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Objective: To compare the efficacy of intravenous phenylephrine infusion versus boluses for blood pressure management in elective caesarean sections. Study Design: Quasi-experimental study. Place and Duration of Study: Anaesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2022. Methodology: Three hundred ninety patients requiring elective caesarean section were divided into an Infusion Group (n=195) and a Bolus Group (n=195). The Infusion Group received phenylephrine with 100 mcg/ml titration immediately after spinal anaesthesia as per weight and height at a 1 ml/minute rate and continued for 5 minutes. Infusion stopped if MAP at 5 minutes was above baseline and restarted if dropped below baseline in subsequent readings. In the case of bradycardia, 600mcg of Glycopyrrolate was administered. Parameters recorded at 1, 5, 10 and 15-minute intervals. In the bolus group, total numbers of 100mcg boluses at the end of fifteen minutes were recorded. Protocol for bradycardia and data record intervals was the same. The primary variables were mean arterial pressure (MAP), heart rate(HR), the total dose of phenylephrine used, and nausea and vomiting. Results: Primary outcome variables showed consistent improvement in maintaining MAP in the Infusion Group versus the Bolus Group (p<0.05). A similar trend was seen with heart rate between both groups (p<0.05). However, the infusion group had an average fall in heart rate compared to the bolus group at all-time intervals. Conclusion: Phenylephrine infusion offers better hemodynamic stability, requiring less ephedrine support than when given in boluses. [ABSTRACT FROM AUTHOR]

The Eocene Kuldana Formation (KF) in the Yadgar area of Pakistan, comprises a diverse range of sedimentary facies, including variegated red beds of shales, mudstones, and sandstones, as well as interbedded limestone and marl. In this study, we conducted an integrated micropaleontological, sedimentological, mineralogical, and geochemical investigation to determine the depositional setting, biochronology, provenance, and paleoclimate of the KF. The study identified six lithofacies and six microfacies, which indicate a variety of environments ranging from floodplains and channels to the margins and shallow marine settings. The nannofossil biostratigraphy places the KF in the Early Eocene, more precisely the NP10 zone (Ypresian), and the fossil zone of benthic foraminifera classifies the study section as the Shallow Benthic Zone SBZ-8 (Middle Ilerdian 2). In terms of petrography, the KF sandstone was classified as litharenite and feldspathic litharenite, while the QtFL diagram suggests a recycled orogen. Geochemical proxies indicate an oxidizing environment, a high-to-low regular sedimentation rate, moderate-to-intense chemical weathering in the source region, and a warm-humid to dry climate during the deposition of KF. Overall, the findings suggest that the deposition of KF marks the end of Neo-Tethys due to the Early Eocene Indian–Kohistan collision and that the uplifting of the Himalayas provided the source for the deposition of KF in the foreland basin. The study provides new insights into the depositional environment, biochronology, provenance, and paleoclimate of KF, and highlights the potential for red beds as reliable indicators of oxygenation levels in proximity to mineral deposits. [ABSTRACT FROM AUTHOR]

Objective: The number of extremely drug-resistant (XDR) Salmonella typhi isolates is growing in the northwest of Pakistan, where health-care facilities are already under strain due to the coronavirus disease 2019 (COVID-19) issue. In Khyber Pakhtunkhwa, Pakistan, we currently describe the first widespread appearance of an XDR Salmonella typhi epidemic during the COVID-19 pandemic. This strain of Salmonella typhi is resistant to all first- and second-line drugs and even the third-generation cephalosporin. Methods: Salmonella species isolated from pediatric blood samples shown a high level of resistance to the various antibiotic classes evaluated between November and December 2020. Gender, age, address, and clinical symptoms were among the demographic information that was recorded. A total of 562 blood cultures from symptomatic patients have been collected by the Pathology Laboratory at a tertiary care institution of Rehman Medical Institute, Peshawar. All samples have been processed in accordance with regulatory requirements and incubated in BacT/ALERT 3D. Results: Of the 562 blood samples, 71 included Salmonella typhi, of which 66 (92.9%) and 5 (7%) were multidrug resistant (MDR) and XDR, respectively. Ciprofloxacin (100%), chloramphenicol (100%), ceftriaxone (100%), ampicillin (100%), and cotrimoxazole (93%) were completely resistant to all isolates. Azithromycin and carbapenems were effective against every Salmonella typhi isolate that was MDR or XDR. Males (76%) were more commonly affected than females (24%), and the frequency was substantially higher in children under 15 years of age (88%) than in adults (P = 0.0016). Conclusion: The emergence of XDR Salmonella typhi with a high level of resistance is in fact alarming. Due to the lack of viable treatment alternatives, the current situation necessitates the immediate implementation of efficient preventive measures, such as campaigns for typhoid vaccination and food and water safety. [ABSTRACT FROM AUTHOR]

Mosquitoes have different preferences for habitats on the basis of their feeding habits and behavior. Spatial hotspots are the target areas in precise control. The diversity indices and habitat web structures are the tools which can be helpful in controlling disease vector in case of epidemic. In this study, microhabitats were specified, surveys were conducted to explore specified microhabitats in Chakwal district of Pothwar region, Punjab, Pakistan. After qualitative and quantitative sorting, checklist of mosquitoes along with diversity indices and quantitative habitat web were prepared, which point out the hotspots of different mosquito species. In this study, a total of 580 specimens, comprising twelve mosquito species belonging to five genera were collected, which were deposited in the Biosystematics Laboratory of Pir Mehr Ali Shah, Arid Agriculture University Rawalpindi. Results show that Park, Forest area, and scrapyard were the most abundant habitats respectively, while the least abundant habitat was crop area. Parks were found to be the richest habitat, while graveyards were the least rich habitat. [ABSTRACT FROM AUTHOR]