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Background: Ventilator Associated Pneumonia (VAP) is one of the frequent infections associated with health care in intensive care units (ICU) prolongs the hospital stay, increases care costs and mortality, and is caused by the migration of oro-pharyngeal microorganisms onto the pulmonary parenchyma. Aim: To determine the effect of educational intervention on the rate of occurrence of ventilator associated pneumonia in patients admitted in Intensive Care Unit (ICU). Place and duration of study: Study was conducted in ICU of Jinnah Hospital, a tertiary care public sector hospital in Lahore, Pakistan for a period of 12 months from August 2019 to July 2020. Study design: Interventional Study. Methods: A total of 270 Patients were enrolled in the study and were divided into two groups, (pre and post educational intervention group). Information about patient's VAP rate, its distribution and patient's length of stay in hospital collected for both groups. Results: Of total 270 enrolled patients, 115(42.6%) were males and 155 (57.4%) were females. The overall rate of VAP was observed 43(15.9%), among them 27(20%) was in pre- interventional group and 16(11.9%) in post interventional group during treatment and stay in ICU. Conclusion: It was concluded that educational intervention played a significant role in controlling the VAP among the patients admitted in the ICU. Keywords: Educational intervention, Nosocomial Infection, Ventilator Associated Pneumonia and Intensive Care Unit

Background: The application of EBP has highly appreciated across healthcare disciplines to improve health care delivery. The utmost goal of nursing is the safe and compassionate patient care that can be achieved through utilization of best research evidence in making decisions for health care services. These expectations have laid the responsibility on clinical instructors to prepare their future nurses for this multifaceted role. Aim: Therefore, the present study aimed to determine the clinical instructors’ level of knowledge, attitude, and practice regarding EBP in the Pakistani context. Methodology: A cross-sectional study design was adopted. Clinical instructors (n=110) from two public and private sectors nursing institutes recruited in the study by using convenience sampling technique. A structured self-administered questionnaire was utilized. Data was entered in SPSS (Version 23.0) for analysis and descriptive analysis was done. Results: The participants were predominantly female clinical instructors (86.4%) as compared to male counterparts. Most of the study participants (62.7%) were having Bachelor of Science in nursing degree. Study yielded the good level of knowledge among most (96.4%) of the instructors whereas about half of the study participants (50.9%) showed moderate level of practice. Moreover, underdeveloped attitude was found among less than half (47.2%) of the participants. Conclusion: Generally, knowledge of clinical instructors regarding EBP was high, but attitude and practice were low among the clinical instructors.

Background: Critical thinking is an imperative outcome of nursing education. However, several factors contribute to the development of critical being including critical thinking dispositions (CTDs). Objective: This study aimed to assess the critical thinking dispositions and factors affecting critical thinking dispositions of BScN students and their educators in twin city Rawalpindi and Islamabad, Pakistan. Methodology: A cross- sectional analytical design was used in this study. A consecutive sample of 215 BScN students and 63 educators participated in the study. Data were collected via Pakistan-Critical Thinking Dispositions Scale (P-CTDS) comprising 54 items under the seven constructs; responses were measured on 5-points Likert scale. Data were analyzed with SPSS version 22. Results: The findings showed that 52% of the educators were at the developed level of CTDs and nearly 48% at the developing level; whereas 76% students were inclined towards CTD and only 23% were found at the developed level of CTDs. Although with considerable difference in the scores of the 7 constructs, both, students and educators obtained highest scores on inquisitiveness and contextual perspective. Similarly, students and educators obtained low score on open-mindedness. The difference between students and their teachers was statistically significant for the total scores of CTDs as well as for the scores of six of seven constructs. Conclusion: Although educators exhibited stronger CTDs than their students, both have room for improvement, specifically their open mindedness. If educators are willing to challenge their personal assumptions, students will also emulate them.

Introduction: Esophageal squamous cell carcinoma (ESCC) is a dismal disease exhibiting striking geographical differences in its incidence. It is multifactorial in origin. Among infectious agents, human papillomavirus (HPV) was introduced as a possible causative agent in the development of ESCC in 1982. Subsequent studies using various methods have confirmed the presence of HPV in ESCC. We aimed to determine the frequency of HPV in ESCC in northwest Pakistan which is part of high risk belt for this disease. Methodology: This study was conducted on two hundred and forty-three (243) diagnosed cases of ESSC at two tertiary care hospitals of Peshawar, Pakistan, from 2011 to 2016. DNA was extracted from all specimens. Polymerase chain reaction (PCR) was used to check the quality of DNA using β-globin primers and frequency and genotypes of HPV using HPV general primers and type-specific primers respectively. HPV and its genotypes were confirmed through the sequencing of a few selected cases. Results: Two hundred and three (203) tissue specimens had adequate DNA and were further analyzed. HPV positivity with general primers alone was 15.7% (32/203). Using HPV general primers and type-specific primers (HPV 16 or HPV 18), the overall positivity of HPV was 31% (63/203). For type-specific primers, frequency of HPV types 16 and 18 was 20.19% (41) and 7.8% (16) respectively where 6 cases were positive for both HPV 16 and 18. Conclusions: The overall high prevalence of HPV indicates it as a possible risk factor for ESSC.

One of the leading causes of infertility in child bearing age females is polycystic ovary syndrome. It is characterized by altered hormonal profile causing androgen excess and insulin resistance which eventually leads to decreased ovulation rate.This was a crosssectional study that included 40 polycystic ovary syndrome (PCOS) patients and 40 infertility patients that did not have polycystic ovary syndrome determined by sonography and clinical features through quota sampling technique. Serum Total Testosterone and Sex Hormone Binding Globulin Levels were assayed. Using these two parameters, Free Androgen Index was calculated. Body Mass Index and central obesity was also determined.Total Testosterone, Free Androgen Index and Body Mass Index were raised in PCOS group as indicated by p-value0.05. Hirsutism was present in PCOS group (p-value0.05). Sex Hormone Binding Globulin Levels were decreased in PCOS patients (p-value0.05) but were within the lower half of normal range.Levels of Sex Hormone Binding Globulin were decreased in PCOS cases and Free Androgen Index can help in better determining hyperandrogenaemia than total testosterone alone.

Background Optimal level of nurse competence is imperative for patient safety and quality of care. A research gap exists in empirical evidence for associating nurses’ competencies with patient safety. Purpose The primary purpose of this study was to measure the association between general ward nurses' competencies with international patient safety goals. Method Correlational research design was adopted. Stratified random sampling was used to recruit (n = 182) nurses working in two JCIA accredited and non-JCIA hospitals. Data were collected using the Competency Inventory for Registered Nurses and International Patient Safety Goals. The research was approved by the Institutional review board and ethics committee. Findings The regression analysis showed enhancement of patient safety with an improvement in nurse competencies R2 = 0.238. Nurse competencies showed a moderate positive association with an overall patient safety such as critical thinking and research aptitude (r = 0.420, P – Value Conclusion Nurses’ clinical competencies are crucial to enhance patient safety. Personal and professional attributes affect the competencies of nurses and patient safety. Hospital management should take mandatory steps to ensure improving nurses’ competencies for better patient safety.

The cosmetic treatment strategies have been considerably popular over the last few decades among the population with respect to age, gender, and ethnicity. These procedures are easily accessible safer, minimally invasive, and more precise. Botox therapy is one of the most common non-surgical cosmetic treatment. Thus, the current study was accomplished to assess the knowledge of female students towards Botox therapy for beautification as well as for therapeutic purposes. The study was conducted form June 2018 to December 2018 in different medical colleges and universities of Karachi-Pakistan. Overall, three hundred and eighty-six female students participated in the study. Descriptive statistics were used to reveal the students’ demographic information. Pearson's chi-squared test was carried out to estimate the relationship between independent variables and responses. The response rate was 77.2%. The mean age of study participants was 26.44±3.33 years. The findings of the present study revealed that 58.3% of the participants were aware of Botox therapy and found it effective in cosmetology. The unexpected side effects, high procedure costs, and lack of cosmetologists were thought to be the main reasons that limit people from using Botox in Karachi-Pakistan. Key words: Botox, cross sectional survey, knowledge, Karachi, Pakistan.

Objective: To determine effect of citrullus lanatus juice on hemoglobin and Serum Glutamic Pyruvic Transaminase (SGPT) level. Study design and setting: It was an experimental study conducted on healthy rabbits for sixty days in the research department of pharmacy University of Karachi. Methodology: Current study was planned to evaluate effect of Citrullus lanatus juice on red blood cells, hemoglobin and liver enzyme. 60 days study was performed at 2 different doses i.e 3and 6ml/kg on rabbits. These rabbits were from either gender and were divided into 3 groups their weight ranges from 1200 to 1800 grams. Group A is control group (Normal saline 6ml/kg), Group B is treated group (3 ml/kg), Group C is treated group (6ml/kg). After taking mean of all values they are compared with control group. Significance of mean can be estimated by Tukes Post Hoc Test. P

Background: Angiogenesis is critical for tumor growth and reflects the aggressive behavior of invasive odontogenic lesions [like amelogenesis (AM) (AM), Odontogenic Keratocyst (OKC) and Central giant cell lesion (CGCL)]. Mean vascular density (MVD) shows the angiogenic potential and CD105 is an ideal endothelial biomarker due to its specificity to new blood vessels for MVD detection. The aim of the study was to compare the MVD (angiogenic potential) among AM, OKC and CGCL in comparison to Pyogenic Granuloma (PG) using CD105 biomarker. Methods: Sixty-four primary cases of odontogenic invasive tumors (AM, OKC and CGCL) and PG, diagnosed clinically and histologically were included in the study, with 16 samples in each group. Tissue samples of peripheral AM, Peripheral GCL of jaws, malignant AM, and specimen with insufficient tissue were excluded. Tissue sections were embedded, processed and stained using Hematoxylin and Eosin (H and E). Immunohistochemistry was performed using antibodies against CD105, with positive brown cytoplasmic staining in the endothelial cells of neo-vasculature. Distinct countable, positively stained endothelial cell or clusters were evaluated under light microscope for identification of MVD. ANOVA and t-test were applied for statistical analysis of data. Results: Highest MVD was displayed in CGCL (32.99±0.77) and the minimum was observed in OKC (7.21± 0.75) respectively. CGCL showed significantly higher MVD to AM, OKC and PG lesions (p

Purpose The current study was designed to investigate the differences in language input related to family factors (maternal level of education [MLE] and socioeconomic level of deprivation [SLD]) and their association with language outcomes in preschoolers. Method This study used New Zealand SLD and MLE classification systems to examine differences in language input related to these factors among 20 typically developing preschool children aged 2–5 years. The quantity of children's language input (adult words [AWs], conversational turns [CTs]) was calculated using the Language ENvironment Analysis audiotaping technology for two typical weekend days. Four 5-min Language ENvironment Analysis recording segments were transcribed and coded, and parental language strategies were classified as optimal language strategy, moderate language strategy, or sub-optimal language strategy (S-OLS) for child language outcomes. The receptive and expressive language of each child was assessed using the Preschool Language Scales–Fifth Edition. Results Mann–Whitney U tests showed significant differences between the quantity of language input (AWs/hr, CTs/hr) for high and low MLE and high and low SLD groups. Consistent with the literature, the use of S-OLSs was significantly lower for families with high MLE ( Mdn = .25, IQR = .14) and low SLD ( Mdn = .22, IQR = .13) than for families with low MLE ( Mdn = .41, IQR = .24) and high SLD ( Mdn = .41, IQR = .26). Spearman correlation coefficients indicated significant associations between language input (AWs/hr, CTs/hr, S-OLSs) and language outcomes. Conclusions Reduced language input and the frequent use of S-OLSs associated with low maternal education and high deprivation and low language outcomes for these children highlight the importance for all parents/families to learn optimal language strategies to support the development of strong language skills in their children in young age.

Polycystic ovary syndrome is the most commonly occurring endocrinopathy in females of reproductive age group. It is characterized by a wide range of signs and symptoms resulting from hormonal derangements leading to reduced fertility.This was a crosssectional (comparative) study. We took 40 cases of polycystic ovary syndrome and 40 controls of infertility without polycystic ovary syndrome depending on the presence of clinical features and ultrasound scans. Blood samples were collected and assayed for luteinizing hormone and follicle stimulating hormone. Data was analyzed with SPSS-19.Luteinizing hormone to follicle stimulating hormone ratio was raised in 3 out of 35 patients (8%) in cases and in 2 out of 39 patients (5%) in controls. There was no statistically significant difference in the luteinizing hormone levels and the follicle stimulating hormone levels and the luteinizing hormone to follicle stimulating hormone ratio of the two groups as indicated by a p-value0.05.Luteinizing hormone to follicle stimulating hormone ratio was not found to be raised in majority of the polycystic ovary syndrome patients included in this study.

Opioids and non-opioids have long been used as analgesic, anti-inflammatory and antipyretic. Long-term use of these drugs may lead to severe toxicities. Therefore natural remedies are now being explored to avoid risk of adverse effects associated with the use of these conventional medicines. Bioactive components from milk of different species have been identified as nutraceuticals, but no experimental or clinical study is conducted so far to explore the analgesic and anti-inflammatory potential of camel milk. In this study we evaluated camel milk for its possible analgesic and antiinflammatory activity. The anti-inflammatory effects of camel milk was studied in rats using paw edema method (induced by acetic acid) while tail-flick method was used to evaluate its analgesic effect in mice. Significantly increased tail-flick latency was shown after camel milk (33ml/kg) treatment when compared with acetylsalicylic acid at all time intervals. Anti-inflammatory activity of camel milk was significant (p0.001) at 4th hour of treatment as shown by maximum percentage inhibition in edema volume (46.84%) in comparison to control. Results of our present study suggested possible use of camel milk as adjuvant therapy in treating various chronic pain and inflammatory ailments. Camel milk could further be investigated in future for recognition of biochemical constituents responsible for its antiinflammatory and pain relieving activities.

This article describes the data regarding the calculations of language input from the natural language environments of children with hearing loss, taken from four full typical days in a week using a LENA (Language ENvironment Analysis) digital recorder. Calculations were based on 14 children with hearing loss from 24 to 60 months as they interacted with their family. Participants were recruited from the Hearing House, the Speech Clinic at the University of Auckland, and Early Childcare Centers (ECC) in Auckland, New Zealand. All families were interacting with their children orally without using sign language. Data were collected from natural language environments from May 2018 to May 2019. Language environments were examined in terms of daily quantity of language input and styles of oral interaction children were exposed to when interacting with their parent/primary caregiver. To determine quantity of language input, two kinds of observations were taken from the LENA automatic calculation of the number of adult words and number of conversational turns. Segments of the recordings were manually transcribed and coded onto 17 styles of oral interaction, which were further classified into three categories (optimal, moderate, and sub-optimal).

Diabetes mellitus is a major metabolic disorder affecting a huge population all over the world. The aim of the current study was to validate the folkloric use of Artemisia indica as an antidiabetic plant by using the isolated compound carnosol from the chloroform fraction of Artemisia indica in streptozotocin-induced diabetes mellitus in rats. The antidiabetic activity-guided isolation of the chloroform fraction of Artemisia indica linn (Asteraceae) led to the isolation and characterization of carnosol. Carnosol was tested for its possible antidiabetic potential in streptozotocin [50 mg/kg. intra peritoneal (i.p)]-induced diabetic Sprague Dawley rats. Blood glucose level, body weight, serum lipid profile and activities of liver enzymes and effects on histopathological parameters were determined. A daily oral dose of carnosol (1–100 mg/kg b.w) for 15 days caused a significant reduction in blood glucose level, which was comparable to the standard antidiabetic drug, glibenclamide (0.5 mg/kg, p.o). Carnosol also showed reduction in triglycerides, total cholesterol, and low density lipoproteins (LDL) as well as serum glutamate pyruvate transaminase, serum glutamate oxaloacetate transaminase, alkaline phosphatase and serum creatinine level in diabetic rats. Furthermore, in histopathological studies, carnosol reversed streptozotocin-induced changes in the pancreatic islets of Langerhans and caused regeneration and restored the integrity of pancreatic islets of Langerhans which may be responsible for its antihyperlgycemic effect. In conclusion, carnosol possesses hypoglycemic, antihyperlipidemic and useful protective effects on the liver and renal functions in diabetic rats, which suggests that the antidiabetic activity of Artemisia indica may be due in part to carnosol.

Vitisvinifera Linn. (Grape) contains a variety of bioactive components including polyphenols. Flavonoids are the major phenolic compounds (65–76%) in grapes. Grape phenolics possess several health promoting properties due to their antioxidant potential. It is thought that antioxidants have memory-enhancing potential. Therefore, in this study, we evaluated the nootropic activity of the Vitis vinifera fruit juice in normal and memory-impaired mice using the Morris water maze model and object recognition test. In the Morris water maze model, there was a significant decrease in escape latency (EL) and a significant increase in time spent in the target quadrant (TSTQ) as compared with normal control and memory-impaired mice (P)

To determine the frequency of atherosclerosis by ankle brachial index in patients with an ischaemic stroke and to assess the association of carotid artery stenosis and ankle brachial index in ischaemic stroke.This cross-sectional study was conducted at Abbasi Shaheed Hospital, Karachi, from July 2011 to May 2014, and comprised patients with ischaemic stroke. The patients were classified according to the Asian stroke criteria for classification of brain infarction. Primary outcome measures included carotid artery stenosis and ankle brachial index. The other independent variables were age, gender, body mass index and waist circumference. SPSS 20 was used for data analysis.A total of 327 patients were enrolled. The overall mean age was 57.6±12.8 years. Besides, 168(51.3%) participants were males. Peripheral artery disease was found in 60(18.3%) patients. Mild carotid artery stenosis was found in 182(55.6%) patients, moderate in 140(42.8%), severe in 3(0.9%) and complete occlusion in 2(0.6%) patients. In patients having mild carotid artery stenosis, 32(17.5%) had peripheral artery disease, whereas in patients with moderate carotid artery stenosis, 25(17.8%) had peripheral artery disease.Abnormally low ankle brachial index suggesting subclinical peripheral artery disease was 18%.

The aim of the current study is to evaluation of plant seed extract of Mucuna pruriens for its gross toxicities and antitussive activity. Anti - tussive effect was observed by inducing cough using su lfur dioxide gas and counts the number of cough before and after administration of extract and centrally acting cough suppressant (codeine phosphate) given orally. Mucuna pruriens seed extract showed highly significant antitussive effect (**p

The purpose of the study was to detect the concentrations of noradrenaline (NA), dopamine (DA), serotonin (5 - HT)), and their metabolites (3, 4 hydr oxyphenylacetic acid (DOPAC), homovanillic acid (HVA) and 5 - hydroxyindoleacetic acid (5 - HIAA) in mice brain after the long - term administration of Aloe vera (leaf gel) and vitamin E . Control group was treated with 0.9% saline and treated groups were adminis tered Aloe vera leaf gel (500 mg/70kg) and vitamin E ( 400 IU/70 kg) orally according to the body weight of mice for 30 days daily. After the administration of drug, all groups of animals were killed by decapitation and samples of brain were removed and ana lyzed after homogenization. Significant changes and alterations in brain biogenic amines can be suggested that the drugs may have potential and use for the treatment of psychotr opic diseases and anxiety.

This study assessed the effect of oral administration of Aloe vera and was to evaluate total serum protein, albumin and globulin concentrations as well as albumin / globulin (A / G) ratio. Twenty rabbits weighing 1000 – 1800 g were divided into 2 groups. Each group consisted of ten animals . One served as control and other group served as experimental group. R es ul t s show that animals after 07, 15 and 30 days dosing of Aloe vera showed highly significant decrease in t otal p rotein and globulin and highly significant decrease in A lbumin after 15 and 30 days of dosing of Aloe vera in comparison to control animals group. It is concluded that the long - term use of Aloe vera may cause hypoglobinemia and hypoalbuminemia at 30 days of dosing and it could be due to the liver disease s , evi dence of hepato toxicity induced Aloe vera also reported in previous studies .

Hydatid disease, a parasitic infection is caused by Echinococcus granulosus. It has serious impact on health and economy especially in countries where it is endemic. It occurs frequently in liver and lung. The disease is chronic and cyst can localize in different organs. A hydatid cyst occurrence in the head and neck is extremely rare. To know the distribution of disease can help in its control and prevention. We report a case of primary cervical hydatid cyst in 20 year old female. A high index of suspicion is required to diagnose hydatid cyst in rare locations like this. Hydatid cyst should be considered in differential diagnosis of benign swellings of head and neck region, so that it can be managed during surgery to prevent acute anaphylaxis. Virtual slides The virtual slides’ for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4915595218376646

Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension.In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Duration of hypertension (HTN) wasor = 2 years). Mean systolic BP (SBP) was 180 +/- 20 mm Hg and diastolic BP (DBP) was 95 +/- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +/- 30 gm/m2 in male while 103 +/- 22 gm/m2 in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD.A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH.

To determine the incidence of Coronary Artery Ectasia (CAE) at our teaching hospital to describe the patients and angiographic characteristics.A retrospective analysis was conducted on all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases, a tertiary care center, between the period of August 2006 and August 2008. A one year follow up was performed to look for primary and secondary endpoints. Data were collected from catheterization films, and medical records.Five thousand coronary angiograms were performed during the periof of the study. A total of 140 (2.8%) angiograms showed coronary ectasia of both mixed and pure types. Pure ectasia with no coronary obstructive lesions was seen in 75 (1.5%). The left anterior descending artery (LAD) was the most commonly affected vessel (63%) followed by the right coronary artery (RCA) 25% and 10% patients had circumflex artery involvement. The primary composite endpoint showed 6 (4.2%) patients with non-ST elevation MI, 5 (3.6%) with ST elevation inferior wall myocardial infarction, 70 (50%) with unstable angina and 2 (1.4%) deaths due to pulmonary oedema. Secondary endpoints showed 50% of the patients still complaining of chest pain.Prevalence of Coronary ectasia in the population presenting to KIHD during the study period was 1.5%. Majority of patients were males, associated with dyslipidaemia, hypertension and smoking. CAE was associated with obstructive coronary artery disease in about 80% of cases. LAD was the most commonly affected vessel.

Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction (STEMI). Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction (AMI).The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase (SK) were enrolled in the study.Of the total 1023, 689 (67.3%) patients were males and 334 (32.6%) were females. Six hundred and twenty-nine (61.5%) were successfully resolved after thrombolytic therapy while in 395 (38.5%) patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve (30%) and 444 (43.4%) with complete resolution, 344 (33.62%) and 325 (31.76%) with partial resolution, 367 (35.8%) and 491 (19.29%) were with no resolution at 60 and 90 minutes respectively.Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution.

To evaluate the successful revascularization in chronic total coronary occlusion lesions and to examine the relationship between lesion characteristics and procedural success and the frequency of in-hospital major adverse cardiac events after percutaneous coronary intervention in these patients.All patients subjected to percutaneous coronary intervention from 2006 to 2008 were identified. These patients had unstable angina ranging from 2 weeks to more than 3 months duration, and majority was subjected to stent implantation.A total of 110 consecutive patients were studied. They had been treated for chronic total coronary occlusion lesions during this period. There were 76 males and 34 females. Drug eluting stents (DES) were used in 84 patients whereas 26 received Bare metal stents (BMS). Successful revascularization was achieved in 103 lesions (94%). Only 6% patients showed unsuccessful results due to failure of the wire to cross the lesion. There was no recorded death during the procedure.Due to latest guide wire technology, procedural techniques and operator experience, our study showed more than 90% success in percutaneous revascularization of chronic total coronary occlusion lesions, with an excellent survival rate .

To determine the accuracy of frozen section in the diagnosis of breast lump.Frozen section diagnosis given in consecutive breast biopsies performed in 5 years in our laboratory was evaluated against the final pathology report of permanent sections.The Aga Khan University Hospital Lab receives more than 400 cases per year for frozen section. Three hundred and nineteen consecutive frozen sections of breast lumps examined from 1999-2003 were considered for analysis. Age of patients ranged between 22 and 90 years (mean age 49 years). In 316 cases (99%) there was no difference between the frozen section diagnosis and the final diagnosis. Three cases (0.94%) were incorrect; 2 cases (0.62%) were false positive. One case was false negative (0.31%). In 7 cases (2.19%), frozen section diagnosis was deferred to permanent sections. Frozen section diagnostic accuracy was 99%. Sensitivity and specificity was 99.3% and 93% respectively. Positive predictive value and negative predictive values of frozen section were 96.6% and 99.3% respectively.High accuracy of the frozen-section diagnosis in the breast lumps was confirmed in our study

To evaluate and compare the histopathological features of endometrial carcinoma among women of various age groups.Descriptive study.The study was conducted at The Aga Khan University Hospital, Histopathology Department, from January 2001--December 2003.All cases of endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy were included.Median age was 55 years. Bleeding per vaginum was the commonest feature and endometrioid adenocarcinoma was the commonest histological type. Tumor involvedandhalf of the myometrium in nearly half of the patients each. Vascular invasion, endocervical invasion and adnexal involvement were evident in a small number of cases. Amongst the 86 patients majority were well differentiated (grade-1) and stage-1, on FIGO staging. Patients (40 years) had endometrioid type of endometrial carcinoma, grade-1, and FIGO stage-1. In 85% tumor was invading tohalf of myometrium. Significant difference was seen among the 40--49 and50 years age groups in grade and depth of myometrial invasion. As 76% were grade-1, 80% had myometrial invasionhalf in patients50 years, while 43.6% were grade-I and 41.8% had myometrial invasionhalf in patients50 years.Patients with endometrial carcinoma presented in early stage (stage-1) and tumor well differentiated (grade-1). In patients of more than 50 years of age even with stage-1, an increased frequency of deep myometrial invasion and less differentiated tumors, adnexal involvement, endocervical invasion, positive peritoneal cytology, vascular invasion and lymph nodes metastasis found.