations in each district were surveyed for the collection of late blight infected samples. During 2016 and 2017, prevalence of disease in all the surveyed districts ranging between 34.6-24.4% and 39.3-28.6% respectively with district Okara recording the maximum (39.3%) and district Jhang the minimum incidence (24.4%) for both the years. Similarly, disease severity ranging from 19.3-16.1% and 21.1-17.4% during the year 2016 and 2017 was recorded with Okara recording the maximum (21.1%) and Sahiwal the lowest blight severity (16.1%). The results clearly depicted that this disease is present in all the surveyed districts of the Punjab during both years with varying intensities. Moreover, disease incidence and severity seems to be varied from region to region and location to location depending on the prevailing environmental conditions, soil type, prevailing of different mating types and the vulnerability of the crop under plantation. [ABSTRACT FROM AUTHOR]

Trichoderma is widely distributed and ubiquitous in almost all type of soils and their species promote growth of the plants and commercially used as bio-fungicide against soil borne plant pathogens. The present study was conducted with the aim to determine the efficacy of Trichoderma species using dual culture and pot assays against Phytophthora infestans (late blight) and Fusarium oxysporum (wilt) of tomato on different compost including carbon rich compost, nitrogen rich compost and nutrient enriched compost. The species of Trichoderma includes T. harzianum and T. asperellum isolated from rhizosphere of tomato from different localities of district Sargodha, Punjab, Pakistan which were recognized morphologically. Three isolates of T. harzianum HM, HK, HC and one isolate of T. asperellum TH were evaluated in dual culture assays and in pots amended with different composts against P. infestans and F. oxysporum. Mycelial growth reduction and inhibition percentage of P. infestans and F. oxysporum in dual culture assay significantly higher by T. harzianum HK as compared to all other isolates. Furthermore, pot experiments conducted with carbon rich compost inoculated with Trichoderma strains with pathogens inoculums provided most effective control as compared with nitrogen rich compost and nutrient enriched compost. These results suggested the potential of Trichoderma spp. for affective control of plant pathogens by considering the growth, environmental conditions favoring the disease suppression. [ABSTRACT FROM AUTHOR]

Objective: To compare per-operative normal saline wound irrigation prior to closure with conventional simple wound closure without irrigation in terms of development of surgical site infection (SSI) in clean contaminated wounds. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Combined Military Hospital Dera Nawab Sahib, from Nov 2014 to Nov 2016. Material and Methods: Group A and group B had 355 patients each. Group A was subjected to per-operative surgical wound irrigation with 300 ml of normal saline prior to skin closure while group B was subjected to conventional simple closure of surgical wound without any kind of wound irrigation. Development of postoperative SSI was checked till 30th post-operative day (POD). A p-value <0.05 was considered statistically significant. Results: Postoperative SSI was comparatively less in group A (4.5%) as compared to group B (10.2%) which was statistically significant (p 0.004). Conclusion: Per-operative surgical wound irrigation was found superior to conventional simple wound closure in terms of development of SSI in clean contaminated cases. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of sub anesthetic dose of ketamine when given 5 minutes prior to Propofol injection in alleviating pain of injection during cesarean section surgery. Study Design: Randomized controlled trial. Place and Duration of Study: Department of anesthesia and critical care, Nishtar Hospital Multan, from Aug 2016 to Feb 2017. Material and Methods: A total number of 130 (100%) patients were included in the study. Data was analyzed using SPSS (v 23.2), mean and SD calculated for continuous data (age, BMI) and in continuous data was presented as frequency and percentages (ASA status, pain of propofol injection). Effect modification seen by applying chi square test and p-value ≤0.05 considered as significant. Results: A total number of 100% (n=130) patients were included in this study, all were females. The main outcome variable of this study was pain of propofol injection. It was observed that, in control group, 87.7% (n=57) patients complaints about pain after propofol injection and 12.13% (n=8) remain normal. But, in ketamine group only 16.9% (n=11) patients complaint about pain of propofol injection and 83.1% (n=54) were remained pain free. Conclusion: Administration of ketamine 0.25μg/kg five minutes before propofol injection is a safe and effective method in preventing propofol injection pain. [ABSTRACT FROM AUTHOR]

Objective: To assess the level of understanding of operation room personnel for application of tourniquets. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was carried out in the department of Surgery, Combined Military Hospital Rawalpindi, from Feb 2013 to Jun 2013. Material and Methods: A previously published questionnaire form with slight modifications was distributed among orthopaedic/plastic/general surgery/anaesthesia operation room staff. The questionnaire comprised 26 questions with total of 56 marks. The answers were taken from the individuals on the spot and forms were marked according to the marking scheme and total score of each individual was recorded. The experience of each individual in his respective specialty was also documented (In years). The individuals were categorized into their respective specialties. Data was analyzed using SPSS version 21. Mean and SD of numerical variables was calculated and frequency and percentages were presented for categorical variables. Results: Fifty six individuals answering all 26 questions from the questionnaire were included in the study. Out of 56 individuals, 6 (11%) were orthopaedic surgeons, 4 (7%) were plastic surgeons, 14 (25%) were general surgeons, 19 (34%) were registrars in surgery, 5 (9%) were registrars in anaesthesia and 8 (14%) were operation room assistants. The mean score of all the participants was 25.1 (± 4.1) out of 56 with minimum of 17 to maximum of 35. Conclusion: The role of tourniquet in the field of orthopaedic surgery has become very significant. As there is no formal teaching to the trainees about its use, there is a need to incorporate its training at the practical level during training. [ABSTRACT FROM AUTHOR]

Objective: To compare fissure healing and complications in chronic anal fissure with use of lateral anal sphicterotomy and 0.2% GTN. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Kohat over a period of 15 months. Material and Methods: Chronic anal fissure was treated with use of lateral anal sphicterotomy after admission to surgical ward and by application of 0.2% glyceryltrinatrate as an outdoor case on 202 patients over a period of 15 months. Sample size was calculated by sample size calculator. Pain was measured using visual analog scale and incontinence to flatus and faeces was inquired from the patients. All cases were called for regular follow up visits but 10 patients failed to report back. Informed written consent was taken from each patient. Inclusion and exclusion criteria were followed. Analysis was done by SPSS version 13 and Chi Square test was applied. Results: Total 202 patients were included in the study and randomly divided into two groups of 101 patients each using random numbers table. Both GTN and sphincterotomy groups revealed significant, but comparable results. Pain relief, fissure healing and incontinence were significantly higher in group B (Lateral anal sphincterotomy) as compared to group A (0.2% GTN). At the end of 8th week pain relief and incontinence became comparable between both the groups but fissure healing remain significantly higher in group B as compared to group A. Conclusion: GTN when applied to patients produces comparable results if used in long term i.e. eight weeks. It produces adequate symptomatic control and healing of the anal fissures and can be considered equivalent to and one of the recommended treatment options along with lateral anal sphincterotomy in treatment of chronic anal fissure if use for more than 8 weeks. Lateral anal sphincterotomy gives early resolution of symptoms and healing. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical and demographic characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP). Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of ENT Combined Military Hospital Quetta and Rawalpindi, from 10 Dec 2012 to 31 Dec 2015. Material and Methods: The study was a descriptive cross sectional study. The study was conducted after approval by the ethical committee. Patients with fixed vocal cords due to some growth of glottic region were enrolled. All the patients presenting with hoarseness of voice in ENT outpatient department CMH Quetta and Rawalpindi undergoing indirect laryngoscopy and the patients with vocal cord paralysis were selected. Informed written consent was taken and gender, age, name, hospital record number, address and phone number of each individual was noted. Every patient was evaluated by detailed history and thorough clinical examination. Patients were not investigated further if cause were revealed after some investigation. Follow-up of patients was done regularly in ENT OPD. CT scans/US neck was done by radiologist and FNAC/biopsy was reported by histopathologist. Data collected were recorded on proforma. Results: In our study, out of 245 cases, 47.76% (n=117) were 16-40 years old and 52.24% (n=128) were 41-80 years, mean ± SD was calculated as 41.23 ± 11.25 years, 45.71% (n=112) male and 54.29% (n=133) were females. Frequency of causes of vocal cord paralysis was recorded as 15.92% (n=39) for idiopathic, 46.53% (n=114) had iatrogenic, 33.06% (n=81) had malignant neoplasm while 4.49% (n=11) had radiation. Conclusion: Vocal cord paralysis is a common clinical condition with substantial morbidity. Awareness on the clinical characteristics and identification of the underlying etiology are keystones for foreseeing complications and determining the required therapeutic modality. [ABSTRACT FROM AUTHOR]

A simple, rapid, precise, accurate high performance liquid chromatography method has been developed and subsequently validated for determination of valsartan in rabbit plasma. The method was developed employing mixture of mobile phase consisting of 0.02 M potassium dihydrogen phosphate buffer and acetonitrile (45:55), pH was adjusted to 2.7 using 50% orthophosphoric acid and pumped thorough chromatographic system at a flow rate of 1 ml/min. An isocratic elution mode was carried out at HPLC system (Agilent Technologies, 1200 series, USA) fitted with variable wavelength detector and data processing software ChemStation. For sample analysis, 20µl sample was injected and eluate was monitored at 225nm wavelength. Pharmacokinetic evaluation was performed in rabbits after the oral administration of valsartan loaded PVA-copoly(AA) hydrogels. The mean Cmax of valsartan was 408.439ng/ml, Tmax was 12h and half life (t1/2) was 8.812h. The extraction procedure was simple with good response even at very low drug concentration, thereby making this method suitable for pharmacokinetic application. It is concluded that developed method is simple, fast, cost effective, and reproducible for the analysis of pharmacokinetic parameters in the rabbit plasma. [ABSTRACT FROM AUTHOR]