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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]

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]

Alternaria alternata and Fusarium sp. are causal agents of fruit rots in grapes. Therefore, efficiency of chemicals, botanicals and antagonists has been estimated for the management of fruit rots of grapes. The current study was conducted at Department of Plant Pathology, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi during 2019 to identify the most efficient technique to control rots of grapes by different treatments of chemicals i.e. (salicylic acid, copper sulphate, sodium bicarbonate, topsin-M) at three concentrations (0.05, 0.2 and 0.4%) were applied. In addition, botanicals including aqueous extracts of eucalyptus, Murraya koenigii and Putranjiva roxburghii at concentrations (0.5, 1% and 2%) were also evaluated against the test fungi. Negative control included the raising for fungal cultures without any treatment with chemicals or botanicals. Efficiency of antagonists (Trichoderma sp.) was estimated by dual culture technique. Trichoderma sp. growth on media plate referred as positive control. Percent growth inhibition (PGI) was measured in both techniques by measuring the radial growth of treatment and comparing with negative and positive control respectively. The results of the study showed that salicylic acid at all concentrations completely inhibited the growth of Fusarium sp. and Alternaria alternata. Copper sulphate also completely inhibited growth at concentrations of 0.2, and 0.4% However, sodium bicarbonate and Topsin-M were least effective against both pathogens. Among botanicals, aqueous extract of Murrayakoenigii and Putranjiva roxburghii significantly controlled Fusarium sp. and Alternaria alternata. In dual culture technique, Trichoderma sp. successfully inhibited (52%) growth of Alternaria alternatawhile 48% growth of Fusarium sp. compared to the control. Chemicals such as salicylic acid, copper sulphate, botanicals (Putranjiva roxburghii and Murraya koenigii) and Trichoderma sp. as biocontrol agents are effective against the grapes pathogens. Therefore, these control measures must be adopted for grape fungal disease management and must be incorporated in integrated disease management strategy. [ABSTRACT FROM AUTHOR]

Objective: To assess growth hormone (GH) stimulation test efficacy in short stature workup for establishing GH deficiency. Study Design: Cross-sectional survey. Place and Duration of Study: Diagnostic Endocrine Section, Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Aug 2020 to Jan 2021. Methodology: The study was conducted on 129 individuals aged 2-16 years. History, axiological data and biochemical parameters were assessed to establish GH deficiency for short stature workup. Results: Out of 129 individuals, 76(59%) boys and 53(41%) girls reported GH stimulation tests. 81(62.3%) children were in <3rd percentile, 29(22.3%) in <5th percentile, 9(6.9%) in <10th percentile and 5(3.8%) in <25th percentile. Among the group with bone age difference >2 years, 34(82.9%) fell in <3rd percentile. GH Stimulation test post-Levo Dopa was performed in 102(78.46%) patients. 49(37.4%) patients responded inadequately to the GH stimulation test. The adequate response to the GH Stimulation test improved as the percentile declined from the 50th to the 3rd percentile. Conclusion: GH stimulation test results can only partially rely upon though their importance remains in combination with other short-stature workup parameters for ruling out growth hormone deficiency. [ABSTRACT FROM AUTHOR]

Field trials were conducted on the efficacy of different control options against Helicoverpa armigera on tomato. We evaluated and compared pest control, safety to natural enemies, crop yield and economics of application for various treatments including: a mycoinsecticide based on Beauveria bassiana; a baculovirus, H. armigera nucleopolyhedrovirus (HaNPV); a plant extract from Dodonaea viscosa; and the insecticide chlorantraniliprole (Coragen®). Trial sites were located in the Bahawalpur, Faisalabad and Rawalpindi regions in Punjab, Pakistan. A combined application of HaNPV + chlorantraniliprole was better than all other treatments in reducing pest larval populations and fruit damage, and in increasing crop yield. The least effective control was with D. viscosa, but plots treated with this plant extract also had the greatest number of natural enemies. Treatment with HaNPV + chlorantraniliprole resulted in the fewest natural enemies at all observation times and in all field sites, but the highest yields, varying from 42.8–46.6 tons ha−1, and the highest cost:benefit ratios of 1:1.74–1:1.81. Our findings suggest that a combined application of a specific microbial agent and an insecticide effectively controls H. armigera, increases tomato yield, reduces costs and maximizes economic returns. This open-field study concludes that all of the microorganisms and other treatments have the potential to combat H. armigera populations and could be used in successful integrated pest management programs. [ABSTRACT FROM AUTHOR]

Objective: To present our experience regarding the safety and efficacy of prone PCNL in morbidly obese patients. Study Design: Observational study. Setting: Armed Forces Institute of Urology, Rawalpindi. Period: February 2018 to February 2020. Material & Methods: After applying inclusion and exclusion criteria, a total of 47 morbidly obese patients undergoing PCNL in prone position were observed prospectively. The demographic data, intraoperative and postoperative outcomes were evaluated. The data were analyzed by SPSS ver. 24. Results: Average age was (46.43±10.41) years with (70.2%) males and (29.8%) females. The mean basal metabolic index (BMI) is (40.47±3.37) kg/m2 and mean stone size was (2.93±0.49 mm). A single stone is seen in twelve patients (25.5%), multiple in sixteen (34.0 %), partial staghorn in nine (19.1 %) and complete staghorn calculus in ten (21.3%) patients. The mean operative time was (83.38±13.20 min), duration of hospital stay (55.94±16.52 hours), stone-free rate (72.3%) and only (27.7%) patients had re-intervention. Calcium oxalate is the most common stone encountered followed by calcium phosphate and uric acid. Intraoperatively, transfusion secondary to bleeding and postoperatively grade 3 clavien-dindo classification is most commonly seen. Conclusion: Prone PCNL is an effective and safe procedure for morbidly obese patients. [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 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 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 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 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]

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]

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 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 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]

ABSTRACT Objective: To determine the pattern of drug abuse from different clinical settings in a reference laboratory of Pakistan during the COVID-19 pandemic and assess any change from the previous trend. 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 Mar to Dec 2020. Methodology: Out of 6902 subjects tested for drug abuse, 672 subjects with positive results were included in the study. The study population was divided into three main Groups. i.e., Psychiatry, ITC/Emergency and Workplace testing. A pattern of drug abuse was compared in the pre (MarDec 2019) and postCOVID (MarDec 2020) periods. Results: Out of 672 study subjects, 338(50%) were psychiatry patients. Around 629(94%) subjects were males. Mainly young individuals (306, 46%) were affected. Cannabis was the most frequent drug of abuse detected (357, 53%), followed by Benzodiazepines (BZD) (236, 35%) individuals and Opiates (47, 7%). Compared with preCOVID data, an overall increase of 3% in the total frequency of drug abuse from 392(7%) to 672(10%) was found in 2020. About 14% decrease, from the frequency of 81(21%) to 47(7%) in Opiates usage, while 8% increase in frequency, from 106(27%) to 236(35%) in Benzodiazepines, was observed. There was significant mean difference (p<0.001) between Psychiatric and ITC patients. Conclusion: Most frequent drug abuse in our settings is Cannabis, followed by Benzodiazepines and Opiates. An overall increase in drug abuse frequency while a decrease in the frequency of Opiates users has been observed, a finding different from previous studies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To compare serum Copper, Zinc, Lead, Aluminium and Iron levels in patients with Parkinson's disease with healthy subjects and the association of these trace elements. Study Design: Comparative Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology at Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Nov 2019 to Jul 2020. Methodology: Out of the total of 129 study participants, 83 were Parkinson's disease patients, and 46 were healthy subjects. Serum Iron level was measured on random access fully automated chemistry analyser advia 1800. In addition, Copper, Zinc, Lead and Aluminium were measured by atomic absorption spectrophotometry. These levels were compared between patients with Parkinson's disease and healthy subjects using the MannWhitney U test. Results: Out of the total 129 subjects, males accounted for 51(61.4%) and females were 32(38.6%) in the diseased Group, while in healthy subjects, males accounted for 22(47.8%) and females for 24(52.2%). Levels of Copper, Zinc and Iron were significantly decreased in patients with Parkinson's disease compared to healthy subjects (p<0.001). However, serum concentrations of Aluminium and Lead showed an increasing trend in patients with Parkinson's disease compared to agematched healthy subjects (p<0.001). Conclusion: Decreased levels of serum copper, iron and Zinc were seen in patients with Parkinson's disease, while aluminium and lead levels were raised, showing the potential neurotoxic role of these elements. [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 µm, 332.81 ± 144.69 µm after one month, 292.81±147.59µm 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 µm, 364.52 ± 167.95 µm after one month and 323.37±155.74 µm 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]