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Objectives: To elucidate the burden and clinico-epidemiological attributes of congenital and hereditary anomalies (CA) in the extended Peshawar Valley of Pakistan. Method: This is a multicenter cross sectional study carried out in Buner, Charsadda, Mardan, Nowshera, Peshawar and Swabi districts, during 2017-2021. The pediatric and adult patients with CA were recruited from hospitals, public places and through door-to-door surveys. The anomalies were classified with the help of specialized clinicians. Descriptive statistics was employed. Results: In this study, 1065 independent subjects with certain types of CA from independent households were included. The index males were 71%; the majority of subjects originated from rural areas (72%), and spoke Pashto (96%). The CA were categorized into 10 major and at least 104 minor categories. There was highest representation of neurological disorders, n=375 (proportion.: 0.352; 95% CI: 0.323-0.381), followed by limb defects (n=281; prop.: 0.264), sensorineural defects (n=128; prop.: 0.120), musculoskeletal defects (n=84; prop.: 0.079), visual impairments (n=67; prop.: 0.063), hemoglobinopathies (n=40; prop.: 0.038), ectodermal disorders (n=34; prop.: 0.032), cardiovascular anomalies (n=19; prop.: 0.018), and orofacial anomalies (n=19; prop). Among the neurological disorder, intellectual disabilities and cerebral palsy were highly prevalent. The majority of the cases had a sporadic presentation (68%), and isolated occurrence (72%), whereas parental consanguinity was witnessed in 58% of cases. Conclusion: A wide range of CA were witnessed in this cohort with a preponderance of neurological disorders. The majority of the anomalies are of severe nature rendering a high morbidity burden in the population and requiring early detection, intervention and management. [ABSTRACT FROM AUTHOR]

The research work is focused on dendroecological potential of Pinus roxburghii (Sarg.) and Pinus wallichiana (A. B. Jacks.) in Jhika gali of murree. Age, growth rate, height, diameter at breast height (dbh), and phytosociological attributes of these two pine species were determined. Increment borers were used to obtain samples from study site. 50 samples from each species were obtained. In P. roxburghii the growth rate varied between 0.93 cm/year to 0.58 cm/year with Dbh 193 and 189.5 cm, respectively. Height was measured in between 30.17 and 18.6 m. In first stand of P. roxburghii maximum growth rate was 0.93 inches/year and minimum in growth rate in second stand was 0.58 cm/year with Dbh 193 and 189.5 cm, respectively. There was an inverse correlation between growth rate and dbh, but growth rate and height it was direct. In P. wallichiana growth rate varied between 1.3 cm/year with dbh 64 cm and 0.41 cm/year with dbh 105.1 cm. The relationship observed between height and growth rate was directly proportional in P. wallichiana, while it was inverse between dbh and growth rate. In Phytosociology, 92 species were collected belonging to 44 different families. IVI values of various species varied between minimum 0.99 and maximum 2.65. TWINSPAN is indicating the diverse nature of plant communities with diverse nature of grouping. Group I (G 1), Group II (G 3) has biodiversity in some of stands while Group II (G 2) has greatest biodiversity with five subgroups and subsequent associations. [ABSTRACT FROM AUTHOR]

This study aims to evaluate municipal landfill sites' operational and financial viability, waste amount and characterization, primary and secondary collection systems, revenue generation from MSW, vehicle routing, and age of landfill sites located in Akhtarabad, Sahiwal Division. Three operational and financial models were developed to calculate cost/ton value based on obtained data. The obtained results indicate that the cost/ton values for models are the following: 20.01 USD for Model-1, 8.96 USD Model-2, and Model-3 is about 10.23 USD. The waste characterization represented waste consisting of compostable (57%), recyclable (10%), Refuse Derived Fuel (RDF) (12%), earth fill (20%), and disposable material (1%). Revenue/ton of municipal solid waste was about 19.47 USD, and according to cost-benefit analysis, the cost of Model-1 was higher than the benefit. In contrast, the costs of Model-2 and Model-3 were found to be lower than the revenue/ton. However, the waste collection efficiency of Model-1 was greater than both remaining models. The study concluded that utilizing all generated waste, only 21% of waste is dumped at the landfill site. It will reduce the area required for landfill sites from 431437 to 90602 m2 for the next 10 years and increase the age of landfill sites by over 20 years. It is recommended that the reuse of municipal solid waste and implementation of the no waste to landfill model would surely save money, land, and fuel, and it will also increase the age of landfill sites. [ABSTRACT FROM AUTHOR]

Objective: Specialty choices in health profession has long been influenced by gender. The field of General Surgery remains the least preferred specialty by females, especially in Pakistan. The objective of this study was to identify the factors leading to success and retention of females in General Surgery in Pakistan. Methods: Qualitative case study was conducted from February to May 2020 at Khyber Medical University, Peshawar. Ten semi-structured interviews were conducted with purposive sample of female surgeons at various academic position in different tertiary care hospitals of Pakistan. Data were thematically analyzed. Results: Participants were driven by their passion for surgery, which led them to choose this specialty in the beginning. Their survival in male dominant workplace was made possible by their own personality traits and conducive environment provided by the supervisors and peers. However, a structured mentorship program for females was found lacking. Conclusion: The necessary ingredients for success are passion and personality traits in any field but attention to nurturing and supportive environment for females in the General Surgery is paramount in determining success. Due consideration to the factors identified in the current study will enhance the retention and success of females in General Surgery. [ABSTRACT FROM AUTHOR]

This study aims to examine the impact of ESG practices on the financial performance of the banking industry of Pakistan during the pre and COVID-19 periods. The data were collected from the annual reports of selected banks for the pre-COVID-19 period (2018) and the COVID-19 period (2020). Results of the t-test show that there is a significant difference in ESG disclosures between the pre and during-COVID-19 periods. The regression analysis shows that the formative ESG factor positively affected the financial performance of the banking industry during the pre-COVID-19 period. While the reflective factors (environmental and social) positively affected the financial performance of the banking industry in the pre-COVID-19 period. During the COVID-19 period, the formative factor of ESG was found to have a significant positive impact on the financial performance of the banking industry. Similarly, in this period, the reflective factors (social and governance) were also found to have a significant positive impact on the financial performance of the banking industry. Interestingly, environmental sustainability negatively impacted the financial performance during the COVID-19 period. It indicates that the banking industry ignored environmental sustainability practices during the COVID −19 period, negatively affecting their financial performance. It suggests that ignoring environmental sustainability practices will deteriorate financial performance following the COVID-19 period. These results have profound policy implications for practitioners and policymakers in the banking industry, which are discussed. [ABSTRACT FROM AUTHOR]

This paper critically analyses how Mohsin Hamid in 'Discontent and Its Civilizations' delineates the rupture lines prompted by a decade and a half of tectonic change, from the 'war on terror' to the struggles of individuals to maintain humanity in the inflexible physiognomy of repressive ideology, or the apathetic face of globalization. Whether he is discussing ritual love affairs or pop culture, drones or the pattern of day-to-day life in an extended family, he carries us beyond the doomsayer headlines of a perturbed West and a turbulent East and helps to bring a dazzling manifold world within spiritual and intellectual reach. The classifications under which the essays are congregated: Life, Art, and Politics may be considered universal, as the themes of these segments are wide-ranging. Hamid's nonfiction pieces of writings are deep-rooted in the shifting nature of his homeland. He talks about the way in which Pakistan "plays a recurring role as villain in the horror sub-industry within the news business" (Hamid, 2014). He believes that in Pakistan, Islam has been as a binding force for developing unity for strengthening nationhood. Although Pakistan; "a test bed for pluralism on a globalising planet" (Hamid, 2014), is still struggling for "more pluralism" (Hamid, 2014). American drone attacks have had a deeply detrimental effect by refusing the sovereignty of Pakistan and Pakistani society, and by demanding 'do more' to accost the problem of extremists who tyrannize Pakistanis/Muslims or non-Pakistanis/non-Muslims in the same way. Such social misrepresentations, for some selfish self-interests, neither only shatter the image of a nation in the world, but also play a vital role in transformation of the nation alike with the help of such vague reflections. Pakistan and Islam both need to be reviewed without any "makeup and plastic fangs" (Hamid, 2014) or else future generations will look back at our era and think of us with the same perplexity that we think of those who lived in societies that legalized slavery. [ABSTRACT FROM AUTHOR]

Objective: To determine the psychological impact of COVID-19 in pregnant patients. Study Design: Crosssectional study. Setting: Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Center, Civil Hospital, Lady Dufferin Hospital. Period: 1st September 2021 to 20th November 2021. Material & Methods: A total of 201 pregnant women without any history of mental illness were included in this cross sectional, multicenter hospital based study conducted in Karachi, Pakistan. An IES-R (impact of event-revised scale) based questionnaire was used to assess the psychological impact of the COVID-19 pandemic. Results: In total 182 (90.55%) pregnant women were mild to moderately psychologically affected while 19 (9.45%) were severely affected by the pandemic. Depression (p value 0.05), insomnia (p value 0.04), and feeling of loneliness (p value 0.007) were the statistically significant effects of COVID-19 in pregnancy. Antenatal care was also affected with 127 (63.2%) of the pregnant women being afraid to go to the hospital for antenatal visits. Conclusion: The pandemic had a mild to moderate effect on the mental health of majority of the pregnant women in Karachi, Pakistan, leading to behavioral changes and impacting antenatal care. These findings suggest that pregnant women need more support during the COVID-19 pandemic and it is important to take appropriate actions to prevent psychological distress. [ABSTRACT FROM AUTHOR]

Foot and mouth disease (FMD) causes severe economic losses to the livestock industry of endemic countries, including Pakistan. Pakistan is part of the endemic pool 3 for foot and mouth disease viruses (FMDV), characterized by co-circulating O, A, and Asia 1 serotypes, as designated by the world reference laboratory for FMD (WRL-FMD). FMDV serotype A lineage ASIA/Iran-05 is widespread in buffalos and cattle populations and was first reported in Pakistan in 2006. This lineage has a high turnover, with as many as 10 sub-lineages reported from Pakistan over the years. In this study, we reconstructed the evolutionary, demographic, and spatial history of serotype A and one of its sub-lineages, A/ASIA/Iran-05/SIS-13, prevalent in Pakistan. We sequenced nearly complete genomes of three isolates belonging to sub-lineage A/ASIA/Iran-05/SIS-13. We estimated recombination patterns and natural selection acting on the serotype A genomes. Source and transmission routes in Pakistan were inferred, and the clustering pattern of isolates of the SIS-13 sub-lineage were mapped on a tree. We hereby report nearly complete genome sequences of isolates belonging to sub-lineage A/ASIA/Iran-05/SIS-13, along with purported recombinant genomes, and highlight that complete coding sequences can better elucidate the endemic history and evolutionary pressures acting on long-term co-circulating FMDV strains. [ABSTRACT FROM AUTHOR]

Background and Objectives: In Pakistan, there is high incidence of congenital and hereditary anomalies (CA) which are a leading cause of infant mortality and morbidity. In order to elucidate the burden and biodemographic correlates of CA, this study was aimed to report the prevalence-pattern and phenotypic attributes of CA in the Hazara population of Khyber Pakhtunkhwa, Pakistan. Methods: In a retrospective cross-sectional study, subjects/families with CA were recruited from district hospitals and community centers. Phenotypic and descriptive data were obtained; pedigrees were analyzed and parental and biodemographic attributes were recorded. Results: A total of 1,189 independent subjects and/or families with CA were ascertained. The malformations were grouped into nine major and 95 minor categories. Neurological disorder had the highest representation (n=486; proportion=0.409; 95% CI=0.381-0.437), followed by limb defects (n=292; proportion=0.246, 95% CI=0.221-0.270), musculoskeletal defects, sensorineural/ear defects, blood disorders, eye/visual impairments, ectodermal anomalies, and congenital heart defects. In this cohort, sporadic cases were 65% and familial 35%. Parental consanguinity was significantly higher in isolated cases compared to syndromic, and in familial cases compared to sporadic. Further, speech apraxia and epilepsy were most common associations among the syndromic cases. The assessment of variables like demography, parental consanguinity, familial/sporadic nature, and pedigree structures showed conspicuous heterogeneity among the major and minor categories of CA. Conclusions: The trend of CA and high incidence of sporadic cases observed in this cohort indicate that nongenetic factors may play a significant role in their etiology which could be minimized by improving the healthcare system. [ABSTRACT FROM AUTHOR]

Objective: To determine patient preferences in the surgical options of early breast cancers and surgeon’s role in the decisionmaking. Study Design: Cross-sectional study. Place and Duration of Study: Breast Surgery Department, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2020 to May 2021. Methodology: Patients having early carcinoma breast were studied, i.e., clinical stage 1 or 2, and their surgical preference was recorded. The cases were discussed in multidisciplinary meetings, and a discussion session with patient conducted and then final decision taken from the patient was recorded again, and the results compared. Results: A total of 28 patients were included in this study and their surgical preferences recorded. Of these patients 22 (78.5%) agreed to breast conservation initially, whereas one of the patients wanted mastectomy. Five (17.8%) patients were undecided between the two. After multidisciplinary team recommendation and discussion with surgeon, only one patient opted for mastectomy (3.6%). Conclusion: Patients with early breast cancer when offered a surgical decision between breast conservation and mastectomy mostly opt for breast conservation; those who select mastectomy do so because of the fear of recurrence. [ABSTRACT FROM AUTHOR]

Rotavirus A (RVA) is a diarrheal pathogen affecting children under age five, particularly in developing and underdeveloped regions of the world due to malnutrition, poor healthcare and hygienic conditions. Water and food contamination are found to be major sources of diarrheal outbreaks. Pakistan is one of the countries with high RVA related diarrhea burden but with insufficient surveillance system. The aim of this study was to gauge the RVA contamination of major open sewerage collecting streams and household water supplies in two major metropolitan cities of Pakistan. Three concentration methods were compared using RNA purity and concentration as parameters, and detection efficiency of the selected method was estimated. Water samples were collected from 21 sites in Islamabad and Rawalpindi in two phases during the year 2014–2015. Meteorological conditions were recorded for each sampling day and site from Pakistan Meteorological Department (PMD). Nested PCR was used to detect the presence of RVA in samples targeting the VP7 gene. Logistic regression was applied to assess the association of weather conditions with RVA persistence in water bodies. Statistical analysis hinted at a temporal and seasonal pattern of RVA detection in water. Phylogenetic analysis of selected isolates showed a close association of environmental strains with clinical RVA isolates from hospitalized children with acute diarrhea during the same period. This is the first scientific report cataloging the circulating RVA strains in environmental samples from the region. The study highlights the hazards of releasing untreated sewerage containing potentially infectious viral particles into collecting streams, which could become a reservoir of multiple pathogens and a risk to exposed communities. Moreover, routine testing of these water bodies can present an effective surveillance system of circulating viral strains in the population. [ABSTRACT FROM AUTHOR]

Objective: To determine the dose of Protamine required for reversal of Heparin effect in Coronary Artery Bypass Grafting (CABG). Study Design: Quasi-experimental study. Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from May to Dec 2022. Methodology: Total 382 patients were included in this study through consecutive sampling and were divided into two groups (n=191 participants in each group). After induction of anesthesia, baseline Activated Clotting Time (ACT) was measured. About 300units/kg of unfractionated Heparin was given non-randomly before establishing Cardiopulmonary Bypass (CPB). After termination of CPB, Protamine was administered in doses of 1 mg/kg and 1.5 mg/kg to Group-A and Group-B respectively. Protamine was diluted in 20ml of saline, and administered at a rate of 100ml/hr. Once Protamine was administered, blood sample was taken after 5min for ACT measurement. If this ACT was within 10% of baseline, it was taken as sign for reversal of Heparin effect. Student t-test and Chi-square test were applied to compare the groups and level of significance taken was p<0.05. Results: Majority cases were males 287(75.1%), whereas 95(24.9%) were females. Statistically significant mean differences were noted between Cardiopulmonary Bypass (CPB) time, ACT after Protamine administration, and requirement for extra Protamine administration between two groups (p<0.05). However, no significant differences were noted between age, weight and ACT before Heparin administration (p>0.05). About 1mg/kg of Protamine reversed the Heparin effect in 116(60.7%) patients in Group-A, whereas 1.5mg/kg reversed the Heparin effect in 180(94.2%) cases in Group-B (p<0.001). Conclusion: Classical doses of 3mg/kg of Protamine in CABG patients may actually be exposing patients to higher than required doses of Protamine. Dose of 1mg/kg and 1.5mg/kg of Protamine was also found to be effective. [ABSTRACT FROM AUTHOR]

Objective: To determine the sensitivity of axillary ultrasound in detecting axillary nodal metastasis in clinically and radiologically uninvolved axillary nodes in early carcinoma breast by comparing with sentinel node biopsy histopathology on frozen section. Study Design: Comparative cross-sectional study Place and Duration of Study: Breast Clinic, CMH, Rawalpindi Pakistan, from Aug 2020 to May 2021. Methodology: Patients included in the study presented with breast cancer lesions with clinically impalpable axillary lymph nodes aged 18-75. Patients with clinically impalpable nodes underwent an ultrasound of the axilla; if suspicious nodes were found, the patient had subsequent axillary node dissection. Sentinel node biopsy (SLNB) was performed on axillary ultrasound in all patients with no suspicious or benign-looking nodes. Histopathological reporting was taken as standard. Lymph nodal status on axillary ultrasound, SLN biopsy and axillary lymph node clearance were documented and analyzed. Results: Twenty-nine patients were included who had benign-looking lymph nodes on axillary ultrasound and underwent sentinel lymph node biopsy. The mean age of the patients was 54.03 ± 7.94. Out of 29 patients, 24(82.8%) patients had negative Sentinel lymph node biopsy, and 5(17.2%) had positive Sentinel lymph node biopsy, who then underwent axillary lymph node dissection. Conclusion: Sentinel lymph node biopsy is the gold standard to determine axillary lymph nodes involved in early carcinoma breast, which seem benign on pre-operative axillary ultrasound. [ABSTRACT FROM AUTHOR]

In this research, the factors that affect individual investor when he/she invests in banking sector of Pakistan have been focused. Six independent variables i.e. Psychology, rate of return, religion, culture, customer perception and one dependent variable that is investment decision making were observed. The data was obtained through survey method from customers and from the financial officers of conventional and Islamic banking sectors of Pakistan. Descriptive analysis was conducted to get empirical analysis results in summary along-with numerical representation. Cronbach Alpha was applied for the reliability analysis of the survey design. Hypotheses testing was also conducted and resulted that multiple factors do effect on the investment decision making except culture and customer perception as they had insignificant effect on investment decision making. Although seven top banks of Pakistan were selected with a bunch of tested important variables. However, its quantity may be enriched to substantiate and improve the findings. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to determine the validity of bispectral in diagnosis of mild and moderate head injury keeping GCS as a gold standard. Study Design: A cross sectional validation study. Place and Duration of Study: This Study was conducted in main Intensive Care Unit of the Combined Military Hospital Rawalpindi and was carried out over eight months from Dec 2009 to Aug 2010. Material and Methods: A minimum of 137 patients were included in study. At the time of admission, Glasgow coma score was calculated by 3 different anesthetists and mean was calculated. At the same time BIS reading was taken using Aspect BIS monitor. Results: Mean age of the patients was 29.5 ± 6.2. 108 (78.8%) patients were male while 29 (29.2%) patients were female. Mean glasgow coma score was 12.2 ± 0.9 and mean bispectral index score was 69.9 ± 8.4. A 2 x 2 table was made between GCS and BIS. Sensitivity was found to be 95.65%, specificity 98.53%, positive predictive value 98.50% and negative predictive value 95.7%. ROC curve was drawn and demonstrated area under curve value of 0.999. Conclusion: BIS monitor can prove to be a useful adjunct in the diagnosis and management of mild and moderate head injury patients in the intensive care units. [ABSTRACT FROM AUTHOR]

The economic growth of the global industrial sector has become a grave concern to immensely degrade the environment in recent years. The industries lack an effective environmental management plan to mitigate environmental contamination and pollution load by following good practices such as less consumption of raw materials, waste reduction, wastewater treatment, and pollution control. Significantly, the current study aims to investigate the environmental baseline conditions of Quaid-e-Azam Industrial Estate (QIE) and design Environmental Management Plan (EMP) to alleviate the impacts of industrial wastewater effluents, ambient air, ambient noise level, and solid waste. In addition, this study monitors the current pollution status and develops the air/water quality indices to evaluate sustainable environmental management practices (SEMP) in QIE. The obtained key finding reported a poor wastewater quality index ranging from 100 to 150. Furthermore, the air quality index suggested that ambient air in the vicinity of QIE varied from 52 to 72, which is evident that ambient air is moderately polluted and pose risk to public health. Additionally, the ambient noise level was considerably 12.8% higher in the morning and 18.7% higher than the prescribed level in the afternoon. Furthermore, approximately 10 t of solid waste was collected regularly from the industrial waste pits. Around 85.8% were moderately polluting ambient air whereas only 5.1% highly deteriorating ambient air. Significantly, a detailed environmental management plan (EMP) was designed to include impact identification, mitigation measures, frequency of monitoring the effectiveness of mitigatory measures, and assigning of responsibilities. Overall, the environmental management plan should become an integral part of the overall management system to achieve sustainable development goals (SDGs), including sustainable cities and communities (SDG11), life below water (SDG14), and life on land (SDG15). [Display omitted] • Measurement of air/water quality indices to assess the Sustainable Environmental Management Practices (SEMP). • Quantification of environmental baseline conditions of Quaid-e-Azam Industrial Estate (QIE), Pakistan. • Monitoring the existing pollution status for the characterization of environmental physicochemical parameters. • Design its environmental management plan (EMP) to mitigate its environmental impacts. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine the frequency of postoperative pulmonary complications after (coronary artery bypass grafting) CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Crosssectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology, Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using nonProbability consecutive sampling. GroupA had history of COVID-19 infection and GroupB was a comparison group and had no history of COVID-19 infection. Patients presenting for elective OnPump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring postoperative reventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e., 20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and reventilation (p=0.451) of both groups. While Intensive Care Unit stay (p=<0.0001) and noninvasive ventilation (NIV) were found to be significant (p=0.007). [ABSTRACT FROM AUTHOR]

Sesame is an important crop that has potential to add to edible oil production of Pakistan but bacterial blight incited by Xanthomonas campestris pv. sesami (Xcs) is most serious and devastating disease of sesame responsible for colossal losses. For decision of effective management strategy, proper identification of pathogen is pre-requisite. Present study was designed to evaluate ELISA with polyclonal antibodies (PAbs) for detection of Xcs with a fact that ELISA is cost effective and can be used for screening of large samples. PAbs were prepared in rabbits against pure isolate of Xcs. Direct antigen coated (DAC)- ELISA was used for the analysis of pathogen in sesame germplasm obtained from NARC (Islamabad). Pathogen from 29 sesame varieties, categorized from resistant to susceptible, was isolated and used as an antigen. After incubation, OD was calculated at 405 nm and results revealed that lowest reaction (0.068) was observed in highly resistant sesame genotypes i.e. SG-22 and SG-55. While varieties SG-34, SG-33 and SG-72 were categorized as resistant based on reactivity (0.073). Thus it is concluded that ELISA with PAbs should be preferred for detection of Xcs because of the fact that they are more stable, target multiple epitopes on single antigen and are easy to produce. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of menstrual problems after tubal ligation. Study Design: Descriptive study. Place and Duration of Study: This study was carried out in gynae department of PAF Hospital Sargodha, Pakistan from September 2011 to September 2012. Patients and methods: Two hundred patients were included in the study with menstrual problems after tubal ligation. Results: Forty seven percent of patients presented with menorrhagia, 28% presented with metrorrhagia, 13% patients were having complaints of polymenorrhoea and 5% patients presented with dysmenorrhea and 7% had oligomenorrhoea after tubal ligation. Thirty one percent of patients ended up in hysterectomy and 37% of patients had improvement of symptoms with medical treatment. Conclusion: Menstrual problem is a common complaint in our gynecological patients. A large number of these patients had history of tubal ligation. Menorrhagia, metrorrhagia, polymenorrhoea and dysmenorrhoea can occur after tubal ligation. Patients giving the history of menstrual problems and wants tubal ligation should be counselled earlier for these symptoms. [ABSTRACT FROM AUTHOR]

Synthetic pollutants are a looming threat to the entire ecosystem, including wildlife, the environment, and human health. Polyhydroxyalkanoates (PHAs) are natural biodegradable microbial polymers with a promising potential to replace synthetic plastics. This research is focused on devising a sustainable approach to produce PHAs by a new microbial strain using untreated synthetic plastics and lignocellulosic biomass. For experiments, 47 soil samples and 18 effluent samples were collected from various areas of Punjab, Pakistan. The samples were primarily screened for PHA detection on agar medium containing Nile blue A stain. The PHA positive bacterial isolates showed prominent orange–yellow fluorescence on irradiation with UV light. They were further screened for PHA estimation by submerged fermentation in the culture broth. Bacterial isolate 16a produced maximum PHA and was identified by 16S rRNA sequencing. It was identified as Stenotrophomonas maltophilia HA-16 (MN240936), reported first time for PHA production. Basic fermentation parameters, such as incubation time, temperature, and pH were optimized for PHA production. Wood chips, cardboard cutouts, plastic bottle cutouts, shredded polystyrene cups, and plastic bags were optimized as alternative sustainable carbon sources for the production of PHAs. A vital finding of this study was the yield obtained by using plastic bags, i.e., 68.24 ± 0.27%. The effective use of plastic and lignocellulosic waste in the cultivation medium for the microbial production of PHA by a novel bacterial strain is discussed in the current study. [ABSTRACT FROM AUTHOR]

Objective: To quantify the rate of pathological complete response (PCR) in a tertiary care hospital in Pakistan, and to explore the association of pathological complete response with tumour histology, tumour grade, and histological subtype based on receptors., Study Design: Descriptive study., Place and Duration of Study: Combined Military Hospital, Rawalpindi, Pakistan from January 2016 to December 2018., Methodology: Data for 110 patients was retrospectively extracted from the medical records for the last three years. Inclusion criteria comprised of patients with non-metastatic breast cancer staged as cT1- 4 N0-1-2 breast cancer who received neoadjuvant systemic therapy, and undergone subsequent surgical procedures and adjuvant treatment as required. Assessment of pathological response was performed on the final (surgical) histopathology specimen. Complete pathological response (PCR) was evaluated according to Austrian Breast and Colorectal Cancer Study Group, and Neo-Breast International Group criteria as no invasive cancer in the breast or nodes; noninvasive breast residuals allowed (ypT0/is ypN0)., Results: The mean age of the study group was 47.21±9.5 years with an age range of 27 - 68 years. Among 110 patients undergoing neoadjuvant systemic therapy and surgery, the rate of pathological complete response was found to be 27.2% (30/110). Univariate analysis showed that pathological complete response was significantly associated with age category, tumour grade, cancer subtype, lymphovascular invasion, and Trastuzumab administration. The occurrence of pathological complete response was significantly different among different cancer subtype groups, being highest (42.8%) among triple-negative cancer subtype, followed by HR-ve/Her+ve, HR+ve/Her+ve, and HR+ve/Her-ve (40.0%, 34.4%, and 13.0% respectively, p=0.022)., Conclusion: Achieving PCR after neoadjuvant chemotherapy is quite promising keeping into consideration that PCR a potential marker for progression-free survival and overall survival. Tumour grade, age of the patient, Her2 positive subtype, anti-Her2 directed therapy, and negative lymphovascular invasion are found to be potential predictors of complete pathological response., Key Words: Breast cancer, Chemotherapy, Neoadjuvant systemic therapy, Pathological complete response, Surgery.

Aims: Autosomal recessive primary microcephaly (MCPH) is a clinically rare and genetically highly heterogeneous developmental disorder. Biallelic variants in the abnormal spindle-like microcephaly-associated ( ASPM ) gene account for 40% to 68% of all MCPH cases. This study was designed to elucidate the genetic basis of MCPH in an extended family. To highlight recurrent mutations useful in implementing genetic testing programs, we further aimed to carry out a descriptive review of the reported ASPM mutations. Materials and Methods: A large inbred kindred with seven affected members was investigated, and detailed clinical and behavioral assessments were carried out. Single nucleotide polymorphism (SNP)-based homozygosity mapping and exome sequencing were performed. Results: Affected individuals had characteristic features, including small head, receding forehead, mild to moderate intellectual disability, developmental delay, short stature, apraxia, and behavioral anomalies. We mapped the disease gene locus and detected a rare frameshift deletion c.6854&#95;6855del (p.(Leu2285GlnfsTer32)) in exon 18 of ASPM . A total of 215 mutations in ASPM have been reported in at least 453 families, nearly 50% of which are of Pakistani origin. These mutations can be classified as recurrent, founder or private in Pakistani and other populations. Conclusion: SNP-based homozygosity mapping and exome sequencing are essential in delineating the genetically distinct microcephaly types. The highlighted recurrent mutations in ASPM could be useful in implementing genetic testing programs for MCPH.

Background: Sudden sensorineural hearing loss (SSNHL) is considered an otologic emergency globally. Aetiology is unknown in most cases but still the disease is believed to be caused by inflammation of the cochlea; therefore, steroids are considered beneficial due to their anti-inflammatory effect., Methods: This study was conducted on 62 patients of sudden sensorineural hearing loss (SSNHL) in Ayub Medical Complex, Abbottabad. The patients were given prednisolone and their response to the therapy was monitored. Factors like age of the patient, gender, degree of hearing loss and duration of symptoms at initial presentation were recorded and their effect of response of the patient was also noted., Results: The research subjects were 62 patients. Majority of the patients suffered from moderate to moderately severe hearing loss. Age and gender did not influence the response to the treatment. While the patients who presented earlier after the onset of disease and the patients who had milder degree of hearing loss at presentation had a better response to therapy., Conclusions: Oral corticosteroid therapy is a good therapeutic option for the treatment of sudden sensorineural hearing loss (SSHNL). The response to therapy is better in patients with milder hearing loss and those who present early to the otologist for treatment.

Many studies have proposed an important role of viruses in the pathogenesis of oral cancer. The present study aimed to find out the prevalence of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human papillomavirus (HPV) among patients with oral squamous cell carcinoma (OSCC) in a Pakistani cohort. We investigated tissue samples obtained from 58 patients with OSCC using the polymerase chain reaction assay. No sample was positive for HPV. EBV was identified in 15 patients (25.86%), and CMV in three patients (5.17%). Coinfection with one or more viruses was detected in two cases and was coinfection with EBV and CMV. These results suggest a low prevalence of these viruses in OSCC patients in the Pakistani population compared to most other countries where the prevalence of these viruses has been reported in the past. Nevertheless, further studies are necessary to determine the potential role of EBV and the possible importance of CMV as an infection cofactor in oral cancer., (© 2020 Wiley Periodicals, Inc.)

Osteoarthritis (OA) is a serious health concern globally and is recognized by degradation of articular cartilage, bone remodeling and synovial inflammation. Resistin is an adipokine that shown to be involved in inflammatory process associated with OA. Aim of the current study was to estimate the link of resistin gene polymorphisms (- 420 C>G, + 299 G>A) with genetic susceptibility of knee OA in a Pakistani population. 280 patients and 308 age and sex matched controls were recruited in this case-control study. Genotype and allele frequencies were evaluated by Polymerase chain reaction-Restriction Fragment Length Polymorphism. Resistin concentration was measured by immunoassay. A significant difference in allele and genotype frequency was observed for both study groups. Resistin - 420 mutant genotype was associated with an increased susceptibility to OA (p = 0.001). Similarly, resistin + 299 GA + AA genotypes showed a relation with an elevated risk of knee OA compared to GG genotype (p = 0.01). Moreover, the mutant alleles frequency was significantly high in patient group as compared to healthy individuals for both loci (p < 0.01). Resistin - 420/+ 299 alleles haplotype analysis demonstrated that mutant alleles were more prevalent in OA affected individuals compared to healthy subjects (p < 0.05). The serum resistin levels were not remarkably different in patient vs. control group (p = 0.9). Further, the circulating resistin level was not found to be influenced by - 420G and + 299A alleles and non significant differences were observed in resistin concentration in mutant vs. wild type genotypes for both SNPs (p > 0.05). Our data suggest an association between investigated resistin genetic variants and knee OA susceptibility in our population. This is the first report to show association between investigated single nucleotide polymorphisms and OA among any population.

Background: Children commonly present to outpatient department with foreign bodies in the nose. Sometimes the history is straightforward but not infrequently presentation is with a foul-smelling unilateral discharge and obstruction. Most of the foreign bodies are inert and do not cause any local tissue reaction but some of these can cause serious complications. The frequency of the different types of foreign bodies is not known in our setup. Our study aims to determine the types and frequencies of different foreign bodies in our catchment area so as to make the attending surgeon aware of the different possibilities he may have to encounter. Also, we aimed to make the general public aware of the hazards which the foreign bodies can create., Methods: This descriptive cross-sectional study was carried out at Department of ENT of Ayub Teaching Hospital Abbottabad, from 1st June to 30th November 2017. During the period of study, patients presenting in outpatient department with nasal foreign bodies were included in the study. We recorded patients' age and gender. Types of foreign bodies recovered from the nose were documented and their frequency was calculated., Results: A total of 155 patients were included in the study. 60% of the foreign objects were inserted in the nasal passage by male children. Children below the age of 4 years comprised more than 55% of the cases. Mean age 4.5±2.36 years. Right nostril was predominantly involved (58%). Various seeds were commonly retrieved (40%). Plastic beads were the second most common foreign bodies (21.2%). Other foreign bodies found were buttons (9%), dry batteries (1.2%), stones (9%), toy pieces (4.5%), and food particles (10%)., Conclusions: The commonest nasal foreign objects in children were organic seeds followed by plastic beads.

Objective: To analyse the prevalence of myths pertinent to healthcare issues of females of reproductive age., Methods: This cross-sectional, simple descriptive, knowledge, attitude and practices-education research was conducted at the Combined Military Hospital, Peshawar, Pakistan, from February to August 2016. A 30-item self-designed questionnaire was applied, collecting demographic details and answers to 21 close-ended questions encompassing the prevalence of myths pertinent to reproductive health issues of women in Pakistan.Every question had three options, Yes(myth), No(correct answer) and Don't Know(unsure). SPSS 21 was used for data analysis., Results: There were 594 participants in the study. The overall mean age was 35.11±12.711 years and the mean duration of education was 9.41±6.353 years. Besides, >50% answers positive for myths and <50% answers positive for myths were given by 326(54.9%) and 268(45.1%) respondents, respectively. The prevalence of myths was directly proportional to age (p=0.004), and inversely proportional to education (p<0.001) and socio-economic class(p<0.001); impact of education was stronger than socio-economic class(Pearson's chi-square being 74.189 and 48.672, respectively). Khyber Pakhtunkhwa-based respondents harboured more myths (p=0.024). There was no significant impact of marital status (p=0.099)., Conclusions: The participants held significant amount of myths regarding health issues in reproductive age.

Background: Multidetector Computed Tomography (MDCT)s has become a major part in evaluation of hepatic and renal tumours. With improvements in MDCT, CT angiography has also improved and normal anatomy and its variants in patients undergoing operative or interventional procedures can be effectively studied. The purpose of this study was to evaluate the frequency of anatomical variation of celiac trunk, hepatic and renal arterial systems in patients undergoing multidetector CT (MDCT) angiography of the abdominal aorta., Methods: A descriptive, retrospective cross-sectional study was carried out on CT angiographies performed during the months of October till December 2015. Hepatic and renal arteries and celiac trunk were studied and normal and anatomical variations were noted. All patients with abnormalities affecting the vessels or a history of any vascular abnormality were excluded from the study., Results: Out of total 110 patients, 69.1% had normal and 30.9% had variant hepatic artery with Michel Type IV being the most common variant whereas 88.2% had normal celiac trunk and 8.2% had gastrosplenic trunk variant. Variation in renal arterial system was observed in 15.5% of the patients with two renal arteries on right and two on left being the most common type. Multiple variants were identified in 11.8% of the patients.., Conclusions: The type and knowledge of anatomy is of prime importance for an optimum preoperative planning in surgical or radiological procedure. MDCT allows minimally invasive assessment of arterial anatomy with high quality 3D reconstruction images.