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Background & Objectives: The administration of antibiotics within one hour of the patient's presentation is a conventional treatment aim for febrile neutropenia (FN). The objective of this study was to identify what proportion of children diagnosed with FN had a time to antibiotic administration (TTA) of less than one hour and to understand the causes of the delay.. Place of Study: Mayo Hospital Lahore Study Duration: January 2021 to June 2021 Methods: The children who presented with FN were the subject of a prospective investigation. The most significant metric of success was the proportion of patients who were administered antibiotics within one hour after the conclusion of the triage process. The presentation's location, the time of day, and the day of the week are all significant predictive variables. An study was conducted on the causes of the delayed TTA. Results: Evaluations for TTA were performed on a total of 200 children (mean age: 7 years) diagnosed with FN. The primary impact as a result 60% of parents were able to complete the TTA within sixty minutes. The likelihood of a delayed TTA occurred less frequently when patients were examined when the night was still young. Patients who did not have a focus of care had a higher risk of having a delayed TTA. The infection, both during the evaluations that took place in the oncology daycare and those that took place over the weekend, was found in none. Patients who were seen during the daytime or on the weekends had a longer time to treatment than those who presented at the AM or night or weekdays. Interpretation & Conclusions: Antibiotics were administered more quickly to the children who were being monitored for fever. The most significant factors contributing to the delay were admission and the need to await blood levels Keywords: Febrile neutropenia, support care, and delay to antibiotics

Background: In order to accomplish the goals of this research project, lidocaine was administered intravenously (IV) to patients who were experiencing neuropathic pain. The researchers had an interest in gaining a deeper understanding of the connections that exist between effect and concentration, as well as graded and quanta1 dose-response. Study Place: Kulsoom International Hospital Islamabad Study Duration: 6months (Feb 2021 To July 2021) Methods and Materials: Fifteen patients received an intravenous dose of lidocaine at a rate of 8.35 milligrams per minute for a total of one hour. During the course of the study, both venous blood samples and visual analog pain scores were collected at regular intervals of ten minutes for duration of sixty minutes. In addition, blood samples were taken in order to determine the concentrations of lidocaine in the serum as well as the amount of water in the serum both at the start of the analgesia as well as when the patient had reached their maximum level of pain relief. In order to determine the levels of lidocaine, a technique known as gas chromatography was performed. Result: In addition to graded dose-response curves for each participant and the group, a quanta1 dose-response curve was created. Besides graded dose-response curves, this was done. Also done: graded dose-response curves. The dose-response relationship for IV lidocaine showed large pain relief for modest dose changes. Despite moderate dosage increases, this was true. This was when the drug was given. The ED administered 370.0 mg of lidocaine, but the ED administered 415.5 mg (5 min of infusion). Similar to the link between concentration and effect, 0.60 pg/mL of lidocaine significantly reduced pain. It's intriguing that serum lidocaine concentration didn't correlate better with analgesia onset or end than free lidocaine concentration did. Free lidocaine concentration correlated with analgesic effect. Lidocaine concentration in the serum was a stronger predictor of analgesia. Conclusion: This suggests that IV lidocaine's analgesic mechanism may not follow a concentration-effect connection. The evidence shows this. Intravenous lidocaine is significantly stronger than oral. The analgesic response to intravenous lidocaine is a quick "break in pain" over a narrow dosage and concentration range. This was true independent of lidocaine dose. It doesn't matter how much lidocaine is given.

Background: The study aims to investigate maternal adiponectin and leptin levels as prospective markers of preeclampsia, as well as the ratio of maternal adiponectin to leptin levels. Additionally, this research investigated the relationship between these two hormones. In addition to that, the purpose of this study was to analyze the connection that exists between the two hormones. Materials and Methods: This is a study that looks forward into the foreseeable future. The pregnant women who were willing to take part in the research were split into two groups: the first group, which was referred to as the study group, consisted of fifty women who had been diagnosed with pre-eclampsia, and the second group, which was referred to as the control group, consisted of fifty normotensive women of the same gestational age who did not have proteinuria. The levels of adiponectin, leptin, and their ratio were evaluated in the maternal serum of pre-eclamptic (the study group)and normotensive women(the control group).. The comparison's outcomes were analysed Results: There was a statistically significant difference in the levels of adiponectin found in the study group compared to the levels found in the control group. When comparing the levels of leptin in the study group with the control group, there was a statistically significant difference (p< 0.001) between the two groups. When compared to the control group, the ratio of adiponectin to leptin was considerably lower in the group that participated in the study (p<

Objectives: Down syndrome is a disorder that affects one in every 700 babies born, and it is one of the most frequent causes of developmental delay (DS). In Pakistan, prenatal screening for Down syndrome is not being practised according to any approved protocol. The biochemical screening that takes place during the second trimester is still carried out using the triple test. Although the quadruple test has a better sensitivity and specificity than other diagnostic methods, its usage in routine medical settings is not advised. The purpose of this study was to explore the second trimester screening for trisomy 21 (quadruple test with genetic sonogram) in order to determine its sensitivity and accuracy in comparison to biochemical testing. Place of Study: District Headquarters Hospital, Gujranwala Duration of Study: January 2021 to December 2021 Methods: This retrospective observational study was carried out in a Fetal Medicine Centre with the purpose of analysing the odds of being affected with Down syndrome, given a positive risk (OAPR) upon screening in the quadruple test; triple test and quadruple test plus a genetic sonogram for highrisk singleton pregnancies (in view of advanced maternal age; an anomaly scan showing some abnormality, etc.). Given the presence of a positive risk factor, the goal of this study was to ascertain the likelihood of having a child impacted by Down syndrome. Practical Implication: To explore the second trimester screening for trisomy 21 (quadruple test with genetic sonogram) in order to determine its sensitivity and accuracy in comparison to biochemical testing. Results: The discovery of trisomies was made after an investigation into 3,042 highrisk pregnancies with a singleton baby. 327 pregnant women who have received positive findings from a triple test, quadruple test, or quadruple test in addition to a genetic ultrasonography opt to have an amniocentesis. This decision was made after the ladies learned that their unborn child may have a genetic disorder. It was discovered that 20 of the developing babies were affected by Down syndrome. The OAPR for the quadruple test was demonstrated to be significantly higher when compared to the OAPR for the triple test (1:29.1 as compared to 1:39.2). It was found that the combination of the triple test and the genetic sonogram had the highest OAPR of 1:7. Conclusions: The triple test combined with a genetic sonogram is the most effective tool for screening for trisomy 21, and it has the potential to cut down on the number of unnecessary amniocentesis operations carried out in high-risk populations. Keywords: Down syndrome, genetic, quadruples test, second trimester screening, triple test,ultrasound

Approaches to learning are the thinking process used for getting, arranging, and recalling the information more effectively. Sound knowledge of Anatomy is mandatory for practicing safely and efficiently in almost all clinical specialties. Aim of this study was to explore the learning approaches proved to be most popular among the undergraduate medical students for the subject of Anatomy in our institution. METHODS: This cross-sectional study was conducted in Anatomy Department, Shaikh Khalifa bin Zayed Al Nahyan Medical College, Lahore. 100 students from first year & 98 students from second year MBBS were included. Participation was purely on voluntary basis. Approaches and Study Skills Inventory for Students (ASSIST) was used to categorize students’ learning approaches towards anatomy as surface, deep or strategic. The data was analyzed using SPSS version 20. Shapiro Wilk test was used to check the normality of the data. Data was normally distributed. Scoring for three learning approaches was described by using mean ± SD. P- Value ≤ 0.05 was considered as statistically significant. RESULTS: Overall, 116 (58.9%) students practiced deep approach, 53 (26.9%) students practiced strategic approach and only 28 (14.2%) showed surface approach. No significant difference was found in practicing different learning approaches between first-year and second-year students.Deep learning approach towards anatomy was the most frequently adopted approach by both male as well as female students. Conclusion: Majority of the students showed predominant deep approach towards learning Anatomy, followed by the students having predominant strategic learning approach. There is still room for improvement in the quest to foster deep learning among students by the development of competent & skillful faculty and improving our assessment tools aligned with the learning outcomes.

Introduction: The adoption of a sedentary lifestyle is a major contributor to the development of disease as well as to morbidity and mortality rates. People who have high blood pressure can benefit from regular physical activity since it lowers their blood pressure. A lower body fat percentage is connected with a lower risk of developing high blood pressure when engaging in physical activity. There is a clear correlation between the body mass index (BMI) and the percentage of body fat (BF%) in terms of the resting rate of sympathetic nerve discharge to skeletal muscle. A greater proportion of fat stored in the abdomen, as opposed to the gluteal region, is associated with an increased risk of a variety of health problems, including diabetes and cardiovascular disease. As a result, the waist-to-hip ratio should be determined in order to conduct an analysis of fat distribution that is separate from an assessment of total obesity. The materials and procedures: Random selection was used to choose from the general population one hundred healthy sedentary volunteers and one hundred healthy non-sedentary subjects. Subjects in the age group (22-55 years) who had a BMI that was greater than 30 (kg/m2) were considered to be obese. Non-obese subjects were defined as having a body mass index (BMI) between 17.50 and 25.20 kg/m2 and an age range of 22 to 55 years. The purpose of this study was to investigate the differences between healthy sedentary and non-sedentary individuals in terms of parameters such as body mass index (BMI), waist-to-hip ratio (WHR), and body fat percentage (BF%). The participants ranged in age from 22 to 55 years old, and the correlation between these parameters and blood pressure was determined. Results: The findings showed that sedentary subjects had higher levels of body mass index, waist circumference, and body fat percentage than non-sedentary subjects did, and there was a positive link between these parameters and blood pressure. Conclusion: The conclusion is that a sedentary lifestyle is linked to an increase in Body Mass Index, Waist Hip Ratio, Blood Pressure, as well as Body fat percentage and fat mass. There was a link between BMI, WHR, BF%, and FM and blood pressure that was in the positive. Keywords: Body fat; body mass index; sedentary lifestyle; waist-hip ratio

The human brain is not only one of the most important organs in the human body, but it is also one of the most convoluted and is still not fully understood.As the process of aging continues, the brain goes through a number of changes as a whole, including both physical and histological shifts Study Design: Research utilizing a cross-sectional prospective study design Study Duration: January 2021 and continuing through November 2021. Place of Study: Allama Iqbal memorial teaching hospital khawaja Muhammad safdar medical college Sialkot Methodology: The participants in the study were given a standardized questionnaire to complete, in addition to a variety of checklists, in order to complete their assessments. The data was transferred over to SPSS version 23 for additional analysis. In order to investigate the nature of the connection that exists between age and gender, in addition to the height and diameter of the third ventricle, we turned to Pearson's product-moment correlation coefficient. Result: The analysis of variance (ANOVA), which calculates the mean difference between age groups, was performed. The p-value needs to be lower than 0.05 in order for the experiment to be considered statistically significant. The mean height of the third ventricle in males was 13.57 millimeters and the mean height in females was 13.52 millimeters. The mean diameter of the third ventricle in males was 2.98 millimeters and the mean diameter in females was 2.56 millimeters. When the size of the third ventricle in males was compared to that of the third ventricle in females, it was discovered that the size of the third ventricle in males is greater than that of the third ventricle in females. Keywords: CT Scan, ventricles dimensions, hydrocephalus, schizophrenia, psychotic disorders

Background: A recognized surrogate marker that can be utilised for the prediction and profiling of atherosclerotic cardiovascular disease is the thickness of the intima-media layer. Despite the fact that it varies geographically and ethnically, the significantly less likely to have it documented. This is despite the fact that there are many different communities . As a result of the process of atherosclerosis, the left anterior descending coronary artery is one of the coronary arteries that is afflicted the most of the time. As a consequence of this, the goal of this study was to determine whether or not there is a correlation between the intima-media thickness of the left coronary artery and the characteristics of the artery based on its morphology. Time and Place of study: Shaikh Zayed Hospital Lahore March 2019 to October 2021 Results: The thickness of the intima and media, on average, was 0.334 + 0.05 mm. It was more prevalent in males than in females.0.329+0.01 mm in females, increased with the number of branches of the left coronary artery, starting from 0.329+0.01 mm in males bifurcation to 0.499+ 0.01 mm in pentafurcation; and was also greater in left coronary arteries that were shorter than the average length of the right coronary artery 0.5mm, in addition to those with bifurcation angles greater than 700. Conclusion: The length, bifurcation angle, and terminal branching pattern of the left coronary artery all have an impact on the intima-media thickness of the left anterior descending artery. Additionally, the intima-media thickness of the left anterior descending artery is greater in males than it is in females. It can be deduced from this that the morphological characteristics of the left coronary artery are anatomical factors that contribute to the development of atherosclerosis.Screening for atherosclerosis ought to be done on those who exhibit these characteristics in order to provide early intervention.

Background Transpedicular screw fixation of the lumbar spine is a popular procedure to attain stability in degenerative conditions, deformity and fracture. An inappropriate size and positioning of the screw however may result in postoperative neurological and vascular complications in up to 42% of cases emphasizing need for precise morphometric data. Aim: This study aimed at providing morphometric features of lumbar vertebral pedicles germane to transpedicular screw fixation in Punjab. Study design: Cross-sectional population study Methods: Lumbar spine measurements of height and transverse diameter of pedicles along with sagittal and transverse angles were recorded from CT scans of 33 adult males and 28 females using ImageJ1.47v radiological image processor. Distance along pedicular and sagittal axes reaching anterior cortex of vertebra (screw length) was also measured. Results: Vertical and transverse diameters of the pedicle were significantly larger in the male. Gradual increase from L1 to L5 in the sagittal and transverse angles was observed in both sexes. Both angles were comparatively larger in the females; transvers angle being much wider than the males. Depth (screw length) of anterior cortex along pediclular axis except at level L3 and parallel to sagittal axis was not significantly different in the two groups. Conclusion: The study has provided useful gender specific data which will be of interest to the researcher and may be useful for the operating surgeon in his preoperative assessment and deliberations of lumbar transpedicular screw fixation. Keywords: Lumbar spine, transpedicular screw fixation, morphometry, lumbar pedicle, lumbar vertebrae, Multan

Background Hypothyroidism increases the risk of cardiac disease as well as autonomic dysfunction (abnormalities of the autonomic nervous system). A prospective case-control study was conducted. The purpose of this study was to compare the QT variability and vascular stiffness of SH patients. Materials and Methods:Using ABI, we compared female SH patients to age- and sex-matched normal controls in order to better understand their condition. HF (0.15–0.4 Hz) and LF (0.003–0.04 Hz) frequencies were investigated spectroscopically. The HF represents vagal regulation, whereas the LF reflects both vagal and limbic regulation. Result In this case research 32 women participated who were 28.02+7.8 years old and 28 women in control group who were age-matched (30.2+ 7.1). Patients had greater QT variability indices (P = 0.01) than healthy controls. Cases showed a higher LF/HF ratio than controls (P = 0.03), which was statistically significant. It was shown that there was a 0.02 point difference in left-right ABI between patients and controls. Conclusion In these circumstances, sympathetic activity predominated over parasympathetic activity, with less of the latter. QTvi may be beneficial in determining the risk of cardiovascular mortality in this particular patient population.

One of the most common gynecologic cancers is ovarian cancer and ranked third after the other two most common cancers: cervical and uterine. The highest mortality rate has been observed in the case of ovarian cancer. To treat ovarian cancer, an immune-informatics approach was used to design a multi-epitope vaccine (MEV) structure. Epitopes prediction of the cancer testis antigens (NY-ESO-1), A-Kinase anchor protein (AKAP4), Acrosin binding protein (ACRBP), Piwi-like protein (PIWIL3), and cancer testis antigen 2 (LAGE-1) was done. Non-toxic, highly antigenic, non-allergenic, and overlapping epitopes were shortlisted for vaccine construction. Chosen T-cell epitopes displayed a robust binding attraction with their corresponding Human Leukocyte Antigen (HLA) alleles demonstrated 97.59% of population coverage. The vaccine peptide was established by uniting three key constituents, comprising the 14 epitopes of CD8 + cytotoxic T lymphocytes (CTLs), 5 helper epitopes, and the adjuvant. For the generation of the effective response of CD4 + cells towards the T-helper cells, granulocyte–macrophage-colony-stimulating factor (GM-CSF) was applied. With the addition of adjuvants and linkers, the construct size was 547 amino acids. The developed MEV structure was predicted to be antigenic, non-toxic, non-allergenic, and firm in nature. I-tasser anticipated the 3D construction of MEV. Moreover, disulfide engineering further enhanced the stability of the final vaccine protein. In-silico cloning and vaccine codon optimization were done to analyze the up-regulation of its expression. The outcomes established the vaccine’s immunogenicity and safety profile, besides its aptitude to encourage both humoral and cellular immune responses. The offered vaccine, grounded on our in-silico investigation, may be considered for ovarian cancer immunotherapy. Supplementary Information The online version contains supplementary material available at 10.1007/s10989-021-10294-w.

Background:Lead harms haematological, biochemical, and hepatic parameters, hence studies have concentrated on antioxidants with therapeutic potentials. Objective: Induced hepatotoxicity and hemato-biochemical parameters in adult Wistar rats with Ocimum Gratissimum extract. Methodology: 42 adult Wistar rats were divided into seven groups of five. Group A was the control, Group B had 120 mg/kg lead, and Group C got 300 mg/kg OG. D and E had 120 mg/kg lead before 300 mg/kg and 600 mg/kg OG. Group F had 300 mg OG extract, then 120 mg lead, whereas Group G got 120 mg lead and 1000 mg ascorbic acid. The animals were then slaughtered and blood and liver tissues were taken for biochemical and histological investigation. Results: The outcome revealed a rise in Control but a drop in B. ALT, AST, GGT, and ALP levels were higher in Group B than in Control and other treatment groups (p≤ 0.05). As in Groups D, E, F, and G, histological investigation of liver tissues revealed degenerative alterations with localised necrosis and aggregated inflammatory cells in B. Conclusion: The extract of OG has the potential to be employed as a medicinal agent in the treatment of lead poisoning. Keywords: Hepatobiochemical; Lead; Liver; Ocimum gratissimum; Wistar rats; Parameters

Background and objective: Low back pain is common in the elderly due to adaptive changes to stress and osteoporosis of the lumbar spine. Skeletal geometry varies in different population groups. Objective of this study was to record reference values of morphometric data of lumbar spine in normal adult male and female subjects of Punjab. Study design: Cross-sectional population study Material and methods: Anterior and central height and concavity index for each vertebra were measured and calculated from radiographs. Anterior and posterior height and anteroposterior diameter were measured for each disc and wedge index was calculated. Results: All parameters were significantly larger in the males as compared to the females. Significant difference was found in the anterior height of the intervertebral discs at L1-2 to L4-5 while it was insignificant at L5-S1. Posterior height of discs was significantly larger in the male group at L1-2 to L3-4. Wedge index (WI) for discs was relatively larger in the female group. Conclusion: The study has provided some reference values of measurements of lumbar spine in adult male and female population of Punjab which may be valuable for better assessments of morphological changes by the clinician and for further research in this area. Keywords: Lumbar vertebrae, intervertebral disc, morphometry, concavity index, wedge index, lumbar spine

Objective: To determine the frequency of factors leading to emergency peripartum hysterectomy Introduction: The emergency peripartum hysterectomy (EPH) is a dreadful complication and to determine its risk factors is very important to early and prompt management. Objective: My objective is to determine the frequency of factors leading to emergency peripartum hysterectomy. Main outcome: EPH is the main outcome which is surgical removal of uterus due to severe postpartum hemorrhage Study design: Descriptive case series Setting: Obstetrics and Gynaecology Department, District Headquarter Hospital, Gujranwala Duration of study: 1 July 2019 to 31 December 2019 Material and methods: Seventy patients undergoing emergency peripartum hysterectomy were selected from the Obstetrics and Gynecology emergency department of District Headquarter Hospital, Gujranwala. Hospital registration numbers was noted and for all enrolled women. The major risk factors like uterine atony, uterine rupture and abnormal placentation was noted down from detailed history and clinical and ultrasound examinations and surgeon notes was collected. All patients will be efficiently managed throughout a per standard guidelines. Data was analyzed using SPSS version 20. The quantitative variables were age, gestational age and BMI. Mean and standard deviation was calculated for quantitative data. Frequency and percentages were calculated for qualitative data like parity and risk factors. Effect modifiers like age, parity and BMI was controlled by stratification. Post stratification Chi square test was applied. P value ≤ 0.05 was considered as statistically significant. Results: The mean age was 28.64 ± 6.836 years. The mean gestational age and BMI were 31.61 ± 3.576 weeks and 23.66 ± 2.904 kg/m2 respectively. The frequency of parity groups was as follows; for parity 1, 2, 3, 4 and ≥5 was 13 (18.6%), 10 (14.3%), 11 (15.7%), 25 (35.7%) and 11 (15.7%) respectively. The main causes of EPH were uterine rupture, abnormal placentation and uterine atony with proportions of 30%, 44.3% and 12.9% respectively. The data was stratified according to age, gestational age, parity and BMI. The results showed that there was no significant impact of age, gestational age, parity and BMI as all p values were >0.05 Conclusion: The emergency peripartum hysterectomy has various causative factors and uterine rupture, abnormal placentation and uterine atony are the most significant factors which can be minimized to reduce its incidence. Keywords: Emergency Hysterectomy Obstetric Outcome Postoperative Complications Postpartum Hemorrhage/epidemiology/surgery Pregnancy

Aim: To find out possible to determine effect of C. reflexa extract on spontaneous contractions of rabbit jejunum. Methods: Animal experimental in vitro study from 1st October 2017 to 30 September 2018 at Pharmacology experimental lab, Wah Medical College Wah Cantt. Study model was Isolated pieces of rabbit jejunum and ileum. Sampling Technique used was Simple Random. Tissue considered fit for experiment after initial equilibration and stabilization. Result: Three increasing concentrations (0.1mg/ml, 0.2mg/ml and 0.4mg/ml) of C. reflexa extract decreased the response to 3.83±0.40, 2.33±0.33 and 1.33± 0.21mm. Decrease in response was significant with p- value 0.04, 0.008 and 0.003 respectively. Conclusion: Freshly prepared aqueous solution of crude extract of C. reflexa decreases the amplitude of spontaneous contractions of isolated rabbit jejunum. Keywords: Rabbit jejunum, effect of drug

Fluvastatin's hepatoprotective impact is being investigated in the current study. It is possible that the oxidative stress pathway is implicated in PCM hepatotoxicity. The acute hepatotoxicity of PCM was investigated in this study. Place of study: Rashid Latif Medical College Lahore Materials and Methods: The rabbits were divided into five groups of ten each. The saline group received (the vehicle). Fluvastatin (20 mg/kg), PCM (600 mg/kg), and PCM + 10 mg Fluvastatin (600 mg PCM + 20 mg Fluvastatin) were administered to the animals. The livers from all the animals were taken out and cleansed. 70% alcohol was used for washing extensively, after which the liver tissue was embedded in paraffin and then 5 mm thick paraffin slices were stained by aid of hematoxylin and eosin. Results: Male rabbits were shown to be harmful to paracetamol (P

Background: Prostate cancer is the second most common male cancer. Prostate cancer is diagnosed via a digital rectal exam, ultrasonography, and serum prostate specific antigen. Dr. Donald Gleason devised a prostate cancer grading system over 50 years ago. This system is still viable with modifications. The ISUP updated in 2005 and 2015. Gleason score and prognosis in prostatectomy stuff Gleason score, tumor volume, and tumor laterality were compared. nephroscopy and prostate Method: The study comprised 42 men with biopsy and prostatectomy materials. Gleason's grade. The new method graded tumors. Between october2019 and October 2021, 42 individuals with prostate cancer were needle biopsy diagnosed and treated with RP. Tumor volume was measured by the number of positive blocks. A significant difference in diagnosed by digital imaging, serum prostate specific antigen, and needle biopsy. Gleason score, location, and volume are unknown tumor features. Result: Gleason score, tumor volume, and laterality between needle biopsy and prostatectomy materials Gleason score and tumor volume enhanced concordance. Conclusion: For a prostate cancer diagnosis, a digital exam, serum PSA and needle biopsy are quite sensitive. Lesser known tumor characteristics include Gleason score, location, and volume. Keywords: Prostate, Adenocarcinoma, Needle biopsy, Radical prostatectomy, Gleason score

Background: Females frequently experience vaginal discharge. A vaginal imbalance can result in bacterial overgrowth and discharge from the vaginal area. Despite extensive knowledge of the illness, it primarily affects women who are sexually active. Bacterial vaginitis is a kind of vaginal infection (BV). Several species of Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus species, Bacteroides spp., Prevotela spp., Peptostreptococcus spp., Fusobacterium spp., and Porphyromonas species have taken the place of the vaginal lactobacillus species in this study. Aim: We were interested in seeing how many sexually active ladies with vaginal discharge presented to emergency department. Methods: The participants in the trial were 88 women of reproductive age who complained of profuse vaginal discharge. Women who are married, women who have skin disorders, and women who have reached menopause are forbidden from participating. Normal Trichomonads were discovered on wet-mount slides made of saline. A grame coloured smear of blood Nugent classification was utilised in the scoring. Pseudohyphae and/or budding yeast cells are used to test for Candida albicans infection. Results: The average age was 30 years old. The most prevalent reason for this was vaginosis (29.54%).Trichomonas (1.13%%) and candidiasis (10.22%) are the most common pathogens. There is no reason for vaginal discharge. It is possible that almost half of the ladies will be fired. Infected as opposed to reactive. TPHA and VDRL are two acronyms that stand for Transparency, Transparency, and Reliability. Conclusion: It is also necessary to upgrade the laboratory services network in order to supply accurate data. More cases of bacterial vaginosis were discovered as a result of the investigation. An STD, RTI, VDRL, and HIV positive individuals were all shown to be substantially associated. Keywords: Vaginal discharge, sexually active females, intrauterine contraceptive device

Introduction: Injury to the ureter is a risk of any pelvic or abdominal surgery. The anatomic proximity of the lower urinary tract and the female reproductive system renders the ureter vulnerable to injury during obstetric and Gynecologic procedures. Ureterovaginal fistula is an uncommon but serious sequela of unrecognized distal ureteral injury during pelvic surgeries because of their common embryologic origin. Method: This study involved a series of 25 patients, who developed ureterovaginal fistula after Obstetric and Gynecologic procedures managed in urology department Muhammad Islam teaching hospital Gujranwala. These patients were managed with open Ureteroneocystostomy, within 2 weeks of primary procedure. In this study we present our postoperative result of 6 months of follow up. Results: All patients were cured (100%) with complete cessation of urinary fistula with complete restoration of renal function and complete restoration of urinary anatomy. Conclusion: The results of our study showed that the patient with Ureteric injury should be evaluated and intervened at the earliest. Early identification and repair of ureterovaginal fistulas results in a high quality of life, less postoperative complications, and a high success rate and preservation of renal function. keywords: Ureteric injury, ureterovaginal fistula.

Background: The term "abnormal uterine bleeding" (AUB) refers to bleeding from the uterus that is either more than usual, occurs for a longer amount of time than normal, or occurs at an irregular time. All three of these factors can contribute to AUB. AUB can affect persons of any age and can manifest itself in a variety of ways. It is also one of the most common reasons that patients go to see their physicians because it is a presenting complaint or symptom. There is a wide variety of underlying reasons, some of which include fibromyoma, adenomyosis, endometrial polyp, ovarian tumour, pelvic inflammatory disease (PID), endometrial hyperplasia, endometrial cancer, hormonal imbalance (such as hypothyroidism), or hypothalamus pituitary illnesses. Place of Study: Rai Medical College Sargodha Duration of Study: November 2018 and March 2022 Methods: The Obstetrics and Gynecology department of RAI Medical College in Sargodha carried out this prospective observational study during the months of November 2018 and March 2022. One hundred and ten patients in all were given permission to take part in the research project after meeting the prerequisites for participation. Results: According to the statistics, the largest number of cases, 51.2%, fell within the age range of 41-50 years. The next largest number of cases, 28.9%, fell within the age range of 31-40 years. In total, there were 110 people who agreed to take part in the research. The average age of all of the patients was 44.87 years old, with a standard deviation of 9.45 years. According to the findings of our investigation, the most common mode of presentation was heavy menstrual bleeding, which was recorded in 54 cases (49.9%). This was followed by delayed menstrual bleeding, which was observed in 23 instances (20.9%). Endometrial hyperplasia was found in 16 (14.5%) of the patients, proliferative endometrium was found in 47 (42.7%) of the cases, secretory endometrium was found in 38 (34.5%) of the cases, and endometrial hyperplasia was found in 15 (13.6%) of the cases. Keywords: Abnormal uterine bleeding, histopathology, dysfunctional uterine bleeding

Recent studies have demonstrated that cancer cells can elude immune cells by creating a sanctuary within the tumor’s microenvironment. Large amounts of immune-suppressing signaling proteins can be expressed by cancer cells. One of the most important mechanisms in this system is immune suppression caused by tumors and the modulation of the immune checkpoint. The immune checkpoint is modulated by both the programmed cell death protein 1 (PD-1) and its ligands, programmed death ligand 1 (PD-L1) and PD-L2. Non-coding RNAs (ncRNA), including the more well-known microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), all play roles in the regulation of biological processes and extensive diseases such as cancer. Thus, the focus of this study is on the interactions between the programmed death protein and its ligands with miRNAs, lncRNAs, and circRNAs during tumorigenesis and tumor progression. Furthermore, some FDA-approved drugs for the treatment of various cancers were based on their interactions with PD-1, PD-Ls, and ncRNAs. This promising strategy is still in the production stages, with additional results and clinical trials being processed.

Background One of the most potent glucocorticoids is known as Dexamethasone. Many metabolic side effect shave been reported on almost every organ after dexamethasone treatment specially its effect on liver. Aim: To investigate harmful side effects of dexamethasone sodium phosphate on rabbit’s liver that serve as human liver model via using light microscope, by administration of two doses (extreme) and two durations in order to depict the duration as well as dosage dependency. Methods: Liver samples were taken via rabbits who were administered dexamethasone sodium phosphate. Then two Stratas were made namely, 1 and 2. The fixations of liver samples were carried out and underwent into evaluation in order to observe any histochemical and histological alterations. Study duration is from February to May 2021 Rabbits were brought from Veterinary Research Institute, Lahore. These Rabbits were kept in cages in the animal house of PGMI, Bird wood road Lahore. Results: The ballooning and vacuolation of hepatic cells were seen in the liver in case of Stratas that were treated along with the degenerative alterations of these cells, congestion and dilatation of central hepatic vein with sinusoidal capillaries, positive periodic acid schiff's stain (PAS) reactions. The severity of all these alterations was dependent upon duration and dosage. Conclusion: Morphological variations induced in the liver by dexamethasone sodium phosphate could be accepted as side effects of these drugs. Keywords: Liver, dexamethasone, histology, glycogen.

Background: Acetylsalicylic acid is in common clinical use but has the side effect of causing gastric mucosal erosions and selective injury to parietal cells. Aim: To explore if prior treatment with Prunus dulcis (almond) had a protective effect against acetylsalicylic acid induced injury. Study design: Experimental study. Methodology: Albino mice weighing 30 to 40 grams were given two drops of almond oil without peel and 300 mg of finely ground whole almond kernel by oral gavage for sixty days followed by 400 mg/kg body weight of acetylsalicylic acid orally. Gastric mucosal damage was observed and recorded as ulcer index. The number of parietal cells/ sq. micrometer and area of parietal cells were observed and recorded under microscope in formalin fixed H and E stained sections. Data analyzed by SPSS 22.0v. Results: Mucosal damage, distortion of gastric glands and damage to parietal cells was pronounced in the positive control animals. The number of surviving parietal cells after acetylsalicylic acid insult in animals given almond oil was significantly higher when compared with positive control animals (p

Objectives: This study was designed to evaluate the frequency of postpartum depression in new mothers at a tertiary care hospital in Faisalabad and identify the factors associated with the condition. Study Design: Cross-sectional study. Setting: Obstetrics and Gynecology Department of Independent University Hospital, Faisalabad. Period: Over a period of three months from February 2018 to May 2018. Material & Methods: Included 213 subjects selected through nonprobability purposive sampling patients who had given birth in the last six months were included in the study. The Punjabi version of Edinburgh Postnatal Depression Scale was used to assess for depression. Socio-demographic and medical information was collected on a pre-designed proforma. Data was analyzed using SPSS version 23. Chi square test was applied to ascertain association. Results: Out of the total 213 participants, 33.8% (n=72) of the study sample were suffering from postnatal depression. The socio-demographic profile of the depressed patients showed that most of them were uneducated (84.72%), housewives (77.78%) living with extended families (68.06%). The difference in the number of depressed women among extended and nuclear families was found to be statistically significant (p-value of 0.004). The study also showed that women suffering from postpartum depression were less likely to breastfeed their babies (p-value 0.046). Conclusion: Postpartum depression was identified in more than one thirds of the females included in this study. This high number should raise an alarm for all health professionals. Detection through mandatory screening and early intervention can prevent the adverse consequences this disorder carries for the mother and the child.

Endocrine Disrupting chemicals including bisphenols have contaminated the environment significantly and is known to damage spermatogenesis via increase in oxidative stress. The anti-oxidant properties of naturally occurring substances like curcumin have been well established. Objectives: To evaluate the protective effects of curcumin against bisphenol-A induced testicular damage. Study Design: Experimental Study. Setting: Department of Anatomy, University of Health Sciences, Lahore. Period: From March 2015 to December 2015. Material & Methods: Thirty six rats were divided into four groups A, B, C and D of 9 animals each. Group A (control) was given 5ml/kg/day of corn oil orally for 10 days. Group B (Bisphenol-A) was given 100mg/kg/day of Bisphenol-A dissolved in corn oil orally for 10 days. Group C (recovery) was given 100mg/kg/day of BPA dissolved in corn oil orally for 10 days and left untreated for 10 days. Group D (Curcumin + BPA) was given 100mg/kg/day of BPA and 100mg/kg/day of Curcumin, dissolved in corn oil orally for 10 days. Rats of group A, B and D were sacrificed on day 11 and those of group C on day 21. After weighing the euthanized rats, testes were removed, processed and tissue sections were stained with H&E for Johnson scoring and with PAS stain for assessment of basement membrane integrity. Results: Bisphenol-A administration caused a significant decrease in weight of animals, a significantly low Johnson score of seminiferous tubules and high frequency of disrupted basement membranes of the tubules in Group B as compared to control. The weight gain of animals improved in the with-drawl group C while no self-recovery was observed in other parameters. Curcumin co-administration improved the body weight gain of animals, increased the Johnson scoring of tubules significantly and partially restored the basement membrane integrity in group D, comparable to the control group. Conclusion: The results of this study indicate that co-administration of a potent antioxidant curcumin causes a significant antagonism of the histo-toxicity of testis produced by Bisphenol-A in albino rats.

Salinity tolerance is a multifaceted trait attributed to various mechanisms. Wild barley is highly specialized to grow under severe environmental conditions of Tibet and is well-known for its diverse germplasm with high tolerance to abiotic stresses. The present study focused on determining the profile of the expression of isoforms of the

Background & objectives: Many pregnant women in Pakistan have iron deficiency anemia (IDA), a dietary deficit. It affects both the mother's and the foetal' health. Oral iron supplementation usually relieves IDA symptoms. Oral iron supplements are hazardous to the GI mucosa, and sensitivity is common. Poor therapeutic compliance leads to treatment failure. Ferrous ascorbate (FeA) and iron hydroxide polymaltose complex (IPC) reportedly improve gastrointestinal discomfort and increase patient compliance compared to ferrous sulphate (FS). These preparations reportedly improve hemoglobin levels and iron stores more quickly than FS. This analysis compared FS's efficacy and safety to IPC and FeA. Place of Study: Rashid Latif Medical College Lahore Duration of Study: February 2019 and October 2021 Methods: It was a randomized, parallel, open label, investigation among pregnant women of gestational age from 10 to 28 weeks with moderate anemia. Patients were randomly selected to receive either FS, IPC or FeA. They were then followed up for 3 months to look for improvement in the hemoglobin levels and other hematological indicators or any adverse drug response. Results: With the exception of 3 months, when the FeA group had a significantly higher hemoglobin level in comparison to the FS group (P

Heavy metal resistant bacteria are of great importance because they play a crucial role in bioremediation. In the present study, 11 bacterial strains isolated from industrial waste were screened under different concentrations of cadmium (Cd) (100 µM and 200 µM). Among 11 strains, the Cd tolerant

Background: Diabetic dyslipidemia is a group of lipoprotein defects described by raised triglycerides, elevated low density lipoprotein and reduced levels of high density lipoprotein. Objective: To assess the effect of blood sugar fasting levels on individual lipoproteins. Study design: Cross-sectional study Place and duration of study: Fauji Foundation Hospital Rawalpindi & POF Hospital Wah Cantt from 1st February 2014 to 31st July 2014. Methodology: Fifty patients with age from 30 to 70 years were enrolled. Patients' body mass index was calculated. Serum cholesterol, high density lipoprotein and triglyceride levels were estimated by enzymatic colorimetric kit. Low density lipoprotein was calculated by Friedewald equation. Results: The mean blood sugar fasting level was 204.050±87.0755. The P-value of low density lipoproteins to blood sugar fasting and cholesterol to high density lipoprotein ratio blood sugar fasting were significant i.e. 0.03 and

Background: Degenerative changes and mechanical stress lead to lumbar spinal canal stenosis resulting in low back pain. Various factors such as genetic, malnutrition, systemic disturbance and trauma may affect the size of lumbar spinal canal. Aim: To record the dimensions of lumbar spinal canal in symptomless adult male and female subjects and compare them with those with low back pain. Study design: Cross-sectional population study Study place Allama Iqbal Memorial Teaching Hospital Khawaja Muhammad Safdar Medical College, Sialkot Study duration February to November 2020 Material and methods: Anteroposterior and transverse diameters and cross sectional areas of the spinal canal were measured on CT scans using ImageJ1.47v at levels L1 to L5 in adult male and female subjects with and without low back pain. Results: Anteroposterior diameter was smaller at level L1in females with pain. Transvers diameter was significantly smaller in females with pain at L2, L3 and L5 and at L3-5 than in those without pain. Comparison of male subjects with and without pain showed significant difference at L5 while similar comparison was significant at L1 and L4 in the females. Highly significant difference (p < 0.0001) was observed at L2 to L5 among the males and L1 to L5 in the females when cross sectional areas were compared for the two groups. Conclusion: Subjects with pain had significantly lower values of various dimensions of the lumbar spinal canal in both sexes. The study has provided gender specific reference data which could be helpful in clinical assessment of spinal canal stenosis Keywords: Lumbar spine, spinal canal, morphometry, low back pain, spinal canal stenosis

Background: Outcome of treatment of orbital floor defects with titanium mesh in zygomatic complex fractures. Eye trauma results in significant aesthetic and functional problems. Rehabilitation necessitates a grasp of the orbit's altered structure and function, as well as the materials and procedures used in its restoration. Study design: Descriptive case series Study duration: 1 year.22 December 2018 to 21 December 2019. Study place: Allama Iqbal Teaching Hospital, Kh. Muhammad Safdar Medical College, Sialkot Results: This study was carried on 150 patients over a period of 6 months from January 1st 2013 to June 30th 2013 at the department of Oral & Maxillofacial Surgery PIMS Hospital Islamabad. 135/150(82.75%) patients were male and 15/150(17.24%) patients were female. The mean average age of the male patients was 30.02 years + 10.26 and the mean average age of the female patients was 29.90 years + 10.53. In our study 82.8% were males and 17.8 were females. Conclusion: The conclusion of study is titanium mesh isa better treatment option in management of complex orbito-zygomatico complex fractures, Diplopia is initially present but eventually resolve within 3 month. Keywords: Titanium mesh, zygomatic complex fracture

No abstract available Keywords: gene tagging; insertion polymorphisms; molecular marker; next-generation sequencing; rice; transposable element.

Background: Osteoporosis progresses with advancing age. Estimation of bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) is valuable in predicting fracture risk in the elderly. DXA machines however may not always be available in under-resourced developing countries. Aim: To find values of CTI and CFI in normal adult young and old, male and female population of Southern Punjab. Study design: Cross-sectional population study Methods: Measurements were recorded from 107 anteroposterior radiographs of proximal femur of normal adult male and female subjects divided in two groups: Young: 22 male and 26 females with mean age 28±3.4 and Old: 31 male and 28 females with mean age 61+5.2. Results: Statistical comparison between male and female subjects for CTI was not significant in the Y and O groups. Similar comparison for CFI while not significant in the Y-group was highly significant in the O-group. In overall comparison of Y and O groups the difference was very highly significant for CTI and CFI; both showing higher values in the Y-group. Conclusion; CTI and CFI measured from radiographs of proximal femur are reliable parameters and can be recommended for preliminary assessment of bone mineral density in developing countries. Keywords: Proximal femur, morphometry, cortical thickness index (CTI), canal flare index (CFI), bone mineral density

Background: One of the complications of diabetes is Peripheral neuropathy that becomes the source of frailty and indisposition. Metabolic malfunction is the root cause in diabetes that target nerve damage. Aim: To evaluate electrophysiological case research with respect to effect of diabetics on nerves and to link it along with blood sugar Methods: Assessment of nerves related to of upper limb was carried out for motor nerve by aid of computerized system and surface electrodes in 40 male individuals suffering from type 2 and 40 healthy males. The ulnar and median nerve was selected for case research. Parameters that were being discussed included conduction velocity and distal latency Results: Diabetics have increased distal delay and reduced conduction velocity. These variables were linked to blood sugar levels in diabetics. Conclusions: There is affect to nerves in case of diabetes as shown by poor motor nerve function and depicted via testing electro physiologically. Increase in sugar blood levels is associate with damage to nerves. Keywords: Electrophysiological tests, Conduction velocity, Peripheral neuropathy, Diabetes

Background: Preoperative assessment by calculating the morphological cortical Index (MCI), canal-calcar ratio (CCR), canal flare index (CFI) and canal bone ratio (CBR) will facilitate appropriate surgical planning for total hip arthroplasty. Since no data on indices and ratios of proximal femur in Punjab is available the study was planned to record the same from radiographs of normal adult population. Study design: Cross-sectional population study Methods: MCI, CCR, CFI and CBR were calculated from measurements on anteroposterior radiographs of the proximal femur from 116 male and 96 female subjects with a mean age of 46 years. Results: Morphologic cortical index, canal calcar ratio and canal flare index did not have any statistically significant difference between the two sexes. Canal bone ratio showed a highly significant difference when the male and female group were compared (p = 0.0042). Conclusion: The study has provided baseline data on morphologic cortical index, canal calcar ratio, canal flare index and canal bone ratio of proximal femur in Punjab which may be helpful in surgical planning for total hip arthroplasty and further research in the area. Keywords: Morphological Cortical Index (MCI), Canal-calcar Ratio (CCR), Canal Flare Index (CFI), Canal Bone Ratio (CBR), proximal femur, morphometry, total hip arthroplasty (THA)

Background: The female reproductive organs include uterus, fallopian tubes and ovaries, these organs when exposed to drugs and metals lead to anatomical damage resulting in infertility. Researchers have documented the harmful effects of the favorable antidepressant Lithium Carbonate on many human viscera’s but even today the medicinal world has scarce knowledge of the ablation of ovarian anatomy by lithium carbonate. Aim: To study and document the results of the detrimental effects of Lithium on the ovaries. Methods: We selected Twenty four adult female rats for this observational and experimental study. The female albinos were divided into two groups. Twelve animals were present in Group A and Group B consisted of twelve female rats. The hygienically prepared laboratory diet which consisted of flour pellets and green vegetables was given to Group A animals and Group B rodents received Lithium carbonate in powder form for eight weeks. After completion of the study time animals were sacrificed and weight of ovaries were recorded and compared in both groups. Results: The results in Group B documented that animals had a highly significantly decline in ovarian weight after chronic Lithium carbonate than in Group A. Conclusion: Our prospective study concluded that chronic administration of Lithium Carbonate causes distortion of its tissue and highly significant decrement of weight of the ovary. Keywords: Ovary, decrement, infertility

Salinity is among the major abiotic stresses negatively affecting the growth and productivity of crop plants. Sodium nitroprusside (SNP) -an external nitric oxide (NO) donor- has been found effective to impart salinity tolerance to plants. Soybean (Glycine max L.) is widely cultivated around the world; however, salinity stress hampers its growth and productivity. Therefore, the current study evaluated the role of SNP in improving morphological, physiological and biochemical attributes of soybean under salinity stress. Data relating to biomass, chlorophyll and malondialdehyde (MDA) contents, activities of various antioxidant enzymes, ion content and ultrastructural analysis were collected. The SNP application ameliorated the negative effects of salinity stress to significant extent by regulating antioxidant mechanism. Root and shoot length, fresh and dry weight, chlorophyll contents, activities of various antioxidant enzymes, i.e., catalase (CAT), superoxide dismutase (SOD), peroxidase (POD) and ascorbate peroxidase (APX) were improved with SNP application under salinity stress compared to control treatment. Similarly, plants treated with SNP observed less damage to cell organelles of roots and leaves under salinity stress. The results revealed pivotal functions of SNP in salinity tolerance of soybean, including cell wall repair, sequestration of sodium ion in the vacuole and maintenance of normal chloroplasts with no swelling of thylakoids. Minor distortions of cell membrane and large number of starch grains indicates an increase in the photosynthetic activity. Therefore, SNP can be used as a regulator to improve the salinity tolerance of soybean in salt affected soils.

Background: One of the leading causes for hepatocellular carcinoma is Nonalcoholic fatty liver diseases (NAFLD) that also increases incidence of mortality rates. Aim: To understand alterations biochemically and clinically in patients suffering from NAFLD since they are at stake of cirrhosis as well as nonalcoholic steatohepatitis (NASH) in case of Pakistani population. Methods: Patients suffering from NAFLD were selected for these case reaches that were all confirmed via ultrasonography. Candidates were tested negative for autoimmune or viral hepatitis serologic markers, no record was found with respect to liver disease related to metabolism, moreover candidates were also not administer any medication that has its impact on liver like Ursobil. Clinically and biochemically all the patients were tested for history, signs and symptoms and they depicted variables. Results: A enrollment of 80 candidates was carried out that included 38 female and 42 male, owing mean age of 40.4 years. The candidates with no diabetes and obesity were 26.4% and 18.3%, respectively. Late dinner sleep disorders and delayed sleep were the most detectable reasons in patients suffering from NAFLD. Moreover, thirst sensation, anxiety, bloating, and upper abdominal pain, warming sensation and defecation disturbances, were seen common in case of patients suffering from NAFLD. Conclusion: NAFLD is regarded as heterogeneous pathology with variety of clinical findings. It has been experienced that gastrointestinal problems as well as anxiety are most frequently seen in patients suffering from NAFLD. Keywords: NAFLD, hepatocellular carcinoma, cirrhosis

Aim: To investigate the causes of incidence of gallstones in case of children and response to treatment via ursodeoxycholic acid (UDCA) Methods: 42 children suffering from cholelithiasis were selected, and gallstones were scanned using ultrasonography. The findings of scan of these children were recorded in Performa. Study duration 18 months Children's Hospital and the Institute of Child Health Lahore Results: The most common risk factor in case of incidence of gall stones was a family history. By the aid of UDCA treatment many children showed positive response especially in first six months where as children suffering from hemolytic diseases were failed to depict any response to UDCA. Treatment Conclusion: UDCA treatment proved to be beneficial to patients with asymptomatic profile before surgery in case of children suffering from cholelithiasis and having no hemolytic pathologies. Keywords: Cholecystectomy, Gallstone, Ursodeoxycholic acid.

Background: Methylcobalamin is essential vitamin required for DNA synthesis during cell division therefore maintain the architecture of nervous tissue distorted by soft metals such as Lithium Carbonate. Accurate documentation of the thickness cerebellar cortical thickness was required in subjects who were injected with methylcobalamin distorted by Lithium Carbonate. Aim: To provide data of cerebellar gray matter thickness distorted by Lithium Carbonate by the anti-oxidant effect of methylcobalamin. Methods: Fifteen albino rats were maintained on food and diet in Animal House of the Basic Medical Sciences Institute, JPMC Karachi for a period of 6 weeks. Results: The results obtained of the thickness of cerebellar gray matter distorted by Lithium Carbonate was restored by methylcobalamin in our study. Conclusion: To observe the neuroprotective effect of B12 on distorted cerebellar cortex treated by Lithium Carbonate. Keywords: Methylcobalamin, Lithium Carbonate, Gray Matter, Cerebellum