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August 5, 2019, was a black day in the history of Sub-continent when I India took a unilateral decision to abrogate Article 370 and 35A from its constitution. In the light of Article 370, Kashmir enjoying a special status as it is disputed diversity between India & Pakistan. With its annulment, the special status came to an end. The abrogation of Article 370 also implies the abolishment of Article 35A, thus the non-residents could now purchase property and take up the government jobs in Indian Illegally Occupied Jammu and Kashmir (IIOJ&K). The abrogation has implications for the region; it could lead to gross human rights violations and could lead to violence along the Line of Control. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of 5% Permethrin with the oral Ivermectin for management of scabies. Study Design: Quasi-experimental Study. Place and Duration of Study: Department of Dermatology, CMH, Abbotabad Pakistan, from Jun to Nov 2021. Methodology: Our study enroled 100 patients, aged 5-80 years, after informed consent. Demographic information and study variables were noted in a data colection tool. Al participants were randomly assigned to one of two groups i.e. Group A received Permethrin 5% twice with a one-week interval, whereas Group B received a single dose of oral Ivermectin. The evaluation was conducted at 2-4 week intervals. Results: From our sample of 100 participants, 57 were females and 43 were males; age ranged from 5 to 80 years. Group A of Permethrin-5% 43(86%) patients' symptoms improved than in Group B 24(48%) patients of oral Ivermectin. There was also a statisticaly significant relationship between Permethrin and Ivermectin (p-value<0.001). Conclusions: Permethrin is more effective than Ivermectin as first dose response. Permethrin is more compliant and safer for scabies patients. [ABSTRACT FROM AUTHOR]

Objective: To study the adjuvant per-operative epidural administration of Triamcinolone in lumbar disc surgery to aleviate post-operative pain. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022 Methodology: Hundred patients aged 20 to 80 years, of either gender, with a single-level prolapsed intervertebral disc and nerve root compression were included and underwent unilateral single-level decompression. A pre-operative MRI scan of the lumbo-sacral spine was done to confirm the diagnosis. Al patients initialy received conservative management (analgesics and physiotherapy) but failed to respond to it. They were divided into two groups by the lotery method. In Group A, an epidural steroid was administered, while Group B acted as the control. Pain was recorded pre-operatively at 24 hours and then at 1 and 2 weeks post-operatively using the Visual Analogue Scale. Results: The pre-operative median VAS of Groups A and B was not significant at pre-operation. After 24 hours of operation, the median VAS of Group A patients was VAS 3 (1), while in Group-B it was 2 (1), (p-value of 0.001). After 1 week, the median VAS of Group-A patients was 2 (2) and Group-B was 3 (1), with a significant p value of 0.024. After 2 weeks, the median VAS of Group-A patients was 1 (1) and Group B was 2 (1), with a significant p value of 0.015. Conclusion: Intra-operative epidural and foraminal administration of steroids in single-level lumbar disc surgery significantly reduces pain in the immediate postoperative period but has no benefit in the folow-up period. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical response of EMLA cream (Eutectic Mixture of Local Anaesthetics; 2.5% Lidocaine/2.5% Prilocaine) in decreasing peripheral cannulation pain in children. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from May to Aug 2021. Methodology: This study was conducted on 80 paediatric patients who were classified as American Society of Anesthesiologists (ASA) Grades I and I and selected using non-probability consecutive sample. They underwent peripheral cannulation to maintain intravascular access for surgical procedure. The forty children in EMLA Group (Group-A) were applied 2.5 ml EMLA cream for 60 min, covered by Tegaderm® over suitable vein, while the 40 children in Control Group (Group-B) received no local anesthetic cream. Participants rated pain during venipuncture on Visual Analog Scale (VAS 0-10; 0, no pain; 10, intolerable pain). Results: Out of 80 patients equaly divided into two groups, 40(50%) were males, while 40(50%) were females. The patients included in our study had mean age of 7.35±1.5 years. In EMLA group the mean score of pain was 1.5±0.87 compared to the Control group (mean score = 7.4±1.4; p=0.001). Conclusion: The result of our study suggests that EMLA cream is more efficacious in decreasing venipuncture pain than if no local anaesthetic cream is applied. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the health professional's knowledge, atitude, and practices towards the COVID-19 pandemic in Karachi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Karachi Pakistan, from Mar to Jul 2020. Methodology: A total of 228 healthcare professionals, i.e. specialists, physicians, nurses, and technicians working in the district East of Karachi were included. Independent sample t test and ANOVA were used for inferential statistics. Results: Our findings showed that 95% study participants had a good knowledge regarding the infection and 81.8% showed a positive atitude towards the infection with over 98% reporting good professional practices regarding COVID-19 infection control. Conclusion: These findings underscore the effectiveness of ongoing education and training initiatives among health professionals in Karachi, contributing to their preparedness and ability to effectively respond to the chalenges posed by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Calcium and Vitamin D deficiency is highly prevalent in Pakistan. Both micronutrients have a significant role in human growth and development. Supplementation becomes essential when the available natural sources like food and sunlight, cannot replenish the deficiencies. Nevertheless, it is critical that while prescribing Calcium or Vitamin D supplements, physicians should know the composition and specific application of each supplement. This review explores the different types of Calcium and Vitamin D pharmaceutical supplements available in the market their composition, indication and contraindications. Data of Calcium and Vitamin D supplements has been colected by Pakistani drug sites databases, including 'Drug Infosys (www.druginfosys.com)', 'Dawaee.pk', 'Sehat.com.pk' and 'Medicine Net' by pharmacists and orthopaedists. The commonly prescribed supplements are Cholecalciferol (Vitamin D) and Calcium Carbonate (Calcium). Over time, an increase in market share of Vitamin D and Calcium supplementations is due to their over-the-counter availability, increased physicians' prescriptions, and self-prescribed use by the population. There is a need to develop national guidelines and policies to safeguard the population's health at large. [ABSTRACT FROM AUTHOR]

Considering the learning style of learners is as significant as the course content being taught in educational institutions. Education based on student-preferred learning styles strives to provide learning methods as well as educational content appropriate for the students. Focusing on preferred learning styles in curriculum designing and academic activities can enhance its effectiveness. The purpose of the current research was to explore the preferences of university students concerning general preferences of learning styles, gender, and discipline differences. The sample consisted of 495 students (44% were females and 55% were male students) of age range 18 to 26 years enrolled under five major faculties from different universities in Pakistan. Felder-Soloman Index of Learning Styles (ILS), a 44-item scale was administered for this purpose. This study addressed three key purposes: The first purpose was the investigation of the general profiles of university students regarding learning style. The second purpose was the exploration of the learning style differences regarding gender while the third purpose was the examination of differences in students' learning styles regarding various disciplines. The statistical practices of average, t-test, ANOVA along with Tukey tests were employed for analyzing data. The preferred learning style of more than half of the students in the present study were sensing, verbal, global, and active learners. Students Learning Styles if grouped according to gender shows higher frequency of male students in Visual-verbal, Active- Reflective, Sequential-Global learning styles. Frequency of female students was higher compared to male in Sensing-Intuitive learning style. Overall result revealed significant differences among university students regarding gender. Results also indicated that the students scored differently in learning styles concerning disciplines in the four ILS scales. This study highlights significant differences in learning styles among university students based on gender and academic discipline. Educators should consider these differences when designing instructional strategies to ensure they are inclusive and effective for all students. Future research should explore these learning style variations in different educational contexts and investigate additional factors influencing learning preferences. [ABSTRACT FROM AUTHOR]

This paper reviews historical, economic and social reasons for working people to migrate from five Central Asian Republics (CARs) to Russia in the early 21st Century. Relationships between Russia and the five Central Asian States changed dramatically after the USSR collapse and in the ensuing three decades, large numbers of workers from Central Asia migrated to Russia. It became imperative for migrating workers to learn Russian to mingle socially and gain economic benefits. Russian-speaking workers amalgamated well in Russia and their remittances improved the GDPs of their home states. However, with greater numbers of migrating workers, Russia imposed new migration laws that required better competence in Russian, which resulted in new difficulties and challenges for migrants and those who aspired to move to Russia for work. [ABSTRACT FROM AUTHOR]

This paper focuses on the actors in the new emerging Cold War. In the last century, the world was experiencing a phase of geopolitical rivalry between two major powers, commonly referred to as the Cold War. After surviving fifty years of proxy warfare, sanctions, arms race, and security concerns between the two dominant worldwide factions, the struggle finally came to an end. The USA exerted significant influence over the western bloc, while the Soviet Union dominated the eastern bloc. The global geopolitical scenario has seen substantial transformations in the twenty-first century. The global landscape has shifted towards a multipolar configuration, resulting in conflicts that have highly unorthodox characteristics. China, being a major player, actively engages in world politics and is enjoying a fair share in a market economy and the development of infrastructure. Amid the ongoing global quest for dominance, Europe is experiencing an emergence of new dynamics, each with its unique alliances and ideas. This article aims to analyze the potential for collaboration and conflict between the major players in the emerging global power transition during the early stages of this Cold War. [ABSTRACT FROM AUTHOR]

Incorrect DegreesDear Editor,MRCP, FRCP, FRCS, MRCS, FCPS, MRCOG, DGO, DCH, FRCOG, and FACS are diplomas awarded by Colleges, Boards, or Institutions. Treating them as.Degrees is IncorrectDouble-barreling oneself, though very common, is rather silly.By Alaf KhanReported by Author [Extracted from the article]

The article discusses various medical practices and traditions in Pakistan, particularly in rural areas. It highlights the use of circumcision ceremonies as elaborate celebrations in the past, which have now been replaced by surgical procedures. The author also describes traditional medical treatments such as bloodletting, branding, and the use of leeches. The article touches on the history of medical advancements, including the introduction of antibiotics and the ongoing battle against viruses and bacteria. It also addresses the issue of misleading titles and designations used by medical professionals. Overall, the article provides insights into the cultural and historical context of medical practices in Pakistan. [Extracted from the article]

Objective: To determine the correlation between the severity of depression and cognitive impairment. Study Design: Cross-sectional study. Place and Duration of Study: Department of Psychiatry, Combined Military Hospital, Gujranwala, Pakistan from May 2016 to December 2016. Methodology: The cross-sectional study was conducted on outpatients in the Department of Psychiatry at Combined Military Hospital Gujranwala. The diagnosis of depression was made based on the WHO's ICD10 diagnostic criteria, and symptom severity was assessed using the Beck Depressive Inventory. Deirdre M. used the Montreal Cognitive Assessment version 7.1 to assess cognitive impairment. Results: Eighty-six subjects were included in this study. A comparison of cognitive impairment and depression revealed that in a total of 16 subjects with minimal depression, only 5 had cognitive impairment; in 14 subjects with mild depression, 11 showed cognitive impairment; 26 subjects had moderate depression, out of which 18 showed signs of cognitive impairment; and among 30 subjects with severe depression, there was cognitive impairment in 25 individuals. The Spearman correlation showed a weak correlation of 0.321 (p<0.001). Conclusion: A high level of depressive symptoms, although weak, is significantly correlated with cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of oral Theophyline compared to Non-Steroidal Anti-Inflammatory Drugs in the management of postdural puncture headache in obstetric patients. Study Design: Quasi-experimental Study. Place and Duration of Study: Anaesthesia Department, Combined Military Hospital, Kharian Pakistan, from Apr to Sep 2018. Methodology: Our study enroled 60 pregnant women suffering from postdural puncture headache. The were divided in to two groups, NSAID-Group (Group-A) who received 30mg of Ketorolac in three divided doses in 24 hours and Theophyline-Group (Group-B) who received 750mg of oral Theophyline in three divided doses in 24 hours after which effects of both drugs were noted. Results: Pregnant women were enroled in NSAID-Group and in Theophyline Group. Mean baseline Visual Analogue Scale score was 7.500±0.97 in NSAID-Group and 7.33±0.92 in Theophyline Group. Mean weight was 66.86±5.25 kg in NSAID-Group and 67.16±7.01 Kg in Theophyline-Group. In NSAID-Group efficacy was noted in 7(23.3%) patients as compared to 25(83.3%) patients in Theophyline-Group, (p<0.001). Conclusion: Theophyline when given oraly in the management of postdural puncture headache proved to be a superior alternative to NSAID medication. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Antithrombin II and Factor V Leiden mutation in stroke among young patients and its association with various socio-demographic aspects. Study Design: Cross-sectional study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2020. Methodology: A total of 103 individuals, aged 18-65 years, with acute ischemic stroke were included. The diagnosis was confirmed using computed tomography/Magnetic Resonance Imaging Brain scan. Plasma AT II activity and Factor V Leiden mutation were analyzed using standard techniques. Various socio demographic features like age, gender, body mass index, smoking, deployment at High altitude (>10,000 feet), family history of stroke and hyperlipidemia were recorded and statisticaly analyzed. Results: Only two (1.9%) patients had AT II deficiency while one (0.9%) patient showed Factor V Leiden mutation. Al patients were male. Working at high altitude, family history of stroke and tobacco smoking were related with the presence of low AT II levels (p-value <0.05). Conclusion: Testing for hypercoagulable states in the seting of stroke in young may be useful if there is family history of stroke, smoking and high-altitude deployment. Investigations to search for the cause should be tailored as per individual patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of sleep quality and quantity on the academic performance of medical and non-medical students. Study Design: Comparative cross-sectional study. Place and Duration of Study: Various universities in Rawalpindi and Islamabad from Jun to Aug 2022. Methodology: The study included medical and non-medical students of either gender, aged 18-24 years. A structured, validated questionnaire, comprising two sections, was used. The first part consisted of demographic information. The second part comprised the Pitsburgh Sleep Quality Index, a measure of the quality and patern of sleep. Results: A total of 356 participants were divided into two groups: medical and non-medical. Out of 192 medical students, 98(50.5%) reported excelent sleep, 60(30.9%) reported good sleep, and 36(18.6%) reported poor sleep. Out of 194 medical students, 88(45.4%) were excelent in academics, 60(30.9%) were good, and 46(23.7%) had poor performance. Out of 164 nonmedical students, 62(37.2%) reported excelent sleep, 70(42.7%) reported good sleep, and 32(19.5%) reported poor sleep. Among these 164 non-medical students, 84(51.2%) had excelent, 41(25.0%) had good, and 39(23.8%) had poor academic performance. A significant association (p<0.05) was found between the Pitsburgh Sleep Quality Index score and academic performance. Conclusion: The majority of medical and non-medical students slept for less than 7 hours each night. Students who got excelent sleep performed wel in both groups. [ABSTRACT FROM AUTHOR]

Objective: To explore demographics, causes, types, bacteriology and outcome of operative hand infections presenting to the Emergency Department of Civil Hospital, Karachi. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Plastic and Reconstructive Surgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Aug 2021 to Apr 2022. Methodology: Patients presenting in Emergency Room with hand infections were studied as per the inclusion criteria. Hand surgeries were performed under general, regional or local anesthesia. Patients were folowed til their discharge from the hospital. Results: A total of 280 patients were studied with predominance of males 182(65%) and median age of 48 years. 189(67.5%) patients had injury in right hand. Among 280 patients, total hand injuries were 300 and the most affected site was dorsum 72(7%) while palm volar was the least affected site 5(1.8%). Eighteen (6.4%) patients had more than one site involved in hand injury. The most frequent infection was superficial abscess 85(30.4%) folowed by felon 81(28.9%), deep abscess 68(24.3%), paronychia 34(12.1%), necrotizing fascitis 18(6.4%), osteomyelitis 10(3.6%) and septic arthritis 3(1.1%). Out of 280 patients, 44(15.7%) did not show positive culture growth. Staphylococcus aureus was the most frequently detected pathogen 167(59.6%) whereas Group A Streptococcus was seen in a single case. Conclusion: Our study concluded that occupational hand injuries were common because of trauma. The most frequently occurring infections in our setings was superficial abscess and the commonest causative pathogen was Staphylococcus aureus. [ABSTRACT FROM AUTHOR]

Objective: To detect the frequency of anti-HCV antibodies in hemodialysis patients. Study Design: Cross-sectional study. Place and Duration of Study: Department of Virology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jul to Dec 2021. Methodology: One hundred and fifteen patients were selected from the Hemodialysis Centre. Blood samples were taken from patients undergoing hemodialysis to detect anti-HCV by enzyme-linked immunosorbent assay. The samples were spun up and checked for anti-HCV antibodies using the Bio-Rad Monolisa anti-HCV version 3 kit and a 3rd generation ELISA. Results: A total of 115 patients were tested for anti-HCV. The anti-HCVs in this study were detected in 34(29.56%) patients. The mean duration of hemodialysis was 2.3±1.4 years. Out of 115 patients, 81(70.4%) had no significant history. Of the 34 positive patients, 15(44.2%) had a history of intravascular exposures, 12(35%) had a history of blood transfusion, 3(8.8%) had a history of tooth extraction surgery during the dialysis period, and 4(11%) had a history of minor surgery during dialysis. Conclusion: The study emphasizes the significant frequency of HCV infection in hemodialysis patients, particularly those with a history of intravenous exposure and blood transfusions. [ABSTRACT FROM AUTHOR]

Objective: To test the sensitivity of localy available strips for the detection of Plasmodium Vivax and Plasmodium Falciparum species at a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion, Rawalpindi Pakistan, done over one week during Nov 2021. Methodology: Four different commercialy available brands of Malaria Rapid Diagnostic Tests were taken. They were tested against venous blood sample taken from only one patient who had lab detected Malaria. Light microscopy showed trophozoites of both Plasmodium Vivax and Falciparum. Nine serial dilutions of different strengths were made from blood sample. These dilutions were tested against commercialy available four different Rapid Diagnostic Tests strips. Results: Malaria Rapid Diagnostic Tests kits from al the four brands which were commercialy available showed positive results for Plasmodium vivax up to 1:512 dilutions. However, only one brand Rapid Diagnostic Tests kits showed positive results with Plasmodium falciparum in 1:2 dilutions, in addition to Plasmodium vivax. Conclusion: The commercialy available Rapid Diagnostic Tests Immunochromatographic Technique have high sensitivity in diagnosing Malaria, but are not resolute when it comes to speciation, particularly for Plasmodium falciparum. [ABSTRACT FROM AUTHOR]

Objective: To note short-term outcome of patients undergoing tetralogy of falot repair. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi Pakistan, from Sep 2020 to Feb 2021. Methodology: A total of 113 patients under 25 years of age who underwent tetralogy of falot correction were included. Preoperative information, echocardiography, investigations and history of the patient were noted. Intra-operative and postoperative information and surgical procedure were also noted. Short-term outcome included data up to discharge or death of the patients enroled. Results: Mean age was noted to be 9.40+5.01 years, with 59(52.2%) of the patients undergoing tetralogy of falot repair were male. Mean saturation of peripheral Oxygen (SpO2) at the time of surgery was noted to be 79.27±.34. There were 76(67.3%) patients without history of previous surgery. Mean cardiopulmonary bypass time was noted to be 106.04±40.59 minutes. Mean aortic cross-clamp time was recorded to be 58.79±27.90 minutes. Additional procedures were required in 68(60.2%) patients. Mean duration of hospital stay was 13.96±8.68 days while mean duration of ICU stay was 87.04±69.37 hours. Mortality was reported in 3(2.7%) patients. Conclusion: Low mortality and low post-operative morbidity were noted among patients undergoing tetralogy of falot repair. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal bleeding in pregnant women undergoing term and pre-term Cesarean delivery. Study Design: Comparative cross-sectional study. Place and Duration of Study: Gynecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi, Pakistan Jan to Jun 2021. Methodology: A total of 211 pregnant women undergoing Caesarian section at our tertiary care center were included in the study. They were divided into two groups based on gestational age as term or pre-term, with delivery at 37 completed weeks being labeled ful term. Lower segment cesarean section was carried out by consultant gynecologist on al the patients as per standard protocol and blood loss was compared in term and pre-term Caesarian deliveries. Results: Out of 211 study participants, 108(51.1%) had a Caesarian section at term while 103(48.9%) had pre-term Caesarian section. The mean age of participants was 29.35±4.10 years. Mean blood loss during the Caesarian section in term pregnancies was 437.03±129.76 ml while in pre-term pregnancies was 641.26±157.40 ml. Independent t-test showed that bleeding was statisticaly significantly more in pre-term pregnancies (p-value<0.001). Post-operative hemoglobin was also significantly different in term and preterm pregnancies (p-vale<0.001). Conclusion: Women undergoing Caesarian section pre-term were at risk of having more blood loss and fal in hemoglobin levels as compared to those undergoing Caesarian section at term. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between Computerized Tomography severity score and oxygen saturation by pulse oximeter in patients of COVID-19. Study Design: Cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Apr 2021. Methodology: CT severity score was calculated for al patients who had undergone Chest CT scan. The oxygen saturation by pulse oximeter was noted at admission. Spearman rank correlation was calculated between the CT severity score and oxygen saturation on pulse oximeter. Results: There were 203 patients in this study. Among them, 124(61.1%) were male and 74(38.9%) females. The greater proportion of the patients, 138(68%) were between 36-55 years old, and 65(32%) were between 18-35 years old. There were 130(64%) patients who had low CT severity score, 73(36%) had high CT severity score. Among 73 patients who had high CT severity score, 67(91.7%) had shortness of breath (p-value<0.001), 48(66%) had fever (p-value=0.021), and 53(72.6%) belonged to the older age group of patients (p-value=0.0294). Statisticaly significant negative correlation between Computerized Tomography severity score and oxygen saturation was noted (rho=-0.264, p= 0.01). Conclusions: Our study provided evidence that there is a negative correlation between the Computerized Tomography severity score and oxygen saturation by pulse oximeter. [ABSTRACT FROM AUTHOR]

Objective: To analyze the role of ASA status in carrying out laparoscopic cholecystectomies by evaluating the perioperative findings of patients. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Jan 2019 to Jan 2021. Methodology: Laparoscopic cholecystectomies were performed on 385 patients with symptomatic galstones. The inclusion criteria comprised of symptomatic cholelithiasis, acute cholecystitis and chronic cholecystitis. Data for the perioperative findings such as galbladder grades, bile, cystic duct, cystic artery and Common Bile Duct were recorded during the study. Results: The study included 226(59%) female patients and 159(41%) males. The mean age was 48.15±15.5 years. There were 145(37.66%) patients in American Society of Anesthesiologists Classification ASA-I, 174(45.20%) patients in ASA-I and 66(17.14%) in ASA-II. Results showed that the abnormalities of cystic duct were 34(23.4%) in ASA-I, 68(39.1%) in ASA-I and 43(65.2%) in ASA-II. For CBD, they were 7(4.8%) in ASA-I, 49(28.2%) in ASA-I and 44(66.2%) in ASA-II. The complications of cystic artery and bile were 34(23.4%) in ASA-I, 60(34.5%) in ASA-I, 46(69.7%) in ASA-II and 82(56.6%) in ASA-I, 119(68.4%) in ASA-I, 50(75.8%) in ASA-II respectively. The galbladder grades I were 27(18.6%) in ASA-I and (4.5%) in ASA-II whereas, grades V were 7(4.8%) in ASA-I and 20(30.3%) in ASA-II. Conclusion: Peri-operative morbidity increased with increasing ASA status, therefore, there is a significant relationship between ASA Status and peri-operative findings. [ABSTRACT FROM AUTHOR]

Objective: To identify anatomical features, association and surgical results of patient with double chambered right ventricle. Study Design: Prospective longitudinal study. Place and Duration of Study: The Children Hospital and Institute of Child Health, Lahore Pakistan, from Jan 2013 to Dec 2018. Methodology: Al patients presenting with mid cavity right ventricular outflow tract obstruction were included. Al patients' demographic data, clinical profile, diagnostic reports, associated anomalies, and surgical data were recorded. Results: Fifty-two patients with mid-cavity right ventricular outflow tract obstruction of various ages (from 6 months to 31 years) were included. Ten patients (19%) presented in infancy. Forty-six patients (89%) had an associated ventricular septal defect, ten (15%) had aortic valve right coronary cusp prolapse with varying degrees of aortic regurgitation. Al patients had a right ventricular mid-cavity and infundibular muscle resection via the tricuspid valve. There was one hospital death due to an intraoperative global neurologic catastrophe. The median folow-up after surgery was 37.5 months. There was no late death. Conclusion: Doubly commited Ventricular septal defect with aortic valve right coronary cusp prolapse with varying degree of aortic regurgitation and absence of subaortic stenosis is a new finding in our study. Early and Medium-term surgical results of repair are excelent. [ABSTRACT FROM AUTHOR]

Objective: To evaluate response of neoadjuvant chemotherapy in Stage I-II triple-negative breast cancer and impact of pathologic complete response on survival. Study Design: Retrospective longitudinal study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore Pakistan, from Jan 2006 to Jul 2014. Methodology: Al patients with triple-negative breast cancer who received neoadjuvant chemotherapy were included and data was retrieved from cancer registry of hospital. The patients received neoadjuvant chemotherapy folowed by surgery. Radiotherapy was given wherever clinicaly indicated. Kaplan-Meier and log-rank test was used to calculate survival. Results: Out of 1113 triple negative breast cancer patients, 150 received neoadjuvant chemotherapy. Mean age was 43±7 years. Fifty-two patients (34.7%) achieved pathological complete response (complete eradication of invasive or in situ carcinoma in breast and axila (ypT0/is/ypN0) in surgical specimen). Over a median folow up of 61 months, 52 patients (34.7%) had disease progression. Patients with pathological complete response had significantly beter 5-years disease-free survival (pvalue 0.001) and 5-years overal survival (p-value 0.002) in comparison to non-pathological complete response group. The 5-years disease-free survival was 90% in pathological complete response group compared to 55% in non-pathological complete response group. Similarly, 5-years overal survival was 94% in pathological complete response group compared to 70% nonpathological complete response group. Conclusions: Neoadjuvant chemotherapy is an effective treatment modality in management of triple-negative breast cancer. Achievement of pathological complete response is a potential surrogate endpoint as it is associated with significantly beter disease-free survival and overal survival. [ABSTRACT FROM AUTHOR]

Objective: To assess the role of non-pharmacological interventions in relieving Tension-type headache. Study Design: Quasi experimental study Place and Duration of Study: Neurology department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: Tension-Type Headache was diagnosed by physician using the International Classification of Headache Disorders II (ICHD-II). Patients were randomized into two groups, Group-A was intervention Group and Group-B was the control group. Both the groups were folowed at 14 and 30 days. Visual analogue pain (VAP) scale and Headache Intensity Test 6 (HIT) was applied to evaluate the intensity of headache. Results: Out of 600 patients with chronic daily headaches, 210(34%) patients had Tension-type headache. The mean age of these females was 35.4± 9.342 years. A total of 112(53%) were working, 172(81.9%) were married. In terms of level of education, 68(32.4%) had done matriculation, 29(13.8%) had done FSc. and 113(53.8%) had completed higher education. At 28 days post intervention, there was significant improvement in Headache Impact Test (HIT) score (43.26±4.48 vs 49.81±5.52, pvalue <0.05) and visual analogue pain scale (3.19±1.481 vs 4.30±2.052, p-value <0.05), in Groups A and B respectively. Conclusion: There was improvement in intensity of mild to moderate Tension-type headache after nonpharmacological intervention. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of molecular markers along with serological markers of Hepatitis B virus, Hepatitis C virus and Human Immunodeficiency Virus among multi-transfused beta-thalassemia patients. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion, Rawalpindi Pakistan, from Apr to Jul 2020. Methodology: A total of 105 beta-thalassemia patients were included in this study. Demographic information and frequency of transfusion was noted. Serological markers were detected using chemiluminescence microparticle immunoassay while molecular markers were identified using real-time polymerase chain reaction. Results: Among 105 beta-thalassemia patients, 61(58.1%) were males and 44(41.9%) were females. The age range was from 2-34 years with a mean age of 11.8±6.4 years. Seropositivity and Nucleic Acid Testing reactivity was observed in 29(27.6%) and 16(15.2%) patients respectively. The frequency of hepatitis C Virus (HCV) antibodies and Ribonucleic Acid (RNA) was highest among infected patients while none of the patient was found to be reactive for anti-HIV and HIV-RNA. Viremia was detected in 12(11.4%) out of 29 seropositive patients and in 4(3.8%) out of 76 seronegative patients. Conclusion: Hepatitis C Virus was the most prevalent in beta-thalassemia patients folowed by Hepatitis B Virus and Human Immunodeficiency Virus. The serology should be augmented with NAT to detect viremia in seronegative cases as wel as seropositive cases. The NAT wil also help in early identification and treatment of infected patients and improve quality of life of these patients. [ABSTRACT FROM AUTHOR]

This refers to the excellent presentation and write up on Prof. Shahzad Ali Khan Vice Chancellor Health Services Academy's address at ILE Webinar published in April 15th issue of Pulse International.Very pertinent and well said and well written and reported Sir.By Prof. Rehan Ahmad KhanReported by Author [Extracted from the article]

Objectives: The objective of this study was to determine the time and sequence of emergence of permanent teeth of Baluchi children and compare them with other national and international reported data. Furthermore, to find out the effect of gender (male/female) type of schools (private/public); and relationship with height, weight, and body mass index of the children at the time of emergence. Methods: Systematic cluster random sampling procedure was used for sample selection. Two dentists along with 2 assistants visited 25 selected schools for data collection. Children with 'just erupted tooth' were selected for data collection. One thousand two hundred and sixty-seven selected children were examined. The selected children were examined for the status of emergence (not erupted, just erupted and erupted) in each tooth. Height and weight were measured and questions regarding food items usually consume in their families were recorded. Two independent samples 't' test, Pearson and partial corrections were used for comparisons and correlations. Results: Male children showed significant higher values of height, weight, and BMI as compared to the female children. Right 1st molars (#16 and #46) showed the lowest mean values of 5.5 and 5.6 years in upper and lower jaws, respectively. 2nd molars (#17 and #37) showed maximum mean values of 12.4 and 12.1 years in upper and lower jaws, respectively. Most of the mean values of male children were higher or equal to the female children. Most of the teeth showed higher values for private schools as compared to public schools. But none of above-mentioned differences were statistically significant. Twenty-two teeth showed significant correlation between emergence time and height of the children, while only 17 teeth showed significant correlation with weight. Conclusion: Mean eruption time of this study was higher than other national studies, but almost the same as other countries data. The eruption time of female children were insignificantly earlier than male children, which do not agree with other American, European African children. Time of emergence was delayed with increasing height, irrespective of the heavy or lightweight children. However, emergence time delayed with weight, if the child was also tall, but has no relationship with weight if the child is short [ABSTRACT FROM AUTHOR]

Poultry industry is confronted to different hurdles which are blamed for the decline in the nutrients supplements for humans. One of the hurdles is the oxidative stress, which is responsible for the reduction of gut morphology and growth performance in the poultry birds. The present study was performed to explore the impact of inorganic selenium (sodium selenite). Day old chicks were kept in a control environment. At day 7, five groups were made with four replicas in each group based on the diet being offered. Group A, the positive control group fed with normal basal diet group B was termed as negative control group offered basal diet + dexamethasone and group C, D and E was offered 0.2mg/kg, 0.3mg/kg, and 0.4mg/kg of basal diet, respectively. The trial lasted for 35-days and on the last day two chickens from each replicate were slaughtered (a cumulatively eight chickens from each group). Samples from different regions (duodenum, jejunum, and ileum) of the small intestine were collected and kept in the fixatives. Slices from each part were stained with H and E stain to make it fit for microscopy. Picture were taken with different magnifications, i.e., 4X, 10X and 40X and histo-morphometry was done through Pixel-Pro (Labomed America Inc). The statistical analysis was through IBM SPSS (Statistics.V22.X86). The present study concluded that selenium improves the intestinal morphology i.e. villus height, villus width, villus surface area showed better growth(P=0.05) in the selenium supplemented groups. The FCR initially did not differ (P=0.05) among the groups but toward the end it was comparatively better (P=0.05) in selenium supplemented groups. The relative body weight of different organs i-e liver, gizzard, heart, pancreas, and proventriculus etc. showed significant (P=0.05) results in each of selenium-supplemented groups. Overall, 0.3 mg/kg (Basal diet) of selenium showed better results with respect to the positive control group. [ABSTRACT FROM AUTHOR]

The Department of Brain and Spine Surgery at Lady Reading Hospital in Peshawar recently organized a Residency Orientation session. The Head of the Neurosurgery Department, Dr. Muhammad Nawaz Khan, welcomed the residents and emphasized the qualities needed to become successful neurosurgeons, including knowledge, skills, emotional stability, and physical stamina. The session also included discussions on the CPSP syllabus, dissertation writing, and the format of the CPSP Part-2 exam. The department was praised for its structured training programs and its status as one of the largest units in the country. The session concluded with the presentation of a lifetime achievement award to Dr. Ali Haider, a senior faculty member. [Extracted from the article]

The present study is the first record of deducing age-wise and sex-wise normal reference intervals (RIs) for various serum biochemical attributes in apparently healthy Sipli sheep being reared under intensive farming system at Livestock Farm of the Faculty of Veterinary and Animal Sciences (FV&AS), The Islamia University of Bahawalpur (IUB). Blood samples were aseptically collected, serum was harvested and analyzed for serum chemistry analytes through semiautomatic chemistry analyzer using commercial kits. For the sake of analysis, groups were assigned as per age i.e. G1= up till 1year (n= 41), G2= from 1 to 2 years (n= 46), G3= from 2 to 3 years (n= 43) and as per sex i.e. females (n= 79) and males (n= 51). All the overall mean values and RIs for all the studied attributes were within the reference ranges provided in earlier studies for sheep. Bilirubin, Alkaline Phosphatase (ALP) and creatinine were significantly (P=0.05) lower in females as compared to those in males. However, uric acid was significantly (P=0.05) higher for females 52.8±2.6mmols/L as compared to 44.5±2.9mmols/L for males. The remaining attributes (Alanine Transaminase, Aspartate Aminotransferase, Total Proteins, Albumin, Glucose, Low Density Lipoproteins, High Density Lipoproteins and Urea) did not differ -significantly (P=0.05) between male and female sheep under study. For age-related results, only ALP, glucose and HDL were significantly (P=0.05) different between the three studied age groups of Sipli sheep. The ALP and glucose were higher in G1 animals (up till 1 year) whereas HDL was lower in G2 animals (from 1 to 2 years) as compared to their counter-part groups 1 and 3. The data can be beneficial in diagnostic/prognostic purpose for veterinarians, academicians, researchers and all other stakeholders of sheep-rearing sector in Pakistan as well as for other indigenous sheep breeds being reared under similar climatic conditions throughout the world. [ABSTRACT FROM AUTHOR]

Objectives: The study focused on investigating the reasons why participants visited quacks for prosthodontics therapy, what factors motivated them to do so, and how satisfied they were with both quacks and qualified dentists. Methodology: This cross-sectional study was conducted between June 2023 and October 2023. A total of 110 patients, aged between 45 and 65 years, who had visited quacks for prosthodontics procedures in the past six months, were interviewed at three different well-equipped clinics in Peshawar. The collected data on their motivations/reasons for seeking treatments from quacks were collected through a pre-designed and pre-tested questionnaire and analyzed through basic statistical methods. Results: Female to male ratio was 1: 1.75 in the current study. The pattern of awareness and reasons for visits to the quacks was observed same for both genders (P> 0.05). The primary reason for visiting the quack was often a lack of awareness. Other factors included economic considerations, proximity to one's residence, the convenience of a single appointment, and referrals. The level of education and age of the participants did not have a significant effect on the scenario (P > 0.05). Many of the participants expressed dissatisfaction with the treatment they received from the quacks and stated that the services offered by qualified dentists were better, safer, and less painful. Conclusions: Awareness programs for altering the attitudes of the community are mandatory. Furthermore, it is essential to implement strictly established laws to stop the illegal practice of quacks. In addition, doctors are deployed to rural areas for practice. [ABSTRACT FROM AUTHOR]

Objective: To provide an account on the demographics, etiology, co-morbidities, presentation findings and frequency of patients with cranial nerve palsies presenting to our Neuro-Ophthalmology clinic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Neuro-Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Dec 2017 to Jun 2022. Methodology: A total of 82 patients were included in the study. The data was compiled on a single proforma by a single investigator which included Co-morbidities, presentation findings (ptosis, headache, diplopia, extra-ocular movements, Anisocoria, Visual Acuity for both eyes, Media and Fundus examination findings). Contrast Enhanced MRI (CEMRI) results were also tabulated where performed. Potential causes such as diabetes mellitus, hypertension, space occupying lesions, aneurysms and injury were also documented for each patient. Results: A total of 22 patients had 3rd nerve palsy, 9(40.91%) out of them had partial 3rd nerve palsy while 6(27.31%) had ischemic 3rd nerve palsy. Out of 45 cases of 4th and 6th nerve palsy, 13(28.90%) patients had ischemic fourth nerve palsy and 13(28.90%) patients had ischemic 6th nerve palsy, followed by post-traumatic fourth nerve palsy. Conclusion: We have provided an account of the possible etiologies and presentation findings in patients presenting with ocular motility disorders in our setting. Diabetes Mellitus was the most common microvascular cause for ischemic cranial nerve palsies. More sinister pathologies like myasthenia gravis, often presenting as mimickers of isolated cranial nerve palsies were quite common in our study. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess the effect of Neodymium: Yttrium Aluminium Garnet laser (ND:YAG laser) on endothelial cell count loss and anterior segment elements. Study Design: Quasi-experimental. Place and Duration Of Study: Armed Forces Institute of Ophthalmology, Rawalpindi from Jul 2021 to Feb 2022. Methodology: A total of 60 patients with a history of posterior capsular opacities planned for Neodymium: Yttrium Aluminium Garnet laser posterior capsulotomy were included. Specular microscopy was done pre and post-laser to study and parameters such as central corneal thickness, endothelial cell count, intra-ocular pressure was noted. Data were analyzed by using the Statistical Package for the Social Sciences version 23 software Result: After four weeks of Neodymium: Yttrium Aluminium Garnet laser, there was no significant change in the intraocular pressure (p=0.334), however, the visual acuity improved from 0.6±0.3-0.05±0.1 (p<0.001) along with a decrease in endothelial cell count 2101±485-1919±427 (p<0.001) and central corneal thickness 0.504±0.03-0.502± 0.03 (p=0.010). A similar trend of changes in the parameters was observed for lower (1.0-1.2MJ) and higher energy (2.1-2.5MJ) in the sample for posterior capsulotomy. Conclusion: Our study concluded that the corneal structural changes occur post-Neodymium: Yttrium Aluminium Garnet posterior capsulotomy, including changes in endothelial cell count. However, there is no significant disturbance in the intraocular pressure after the procedure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of artificial tear treatment on central corneal thickness in patients with dry eyes coming to a tertiary care eye hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Tertiary Care Eye Center, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Nov 2022. Methodology: The study included central corneal thickness of 210 eyes (n=210) of 110 patients with dry eye disease measured before and after treatment with continuous use of artificial tear drops one month apart, patients were diagnosed on the presence of symptoms such as burning, dryness, pain, irritation, grittiness followed by slit lamp examination for marginal tear meniscus(<0.25mm) or absent, tear film BUT of <10 seconds, Schrimer test 2 of <6mm after 5 minutes and ocular surface staining score of >1 with fluorescein. Central corneal thickness was measured using corneal topography (Galleli G6 Ziemer). Results: A total of two hundred and twenty eyes of 110 individuals having dry eyes were included in our study. Median CCT before treatment with artificial tears was 522(75)pm while median CCT after 1 month treatment with artificial tears was 547(22.25)pm this showed a percentage increase of 3.79% in central corneal thickness after one month treatment with artificial tears (p-value <0.001) therefore treatment with artificial tears was significantly associated with an increase in central corneal thickness in dry eye disease. Conclusion: Central corneal thickness is substantially related to dry eyes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship of serum Vitamin B12 and serum Homocysteine levels with Pseudo Exfoliation Syndrome. Study Design: Cross-sectional study. Place and Duration of Study: Department of Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jun to Nov 2022. Methodology: We included 55 individuals with unilateral Pseudo Exfoliation Syndrome without glaucoma and 50 healthy individuals as controls. All participants were subjected to the assessment of serum Homocysteine levels by high-performance liquid chromatography and Vitamin B12 levels by chemi-luminescent enzyme immunoassay. Results: Thirty-two (58.18%) individuals out of 55 with unilateral Pseudo Exfoliation Syndrome had increased serum Homocysteine levels (>5umol/L). Of these 32, 25(78.12%) individuals had moderately high serum Homocysteine levels, while 7(21.87%) had severely high serum Homocysteine levels. Twenty-six (47.27%) out of 55 individuals with Pseudo Exfoliation Syndrome had decreased serum Vitamin B12 levels, while the rest 29(52.72%) had normal-range serum Vitamin B12 levels. In comparison, 7(14%) had reduced serum Vitamin B12 levels, while the rest, 43(86%), had normal serum Vitamin B12 levels. Conclusion: Our study showed that raised Hcy levels were present in individuals with PXS without glaucoma and reduced serum Vitamin B12 levels. Assessment of Hcy level in individuals presenting with PXS may be undertaken as it is a known risk factor for vasuclopathies. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of positive Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis serology in patients with bilateral congenital cataract and their correlation with different type of cataracts and age groups. Study Design: Cross sectional study. Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022. Methodology: Data was collected by a single investigator on Microsoft Excel sheet including patient's age, gender, mode of delivery, consanguinity of parents, and type of congenital cataract, results of TORCH Screening and Presence or absence of amblyopia. TORCHS screening comprised of serum IgM and IgG levels for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis. Results: A total of 134 patients reported to our institute with bilateral congenital cataract during the study period. Out of them 56 patients had positive results of TORCH screening (41.7%) Out of total 56 patients with bilateral congenital cataract testing positive for TORCH, 30(53.6%) were male while 26(46.4%) were female. Age range was from 1-17 months (9.2±4.2 months). Lamellar cataract was the most common cataract type in our study sample 16(28.6%). Conclusion: In patients with bilateral congenital cataract positive TORCHS serology was most frequent. Serum Rubella IgM followed by Rubella IgG was positive in most cases. Most common age of presentation in our study was from 4-7 months. Furthermore, lamellar cataract followed by nuclear cataract was the commonest cataract type. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcome of patients admitted with head injury at an intensive care unit and look for the relationship of various factors with the poor outcome. Study Design: Cross-sectional Study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan. Six months, from Oct 2018 to Apr 2019. Methodology: Patients presenting with head injury at our hospital and needed Intensive Care Unit admission were included. Fifty-eight patients with head injury were admitted in Intensive Care Unit during the six months study period. Outcome was broadly classified as survivor or non survivors. Various factors were correlated with presence of poor outcome among the patients. Results: A total of 58 patients were admitted in the intensive care unit with head injury during the study period. Twenty-nine patients (50%) survived and were shifted to the wards or High Dependency Unit while 29(50%) patients died in the critical-care-unit. Mean age of patients included in the study was 29.63±3.46 years. Low Glasgow-Coma-Scale (GCS) score at the time of presentation and severe Kampala-Trauma-Score (KTS) class was associated with the presence of poor outcome in our sample population. Conclusion: Head injury has emerged as a common reason for admission in the critical care setting. Mortality of such patients remained high even in the specialized and supportive setting of intensive care unit. Low Glasgow Coma Scale (GCS) score at time of presentation and severe Kampala Trauma Score (KTS) class emerged as strong predictors of poor outcome i.e, death in our target population. [ABSTRACT FROM AUTHOR]

A total 240 1-day-old straight-run (Ross-308) broilers were used to investigate the effect of fruit waste (FW) on live performance and blood parameters of Broilers for 56 days. Four experimental diets comprising 3 replicates with 20 birds each were tested with using complete randomized method consisting Diet 1 (D1) (treatment 1) with 100% basal feed (BF) and 0% fruit waste (FW), diet 2 (D2) (75 BF + 25% FW), diet 3 (D3) (50% BF + 50% FW) and diet 4 (D4) (25% BF + 75% FW). Non-significant results (p>0.05) were found in feed intake and body weight gain and carcass characteristics in all treatment groups while feed conversion ratio (FCR) were resulted significantly difference (p<0.05) in D2 (1st, 3rd, 4th, 5th week), D3 (1st and 3rd week) and D4 (1st, 2nd, 4th and 5th week). In case of organs weight except gizzard, all other organs (liver, heart, intestine, pancreas, lungs, spleen and kidney) resulted significantly difference (p<0.05) and affected with FW supplementation. Broiler fed with 25% and 50% FW affected positively (p<0.05) to lymphocytes, granulocytes, red blood cells, hemoglobin, mean corpuscular hemoglobin and mean platelet volume while D3 also resulted positively in results of mid-range absolute count. While birds fed D4 (75% FW) resulted significant difference (p<0.05) in mean platelet volume. Overall, D2 and D3 that offered with 25% and 50% FW replacement showed better results than the control treatments with basal feed. It is suggested that as a supplements, FW can be added in feed as medicinal effects of fruit wastes by reducing the antibiotic usage in broilers and decreased the environmental pollution and for functional food ingredients, natural antioxidants, antimicrobial compounds and substantially reduce the amount of waste. [ABSTRACT FROM AUTHOR]