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Objective: To compare the mean facial soft tissue thickness between males and females in different malocclusion groups. Study Design: Cross-Sectional Study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jan 2020 to Jan 2021. Methodology: Cephalometric radiographs of 230 patients were used to measure soft tissue thickness at seven landmarks: the glabella, subnasal region, labrale superius, labrale inferius, sulcus labrale superius, labiomentalis, and soft tissue chin. Results: Of 230 patients, 39% were of Class I, 21% of Class II/1, 26% of Class II/2 and 13% of Class III. The gender ratio was the same in all skeletal classes. The mean age of 230 patients was 18.36±2.29 years. The mean ANB angle and UI were 4.02±3.22 and 25.95±8.86. The mean ANB angle and UI significantly differed between skeletal classes. In contrast, the mean age of patients of different skeletal classes was not significantly different, with a p-value of 0.433. The mean FSTT measured from subnasal area (A-NS), sulcus labrale superius (RR-SLS), labrale superius (J-LS), labrale inferius (I-Li) and chin (Pg-Pg1) was significantly different between skeletal classes (p value

Objective: To compare various labour parameters in partogram among primiparous women and women with one previous caesarean section scar Study Design: Comparative cross-sectional study Place and Duration of Study: Gynaecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022. Methodology: This study was conducted on primiparous women and women with one previous scar who were booked cases in our department for antenatal checkups and labour. Patients were divided into two groups for comparison. Group-I were primiparous, while Group-II had one previous scar. All women underwent detailed labour records via conventional partogram in the labour room. Duration of the active phase of labour, duration of the second stage, time to progress by 1 cm and time after the alert line were compared in partograms of both the study groups. Results: A total of 390 women who were either primiparous or had one previous caesarean section were recruited for this study. Of the study participants, 226(42.6%) were primiparous, while 164(57.4%) had one previous caesarean section scar. Statistical analysis revealed that the duration of the active phase of labour, time to progress by 1 cm and time after the alert line were statistically significant (p-value

ABSTRACT Introduction: Abnormal Implantation of the Placenta in uterine walls is the condition known as Morbidly Adherent Placenta. It includes Placenta accreta, increta and percreta. It is mostly reported after history of placental previa and C-section. The irreversible damages from Abnormal Placentation that includes morbidity and mortality in women can be prevented by a holistic approach of treatment. Objective: To determine the frequency of hysterectomy in morbidly adherent placenta in post-cesarean section patients. Methodology: A Hospital based descriptive cross-sectional study of 8 months, from September 2019 to April 2020 was carried out at the Obstetrics and Gynecology department. A total of 210 participants were selected for the study. Non probability consecutive sampling technique was used for data collection. Results: The Frequency of Hysterectomy in morbidly adherent placenta in post Cesarean section women was reported 166 (79.04%), out of the remaining 44 (20.96%) patients the Triple P was reported in 21 (10%) patients and B-Lynch done in 15 (7.14%) patients and 8 (3.8%) were reported with Balloon Tamponade. Conclusion: The frequency of hysterectomy in MAP is high. Attention is required to be given to conservative methods to protect fertility.

Objective: To evaluate and compare clinical performance and caries inhibition of Resin modified glass ionomer cement and composite restoration in primary molars Study Design: Quasi-experimental study. Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb 2019 to Jan 2020. Methodology: Eighty-three patients fulfilling the selection criteria having at least one carious mandibular primary molar on both sides were divided by split-mouth design. Resin-modified Glass ionomer restorations were done on one side and termed Group-A, and Composite Restorations were done on the other side and termed Group-B. Each restoration was clinically evaluated regarding the appearance of secondary caries at 3, 6 and 12 months after placement by the same operator who performed the treatment. Results: A total of 166 conventional restorations were placed in the 83 children having carious mandibular primary molars, at least one on each side of the arch. The assessment of restorations, performed after six months, showed an 89.2% success rate of Resin modified Glass ionomer restorations and a 66% success rate of Composite Restoration. One year of follow-up showed an 80% success rate for Resin modified Glass ionomer restorations and 60% for Composite Restoration, as regards secondary caries; statistically significant differences were found in both groups. Conclusion: The study results showed that Resin modified Glass ionomer cement used to restore primary molars affected by caries performed better clinically than composite in assessing secondary caries.

Objective: To ensure family spacing in our low socio-economic class. Study Design: Quasi-experimental study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2019. Methodology: Two hundred females using oral contraceptive pills for spacing of children coming to Pak Emirates Military Hospital were selected. The problems of using contraceptive pills were identified. Out of these 87 women agreed to choose an intrauterine copper device (IUCD). Results: Out of 200 women 87 converted from oral contraceptive pills to intrauterine copper device use. Most of them faced daily dosage problems 168 (84%). Nausea was encountered by 123 (61.5%) women and later settled in 89 (44.5%) women. About 31 (15.5%) were worried about the chances of uterine perforation and 56 (28%) were worried about lost intrauterine copper device resulting in laparotomy. About 65 (32.5%) were afraid of infection, backache and vaginal discharge. About 91 (45.5%) women thought to have gastric problems with the intrauterine copper device. About 71 (81%) agreed to have a spacing of children for about five years and removal whenever desired. Conclusion: Intrauterine contraception is a very safe and efficient method for contraception as compared to oral pills. If expertise is, available it should be used and couples should be fully educated for its safety.

Objective: To compare the effectiveness of mirror therapy and motor relearning program for improving the upper limb motor function in stroke patients. Study Design: A randomized control trial with registration number IRCT20200316046791N1 (IRCT). Place and Duration of Study: Al-Noor Hospital and Al Jannat Medicare, Rahim Yar Khan Pakistan, from Jan to Jul 2020. Methodology: Sample size consisted of 30 patients recruited by convenient sampling. Patients were randomized into two groups. Both groups received 5 sessions a week for 6 weeks. Group A received Motor Relearning Program while the treatment of group B was Mirror Therapy. Motor part of Fugl Meyer Assessment was used as an outcome measure. Non parametric Friedman test was used for within group analysis, while for between group analyses Karuskal-Wallis test was used. Results: The total participants who suffer from left hemiplegia were 22 whereas the patients having right hemiplegia were 8. The mean age of participants in both groups was 53.80 ± 7.6 group A median (interquartile range) at pre-assessment was 5.00 (3) at mid-assessment median=15.00 (4) while at post assessment median was 25.00 (6). Group B median at baseline was 6.00 (4), at mid-assessment median=14.00 (9), post assessment median was 17.00 (13). Mid and post assessment comparison showed both treatments improved the motor function. Statistically the results were non-significant (p>0.005). Both treatments improved the motor function in stroke patients. Conclusion: There is no significant difference between the effectiveness of Mirror Therapy and Motor relearning program in improving the upper limb motor function of stroke patients.

Objective: To find the association of preterm delivery with metabolic syndrome in females presenting in a tertiary care hospital. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics & Gynecology, Combined Military Hospital Kharian, from May 2020 to Oct 2020. Methodology: A total of 150 females fulfilling inclusion criteria were enrolled in the study which were divided into two equal groups ‘A’ and ‘B’. Group ‘A’ was with metabolic syndrome and group ‘B’ without it. These females were followed in OPD till active labor, assessed and followed till delivery of fetus. If delivery occurred before 37 weeks, then preterm delivery was labeled. All this information was recorded on a pre-designed proforma. Results: The risk for preterm delivery was 2.18 times higher in group ‘A’ as compared to group ‘B’. (Relative Risk = 2.18, CI (95%) 1.1529 - 4.12). Conclusion: There is a strong association of preterm delivery with metabolic syndrome in females.

Objective: To determine the frequency of diastasis recti abdominis and its associated risk factors in postpartum women. Study Design: Cross-sectional study. Place and Duration of Study: Omar Medical Center Lahore, Yaseen Medical Center Lahore and Social Security Hospital Lahore, from Sep 2019 to Dec 2019. Methodology: This study included 128 participants fulfilling the eligibility criteria. The assessment of diastasis recti abdominis was done manually by a female physiotherapist using single finger, double finger and three finger methods on abdomen at three levels: at the umbilicus, 4.5 cm below and above the umbilicus. Results: The frequency of diastasis recti abdominis out of 128 participants was 97 (75.8%). Out of 128 participants about 38 (29.7%) were primigravida and 90 (70.3%) multigravida. Statistical significance (p=0.015) was found between presence of diastasis recti abdominis and number of pregnancies (gravidity). No association was present between diastasis recti abdominis and delivery method (p=0.09). The p-value (0.56) showed no significant association of diastasis recti abdominis with pelvis floor dysfunction and urinary incontinence. Conclusion: The findings of this study concluded high frequency of diastasis recti abdominis in postpartum women. As the number of pregnancies increased, it decreased the integrity of linea alba and caused the separation of rectus abdominis muscle.

Objective: To see the efficacy of the gynecological procedure of outdoor endometrial biopsy using pipelle biopsy. Study Design: Prospective observational study. Place and Duration of Study: Sampling was done at obstetrics and gynecology department Pak-Emirates Military Hospital Rawalpindi, from Jan 2018 to Aug 2018. Methodology: A 100 cases of perimenopausal/postmenopausal women presenting with menorrhagia/menorrhagia after the age of 40 years were selected for the study. Pipelle biopsy was employed in all the cases. Results: The patients presenting with metorrhagia, menorrhagia, polymennorrhagia and postmenopausal bleeding with mean age of 46 ± 3.26 were included in the study. Sixty eight (68%) patients had metorrhagia, 10 (10%) presented with menorrhagia, 10 (10%) patients had polymennorrhagia while 12 (12%) patients had postmenopausal bleeding. Histopathological results showed that 5 (5%) patients were suffering from chronic endometriosis, 20 (20%) had hormonal imbalances, 45 (45%) had proliferative endometrium, 18 (18%) had endo-metrial benign hyperplasia. Conclusion: It is concluded that outdoor endometrial conventional biopsy using pipelle biopsyis cost-effective and convenient method for diagnosing endometrial diseases. The procedure while providing reliable histopathological results in all cases is cheap and causes minimal discomfort to patients.

Objective: To compare the efficacy of cervical cerclage with vaginal progesterone in patients with cervical insufficiency. Study Design: Quasi experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital Lahore, from Jan 2018 to Jun 2018. Methodology: The study involved 188 pregnant women with cervical insufficiency reporting in outpatient Department. After taking informed consent, the outcome variables age, number of mid-trimester pregnancy losses, body mass index and gestational age were recorded on specially designed proforma. Efficacy as if pregnancy was carried to 37 weeks of gestation was recorded. 93 patients were inducted in cerclage arm and 95 patients were treated with vaginal progesterone 400 mg once daily. Results: The mean age of the patients with cervical cerclage and vaginal progesterone was 31.622 ± 1.90 years and 31.42 ± 1.86 years respectively, while mean gestational age of cervical cerclage group was 21.840 ± 1.46 weeks and vaginal progesterone was 21.46 ± 1.52 weeks. The mean number of mid-trimester pregnancy losses with cervical cerclage was 2.39 ± 0.63 and vaginal progesterone was 2.44 ± 0.84. The mean body mass index of cervical cerclage group was 27.84 ± 1.86 kg/m2 and vaginal progesterone group was 28.01 ± 1.7 kg/m2. Efficacy in cervical cerclage group was seen in 79 (84.9%) patients and in 82 (86.3%) patients in vaginal progesterone group. Conclusion: Prophylactic cervical cerclage and vaginal progesterone were equally effective in preventing preterm birth in patients with high risk of cervical insufficiency.

Objective: To determine the protective effect of human milk on development of retinopathy of prematurity (ROP) in preterm babies. Study Design: Observational study. Place and Duration of Study: King Edward Medical University Lahore, Department of pediatrics over a period of 11 months, from Feb 2016 to Dec 2016. Material and Methods: A total 142 preterm babies with birth weight

Objective: To evaluate and compare clinical performance and caries inhibition of Resin modified glass ionomer cement and composite restoration in primary molars Study Design: Quasi-experimental study. Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb 2019 to Jan 2020. Methodology: Eighty-three patients fulfilling the selection criteria having at least one carious mandibular primary molar on both sides were divided by split-mouth design. Resin-modified Glass ionomer restorations were done on one side and termed Group-A, and Composite Restorations were done on the other side and termed Group-B. Each restoration was clinically evaluated regarding the appearance of secondary caries at 3, 6 and 12 months after placement by the same operator who performed the treatment. Results: A total of 166 conventional restorations were placed in the 83 children having carious mandibular primary molars, at least one on each side of the arch. The assessment of restorations, performed after six months, showed an 89.2% success rate of Resin modified Glass ionomer restorations and a 66% success rate of Composite Restoration. One year of follow-up showed an 80% success rate for Resin modified Glass ionomer restorations and 60% for Composite Restoration, as regards secondary caries; statistically significant differences were found in both groups. Conclusion: The study results showed that Resin modified Glass ionomer cement used to restore primary molars affected by caries performed better clinically than composite in assessing secondary caries. [ABSTRACT FROM AUTHOR]

Objective: To ensure family spacing in our low socio-economic class. Study Design: Quasi-experimental study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2019. Methodology: Two hundred females using oral contraceptive pills for spacing of children coming to Pak Emirates Military Hospital were selected. The problems of using contraceptive pills were identified. Out of these 87 women agreed to choose an intrauterine copper device (IUCD). Results: Out of 200 women 87 converted from oral contraceptive pills to intrauterine copper device use. Most of them faced daily dosage problems 168 (84%). Nausea was encountered by 123 (61.5%) women and later settled in 89 (44.5%) women. About 31 (15.5%) were worried about the chances of uterine perforation and 56 (28%) were worried about lost intrauterine copper device resulting in laparotomy. About 65 (32.5%) were afraid of infection, backache and vaginal discharge. About 91 (45.5%) women thought to have gastric problems with the intrauterine copper device. About 71 (81%) agreed to have a spacing of children for about five years and removal whenever desired. Conclusion: Intrauterine contraception is a very safe and efficient method for contraception as compared to oral pills. If expertise is, available it should be used and couples should be fully educated for its safety. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of mirror therapy and motor relearning program for improving the upper limb motor function in stroke patients. Study Design: A randomized control trial with registration number IRCT20200316046791N1 (IRCT). Place and Duration of Study: Al-Noor Hospital and Al Jannat Medicare, Rahim Yar Khan Pakistan, from Jan to Jul 2020. Methodology: Sample size consisted of 30 patients recruited by convenient sampling. Patients were randomized into two groups. Both groups received 5 sessions a week for 6 weeks. Group A received Motor Relearning Program while the treatment of group B was Mirror Therapy. Motor part of Fugl Meyer Assessment was used as an outcome measure. Non parametric Friedman test was used for within group analysis, while for between group analyses Karuskal-Wallis test was used. Results: The total participants who suffer from left hemiplegia were 22 whereas the patients having right hemiplegia were 8. The mean age of participants in both groups was 53.80 ± 7.6 group A median (interquartile range) at pre-assessment was 5.00 (3) at mid-assessment median=15.00 (4) while at post assessment median was 25.00 (6). Group B median at baseline was 6.00 (4), at mid-assessment median=14.00 (9), post assessment median was 17.00 (13). Mid and post assessment comparison showed both treatments improved the motor function. Statistically the results were non-significant (p>0.005). Both treatments improved the motor function in stroke patients. Conclusion: There is no significant difference between the effectiveness of Mirror Therapy and Motor relearning program in improving the upper limb motor function of stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To find the association of preterm delivery with metabolic syndrome in females presenting in a tertiary care hospital. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics & Gynecology, Combined Military Hospital Kharian, from May 2020 to Oct 2020. Methodology: A total of 150 females fulfilling inclusion criteria were enrolled in the study which were divided into two equal groups ‘A’ and ‘B’. Group ‘A’ was with metabolic syndrome and group ‘B’ without it. These females were followed in OPD till active labor, assessed and followed till delivery of fetus. If delivery occurred before 37 weeks, then preterm delivery was labeled. All this information was recorded on a pre-designed proforma. Results: The risk for preterm delivery was 2.18 times higher in group ‘A’ as compared to group ‘B’. (Relative Risk = 2.18, CI (95%) 1.1529 - 4.12). Conclusion: There is a strong association of preterm delivery with metabolic syndrome in females. [ABSTRACT FROM AUTHOR]

Objective: To compare various labour parameters in partogram among primiparous women and women with one previous caesarean section scar Study Design: Comparative cross-sectional study Place and Duration of Study: Gynaecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022. Methodology: This study was conducted on primiparous women and women with one previous scar who were booked cases in our department for antenatal checkups and labour. Patients were divided into two groups for comparison. Group-I were primiparous, while Group-II had one previous scar. All women underwent detailed labour records via conventional partogram in the labour room. Duration of the active phase of labour, duration of the second stage, time to progress by 1 cm and time after the alert line were compared in partograms of both the study groups. Results: A total of 390 women who were either primiparous or had one previous caesarean section were recruited for this study. Of the study participants, 226(42.6%) were primiparous, while 164(57.4%) had one previous caesarean section scar. Statistical analysis revealed that the duration of the active phase of labour, time to progress by 1 cm and time after the al ert line were statistically significant (p-value<0.05) in partograms of women in Group-I (primiparous) as compared to those in Group-II (women with one previous scar) (p-value<0.05). Conclusion: The main parameters of the partogram differ significantly among primiparous women and women with one previous caesarean section scar. [ABSTRACT FROM AUTHOR]

Objective: To see the efficacy of the gynecological procedure of outdoor endometrial biopsy using pipelle biopsy. Study Design: Prospective observational study. Place and Duration of Study: Sampling was done at obstetrics and gynecology department Pak-Emirates Military Hospital Rawalpindi, from Jan 2018 to Aug 2018. Methodology: A 100 cases of perimenopausal/postmenopausal women presenting with menorrhagia/menorrhagia after the age of 40 years were selected for the study. Pipelle biopsy was employed in all the cases. Results: The patients presenting with metorrhagia, menorrhagia, polymennorrhagia and postmenopausal bleeding with mean age of 46 ± 3.26 were included in the study. Sixty eight (68%) patients had metorrhagia, 10 (10%) presented with menorrhagia, 10 (10%) patients had polymennorrhagia while 12 (12%) patients had postmenopausal bleeding. Histopathological results showed that 5 (5%) patients were suffering from chronic endometriosis, 20 (20%) had hormonal imbalances, 45 (45%) had proliferative endometrium, 18 (18%) had endo-metrial benign hyperplasia. Conclusion: It is concluded that outdoor endometrial conventional biopsy using pipelle biopsyis cost-effective and convenient method for diagnosing endometrial diseases. The procedure while providing reliable histopathological results in all cases is cheap and causes minimal discomfort to patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of diastasis recti abdominis and its associated risk factors in postpartum women. Study Design: Cross-sectional study. Place and Duration of Study: Omar Medical Center Lahore, Yaseen Medical Center Lahore and Social Security Hospital Lahore, from Sep 2019 to Dec 2019. Methodology: This study included 128 participants fulfilling the eligibility criteria. The assessment of diastasis recti abdominis was done manually by a female physiotherapist using single finger, double finger and three finger methods on abdomen at three levels: at the umbilicus, 4.5 cm below and above the umbilicus. Results: The frequency of diastasis recti abdominis out of 128 participants was 97 (75.8%). Out of 128 participants about 38 (29.7%) were primigravida and 90 (70.3%) multigravida. Statistical significance (p=0.015) was found between presence of diastasis recti abdominis and number of pregnancies (gravidity). No association was present between diastasis recti abdominis and delivery method (p=0.09). The p-value (0.56) showed no significant association of diastasis recti abdominis with pelvis floor dysfunction and urinary incontinence. Conclusion: The findings of this study concluded high frequency of diastasis recti abdominis in postpartum women. As the number of pregnancies increased, it decreased the integrity of linea alba and caused the separation of rectus abdominis muscle. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of cervical cerclage with vaginal progesterone in patients with cervical insufficiency. Study Design: Quasi experimental study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital Lahore, from Jan 2018 to Jun 2018. Methodology: The study involved 188 pregnant women with cervical insufficiency reporting in outpatient Department. After taking informed consent, the outcome variables age, number of mid-trimester pregnancy losses, body mass index and gestational age were recorded on specially designed proforma. Efficacy as if pregnancy was carried to 37 weeks of gestation was recorded. 93 patients were inducted in cerclage arm and 95 patients were treated with vaginal progesterone 400 mg once daily. Results: The mean age of the patients with cervical cerclage and vaginal progesterone was 31.622 ± 1.90 years and 31.42 ± 1.86 years respectively, while mean gestational age of cervical cerclage group was 21.840 ± 1.46 weeks and vaginal progesterone was 21.46 ± 1.52 weeks. The mean number of mid-trimester pregnancy losses with cervical cerclage was 2.39 ± 0.63 and vaginal progesterone was 2.44 ± 0.84. The mean body mass index of cervical cerclage group was 27.84 ± 1.86 kg/m2 and vaginal progesterone group was 28.01 ± 1.7 kg/m2. Efficacy in cervical cerclage group was seen in 79 (84.9%) patients and in 82 (86.3%) patients in vaginal progesterone group. Conclusion: Prophylactic cervical cerclage and vaginal progesterone were equally effective in preventing preterm birth in patients with high risk of cervical insufficiency. [ABSTRACT FROM AUTHOR]

Objective: To determine the protective effect of human milk on development of retinopathy of prematurity (ROP) in preterm babies. Study Design: Observational study. Place and Duration of Study: King Edward Medical University Lahore, Department of pediatrics over a period of 11 months, from Feb 2016 to Dec 2016. Material and Methods: A total 142 preterm babies with birth weight <2.5kg and gestation age <37 weeks were included by non-probability convenient sampling. Neonates were assessed and grouped according to the type of feeding. Eye examination was performed minimally at 4 weeks of life and then serially by trained consultant in the Department of Ophthalmology. Data were analyzed through SPSS 20.0 and Chi square test was applied. Results: Mean age at enrollment was 11.22 ± 16.48 days. Mean gestational age was 33.1 ± 13.06 weeks and mean birth weight recorded was 1.7 ± 0.43 kilograms. Among the study cases, 84 (59.2%) babies were on human milk and 58 (40.8%) were taking formula milk. Mean duration of oxygen therapy was 3.7 ± 3.77 days. Changes compatible with ROP was found in 9 (6.3%) cases. Among human milk fed babies, three babies (3.57%) developed ROP and in formula fed group, 6 (10.3%) babies developed changes of ROP. Thus, the risk of developing ROP was higher in formula milk fed babies as compared to human milk. However protective effect was not statistically significant as shown by value of Chi-square test: 2.65 (p-value=0.103). Conclusion: Though human milk was protective for the development of ROP but result was not statistically significant. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of preserving pulmonary valve in total correction for Tetralogy of Fallot Study Design: Descriptive Cross-sectional study. Place and Duration of Study: Department of Paeds Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Disease (AFIC/NIHD), from Sep 2017 to Oct 2018. Material and Methods: Tetralogy of Fallot (TOF) in 50 cases done by a single operator, were studied for early post-operative outcomes. A total of 50 patients with classic TOF were included in this study. There were 33(66%) males and 17 (34%) females. Their age ranged from 1-15 years with a mean age of 7.32 ± 4.97 years. Total correction for tetralogy of Fallot was done through primary repair securing the integrity of the pulmonary valve. In operative technique, two patch techniques to the main pulmonary artery (PA) and right ventricular outflow tract was done in 5(10%) cases, open pulmonary valvotomy in 18 (36%) cases while monocusp patch from the native pericardium was applied to the pulmonary valve in 10 (20%) cases. Limited transannular pulmonary valvotomy was done in 2 (4%) cases while in 15(30%) cases normal pulmonary valve only infundibulactomy was done. Results: About 3 (6%) patients died due to septicemia after having pulmonary valvotomy and MAPCA coiling intotal correction procedure. Bilateral pleural effusion was reported in 10 (20%) and 5 (10%) patients hadascites. Superficial wound infection occurred in 7 (14%) of the patients. Conclusion: Pulmonary valve securing approach is a significant factor for total correction of TOF. [ABSTRACT FROM AUTHOR]

Objective: To measure the frequency of heart failure in patients with segment elevation myocardial infarction treated with PPCI and to associate it with ischemic time. Study Design: A descriptive cross-sectional study. Place and Duration of Study: This study was conducted at the Emergency Department, Catheterization Laboratory and Coronary Care Unit of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from May 2018 to December 2018. Material and Methods: All patients presenting to Emergency Department with acute STEMI and undergoing PPCI were included while STEMI patients who already have established heart failure on arrival to ER were excluded from the study. All patients with the diagnosis of STEMI treated with PPCI were assessed. The initial standard 12 lead ECG, recorded immediately after the patient’s admission to the emergency department, were considered as baseline. Continuous bedside monitoring was carried out and any of the symptoms or signs of heart failure according to KILLIP class occurring over the following 72 hours were noted. All patients were separated in defined groups and were compared for different variables and will be recorded on a data collection tool. Results: Total 500 patients of STEMI were recruited for the study out of which 384 (76.9%) were male patients while 116 (23.0%) were female patients. Mean age of the patients was found to be 58 ± 8.6 years. The most common risk factor was hypertension in 445 (89.0%) patients followed by smoking history in 373 (74.7%), Diabetes Mellitus, Family history of coronary artery disease, Grade III obesity and Previous PCI/CABG. Within ≤90 minutes of ischemic time only five patients developed heart failure in next 72 hours, 16 (3.2%) patients developed heart failure in 91-150 minutes, 49 (9.8%) patients in 151-360 minutes and 65 (13.1%) patients developed heart failure >360 minutes. Conclusion: Total ischemic time was associated with mortality. The present study suggests that additional efforts are needed to shorten total ischemic time including patient and pre-hospital systemic delay for better prognosis after primary PCI [ABSTRACT FROM AUTHOR]

Objective: To compare the short-term clinical outcomes of staged versus one-time multivessel percutaneous coronary intervention (PCI) in elderly patients. Study Design: Cross-sectional study. Place and Duration of Study: Three months study at Post Cath wards of Armed Forces Institute of Cardiology. Material and Methods: We analysed the data of patients with multivessel percutaneous coronary intervention (PCI) who were enrolled in AFIC/NIHD. A total of286 eligible patients aged ≥ 60 were further categorized into “one-time” group (n=119) and staged PCI group (n= 48) according to intervention strategy. The primary endpoint was composite outcome of survival (discharged) or contrast induced nephropathy or stent thrombosis acute or subacute or cardiac death during 48to 72 hours follow-up. Results: The estimated 48 to 72 hours composite rate of cardiac death was 1.9% in the staged PCI group and 2.2% in the “one-time” group. Multivariate analysis confirmed the benefit of staged PCI on the primary events in the elderly (co-morbids p= 0.007). Staged PCI was associated with more stable patients and the discharged rate was higher i.e., 39.9% than one-time PCI (33.6%). There was no difference in target vessel revascularization (1.1% vs. 1.1%). Conclusion: In elderly patients with MVD, staged PCI might be an optimal strategy associated with reduced short-term cardiac death or major cardiovascular events compared with “one-time” PCI strategy, which needs further confirmation. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates the effect of preserving pulmonary valve in total correction repair for Tetrology of Fallot in terms of early clinical outcomes. Study Design: Retrospective observational study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Disease, from Oct 2016 to Jan 2017. Material and Methods: All 15 cases of classic Tetrology of Fallot (TOF) undergoing total correction by a single operator were studied for early post operative outcomes. A total of 15 patients with classic TOF were included in this study. There were 10 (66.7%) males and 5 (33.3%) females. The age ranged from 2-15 years with a mean age of 6.73 ± 4.2 years. Total correction for tetrology of Fallot was done through primary repair securing the integrity of the pulmonary valve. Two of the patients (13.32%) had repair through mono cusp valve made from native pericardium while 2 (13.32%) had Donhl patch to main pulmonary artery and right ventricular outflow tract. Six of all patients (39.69%) had normal pulmonary valve while 5 patients (33.30%) had open pulmonary valvotomy. Results: One patient (6.66%) died due to septicemia after having pulmonary valvotomy and MAPCA coiling in total correction procedure. Bilateral pleural effusion was reported in 4 (26.64%) and 2 patients (13.32%) had ascites. Superficial wound infection occurred in 4 (26.64%) of the patients. Conclusion: Pulmonary valve securing approach is a significant factor for total correction complete repair for tetrology of Fallot. [ABSTRACT FROM AUTHOR]

Objective: To determine the role of ghrelin in stimulating leukopoiesis of myelosuppressed rats by stimulating growth hormone release. Study Design: Randomized controlled trial. Place and Duration of Study: It was conducted at Department of Physiology, Foundation University Medical College, in collaboration with National Institute of Health, Islamabad, from February 2013 to June 2014. Material and Methods: Out of 130 Sprague-Dawley rats, 10 were used for baseline sampling and rest was randomly divided into four groups. Group I received ghrelin only while group II and III were administered intraperitoneally with both carboplatin and 5-flurouracil with and without rat ghrelin. Group IV in addition to chemotherapy and ghrelin received growth hormone releasing hormone antagonist (GHRH antagonist). Total leukocyte count, differential leukocyte count and growth hormone levels were measured on day 7 and 14. Results: The fall in leukocyte count of chemotherapy and ghrelin group on day 7 was less as compared to the chemotherapy-only treated group and chemotherapy, ghrelin and growth hormone releasing hormone antagonist treated group (p<0.05). Further decreases were also prevented in the chemotherapy and ghrelin group. The serum growth hormone levels in chemotherapy and ghrelin treated group were higher as compared to the chemotherapy and chemotherapy, ghrel in, GHRH antagonist treated group (p< 0.05). Conclusion: Enhanced leukopoiesis in ghrelin treated myelosuppressed rats as compared to the chemotherapy group (p<0.05) suggest role of ghrelin in enhancing leukopoiesis. While the failure of enhanced leukopoiesis and growth hormone level to rise in chemotherapy, ghrelin and GHRH antagonist treated group suggested the possibility of growth hormone as possible mediator of ghrelin in leukopoiesis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare clinical performance and caries inhibition of Resin modified glass ionomer cement and composite restoration in primary molars Study Design: Quasi-experimental study. Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb 2019 to Jan 2020. Methodology: Eighty-three patients fulfilling the selection criteria having at least one carious mandibular primary molar on both sides were divided by split-mouth design. Resin-modified Glass ionomer restorations were done on one side and termed Group-A, and Composite Restorations were done on the other side and termed Group-B. Each restoration was clinically evaluated regarding the appearance of secondary caries at 3, 6 and 12 months after placement by the same operator who performed the treatment. Results: A total of 166 conventional restorations were placed in the 83 children having carious mandibular primary molars, at least one on each side of the arch. The assessment of restorations, performed after six months, showed an 89.2% success rate of Resin modified Glass ionomer restorations and a 66% success rate of Composite Restoration. One year of follow-up showed an 80% success rate for Resin modified Glass ionomer restorations and 60% for Composite Restoration, as regards secondary caries; statistically significant differences were found in both groups. Conclusion: The study results showed that Resin modified Glass ionomer cement used to restore primary molars affected by caries performed better clinically than composite in assessing secondary caries. [ABSTRACT FROM AUTHOR]

Objective: To see the radiographic cervical spine damage in polyarticular juvenile idiopathic arthritis (PJIA) coming to a tertiary care hospital in Islamabad, Pakistan. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The study was conducted in department of Rheumatology at Pakistan Institute of Medical Sciences from Jun 2013 to Dec 2013. Subjects and Methods: A total of 50 patients of PJIA coming to Rheumatology Outpatient Department were recruited in the study after informed consent. Radiographs of cervical spine were performed for each patient in antero-posterior, lateral with flexion and extension and open-mouth views. Radiographs were reviewed for the following features: loss of cervical lordosis, odontoid process erosion, anterior atlantoaxial subluxation, C1-C2 arthritis, atlantoaxial impaction, inflammation of disc, apophyseal joint arthritis, anterior ankylosis, apophyseal joint ankylosis, anterior and posterior subaxial subluxation and growth disturbances. Data was analysed using SPSS version 18. Results: Out of the total 50 patients, 28 (56%) were females while 22 (44%) were males. The mean duration of pJIA was 5.54 ± 3.28 years. Radiological cervical spine involvement was seen in 52% patients. The most common structural lesions were anterior atlantoaxial subluxation (30%), C1-C2 arthritis (22%) erosion of the odontoid process (18%), and apophyseal joint arthritis (16%). Loss of cervical lordosis was found in 7(14%) patients. There was no growth disturbances observed in vertebra. Conclusion: Cervical spine involvement is common in patients of PJIA. It is mostly asymptomatic, so routine cervical spine radiographs in all patients suffering from PJIA is recommended. [ABSTRACT FROM AUTHOR]

Objective: To study the safety and efficacy of nasal continuous positive airways pressure by infant flow driver in neonates admitted with respiratory problems. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at CMH Lahore from April 2012 to March 2013. Subjects and Methods: All infants who were treated with nasal continuous positive airway pressure (nCPAP) for various indications at neonatal intensive care unit (NICU) of CMH Lahore were evaluated for gestational age, weight, gender, indications and duration on nCPAP, pre-defined outcomes, complications and length of hospital stay. Efficacy was defined as the ability to manage an infant on nCPAP alone thus avoiding the need for mechanical ventilation. Results: During the study period, 343 neonates were admitted in NICU. Forty five neonates were placed on nCPAP. Mean gestational age was 33.85 ± 3 weeks. Mean weight was 2043 ± 770 grams. Main indications for applying nCPAP were respiratory distress syndrome (48.9%) and neonatal pneumonia (17.8%). Most common complication was abdominal distension (6.7%). Out of 45 infants placed on nCPAP, 32 (71.1%) were managed on nCPAP alone while 13 (28.9%) needed mechanical ventilation after nCPAP failure. Conclusion: Nasal CPAP by an infant flow driver is a useful method to manage respiratory distress in neonates. It reduces the need for mechanical ventilation and can be used as first line respiratory support before mechanical ventilation. [ABSTRACT FROM AUTHOR]

An 11-year-old girl, born to "non-consanguineous" parents presented with drooling of saliva, protrusion of tongue and difficulty in speech. She had signs of pyramidal tracts involvement, bulbar dysfunction and lingual dyskinesia. Magnetic resonance imaging (MRI) of brain revealed classical findings in basal ganglia consistent with Wilson Disease. Aggressive medical treatment was started with strict follow-up visits. It is always difficult to sift through the myriad neurological presentations, to reach a definite diagnosis in a child with this rare disease. Early and prompt treatment is imperative not only for the child but also for other siblings. [ABSTRACT FROM AUTHOR]