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The following is an English translation of three essays by the late nineteenth-century Urdu novelist, historian, and essayist ʿAbd ul-Ḥalīm Sharar (1860–1926). In the essays translated here, Sharar offers commentary on contemporaneous world-historical events such as the dissolution of the Ottoman Empire (which had garnered huge public uproar in British India, later culminating in the Khilafat movement) and the “Great Game” in Iran that resulted in its bifurcation into Russian and British spheres of influence. These polemical pieces concerning major imperial changes of the early twentieth century oscillate between impassioned pleas to the colonial government to save Islamic empires from total ruin and rousing calls to action to the Muslim community to band together and save themselves. The first essay, “The Fall of the Persians” (Zavāl-e ʿAjam), reflects on the twilight years of Qajar Iran and presents “Islamic” Persia as the civilizational fountainhead of large swathes of Asia from “the Bosphorus to China.” The second essay, “The End of Ottoman Power” (ʿUṡmānī Sat̤vat kā Ḳhātimah), responds to the dissolution of the Ottoman Empire in 1912 by analyzing the material reasons for the triumph of Europe. The third piece, “The Democratic Spirit of the Arabs” (ʿAraboñ kī Jamhūriyat-pasandī), captures the style for which Sharar was primarily known: narrating history through entertaining stories for moral edification. Here, a short vignette about the Andalusian ruler ʿAbd ul-ʿAzīz and his gradual decline towards conceit, at the behest of his Gothic wife, is framed by a historical review of the many ways in which Islamic rulers avoided inadvertent polytheism by not using grand titles like sult̤ān and bādshāh for themselves. This is held up as representing the intrinsic democratic ethos of the Arabs which was forfeited by later Islamic rulers under the influence of Persian culture. These essays will be of interest to literary scholars and historians of twentieth-century India interested in imperial transitions. They preserve trends in Urdu historiography that were central to the fashioning of national publics, providing a window into negotiations of the place of Urdu and Indian Muslims in the world.

Photobiomodulation (PBM), also known as low level laser therapy (LLLT) or cold laser therapy uses light energy to elicit biological responses from the cell and help regulate cell function. From a clinical point of view PBM offers dental practitioners a non-invasive treatment modality that can be used as an adjunct to the traditional therapies or as a therapeutic tool on its own. This is a case of surgical excision of a fluctuant mass using a scalpel and diode laser 980nm wavelength.

This paper focuses on the inflation problem about a worldwide issue. The aim of this study is to discuss the technique over the data collected for the last thirty-eight months. This study explores the significance of inflation and inflation volatility. The results were also compared with the estimates for effectiveness and volatility by the ARCH/GARCH technique. The entire model is statistically significant. There is a positive relationship between money supply and exchange rate with current inflation. The Granger test is applied to examine the causality connecting inflation and inflation volatility. The result shows that inflation will be increased in the future in Pakistan. Future studies can be extended by considering more factors to obtain more precision to control the inflation volatility in Pakistan.

There is an assumption that using English language at first meeting enhances first impression and it is also a parameter to judge status. Keeping this scenario in the view this research conducted a careful investigation about how use of English language on texting forms a good first impression and how English is used as a parameter to judge status. It is a survey research and well-designed questionnaire, included 10 close ended questions was used to collect data. Sample was based on randomly selected 100 students of Department of English, University of Kotli Azad Kashmir who were interested to take part in this research. The sample consists 45% of the total population. As a framework the researcher used a mixture of Big Five Personality Sub-Traits merged with other impression factors according to the needs of the current study. After analyzing it is found that use of English language at first meeting have a great effect on impression formation. As English is considered a prestigious language in many countries, people admire individuals who frequently use English in their conversations. That’s how it is also used as parameter to judge status.

Background: One of the most popular surgical operations performed using a variety of techniques is a tonsillectomy. The two that are used the most frequently are the traditional cold dissection technique (CDT) and electrocautery, the latter of which is carried out using the monopolar and bipolar electrocautery procedures (BET).All techniques used during tonsillectomy are intended to lessen perioperative bleeding, the intensity of felt pain, and postoperative morbidities. Aim: To compare the outcomes of the bipolar electro cautery tonsillectomy versus cold steel dissection pediatric tonsillectomy in terms of mean-operative time and intra-operative blood loss. Setting: ENT department of Sir Ganga Ram Hospital, F.J. Medical University Lahore from 11-03-2022 to 10-09-2022 Study design: Randomized Controlled Trial Study type: Quantitative study type Methods: The sample size of 110 (55 in group A 55 in group B) was estimated by using 95% confidence level, 90% power of test with an anticipated mean loss of blood during surgery of tonsillectomy i.e. 7.38±2.81m1 with bipolar electro cautery dissection and 11.73±2.86 ml with cold steel dissection. Results: One hundred and ten patients were included as per calculated sample size with the mean age of 8.96±2.42 years. The lowest age limit of children was 5 years while the maximum age limit of children was 13 years. In group A, the mean age of children was 8.80±2.46 years. In group B, the mean age of children was 9.13±2.38 years. The difference was observed as insignificant i.e. p--value = 0.481. Of 110 patients, 67(60.91%) patients were male whereas in group B 29(52.7%) were males. Similarly in group A 17(30.9%) were females and 26(47.3%) were females. The difference was observed as insignificant i.e. p--value = 0.079.In group A, the mean operative time was 19.76±4.47 minutes. Conclusion: This study concluded that bipolar electro cautery tonsillectomy showed significantly better outcome as compared to cold steel dissection pediatric tonsillectomy. Keywords: Cold dissection tonsillectomy, Electrocautery tonsillectomy, Mean operative time, Intra operative blood loss.

Background: Mild cognitive impairment (MCI) is a common phenomenon which is noticeably common among the older individuals population. Progression of this disorder is known to increase risk of Alzheimer's disease and Dementia. Objective: The objective of this study was to determine the association of quality of life and mild cognitive impairment in geriatric population. Methods: The data was collected using Memory Symptom Assessment Scale-Short Form (MSAS-SF) and Quality of life- Alzheimer Disease (QOL-AD) during a time period of six months from 300 individuals aged between 55-85years. The data analysis of this study was done using SPSS 21 version. Spearman test values were calculated to obtain results. Results: MSAD-SF and QOL-AD showed a significant decline of QOL in individuals with mild cognitive impairment. MSAS-SF and QOL-AD had a significant association with pain, lack of energy, difficulty sleeping, problems with urination, lack of appetite, dizziness, feeling sad, worrying, feeling irritable, memory, ability to do chores around the house, physical health, self as a whole and ability to do things for fun (pvalue< 0.05). Domains in both questionnaires indicated a decline in QOL with significant p-values of

Image processing is an important domain for identifying various crop varieties. Due to the large amount of rice and its varieties, manually detecting its qualities is a very tedious and time-consuming task. In this work, we propose a two-stage deep learning framework for detecting and classifying multiclass rice grain varieties. A series of steps is included in the proposed framework. The first step is to perform preprocessing on the selected dataset. The second step involves selecting and fine-tuning pretrained deep models from Darknet19 and SqueezeNet. Transfer learning is used to train the fine-tuned models on the selected dataset. The 50% sample images are employed for the training and rest 50% are used for the testing. Features are extracted and fused using a maximum correlation-based approach. This approach improved the classification performance; however, redundant information has also been included. An improved butterfly optimization algorithm (BOA) is proposed, in the next step, for the selection of the best features that are finally classified using several machine learning classifiers. The experimental process was conducted on selected rice datasets that include five types of rice varieties and achieves a maximum accuracy of 100% that was improved than the recent method. The average accuracy of the proposed method is obtained at 99.2%, through confidence interval-based analysis that shows the significance of this work.

Background: Urine cytology is an initial noninvasive screening test done in patients with suspected urothelial carcinoma. The objective of this study was to compare the sensitivity of conventional smear cytology with cell block technique for the diagnosis of malignant cells in urine and to assess the efficacy of p53 immuno-marker in the diagnosis and prognosis of urinary bladder cancer. Methodology: The study was carried out in the department of Histopathology, Pakistan Institute of Medical Sciences(PIMS), Islamabad. Cell blocks and cytology smears and were prepared from urine samples of 80 patients of urothelial carcinoma and p53 stain was applied. Data was analyzed using version 21. Sensitivity of conventional smear and cell block techniques were calculated for both low and high grade urothelial carcinomas. Results:The sensitivity of detecting atypical cells using conventional smear was 31% and 70.6% for low grade and high grade urothelial tumors respectively. The sensitivity increased to 41.4% and 84.3% for low and high grade urothelial carcinomas respectively with cell block technique. Positive p53 stain was seen in 13.8% of cases with low grade tumors and 66.7% cases with high grade tumors. Chi-square test was used to find the association of cytology findings with the histologic grade. Conclusion: Sensitivity of urine cell blocks is higher than the conventional smear method for detecting high grade lesions. It can be used as an efficient non-invasive technique and an adjunct tool for the determination of disease relapse and overall survival in patients. Keywords: Carcinoma, Cytology, P53 Protein, Urine

BACKGROUND: Tonsillectomy is the most routinely performed surgical operation in the recent years. There have been lots of controversies about tonsillectomy techniques to provide better conditions with more benefits and less complications. Coblation tonsillectomy is an advanced surgical technique and demands further research to be proven as a suitable and standard method of tonsillectomy. For more than a century, traditional dissection tonsillectomy has remained the gold standard for tonsil removal. OBJECTIVE: The objective of this study is to compare mean operation time and blood loss after radiofrequency coblation tonsillectomy versus dissection tonsillectomy in management of patients with chronic tonsillitis RESULTS: The mean age of cases in this study was 33.78±16.21 years with 56(46.67%) male and 64(53.335) female cases in this study. In dissection group mean blood loos was 143.63±34 mL and in Coblation group the mean blood loos was 113.45±24.61 mL, p-value < 0.001. The mean surgery time in dissection group was 40.08±6.64 minutes and in Coblation group was 32.62±4.21 minutes with significantly less in Coblation method when compared with dissection group, p-value < 0.001. Conclusion: Through the findings of this study we found that radiofrequency Coblation yields less mean operation time and mean blood loss when compared with dissection tonsillectomy in management of patients with chronic tonsillitis. Using radiofrequency Coblation better outcome can be achieved along with patient’s and surgeons satisfaction.

This article examines the Afro-Asian Writers’ Association’s (AAWA) magazine, Lotus, as an example of the cultural discourse of Afro-Asianism and the logistical and political challenges of institutionalizing a Third World literary canon within the broader context of Cold War alliances. The author's focus on the magazine’s conceptual vocabulary and its internal mechanisms reveals how anticolonial writers and cultural actors brought their own different (often, competing) versions of Marxism and varying degrees of alignment with Soviet-style socialism to the project of cultural decolonization and contributed to a global socialist order. Concerns of literary form, political liberation, and the context of noncommercial patronage shaped an all-encompassing cumulative aesthetic that was not always aligned with Moscow mandates. Her reading of the Lotus archive also draws out the frictions between various geopolitical pivots of the Afro-Asian—a focus on nation, civilization, race, and the larger socialist internationalism—to contribute to studies of the political entanglements between postcolonial and postsocialist studies that can offer insights into current geopolitical predicaments, especially for regions that continue to suffer from new and old forms of occupation and imperialism.

This study is conducted to discuss the thermal transport of second grade nanofluid flowing through a vertical channel. The nanoparticles, alumina (Al2O3), and titanium (TiO2), are dispersed into the second grade base fluid to form a hybrid nanofluid. The governing equation prescribed model is constructed by applying the laws of conservation of mass and energy. It can be modified by converting the non-dimensional classical model to the fractional derivative model using Fick’s and Fourier’s laws. With the help of the Laplace transforms, the resulting dimensionless form of the governing equations and the closed form relations of temperature, concentration, and velocity are obtained. The physical behavior of the obtained result is judged graphically. The nanoparticle’s volume percentage increases the concentration and temperature distribution, but it has the opposite impact on the velocity profile.

Objective: To assess the general oral and periodontal health status of chronic kidney disease patients in various stages and compare it to healthy controls. Methodology: A Cross-sectional comparative study was conducted in Sharif Medical and Dental College, Lahore on 50 patients with chronic kidney disease and 58 controls for the time duration of one year. Data collection was based on the Community Periodontal Index of Treatment Needs and Decayed Missing and Filled index. Results: There was a significant association between stage of kidney disease and periodontal health (p= ≤0.001) and general oral health as determined by the DMFT index (≤0.001). There was a significant difference in the scores of decayed teeth between the controls and stage 3 (0.042), stage 5 (≤0.001) and stage 4 (p= 0.001). The difference in the scores of missing teeth was significant between controls and stage 5 (p=≤0.001) and stage 4 (p=0.001). Similar was the case for decayed missing and filled teeth index scores for controls and stage 3 (p=0.013), stage 5 (≤0.001) and stage 4 (≤0.001). Conclusion: Bleeding gums were most common in stage 3 while pocket depths of 4-5mm were highest in stage 4 and 5 patients. Pocket depth of 4 to 5mm was the most prevalent periodontal problem in controls. In the controls, more individuals had a high DMFT score in comparison to low scores. The scores of decayed teeth and decayed missing filled index were significantly different among the controls and stages 3, 5 and 4 while for missing teeth score, the difference was significant between controls and stages 4 and 5. Keywords: Periodontal health, Community periodontal index for treatment needs (CPITN), Decayed missing and filled teeth (DMFT) index, chronic kidney disease.

Introduction: COVID-19 is a pandemic, which originated in 2019 and is continuing to spread with new variants. It is believed that the use of vaccines can help bring better outcomes, however, the people of Karachi have serious reservations about the vaccines because of the widespread myths. Methodology: The data has been collected in a sample size of 550 participants to find out the correlation between the acceptances of the COVID-19 vaccine. It shows the association between exposure to the virus, administration of a vaccine, reasons behind acceptance and rejection of vaccine, and feared outcomes from May 2020 to June 2021. Results: The results show that 401 people were vaccinated while people received vaccination for better protection, and to retain their salary and travel nationally or internationally. For those who refused to get vaccinated, the majority feared that the rumor about infertility may be true while some did not consider it important. The types of rumors included planting chips, death in two years, infertility, and side effects. Some people feared side effects such as body pain, infections, and infertility. Discussion: As compared to previous researches, the strong anti-vaccine sentiments in the people of Pakistan may be reducing as more people continue to get vaccinated every day. However, there is still a need to educate the mass population about the benefits of vaccines to combat the myths and increase the ratio of the overall vaccinated population

Background: Tonsils and adenoid are part of local immunity near the entrance of respiratory and digestive tracts. However they may become infected and can be a source of chronic or recurrent infections and can lead to OSAS if enlarged. In case of significant morbidity surgical resection is indicated. Aim: To study the relationship between tonsillectomy and increase in weight in children. Setting: ENT Unit II of Fatima Jinnah Medical University and Sir Ganga Ram Hospital Lahore Duration: 1st February 2021 to 31st January 2022. Study design: Quasi experimental study Method: All patients of 5 to 9 years of age with history of recurrent tonsillitis and obstructive sleep apnea syndrome were included. Total of 88 patients selected with non probability convenient sampling. Clinical assessment was done for recurrent and chronic tonsillitis and tonsil hypertrophy causing OSAS. Pre operative weight measured and compared with post operative weight at 3 months follow up. Results: Out of 88 participants 74(84.1%) have recurrent tonsillitis and 75(85.2%) have OSAS. Mean pre operative weight was 16.6591 kg and mean post operative weight was 19.8182 kg. Paired sample t test was applied and p value was calculated which was statistically significant. Conclusion: There is a significant increase in weight after tonsillectomy in children at 3 months follow up that is beneficial in terms of quality of life, school performances, behavior and mental well being. Keywords: Recurrent tonsillitis, Obstructive sleep apnea syndrome, Tonsillectomy, Nocturnal enuresis, Chronic tonsillitis.

To evaluate dentists' knowledge, attitude, and practice of cross infection control protocol. The questionnaire proforma was based on 15 questions was used to check the knowledge, attitude, and practice of the standard infection control protocols among the 3rd and 4th-year students of BDS, house officers and demonstrators of College of Dentistry, Sharif Medical and Dental College, Lahore, who were active in dental health provision in a clinical setting. A total of 200 participants were enrolled in the study after convenient sampling. We found that despite good knowledge of safety protocols, implementation of these standards is lacking. Non-compliance in following standard infection control protocols is a big challenge and can increase the risk of cross-infection. Keywords: cross-infection, dental practitioners, sterilization.

Background: Systemic uptake of hypotonic fluid during irrigation performed at the time of Transurethral Resection of the Prostate (TURP) may cause electrolyte changes including sodium, potassium and calcium. The present study was aimed to assess the degree of sodium changes during Transurethral Resection of Prostate (TURP). Methods: 50 males aged 54 to 86 years, presented for TURP, were enrolled in the study with ASA classification of I to IV grades. Glycine 1.5% was used with height of irrigation kept at 60 cm. One day preoperatively and one hour postoperative, levels of serum sodium were measured for all the patients. Results: Spinal anaesthesia was given in 31 patients, whereas 19 patients were managed under general anaesthesia, with mean duration time being 72.42 ± 24.77min. The mean size of the resected prostate was 54.82 ± 25.04g. 58% patients developed mild hyponatremia, 4% had asymptomatic moderate hyponatremia and no patient developed severe hyponatremia or TURP Syndrome. The systemic diseases like hypertension, DM, or IHD found to be insignificant. Conclusion: TURP was associated with a high incidence of asymptomatic mild hyponatremia. Duration of operation was one of the most important factors.

Introduction: Type 2 diabetes mellitus (T2DM) is a group of metabolic diseases depicted by crippled insulin release by the pancreas and insulin resistance of body tissues. Objectives: The main objective of the study is to analyse the prevalence of type 2 diabetes mellitus and pre-diabetes using HbA1c. Material and Methods: This cross sectional study was conducted in Islam Medical College Sialkot during 2020 to 2021. A special questionnaire concerning family history and health-related information was filled for all participants by direct interviews with the researchers. People previously diagnosed with diabetes or hemoglobinopathies were ruled out from the study. Blood samples were collected from all subjects using EDTA tubes and centrally analyzed for HbA1c. Results: The data was collected from 200 patients of both genders. In all, 200 participants were found to be currently diabetic, giving an overall prevalence of current condition to be 24.6% (95% CI 21.90 - 27.49) in the study population. History of disease was reported by 31.5% participants (P < 0.001). Conclusion: It is concluded that adjustments in platelet files are believed to be measurably connected with diabetes and its intricacies. The prevalence of type 2 diabetes and pre-diabetes is much higher than previously thought in Pakistan.

Background: Endoscopic Sinus Surgery is a minimally invasive procedure that involves the use of an endoscope to improve sinus airflow and drainage as well as the removal of polyps. The extent of surgery varies depending on the severity of the condition and the surgeon's experience. This method has been utilized to treat sinonasal problems for over a decade. Aim: To find the frequency of success of Endoscopic Surgery in patients of Nasal Polyposis. Study design: Descriptive (Prospective) case series. Setting & duration: Department of ENT Unit II, Sir Ganga Ram Hospital, Lahore from 27-01-2021 to 26-07-2021. Methods: In current study, 80 patients of Nasal Polyposis were enrolled. All Patients were undergone Endoscopic Surgery procedure, following the patient at 3 weeks post-operatively as per operational definition addressed by success. Post-stratification chi-square test was applied. Results: Regarding age distribution, mean age was observed 37.60±4.479 years ranged from 30 to 45 years.35 patients were below 38 years of age whereas 45 patients were either 38 years or above. Out of 80 patients, 44 patients (55%) were male while remaining 36 patients (45%) were female. Frequency of patient success after Endoscopic surgery in Nasal polyposis was 64(80%). Conclusion: In conclusion, the success of the patients was considered to be high and comparable to recent literatures both local and international. The percentage of success of patients was higher i.e. 80%. Key words: Success, Endoscopic sinus surgery, Nasal Polyposis.

Background: One of the major consequences of nasal septum surgery is bleeding so bilateral nasal packing is extensively done following nasal surgery to control this postoperative bleeding. This therapeutic blockage of nasal cavity results in discomfort associated with nasal obstruction while pack is in place. Patients also experience varying degrees of discomfort while pack is removed. Aim: To compare the outcome of using innovative breathable nasal packs with bismuth iodoform paraffin paste soaked gauze packs. Setting: Department of Otorhinolaryngology Unit II Sir Ganga Raam Hospital, Fatima Jinnah Medical University, Lahore. Duration: Six months from July 2021 to December 2021. Study design: Randomized Controlled Trial Methods: A total of 112 patients undergoing intranasal septal surgery, due to deviated nasal septum, under general anaesthesia were randomly allocated into two groups. Group A was consisted of patients who were postoperatively packed bilaterally with innovative breathable nasal packs and group B patients were packed bilaterally with conventional bismuth iodoform paraffin paste soaked gauze packs. All the packs were removed after 24 hours. Visual analogue scale was used to record outcome measures. All the information was recorded on proforma. Results: The average age of the patients was 29.60±9.18 years. Mean nasal blockage and sleep disturbance was significantly low in group A than group B [41.79±17.17 vs. 51.07 ± 22.86; p=0.017] and [51.61±14.74 vs. 61.79 ± 24.05; p=0.008]. Conclusion: Innovative breathable nasal packs are a good option for nasal packing as it causes less discomfort to the patient as compared to conventional nasal packs in terms of nasal blockage and sleep distrubance. Keywords: - Nasal septum surgery, Innovative breathable nasal packs, bismuth iodoform paraffin paste soaked gauze packs.

Background and Objective: Ribavirin (RBV), due to its mutagenic property, exerts cytotoxic effects on the testicular seminiferous tubules and its interstitium in various experimental animals. However, no study was done on the morphology of testicular capsule. Therefore, the present experimental study is designed to observe the transient effects of RBV in different doses on the testicular capsule thickness in albino rats.Methods: A total of 72 sexually mature adult male albino rats were divided into four groups: A (control) and, B, C, D where RBV was administered intraperitoneally for 5 days in different doses (20, 100, and 200 mg/kg body weight, respectively). Group received distilled water intraperitoneally. Each group was further divided into three subgroups according to three sacrificial time points that were 20th, 40th, and 60th day from the last exposure to drug. Randomly selected rats from each group were sacrificed on every time point. Histological slides were prepared and changes were observed microscopically.Results: On 20th sacrificial day, the increase in the thickness of capsules was seen in all groups with subcapsular edema in comparison to control group (p < 0.001). After discontinuation of drug, histological evidence of recovery in the form of decrease in the thickness of capsule with decrease in subcapsular edema were observed in low dose groups on 40th and 60th sacrificial days as compared to high dose groups which showed late recovery on both time points (p < 0.001).Conclusion: The testicular capsular thickening induced by RBV is reversible after cessation of treatment. &nbsp

Back ground: Recurrent laryngeal nerves being adjacent to the thyroid glands are prone to surgical trauma by thyroid surgery done for thyroid disease leading to vocal cord paralysis. Aim: To determine frequency of vocal cord paralysis in thyroidectomy Methodology: This is a descriptive cases series was completed in 6 months [December 4, 2019 till June 4, 2020] at Department ENT, Sir Ganga Ram hospital Lahore. The sample technique used is non-probability consecutive sampling .All 170 patients meeting inclusion criteria were inducted in the study from ENT SGR hospital, Lahore. Results: The mean age of all patients was 39.52±11.30 years with minimum and maximum age as 20 and 60 years. There were 91(53.5%) cases that were 20-40 years old and 79(46.5%) cases were 41-60 years old. There were 62(36.5%) male and 108(63.5%) female cases with higher female to male ratio. In 96(56.5%) cases left side and in 74(43.5%) cases right side was involved. There were 37(21.8%) who had vocal cord paralysis while 133(78.2%) cases did not have vocal cord paralysis. Conclusion: It is concluded that high number of patients i.e. 21.8% had vocal cord paralysis, so in future ENT surgeons should adopt safety measures for prevention of VCP such anatomical considerations of the sensitive area Keywords: ENT, thyroidectomy, complications, vocal cord paralysis

Introduction Implantable vagus nerve stimulation (VNS) is an established treatment for drug resistant epilepsy. New onset obstructive sleep apnea (OSA) is a rare side effect of VNS. There are few studies describing VNS induced sleep apnea in adults. [1-2] A study of 16 patients with drug-refractory epilepsy found 5 patients with normal AHI develop mild OSA after VNS treatment for 3 months. [2] However, no literature exists regarding OSA after long term VNS implantation. Untreated OSA in patients with epilepsy can impact epilepsy outcomes. We report a case of new onset OSA after long term VNS implantation, refractory to PAP therapy. Report of case(s) A 36 year-old man with Lennox-Gastaut syndrome presented with gasping during sleep and daytime hypersomnolence. He underwent VNS implantation at the age of 12. A prior PSG in 2018 showed no sleep apnea. Repeat PSG showed VNS-induced OSA (AHI 10.1/hour). After failed CPAP titration, BPAP-S at 25/16 cm H2O improved OSA. Review of therapy data on follow up showed AHI of 13.7/hour and CAI of 10.9/hour, which is concerning for treatment induced central sleep apnea on BPAP. Diagnostic study with VNS turned off revealed mild OSA (AHI 5.8/hour). A multidisciplinary approach involving ENT for drug-induced sleep endoscopy to optimize VNS stimulation parameters along with neurology and sleep involvement is planned. The optimized VNS setting could be used during planned sleep times using a VNS device with dual-programming capability. Conclusion To our knowledge, there is no literature on development of sleep apnea after long term VNS implantation. Although the exact mechanism is unknown, VNS can cause sleep apnea or worsen sleep apnea in patients with a preexisting diagnosis. [1] This case demonstrates need for continuous monitoring and screening for sleep apnea in patients who have been implanted with VNS, even if baseline and follow up PGSs are normal. Current literature suggests discontinuation of VNS to resolve VNS-induced OSA, but we describe a case here where VNS is needed for ongoing management of epilepsy. Further studies are needed to identify treatment options for patients that cannot discontinue VNS therapy who also cannot be successfully treated with PAP if they develop VNS-induced OSA. Support (if any)

The plant Manilkara zapota belongs to the family Sapotaceae and is commonly known as Chiku in Pakistan. Traditionally, M. zapota is used in pulmonary diseases, diarrhea, rheumatism, hemorrhage, and ulcers. There is no study available on the in vivo antiarthritic activity of M. zapota and its gold nanoparticles (AuNPs). The aim of this study is to evaluate the in vivo acute and sub-acute antiarthritic activity of aqueous extract of M. zapota and its biosynthesized gold nanoparticles (AuNPs). Plant-induced reduction method was used for the synthesis of AuNPs. The synthesized AuNPs were characterized via UV, FTIR, SEM, and zeta potential measurements and were optimized by screening various parameters including time, temperature, pH, and salt concentration. Arthritis in rats was induced by Freund's Complete Adjuvant (FCA) injection in hind paw. The antiarthritic effect was evaluated by the determination of paw volume, joint diameter, latency time, hematological, biochemical parameters, antioxidant biomarkers, TNF-α level, and radiological evaluation. The aqueous extract and nanoparticles significantly decreased the paw volume, joint diameter, and significantly increased latency time as compared to the FCA-induced arthritic group. They significantly normalized the hematological, biochemical parameters, and oxidative stress biomarkers in comparison to the arthritic group. They also significantly decreased the TNF-α level when assessed against the arthritic group. Radiological evaluation confirmed the antiarthritic effect of the aqueous extract and nanoparticles of M. zapota leaf extract. It is concluded that the aqueous extract and nanoparticles of M. zapota possess significant analgesic, antiarthritic, and anti-inflammatory activity. However, nanoparticles possess more pronounced antiarthritic activity as compared to the aqueous extract. Moreover, free radical scavenging action and TNF-α reduction showed a prominent role in their antiarthritic activity. Further, investigation is underway to identify the active phytochemical constituent responsible for the antiarthritic activity.

Vegetable waste (spinach, potato, and cauliflower) is a rich and natural source of nutrients, potentially good for supplying minerals, essential amino acids, and antioxidants to the birds. Relatively, its cost very low, easily to accessible, easily process & pose little risk of illness. The aim of present study was to evaluate the effect of vegetable waste (VW) as feed supplement on growth performance and hematology of broiler chicks. For this purpose, a total of 200 (4 days old) vaccinated chicks were acquired from a commercial hatchery Multan which was acclimated for three weeks (21 days) on basal starter feed after that 25-day-old chicks with uniform body weight were allocated according to a CRD (completely randomized design) into four dietary treatments with three replicates of each contained 15 chicks in 12 pens. In dietary treatments, chicks were feed with basal feed (BF) and supplemented feed with vegetable waste (VW) of spinach, potato, and cauliflower. For this purpose, the dietary treatments included control treatment ( T 1 ) (100% BF+0% VW) and other dietary treatments ( T 2 ) (75% BF+25% VW), ( T 3 ) (50% BF+50% VW), and ( T 4 ) (25% BF+75% VW). The body weight, feed intake, food conversion ratio (FCR), and mortality were checked on weekly and daily basis. For hematology analysis, after the 1st experimental week (25-day-old chicks) and the last 5th experimental week (56-day-old chicks), the samples of blood were gathered from the wing’s veins of two birds from each treatment in random way. At the end of five weeks (35 days), birds with uniform average body weight were selected per treatment with three replicates (2 bird/replicate) and then were manually slaughtered according to the Halal method to analyze the weight of internal body organs of broilers by physical and statistical analysis (ANOVA). There was no significant effect ( P > 0.05 ) on feed intake and FCR among all the dietary treatments. But in average, body weight and BWG were higher in treatment ( T 2 ) ( P < 0.01 ) than all other dietary treatments ( T 3 ) and ( T 4 ) and control treatment ( T 1 ). The blood constituents in this study showed that broilers in control treatment ( T 1 ) and other dietary treatments ( T 2 ), ( T 3 ), and ( T 4 ) fed on different doses were significantly ( P < 0.01 ) different from each other. The week 5 ( W 5 ) shows higher values of blood constituents ( P < 0.01 ) than week 1 ( W 1 ). The carcass yield of the chicks fed on different doses showed that they were significantly different ( P < 0.01 ) among the dietary treatments. The VW inclusion 0%, 25%, 50%, and 75% had positive effect on blood constituents and carcass yield of the broiler chicks; they were significantly ( P < 0.01 ) different among the treatments.

Chronic kidney disease (CKD) is defined as any abnormality and impaired kidney functions for more than three months. Most common causes of CKD is diabetes and hypertension. Objective: To determine the association between renal length and echogenicity in patients with or without chronic kidney disease. Methods: In Gilani Ultrasound Centre ,Lahore a descriptive study was conducted on Ultrasound Machine, Nemio 17 Toshiba.70 patients with or without chronic kidney disease were included. Patients with no previous clinical record of diabetes, high blood pressure and age below than 15 were excluded. Results: Data analysis demonstrated that total of 70 patients, (35 normal and 35 with CKD ) were selected in our study.Out of 70, 46(65.7%) were male and 24(34.3%) were female. Our results shows that (out of 70 patients) in right kidney echogenicity, 36(51.0%) no; of patients shows normal echogenicity with grade 0, 18(25.7%) with grade I, 10(14.3%) with grade II, 6(8.6%) with grade III , and in left kidney echogenicity ,37(52.9%) no;of patients shows normal echogenicity with grade 0,16(22.9%) with grade I, 10(14.3%) with grade II, 7(10.0%) with grade III. respectively a significant correlation of CKD with right and left renal were found as ,in right renal length with CKD mean length was 8.914 ±1.43 and without CKD ,10.4 ± 1.2 similarly in left renal length with CKD mean length was 9.49 ± 1.48 and without CKD,10.28 ±1.14.There is also a significant correlation was found between CKD ,right and left renal echogenicity ( significant P value is .000 for right and .000 for left renal length). Conclusion: Study concluded that echogenicity and renal length can help us to estimate the severity of CKD. It also states that there is a significant association, that was found between renal echogenicity, renal length and CKD.