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Introduction: Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia. Aim: To study the extent to which the rates of brain volume loss in TIA patients differ from healthy controls and how they are correlated with cognitive impairment. Methods: TIA or minor stroke patients were tested with a neuropsychological battery and underwent T1 weighted volumetric magnetic resonance imaging scans at fixed intervals over a 3 years period. Linear mixed effects regression models were used to compare brain atrophy rates between groups, and to determine the relationship between atrophy rates and cognitive function in TIA and minor stroke patients. Results: Whole brain atrophy rates were calculated for the TIA and minor stroke patients; n = 38 between 24 h and 18 months, and n = 68 participants between 18 and 36 months, and were compared to healthy controls. TIA and minor stroke patients demonstrated a significantly higher whole brain atrophy rate than healthy controls over a 3 years interval (p = 0.043). Diabetes (p = 0.012) independently predicted higher atrophy rate across groups. There was a relationship between higher rates of brain atrophy and processing speed (composite P = 0.047 and digit symbol coding P = 0.02), but there was no relationship with brain atrophy rates and memory or executive composite scores or individual cognitive tests for language (Boston naming, memory recall, verbal fluency or Trails A or B score). Conclusion: TIA and minor stroke patients experience a significantly higher rate of whole brain atrophy. In this cohort of TIA and minor stroke patients changes in brain volume over time precede cognitive decline.

In the last decade, the number of children with nephrolithiasis increased to 50 cases per 100,000. Percutaneous nephrolithotomy (PNCL) has been shown to be a successful treatment. However, standard PCNL has resulted in a number of problems, in pediatric patients, because to the large nephroscope and amplatz size of 24-30 F. Aim of this systematic review was to compare available literature of Mini PCNL and Standard PCNL to assess efficacy and Stone free rates (SFR) in pediatric population. In this systematic review and meta-analysis investigating the effect of different amplatz sheath sizes for percutaneous nephrolithotomy (PCNL) in pediatric population. Our report follows the PRISMA protocol. A methodical search was conducted using multiple databases of research-based literature including PubMed, Cochrane, Google Scholar, and Web of Sciences. Statistical Package for Social Sciences (SPSS) version 22 and STRATA were used to sort, analyze, and present data graphically. Stone free rates were reportedly higher in standard PCNL in three (3/6) studies with 93.7% / 91.7%, 83.4% / 74.9% and 94.7% / 89.5% while all other studies reported mini PCNL SFR higher than Standard PCNL with 75.8% / 71.4%, 90.5% / 85.7 and 87.9% / 59.1% respectively. Multivariate analysis was reported in only 1 study with coefficient of 0.079 and 95% CI as 0.944 - 1.241 (Lower - Upper). When it comes to managing both simple and difficult renal calculi in children, mini-PCNL is just as safe and successful as SPCNL, with similar operational times, SFRs, and total problems. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical response of EMLA cream (Eutectic Mixture of Local Anaesthetics; 2.5% Lidocaine/2.5% Prilocaine) in decreasing peripheral cannulation pain in children. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from May to Aug 2021. Methodology: This study was conducted on 80 paediatric patients who were classified as American Society of Anesthesiologists (ASA) Grades I and I and selected using non-probability consecutive sample. They underwent peripheral cannulation to maintain intravascular access for surgical procedure. The forty children in EMLA Group (Group-A) were applied 2.5 ml EMLA cream for 60 min, covered by Tegaderm® over suitable vein, while the 40 children in Control Group (Group-B) received no local anesthetic cream. Participants rated pain during venipuncture on Visual Analog Scale (VAS 0-10; 0, no pain; 10, intolerable pain). Results: Out of 80 patients equaly divided into two groups, 40(50%) were males, while 40(50%) were females. The patients included in our study had mean age of 7.35±1.5 years. In EMLA group the mean score of pain was 1.5±0.87 compared to the Control group (mean score = 7.4±1.4; p=0.001). Conclusion: The result of our study suggests that EMLA cream is more efficacious in decreasing venipuncture pain than if no local anaesthetic cream is applied. [ABSTRACT FROM AUTHOR]

Background: Maternal and neonatal health has always been a point of concern for policymakers in Pakistan, understanding all determinants resulting in adverse maternal or fetal outcomes is an essential point to eliminating risk factors and establishing better opportunities for survival for mothers and newborns. This study aims to evaluate the association of psychological wellbeing with pregnancy outcomes, and maternal and neonatal health in the Pakistani population. Objective: To assess the psychological wellbeing in pregnant females and its association with pregnancy outcomes, maternal and neonatal health in Pakistani population. Methods: This is a prospective, cohort study conducted at private antenatal care centers of Karachi from January 2022 till March 2023, the estimated sample size was 384. Kupposwami scale for socio-economic status, psychological assessment Wellbeing in pregnancy questionnaire and satisfaction With Life Scale (SWLS) were used to assess psychological wellbeing during pregnancy. Cross-tabulation and Paired sample t-test was used along with chi-square test, keeping the p-value = 0.05 as significant. Results: The mean results of the SWL score indicated minimal satisfaction with life with a 12.9 ± 8.1 mean value. Pre-term labor was reported in 37 (9.6%) and maternal mortality was reported in 9 (2.3%). low birth weight (<1500) was reported in 11 (2.8%) while small for gestational age was reported in 19 (4.9%), neonatal mortality was reported in 15(3.9%). Conclusion: This study concludes that maternal mental health distress is independent risk factor for low birth weight, and preterm deliveries. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Lignocaine and Dexmedetomidine in minimizing the hemodynamic stress response associated with laryngoscopy and endotracheal intubation. Study Design: quasi-experimental study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, Pakistan, from Jul 2020 to Feb 2021. Methodology: A total of 60 patients, aged 18-55 years were included in this study. They were randomly allocated to one of two groups. Group-L received intravenous Lignocaine, 1.5 mg/kg. Group-D received Dexmedetomidine 1 µg/kg as intravenous infusion 10 minutes before induction. Heart rate and mean arterial pressure were monitored at basal, pre-induction, induction, laryngoscopy and intubation and 1, 3, 5 and 10 minutes afterwards. Results: Significantly reduced stress response was seen in Group-D as compared to Group-L. A lesser increase in heart rate was observed during intubation as compared to basal level in Group-D (14.14%) while it was 37.66% in Group-L. MAP was also seen to be less increased in Group-D (1.07 %) as compared to Group-L (22.6%). Conclusion: Dexmedetomidine, when infused at a dose of 1 mcg/kg over 10 min prior to intubation, attenuates the hemodynamic stress response more efficiently, in comparison to 1.5 mg/kg of Lignocaine infusion. [ABSTRACT FROM AUTHOR]

SOCIO-ECONOMIC DETERMINANTS OF DIVORCE: REGIONAL Objective: To investigate whether extreme of body mass index (BMI) is associated with pregnancy outcomes. Study Design: Retrospective cohort study. Place and Duration of Study: Hamdard University Hospital, Karachi, Pakistan, from Feb 2019 to Jan 2020. Methodology: We conducted a retrospective cohort study of 1000 women delivered in between February 2019 to January 2020. BMI is categorized into four groups according to the Asian-Pacific cutoff points as underweight (<18.5 kg/m²), normal weight (18.5-22.9 kg/m²), overweight (23-24.9 kg/m²), and obese (>25 kg/m²). Maternal outcomes measured were pre-eclampsia, gestational diabetes, delivery by cesarean section, instrumental delivery, anemia, postpartum hemorrhage and fetal outcome included small for gestational age and large for gestational age. Logistic regression model was used to adjust the confounder. Maternal outcomes were evaluated with relative risks and 95% confidence intervals. Results: In results, 13%, 54%, 22%, 9% and 2% were underweight, normal body mass index, overweight, obese and morbidly obese categories respectively. The gestational diabetes, pre-eclampsia, labour induction, frequency of cesarean section, postpartum hemorrhage increased linearly with increasing body mass index and expressed as adjusted odds ratio (95% confidence interval) respectively: 10.0 (95% CI 3.5, 28.7), 5.3 (95% CI 2.0, 14.1), 2.7 (95% CI 1.1, 6.8), 4.9 (95% CI 2.8-8.8), 2.5 (95% CI 0.31- 20.6). The anemia and small for gestational age were found in underweight group with adjusted odd ratio2.47 (95% CI 1.6- 3.6), 4.6 (95% CI 2.6, 8.1) respectively. Conclusion: Obese women are more prone to have maternal and fetal complication which includes preeclampsia, gestational diabetes, caesarean section rate, labor induction and macrosomic babies. Underweight women are not risk free for complication as they are associated with anemia and small for gestational age. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the difference in microflora produced by banded and bonded orthodontic attachments. Study Design: Comparative cross sectional study. Place and Duration of Study: Orthodontics department, Armed Forces Institute of Dentistry, Rawalpindi, from May 2017 to Jul 2018. Methodology: Bacterial samples from 162 sites (premolar brackets and bands) were collected in patients undergoing fixed orthodontic therapy at T1 and T2. These samples were evaluated for various periodonto pathogenic organisms. Results: Eighty four patients (162 teeth) with 37 (44%) males and 47 (55.9%) females were inducted into the study. Bacterial growth (log CFU/mg) in plaque samples from first premolars with orthodontic bands and brackets was 6.60 (SD ± 6.3) and 6.98 (SD ± 7.0) (p=0.03). The proportion of facultative anaerobes from molars with orthodontic bands and brackets were 81.3% and 75.3%. There is a statistically significant (p=0.02) difference in microflora in plaque samples around different types of orthodontic attachments such as bands and brackets. Conclusion: There was a significant difference of microbiota associated with different orthodontic armamentarium. Banded attachments showed more affinity for cariogenic bacteria whereas periodontal pathogens more frequently colonizes the plaque associated with orthodontic brackets. [ABSTRACT FROM AUTHOR]

End of Life decision-making, in pediatrics is critical, imparting a great burden of responsibility on those involved in the process. The decision-making is multidimensional. Pediatricians encounter many ethical concerns during this process. Qualitative, phenomenological research based on in- depth interviews of 12 pediatricians from three tertiary care hospitals of Karachi, Pakistan. Data was analyzed using Nvivo 9 software. Six themes were identified, a) Major factors are clinical information and available resource; b) It is clinically and psychologically challenging; c) Participation of parents is influenced by emotional, socio-economic and religious factors; d) Communication is the most crucial aspect of conflict resolution; e) Institutional policies and expert opinions guide pediatricians f) Clinical Ethics consultation is underutilized in Pakistan. The parents and pediatricians are responsible for decisions aligned to the best interest of children. The role of Pediatricians is critical as they look for the best possible ways to provide care through limited healthcare resources. Parents generally base their views on social and spiritual values. We recommend that healthcare organizations [ABSTRACT FROM AUTHOR]

Objective: To compare Tanaka-Johnston Mixed Dentition Analyses, Melgaco’s Formula and Bherwani’s Regression Equation in predicting the widths of mandibular canine and premolars, in a population presenting to AFID. Study Design: Cross-sectional Analytical Study. Place and Duration of Study: Department of Orthodontics, Armed Forces Institute of Dentistry Rawalpindi, from Aug 2018 to Jul 2019. Methodology: According to selection criteria, 200 subjects presenting to AFID were selected through nonprobability consecutive method. Study models were poured and mesiodistal widths of mandibular incisors, canines, premolars and molars were measured. The results were compared with predicted width values obtained from Tanaka Johnston Analysis, Melgaco Formula, and Bherwani’s Regression Equations and analyzed using paired sample t tests. Results: There was a significant difference between actual and predicted widths of lower canines and premolars for all three methods; Tanaka Jhonston Analysis (p<0.001), Melgaco’s Formula (p<0.001) and Bherwani’s Regression Equation (p<0.001), although values predicted by Bherwani’s Equation were closest to the actual widths. There existed a mean discrepancy of 0.37 mm among tooth widths between both the genders which was statistically significant with a p-value of <0.001. Conclusion: Tanaka Johnston Analysis, Melgaco’s Formula and Bherwani’s Regression Equation did not accurately predict for our sample although Bherwani’s Regression Equation was closest in predicting the actual tooth widths. Sexual dimorphism was established in our sample population as there existed a mean discrepancy of 0.37mm for tooth widths among both the genders. [ABSTRACT FROM AUTHOR]

Objective: To compare upper airway volume, lower airway volume and total airway volume between the Class II Division 1 and Class II Division 2 individuals, using Cone Beam Computed Tomography scans. Study Design: Cross-sectional analytical study. Place and Duration of Study: Orthodontics department, Armed Forces Institute of Dentistry, Rawalpindi, from Jan 2017 to Dec 2018. Methodology: It was a cross-sectional study in which a comparison between upper airway volume, lower airway volume and total airway volume was drawn between the Class II Division 1 and Class II Division 2 individuals, using Cone Beam Computed Tomography scans. Independent sample t test was applied for testing the statistical significance between mean scores of the groups. Results: Results suggested that difference among upper and lower airway volumes among the two groups was statistically significant. Upper airway in Division 1 group was 8870.02 ± 454.53mm3 as compared Division II 9402.00 ± 80.76 mm3, with a p-value of 0.04 and lower airway in Division 1 group was 8368.35 ± 41.18mm3 as compared Division II, 8773.52 ± 185.847mm3, with a p-value of 0.04. Whereas total airway volume showed an insignificant difference with Division I having a total volume of 8368.35 ± 412.18 mm3 and Division II, 8773.52 ± 185.85 mm3 with a p-value of 0.75. Conclusion: Class II generally has lesser airway volumes as compared to other facial forms. Among class II, Division 2 profile has greater values of upper and lower airway volumes when compared to Division and total airway volumes are not statistically different among Division 1 and 2. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean rate of canine retraction on round and rectangular stainless steel arch wires. Study Design: Quasi experimental study. Place and Duration of Study: Orthodontics department, Armed Forces Institute of Dentistry, Rawalpindi, from May 2017 to Jul 2018. Methodology: Forty patients were inducted requiring fixed orthodontic therapy with first premolar extractions. After initial alignment and premolar extractions, canine retraction was initiated on customized arch wires having a round wire segment on one side and a rectangular wire segment on another. The distance between lateral incisor and canine were measured before starting retraction and 1-month post. Difference between the two measurements was recorded and data was analyzed using IBM SPSS 21.0 and paired sample t-test was applied. Results: Forty patients (80 teeth) with 21 males (52.5%) and 19 females (47.5%) were included. The mean rate of maxillary tooth movement observed on the experimental side was 0.51 ± 0.1549 mm over a period of one month. Whereas, on the control side 0.20 ± 0.1086 mm movement was recorded. There was a difference of 0.31 ± 0.2036 mm per month in the rate of space closure between the two sides (p=0.01). Conclusion: Mean rate of canine retraction was significantly greater in round wire segment as compared to the rectangular wire segment. [ABSTRACT FROM AUTHOR]

Objective: This study compared the positional changes in mandibular condyle before and after treatment with functional appliances. Study Design: Comparative, cross sectional study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Dec 2016 to Dec 2018. Methodology: In this study patients opting for orthodontic treatment in Armed Forces Institute of Dentistry (AFID) and falling on our inclusion criteria were selected and were compared for pre and post treatment positional changes of condyle associated with twin block/bionator therapy, by comparing lateral cephalometric changes. Results: Age range was 11 years to 15 years, with mean of 12.02 ± 1.05. Changes in condyle position with respect to midface were found to be significant with a mean of 2.20 ± 2.97, p<0.001 between pre and post treatment values. Changes in condyle position with respect to anterior cranial base were also significant reported by a mean pre and post treatment difference of 2.09 ± 1.23, p<0.001. Orientation of long axis of condyle with posterior cranial base was also significantly changed with a mean difference of 5.11 ± 4.19, p<0.001. Conclusion: Condyle was displaced posteriorly with respect to anterior cranial base as well as midface. Vis-à-vis the orientation of long axis of mandibular condyle, it attains a more upright position post treatment, with respect to cranial base. [ABSTRACT FROM AUTHOR]

Objective: To determine IV Ondansetron efficacy in preventing post-spinal shivering during LSCS. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Mar 2019. Methodology: A total of 60 women undergoing LSCS under spinal anaesthesia were included. Group-A was given 8 mg/4 ml Ondansetron, while Group-B was given 4 ml Normal Saline 0.9% IV immediately before induction of spinal anaesthesia. Body temperature, level of sensory block, and shivering scores during the peri-operative period were recorded. After surgery, patients were shifted to Post Anaesthesia Care Unit (PACU). Shivering was graded using Crossley and Mahajan 5-item scale. Injection Tramadol 1mg/kg intravenously was used as a rescue anti-shivering drug. Results: The majority of the patients 33(55.0%) were between 18-25 years of age. Efficacy of Intravenous Ondansetron in preventing post-operative shivering during spinal anaesthesia in patients undergoing caesarean section was seen in 26 86(67%) patients (Group-A) as compared to 17(56.67%) patients in the Control Group (Group-B) (p-value=0.010). Conclusion: The study concluded that there was less post-operative shivering with intravenous Ondansetron during spinal anaesthesia in patients undergoing caesarean section as compared to the Control Group. [ABSTRACT FROM AUTHOR]

The objective of our study was to evaluate the efficacy of Master Lithoclast, also known as trilogy lithoclast, in simultaneous bilateral Percutaneous Nephrolithotomy (PCNL). The study was a prospective case series, involving 40 patients undergoing bilateral simultaneous PCNL, with 20 (50%) males and 20 (50%) females. The mean age of subjects was 32.9±7.9 years. In Guy's stone scoring 7(17.5%) patients classified in Group I, 28 (70%) in group II and the remaining 5(12.5%) patients were placed in group III. Total operative time observed was 74.8±17.9 minutes. Complete stone clearance was observed in 30 (75%) patients. In conclusion, study data confirmed that Master Lithoclast provides faster stone clearance and is unaffected by the composition of stones, ease of usability, and improved tissue safety with reduced chances of fragments blocking are key factors.

Objective: To evaluate unhealthy and healthy food consumption and their association with perceived stress in teenagers., Methods: The cross-sectional study was conducted from February to April 2017 at five educational institutions in Faisalabad, Pakistan, and comprised individuals of either gender aged 13-19 years. Dietary habits were recorded on a proforma and perceived stress scores were calculated using Cohen's perceived stress scale. Multiple regression analysis was used to predict perceived stress scores., Results: Of the226 subjects, 96(42.5%) were males and 130(57.5%) were females. The frequency of consumption per week of sweet snacks, fried foods, soft drinks, sports drinks, energy drinks and vegetables was significantly more in males compared to the females (p<0.05 each). The consumption of such unhealthy food had significant positive relationship with perceived stress scores, while consumption of healthy food, like fresh fruits and vegetables, had a significant negative relationship with it in males only (p<0.05 each). Perceived stress score was primarily predicted by higher consumption of sports drinks (p<0.05) and lower consumption of fresh fruits (p<0.05)., Conclusions: Increased consumption of unhealthy food items and low intake of healthy food could lead to stress in young individuals, especially in males.

Introduction: Patients with transient ischemic attack (TIA) and minor stroke demonstrate cognitive impairment, and a four-fold risk of late-life dementia. Aim: To study the extent to which the rates of brain volume loss in TIA patients differ from healthy controls and how they are correlated with cognitive impairment. Methods: TIA or minor stroke patients were tested with a neuropsychological battery and underwent T1 weighted volumetric magnetic resonance imaging scans at fixed intervals over a 3 years period. Linear mixed effects regression models were used to compare brain atrophy rates between groups, and to determine the relationship between atrophy rates and cognitive function in TIA and minor stroke patients. Results: Whole brain atrophy rates were calculated for the TIA and minor stroke patients; n = 38 between 24 h and 18 months, and n = 68 participants between 18 and 36 months, and were compared to healthy controls. TIA and minor stroke patients demonstrated a significantly higher whole brain atrophy rate than healthy controls over a 3 years interval ( p = 0.043). Diabetes ( p = 0.012) independently predicted higher atrophy rate across groups. There was a relationship between higher rates of brain atrophy and processing speed (composite P = 0.047 and digit symbol coding P = 0.02), but there was no relationship with brain atrophy rates and memory or executive composite scores or individual cognitive tests for language (Boston naming, memory recall, verbal fluency or Trails A or B score). Conclusion: TIA and minor stroke patients experience a significantly higher rate of whole brain atrophy. In this cohort of TIA and minor stroke patients changes in brain volume over time precede cognitive decline.