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Abstract Machine learning has emerged as a leading field in artificial intelligence, demonstrating expert-level performance in various domains. Astronomy has benefited from machine learning techniques, particularly in classifying and identifying stars based on their features. This study focuses on the spectra-based classification of 11,408 B-type and 2422 hot subdwarf stars. The study employs baseline correction using Asymmetric Least Squares (ALS) to enhance classification accuracy. It applies the Pan-Core concept to identify 500 unique patterns or ranges for both types of stars. These patterns are the foundation for creating Support Vector Machine (SVM) models, including the linear (L-SVM), polynomial (P-SVM), and radial basis (R-SVM) kernels. Parameter tuning for the SVM models is achieved through cross-validation. Evaluation of the SVM models on test data reveals that the linear kernel SVM achieves the highest accuracy (87.0%), surpassing the polynomial kernel SVM (84.1%) and radial kernel SVM (80.1%). The average calibrated accuracy falls within the range of 90–95%. These results demonstrate the potential of using spectrum-based classification to aid astronomers in improving and expanding their understanding of stars, with a specific focus on the identification of hot subdwarf stars. This study presents a valuable investigation for astronomers, as it enables the classification of stars based on their spectra, leveraging machine learning techniques to enhance their knowledge and insights in astronomy.

Abstract Mixture distributions are naturally extra attractive to model the heterogeneous environment of processes in reliability analysis than simple probability models. This focus of the study is to develop and Bayesian inference on the 3-component mixture of power distributions. Under symmetric and asymmetric loss functions, the Bayes estimators and posterior risk using priors are derived. The presentation of Bayes estimators for various sample sizes and test termination time (a fact of time after that test is terminated) is examined in this article. To assess the performance of Bayes estimators in terms of posterior risks, a Monte Carlo simulation along with real data study is presented.

Background: The outcome for this neurosurgical problem is still far from set target in many developing countries like Pakistan. Major proportion of cases presenting with EDH in hospital still has poor outcome. This poor outcome of EDH is attributed to many factors including weak health systems of most developing countries. Objective of study was to analyze factors influencing outcome among patients of head injury with an extradural hematoma before surgery admitted in neurosurgery department of Dera Ghazi Khan Medical College, Dera Ghazi Khan. Materials and Methods: This cross-sectional analytical study was conducted in neurosurgery department of Dera Ghazi Khan Medical College from January 2019 to December 2019 after ethical approval. All the patients with extradural hematoma of either gender admitted in the department during the study duration in which surgery was performed to evacuate extradural hematoma were included in the study. Data was collected by using preformed, pretested questionnaire. A vital signs and Glasgow coma scale record was maintained at thirty minutes interval. Computerized tomography was done in every patient. The EDH volume was calculated by using Peterson and Epperson equation a x b x c x 0.5. Data was entered and analyzed by using SPSS version 22. Chi square test was applied to observe any statistically significant difference between various strata if existed and p value

Objective: To investigate the relationship between immature platelet fraction and poor short-term prognosis in dengue fever patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pakistan Air Force Hospital, Islamabad Pakistan, from Oct to Dec 2022. Methodology: In this study, a total of 300 cases had a confirmed diagnosis of dengue fever and were admitted to the hospital. An immature platelet fraction was performed on all the patients on the fifth day of febrile illness. All the patients were monitored closely by the treating team at 24, 48, and 72 hours for the presence of thrombocytopenia on the complete blood picture or other clinical complications of dengue fever. Results: In the study, the median age of patients with dengue fever was 36(IQR-42) years. Out of 350 patients, 239(68.2%) were males, while 111(31.8%) were females. 282(80.5%) patients had a good prognosis, while 68(19.5%) did not have a good prognosis and showed clinical or haematological manifestations. On the fifth day of illness, 279(79.7%) had an IPF of >10%, whereas 71(20.3%) had an IPF of

BACKGROUND & OBJECTIVE: Lectures are still the most appropriate and practical way of conveying knowledge in available limited resources but their effectiveness is very debatable. The pause procedure is a strategy that uses strategic pauses in a lecture to help students overcome this problem. The objective of this study was to analyze the effectiveness of pausing to enhance learning during lectures in medical colleges. METHODOLOGY: After institutional permission # 48.ERC/FMU/2023-24.384, this comparative cross-sectional study was conducted on fourth-year MBBS students (the whole Batch was involved, which comes to the urology ward) in a public sector medical institution. The technique of taking a clarification pause during the long sessions (equal to or more than 45 minutes) was utilized and feedback was taken. RESULTS: Student satisfaction was described by 75% of students in Method-A (taught with pausing technique) and 48% of the students in Method-B (taught without pausing) (p=0.018). Maintaining the attention span till the end of the lecture was described by 74% of Method-A and 34% of Method-B students (p≤0.001). Clarity of the topic was described by 82% with A and 51 % with B students(p≤0.001). The mean MCQ score of the students group after method A was 62% and 52% with B. CONCLUSION: The pause procedure is an effective methodology to improve learning and academic performance in undergraduate medical students without causing any added burden.

Abstract Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies/departments in Pakistan. Health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to emergencies. We conducted an assessment of public health emergency response coordination implemented during the COVID-19 at strategic level. This was mix-method qualitative study. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment. The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies. Effective public health emergency response is based on multi-departmental coordination, resource mobilization, and clear roles for each agency. Pakistan must proactively address these challenges for pandemic response in future.

The authors would like to make the following correction to this published paper [...]

Objective: To assess the presence of Thrombocytopenia among the neonates born to mothers having pregnancy-induced hypertension and associated socio-demographic factors. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr to Jun 2021. Methodology: This study was conducted on neonates who were born to mothers who were diagnosed and managed with pregnancy-induced hypertension. Thrombocytopenia was defined as a platelet count of

Objective: To compare the effect of pre-mixed human insulin with insulin analogue in diabetic control among type-2 Diabetes mellitus patients at tertiary care hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from Jun 2021 to Apr 2022. Methodology: Eleven hundred and fifty-six patients with poorly controlled type-2 diabetes on oral hypoglycemic agents requiring insulin were recruited for the study. Patients were divided into two groups via a lottery method. Group-A received the pre-mixed human insulin, while Group-B received the Insulin analogue advised by the consultant endocrinologist or medical specialist according to the requirements based on recent investigations. Diabetes control was compared in both groups at the end of twelve weeks of treatment. Results: Out of 1156 patients with type-2 diabetes mellitus included in the study, 810(70.1%) were male, while 346(29.9%) were female. The mean duration of DM in the study participants was 3.42±4.44 years. At the end of three months, 978(84.6%) patients had good glycemic control, while 178(15.4%) patients had poor glycemic control. Statistical analysis revealed that the type of insulin used to manage these patients had no significant relationship with glycemic control in our study participants (p-value>0.05). Conclusion: No statistically significant difference was observed in the number of patients achieving adequate glycemic control between those using pre-mixed human insulin and those using insulin analogue in our study.

Abstract The acquired drug resistance by Mycobacterium tuberculosis (M. tuberculosis) to antibiotics urges the need for developing novel anti-M. tuberculosis drugs that possess novel mechanism of action. Since traditional drug discovery is a labor-intensive and costly process, computer aided drug design is highly appreciated tool as it speeds up and lower the cost of drug development process. Herein, Asinex antibacterial compounds were virtually screened against thioesterase domain of Polyketide synthase 13, a unique enzyme that forms α-alkyl β-ketoesters as a direct precursor of mycolic acids which are essential components of the lipid-rich cell wall of M. tuberculosis. The study identified three drug-like compounds as the most promising leads; BBB_26582140, BBD_30878599 and BBC_29956160 with binding energy value of − 11.25 kcal/mol, − 9.87 kcal/mol and − 9.33 kcal/mol, respectively. The control molecule binding energy score is -9.25 kcal/mol. Also, the docked complexes were dynamically stable with maximum root mean square deviation (RMSD) value of 3 Å. Similarly, the MM-GB\PBSA method revealed highly stable complexes with mean energy values

Abstract Coccidiosis causes huge economic losses worldwide. Current study evaluated the effect of biosynthesized Zinc oxide nanoparticles (ZnONPs) using Nigella sativa, on Eimeria tenella infected broilers. Scanning electron microscopy showed spherical ZnONPs with 50–100 nm diameter, Fourier transforms infrared spectroscopy revealed the functional groups involved in the reduction of zinc acetate dihydrate to ZnONPs, UV–vis spectroscopy showed a peak at 354 nm, and Zeta potential exhibited stability at − 30 mV. A total of 150, a day-old broiler chicks were divided into 5 equal groups. Control negative: uninfected and untreated; Control positive: Infected and untreated; 3rd, 4th and 5th group were infected orally with 5 × 104 sporulated oocysts of Eimeria tenella and treated with 60 mg/kg ZnONPs, 1% Nigella sativa seeds and amprolium 125 ppm, respectively. ZnONPs significantly (p

Objective: To determine the abnormal anthropometric findings among children diagnosed with and managed for transfusiondependent beta-thalassemia major. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatric Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2019 to Aug 2020. Methodology: This study involved 310 children of both genders aged 2 to 18 years presenting with beta-thalassemia Major receiving multiple blood transfusions. Anthropometric findings, including height and weight for age, were measured and plotted via World Health Organization-2007 growth charts in all the study participants. Relevant socio-demographic variables, including serum ferritin, were correlated with abnormal anthropometric findings among these children. Results: The mean age of the patients was 8.87±7.42 years. 170(54.8%) male and 140(45.2%) female patients were in the study group. Most of the children [218 (70.3%)] had any abnormal an-thropometric findings, either weight or height for age, while 92 (29.7%) had no anthropometric abnormality. Majority of the patients [198 (63.8%)] patients had stunted growth, while 170 (54.8%) were underweight. Longer duration of transfusion and raised serum ferritin levels had a statistically significant correlation with any anthropometric abnormality among the beta-thalassemia major patients (p-value

Amblyopia is a common developmental disability resulting in reduced visual acuity and gaze stability; it occurs in approximately 5% of the general population. Here, we present the case of an 18-year-old girl diagnosed with amblyopia. Subsequent to her diagnosis of amblyopia, she developed a depressive episode with co-morbid anxiety symptoms. She was treated with low intensity psychological intervention, Problem Management Plus, as home-based intervention. This intervention was associated both subjectively and objectively utilising psychometric measures (i.e. psychiatric interview, depression, anxiety and stress scale, general health questionnaire) with a significant amelioration of her mental state. This case provides preliminary evidence for the effectiveness of Problem Management Plus intervention and suggests that this intervention should be considered for other individuals with similar clinical presentations. Keywords: Disability, amblyopia, low vision, Patient Management Plus.

Haemophilus influenzae is a Gram-negative bacterium characterized as a small, nonmotile, facultative anaerobic coccobacillus. It is a common cause of a variety of invasive and non-invasive infections. Among six serotypes (a–f), H. influenzae type b (Hib) is the most familiar and predominant mostly in children and immunocompromised individuals. Following Hib vaccination, infections due to other serotypes have increased in number, and currently, there is no suitable effective vaccine to induce cross-strain protective antibody responses. The current study was aimed to validate the capability of two 20-mer highly conserved synthetic tbp1 (transferrin-binding protein 1) peptide-based vaccine candidates (tbp1-E1 and tbp1-E2) predicted using in silico approaches to induce immune responses against H. influenzae strains. Cytokine induction ability, immune simulations, and molecular dynamics (MD) simulations were performed to confirm the candidacy of epitopic docked complexes. Synthetic peptide vaccine formulations in combination with two different adjuvants, BGs (Bacterial Ghosts) and CFA/IFA (complete/incomplete Freund’s adjuvant), were used in BALB/c mouse groups in three booster shots at two-week intervals. An indirect ELISA was performed to determine endpoint antibody titers using the Student’s t-distribution method. The results revealed that the synergistic use of both peptides in combination with BG adjuvants produced better results. Significant differences in absorbance values were observed in comparison to the rest of the peptide–adjuvant combinations. The findings of this study indicate that these tbp1 peptide-based vaccine candidates may present a preliminary set of peptides for the development of an effective cross-strain vaccine against H. influenzae in the future due to their highly conserved nature.

Abstract The Rift Valley fever virus (RVFV) is a zoonotic arbovirus and pathogenic to both humans and animals. Currently, no proven effective RVFV drugs or licensed vaccine are available for human or animal use. Hence, there is an urgent need to develop effective treatment options to control this viral infection. RVFV glycoprotein N (GN), glycoprotein C (GC), and nucleocapsid (N) proteins are attractive antiviral drug targets due to their critical roles in RVFV replication. In present study, an integrated docking-based virtual screening of more than 6000 phytochemicals with known antiviral activities against these conserved RVFV proteins was conducted. The top five hit compounds, calyxin C, calyxin D, calyxin J, gericudranins A, and blepharocalyxin C displayed optimal binding against all three target proteins. Moreover, multiple parameters from the molecular dynamics (MD) simulations and MM/GBSA analysis confirmed the stability of protein–ligand complexes and revealed that these compounds may act as potential pan-inhibitors of RVFV replication. Our computational analyses may contribute toward the development of promising effective drugs against RVFV infection.

Abstract Tuberculosis, caused by Mycobacterium tuberculosis, is a high-burden disease in Pakistan, with multi-drug (MDR) and extensive-drug (XDR) resistance, complicating infection control. Whole genome sequencing (WGS) of M. tuberculosis is being used to infer lineages (strain-types), drug resistance mutations, and transmission patterns—all informing infection control and clinical decision making. Here we analyse WGS data on 535 M. tuberculosis isolates sourced across Pakistan between years 2003 and 2020, to understand the circulating strain-types and mutations related to 12 anti-TB drugs, as well as identify transmission clusters. Most isolates belonged to lineage 3 (n = 397; 74.2%) strain-types, and were MDR (n = 328; 61.3%) and (pre-)XDR (n = 113; 21.1%). By inferring close genomic relatedness between isolates (

Objective: to determine the cases brought to the Otolaryngology Department with adenoidal hyperplasia. Study Design: Cross-sectional study. Place and Duration of Study: ENT Department, Combined Military Hospital, Multan Pakistan from Jan to May 2022. Methodology: The study was conducted on children of age more than 2.5 years having adenoid hypertrophy that was confirmed by an X-Ray lateral view of the nasopharynx for adenoids. Their tympanogram was obtained. Results: The study showed that 2(2%) cases had a Type-B curve in a single ear, and 14(14.3%) had a Type-B curve in both ears.PTA was normal in 32(32.7%) cases. Up to 25 decibels (dB) of hearing loss was seen in 6(6.1%) cases. In 8(8.2%) cases, hearing loss, was more than 25Db. Conclusion: The tympanometry test is an objective test which is very easy to carry out and can very easily detect patients having glued ears which can be managed, and possible complications of the disease can be avoided.

BACKGROUND & OBJECTIVE: Dengue virus (DENV) genomic study is crucial for understanding how it spreads and presents and become dangerous. Three structural and seven non-structural proteins are encoded by the positive stranded RNA DENV. Caspid protein (C) is one of the structural proteins which helps in the encapsidation of viral RNA. Objective of the study is to identify the DENV serotypes and the most common geographic specific mutations in the C protein, circulating in Punjab province of Pakistan. METHODOLOGY: It was cross sectional study in which About 120 DENV isolates were selected, by the procedure of temporal sampling done in peak season of dengue fever in 2022, from the major tertiary care hospitals for whole genomes sequence analysis. Among which only 23 whole genomes sequences were performed after virus isolation, quantification and cDNA synthesis. RESULTS: All the samples were found to be of genotype 1 and 2 in which 44 non-synonymous mutations were detected in the C protein. The most common mutations were; N90S (n=11) and G70S (n=11) followed by V26G (n=5) and R10Q (n=4), in which G70S is novel. CONCLUSION: Mutations in the current study are of particular interest to design of DENV vaccine projects in future. Genomic epidemiology during each outbreak of DENV in different locations is critical for better public health and for designing new policies for future outbreaks.

Monkeypox virus (MPXV) outbreaks have been reported in various countries worldwide; however, there is no specific vaccine against MPXV. In this study, therefore, we employed computational approaches to design a multi-epitope vaccine against MPXV. Initially, cytotoxic T lymphocyte (CTL), helper T lymphocyte (HTL), linear B lymphocytes (LBL) epitopes were predicted from the cell surface-binding protein and envelope protein A28 homolog, both of which play essential roles in MPXV pathogenesis. All of the predicted epitopes were evaluated using key parameters. A total of 7 CTL, 4 HTL, and 5 LBL epitopes were chosen and combined with appropriate linkers and adjuvant to construct a multi-epitope vaccine. The CTL and HTL epitopes of the vaccine construct cover 95.57% of the worldwide population. The designed vaccine construct was found to be highly antigenic, non-allergenic, soluble, and to have acceptable physicochemical properties. The 3D structure of the vaccine and its potential interaction with Toll-Like receptor-4 (TLR4) were predicted. Molecular dynamics (MD) simulation confirmed the vaccine's high stability in complex with TLR4. Finally, codon adaptation and in silico cloning confirmed the high expression rate of the vaccine constructs in strain K12 of Escherichia coli (E. coli). These findings are very encouraging; however, in vitro and animal studies are needed to ensure the potency and safety of this vaccine candidate.

Objective: To evaluate the perception, knowledge, empowerment and comfort level of critical care staff in relation to the implementation of safety huddles in paediatric intensive care unit of a tertiary care hospital. Method: The descriptive cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September 2020 to February 2021, and comprised physicians, nurses and paramedics who were part of the safety huddle. Staff perception regarding this activity was evaluated using open-ended questions that were scored on a Likert scale. Data was analysed using STATA 15. Results: Of the 50 participants, 27(54%) were females and 23(46%) were males. Overall, 26(52%) subjects were aged 20-30 years age, while 24(48%) were aged 31-50 years. Of the total, 37(74%) subjects strongly agreed that safety huddle had been routinely held in the unit since initiation; 42(84%) felt comfortable sharing their concerns about patient safety; and 37(74%) considered the huddles worthwhile. Majority 42(84%) felt more empowered through huddle participation. Moreover, 45(90%) participants strongly agreed that daily huddle helped them in becoming clearer about their responsibilities. For safety risk assessment, 41(82%) participants acknowledged that safety risks had been assessed and modified in routine huddles. Conclusion: Safety huddle was found to be a powerful tool to create a safe environment in a paediatric intensive care unit where all team members can speak up freely about patient safety. Key Words: Safety huddle, Staff perception, Staff empowerment, Patient safety in PICU.

Precision agricultural techniques try to prevent either an excessive or inadequate application of agrochemicals during pesticide application. In recent years, it has become popular to combine traditional agricultural practices with artificial intelligence algorithms. This research presents a case study of variable-rate targeted spraying using deep learning for tobacco plant recognition and identification in a real tobacco field. An extensive comparison of the detection performance of six YOLO-based models for the tobacco crop has been performed based on experimentation in tobacco fields. An F1-score of 87.2% and a frame per second rate of 67 were achieved using the YOLOv5n model trained on actual field data. Additionally, a novel disturbance-based pressure and flow control method has been introduced to address the issue of unwanted pressure fluctuations that are typically associated with bang-bang control. The quality of spray achieved by attenuation of these disturbances has been evaluated both qualitatively and quantitatively using three different spraying case studies: broadcast, and selective spraying at 20 psi pressure; and variable-rate spraying at pressure varying from 15-120 psi. As compared to the broadcast spraying, the selective and variable rate spray methods have achieved up to 60% reduction of agrochemicals.

Objective: To study the frequency and distribution of Female genital tract (FGT) malignancies through data recouped from the tumour registry of Armed Forces Institute of Pathology, Rawalpindi Pakistan. Study Design: Retrospective longitudinal study. Place and Duration of Study: Histopathology Department, Armed Force Institute of Pathology, Rawalpindi Pakistan, from 2009-2018 Methodology: A total of 1586 cases of malignant tumours of FGT were retrieved from the AFIP tumour registry, and data were analyzed in terms of the age of the patients' site of the tumour. It was also compared with regional and international data. Results: Thirty-seven thousand seven hundred ninety-three malignant cases were reported at AFIP from 2009-2018, out of which 1586(4.19%) were of the female genital tract. Ovarian malignancies were most frequent among FGT tumours,637(40.1%), followed by uterine tumours 519(32.6%). Carcinoma of the cervix was found in 237 cases (15%). Vulva and vaginal cases were seen in only 7.7% patients. The FGTs ranked fourth among the top ten commonest tumours in females. Conclusion: The most common malignancy of the female genital tract was ovarian cancer. Endometrial carcinoma was the second most frequent gynaecological malignancy, followed by cervical carcinoma. Ovarian malignancies were in fourth position among the top ten commonest female tumours in the current analysis as well, as in the previous analysis from AFIP.

Objectives: It was a community based, cross sectional study undertaken to access the frequency of HCV infection and to find out risk factor accociated with its spread.. Results: The frequency of HCV was found to be 53.6%.The most important risk factore associated with the transmission of HCV infection was unsafe injection therapy with contaminated equipment.

Trichinella spiralis (T. spiralis), a nematode parasite, is the major cause of Trichinellosis, a zoonotic disease. A key role of MAPR in the reproductive system is to maintain pregnancy. Previous studies found that antihormone drug design and vaccine therapy of recombinant protein (rTs-MAPRC2) control T. spiralis infection. The current study investigates the inhibitory effects of different ratios of antibodies against Ts-MAPRC2 on the development of muscle larvae (ML) and newborn larvae (NBL). First, we performed indirect immunofluorescence assays and examined the effects of rTs-MAPRC2-Ab on ML and NBL in vitro as well as in vivo. Afterward, siRNA-Ts-MAPRC2 was transfected into T. spiralis muscle larvae. Following that, Ts-MAPRC2 protein was detected by Western Blotting, and mRNA levels were determined by qPCR. We also assessed whether siRNA-treated NBLs were infective by analyzing muscle larvae burden (MLs). Our results showed that rTs-MAPRC2-Ab greatly inhibited the activity of the Ts-MAPRC2 in ML and NBL of T. spiralis and rTs-MAPRC2-Ab reduced larval infectivity and survival in the host in a dose-dependent manner (1:50, 1:200, 1:800 dilutions). Furthermore, siRNA-Ts-MAPRC2 effectively silenced the Ts-MAPRC2 gene in muscle larvae (ML) in vitro, as well as in newborn larvae (NBL) of T. spiralis in vivo. In addition, siRNA-Ts-MAPRC2 (siRNA180, siRNA419, siRNA559) reduced host larval survival and infectivity significantly. This study, therefore, suggests that Ts-MAPRC2 might be a novel molecular target useful in the development of vaccines against T. spiralis infection.

Background: Nearly half of the world is at risk of developing dengue infection. Dengue virus is the causative agent behind this public healthcare concern. Millions of dengue cases are reported every year, leading to thousands of deaths. The scientific community is working to develop effective therapeutic strategies in the form of vaccines and antiviral drugs against dengue. Methods: In this review, a methodological approach has been used to gather data from the past five years to include the latest developments against the dengue virus. Results: Different therapeutics and antiviral targets against the dengue virus are at different stages of development, but none have been approved by the FDA. Moreover, various vaccination strategies have also been discussed, including attenuated virus vaccines, recombinant subunit vaccines, viral vector vaccines, DNA vaccines, nanotechnology, and plant-based vaccines, which are used to develop effective vaccines for the dengue virus. Many dengue vaccines pass the initial phases of evaluation, but only two vaccines have been approved for public use. DENGVAXIA is the only FDA-approved vaccine against all four stereotypes of the dengue virus, but it is licensed for use only in individuals 6–16 years of age with laboratory-confirmed previous dengue infection and living in endemic countries. Takeda is the second vaccine approved for use in the European Union, the United Kingdom, Brazil, Argentina, Indonesia, and Thailand. It produced sustained antibody responses against all four serotypes of dengue virus, regardless of previous exposure and dosing schedule. Other dengue vaccine candidates at different stages of development are TV-003/005, TDENV PIV, V180, and some DNA vaccines. Conclusion: There is a need to put more effort into developing effective vaccines and therapeutics for dengue, as already approved vaccines and therapeutics have limitations. DENGVAXIA is approved for use in children and teenagers who are 6–16 years of age and have confirmed dengue infection, while Takeda is approved for use in certain countries, and it has withdrawn its application for FDA approval.

The 1,3,4-oxadiazole derivatives Ox-6a-f have been synthesized by incorporating flurbiprofen moiety with the aim to explore the potential of target molecules to decrease the oxidative stress. The title compounds Ox-6a-f were prepared by simple reactions in which a flurbiprofen –COOH group was esterified with methanol in an acid-catalyzed medium, which was then reacted with hydrazine to afford the corresponding hydrazide. The acid hydrazide was then cyclized into 1,3,4-oxadiazole-2-thiol by reacting with CS2 in the presence of KOH. The title compounds Ox-6a-f were synthesized by the reaction of an –SH group with various alkyl/aryl chlorides, which involves an S-alkylation reaction. The structures of the synthesized Ox-6a-f derivatives were ascertained by spectroscopic data. The in silico molecular docking was performed against target proteins cyclooxygenase-2 COX-2 (PDBID 5KIR) and cyclooxygenase-1 COX-1 (PDBID 6Y3C) to determine the binding affinity of the synthesized compounds with these structures. It has been inferred that most of the synthesized compounds bind well with an active binding site of 5KIR compared to 6Y3C, and especially compound Ox-6f showed excellent binding affinity (7.70 kcal/mol) among all synthesized compounds Ox-6a-f. The molecular dynamic (MD) simulation has also been performed to check the stability of docking complexes of ligands with COX-2 by determining their root mean square deviation and root mean square fluctuation. Little fluctuation was observed in case of Ox-6f, which forms the most stable complex with COX-2. The comprehensive antioxidant potential of the synthesized compounds has been evaluated by determining their free radical scavenging activity, including DPPH, OH, nitric oxide (NO), and iron chelation assay. The derivative Ox-6f showed promising results with 80.23% radical scavenging potential at a dose of 100 µg/mL while ascorbic acid exhibited 87.72% inhibition at the same dose. The anti-inflammatory activity of the final products has also been performed, and inflammatory markers were assayed, such as a thiobarbituric acid-reducing substance, nitric oxide, interleukin-6 (IL-6), and COX-2. The derivatives Ox-6d and Ox-6f displayed higher anti-inflammatory activity, exhibiting 70.56% and 74.16% activity, respectively. The results were compared with standard ibuprofen, which showed 84.31% activity at the same dose, 200 µg/mL. The anti-inflammatory potential has been performed by following the carrageen-induced hind paw edema model, and results showed that derivative Ox-6f exhibited 79.83% reduction in edema volume compared to standard ibuprofen, which reduced 84.31% edema volume. As dry lab and wet lab results confirm each other, it has been deduced that derivative Ox-6f may serve as the lead structure to design potent compounds to address oxidative stress.

OBJECTIVE: To determine the frequency of proptosis and associations of proptosis with demographic, clinical and hematological characteristics with acute myeloid leukemia (AML) in children. METHODS: This descriptive study was conducted at Combined Military Hospital, Rawalpindi, Pakistan from January 2018 to July 2020. Patients of AML between 1-12 years of age who presented with and without orbital granulocytic sarcomas (OGS), selected by non-probability convenience sampling technique were evaluated for proptosis. Patients were classified into different subtypes of AML according to French-American-British (FAB) classification. Cytogenetic studies by karyotyping were done to identify different genetic abnormalities associated with AML. Kaplan- Meier survival analysis was used to analyze the overall survival of AML patients. RESULTS: Out of 230 patients diagnosed with AML, 34 (14.78%) patients presented with proptosis. Mean age of presentation was 6.80±3.69 years, with male-female ratio of 2.1:1. Proptosis was unilateral in 19 (55%) and bilateral in 15 (45%) patients. Ten (29.40 %) patients presented primarily with proptosis while 24 (71%) patients presented with proptosis and systemic features of leukemia. Overall AML-M2 was found in 102 (44.3%) cases and other types were observed in 128 (55.6%) cases. Most common FAB AML subtype associated with proptosis was AML-M2 (n=26; 76%). Median duration of survival in AML patients with OGS was 867 days and as compared to 353 days in AML patients without OGS. CONCLUSION: Proptosis is a frequent finding in children with AML. AML-M2 is associated with proptosis in children with AML. Survival in patients with OGS was better than patients without OGS.

OBJECTIVE: To study the impact of nutritional status on induction mortality among pediatric patients suffering from acute lymphoblastic leukemia (ALL). METHODS: This descriptive analytical study was conducted on pediatric ALL patients who completed induction chemotherapy in Pediatric Oncology Department Combined Military Hospital, Rawalpindi, Pakistan from 1st January 2012 to 30th June 2021. All patients of ALL diagnosed on basis of National Comprehensive Cancer Network Clinical Practice Guidelines, aged 1-18 years were included. Patients who left before completion of induction chemotherapy or refused to participate were excluded. Cases were divided into three groups based on nutritional status. Induction chemotherapy was given as per UKALL 2011 protocol. RESULTS: Out of 926 patients diagnosed with ALL, 586 (63.3%) were males and 340 (46.7%) were females. Mean age of patients was a 5.83±3.627 years. Majority of the patients (n=679, 73.3%) were well-nourished; and 161 (17.4%) and 86 (9.3%) were moderately and severely malnourished, respectively. About 49.8% (n=461) patients received standard risk chemotherapy protocol with three-drug induction and 50.2% (n=465) received four-drug induction chemotherapy. Infection was the most common complication in 742 (80.1%) patients. Overall induction mortality was 12.9% (n=119/926) in all patients including 9.54% (n=44/461) in standard-risk and 16.12% (n=75/465) in high-risk patients (p=0.003). Induction mortality was significantly high in malnourished-group (17.8%) and 12.2% in normally-nourished children (p=0.008). CONCLUSION: Nutritional status and risk group at time of diagnosis emerged as predictors of induction mortality among ALL patients. Considerable number of patients died during induction phase of treatment. Malnourished children have a high mortality rate.

Objective: To compare the efficacy of total laryngeal anesthesia and simple local anesthesia during awake fiberoptic bronchoscopy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pulmonology, Combined Military Hospital Lahore, from Jan to Jul 2020. Methodology: A total of 70 patients, who were undergoing fiberoptic bronchoscopy were divided into two groups. Group-I patients were given topical anesthesia with 2% Lignocaine while group-II patients, in addition to topical Lignocaine, had 2% Lignocaine injected into bilateral internal laryngeal nerves for total laryngeal anesthesia. Assessment of efficacy of anesthesia was evaluated by Reasoner scale. Results: In group-I, 26 (74.28%) patients showed mild or moderate cough and gagging during stage-1. Fifteen (42.85%) patients showed moderate cough and gagging that interfered with the procedure during stage-2 and 19 (54.28%) patients showed mild cough or gagging that did not interfere with the procedure in stage-3. In group-II, 17 (48.57%) patients exhibited mild cough or gagging during stage-1. Sixteen (45.71%) exhibited mild cough or gagging that did not interfere with the procedure during stage-2 with all the patients showing either no cough or mild cough and gagging that did not interfere with the procedure during stage-3. More patients of group-II 32 (91.42%) agreed to a repeat test if required medically as compared to group-I 28 (80%). Conclusion: Patients undergoing fiberoptic bronchoscopy who underwent total laryngeal anesthesia and sedation, in addition to topical anesthesia experienced less cough and gagging than those receiving only local anesthesia.

Abstract In the current study, APOB (rs1052031) genotype-guided proteomic analysis was performed in a cohort of Pakistani population. A total of 700 study subjects, including Coronary Artery Disease (CAD) patients (n = 480) and healthy individuals (n = 220) as a control group were included in the study. Genotyping was carried out by using tetra primer-amplification refractory mutation system-based polymerase chain reaction (T-ARMS-PCR) whereas mass spectrometry (Orbitrap MS) was used for label free quantification of serum samples. Genotypic frequency of GG genotype was found to be 90.1%, while 6.4% was for GA genotype and 3.5% was for AA genotypes in CAD patients. In the control group, 87.2% healthy subjects were found to have GG genotype, 11.8% had GA genotype, and 0.9% were with AA genotypes. Significant (p = 0.007) difference was observed between genotypic frequencies in the patients and the control group. The rare allele AA was found to be strongly associated with the CAD [OR: 4 (1.9–16.7)], as compared to the control group in recessive genetic model (p = 0.04). Using label free proteomics, altered expression of 60 significant proteins was observed. Enrichment analysis of these protein showed higher number of up-regulated pathways, including phosphatidylcholine-sterol O-acyltransferase activator activity, cholesterol transfer activity, and sterol transfer activity in AA genotype of rs562338 (G>A) as compared to the wild type GG genotype. This study provides a deeper insight into CAD pathobiology with reference to proteogenomics, and proving this approach as a good platform for identifying the novel proteins and signaling pathways in relation to cardiovascular diseases.

Objective: To examine the clinical severity and magnitude of COVID-19 patients after the second dose of the COVID-19 vaccine. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary Care Hospital, Islamabad Pakistan, from Feb to Jun 2021. Methodology: The individuals who had two doses of the vaccine (dead inactivated- Vero Cell) and got COVID-19 at least two weeks after vaccination were included in the study. These patients were divided into Mild, Moderate and Severe categories based on their symptoms and Investigations. Results: Out of 5000 individuals vaccinated, 225(4.5%) got infected with COVID-19 later. Among these 225, 172(76.4%) had mild symptoms and recovered, with only 1(0.4%) death was reported. Conclusion: COVID-19 vaccination does not infer 100% immunity, but if someone gets infected with COVID after vaccination,there are remarkable chances of recovery.

Objective: To study the frequency and distribution of malignancies of the male genital tract and urinary system. Study Design: Retrospective longitudinal study. Place and Duration of Study: Histopathology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, fromJan 2009 to Dec 2018. Methodology: Two thousand four hundred thirteen cases of malignant tumours of the male genital tract and 4278 cases of tumours of the urinary system were extracted from the tumour registry of the Armed Forces Institute of Pathology (AFIP). Results: Thirty-seven thousand seven hundred ninety-three malignant cases were reported at AFIP from 2009-2018, in which 2413(6.38%) were of the male genital tract and 4278(11.32%) were of the Urinary system. The most frequent tumour out of these was carcinoma prostate 2024(83.8%), followed by tumours of testis 359(14.8%), penis 7(0.3%) and MGT tumours (NOS).In the urinary system, bladder cancers were most frequently seen 3289(78%), followed by kidney tumours 989(22%). Bladder cancer was the top most and prostate cancer was the second most common tumour in males in the seventh decade (60-69 years). Kidney tumours were the third most common in female children in the first decade, following eye and lymph node malignancies. Conclusion: Carcinoma prostate was the most frequent male genital tract cancer, followed by the testicular tumour. In the urinary system, bladder cancers were most frequently reported with male predominance followed by kidney tumours.

Objective: To study the clinical profile and induction outcome in children diagnosed with T-cell acute lymphoblastic leukaemia and lymphoblastic lymphoma. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2012 to Dec 2020. Methodology: One hundered and twenty-one diagnosed patients of T-ALL and LBL were evaluated with bone marrow biopsy and Contrast-enhanced CT scan of the active region after induction chemotherapy with Dexamethasone, Vincristine, Asparaginase and Daunorubicin along with intrathecal Methotrexate. This was carried out on days-8 and 29 to determine the early remission status and end of induction response, respectively. Results: Out of 121 patients, 99(81.8 %) had T–ALL, while 22(18.18%) had LBL. Day-8 assessment showed that 94(77.7%) patients were rapid early responders, 24(19.4%) were slow early responders, while 3(2.4%) patients expired before the day eight assessment. Day-29 bone marrow assessment of 88 T-ALL patients showed complete remission in 77 patients (87.5%), incomplete remission in 5(5.68%) patients and treatment failure in 2(2.27%) patients. 20(93.1%) patients with LBL achieved remission by Day-29, while 2 (0.02%) LBL patients died before the Day-29 assessment. Conclusion: The remission induction rates and mortality rates in our setup are encouraging and comparable to international data. Further improvements can be made by early management of the affected cases and more accessible pediatric oncology health services.

Objectives: To study the clinical presentation, complications and drug sensitivity patterns of multi drugs- resistant enteric fever. Study Design: Prospective longitudinal study. Place and duration of study: Combined Military Hospital, Malir Cantt Karachi Pakistan, from Mar to Oct 2019. Methodology: A hundred cases of multi-drug resistant enteric fever were enrolled. Their demographic data, clinical and laboratory features and drug sensitivity pattern was recorded. Results: Out of 100 cases, 67 were within 5 to 11 years of age. Twenty-one patients presented with loose motion and splenomegaly each. Seventy cases had a fever of 1 to 2-weeks duration. Complications were seen in 42 cases, out of which hepatitis was most commonly observed (in 27 cases). Ciprofloxacin and Ceftriaxone sensitivity were found to be only 3% and 9%, respectively. Sensitivity to Azithromycin was 95%, while all cases were sensitive to Meropenem and Imipenem. Conclusion: Very high frequency of extensively drug-resistant typhoid fever was found. Most cases of enteric fever had a fever as the only presenting feature. Typhidot test has very low sensitivity.

Abstract Objective: To determine the frequency of mismatch repair deficiency in colorectal carcinoma determined by immunohistochemistry. Study Design: Cross-sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from Aug 2018 to Jan 2019. Methodology: A total of 101 patients of adenocarcinoma of colorectum who underwent surgical resections and their characteristic and clinical data were recorded. Immunohistochemical stains were performed using antibodies MLH1, MSH2, PMS2 and MSH6. Results were interpreted and mismatch repair deficiency status of all patients was determined. Patients with loss of expression for MLH1, MSH2, PMS2 and MSH6 antibodies were observed and noted. Results: In this study, out of 101 patients with CRC, 71 (70.3%) were male and 30 (29.7%) female. The mean age was (54 years ± 15.9). Amongst the 101 cases loss of immunohistochemical staining for MMR proteins was noted in 19 patients (18.8%). The combined loss of all four antibodies was seen in one case, loss of MLH1 and PMS2 in 7, MSH2 and MSH6 in 5 and MLH1 only in 6 patients. However, no mismatch repair deficiency was detected in remaining 82 cases. According to statistical analysis no significant association between mismatch repair deficiency and variables was found. Conclusion: The frequency of mismatch repair deficiency in colorectal carcinoma patients was found to be 18.8% in our population.

Abstract All-optical control dynamics of magnetization in sub-10 nm metallic thin films are investigated, as these films with quantum confinement undergo unique interactions with femtosecond laser pulses. Our theoretical analysis based on the free electron model shows that the density of states at Fermi level (DOSF) and electron–phonon coupling coefficients (Gep) in ultrathin metals have very high sensitivity to film thickness within a few angstroms. We show that completely different magnetization dynamics characteristics emerge if DOSF and Gep depend on thickness compared with bulk metals. Our model suggests highly efficient energy transfer from femtosecond laser photons to spin waves due to minimal energy absorption by phonons. This sensitivity to the thickness and efficient energy transfer offers an opportunity to obtain ultrafast on-chip magnetization dynamics.

Abstract Tuberculosis (TB), caused by Mycobacterium tuberculosis, is endemic in Pakistan. Resistance to both firstline rifampicin and isoniazid drugs (multidrug-resistant TB; MDR-TB) is hampering disease control. Rifampicin resistance is attributed to rpoB gene mutations, but rpoA and rpoC loci may also be involved. To characterise underlying rifampicin resistance mutations in the TB endemic province of Khyber Pakhtunkhwa, we sequenced 51 M. tuberculosis isolates collected between 2016 and 2019; predominantly, MDR-TB (n = 44; 86.3%) and lineage 3 (n = 30, 58.8%) strains. We found that known mutations in rpoB (e.g. S405L), katG (e.g. S315T), or inhA promoter loci explain the MDR-TB. There were 24 unique mutations in rpoA, rpoB, and rpoC genes, including four previously unreported. Five instances of within-host resistance diversity were observed, where two were a mixture of MDR-TB strains containing mutations in rpoB, katG, and the inhA promoter region, as well as compensatory mutations in rpoC. Heteroresistance was observed in two isolates with a single lineage. Such complexity may reflect the high transmission nature of the Khyber Pakhtunkhwa setting. Our study reinforces the need to apply sequencing approaches to capture the full-extent of MDR-TB genetic diversity, to understand transmission, and to inform TB control activities in the highly endemic setting of Pakistan.

Objective: To analyze the risk factors for pulmonary embolism stationed at high altitudes with high altitude as one of the determinants. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital Skardu Pakistan, from Jan 2016 to Jan 2020. Methodology: A total of 25 consecutive cases with pulmonary embolism reported to this hospital during the study period were enrolled. Medical records of all patients were retrospectively analyzed to determine the risk factors. In addition, patient demographic data, clinical features, and laboratory and radiological findings were recorded. Results: Mean age of the patient was 30.68±5.37 years with a range from 23 to 40 years, the mean height of deployment was 17223.00±3577.00 feet, while the mean duration of stay was 53.92±44.76 days. Dyspnoea (84%) was the commonest clinical presentation followed by palpitation, chest pain, headache and haemoptysis. Most patients (88%) were non-smokers, while no patient had known significant risk factors. Thrombophilia and vascultitic screening were negative for all patients. In the absence of any significant hereditary or acquired risk factor, high altitude remains the only thrombogenic risk factor patients deployed at heights. Conclusion: Stay at a high altitude is a major risk factor for pulmonary embolism in young patients without any other known risk factor.

Objective: To determine the frequency of change in diagnosis and level of errors in cases referred to Armed Forces Institute of Pathology for second opinion and their impact on modifications of treatment and prognosis. Study Design: Cross sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, form Mar to Oct 2017 Methodology: All the cases referred for review diagnosis were tested by applying panel of immunohistochemical markers and special stains on formalin fixed paraffin embedded tissue sections as decided on morphology. Level of errors were defined as level I error: minor discrepancy with no impact on management, level II: minor discrepancy with impact on management, level III: main category remains same but there was change/confirmation of specific diagnostic entity with an impact on management and level IV: gross changes in diagnosis with significant impact on management. Level IV was further subdivided into IV a: benign misdiagnosed as malignant, IV b: malignant misdiagnosed as benign and IV c: changes in tumor subtype. Results: A total of 100 cases, where review diagnosis was changed were included. Minor discrepancies (level I and level II) were observed in only 7% cases with little or no impact on the management. Most frequent discrepancy observed as Level III in 75% cases. Major discrepancy (Level IV errors) was noted in 18% cases. Conclusion: There were high discrepancy rates between previous diagnosis and review diagnosis. The higher use of extended panels of immunohistochemistry markers were the most likely explanations.

Objective: To evaluate the impact of introducing newly-designed warning labels in relation to the available conventional cigarette packs. Method: The quasi-experimental study was conducted at four co-educational academic institutions selected using cluster random sampling technique in Gulshan-e-Iqbal town of Karachi from September 2016 to October 2017. The respondents, aged 16-24 years, were exposed with an experimental condition using five graphic cards; each comprising of two separate labels; label 1 being a cigarette pack currently rotated, and label 2 being the newly designed graphic and text warning label. Each participant responded over efficacy measures for each label separately. The difference in the efficacy scores between the two labels was assessed using repeated measure ANOVA with Bonferroni correction in analysis. Results: Of the 388 students, 256(66%) were males and 132(34%) were females. The overall mean age was 18±2.76 years. Also, 188(48.5%) subjects were studying in higher secondary, 179(46.1%) undergraduate and 21(5.4%) postgraduate levels. Of them, 104(26.8%) were ever-smokers and 284(73.2%) reported to be never-smokers. In the newly-designed warning label elements of ‘poverty’ and ‘not to start smoking’ in the current cigarette pack were significant (p=0.006). Non-smoking males perceived newly-designed label element ‘dead person’ as fear-arousing (p=0.045), while non-smoking females considered ‘look after family’ as efficacious (p=0.024). Conclusion: There was some evidence of variation in efficacy scores after stratifying on gender and smoking status. A more holistic approach is needed in this regard. Key Words: Cigarette packaging, Cigarette smoking, Health warning labels, Quasi-experiment, Self-efficacy, Tobacco. Continuous...

Objective: To elucidate the possible association between suicidal tendencies and psychiatric symptoms associated with anabolic androgenic steroid usage among athletes. Method: The cross-sectional study was conducted from December 2016 to July 2017 in Rawalpini and Wah Canttonment, Pakistan, after approval from the International Islamic University, Islamabad, and comprised male athletes aged >18 years. Those using androgenic anabolic steroid formed group A, while the non-users were in group B. In addition to demographis, data was collected using Beck Scale for Suicidal Ideation and the Symptoms Checklist-90. Data was analysed using SPSS 22. ---Continue

It has been established that the benefits of physical activity on physical, psychological and social aspects of humans are substantially correlated with cardiovascular disorders, obesity, cancer, social anxieties and depressions, and enhanced socio-economic profile. In children and adolescents, physical activity has been correlated with academic achievements, social harmony and mental health. Similarly, in adults/old people, physical activity has been of variable benefits, bringing the chances of prolonged healthier lives. Though substantial work has been reported globally, there still is a paucity of literature in Pakistan regarding various aspects of physical activity. The current narrative review was planned to summarise the research work conducted in, or has emanated from, Pakistan in teens/college/school and university students, and adults from Pakistan on associated aspects of physical activity, ---Continue

Although Pakistan has rich biodiversity, many groups are poorly known, particularly insects. To address this gap, we employed DNA barcoding to survey its insect diversity. Specimens obtained through diverse collecting methods at 1,858 sites across Pakistan from 2010–2019 were examined for sequence variation in the 658 bp barcode region of the cytochrome c oxidase 1 (COI) gene. Sequences from nearly 49,000 specimens were assigned to 6,590 Barcode Index Numbers (BINs), a proxy for species, and most (88%) also possessed a representative image on the Barcode of Life Data System (BOLD). By coupling morphological inspections with barcode matches on BOLD, every BIN was assigned to an order (19) and most (99.8%) were placed to a family (362). However, just 40% of the BINs were assigned to a genus (1,375) and 21% to a species (1,364). Five orders (Coleoptera, Diptera, Hemiptera, Hymenoptera, Lepidoptera) accounted for 92% of the specimens and BINs. More than half of the BINs (59%) are so far only known from Pakistan, but others have also been reported from Bangladesh (13%), India (12%), and China (8%). Representing the first DNA barcode survey of the insect fauna in any South Asian country, this study provides the foundation for a complete inventory of the insect fauna in Pakistan while also contributing to the global DNA barcode reference library.

Objective: To investigate the immunohistochemical expression of PD-1 and PD-L1 in breast cancer cases and its correlation with clinicopathological factors. Study Design: Cross sectional study. Place and Duration of Study: Histopathology department, Armed Forces Institute of Pathology Rawalpindi, form Jan to Jun 2019. Methodology: Sixty five cases of breast cancer were retrieved. Clinicopathological parameters like age, gender, tumor grade and receptor status were noted. Immunohistochemistry for PD-1 and PD-L1 was applied. The data was entered and statistical analysis was done using SPSS version 21. The associations between variables were found using the Fisher exact test. Results: Sixty five cases of breast cancer were investigated from tumour registry. The sample included female patients, having mean age of 50.86 ± 11.1 Years. Invasive mammary (ductal) carcinoma, NST was the most prevalent subtype 60 (92.3%) and most tumors were grade I/II 53(82%). PD-1 expression was seen in TIL’s 31 (48%) and PD-L1 expression was observed in tumour cells 30 (46%). Expression of PD-1/PD-L1 expression was more common in premenopausal age group and grade I/II tumors. Among molecular subtypes, PD-L1 expression was detected in 11 (52%) TNBC, 5 (71%) in HR-/HER2+ and 12 (32)% in HR + HER2 - and PD-1 expression was observed in 13 (62%) TNBC, 5 (71%) in HR-/HER2+ and 13 (35%) in HR+ HER2-. Conclusion: A large proportion of breast cancer cases show expression of PD-1 / PD-L1. Anti PD-1 and PD-L1 therapy may benefit these patients.

Objective: To determine the diagnostic accuracy of in-house biochemical testing for identification of enterococcus species isolated from various clinical specimens against gold standard i.e., automated Vitek 2 system. This study also includes the antimicrobial susceptibility testing of enterococci against various antimicrobials. Study Design: Cross-sectional comparative study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2017 to Mar 2018. Methodology: A total of 218 isolates from various clinical specimens suspected to be Enterococcus spp. were checked by in-house biochemical testing including bile esculin, 6.5% NaCl and 1% arabinose and results were compared with Vitek 2 compact system. The frequencies were determined by both systems and antimicrobial susceptibility testing was performed by disk diffusion as per clinical and laboratory standards institute guidelines. Results: Comparing the results of in-house testing with gold standard i.e., Vitek 2 system, the statistical data was calculated. Sensitivity turned out to be 100%, Specificity was found to be 68.75%. Positive and negative predictive values were 97.58% and 100% respectively. Accuracy turned out to be 97.71%. Conclusion: The in-house biochemical testing can be quite a useful method for identification of enterococci in resource-limited settings. However, it requires overight incubation and cannot identify other enterococcal species and non-enterococcal species. Vitek 2 is an automated system that is easy-to-handle, provides a rapid and reasonably accurate identification of enterococci alongwith accurate AST results. Enterococcal isolates from various clinical specimens in our setup showed least resistance to linezolid, followed by teicoplanin and vancomycin. Nitrofurantoin and.............

Objective: To introduce a relatively convenient and effective way of conducting Insulin Tolerance Test for diagnosis of Growth Hormone deficiency in children with short stature. Study Design: Cross sectional analytical study. Place and Duration of Study: Conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from May 2017 to Jul 2018. Methodology: A total of 185 cases were included. Sample selection was done by non-probability consecutive sampling technique. Insulin tolerance test was performed by taking basal sample for serum growth hormone and plasma glucose levels before giving intravenous insulin bolus according to dose of 0.15 IU/kg. Samples for Growth Hormone level were repeated at time of induced hypoglycemia (defined as plasma glucose level of 20 mIU/l) at induction alone, followed by 30 minutes post induction; reflecting the significance of these two samples in diagnosis of growth hormone deficiency. Conclusion: We concluded that there is a simpler ...........

Objective: To evaluate interobserver variability in core breast biopsies of category B3 and B4 at a tertiary care centre Study Design: Retrospective, observational, cross-sectional study. Place and Duration of Study: Histopathology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Mar 2017 to Jun 2018. Methodology: A total of thirty cases of histologically confirmed lesions of category B3 and B4 on core breast biopsies from March 2017 to June 2018 were retrieved from archive of Histopathology department, AFIP Rawalpindi. Patients’ age, histologic diagnosis and reporting B category were noted. The selected cases were anonymized and distributed among 3 pathologists for independent review. The participating pathologists were kept unaware of the findings given by fellow participants and previously agreed reference diagnoses. Study cases were reviewed by the participating pathologists. The results were analyzed and overall concordance rate, discordance rate, over interpretation rate and under interpretation rate were calculated. Results: A total of 30 (n=30) patients were enrolled of which 22 were assigned category B3 (73%) and 8 were assigned category B4 (27%) on initial microscopic evaluation (original opinion). The ages of the study patients ranged from 25 to 85 years. The average concordance rate of morphologic findings of study pathologists compared to the reference diagnosis was 63% (19/30). Among these the average concordance rate compared to reference diagnosis among category B3 lesions was 73% (16/22) and among category B4 lesions was 37.5% (3/8). The average rate of disagreement of morphologic findings of study pathologists compared with the reference diagnosis was 37% (11/30). Among these the average rate of disagreement compared to reference diagnosis among category B3 lesions 27% (6/22) and among category B4 lesions was 62.5% (5/8). The overall over inter-pretation rate was 44% and overall under interpretation rate was 56%. The overall rate of unanimous agreement of independent diagnoses among the three panel consultants was 50% (15/30). Among these 15 cases 12 were assigned category B3 and 3 were assigned category B4. The overall rate of disagreement of independent diag-noses among the three panel consultants was 50% (15/30). Conclusion: In our study the opinion was established by interpretation of a single slide. Average concordance rate among the participating pathologists’ findings and the previously agreed upon final diagnoses was 63% and disagreement was 37%, the rate of agreement being higher in the category B3 and lower in the category B4 lesions. However effect of these results on the therapy and prognosis of patients still needs to be evaluated

Objective: To determine the frequency of immunohistochemical expression of p53 in invasive ductal carcinoma of breast in Pakistani women. Study Design: Descriptive, cross-sectional study. Place and Duration of Study: Department of Histopathology, Combined Military Hospital, Lahore, from Jul 2015 to Jan 2016. Methodology: This study involved 80 histopathological samples of invasive ductal carcinoma breast which were tested for p53 expression. Sample size with 80 cases was calculated using 95% confidence level and 10% margin of error while expected percentage of p53 expression will be 71.67%. Specimens were selected by non-probability, consecutive sampling. All specimens of newly diagnosed cases of invasive ducal carcinoma at CMH Lahore on histopathological examination of female patients aged between 15-80 years. IHC application of p53 was done as per technique mentioned in the manual given by the DAKO. Results: Patient age was calculated which was between 25 years and 80 years while mean age was 50.76 ± 11.80 years. Majority of the patients were aged between 25-50 years (n=44, 55.0%). In 54 (67.5%) patients lymph nodes were positive for tumor metastasis. Majority 64 (80%) of the tumors were Grade-II followed by Grade-III in 15 (18.7%) patients. The size of the tumor ranged from 0.2 cm to 14 cm with a mean of 4.16 ± 2.59 cm. p53 expression was positive in 38 (47.5%) patients. The expression of p53 was higher in patients who have positive lymph nodes (59.3% vs. 23.1%; p=0.002). However, expression of p53 was not so significant for age (p=0.079), tumor size (p=0.414) and tumor grade (p=0.176) groups. Conclusion: The frequency of p53 expression was found to be 47.5% in invasive mammary cancer in Pakistani population. The expression of p53 was higher in patients who have positive lymph nodes (59.3% vs. 23.1%; p=0.002). However, expression of p53 was not so significant for age (p=0.079), tumor size (p=0.414) and tumor grade (p=0.176) groups.