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This study evaluates the efficacy of pan retinal and targeted retinal photocoagulation (PRP and TRP) for the treatment of proliferative diabetic retinopathy (PDR). A retrospective review of medical records was conducted of patients with PDR who had undergone PRP or TRP as primary treatment at a tertiary care center. Outcome measures included visual acuity, intraocular pressure, and retinal appearance. Results showed that PRP and TRP were both effective in reducing intraocular pressure and improving visual acuity, with no significant difference between the two. However, PRP was associated with a higher rate of retinal detachment and greater risk of recurrence of PDR. Based on the results, PRP and TRP are both effective treatments for PDR, but PRP may be associated with increased risk of complications.

People with cystic fibrosis (PwCF) suffer from gastrointestinal (GI) symptoms affecting their quality of life (QOL). Despite the relevance of GI symptoms to the overall health of PwCF, a paucity of studies only have comprehensively assessed the prevalence, severity and QOL of GI symptoms in both children and adults with Cystic Fibrosis (CF).Eligible participants ≥2 years of age across 26 US CF centers were followed for 4 weeks. Three validated GI electronic patient-reported outcome measures (ePROMs) with a recall period of 2 weeks and a stool-specific questionnaire were administered weekly over four weeks. Total and domain scores of ePROMs were evaluated overall and in subgroups using linear mixed-effect models.Of 402 enrolled, 58% were ≥ 18 years of age (52% male). The mean (SD) of the total score for PAC-SYM was 0.52 (0.55), for PAGI-SYM was 0.63 (0.67), and for PAC-QOL was 0.67 (0.55). For specific ePROM questions, prevalence of moderate to very severe symptoms were as follows: straining (20.3%), fullness (18.3%), incomplete bowel movements (17.1%), bloating (16.4%), distension (16.4%), abdominal pain (upper-5.1%, lower-7.5%). Comparing participants ≥18 versus18, a higher prevalence of bloating (63.7% versus 27.3%), lower abdominal pain (39.8% vs 26.2%), stomach fullness (75.6% versus 56.2%), and abdominal distension (60.2% versus 34.9%) was found. Both age groups reported high treatment dissatisfaction as measured with PAC-QOL, mean 1.39 (95% CI: 1.30, 1.47).GI symptoms were reported in all age ranges irrespective of gender, with higher prevalence observed amongst older and female subgroups. Dissatisfaction with GI targeted treatments were reported in a large proportion of participants despite therapy, highlighting an unmet need for clinical interventions.GOV: NCT03801993.

Objective: To determine the peri-operative analgesic efficacy and quality of block by adding Dexmedetomidine as an adjuvant to Bupivacaine for spinal anaesthesia in patients undergoing abdominal hysterectomy. Study Design: Comparative cross-sectional Study. Place and Duration of Study: Anesthesia Department, Nishtar Hospital, Multan Pakistan, Jan to Jun 2019.Methodology: A total of 100 women aged 30-65 years, who were planned for abdominal hysterectomy due to benign causes, and having ASA) status I-II were included. The patients were divided into two equal groups. In Group-B, 12.5mg of 0.5% hyperbaric diluted in 3ml normal saline was administered for induction of spinal anaesthesia. In contrast, in Group-B+D, 10µg Dexmedetomidine and 12.5mg 0.5% hyperbaric Bupivacaine diluted in 3ml normal saline were given. Time of sensory and motor block onset, total duration of the block, and analgesia were noted. Results: The mean time of sensory and motor onset was significantly lower in the Group-B+D. The total duration of sensory block was 181.6±31.6 minutes in Group-B versus 345.2±23.5 minutes in Group-B+D (p-value

This is a project of public interest and the child's immune system is particularly fragile following the corona phase. Water testing is so crucial, and this is the most crucial truth. why did we select this topic? We believe that the majority of the disease-causing bacteria are present in the water, which is the only reason we are testing the water sample. It is an environmentally friendly and crucial project for Yavatmal City because it is located in a hilly area and that most schoolchildren are no longer attending because of health concerns. Water is a valuable resource, and life on earth is impossible without it. Due to excessive and negligent use, water is becoming more and more polluted, and as a result, less and less of it is available for human use. Water pollution can be caused in a variety of ways, and both living things and non-living things are negatively impacted. In current situation water is a more contaminated that’s why it is verry essential to check the quality of water. The causes of water pollution include sewage systems, industrial waste, acid rain, the oil industry, aquatic plants, and household garbage. We studied environmental engineering in the previous section, when we looked at the water quality found in nature. It is well known; the quality of the water is not verified after a corona. As a result, we are undertaking this endeavour for public benefit.

Objective: Determine the total number of Category-1 patients with ocular toxicity from Ethambutol after DOTS therapy. Methodology: This study conducted in department of Ophthalmology of abaseen hospital and Khyber medical center Peshawar over the one year, from May 2021 to April 2022 included Category-1 TB patients (both genders) aged 14 and 65 who had normal ocular parameters on an ophthalmological examination when starting DOTS treatment. The frequency of any vision change, optical symptom, including color vision, contrast sensitivity while receiving Ethambutol medication was examined in 240 eyes (120 patients). At the end of the first month and again at the end of the second month of therapy, Each patient's compliance with Ethambutol was examined, and all tests for ocular toxicity were repeated for each chosen patient. The study did not include patients in category-2 with positive sputum smears who had relapsed, had therapy fail, or was getting treatment after a break in treatment. Results: Out of 120 patients (240 eyes), 62 (51.6%) of them were male, and 58 (48.4%) of them were female patients. After a month, there was no sign of ocular toxicity. Ocular toxicity, on the other hand, appeared in 3 (2.5%) of the patients after the second month. Moreover, these three patients showed decreased visual acuity, poor color vision, decreased contrast sensitivity, and optic disc abnormalities. Conclusion: Patients with tuberculosis who use Ethambutol are at risk of developing ocular toxicity. As a result, it is essential to identify visual symptoms and signs as soon as possible to avoid unnecessary diagnostic delays and maybe irreversible vision loss. Keywords: Tuberculosis, Color Vision, Contrast Sensitivity, Optic Disc, Ethambutol-induced ocular toxicity, visual acuity, treatment strategies

Objective: To evaluate the visual outcomes in patients with branch retinal vein obstruction after intravitreal bevacizumab (Avastin) injection. Study Location and Duration:, Department of Ophthalmology Abaseen hospital and Khyber medical center Peshawar from January 2019 to January 2022 both department conducted this multi-center study. Methodology: Patients with BRVO received at least one intravitreal Bevacizumab (Avastin) injection of 1.25 mg in 0.05 ml. Snellen visual acuity tests, Fundus Fluorescein Angiography (FFA), and Optical Coherence Tomography were used to assess the patients (OCT). A complete eye exam was conducted before treatment began, and monthly follow-up examinations were scheduled for the following six months. Results: The total number of patients and eyes was 78, with a mean age of 60. (SD 15.1). The average number of Intravitreal bevacizumab (Avastin) injections administered to patients was four (SD 1.40) per eye. There were no negative consequences observed. Before treatment, the average central macular thickness was 568 microns, but after three months it was only 370 microns (p0.001), and by six months it had decreased to 290 microns. Three months later, the average acuity was much better than at the start (p=0.001), with log MAR = 0.30 (SD 0.22). During the most recent 6-month follow-up, the mean visual acuity was log MAR = 0.40 (SD 0.23), better than the baseline value (p 0.001). Overall, 44 eyes showed an improvement in their vision. Conclusion: Intravitreal Bevacizumab intravitreally for branch retinal vein occlusion improves vision. Bevacizumab intravitreally enhances visual acuity, macular edema, and ischemia. Bevacizumab reduces the risk of vision-threatening vitreous hemorrhage and neovascularization. Hence, Bevacizumab improves vision and treats branch retinal vein occlusion effectively. Keywords: Intravitreal Bevacizumab (Avastin), Branch Retinal Vein Occlusion (BRVO), Visual Acuity Improvement, Macular Ischemia Relief. Retinal Neovascularization Reduction

COVID-19 is causing multiple psychological problems directly influencing the ability of learning among students. Objectives: To investigate the impact of COVID-19 pandemic on medical education and to explore the influence of different predictors of educational difficulties and poor academic performance. Methods: This cross-sectional study was conducted in Multan Medical & Dental College, Multan, over a period of one month. Through convenient purposive sampling, all the enrolled students from all specialties who agreed to fill the online survey questionnaire voluntarily were included. A self-developed, reliable and validated research instrument was used as a data collection tool to inquire about the demographic details, psychological predictors and educational difficulties. Results: A positive and significant correlation was observed between the psychological distress due to COVID-19 and students’ educational learning difficulties in medical setting. It was found that depression and obsessive-compulsive disorder (p≤0.05) significantly influenced the students’ education and learning but anxiety and posttraumatic stress disorder had no significant impact. Females and students with psychiatric history showed higher level of psychological distress and educational difficulties as compared to males and students without psychiatric history. Conclusions: COVID-19 pandemic has tremendously affected the medical education as strong positive correlation has been observed between psychological predictors and students’ educational learning difficulties. However, during this pandemic learning hazard were more significantly perceived in students with depression and obsessive compulsive disorder.

Bulimia nervosa and anorexia nervosa are both serious eating disorders that affect millions of individuals worldwide. Despite sharing similarities in terms of psychological and behavioral aspects, these disorders possess distinct characteristics and require specific approaches to diagnosis and treatment. Objective: his article aims to provide a comparative analysis of bulimia nervosa and anorexia nervosa, shedding light on their unique features while highlighting their commonalities. Methods: Cross-sectional study included a representative sample of patients diagnosed with bulimia nervosa and anorexia nervosa who sought treatment at Allama Iqbal Memorial Teaching Hospital in Sialkot. The participants were selected based on their availability and willingness to participate in the study. Data for this study were obtained from the Health and Nutrition Examination Survey, which includes comprehensive information on demographics, medical history, eating behaviors, and psychological factors related to eating disorders. The survey was administered to the participants by trained healthcare professionals. Results: results suggest that there are no significant differences in demographics, prevalence, diagnostic criteria, physical symptoms, and treatment approaches between bulimia nervosa and anorexia nervosa, both among males and females. It is important to note that the absence of statistical significance does not necessarily indicate the absence of meaningful differences, and further research and analysis may be required to draw more definitive conclusions. Conclusions: This will help improve our understanding of BN and AN and facilitate the development of more targeted and effective interventions. Overall, the study contributes to our understanding of the similarities between BN and AN while highlighting the importance of a comprehensive and inclusive approach in addressing these complex eating disorders. Keywords: Bulimia Nervosa, Anorexia Nervosa, Eating Disorders, Cross-sectional study, Prevalence, Allama iqbal memorial teaching hospital, Sialkot, Health and Nutrition Examination Survey

BACKGROUND: In the STOP2 (Standardized Treatment of Pulmonary Exacerbations-2) study, intravenous (IV) antimicrobial treatment duration for adults with cystic fibrosis (CF) experiencing pulmonary exacerbations (PEx) was determined based on initial treatment response. The impact of home vs hospital care remains an important clinical question in CF. Our hypothesis was that STOP2 participants treated at home would have less improvement in lung function compared to those treated in the hospital. METHODS: Treating clinicians determined PEx treatment location, which was a stratification factor for STOP2 randomization. Lung function, weight, and symptom recovery were evaluated by treatment location. Propensity scores and inverse probability treatment weighting were used to test for differences in clinical response by treatment location. RESULTS: In all, 33% of STOP2 participants received IV antimicrobials in the hospital only, 46% both in the hospital and at home, and 21% at home only. Mean (95% CI) ppFEV(1) improvement was significantly (p

Objective: To compare the frequency of opioid requirement, after intravenous lignocaine infusion and ketorolac tromethamine in the upper limb surgeries. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Oct 2017 to Apr 2018. Methodology: ASA I/II patients of either gender undergoing upper limb surgery were included. Patients were randomly divided into two equal groups, “L” (Lignocaine) and “K” (Ketorolac). In L-group, patients were given intravenous 1.5 mg/kg lignocaine bolus, followed by 2.0 mg/kg/hr infusion during entire procedure; while in K-group, patients were given intravenous 0.5 mg/kg (maximum 30 mg) ketorolac, at induction. The patients were monitored for 12 hours postoperatively and in case of severe postoperative pain (Visual Analogue Scale score >5), rescue analgesia (intravenous Nalbuphine 0.1 mg/kg) was provided. Results: Total eighty patients were included in the study. There was no statistical difference between the two groups with age (p-value 0.823), gender (p-value 0.808) and ASA status (p-value 0.184). There was statistically significant difference between the two groups in terms of opioid requirement at 1-hour (p-value 0.035), 6-hours (p-value 0.032) and 12-hours (p-value 0.035), with K-group showing more requirement as compared to the L-group. Conclusion: Intraoperative administration of intravenous lignocaine infusion is superior to ketorolac in effective postoperative pain management in patients undergoing upper limb surgeries.

INTRODUCTION: Paroxetine is an antidepressant belonging to the class of SSRI. It is used in multiple psychiatric disorders including depression, anxiety and obsessive-compulsive disorder. Apart from being very efficacious, it causes some adverse effects too and hyponatremia is one of them. The association between the two is not well established, which makes this case worth of attention. CASE PRESENTATION: A 52 years old male hypertensive patient was brought to the ER after having an episode of seizure. Hyponatremia due to an unknown cause was made a provisional diagnosis. He was then referred to the psychiatric department for further assessment, where his detailed history was taken and mental state examination was performed. The patient was found to be suffering from chronic depression. The patient has been taking a combination of antipsychotics and antidepressants for this condition. Paroxetine, Olanzapine and Quetiapine were prescribed to him by his psychiatrist 10 years back, and since then he was taking it daily. His current medication was then immediately altered and paroxetine was replaced by mirtazapine. DISCUSSION/ CONCLUSION: Numerous studies have been done on the effects of SSRIs, but very few of them mentioned their association with hyponatremia. Electrolyte imbalances are common with many medications including antiepileptic and antidepressant drugs as well. Although some literature has shown the link between the two, drug induced hyponatremia remained one of the rarest adverse effect. In summary, paroxetine is very effective in the management of depression but its long-term use could result in an electrolyte imbalance in hypertensive patients

Objective: Despite the advantages of ultrasound scan, its use as a screening tool in blunt abdominal trauma is controversial. The aim of this study was to evaluate the diagnostic value of early and late ultrasound in patients with blunt abdominal trauma (BAT). Methods: In this study which was performed in Jinnah Hospital, Lahore, Pakistan, firstly, 2418 patients with BAT had ultrasound (US) examination by two trauma expert radiologists. Results were compared with the best available gold standards such as laparotomy, CT, repeated ultrasound or clinical course follow-up. Then, 400 patients with BAT were examined by a trained residency student. Results: In the first phase, sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasound were 97%, 98.1%, 99.7%, 83% and 98% respectively. In the second phase, they were 97.3%, 97.2%, 97.7%, 96.8% and 97.3% for the early and 98.5%, 97.6%, 98.5%, 97.5% and 98% for the late ultrasound respectively. Conclusion: Results obtained from this study indicate that negative ultrasound findings associated with negative clinical observation virtually exclude abdominal injury, and confirmation by performing other tests is unnecessary. High sensitivity and negative predictive value are achieved if ultrasound is performed by expert trauma radiologist.

Introduction: Patients with conversion disorder (dissociative disorder) are common in various hospitals and communities in Pakistan. What people think about the disease decides what treatment they receive. Therefore, this analysis was held to determine the attribution and health seeking behaviours for conversion disorder. Study Design: A cross-sectional and exploratory hospital study. Place and Duration: In the department of Psychiatry and Behavioral Sciences PGMI /AMC / LGH, Lahore Pakistan for the duration from February 2022 to July 2022. Methods: A total of 60 patients were included in this study and selected with purposive sampling method. Conferring to the criteria of ICD 10; the analysis of dissociative disorder was made. A self-developed questionnaire was used. The help seeking behavior and knowledge regarding dissociative disorder was assessed by self developed questionnaire. Results: The results exhibited that the frequency of dissociative convulsions (26.8%) and possession and trance (33.3%) were higher than in the other groups. Similarly, 8 (13.3%) had stupor, 6 (10%) has motor disorders in all movement and (3.3%) has sensory disorders and (5%) had mixed dissociative disorder. It was found that the majority of family members seeking treatment from faith healer (63.3%), trailed by paramedics (11.7%) and doctors (25%). Of all subjects, 46.6% visited a mental health professional for more than 2 weeks, 31.7% visited them within 48 hrs to two weeks, and 21.7% within 48 hours. 38.3% of members answered to ailment as a physical cause. About 43.3% of participants said conversion disorder was a mental condition. The participants who replied disease as a supernatural problem were 40%. Solitary 35% of contributors believed that counseling, psychotherapy and medicine could cure conversion disorder, while 46.7% believed that a faith-healer might cure it. Conclusion: Societies in Pakistan still have their roots in ethnic practices and faith healing. It is very important to run the awareness program and work in co-operation with faith healers is significant. Keywords: Conversion (Dissociative) Disorder, Attribution, health seeking, attribution

Objective: This study aims to analyze the retinitis pigmentosa patients' Clinical Presentation and inheritance patterns. Research conducted at the tertiary care hospital Material and methods: this tertiary care hospital study was carried out at a level I trauma center between 05 January 2018 to 05 January 2021. fifty-six patients and members of their families underwent an ophthalmic evaluation to help identify those with the condition and define its phenotype. The family tree was traced. Several relatives also had optical gheremco tomography and fundus photography. Results: at Presentation, 52 eyes (47%) were judged to be legally blind, whereas 38 (32%) had some degree of visual impairment. The visual field was narrowed in 22 instances ( 40%) due to the brightness of the interaction. In terms of inheritance patterns, we discovered that three cases were autosomal dominant (4%), 39 cases were autosomal recessive (70%), and three cases were x-linked (6%). Of the total cases, 11 (20%) were isolated incidents. There were 48 patients with a conventional retinitis pigmentosa image (86%) and eight patients with an unusual RP picture (12%), including three instances of pericentric RP (5%), 3 cases of Usher's disease (4%) and 1 case of retinitis punctata albescence (2%) bardet-biedl were identified in a single patient. Conclusions: Retinitis Pigmentosa Patients Have A Very Significant Risk Of Becoming Blind. Autosomal Recessive sporadically follows the Most Prevalent Pattern Of Inheritance. Early Detection Of Retinitis Pigmentosa Is Important In Preventing Blindness From The Disease, As Is Encouraging Patients To Forego Marriages To First Cousins. Keywords: Genetics and Clinical, Presentation, Retinitis Pigmentosa, kpc

Background The COVID-19 pandemic has accelerated the transition to telehealth, including the use of home spirometry in cystic fibrosis. Evaluating the accuracy and precision of longitudinal home spirometry is a requisite for telehealth-based research. This secondary analysis of a CF study (eICE) evaluates whether there are cross-sectional or longitudinal differences between home and clinic spirometry. Methods Participants age ≥14 years with ppFEV1>25 were recruited from 2011-2015, issued a home spirometer, and asked to complete spirometry efforts twice per week for one year. Clinic spirometry was collected at baseline and every three months. Cross-sectional differences between clinic spirometry and the closest home spirometry measurement were analyzed. Longitudinally, we apply 5 methods to analyze the precision of home spirometry, and differences between clinic vs. home data. Results Home spirometry is estimated to be 2.0 (95% CI: 0.3, 3.5) percentage points lower than clinic spirometry cross-sectionally. Longitudinally, the estimates of 12-month change in home spirometry varied by analysis method from -2.6 to -1.0 ppFEV1/ year, with precision markedly different. However, home spirometry change estimates were qualitatively similar to the clinic results: -3.0 ppFEV1/year (95% CI: -4.1, -1.9). Conclusions To leverage the potential cost, feasibility and convenience of home spirometry, the differences with clinic spirometry must be acknowledged. Significantly lower ppFEV1 in home devices shows that direct comparison to clinic spirometers may induce a spurious change from baseline, and additional variability in home devices impacts statistical power. The effect of coaching, setting, and equipment must be understood to use and improve home spirometry in CF.