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In the present investigation, zirconium dioxide (ZrO2) and zirconium diboride (ZrB2) have been used in the development of an aluminum-based composite. A microwave sintering technique was employed for the processing of the composite. The aluminum-based composite was developed with the constant 5 wt.% of ZrO2. The weight percent of ZrB2 increased from 2.5% to 7.5%. Uniform distribution of the reinforcement particles was observed for the composition Al–5 wt.% ZrO2–2.5 wt.% ZrB2 composite and Al–5 wt.% ZrO2–5 wt.% ZrB2 composite. The relative density of Al–5 wt.% ZrO2–5 wt.% ZrB2 composite was found to be 0.9874. The percent porosity of the Al–5 wt.% ZrO2–5 wt.% ZrB2 was 1.259%. Results showed that hardness, compressive strength, % tensile strength, and fatigue strength (at 1 × 107 cycles) were improved by about 74.28%, 18.18%, 58.77%, and 60.77%, respectively. XRD of the Al/ZrO2/ZrB2 composite showed the presence of Al, ZrO2, ZrB2, MgAl2O4, and Al2Cu phases. The number of grains per square inch for composition Al–5 wt.% ZrO2–5 wt.% ZrB2 composite was found to be 989.11. This result showed that a finer grain structure has been obtained after the solidification of Al–5 wt.% ZrO2–5 wt.% ZrB2 composite. The fracture surface of the Al–5 wt.% ZrO2–5 wt.% ZrB2 composite was composed of a dendrite structure with micro-porosities. Dimples were also not observed from the tensile fracture surface morphology of the composite. [ABSTRACT FROM AUTHOR]

Background: Palliative radiotherapy in patients with metastatic spinal cord compression is a wellknown treatment modality but little is known whether it improves quality of life and performance status. Our study focusses on analyzing the impact of palliative radiotherapy on these two parameters in patients with metastatic spinal cord compression. Methods: We performed a prospective observational study from August 2020 to April 2021 to assess consecutive patients presenting to emergency department with suspected MSCC. We enrolled 24 patients in the study, and they were evaluated for their performance status and quality of life using ECOG and FACITPAL 14 scores respectively. Palliative radiotherapy was administered, and the patients were followed up four to six weeks later. Their ECOG and FACIT-PAL 14 scores before and after receiving palliative radiotherapy were analyzed. Results: The mean age of the patients was 48 (IQR 35-62), with 14 (58%) being male. 1 patient died soon after admission. Median dose fractionation was 2000 cGy. Median (IQR) of ECOG performance status score on admission and follow up was 2.5 (1.0-3.7) and 1.5 (1.0-3.7), p=0.719, respectively. Median (IQR) FACIT-PAL 14 score on admission and follow up were 35.5 (34.0-37.6) and 36.5 (30.2-44.7), p=0.277, respectively. Our results indicate that there was no statistically significant difference in the median ECOG performance status and FACIT PAL 14 scores before and after the administration of palliative radiotherapy. Conclusion: Our study indicates that palliative radiotherapy in patients with metastatic spinal cord compression had little benefit in objectively improving quality of life and performance status using the well-known and widely used scores. This lack of response could be due to delayed presentation of the patients. Earlier involvement of palliative care team could have improved both these parameters. Further research with larger population of patients over a longer period is needed to further assess these outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dependency on feeding gastrostomy tubes in patients with head and neck cancers treated with radiotherapy alone or concurrent chemo-radiotherapy. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Shaukat Khanum Hospital, Peshawar Pakistan, from Jan and Jul 2022. Methodology: A total of 115 patients with head and neck cancers having no baseline dysphagia and having gastrostomy tubes were included. All had received an equivalent of 60 greys in 30 fractions or more of radiotherapy. Their swallowing was evaluated weekly during radiotherapy and then every 4-6 weeks on post-treatment follow-up. The total time duration of patient dependency on feeding gastrostomy tube after treatment completion was noted for each head and neck cancer subsite. Results: Of a total of 115 patients, 49(43%) of the patients had nasopharyngeal cancers, 22(19%) had laryngeal, 29(24%) oral cavity, 7(6%) hypopharyngeal and 9(8%) had cervical esophageal cancers. Proportion retaining gastrostomy tube for more than six months of treatment was 8.7% (median duration of retention was five months) with hypopharyngeal, nasopharyngeal, oral cavity, and laryngeal cancer were 14%, 9%, 9% and 5%, respectively. Conclusion: The proportion of patients with head and neck cancers requiring more than six months of a gastrostomy tube is 5-14%. Baseline assessment of swallowing and nutrition and prophylactic feeding gastrostomy can avoid treatment interruptions. Longer duration of retention of a gastrostomy tube is associated with poor quality of life in head and neck cancer patients receiving radiation or concurrent chemo-radiation. [ABSTRACT FROM AUTHOR]

Objective: To analyze the predictive value of drumhead perforation to overall visceral damage by the blast waves. Study Design: Retrospective observational study. Place and Duration of Study: It was a multi-centric study extending from Jul 2005 to Jun 2009. Blast victims in Wana (Pak Afghan border area, a hot center of war against terrorism in Pakistan), Lahore (provincial capital of Punjab, Pakistan) and Quetta (provincial capital of Baluchistan, Pakistan) were included in the study. Methodology: A total of 354 patients were included in the study. A preliminary examination by surgeon and ENT specialist was carried out to evaluate patient’s general condition and state of tympanic membranes. Sonographic examination, computerized tomography (CT) scan and other relevant investigations were subsequently carried out to further ascertain the patient’s condition and visceral damage. The data were then analyzed to correlate visceral damage as a result of blast injury to the laterality and size of tympanic membrane perforation. Results: The extent of visceral damage was less in cases with intact drumheads, more in cases with unilateral perforation and maximum in cases with bilateral subtotal perforation. Conclusion: The size and laterality of drumhead perforation as a result of blast injury is a rough predictor of visceral damage sustained as a result of blast injury. [ABSTRACT FROM AUTHOR]

Neuroendocrine breast carcinoma (NEBC) is histologically a rare type of invasive breast cancer. It constitutes only 0.2-0.5% of all invasive breast cancers. In this case series, we are presenting five cases having primary neuroendocrine breast cancers that had been reported at a high-volume cancer centre in Pakistan. In this study, neuroendocrine breast cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre Peshawar were evaluated. We had retrospectively collected information on demographic characteristics of our patients, physical examination, radiological findings, surgical procedures with their outcomes, histopathological and immuno-histochemical characteristics, systemic adjuvant/neoadjuvant therapy and follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To determine the short-term mortality rate of patients on mechanical ventilation in a tertiary care center in Sialkot, Pakistan. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was conducted jointly by the departments of Anesthesiology, Surgery and Gynecology & Obstetrics at Combined Military Hospital Sialkot Cantonment, from Jul 2013 to Jun 2015. Material and Methods: A total of 112 patients placed on mechanical ventilation were included in this study. The patients' age, gender, disease on admission, duration of ventilation, indication for ventilation, outcomes and complications were noted. SPSS 21 was used for data analysis. Results: Fifty-eight (51.78%) patients expired while 54 (48.21%) were weaned off successfully. In the former group of expired patients, the major factors contributing towards the mortality were multi-organ failure (37.9%), VAP/ventilator-associated pneumonia (32.7%), coagulopathy (29.3%) and sepsis (27.5%). However, in the survivor patients group5 patient (9.25%) developed VAP, 3 (5.55%) developed pneumothorax while 3 others (5.55%) developed a fever of unknown etiology. Conclusion: The short-term mortality rate of patients who receive mechanical ventilation in an intensive care unit (ICU) in Sialkot, Pakistan is significantly higher than that of developed countries. [ABSTRACT FROM AUTHOR]

Objective: This study was cross sectional survey conducted to find the prevalence of Restless legs syndrome (RLS) in end stage renal disease (ESRD) patients on haemodialysis (HD). Methods: Data were obtained from 250 patients on chronic maintenance HD. To assess the prevalence of RLS, Clinical diagnostic criteria for RLS was used which is established by the International RLS Study Group. Results: Total 250 patients were included in this study. 153 (61.2%) patients were male and 97 (38.8%) were females. Mean age of the patients was 45.27 years. Mean duration of HD was 26.10 months. Total162 (64.8%) patients were found to be suffering from RLS. Out of 153 males, 87(56%) were suffering from RLS and among 97 females, 75(77.3%) were suffering from RLS. In our study, gender was statistically significantly associated with RLS (p-value 0.001). In age groups 159(63.6%) patients were below 51 years; among them 102(64.1%) were suffering from RLS; whereas 91(36.4%) patients were equal or above 51 years of age and among this group 60(65.9%) patients were suffering from RLS. There was no statistically significant association between RLS and age groups (p-value 0.776). Conclusions: RLS is common in patients undergoing regular HD. It is more commonly seen in females. [ABSTRACT FROM AUTHOR]

Background: Pharmacoeconomics has been defined as: the description and analysis of the cost of drug therapy to health care systems and society. Aim was to observe the Medication Therapy on the basis of Phamacoeconomics Analysis and to save the economic resources., Methods: This Descriptive Cross sectional study was conducted at Ayub Teaching Hospital and Combined Military Hospital, Abbottabad, from May-August 2011. The case histories of 100 patients were scrutinized thoroughly specially with reference to socioeconomic history, Clinical laboratory tests, Medication history and treatment at hospital and discharge medications. After their collection, these case histories were analyzed with respect to Phamacoeconomics and compared with the world literature., Result: A total of 100 patients were studied. Pharmacoeconomic analysis shows that in 49 Patients' medications were according to international standards while in 51 patients' medications prescribed were irrational., Conclusion: Mutual interaction between physician, surgeon, other healthcare professionals, and clinical pharmacist is necessary to assure rational medication therapy and positive response to therapy of each patient.

Background: Spondylolithesis is forward slipping of upper vertebra in relation to its lower one, which at times requires surgery. The objective of present study is to document the outcome of surgical treatment in spondylolisthesis of lumbosacral region., Methods: We reviewed outcome of surgery in 45 patients with spondylolisthesis. Improvement in pain intensity, neurological status and union achieved after surgery was studied. All patients requiring surgical treatment were included in the study. The patients were operated by single spine surgeon. A Performa was made for each patient and records were kept in a custom built Microsoft access database., Results: Majority of our patient were in 4th and 51th decade with some male domination. Pain was main indication for surgery which was excruciating in 6. severe in 33, and moderate in 6 cases. The neurological status was normal in 34 cases while 11 patients had some deficit. L5-S1 was affected in 26, L4-L5 in 13 and multi or high level was found in rest of cases. Slip grade was measured with Meyerding grades, 18 had grade II, 15 had I, 9 had III and 3 had IV spondylolisthesis. Posterior lumbar inter body fusion (PLIF) was done in 24 patients, posterolateral, transforaminal lumbar inter body and anterior inter body fusion in others. Translaminar screw fixation, transpedicular transdiscal transcorporial and Delta fixation in some cases. Pedicle screw fixation was done in most cases, AO fixator internae and 4.5 mm screw in others. Average follow up was 2 years and 5 months, max 5 years and minimum 6 months. Pain relief was achieved in 82%, neurological improvement 60% and union in 91% cases. There was no deterioration of neurological status, two implant failure and one wound infection., Conclusion: Surgical procedure for Spondylolisthesis must be individualised. Young patients with spondylolysis can be treated with osteosynthesis and sparing of motion segment. PLIF provides satisfactory results in majority of low to moderate cases with some reduction. Transpedicular transdiscal transcorprial and delta fixation is good procedure for severe slips in adult.

Background: Hydrocoele is an abnormal quantity of serous fluid within the tunica vaginalis. It can be primary or secondary. The primary can in turn be congenital or acquired. Objective of this study was to see the frequency of primary hydrocoeles in children presenting to Ayub Teaching Hospital, Abbottabad., Methods: This prospective study was conducted in Surgical 'B' Unit, Ayub Teaching Hospital, Abbottabad, from Feb 2007 to Feb 2009. All Children above 6 months age with hydrocoeles and operated were included in this study. All details were recorded on a proforma. The collected data were analysed, results calculated, and conclusions drawn., Results: In all 186 operated cases, the maximum (58, 37%) incidence was in 2-3 years age group. Injury to the vas occurred in 1 (0.7%) case, infection rate was 0% and scrotal haematoma occurred in 18% cases., Conclusion: Children with hydrocoeles should be operated after 6 months age. Herniotomy is the only satisfactory treatment and in expert hands complications are very rare.

Background: Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis., Methods: This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated., Result: Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +/- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +/- 5.43 years in male and 48.76 +/- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females (p=0.03, statistically significant). Majority of females (60%) had > or = 40 U/ml antibody titre (p=0.917, non-significant)., Conclusion: A possible relationship was identified between Helicobacter pylori and calcular cholecystitis.

Background: Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored., Methods: Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months., Results: Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%., Conclusion: Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery.

Background: Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006., Methods: 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany., Results: No major postoperative complication was noted. Only 1 patient (1.14%) developed unilateral recurrent laryngeal nerve damage and 2 patients (2.27%) developed transient hypocalcaemia that recovered quickly., Conclusion: Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery.