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Introduction: Congenital adrenal hyperplasia (CAH) is an autosomal-recessive condition primarily caused by 21- hydroxylase deficiency. It is the most common cause of ambiguous genitalia in infants and children. It can be a fatal condition if left untreated. Objectives: The study's objective was to estimate the levels of 17-hydroxyprogesterone, plasma direct renin, testosterone, and electrolytes in patients with CAH. Place and Duration of Study: This cross-sectional study was conducted at the University of Child Health Sciences, Lahore between March 2021 till April 2022. Material & Methods: This study included ninety CAH patients up to 14 years of age who underwent clinical and physical testing without gender restriction. Patients without confirmed CAH but with elevated levels of 17- hydroxyprogesterone were excluded. An ultrasound examination was done to confirm the presence of ambiguous genitalia. ELISA was used to estimate the values of 17-hydroxyprogesterone. Plasma direct renin and testosterone were measured by chemiluminescence immunoassay. The values of sodium, potassium and chloride were measured using an electrolyte analyzer. Data was analyzed using IBM SPSS version 26.0. Results: Of the total 90 patients, 46 (51.11%) were boys and 44 (48.88%) were girls. 55 (61.10%) CAH patients had high levels of 17-OHP. High testosterone and plasma direct renin levels were observed in 31 (34.40%), and 43 (47.80%) CAH patients respectively. Mostly, CAH patients had normal levels of sodium 70 (77.80%), potassium 54 (60.0%), and chloride 57 (63.30%). The difference in 17-OHP (ng/mL) levels was found to be statistically significant (p=0.002) in both genders. Conclusion: There is a significant association between elevated 17-OHP and CAH in the pediatric population, indicating that the 17-OHP can be used as a diagnostic tool for CAH patients.

Background/Aim: Bystander cardiopulmonary resuscitation (CPR) during out of-hospital cardiac arrest increases both survival rates and neurological recovery, but in Pakistan, an alarmingly low 2.3 % of these individuals receive bystander CPR. This study was designed to identify the reasons that affect the perception and willingness of the public toward bystander CPR training and performance in Lahore, Pakistan. Methods: A CPR master trainer from the USA visited various organisations from 1 December 2022 to 31 January 2023, to conduct training sessions. Before and after the training, a questionnaire was distributed among respondents to fill in. The subjects were asked to answer questions about their perception and willingness to perform bystander CPR. Results: Out of 401 participants, 240 completed the survey, with a response rate of 59.85 %. The majority of them were males [146 (60.8 %)], 215 (89.6 %) were below the age of 40, 107 (44.6 %) were graduated, 182 (75.8 %) never participated in any CPR training, mainly due to their ignorance towards the importance of bystander CPR (52.8 %) and 152 (63.3 %) were eager to participate in the CPR training course. Furthermore, the leading problem in providing bystander CPR was lack of technique or fear of possible harm that can be proved fatal (48.8 %), followed by concerns related to involvement in any legal procedure (10.0 %). Conclusions: Bystander CPR is still uncommon in Pakistan. Participants were reluctant to perform bystander CPR because of various concerns and fears. Lack of proper skill and causing additional harm were the main reasons associated with this. Hence, while improving CPR training and public education, these findings must be considered.

Byline: Navid. Khaledi, Rao. Khan, James. Gräfe Radiosurgery and stereotactic radiotherapy have established themselves as precise and accurate areas of radiation oncology for the treatment of brain and extracranial lesions. [...]

Objective. This study simulated the potential of gold nanoparticles (GNPs) to improve the effectiveness of radiation therapy in pancreatic cancer cases. The purpose of this study was to assess the impact of GNPs on tumor control probability (TCP) and normal tissue complication probability (NTCP) in pancreatic cancer cases undergoing radiation therapy. The work aimed to compare treatment plans generated with a novel 2.5 MV beam using GNPs to conventional 6 MV plans and evaluate the dose-volume histogram (DVH), TCP, and NTCP. Approach. Treatment planning for five pancreatic computed tomography (CT) images was performed using the open-source MATLAB-based treatment planning program matRad. MATLAB codes were developed to calculate the relative biological effectiveness (RBE) of GNPs and apply the corresponding dose and RBE values to each voxel. TCP and NTCP were calculated based on the applied RBE values. Main results. Adding GNPs to the 2.5 MV treatment plan resulted in a significant increase in TCP, from around 59% to 93.5%, indicating that the inclusion of GNPs improved the effectiveness of the radiation treatment. The range in NTCP without GNPs was relatively larger compared to that with GNPs. Significance. The results indicated that the addition of GNPs to a 2.5 MV plan can increase TCP while maintaining a relatively low NTCP value (<1%). The use of GNPs may also reduce NTCP values by decreasing the dose to normal tissues while maintaining the same prescribed dose to the tumor. Hence, the addition of GNPs can improve the balance between TCP and NTCP. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of oral Theophyline compared to Non-Steroidal Anti-Inflammatory Drugs in the management of postdural puncture headache in obstetric patients. Study Design: Quasi-experimental Study. Place and Duration of Study: Anaesthesia Department, Combined Military Hospital, Kharian Pakistan, from Apr to Sep 2018. Methodology: Our study enroled 60 pregnant women suffering from postdural puncture headache. The were divided in to two groups, NSAID-Group (Group-A) who received 30mg of Ketorolac in three divided doses in 24 hours and Theophyline-Group (Group-B) who received 750mg of oral Theophyline in three divided doses in 24 hours after which effects of both drugs were noted. Results: Pregnant women were enroled in NSAID-Group and in Theophyline Group. Mean baseline Visual Analogue Scale score was 7.500±0.97 in NSAID-Group and 7.33±0.92 in Theophyline Group. Mean weight was 66.86±5.25 kg in NSAID-Group and 67.16±7.01 Kg in Theophyline-Group. In NSAID-Group efficacy was noted in 7(23.3%) patients as compared to 25(83.3%) patients in Theophyline-Group, (p<0.001). Conclusion: Theophyline when given oraly in the management of postdural puncture headache proved to be a superior alternative to NSAID medication. [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]