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In the current global energy crisis scenario, microalgae are considered an efficient feedstock for the green synthesis of biofuels. Therefore, it is a dire need of time to screen, select and optimizes the growth conditions of indigenous microalgal strains for enhanced biofuel production. This study was designed to optimize the physicochemical conditions required for the growth of indigenous microalgal strains (n=10). All strains were grown in BG-11 media and optimized for different physical requirements, i.e., pH, temperatures, light intensity, NaCl, and chemical requirements, i.e., carbon source (glucose, glycerol, maltose, acetic acid), nitrogen source (urea, ammonium chloride, potassium nitrate, sodium nitrate), Nitrogen levels, phosphorus level, sodium bicarbonate concentration, and CO2. All strains were grown for 10 days, and growth was monitored by measuring optical density at 650 nm. Results revealed that out of 10 strains, the optimum growth of most of the strains was at 35oC (5/10, 50%), pH 7 (8/10, 80%), light intensity of 2000 lux (5/10, 50%), and 1% NaCl (5/10, 50%). Similarly, most of the strains had higher growth in media supplemented with 40 mM of NaNO3 (7/10, 70%), 2 mM phosphorus (5/10, 50%), 1% glycerol (9/10, 90%) in autotrophic conditions, and 1% glucose (5/10, 50%) in mixotrophic conditions. The overall finding of the study revealed that Scenedesmus AIN01 showed significantly higher growth at 35oC, pH 7, 2000 lux light, 1% NaCl, 40 mM NaNO3, 1.5 mM phosphorus, 1% glycerol, and 0.1% bicarbonate as compared to other strains grown at their optimum conditions. It is concluded that the strains in this study, especially Scenedesmus AIN01, may be grown using their optimum physicochemical conditions for enhanced growth for subsequent use in biofuel production. [ABSTRACT FROM AUTHOR]

Heavy metal contamination usually causes depletion in feed utilization in fish, and such disturbance may result in reduced metabolic rate and hence causing reduction in their growth. The present study assessed theharmful effect of sublethal concentrations of four different heavy metal mixturesi.e., Mix-I (Mn+Ni), Mix-II(Mn+Ni+Pb), Mix-III (Mn+Pb+Zn+Fe), and Mix-IV (Mn+Ni+Pb+Zn+Fe) on five fish species including Labeorohita, Catla catla, Cirrhinamrigala, Hypophthalmichthys molitrix, and Ctenopharyngodonidella. The experiment was carried out in triplicate for each species separately in glass aquarium for 12 weeks. The results showed a significant(p < 0.001)effect on the treated group as compared to the control group. The average weight gain was as C. catla>L. rohita>C. mrigala>C. idella>H. molitrix. The condition factor was as C. idella>C. mrigala>L. rohita>C. catla>H. molitrix. Similarly, the feed intake also reduced significantly (p>0.001) in the treated group, and the feed conversion efficiency showed significant (p>0.05) effect of metal mixtures on fish metabolism and growth activity. The current study concluded that the studied heavy metals are toxic to different fish species, even at sub-lethal concentrations, and affect different biological parameters of fish growth. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of depression among dialysis dependent end-stage renal disease patients, associated factors and effect on patients' compliance and clinical performance parameters. Study Design: Cross-sectional study Place and Duration of Study: Department of Nephrology, Bahawal Victoria Hospital, Bahawalpur Pakistan, from Apr 2017 to Mar 2018. Methodology: End-stage renal disease patients above 16 years of age who were on maintenance haemodialysis for more than 6 months were requested to complete the questionnaire of Urdu version of Patient Health Questionnaire 9. The information about missed treatments, shortened sessions, fluid overload and monthly laboratory data was obtained from medical records. Patient Health Questionnaire 9 score was calculated for all the patients and categorized as mild (5), moderate (10), moderately severe (15) and severe (20) depression. Results: There were 146 dialysis dependent end-stage renal disease patients (95 males, 51 females) with mean age of 45.1±14.3 years. Duration of dialysis dependence was significantly higher among females (p=0.022). Out of 146 patients, 116 had depression and 27(18.5%) had severe depression. Patients with depression were younger (p=0.037) and lack of social support was significantly associated with depression (p=0.018). Severe depression was significantly more frequent among females (p=0.041). Serum albumin was significantly low among patients with depression (p=0.044). Conclusion: Depression is common among haemodialysis dependent end-stage renal disease patients. It is common among young patients and those who lack social support and it is associated with hypoalbuminemia. [ABSTRACT FROM AUTHOR]

One of the most significant narrative devices, magical realism, emerged in postcolonial literature for a number of reasons. Many authors have used it in their works for a variety of purposes. Toni Morison, one of the most important postcolonial writers, has utilized this technique in her novel Beloved to reconstruct the history of enslaved African-Americans. For this purpose, she has used magical realism as a valuable tool to defy the prevailing command of history. The history of slavery significantly influences the psyche of the characters, i.e. Sethe, Baby Suggs, and Paul. D. This study highlights the response of black people to re-establish their history and re-narrate it from their own viewpoint. The textual analysis technique employed in the book, within the context of postcolonial theory, shows how Toni Morrison gives voice to the marginalized and restores history. [ABSTRACT FROM AUTHOR]

Objective: To assess children with cerebral palsy using the Common Brief Core Set of International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Study Design: Cross-sectional study Place and Duration of Study: Children Hospital & Institute of Child Health, Lahore Pakistan, from Nov 2020 to Jan 2021. Methodology: Fifty-nine children with cerebral palsy (CP) aged 0-18 years were included. Common Brief Core Set of International Classification of Functioning, Disability, and Health in Children and Youth (ICF-CY) was administered to children with cerebral palsy to assess their functional status. Strengths and weaknesses in body structure, body function, activity and participation and environmental factors were evaluated using the Common Brief Core Set of ICF-CY. Results: The majority of study participants were 38(64.4%), were spastic quadriplegic. Periventricular leukomalacia was noted in 36(67.9%) cases on MRI brain. Moderate to severe impairment was noted in body functions like intellectual function 46(78%). In addition, 26(44.1%) children with cerebral palsy had mild to moderate impairment in walking, while 4(6.8 %) could walk without any impairment. Social attitudes, construct, and design of buildings were the major barriers affecting the functionality of children with cerebral palsy. Conclusion: It was found that the Common Brief Core Set of ICF-CY in children with different types of cerebral palsy is a useful tool for assessing their functional level. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between parenting practices and aggression in children with behaviour disorders. Study Design: Cross-sectional study. Place and Duration of Study: Children Hospital and Institute of Child Health, Lahore Pakistan, from Nov 2020 to Jan 2021. Methodology: Parents of children and eighty-five children between the ages of 3 to 12 years with the diagnosis of behaviour disorders (autism spectrum disorder, attention deficit hyperactive disorder, social communication disorder) and showing aggressive behaviour were enrolled. The multidimensional assessment of parenting scale was used to assess positive (proactive parenting, positive reinforcement, warmth and supportiveness) and negative (hostility, lax control, physical control) parenting practices. The modified overt aggression scale was used to assess aggression, including verbal aggression, aggression against property, auto-aggression (towards self), and physical aggression (towards others). Correlation and multiple regression analysis were done. Results: Among negative practices, it was found that leniency and inconsistent parenting (lax control) was significant positive predictor of aggression (p<0.01) in children with behaviour disorders. Supportiveness was a significant negative predictor of verbal aggression (p<0.01), while physical control positively predicted total aggression (p<0.05). Among positive parenting practices, positive reinforcement decreased auto aggression (p<0.05) in children with behaviour disorders. Lower maternal education correlated with more aggressive behaviours (p<0.05) in these children. Conclusion: Negative parenting practices may lead to aggression in children with behaviour disorders. While positive reinforcement by parents may encourage less self-harm in these children and help improve their behaviour problems. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of the extended sick neonatal score (ESNS) in neonates admitted in a resource-limited neonatal intensive care unit (NICU) at Peshawar. Study Design: Cross-sectional analytical study Place and Duration of Study: Neonatal Intensive Care Unit, CMH Peshawar Pakistan, from Mar to May 2020. Methodology: Primary data was collected from 60 neonates admitted to NICU after taking consent from the parents. The receiver operating characteristic curve (ROC) was plotted to determine the clinical score (ESNS) cut-off value in predicting mortality. Result: The sensitivity and specificity of the Extended sick neonatal score to predict mortality among neonates was 93.3% and 97%, respectively, for a cut-off of 12.5. The area under the ROC curve was 0.990 (95% CI: 0.971-1.000). This was statistically significant with a p-value of <0.001 Conclusion: Extended Sick Neonatal score is an important tool that helps predict the risk of mortality of a neonate without the help of any invasive diagnostic procedure, thus enhancing the prioritization of health care to the most deserving neonates. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Probiotics with the yoghurt in the management of children with acute diarrhoea in terms of frequency and consistency of stools. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Paediatric Medicine, Combined Military Hospital, Peshawar Pakistan, from Jun to Dec 2020. Methodology: Patients were allotted into three Groups A, B, or C. Group-A received a Probiotic (Bacillus Clausii), Group-B received plain yoghurt, and Group-C did not receive yoghurt or Probiotic. The outcome was an improvement in stool consistency at 72 hours. Stool consistency was assessed via Bristol stool chart along with frequency. Data were collected 72 hours after initiation of treatment. Result: The total number of patients enrolled was 159(53 in each Group). Among these, 85(53.5%) were males, and 74(46.5%) were females. There was a statistically significant association in terms of consistency (p=0.001) and term of frequency (p<0.001) in the Probiotic and Yoghurt-Group. Conclusion: The outcome in terms of consistency is almost equal in the Probiotic and Yoghurt-Group. However, Probiotic is superior to yoghurt in terms of frequency. [ABSTRACT FROM AUTHOR]

Objective: To see the impact of screen media usage on early childhood development. Study Design: Cross-sectional study. Place and Duration of Study: Developmental Behavioural Paediatrics Department, Children's Hospital and Institute of Child Health, Lahore Pakistan, from Oct to Dec 2020. Methodology: This study included 100 children with an age range between 15-36 months and divided into two groups. Group-1 was children with communication behaviour disorders (CBD) (n=50), and Group-2 was typically developing (TD) children (n=50). ShaMaq Developmental Screening Tool (SDST) was administered to children to screen their development. Childhood behaviours were rated on a scale of 0-10 on a Behaviour rating scale. Results: Children with CBD had poor eye contact, response to names, poor imitation, poor pointing and poor one-step command following (p<0.001) compared to typically developing children. Children with CBD had poor eating habits (p<0.01), were more restless (p<0.001), and had a developmental delay (p<0.001) on SDST as compared to the other group. In children with CBD, the extent of screen media exposure was significantly correlated with restlessness (p<0.05) and poor pointing (p<0.01). Conclusion: Exposure to screen media at an early age and prolonged use of screens can lead to adverse developmental outcomes and behaviour issues in children. This is more evident in children with CBD than in typically developing children. [ABSTRACT FROM AUTHOR]

Objective: To discuss the presentation stages of Cholesteatoma in patients of various areas of Kohat division. Study Design: Case series study. Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Nov 2017. Methodology: A total of 60 patients having Chronic Suppurative otitis media with Cholesteatoma were selected from outpatient department. Disease process was evaluated by otomicroscopy as well as radiologically. Perioperative disease spread pattern was also assessed and documented. Results: Out of 28 patients with pars tensa cholesteatoma 28.5% were in stage II and 53.5% were in stage III disease. Out of 32 patients with pars flaccid cholesteatoma, 3.1% presented with stage 1 disease, 37.5% with stage II disease, 50% with stage III disease and 9.3% with stage IV disease. Conclusion: Appropriate measures should be taken for training of general physicians as well as otologists at National level to help early diagnosis and better outcome. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the usability and effectiveness of tailor made internal and external nasal splints after nasal surgery. Study Design: An observational study. Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Aug 2017. Methodology: the study was carried out on 523 patients who underwent nasal surgery by the same team of surgeons. Custom made free of cost internal and external nasal splints were used as required. Complications pertaining to the use of nasal splints were recorded. Results: The custom made splints were found to be an excellent and cost effective alternative of commercially available expensive splints. The benefits and pitfalls were comparable. Conclusion: Where these free of cost splints does the job they as well save a lot of money and can be used as an effective alternative to commercially available splints. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to gather information regarding the knowledge and attitude of students at Hamdard University about this disease. Methods: A cross-sectional study was conducted at Hamdard University, Karachi, after obtaining ethical approval from the Ethical Committee of the Faculty of Pharmacy, Hamdard University, Karachi Campus. A total of 403 valid responses were included in the study. The sample size was calculated using Raosoft software using the standard formula of sample size calculation which was calculated to be 365. Data was collected from October to December 2023 for three months at Hamdard University. Statistical analysis was performed using SPSS-20. The chi-square test was applied due to the non-normal distribution of the data. The response rate was less than 50%. Data was considered significant when p < 0.05. Results: A total of 403 student's data is included in the study. The results showed that 62% of participants had good knowledge about the disease and 70% showed a positive attitude. Data strongly depended on gender (2 = 3.9, p < 0.05 knowledge; 2 = 6.78, p < 0.01 attitude) with female predominance. Type of profession (2 = 4.53, p < 0.05 knowledge; 2 = 9.5, p < 0.01 attitude) where students of health-related professions showed better knowledge and positive attitude compared to students of the non-medic profession. Participants showed worry about the disease and were significantly willing to get vaccinated if provided (2 = 10.83, p < 0.05) Conclusion: This study concludes that there is a gap in awareness and health facilities among university students along with inadequate budget allocation. This study stresses that awareness regarding infectious disease should be encouraged and a sound health policy should be formulated to overcome any emergency infectious disease burden. [ABSTRACT FROM AUTHOR]

Objective: To study clinical profile, blood profile and culture sensitivity patterns of Salmonella typhi in paediatric patients and factors associated with multi-drug resistant pattern. Study Design: Comparative cross-sectional study. Place and Duration of Study: Paediatrics and Microbiology Department, Combined Military Hospital Peshawar from Jan 2021 to Jan 2022. Methodology: A total of 97 paediatric patients with a confirmed diagnosis of Salmonella typhi were included in the study. A detailed clinical proforma was designed to document all the symptoms this patient had since admission. In addition, all baseline blood investigations and culture sensitivity analysis were requested during clinical evaluation. Basic demographic factors were associated with the presence of multi-drug resistant disease patterns in study participants. Results: Out of 97 children in the study, 65 (67.1%) were males, while 32 (22.9%) were females The mean age of the children in our study was 9.82±3.26 years. 61 (62.8%) patients had Salmonella typhi, which was not multi-drug resistant, while 36 (37.2%) had multi-drug resistant disease. Fever was the commonest symptom reported by our study participants. No organism was found resistant to Meropenem. Statistical analysis revealed that raised C-reactive protein levels at the time of assessment had a statistically significant relationship with the presence of multi-drug resistant disease (p-value=0.001). Conclusion: A considerable number of pediatric patients with typhoid had multi-drug resistant illnesses in our study participants. Therefore, special attention should be paid to children who had raised C-reactive protein levels at the time of initial assessment. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of Rh alloantibodies in pregnant women of the Rh-D negative blood group. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT) Rawalpindi, from Jan to Dec 2017. Methodology: The blood samples of pregnant women received for blood grouping, cross matching and antibodies screening were included in the study. The blood was typed for Rh-D along with ABO blood groups by Column Agglutination Technique (CAT), commonly known as the gel card method. Then, the samples included in the study were subjected to antibody screening by three cell antibody screening panel (Dia Cell, a product of Bio-Rad) by Column Agglutination Technique. The samples with positive antibody screening were further processed by 11 cell antibody screening panel (Dia Cell, Bio-Rad) for Rh antibody identification by Column Agglutination Technique, the same as the indirect antiglobulin test (IAT). Results: 453 Rh-D negative pregnant women were screened for alloantibodies during the study period. Rh alloantibodies were present in 55 (12.08%) cases. The most common alloantibody identified was anti-D in 48 (87.3%) samples, followed by anti-C in 6 (10.9%) and anti-E in 1 (1.8%) case. Conclusion: The most prevalent Rh alloantibody identified in Rh-D negative pregnant women was anti-D, while the anti-C and anti-E were less prevalent. However, no case of anti-c and anti-e alloantibody was identified. [ABSTRACT FROM AUTHOR]

Objective: To calculate tumour budding pT2 colorectal carcinomas and study its association with other prognostic indicators. Study Design: Cross-sectional study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research centre, from 2018-2019. Methodology: Hematoxylin and eosin-stained slides of 50 Patients using 4-5 microns' thick sections were prepared using Leica Peloris for processing, Leica ST 5020 for staining and Leica CV 5030 for cover slipping. An Olympus cx31 microscope was used to assess tumour budding. The "Hotspot method" (as proposed by ITBCC) was used. Results: 26 (52%) slides showed low tumour budding (BD1), 8 (16%) showed intermediate tumour budding (BD2), and 16 (32%) showed high tumour budding (BD3). one patient out of 26 had positive nodal status in the low tumour budding category (3.8%). However, at the initial diagnosis, this number was significantly higher in the intermediate (50%) and high tumour budding (37.5%) categories. The mean survival in patients with low tumour budding was 22.615 months, which was significantly higher than 12.250 months and 13.188 months for intermediate and high tumour budding, respectively, with overall mean survival of 17.94 (±5) months. The overall survival rate in our study was 92.30% (24/26 patients), 25% (2/8 patients) and 12.5% (2/16 patients) for BD1, BD2 and BD3 patients, respectively (p=0.001). Conclusion: Our study supports the inclusion of tumour budding in colorectal tumour checklists because of its association with survival and lymph node metastases. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the expression of epidermal growth factor receptor (EGFR) in surface epithelial ovarian cancers (EOCs) among the local population, considering its potential role as a therapeutic target in ovarian cancer treatment. METHODS: This cross-sectional study was conducted at Ayub Medical College, Abbottabad, and Khyber Medical University Peshawar, Pakistan, from July 1st to December 31st, 2022. Data from 73 patients diagnosed with EOC were collected using consecutive sampling. Inclusion criteria required histopathological confirmation of EOC and sufficient biopsy specimens for immune-histochemical (IHC) analysis. Patients who declined participation or lacked adequate biopsy samples for IHC were excluded. Biopsy samples were histologically confirmed for EOC, and IHC staining was performed to detect EGFR-1 protein, validated with positive and negative controls. RESULTS: The mean age of the participants was 53.42±9.99 years, with serous type lesions being the most prevalent (n=40, 54.8%). EGFR expression varied, with 46.6% showing moderate positivity, 27.4% and 19.2% cases demonstrating weak and strong positivity respectively. Significant differences in EGFR positivity were noted between lesion types (p=0.002) and among patients with positive vs. negative family histories (p=0.001). No significant associations were found with parity or socioeconomic status. ANOVA analysis revealed no significant differences in age, age at menarche, or age at menopause based on EGFR positivity levels (p > 0.05). CONCLUSION: A moderate to high intensity level of EGFR expression in cases of serous cyst adenocarcinomas and patients with family history of reproductive system malignancy suggest its potential as a therapeutic target for ovarian cancer treatment in such patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the utility of four immunohistochemical stains in the categorization of hepatoblastoma. Study Design: Retrospective longitudinal study. Place and Duration of Study: Histopathology Department, Shaukat Khanum Memorial Cancer Hospital, Peshawar Pakistan, from 2016 to 2018. Methodology: We retrospectively reviewed 50 cases of hepatoblastoma from 2016-2018, from our hospital database and studied the pattern of four immunohistochemical stains (Beta-catenin, Glutamine synthetase, Heppar 1 and Cyclin D1) in various subtypes. Results: Ten out of fifty cases were mixed epithelial and mesenchymal hepatoblastomas, and forty were pure epithelial. In the pure epithelial category, the fetal subtype showed Heppar 1 and Cyclin D1 positivity in twenty-eight cases, while Glutamine synthetase and Beta-catenin were positive in all the thirty cases. One case of embryonal subtype displayed negativity for Heppar 1; the rest of the immunohistochemical stains were positive. Ten tumours exhibiting mixed epithelial and mesenchymal morphology showed positivity for all the four immunohistochemical stains in the epithelial component. However, Heppar 1 and cyclin D1 were negative in the mesenchymal component in all the ten cases. Five cases (50%) showed Glutamine synthetase and Beta-catenin positivity in the mesenchymal component. Conclusion: All the four immunohistochemical stains, especially Beta-catenin and Glutamine synthetase, were efficient diagnostic tool, especially for tumours with complex or vague morphological features. [ABSTRACT FROM AUTHOR]

Objective: To assess the knowledge of epidemiology, transmission, prevention and control of rabies and to find the effect of an educational intervention in paramedical students of HITEC-IMS, Taxilla. Study Design: Quasi-experimental study. Place and Duration of Study: HITEC-IMS, Taxilla, from Mar to Sep 2019. Methodology: Study was carried out among paramedical students enrolled in 2 years diploma course in HITEC-IMS, Taxilla. Students were included by non-probability consecutive sampling. Results: Out of the total of 89 participants, the fatality of rabies was identified by 63 (70.8%) respondents in pre-test and by 84 (94.4%) respondents in post-test (p<0.001). Less than half of the participants knew about bats as a reservoir of rabies (22, 24.7%) in pre-test that raised to 59 participants (66.3%) in post-test (p<0.001). The proper sequence of protocol for postexposure prophylaxis (PEP) in un-vaccinated persons was identified by 42 (47.2%) respondents with an improvement of 27% in post-test (p<0.001). Proper order of rabies post-exposure prophylaxis (PEP) vaccine schedule in humans were identified by 16 (18.0%) respondents with an improvement of 6% in post-test (p=0.031). Conclusion: Knowledge of reservoir, mode of transmission, prevention and control of rabies after educational intervention showed a significant increase in the students. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinicohaematological presentation and outcome of patients with antibodies to high frequency antigen (HFA) in our setup. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion, Rawalpindi, from Jan 2016 to Jan 2018. Methodology: We diagnosed 29 cases of uncommon red cell antibodies including antibodies to HFA, in a span of two years (2016-2018). Information regarding patient's age, diagnosis, transfusion history, incompatible cross match and history of pregnancy was obtained. Venous blood sample of 3ml was taken in EDTA for grouping, red cell phenotyping and Direct Anti-Globulin Test (DAT) and 5 ml venous blood was taken for Indirect Antiglobulin Test (IAT), antibody screening and identification. Tube method was used for forward and reverse blood grouping, DAT and IAT. Column Agglutination Technique (CAT) was used for antibody screening, identification and red cell phenotyping. Results: Out of a total of 29 cases, 24 (83%) were of anti H antibody (Bombay blood group). Rest of 5 (17%) included one each of anti Rh 17, anti Rh 29 (Rh null), anti P1Pk, anti-ENA/WRB and anti P antibodies. Anti H Lectin (Ulexeuropaeus) was used for confirmation of H antigen absence, while rest of antibodies were confirmed by IBGRL Bristol, UK. Conclusion: The sources of antigen negative blood are family members, rare donor registry, autologous donations and frozen blood banks. Finding compatible blood for patients with an antibody to HFA may be a challenge. [ABSTRACT FROM AUTHOR]

This study intended to explore causal relationships between the corporate performance and financial decisions of the firms which are listed on the Pakistan stock exchange (PSX). This study has used Return on assets and Tobin's Q as the measures of accounting performance and market performance respectively. To effectively examine the causal structure of corporate financing, investment, dividend payout decisions, and the firm performance simultaneously this study has used path analysis approach. The sample comprises 292 non-financial firms which are listed on the Pakistan Stock Exchange (PSX). The findings clearly show that debt financing has positive effect on the investment and dividend has negative effect on the investment decisions. The debt financing and investment has a negative impact on corporate performance while dividend decisions has a positive impact on corporate performance. This study helps to understand the corporate decision making process of Pakistani firms. To the author's knowledge this is the first study attempted to check the application of path analysis in emerging economies to study the causal structure of corporate financial decisions and corporate performance. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of earliest symptoms of COVID-19 infection among patients with confirmed SARSCOVID-19 infection. Study Design: Cross-sectional analytical study. Place and Duration of Study: Combined Military Hospital Multan, from Jun to Dec 2021. Methodology: Data from 299 patients admitted in tertiary care settings was collected on a questionnaire. Patients regardless of gender and age who had confirmed COVID-19 infection through Real Time Polymerase Chain Reaction (RT-PCR) were included in the study. A nonprobability consecutive sampling technique was used to select samples. Data was entered and analyzed through SPSS version 22. Frequencies and percentages of various presenting symptoms were calculated. Sample size calculated at 95% level of confidence, 1% required precision, and 27% anticipated population proportion were 299. The overall difference in frequencies of symptoms in various groups was compared by using chi-square test. p-value <0.05 was taken as significant. Results: A total of 299 participants were included in this analysis. The median age for participants (interquartile range [IQR]) was 46 (36-54) years. Among 299 adults the reported symptoms were cough 238 (79.6%), fever 176 (58.7%) and, dyspnea 113 (37.8%). Only 78 (26.1%) of participants with confirmed infection reported having all three symptoms of cough, fever, and dyspnea. Other reported symptoms in patients were diarrhea 54 (18.1%), fatigue 128 (42.8%), myalgia 113 (37.8%), and anosmia 98 (32.8%). There was no significant difference in the frequency of symptoms across both genders. Conclusion: The most frequent symptoms of COVID-19 are cough, fever, and dyspnea. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17. Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was 61.1%. Conclusion: Permeatal endoscopic myringoplasty is a reliable, relatively swift procedure with lesser post operative morbidity. It has overall success rate of 81.3%. This technique should be encouraged for further research, to contemplate results on larger sample size. [ABSTRACT FROM AUTHOR]

Objective: To assess efficacy of functional endoscopic sinus surgery (FESS) in treatment of postnasal drip (PND) as an ancillary procedure to Septoplasty with Turbinoplasty. Study Design: Quasi experimental study. Methodology: Sample size was n-200, Patients were placed in two groups Group A (n-126) had septoplasty with turbineplasty. Group B (n-74) included patients with Septoplasty and Turbinoplasty combined with functional endoscopic sinus surgery. Post operative results regarding postnasal drip were compared amongst the Two groups. Results: Data was analysed in SPSS-17, Septoplasty along with turbinectomy was performed in n-126 patients (group A). And septoplasty, turbinectomy along with functional endoscopic sinus surgery was performed in n-74 patients (group B). Post nasal drip was significantly reduced in group B at 3 months follow up (p<0.046). More significant difference was noted at 6 months follow up (p<0.003). Conclusion: Patients having Chronic rhinosinusitis with postnasal drip as predominant symptom, should undergo functional endoscopic sinus surgery as an ancillary procedure to conventional nasal surgery. [ABSTRACT FROM AUTHOR]

Objective: To explore the disappearance of neutralizing antibodies from patients, their myths, and facts. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Multan Pakistan, from Jul 2021 to Aug 2021. Methodology: A total of 100 blood samples were collected from 100 COVID-19 patients. These 100 patients were followed up for a period of 3 months. Antibodies were determined with the modified neutralization assay method and enzyme-linked immuno-sorbent assay (ELISA). Results: The antibody level by NA and ELISA peaked on days 30-35 then decreased slightly. In multivariate analysis, patients aged 25-35, 36-56, and 57-84 years had a higher neutralizing antibody level than those aged 10-21 years. The patient with the worst clinical manifestation had a higher neutralizing antibody titer. In serum samples, IgG was undetectable at 18.3% and 11% and the geographical mean reciprocal titers dropped from 244 at 3-month period and neutralizing antibodies, the geographical mean reciprocal titers dropped from 874 at 3 months. Conclusion: All COVID-19 patients were seropositive and significantly neutralizing antibody response. Neutralizing antibody levels depend on the time after the onset of symptoms, age, and severity of the disease. [ABSTRACT FROM AUTHOR]

Objective: To determine the presence and severity of depression and anxiety in patients with tinnitus. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at department of Psychiatry, Combined Military Hospital Multan in collaboration with ENT department, Combined Military Hospital Multan, from Sep 2019 to Mar 2020. Methodology: All diagnosed cases of tinnitus in ENT out-patient department Tinnitus Handicap inventory (THI) was applied to assess the severity of tinnitus. Diagnosis of depression and Anxiety was done based on diagnostic criteria of ICD10 of WHO and symptom severity was assessed using Beck Depressive Inventory (BDI) for depression and Beck Anxiety Inventory (BAI) for Anxiety. Results: A total of 88 participants were included in this study. Fifty-three (60.2%) were male, 35 (39.7%) were females. Twentythree (20.2%) ranged between 18-40 years of age, 65 (57.2%) participants ranged between 41-60 years of age. Seven (12.5%) participants scored less than 38 on tinnitus handicap inventory showing mild severity of tinnitus, 3 (5.3%) individuals scored moderate while 19 (33.9%) had severe level of tinnitus. Thirty-three (37%) participants had depression 55 (62%) out of total 88 participants had anxiety. Conclusion: Studies show presence of anxiety and depression in patients with tinnitus so it seems prudent to screen all patients of tinnitus for psychiatric co morbidity. A multidisciplinary approach is required for the treatment of patients with tinnitus so that physical as well as psychiatric/psychological management of these patients is provided well in time. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of endoscopic turbinoplasty versus conventional inferior turbinectomy for hypertrophy of inferior turbinate. Study Design: Comparative prospective study. Place and Duration of Study: Ear, Nose and Throat (ENT) Department Combined Military Hospital (CMH) Multan, from Jun 2019 to May 2020. Methodology: This study comprised of 50 patients of various age groups and both genders. Patients were grouped into two groups A and B, each group having 25 patients through random sampling. Patients in group A had endoscopic turbinoplasty whereas patients in group B had partial turbinectomy through conventional surgical method. Patients were followed regularly in both groups and were inspected postoperatively at 2 weeks, after 1 month and after 3 months. Results: Patients who underwent Endoscopic turbinoplasty experienced less pain (p=0.05) postoperatively at 2 weeks compared to conventional surgical turbinectomy. In addition, these patients showed statistically significant healing and reduced crusting at 1 month postoperatively. At 3 months post operatively all patients had healed completely as opposed to only 72% with surgical turbinectomy. Conclusion: Endoscopic turbinoplasty is more effective than conventional surgical technique for inferior turbinate hypertrophy as it leads to less post-operative pain, reduced nasal crusting and earlier healing. [ABSTRACT FROM AUTHOR]

Objective: To assess the hearing results of transcanal endoscopic stapedotomy Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez Islamabad Pakistan, from Jun 2016 to Jun 2020. Methodology: All patients with surgically confirmed otosclerosis were included in the study. All patients were operated with 0-degree 3mm, 14cm rigid endoscope under general anesthesia. Preoperative and post operative air bone gap was noted along with demographic data, middle ear anomalies (persistent stapedial artery, dehiscent facial nerve, anteriorly placed facial nerve, floating foot plate) and injury to chorda tympani. Postoperative air bone gap (A-B Gap) was documented 12 weeks after surgery. All patients were followed up for 6-12 months Results: Mean age of patients was, 37 years and standard deviation was 12.34 (range 27-52 years). Out of total 45 cases 13 were males (29%) and 32 females (71.%). Four (8.8%) patients had dehiscent facial canal and 1 (2.2%) patient had persistent stapedial artery. Average preoperative A-B gap was 35 db and Average Postoperative A-B Gap was 7 db. Chorda tympani was preserved in all cases. One patient (2.2%) complained of altered taste which resolved after 3 months. Four patients had Postoperative vertigo that lasted 2 days on average. Conclusion: Endoscopic trans canal Stapes surgery is scarless safe effective procedure demonstrable hearing benefits in all patients with minimum complications. The Technique is single handed and has steep learning curve. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of aesthetic surgery on quality of life. Study Design: Cross-sectional study. Place and Duration of Study: The departments of Psychiatry, Plastic Surgery and ENT, Combined Military Hospital Multan, from Jan to Nov 2020. Methodology: Seventy-four patients were enrolled for this study. They underwent aesthetic surgery. A standard questioner was designed for these patients and response was obtained before undertaking the procedure and then after six months postoperatively. The questions were designed keeping in mind the specific type of surgery. Questions on Life Satisfaction, and the Patient Health Questionnaire (PHQ-4) were asked. The data were collected and analyzed by using SSPS-25. Results: There is high satisfaction postoperatively after aesthetic surgery. There are improvements in quality of life (p=0.03), physical well-being (Health) (p=0.03), body image (p=0.02), emotional stability (p<0.01) and emotional distress (Depression) (p=0.04 and anxiety (p=0.01) were noted to be reduced. Conclusion: Aesthetic surgery leads to higher satisfaction in physical appearance, health, emotional stability and reduction of anxiety. [ABSTRACT FROM AUTHOR]

Objective: To find out the outcome of the ear Reconstruction and its association with improvement in psychological wellbeing along with physical benefits. Study Design: A cross-sectional study. Place and Duration of Study: Department of Plastic Surgery and ENT, Combined Military Hospital Quetta and Multan in liaison with the department of Psychiatry, from Jan 2017 to Jan 2021. Methodology: A sample size of 108 was estimated while keeping level of significance 5%, confidence level 90%, estimated true proportion 63% based on the observation made in the study by Steffen, and 5% of absolute precision. Specific performas were filled by the patient pre and post operatively and data analysis was performed using SPSS-20. Results: The mean age was 20 ± 8.75 years with a range of 12-29 years. Thirteen (11.11%) were male and ninety-five (87.8%) were females, 14 (12.9%) were married, 94 (86%) were un-married and all (100%) had social support. Fifty-two (48.1%) had primary education. Ninety-four (94%) were un-employed. Fifty-five (50.9%) of participants had congenital ear defect. Ninetyeight (90.7%) of the participants showed confidence in surgical procedure and would go for the same procedure if required, 5 (4.6%) said no to the same procedure while 8 (7.4%) did not know whether to opt for same procedure. Conclusion: Ear Reconstruction is a very rewarding procedure for surgeon and patients. Apart from aesthetic and functional improvement it also enhances the self-esteem of the patients. [ABSTRACT FROM AUTHOR]

Objective: To study the incidence of Recurrent Laryngeal Nerve Palsy (RLNP) in cervical anastomosis after esophagectomy for carcinoma of the esophagus. Place and Duration of Study: Military Hospital's Thoracic surgery departments, Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan, from Jan 2010 to Sep 2020. Study Design: Prospective observational study. Methodology: Designated proformas were used to collect data. Histopathologically proven, operable cases of carcinoma esophagus with normal phonation were included, all of which underwent cervical anastomosis. All cases of benign pathologies and per-operative macroscopically advanced loco-regional disease were excluded. Recurrent laryngeal nerve (RLN) was identified in all cases and follow-up of 6 months for recovery period was executed. Results: 220 cases were included out of which 121 (55%) were males while 99 (45%) females. The age range was 14-81 years (mean is 38.7 ± 16.78). Out of 29 (13.6%) cases underwent minimally invasive esophagectomy (MIE) while thoracophreno laparotomy was performed in 100 (45.4%) cases, McKeown in 46 (20.9%) and Trans-hiatal esophagectomy (THE) in 45 (20.4%) patients. Recurrent Laryngeal Nerve Palsy was found in 19 patients (8.6%), tracheal injury in 3 (1.3%) and bronchial injury in 1 (0.4%) patient. Recurrent Laryngeal Nerve Palsy was transient in 14 cases and permanent damage persisted in 5 patients. Conclusion: Recurrent Laryngeal Nerve Palsy after esophagectomy is related to increased morbidity due to respiratory complications. With Sharp dissection technique, adequate surgical skill and equipment, the incidence of Recurrent Laryngeal Nerve Palsy can be decreased. In our study, it is less than 8.6% (transient injury) and 2.2% (permanent injury). [ABSTRACT FROM AUTHOR]

Objective: To train young doctors and paramedical staff on needle cricothyroidotomy and surgical cricothyroidotomy and provision of kits in trauma centers, main operation theatres and medical reception centers of the hospitals. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Peshawar and Pakistan Naval Ship Shifa, Karachi Pakistan, from Nov 2017 to Oct 2020. Methodology: Doctors and paramedical staff were selected on volunteer basis. Small groups were trained in 2-3hours. The participants were shown two videos of two procedures in Urdu language first and then were trained on mannequin. Results: A total of 345 participants including 205 males and 140 females were trained with mean age was 28.2667 ± 6.24 (SD) years. Out of 61 residents, 54 medical officers, 143 house officers, 35 nurses and 52 paramedical staff were participants. Conclusion: ENT surgeons must arrange mannequins and conduct training sessions of small groups after every 1 to 2 months. [ABSTRACT FROM AUTHOR]

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success rate whereas near total or total perforations had 86% Success rate. Average preoperative A-B gap was 35 db and Average Postoperative A-B Gap was 15db. Ossicular discontinuity was noted in 34 (21.6%) cases and occlusion of ventilation including obstruction of eusthachian-tube opening was noted in 61 (38%) cases. Average Operative was 67 minutes. Incision scar was visible only in 2 patients 3 months after surgery. Conclusion: Endoscopic trans canal cartilage tympanoplasty is scarless safe effective procedure with demonstrable tympanic membrane perforation closure rates and hearing gains in all patients with minimum complications. The Technique is single handed and has steep learning curve. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the presence and relation of depression and anxiety among patients seeking rhinoplasty Study Design: A cross-sectional study. Place and Duration of Study: Departments of Psychiatry, department of Plastic Surgery and ENT, Combined Military Hospital Multan, from Jan 2019 to Mar 2020. Methodology: A total of 102 patients were recruited that reported to Plastic surgery and ENT unit. Patients were divided equally in two groups of 51 each. One group included patients seeking rhinoplasty while other group included those patients that reported in Plastic surgery and ENT unit for reasons other than rhinoplasty. Symptom were assessed using Beck Depressive Inventory for depression and Beck Anxiety Inventory for anxiety. Results: A total of 102 participants were included in the study, of these 51 were patients seeking rhinoplasty and 51 were controls. Significant correlation exist between anxiety and depression (p<0.00). Conclusion: There is a very high frequency of anxiety and depression among patients seeking Rhinoplasty along with significant positive correlation. [ABSTRACT FROM AUTHOR]

Objective: To compare isoconazole nitrate versus nystatin for treatment of otomycosis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Combined Military Hospital Mardan, from Jan to Dec 2018. Methodology: Total 204 cases fulfilling the inclusion criteria were selected from outpatient department of Combined Military Hospital Bahawalpur and Mardan. They were divided into 2 groups of 102 each using random number tables. Group A cases were given Isocona-zole nitrate for application in external auditory meatus and group B cases were given Nystatin. All the cases were examined two weeks later and outcome was compared in terms of clinical improvement and symptoms resolution. Results: Out of 204, 125 patients were females and rest 79 were males. Age range was from 12-87 years with mean age 31 ± 2.4. Both groups were identical in terms of gender. In group A patients, 74 (72.5%) showed marked improvement after two week, 15 (14.7%) showed moderate improvement and 13 (12.7%) showed minor improvement. However, in group B, 55 (53.9%) showed marked improvement after two week, 23 (22.5%) showed moderate improvement and 24 (23.5%) showed minor improvement. Group A treatment was found significantly better than group B treatment (p=0.021). Conclusion: Isoconazole nitrate ointment was found significantly more effective for treating otomycosis than nystatin. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of ENT, Combined Military Hospital, Rawalpindi, from Aug 2020 to Jul 2021. Methodology: We studied a total of 59 patients suffering from chronic rhinosinusitis. Patients with previous sinus surgery and immunosuppressed states were excluded. All participants underwent evaluation with a 5-point Likert scale and the Connecticut odor identification test both pre- and post-Functional endoscopic sinus surgery at 3 months post-procedure. Data were analyzed in SPSS version 26. Results: Our sample had a male to female ratio of 1.19:1. The mean age was 45.37 ± 14.25 years. A total of 37 (62.7%) patients reported an improvement of 19.2% in olfactory function post-FESS while 22 (37.2%) reported no difference or worsening of olfaction. Conclusion: Functional endoscopic sinus surgery performed for chronic rhinosinusitis is associated with an improvement in olfactory function. [ABSTRACT FROM AUTHOR]

Objective: To share our experience of tracheostomy in COVID-19 positive patients. Study Design: Prospective observational study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Apr to Jul 2020. Methodology: A total of 94 COVID-19 positive cases admitted to the Intensive Care Unit of this hospital, placed on ventilatory support and who ultimately underwent tracheostomy (whether percutaneous or surgical) were included in the study. Patients were included irrespective of any age group or gender. Results: Out of 94 patients placed on ventilator, tracheostomy was performed only in 17 patients. Male predominance was 13 (76%), with mean age of patients as 55.59 ± 12.93 in 12 patients, surgical tracheostomy was performed (70.58%) whereas in 5 (29.4%) cases percutaneous tracheostomy was done. On post-operative follow-up 8 out of 17 (47%) patients recovered and were successfully decannulated whereas 9 (52.9%) patients could not survive. Tracheostomy was successfully performed as early as 8th day of mechanical ventilator support. Health Care Workers (HCWs) involved were subjected to RT-PCR and remained negative for SARS- CoV-2. There was statistically significant association between the type and indication of tracheostomy, p=0.002. Conclusion: Tracheostomy, in COVID-19 positive patients, being aerosol- generating procedure remains a medical hazard for the HCWs. By following strict safety protocols according to the medical resources available and training of the HCWs, it can be performed with complete safety. It can be done as early as 8th day of ventilator support. [ABSTRACT FROM AUTHOR]

Bovine brucellosis, caused by Brucella abortus, is an economically significant bacterial disease causing enormous economic losses in developing countries. Due to emerging antibacterial resistance in current use of antibiotics and insufficient immunity by WHO recommended vaccine strategies, it is recommended to cull the positive animals to control the disease. In such circumstances, use of host specific bacteriophages could be an alternate option to control the disease. In present study, brucellaphages were isolated from slurry samples (n=50) of livestock farms. Seven samples were found positive in spot method, while two samples gave the positive plaques of pinpoint size (0.5 mm) with round and clear appearance in plaque assay. Isolated brucellaphages (BaP1 and BaP2) did not produce plaques against Staphylococcus aureus, Streptococcus, Bacillus, Escherichia coli, Salmonella, and Pasteurella multocida. Physicochemical characterization revealed that lytic activity of phages was present up to 60oC which started to decrease at 70oC and maximum stability was between 7 to 9 pH. Exposure of sunlight, normal fluorescent and UV light inactivated these phages within 3 hours, 24 hours and 15 minutes, respectively. Phages become inactivated in 15 minutes when treated with Sodium Dodecyl Sulphate, chloroform, Lysozyme, and Proteinase K, however, no effect of EDTA, normal saline, Trypsin and RNAse was observed on brucellaphages. In conclusion, the results have laid the foundation to standardize practical applications of brucellaphages after detailed in-vitro and in-vivo experimental evaluations. [ABSTRACT FROM AUTHOR]

To study the effect of different concentrations of indole butyric acid (IBA) on olive cuttings, a greenhouse study was conducted, at Agricultural Research Institute, Tarnab during the growing season 2016. Completely randomized design (CRD) was used with four treatments that were replicated three times. The IBA concentrations used were (T1: control, T2: 1000 mgL-1, T3: 2000 mgL-1, T4: 3000 mgL-1). Data were recorded on days to 50% sprouting, number of sprouts cutting-1, sprouts length cutting-1, number of leaves cutting-1, days to rooting, and survival percentage. Significant differences (P=0.01) were observed among olive cultivar treated with different IBA concentrations for days to 50% sprouting, days to rooting, and survival percentage, while non-significant differences were observed for the number of leaves cutting-1, number of sprouts cutting-1 and sprouts length cutting-1. The cuttings treated with IBA @ 3000 mgL-1 took fewer days to sprout (25.00), and rooting (46.66), showed high value for the number of sprouts cutting-1 (3.33), and survival percentage (39.67), while the maximum number of leaves cutting-1 (7.33), and maximum sprout length cutting-1 (5.00) was recorded with IBA @1000 mgL-1 and 2000 mgL-1 respectively. As most of the studied parameters had improved by IBA @ 3000 mgL-1, therefore it can be used effectively as propagating material for olive cuttings. [ABSTRACT FROM AUTHOR]

Objective: To find out the pattern of foreign bodies inhaled or ingested in a series of patients. Study Design: Case series. Place and Duration of Study: Ear, Nose and Throat (ENT) department, Pak Emirates Military Hospital (PEMH) Rawalpindi, Jan 2016 to Dec 2016. Methodology: A total of 46 cases of foreign body upper aero digestive tract who presented in the ENT Department, PEMH Rawalpindi in 2016 were included in this study. Twenty eight cases were of foreign body esophagus and 18 were of foreign body airway. The age, gender, duration of foreign body lodgment, types of foreign body’s physical signs and symptoms were recorded. Relevant radiographic studies were performed. Results: Out of 46 patients of foreign body aero digestive tract 33 were males and 13 were females. The overall frequency of foreign bodies’ upper aero digestive tract was 46 (0.14%) with 28 (0.08%) being foreign bodies esophagus and 18 (0.06%) foreign bodies airway. In 50% cases of bronchial foreign bodies were in age group 0-3 years. The most frequent foreign body in the esophagus was coin in 13(46.4%) followed by chicken bone 5 (17.8%) and fish bone 3 (10.7%). Peanuts, peas, and beans were predominant component of the airway foreign bodies constituting 6 (33.3%), 3 (16.6%) and 3 (16.6%) respective of the total. Most frequent sites of impaction of the foreign body were cervical esophagus 16 (34%), right main bronchus 11 (23.9%) and left main bronchus 3 (6.5%). Conclusion: Foreign body aero digestive tract is an uncommon but potentially life threatening presentation in ENT practice. Prompt management includes high index of suspicion and investigation to reach definitive diagnosis followed by intervention. [ABSTRACT FROM AUTHOR]

Objective: To share experience of 1000 patients who underwent functional endoscopic sinus surgery (FESS) in 4 different hospitals for various diseases over span of 9 years. Study Design: Prospective observational study. Place and Duration of Study: Sheikh Khalifa Hospital Muzaffarabad, Combined Military Hospital Sialkot, Pak Emirates Military Hospital Rawalpindi and Combined Military Hospital Quetta, from Jun 2009 to Jun 2018. Methodology: We included 1000 patients who underwent Functional endoscopic sinus surgery (FESS) in four different military hospitals, suffering with various diseases discussed later. Patients were operated after failure to get response to medical therapy. All the patients had preoperative endoscopic examination and CT-scan paranasal sinuses (PNS) done for disease assessment. Patients were examined post operatively at 1, 15 days and 2 months. All patients were documented for the level of satisfaction at end of 2 months post-operative period. Results: Most patients were suffering from rhino sinusitis 364 (36.4%). Bilateral ethmoidal polyps constituted the second largest group at 289 (28.9%) patients. About 837 (83.7%) of patients were completely free of symptom, 104 (10.4%) with partial improvement whereas, 59 (5.9%) patients did not report any improvement in symptoms. 899 (89.9%) of patients were discharged on their first post operation day meaning less hospital stay and quick recovery. Conclusion: Functional endoscopic sinus surgery (FESS) can be employed to treatment variety of common nasal diseases (chronic rhino-sinusitis, nasal polyps) and non-nasal diseases like cerebrospinal fluid (CSF) rhinorrhea and as approach to skull base. This method of treatment was quite effective in alleviating symptoms of patients. [ABSTRACT FROM AUTHOR]

Objective: To assess short and long term aesthetic and functional outcomes of nasal ala reconstruction by three staged folded forehead flap. Study Design: Prospective study. Place and Duration of Study: Plastic and Reconstructive Surgery Department of Combined Military Hospital Bahawalpur and Quetta, from Dec 2014 to Dec 2018. Methodology: Total of 29 patients were enrolled through consecutive sampling technique. Nasal ala defects were reconstructed by three staged frontal forehead flap under general anesthesia. Follow up visit at 2 weeks bleeding, wound Infection, partial skin graft loss and partial flap necrosis was documented. Follow up at 24 weeks, functional outcome of nasal reconstruction was assessed by history and clinical examination for nasal obstruction and/or crusting. Patients’ subjective satisfaction about aesthetic outcome of nasal reconstruction was documented on 5 point likert scale. Objective aesthetic assessment of reconstruction was done on 2D photograph by two independent surgeons. Results: Twenty six (89.66%) males and 3 (10.34%) females participated in study. The mean age was 35 years range 16 to 64 years. Follow up at two weeks revealed postoperative bleeding in 2 (6.8%), wound infection in 1 (3.4%) and partial flap loss in 1 (3.4%) patient. At 24 weeks follow up all patients had patent nasal ala. Subjective and objective assessment of nose shape was documented. Conclusion: Use of three staged folded forehead flapis useful method of reconstruction for full thickness defects of nasal alaewith good functional and aesthetic outcome. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the increase in paediatric burn admissions. Find various causes of this trend and assess the morbidity and mortality in paediatric population, and suggest remedies. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at department of Burns & Plastic Surgery, Army Burn Centre, Combined Military Hospital, Kharian, from Sep 2017 to Aug 2019. Methodology: Total number of acute burn admissions under 12 years were recorded. Sub divided this group into 0-2 years and 2 to 12 years. We assessed epidemiology, sex, cause of burn, mode of admission, location of incident, type of first aid given, mortality, and compared results during two equal halves of this period. We used SPSS 20 for data analysis. Results: A total of 504 (49.85%) were pediatric acute burn admissions. Age range 25 days to 12 years (mean 5 ± 1.2 years). One hundred and fifty two infants/toddlers aged 0-2 years. Two hundred and seventy male and 234 females. Three hundred and sixteen direct admissions. There were 72.43% more pediatric burn admissions. Three hundred and eighty one scalds, 91 flame burns, 21 electric burns and 11 chemical burns. There was 11.94% improved survival among burn patients. Two temporal peaks, largest in summer from May to Jul and second in winters. The first peak in summers is unique in subcontinent. This is the time of summer vacations in schools when children are less well supervised. Conclusion: There is a rising trend of preventable pediatric burns. A mass public awareness program is the need of the hour. [ABSTRACT FROM AUTHOR]

The transnasal approach for pituitary lesions has been adopted increasingly by neurosurgeons for removing sellar lesions. It has made surgery in this region safer with fewer complications in experienced hands. However, the approach requires good knowledge of nasal anatomy and formal training to achieve good results since the territory is unfamiliar to most neurosurgeons. The approach has a somewhat steep learning curve. In our experience of 41 cases, we have presented here. We have discussed the history of this approach, technique and relevant complications and their avoidance. [ABSTRACT FROM AUTHOR]