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Background: Maternal skin contact has impact on physiological parameters in newborns, some studies showed positive effects but as we live in under developing country and the data on impact of kangaroo mother care (KMC) on physiological parameters is very limited. We hypothesized that KMC is effective in stabilizing the heart rate, respiratory rate and maintaining the oxygen saturation and body temperature of low birth weight (LBW) newborns. Objective: The aim of the study was to determine effects of 3 hours KMC on physiological parameters such as body temperature, heart rate, respiratory rate and oxygen saturation in LBW neonates. Study Design: Observational Quasi-experimental study Study Setting: This study was conducted in Department of Neonatology, Children Hospital, PIMS, Islamabad, Pakistan from 1st June 2022 to 1st December 2022. Methodology: The neonates were hemodynamically stable admitted in NICU and Nursery of Children Hospital, PIMS with LBW with the bodyweight

Background: Mechanical low back pain is the pain caused by natural vulnerability of the spine to static loads owing to muscular and gravity forces, as well as pain that is caused by kinetic deviation from normal physiology. Positional release technique, commonly known as strain counterstrain (SCS), is a passive positional therapy that uses indirect hand manipulation to reduce musculoskeletal discomfort and dysfunction. Aim: To compare the effects of positional release therapy and deep transverse friction massage on lumbar pain, lumbar range of motion and disability among patients with mechanical low back pain Methods: After getting ethical approval from the University of Faisalabad, 40 male and female mechanical low back pain patients aging 20-40 years, having at least one trigger point in the iliopsoas muscle on the anterior lumbar aspect were recruited in the study bu purposive sampling, and were randomly allocated into 2 groups by means of lottery method. The outcome measures were assessed at three different occasions i.e. baseline, 2nd week and 4th week. The numeric pain rating scale for lumbar pain, goniometry for lumbar range of motion and oswestry disability scale for lumbar disability were used in the study. Results: A total of 40 participants were included of which 57.5 % were male and 42.5% were females. The mean age was 30.37±6.01 years, mean BMI was 24.94 ± 3.64. 2 participants from positional release group and 1 from deep transverse friction massage were dropped out. NPRS showed 3.27 and 3.05 decrease, lumbar flexion showed 11.28 and 11.42 degrees increase, lumbar extension showed 4.9 and 4.94 degrees increase and ODI showed 14.53 and 14.78 points decrease in positional release technique and deep transverse friction massage, respectively. Conclusion: Both the techniques produced significant results in reducing lumbar pain, the lumbar disability and improving lumbar range of motion in their respective group, but none of them proved to be superior to other in between group comparison. Keywords: Deep Transverse Friction Massage; Mechanical Low Back Pain; NPRS; Positional Release Technique.

Background: The addition of medium chain triglycerides is preferable as they are more easily digested and quickly absorb in bloodstream than long chain fat and provide ready supply of energy by increasing fatty acid bioavailability. Modular products like micro lipids and medium-chain triglyceride (MCT) oils are now focused as a fat supplementation. The rate of weight gain with MCT is not well known, and there is very less research done in Pakistan. Objective: To determine the effect of MCT oil supplemented human milk compared with un supplemented human milk fed to preterm infants on promoting weight gain. Study Design: Randomized controlled trial Study Setting: This study was conducted in Department of Neonatology, Children Hospital, PIMS, Islamabad, Pakistan from 20th August 2022 to 20th February 2023. Methodology: The study conducted after approval from institutional ethical committee. A total of 160 preterm infants fulfilling the inclusion criteria and enrolled in the study after informed consent from parents. The patients were receiving enteral feeding of human milk within neonatology department of hospital was included and they were randomly assigned to Group NF (receiving 20 ml of human milk without MCT oil), Group F (receiving 20ml of human milk with 1 ml of MCT oil fat). Primary outcomes were including growth in term of weight gain at measured at 1st ,5th and 10th day of MCT oil intake after hospital admission. Secondary outcome included feeding intolerance, diarrhoea, sepsis and necrotising enterocolitis. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: One sixty very low birth weight infants were analyzed in this study. All infants were randomly divided into two groups: F and NF, the demographic details. The weight of infants was measured on first day, fifth day and tenth day and noted that the frequency of infants improved the weight gain after taking human milk without fat supplementation or human milk with fat supplementation. We found the gradually infants more increasing their weights in Group F as compared to Group NF. On tenth day 75% infants reaches between1400-1490 gm weight (p

Introduction: Maclura pomifera, is small deciduous tree which is commonly called as Osage orange. It typically grows about 8 to 15 meters tall. Maclura pomifera secrete white latex material which is sticky in nature on damaging. The common name of this plant is not related with citrus fruit family “orange” Maclura pomifera belongs to mulberry family called Moraceae. Method: The extract of Maclura pomifera leaves was prepared by using ethanol as a solvent. The major groups of phytochemicals were present it such as, alkaloids, tannins, saponins, flavonoids and steroids. Results: The different parts of plants contain, alkaloids, flavonoids, and polyphenolic and many other bio-compound. Due to these compounds, plants posse’s antidiabetic, anti-cardiovascular, and anticancer activities. The leaves of Maclura pomifera extract possessed higher cytotoxic potential with IC50 78.9 µg/ml. The cytotoxic potential of extract was checked through MTT assay against the hepatic cancer (HepG2) cells, Conclusion: These bio-compounds are present in the Maclura pomifera, due to this reason, this plant is used against several disorders such as diabetes, cardiovascular and cancer. Which give the valuable results. Keywords: Phytochemicals, Anticancer, Cardiovascular, Maclura pomifera, Bio-compounds, Cytotoxic potential

Background: Oral health plays a vital role in overall health and quality of life. Hence, it is professional dutyof undergraduate dental students to possess good knowledge of a pristine oral health,all the pros of maintenance of it, cons pertaining to poor maintenance of it and thus be able to invoke awareness and impact the masses of a developing country like Pakistan, in a positive way. Aim: The aim of the study wasto assess thebehavior, attitude and knowledge of 2ndand 3rd year dental undergraduate students regarding practices and maintenance of good oral health. Methods:A Questionnaire was designed to assess the routine practices of the students, their habits and methods used for maintenance of good oral hygiene along with testing their basic knowledge regarding its influence over the oral and systemic health of the patient. Results: It was noted that the undergraduate students needed improvement in their practices of maintainingoral hygiene. Although in their clinical years, Third Year undergrads showed adequate knowledge but inferior oral hygiene maintenance practices as compared to their Second Year counterparts. Results obtained from the questionnaires distributed among the undergrads showed that 49.5% of 3DS, and 58.5% of 2DS used Modified Bass technique for brushing whereas usage of dental cleaning aids like wooden toothpicks, interdental brushes, dental floss and oral rinses was found to be 15.5%, 14.2%, 42.3% and 50.7% among 3DS whereas 20.5%, 25.4%, 50.8%, and 60.5% in 2 DS respectively. Variations in the basic knowledge of theundergrads regarding causative agents leading to tooth decay, diseases involving the periodontium and other diseases involving various systems of the human body, are shown in Table 3. Conclusion: The cross-sectional study we carried out among our dental students provided us with a new insight into knowledge, practices, condition and maintenance of oral health among dental students, the results of which, may help to reshape dental undergrad education and thus establish a model for dentists to improve oral health care awareness, practices and services. Keywords: Knowledge of good oral hygiene, Oral hygiene maintenance methods, Dental undergrad students, Pakistan.

Background: Extensive and demanding medical curriculum manifests itself as stress in medical students. Different individuals perceive stress differently. Stress greatly affects academic performance and mental health of medical students. Levels of stress vary with gender, year of study and living conditions of students. Objective: This study was performed to evaluate stress levels of undergraduate medical students in Pakistan. Study Design: Descriptive cross-sectional study. Duration: Two months from December 2021 to January 2022. Setting: Multan Medical and Dental College, Multan, Pakistan. Methods: First year, second year, third year, fourth year and final year MBBS students from Multan Medical and Dental College (MMDC), Pakistan were selected through census sampling. Students were asked to fill Perceived Stress Scale Questionnaire (PSSQ-10). After quantitative data was analyzed through descriptive studies, all students were divided into three groups: low stress, moderate stress, and high stress bearers. Results: Among 427 students, 54 (12.65%) students had low stress, 311 (72.83%) students had moderate stress and 62 (14.52%) students had high stress. Females were more stressed compared to males. Among high stress group, 18% females were affected compared to 9% males. 73.94% females had moderate stress compared to their male counterparts i.e., 71.08%. Male boarders were less stressed compared to female boarders. Students of first year had lowest perceived stress (M=9, SD=3.82), whereas final year students had highest stress (M=30.5, SD= 2.8), followed by third year, fourth year, second year and first year students. Practical implication: This study is intended to give an insight into level of stress that medical students are encountering. Early intervention by concerned authorities for high levels of stress can enable students to handle stress in a better way in years to come and prevent them from developing any psychiatric disorders. Students with mild and moderate stress levels can be helped to prevent more serious stress conditions. A less stressful environment is congenial for students for academics and mental health. Conclusion: The study highlights the issue of prevalence of perceived stress among medical students, which is affecting their academic performance and health. Keywords: Moderate Stress, Under-Graduate Perceived Stress Scale ,, Discomfort, Academic

Background: Multiple sclerosis (MS) frequently affects spinal cord (SC), resulting in motor, sensory, and autonomic impairment. Many pathological problems, including demyelination and neuroaxonal loss, are examined in vivo with MRI in MS. Objectives: This research was performed for confirming effects of early SC pseudoatrophy (PA) in MS treated using interferon beta on SC in early IFN therapy. Methods: PA was diagnosed using MRI and patients were classified based on McDonald’s 2010 criteria into 05 categories of clinical attacks. They were treated using IFN-1a 44 g, beginning after FCDE, administered thrice or once weekly for 2 years and their EDSS scores were baseline evaluated. Results: Kurtzke EDSS scoring system was implied to determine the disability of MS. After treating for 02 years, the Group A patients was scored 1.0 and Group B 1.5. The MS disability in SC was significantly reduced in both treatment groups, though, significantly enhanced domino effects (p

Study Objective: The objective of my study is assess the quality of life in coronary artery disease patients using WHO QoL BREF and to identify the different variables and factors which are affecting the quality of life in CAD patients in our population in general and the economic progress of the country in particular. Material & Methods: The study design will be cross-sectional and purposive sampling technique will be used. The study population will be the patients presenting in cardiology OPD of Shalamar hospital & Punjab Institute of Cardiology Lahore. Inclusion criteria will be the patients of both sexes above 30 years and exclusion criteria will be the patients with ailments other than coronary artery diseases. Results: A total of 611 CAD patients includes in for the research. 305 from Public & 306 from private hospital. Mean age was 56 years out of which 377 (61.7%) were male patients and 234 (38.3%) were females. Out of 611 patients that were included in the study 19 (3.1%) rated their quality of life very poor; 265 (43.4%) poor; 200 (32.7%) neither poor nor good & 127 (20.8%) good. Conclusion: The study showed life’s quality and general wellbeing, with the majority of patients having a "poor" life’s quality . The relationship among quality of life and patients' perceptions of health and age was statistically significant.

Background: South Asia is the world's most populous region, and it also has the highest rate of pregnancy loss. It is necessary to understand the risk factors for pregnancy loss in South Asian countries like Pakistan for reducing the global burden of pregnancy loss. Aim: To determine the potential clinical factors affecting pregnancy outcomes of Pakistani women aged 15-49 years during 2016-2019. Study design: This study was conducted using Pakistan Maternal Mortality Survey (PMMS 2019) during 2020-2021. All eligible ever-married women (n=7096) aged 15-49 were selected for this study. In this study, the clinical risk factors considered are fever, unconsciousness, high blood pressure, diabetes, vaginal bleeding, problems associated with the placenta, problems associated with the position of the baby, and preeclampsia. The response variable was pregnancy outcome comprising four categories that are live-birth, stillbirth, miscarriage, and abortion. A multinomial logistic regression model was applied to test the relationship between the dependent variable and each of the eight risk factors. Results: Multinomial logistic regression model identified that fever (OR=0.723), vaginal bleeding(OR=1.614), high blood pressure (OR=1.473), and problems associated with the position of the baby (OR=0.396)are significantly associated with a stillbirth at a 10% level of significance. Additionally, unconsciousness (OR=1.019) appears as a potential risk factor for abortion. Practical implication: Understanding the most significant risk factors that contribute to negative pregnancy outcomes, it can prioritize resources to improve maternal health. Also, assistance to healthcare providers and policymakers in making informed decisions regarding maternal health in Pakistan can be provided. Conclusion: Fever, vaginal bleeding, high blood pressure, problems associated with the position of the baby are significant risk factors of stillbirth. However, unconsciousness identified a risk factor of abortion. It is concluded that in Pakistan pregnancy loss can be reduced by controlling the prevalence of diseases during pregnancy. Keywords: Abortion, Clinical risk factors, Miscarriage, Multinomial logistic model, Pregnancy loss, Stillbirth

Aim: To determine the factors that influence the stunting level of children under the age of five years in Pakistan. Methods: This study was conducted using Pakistan Demographic and Health Survey (PDHS) 2017-2018 during 2020-2021.The response variable comprised two categories: stunted and not stunted. In this study the demographic and socioeconomic factors affecting stunting are region, birthplace, preceding birth interval, women's education level, husband\partner`s education level, women's age, breast feeding, size of child at birth, total child ever born, type of place of residence, frequency of listening to the radio, sources of drinking facilities, and antenatal visits. A binary logistic regression model was applied to access the relationship between stunting with potential demographic and socioeconomic factors. Results: The binary logistic regression model identified that the significant factors for stunting of children in the regions of Pakistan are: Punjab (OR=.311, CI; 0.104, 0.934),KPK(OR=0.278,CI; 0.091,0.853), mother education(secondary OR=2.671,CI; 1.025,6.959),father education (Secondary OR=0.370, CI;0.146, 0.938),breastfeeding (1-year OR=0.197, CI; 0.056,0.689), child size (larger than average OR=0.113, CI; 0.020,0.646) and (average OR=0.212, CI;0.047,0.962). Practical implication: Identifying the determinants of stunting can lead to improved health outcomes for children, including reduced mortality rates, better cognitive development, and improved physical growth. Conclusion: This study discovered that stunting in Pakistan can be reduced by improving the education level of parents, proper breastfeeding, and proper diet during pregnancy duration. Keywords: Stunting, Binary logistic model, children, parent’s education

Objective: The object of this survey study was to assess the knowledge, attitude and practice of dentists towards resin bonded bridges across Pakistan. Methodology: A cross-sectional survey study was conducted. A self-administered questionnaire was distributed among 500 dentists across Pakistan as a google form through electronic media. The questionnaire had three sections. First two sections had details about purpose of study and demographic details respectively. In the third section knowledge, attitude and practice of the participants were assessed. Knowledge and attitude were scored. Level of knowledge and attitude towards use of RBBs was correlated with other variables. Significance of factors related to RBB success was evaluated as percentages. Results: A total of 162 males (78%) and 128 females (63.1%) had adequate knowledge. Overall, 303 (75.2%) participants were inclined to use the RBB while only 100 (24.8%) were not in the favor of using this treatment. 286 participants (71%) were confident to offer this treatment to their patients however, 85% of them actually employed RBBs for ≤ 20% of their tooth replacements. Lack of skills was considered as a major hindrance to employ RBB treatment followed by the lack of technical support. Conclusion: The results of the study showed that participants are poised in knowledge regarding RBBs but they are reluctant to use this confidently because of lack of practical skills. Modest use of RBB in clinical practice is a question mark and a food for thought. Keywords: Resin Bonded Bridges, Conservative Dentistry, Minimally Invasive Dentistry.

Background: The trigger points are hyperirritable spots found usually in the muscle fascia or within the taut bands of skeletal muscles that is painful on compression. Ischemic compression technique uses the application of sustained pressure with sufficient force and for long enough so as to slow down the flow of blood and releasing tension out of the muscle. Strain counterstrain (SCS), also known as positional release, is a passive positional treatment that relieves musculoskeletal pain and dysfunction by indirect hand manipulation. Objectives: The aim of this study was to compare the effects of ischemic compression technique and strain counterstrain technique on pain, neck lateral flexion and disability in patients with upper trapezius trigger points. Methodology: The RCT was conducted on 36 male and female participants aging 25-45 having maximum of 5 trigger points in the upper trapezius bilaterally. The patients were divided equally to ischemic compression and strain counterstrain group by lottery method. The treatment was given for 3 days a week for 4 weeks. The NPRS, NDI and cervical lateral flexion were used as outcome measure. The assessment of the outcome measures was done on baseline, after 2nd week and after 4th week. The data was analyzed by SPSS version 26 using appropriate tests depending upon the normality by keeping the level of significance at 0.05. Results: Out of 36 participants (Mean age 32.96 ± 5.91), 20 were male and 16 were female, 3 participants lost to follow up. The within group analysis of NPRS and NDI done by Friedman test and that of cervical flexion done by repeated measures ANOVA showed that the both the interventions has produced significant (p0.05) as compared to the other in subjects with upper trapezius trigger points. Conclusion: A 4-week intervention of the ischemic compression and strain counterstrain produced significant results in reducing the intensity of pain, the cervical disability and improving the cervical range of motion, but the intergroup comparison showed that both the ischemic compression and strain counterstrain were equally effective and none of them produced significant results as compared to others on patients with upper trapezius trigger points. Keywords: Ischemic Compression Technique; Strain Counterstrain; Upper Trapezius Trigger Points.

Background: Malaria continues to be a serious global public health and development issue. Plasmodium falciparum, the most lethal type of the malaria parasite, is responsible for the great majority of malaria-related death and morbidity in children. Aim: To ascertain malaria knowledge, attitudes, and practices among mothers of patients aged 5 to 15 in the district of Bahawalgar, Pakistan. Methods: Study Design: Cross sectional Descriptive study. Settings: The study was done at District health quarter hospital Bahawalnagar. Duration of Study: The duration of study was 9 months from October to June. A questionnaire was used to collect the data from mothers of patients visiting medical OPD. Data was analyzed with SPSS version 25. Results: Findings of the study showed that a total of 241 malaria infected children were studied, to observe their plasmodium prevalence and their parental KAP of malaria. Most common age group of children was 13-15 years among 56.0%. Female’s children were commonest as 63.9%. Most of parents 46.1% were found with intermediate education. P-vivax was P-vivax was mostly seen among 66.4% children followed by p-falciparum 17.4%, p-malariae 3.3% and Plasmodium Vivax + falciparum 12.9%. The prevalence of plasmodiums was insignificantly related to demographic characteristics, with p-values that were relatively low. Conclusion: The study concluded that plasmodium vivax was the most prevalent malarial parasite. Parents had partial knowledge regarding malaria and its treatment. Parents had good attitude and agreed to participation in its prevention. Keywords: Malaria, parents, knowledge, practice, children’s mothers

Objective: Evaluate the effectiveness of Ipratropium Bromide in combination with Salbutamol and Salbutamol alone for the treatment of recurrent wheezes in children with asthma who seek care at LRH, Peshawar. Methods: After the approval from the institution review board, this randomized controlled trial was performed at Department of Pediatrics, LRH, Peshawar, from 7th January 2021 to 7th July 2021. A total of 128 patients who met the inclusion criteria were recruited from the Department of Pediatrics at LRH Peshawar. In Group A, 64 patients were given Ipratropium Bromide in addition to Salbutamol, whereas in Group B, 64 patients were given Salbutamol alone. In group A, children were subjected to salbutamol 2.5 mg thrice a day plus ipratropium bromide 125 ug 8 hourly during the exacerbation episode. In group B, children were subjected to 2.5 mg of salbutamol thrice a day during the exacerbation episode. Patients were contacted three months later to assess progress, and outcomes were recorded using a custom-made proforma. Results: 21.9% of the children were between age 1-2 years, while and 78.1% children were between 3-5 years of Age. Mean age was 4.56±1.357 in both the study groups. 0ver all there were 70.3% male children and 29.7 % were females. In 27.3% of the children duration of the disease was 6 months and 72.7% have more than 6 months. Most of the participated children have weight between 16-20 kg (30.5%), followed by 26.6% have weight more than 30kg, followed by 21.1% have weight between 21-25kg. in 56.2% of the children had a family history of asthma, while 43.8% had no family history of asthma. Group wise distribution of efficacy among 128 children were analyzed as children in Group A (Ipratropium Bromide with Salbutamol) showed 45% decrease number of wheezing episodes and Group B (Salbutamol alone group) showed 51.5% decrease number of wheezing episodes Conclusion: Our research reveals that the addition of ipratropium bromide to salbutamol for the treatment of mild to moderate asthma attacks in children does not improve outcomes over the use of salbutamol alone. Keywords: Efficacy of Ipratropium Bromide with Salbutamol and Salbutamol alone, Recurrent wheezes, Children with asthma

Background: The aim of this study to evaluate the outcome of the efficacy of the PRP use to promote wound healing and bone regeneration. Study design: The study was cross sectional being conducted in the department of Dentistry, Bahria University Dental College, Karachi six months from June 2022 to November 2022. Methods: A total number of the participants were 150. The male and female genders were both included who suffered dental surgery. The sample of blood was taken around 55cc by a trained medical expert. After that, blood will be centrifuged to separate the platelet-rich plasma from the remaining components of your blood. For the greatest results, your blood will often be spun two to three times. Results: The age range was 20-60 years and > 61 years old, with an average of 51.1±12.5 years, which indicate highly significant tooth loss at above 61 years old age p

Introduction: Anticoagulant therapy is essential for patients with various medical conditions. The use of anticoagulant medications is associated with a prolonged bleeding time. Platelet-rich plasma (PRP) contains a high concentration of platelets. PRP has been used to improve bone and soft tissue regeneration and lessen postoperative complications. Study design: It is a randomized controlled study conducted at DOW International Dental College, Karachi for the duration of six months from August 2022 to January 2023. Material and Methods: The study was done on 40 patients who visited tertiary care unit for duration of six months. There were 6 patients that belonged to the age group 40-50 years. 19 and 15 patients were in the age group 55-60 years and 60-65 years respectively. There were 14 males and 26 females included in our study. There were 72 extractions performed on these patients. Results: It was found that there were 4 patients who reported about hemorrhagic complications. There were two women that had hemorrhage linked to poor placement of platelet gel. One patient reported about hemorrhage related to severe formation of coagulum. Mild bleeding was observed in 13 patients. Conclusion: In conclusion the results of our trial suggest that PRP is a successful anticoagulant therapy that can be used for preventing any post-operative hemorrhagic complication among patients going through dental surgery, as PRP is easy to use, it has low cost and a good placement into residual alveolar bone, therefore it has better outcomes among patients. Keywords: postoperative bleeding, anticoagulant therapy and Platelet-rich plasma.

Objectives: To assess difference in oral hygiene status among right- and left-handed individuals using different dental indices. Materials and Methods: The research was conducted among two hundred and ninety-six students aged between 18 to 25 years. Data was collected using convenience sampling technique. Handedness was ascertained by using Edinburgh handed scale. Students were provided questionnaire to be filled about oral hygiene practices and oral examination was performed to assess DMFT, Plaque Index, Gingival Index and Oral Hygiene Index Simplified. Data was analyzed using SPSS software version 21. Results: The study showed that 16.2% of the participants were males and 83.8% were females. Out of these 90.55% were right-handed and 9.5% were left-handed. It was observed that scores of left-handed individuals were higher with mean DMFT score (0.06), OHI-S score (1.71) and PI score (1.11) when compared to right-handed people. However, greater GI score was seen in right-handed (0.44). Conclusion: This study concluded that individuals who are right-handed have better oral hygiene as seen by their better DMFT, OHI-S and PI scores and therefore lower frequency of dental caries. Practical implication: The difference in oral hygiene status among right- and left-handed highlights the need to focus on manual dexterity that effects brushing efficiency and ultimately oral hygiene performance. Keywords: Gingival health, Oral hygiene, Dental caries, Right- and Left-handedness, Manual dexterity

Objective: To determine transfusion transmitted infectious disease (TTI) pattern in potential healthy replacement donors. Study Design: Cross sectional study Place and Duration: Diagnostic and Research Laboratory Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad. Jan-2022-Dec 2022 Methods: Total 14,355 replacement donors of age 18-55 years were selected in this study as per inclusion criteria, which comprised of 25 questionnaire, evaluating donors for history of Injections, medicines, time since last donation, tattoos, not feeling well, dental work, sexual relationships, history of malaria / T.B, surgery, jaundice vaccination positive viral markers in the past followed by physical examination. SPSS 24.0 was used to analyze all data. Results: There were 9635 (67.1%) males and 4720 (32.95) females in this study. Among all, 42.8% cases had age 18-25 years, 26.8% cases had 26-30 years, 16.6% cases had 31-35 years and 13.7% patients were from age group 36-55 years. Majority of the donors 32.3% had blood group B positive, followed by O positive in 29.9%, 22% donors had A positive and AB positive blood group found in 8.7% cases. According to screening results, most common infection was Hepatitis B Core Antibody found in 10% cases, anti-HCV found in 2.17% cases, HBsAg in 0.3% cases, ICT malaria in 0.05% cases, RPR 0.41% and HIV 1&2 in 0.1% cases. Conclusion: HB core total antibody showed highest positivity in replacement donors despite stringent donor selection criteria, followed by Anti HCV. Syphilis, HBsAg, HIV and malaria showed lowest prevalences. Keywords: Blood Donors, HCV, HBV, ICT Malaria

Background: Thecaesarean section (C/Section) births are escalating continuously. Foetal and Maternal outcome parameters might fluctuate under subarachnoid block. So, this investigation was delineated referring to fetomaternal outcome as Subarachnoid block was routinely employed for operative delivery in our institution. Objective: This study was conducted to determine fetomaternal outcome of neonatal and Maternal wellbeing in parturient undergoing elective caesarean section employing Subarachnoid block. Methodology: A Descriptive, cross sectional study employing Non-Probability Convenient Sampling was organized in Department of Obstetrics and Gynaecology, at a Tertiary Care Hospital at Lahore-Pakistan.240 parturients of 15 to 40 years of age were scrutinised for study. The study was of six months starting from August 2021 till January 2022. Results: TheNeonatal outcome was recorded as 1minute Apgar score of ≥7 was 233(97.1%) and 4 62(25.8). Conclusion: APGAR Score at 1 minute & 5 minutes was significantly high in parturients receiving Subarachnoid block for elective caesarean section. Keywords: APGAR score, Elective Operative Delivery, Foetal outcome, Maternal outcome, Subarachnoid block

Background and Aim: A facial paralysis can be enormously distressing for a person. In order to restore and rehab face symmetry, it is essential to understand the source and type of nerve damage. Lower motor neuron facial paralysis was investigated in the current study to assess its various causes. Patients and Method: This prospective study was carried out on 48 facial nerve palsy (FNP) in the Department of Medicine, Liaquat University Hospital, Hyderabad from January 2021 to August 2022. Patients diagnosed with peripheral facial nerve paralysis of any age and both genders were enrolled. Patient’s details such as time of symptom onset, paralysis duration, rapidity of progression, and paralysis completeness were evaluated. Each individual was interviewed about family history, medical illness such as malignancy, tuberculosis, diabetes, autoimmune disorders, previous episodes, any prior surgery, trauma history, and related symptoms such as neurological, auditory, and vestibular. Lesion site and treatment response was administered by Topo diagnostic tests. Data analysis was carried out in SPSS version 26. Results: Out of 48 FNP patients, 34 (70.8%) were male and female 14 (29.2%) respectively. The overall mean age was 35.8±6.2 years with an age range 5 to 70 years. Patients were distributed into different age groups as follows: 6 (12.5%) in 5-20 years, 19 (39.6%) in 21-35 years, 16 (33.3%) in 36-50 years, and 7 (14.6%) in 51-70 years. The prevalence of left and right side affected patients were 20 (41.7%) and 28 (58.3%) respectively. The most prevalent causes of FNP were idiopathic and external trauma found in 12 (25%) cases followed by infections and tumour found in 8 (16.7%) cases. Severity of paralysis calculated based on H. Brackman grading were as follows: Grade IV, V, and VI paralysis were found in 22 (45.8%), 8 (16.7%), and 2 (4.2%) respectively. Physiotherapy and conservative treatment was given to 26 (54.2%) patients followed by facial nerve surgery in 14 (29.2%) patients. Conclusion: The present study found that External trauma and Bell's palsy are the leading causes of LMN facial nerve paralysis. The right side was more affected than the left side, and male patients predominated. Upon presentation, most lesions were suprageniculate and had House Brackmann severity scores of IV. After a one-year follow-up, most of our peripheral facial paralysis cases had recovered fully or partially. Keywords: Facial nerve palsy, Outcomes, Causes, House Brackmann severity.

Aim: To evaluate the effectiveness of trunk stabilization exercises on Static and Dynamic Sitting Balance among Children with Cerebral Palsy Method: This randomized controlled trail was conducted at physiotherapy department, Mayo hospital, Lahore. 38 children were with cerebral palsy were enrolled in this study via non-probability purposive sampling technique which later on randomized and allocated to two equal groups. Group A received specific core stability training while group B received conventional physical therapy treatment. Written informed consent was procured from every participant or their guardian through signed consent forms. Questionnaire used for data collection was Gross Motor Function Measure (GMFM-88) also used for assessment of sitting balance. Results: Descriptive statistics showed participants were having mean age of6.00 ±2.00 for group A and 5.52±.1.80 for Group B. Participants who received trunk stabilization exercises showed marked improvement as compared to group B. There was a statistically significant improvement in all measured variables following the intervention (P

Background: PECS, or Picture Exchange Communication System, addressed in writing. The answers for such schemes to influence word retrieval in autism spectrum disorders in children (ASD). Objective: The objective of the current study finding out the effects of Development of the picture exchange communication system in autistic children's speech and communicative requesting was the main goal of the current study. Materials & Methods: The study design was Qusai experimental. The research was carried out at Riphah International University Lahore campus. Data was collected from Lahore. The study time was six months after the approval of synopsis. Data was collected from the Autistic children and purposive sampling technique was used in this research. The sample size calculated was ten. The picture-exchange technique for communication (PECS) was used for data collection. Data was examined using SPSS software and Endnotes were used for references. Results: Results from the Childhood Autism Rating Scale (CARS) assessment scoring form indicated that there is a significant relationship between the Effects of Communicative PECS speech and request development in autistic children, overall analysis of the pre and post scores of CARS assessment. In which mean of pre score is 36.15 and mean of post score is 29.5. The standard deviation of pre score is 8.47 and the post score standard deviation is 5.39. The mean difference showed the improvement between CARS pre and post assessment. Used was the paired sample t test for finding the mean difference between the pre and post scores. The results indicate that every participant showed improvement in different skills such as verbal and nonverbal communication, visual response. Some participants got higher in verbal communication Practical implication: This will give us a better understanding of how speech develops in children with autism and how children’s vocabulary develops and awareness develops in children. Conclusion: The pre-post assessment of The Childhood Autism Rating scale (CARS) with intervention of PECS concluded that there is significant influence of intervention using a photo exchange communication technology for autistic kids. Keywords: Autism, Chemical Imbalance, PECS, CARS, Autism Rating Scale, Autism spectrum condition

Background: The present study aimed to evaluate the efficacy and safety of Cisplatin plus 5-Fluorouracil in comparison with Gefitinib in advanced and recurrent head and neck cancer. Methods: A quasi experimental study was undertaken at the Department of Oncology, Jinnah Postgraduate Medical Centre between 2nd April 2022 and 2nd December 2022. All patients with histologically confirmed new or recurrent cases of head and neck cancer in the advanced clinical stage were recruited. Demographic data (age, gender, body mass index, comorbidity, etc.), medical history and clinical characteristics, routine biochemical analysis, urinalysis, and tumor assessments via CT scans and MRI, adverse effects and toxicity were recorded. Patients were divided randomly into two groups. Group A received Cisplatin plus 5-Fluorouracil while group B received Gefitinib monotherapy. The primary end point of the study was the overall response rate (ORR). Results: Complete response was demonstrated by seven (7.3%) and four (4.8%) individuals in Group A and B, respectively. Vomiting was significantly associated with Cisplatin plus 5-Fluorouracil with a frequency of 38 (39.58%) as compared to 10 (11.9%) in Group Gefitinib (p

Objective: To determine the predisposing factors contributing to unintentional home injuries in children under 5 years of age presenting to Emergency department of Ziauddin medical university and hospital, Karachi Place and duration of study: The study is conducted at Department of Emergency, Ziauddin Medical University and Hospital, Karachi And the duration of study is 13th October 2019 To 12th April 2020. It is a cross-sectional study design having having 200 patients, in which non-probability consecutive sampling technique is used. Material and Method: There were 200 patients in total with Injuries that happened at home environment. Mothers participated in an interview. After each child received the recommended care, data were gathered.Calculated descriptive statistics were used. Stratification was used to manage effect modifiers. The chi-square test was used after stratification. P-values lower than 0.05 were regarded as significant. Results: There were 46% male and 54% female patients. Mean age was 35.02±13.79 months. Most of the children were injured >3 times in last one month. 57% patients were found with injury due to falling down while most of the injuries (32.5%) were occurred at stairs. In our study, 39% of children caused injury due to lack of care, 11.5% due to availability of hazardous material and 49.5% due to unsafe home environment. Practical implications: From the standpoint of injury prevention, this study suggests that the risk of non-fatal injury in children under the age of five is complicated and multidimensional, and that effective prevention measures must target numerous components. To effectively increase children's comprehension of the safety issue and lower their risk of hazard, health care providers, parents, or both should design alternative strategic teaching methods. Conclusion: Most prevalent cause of injury was falling down. 39% children injured due to lack of care, 11.5% due to availability of hazardous material and 49.5% due to unsafe home environment. Keywords: Unintentional Home injuries, Children, predisposing factors, falling down, Injuries

Aim: To foresee the outcome of heart failure(HF) in Pakistani patients with potential predictors and through various machine learning (ML) methods. Study design:The secondary data of Pakistani patients is taken from the UCI repository in which a cross-sectional, analytical study was planned. Place and duration: This data was collected in April-December, 2015 at the Institute of Cardiology and Allied hospital Faisalabad-Pakistan. Methodology: The data set consisted of299 patients distributed among male (194) and female patients (105). Ages, serum sodium (SS), serum creatinine (SC), gender, smoking, high blood pressure (HBP), ejection fraction (EF), anemia, platelets, Creatinine Phosphokinase (CPK), and diabetes were considered as the potential predictors for predicting the outcome of HF.The data set was analyzed with the help of various machine learning (ML) predictive models including Logistic regression (LR), K-nearest neighbor (KNN), and Decision trees (DT). Results: The ages of the patients were within 60.833±11.894 years. Out of 299 patients, 129 were anemic, 105 had high blood pressure (HBP), and 96 had a smoking history. A statistical model was estimated by applying LR which assisted us in identifying the significant predictors. The sensitivity of the LRwas observed to be 92.1%, whereas 85.6% of the outcome of HF patients was correctly predicted by this model (LR) and DT achieved89.6% prediction accuracy. Conclusion:Since HF is a substantial reason for deaths in Pakistan. Therefore, the identification of its potential risk factors and its accurate prediction by some modern tools are highly demanded. This study applied ML tools for the said task and concluded that among all the fitted ML models, DT predicted the correct outcome for HF patients proficiently. Keywords: Heart failure, machine learning, logistic regression, k-nearest neighbor, decision trees

Background: Malaria continues to be a serious global public health and development issue. Plasmodium falciparum, the most lethal type of the malaria parasite, is responsible for the great majority of malaria-related death and morbidity in children. Aim: To ascertain malaria knowledge, attitudes, and practices among mothers of patients aged 5 to 15 in Bahawalgar District, Pakistan. Methods: The Cross sectional Descriptive study was done at District health quarter hospital Bahawalnagar. A questionnaire was used to collect the data from mothers of patients visiting medical OPD. Data was analyzed with SPSS version 25. Results: Findings of the study showed that a total of 241 malaria infected children were studied, to observe their plasmodium prevalence and their parental KAP of malaria. Most common age group of children was 13-15 years among 56.0%. Female’s children were commonest as 63.9%. Most of parents 46.1% were found with intermediate education. P-vivax was P-vivax was mostly seen among 66.4% children followed by p-falciparum 17.4%, p-malariae 3.3% and Plasmodium Vivax + falciparum 12.9%. The prevalence of plasmodiums was insignificantly related to demographic characteristics, with p-values that were relatively low. Conclusion: The study concluded that plasmodium vivax was the most prevalent malarial parasite. Parents had partial knowledge regarding malaria and its treatment. Parents had good attitude and agreed to participation in its prevention. Key words: Malaria, parents, knowledge, practice, children’s mothers

Objective: To compare the conventional surgical turbinoplasty versus microdebrider assisted turbinoplasty in cases of inferior turbinate hypertrophy. Design of the Study: It was a cross-sectional survey. Place and Duration of Study: This study was carried at the Department of ENT Nishtar Medical University and Hospital, Multan from January 2022 to June 2022. Patients and Methods: Patients with hypertrophy of the inferior turbinates, the most common cause of nasal obstruction, were split into two groups of 30. The size of the inferior turbinates was classified as Grade I if they took up less than a third of the nasal cavity, Grade II if they took up more than a third but less than half, and Grade III if they took up more than half. Each group had either a standard partial inferior turbinectomy or a turbinoplasty with the help of a microdebrider. Visual evaluation was used to categorise blood loss during and after surgery. Patients were checked on at 1, 2, 4, and 6 months after surgery. Relief from symptoms and the occurrence of problems such crusting and synechiae formation were evaluated. Results of the Study: Both groups showed comparable significant improvements in nasal blockage. Most patients in the CPIT group experienced intraoperative blood loss of grade II (66.66%) or grade III (10%). When the packs were taken off, 60% of patients experienced grade I blood loss, 36.66% experienced grade II blood loss, and 3% experienced grade III blood loss after surgery. Most patients (46%) and surgeons (40%) in the MAT group experienced grade II or higher intraoperative blood loss. The majority of patients' postoperative blood loss was classified as grade I. Six months later, 6.66 percent of the CPIT group had acquired crusting, and 6.66 percent had developed synechiae. Those that received MAT did not have these problems. Practical implication: The choice of surgical procedure is up to the surgeon's attitude and experience due to the lack of agreement regarding their efficacy. That’s why we compared the effectiveness of these treatment methods for turbinate reduction in order to provide evidence to evaluate the results of the several surgical techniques in local population. Conclusion: According to the findings, both surgical approaches are effective in addressing nasal blockage. Complications are less likely to occur with microdebrider-assisted inferior turbinoplasty since the mucosa and nasal physiology are preserved. Keywords: Microdebrider assisted inferior turbinoplasty, Hypertrophied inferior turbinate, Conventional partial inferior turbinectomy

Aim: To assess the prevalence of periodontal disease and caries on 2nd mandibular molar in association with erupted 3rd molars. Methodology:: This cross sectional study was conducted at the Periodontology Department, Avicenna dental college, Lahore from July 2021 to June 2022. A total of 81 patients were examined in the age range of 21-50 years. Patients of both genders were assessed. Data was entered and analysed by IBM SPSS 25. Level of significance was kept at p-value ≤ 0.05 Results: Total of 81 patients were examined with the total number of teeth evaluated were 156. Age taken as demographic variable was further divided into three groups. Group 1 consisted of patients between the age range of 21-30 years n=18 (22.22%). Group 2 have patients between the age range of 31-40 years n=43 (53.09%) and Group 3 consisted of age range of 41-50 years patients n=20 (24.69%).Highest prevalence of distal caries was related to level A (68.33%) and periodontal disease was prevalent in level C followed by level B molars Conclusion: Regardless of eruption status, 3rd molar is associated with occurrence of periodontal disease and caries on 2nd mandibular molars. Ergo, regular clinical evaluations and monitoring are required even in apparently symptom free 3rd mandibular molars, as their existence is analogous to Distal Surface Caries (DSC) and PPD≥5mm development in mandibular 2nd molars. Else, to improve the long term survival of 2nd mandibular molars, prophylactic extraction of 3rd mandibular molars can be considered as a treatment option. Keywords: Eruption status, distal surface caries, periodontal disease.

Aim: To find the consequences of trunk exercises in addition to the traditional physiotherapy practices for trunk control, mobility, and balance in hemiparetic cerebral palsy children. Methods: Forty children withhemiparetic cerebral palsy of 10-14 years (without gender discrimination), were included in this randomized controlled trial. Both groups received a conventional physical therapy program, whilethe study group additionally received trunk exercises. Participants were re-evaluated after three months of treatment by using the Trunk Impairment Scale (TIS) for assessment of trunk control, Pediatric Berg Balance Scale (PBS) for balance assessments, and the dynamic gait index scale (DGI) for walking mobility function. Results:The Mann Whitney ‘U’ test was used to measure the difference between the 2 groups while Wilcoxon test was used to measure the difference within the group.Results were demonstrated as mean and standard deviations for pre and post-treatmentscores of variables TIS, PBS, and DGI.Comparison of outcome measures of each group before treatment specified no substantial differences. While, comparison of outcome measures after the treatmentwith traditional physiotherapy along with trunk exercises revealed noteworthy increase in the aptitude to maintain trunk stability, balance, and walking mobility function in study group A (p

Introduction: Perceptions of teachers and students about curriculum viability inhibitors are equally important yet may differ. Divergence can lead to destructive friction and adversely affect curriculum viability. Objectives: Our team aimed to find the perceptions of teachers and students on inhibitors affecting the viability of an implemented medical curriculum, report their convergence or divergence, and explore approaches to reduce divergence. Material and Methods: This is a mixed-method study. For quantitative data, teachers’ perceptions were collected through validated, targeted questionnaires measuring viability inhibitors. For qualitative data, a focus group discussion (FGD) among teachers explored possible approaches to diverging teachers’ perceptions. Results: The data was collected from 53 faculty members (100%). This study provides an approach to measure curriculum viability inhibitors in an undergraduate Dental curriculum, to find solutions of these inhibitors through focus group discussion. No difference in opinion was found in interdepartmental, designation regarding curriculum viability. Years of Experience in different departments affect the choice of assessment tools on the basis of K.S.A. Practical implication: this study will also helpful in improving the curriculum even when no strong inhibitors are present. Conclusion: We believe this approach might help to improve the curriculum, even when no strong inhibitors are present. The suggestions to deal curriculum inhibitors. Questionnaires measuring curriculum viability inhibitors can be used stand-alone or as part of the curriculum evaluation process. Keywords: Mixed method design; teacher perceptions; curriculum viability; curriculum inhibitors.

Introduction: Iron is the most prevalent nutrient deficiency in infants and young children around the world despite its importance for healthy brain development. Infants who drink whole cow's milk or other animal milks are at a greater risk of developing iron deficiency anaemia. In our culture, cow's milk consumption is widespread. There were no local studies available on iron deficiency anemia in infants using different types of milk so need for the present study was felt. Objectives: The objectives of this study were to determine the frequency of exclusively breastfed and cow’s milk fed infants at 3 month of age and to compare the frequency of iron deficiency anemia in exclusively breastfed and cow’s milk fed infants. Study Design: It was a cross-sectional study. Setting and Duration: Research was conducted at the Medical Outpatient Department of The Children’s Hospital and The Institute of Child Health Lahore from 08/02/2022 to 07/08/2022. Material and Methods: This study involved 220 infants of both genders at 3 months of age presenting for vaccination. Outcome variables were frequency of exclusive breast feeding and iron deficiency anemia. All patients' guardians signed an informed consent form. Results: There were 115 (52.3%) male and 105 (47.7%) female patients in the study group. The Hb of the patients ranged from 7.6 g/dl to 14.5 g/dl with a mean of 11.00±1.98 g/dl while the serum iron level ranged from 41 µg/dl to 115 µg/dl with a mean of 67.94±22.99 µg/dl. Majority of the parents (56.4%) belonged to poor class and 46.4% mothers were illiterate. The frequency of exclusive breastfed infants was 45 (20.5%). There was no significant difference in the frequency of exclusive breast feeding across gender (p=0.873), socioeconomic (p=0.900) and educational (p=0.858) status. 76 (34.5%) Infants had iron deficiency anemia. The frequency of iron deficiency anemia was higher among infants on cow’s milk (37.7% vs. 22.2%) as compared to those on exclusive breast feeding however the observed difference was statistically insignificant (p=0.051). Similar insignificant difference was observed across gender, socioeconomic and educational status groups. Conclusion: The frequency of exclusive breastfed infants was 45 (20.5%). There was no significant difference in the frequency of exclusive breast feeding across gender (p=0.873), socioeconomic (p=0.900) and educational (p=0.858) status. 76 (34.5%) Infants had iron deficiency anemia. The frequency of iron deficiency anemia was insignificantly higher among infants on cow’s milk (37.7% vs. 22.2%; p=0.051) as compared to those on exclusive breast feeding. Similar insignificant difference was observed across gender, socioeconomic and educational status groups. Keywords: Exclusive Breast Feeding, Cow’s Milk Feeding, Iron Deficiency Anemia

Background: Kidneys are the major organs responsible for elimination of toxic metabolites from the body. Aim: To determine role of ghrelin in mitigating nicotine induced renal damage in Balb/c mice by assessing serum creatinine levels, renal tissue MDA levels and renal tubular histological changes. Methodology: It was a Randomized Control Trial. Healthy male BALB/c mice (n=27) through non probability convenience sampling were taken from NIH Islamabad and sorted into 3 groups (nine each). Group I was labeled as control group and given intraperitoneal normal saline for 29 days. Group II was labeled as nicotine group and received intraperitoneal nicotine for 29 days. Group III was labeled as ghrelin + nicotine and received intraperitoneal ghrelin on alternate days and nicotine daily for 29 days. On 30th day intracardiac sampling was done for estimation of serum creatinine. After intra cardiac sampling dissection was done to obtain renal tissue sample for lipid peroxidation and histological analysis. Data was evaluated by using SPSS version 23. One way ANOVA and post hoc tukey’s test were applied. Results: In group 2, nicotine administration markedly elevated serum creatinine and tissue MDA levels whereas ghrelin administration along with nicotine in group 3 restored serum creatinine and tissue MDA levels back to normal. Renal tubular changes caused by nicotine in group-2 are also mitigated by ghrelin and nicotine administration in group-3. Practical Implication: Ghrelin a newly discovered peptide has shown to have anti-oxidant properties and nephro-protective effect thus has potential to reduce renal damage. It can restored creatinine levels thus minimizes renal damage. Conclusion: It was concluded that ghrelin protects kidneys against nicotine induced renal damage by restoring serum creatinine, lipid peroxidation marker and histological changes. Keywords: Ghrelin, Lipid Peroxidation, Nicotine, Nephro-Protection, Anti-Oxidant and MDA.

Aim: To evaluate the effect of lifestyle modification upon dysmenorrhea and pain severity in university students of Karachi. Methodology: This is a prospective cohort study, the sample size was 383 participants, and data was collected from the Karachi institute of health sciences. Participants were followed after lifestyle modifications, weight reduction, stress management, physical exercise, and nutrition. Menstruation pain severity was measured by pain visual analog scale score (VAS) score, after 4 weeks and 8 weeks of modification follow-up, participants were asked to fill a validated questionnaire including pain VAS score again to assess the difference in dysmenorrhea and its associated symptoms. Results: Out of 383 study participants, the mean age was 22.2±1.9 years while the mean weight was 72.9±4.7 years, mean age of menarche was 13.4±0.7 years. Pain VAS score was categorized within mild and tolerable, moderate and Uncomfortable, and severe with an immediate need for medical intervention, indicating 82(21.4%), 195(50.9%) and 106(27.6%) frequencies respectively. The effect of lifestyle modification afterthe first menstruation cycle questionnaire was filled again, and results indicated mild, moderate, and severe results as 277(72.3%), 90(23.4%) and 16(4.1%) while on the second cycle 343(89.5%), 34(8.8%) and 6(1.5%) were identified respectively. Conclusion: Lifestyle modification, maintaining a healthy weight, having proper nutrition, and managing stress can sufficiently reduce the chances of dysmenorrhea and decreases the severity of menstrual pain. Keywords:Dysmenorrhea, Pain-vas score, lifestyle modification

Aim: To compare the efficacy of letrozole and clomiphene citrate in women having anovulatory infertility. Study design: Randomized Controlled Trial. Place and duration of study: 16th October 2020 to 15th September 2021 in Department of Obstetrics & Gynecology, Shahida Islam Medical Complex Lodhran. Methods: In our study 112 patients between ages 18 to 40 years with anovulation were included. Patients having H/O previous pelvic surgery, raised prolactin and TSH levels were excluded. These women were divided into02 groups i.e. Group A (clomiphene citrate) & Group B (letrozole), by lottery method and the effectiveness was noted in both groups. Results: Mean age of women in group A was 24.53±6.12 years and in group B was 25.37±6.33 years. Majority women included in our study, 78(69.64%) were between ages 18 to 30 years. Duration of infertility was 3.28±2.11 years. Mean infertility duration in group A was 3.63±2.10 years and in group B was 3.79±2.14 years. The efficacy of drug shownin Group A was 9(8.03%) while in Group B was 18(16.07%) (p-value = 0.005). Conclusion: We concluded from this study that letrozole is proved to be more efficacious than clomiphene citrate in anovulatory infertility. Keywords: Anovulation, Infertility, Letrozole, Clomiphene Citrate, Conception Rate

Background: The rectum is the lower part of the colon. Its cancer is the third most common cancer worldwide. Aim: To determine frequency and severity of acute perineal skin reactions in rectal cancer patients at the completion of preoperative pelvic radiotherapy. Study Design: Descriptive case series. Methodology: Study conducted at the Department of Clinical Oncology, Shaukat Khanum Memorial Cancer Hospital Multan. Patients (n=96) were enrolled through non-probability consecutive sampling. All patients received neoadjuvant chemotherapy consisting of fluoropyrimidine and oxaliplatin, Radiotherapy planning was carried out for all patients with a dose of 50.4 Gray in 28 fractions through external beam radiotherapy, consisting of concurrent chemotherapy oral capecitabine twice daily. Severity of skin side effects and were evaluated according to toxicity proforma, based on RTOG/EORTC Toxicity criteria. Data was evaluated by using SPSS vr 23. Poststratification Chi-square test was applied with P-value of 0.05 was considered as significant. Results: Among 96 patients the radiation dermatitis was found in 50(52.08%) patients, grade I treatment toxicity was noted in 27(54%) patients and grade II treatment toxicity was found in 23(46%) patients. Conclusion: It was concluded that patients of rectal carcinoma showed better response rate to concomitant chemo-radiation using Capecitabine with high radiation induced dermal toxicity. Keywords: Rectal Cancer, Oral Capecitabine, Concurrent Chemo-Radiation and Skin toxicity.

Background: The causes of preeclampsia and eclampsia, two serious maternal disorders, are unknown. Understanding the precise correlation between various weather patterns may aid us in determining the possible causes of these phenomena. Eclampsia is associated with decreased temperature, increased humidity, and decreased barometric pressure. Aim: To understand the correlation between weather changes and the prevalence of eclampsia in patients visiting Khyber Teaching Hospital Peshawar. Methods: This cross sectional study was carried out at Department of Gynaecology and Obstetrics Khyber Teaching Hospital Peshawar from July 2020 to June 2021. We conducted a retrospective analysis of data collected over a 12-month period, noting the prevalence of eclampsia in our patients who presented for delivery. Results: Total 5330 deliveries over a 12-months period wererecorded. Age ranged between 16-45 years with a mean age of 30.5 years. Total 2110(39.6%) belong to maternal age of 16-20 years, 2280(42.8%) in 21-30 years and 940(17.6%) belongs to maternal age of 31-45 years. The highest number ofdeliveriesoccurredinsummer 1720(32.2%), followed by 1412(26.5%) in winter, 1190(22.3%) in Spring and 1008(18.9%) in Fall season. Practical implication: The result of this study is important for improving the quality-of-life and survival status of mothers and newborn babies and for social-capital and sustainable economic growth of the country at large. Conclusion: A slight reduction in the incidence of eclampsia was related with delivering in the fall as opposed to the winter. This is because the incidence of eclampsia has a direct linear association with rising temperature. Keywords: Eclampsia, Weather, Climate, Temperature, Humidity, Atmospheric pressure.

Background: Bio-mechanical changes during pregnancy impose postural deviation, its leading sacroiliac joint pain, or this pain increase with advancing pregnancy or interface the daily activities or sleep. Aim: To determine the prevalence of sacroiliac joint pain. Methods: This Cross sectional study was conducted at Kannan Physiotherapy and Spine Clinic Lahore, Pakistan. Convenient sampling non-probability sampling method was used, PGQ questionnaire or clinical tests are used to diagnose the sacroiliac joint pain. Results: Total pregnant women are 196, There sum of all activity or sum value divided by 75 or multiply by 100, mean 37.30; std. deviation 18.239; minimum 0; maximum 85.(the population of 1000 pregnant women were considered of which 196(19.6%) said they feel pain while 804(80.4%) said they didn’t feel pain or pain increase with trimester. Conclusion: The study concluded that pregnant women are at mild to moderate rate of developing sacroiliac joint pain due to repetitive bad posture or heavy weight during pregnancy. Keywords: Pregnancy, Sacroiliac joint pain, Pelvic girdle questionnaire, clinical test.

Background: Pelvic floor dysfunctions are common among pregnant women. Pelvic floor exercises play an important role in prevention of pelvic floor dysfunctions. Aim: To determine the knowledge and practice of pelvic floor exercises among pregnant women during antenatal period. Methodology: An observational cross-sectional study was conducted at gynecology department of private hospitals of Lahore in which 150 pregnant women were enrolled using convenient sampling, through standardized questionnaire. Data was evaluated by using SPSS version 23. Qualitative variables were presented as percentage. Results: The study showed the high percentage of pelvic floor dysfunctions (41%) were observed among pregnant women. Moreover, the large population of women (67%) were having no knowledge about PFMEs. Among those having knowledge, 91% of women were not performing these exercises. Practical Implication: Present study highlighted the significance of pelvic floor muscle exercises during pregnancy. This study also showed awareness and knowledge of females regarding pelvic exercises. These studies are the need of hour to bring more awareness among females to improve pregnancy results. Conclusion: It was concluded that unfortunately, there was knowledge about importance about PFME’s during pregnancy, but practice is low. Keywords: Pelvic Floor Dysfunction, Pelvic Floor Exercises, knowledge and performance.

Background: Bipolar disorder (BD) is a psychiatric condition and is defined as mood swings that alternate between mania, hypomania, and depression. Studies have been conducted globally to assess lipid profile (High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL)) for BD with varying results. No such studies have been conducted in Pakistan. Therefore, current study was designed to assess lipid profile (HDL, LDL, VLDL) in clinically diagnosed bipolar BD. Materials and Methods: One hundred and twelve blood samples were collected of diagnosed BD patients visiting Sheikh Zayd Hospital (SZH) and Punjab Institute of Mental Health (PIMH) Lahore. HDL, LDL and VLDL were estimated using standard biochemical methods. Results: Results obtained were statistically analyzed using SPSS. A total of 112 BD patients, 48 (58.5%) were manic, 26 (31.7%) were depressive, 8 (9.8%) were euthymic. The mean HDL (41.26±12.57 mg/dl), LDL level (115.15±38.26 mg/dl) in bipolar group (manic, depressive and euthymic) as compared to control group were statistically significant with p-value 0.026. The mean VLDL level (33.17±18.43 mg/dl) level in bipolar and control groups was statistically insignificant with p-value 0.609. Conclusions: The present study suggests that HDL level is decreased in manic BD patients. The raised value of LDL-C is found in depressive and euthymic patients. VLDL level was same in BD and control groups. Keywords: Bipolar Disorder, Lipid Profile, High Density Lipoprotein, Low Density Lipoprotein, Very Low Density Lipoprotein