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Background: With the rise of non-communicable diseases (NCDs) in a country that is already facing high tuberculosis (TB) burden, TB multi-morbidity is likely to pose a significant public health challenge in Pakistan. Data were analysed to determine the prevalence of TB and explore the distribution and determinants of multi-morbidity associated with TB in the population of Khyber Pakhtunkhwa -a province of Pakistan. Methods: This is a secondary analysis of data gathered as part of the KPIPHS survey conducted in 2016-17 in both the rural and urban areas of Khyber Pakhtunkhwa, Pakistan. An interviewer-administered questionnaire was used to collect data, from adults, on demographics, education and socioeconomic status, physical and mental health, reproductive health, child health, health-related quality of life, and self-reported cardiometabolic diseases including Diabetes, hypertension, renal disorders, cardiac failure, angina, and stroke. Results: A total of 20,715 participants were recruited in the survey including 52.8% (n=10,943) males and 47.2% (n=9,772) females with a mean age of 41 (13.1) years. Data on TB status was available for a total of 14452 participants. The prevalence of TB in Khyber Pakhtunkhwa was found to be 0.49% (n=72) including an almost equal number of males and females [48% (n=34) vs 51% (n=36)], respectively. The mean age of the patients with TB was 47.5 (11.6) years. A higher proportion of people with TB had cardiometabolic diseases compared to people without TB (45.9% vs. 30.9%). Amongst the cardiometabolic disorders, self-reported hypertension (OR: 1.81, 95% CI 1.08-3.02, p=0.02), Diabetes (OR: 3.99, 95% CI 1.95-8.18, p=<0.002), and angina (OR: 3.88 95% CI 1.20-12.49, p=0.02) were positively associated with the occurrence of TB. In the adjusted analysis, only self -reported Diabetes was positively associated with the occurrence of TB (OR: 3.33, 95% CI 1.61-6.88, p=0.001). Conclusion: There is a higher burden of self-reported cardiometabolic diseases among people with TB, suggesting that this high-risk group should be screened for cardiometabolic diseases, especially Diabetes. [ABSTRACT FROM AUTHOR]

Background: Previous studies highlighted that CIAF is the better tool for malnutrition assessment which screen more children compared to other anthropometric approaches like MUAC, BMI for age, and conventional indices (Stunting, Wasting and Underweight). In the literature, none of the studies has mentioned CIAF performance by gender in comparison with other anthropometric approaches. The study solves this puzzle, of whether CIAF has the same performance in gender analysis too or not. Data from 1152 homes were gathered using a purposive random sample approach. The CIAF detects more malnourished children (63%) compared to other methods. Results show that male children in the study region had a greater frequency of malnutrition than female children. The results of the chi-square showed that the age and gender of the child have a significant relationship with CIAF than other approaches. The CIAF is a superior instrument for assessing child malnutritional status since it detects more malnourished children even with gender analysis. [ABSTRACT FROM AUTHOR]

Background: Takayasu arteritis (TKA) is a rare large vessel vasculitis occurring in young adults of less than 50 year of age. We analyse the clinical, radiological features, and treatment regimens in Pakistani patients presenting to a tertiary care center. Methods: A retrospective cross-sectional analysis of TKA patients done at the Rheumatology department of Fatima Memorial Hospital. A comprehensive evaluation of clinical, laboratory, radiographic features and treatment regimens was carried out. Results: A consecutive cohort of 18 patients, with 13 patients (72%) of female gender was studied. Mean age of the cohort was 35.94±2.7 years. A mean delay of 2.32±0.43 years between symptoms and final diagnosis was reported, attributed to alternate diagnosis in 57.1% and late presentation in 42.8% cases. Limb claudication (44.4%), absent pulses (38.9%), were the common initial manifestation. Hypertension (61.5%), blood pressure discrepancy between arms (88.9%) and bruit (72.2%) over major vessels were common systemic features. As per angiographic classification, Type V (44.4%), and Type I (33.3%), were most common pattern of disease in the cohort. Subclavian artery (72.2%), renal artery (33.3%), iliofemoral arteries (27.8%), and coronary artery involvement (16.7%) were the common lesions. Coronary artery lesion was higher in females (p=0.52) while renal artery lesion in males (p=0.27). There was no statistically significant difference in involvement of vessels according to gender (p >0.05). Conclusion: Type V and Type I are the common pattern of TKA. Limb claudication was the most common initial manifestation. Renal artery involvement was seen more commonly in males while coronary artery involvement more commonly in females. [ABSTRACT FROM AUTHOR]

Background: Five million deaths per year in under-five children are reported to be due to preventable and treatable causes. IMCI strategy targets these causes through improvement in the case management skills of health care workers. The objectives of this study were to identify eligible clusters and identify & rectify any process, resources, and management-related issues for the main trial. Methods: This study was conducted in two phases. Phase 1 was conducted for eligibility of Basic Health Units from which sample can be drawn for the main cluster randomized control trial. A single-page proforma was sent to all 54 BHUs of Abbottabad through registered mail service and replies received were analysed through SPSS-V25 and MS Excel-2016. Afterward a sample of 26 BHUs was drawn for the definitive trial. In phase 2, four BHUs were conveniently selected from the remaining sampling frame; one in the control arm while three in the intervention arm. From each BHU, a health care worker responsible for under-five consultations was trained; control arm in standard IMCI while intervention arm on distance learning IMCI. Ten observations in the form of cases managed were assessed at each BHU by a gold standard IMCI master trainer after a specific period. Descriptive summary measures and 95% CI were calculated using SPSS-V25. Results: Out of 54 BHUs, 3 were nonrespondents while 36 were identified as an eligible sampling frame. The mean index of integrated assessment was found to be 0.90 and 0.89 for the control and intervention arm respectively. Discrepancies in filled forms were noted as 60% in control while 63.3% in intervention arm. Conclusion: Modifications in the plan for the maiin trial based on the findings of pilot study can ensure credibility and rigor in the definitive trial. [ABSTRACT FROM AUTHOR]

Background: Pulmonary valve stenosis (PS) is common congenital heart disease in children and patient can present with cyanosis, chest pain, dyspnea and failure with severe form. The objective of this study was to enlighten the short outcome of balloon pulmonary valvuloplasty in children with severe pulmonary stenosis. Methods: This cross sectional observational study was done in paediatric cardiology department of Lady Reading Hosptial, Peshawer form June 2019 to December 2020 over 1.5 years. Children aged 6 months to 16 years of either sex diagnosed as case of severe stenosis with doming pulmonary valve and having symptoms of chest pain and dysnea on exeration and pregradient pressure of 64 mm Hg or more on echocardiography were included. Patients were interviened with ballon-valvuloplasty. Outcome was taken as discharge from hospital with complications after procedure if any. Patients were followed up for 3 months. Data including age, sex, pre cath echocardiography, cath pulmonary valve annulus, post ballooning pulmonary valve (PV) gradient, PV gradient on echocardiography after intervention and follow up gradient on echocardiography at three months was documented. Data was analyzed by SPSS 20. Chi square test and paired T - Test was applied where required. Results were taken as significant with p value <0.05. Results: There were 51 patients, 35 (68.6%) male and 16 (31.4%) female. Mean age was 8.35±4.93 years. Mean pre cath gradient across the pulmonary valve on echocardiography was 109.14±31.44 mm Hg. Post intervention mean pressure gradient across PV was 32.41±11.49 mm Hg. Pulmonary valve annulus on echocardiography before intervention ranged from 7 to 25 mm with mean of 14.67±3.79 mm. There was no complication in majority (82.4%) of patients. Mild PR was in 5 (9.8%) patients. There was significant relationship between pre and post intervention pressure gradient across PV valve with p value of <0.001. Conclusion: Balloon pulmonary valvuloplasty in one of the safest intervention for PS in children with few complications. [ABSTRACT FROM AUTHOR]

Background: Eye involvement is a common and potentially devastating complication of various immune related rheumatic diseases. We aimed to determine the spectrum, associations and the impact of ocular manifestations among well characterised autoimmune rheumatic disease patients presenting to ophthalmology and rheumatology clinics in a tertiary care hospital in Lahore, Pakistan. Methods: Descriptive cross-sectional study performed in Rheumatology department of Fatima memorial hospital. Only those rheumatic disease patients were included who have been attending ophthalmology department for their ophthalmic conditions. The patients with ophthalmic symptoms who have not attended an ophthalmologist were not included in this study. Proforma was designed and the studied parameters were recorded prospectively from patient's interview and also by reviewing patient's medical and ophthalmologic medical records. Parameters assessed were demographics, symptoms and the diagnosis of eye disease, unilateral or bilateral presentation, duration of eye symptoms along with the duration of the primary rheumatologic disease, and the complications of the eye disease whether due to the eye diagnosis or its treatment. Results: Eighty-three consecutive patients with mean age 33±11 years, 67.5% being female were recruited. Spondylarthritis (SpA) comprised 38.6% (n=32) of patients followed by 21.7% (n=18) of Behcet's disease. Majority of patients (68.7%) had bilateral eye symptoms. In our cohort, 70% (n=58) of the patients had uveitis and almost all of these patients had either SpA or Behcet's disease as their primary rheumatologic diagnosis. Scleritis in 15.7% (n=13) patients followed by retinal vasculitis in 9.6% (n=8) patients, while glaucoma and keratopathy were present in 2.4% (n=2) patients each comprised other manifestations. Reassuringly our uveitis patients had no long-term eye related complications either due to the disease or its treatment. Conclusion: Uveitis represented the most common ophthalmologic manifestation associated with underlying rheumatologic diseases in our cohort, and it was associated with underlying Behcet's disease and SpA. Uveitis associated with connective tissue diseases has good prognosis with low-risk of significant long-term complications. Moreover, uveitis associated with SpA was noted to present much earlier in its disease course. [ABSTRACT FROM AUTHOR]

Background: Traumatic spinal cord injury is a debilitating condition that may cause long term disabilities with tremendous socioeconomic impact on affected individuals and their families. Secondary injuries can best prevent or minimized by appropriate pre hospital management and proper referral and transfer. This study was conducted to assess the clinical profile of traumatic spinal cord injuries and level of pre-hospital care provided to patients either at the site of injury or at other healthcare facilities. Methods: This prospective study was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad, from January 2012 to January 2017. All patients with suspected spinal injury were included in the study. Age, gender, mode of injuries and the pre-tertiary care provided were recorded. Results: Out of 4464 patients with suspected spinal cord injury, 3685 (82.5%) were male, 779 (17.4%) were female. Age ranged from 10-70 years. 1685 (37.8%) were diagnosed as having spinal injury. Cervical spine was the most common affected level 743 (44.09%), followed by thoracic spine 135 (8.01%). 1441 (85.5%) were incomplete while 224(14.5%) were complete spinal cord injuries. Road traffic accident was the most common mechanism of injury 884 (52.4%). Only 4 (0.23%) patients directly received in our unit were properly transported, 66 (3.91%) were brought after proper spinal immobilization, intravenous line was maintained in 584 (34.66%) patients, 410 (24.3%) patients received some fluid resuscitation, parenteral analgesia was given to 441 (26.17%) patients while urinary catheterization was done in 195 (11.75%) patients. Those received from other healthcare facilities only 4 (0.23%) were brought by properly equipped ambulance, intravenous access was maintained in 438 (25.99%),320 (18.99%) received some fluid resuscitation, urinary catheterization was done in 229(13.59%) while proper parenteral analgesia was given to 988 (58.63%) patients. Conclusion: There is a complete lack of proper transport and referral of trauma patients in our area which reflects almost non-existent emergency medical (rescue) services, deficient health care facilities. [ABSTRACT FROM AUTHOR]

Background: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)-ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. Methods: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. Results: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. Conclusion: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to estimate the effect of social distancing (days since the imposition of a lock-down) and the number of daily tests conducted per million population on the daily growth rate of COVID-19 cases. Methods: After excluding the first 30 days since the announcement of an index case in a country, relevant data for the next forty days was collected from four countries: Belgium, Italy, South Korea and United Kingdom. Two online databases: Our World in Data and worldometer were used for the collection of data which included the number of new COVID-19 cases and the number of tests conducted on a given day. The acquired figures were transformed into per million population of the given country. The growth rate of daily COVID-19 cases was derived and was used as the regress and in a multiple linear regression with the number of tests per million population per day and the number of days since a lock-down was imposed as the regressors. Results: It was found that the growth rate of daily COVID-19 cases decreased by .051% when the number of daily tests conducted per million population increased by 1. A .532% decrease in the growth rate of daily COVID-19 cases was observed with each passing day of a lock-down, which essentially represented the most effective form of social distancing. A significant regression was calculated (F (2, 155) = 35.191, p=.014), with an R2 of .054. Neither the daily number of tests conducted per million population nor the number of days of maintaining social distancing (lock-down) was individually significant contributors to the prediction of the growth rate of daily COVID-19 cases (p=.267 and p=.554 respectively). Conclusion: An extensive and rapid increase in the daily number of testing capacity and maintaining social distancing can decrease the growth rate of daily COVID-19 cases. Depending on the availability of the required resources, timely implementation of these measures can lead to better outcomes for a given population. [ABSTRACT FROM AUTHOR]

Background: Psychiatric co-morbidity is a frequent finding in patients with chronic liver disease (CLD). Patients with CLD may have anxiety, depression, sleep disturbances and behavioural disorders as well as cognitive defects. Therefore, this study was designed to determine the frequency of major depression in patients diagnosed with chronic liver disease Methods: This descriptive cross-sectional study was conducted at the department of gastroenterology Ayub Teaching Hospital Abbottabad from January-July 2017. One hundred and eleven patients diagnosed with chronic liver disease were included in the study using consecutive non-probability sampling technique. A detailed medical history was taken and physical exam was conducted before the patients were asked to answer a questionnaire (HADS-D). The answers were marked to obtain a final score. Quantitative variables like age, HADS-D score, and duration of CLD were described in terms of mean and standard deviation. Categorical variables like gender and depression were described in terms of frequencies and percentages. Stratification was done on age, duration of CLD and gender to see the effect modifiers. Chi-Square test was used at 5% significance level for determining statistically significant difference. Results: Out of 111 patients, 38 (34.2%) were found to have depression on the basis of their HADS-D score. When depression was stratified according to age, gender and duration of chronic liver disease, a strong statistical association was seen with duration of chronic liver disease and increased serum ALT levels (p<0.05). Conclusion: Depression is fairly common in patients with CLD and is significantly associated with the duration of CLD and derangement of liver enzymes. [ABSTRACT FROM AUTHOR]

Background: Due to poor oral hygiene and use of tobacco, dental discolorations are present in some people and may indicate presence of toxic substances in food or body, while some have anatomical faulty alignment of teeth. The objective of the study was to know the frequency of these discolorations and faulty dental alignment in the target population so that a forensic tool could be developed. Methods: A cross sectional descriptive study was done in the Dentistry Department of Ayub Teaching Hospital Abbottabad during the month of October 2019, on routine patients visiting the department, using non-probability convenience sampling. A Performa was made to be filled by dentists examining their patients using the standard dentition chart to locate teeth; notation chart was used for recording observations. The preliminaries along with subvariables were recorded in the Performa for each of 101 patients observed; data were analyzed by SPSS 20 for descriptive statistics. Results: Of 101 subjects examined, 54.5% were males and 45.5% females; the percentage of good, satisfactory, and bad hygiene among patients was 12.9%, 11.9%, and 75.2% respectively, with a significant difference of poor oral hygiene among males (p=0.034). Dental discoloration was present in 87.1% of patients, with a significant male dominated gender difference (p=0.038). Faulty alignment was present in 37.6%, as an independent variable. Conclusion: Dental discolorations and faulty alignment of teeth can be utilized as useful tools in exclusionary method of identification which can be used in living and dead for investigation of identification. It was also observed that there is need to emphasize on community dental hygiene in our hospitals. [ABSTRACT FROM AUTHOR]

Background: In addition to depression, acne has considerable negative effects on the quality of life (QOL) which is estimated to be equal to that reported by patients with other chronic diseases. The immense suffering of ace patients both terms of depression and deterioration in quality of life and subsequent compromised social, vocational and academic performance makes them seek professional help more often for non-cutaneous manifestations e.g., poor body image, anxiety, depression etc. This study was conducted to determine the prevalence of depression and status of quality of life in acne patients visiting outpatient dermatology. Methods: This was a cross-sectional study conducted in the outpatient dermatology department of Ayub Teaching Hospital, Abbottabad between January and August 2018. The 74 consecutive acne cases visiting the dermatology OPD during the study period between the ages of 13 and 30 years were assessed for depression and QOL. Data was collected by Dermatology life quality Index (DLQI) and Patient Health Questionnaire (PHQ 9). Results: The ages of acne patients ranged between 14 years to 28 years with a mean age of 21.6 ±3.034 years. Majority 49 of the acne patients (66.2%) were female. Mean DLQI was 59±5.38. Of the total, 9 (12.2%) acne patients had no effect on the quality of life, 23 (31.1%) had small effect, 23 (31.1%) had moderate effect, 18 (24.3%) had large effect and 1 (1.4%) had extremely large effect on their quality of life. Mean PHQ-9 scale score was 7.72±4.93. Six (8.1%) acne patients were categorized as having no depression, 17 (23%) had minimal depression, 25 (33.8%) were having mild depression, 18 (24.3%) were moderately depressed and patients with moderately severe depression constituted only 8 (10.8%) acne patients. Conclusion: Acne is associated with depression and deterioration in QOL, which are more pronounced in teens and women. [ABSTRACT FROM AUTHOR]

Background: With the rise of non-communicable diseases (NCDs) in a country that is already facing high tuberculosis (TB) burden, TB multi-morbidity is likely to pose a significant public health challenge in Pakistan. Data were analysed to determine the prevalence of TB and explore the distribution and determinants of multi-morbidity associated with TB in the population of Khyber Pakhtunkhwa -a province of Pakistan., Methods: This is a secondary analysis of data gathered as part of the KPIPHS survey conducted in 2016-17 in both the rural and urban areas of Khyber Pakhtunkhwa, Pakistan. An interviewer-administered questionnaire was used to collect data, from adults, on demographics, education and socioeconomic status, physical and mental health, reproductive health, child health, health-related quality of life, and self-reported cardiometabolic diseases including Diabetes, hypertension, renal disorders, cardiac failure, angina, and stroke., Results: A total of 20,715 participants were recruited in the survey including 52.8% (n=10,943) males and 47.2% (n=9,772) females with a mean age of 41 (13.1) years. Data on TB status was available for a total of 14452 participants. The prevalence of TB in Khyber Pakhtunkhwa was found to be 0.49% (n=72) including an almost equal number of males and females [48% (n=34) vs 51% (n=36)], respectively. The mean age of the patients with TB was 47.5 (11.6) years. A higher proportion of people with TB had cardiometabolic diseases compared to people without TB (45.9% vs. 30.9%). Amongst the cardiometabolic disorders, self-reported hypertension (OR: 1.81, 95% CI 1.08-3.02, p=0.02), Diabetes (OR: 3.99, 95% CI 1.95-8.18, p=<0.002), and angina (OR: 3.88 95% CI 1.20-12.49, p=0.02) were positively associated with the occurrence of TB. In the adjusted analysis, only self-reported Diabetes was positively associated with the occurrence of TB (OR: 3.33, 95% CI 1.61-6.88, p=0.001)., Conclusions: There is a higher burden of self-reported cardiometabolic diseases among people with TB, suggesting that this high-risk group should be screened for cardiometabolic diseases, especially Diabetes.

Background: Brucellosis is one of the prevalent zoonotic diseases worldwide. It not only adds to the global burden of disease but also has huge economic impact. Clinical features of human brucellosis are usually vague. This study was carried out to find out the frequency of brucellosis among patients presenting with nonspecific symptoms in hospital setting and to find out risk factors., Methods: Study was carried out in outpatient Medicine Department of Ayub Teaching Hospital Abbottabad for the period of 3 months. Patients presenting with nonspecific symptoms of fever, body aches, myalgias, arthralgia, headache, backache, malaise and insomnia of either gender between the ages of 18-60 years were included in the study through consecutive sampling technique. Blood Samples from patients were sent for screening Brucella antibodies by serum agglutination method. Antibodies were checked for both Brucella abortus and mellitensis., Results: total 70 patients were recruited in the study. Out of these 49 (70%) were found positive for Brucella. These positive Brucella patients were mostly 42 (85.71%) female and majority 35 (71.4%) were in the age group of 21-40 years. In both male and female patients' majority were positive for both species of Brucella. Nonspecific symptoms included Aches, Pains and Myalgia in all the patients with additional symptoms of Malaise in 13 (18.6%), headache 10 (14.3%) and insomnia and fever in 9 (12.9%) each. Majority of the enrolled patients 53 (75.71) gave negative history of using boiled/pasteurized milk in their daily consumption while 17 (24.3%) patients suggested use of boiled/pasteurized milk., Conclusions: A high frequency of human brucellosis was found among patients presenting with nonspecific symptoms, therefore it is recommended that such patients should be screened for brucellosis.

Background: Internet is a technology that was designed to facilitate research and official communication. According to Internet World Stats, there are 3.36 billion internet users in the world. The internet usage has increased by 832.5% in the world since 2005. In Pakistan there are 25 million active users using internet. It is a multi-dimensional behavioural disorder that manifest in various physical, psychological and social disorders and causes a number of functional and structural changes in brain with related various comorbidities. There is paucity of local researches on this topic but the access to internet and its use is enormous. This study was conducted to find the magnitude of internet addiction in medical students., Methods: It was a descriptive crosssectional study carried out in Ayub Medical College, Abbottabad. One hundred & forty-eight students were selected in the survey using stratified random sampling. The data was collected using academic and school competence scale and internet addiction diagnostic criteria., Results: In this study, 11 (7.86%) fulfilled the criteria for internet addiction. Most of the students 93 (66.3%) used internet to visit social media applications. Majority of the students 10 (90.9%), showed tolerance as major non-essential symptom of internet addiction. Internet addicts showed significant p=0.01 below average academic performance when compared to non-addicts. Internet addiction showed a significant p=0.03 gender association with internet addiction more prevalent in females than males (12.5% Vs 2.9%)., Conclusion: This study shows that excessive internet use leads to its addiction and is an entity of concern among medical students.

Background: Finger printing is an absolute method of identification. Recovery of finger prints from a crime scene is an important method of Forensic identification. Human finger prints are detailed, unique, difficult to alter, easily classifiable and durable over life making them stable and long-term tool of human identification., Methods: This cross-sectional study was conducted on 95,3rd year MBBS students of Ayub Medical College Abbottabad from December 2014 to August 2015 to establish the frequency of left hand thumb imprints by rolling and plain method., Results: Study shows Loops among most common finger print pattern in 55 (58%) students out of 95, followed by whorls 33 (35%), arches 5 (5%) and composite 2 (2%)., Conclusions: It is thus concluded that most common finger print pattern is loops followed by whorls, arches and composite.

Background: According to World Health Organization (WHO), six million deaths are attributable to tobacco use globally, of which nearly 1.2 million occur in South-East Asia. Use of smokeless tobacco is highly prevalent in subcontinent and is home to over 250 million smokeless tobacco (ST) users. ST is a major public health problem. It cause localized oral lesions and poses risk for developing oral cancers owing to it containing more than 30 cancer causing substances, in addition to nicotine which is a highly addictive. This study was conducted to assess the overall knowledge and compare knowledge, attitude and perceptions of ST users presenting to private and public health care facilities., Methods: This cross sectional comparative study was carried out from April to July 2011 to establish the details of underlying factors and perceptions of areca/ST users presenting in public and private health care facilities of Karachi. Through systematic random sampling, 464 male and female users (≥ 14 years) were interviewed. The data was analysed in SPSS-16., Results: Mean age of the users of Private Clinic (PC) was 25 ± 7.183 years while that of Public hospitals (PH) respondents was 34 ± 11.3 years. The respondents present in PC (94%) had comparatively more knowledge than the users in PH (75%). About 78% of the study population in PH wanted to quit this habit of chewing whereas 88% in PC have the same attitude (p-0.01). About 68% in Public and 89% in Private clinics ever tried to quit but failed; (p-0.000)., Conclusion: Although respondents have substantial knowledge about the harmful effects of smokeless tobacco but due to their perceived psychological and emotional dependency, they remain addicted.

Background: Acute flaccid paralysis (AFP) is clinical presentation marked by acute onset of weakness and reduced tone. Aetiologies of AFP are diverse including infectious agents, trauma or autoimmune reaction. Currently only three countries in the world that are Nigeria, Pakistan and Afghanistan have endemic poliomyelitis. Pakistan's polio crisis represents one of the last hurdles in a 23-year campaign run by the World Health Organization. Bannu due to its geographical location stands out to be one of highest risk areas for Poliomyelitis. The objective of this study was to determine frequency of AFP and their aetiologies in District of Bannu during time period of four years from 2007 to 2011., Methods: It was a cross-sectional descriptive study. Data was collected from EDO office District Bannu and analysed using Microsoft Excel 2007. Results: During this period there were 180 cases of AFP in district Bannu. 15% of cases were diagnosed as Guillian Barre Syndrome, making it the leading aetiology. Only 3 (1.66%) cases were diagnosed with Poliomyelitis. Out of 180 AFP cases 104 cases were male and 76 cases were female., Conclusion: Bannu needs enthusiastic educational and vaccination campaigns to eradicate Polio from the area and henceforth from the Pakistan.

Background: Peptic ulcer is a common ailment for which over production of gastric acid is the main cause. This study was undertaken to find out the effects of Calcium channel blocker Verapamil and Cimetidine on volume and acidity of Carbacol induced gastric section, free and total acidity of carbachol induced gastric secretion and their effects were also compared., Methods: Thirty rabbits of local breed weighing 1-1.5kg were used. The animals were kept on fasting for 48 hours after which the pylorus of each was ligated. Verapamil 10mg/kg, Cimetidine 2.5 mg/kg and Carbachol 600 microg/kg body weight were administered intrapertoneally in pylorus ligated rabbits., Results: It was found that Verapamil reduced the volume, free and total acidity of gastric secretion, which were statistically highly significant when compared with Carbachol (P<0.001). Cimetidine also had the same effects. when the difference of means values brought about by verapamil were compared with those of Cimetidine, all these differences were found statistically non significant, indicating that Verapamil has similar effect as that of Cimetidine on all parameters included in study., Conclusion: Verapamil has significant effect on volume and acidity of carbachol induced gastric secretion.