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Our recently reported Ru(III)–NHC complexes 1a and 1b were utilized as suitable precursors to prepare new Ru(II)–NHC–(DMSO)2 complexes 2a and 2b. Complexes 2a and 2b reacted with 2,2′-bipyridine to give complexes 3a and 3b, respectively, with substitution of only one of the DMSO ligands. All new complexes were characterized using various spectroscopic techniques and the molecular structures of 2a and 3a were determined using single-crystal X-ray diffraction technique. Complexes 2a, 2b, 3a, and 3b showed the S → O linkage isomerization of the DMSO ligand upon oxidation of the Ru centre from +II to +III, as confirmed by the thermodynamic and kinetic data obtained from cyclic voltammetry experiments. It was observed that in the bisdimethylsulfoxide complexes 2a and 2b, only one DMSO ligand isomerized, which was further corroborated by the computational studies performed to optimize the geometry of the possible linkage isomers of complexes 2a and 3a in +2 and +3 oxidation states, whereas complexes 3a and 3b showed a high preference for the O-bound isomer in the Ru(III) redox state. The role of NHC in stabilizing the mixed isomer in complexes 2a and 2b and preventing the isomerization of both DMSO ligands coordinated to the Ru centre was studied; moreover, NHC provided good solvent compatibility for photochemical S → O isomerization in all the complexes. Taking advantages of the photoinduced linkage isomerization in 2a and 2b, the synthesis of 3a and 3b was revisited and performed using 2a and 2b, respectively, following a photoinduced substitution reaction in the presence of 2,2′-bipyridine. The kinetics of the reversion from the O-bound to S-bound isomer was found to follow the DMSO-assisted intermolecular S → O isomerization pathway. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of port site bupivacaine infiltration in postoperative pain reduction among patients undergoing LC in a tertiary care hospital in Karachi, Pakistan. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Hamdard Hospital, Karachi, Pakistan. Period: April 2022 to September 2022. Material & Methods: Patients of either gender aged between 18-45 years, undergoing elective laparoscopic cholecystectomy were included. Twenty ml of 0.25% bupivacaine solution were locally injected into the intervention group at the port locations. Treatment for the control group was consistent with standard of care. Post-surgery, to measure the severity of the pain, a visual analogue scale (VAS) was utilized and compared. Results: In a total of 170 patients, age, weight, systolic and diastolic blood pressure, ASA grade, SPO2, and the duration of the surgery were not substantially different between the two study groups at baseline (p>0.05). Post-operatively, from third hour till ninth hour pain score, abdominal pain, incisional pain and shoulder pain were significantly lower among the group received local infiltration of bupivacaine. No significant differences were seen at 12th hour. Median time to rescue analgesia was 12 (IQR=6-12) hours and 6 (IQR=6-9) hours among the intervention and control group (p<0.001). Conclusion: This study found lower pain intensity and higher time of rescue analgesia to be associated with local infiltration of bupivacaine at port as compared to control group in the early postoperative period among patients underwent laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: To study parenting styles and social-emotional competence among adolescents. Method: The cross-sectional investigation took place in Faisalabad, Pakistan between August 2022 and January 2023. A total of four hundred participants were included in the study, employing a purposive sampling method. Specifically, two hundred adolescents were chosen from various schools and residential areas, while an additional two hundred parents of these adolescents were engaged to gather data. To assess parenting styles, the Parenting Style Questionnaire was utilized, while the Social-Emotional Competence Scale was employed to evaluate the social and emotional competence of the adolescents. The data obtained were analysed using SPSS-21. Results: For the present investigation, individuals aged between 10 to 21 years were enlisted as participants, comprising 50.2% females and 49.8% males. The parents who participated in the study included both mothers (64%) and fathers (46%), without any age restrictions. The findings of the study indicated a substantial association between parenting styles and the social-emotional competence of adolescents, with a significance level of (p<.01). Conclusion: Parenting styles emerged as a powerful predictor of adolescents' social-emotional competence, yielding impactful insights into the crucial role parents play in shaping their children's emotional well-being and social abilities. [ABSTRACT FROM AUTHOR]

A series of Ru(III)–NHC complexes, identified as [RuIII(PyNHCR)(Cl)3(H2O)] (1a–c), have been prepared, starting from RuCl3·3H2O following a base-free route. The Lewis acidic Ru(III) centre operates via a halide-assisted, electrophilic C–H activation for carbene generation. The best results were obtained with azolium salts having the I− anion, while ligand precursors with Cl−, BF4−, and PF6− gave no complex formation and those with Br− gave a product with mixed halides. The structurally simple, air and moisture-stable complexes represent rare examples of paramagnetic Ru(III)–NHC complexes. Furthermore, these benchtop stable Ru(III)–NHC complexes were shown to be excellent metal precursors for the synthesis of new [RuII(PyNHCR)(Cl)2(PPh3)2] (2a–c) and [RuII(PyNHCR)(CNCMe)I]PF6 (3a–c) complexes. All the complexes have been characterised using spectroscopic methods, and the structures of 1a, 1b, 2c, and 3a have been determined using the single-crystal X-ray diffraction technique. This work allows easy access to new Ru–NHC complexes for the study of new properties and novel applications. [ABSTRACT FROM AUTHOR]

Objective: To compare early post-operative pain in mesh fixation versus without fixation in open Lichtenstein hernioplasty. Material and Methods: All patients meeting the inclusion criteria and presenting with inguinal hernia were admitted from out-patient department (OPD) in Surgical unit, District Headquarter (DHQ) Hospital, Abbottabad from period February 2019 till October 2021. The patients were randomized into two groups of 40 patients each and were managed with Lichtenstein repair followed by either suture fixation for mesh or non-fixation of Mesh. Standard protocols set by the department were followed. Results: There was statistically significant difference between the two groups in terms of postoperative pain (p <0.001). Independent samples t-test was used to compare the VAS score in two groups and the results were found to be statistically significant (p <0.001). Conclusion: There was statistically significant difference in occurrence of post-operative pain in fixed versus non-fixed mesh. [ABSTRACT FROM AUTHOR]

Background: Choosing Wisely (CW) is an international movement comprised of campaigns in more than 20 countries to reduce low-value care (LVC). De-implementation, the reduction or removal of a healthcare practice that offers little to no benefit or causes harm, is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods: Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Findings: Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not 'patient facing'; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, providing insight into the complexities and nuances of harm, resources and prevalence. Harm from potential or common infections, reactions, or overtreatment was viewed as the most significant types of harm. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation. [ABSTRACT FROM AUTHOR]

Objective: To determine the utility of EEG and its association with both normal and abnormal results among patients presenting in a private psychiatric facility Materials and Methods: A total of 15950 patients were seen from June 2013 to June 2016 in a private psychiatric facility in Peshawar and about 1714 patients who underwent EEG investigation for diagnosis and on demand with no prior or current medical history were included in the study using a cross sectional study design. The data was collected in a standardized manner, recorded in a private clinic's database and evaluated on the basis of international classification of diseases (ICD-10) and international classification of headache disorders (ICHD-III). Results: A total of 1714 patients were identified who had gone through EEG either to confirm their diagnosis or to satisfy patients on their demand regarding the diagnosis. The participants comprised of majority of females (F=1143, 66.6%) and males almost half of the females (M=571, 33.3%) with majority of age ranges between eighteen to thirty years. Electroencephalograms done for assistance in diagnosis was associated with abnormal results while Electroencephalograms done on demand was associated with normal results. Conclusion: This study determined the incremental value of electroencephalogram in order "to increase the probability of correct diagnosis" among people with psychiatric conditions by showing more abnormal results. [ABSTRACT FROM AUTHOR]

Introduction: Trauma to the elbow is an ordinary source of joint stiff ness that might require surgical release. Release of the stiff elbow can be done by open or arthroscopic approach. Th ere is no high-level evidence for the best surgical treatment modality for post-traumatic elbow stiff ness. Objective: Objective of this study is to assess the percentage improvement in range of motion aft er surgical release for management of patients of post-traumatic stiff elbows. Material and Methods: Th is Quasi experimental study was done at Ghurki Trust Teaching Hospital, Lahore from January 2018 to December 2018. Total 95-patients fulfi lling the selection criteria were included in this study from Orthopedic Ward of Department of Orthopedic and Spine Surgery, Ghurki Trust Hospital, Lahore. An informed consent was obtained. Demographic profi le was obtained. Th en ROM at baseline was noted. Th en all patients underwent surgical release under general anesthesia by a single surgical team. Bone resection procedure was used to release the stiff ness. Patients were followed-up in OPD aft er 4-weeks, 12-weeks and then 24-weeks. Th en aft er 24-weeks, ROM was noted and percentage improvement was calculated. Results: In this study percentage improvement in ROM aft er surgical release for management of patients of post-traumatic stiff elbows was 59.83%±8.39. Minimum and maximum percentage of improvement in ROM was 43% and 74.14% respectively. However age, gender, duration of disease and body mass index of patients was not signifi cantly associated with percentage improvement in ROM aft er surgical release. Conclusion: In this study patients undergoing surgical treatment of post traumatic stiff ness of the elbow had good percentage improvement in ROM. Th is shows the eff ectiveness of surgical release in post-traumatic stiff elbows. However age, gender, duration of disease and body mass index did not establish any signifi cant changes in the prognosis regarding release of the elbow stiff ness. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean onset time of motor and sensory block of Isobaric Ropivacaine and Hyperbaric Bupivacaine for elective caesarean sections at Tertiary Care Hospital, Karachi. Methods: A double blinded Randomized control trial study carried out over the period of six months, from August 2016 to January 2017 using non probability consecutive sampling technique. A total of 128 pregnant women planned for LSCS under spinal anesthesia were enrolled in this study. Patients were randomly divided into two groups (Group B and Group R) receiving equipotent doses of spinal anaesthetic drugs. In group B, spinal anaesthesia were given to 64 patients with intrathecal injection of 3ml of 0.5% (5mg/ml) Hyperbaric Bupivacaine and in group R, 64 patients received spinal anaesthesia using 3ml of 0.5% (5mg/ml) Isobaric Ropivacaine. Motor block was evaluated by using Modified Bromage scale score and a score of >2 is consider as optimal motor nerve block. Sensory block was evaluated by using 25G needle pinprick method along the mid clavicular line bilaterally and sensory block (loss of sensation to pain) at T6 level is consider as optimal sensory nerve block. At 10 minutes, Final outcome for each group B and R will be labelled in term of mean time of achievement of motor and sensory block and two dermatomal sensory segment regression. Results: Out of 128 patients, 64 patients receiving spinal anaesthesia using Hyperbaric Bupivacaine the mean duration to achieve sensory nerve block at T6 Level is found to be faster as compare to Isobaric Ropivacaine while the mean onset time of motor nerve block was also considerably significant in between the two groups (p=0.049). The Regression time of maximum sensory block from two dermatomal skin level is also found to be earlier in Isobaric Ropivacaine as compare to patients receiving spinal anaesthesia with Hyperbaric Bupivacaine (130.34 ± 15.26 vs 146.41 ± 12.81; p-value=0.0005). These regional anaesthetic properties of Isobaric Ropivacaine makes it a safer regional anaesthetic agent as Hyperbaric Bupivacaine. Conclusion: Spinal anaesthesia using intrathecal Ropivacaine for elective caesarean sections is an effective and optimal drug of choice. Two Dermatomal Sensory Regression was also found to be earlier in Isobaric Ropivacaine thus ropivacaine provides surgically effective anaesthesia of shorter duration and early sensory onset without compromising neonatal outcome and maternal hemodynamics. [ABSTRACT FROM AUTHOR]

Background The objective of this study was to investigate the changes in blood pressure among patients enrolled in the Telehomecare programme in Ontario, Canada. Methods This observational study utilised a prospective longitudinal cohort design, including patients with heart failure and chronic obstructive pulmonary disease enrolled in the Ontario Telehomecare programme from July 2012 to July 2015. The outcome of interest was change in mean (biweekly) systolic and diastolic blood pressure levels over a six-month period. Patient data were extracted from the Ontario Telemedicine Network database, and analysed using generalised linear mixed model procedures. Results Overall, we analysed data for 3513 patients. Patients were on average 74.1 ± 11.4 years of age; almost half were men, 62% had heart failure, 55% chronic obstructive pulmonary disease and 29% diabetes. At baseline, the mean systolic and diastolic blood pressure levels were 130.4 ± 19.1 mmHg and 72.2 ± 12.5 mmHg for the total sample. At six months, the adjusted reduction in systolic and diastolic blood pressure values were 4.0 mmHg (95% confidence interval: -4.5 to -3.5) and 2.7 mmHg (95% confidence interval: -3.1 to -2.4), respectively. In a subgroup of 1220 patients with uncontrolled blood pressure at baseline (systolic/diastolic blood pressure of 150.7 ± 10.2 mmHg/80.2 ± 13.5 mmHg) the adjusted reduction in systolic blood pressure was 12.5 mmHg (95% confidence interval: -13.4 to -11.6) and in diastolic blood pressure was 7.1 mmHg (95% confidence interval: -7.8 to -6.5) over the six-month period. Conclusions Blood pressure levels were significantly reduced in patients enrolled in the Telehomecare programme, with changes being more pronounced in patients with uncontrolled blood pressure. The sustainability of decreased blood pressure on other clinical outcomes needs further evaluation. [ABSTRACT FROM AUTHOR]

A series of Ru(III)-NHC complexes, identified as [Ru III (PyNHC R )(Cl) 3 (H 2 O)] (1a-c), have been prepared, starting from RuCl 3 ·3H 2 O following a base-free route. The Lewis acidic Ru(III) centre operates via a halide-assisted, electrophilic C-H activation for carbene generation. The best results were obtained with azolium salts having the I - anion, while ligand precursors with Cl - , BF 4 - , and PF 6 - gave no complex formation and those with Br - gave a product with mixed halides. The structurally simple, air and moisture-stable complexes represent rare examples of paramagnetic Ru(III)-NHC complexes. Furthermore, these benchtop stable Ru(III)-NHC complexes were shown to be excellent metal precursors for the synthesis of new [Ru II (PyNHC R )(Cl) 2 (PPh 3 ) 2 ] (2a-c) and [Ru II (PyNHC R )(CNC Me )I]PF 6 (3a-c) complexes. All the complexes have been characterised using spectroscopic methods, and the structures of 1a, 1b, 2c, and 3a have been determined using the single-crystal X-ray diffraction technique. This work allows easy access to new Ru-NHC complexes for the study of new properties and novel applications.

Objective: To explore the unmet psychosocial needs, coping styles and psychological distress among people with cancer., Methods: The cross-sectional correlational study was conducted from May to July 2017 at Shifa International Hospital, Islamabad and Hayatabad Medical Complex, Peshawar, Pakistan which comprised of 182 patients diagnosed with cancer. Data was collected using the Supportive Care Needs Survey-Short Form-34, Mini-Mental Adjustment to Cancer Scale and the Hospital Anxiety Depression Scale. Data was analysed using SPSS 23v., Results: It was found that all psychosocial needs were unmet among all participants (100%) who were suffering from cancer. However, health care information needs and psychological needs emerged to be strikingly unmet with 35.61% and 30.7% respectively. Moreover, maladaptive coping styles were highly endorsed than adaptive coping styles., Conclusion: This study pointed towards gaps in delivering quality care services in health care settings, inadequate attention and serious psychological health care neglect of people fighting with life threatening disease, indicating a dire need for proper psychological interventions for effective and holistic treatment planning to improve the whole process of illness and recovery.