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Tendinopathy, enthesopathy, labral degeneration, and pathologic conditions of the articular disc (knee meniscus and ulnocarpal) are sometimes described in terms of inflammation or damage, while the histopathologic findings are often consistent with mucoid degeneration. A systematic review of the histopathology of these structures at diverse locations might reconceptualize these diseases as expected aspects of human aging. The potential benefits of this evolution might include healthier patient and clinician mindsets as well as a reduced likelihood of overdiagnosis and overtreatment resulting from greater awareness of base rates of pathology.In this systematic review of studies of surgical specimens, we asked: Are there are any differences in the histopathologic findings of structural soft tissue conditions (mucoid degeneration, inflammation, and vascularity) by anatomic site (foot, elbow, or knee) or structure (tendon body, muscle or tendon origin or insertion [enthesis], labrum, or articular disc)?Studies between 1980 and 2021 investigating the histopathologic findings of specimens from surgery for trigger digit, de Quervain tendinopathy, plantar fasciitis, lateral and medial elbow enthesopathy, rotator cuff tendinopathy, posterior tibial tendinopathy, patellar tendinopathy, Achilles tendinopathy, or disease of the hip labrum, ulnocarpal articular disc, or knee meniscus were searched for in the PubMed, EMBASE, and CINAHL databases. Inclusion criteria were the prespecified anatomic location or structure being analyzed histologically and any findings described with respect to inflammation, vascularity, or mucoid degeneration. Studies were excluded if they were nonhuman studies or review articles. Search terms included "anatomy," "pathology," and "histopathology." These terms were coupled with anatomic structures or disorders and included "trigger finger," "de Quervain," "fasciitis, plantar," "tennis elbow," "rotator cuff tendinopathy," "elbow tendinopathy," "patellar tendonitis," "posterior tibial tendon," and "triangular fibrocartilage." This resulted in 3196 studies. After applying the inclusion criteria, 559 articles were then assessed for eligibility according to our exclusion criteria, with 52 eventually included. We recorded whether the study identified the following histopathologic findings: inflammatory cells or molecular markers, greater than expected vascularity (categorized as quantitative count, with or without controls; molecular markers; or qualitative judgments), and features of mucoid degeneration (disorganized collagen, increased extracellular matrix, or chondroid metaplasia). In the absence of methods for systematically evaluating the pathophysiology of structural (collagenous) soft tissue structures and rating histopathologic study quality, all studies that interpreted histopathology results were included. The original authors' judgment regarding the presence or absence of inflammation, greater than expected vascularity, and elements of mucoid degeneration was recorded along with the type of data used to reach that conclusion.Regarding differences in the histopathology of surgical specimens of structural soft tissue conditions by anatomic site, there were no differences in inflammation or mucoid degeneration, and the knee meniscus was less often described as having greater than normal vascularity. There were no differences by anatomic structure. Overall, 20% (10 of 51) of the studies that investigated for inflammation reported it (nine inflammatory cells and one inflammatory marker). Eighty-three percent (43 of 52) interpreted increased vascularity: 40% (17 of 43) using quantitative methods (14 with controls and three without) and 60% (26 of 43) using imprecise criteria. Additionally, 100% (all 52 studies) identified at least one element of mucoid degeneration: 69% (36 of 52) reported an increased extracellular matrix, 71% (37 of 52) reported disorganized collagen, and 33% (17 of 52) reported chondroid metaplasia.Our systematic review of the histopathology of diseases of soft tissue structures (enthesopathy, tendinopathy, and labral and articular disc) identified consistent mucoid degeneration, minimal inflammation, and imprecise assessment of relative vascularity; these findings were consistent across anatomic sites and structures, supporting a reconceptualization of these diseases as related to aging (senescence or degeneration) rather than injury or activity.This reconceptualization supports accommodative mindsets known to be associated with greater comfort and capability. In addition, awareness of the notable base rates of structural soft tissue changes as people age might reduce overdiagnosis and overtreatment of incidental, benign, or inconsequential signal changes and pathophysiology.

Nitrogen is one of chemical gases which has drastic impact on human health. It is also renowned globally as a major component of climate change. Lahore city has been selected as the study area to conduct this research. The basic objective of this study is to assess the temporal and seasonal change of Nitrogen Dioxide (NO2) concentration in the study area and its effects on human health. For this purpose, the two-phase methodology has been adopted. In the first phase, primary and secondary datasets were collected through an online questionnaire and Environmental Protection Agency (EPA), respectively, while in the second phase, satellite imageries were acquired from NASA Earth Observatory (NEO). An online questionnaire survey was conducted for a better understanding and assessment of NO2 effects on inhabitants. The interpolation technique was applied to show a temporal change in Concentration of NO2 from 2010-2022 and for seasonal change in 2022. Findings of this research showed that NO2 levels are high during winters as compared to summers. Whereas, temporal analysis from 2010-2019 revealed that high dense columns of NO2 were found in 2019 & 2020 and less dense columns were found in 2019, whereas this concentration declined due to the arrival of COVID from 2020 to the end of 2021. The main reason of this decline is the lack of transport or industrial exhaust due to lockdown by COVID. The results of the questionnaire indicate that people encountered diverse health problems due to long- and short-term exposure to NO2. Moreover, this study helps to display the drastic impacts of NO2 concentration on human health and the natural environment.

Glaciers can be an important indicator of climate change. In Pakistan, glaciers are found in the Northern Part of the country. In this study, we have discussed the occurrence of surge velocity, lake formation, and outburst of Shisper Glacier, Hunza, Gilgit, and Baltistan. To conduct this study satellite remote sensing techniques have been used. For this purpose, Sentinel-2 and Landsat 8 have been downloaded for 2015-2019. While to examine the elevation difference ASTER 2000 and SRTM 2014 Digital Elevation Model (DEM) have been downloaded, along with this other remote sensing analyses were applied including temporal change, land cover, and morphometric analysis including indices Normalized Difference Snow Index (NDSI) and Normalized Difference Water Index (NDWI). It has been analyzed that Ice-Dammed Lake formed in November 2018, which is the greatest threat to the study area as it can cause glacial lake outbursts and the volume of the lake is showing a continuous increase from 2018- to 2020. The land cover change indicated that snow area has increased about 35% from 2015 to 2018 along with an increase in debris glacier by about 20%. Whereas, a decrease in vegetation was observed up to 2% in 3 years. This study concludes that snow and clear glacier are enlarged over time. Taking into account our research, our suggestion is obligatory stride should be taken to keep away from the disastrous occurrence in the Shisper glacier.

The usage of artificial light is excessive and improper. Earth's night picture has changed significantly from space and studies have shown that over-exposure to artificial light in the night can influence animals, the environment and human beings. The purpose of this study was to monitor and measure skylights of Lahore City and temporary light pollution from 2012-2019. The Suite-Day/Night band of the Visible Image Radiometer was used for time changes analysis with GIS and Remote Sensing tools. Indicators were established as a table tool through zonal statistics, and a field survey was also undertaken to measure the Sky-Glow of Lahore with Sky Quality Meter-L. The results suggest that from 2012 to 2019, light pollution rose by 23.43 percent. Results suggest that around 53.99% of Lahore suffered from light pollution. The number of lights in Lahore has increased by 161.82 percent between 2012 and 2019. In the study period, the mean night light and the standard night light deviation were 127.87 and 98.22 percent, respectively. Lahore's night sky was heavily polluted by light. Lahore's average skylight is 17.15 meters above sea level, which means low quality skies at night. This research aims to provide people an insight into light pollution and the causes of local light pollution. Furthermore, this study aims to enhance public attention to light pollution mitigation attempts by governments and politicians.

COVID-19, highly infectious, respiratory illness caused by SARS-CoV2 (Severe Acute Respiratory Syndrome) virus. It has devastating effects with high mortality.Infection become worse in patients with pre-existing medical conditions. Hospitals increased the number of critical care units in order to stabilize the pandemic's crisisand to minimize person to person transmission, installation of telemedicine networks, distant workers and internet-based health visits. Objective: To assess the acceptability, attitude and utilization towards telemedicine among COVID19 pandemic. Materials and Methods: In Sheikh Zayed Hospital, Rahim Yar Khan, a telemedicine network was quickly set during COVID-19 epidemic. A descriptive cross-sectional study comprising 144 study subjects aged between 34-58 year who seek telemedicine problems of surgery, cardiology, ENT, dermatology, gynaecology and obstetrics, pulmonology, medicine and paediatrics. Results: Out of 144 study subjectswith telemedicine consultation percent distribution of ENT and pulmonology was (48) 33.3% followed by medicine, gynaecology and obstetrics, dermatology, pediatrics and surgery.Patient’s satisfaction level was 62.5% in cardiac patients. In department of gynaecology and obstetrics patients satisfaction towards telemedicine was 88.9%, (65%) patients in medicine were satisfied, followed by surgery 41.7%. Gender wise distribution showed 64.1% males were satisfied followed by 61.3% females Conclusion: The COVID-19 pandemic is creating a historic global challenge for health care providers, patients, and societies. Telemedicine is now widely available at low-cost, and broadly acceptable by physicians and patients. Current study highlights the use of telemedicine and effective applications throughout COVID-19 crisis. Telemedicine played an important role for medical practitioners to manage the COVID-19 situation. Keywords: Telemedicine, COVID-19, Pandemics, Crisis, Gynaecology and Obstetrics

Background Accurately distinguishing the severity of pathophysiology from the level of symptom intensity and incapability is a foundation of effective treatment strategies under the biopsychosocial paradigm of illness. With respect to idiopathic median neuropathy at the carpal tunnel (the symptoms and signs of which are referred to as carpal tunnel syndrome), surgeons who are more likely to recommend surgery based on the magnitude of symptoms and incapability rather than the severity of neuropathy may be underappreciating and undertreating mental health opportunities and overtreating mild, and on occasion unmeasurable, disease. A survey-based experiment that randomizes elements of the patient presentation can help determine the relative influence of magnitude of incapability on ratings of pathology severity. Question/purpose What factors are associated with severity rating of idiopathic median neuropathy at the carpal tunnel on an 11-point ordinal scale? Methods One hundred eight hand and wrist members of the Science of Variation Group (among approximately 200 participants who complete at least one survey-experiment a year related to the upper extremity on average) reviewed seven scenarios of fictional median neuropathy with seven randomized variables: age, gender, limitations of daily activity (incapability), Tinel and Phalen test results, duration of numbness episodes, prevention of numbness with nocturnal splint immobilization, constant numbness, and weakness of palmar abduction. Participants had a mean age of 51 ± 10 years, 90% (97 of 108) were men, and 74% (80 of 108) were subspecialized in hand surgery. Surgeons were asked to rate the severity of idiopathic median neuropathy at the carpal tunnel on a on an 11-point ordinal scale. Factors associated with rated severity were sought in multilevel ordered logistic regression models. Fifteen surgeons did not complete all of their assigned randomized scenarios, resulting in a total of 675 ratings. Results After controlling for potentially confounding variables such as magnitude of incapability, factors associated with severity rating on the 11-point ordinal scale included palmar abduction weakness (odds ratio 11 [95% confidence interval 7.7 to 15]), longer duration of symptom episodes (OR 4.5 [95% CI 3.3 to 6.2]), nocturnal numbness in spite of splint immobilization (OR 3.2 [95% CI 2.3 to 4.3]), constant numbness (OR 2.5 [95% CI 1.9 to 3.4]), positive Tinel and positive Phalen test results (OR 2.2 [95% CI 1.6 to 2.9]), and older age (OR 1.6 [95% CI 1.2 to 2.1]). Conclusion Our results suggest that surgeons rate the severity of idiopathic median neuropathy at the carpal tunnel based on evidence of worse pathophysiology and are not distracted by greater incapability. Clinical relevance Surgeons who consider greater incapability as an indication of more severe pathology seem to be practicing outside the norm and may be underappreciating and undertreating the unhelpful thoughts and feelings of worry or despair that consistently account for a notable amount of the variation in symptom intensity and magnitude of incapability.

Objective: β- thalassemia Minor (BTM) and Iron Deficiency Anemia (IDA) are the main causes of microcytic hypochromic anemias currently in Asian subcontinent. Healthcare facilities in Pakistan have to encounter massive number of patients with anemias every day, where we need to distinguish between (IDA) and (BTM). A number of discrimination indices have been suggested for rapid differentiation of these entities over parameters achieved from automated blood-count analyzers. Objective. To determine the prevalence of β-thalassemia and IDA amongst the unmarried youngsters of Rahim Yar Khan. Methods: A cross-sectional study performed in Sheikh Zayed Medical College/Hospital Rahim Yar Khan, Pakistan in 04 months from October 2021 to February 2022, 506 unmarried youngsters were included in the study. CBC, Serum Ferritin and Hb Electrophoresis were performed in Hematology Section, Pathology Department of SZMC Rahim Yar Khan. Results: Out of 506 subjects, the prevalence of beta thalassemia trait was found 3.3% in males followed by 2.2% in females whereas the prevalence of IDA was 1.7% in males followed by 1.3% in females. Conclusion: These results indicates that intensive education and awareness strategies are necessary to increase consumption of iron-rich dietary sources. This screening program is beneficial in prevention of high-risk marriages. Screening of spouses by pre-marital screening program is an actual way to control β-thalassemia major. Keywords: βeta-thalassemia trait (BTT), iron deficiency anemia (IDA), premarital screening.

In recent times, many parts of the world are experiencing drastic levels of air pollution, which includessmog, the mixture of fog and smoke, polluted air formed by human activities like burning of coal, excessive use ofvehicles and many others. During November 2016, Lahore city also experienced the smog due to increased level of airpollutants. In earlier studies, very limited research work has been done related to smog, therefore, this research is aimedto study the pattern of smog in Lahore and its impact on visibility through remote sensing and GIS. Satellite images ofMODIS and Landsat OLI, of November, 2016 is used to study the pattern of smog, whereas the visibility data wasacquired from Pakistan Meteorological Department (PMD). For the processing and analysis of data ERDAS IMAGINE14 and ArcGIS 10.1 software were used. The findings of this research reveal that the dense smog cover on 2nd, 3rd,and 4th November 2016 leads to the considerable reduction in visibility. As on 2nd November’16, it was only 111.6meters (m) while during bright days it was recorded more than 300 m or 400 m.

Normal vaginal flora contains a wide range of microorganisms. Hydrogen peroxideproduced by Lactobacillus strains plays a vital role in maintaining the microenvironment of thevagina and in the inhibition of overgrowth of potentially pathogenic bacteria. Bacterial vaginosisBV is the main reason of vaginal discharge. Many gram positive and gram negative rods i.e.E.coli, Klebsiella, Proteus, Acinetobacter and Pseudomonas spp. are major contributors inbacterial vaginosis. Aim: The present study was conducted to elucidate the frequency of variousgram-negative rods in high vaginal swabs and sensitivity pattern of bacteria to antibiotics thatare currently used. Study Design: Cross sectional study. Setting: Department of Obstetricsand Gynecology of Benazir Bhutto Hospital Rawalpindi, a tertiary health care center for thepeople of Rawalpindi. Period: January 2015 to May 2016. Material and Methods: A total of220 High vaginal swabs (HVS) were collected both from indoor and outdoor patients presentingwith symptoms of vaginal discharge aged between 20 to 65 years. Swabs were inoculated onblood, Chocolate and MacConkey’s agar. After overnight incubation plates were examined forgrowth, colonial morphology, final confirmation was done on the basis of biochemical testingand API 20-E system (BioMerieux, France) up to species level. Antibiotic sensitivity testing wasdone by (modified Kirby-Bauer’s) disc diffusion method using amikacin, ampicillin, amoxicillinclavulanic acid, imipenem, ceftazidime, tigecycline, ciprofloxacin, sulzone and cefixime. Afterovernight incubation plates were examined to read the susceptibility zone. Results: Out of 220HVS samples, 100 samples showed bacterial growth and confirmed as Gram negative bacilli.Age wise distribution of infection showed highest rates b/w age 20-30 was 36% followed by 31-40 (23%), 41-50 (25%) and 11% above 50 years of age. Bacteria isolated from HVS were E.coli(53%), Klebsiella (22%), Pseudomonas (12%), citrobacter (6%), Proteus (5%) and Acinetobacter(2%) respectively. Highly sensitive antibiotics against bacteria were imipenem (96%), sulzone(90%) and Ciprofloxacin (88%), whereas least affective antibiotics against gram negative rodswere penicillins (ampicillin, amoxicillin-clavulanic acid), amikacin due to indiscriminate use ofantibiotics. Conclusion: High prevalence of gynecological infections demands that the patientswho have vaginosis must be investigated regularly and carefully through culture and identificationof causative bacteria. Emergence of antibiotic resistance must be controlled in order to avoidimproper use, frequent abuse, insufficient dosages, trouble-free availability of antibiotics andtreatment schedule must be designed subsequent to proper laboratory investigations.

Malaria is one of the devastating diseases worldwide. More than 3 billion people live under the threat of malaria in endemic countries and kills more than one million each year. Malaria leads to multiple hematological (thrombocytopenia) and other abnormalities like renal system, nervous system with increased morbidity and mortality. Aim: The present study was conducted to determine the prevalence of human malaria, its correlation with thrombocytopenia and treatment in patients of District Rahim Yar Khan. Materials and Methods: A total of 200 patients including 140 males and 60 females were the part of our study. Blood samples collection was done during September to November following monsoon season. Patients were diagnosed through peripheral blood smear. Both P. falciparum and P. vivax parasites against 300 white blood cells (WBCs) were examined on the thick smear. Platelet count was done by using an automated cell count analyzer. A platelet count of less than 150 x10 9 /L defined thrombocytopaenia. First line of treatment was Chloroquine in cases of Plasmodium vivax whereas Neo fansidar in cases of Plasmodium falciparum. Results: Gender wise distribution of patients was 140 (70%) males and 60(30%) females. We had 74 (37%) patients from urban and 126 (63%) from rural population. Malaria was most frequent 64% by P.vivax and 36% by P.falciparum. Fever was high during admission to hospital and after usage of antimalarials recovery and improvement in number of platelets was noted. Conclusion: The high prevalence rate of P. vivax pose a major health hazard but of P. falciparum also may lead to serious complications. The high frequency of human malaria infection should be a major concern for authorities in the fight against malaria control programs in Pakistan.

Shrimps are very important part of the export economy of Pakistan. They share about 60 % the total exports of the sea food. For the studies of shrimp health, the length-weight studies are critical for the evaluation of the shrimp stocks. In this paper an attempt has been made to explore the Length-weight relationships of the shrimps at the creeks zone of Sindh coast (the study area). Furthermore, the impacts of seasonal change on the growth of shrimps (length and weight treated as parameter) have been evaluated. The main objective of this study is to analyze the seasonal and spatial pattern of growth and condition of the selected shrimp species. For this purpose, three most abundant shrimp species Penaeus indicus, Metapenaeus affinis and Exopalaemon styliferus have been selected out of 30 found at the coastal creeks areas of Sindh, Pakistan from April 2013 to January 2014. Pre and Post-Monsoon seasonal changes were analyzed through Geographic Information Science (GIS) and universally accepted equation for LWRs logW = alogLb were applied on three species selected. It has been found that post-monsoon is the ideal period for shrimp catch for three species. LWRs (growth pattern) found stable in Penaeus indicus and Metapenaeus affinis while predicting an alarming deteriorated situation for Exopalaemon styliferus at creeks zone.