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The purpose of this research paper is to find out the impact of Corporate Social Responsibility (CSR) on brand loyalty with the mediating role of cooperate branding from the customers of the retail banking sector of Punjab, Pakistan. The current study uses the structured survey data collection technique consisting of 5- Likert scale points while collecting the data from 335 individual customers of retail banking sectors of Dera Ghazi Khan city, Punjab, Pakistan. Further, data was analyzed through SEM (structural equation modeling) using SmartPLS (Smart Partial Least Square) software. The study's results suggest a significant positive impact of corporate social responsibility (CSR) on brand loyalty; other developments suggest the positive mediating role between CSR and brand loyalty. Further, the study uses the auxiliary hypothesis, showing a significant positive impact on brand loyalty. Additionally, the study has substantial implications for the managers of banking sectors. This will help managers promote CSR in their banking sectors to increase sustainability and profitability and provide an edge in the market.

The research's goal was to investigate how green human resource management promotes the growth of green creativity through the mediating role of individual green values and green psychological climate. Green behavioral intention work as a mediator in the connection between green human resource management and green creativity. Quantitative research was done in Pakistan to cover this issue. A questionnaire was used to collect the data from 450 respondents, including government officials, workers from the private sector, and firm leaders. The suggested framework for this research uses SPSS to generate statistical results such as demographics, reliability, descriptive statistics, and correlation. SmartPLS 4 was used to apply the SEM-Structured Equation Model approach to the provided framework. Green human resource management characteristics, individual green values, green psychological environment, green behavioral intention, and green creativity were shown to have a substantial positive correlation. Discussions and potential ramifications are presented after the conclusion of this paper.

Pesticides especially insecticides are widely used in the field of agricultural development all over the world to increase crop production. Moreover, exposure to such compounds does not only influence the intended targets but also induces adverse impacts on a number of unintended targets in animals. This research aimed to determine the toxic impacts of lufenuron (an insecticide) on the health status of fish in terms of measurement of oxidative stress, antioxidant enzymes, DNA damage and histopathological changes in Nile tilapia (Oreochromis niloticus) exposed to different concentrations. For this purpose, Oreochromis niloticus fish, weighing about 75-80g were arbitrarily separated into four different groups and then exposed to lufenuron @ 0.7, 1.2 and 1.7µg/ L for 39 days. The results showed that the fish exposed to the pesticide had significant changes in oxidative stress, antioxidant profile in gills and percentile rate of DNA damage in different visceral organs including liver, kidney, and gills. Results of light microscopic investigations indicated different histological changes in liver (necrosis of hepatocytes, degeneration of hepatocytes, vacuolar degeneration and congestion), gills (necrosis of lamellar epithelial cells, telangiectasia, and atrophy of secondary lamellae), heart (congestion, necrosis of neurons, microgliosis and intracellular edema), brain (congestion, myofibrosis, neutrophilic and myocarditis) and kidneys (necrosis of renal tubules, widening of urinary space, necrosis of renal tubular epithelial cells). A significantly escalate in oxidative stress while lower quantity of antioxidant biomarkers was documented in experimental fish. The findings of this study suggest that long-term exposure to lufenuron has negative health effects via induction of DNA damage, increased oxidative stress, lowering of enzymatic antioxidants profile and histological lesions in visceral organs of Nile tilapita (Oreochromis niloticus).

Cognition is the scientific term referring to the mental processes involved in gaining an understanding of knowledge including, judging, thinking, reasoning, knowing, remembering, and problem-solving. Objective: To observe metacognition's impact on medical students' academic achievement. Methods: It was a cross-sectional analytical study. Three medical colleges were surveyed to obtain data from second-year medical students. The data from the Metacognitive Awareness of Reading Strategies Inventory (MARSI) and each student's first-year academic achievement information were collected from January to June 2021. A simple random sampling procedure. Academic performance was a dependent variable, while the metacognitive score was an independent variable. Three hundred thirty-two students participated in the survey. Results: With a correlation coefficient value of 0.257, the findings indicated a significant link between metacognition and academic success (p 0.01). Metacognition levels among medical students from various colleges are nearly identical. Conclusions: Current study findings have shown that all three dimensions are positively and strongly correlated to each other.

Background and objective: we conducted this study to find out the important relationship between time-management skills and physician career satisfaction and explore the importance of utilizing strategies that promote efficient time management. Methods: In this cross-section study, used a self-designed and validated questionnaire. The current study was conducted during a series of workshops, in CMH Lahore Medical College & IOD from August-October 2021. Participants were, no prerequisite knowledge, skills, or resources were required for the workshop. Results: A total of 157 participants were enrolled for a workshop and 155 participants fill the questionnaire completely so the response rate was 98.72%. Questionnaire, Cronbach’s Alpha value was 0.78 male participants were 60 (38%) and females 96 (61.4%). The age average was 25-39 years. Most participants are demonstrators/lecturers/registrars. About 77 (49%) of the physician’s sleep duration was normal hours and 78 (51%) complain to insomnia. Only 67 (43.9%) physicians give family time properly but 88 (56.4%) spend less than 4 hours with their families. Doctors spend less time on their smart devices 16 (10.3%) spend more than 2 hours/day. Very few physicians do their favorite hobby or any physical activity daily. Conclusion: Physicians are not good time managers, its means their patients are kept waiting, they get stressed, their work becomes less enjoyable, stress can build, they lose their sense of humor and they lose valuable time for family, exercise, and sleep, insignificantly different across gender, age, experience and entering qualification.

Background: The Education system has taken a 180-degree paradigm shift since Covid-19 wrapped up the prevailing global system. Now educational system used made electronic communication devices the prerequisite. Not only were the students, parents, and teachers dragged out of their comfort zone to learn and stretch their expertise in the digitalization of education and work. The endeavor has brought us to set standards and meet the needs of new standers. This study aimed to discover the suggestions of students and faculty to deal with the resentment that is being experienced with this online facade. Methodology: Cross-sectional study from March to May 2020, total participants was 523 including male and female medical students and faculty. Ethical approval was obtained from Ethical committee CMH Lahore Medical College and Institute of Dentistry (CMH LMC & IOD). Verbal informed consent was obtained. Self-administered questionnaires were given to the participants. Results: E-Learning opportunities need to be taught explicitly. Modern tools are the need of time. The faculty needs to understand student psychology as well as the application of modern tools and gadgets. Conclusions: E-learning posed a technological divide among the faculty members and students. The pandemic allowed us an opportunity to explore the realms of the digital world and expand our horizons to challenge the already existing medical education system, curriculum, and mode of its execution.

Introduction: Nasopharyngeal passages are the primary passageway for respiratory exchange in humans. But chronic obstruction of the nasal passage encountered in youth causes a physiological shift in normal breathing pattern from nasal to oral breathing. Oral breathing results in craniofacial modification and postural adjustments. This study will be helpful for orthodontists to observe the cervical vertebral column area in growing children to prevent changes in cervical lordosis and associated sequelae from developing by early intervention, when required. Material & Methods: In this case control study conducted at the ’Montmorency College of Dentistry over 6 month period from 10th July, 2017 till 10th January, 2018, 60 patients fulfilling inclusion and exclusion criteria, were recruited from OPD and divided into two groups. Group “A” patients showing alteration in their cervical lordosis as observed on lateral cephalograms and group “B” patients with normal cervical lordosis on lateral cephalograms. Their breathing pattern, BMI and other demographic information were recorded. All the collected data were analyzed with SPSS version 23.0. Results: Mean age of the patients in group A (altered cervical lordosis) was 9.13 (+/- 1.68) years and in group B (normal cervical lordosis) was 8.77 (+/-1.91) years). Chi square test was applied for comparison of groups, p-value ≤ 0.05 considered as statistically significant. The alteration in cervical lordosis had a statistically significant association with oral breathing when compared with nasal breathers, chi square value 27.149 (p value 0.000). Conclusion: Significant association between alteration in cervical lordosis and oral breathing.

Background: A significant proportion of people infected with COVID-19 report new onset of smell and taste loss. The duration of the chemosensory impairment and prognostic factors of recovery is still unclear. We aimed to investigate the prevalence rate and other signs and symptoms which are predictors in patients. Objective: To find out the association of Anosmia and Ageusia with COVID-19. To find out relationship of Gender with Anosmia and Ageusia in COVID-19 or other URTI. Methods: I was a cross-sectional study, participants were from CMH, Multan, Hospitals of different cities of the province of Punjab, Pakistan. The study was conducted from 1st July to 31st of August 2021. 185. All faculty members and medical Students of CMH Bahawalpur. Results: Out of 185 participants, 99 (53.5%) were male and 86 (46.5%) were female. The mean age was 23.93 ± 6.661years. Pearson correlation of covid-19 with loss of smell is 0.533 which shows that there is strong positive relationship between them. On one-way ANOVA fever sig. is 0.002 which shows high significance. URTI also shows association but other signs and symptoms like dyspnoea, dry cough do not show any significance. Shows the majority of participants are suffering from taste and smell loss (95.1%) along with body aches (82.7%), dyspnoea (94.6%), acute dry cough (36.2%), URTI (19.5%) and fever (36.2%).

Introduction: FDP is an integral part of any organization to improve the expertise and skills of the faculty that is needed to indorse educational excellence. It is an important tool to enhance student learning and ultimate patient care. To get maximum benefit it must be well formed, properly executed and evaluated. Needs of faculty and institution play important role in organizing faculty development program. Aims & Objective. Current study was conducted to explore professional needs of medical faculty required for implementation of integrated curriculum in various medical colleges of Lahore. Material & Method: This is a descriptive cross sectional study conducted during the period of August to October 2019. Online google form was developed to identify the area of concern. It has two parts, demographic and faculty need assessment. Need assessment questionnaire having six domain (teaching and learning, assessment, curriculum, research, publication and community services) that comprises of 38 items. Each item has five point Likert scale (Strongly disagree to strongly agree). Link of this form was share with the medical faculty through whatsApp and email. Medical teaching faculty were asked to fill the survey form. Result: The response rate was 73%. All Participants exhibited more interest in areas especially teaching competance(70%), publication competence(78%), community services(69%). Whereas express comparatively less interest in research competence(63%), curriculum(63%) and assessment(60%). Conclusion: Need assessment is basic and fundamental part of any FDP. This survey enabled us to identify the concerns of our faculty and areas that needs enhancement in faculty development program. Keywords: Faculty development program, integrated curriculum , need assesssment

Introduction: Allergic conjunctivitis is in fact a bunch of diseases affecting the visual surface and is usually related with type1 hypersensitivity reactions. Two acute disorders, seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do 3 chronic illnesses, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. Seasonal allergic conjunctivitis is related with seasonal hypersensitivities that ordinarily happen amid the spring and summer months, and in some cases amid the fall. Exposure to dust, grass and other airborne allergens causes seasonal allergic conjunctivitis. Low levels of vitamin D somewhat related to allergic disorders. This study show a relationship between Serum vitamin D and Immunoglobulin’s E in patients of seasonal allergic conjunctivitis Objective: To evaluate serum vitamin D and serum total immunoglobulin E levels in patients with seasonal allergic conjunctivitis (SAC). Material and Methods Study design: quantitative cross sectional Duration: Six months i.e. 1st September 2021 to 28th February 2022 Data Collection procedure: A cross sectional study was conducted on 100 patients. The study was conducted in Holy Family Hospital Rawalpindi. Ethical approval was taken from ethical committee. An educated consent was taken from the participants. 60 patients in this study presented with seasonal allergic conjunctivitis and 40 healthy normal persons were included. Serum vitamin D and serum total IgE levels were calculated. Results: The average age of the participant in this study was in between 30-50 years of age. In SAC group 40 were males and 20 females. Group two healthy normal consist of 25 males and 15 females. There is a significant decrease of vitamin D level in patients who were diagnosed seasonal allergic conjunctivitis and IgE levels were high when compared to normal healthy group Conclusion: In conclusion, we demonstrated lower plasma vitamin D levels in patients with SAC compared with the control bunch. To conclude a certain association between vitamin D status and allergic conjunctivitis, both multicenter larger case arrangement and further studies examining the impacts of vitamin D supplementation ought to be performed in the long run. Keywords: Vitamin D, seasonal allergic conjunctivitis, IgE, Allergy

Three experiments were conducted to optimize boron (B) delivery through seed coating for improving wheat yield and biofortification to fight against the malnutrition in the most consumable crop. First experiment was conducted in Petri plates kept in laboratory at room temperature. Seed were coated with 0, 0.25, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75 and 2.00 g B kg-1 seed by boric acid (H3BO3) and borax (Na2B4O7) as source of B. Results of this experiment revealed that least mean germination time (MGT) was recorded in seed coated with 0.05 g B kg-1 using borax as source of B (2.06 days) than control (2.34 days) followed by 0.25 g B kg-1 seed using same source and 0.25, 0.50 g B kg-1 seed using boric acid. Higher final germination percentage (FGP) was also recorded in 0.25, 0.50 g B kg-1 seed by using boric acid (100% and 98.8% respectively) and 0.25, 0.50 g B kg-1 seed by using borax (100% and 100% respectively). Moreover, higher shoot length (10.68 cm) was recorded in seed coated with 0.25 g B kg-1 seed using boric acid, while higher root length and seedling dry weight (13.49 cm and 17.88 mg respectively) was recorded in seed coated with 0.25 g B kg-1 seed using borax. Optimized seed coating treatments 0.25 ad 0.50 g B (as boric acid and borax) kg-1 seed were further evaluated against uncoated control seed in 2nd experiment which was conducted in sand filled small cups kept in laboratory at room temperature. Seed coated by 0.25 and 0.50 g B (as borax) kg-1 seed resulted in higher seedling growth i.e., root length, shoot length and seedling dry weight, than control. In 3rd experiment seed were coated with 0.25 and 0.50 g B (as borax) kg-1 seed. This experiment was conducted in soil filled clay pots kept in glass house in room temperature. Results of this experiment showed that treatments did not influence seedling emergence; nonetheless, seed coating using 0.25 g B kg-1 seed enhanced grain yield (13.75 g per pot) and grain B concentration (1.76 µg g -1 ). In conclusion, wheat seed may be coated with 0.25 g B (as borax) kg-1 seed to mend seedling growth, grain yield and grain B concentration of wheat. Increased B concentration wheat grain may play a significant role to eliminate malnutrition in humans if adapted in the wheat cultivation.

Background: The use of physical restraints for patients’ safety and to reduce the interference in treatment is common in psychiatric hospitals. In Psychiatric hospitals, Physical restraint is viewed as a simple solution to maintain patient comfort and safety. Physical restraint is always accompanied by risk of complications but correct application of physical restraints is a central nursing responsibility for patients who are temporarily incapacitated. Objective: To determine the knowledge, attitude and practices of staff nurses regarding the use physical restraints. Methodology: A descriptive cross sectional study design was used to achieve the study objective. The present study was carried out among psychiatric nurses at Punjab institute of mental Health, Lahore during month of January 2022 to March 2022.A convenient sample of 150 nurses who were working in the previously mentioned setting was included. In data collection a structured demographic questionnaire and predesigned questionnaire on level of Knowledge, Attitude and Practices of staff Nurses regarding Physical Restraints was used. Results: The staff nurses mean age was 27.86±3.55 years and mean experience (years) was 4.80±2.53. The mean standard deviation of level of knowledge, attitude & practices of physical restraints scale was 7.01±0.89, 35.04±3.62 and 36.26±1.54 among the respondents respectively. Knowledge and attitude was insignificant with sociodemographic and other factors (p-value >0.05), whereas practices were found significant with gender, marital status, special course attended as well as previous training acquired (p-value

Introduction: The frequency of polycystic ovarian syndrome (PCOS) has come to nearly epidemic extents in ladies of reproductive age around the world. Polycystic ovarian syndrome is one of the foremost common endocrinological problems in ladies. In expansion to chronic oligo-anovulation, the fundamental highlights of the PCOS incorporate raised levels of circulating androgens or clinical hyperandrogenism, polycystic ovary morphology, modified gonadotropin secretion, insulin resistance and compensatory hyperinsulinemia frequently related with obesity. Objective: The purpose of this study was to compare the affiliations of anti-Müllerian hormone (AMH) with biochemical characteristics between ladies with and without polycystic ovary syndrome (PCOS). Material & Method: Study design: Quantitative cross sectional Settings: Lady Wallington Hospital Lahore Duration: Six months i.e. 1st July 2021 to 31st December 2021 Methodology: Quantitative cross sectional study was performed at lady Wallington hospital Lahore. The total numbers of patients were 150. Age of females was in between 18-35 years. The diagnosis of polycystic ovarian syndrome was made according to the Rotterdam ESHRE-ASRM criteria. The various parameters which include Body mass index, lipid profile, Blood sugar levels, FSH, LH, Prolactin, testosterone levels, AMH DHEA-S, HOMA-IR and adiponectin were measured. Collected data was entered in SPSS version 23 and analyzed. Results: Data for females with PCOS and control summarized briefly in table no 1. AMH level have significant p value 0.001 and clearly showed that it is higher in females with PCOS whether fatty or non-fatty than normal or control. Conclusion: In conclusion, AMH levels were essentially higher in ladies with PCOS, in any case of age and BMI, and exhibited no relationship with obesity, insulin resistance, or metabolic syndrome-related factors. Only testosterone shown an impact on serum AMH levels in PCOS group, whereas age, adiponectin as well as testosterone altogether related with AMH levels within the control group. Keywords: Polycystic ovarian syndrome, AMH, Gonadotrophin, TSH, Insulin

Background: Infection caused by hepatitis C virus is common and important issue of public health in Pakistan. The risk factors associated with type 2 diabetes mellitus and hepatitis C virus has common association. Objectives: To find out the frequency of hepatitis C virus in Type 2 Diabetes mellitus patients and to assess the association between Type 2 Diabetes mellitus and hepatitis C virus. Methodology: This was descriptive study piloted at the Department of Medicine Hayatabad Medical Complex Peshawar for duration of one year. Totally, 157 type 2 diabetic patients were included. All information’s were documented on a prescribed Performa. Results: Out of 157 confirmed diabetic patients, 50 (31.85%) were seropositive for anti HCV antibodies while 107(68.15%) were negative. There were 48% males and 52% female in the entire study. Patient’s age ranged from 31 to 73years. The seroprevalence of HCV in female was 29(58%) while in male it was 21(42%). Conclusion: Our study concludes that HCV infection is highly prevalent in patients with Type 2 Diabetes mellitus. Keywords: Chronic Hepatitis C, Hepatocellular Carcinoma, Diabetes mellitus.

The T-tube-directed biliary anastomosis in orthotopic liver transplantation (OLT) aims to minimize preventable biliary complications, including bile leaks and strictures. Biliary complications in patients with OLT increase the risk of morbidity and mortality. This review paper evaluated the current evidence on the routine use of T-tube reconstruction in OLT cases. A review of prospective, retrospective, observational, cohort studies as well as systematic reviews, meta-analyses, review papers, and opinion papers has been conducted to evaluate the therapeutic potential of T tube-based biliary anastomosis in cases of OLT. Our finding showed a bile leak incidence of 16.6% and 6.6% in T-tube and non-T-tube groups, respectively. The results indicated a lower incidence of anastomotic fistulae in the non-T-tube group (0.6%) compared to the T-tube group (4%). The findings negated statistically significant differences in the three-year actuarial survival rates based on biliary anastomosis with and without T-tube intervention (62.5% vs. 69.8%). The studies revealed a 6-11% and 2-11% incidence of cholangitis in OLT patients with T-tube-based reconstruction and those without a T-tube, respectively, and 26% and 20% incidence of total biliary complications in OLT patients with and without T-tube, respectively. In addition, the findings ruled out the influence of a T-tube on the incidence of perioperative complications, endoscopies, and reoperations in OLT cases. The current evidence correlates the increased incidence of bile leaks, cholangitis, and overall biliary complications with the use of a T-tube during OLT. In addition, T-tube-guided reconstruction has no impact on perioperative complications, overall survival, endoscopies, and reoperations in OLT cases.

Background: Spinal arteriovenous malformations (AVMs) are a cause of 20–30 of all spinal vascular malformation. The treatment option for the AVM depends upon the type of AVM. Here, we present a case series to discuss the type, management, and post-operative conclusion of the spinal AVMs. Method: Four patients with spinal AVMs were retrospectively reviewed. All 4 patients were with a nidus-type AVM. Treatment for all patients required embolization. Clinical features, imaging, treatment, and clinical results were observed. All 4 patient’s clinical outcome was assessed using the Modified Ranked Scale. Result: The follow-up after management showed that all four-patient recovered without any residual deficit. All four-patient scored zero (0) on the Modified Ranked Scale. Conclusion: Pediatric spinal AVMs are rare and require complex multimodal approach to achieve favorable outcomes.

In order to evaluate the possible human health risk by phyto-accumulation of five heavy metals, viz. Cr, Cd, Cu, Pb and Ni, four Brassica species, namely B. campestris, B. juncea, B. napus and B. nigra, were grown under field conditions irrigated with 100% (undiluted) and 50% (diluted) wastewater (WW). The groundwater treatment was taken as control. WW irrigations (50% and 100%) were found to increase growth parameters (length, fresh biomass and dry biomass of shoot and root) and seed yield of all Brassica species. Calculated metal indices showed tolerance ability (tolerance index, TolI > 1) of all four Brassica species growing in both 50% and 100% WW-irrigated soil, but none of these could act as hyperaccumulator (bioconcentration factor, BCF 1), representing the human health at serious risk.

Systemic mastocytosis is a rare hematologic disorder characterized by the clonal proliferation of mast cells in extra-cutaneous organs. This disease can be further subdivided into five different phenotypes: indolent systemic mastocytosis (ISM), smoldering systemic mastocytosis (SSM), aggressive systemic mastocytosis (ASM), systemic mastocytosis with an associated hematological neoplasm (SM-AHN) and mast cell leukemia (MCL). The tyrosine kinase inhibitor (and also potent KIT D816V inhibitor) avapritinib, initially approved for the treatment of gastrointestinal stromal tumors (GISTs) bearing a PDGFRA exon 18 mutation, also showed great promise in patients with systemic mastocytosis, a disease known to be driven by a mutation in KIT (D816V). We present an overview of this rare disorder, including a review of the current understanding of the genetic mechanisms which lead to the disease state, the action of the tyrosine kinase inhibitors, as well as the latest clinical trial data which led to the current recommendations for the use of avapritinib.

Reciprocal relationships between viral illness and chronic diseases have been established. Such relationships augment one another and increase the potential harm. The coronavirus 2019 pandemic proved that the most vulnerable populations are the ones with underlying chronic diseases, especially diabetes mellitus. As new data are evolving, viral illnesses, like COVID-19, have been speculated to potentially induce diabetes mellitus. Here we report a 20-year-old male with no past medical history who presented with polyuria, polydipsia, and dry mouth. He was found to have significant hyperglycemia. He had COVID-19-like symptoms a few weeks prior to admission and was tested positive for COVID-19, but the symptoms had resolved prior to his presentation. He was managed with intravenous fluids (IVFs), electrolytes replacement, and insulin. He was diagnosed with new-onset diabetes mellitus likely secondary to a recent COVID-19 infection and was discharged home on insulin, oral antidiabetic medications, and outpatient follow-up with primary care clinic and endocrinology clinic.

Background Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life. Aim To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed. Methods We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain. Results Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health, smoking, cancer, and transplant. Conclusion Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.

Objective: During general anesthesia, if there should arise an occurrence of grown-ups and youngsters, supraglottic airway route devices are acceptable substitute to making sure about airway route than tracheal intubation. This contextual analysis focused on examination between old style laryngeal cover airway route (LMA) and present day I-gel regarding sufficient position, simplicity of addition of device, keeping up of boundaries like ETCO2 and SPO2, intra usable and postoperative confusion perspective. Study Design: Comparative Study Place and Duration of Study: This study was conducted at the Department of Anaesthesia DHQ Teaching Hospital Gujranwala Materials and Methods: There was choice of 120 patients in this randomized clinical preliminary from age went from 5 to 60 years of one or the other sex and from ASA evaluating went from I-III. These all patients were worked in recumbent situation under broad sedation. Sedation was instigated to every one of these patients in the wake of accepting premedication. Specialists that were utilized in sedation were fundamentally, inj. Succinylcholine 1.5-2mg/kg and inj. Propofol 2-3 mg/kg. Patient's airway route was made sure about with either old style LMA or I-gel in 'sniffing air" position. The device position was observed by typical chest extension, by square wave capnography, nonattendance of discernible break and SPO2 >95%. The patients were checked keeping in view the boundaries like number of endeavors, simplicity of inclusion, time used in addition, hemodynamic changes preoperatively and inconvenience included intraoperatively just as postoperatively. Results: Statistically, no critical contrast was found in patients of both the Groups regarding BP, SPO2 ETCO2 and pulse, anyway it was seen that inclusion time was more noteworthy in Groups old style LMA when contrasted with bunch I-gel. Conclusion: I-gel is viewed as better and great alterative substitution device to LMA as its inclusion is route simple, alongside negligible entanglements intraoperatively just as post operatively. Key Words: I-gel, LMA, advantages, disadvantages.

Objective: To determine the frequency of spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Material and Methods: This was a cross sectional study, carried out at Saidu Teaching Hospital, Swat and the duration of this study was from January 2020 to May 2020. In this study the patients of liver cirrhosis of either gender and with age range of 20 to 70 years were included. The diagnosis of liver cirrhosis was made on clinical examination and on USG abdomen revealing coarse echo texture with or without splenomegaly. The patients with alcoholism and hepatocellular carcinoma were rule out. Spontaneous bacterial peritonitis was labelled when Serum ascitic albumin gradient >1.1, total leukocyte count >500/ml and neutrophil count > 250/ml. Results: In this study there were 100 patients of liver cirrhosis and out of these 64 (64%) were males and 36 (36%) females. The mean age of the patients was 51.34±9.62 years. There were 67 (67%) in Child Pugh class C. Spontaneous bacterial peritonitis was seen in 32 (32%) of the patients. There was no significant difference in terms of gender and age with p values of 0.97 and 0.95 respectively. However, spontaneous bacterial peritonitis was significantly high in patients that had child Pugh class C where it was seen in 25 (37.21%) of patients as compared to 7 (21.21%) of patients in class B with p value of 0.04. Conclusion: Spontaneous bacterial peritonitis is seen in almost every 3rd patient of liver cirrhosis and is seen significantly high in patients that had Child Pugh class C. KEYWORDS: Splenomegaly, Liver Cirrhosis, Spontaneous Bacterial Peritonitis, Neutrophil, Carcinoma

Voltammetric parameters are studied to confirm the antioxidant activity of citric acid towards reduced form of methyl viologen dication (1, 1'-dimethyl-4, 4'-bipyridinium, MV

Objective: To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU). Methods: One hundred and fifty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent. Results: The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014). Conclusion: Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients.