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Background: Eventually Oral submucous fibrosis causes pronounced stiffness and failure to open the mouth. Objectives are to determine compare the efficacy of intralesional steroids alone and combination of steroids with hyaluronidase on mouth opening in oral submucous fibrosis. Methods: It was a prospective comparative cohort study. Total of 74 patients both male and female having history of pan chewing and limited mouth opening and burning sensations were included in the study. Informed consent was taken and divided into two groups. Patients of group 1 were managed with mixture of betamethasone 1 ml and hyaluronidase 1500 IU and patients of group 2 were treated with only steroid injection of betamethasone 1 ml given intralesional, both injections were given intralesional, by multiple puncture technique and once a week and continued for twelve weeks (3 months). And data compiled and analyzed in SPSS-20. Results: The mean age of group 1 was 40.027±6.97years, and mean age of Group 2 was 37.351±5.48 years. In both groups, the greatest number of cases aged from 31–59 years. Compared to females in both groups, the majority of patients were males. In 32 (86.4)% patients of group 1 showed efficacy compared with 18[43.2] patients in group 2 [p-0.000]. Conclusion: In this study Intralesional steroids with hyaluronidase injections are more efficient for opening the mouth in patients with oral sub-mucus fibrosis.

Literature has been studied and read for its own reasons since the beginning. Every day, new ideas are developed that offer fresh methods for studying literature. It served as a potent vehicle for writers to voice their outrage at the inexplicable actions of their fellow citizens. Literature not only amuses us but also informs us of past customs and traditions that were being practiced now. Om Prakash Valmiki’s Joothan: A Dalit's life is his autobiography, which tells us about the suffering in his society. Dalit autobiography is a literary genre that describes a person's life; it is a pretty unique experience. In his autobiography, Valmiki describes his humiliating life and the harrowing tale of how he had to survive by eating leftovers. He receives insults for meal leftovers simply because he was born into the Chuhra caste. He had cost prejudice because he comes from a poor income. Due to his religion, the so-called upper caste Hindus rejected his request for human rights. His schooling had been awful, agonizing, and incomprehensible. The purpose of the paper is to examine the description of the suffering that Valmiki underwent, IJSRED-International Journal of Scientific Research and Engineering Development

Background: Lip and oral squamous cell carcinoma maintains a significant disease burden in Pakistan. The latest research on cancer focuses more on the role of body’s immune response in tumour progression and spread rather than on the nature of neoplastic cells. Tumour-infiltrating lymphocytes constitute a major part of tumour microenvironment and infiltration of tumour stroma by cytotoxic T-cells are known to limit the tumour progression in various malignancies, such as, colorectal and stomach cancers. In our study, we aim to establish the prognostic role of CD8+ tumour-infiltrating lymphocytes in lip and oral squamous cell carcinoma. Methods: Clinico-pathological data and paraffin-embedded blocks were obtained for 100 cases of lip and oral squamous cell carcinoma. These cases were selected through non-probability, convenience sampling at the Histopathology department of A.F.I.P., Rawalpindi. Fresh sections from the tumour proper were taken and CD8 immuno-marker was applied. Data was recorded, entered and analyzed with S.P.S.S. version 27.0 and Microsoft Excel. Qualitative variables were represented as frequency/percentages and quantitative variables were represented as mean and standard deviation. Chi-squared test was applied to test association between categorical data. A p-value of

Background: Carcinomas of the salivary gland are known to be aggressive in nature, making them difficult to manage. The therapeutic options offered include excision of the gland (maxillectomy in cases of palatal tumours), with or without lymph node dissection, proceeded with radiotherapy. Chemotherapy has not produced promising outcomes and has a minimal impact as a therapeutic alternative. Targeted therapy against human epidermal growth factor receptor 2 (HER-2), which is a commonly used treatment modality for their mammary analogues, is not being offered to these patients since scant literature is available showing its usefulness and no promising evidence is present regarding their efficacy and efficiency in such cases. The study aimed to evaluate and quantify the immunohistochemical expression of HER-2 in cases of adenoid cystic carcinoma (AdCC), mucoepidermoid carcinoma (MEC) and salivary duct carcinoma (SDC), which are analogues of similar tumours arising in breast tissue. Methods: A retrospective, cross-sectional study was carried out in the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, duration of which was six months. A total of 45 cases (15 of each tumour) were taken, and sampled using non-probability convenience technique. The immunohistochemical marker, monoclonal HER-2 antibody (Leica microsystem Germany) was applied on appropriate blocks of all included cases. The staining pattern and intensity were recorded after visualizing the slides under a light microscope. Results: Seven cases of salivary duct carcinoma and a single case of mucoepidermoid carcinoma expressed positivity for HER-2, while no expression could be seen in the case of adenoid cystic carcinoma. A statistically significant difference was seen when HER-2 expression was compared among the aforementioned tumours. Conclusion: The use of targeted therapy against HER-2 is limited to patients of salivary duct carcinoma and a fraction of patients suffering from mucoepidermoid carcinoma.

Aim: To evaluate the effects of alcohol on the microscopic morphology of the exocrine pancreas and blood serum amylase and to explored that if vitamin E has a protective role against alcohol-induced damage in the pancreas of rabbits. Study design: Analytical experimental study Place and duration of study: Departments of Anatomy, Pathology and Pharmacology in Peshawar Medical College Pakistan from 1st January 2019 to 30th June 2019. Methodology: Eighteen healthy adult male domestic rabbits weighing 1-1.5 kg were chosen (oryctolaguscuniculus). The control group A received proper food and normal saline as drinking water, experimental group B received proper diet and 30 percent ethanol solution (30ml/kg/day) orally daily with normal saline, and experimental group C received proper diet, 30 percent ethanol solution (30ml/kg/day), vitamin E (50mg/kg/day) orally daily with normal saline. Each rabbit's blood was taken for serum amylase. Morphology of acinar cells included: 1) number of cells, (10 acini/field, 2) size of acini, 3) size of acinar cells, and 4) size of acinar nuclei. Results: Normal value of serum amylase in rabbits was found. The difference in serum amylase levels between the control and experimental groups for both E4 and E8 animals was not statistically significant. There was no significant difference in the number of pancreatic acinar cells, size of pancreatic acini, the pancreatic acinar cell size, and pancreatic acinar cells nuclear size in the control and experimental groups for both E4 and E8 animals. Conclusion: Alcohol consumption had no influence on the histomorphology of the rabbits' pancreatic acini in a short period (4-8 weeks). No significant variation was noted in the pancreatic acinar cells count & size, pancreatic acinar cells nuclear count and size, and pancreatic acini size. Therefore, protective role of vitamin E was not usefully identified. Keywords: Alcohol, Pancreas, Histomorphology, Vitamin E, Serum amylase

Background: Alcohol encourages fibrotic changes in liver by initiating collagen deposition in liver parenchyma. Vitamin E can slow down progress of fibrosis in alcoholic liver injury and play a defensive part against these changes. Aim To observe difference in fibrotic changes in livers of vitamin E treated and non-treated rabbits exposed to intra-gastric administration of alcohol. Study Design: Analytical experimental study Place and duration of study: Department of Anatomy, Peshawar Medical College, Peshawar Pakistan from 1st May 2019 to 30th October 2019. Methodology: Eighteen domestic type male rabbits (Oryctolaguscuniculus) were included. All animals were divided in two categories on the basis of experiment time frame. “Category E8” animals having 8 weeks’ time period and “Category E4” animals having 4 weeks experimental duration. Each category was then clustered in “Control Group A” (appropriate food as per standard laboratory requirements, and normal saline as drinking water was provided daily), “Experimental Group B” (proper standard nutrition, 30% solution of ethanol made in distal water in the dosage of 30ml per kg/day through nasogastric tube and normal saline for drinking purpose were provided daily) and “Experimental Group C” (treated with suitable standard required diet, 30% of ethanol solution made in distal water in the dosage of 30ml per kg/day via NG tube and “Vitamin E” 50mg dissolved in 2ml distal water per kg/day with same nasogastric tube daily and normal saline for drinking purpose were given). Results: Collagen fibers deposition (fibrosis) in liver stroma was detected and recorded according to Knodel histological activity index. Quantitative difference in the collagen deposition among all groups from both “Category E4” and “Category E8” presented vastly significant “P” values. Conclusion: Alcohol can cause major fibrotic changes in “liver” even if it is consumed for the minor duration of 4 to 8 weeks, and these alterations can be minimised by the proper use of vitamin e through its “antioxidant effect”. Keywords: Alcohol, Liver, Fibrosis, Vitamin E, Hepatocyte, Collagen

Purpose of the Study: The purpose of this research study was to measure and compare critical thinking among secondary school students in a district of Gilgit-Baltistan. Methodology: Quantitative research approach was applied to study critical thinking. A sample of 400 students was selected through a convenient sampling technique to collect the data. Critical thinking was measured by applying an adapted tool (Sarigoz, 2012). Descriptive and inferential statistics were used to analyze the data. Main Findings: Findings of the study revealed that female students, rural school students, and science group students showed slightly higher critical thinking than male, urban, and arts group students. The results were consistent with earlier studies having higher critical thinking among female and science group students. However, the results were inconsistent with the earlier research studies having slightly higher critical thinking among rural school students than urban school students. The study revealed that there is a discrepancy in aligning critical thinking with teaching and learning activities in secondary school classrooms. Application of this study: The findings of the study help understand the level of male and female students' critical thinking at the secondary level. It will surely assist the teachers in designing their classroom activities and modifications in teaching methodologies for gender perspective. Novelty/Originality of this study: The study is original as not a single research study investigated the critical thinking of secondary school students in the region of district Ghizar in Gilgit-Baltistan.

Aim: To observe the changes in the caliber of hepatic central vein of Albino rats exposed to the oral administration of toxic doses of Imatinib and to assess the protective effect of vitamin E. Study design: Experimental study Place and duration of study: Department of Pharmacy, Peshawar Medical College Peshawar from 1st October 2015 to 31st March 2016. Methodology: Twenty four male Sprague-Dawley rats (150- 200g) were selected for this study and these rats were divided into three groups. Group 1 was control group, Group II received oral Imatinib solution (50 mg/kg/day) and Group III received Imatinib solution (50mg/kg/day) orally along with vitamin- E (500MG/kg/day) for 14 days. At the end of experiment central vein dilatation in liver tissue of rats were observed. Results: The increase in mean central vein dilatation in liver of group II were statistically significant (p=0.001) in comparison with the control. The mean central vein caliber of liver was decreased significantly in group III. Conclusion: The simultaneous use of vitamin E as an antioxidant with Imatinib can protect the toxic effects of the Imatinib on hepatic toxicity which includes central vein dilatation. Keywords: Imatinib mesylate, Hepatic tissue, Central vein dilatation, Vitamin E

Objective: To determine the immunohistochemical expression of CK 13 and CK 17 in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma. Methods: A total of 170 cases were retrieved from record files of Histopathology Department, to conduct a cross sectional study at Armed Forces Institute of Pathology, Rawalpindi, over a period of one year from June 2018 to June 2019 along with their formalin-fixed, paraffin embedded blocks comprising 85 cases of each oral squamous cell carcinoma and oral epithelial dysplasia. Blocks were trimmed and cut into very thin sections of 5 microns using microtome and mounted on slides. Tissue mounted slides were stained with routine haematoxylin and eosin followed by immunohistochemical staining of cytokeratin 13 and cytokeratin 17. New histological diagnosis of each case was made. Mean and standard deviation were calculated for quantitative variables. Frequency and percentages were calculated for qualitative variables. Chi-square test was employed to assess the significance of difference. The P-value

Objectives: To determine the frequency of second mesiobuccal canal (MB2) in a sample of 223 extracted maxillary permanent 1st molars. Study Design: In-vitro Cross-sectional study. Setting: Department of Endodontic at Peshawar Dental Hospital. Period: June 2019-Nov 2019. Material & Methods: The samples were processed with application of the Clearing Technique which includes demineralization with nitric acid, dehydration with ethanol and clearing with methyl salicylate. The samples were classified according to Weine’s system of root canal classification. Results: Among the 223 samples, 30% were found to have Weine’s type1 root canal in the mesiobuccal root (second mesiobuccal canal absent). Second mesiobuccal canal was present in majority of the samples (70%) with Weines type2 (2-1) predominant with 23.32%, Weines type3 (2-2) present in 15.7% and Weines type 4 (1-2) present in 21% of the samples. 9% of the samples could not fit into Weines classification so they were placed in Vertuccis classification for root canal system type 6 (2-1-2). Conclusion: The present study concludes that the second mesiobuccal canal is more frequently found in maxillary permanent 1st molar teeth than our textbooks report, irrespective of quadrant and gender. Therefore, time should be given to evaluation of its anatomy by the clinician before starting the root canal treatment for the greater good of the community.

Traditional medicine is an important component of the health care system throughout world. Herbal medicine is the use of medicinal plants for prevention and treatment of various diseases. It ranges from traditional and popular medicines of every country to the use of standardized and analyzed herbal extracts. Although therapies involving these agents have shown promising potential with the efficacy of a good number of herbal products clearly established, many of them remain untested and their use are either poorly monitored or not even monitored at all. Herbal-derived remedies need a powerful and deep assessment of their pharmacological qualities and safety issues due to the large and growing use of natural-derived substances all over the world. Based on the current situation, worldwide research on herbal medicine safety is still not broad or deep enough. For next step, more attention should be paid to researches on the toxicity and the herb-drug interaction of commonly used herb medicines, which are the most necessary and urgent work. For clinical safety monitoring, spontaneous reporting system or active pharmacovigilance is effective in identifying therapeutically relevant safety issues. In this paper, an attempt has been made to summarize the information described in scientific research conducted about Present status, Standardization and safety concerns of herbal drugs.

Background: Liver injuries induced by different toxic substances have been recognized as one of the great toxicological problem for years. However, there are a lot of herbal medicines existing to compensate these disorders.Alcohols are one of the most important organic compounds in different areas of our daily lives. The health benefits of Ajwa Date Fruit Extract are well documented in literature. Objective: To determine the effect of alcohol on weight of liver and possible protective role of Ajwa date fruit extract (ADFE) in adult male albino rats. Study Design:Experimental Study Place and Duration of Study: Department of Anatomy, Postgraduate Medical Institute, Lahore from 1st October 2018 to 31st March 2019. Methodology: Twenty four adult male albino rats were used in this research and divided into the 4 groups A, B, C and D having 6 rats in each group. Group A was designated as control group;group B received ethanol 3g/kg/day of 40% v/v prepared in distilled water; group C received ethanol and ADFE1g/kg/day and group D received ethanol and ADFE 2g/kg/day by oral gavage once daily for 28 days.The 100% pure alcohol was dissolved in distilled water for preparation of 40% alcohol. Dates palm (Phoenix dactylifera L.) fruits washed with tap water and removed the seeds. The extract of the date fruits made by adding distilled water to date fruit (3:1) and leaving for 48 hours in refrigerator (4°C). Results: The increase in mean weight of liver in group B on 29th day of experiment were statistically significant (p=0.001) in comparison with the control. The mean weight of liver was decreased significantly after 28 days of experiment in experimental groups C and D. Conclusions: Alcohol administration in the male albino rats significantly increase their weight of liver which was improved by the use of ADFE. Key words: Alcohol, Ajwa date fruit extract, Rats

The objective of this study was to determine the Immunohistochemical expression of PD- 1, PD-L1 and its association with nodal metastasis in head and neck squamous cell carcinoma.A total of 66 cases were studied at Oral pathology/Histopathology, Armed forces Institute of Pathology (AFIP), Rawalpindi. The tissue sampling and processing yielded the formalin fixed, paraffin wax blocks. These blocks were cut into the thin sections (5 microns) by the microtome and then were mounted on the glass slides. This was followed by the routine HE staining and then IHC staining (PD-1 and PD-L1) of these tissues mounted slides. For each case a definitive histological diagnosis was made. The two types of variables were analyzed. For qualitative variables frequencies and percentages were calculated whereas for quantitative variables means and standard deviations were analyzed. The Chi-square test then was applied to evaluate the significant difference and p-value of ≤0.05 was taken significant.This study was conducted at Histology department, Armed Forces Institute of Pathology, Rawalpindi over a period of one year from June 2019 to June 2020. It revealed male and female patients with 66.7% (44 Cases) and 33.3% (22cases) percentages respectively. The mean age was found to be 59.53 ± 13.637 (mean ± SD) and the mandible (37.9%) was the most commonly affected site. In total of 66 cases, 48 (72.7%) cases with metastasis of lymph nodes were presented. Out of 66 cases ,47 (71.2%) cases showed positive expression of PD-1 in the TILs seen among the primary tumor of the specimens, whereas, 40 (60.6%) cases showed positive PD-L1 expression in tumor cells of primary tumor.In comparison, as out of 66 cases ,48 (72.5%) cases showed lymph nodes metastasis, out of which 45 showed positive expression for PD-1 and 25 out of those 48 cases showed positive expression for PD-L1 in metastatic lymph nodes.The p-value turned to be significant for PD-1 IHC expression and PD-L1 IHC expression in the primary tumorand metastatic lymph nodes.A significant correlation was inferred among IHC expression of PD-1 and PD-L1 with lymph nodes metastasis. Accurate evaluation, analysis and precise management with aid of IHC markers results in initial and timely diagnosis and favorable treatment outcomes helping in the evaluation of disease course at preliminary diagnosis on incisional biopsies.

Aim: To study the frequency and factors associated with peritoneal involvement among patients operated for acute appendicitis in a tertiary care hospital. Place and duration of study: Department of Surgery, Benazir Bhutto Hospital Rawalpindi Pakistan from 1stJuly 2020 to 30thJune 2021. Methodology: This comparative cross-sectional study 500 patients diagnosed as acute appendicitis and operated by consultant surgeon were included. Peritoneal involvement was defined as signs of inflammation or infection on abdominal lining observed by operating surgeon during the time of surgery. Factors like age, gender, presence of comorbid illnesses and history of previous abdominal surgeries were associated with presence of peritoneal involvement. Results: There were 305 (61%) males while 195 (39%) were females with mean age was 32.331±4.544 years.Four hundred and forty two (88.4%) did not show any peritoneal involvement at the time of surgery while 58 (11.6%) had peritoneal involvement. Chi-square test revealed that history of previous abdominal surgeries and advancing age had statistically significant association with peritoneal involvement among the study participants (p-value

Background: All thyroid states are associated with psychiatric manifestation, be it hypothyroid, hyperthyroid or euthyroid state. Depression is more severe in hypothyroidism. Aims and objectives: The study was conducted to evaluate the effect of adequate antidepressant dose of escitalopram on thyroid function in patients with depression of euthyroid state over a period of six weeks and the relationship between thyroid function and depression. Material and methods: The study was conducted at Government Medical College Srinagar and associated hospitals from May 2013 to April 2016. The study sample comprised of 191 patients diagnosed with first episode depression. The evaluation of patients was done by using pro-forma to gather information on parameters pertaining to mental health/ illness also physical indices. DSM-5 diagnostic criteria have been used for diagnosing the patients having depression. Diagnosis was confirmed by the consultant in the department. Hamilton Depression Rating scale (HAM-D) has been used for assessing the severity of depression. Baseline thyroid function test was performed in these patients and these patients were given approved/adequate dose of escitalopram. Results: The mean age was 35.3 years and males were 55.5%. Only 19.9% have family history with psychiatric illness and 11.5% have family history of thyroid disorder. HAMD score before treatment was 13.34 ± 3.080 (p

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter total hospital stay and reduction in days away from work at the cost of longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Introduction: In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique.Laparascopic hernioplasty is the latest technique with several advantages over open procedures like reduced post operative pain, shorter recovery period. However the steeper learning curve and cost of the procedure have been cited as limiting factor. Aims and objectives: To study the outcome of laparoscopic transabdominal pre-peritoneal mesh hernioplasty for inguinal hernias in terms of operative time, complications, Hospital stay and recurrence. Material and methods: This study was carried out from December 2011 to January2017. Case records of 112 patients that underwent trans-abdominal pre-peritoneal (TAPP) by a single surgical team were followed prospectively for a period of 1 year. All patients, above 18 years of age with uncomplicated inguinal hernia were included in the study. Complicated hernias, patients unfit for general anesthesia, patients with previous lower abdominal or pelvic surgery and patients unwilling to take part in study were excluded from the study. Data regarding, operative time, complications, chronic post operative pain, hospital stay and recurrence were recorded and evaluated. Results: 112 patients presenting with uncomplicated inguinal hernias were operated over a period of five years. The age of the patients ranges from 15-70 years. There were 106 (94.64 %) male patients and 6 (5.35%) female patients. Mean operative time was 55 minutes (range 40-110 minutes).The complications that occurred, were bleeding 1(0.89%), conversion to open 1(0.89%), seroma 4(3.57%), urinary retention 4 (3.57%), chronic pain 3 (2.67%) and recurrence 3 (2.67%). No incidence of bowel injury, bladder injury, spermatic cord injury, scrotal hematoma, mesh infection and port site infection has been reported. Average Hospital stay was 1.2 days (1-3). 97.33% were satisfied with their repair and returned to work after with a median of 15.1 days (12-21 days). Conclusion: We concluded that TAPP is an effective and safe procedure with low prevalence of chronic pain, that was generally of a mild, infrequent nature, faster convalesce and return to productive activity with fewer complications and a recurrence rate as low as that of an open mesh repair. However operative time is prolonged which decreases with experience. Learning curve is not so steep as claimed, and considering advantages, the cost of the procedure should not be a limiting factor even in developing countries.

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis >2 cm from deep inguinal ring in 20, near deep ring

Background: The purpose of this study is to evaluate the role of multi-slice computed tomography (CT) with reference to presence or absence of intestinal obstruction, level of obstruction, the cause of obstruction, and correlating with their clinical diagnosis.Methods: Patients were admitted directly from Out Patient Department or emergency department with complaints suggestive of intestinal obstruction. Computed tomography scan interpretations performed by experienced radiologists were compared with the final diagnosis that was made on the basis of information obtained clinically, by investigations, and by surgical findings.Results: Majority of patients were males 62%. Mean age 51.62±17.46 years. Majority presents with abdominal pain 94% and constipation 72%.The most common cause of obstruction was adhesion bands 18%.The pre CT diagnosis was changed because of CT findings in 28 patients. Only in 50 (89.28%) patients CT findings matched with intra-operative and cause of obstruction was also found, and in 6 (10.71%) patients intra-operative findings are different from CT findings. In bowel obstruction, the CT sensitivity was 89.28%, specificity 90.90%, positive predictive value 92.59%, negative predictive value 86.95% and accuracy 92.59%.Conclusions: We concluded that multi-slice CT is highly sensitive and specific in determining the presence, the cause and site of bowel obstruction, the site of obstruction and cause of obstruction. We recommended the use of CT scan when diagnosis between ileus and obstruction on the basis of clinical and plain radiographic are difficult or in patients in whome small bowel obstruction is diagnosed when conservative management is contemplated.

Background: The hypotensive effect of propofol is attributable to a decrease in sympathetic activity, direct vasodilatation and myocardial depression. The aim of the study was to assess the effect of propofol when injected at different speeds for induction of general anesthesia on the following parameters: blood pressure, time of induction of anesthesia, dose of propofol used.Methods: The present study was conducted in post Graduate Department of Anesthesia and Surgery, Govt. Medical College, Srinagar for a period of two years and included 90 patients from July 2014 to June 16, the study was prospective one.Results: In our study patients divided into three groups with 30 patients in each group. The mean age in group P400, P600, P800 was statistically insignificant p>0.843.The mean weight in group P400, P600, P800 was statistically insignificant p>0.885.The mean height in group P400, P600, P800 was statistically insignificant p>0.748. The mean induction time in P400 and in P600 was statistically significant. The mean systolic blood pressure, pre and post induction in P400, in P600 and in group P800 was statistically significant. The mean diastolic blood pressure, in pre and post induction in P400, P600, P800 was statistically insignificant with a p>0.05. The mean arterial pressure in pre and post induction in P400, P600, P800 was statistically significant (pConclusions: We concluded that induction dose required for loss of consciousness increased with a faster rate of infusion while time for induction was shorter in P800 compared to P400 and P600, and the decrease in mean blood pressure was less after induction in P400. Propofol injection should be slow enough to prevent any hemodynamic deterioration in anesthesia induction.

Summary Objectives Very few studies have examined mental health morbidity in Bangladesh. This community-based study of rural Bangladesh in 2000–2001 estimated the burden of mental morbidity among rural people of working age. Study design and methods Community surveys were conducted with one respondent from each household of three selected villages in the service provision area of a non-profit public health organization. General Health Questionnaire 60 (GHQ-60) was used as a screening tool in Stage I, and clinical examination by a Western-trained psychiatrist was undertaken for concurrent validation in Stage II. Results The overall prevalence of psychiatric disorders in this rural area was 16.5%. Depressive disorders and anxiety disorders constituted about one-half and one-third of the total cases, respectively. A significantly higher prevalence of mental disorders was found in the economically poor respondents, those over 45 years of age, and women from large families. Conclusion There is a high prevalence of psychiatric disorders in rural Bangladesh. These findings should aid the planning of locally relevant and appropriate mental healthcare programmes. There is an urgent need for a national mental healthcare policy that strengthens primary mental healthcare services.

A pilot study was carried out in Bangladesh during August and September, 1995, using a "snowball" technique with 30 male multiple drug users in order to investigate buprenorphine use, characteristics of the users, their reasons for its use and the drug's effects.

To determine the frequency of p53 gene mutation and protein expression in Oral Squamous Cell Carcinoma (OSCC) and to establish correlation between the two.Analytical study.Histopathology Department and Molecular Biology Laboratory, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from May 2010 to May 2011.Thirty diagnosed cases of OSCC were selected by consecutive sampling. Seventeen were retrieved from the record files of the AFIP, and 13 fresh/frozen sections were selected from patients reporting to the Oral Surgery Department, Armed Forces Institute of Dentistry (AFID). Gene p53 mutation was analyzed in all the cases using PCRSSCP analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh/frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases and overexpression of protein p53 was recorded.Immunohistochemical expression of marker p53 was positive in 67% [95% Confidence Interval (CI) 48.7-80.9] of the cases. Mutations of the p53 gene were detected in 23% (95% CI 11.5-41.2) of the OSCC. No statistically significant correlation was found between p53 gene mutation and protein p53 expression (rs=-0.057, p=0.765).A substantial number of patients have p53 gene mutation (23%) and protein p53 expression (67%) in oral squamous cell carcinoma (OSCC).

The present study is a comparative study to assess the quality of nursing care rendered by staff nurses and level of satisfaction perceived by patients in selected wards of a selected government and a private hospital.