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Background: Postgraduate training is a stressful and demanding job. The long working hours and profound professional responsibilities of these doctors make it one of the most stressful phases of their lives. The commonly reported conditions during this period are emotional impairment, depression and burnout. This study's concept is to assess work-associated stress in female postgraduate residents. Materials & Methods: This cross-sectional descriptive study was conducted at three Public Sector Teaching Health Institutes of Peshawar (Khyber Teaching Hospital, Hayatabad Medical Complex, and Lady Reading Hospital) from 1st February 2023 to 1st March 2023. A convenient sampling technique was utilized after approval from Institutional Ethical Committee. The sample size was 152 female postgraduate residents. A validated Kessler-10 Psychological Index (KSI) was used as a research tool to assess stress levels. Data were analyzed by the SPSS software Version 21. Overall stress and in relation to specific departments, marital status, maternal status and year of residency were calculated. Results: Out of 152 participants, 70 (46.1%) had mild stress, 57(37.5%) had moderate stress and 17 (11.2%) had severe stress. Eight (5.2%) had no stress. The highest level of severe stress in female postgraduate residents was documented from Pediatrics Department (16.7%), followed by Gyne/Obstetric Department (15.0%) and General Medicine Department (14.3%). Conclusion: High levels of perceived severe stress are reported in the Pediatrics/Gyne/obstetric and General Medicine Departments during the training period. The potential high workload and prolonged duty hours can be the underlying phenomenon; however, further multicenter studies involving large cohorts are required for generalization. [ABSTRACT FROM AUTHOR]

Background: Changes in visual functions such as visual acuity, contrast sensitivity, and color vision have been reported by many women with normal menstrual cycle, which may be due to sensory and perceptual processes. The objective of this study was to observe the changes in visual acuity (VA), contrast sensitivity (CS) and color vision (CV) during one complete menstrual cycle (MC) among young females. Materials & Methods: This cross sectional observational study was conducted from 1st October to 30th December 2021 on healthy, young unmarried females in Department of Ophthalmology, Hayatabad Medical Complex, Hayatabad, Peshawar, KP, Pakistan. Each subject was examined five times during the whole MC: Menstrual phase (MP), follicular phase (FP), ovulatory phase (OP), post ovulatory phase, and luteal phase (LP). In each phase, VA, CS, and CV were recorded on the Logarithm of the Minimum Angle of Resolution (Log MAR) chart, the Pelli-Robson CS chart and PV-16 respectively. The mean and standard deviation of VA and CS and differences in their scores at the five points of the MC were analyzed through a sample t-test and a paired t-test, respectively. Descriptive statistics were used for CV abnormalities. Results: There were total 35 participants in the study. Their mean age was 21.89 ±1.102 years. The duration of the MC ranged from 21 to 35 days. A significant difference in the mean score of VA and CS was observed only between the LP and MP, in both eyes. Mild confusion in tritan was observed in LP among three participants. In the FP, two participants reported mild confusion and one participant noticed severe confusion in tritan. All other participants did not show any changes in the CV. Conclusion: Significant change in VA and CS was observed only in the LP and MP. Mild confusion in tritan was noted in some of the females while most of them did not show any change in CV. [ABSTRACT FROM AUTHOR]

Background: Allergic conjunctivitis is a common hypersensitivity disorder that is prevalent globally. The objective of this trial was to compare the efficacy of Olopatadine versus Ketotifen ophthalmic solution in relieving itching in allergic conjunctivitis in population of Peshawar, Pakistan. Materials & Methods: This RCT was conducted at Department of Ophthalmology, Khyber Girls Medical College, Peshawar, Pakistan from March 01, 2022 to June 30, 2022. One-eighty-six patients with allergic conjunctivitis with itching score of 2-3 and aged 5-65 years were randomly allocated to two groups; 93 to experimental/ Olopatadine and 93 to control/Ketotifen group. Itching was graded as; no itching zero, mild itching 1, moderate itching 2 and severe itching 3. Pre-treatment itching score was measured. Experimental group used Olopatadine Hydrochloride 0.1% b.i.d., while control group used Ketotifen Fumarate 0.025% q.id., both for six-weeks. Posttreatment presence of itching was measured as 0-1 as itching relieved and 2-3 as not relieved. Sex, age groups, pre-treatment itching score and presence of itching were described by count and percentage. Hypothesis was verified using McNemar chi-square test. Results: Experimental/Olopatadine group included 58 (62.37%) men and 35 (37.63%) women, while control/ Ketotifen group included 55 (59.14%) men and 38 (40.86%) women. There were 78 (83.87%) patients in age group 5-35 years and 15 (16.13%) in age group 36-65 years in each group. Pre-treatment itching score was 2 in 40 (43.02%) and 3 in 53 (56.98%) patients in experimental group, and 2 in 42 (45.16%) and 3 in 51 (54.84%) patients in control group. Itching was relieved in 77 (82.80%) in experimental/Olopatadine group, and in 67 (72.04%) patients in control/Ketotifen group. Experimental/Olopatadine showed statistically significantly higher efficacy than control/Ketotifen (p-value .0139). Conclusion: The efficacy of Olopatadine Hydrochloride 0.1% b.i.d. was higher than Ketotifen Fumerate 0.025% ophthalmic solution q.i.d. in terms of itching relief in allergic conjunctivitis. [ABSTRACT FROM AUTHOR]

Background: Glaucoma is an irreversible optic neuropathy that results in a distinctive pattern of vision loss. The objective of this study was to determine the number of trabecular meshwork cells (TMCs) in adult POAG patients from Khyber Pakhtunkhwa, Pakistan. Materials & Methods: This cross-sectional study was conducted in Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan from 01/07/2016 to 31/12/2016. Trabecular meshwork samples from 75 POAG patients who underwent trabeculectomy were included. After staining with haematoxylin-eosin, nuclei in TMCs were counted under 400X objective. Number of TMCs, sex, age groups and age in years were variables. Sex and age groups were analyzed as count and percentage. Two ratio variables were skewed, hence analyzed by median/quartile (Q2), Q1, Q3 and IQR with 95%CI. Hypothesis was tested with non-parametric one-sample Wilcoxon signed-rank test. Results: Seventy-five patients included 58 (77.33%) men and 17 (22.67%) women, with 42 (56%) patients in 36-60 years, 25 (33.33%) in 61-70, 8(10.67%) in 71-80 and no (0.0%) patient in 81-90 years. The mean age was 57.53±10.86 (35-78, range 43) years, 95%CI 55.03-60.03. The median (Q2) number of TMCs/mm2 was 260 (214-367, IQR 153), 95%CI 230-291. Null hypothesis was rejected (p<.00001), showing that the number of TMCs in glaucomatous adults of Khyber Pakhtunkhwa, Pakistan was statistically significantly lower than normative sample of non-glaucomatous enucleated eyes. Conclusion: The number of trabecular meshwork cells in adult POAG patients from Khyber Pakhtunkhwa, Pakistan was significantly lower than normative sample of non-glaucomatous enucleated eyes. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to investigate the effect of H. Pylori proteins JHP 0290 (FL) and JHP 0290 on host cell response. Materials and Methods: This study was conducted at Khyber Teaching Hospital (KTH), Peshawar from April 2021 to September 2021. H. Pylori genomic DNA (J99 and 26695), pET expression system plasmid (PET21a, 22b & 28b+), kanamycin 50µg/ml and ampicillin 100µg/ml, LB agar plates and LB media, Talon@IMAC resin column were used for studying H. pylori proteins. Genes coding for these proteins were successively cloned into PET21a, PET22b, and PET28b+ expression vectors but no expression was seen with different concentrations of IPTG in BL21(DE3) culture, and expression was prolonged for 4hrs. Results: Only JHP0290 (FL) & JHP0290 (-17a.a) were successively cloned in PET28b+ and expression was induced by using 100µM IPTG in E.coli strain (BL21DE3). Restriction analysis showed the size of JHP0290 (FL & -17a.a) at approximately 550bp and protein size was analyzed on SDS-page which was 20Kda approximately. JHP0290FL protein was found in pellets while JHP0290 (-17a.a) protein was found in pellets & supernatant before being applied to Talon cell through resin column to get purified protein. The study showed a clear band of JHP0290 (FL) on SDS-page with imidazole eluted fraction pooled, while a faint band with a distinct band of JHP0290 (-17a.a) was also seen on SDS-page. Conclusion: These changes are indicative of altered host cell response induced by H.pylori protein JHP0290 suggesting its possible involvement in the development and severity of the disease. [ABSTRACT FROM AUTHOR]

Objective: To analyze the prevalence of CALR and JAK2 mutation co-occurrence in myelofibrosis (MF) patients in KP Methods: This cross-sectional study included Myelofibrosis (MF) patients (n = 50) enrolled in the Hematology/Oncology department of Hayatabad Medical Complex (HMC), Institute of Radiotherapy and Nuclear Medicine, Peshawar (IRNUM) and Blood Diseases Clinic, Peshawar. Non-probability convenience sampling technique was used. All patients with JAK2 V617F positive and negative primary or secondary MF were included. After taking blood samples, DNA was extracted manually and analyzed for JAK2 mutations using conventional PCR. Sanger sequencing technique was employed to analyze the samples for CALR mutations. Data were recorded & analyzed statistically. Results: Among the 50 patients, 48(96%) had JAK2 mutations. The typical CALR mutations was not identified in the current study. However, two specific genetic variants were identified in 30 patients i.e., a single nucleotide polymorphism (c.1381 G > T) in the 31 UTR and a novel insertion-deletion variant (c. 1099 CTT > AC). Seven patients had the Indel frameshift variant (p.Leu 367 Thr Fx 63), whereas 23 had SNR In JAK-2 positive patients (n=28), six had the Indel variant, and 22 had the SNR Two patients were JAK2 negative, one with SNP and the other with a frameshift mutation. Conclusion: Majority of the MF patients had a novel frameshift variant (p. Leu367Thr Fx63) (n = 07) and an SNP in the 31 UTR (G > T) (n = 23) in CALR gene. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of correction of refractive error, use of contact lenses and low vision aids in visual rehabilitation of people with Myopic Macular Degeneration (MMD). Methodology: This cross-sectional study included participants with MMD assessed for visual rehabilitation in a low vision clinic at Department of Ophthalmology Hayatabad Medical Complex, Peshawar, from June 2017 to June 2020. Data regarding distance and near visual acuities at the time of presentation with amount of myopia, best corrected visual acuity (VA) with glasses and contact lenses, VA with low vision devices and types of low vision devices prescribed were collected and analyzed. VA was recorded on Logarithm of the Minimum Angle of Resolution (LogMAR) chart. Data was analyzed using SPSS v.19.0. Results: Out of 78 participants with MMD, 74.4% were male with mean age was 29.13±19.1 years. About 22% had vision impairment with their own glasses, 19% had severe impairment and 59% had blindness. Mean spherical equivalent refractive error amongst participants was -14.56 ± 5.39D and -12.52 ± 6.64D in right and left eyes respectively. With optimum correction (glasses/contact lenses) in 41% of participants distance VA was improved to 6/18 (0.54 Log MAR) or better in the better-seeing eye. With low vision devices, mean distance visual acuity was enhanced to 0.18 Log MAR (p<0.001). Conclusion: Correction of myopia is very important in visual rehabilitation of people with MMD. Low vision aids can be successfully used to enhance the residual vision among people with MMD in order to improve life efficiency. [ABSTRACT FROM AUTHOR]

Background: Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. The objective of this study was to determine the frequency of acute rise of intraocular pressure (IOP) following Neodymium-Yttrium Aluminum Garnet (Nd:Yag) laser posterior capsulotomy. Materials & Methods: This cross-sectional study was conducted in the Department of Ophthalmology, HMC, Peshawar, Pakistan, from July-December 2016. Sample size was 325 selected by consecutive sampling technique. Inclusion criteria were all patients having significant PCO after uneventful cataract surgery with intra ocular lens implant. Demographic variables were sex, age groups and age in years. Research variable was presence of acute rise of IOP following Yag laser capsulotomy. Pre-laser assessment included slit lamp examination and recording of IOP with Goldmann applanation tonometer by a single ophthalmologist. IOP was measured 3 hours after Nd: Yag laser capsulotomy. Rise in IOP was labeled when IOP was ≥5 mmhg from baseline. Mean ±SD was used to express quantitative variables like age. Categorical variables were analyzed as frequency and percentage. Goodness-of-fit was applied to compare the frequency of acute rise in IOP between sample and population. SPSS-20 was used for data entry and its analysis. Results: Out of 325 patients, 170(52.3%) were men and 155(47.7%) were women. The mean age of the sample was 44.92 ±23.843 years. A total of 107(32.9%) patients were 20-39 years old whereas 218(67.1%) were 40-70 years. IOP was raised in 61 (18.8%) patients while in 264(81.2%) patients it was not raised. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population. Conclusion: Men were more than women, especially of old age. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population. [ABSTRACT FROM AUTHOR]

Objective: To estimate the frequency of vitamin D deficiency in patients with newly diagnosed pulmonary tuberculosis in Khyber Pukntunkhwa. Methodology: It was a descriptive cross sectional study conducted in a private consulting clinic at Ibrahimi Hospital, Dabgari Gardens, Peshawar from 01 April, 2014 to 30 June 2015. A total of 194 patients of either gender, between 15 to 70 years of age with newly diagnosed pulmonary tuberculosis were included in the study. 10cc of blood was obtained under strict aseptic technique and immediately sent to laboratory to estimate vitamin D levels. Results: Of the 194 patients included, 108(55.67%) were male and 86(44.33%) were females. Male to female ratio was 1.26:1. The frequency of vitamin D deficiency in patients suffering from pulmonary tuberculosis was observed in 82(42.27%) while 112(57.73%) were having normal vitamin D levels. More females 49(57%) were suffering from Vitamin D Deficiency compared to males 33(30.6%). Conclusion: Patients with pulmonary tuberculosis are significantly Vitamin D deficient. This deficiency was more marked in females. [ABSTRACT FROM AUTHOR]

Objective: To find out changes in choroidal thickness by optical coherence tomography (OCT) of diabetic patients after pan-retinal photocoagulation (PRP). Methodology: This case series study was conducted at Hayatabad Medical Complex, Peshawar and Bacha Khan Medical Complex, Swabi from January 2015 to February 2018. One hundred patients with diabetic retinopathy (DR) undergoing PRP were selected by consecutive sampling. All patients underwent enhanced depth images of spectral domain OCT for choroidal thickness at baseline before PRP. After PRP, all patients were followed up after 4 and 12 weeks with repeated OCT to check for choroidal thickness. Results: A total of 146 eyes of 100 patients were included in the study. The mean age was 58.35 ±4.89. Mean baseline choroidal thickness on OCT for central 1mm zone was 312.92 ±23.73µ, for intermediate 3 mm it was 321.22 ±18.88µ while for outer 6 mm zone it was 329.11 ±27.22µ. After four weeks of PRP, mean choroidal thickness on OCT for central 1mm zone was 331.67 ±15.22µ, for intermediate 3 mm was 344.21 ±19.33µ while for outer 6 mm it was 349.99 ±21.56µ. At 12 weeks, mean OCT for central 1mm was 281.1 ±17.11µ, for intermediate 3 mm was 276.21 ±19.21µ while for outer 6 mm it was 269.49 ±21.34µ. Conclusion: There was transient increase in choroidal thickness after PRP. However, after 12 weeks there was gradual decline in choroidal thickness which was more than the initial pre-treated state. [ABSTRACT FROM AUTHOR]

The current study was conducted to investigate the prevalence of Salmonella and its dominant serovars, S. Enteritidis and S. Typhimurium by phenotypic and molecular characterization in poultry. We reported the antimicrobial resistance profile, biofilm formation and presence of resistant and virulent genes of S. Enteritidis and S. Typhimurium of poultry origin in Peshawar. A total of 310 liver samples were collected from morbid and dead birds and processed both by direct plating and selective enrichment methods. Over all prevalence of Salmonella was found to be 21.6% in poultry liver. PCR based molecular screening of Salmonella isolates through serovar specific genes revealed that S. Enteritidis (74.11%) and S. Typhymurium (18.8%) were the most prevalent serovars. Salmonella isolates were found highly resistant to Tetracycline, Oxytetracycline, Nalidixic acid, Doxycycline, Sulfamethoxazole and Erythromycin. While susceptibility of Salmonella isolates was noted against Ceftriaxone, Cefotaxime, Meropenem, Amikacin, Norfloxacin and Ceftazidime. The prevalence of MDR strains were found to be 93.3% of the total isolates while 14.4% isolates were ESBLs producers. The most prevalent resistant genes in Salmonella were sul1 (98.8%), sul2 (97.6%), gyrA (95.2%), strB and CTX-M (80%). Four virulent genes i.e. SpaN, CsgA, SipA and MsgA were present in more than 80% of isolated strains of Salmonella. Hence, it was concluded that poultry birds in the Peshawar region are carrier of highly resistant and virulent S. Enteritidis and S. Typhimurium strains and are a potential public health risk. A routine surveillance and a regulated antimicrobial application are required for control and prevention of the current situation in the poultry. [ABSTRACT FROM AUTHOR]