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Background: In Pakistan, there is a lack of information about the work environment of residency programs. This lack is a major impediment in their improvement. One of the approaches for improvement in these programs can be directed through the residents' own perception of their working conditions. Therefore, we collected data which would reflect working conditions of residents. Aim: To assess the perceived status of "work environment" in different specialities Materials and Methods: A cross-sectional survey was conducted in four teaching hospitals of Karachi from July 1999 to January 2000. Residents from selected programs were grouped into four broad groups: specialist, medical, surgical, and multidisciplinary. Responses of residents were obtained on a Likert scale of 0 to 4. Indices were formed for two components of work environment: academic and mistreatment. Statistical Analysis: Differences between residents' groups were assessed through analysis of variance (ANOVA) at 5% significance. Results: A total of 341 registered residents responded (response rate: 75%). Surgical residents were working more than 80 h/week and this was more than the other three groups. Medical residents were spending the highest actual time on research and teaching activities (10% and 14%, respectively). Academic index score was highest for surgical group (15.81, SD = 4.69) and lowest for multidisciplinary group (11.82, SD = 4.80). Medical group had the highest perceived mistreatment index score (5.56, SD = 4.57). Conclusions: In a study of work environment of residency programs, differential impact was found for the four groups on work environment perceptions. Most of the residents recognized undergraduate teaching, grand rounds, patient rounds, and seminars or workshops as contributing to their academic learning. Reporting of sexual harassment was low, indicating either underreporting or cultural dynamics of our setting. [ABSTRACT FROM AUTHOR]

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Objective: To map the practice of paediatric perioperative pain assessment and management among consultant anaesthetists working in teaching institutions in the two provinces of Pakistan., Study Design: A cross-sectional survey. Place and Duration of the Study: Department of Anaesthesiology, Teaching institutions of Sindh and Khyber Pakhtunkhwa (KPK), Pakistan, from January to October 2022., Methodology: A questionnaire was designed to determine the participants' practices about perioperative pain assessment and management. It consisted of 26 questions that included participants' demographic data and questions about their paediatric practice., Results: A total of 152 responses were received (response rate 76%). Most participants (n = 84, 55.3%) had a two-year diploma in anaesthesiology, while 38.2% had a four-year diploma. Additionally, 66.4% worked at public sector hospitals and 28.3% at private hospitals. Only 66% of respondents used paediatric pain scales for pain assessment in the recovery rooms. Most participants, 72.2%, had no Paediatric Pain Management Guidelines available at their institution. Only 5% had access to 5 analgaesic medications, while 32% had access to only 2 medications for intraoperative pain management., Conclusion: The practice of anaesthesiologists in these two provinces of Pakistan is highly varied since there is a lack of national guidelines., Key Words: Paediatric anaesthesia, Acute pain, Pain management, Pain measurement, Paediatric pain assessment, Anaesthesia and analgaesia, Survey and questionnaires.

Objective: To compare the efficacies of common therapeutic regimens and their combinations, used in polycystic ovarian syndrome (PCOS) to improve fertility in reproductive-age women., Study Design: A descriptive study. Place and Duration of the Study: Department of Obstetric Gynaecologist, Medicare Cardiac and General Hospital, Karachi, Pakistan, from November 2022 to July 2023., Methodology: Out of 300 patients with the symptoms of menstrual irregularities and infertility, 152 were diagnosed as PCOS patients based on the ultrasound and hormonal assays and selected for study purpose. They were divided according to their therapeutic regimen into four treatment groups, treated by different therapeutic agents. Group A received metformin 500 mg/day (n = 38); Group B received metformin + myo-inositol 1g (n = 49); Group C received metformin + letrozole 2.5 mg (n = 36), and Group D received metformin + letrozole + myo-inositol (n = 29), orally for three months. All continuous variables, such as body mass index (BMI), FSH, LH, FT4, and FSI were analysed by applying t-test to all therapeutic groups, keeping p ≤0.05 as the level of significance., Results: HCG-positive was found as 86% (n = 33) in Group A, 63% (n = 31) in Group B, 52% (n = 19) in Group C, and 27% (n = 08) in Group D. There were statistically significant (p <0.001) changes in BMI, FSH, LH, FT4, and FSI as well. Metformin alone and metformin plus myo-inositol came out to be more effective than other regimens., Conclusion: Metformin alone and myo-inositol plus metformin are effective therapeutic options in PCOS-induced infertility problems., Key Words: Polycystic ovarian syndrome, Infertility, Metformin, Myo-inositol, Letrozole, Menstrual irregularities.

Gender disparity in work distribution among cardiology trainees is a crucial issue that can impact career development and the overall representation of women in the field. This cross-sectional survey aimed to examine the gender disparity in work distribution among cardiology trainees in Pakistan. A total of 1156 trainees from various medical institutions across the country participated in the study, with 687 male trainees (59.4%) and 469 female trainees (40.5%). Demographic characteristics, baseline characteristics, work distribution patterns, perceptions of gender disparity, and career aspirations were assessed. The findings revealed that male trainees reported being assigned more complex procedures compared to female trainees (75% vs 47%, P < 0.001), while female trainees reported a higher frequency of being assigned administrative tasks compared to male trainees (61% vs 35%, P = 0.001). Both genders reported similar perceptions of the overall workload. However, female trainees experienced significantly higher rates of perceived bias and discrimination compared to male trainees (70% vs 25%, P < 0.001). Moreover, female trainees expressed a higher perception of unequal opportunities for career advancement due to gender disparities (80% vs 67%, P < 0.001). While male and female trainees showed similar aspirations for pursuing advanced subspecialties within cardiology, male trainees expressed a higher intention to pursue leadership positions within the field (60% vs 30%, P = 0.003). These findings shed light on the existing gender disparities in work distribution and perceptions within cardiology training programs in Pakistan., Competing Interests: Declaration of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This survey aimed to investigate the extent of bullying among junior physicians in cardiology departments, by way of an anonymous web-based questionnaire in Pakistan. A survey of Pakistan cardiology trainees was piloted as a cross-sectional qualitative survey of junior cardiologists (including resident physicians and senior registrars) from teaching institutes all over Pakistan. Negative Acts Questionnaire-Revised was used as the tool for monitoring and reporting bullying nationwide. Of 1852 trainees, bullying was reported by 10.2% of males and 13.4% of females. Women had higher odds of reporting being bullied (odds ratio [OR] {95% confidence interval [CI]}: 1.42 [1.07-2.36]; P-value = 0.018), and the religious minority group (Hindu) reported more bullying (OR [95% CI]: 3.27 [2.16-4.73]; P-value < 0.001). Women were more likely than men to report sexist language (24.1% vs 7.5%; P-value < 0.001) while men reported more racist language (4.2% vs 16.5%; P-value < 0.001). Consultants in cardiology (75.4%) and other specialties (68.3%) commonly perpetrated bullying on cardiology trainees. Bullying in cardiology is a common finding and proportionally affects both males and females, religious minorities, and trainees working in tertiary care hospitals. In addition, females are reporting more sexist language being used by consultants as the majority., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Most research has focused on determining how popularity and peer pressure impact behaviours, rather than identifying a key feature such as dental aesthetics and studying its impacts in relation to popularity and peer pressure., Methods: A cross sectional study was conducted on a sample of 527 children from four schools located in Lahore, Pakistan. A 14-point questionnaire was developed, using existing measures of peer pressure, and popularity. The selected questions were modified to investigate the issues of dental aesthetics and integrated into the WHO oral health questionnaire for children., Results: More than 50 % of the participants indicated popularity issues regarding dental aesthetics. 63.5 % of the responses indicated an influence of relatives and friends, whereas 38 % responses reported of harassment and bullying at schools. Regression analysis shows that the females were 1.99 times more likely to get comments from relative or friends about their teeth and 2.17 times more likely to be bullied or harassed at school due to their teeth when compared to the males. Fathers with a higher education brought about higher popularity and peer pressure issues. Mothers with a higher education were less likely to cause popularity and peer pressure issues than mothers with a lower education. Popularity and peer pressure were both significantly related to higher dental visitation., Conclusions: Popularity and peer pressure have a direct link to dental aesthetics in an individual and are impacted by gender, family relatives and parental influences. The area of popularity and peer pressure related to dental aesthetics can be targeted in health education programs to empower children to adopt better oral health behaviours., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction: Non-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care., Methodology: This is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs., Results: There was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level., Conclusion: This study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rashid, Mahmood, Asma Iftikhar, komal, Butt, Mumtaz and Shellah.)

Objectives: This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views., Methods: A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis., Results: A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance., Conclusion: Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.

Objective: To determine the prevalence of smoking and to evaluate the knowledge about preoperative smoking cessation in patients coming for elective surgery., Methods: The cross-sectional study was conducted from July 30, 2019, to March 17, 2020, in the preoperative anaesthesia assessment clinic and surgical wards of Aga Khan University Hospital, Civil Hospital Karachi, and Abbasi Shaheed Hospital, Karachi, and comprised all patients of either gender aged >12 years scheduled for elective surgery having American Society of Anaesthesiologists physical status I-IV. Data was analysed using Stata 13., Results: Of the 811 patients, 478(59%) were male and 333(41%) were female. The overall mean age was 43.4±16.4 years and mean BMI was 25.0±5.8kg/m2. There were 164(20.2%) smokers in the sample. The overall knowledge about preoperative smoking cessation was significantly associated with the level of education and gender (p<0.05)., Conclusions: Smoking in surgical patients was about one-fifth of the overall sample, and knowledge related to preoperative smoking abstinence was significantly associated with educational status and gender.

The excessive use of pesticides is posing major threats to humans and the environment. However, the environmental exposure and impact of pesticides in Pakistan have yet been systematically reviewed, despite the country's leading role in pesticide use. Therefore, this study identified and then reviewed 85 peer-reviewed scientific publications on the topic. It was found that, compared to the worldwide average, Pakistan had high consumptions of pesticides, with an alarming increase of 1169% in the last two decades. The quantities of pesticides used followed an order of pyrethroids > organophosphates > organochlorines > carbamates, but organochlorines were the most problematic due to their environmental occurrence, the ability to transport across the media, and identified human and ecological toxicities. Additionally, the misuse or overuse of pesticides by farmers is prevailing due to insufficient knowledge about the risks, which leads to high risks in occupational exposure. These issues are further aggravated by the illegal use or continuous impacts of banned organochlorine pesticides. For the future, we suggested the establishment of organized monitoring, assessment, and reporting program based on environmental laws to minimize contamination and exposure to pesticides in Pakistan. Remediation of the contaminated areas to mitigate the adverse environmental-cum-health impacts are recommended in the most affected regions., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Mercury is a highly toxic and highly mobile heavy metal. It has been regarded as more toxic than other nonessential and toxic nonradioactive heavy metals. Moreover, it has a high tendency of bioaccumulation and biomagnification in the ecosystem. This study aimed to assess the environmental and health risks related to Hg. Seventy studies related to Hg in environmental media, aquatic biota, and food stuffs across Pakistan were reviewed, and their concentrations were used for ecological and human health risk assessments. High concentrations of Hg were reported in the environment, with maximum concentrations of 72 mg L -1 , 144 mg kg -1 , 887 mg kg -1 , and 49,807 ng m -3 in surface water, surface soil, surface sediments, and urban atmosphere, respectively. The possible non-carcinogenic health risk (hazard quotient) of Hg was assessed in soil, water, and fish. High risks were calculated for seafood and vegetable consumption, while low risks were estimated for soils and groundwater ingestion and exposure. Overall, children showed higher risks than adults. Last, the risk quotient analysis (RQ) revealed significant risks for aquatic species. RQs showed that multiple species, especially those with smaller resilience, could face long-term detrimental impacts. High, medium, and low risks were calculated from 66.66, 16.17, and 16.17% of the reported Hg concentrations., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The pollen morphology, with special reference to exine sculpture, of some species of the gymnosperms was assessed for the first time from the subalpine and alpine zones of western Himalayas northern Pakistan. The pollen of all these species is airborne and allergenic, so pollen morphology helps for identification of this allergenic pollen at specific level. Different morpho-palynological characteristics were analyzed including size range of pollen, polar and equatorial diameter ratio, exine ornamentation, sculpturing, exine thickness, pollen type, and shape. For accurate and quick identification of species, taxonomic key was made based on different morpho-palynological characteristics. The quantitative data were processed using SPSS software. Gymnospermal pollen includes inaperturate, rarely 1-colpate observed in (Cupressaceae), hexazonocolpate in (Ephedraceae), vesiculate, bissacate in (Pinaceae), and inaperturate in (Taxaceae). Different pollen shapes observed were prolate (4 spp), sub-spheroidal (7 spp), and oblate (1 spp). Variation was observed in exine sculpturing granular (4 spp), reticulate (1 spp), areolate-punctate (3 spp), and psilate (2 spp). This is based on the analysis of 10 plants belonging to four families of gymnosperms. Distinct pollen shape has emerged as the most diagnostic feature to separate some genera such as spheroidal in (Cupressaceae, Taxaceae), prolate and radiosymmetrical in (Ephedraceae), and bilateral in (Pinaceae). Exine thickness and sculpturing proved to be helpful at generic and specific levels. The results reinforced the significance of gymnospermal pollen morphological features which were used as aid for valuable taxonomic tool in plant systematics., (© 2021 Wiley Periodicals LLC.)

The study was conducted to highlight a detailed account of morphology of pollen chosen species of Lamiaceae through scanning electron microscopy, and the anatomical characteristics of leaf epidermis of seven species using simple light microscopy. In results, Anisomeles indica and Otostegia aucheri belong to subfamily Lamioideae because it has tricolpate pollen while the rest eight species belong to subfamily Nepetoideae (hexacolpate pollen). The exine sculpturing of pollen of studied species was found to be reticulate. In the family Lamiaceae, four kinds of stomata were found anomocytic, anisocytic, diacytic, and actinocytic, respectively. The cell wall patterns of epidermal cells were irregular or polygonal with straight or undulate walls. It was noted that the variety of the epidermal trichomes seems of taxonomically important for the identification of species of Lamiaceae. Both nonglandular and glandular trichomes were analyzed. The nonglandular trichomes were characterized with long, thin, and pointed apical unicellular cells. The nonglandular trichomes were A-shaped in Thymus linearis. In Perovskia abrotanoides, stellate glandular trichomes were observed whereas in A. indica and Mentha royleana both glandular and nonglandular trichomes were found. In A. indica, the nonglandular trichomes were sessile and peltate in M. royleana. For the first time in this study, pollen and foliar micromorphological features of selected species of this area are carried out. These taxonomic characters were found to be important in discrimination of species from each other. In future, the detailed study with comprehensive morphology coupled with other important characters is required for delimitation of taxa at various levels., (© 2020 Wiley Periodicals, Inc.)

Swertia cordata (G. Don) C.B. Clarke is one of the potential medicinal plants extensively used in eastern traditional medicine such as Unani, Ayurveda, Siddha, and in traditional Tibetan and Chinese medicine. S. paniculata is the common adulterant of S. cordata at herbal shops and markets but S. paniculata is also used in number of herbal formulations. The present study was conducted to use microscopic, pharmacognostic, and phytochemical techniques as a tool for the authentication of herbal drug chiraita (S. cordata). In herbal markets, mixing, adulteration, and use of spurious materials as substitute have become a major concern for herbal practitioners, local user, and industry for reasons of safety and efficacy. Therefore, authentication of medicinal plants is of utmost importance at each level of drug research. In the present study, anatomical features of two species showed a great diversity, as irregular epidermal cells and nonglandular, unicellular trichomes were found in S. cordata while in S. paniculata epidermal cells were hexagonal in shape and trichomes were A-shaped. Antioxidant activity of two species showed a great variation where IC 50 value recorded for S. cordata was 208 μg/mL, while for S. paniculata IC 50 was 624 μg/mL. The study can serve as an important source of information to achieve the authenticity and to evaluate the quality and purity of the plant material in accordance to WHO guidelines. As this species is greatly exploited, so conservation is highly recommended., (© 2019 Wiley Periodicals, Inc.)

Pollen morphology of 10 species and foliar epidermal anatomy of eight species of Papilionaceae from Skardu valley, northern Pakistan has been estimated for the first time. The present study was commenced with an aim to provide a detailed account of the pollen morphology by scanning electron microscopy and foliar epidermal anatomy by light microscopy. The pollen aperture was tricolporate with reticulate exine in the selected species. Stomata types are actinocytic, paracytic, and anomocytic. Irregular or polygonal with undulate or straight walls, epidermal cells were reported. A unique diversity was observed in the foliar trichomes that show the taxonomic significance of the discrimination of taxa. Non-glandular trichomes were observed in the selected species which are unicellular with thin, long and pointed apical cells. Pollen and foliar micro morphological characters proved to be helpful for the identification of taxa at a specific level., (© 2019 Wiley Periodicals, Inc.)

Ethnopharmacological Relevance: Present study was commenced with an aim to document the indigenous knowledge of medicinally important shrubs and trees of Himalayan region of Azad Jammu and Kashmir, Pakistan. This is the first contribution to the quantitative ethnobotany of this region, as no reported data focusing on shrubs and trees from the area have been published. Study reported the ethnobotanical significance of medicinal plants for the treatment of various diseases., Method: Study was conducted during 2012-2014 following standard ethnobotanical methods. The ethnomedicinal data was collected through informed consent semi- structured interviews of 160 key informants. Documented data was analyzed by using quantitative indices of informant consensus factor (ICF), fidelity level (FL), use value (UV) and relative frequency citation (RFC)., Results: A total of 73 shrub and tree species belonging to 56 genera and 37 families were reported to be used ethnomedicinally for the treatment of various ailments. Medicinal plant diversity showed that Rosaceae was dominating family with (9 spp.) followed by Moraceae (7 spp.), Euphorbiaceae, Mimosaceae, Pinaceae, Rhamnaceae (4 spp. each), Oleaceae (3 spp.), Apocynaceae, Caesalpinaceae, Ebenaceae, Fagaceae, Lythraceae, Papilionaceae, Acanthaceae, Verbenaceae (2 spp. each) while remaining 22 families were represented by one species each. Leaves (23%) were highly utilized plant parts, followed by fruits (22%), bark (18%), seeds (10%), roots (9%), flowers (8%), whole plant and aerial parts (4% each) and stem (2%). Modes of preparation fall into 14 categories including powder (33 reports) followed by decoction (29 reports), paste (22 reports), juice (18 reports), infusion (12 reports), raw (8 reports), extract and latex (5 reports each), gum and oil (4 reports each), fresh part and pulp (2 reports each), chewed and cooked (1 report each). The highest FIC was recorded for Gastro-intestinal disorders (0.58) followed by nail, skin and hair disorders (0.44). Maximum fidelity level (FL=100%) was expressed by Abies pindrow, Adhatoda vasica, Bauhinia variegata and Cedrela serrata. Based on use value Juglans regia (0.88) was found most significant species followed by Acacia nilotica (0.83), Phyllanthus emblica (0.81), Pinus roxburghii (0.75) and Punica granatum (0.71)., Conclusion: The area has a rich diversity of medicinally important shrub and tree species. The tradition of using plants for medicinal purposes is still alive in the local community but recently this tradition is gradually declining in new generation. Therefore awareness is needed to be raised among the local people on sustainable use and conservation of local flora., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Ethnopharmacological Relevance: The current survey was aimed to identify the prime important medicinal plants in terms of medicines and further pharmacological screening of such plants. As far as, we know, no reported data from Deosai Plateau have been published and this is the first documented information of the study area., Material and Methods: Ethnomedicinal information of plants was collected through semi-structured interviews through a participatory rural appraisal (PRA) method., Results and Discussion: This study provided information of 50 medicinal plant species used to treat 29 different ailments. A total of 42 species (84%) were herbs while shrubs and subshrubs were represented by 8 species (16%). Leaves (37%) were the predominant plant parts followed by, roots (27%), aerial parts (13%), flowers (12%), fruit (7%), seeds (3%), and tuber (1%). Method of preparation fall into five categories including infusion (31%), paste (23%), decoction (20%), powder (18%), and juice (8%)., Conclusion: The study area is rich in medicinal plant diversity growing in wild. Our efforts in this regard are only a little contribution to the ethnobotanical study of this area focusing on medicinal plants while more clinical studies are required in future to prove such claims of local inhabitants., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: This paper represents the first ethnobotanical study in Chail valley of district Swat-Pakistan and provides significant information on medicinal plants use among the tribal people of the area. The aim of this study was to document the medicinal uses of local plants and to develop an ethnobotanical inventory of the species diversity., Methods: In present study, semi-structured interviews with 142 inhabitants (age range between 31-75 years) were conducted. Ethnobotanical data was analyzed using relative frequency of citation (RFC) to determine the well-known and most useful species in the area., Results: Current research work reports total of 50 plant species belonging to 48 genera of 35 families from Chail valley. Origanum vulgare, Geranium wallichianum and Skimmia laureola have the highest values of relative frequency of citation (RFC) and are widely known by the inhabitants of the valley. The majority of the documented plants were herbs (58%) followed by shrubs (28%), trees (12%) and then climbers (2%). The part of the plant most frequently used was the leaves (33%) followed by roots (17%), fruits (14%), whole plant (12%), rhizomes (9%), stems (6%), barks (5%) and seeds (4%). Decoction was the most common preparation method use in herbal recipes. The most frequently treated diseases in the valley were urinary disorders, skin infections, digestive disorders, asthma, jaundice, angina, chronic dysentery and diarrhea., Conclusion: This study contributes an ethnobotanical inventory of medicinal plants with their frequency of citations together with the part used, disease treated and methods of application among the tribal communities of Chail valley. The present survey has documented from this valley considerable indigenous knowledge about the local medicinal plants for treating number of common diseases that is ready to be further investigated for biological, pharmacological and toxicological screening. This study also provides some socio-economic aspects which are associated to the local tribal communities.

The past decade has witnessed increasing global attention and political support for maternal, newborn and child health. Despite this increased attention, actual progress has been slow and sporadic: coverage of key maternal and newborn health interventions remains low and there are wide disparities in access to care, within and across countries. Strategies for improving maternal and newborn health are closely linked, and can be delivered most effectively through a continuum of care approach. While these interventions are largely known, there is little information on which interventions have a positive health impact for both women and newborns. This supplement identifies the interventions during the preconception, pregnancy, intrapartum and postnatal periods found to have a positive, synergistic effect on maternal and neonatal outcomes. These interventions are then grouped into packages of care for delivery at the community, health center or hospital levels.

Objective: To ascertain the prevalence of risk factors for ischemic stroke in Pakistani patients at Shifa International Hospital (SIH), Islamabad, Pakistan., Methods: This retrospective cross-sectional study included patients of either gender, with no age limit admitted to the Department of Neurology at Shifa International Hospital, Islamabad, Pakistan, with the diagnosis of stroke verified by brain CT scan during a period of 2 years from January 2007 to December 2009. The data were analyzed by grouping our patients according to their age based on the frequency of risk factors. Group 1; 25-55 years (23.8%), group 2; 56-71 years (43.4%), and group 3; 72-103 years (32.7%)., Results: A total of 418 patients were included in the study; 137 patients were excluded due to incomplete information. The data from the remaining 281 were analyzed. The mean age of the population was 65 ± 0.8 years, and the male to female ratio was 1.30:1. The most frequent risk factors included hypertension 86.8% followed by diabetes mellitus 59.8%, dyslipidemia 59.1%, and smoking 18.1%. The highest frequency of 4 risk factors was present in the age group 56-71. Gender distribution of risk factors showed that hypertension and dyslipidemia are major risk factors in group 1. Abnormal high-density lipoproteins (HDL) emerged as the major lipid among 3 groups, especially in group 1, which predisposed to stroke., Conclusion: A decrease in HDL and control of blood pressure is important to reduce the risk of stroke especially in early age (namely, ≥ 25 years) and could become an increasingly useful tool to identify patients at a high risk of stroke.

Background: To identify the causative variants of achromatopsia (ACHM) in four Pakistani families presenting autosomal recessive ACHM., Methods: Four families (50, 55, 70 and 74) exhibiting features of achromatopsia were subjected to homozygosity mapping with STS markers flanking known ACHM loci. Mutation screening was done for two of the families linked to CNGA3 and CNGB3 by direct sequencing of the coding regions and exon-intron boundaries of genes to find the pathogenic variant., Results: Homozygosity mapping showed co-segregation of CNGA3 in family 50 and CNGB3 in family 74. Sequencing of coding regions of CNGA3 in family 50 revealed a novel missense mutation, c.827A>G, in exon 7, which results in p.N276S substitution. N276S is located in the S4 motif of the CNGA3 protein and is conserved in all channel proteins. Bioinformatics analysis showed that the N276S substitution altered the channel conformation by shifting the helix. No pathogenic variation was identified in any affected members of family 74 in the coding sequence of CNGB3. The other two families, 55 and 70, were not linked to any known ACHM loci, indicating further heterogeneity of the ACHM phenotype., Conclusions: We describe a novel S4 motif mutation of CNGA3 in a Pakistani family.

Objective: The objective of the study was to analyze the clinical and laparoscopic features, which may help to differentiate between infertility in females due to Genital Tuberculosis from Pelvic Inflammatory Disease (PID) and Endometriosis., Methods: This case control study was carried out in a teaching tertiary care hospital. Medical records were searched from 1st January 1987 to 31st December 2000 and 43 infertile women with biopsy proven genital tract tuberculosis were found. Equal number of infertile females with diagnosed PID and Endometriosis were randomly selected. Comparisons were done between features of Genital Tuberculosis with PID and Endometriosis separately and also genital tuberculosis with combined controls of PID and Endometriosis., Results: Patients with genital tuberculosis commonly had primary infertility. PID and Endometriosis patients had early menarche and increased duration of menstruation. On physical examination, patients with Genital Tuberculosis were found to have short heights. No significant findings were observes in the pelvic examination and menstruation history between the comparison groups. Laparascopic examination revealed that fallopian tubes were abnormal, tortuous, bilaterally blocked and thickly adherent more commonly in Genital Tuberculosis when compared to other groups., Conclusion: The primary infertility patients with chronic malnutrition and massive adhesive fallopian tubes on laproscopic examination should be evaluated for genital tuberculosis.

The WHO community-based rehabilitation programme has been tested in a village and a slum area in Pakistan. House-to-house surveys by physicians identified medical diagnoses and impairments and handicaps according to the ICIDH. Volunteer local supervisors from the communities were taught to identify and train disabled persons according to the CBR manual. The effect of training was evaluated after 1-2 years by an occupational therapist, using questions from the same manual. Of the 82 persons followed up, 80% showed improvement in function. The prevalence of disablement identified by the local supervisors and of handicap identified by a physician agreed well, and was of the order of 5%.

A health survey using the impairment and handicap classifications from the ICIDH was carried out in conjunction with a study of the WHO community-based rehabilitation programme in a village and a slum area in Pakistan. The prevalence of handicaps defined in this way was about half that of impairments, the most common handicaps being with mobility, occupation, and social integration. There was a slightly higher degree of handicap in the village. In both areas diseases of the musculoskeletal system, the ear, and the respiratory tract were common, but the frequency of infectious, respiratory, endocrine, blood, and digestive diseases was higher in the slum area.