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Globally, multipurpose large dams play significant roles by providing water for irrigation, flood control and hydropower. This study aims to evaluate different strategies for the evacuation of deposited sediments in Tarbela reservoir by using Hydrologic Engineering Center-River Analysis System. Sediment flushing from existing power tunnels was found infeasible due to the downstream constraints and the loss of hydropower. New sediment bypass tunnels on the right-side bank of the dam to overcome the constraints were analysed. The sediment balance ratio, long-term capacity ratio and economic analysis were computed along with sediment modelling for different scenarios. The most technically viable scenario was 90 days flushing at 390 m drawdown level with a discharge of 5000 m3/s. This scenario was not economically feasible in terms of net present value, internal rate of return and the benefit cost ratio. The upstream under construction Diamer Basha dam was also evaluated. The results suggested a large volume of sediment would be trapped in the upstream reservoir, which would ultimately lead to a significant reduction in the inflow of sediment and the delta movement in the Tarbela reservoir. This option was recommended due to its multiple benefits and potential capacity to enhance Tarbela reservoir's life.

Aphtha is a Greek word for ulceration which is a common problem in dentistry for diagnosis and treatment. Objective: To assess serum levels of iron among patients with RAS and its comparison with the control group. Methods: The analysis involved 150 subjects alienated into 2 groups as a group with recurrence of aphthous ulcer and a control group. The 75 patients were encompassed in the control group and 70 in the aphthous ulcer matched for age and sex. Based on the history and clinical examination, the diagnosis of RAS was made. By ELISA test and ELX 800 Absorbance Microplate Reader tool, Serum ferritin was measured, while micro-lab 300 was used to evaluate serum hemoglobin and iron levels. Results: Grounded on standard values of laboratory investigations, serum levels of iron were suggestively lower in patients of RAS in comparison to the control group. Minor RAS type was observed in 71 patients (94.7%), while major RAS was reported in 4 patients (5.3%). Out of 75, 20% had multiple ulcers and 80% had a single ulcer. While RAS was localized in non-keratinized mucous membrane in 64 patients (85.3%), in 6 patients (8%); RAS was located in keratinized mucous membrane and both non-keratinized and keratinized mucosa were seen in 5 subjects (6. 7%). Conclusion: The presence of iron deficiency has been linked to recurrent aphthous stomatitis

TITLE: Awareness of dental personnel towards occupational injury- a cross sectional study ABSTRACT Objective: To determine the awareness of dental personnel towards dental occupational injury in Karachi. Methods: This cross-sectional prospective study was conducted using pre-designed questionnaire addressing dental personnel of two dental hospitals of Karachi. It includes final year students, house officers, dental officers, general dental practitioners, consultants, post-graduate residents, and dental staff assistants. The inclusion criteria include dental personnel from both genders aged between 20 years to 60 years and had given verbal consent for the study. The non-cooperative respondents, not willing to participate in the study were excluded The sample population includes final year BDS students, house officers (HOs), dental officers (DOs), general dental practitioners, consultants, post-graduate residents (PGs) and dental staff assistants (DSAs). The dental health care workers were asked for the frequencies, tool, procedure and the departments in which they experienced NSI/SII; their knowledge and practice regarding standard management protocols for NSI/SII and their reporting was assessed. A sample size of 201 personal was selected. Through informed verbal consent dental personnel of both genders aged between 20-60 years, filled questionnaire. Statistical analysis was done on SPSS version 19.00. Results: Female and final year BDS participants were74.6% (n=150) and 35.3% (n=71) respectively. Needle stick injury or sharp instrument injury (NSI/SII) was 69.6 % (n=140). Most frequent Instrument causing injury was dental needle i.e. 54.3% (n=76) while most frequent procedure was during local anesthesia administration i.e. 28.6% (n=40). Department of Oral Surgery was the most common department reported for injury i.e. 53.6% (75). Total 86.6% (n=174) were aware and 79.3% (n=111) of dental personnel followed standard protocols for its management. The statistical analysis was done with SPSS version 19.0. with significant p-value was < 0.05. Conclusion: The percentage of dental occupational injury is high and awareness of dental personnel towards dental occupational injury in Karachi is inadequate. Keywords: Wounds and Injuries, occupational injuries, dental instruments word count abstract: 204 word count: 1781 Number of tables and Figures: 2 each Conflict of interest and funding: None TITLE: Awareness of dental personnel towards occupational injury- a cross sectional study ABSTRACT Objective: To determine the awareness of dental personnel towards dental occupational injury in Karachi. Methods: This cross-sectional prospective study was conducted using pre-designed questionnaire addressing dental personnel of two dental hospitals of Karachi. It includes final year students, house officers, dental officers, general dental practitioners, consultants, post-graduate residents, and dental staff assistants. The inclusion criteria include dental personnel from both genders aged between 20 years to 60 years and had given verbal consent for the study. The non-cooperative respondents, not willing to participate in the study were excluded The sample population includes final year BDS students, house officers (HOs), dental officers (DOs), general dental practitioners, consultants, post-graduate residents (PGs) and dental staff assistants (DSAs). The dental health care workers were asked for the frequencies, tool, procedure and the departments in which they experienced NSI/SII; their knowledge and practice regarding standard management protocols for NSI/SII and their reporting was assessed. A sample size of 201 personal was selected. Through informed verbal consent dental personnel of both genders aged between 20-60 years, filled questionnaire. Statistical analysis was done on SPSS version 19.00. Results: Female and final year BDS participants were74.6% (n=150) and 35.3% (n=71) respectively. Needle stick injury or sharp instrument injury (NSI/SII) was 69.6 % (n=140). Most frequent Instrument causing injury was dental needle i.e. 54.3% (n=76) while most frequent procedure was during local anesthesia administration i.e. 28.6% (n=40). Department of Oral Surgery was the most common department reported for injury i.e. 53.6% (75). Total 86.6% (n=174) were aware and 79.3% (n=111) of dental personnel followed standard protocols for its management. The statistical analysis was done with SPSS version 19.0. with significant p-value was < 0.05. Conclusion: The percentage of dental occupational injury is high and awareness of dental personnel towards dental occupational injury in Karachi is inadequate. Keywords: Wounds and Injuries, occupational injuries, dental instruments word count abstract: 204 word count: 1781 Number of tables and Figures: 2 each Conflict of interest and funding: None TITLE: Awareness of dental personnel towards occupational injury- a cross sectional study ABSTRACT Objective: To determine the awareness of dental personnel towards dental occupational injury in Karachi. Methods: This cross-sectional prospective study was conducted using pre-designed questionnaire addressing dental personnel of two dental hospitals of Karachi. It includes final year students, house officers, dental officers, general dental practitioners, consultants, post-graduate residents, and dental staff assistants. The inclusion criteria include dental personnel from both genders aged between 20 years to 60 years and had given verbal consent for the study. The non-cooperative respondents, not willing to participate in the study were excluded The sample population includes final year BDS students, house officers (HOs), dental officers (DOs), general dental practitioners, consultants, post-graduate residents (PGs) and dental staff assistants (DSAs). The dental health care workers were asked for the frequencies, tool, procedure and the departments in which they experienced NSI/SII; their knowledge and practice regarding standard management protocols for NSI/SII and their reporting was assessed. A sample size of 201 personal was selected. Through informed verbal consent dental personnel of both genders aged between 20-60 years, filled questionnaire. Statistical analysis was done on SPSS version 19.00. Results: Female and final year BDS participants were74.6% (n=150) and 35.3% (n=71) respectively. Needle stick injury or sharp instrument injury (NSI/SII) was 69.6 % (n=140). Most frequent Instrument causing injury was dental needle i.e. 54.3% (n=76) while most frequent procedure was during local anesthesia administration i.e. 28.6% (n=40). Department of Oral Surgery was the most common department reported for injury i.e. 53.6% (75). Total 86.6% (n=174) were aware and 79.3% (n=111) of dental personnel followed standard protocols for its management. The statistical analysis was done with SPSS version 19.0. with significant p-value was < 0.05. Conclusion: The percentage of dental occupational injury is high and awareness of dental personnel towards dental occupational injury in Karachi is inadequate. Keywords: Wounds and Injuries, occupational injuries, dental instruments word count abstract: 204 word count: 1781 Number of tables and Figures: 2 each Conflict of interest and funding: None

Multipurpose large dams play a key role in the development of world by providing water for irrigation, flood control and hydropower. Tarbela is one of the world's largest earth and rock fill dam. Being multipurpose dam, it provides vital role for economic stability and social development of Pakistan. Tarbela Reservoir has lost its significant capacity due to sediment deposition. The objective of the study was to evaluate different options for evacuation of deposited sediments and reducing sediment inflows to Tarbela Reservoir through sediment modeling by HEC-RAS. Sediment flushing from existing power tunnels was evaluated in first option and found not feasible due to the downstream constraints and loss of 7848 MW hydropower from Tarbela and Ghazi Barotha. New sediment bypass tunnels were proposed on right bank of the dam to overcome the constraints in second option. Sediment modeling was performed by HEC-RAS to evaluate each scenario of sediment flushing with different parameters. The sediment balance ratio and long term capacity ratio was also checked for each scenario for technical evaluation and also economic analysis was performed. Most technical viable scenario was flushing for 90 days at reservoir drawdown level of 390 m with discharge of 5000m 3 /s. However, this scenario was not economically feasible as net present value was negative, internal rate of return was 3-4 %, and benefit cost ratio was found less than one. The 3 rd option, with under construction multipurpose Diamer Basha Dam on upstream of Tarbela Reservoir, was also evaluated on HEC-RAS. Results depicted that large amount of sediments were trapped in the upstream reservoir which ultimately reduced significantly the inflow of sediments and delta movement in Tarbela Reservoir. This option is recommended because it will enhance the life of Tarbela Reservoir and it will keep on providing multiple benefits for longer time.

Introduction: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of non-complicated cases. Aims and objectives: The basic aim of the study is to analyse the prosthetic mesh repair in obstructed inguinal hernia. Material and methods: This cross sectional study was conducted in Nishtar Medical College, Multan during January 2019 to October 2019. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Results: Mesh-based repair techniques were performed on the 35 patients comprising Group 1, while tissue repair techniques were performed on the 35 patients comprising Group 2. In this study, 81.5% of the patients were male, while 18.5% were female. Female patients had a significantly higher ratio of femoral hernia than male patients, while male patients had a significantly higher ratio of inguinal hernia than female patients. Conclusion: It is concluded that the use of polypropylene mesh in incarcerated inguinal hernia repair has no negative effect on wound infection or complications.

Introduction: Hypokalemia refers to a serum potassium concentration (SPC) of Objectives of the study: The basic aim of the study is to analyse the serum potassium levels and mortality in acute myocardial infarction in Pakistan. Methodology of the study: This cross sectional study was conducted in DHQ Hospital, Rajanpur during 2018 to 2019. The data was collected from 100 male and female patients with myocardial infarction. We determine the impact of plasma potassium concentration for patient survival following myocardial infarction. Current guidelines emphasize the importance of avoiding hypokalemia, advising that patients diagnosed with myocardial infarction should be given potassium supplements, if necessary, to maintain serum potassium in the range of 4.0-5.0 mmol/L.Results: The data was collected from 100 patients of MI. Mean age of male patients was found to be 64.12±12.34 and female patients was 46.21±10.24. There was statistically significant decrease in serum sodium and potassium levels in study group among both the ages compared to normal healthy control group. Conclusion: It is concluded that reduction in sodium level was assessed only in patients with AMI as compared to healthy persons. Estimation of serum electrolyte is of utmost importance for diagnosis and prognosis of AMI.

Approximately 350 million patients of hepatitis B and 170 million patients of Hepatitis C are present worldwide according to WHO. Many risk factors are involved in the transmission of theses deadly viral infections but blood transfusion in Beta thalassemic patients is working with two faces, one as remedy and the other is key risk factor in the spread of silent killers. Thalassemia patients registered in Combine Military Hospital (CMH) Rawalakot and Sheikh Khalifa Bin Zayed Al-Nahyan Hospital, Muzaffarabad Azad Jammu and Kashmir Pakistan were studied for the viral hepatitis B and C prevalence. A total of 303 (including 164 males and 139 females) individuals, aged between 1 and 12 years were studied. All the understudy participants were interviewed through questionnaire method. After taking written consent from each participant or guardian, 5 ml of blood was collected from each participant and brought to the working laboratory for HBV and HCV screening through ICT kit method. All ICT positive samples were further confirmed through ELISA. Individuals 25(8.2%) were found positive for both hepatitis B surface Antigen (HBsAg) and Anti hepatitis C antibody (Anti-HCV antibody) after initial screening with no coinfection of both diseases. Out of 25 total infected individuals, 05(1.6%) were found HBsAg positive and 20(6.6%) were found anti-HCV positive. All the ICT positive individuals were further confirmed by quantitative Enzyme Linked Immunosorbent Assay (ELISA) and 23(7.6%) individuals were confirmed for both hepatitis B and C including 05(1.6%) HBsAg positive as well as 18(5.9%) anti-HCV antibody positive individuals. We can conclude that 8.2% prevalence of hepatitis B and C among thalassemic patients is an alarming health concern which directly indicates to pay attention for ensuring 100% safe blood transfusion.