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Objective: To assess the early complications of surfactant administration in neonates with respiratory distress syndrome. Study Design: Perspective longitudinal study. Place and Duration of Study: Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jun to Dec 2021. Methodology: A total of 64 neonates admited in ICU with gestational age 27-32 weeks requiring Continuous Positive Airway Pressure and surfactant administration were included. Neonatal complications after 24 hours of administration of surfactant and final outcome was recorded on a predesigned data colection tool. Results: Mean duration of stay on ventilator was 41.12±8.88 hours. Mean duration for Continuous Positive Airway Pressure was 43.59±22.70 hours. Second dose of surfactant was given to 34(53.1%) of neonates. Among neonates 25% suffered from pulmonary hemorrhage and 7.8% from bradycardia, 48(75%) were discharged and 16(25%) died. Conclusion: The mortality rate decreased in neonates after administration of surfactant. In future, we wil implement surfactant in term neonates, diagnosed with Respiratory Distress Syndrome, in order to improve the survival of neonates and reduce complications. [ABSTRACT FROM AUTHOR]

Energy is a crucial factor and a capital of a country's resources leading indicator. World's energy focus is shifting towards alternate renewable, cheap and environment-friendly resources that can provide long-term sustainability for survival. Due to the fossil fuels depletion and their ever-growing cost, the need to shift focus towards renewable energy resources has increased a lot. To overcome the above-said problems, there is a need to look for a feasible and robust solution for thermal applications in remote areas. Biomass gasification proved to be one of the most efficient and clean waste-to-energy conversion processes in contrast to direct combustion of agricultural waste. Other than controlled burning of biomass, it can be subjected for different purposes like a thermal, synthesis of ethanol, engine running, and for fuel cell applications. An excessive amount of impurities like char, ash, tar, and particulate matter are making these syngas non-feasible for thermal or engine applications. To overcome the above-stated problem, a downdraft gasifier with cyclone separator and hybrid biomass filter was fabricated using locally available materials in the workshop of the Dept. of Farm Machinery and Power at the University of Agriculture, Faisalabad. Uniform distribution of 2.54-5.08 cm2 sizes of feedstock was used for gasification. Air was used as a gasifying agent. The reactor capacity was 0.19 m3. The values of performance parameters for wood waste and corncobs were recorded as fuel consumption rate (0.002195, 0.002323) kg-s-1, the volume of gas produced (24.56, 26.33) m3, operating time (5480, 5164) s, cleaning unit efficiency (81.79, 79.9) % and gas yield (2.04, 2.19) m³-kg-1. [ABSTRACT FROM AUTHOR]

Energy is a crucial factor and a capital of a country’s resources leading indicator. World’s energy focus is shifting towards alternate renewable, cheap and environment-friendly resources that can provide long-term sustainability for survival. Due to the fossil fuels depletion and their ever-growing cost, the need to shift focus towards renewable energy resources has increased a lot. To overcome the above-said problems, there is a need to look for a feasible and robust solution for thermal applications in remote areas. Biomass gasification proved to be one of the most efficient and clean waste-to-energy conversion processes in contrast to direct combustion of agricultural waste. Other than controlled burning of biomass, it can be subjected for different purposes like a thermal, synthesis of ethanol, engine running, and for fuel cell applications. An excessive amount of impurities like char, ash, tar, and particulate matter are making these syngas non-feasible for thermal or engine applications. To overcome the above-stated problem, a downdraft gasifier with cyclone separator and hybrid biomass filter was fabricated using locally available materials in the workshop of the Dept. of Farm Machinery and Power at the University of Agriculture, Faisalabad. Uniform distribution of 2.54-5.08 cm² sizes of feedstock was used for gasification. Air was used as a gasifying agent. The reactor capacity was 0.19 m³ . The values of performance parameters for wood waste and corncobs were recorded as fuel consumption rate (0.002195, 0.002323) kg-s-1, the volume of gas produced (24.56, 26.33) m³, operating time (5480, 5164) s, cleaning unit efficiency (81.79, 79.9) % and gas yield (2.04, 2.19) m³ -kg-1. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of the information seminar on breast cancer awareness among the medical and nursing students of CMH institute of Medical Sciences (CIMS) Multan Pakistan. Study Design: Prospective Comparative Study. Place and Duration of Study: One-day seminar at CMH Institute of Medical Sciences (CIMS) Multan Pakistan. Methodology: A one-day seminar on breast cancer awareness was arranged at CMH Institute of Medical Sciences Multan Pakistan for 3rd and 4th-year MBBS and 3rd-year BSc Nursing students. A total of 137 participants were recruited. Participants were selected by non-probability consecutive sampling. A validated 13-question questionnaire was designed to assess participants' basic knowledge of breast cancer and breast self-examination (BSE). Results: The mean age of participants was 21.27±0.99 years. 30(21.9%) were males and 107(78.1%) were female students. Before the seminar, approximately half of the students were correct about the demographics and presentation of breast cancer which increased to more than 80% in all avenues post-seminar (p<0.001). The most significant improvement was the correct responses regarding the age at which BSE should begin. Its frequency and correct technique pre-seminar were 75(54.7%), 51(37.2%) and 23(16.8%), which in post-seminar were 98(71.5%), 106(77.4%) and 75(54.7%) respectively (p<0.001). Conclusion: This one-day educational seminar played a significant role in increasing awareness among medical and nursing students. [ABSTRACT FROM AUTHOR]

Objective: To detect the resistant pattern of uropathogens and find the association of different factors with the resistance in the Poonch District of Azad Kashmir. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Shaikh Khalifa Bin Zayed Hospital, Rawalakot, from Mar to Aug 2019. Methodology: Patients having signs and symptoms of urinary tract infection and growth of bacteria on urine culture were included in the study. The antimicrobial susceptibility of the isolates was determined by using the standard, modified Kirby Buer disc diffusion method. Zone sizes were interpreted following Clinical Laboratory Standards Institute (CLSI) 2019 guidelines. Results: 68 culture-positive patients were included in the study, 45 (66%) patients were female. There was a previous history of urinary tract infection in 44 (64.7%) patients, and 52 (76.5%) gave a history of antibiotic use in the last three months. E. coli was the commonest organism isolated, followed by Klebsiella, Proteus and Pseudomonas. All patients were resistant to at least one antibiotic, 48 (72%) isolates were multi-drug resistant. Uropathogens showed the highest resistance to Ampicillin in 67 (98.5%) patients and the lowest resistance to Piperacillin/Tazobactam 2 (3%) patients only. Resistance was significantly higher in patients having a history of recurrent urinary tract infection (p=0.028) and the use of antibiotics in the last three months (p<0.001). Conclusion: Resistance to antimicrobial agents is increasing in community-acquired urinary tract infections. Resistance is significantly higher in patients having a history of recurrent urinary tract infection and the use of antibiotics in the last three months. [ABSTRACT FROM AUTHOR]

Over the years, a crop variety grown on the commercial scale and under different conditions becomes vulnerable to various kinds of issues involving both biotic and abiotic plant stresses, alone or in combinations. This demands their substitution with new and improved genotypes possessing higher productivity and inherent resistance/tolerance against yield-limiting stresses. In this context, this editorial reports the development of a new chickpea kabuli variety "Noor-2019". This cultivar has improved yield potential, dietary elements (proteins, fat, ash), and more importantly, resistance against fusarium wilt and ascochyta blight compared to the existing varieties. The evolution of this strain commenced in 2002-03 cropping season by crossing K-90399 as a female parent with K-52582 as a male parent. The female parent had high yield potential, whereas the male parent had wilt resistance and was developed through introgression breeding using ILWC-126, an accession of Cicer reticulatum. Henceforth, the genetic variability was created to select for high yield and wilt resistant recombinants in subsequent generations. Resultantly, a uniform and high yielding progeny line PCK-09012, later designated as "Noor-2019" was selected and evaluated for yield, agronomy, and insect pests. This cultivar revealed a potential yield of 2882 kg ha-1 in testing phase and outperformed standard checks by producing 78.2%, 13.1%, and 28.8% higher grain yield in station, adaptation and national uniform yield trials, respectively. The plants of Noor-2019 are 60-65cm tall, semi-erect, and medium in canopy spread. Its grains are light brown, ram-headed, medium in size with a 100-seed weight of 25 g. Adoption of this cultivar across different climatic regions of Punjab, and other provinces could contribute in attaining self-sufficiency in local chickpea production as well as plummeting import bill. [ABSTRACT FROM AUTHOR]

We present disseminated intravascular coagulation (DIC) with excessive fibrinolysis (XFL) as an unusual presenting manifestation of metastatic prostate cancer (PC), which was successfully treated with chemotherapy with Docetaxel which not only controlled the disease but also reversed the patient's coagulopathy within seven days effectively. Thus highlighting rare and life-threatening haemorrhagic complications of prostate cancer along with its satisfactory management option. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of the Mentzer index as a screening tool for iron deficiency anaemia, using an iron profile as the gold standard in patients presenting with hypochromic microcytic anaemia. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to May 2022. Methodology: Data was collected from 163 patients with hypochromic microcytic anaemia. Red cell indices were noted for each patient and recorded on a defined proforma. Results: The mean age of the patients was 8.23±3.57 years. 85(52.1%) patients were males and 78(47.9%) were females. Moreover, out of 163 patients, the specificity, sensitivity, negative predictive value, positive predictive value, and diagnostic accuracy of the Mentzer index for the diagnosis of iron deficiency anaemia were 90.1%, 90.1%, 84.6%, 93.8%, and 90.8%, respectively. Conclusion: The cell-count-based indices, especially the Mentzer index, are reliable and available methods for diagnosing iron deficiency anaemia. They have an accurate discrimination ability. [ABSTRACT FROM AUTHOR]

Current study was aimed to formulate a nutritious snack bar by incorporating date pit powder (by product) and soy protein isolate in date paste. Date bars were formulated after ingredients optimization and were analyzed for physico-chemical, in-vitro starch and protein digestibility, antioxidants and microbial count. Results showed that date bars are rich source of protein, fiber, carbohydrates and fat with good digestibility properties. Date pit powder and soy protein isolate incorporation enhanced the total antioxidants and DPPH activity in soy date bars however, decreasing trend was observed in total antioxidants and inhibition of DPPH radical activity during 90 days of storage. Based on the results, it has been suggested that date bars may be considered as a source to meet the energy requirements of health-conscious consumers. Moreover, date pit powder and soy protein isolate can be used as nutraceutical in different functional foods as a valuable nourishment source for target population. [ABSTRACT FROM AUTHOR]

Objective: To discern the relationship of height and weight with body composition in healthy attendants of cancer patients. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Oct to Dec 2022. Methodology: A total of 226 healthy adults aged 19-47 years having similar daily physical activity levels were included. The body composition of study participants was evaluated using a bioelectric impedance analysis (BIA) machine. The weight of all participants was recorded with the help of a weighing machine. The participants' height was measured using a Harp enden Stadiometer and recorded. Results: Our study showed that weight had a significant positive correlation with body fat mass (rs value=0.83), skeletal muscle mass (rs value=0.763), total body water (rs value=0.704), fat-free mass (rs value=0.75) and per cent body fat (rs value 0.716). On the other hand, height had a negative but non-significant association with fat mass (rs value= 0.025) and a negative significant association with per cent body fat (rs value=-0.16). Height had a positive and significant association with fat-free mass (rs value=0.553), total body water (rs value=0.501) and skeletal muscle mass (rs value=0.505). Conclusion: Weight, if used alone, is not a good indicator of obesity or emaciation, and height has a negative association with fat mass. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic accuracy of the pSOFA score in predicting mortality in critically ill pediatric patients. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Paediatrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, Aug 2021 to Feb 2022. Methodology: We studied 76 critically ill paediatric patients. All patients underwent pSOFA scoring on admission and then at 72 hours post-admission and were followed up till discharge or till mortality occurred. A pSOFA score of >10 was considered a high mortality risk. The two-by-two table was constructed to calculate the sensitivity, specificity and diagnostic accuracy of the pSOFA score in predicting the occurrence of death. Results: The pSOFA score had a sensitivity of 88.9% at Day-0, which improved to 100% by Day-7 in predicting whether mortality occurred. The specificity was 80.6% on Day-0 and 97.0% on Day-7. The diagnostic accuracy of pSOFA in predicting mortality was 81.6% when performed on the day of admission, which increased to 90.8% when calculated on Day 3 and was the highest on Day-7 when it was 97.4%. Conclusion: The pSOFA score has good diagnostic accuracy in predicting the occurrence of mortality in paediatric patients admitted to intensive care, which increases as the length of stay increases. [ABSTRACT FROM AUTHOR]

Sinonasal glomangiopericytoma is a tumor showing similarities to a glomus tumor but is less aggressive with a low malignant potential. The treatment of choice is complete excision followed by a regular long-term surveillance. The role of adjuvant chemotherapy and radiation remains undetermined. Our patient was a 45-year-old man who presented with nasal obstruction. Endoscopic excision showed sinonasal glomangiopericytoma. No adjuvant treatment was offered and patient was advised active surveillance. Patient was on a regular three-monthly follow-up. There was no evidence of disease recurrence after one year. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of the information seminar on breast cancer awareness among the medical and nursing students of CMH institute of Medical Sciences (CIMS) Multan Pakistan. Study Design: Prospective Comparative Study. Place and Duration of Study: One-day seminar at CMH Institute of Medical Sciences (CIMS) Multan Pakistan. Methodology: A one-day seminar on breast cancer awareness was arranged at CMH Institute of Medical Sciences Multan Pakistan for 3rd and 4th-year MBBS and 3rd-year BSc Nursing students. A total of 137 participants were recruited. Participants were selected by non-probability consecutive sampling. A validated 13-question questionnaire was designed to assess participants' basic knowledge of breast cancer and breast self-examination (BSE). Results: The mean age of participants was 21.27±0.99 years. 30(21.9%) were males and 107(78.1%) were female students. Before the seminar, approximately half of the students were correct about the demographics and presentation of breast cancer which increased to more than 80% in all avenues post-seminar (p<0.001). The most significant improvement was the correct responses regarding the age at which BSE should begin. Its frequency and correct technique pre-seminar were 75(54.7%), 51(37.2%) and 23(16.8%), which in post-seminar were 98(71.5%), 106(77.4%) and 75(54.7%) respectively (p<0.001). Conclusion: This one-day educational seminar played a significant role in increasing awareness among medical and nursing students. [ABSTRACT FROM AUTHOR]

The main purpose of the study was to determine the suitable selection method for genetic improvement in chickpea. The current investigation was conducted at the research area of the Arid Zone Research Institute, Bhakkar, Punjab, Pakistan. Twelve chickpea genotypes were sown in RCBD following three replicates. Data regarding primary & secondary per plant, days for maturity, plant height as well as potential yield were recorded. The measured data were analyzed to principal component analysis (PCA), correlation, and path coefficient analysis. Analysis of variants revealed good variation among the accessions for the data recorded traits. Principal coefficient analysis differentiates all the traits into six PCs. Two components expressed more than one Eigenvalue which collectively contributed 80.12% towards the genetic variation. High positive loadings were expressed by the secondary branches per plant and pods per plant in all components. Path analysis revealed that secondary branches/plants expressed the highest direct positive effect (0.872) grain yield followed by the pods per plant (0.623). Analysis of correlation coefficient also confirmed the highest significant contribution of secondary branches per plant (91.57%) followed by pods (78.12%) and each plant's primary branches (64%). It was proved from the current experiment that Plants with secondary branches as well as pods may be focused on while assessing meaningful selection criteria for genetic improvement in chickpea. [ABSTRACT FROM AUTHOR]

The main purpose of the study was to determine the suitable selection method for genetic improvement in chickpea. The current investigation was conducted at the research area of the Arid Zone Research Institute, Bhakkar, Punjab, Pakistan. Twelve chickpea genotypes were sown in RCBD following three replicates. Data regarding primary & secondary per plant, days for maturity, plant height as well as potential yield were recorded. The measured data were analyzed to principal component analysis (PCA), correlation, and path coefficient analysis. Analysis of variants revealed good variation among the accessions for the data recorded traits. Principal coefficient analysis differentiates all the traits into six PCs. Two components expressed more than one Eigenvalue which collectively contributed 80.12% towards the genetic variation. High positive loadings were expressed by the secondary branches per plant and pods per plant in all components. Path analysis revealed that secondary branches/plants expressed the highest direct positive effect (0.872) grain yield followed by the pods per plant (0.623). Analysis of correlation coefficient also confirmed the highest significant contribution of secondary branches per plant (91.57%) followed by pods (78.12%) and each plant's primary branches (64%). It was proved from the current experiment that Plants with secondary branches as well as pods may be focused on while assessing meaningful selection criteria for genetic improvement in chickpea. [ABSTRACT FROM AUTHOR]

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorptiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted osteopenia/osteoporosis in patients included in our study. [ABSTRACT FROM AUTHOR]

Objective: To look for QTc changes associated with Tyrosine Kinase inhibitors and factors related to these changes among patients suffering from cancer. Study Design: Comparative cross-sectional study. Place and Duration of Study: Oncology Department, CMH Rawalpindi Pakistan from Dec 2020 to Apr 2021. Methodology: The study included one hundred and eighty patients with solid or haematological malignancies taking Tyrosine Kinase inhibitors for more than three months. They underwent 12 lead ECGs inside the oncology department. QTc interval was calculated on the ECG of all the patients, and they were evaluated for the presence of prolonged QT interval. Age, gender, duration of Tyrosine Kinase inhibitor use and presence of comorbid illness were correlated with the presence of QTc changes in our study participants. Results: Out of 180 cancer patients using Tyrosine Kinase inhibitors for more than three months included in the study, 96 (53.3%) were male, while 84 (46.7%) were female. One hundred and eighteen (65.5%) had normal QTc intervals, while 62 (34.5%) had prolonged QTc intervals in our study participants. Chi square test revealed that the advanced age of the patient and prolonged use of Tyrosine Kinase inhibitors was statistically significantly associated with QTc prolongation in our study (p-value<0.001). Conclusion: Significant number of cancer patients using Tyrosine Kinase inhibitors had prolonged QTc intervals in our study. Special attention should be paid to cancer patients with advancing age and prolonged use of Tyrosine Kinase inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of serum cholesterol and body mass index with body composition in the healthy Pakistani adults. Study Design: Cross sectional study. Place and Duration of Study: Physiology Department, Army Medical College Rawalpindi/National University of Medical Sciences (NUMS), in collaboration with Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi and Clinical Pathology Laboratory (CPL), Pak-Emirates Military Hospital, Rawalpindi. (Duration to be asked form the authors). Methodology: The total study sample of 100 participants was taken, that comprised of two groups. Group-1 included male participants (n=50) while group-2 included female participants (n=50). The participants were healthy adults of ages 18-60 years having same physical activity background. Body composition of the participants was evaluated by bioelectric impedance analysis machine. Measurement of serum cholesterol was carried out by the Bosh Diagnostic Kit. Body Mass Index (BMI) was determined by the formula. Results: Serum cholesterol was found to be significantly correlated with body fat mass and percent body fat in males (r-value = 0.90 and 0.82, p-value <0.001 and 0.002 respectively) and in females there was significantly positive correlation with the body fat mass (r-value=0.51, p-value 0.007), skeletal muscle mass (r-value = 0.59, p-value 0.005), total body water (r-value=0.67, pvalue 0.006) and fat free mass (r-value=0.47, p-value 0.008). Conclusion: Serum cholesterol and BMI were associated with the body composition in females but with only fat parameters in the males. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dependency on feeding gastrostomy tubes in patients with head and neck cancers treated with radiotherapy alone or concurrent chemo-radiotherapy. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Shaukat Khanum Hospital, Peshawar Pakistan, from Jan and Jul 2022. Methodology: A total of 115 patients with head and neck cancers having no baseline dysphagia and having gastrostomy tubes were included. All had received an equivalent of 60 greys in 30 fractions or more of radiotherapy. Their swallowing was evaluated weekly during radiotherapy and then every 4-6 weeks on post-treatment follow-up. The total time duration of patient dependency on feeding gastrostomy tube after treatment completion was noted for each head and neck cancer subsite. Results: Of a total of 115 patients, 49(43%) of the patients had nasopharyngeal cancers, 22(19%) had laryngeal, 29(24%) oral cavity, 7(6%) hypopharyngeal and 9(8%) had cervical esophageal cancers. Proportion retaining gastrostomy tube for more than six months of treatment was 8.7% (median duration of retention was five months) with hypopharyngeal, nasopharyngeal, oral cavity, and laryngeal cancer were 14%, 9%, 9% and 5%, respectively. Conclusion: The proportion of patients with head and neck cancers requiring more than six months of a gastrostomy tube is 5-14%. Baseline assessment of swallowing and nutrition and prophylactic feeding gastrostomy can avoid treatment interruptions. Longer duration of retention of a gastrostomy tube is associated with poor quality of life in head and neck cancer patients receiving radiation or concurrent chemo-radiation. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic value of red blood cell distribution width and red cell distribution width index in differentiating iron deficiency anaemia and beta-thalassemia trait. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Feb 2022. Methodology: A study population of 110 children with an age limit of 1.5-7 years who reported low haemoglobin was subjected to serum iron and ferritin levels with further evaluation of red cell count, blood morphology, and comparison of mean corpuscular volume. Red cell distribution width was taken from the lab report, whereas Red blood cell distribution width index value was computed for the samples. Results: A total of 110 patients were enrolled in the study. Seventy-five (68.18%) participants were diagnosed with IDA, 26(23.63%) participants were the candidate of PTT. Nine participants were suffering from anaemia of variable etiologies such as chronic ailment and sideroblastic, etc. PTT patients presented with higher RBC counts with a mean of 5.71±1.2 x1012 /l (6.8-8.5 x1012 /l) when compared to IDA participants who deciphered values of 3.5±0.5 (2.6-4.3 x1012 /l). Mean MCV in PTT was 52.2±2.7(50.1-56.8) whereas for IDA were 72.5±1.2(61.2-78.3). In IDA low serum ferritin was recorded 4.02±1.1(2.2-9.2) as compared to mean values of PTT patients. Conclusion: Red cell distribution width index and Red blood cell distribution width are authentic variables and inexpensive modalities in differentiating between iron deficiency anaemia and beta-thalassemia trait with reliability. [ABSTRACT FROM AUTHOR]

Neuroendocrine breast carcinoma (NEBC) is histologically a rare type of invasive breast cancer. It constitutes only 0.2-0.5% of all invasive breast cancers. In this case series, we are presenting five cases having primary neuroendocrine breast cancers that had been reported at a high-volume cancer centre in Pakistan. In this study, neuroendocrine breast cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre Peshawar were evaluated. We had retrospectively collected information on demographic characteristics of our patients, physical examination, radiological findings, surgical procedures with their outcomes, histopathological and immuno-histochemical characteristics, systemic adjuvant/neoadjuvant therapy and follow-up. [ABSTRACT FROM AUTHOR]

A field trial was conducted to test the bio-efficacy of five commercial acaricidal formulationsviz., azocyclotine 25% WP (Gallop), fenpyroximate 5% SC (Unique-M), diafenthiuron 500 SC (Trophy), hexythiazon 10% WP (Nissorun) and abamectin 1.8% EC (Commando) against brinjal mites, Tetranychus urticae, on brinjal crop under field conditions. Brinjal vegetable was raised under standard agronomic practices. Field recommended dose of these acaricides were used knapsack sprayer. Results showed a significant mite reductionby allacaricides as compared to control. Among the tested acaricides, hexythiazon 10% WP (Nissorun) gave the highest reduction of mites (i.e., 41.42, 55.56 and 37.90%) after 3, 5, and 7 days of first spray, respectively. Similarly, after second spray, hexythiazon 10% WP (Nissorun) again gave maximum reduction (i.e., 41.65, 39.33 and 16.40%) of T. urticae at 3, 5 and 7 days, respectively. [ABSTRACT FROM AUTHOR]

To improve yield and shelf life of stock can enhance economic value to flowers growers globally. A study was conducted to evaluate the efficacy of various bio-stimulants on yield and quality of stock. Three cultivars of stock, viz. 'Cheerful White', 'Iron Rose' and 'Iron White' foliarly sprayed by bio-stimulants (Isabion and Tecamin Max) with three different concentrations (1 ppm, 3 ppm, and 5 ppm) with the different number of sprays (1, 2, or 3 sprays). The first spray was applied after one month of transplanting, while the other two were applied at fortnight intervals after the first spray. Fisher's Analysis of variance revealed that Isabion at 1 ppm as 1 spray, 3 ppm as 3 sprays, and 5 ppm as 3 sprays produced the highest plant height for three cultivars of stock. 'Cheerful White' had the highest stem length when plants were sprayed once at 1 ppm Isabion. Among cultivars, 'Iron Rose', produced highest leaf area (42.8 cm2) with 3 ppm Isabion application, when sprayed only one time. Among the number of sprays, plants sprayed three times with Isabion produced the thickest stem diameter followed by 2 and 1 sprays. 'Cheerful White' had maximum leaf total chlorophyll contents, followed by 'Iron White' and 'Iron Rose' (69.1 SPAD and 68.8 SPAD, respectively). Among the number of sprays, plants sprayed three times had the longest vase life. Cheerful White proved early cultivar of stock while Iron White were late cultivars when grown in agro-climatic conditions of Faisalabad. Tecamoin Mix is recommended biostimulant for quality production of Mathiola incoma L. rather than isabion. [ABSTRACT FROM AUTHOR]

Purple blotch disease is exerting a severe threat on onion production. The current study was conducted for screening of accessions against purple blotch disease and determining the source of resistance against Purple blotch disease of onion caused by Alternaria porri. Potential of 50 onion accessions was evaluated against A. porri during 2017 and 2018 under field conditions. After that effect of some fungicides and plant extracts was determined for disease suppression on a susceptible variety of onion. During both years of study, eight accessions (Phulkara, Texas Early, Cylon, Sunset, Red Gystal, Rubi F1, Red Flame, ON-14133) exhibited resistant response with minimum percent disease index (PDI) which ranged between 5-10%, followed by Mirpurkhas, Nasarpuri, HON-1069, Pania, Rubi F2, GSL-132, Red Moon, PK-1032, F-1122, Red Imposta, Early Red, Desi Large and Vrio-4 which showed moderately resistant response to A.porri with PDI of 11-20%, whereas, the four accession including Golden Arab, Desired, Sultan F1 and Red Nasik expressed Moderately resistant response with PDI of 21-40%. Moreover, six accessions (Yellow Gystal, Vrio-9, Vrio-5, Vrio-4, Vrio-1, and Vrio-3) expressed susceptible response with high value of PDI 41-60% whereas; nine accessions (CBS-130, ON-14121, Pink Panther, Vrio-7, Vrio-3, F1 Zeus, SE-16, Vrio-8 and Marvi) showed maximum value (Above 60%) of PDI and expressed highly susceptible response to A.porri. Among fungicides and botanical extracts, Chlorostrobin and Azadirachta indica extract expressed significant reduction in disease severity. It was concluded that out of 50, only eight accessions were resistant which might be grown successfully for higher crop production. Moreover, use of Chlostrobin and extract of Azadirachta indica may be used for disease management. [ABSTRACT FROM AUTHOR]

To improve yield and shelf life of stock can enhance economic value to flowers growers globally. A study was conducted to evaluate the efficacy of various bio-stimulants on yield and quality of stock. Three cultivars of stock, viz. ‘Cheerful White’, ‘Iron Rose’ and ‘Iron White’ foliarly sprayed by bio-stimulants (Isabion and Tecamin Max) with three different concentrations (1 ppm, 3 ppm, and 5 ppm) with the different number of sprays (1, 2, or 3 sprays). The first spray was applied after one month of transplanting, while the other two were applied at fortnight intervals after the first spray. Fisher’s Analysis of variance revealed that Isabion at 1 ppm as 1 spray, 3 ppm as 3 sprays, and 5 ppm as 3 sprays produced the highest plant height for three cultivars of stock. ‘Cheerful White’ had the highest stem length when plants were sprayed once at 1 ppm Isabion. Among cultivars, ‘Iron Rose’, produced highest leaf area (42.8 cm² ) with 3 ppm Isabion application, when sprayed only one time. Among the number of sprays, plants sprayed three times with Isabion produced the thickest stem diameter followed by 2 and 1 sprays. ‘Cheerful White’ had maximum leaf total chlorophyll contents, followed by ‘Iron White’ and ‘Iron Rose’ (69.1 SPAD and 68.8 SPAD, respectively). Among the number of sprays, plants sprayed three times had the longest vase life. Cheerful White proved early cultivar of stock while Iron White were late cultivars when grown in agro-climatic conditions of Faisalabad. Tecamoin Mix is recommended biostimulant for quality production of Mathiola incoma L. rather than isabion. [ABSTRACT FROM AUTHOR]

Purple blotch disease is exerting a severe threat on onion production. The current study was conducted for screening of accessions against purple blotch disease and determining the source of resistance against Purple blotch disease of onion caused by Alternaria porri. Potential of 50 onion accessions was evaluated against A. porri during 2017 and 2018 under field conditions. After that effect of some fungicides and plant extracts was determined for disease suppression on a susceptible variety of onion. During both years of study, eight accessions (Phulkara, Texas Early, Cylon, Sunset, Red Gystal, Rubi F1, Red Flame, ON-14133) exhibited resistant response with minimum percent disease index (PDI) which ranged between 5-10%, followed by Mirpurkhas, Nasarpuri, HON-1069, Pania, Rubi F2, GSL-132, Red Moon, PK-1032, F-1122, Red Imposta, Early Red, Desi Large and Vrio-4 which showed moderately resistant response to A.porri with PDI of 11-20%, whereas, the four accession including Golden Arab, Desired, Sultan F1 and Red Nasik expressed Moderately resistant response with PDI of 21-40%. Moreover, six accessions (Yellow Gystal, Vrio-9, Vrio-5, Vrio-4, Vrio-1, and Vrio-3) expressed susceptible response with high value of PDI 41-60% whereas; nine accessions (CBS-130, ON-14121, Pink Panther, Vrio-7, Vrio-3, F1 Zeus, SE-16, Vrio-8 and Marvi) showed maximum value (Above 60%) of PDI and expressed highly susceptible response to A.porri. Among fungicides and botanical extracts, Chlorostrobin and Azadirachta indica extract expressed significant reduction in disease severity. It was concluded that out of 50, only eight accessions were resistant which might be grown successfully for higher crop production. Moreover, use of Chlostrobin and extract of Azadirachta indica may be used for disease management. [ABSTRACT FROM AUTHOR]

Objective: To study the role of Hydroxyurea in patients suffering from P-thalassemia major. Study Design: Prospective longitudinal study. Place and Duration of Study: Department Paediatrics, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Oct 2020. Methodology: Data from 73 beta-thalassemia major patients was collected using a structured questionnaire containing inquiries about basic socio-demographic details, disease history, laboratory reports and particulars of former treatment regimens. Hydroxyurea was administered, and its effects were noted among the subjects regarding the frequency of transfusion, haemoglobin levels and severity of clinical symptoms. Results: The mean age of study subjects was 9.15±3.99 years, and most study subjects (56.14%) were boys. The preintervention (before administration of Hydroxyurea) levels of Hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and serum ferritin levels were unremarkable when compared to postintervention levels. However, a significant difference was observed in HbF levels. In addition, an encouraging decrease was reported in the self-rated severity (using VAS) of symptoms such as fatigue (p<0.05), weakness (p>0.05), and shortness of breath (p>0.05). In addition, the transfusion interval was significantly reduced (p<0.05). Conclusion: After carefully considering the results, it can be concluded that Hydroxyurea plays a positive role and brings about significant improvement among patients suffering from P-thalassemia major. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To analyze the factors associated with adverse effects in elderly women receiving chemotherapy for breast cancer. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital (CMH), Rawalpindi Pakistan, from Dec 2020 to Nov 2021. Methodology: This study was conducted on 145 female patients (>65 years) with breast cancer who were taking chemotherapy of any type and had undergone one cycle. All the study participants underwent detailed clinical evaluation by a consultant oncologist to assess the presence of various adverse effects of chemotherapy. In addition, the association of Anthracycline use, >3 months of treatment, low haemoglobin at baseline and abnormal liver functions at baseline were studied with adverse effects in the study participants. Results: The final analysis included one hundred fortyfive elderly female patients with breast cancer receiving chemotherapy. The mean age of the patients was 69.731±8.794 years. 89(61.4%) patients had no adverse effects, while 56(38.6%) had one or more adverse effects during chemotherapy. Anaemia 26(17.9%) was the commonest adverse effect, followed by fatigue 18(12.4%) and abnormal liver function tests 18(12.4%). It was revealed that the use of Anthracyclinebased chemotherapy and long duration of chemotherapy were statistically significantly associated with adverse effects (p-value<0.05) in our study participants. Conclusion: Considerable number of elderly patients with breast cancer undergoing chemotherapy showed the presence of adverse effects. In addition, patients using Anthracyclinebased chemotherapy and taking chemotherapy for more than three months were more at risk of developing adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorptiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted osteopenia/osteoporosis in patients included in our study. [ABSTRACT FROM AUTHOR]

Objective: To look for QTc changes associated with Tyrosine Kinase inhibitors and factors related to these changes among patients suffering from cancer. Study Design: Comparative cross-sectional study. Place and Duration of Study: Oncology Department, CMH Rawalpindi Pakistan from Dec 2020 to Apr 2021. Methodology: The study included one hundred and eighty patients with solid or haematological malignancies taking Tyrosine Kinase inhibitors for more than three months. They underwent 12 lead ECGs inside the oncology department. QTc interval was calculated on the ECG of all the patients, and they were evaluated for the presence of prolonged QT interval. Age, gender, duration of Tyrosine Kinase inhibitor use and presence of comorbid illness were correlated with the presence of QTc changes in our study participants. Results: Out of 180 cancer patients using Tyrosine Kinase inhibitors for more than three months included in the study, 96 (53.3%) were male, while 84 (46.7%) were female. One hundred and eighteen (65.5%) had normal QTc intervals, while 62 (34.5%) had prolonged QTc intervals in our study participants. Chi square test revealed that the advanced age of the patient and prolonged use of Tyrosine Kinase inhibitors was statistically significantly associated with QTc prolongation in our study (p-value<0.001). Conclusion: Significant number of cancer patients using Tyrosine Kinase inhibitors had prolonged QTc intervals in our study. Special attention should be paid to cancer patients with advancing age and prolonged use of Tyrosine Kinase inhibitors. [ABSTRACT FROM AUTHOR]

Weeds are serious pests in rice sown under direct-seeded rice (DSR) technology. Herbicide-based weed management is becoming increasingly popular, but there is a dire need to choose appropriate herbicides and their effective dose for controlling weeds in DSR fields. A field trial was conducted to appraise the comparative efficacy of three post-emergent herbicides applied at different doses [Clover 20% EC (bispyribac sodium) at 39.54, 59.30, and 79.07 g a.i. ha-1, Pyranex Gold 30% WDG (bispyribac sodium + bensulfuron methyl) at 74.13, 111.20, and 148.26 g a.i. ha-1, and Puma Super 7.5% EW (fenoxaprop-p-ethyl) at 46.33 and 92.66 g a.i. ha-1] at 20 days after sowing (DAS) for weed control and paddy yield performance under DSR system. A weedy check was retained as control. Results revealed that Clover and Pyranex Gold applied at either dose significantly (p≤0.05) reduced the population and growth of Cyperus iria (90-97% weed density and 93-97% weed dry biomass) and Echinochloa colona (94-97% weed density and weed dry biomass) weeds over control, while Puma Super proved efficient in suppressing Leptochloa chinensis and Echinochloa colona weeds. Among all the tested treatments, application of Puma Super at 92.66 g a.i. ha-1 furnished the highest number of tillers (137.3 in 2014 and 141.3 in 2015), grains panicle-1 (77 in 2014 and 79 in 2015), final paddy yield (1983.8 and 1570 kg ha-1 in 2014 and 2015, respectively), and net economic returns (Rs. 95915 ha-1), followed by the use of Puma Super at 46.33 g a.i. ha-1 which offered the next best economic benefits (Rs. 81906 ha-1). Thus, applying Puma Super at 92.66 g a.i. ha-1 is appeared viable approach to control grassy weed flora and ensure higher paddy yield with higher economic returns when rice is sown under DSR technology. [ABSTRACT FROM AUTHOR]

Tunnel farming is getting popular in the farmer's community of Pakistan due to the possibility of growing off-season vegetable crops with high yield in a controlled environment. In the current study, the development and validation of IoT system consisting of monitoring and control units were carried out for controlling the environmental factors in tunnel farming. Three tunnels were set for monitoring the environmental factors using temperature, humidity and soil moisture sensors. Two of three tunnels were fit with control units of exhaust fans and air heaters and a water pump for controlling the temperature and soil moisture. During the testing and validation of the system, temperatures recorded through DHT-21 sensor and thermometer in tunnel 1, 2 and 3 had strong correlations of 0.9986, 0.998 and 0.9978 respectively. Similarly, strong correlations of 0.9987, 0.9994 and 0.998 were found for RH (%) measured through DHT-21 sensor and RH meter for tunnel 1, 2 and 3 respectively. For soil moisture measurement, similar correlations were observed for resistive soil moisture sensor and oven dry method. It was explored that an increase in temperature through an air heater decreases the RH in tunnel 1 and 2 compared to tunnel 3 which has higher RH because it was not installed with air heater and exhaust fan. System controlled the temperature and soil moisture within adjusted limits of 22-27 °C, 17-23 % for tunnel 1 and 19-22 °C, and 19-23 % for tunnel 2. [ABSTRACT FROM AUTHOR]

Tunnel farming is getting popular in the farmer's community of Pakistan due to the possibility of growing off-season vegetable crops with high yield in a controlled environment. In the current study, the development and validation of IoT system consisting of monitoring and control units were carried out for controlling the environmental factors in tunnel farming. Three tunnels were set for monitoring the environmental factors using temperature, humidity and soil moisture sensors. Two of three tunnels were fit with control units of exhaust fans and air heaters and a water pump for controlling the temperature and soil moisture. During the testing and validation of the system, temperatures recorded through DHT-21 sensor and thermometer in tunnel 1, 2 and 3 had strong correlations of 0.9986, 0.998 and 0.9978 respectively. Similarly, strong correlations of 0.9987, 0.9994 and 0.998 were found for RH (%) measured through DHT-21 sensor and RH meter for tunnel 1, 2 and 3 respectively. For soil moisture measurement, similar correlations were observed for resistive soil moisture sensor and oven dry method. It was explored that an increase in temperature through an air heater decreases the RH in tunnel 1 and 2 compared to tunnel 3 which has higher RH because it was not installed with air heater and exhaust fan. System controlled the temperature and soil moisture within adjusted limits of 22-27 °C, 17-23 % for tunnel 1 and 19-22 °C, and 19-23 % for tunnel 2. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2-cyanoacrylate treatment. Study Design: Prospective comparative study. Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019. Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted. Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005). Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of adjuvant Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) therapy in neonatal sepsis. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, Mar 2019 to Mar 2020. Methodology: Thirty neonates (15 cases and 15 controls) were randomly selected for this study. The Interventional Group was given GM-CSF and standard-of-care treatment; the Control Group only received standard care. Both groups were followed for the primary outcome (i.e., discharge or death). Secondary outcomes included the effects of GM-CSF on haematological parameters of neonatal sepsis. Results: The mean gestational age of the children was 33.46±2.47 weeks. In the Interventional-Group, 56.7% of the neonates were discharged with the resolution of the sepsis. There was no significant difference concerning the secondary outcome, but the mortality was higher in the neonates among the Control-Group (p-value>0.05). Conclusion: Our study showed no difference in mortality between the Interventional and the Control Groups. The GM-CSF therapy could be used as an adjuvant therapy in neonates with neonatal sepsis to increase the total leukocyte and absolute neutrophil counts. Further studies are needed to holistically chart the clinical benefit of GM-CSF adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective: To study the role of Hydroxyurea in patients suffering from β-thalassemia major. Study Design: Prospective longitudinal study. Place and Duration of Study: Department Paediatrics, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Oct 2020. Methodology: Data from 73 beta-thalassemia major patients was collected using a structured questionnaire containing inquiries about basic socio-demographic details, disease history, laboratory reports and particulars of former treatment regimens. Hydroxyurea was administered, and its effects were noted among the subjects regarding the frequency of transfusion, haemoglobin levels and severity of clinical symptoms. Results: The mean age of study subjects was 9.15±3.99 years, and most study subjects (56.14%) were boys. The pre-intervention (before administration of Hydroxyurea) levels of Hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and serum ferritin levels were unremarkable when compared to post - intervention levels. However, a significant difference was observed in HbF levels. In addition, an encouraging decrease was reported in the self-rated severity (using VAS) of symptoms such as fatigue (p<0.05), weakness (p>0.05), and shortness of breath (p>0.05). In addition, the transfusion interval was significantly reduced (p<0.05). Conclusion: After carefully considering the results, it can be concluded that Hydroxyurea plays a positive role and brings about significant improvement among patients suffering from β-thalassemia major. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To assess the clinical characteristics of COVID-19 Virus disease in the pediatric population in Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2020 to Jan 2021. Methodology: All children presenting to the department with symptoms consistent with COVID-19 disease were tested for the virus. Patients who tested positive on the PCR were included in the study. Patients with nonconsistent symptoms of COVID-19 and those who tested negative on the PCR were excluded from the study. All clinical data, including the age of the child, the onset of symptoms, the gap between the onset of symptoms and presentation as well as clinical symptoms, were documented on a predefined proforma. Results: A total of 106 patients were enrolled on the study. The mean age of patients was 5.6±2.5 years. The most frequent symptoms were fever (63, 59.6%) and cough (49, 46.2%). There were 3(2.9%) cases with severe or critical illness. The most frequent abnormal laboratory findings were leukopenia (29, 27.4%) and increased creatine kinase (38, 36.0%). Groundglass opacities were observed in the HRCT chest of 17(65.3%) cases, out of 26 children diagnosed with pneumonia. The majority (70, 66%), had a positive exposure history. 88(83%) cases did not abide by the precautionary measures against the COVID-19 disease. Conclusions: The current study indicates that children usually present with mild symptoms but can present as severe diseases, as observed in this study. [ABSTRACT FROM AUTHOR]