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Objective: To examine the impact of the international organization for standardization (ISO), the challenges faced in its implementation and the implications of the process on patient care in the long-term accreditation in a tertiary care hospital in Kharian. Study Design: Cross-Sectional Study Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Jan to Dec 2019. Methodology: Patient satisfaction questionnaires were given to 1600 patients presenting to the Indoor, Outdoor, Accidents & Emergency, Pharmacy, Radiology Department and Laboratory of Combined Military Hospital, Kharian Pakistan, as a part of a routine ISO audit annually for 2019. Responses were analyzed and tabulated. Results: The upward trend in patient satisfaction was attributed to administrative intervention policies based on patient complaints and suggestions incorporated into the questionnaires’ comment boxes. There was a significant difference between the response rates of patients in departments (p=0.016). It indicates that the satisfaction rate was higher among different departments. Conclusion: Patient satisfaction is directly proportional to interventional measures based on patient feedback. When utilised positively, these feedback loops can lead to an increase in the hospital's overall efficiency index and the standard of care.

Objective: To determine the commonest site of non-suicidal self-inflicted firearm wound in comparison with accidental firearm wounds. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospitals Jhelum, Bannu & Kharian, from Nov 2014 to Nov 2018. Methodology: Sixty-four patients with firearm injuries were observed. All the participants were males between the ages of 18- 60 years. The injuries were determined to be either self-inflicted or accidental by an independent committee. The participants’ replies and responses were assessed by dividing them into five main domains by using quantitative software SPSS version 20. Variables involving demographic characteristics of participants such as age, occupation, marital and socioeconomic status, were associated with mental health variables such as psychological stress, previous history of self-harm and clinical psychiatric illness. Result: Fifteen subjects were found to have self-inflicted injuries and 50 had accidental injuries. There was a marked preference for left foot and left lower limb as a site for non-suicidal self-inflicted injuries (94.6%) as compared to other sites (left upper extremity 1.8%, chest 1.8% and right lower extremity 1.8%). Conclusions: Left lower limb and left foot was a more common site for self-injury as compared to the other sites.

Objective: To establish efficacy of malaria prevention programs by screening troops returning from UN peacekeeping services in high risk areas in Africa for malarial parasites. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital, Kharian, from Jan 2017 to Jan 2019. Methodology: In this cross sectional study, individuals of regiments returning to Pakistan from high risk areas in Africa were screened for malarial parasites. A total of 1632 samples were analyzed during this time frame. Informed consent was taken at the individual and institutional level. Blood samples obtained from each participant were tested by both immuno-chromatographic techniques and peripheral blood films. Results: Total 1632 individuals were screened for malarial parasites. Peripheral blood slides were negative in all individuals except one. Immuno-chromatographic techniques for detection of malarial parasites were positive in 17 individuals for Plasmodium falciparum antigen. Only one individual had both Plasmodium vivax and Plasmodium falciparum positivity via both methods. All of them were asymptomatic at the time of screening, had a past history of high grade fever treated with anti-malarial drugs and were admitted for observation and follow up. Conclusion: Despite the high prevalence of malaria in Africa, the current prevention protocols prove to be highly efficacious in protecting UN peace-keeping forces from infection and lowering mortality rates.