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Railway projects are incredibly costly due to their complex nature. This study performs risk analysis and management of Pakistan railways ML-1 project expansion and upgradation that will be undertaken at US$6.8 billion under the China-Pakistan Economic Corridor (CPEC). The risks were identified based on an extensive literature review and their relevance to the CPEC. We employed fuzzy set theory (integrated with the risk severity index) to obtain the most severe risks. The novelty of this study is the technique employed to analyse and rank the risk, also there are no previous studies conducted that emphasized the construction risk of railway projects in Pakistan. The study is useful for all stakeholders of the project, as it can plan for them to tackle these risks and implement ML-1 successfully.

Objective: To identify demographic patterns and etiologies of CNS infections and to identify the clinical presentations, diagnostic accuracy, and clinical outcomes of various CNS infections in hospitalized patients in a tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2019 to Jun 2020. Methodology: A total of 97 adult patients presenting with clinical features of Central Nervous System (CNS) infection were enrolled for this in-hospital study. Cerebrospinal fluid (CSF) was collected for a routine examination, bacterial culture, and viral Polymerase Chain Reaction (PCR) test. Human Immunodeficiency Virus (HIV) serology and neuroimaging were done in all cases. The diagnosis was established based on World Health Organization guidelines for infectious diseases. Infections were classified into four major categories for analysis purposes. Results: Of 97 enrolled patients, the mean age was 38.8±18.5 years. CNS tuberculosis was the most common infection seen in 46(47.4%) cases, 25(25.7%) patients had viral encephalitis, and 17(17.5%) had bacterial meningitis. The rest of the patients (n=9) had fungal (3%) or parasitic infections (4%). In contrast, two patients were found to have focal cerebritis, one due to Brucella and the other due to Salmonella typhi. Conclusion: Tuberculosis is the most common (CNS infection in this region. First, patients with CNS infections, especially chronic ones, present very late in our setting, leading to increased morbidity and mortality. Secondly, Molecular diagnosis is obtainable in only a small percentage of cases for various reasons.

Objective: To determine the role of Methylprednisolone in managing COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jan to Feb 2021. Methodology: This study was carried out at the Department of Medicine. Medical records of all moderate, severe and critical COVID-19 patients admitted and receiving Methylprednisolone were reviewed. Methylprednisolone was used in all patients at doses 0.-2 mg per kg. Results: A total of 200 cases were included. The most common presenting symptoms were cough (77.5%), fever (67.5%) and shortness of breath (63.5%). Most patients (85%) presented within the first week of their illness. One or more comorbidities were present in 75% of patients. Most common being hypertension in 70(35%) and diabetes mellitus in 63(31.5%).Complications seen in the study were Cytokine release storm 92(46%) and acute respiratory distress syndrome 44(22%). The median time for initiation of corticosteroid therapy was 4 hours (range 1-96 hours). Overall survival (OS) in the study was 83.5%. OS for patients with moderate, severe and critical diseases was 97.8%, 86.2% and 62%, respectively (p

Objective: To determine the frequency of non-compliance among the patients of epilepsy and factors related to the presence of non-compliance at a tertiary care hospital of Pakistan. Study Design: Cross-sectional analytical study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, form Dec 2018 to Jun 2019. Methodology: A total of 133 cases were included in the study, which were diagnosed as epilepsy for more than 6 months by a consultant neurologist. Medication and drug adherence was assessed by validated Urdu version of our-item Morisky Medication Adherence Scale. Relationship of age, gender, socio-economic class, duration of epilepsy, education, marital status and poly-pharmacy was assessed with the presence of non-compliance among the patients suffering from epilepsy. Results: There were 53 (39.9%) patients were females while 80 (60.1%) were males. Out of 118 patients of epilepsy, 59 (44.4%) showed the presence of non-compliance while 74 (55.6%) had good compliance. After applying the logistic regression we found that duration of illness and poly-pharmacy had significant association with the presence of non-compliance among the patients of epilepsy. Conclusion: Non-compliance emerged as a highly prevalent behavior or clinical condition among the patients of epilepsy in our target population. Before combining the pharmacological agents it is advisable to check the compliance of already prescribed drugs used to control the seizures. Patients with long standing illness or those who are put on multiple medications should be regularly screened for non-adherence.