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Aim: To determine the relationship between serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and active disease in patients with juvenile rheumatoid arthritis (JRA). Methods: This is a cross-sectional analytical study conducted over a year from October 2020 to October 2021 at Lady Reading Hospital, Peshawar Rheumatology and Pediatrics Unit. All MJA patients who met the criteria of the American College of Rheumatology (ACR) were enrolled in the study. The ACR 20 recovery criteria were used to define disease forgiveness, and those meeting the ACR 20 recovery criteria were included in the remission group. Laboratory tests such as PCR and ESR were done. Statistical analysis was performed using SAS software (version 10.3). Results: 90 patients were enrolled in the study, 28 (31.2%) in the remission group and 62 (68.88%) in the active disease group. There were 61.11% (n = 55) of women, and the ratio of men to women was 3: 4. The mean age of the subjects was 10.12 ± 3.39 years (4-17 years). Age distribution at reporting by different subgroups, 13 patients (14.44%) 1-5 years old, 31 patients (34.44%) 5-10 years old, 40 patients 10-15 years old (44.44 %), and 6 patients (6.66) were over 15 years of age. The mean disease duration was 2.40 + 2.11 years (range = 0.3 to 7 years). The onset of the disease in 21 patients (23.33%) was after one year (22.9%), in 48 patients (53.33%) between years and 5 years from the onset of the disease, in 21 patients (23.33%) five years. The most common type of arthritis was polyarthritis in 43 patients (47.77%), followed by polyarthritis in 31 patients (34.44%), and systemic onset in 12 patients (13.33%). The mean ESR was 41.03 + 27.80 mm / h 1 (range = 07-128 mm / h 1) and the mean CRP was 16.1 + 13.80 mg / L (range = 6-47 mg / L). ESR was> 30 mm / 1 hour. in 50 (55.55%) of 90 patients, while 43 (86%) of these 50 patients were in the active disease group. Similarly positive CRP was detected in 58 (64.44%) patients, of which 52 (89.7%) belonged to the group with active disease. Compared to the remission and active disease groups, 33 of the patients with active disease were female. In the active disease group, the mean age was 11.01 + 3.30 years, and the duration of the disease in patients started after one year. Polyarthritis was detected in 26/62 (41.9%) of patients from the active group of the disease. Conclusions: High CRP and ESR parameters are good in predicting active disease in JRA patients. Key words: C-reactive protein, juvenile rheumatoid arthritis, JRA and erythrocyte activity.

Background- The typical definition of fatigue is the feeling of aversion to effort, lack of energy, weariness, and early exhaustion. Due to inactive lifestyle, the rate of fatality became after three years of stroke in individuals who are the survivor of stroke with fatality. The induced activity which damage the ability to exert force is called Neuromuscular fatigue. Neuromuscular fatigue can be measured by the reduction in ability of muscles for exerting a force during an activity. After stroke, the walking function greatly impacted by the paretic leg muscles fatigue. That’s why, muscular fatigue in people after stroke can be quantitatively measured by the association of walking function with paretic leg muscles. This is a slight research which particularly measures the neuromuscular fatigue resulting stroke. The main objective of this study was to access relation of neuromuscular fatigue which can result in stroke and compare it with gender and age matched healthy individuals. Methodology- For this study total 80 subject were taken, and by purposive sampling these 80 participants divided in to two groups named as control group and experimental group and each group had 40 subjects. All those patients were included who were diagnosed to have chronic stroke before six months by Registered Doctors. Using Dual Bio Stimulator/Amp the hamstrings and quadriceps muscles activity of all subject were recorded of both non-paretic and paretic side. By performing “Maximum Voluntary Contraction” (MVC) exercise EMG signals induced in Pre-fatigue were recorded on both muscles of all participants. Also, in the same way “Sit to Stand test (STS)” was performed on all patients and exercise EMG signals were recorded induced in post-fatigue. To assess the chronic fatigue “Fatigue Severity Scale (FSS)” was used whereas to assess the subjective levels of pre and post exercise in fatigue “Visual Analog Fatigue Scale (VAFS)” was used. Results- “In hamstrings the mean activity of post fatigue EMG is significantly lower as compared to the mean activity of pre-fatigue EMG in non-paretic, paretic and control study group. Likewise, in quadriceps, the mean activity of post fatigue EMG is significantly lower as compared to the mean activity of pre-fatigue EMG in non-paretic, paretic and control study group.” Conclusion- In this study it was observed that in chronic stroke, the peripheral neuromuscular fatigue is different in comparison of matched control group with same gender and age. Keywords: Visual analog fatigue scale, Fatigue severity scale, Surface electromyography, neuromuscular fatigue, Chronic stroke, Chronic fatigue.

Objective- In newborn infant’s pain management is underused particularly for mild to moderate pain. For this purpose, glucose and sucrose use can be very effective. The main objective of this is to analyze the oral dextrose effects on pain relief in newborn infants. Methodology- For this study 124 newborn infants were enrolled for clinical trial which was randomized controlled. The Study was conducted in Bahawalpur Victoria Hospital in Paediatric unit .Before venipunctures, the enrolled infants were randomized to get breast milk or oral dextrose (25%) two minutes. After venipunctures, to know the pain reactions oxygen saturation, heart rate, and NIPS pain scoring system was recorded. Results- After venipunctures in dextrose group, pain was significantly lower (at 1st minute NIPS pain score was 6.62+0.82 and 4.67+1.04, at 2nd minutes it was 4.08 ± 1.05 and 2.04 ± 1.45 and at 3rd minutes it was 3.02+1.08 and 1.63+0.76 respectively). After comparison it was observed that 1st group heart rate was higher than the 2nd group as in 2nd group it was (144.8 ± 12.44/min) and in 1st group it was (166.57 ± 12.25/min). In both groups, desaturation was observed. Conclusion- In newborn to manage pain from mild to moderate the solution of 2ml of 25% dextrose is non-pharmacologic, non-expensive, easy, and useful method. Keywords: analgesia, breast milk, dextrose, newborn, pain.

The research study evaluated the performance of irrigation system by using special scientific tools like Remote Sensing and GIS technology, so that proper measurements could be taken for the sustainable agriculture and water management. Different performance evaluation parameters had been calculated for the purposed data was gathered from field investigation and different government and private organizations. According to the calculations, organic matter ranges from 0.19% (low value) to 0.76% (high value). In flat irrigation system for wheat yield ranges from 3347.16 to 5260.39 kg/ha, while the total water applied to wheat crop ranges from 252.94 to 279.19 mm and WUE ranges from 13.07 to 18.37 kg/ha/mm. For rice yield ranges from 3347.47 to 5433.07 kg/ha with total water supplied to rice crop ranges from 764.71 to 978.15 mm and WUE ranges from 3.49 to 5.71 kg/ha/mm. Similarly, in raised bed system wheat yield ranges from 4569.13 to 6008.60 kg/ha, total water supplied ranges from 158.87 to 185.09 mm and WUE ranges from 27.20 to 33.54 kg/ha/mm while in rice crop, yield ranges from 5285.04 to 6716.69 kg/ha, total water supplied ranges from 600.72 to 755.06 mm and WUE ranges from 6.41 to 10.05 kg/ha/mm. Almost 51.3% water saving is observed in bed irrigation system as compared to flat system. Less water supplied to beds is more affective as its WUE value is higher than flat system where more water is supplied in both the seasons. Similarly, RWS values show that maximum water deficit while minimum area is getting adequate water supply. Greater yield is recorded in bed system as plant per square meter is more in bed system in comparison of flat system Thus, the integration of GIS tools to regularly compute performance indices could provide irrigation managers with the means for managing efficiently the irrigation system., {"references":["Abernethy, C.L. 1989. Indicators of the performance of irrigation\ndistribution systems. In: Proceedings of the Symposium on the\nPerformance Evaluation of Irrigation Systems. International Irrigation\nManagement Institute (IIMI), Colombo, 23 November 1989.","Ahmad, I. and S. Iram. 2004. Diversity of bipolaris sorokiniana isolates\nfrom wheat growing areas under rice-wheat cropping system in Punjab,\nPakistan. Pak. J. Bot., 36: 439-444.","Ahmad, M.D., W.G.M Bastiaanssen and R.A. Feddes. 2005. A new\ntechnique to estimate net groundwater use across large irrigated areas by\ncombining remote sensing and water balance approaches, Rechna Doab,\nPakistan. 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