Search

Peaceful settlement of any conflict through negotiations is an ideal way of pursuing and resolving every course which is the ideal practice to be followed by the international community. However, in the context of prevailing situation, Indians are trying to avoid every course of action adopted by Pakistan unless the ongoing insurgency has bled them white, leaving them with no other option. After winning election of 2019 Bharatiya Janata Party (BJP), Indian government has emanated with more aggression and revealed more violent policies against Pakistan hence leaving no chance for the negotiation of dialogue for pursuance of Kashmir issue. BJP has long history of history of opposing the article 370 and they used its revoking as election manifesto in 2019. This may not be possible in the wake of imposing external pressure by the international community. Thus presently, to fulfil the long waited commitment for Kashmiris, and to realize the importance of Kashmir issue, to save the Kashmiri nation from Indian atrocities and by putting pressure on Indians to come on a political platform, Pakistan needs to create conducive environments through diplomatic platform with added diplomatic support for Kashmiris on the international forums. [ABSTRACT FROM AUTHOR]

A bacterial strain (TA7) capable of consuming three N-methylated carbamates as sole nitrogen and carbon source was isolated and identified as "Enterobacter cloacae" on the basis of 16S rRNA, from carbamate contaminated agricultural soil by enrichment culture technique. The agar entrapment was used to immobilize the bacterial cells. Both the free as well as the immobilized cells were used to study the degradation of three carbamets viz. aldicarb, carbofuran, and carbaryl. The immobilized cells degraded all the three carbamates much faster than their free cell counterparts. The biodegradation kinetics of aldicarb, carbaryl, and carbofuran was studied using 50 ppm as initial concentration in the presence of free cells. The average values of Ks for aldicarb, carbofuran, and carbaryl were 22.6, 17.87, and 8.9 mg/L, respectively, whereas the values for µmax were calculated as 1.35, 1.3, and 1.2 mg/l/h−1. The results indicated that the bacterium has high affinity towards all the three carbamates. However, relatively higher affinity is for carbaryl, in comparison with carbofuran and aldicarb. Results indicate the potential of E. Cloacae TA7 to remediate N-methylated carbamates polluted water and soil. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this Research paper is to explore the China's relations with Central Asian region and to study its embodied effects on Pakistan. Objectives of the Study: To investigate the strategic depth of China Central Asian relations in the changing paradigm of regional and international politics. To analyze the Pakistan relations with Central Asia and to provide options for CARs to grapple the economic advantages of this regional connectivity of Kashgar to Gwadar through Pakistan China Economic Corridor. Design/Methodology/Approach: This research has been carried out using various techniques; documents based on content analysis, and case studies. Historical, descriptive, comparative and analytical method have been taken into practice on all Qualitative and Quantitative data sources which includes Govt. publications, organizational reports, thesis, academic papers, published, printed sources, Newspapers, Books, Journals, Periodicals, electronic sources and ejournal etc. to acquire the optimal results and conclusions. Research Limitation-This research enshrines only three major areas of cooperation among the triangular relations of Pakistan, China, and Central Asia. These three areas are Energy, Economy and Extremism. The regional and international challenges have also been taken into account. Theoretical Framework A theoretical framework in social science not only enhances credibility of research but also provides the substructure to the research by interpreting the relevant theories related to research objectives. According to the realist school of thought global political system is anarchic one and states are the main actors in this system. Every state peruses her national self-interest based on rationality and there is no any supranational authority to govern the states. Every state has desire of acquiring more and more power to ensure its self-preservation. Power is perpetual as well rational concept. It does not exist in vacuum but in relations with other state. China is expanding herself in terms of economic advancement and affluence not only in the region but as well on world scenario. China is very much engaged in Central Asia to magnify its strategic and economic power to preserve its interest. Regionalism is the process of integration, geographical relationship, formation of interstate coalition mutual interdependence of the states on the basis of regions. The key ingredients of regionalism are unilateralism, multilateralism and international trading system. The main idea of regionalism is to economically and politically integrate states on regional identification. The SCO (Shanghai Cooperation Organization) is also turning itself into regionalism. Eurasia has abundant energy resources. The exploitation and transportation of these energy resources to the rest of the world has become major challenge due to the deteriorating security situation and unrest of the region. SCO is a powerful regional mechanism which can play significant role in improving security of the region. Regionalism theoretical interpretations can be glimpsed on Central Asia, East Asia and South Asia in terms of economic, energy and security integration. The Mahan, A. Thayer in his book "The influence of sea power upon history 1660-1783" has concluded that naval strategy and power is a noteworthy factor for the rise of British Empire. The determinants of sea power are economy, population, political will of government and number of coastline and harbors available for sea trade traffic. The ongoing development project of Gwadr by China has proclivity to cater not only Chinese trade through CPEC but also have capacity to provide landlocked Central Asia access to hot water port for energy exports. Originality / Value: This paper is an original research work. The analysis provided is based on facts from various national and international publications. [ABSTRACT FROM AUTHOR]

The main purpose of the study is to analyze the role of Ideology and pragmatism in Iranian foreign policy. Main thesis is whether one factor surpasses the other while making the choices and decisions or both impacts equally influence the course of action in global political arena. The focus remains on the Iran's foreign policy towards the western world in general and America in particular. It also focuses the role of cultural disparity and why constructive breakthrough has not been achieved previously. Moreover, the cordial relationship with United States has been held in abeyance due to ideological clash and policy priorities between the two states. Iran remained focused more on ideology rather giving attention to US strategic concerns in the region since the end of cold war. Diplomatic behaviors of the states are results of the historical animosities and cordialities among the states. Moreover, Iranian policy priority has been anti-hegemonic and antiimperialistic designs of the big powers in the post-cold war era. They kept their ideology alive and remained fixed on their strategic interests and ideology. Moreover, the scenario in the post 9/11 has been changing and global environment continue to be tougher for underdeveloped and the developing countries. Iran has been suffering due to unlimited economic and political bans because it is not bowing before the global superpower. However, things started changing and a shift came up in the policy of Iran with the emergence of new rapprochement in shape of a historical deal with United States. It seems the Iranian policy has tilted more on the side of pragmatism. [ABSTRACT FROM AUTHOR]

Globalization is a growing phenomenon in the contemporary times when man has become modern in its thinking, actions and evaluation. Growing awareness regarding human rights is not only bringing human into mainstream affairs being major stakeholders indirectly but also greater expectations. This reality of preservation of human rights has brought the issue into legislation to make it law as a written part of the constitution at national, regional and global level in almost all spheres. Consequently, assurance of human fundamental rights is ground reality and written part of all the constitutions of the world. Globalization has transformed the world into a global village where there are commonalities of the cultures, exchange of ideas and free economic approaches are struggling to bring consensus among the world society to protect and preserve the human rights against any violation. World has divided into two blocks global north and global south based on their economic and political capacities. Globalization phenomenon was started by global north so it augurs well for the advancement of their interests while South is less benefited because of having under-developed status and weaker rule of law, social, economic and political condition. There are disparities of resources between both the blocks that are why south is suffering and north is maintaining status quo. State like Pakistan being the part and parcel of global south is facing economic and political hurdles where there is no provision of basic human requirements like food, health, education, employment and socio-economic stability. Globalization is north-centered phenomenon and more beneficial for them as compare to south. Globalization has positives and negatives. On one side it is providing awareness about the human rights violations while on other side it seems unable to protect human rights violations. Human rights violation scale is growing in Pakistan where there is nationalistic economy that is anti-thesis of the globalization and free market economy of north. Moreover, weak socio-economic and political conditions in Pakistan causing deprivations and grievance are growing where a specific chunk of society is violating all norms and rules of human rights by using their economic power and social status. In comparison to internationalization of economies under the umbrella of globalization, limited weightage is given to Pakistani exports in international market as compare to exports that proves very costly with the emergence of issue balance of payment that causes severe economic implications on Pakistan economy where social and political sector already going downwards and lacking to provide basic needs of life and fundamental rights. Labor issues and forced labor menace is growing in Pakistan where there are less facilities and larger number of labor and phenomenon of brain drain is growing. Globalization is impacting Pakistan more in a negative way and less in positive way. In this phase of initial years of second decade of twenty first century, human rights violation has decreased due to constitutional protection, media campaigns, role of NGO's but still long way to go ahead to curb the menace. Purpose-The purpose of this paper is to explore the embodied effects of process of globalization on human rights in Pakistan. Objectives of the study- To investigate explore and analyze the present status of human rights status in Pakistan in this globalized arena and legislative measures taken by the government. To highlight, the growing hurdles in the protection of human rights violations in Pakistan. Research Questions- What can be the impacts of globalization on global South? And how it is affecting human rights in Pakistan? What actions should be taken to support and extend rights to the humans in the era of globalization? Design / Methodology / Approach- Descriptive method is used based on secondary sources like UNDP reports, human rights commission of Pakistan reports, academic papers, books and newspaper articles etc. An analytical approach has also been used to illustrate the human rights violation in Pakistan and explore the underlying realities. Findings-This paper provides the pen picture of the Globalization phenomenon and its significant impacts on human rights in Pakistan, either it has created opportunities for the preservation of human rights or it has threatened the human rights. It is concluded that globalization is the major independent variable. Although through integrating Pakistan's commercial, financial and economic institutions with the world the dream of economic globalization can be materialized and freedom of equal socio-economic rights and freedom to engage in economic transactions may be ensured but still it might will remain at loss because of weak economy, limited resources and political immaturity, moreover, other human rights violations occurred in Pakistan are needed to be addressed at state level in a more pragmatic way and viable policy methods by analyzing situation in depth. Research Limitation-The focus of this research would be only Pakistan regarding violation of human rights with the detail discussion of globalization and human rights in general. The policy making at Government level i-e role of parliament, role of international organizations and role of NGOs would also be studied for law making and to preserve the human rights. The period of the research would be 2011 to 2013. Hypothetical framework- Globalization phenomenon is a promoter of liberal thoughts in socio-economic and political perspectives. Liberalism of globalization gives a perception that assists in the prevention of human rights violation in developing societies. The underlying socio-economic disparities between global North and global South are creating un-favorable environment for the protection of human rights in developing world. Pakistan is facing human rights violations due to inherent socio-economic and political weakness with unfavorable impacts of globalization because of her mismatch with the western standards. This clearly shows the indiscriminate impacts of globalization on different regions of the world. Originality / Value-This is original research work. The analysis provided is based on facts and information is acquired from human rights commission of Pakistan reports. [ABSTRACT FROM AUTHOR]

Recognizing the potential significance of using nuclear techniques in biological control, investigations were conducted on the rearing of parasitoids of the peach fruit-fly,Bactrocera zonata(Saunders) (Diptera: Tephritidae) to lead to a greater flexibility in the use of irradiated hosts. For improving mass production of the biological control agents, the use of irradiated fruit-fly larvae at the dose of 15 Gy proved useful for enhancing the parasitism and adult emergence of the larval parasitoid,Trybliographa daci(Weld) (Hymenoptera: Eucoilidae) due to no negative repercussions on parasitoid development. Overall, parasitism by the parasitoid increased with age of the host larvae; however, significantly higher parasitism occurred on 4 d-old irradiated larvae ofB. zonatacompared to those aged 5 d. The female parasitoids preferred the irradiated larvae, and significantly higher numbers of larvae were parasitized compared with non-irradiated larvae. There was no significant difference in adult parasitoid emergence with respect to the sex of the host. A radiation level of 80 Gy was the best dose for rearing of the pupal parasitoid,Dirhinus giffardii(Silvestri) (Hymenoptera: Chalcididae) owing to broad tolerances in the use of irradiation for the rearing of fruit-fly's parasitoids. Percentage parasitism byD. giffardiivaried with host pupal age, and the preference of the female parasitoid was lower on 48 h old host pharate pupae due to optimum size and mass of host. Present findings further revealed that the 24 h old host pupae ofB. zonatawere relatively more suitable for the maximum parasitism and progeny production ofD. giffardii. Parasitisms byD. giffardiiandT. daciwere significantly higher onB. zonatahost when parasitoids were released at a density of 3000 individuals per acre (7500 per hectares) than the other release rates of parasitoids for the management of fruit-flies in mango orchards. The implementation of these findings ought to help improve the mass production of parasitoids and the effectiveness of releases of biocontrol agents for control ofB. zonatain mango plantations. [ABSTRACT FROM PUBLISHER]

Purpose-The purpose of this paper is to explore the Oil and Gas potential of Central Asian Republics and to look to new opportunities for Pakistan if relations with CARs are more developed. Design/Methodology / Approach- Descriptive and analytical method is used based on secondary data from reports by EIA (U.S Energy Information Administration), B.P Statistical review of world energy June 2013, Academic papers, books and Newspaper articles etc. A mathematical equation and graphic usage is carried out to illustrate the energy resources of CARs and options are considered for Pakistan to develop better ties with Central Asian Republics. Findings-The paper provides the pen picture of energy richness of Central Asia's its future growth and prosperity which is directly linked with the development of inter-state and intra-state infrastructure like road and rail. This paper also focus on the challenges at international and regional level and role of global powers those are creating hurdles for CARs to develop economic ties with Pakistan and other regional countries. The presence of US and NATO forces in the region and unrest in Afghanistan has also implications for trade. Research Limitations-This article is related to an energy potential map of CARs with special emphasized on oil and natural Gas resources. The factors those are affecting the Pakistan relations with CARs are also discussed but analysis of U.S interests in Central Asia, great game and control over Eurasia, regional conflicts and political instability are not extensively discussed. Originality/Value-This is the original work. The analysis provided in the paper is based on facts and information based on EIA and other secondary sources. [ABSTRACT FROM AUTHOR]

Carbamates are synthetic pesticides, extensively used throughout the world due to their broad specificity against various insect pests. However, their enormous and inadequate use have made them a potential threat to the environment. At low temperature, degradation of carbamates becomes difficult mainly because of low biological activity. In the present study, we isolated a bacterial strain from a low temperature climate where the N- methylated carbamates are used for crop protection. The bacterium, was identified as Pseudomonas plecoglossicida strain (TA3) by 16S rRNA analysis. Degradation experiments with both free and immobilized cells in minimal salt medium indicated that the strain TA3 utilized carbaryl, carbofuran and aldicarb as both carbon and nitrogen source. TA3 can grow well at 4 °C and demonstrated the ability to degrade three carbamates (50 μgml -1 ) at low temperature. The immobilized cells were found more efficient than their free cells counter parts. Immobilized cells has ability to degrade 100% of carbamates at 30 °C while 80% at 4 °C but incase of their free cells counter parts the efficiency to degrade carbamates was less which was 60% at 4 °C and 80% at 30 °C. TA3 free cellsextract also depicted high activity against all the three carbamates even at 4 °C indicating a possible enzymatic mechanism of degradation., (© 2019 The Authors.)

Limited information about the sludge quality is a major constraint for its usage and proper disposal. This study investigated the occurrence of 49 elements in sludge from 11 wastewater treatment plants (WWTPs) in Chongqing and Xiamen cities of China. The concentration of 46-detected elements ranged from 16.2 μg kg -1 (Pt) to 55.0 g kg -1 (Al) on dry solid basis in the sludge. The enrichment factor of most of the elements was > 1.5, indicating their possible anthropogenic origin. The precious metals had considerably higher enrichment factor ranging from 56.3 to 200,000. Principal component analysis clustered the samples from Chongqing and Xiamen separately to suggest strong spatial variations. Contamination factor, pollution loading index, and integrated pollution degree were calculated to evaluate the elemental pollution risk. The pollution loading index indicated unpolluted to highly polluted levels of the elements in the sludge. In addition, results from the ecotoxicological risk index showed an individual low to very high ecotoxicological risk posed by eight metal(loid)s (As, Cd, Cr, Cu, Mn, Ni, Pb, and Zn) in the WWTPs.

We investigated selected chlorinated pollutants (β-HCH, γ-HCH, DDDs, DDEs, o,p'-DDT, p,p'-DDT, heptachlor, aldrin, dieldrin, and endrin) in the Lahore and the Sialkot districts of Pakistan, using eggs of cattle egret (Bubulcus ibis) collected during May and June 2007. The pollutant with highest level and frequency was ΣDDT, followed by β-HCH, γ-HCH, heptachlor, aldrin, dieldrin, and endrin in descending order. The concentration(s) were significantly higher in Sialkot heronry for all the pollutants (except p,p'-DDT) than in Lahore. The values for DDTs, β-HCH, γ-HCH, and heptachlor were significantly higher (p < 0.05) in the egg(s) than in sediment(s) and in the chicks' diet, due to biomagnification. Among DDTs analogues, p,p'-DDD was the major contaminant with >60 % of total DDT burden, reflecting the widespread aged as well as recent use of DDT as well as anaerobic degradation (DDD/DDE > 1 in many cases) in the nearby paddy soils. In few samples, p,p'-DDT/(DDD + DDE) > 0.5 suggested the recent emission patterns from surrounding contaminated areas of demolished DDT units and obsolete pesticide stores. The higher levels of HCHs (i.e., β-HCH) in the samples collected from Sialkot indicate exposure from long-term agricultural use. Overall, concentrations of all studied POPs were less than the threshold levels known to affect reproduction. Nevertheless, total DDTs and/or HCHs burdens in some eggs contained concentrations of greater than what would educe adverse effects on birds. This is among few studies on OCPs exposure to avian species, which provide the evidence of Pakistan's contribution toward the Global POPs emission.

Objective: To evaluate the clinical outcome of linear accelerator based multisession stereotactic radiosurgery (SRS) for large benign brain tumors of >3cm., Methods: Between June 2009 and May 2011, 35 patients having large benign brain tumors of >3cm (≥15 cm 3 ) were treated by multisession stereotactic radiosurgery. This retrospective study was carried out at Neurospinal & Medical Institute Karachi. There were 17 (48.6 %) males and 18(51.4 %) females. Median age was 36 years (range: 13-65 years). Median target volume was 49.4 cm 3 (range: 15-184 cm 3 ). The median marginal dose was 25 Gy (range: 20-27.5Gy) prescribed to a median 75% isodose line (range: 65-100 %). Median number of 5 fractions were used ranging 3-5 fractions., Results: All the patients tolerated treatment very well. 21 (58.3%) patients had remarkable clinical improvement of neurological symptoms, 14 (38.9%) patients had stable symptoms, and only one patient had transient worsening of symptoms. No permanent neurological damage or radiation injury was seen. Radiologically, 9 (25.7%) patients achieved reduction in size of the tumor, 26(74.3 %) patients were having stable disease, and overall control rate was found to be 100 %. Median follow-up time from the end of SRS was 6.4 months (range: 1-22.5months)., Conclusion: Linear accelerator based multisession stereotactic radiosurgery for large benign brain tumors of >3cm is effective and well tolerated.

Objective: To determine the 30 days outcome measured in terms of morbidity and mortality in cases of ventricular septal defect (VSD) with increased pulmonary vascular resistance (PVR) managed with double flap patch closure., Study Design: Case series., Place and Duration of Study: Armed Forces Institute of Cardiology (AFIC/NIHD), Rawalpindi, from December 2005 to December 2008., Methodology: Forty patients with VSD having PVR 9.58 + 4.33 wood units underwent double flap patch closure. The patch was fenestrated as one half of the expected aortic annulus diameter. A separate flap patch 5 mm larger than fenestration was attached to superior upper one third margins of fenestration. The patch was placed with flap to open towards the left ventricular apex. Modified ultra filtration (MUF) was employed in every case and sildenafil was given postoperatively., Results: The age of patients ranged from 1 to 28 years with a mean of 6.66 + 5.70 years. There were 22 males and 18 females. All patients were weaned off from inotropic and ventilatory support as earlier as possible postoperatively with intensive care unit (ICU) stay of 77.15 + 54.56 hours. Postoperative pulmonary artery pressures were reduced to 42.63 + 10.86 mmHg as compared to pre-operative pulmonary artery pressures of 88.3 + 15.2 mmHg. Postoperatively 11 patients with suprasystemic pulmonary artery pressures and desaturation went into pulmonary hypertensive crisis in which immediate 2D echo evidenced the functioning flap valve with right to left shunt. There was only one death (early) out of 40 patients with an overall mortality of 2.5% along with limited morbidity., Conclusion: Double flap patch is an inexpensive, easy to construct technique with low morbidity and mortality in cases of VSD with raised PVR.

Objective: To determine the role of remote ischemic pre-conditioning (rIPC) on myocardium, against ischemia reperfusion injury in patients undergoing coronary artery bypass graft (CABG) surgery by measuring CKMB levels., Study Design: A randomized controlled trial., Place and Duration of Study: The Surgical Department of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from January to June 2008., Methodology: One hundred patients with double and triple vessels coronary artery disease were randomized in two groups of 50 each. rIPC protocol consisted of 3 x 5 minutes of forearm ischemia, induced by a blood pressure cuff inflated to 200 mmHg, with an intervening 5 minutes of reperfusion, during which the cuff was deflated. Patients in the control group were not subjected to limb ischemia. The protocol of induced ischemia was completed before placing patients on extracorporeal bypass circuit. At the end of surgery serum CKMB levels were measured and compared at 8, 16, 24 and 48 hours from both the groups. Written informed consent was taken from patients. Study was approved by the hospital ethical committee., Results: Remote ischemic pre-conditioning significantly reduced CKMB levels at 8, 16, 24 and 48 hours after surgery with p-values of 0.026, 0.021, 0.052 and 0.003 respectively. There was mean reduction of 3 iu/l in CKMB levels, in patients who underwent rIPC protocol prior to CABG surgery, compared to control group., Conclusion: This study showed a significant reduction of enzyme marker CKMB in patients subjected to rIPC prior to CABG surgery. This suggests lesser degree of myocardial damage compared to control group in CABG patients.

Objective: To determine the radiologic downstaging and histological response after neo-adjuvant concurrent chemoradiation in locally advanced rectal cancers., Study Design: Case series., Place and Duration of Study: Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from December 2004 to November 2005., Methodology: Thirty patients with histopathologically confirmed locally advanced carcinoma rectum who had not received any treatment (chemotherapy, radiotherapy or surgery) prior to presentation were enrolled. Radiation therapy was delivered with a three-field technique to a dose of 50.4 Gy over 5 weeks at the rate of 1.8 Gy/day. Two cycles of chemotherapy were given synchronously, which comprised of 5-fluorouracil 350 mg/m2 and folinic acid 20 mg/m2 continuous intravenous infusion over first five days and last five days of radiotherapy. Surgery was planned 4-6 weeks later to chemoradiation after radiologic post therapy staging. Viable specimens were identified and toxicity was observed., Results: All patients completed treatment without modification. Radiologic downstaging was found in 56.7%, stable disease was seen in 30.0% and progressive disease was present in 13.3% of the patients. Radiologically complete resolution of tumour was not observed. Pathological complete resolution of tumour was achieved in 3.3% and near complete resolution was observed in 13.3% of the patients. In 86.6% cases, a total gross tumour resection with no macroscopic residual disease was possible. All the patients tolerated the treatment well., Conclusion: Neo-adjuvant chemoradiation for locally advanced rectal cancers is associated with high resectability rate and is relatively safe with acceptable morbidity which favours its use in future.

Objective: To determine the efficacy of bidirectional Glenn shunt (BDG) without cardiopulmonary bypass (CPB)., Study Design: Quasi experimental study., Place and Duration of Study: The Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFICNIHD), Rawalpindi., Methodology: Thirty one patients underwent BDG without CPB between January 2006 to December 2007. Subjects for off pump BDG were those who did not require any intracardiac repair, had good sized branch pulmonary arteries, had acceptable PA pressures (< 16 mm Hg), and did not have any significant atrio-ventricular (AV) valve regurgitation. The off pump BDG was performed using veno-venous shunt between the superior vena cava (SVC) and right atrium (RA) following heparinization. All patients underwent discharge echocardiography to assess BDG patency. Statistical significance was determined using t-test with statistical significance at p < 0.05., Results: There were 18 males and 13 females. All patients survived. Twenty seven (87.09%) patients received BDG and 04 patients (12.90%) received bilateral BDG. Atrial septectomy with inflow occlusion was performed in 5 patients. Antegrade pulmonary blood flow was left in 24 (77.41%) of 31 patients. There was significant improvement in postoperative SpO2 (p = 0.000) in all the cases. There were no postoperative neurologic complications. Sepsis occurred in 2 patients who ultimately recovered. One patient had chylothorax which stopped after three (03) days in ICU. No SVC/PA distortions were noted by discharge echocardiography. Eliminating CPB reduced the cost of the procedure substantially and saved the patients from its inherent complications., Conclusion: BDG without CPB is a safe procedure in selected patients. It avoids CPB related problems and is cost effective, with excellent results.

Objective: To determine the outcome of Coronary Endarterectomy (CE) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery for diffuse Coronary Artery Disease (CAD), in terms of postoperative mortality and morbidity, relief from angina and survival at one year., Study Design: A case series., Place and Duration of Study: Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2003 to November 2005., Methodology: Included in the study were all patients with such diffuse CAD that conventional bypass grafting was not possible. Those with the diseased coronary artery supplying an akinetic myocardium and a fixed perfusion defect on perfusion scan, or with poor left ventricular function (ejection fraction<30%) in association with severe chronic hepatic disease and deranged liver function tests, permanent severe immune deficiency state, or poor results at lung function tests were excluded. Cardiopulmonary Bypass (CPB) was used in all patients. All patients were followed up for a mean time of one year, for assessment of postoperative mortality and morbidity, relief from angina and survival., Results: Fifty five patients (3.2%) underwent CE of at least one major coronary artery for severe diffuse atheromatous disease. The mean age was 53.9+/-9.5 years. Twenty six (47.3%) had previous Myocardial Infarction (MI), 16 (29.1%) had unstable angina, 12 (21.8%) had poor Left Ventricular (LV) function, 5 (9.1%) underwent emergency CABG surgery for impending infarction, 39 (70.9%) had angina Canadian Cardiovascular Society (CCS) class II/III, 11 (20%) had critical left main stem disease and 12 (21.8%) required Intra-Aortic Balloon Pump (IABP) for hemodynamic support. There were 2 (3.6%) early deaths and 2 (3.6%) cases of non-fatal infarctions. Three (5.4%) patients had low Cardiac Output (CO) after operation. At one year follow-up, there were no late deaths and 43 patients (91.5% of those reporting for follow-up) did not have angina., Conclusion: CE acted as an adjunct to CABG surgery with acceptable operative risks and satisfactory results at one year in terms of mortality and angina relief.

Background: To evaluate the surgical and medical efficacy of the patients operated for Ventricular Septal Defect (VSD) with Pulmonary Hypertension and Pulmonary Vascular Resistance (PVR). Infants and children with elevated PVR and Pulmonary Hypertension are associated with significant mortality and morbidity after surgical closure. Circulatory assist devices and sophisticated medicines may not be available to help in the management of infants and children with elevated Pulmonary artery pressure and resistance. We left Patent Foramen Ovale (PFO) or made atrial communication to decrease the morbidity and mortality associated with the closure of large VSD in this risky group., Methods: Sixteen infants and children were operated with median age of 12 months, operated by the same surgeon (IU), from January' 2004 to December' 2005. They were with large VSD of elevated PVR (3.9+0.3) and underwent VSD closure leaving PFO or artificial ASD (5mm). Surgical approach was through right atrium. Post operatively, all the patients were electively ventilated for 36 hours. They were given intravenous dilators (Glyceral Trinitrate + Phentolamine) and oral Sildenafil up to 1 mg /Kg, six hourly. Five cases went into acute pulmonary hypertensive crisis postoperatively, and were rescued by Prostacycline Nebulization., Results: Sixteen patients had VSD as the primary lesion that underwent operation. The overall early mortality was 6.25% (1/16). There have been no late deaths., Conclusion: Closure of large VSD with elevated PVR can be performed, leaving PFO or artificial ASD, with acceptable mortality and morbidity.

Objective: To identify the factors affecting the outcome, measured in terms of morbidity and mortality, after primary ventricular septal defect (VSD) closure., Design: Descriptive study., Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from January 2002 to October 2003., Subjects and Methods: Children upto the age of 5 years who had primary VSD closure were studied. Patients were divided into two groups. Group-I included survivors and group-II included non-survivors. There was no difference in the conduct of operation among the two groups., Results: A total of 53 patients were operated of whom 47 survived. Pulmonary hypertensive crisis (p < 0.001), pulmonary infections (p < 0.001) and pleural effusions (p < 0.003) were higher in non-survivor group. Patients in non survivor group were younger (0.75 + 0.34 years vs 2.24 + 1.16 years, p = 0.01) having less body weight (4.91 + 1.56 kg vs 7.94 + 3.35, p = 0.03) and high pulmonary artery to systemic pressure ratio at the time of coming off bypass (0.63 + 0.13 vs 0.43 + 0.09, p < 0.001). Non survivors had higher association (66.6 % vs 19.1%) of additional left to right shunts (p < 0.001)., Conclusion: Body weight less than 5 kg along with young age, high pulmonary artery to systemic pressure ratio at the time of coming off bypass and presence of additional left to right shunt are risk factors for adverse outcome.