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Objective: The objective of study was to determine the pattern of dyslipidemias in patients with end-stage renal disease on conventional hemodialysis in three months duration. Material and Methods: This study was conducted in the Department of Medicine and Dialysis Unit, Sargodha Medical College, District Headquarter Teaching Hospital, Sargodha. We conducted conventional hemodialysis (2cycles/week) for at least three hours and measured fasting lipid profile of 115 subjects with end-stage renal disease. Results: Our study included 115 subjects with end-stage renal disease. The mean age was 51.03 ±10.73 years. Out of 115 subjects, 69 (60%) were male and 46 (40%) were female. From study population, 39 (33.9%) patients were smokers and 76 (66.1%) patients were non-smokers. The mean baseline HDL cholesterol was 45.19±4.9 mg/dl, which after the end of study period was 41.07±8.57mg/dl. The difference was statistically significant as indicated by the p-value <0.001. The mean baseline triglyceride was significantly increased before and after the study. Almost all of our sample population exhibited elevated serum triglycerides and decreased HDL. Conclusion: The current study findings strongly support the notion that dyslipidemias are more prevalent in patients with end-stage renal disease. It could be an independent causative factor for cardiovascular deaths in end-stage renal disease. Additional large-scale case-control studies are needed to further strengthen the above statement. Key Words: End-Stage Renal Disease, Lipid Profile, Conventional Hemodialysis

Abstract Objective: To study the antifungal activities of aqueous and organic extracts of Prosopis cineraria against selected fungal strains including Aspergillus niger and Candida albicans. Material and Methods: Prosopis cineraria extracts were prepared using different solvents including water, methanol, ethyl acetate and n-hexane. Disc diffusion method was used to study the antifungal activities of prepared extracts. The extracts were tested for antifungal activities at different concentrations i.e., 75, 50, 25, 12.6, 6.5, 2.9 and 1.8 µg/mL. Inhibition zones of tested concentrations of extracts were compared with fluconazole (standard drug) for their antifungal activities. Results: Significant antifungal activity of Ethyl acetate extract was seen against the Candida albicans at the minimum inhibitory concentration (MIC) 2.9 µg/mL, for methanolic extract MIC was 12.6 µg/mL. For the n-hexane and aqueous extracts no MIC was seen against Candida albicans. P. cineraria didn’t show any significant activity against the Aspergillus niger strain. Conclusion: P. cineraria expressed promising antifungal activity against Candida albicans. Further phytochemical analysis is required to identify the biologically active constituents which may lead towards the development of new novel antifungal drugs. Key Words: Prosopis cineraria, Candida albicans, Aspergillus niger, Antifungal activity

Objective: To study an alternative and cheap way for the waste water treatment to remove the dyes. Material and Methods: Three adsorbents i.e. banana bark, rice straw and wheat straw were used without any treatment, having a particle size less than 841 micron to remove disperse blue 106 dye and reactive red 195 (C.R) dye from their aqueous solution. Experiments were performed in the batch method. All the experiments performed for various variables such as dose of the bio-adsorbent, shaking time, dye concentration, pH and nature of the bio-adsorbent under both shaking and static conditions. Percent (%) removal of each of the bio-adsorbent was estimated after every six hours for shaking condition and 24 hours for the static condition with the help of U.V visible spectrophotometer. Results: Banana bark proved to be the best adsorbent for Reactive red 195 dye and wheat straw for Disperse blue 106 dye. Banana bark showed best efficiency (50%-100%) for red dye as compared to the other two adsorbents and wheat straw proved to be the best adsorbent for blue dye having % removal of 40%-100% depending upon dye concentration in aqueous solution. Conclusion: Biosorbents are the hope for developing countries to protect the underground water and ecosystem from toxic effects of industrial effluents. Key Words: Biosorbent, industrial effluents, pollution, dye removal, health improvement

Abstract Osteoporosis (low bone mineral density) and sarcopenia (muscle loss) are collectively known as Osteosarcopenia. Osteoporosis and sarcopenia appear to affect the patient's fat content as the level of physical activity decreases, resulting in obesity. These three terms are named as “Osteosarcopenic obesity.” Osteoporosis and obesity have increased health care costs tremendously over the years. Nutritional modifications like sufficient magnesium, calcium, protein, vitamin D, and omega-3 and some pertinent exercises help patients dealing with this syndrome. This syndrome could be overcome by modifying dietary patterns and increasing physical activity as lifestyle choices greatly influence its prevalence. This article will help to understand the relationship between Osteosarcopenia and obesity and their associated risks. Keywords: Osteoporosis, Sarcopenia, Obesity, Nutritional modifications

Objective: To study the antimicrobial activity of the purified peptides/proteins isolated from the seeds extract of Nigella sativa (Kalongi). Material and Methods: Peptides/proteins isolates of Nigella sativa was screened for their antimicrobial activity against the bacterial strains including Staphylococcus aureus, Escherichia coli, Bacillus subtilis and Pasturella multocida and fungal strains including Aspergillus niger, Alterneria alternata, Aspergillus flavis and Rhizopus solani. Purification was carried out by dialysis, ammonium sulphate ((NH4)2SO4) precipitation, gel filtration chromatography using Sephadex G-100 gel and ion exchange by using DEAE-Sephadex A-50, fractions eluted using the gradient buffered NaCl (0.2-1 M). Results: Nigella sativa showed good antibacterial activity against S. aureus and E. coli while minimum zones of inhibition were noted against fungal strain A. niger and poor antifungal activity against Rhizopus solani. SDS-polyacrylamide gel electrophoresis revealed that the purified protein was a monomer with molecular mass of 14 kDa which possesses a strong and broad spectrum antimicrobial activity. Conclusion: Peptides/proteins contained by the N. sativa showed good antimicrobial activities. Keyword: N. sativa, antimicribial, peptides, proteins

Objective: To investigate the risk of hypertension among male university students in relation to dietary habits, lifestyle and obesity. Material and Methods: The cross-sectional study was performed at the Rawalpindi Medical University during September-December 2018. Participants were healthy male students aged 18-25 (medical & allied health students) selected via simple random sampling. Closed ended questionnaire was used to document life style and eating habits of participants. Blood pressure of all participants was recorded at two different occasions. BMI was calculated. The participants were selected by simple random sampling. Results: Of the 370 participants, 38(10.27%) were obese, 88(23.78) were overweight and 244 (65.95%) were with normal BMI. Out of the 370, 8(2.16%) were hypertensive whereas 68(18.38%) were pre-hypertensive and 294(79.46%) had normal blood pressure. Overall, out of 8 hypertensive participants 6(80%) were obese, 2 (20%) were overweight. Out of 68 Pre-hypertensive participants 24 (35.29%) were obese and 42(61.76%) were overweight and 2 (2.94%) were normal. These participants were taking at least two fast food meals weekly. Also, 318 (79.5%) responders were consuming soft/energy drinks more than once/day. Interestingly, 318(85.95%) respondents were spending 2-3 hours/day watching TV, playing video games or browsing on internet Conclusion: All of the hypertensive and Pre-hypertensive participants were either obese or over weight with sedentary lifestyle and unhealthy eating habits. Key Words: Hypertension, Sedentary lifestyle, Obesity, Dietary habits

Objective: The objective of this study was to determine the prevalence of anaemia in pregnant patients attending antenatal outpatient department (OPD) and to assess the cause and severity of anaemia. Material and Methods: Study design: Non-probability convenience sampling technique. Place and Duration of study: Antenatal outpatient department (OPD) Obstetrics and Gynaecology, Moula Bakhsh Hospital, District Head Quarters Teaching Hospital Sargodha from February 2017 to February 2018. Haemoglobin concentration of all the study patients was measured photometrically. Then, the patients have been classified according to the types of anaemia, its prevalence in pregnancy and the socioeconomic status of patients. Results: 75.2% of pregnant women were found anaemic. Anaemia was more common in patients with increasing parity, low socioeconomic status, and in patients who presented late in their pregnancy. Amongst anaemic patients, iron deficient anamia was found in 73% of the patients. Conclusion: Anaemia is highly prevalent in our population so effective measures must be envisaged to diagnose and prevent it early in pregnancy. Key Words: Anaemia, hemoglobin, pregnancy

Objective: To determine frequency of women presenting for IUD removal due to abdominal pain after immediate post-partum insertion. Material and Methods: This is a descriptive case series conducted at Department of Obstetrics & Gynecology, Nishtar Hospital, Multan from 15th January 2016 to 15th July 2016. Pregnant women age 25-34 years old were included with Parity ≥3 having gestational age of 36-40 weeks on ultrasound. Sample size was 148. Results: Age range in this study was from 25 to 35 years with mean age of 32.067±1.64 years, mean gestational age 38.040±1.08 weeks, mean BMI was 28.033±1.94Kg/m2 and VAS score was 6.662±1.16. Majority of the patients were from 31-35 years (86.5%). 3-4 parity was seen in 82.4% patients. Vaginal delivery was seen in 55.4% patients. IUD removal due to pain was seen in 17(11.5%) patients. Conclusion: This study demonstrated that the insertion of immediate post-partum intrauterine device is a suitable, feasible and safe way for contraception. The insertion of IUD at post-partum time is safe, has more advantages due high motivation of the patient and ease of insertion. It is highly convenient for both the patient and the doctor. Key Words: Gestational Age, BMI, Parity, IUD, Contraception.

Objective: Anemia during pregnancy is a frequent medical problem that contributes to increased maternal and fetal morbidity. Current work was planned to investigate the iron deficiency anemia associated with pregnancy. Material and Methods: A total of 150 pregnant females with different trimester and different history of gravida were selected from different rural areas of Sargodha District Punjab-Pakistan. A questionnaire was completed and blood samples were collected from all subjects to determine the concentration of Hemoglobin, serum Iron and Total iron binding capacity. Results: Study results revealed that prevalence of iron deficiency anemia is more significant (p<0.05) during second trimester with Hemoglobin concentration (9.1±1.7 g/dL), iron (29±5.1 µg/dL) and TIBC (367±91 µg/dL) as compared to first and third trimester. Furthermore, the results showed that prevalence of iron deficiency anemia is 89% with hemoglobin < 11.0 g/dL; of which mild anemia was 47 % (Hb 9-11 g/dL), moderate anemia 33% (Hb 7-8.9g/dL), severe anemia 08% (Hb <7 g/dL) and only 11 % pregnant female have hemoglobin > 11 g/dL. Conclusion: It could be concluded that iron deficiency anemia is significantly associated with progression of gestational period which is more prevalent in rural areas of Sargodha. Further, this condition could be controlled by improving the socioeconomic status of local population as well as with iron supplementation. Key Word: Anemia, iron deficiency, pregnancy, rural areas

Objective: Chronic obstructive pulmonary disease is an inflammatory disease with airway obstruction that can affect breathing pattern and consequently posture. The objective of the study was to measure the effects of chronic obstructive pulmonary disease on cervical and lumbar spinal mobility. Material and Methods: This was analytical cross-sectional study, consists of 75 patients with COPD. An inclinometer was used to assess a range of motion, and the Dutch Musculoskeletal Questionnaire (DMQ) was used to assess pain. Analysis of data done by using SPSSv20. Percentage and frequency were used for categorical variables, age, and gender. Results: Majority of participants had limited lumber ranges and mild limitation in cervical ranges. Patients felt much trouble in moving heavy load and little trouble when working in an uncomfortable posture. Conclusion: The findings of this study indicate that majority of patients had limited lumber ranges, and they felt trouble in doing activities. Key Words: COPD, Posture, Inclinometer, Range of motion

A comprehensive body of evidence now exists concerning the protective effect of healthy eating habits and food choices against a number of chronic diseases particularly diabetes, cancer and stress. In the main body of the review, the factors that affect food choice decisions of university students in relation to healthy eating habits are studied. Determinants covered included; socio- demographic, breakfast skipping, availability of food, media advertisings, fast-food consumption, family choices, stress and poor meal patterns. The content of review showed that poor food choices are leading towards chronic diseases. The purpose of this review is to highlight the determinants affecting food choices and eating patterns of students by showing the association with chronic diseases and poor health status. Key Words: Food Choices, Meal Patterns, Diabetes, Cancer, Psychological Stress, Breakfast Consumption

Abstract Objective: Cardiovascular disease (CVD) is a major and growing contributor to morbidity and mortality in Asian countries including Pakistan. This study is planned to examine the variations in various hematological indicators in cardiac patients from Faisalabad, Pakistan. Material and Methods: The study population consists of fifty subjects including healthy individuals as control group (n=20) and cardiac patients as test group (n=30). The blood samples taken from subjects were investigated for hematological indices using an Automated Hematology Analyzer Sysmex KX-21. Results: Significant variations in hematological indices were observed between the control group and test group individuals. Results showed that mean corpuscular volume, total white blood cells, packed cell volume and platelets count were increased significantly (p<0.05) in test-group individuals than in control-group. Erythrocyte sedimentation rate (ESR) was also increased in test group individuals. It was also found that hemoglobin concentration and percent neutrophil count were decreased significantly (p<0.05) in test-group as compared to control-group. Conclusion: This study concluded that investigating hematological indices is a useful indicator for evaluating the health status of cardiac patients along with other specific markers for cardiovascular diseases. Key Words: Cardiovascular disease, Hemoglobin, White Blood Cells Count, ESR

Objective: The objective of this study is to determine the frequency of most common bacteria from bacterial isolates and their antimicrobial sensitivity pattern in neonatal sepsis. Material and Methods: A total of 200 neonates of both genders aged under 28 days of life who presented with neonatal sepsis were included in the study. Blood culture and sensitivity reported were obtained, and frequency of common bacterial isolates and their antibiotic sensitivity pattern were recorded. Results: The age of the patients ranged from 2 days to 27 days with a mean of 8.25±5.99 days. Majority (n=172, 86.0%) of the patients were aged under 2 weeks. The weight of the patients ranged from 1.6 Kg to 4.0 Kg with a mean of 2.53±0.56 Kg. Body weight was between 1.6-2.8 Kg in 150 (75.0%) patients while the remaining 50 (25.0%) patients had body weight in the range of 2.9-4.0 Kg. There were 124 (62.0%) male and 76 (38.0%) female patients (with male to female ratio of 1.6:1). E. Coli was the most frequent bacteria found in 78 (39.0%) cases while Ciprofloxacin (49.0%) and Meropenem (43.0%) were least resistant antibiotics. Conclusion: E coli were the most frequent bacteria followed by S. aureus, Klebsiella spp., Pseudomonas spp. and S. epidermidis in patients with neonatal sepsis. Ampicillin was found to be the most frequent resistant antibiotic and meropenem was least resistant drug. Key Words: Neonatal Sepsis, Bacterial Isolate, Antibiotic Sensitivity Pattern

Objective: Lung cancer (LC) is one of the leading causes of cancer related deaths worldwide. Among other reasons, one cause of LC deaths is the lack of early diagnosis. Serum biomarkers might be helpful in early detection of this cancer but there is no up to date specific biomarker reported to diagnose LC. Aim of the present study was to predict the tumor associated proteins as potential biomarkers for the early detection of Lung Cancer (LC). Material and Methods: 50 serum samples from LC patients were tested and SDS-PAGE profiling was performed. The visualization of detected protein bands the gels were stained by Coomassie blue staining method. Results: Two bands were differentially expressed by LC patients comparing control sera. A 41 kDa band was stained in 21% testing sera while 110 kDa band was stained with 17% testing sera of patients. Conclusion: These protein bands might serve as candidate potential biomarkers for early LC diagnosis after mass spectrometry confirmation with large scale testing sera. Keywords: Sera, Diagnostic biomarker, Lung cancer

Objective: This study was designed to profile differently expressed proteins (by SDS-PAGE) from sera of patients of thyroid cancer, and to analyze using bioinformatics tools. Material and Methods: 30 serum samples were collected from thyroid cancer patients. The protein extract was resolved by SDS-PAGE for protein separation to profile the proteins differentially expressed in sera of patients. These proteins were analyzed using bioinformatics tools to predict the peptides produced by cutting the proteins, their physiochemical properties and the transmembrane domains using ExPASy server (www.expasy.org/tools/). Results: Seven protein bands were differentially stained in sera of thyroid cancer patients comparing sera of healthy subjects. The protein bands of 15 kDa, 32 kDa, 37.5 kDa, 38 kDa, 49 kDa, 82 kDa and 90 kDa were observed which might correspond to Gal3, CK19, TPO, Ki67, Calcitonin, Thyrotropin receptor and E cadherin. Physiochemical properties were predicted using ProtParam and putative transmembrane domains were predicted by ProtScale bioinformatics tool. The transmembrane domains were found more in thyrotropin receptor, few or less in Gal3, Ki67 and E cadherin, moderate in CK19 and TPO while null in calcitonin. Conclusion: The present study provides potential predictions on physiochemical properties, transmembrane domains and secondary structure of proteins differentially expressed in the sera of thyroid cancer patients which might be helpful in the discovery of prospective biomarkers for thyroid cancer diagnosis. Key Words: Thyroid Cancer, SDS-PAGE, ExPASy, Bioinformatics tools

Objective: The objective of the study was to compare the efficacy of Kinesio Tapping and conventional physical therapy for the treatment of subacromial impingement syndrome. Material and Methods: A comparative study was conducted. A total of 54 patients were randomly allocated to the experimental group (n=27, Kinesio taping plus conventional therapy) and control group (n=27, conventional physical therapy). Patients were treated for four weeks. Shoulder pain disability index (SPADI) and numerical pain rating scale (NPRS) were used for the outcome measure before and after the treatment protocols. Results: Total of 54 patients with shoulder impingement participated in this study with age ranges from 40 to 60, where the mean and SD for age was 48.91±6.26. In 54 patients, 34(63%) were male, while 20(37%) were female. After treatment, the mean scores ±SD for Visual analogue scale in the experimental group was 3.05 ± .51 While Conventional therapy VAS was 4.97± 2.02, showing that patients significantly improved in the treatment group. The mean scores ±SD for SPADI in the Tapping group was 50.37 ± 20.27 While Conventional therapy SPADI was 75.67± 11.15, showing that patients significantly improved in the treatment group. P-value of <0.05 was considered statistically significant. Conclusion: This study suggests the effectiveness of KT and conventional PT on pain reduction and disability in patients with SIS as compared to conventional physical therapy alone for the treatment of SIS. Keyword: Physical Therapy, Exercise, Kinesio Tape, Shoulder, Shoulder Impingement Syndrome

Objective: The objective of the study was to determine the risk factors and pregnancy outcome in patients having placenta previa along with placenta accreta. Material and Methods: A cross sectional study was carried out at Obstetrics & Gynecology Department, Sir Ganga Ram Hospital Lahore. Total 50 pregnant women with singleton pregnancy and >24 weeks gestation. Patients having placenta previa on trans abdominal ultrasound and during caesarean section were included in the study. Placenta previa-accreta was clinically diagnosed while doing caesarean section. Results: The age of patients was from 20 to 50 years, with 42.0% >36 years. Majority of the patients were multipara while primipara with placenta previa were only 3.6%. All patients with placenta previa gave the history of cesarean section. Age, parity and previous history of cesarean section has significant relation with placenta previa. 12(24.0%) and 15(30.0%) of patients showed grade-III and grade-IV placenta previa respectively. 36(72.0%) had anterior previa and 14(28.0%) had posterior previa. 16 patients underwent caesarean hysterectomy. 11(22.0%) patients were diagnosed as having placenta accreta along with placenta previa. Conclusion: Risk of placenta previa along with accreta rises with previous cesarean sections, age and parity. Sonographic detection of abnormal placenta should be carried out for diagnosis to avoid massive maternal hemorrhage to reduce the morbidity linked with placenta previa. Key Words: Placenta Previa, Maternal Outcomes, placenta accreta

Smoking is leading cause of lung cancer accounting for about 85% lung cancer cases. Even, illness associated with smoking caused about 5 million deaths globally every year. It is alarming that about one-third of adults globally are considered to be smokers and this rate is significantly increasing in female. It is worrisome that estimated deaths attributed to tobacco smoking will rise up to 10 million by 2025. A number of researches reported strong association between cigarettes smoking and lung cancer and cigarette smoking related deaths accounts about one-third of all adult deaths. A constant smoker has 20-40 times higher risk for the development of lung cancer as compared to non-smokers. About sixty carcinogens have been identified in cigarette in laboratory settings which are proven to induce carcinoma. This review article described the linkage of lung cancer and smoking with some etiologies for the development of cancer in tobacco consumers. Key Words: Smoking, DNA adducts, carcinogenic metabolites, pulmonary cancer

Objective: The objective of study was to identify the results of task-oriented strength-training on lying and rolling in children having cerebral palsy Material and Methods: This study is a quasi-experimental study design to check the effects of task-oriented strength training in improving rolling and lying in children with cerebral palsy with age 5 to 15. The total of thirty-two Cerebral Palsy (CP) patients having either type spastic or athetoid CP were included. Gross Motor Function Measure (GMFM) scoring system was used for analysis of the patients. Intervention used in this study was set of exercises in lying position. Duration of intervention was five days in week for six months. Results: Results showed mean Pre-lying and rolling score was 90.68 ± 11.87 and post mean score in lying and rolling domain was 94.72 ± 6.74. Paired sample T test was used for comparing pre and post GMFM score which indicate significant difference. Conclusion: The conclusion was that task-oriented strength training have significant role in improving in lying and rolling in children having cerebral palsy. Key Words: Cerebral palsy, motor strength, task-oriented strength training

Objective: To examine the impact of sports activities on stress among medical and undergraduate’s students. Material and Methods: It’s a descriptive cross-sectional study undertaken in four private sectors teaching institutions situated in Faisalabad. Sample consisted of 150 students. 75(50%) students were selected form medical and 75(50%) students (20 to 30 years) were having undergraduate level of education. Data was collected through self-administered structured questionnaire. Results confirmed that the internal consistency (reliability analysis) of all questionnaires in this study are in adequate values of Cronbach’s alpha (.83 to .94). Results: Out of 150 study participants, there were 86 male and 64 female participants. Mean age of participants was 22.75 years+1.14. The study showed deep insights on the relationship between stress of adults and physical activity. The result displays that rational sports activity is positive significant (p < .01) correlate with stress (r = -.43). While, depend sports activity is also positive significant (p < .01) correlate with stress (r = .26). It means if rational sport activity will increase then stress will decrease. Additionally, rational sports activity has significant negative impact on stress, while depend sports activity has significant positive impact on stress. Conclusion: It is concluded that sports activity has significant impact on stress among medical and undergraduate students. Counselling sessions should be offered to student to reduce their stress and engage in sport activities. Key Words: Stress, Sports Activities, Medical students, Undergraduates Students

Objective: Purpose of the study is to study the effects of Kinesio Taping on individuals with non-specific neck pain. Material and Methods: The methodology comprises of 40 Individuals who were selected for the study. The individuals were selected form Karachi University and NED University, as the complaint of mechanical neck pain is common among students. SPSS (statistical package of social sciences version 23 were used to analyzed data. Descriptive statistics was used to analyses the frequency and percentages and pre and post outcomes. Results: Finding revealed before the treatment the pain score was 6.50 standard deviation 1.53, while after the treatment it was 2.10 standard deviation 1.11. The mean decrease in both the pains was on average 4.40 units with significant p value less than 0.01. Conclusion: It has been concluded from the study that the neck pain was reduced when kinesio-taping was applied on the neck. Furthermore, study showed that the disability of the neck was widely effected and reduced because of taping. Key Words: Neck pain, Neck disability, Taping, Kinesio-taping.

Objective: The study aimed to determine the prevalence of painful diabetic peripheral neuropathy (PDPN) in uncontrolled type 2 diabetes patients. Material and Methods: A simple random sampling technique was used to collect data from 120 patients in four months; data collection was carried out via a questionnaire. Statistical package for the social scientists SPSS version 23 was used to analyze data statistically. Results: This study revealed that out of 120 individuals, thirty-seven percent were males, and sixty-three percent were females. All were suffering from Type-2 Diabetes Mellitus. Among them, seventy-one percent of subjects were suffering from diabetic peripheral neuropathy (DPN), and fifty-three percent were suffering from painful diabetic peripheral neuropathy (PDPN). Conclusion: This study concluded that painful diabetic peripheral neuropathy (PDPN) is highly prevalent in type 2 diabetes i.e. 52.9%, in Pakistan. Key Words: Diabetes mellitus, Diabetic peripheral neuropathy (DPN), Painful diabetic peripheral neuropathy , Prevalence, Burning sensation, Muscle cramps.

Objective: To find out balance problems after mild traumatic brain injury among young adults in Lahore, Pakistan. Material and Methods: The descriptive case series was conducted at Lahore General Hospital 20 patients were recruited who completed the inclusion criteria. In the study, the data was collected by conducting interviews and balance test. The static and dynamic balance of the patients was assessed by Berg Balance Scale. Results: In the study population, the mean age of the patients was 26.40, with a range of (18-35years). Out of them, 75 % of the patients were male and 25 % were female. In the study (N=20), it was found that 30% patients were at high risk of falling, whereas 55% patients were at medium and 15% patients were at low risk of fall respectively according to the Berg Balance Scale. Conclusion: Mild traumatic brain injury significantly influences the balance of the individuals resulting in marked limitation in physical activities and increases the risk of falling and related consequences. Key Words: Mild traumatic brain injury, young adult, postural balance

Objective: Constraint-induced movement therapy is a form of rehabilitation therapy that improves function of involved extremity in patients of stroke and other patients with damage to brain by selectively increasing the use of their affected upper limb. The basic purpose of current study was to access the functional abilities of upper limb among older adults having constraint induce movement therapy post 6-9 months of ischemic stroke. Material and Methods: A descriptive study was conducted on 43 stroke patients who had undergone constraint induced movement therapy. Data was collected from patients with stroke coming to physical therapy department of multi-setting Hospitals. Data collection was performance based and patients were evaluated by help of Wolf Motor Function Test that is standardize tool and involves 15 items and two strength items. Validity of WMFT is 0.92. Results: The mean age of patients was 62.44 whereas standard deviation 7.95. Mean and Standard deviation of functional ability was 3.3488 with a Standard Deviation 0.9228 and a P value of 0.001. Conclusion: Use of CIMT therapy during sub-acute stage rehabilitation period of post stroke patients facilitates functional improvement of a pelagic upper limb. Key Words: Constraint Induced Therapy, Functional Ability, Stroke, Manual coordination.

Objective: Asthma is a chronic inflammatory disease and its prevalence is increasing with each passing day. This research work was aimed to study the impact of a pharmaceutical care program on asthmatic patients. Material and Methods: Prospective study was performed on sixty patients in Gulab Devi chest hospital Lahore by questionnaire evaluation. Two methods were used for data collection including the use of pharmaceutical care model instrument to collect participant’s baseline data, peak expiratory flow rates, adverse reaction of asthma medication and triggering factors. A seven-point scale score method was used for technique of using inhaler in proper way Results & Conclusion: Majority of study participants were female 58% under 35-45years of age and 75% of patients had family history of asthma. The average peak expiratory flow rate was 280±7.7 and a significant difference (p<0.05) was found between pre and post intervention group. Most of the study participants had a maximum of primary school education 46.5%. The daily symptoms occurrence was 13.9% and the night-times awakenings was 14.2% more than once in a week, 61.7 % patients showed adherence to preventive medication. Itching, sweating, cough and headache were the most frequently reported adverse effects perceived to be associated with asthma medicine. Results showed that only 17% and 12% of participants were metered dose inhalers and dry powder inhalers, respectively. The average score of metered dose inhaler (MDI) and dry powder inhaler (DPI) were 3.5±3.1 and 2.14 ±1.3, respectively. Conclusion: To achieve proper outcomes and to ensure better quality of life to patients, pharmacist should counsel patients about the proper use of medications as well as inhaler use especially meter dose inhaler and also about the avoidance of triggers of disease. Keyword: Asthma, pharmaceutical care, patient education, inhaler technique, avoidance of triggers.

Objective: The objective of the study was to compare the effects of McKenzie Extension Exercises versus Mulligan Sustained Natural Apophyseal Glides on Pain and Functional outcomes in patients with Acute Non-Specific Low Back Pain. Material and Methods: Study design was experimental. 84 Patients were selected randomly through computer balloting and were allocated into group A and B. The questionnaire was based on two primary outcome measures i.e. Visual Analogue Scale for pain and Back performance scale for functional abilities. Patients were assessed by a research assessor at pre-treatment i.e. t0, mid treatment i.e. t1 and after treatment i.e. t2. Results: Mean age for patients in group A was found to be 41.97±8.16 and 45.02±7.29 for patients in group B. 45.24% were males and 54.76% were females. Pain score according to VAS was recorded to be 8 which significantly dropped to 4.02±0.80 and 4.12±0.76 (p=0.56 i.e. non-significant) in patients of group A and B respectively at mid treatment level. Moreover, pain was recorded to be 1.45± 0.50 and 1.43 ± 0.50 (p=0.81 i.e. non-significant) in group A and B respectively. Functional abilities measured by Back Performance Scale was found to be 5.02 ± 2.05 and 6.78 ± 3.3 at post treatment level (p=0.00). Back Performance Scale results at 8th week follow up for both groups were significant (p-value of 0.03) with values of 2.15 ± 1.64 and 3.16± 2.43 respectively. Conclusion: The present study concluded that McKenzie exercises and SNAGs both were equally effective in improving pain whereas McKenzie exercises improved Functional abilities better than SNAGs. Key Words: Nonspecific Low back pain, McKenzie extension exercises, Mulligan SNAGs.

Objective: Restless leg Syndrome has adverse effects on sleep quality. The study intended to find out the incidence of Restless Leg Syndrome (RLS) in Type-2 diabetic patients and its relationship with Quality of Sleep. Material and Methods: The population under study consisted of 203 patients attending three major hospitals in the city of Lahore, Pakistan. RLS was diagnosed by consulting the criteria defined by the “International Restless Legs Syndrome”. The Pittsburgh Sleep Quality Index scale assessed the quality of sleep. Subjects were interviewed using these questionnaires to determine the presence, frequency & severity of RLS symptoms and their effect on the quality of their sleep. Results: Out of 203 patients, 66 were males, 137 were females. Present results revealed that RLS was present in 65% of patients. The Pittsburgh Sleep Quality Index (PSQI) showed that 155 out of 203 participants were poor sleepers, and 48 were good sleepers. The disturbances in the sleep were found more among the patients with RLS than non-RLS (86.36% Vs 57.7%). A positive association was found between RLS and sleep quality. Conclusion: The findings of this study demonstrated that the occurrence of RLS was very high among diabetic patients, and RLS is strongly associated with poor quality of sleep. Key Words: RLS, Diabetes, Sleep quality, Pittsburgh Sleep Quality Index

Objective: This Experimental study was organized to investigate the ameliorating effect of Renadyl on some hematological and biochemical changes in young male rats after gentamicin induced nephrotoxicity. Material and Methods: Total eighteen (18) rats were used and divided into a control group (n=6) and treated groups (n=12). Gentamicin was given through the intraperitoneal route for 8 days. After 8 days half (n=6) rats were sacrificed from the treated group. Renadyl was administered orally to the remaining rats (n=6) for a further 10 days. After this rats were decapitated for investigation. Results: Data were analyzed by one way ANOVA. A significant difference (p≤0.05) was found in mean corpuscular hemoglobin, creatinine, urea, HDL, LDL, glucose, TAC, TOS, kidney, and liver weight in Renadyl treated group as compared to Gentamicin treated group. The results indicated that Renadyl has the potential to reduce toxicity level induced by gentamicin by using creatinine and other toxic agents as their food ingredients and also remove enteric toxins which further provoke kidney damage. Conclusion: Renadyl possesses a nephroprotective approach against Gentamicin induced nephrotoxicity. Key Words: Gentamicin, Nephrotoxicity, Renadyl, nephroprotective

DOI: https://doi.org/10.52587/njhms.v4i1.37 Objective: Hemostasis is the natural process causing the blood to stop flowing out from damaged blood vessel following an injury. This involves the coagulation process activating the coagulation mechanism to form fibrin clot. Cytotoxicity is the ability of an agent to destroy the living cells. The current work was aimed to study the thrombolytic and cytoprotective potential of Moringa oleifera leaves extract through in vitro assays. Material and Methods: M. oleifera leaves extract was tested for thrombolytic activity against human blood clots through clot lysis assay using streptokinase as standard thrombolytic agent. For evaluation of cytoprotective potential of the aqueous leaves extract, hemolytic assay was performed using washed human erythrocytes. Distilled water and Triton X-100 was used as negative and positive controls, respectively. Results: Current study results showed significant (p<0.05) clot lysis activity against blood clots but the percent clot lysis by M. oleifera extract (42.74±1.8%) was lower than that of standard streptokinase (79.4±2.6%). No significant (p>0.05) hemolysis was observed in M. oleifera leaves extract (6.58±1.02%) treated red cells and distilled water (2.84±0.78%) while remarkably significant (p<0.05) hemolysis of washed red cells incubated with triton X-100 (86.04 ± 4.87 %) was observed. Conclusion: The study indicated that M. oleifera leaves have therapeutic potential against blood clots with less cytotoxic effect on human erythrocytes. Hence, this plant might be used as cardioprotective and membrane stabilizing agents in pharmaceutical preparations after proper screening and analysis of bioactives present in aqueous extract of this plant. Keywords: Thrombolytic, streptokinase, cardioprotective, cytotoxicity

DOI: https://doi.org/10.52587/njmhs.v4i1.32 Objective: This study aims to compare the compare the treatment response of azithromycin against ciprofloxacin while treating salmonella infection in children. Material and Methods: The study was conducted in Yaseen Memorial Hospital, Faisalabad Pakistan. Informed written consent was taken from parents or guardians of patients. The sample size of the study was 200 children. The Patients that are included in the study after fulfillment of the criteria were included in study and were randomly divided into Azithro-group and Cipro-group. Cipro-group was treated with oral ciprofloxacin 15mg/kg/dose twice a day for 7 days. Azithro-group was treated with oral azithromycin 10mg/kg/dose Once/day for 7 days. Patients were closely monitored during the whole study period. Results: Out of 200 patients, 125 patients fall between 3- to 8-year age group. Out of these, 71 were in Cipro-group and 54 were in Azithro-group. Rest of the 75 patients fall between the 9- to 14-year age group. Out of these, 29 were in Cipro-group whereas 46 in Azithro-group. The Comparative efficacy of the oral azithromycin vs oral ciprofloxacin in children with typhoid infection demonstrates that 89% patient in Azithro-group and 68% patient in Cipro-group met the criteria of effectiveness. While 32% in Cipro-group and 11% in Azithro group did not meet the criteria of effectiveness despite the same treatment. Differences were considered statistically significant if p<0.05. Conclusion: Clinical treatment response with azithromycin is significantly higher both age groups of children in comparison to ciprofloxacin for treating typhoid fever. Keywords: Children, Typhoid fever, treatment response, azithromycin, ciprofloxacin

DOI: https://doi.org/10.52587/njmhs.v4i1.15 Objective: Tuberculosis affects mainly lungs, and other organs of human body such as brain, bones and intestine may be involved. Tuberculosis treatment causes significant hematological and biochemical changes during treatment. The aim of this study was to assess the hematological profile of TB patients who are treated with anti-TB drugs. Material and Methods: This descriptive study was carried out on newly diagnosed pulmonary TB patients who were treated with standard regimen for the treatment of TB. The data before the treatment and during the treatment of five-month was collected at FJC Hospital, Quetta-Pakistan. The data about the indicator enzymes of hepatocellular functions in the serum (such as ALT, AST and ALK-P) and the hematological parameters (such as changes in RBC and WBC counts) during tuberculosis treatment were included in the study. Results: The level of different biochemical and hematological parameters in the blood were significantly affected. The mean value of RBC count in TB patient before treatment was 4.89±0.51 million cells/mcL and after five-month treatment it was 4.84±0.54 million cells/ mcL. The average total WBC in TB patients before treatment (10.29±1.49 ×109/L) and after completion of five-month treatment (6.83±.97×109/L) decreases significantly. The mean thrombocyte count in TB patients before treatment (244.98±20.32×109/L) and after five-month treatment (244.66±28.37×109/L) changed slightly. The ALK-P in TB patient before treatment was 111.10±12.9 IU and after completion of five-month of anti TB drugs the value was 127.80±7.2 IU, which slightly increased. The mean ALT in TB patient before treatment was 39.56±1.37U/L and after five-month treatment it was 43.56±4.16U/L. The average globulin level in TB patient after completion of five-month treatment increased significantly. Conclusion: The data showed significant variations in the different biochemical and hematological parameters in the blood of TB patients before initiation and after the completion of anti-TB treatment. The TB patient should be monitored during and after intensive phase of treatment especially for liver enzymes. Keywords: Biochemical assessment, anti TB drugs. Liver enzyme, Hematological indices

DOI: https://doi.org/10.52587/njmhs.v4i1.29 Objective: The objective of study was to find out the prevalence of flat foot in the female adults of university and to find out the association of flat foot with obesity and footwear. Material and Methods: A cross sectional study conducted in the female students with sample size of 714 who meet our inclusion and exclusion criteria. Duration of study was six months. Study was conducted at department of Allied Health Sciences, University of Faisalabad. Sample was selected by convenient sampling and then measure the primary outcomes of our study i.e., body mass index (BMI) and footwear. The clinical tests i.e., single limb heel rise test and Supple Pes Planus test were performed and the Clarke’s angle of foot prints is measured. Results: The prevalence of flat foot in the female students of the University of Faisalabad was 9.64% in which 4.00% were unilateral flat foot and 5.64% were bilateral flat foot. The 72.55% females had negative ligamentous test and 27.45% had positive ligamentous test. The 20.18% females had positive Single limb heel rise test and 79.82% females had negative test. There is no association of flat foot with BMI, type of shoes and type of heels, p=0.465, p=0.783 and p=0.209 respectively. Conclusion: The prevalence of pes planus was 9.64% in which 7.45% had mild flat foot and 2.18% had moderate flat foot and 4.00% were unilateral and 5.64% were bilateral. The bilateral flat foot was more than unilateral flat foot. There was no association of obesity and footwear with Clark’s Angle in the flat foot individuals. Keywords: Supple pes Planus, Single Limb Heel Rise, Clarke angle, BMI, Footwear, Flat foot.

DOI: https://doi.org/10.52587/njmhs.v4i1.31 Objective: Kidney stones have both genetic and environmental factors for its formation. The objective of this study was to find the affected lab parameters in urolithiasis patients and to find the association between dietary habits and kidney stone formation in confirmed urolithiasis patients at Jinnah hospital, General hospital, and Sheikh Zaid hospital Lahore. Material and Methods: About 140 confirmed urolithiasis patients were included in the study from Urology wards of above-mentioned hospitals with due permission of competent authorities. Related data was collected by using pre-certified questionnaire. Data was analyzed by using SPSS version 26.0. Results: Selective blood parameters like Urea, Creatinine, Lymphocytes, and granulocytes were found significantly (p<0.05) high in the participants. MPV and RDW were also raised in these patients. Results also showed that dietary factors including green leafy vegetables (Spinach, mustard greens, curly leaves and cabbage), meat (red meat, fish meat and organ meat), lentils and lack of water intake were found significantly (p<0.05) major dietary factors which might be associated with kidney stones development in these urolithiasis patients. Conclusion: Kidney stone formation can influence lab markers such as urea, Creatinine, lymphocytes, MPV, granulocytes, and RDW, which might prove helpful in early detection of the disease. Dietary factors like certain vegetables, meat (Red meat and organ meat), cereals and lack of water intake might have some association with kidney stones development in urolithiasis, that warrants further studies to get clear association. Keywords: Renal stones, prevalence, risk factors, hot weather, dietary habits, renal parameter

Objective: The study is conducted to access the effectiveness of Isometric Handgrip (IHG) Exercise in pre-eclamptic females. Material and Methods: Fifty-six diagnosed females with history of pre-eclampsia were randomly allocated into two groups: A with 28 subjects and B with 28 subjects. Participants with group A received isometric handgrip exercise along with medicines while Group B was treated only with medicines. Each patient was treated three times a week for a period of 4 weeks. Pre-treatment, 2nd week and 4th week measurements of blood pressure was taken by a sphygmomanometer, reading was taken according to American Heart Association. Results: While comparing the values of both experimental and control group, both groups show statistically significant changes in the results after treatment, but experimental group shows more improvement than control group. Conclusion: In the study, it has been demonstrated that reduction in SBP and DBP was seen after 4 weeks of isometric handgrip exercise. It is also concluded that IHG training may be an easy, simple, cost-effective, efficacious, and non-pharmacological therapy in clinical management for reduction of blood pressure in pregnancy. Keywords: Hypertension, Diastolic blood pressure, Isometric handgrip exercise, IHG Training, Pre-eclampsia, Systolic blood pressure

DOI:https://doi.org/10.52587/njmhs.v4i2.35 Abstract Objective: Breech presentation is a common complication during pregnancy that increases the risk of fetal morbidity and mortality during vaginal delivery compared to caesarean section. To reduce the number of caesarean sections and associated complications, external cephalic version (ECV) is recommended. The objective of this cross-sectional study was to determine the success rate of ECV in uncomplicated singleton breech presentation at term. Material and Methods: The study was conducted on 85 patients at Gynae-unit I, SPH/ Bolan Medical Complex Hospital, Quetta, Pakistan. The success rate of ECV was found to be 42.4%, while the failure rate was 57.6%. Multigravida had a higher success rate (80.6%). Complications such as fetal distress, ruptured membranes, placental abruption, and emergency cesarean section occurred in a small percentage of cases. Results: According to study, the success rate was 42.4% and failure rate was 57.6%. Multigravida shows higher success rate (80.6%). In one patient (1.2%) emergency cesarean section was done due to abruption placenta, that occur in (1.2%) after the successive version, and in 4.7% cases fetal bradycardia was seen, which was transient, that resolved spontaneously. No complication seen after failed ECV. Conclusion: The study concludes that ECV is an effective and safe procedure in reducing the incidence of breech presentation at term with a low risk of complications. Maternal age and multiparity are associated with a higher success rate, and the procedure is simple to learn and perform. Properly counseled women are satisfied with the procedure, and well-equipped obstetrics units should routinely offer the procedure in selected cases during term pregnancies. Keywords: Abruption placenta, Breech presentation, External cephalic version, Term pregnancy

DOI:https://doi.org/10.52587/njmhs.v4i2.40 Objective: The study was planned to measure markers of myocardial injury in experimental model of acute myocardial infarction. Material and Methods: This was a randomized experimental study. In the study, 40 male rabbits were included and distributed equally into five groups. During first 14 days, G-1 and G-2 (control group and Iso-control group) animals got 1ml normal saline, while G-3, G-4 and G-5 animals got citric acid at the dose of 250 mg/kg, 500 mg/kg and 750 mg/kg body weight respectively. Isoproterenol (85mg/kg body weight) was injected subcutaneously for induction of acute myocardial infarction in experimental model except for G-1. Markers of myocardial injury like serum- CK-MB, LDH., SGOT and SGPT were analyzed in the study. Results: The data in the study shows that there was significant rise in myocardial injury markers such as CK-MB, LDH, SGOT and SGPT as compared to control-group indicating severe infarction and myocardial cell death. On the other hand, citric acid treated groups showed significant restoration of CK-MB, LDH, SGOT and SGPT as compared to Iso-control group. Conclusion: It is clear from this study that citric acid possesses cardio protective potential. It reduces the impact of ischemic injury to myocardium during acute attack of myocardial infarction, evident by reduced cardiac enzymes levels. Keywords: Acute myocardial infarction, Cardio protection, Isoproterenol, Cardiac Enzymes, CK-MB, LDH, Citric acid.

DOI:https://doi.org/10.52587/njmhs.v4i2.43 Objective: This study is carried out to assess the adapted insulin mechanism through comparative insensitivity in early pregnancy in the population of Lahore region. Material and Methods: Sixty-five subjects in early pregnancy stage and twenty-five non-pregnant subjects volunteered for the present study. General data and blood samples of all the participants were obtained. Glucose and insulin level in the blood were assayed and analyzed statistically. Results: It was found that insulinemia was 67 more in pregnant females when compared to non-pregnant controls, with significant difference in the comparing groups (p<0.0001). Comparative study found hyperinsulinemia in the phases of the pregnancy. Glycemia was found to be 5.4% lesser in pregnant females as compared to the non-pregnant controls. Thus there was a non significant difference in values in both the comparing groups. The relationship based on HOMA-IR concept was also analyzed and the value observed was 6.700.37 in the control non-pregnant subjects of the study. In early pregnancy subjects the values were 10.880.39. The relationship shows about 62% greater insulin index in the pregnant subjects as compared to the non-pregnant controls. The difference is highly significantly different statistically (p=0.0007). Conclusion: The responses of the insulin to the glycemia acquired in the early pregnancy certainly showed comparative insulin insensitivity in early pregnant subjects as compared to the non-pregnant controls. The pattern of insulin insensitivity in the early pregnancy in a subject may also provide clue of the development of gestational diabetes at the later stage of the gestation. Keywords: Glycemia, Insulinemia, Pregnancy, HOMA-IR, Gestational diabetes.

DOI: https://doi.org/10.52587/njmhs.v4i2.33 Objective: The objective of this study was to determine the association between sacroiliac joint dysfunction and body mass index (BMI) in postpartum females who had normal deliveries and lower segment cesarean sections. Materials and Methods: Data was collected from postpartum women who provided written consent and were informed about the procedure. Participants underwent five provocation tests, and a diagnosis of sacroiliac joint dysfunction was made if three of the five tests were positive. Results: The study shows that out of the participants (340 postpartum females), 271 (79.7%) were found to have sacroiliac joint dysfunction, while 69 (20.3%) did not. The results showed that approximately 74% of middle-aged participants were overweight, and approximately 51% were obese. The study found a high prevalence of sacroiliac joint dysfunction in this age group. Conclusion: This study concluded that there is a strong association between sacroiliac joint dysfunction and BMI in postpartum females. Obese females with higher BMIs had a higher prevalence of sacroiliac joint pain. Keywords: Body mass index, Postpartum, Sacroiliac joint, Sacroiliac joint dysfunction.

DOI:https://doi.org/10.52587/njmhs.v4i2.41 Objective: The aim of this study was to assess the effectiveness of proprioceptive and therapeutic exercises on pain among patients with knee osteoarthritis. Material and Methods: In this study, fifty-four patients having knee osteoarthritis were arbitrarily assigned into two groups: Group-A with 27 patients and Group-B with 27 patients. Both groups were given local heat for 20 minutes. Group A received proprioceptive exercises while Group B was treated with therapeutic exercises. Each patient was treated four times a week for a period of 4 weeks. Pre-treatment, 2nd week and 4th week intensity of pain, stiffness and physical difficulties were evaluated by using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Results: After the fourth week of exercises, both Groups A and B's mean values on WOMAC scores significantly decreased (P<0.001). However, it was found that the Group A having proprioceptive exercises performed better than Group B with therapeutic exercises. Conclusion: The special effects of proprioceptive exercises on the pain are more effective than therapeutic exercises among the patients of knee osteoarthritis. Further studies are needed to explore the better strategies to manage knee osteoarthritis with the help of proprioceptive exercises. Keywords: Knee Osteoarthritis, Proprioceptive Exercises, Therapeutic Exercises, Pain intensity.

DOI: https://doi.org/10.52587/njmhs.v4i2.28 Objective: This study aims to compare the performance of fentanyl and bupivacane 0.5% with hyperbaric bupivacane 0.5% as spinal anesthetics during transurethral resection of the prostate (TURP). Material and Methods: In the study, 50 male patients aged 55 to 75 years who were admitted for TURP at the Khyber Teaching Hospital over a one-year period from June 2019 to June 2020 were recruited. The patients were randomly allocated in a double-blind fashion in to 2-groups. Group-A got a combination of 0.5% bupivacaine and fentanyl, while Group-B received 0.5% bupivacaine alone. The effectiveness of each anesthetic is determined by examining the relative initiation and interval of both sensory and motor block. A faster onset and longer duration of sensory block is considered a better outcome, while a faster onset and shorter duration of motor block is considered the preferred outcome. Results: The average age of patients in Group-A was 66.6 ± 6.4 years and in Group-B was 76.3 ± 6.1 years, with no significant difference between the groups (P > 0.05). Similarly, there were no significant differences in weight, height, and body mass index (BMI) between the two groups (P > 0.05). The onset of sensory block was significantly quicker in Group-A (4.9 ± 1.1 minutes) compared to Group-B (7 ± 1.4 minutes, P < 0.05), and the regression of two sensory dermatomes was also significantly prolonged in Group-A (125.4 ± 11.8 minutes) compared to Group-B (85.2 ± 10.4 minutes, P < 0.05). The total duration of sensory block was also significantly prolonged in Group-A compared to Group-B (P = 0.00). For motor block, the onset was quicker in Group-A (8.8 ± 2.4 minutes) compared to Group-B (11 ± 2.7 minutes, P < 0.05), but the duration was extended in Group-B (189.4 ± 6.9 minutes) compared to Group-A (146.8 ± 15.4 minutes, P < 0.05) in significant manner. The prevalence of adverse effects was higher in Group-B (13 patients) compared to Group-A (8 patients, P = 0.04), and the mean dose of postoperative analgesics was lower in Group-A (P = 0.035). No significant variance was found in the heart rate and systolic blood pressure during the procedure between the groups examined (P > 0.05). Conclusion: Given the longer duration of sensory block, shorter duration of motor block and reduced postoperative analgesic requirements, of 0.5% buipvacaine and fentanyl compared to hyperbaric bupivacaine, it seems that this drug can be used as an appropriate spinal anaesthetic for patients receiving TURP. Keywords: Bupivacaine and fentanyl, prolonged sensory block, reduced motor block, spinal anaesthesia, TURP.

DOI: https://doi.org/10.52587/njhms.v3i2.26 Objective: Current research work was planned to investigate the medication-related side effects and cytotoxic and bone marrow suppressive effects of DAAs to provide evidence-based findings to convince the local population of HCV infection treatment. Material and Methods: Present research investigated the appearance of medication-related side effects both in males (n=200) and females (n=200) by conducting in-depth interviews with hepatitis C patients and collecting blood samples for measuring selected haemato-biochemical parameters at DHQ Hospital, Faisalabad and Samnabad General Hospital, Faisalabad-Pakistan. Further, grouping was done based on age (below 40 years and above 40 years of old) and regime combination as double regime (SOF + Daclatasvir) and triple regime (SOF + Ribavirin + Daclatasvir). Results: It was reported that headache, fever, body aches, joint pain, heartburn, tension, aggressive behaviour, weakness and abdominal pain are among the general side effects that appeared in HCV patients on oral medications. However, the results explored that patients taking oral medication did not have vomiting, insomnia, nausea, the feeling of chill, blurred vision and tiredness-like side effects, which might imbalance the socioeconomic life of an individual. Further, cytotoxic and bone marrow suppressive effects are non-significant (p>0.05) evaluated by selected blood tests, including ALT, Haemoglobin, Neutrophils percentage, Total leucocytes count, and platelets count in comparison with a control group. Conclusion: It could be concluded that all oral direct acting antiviral therapy is safe and effective compared to previously used therapies. Moreover, physical factors reported in patients could be minimized by improving the socioeconomic status of the local population in Pakistan. Keywords: Hepatitis C treatment, direct-acting antivirals agents, interferon-free, safety profile

DOI: https://doi.org/10.52587/njmhs.v5i1.59 Objective: We primarily aimed to detect, isolate and enumerate circulating tumor cells with the help of a panel of markers in a cohort of breast cancer patients in Pakistani Population. Based on clinical utility of CTCs we build a comparison between level of CTCs before and after at least one cycle of chemotherapy monitoring the therapeutic response by using CTCs as Prognostic marker. Material and Methods: EDTA Blood samples of Breast cancer female patients were collected at two different time’s points of their therapeutic regime. RNA was extracted and cDNA was synthesized. After isolation of CTCs, quantification of CTCs was determined with the help of a panel of markers (EpCAM, KRT & MAM) by using real time PCR during different time’s points of chemotherapy along with the formation of conclusive statistical relationships. Results: Our multi-marker analysis for CTCs on the basis of selected biomarkers is strongly associated with cancer manifestations including treatment efficacy and predicting its potential measures to metastasize. We found increase in expression of the three markers for CTCs in metastatic breast cancer patients as compared to the ones on neo adjuvant and adjuvant chemotherapeutic regimes. Moreover, the level of CTCs varied with molecular subtypes. HER2neu have more CTCs as compared to Luminal classified cancers. Conclusion: It will help the clinicians not only in determining personalized chemotherapeutic regimen but also help in stratifying patients into low and high risk of developing metastasis. It will further help to devise anti-metastatic therapies and improving prognosis. The prospect of CTCs is to be provided with the platform of analysis beyond just enumeration. Keywords: Breast Cancer, CTCs, RT-qPCR, Liquid Biopsy, HER2neu

DOI: https://doi.org/10.52587/njmhs.v5i1.61 Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) with Flavivirus genus of the Flaviviridae family. ZIKV was originated in Africa, but it has become a substantial community health concern. The genus is associated to mosquito or tick-borne viruses of public health interest especially Yellow Fever Virus (YFV), Dengue Virus serotype 1-4 (DENV 1-4), and West Nile virus (WNV). A comparative analysis based on individual structural envelope (E) gene phylogenies is performed to identify the genetic variation and evolutionary configuration. Material and Methods: Molecular evolutionary analyses of zika virus (ZIKV) isolates across the globe were conducted to infer phylogenetic relationships. Twenty-one full genome sequences and one Spondweni virus were downloaded from NCBI GenBank. The evolutionary distances of the sequences were determined by means of three“Neighbor-joining (NJ), Maximum-likelihood (ML), and Maximum-parsimony (MP) methods.” Results: Phylogenetic-constructed trees based on the individual envelope (E) nucleotide along with the sequences of amino acid showed that the globally diverse zika virus (ZIKV) strains belong to the two main lineages which suggested genetic intimacy. The evolutionary history of the E-gene of zika virus (ZIKV) represents a most existing common ancestor observed at the tips of the tree. The topology of the NJ-based phylogeny differed from ML and MP analysis of structural envelop (E) nucleotide gene as supported by strong bootstrap. While the key difference was noted such as the Nigerian strain swapped into the first main lineage in the ML-based amino acid tree. These findings recommend a considerable discrepancy in the evolutionary trajectory of the premeditated gene. Conclusion: In light of the prospect investigation, we propose that evolutionary studies on zika virus (ZIKV) strains ought to be achieved on envelope (E) gene phylogenies. It is suggested that the differences in phylogenetic trees, especially the ML-based amino acid tree, emphasized distinct evolutionary trajectories, such as the unique positioning of the Nigerian strain. Keywords: Envelope gene; phylogenetic; zika virus, West Nile virus, phylogenetic analysis

DOI:https://doi.org/10.52587/njmhs.v5i1.62 Objective: The purpose of this study is to find out the association of BMI with the medial longitudinal arch (MLA) of the foot, and lateral curvature of the spine in school-going children. Material and Methods: This cross-sectional analytical study included 385 number of schools children aged 6-15 years. Their weight status and body mass index were determined. The navicular drop test was used to evaluate the medial longitudinal arch of the foot. Both weight-bearing and non-weight-bearing circumstances were used in the test. Lateral curvature of the spine was assessed by Adam’s forward bend test. Data were analyzed by SPSS version 23.0. Frequency tables, Bar charts, and Mean ± SD were used for descriptive analysis. The p-value for the connection between variables was determined using the chi-square test. Results: Among 385 participated children, there were 217 normal weight children, 82 underweight, 70 overweight and 17 obese children. In determining foot arch, there were 318 number of children having normal arch, 28 with high arch, and 39 with low arch (flat foot). Low medial arch was more prevalent among children with high BMI. While determining the occurrence of lateral curvature of spine, 11 with lateral curvature of spine were found underweight, 2 normal weight, and 1 overweight out of 385 children. These results showed that children with low BMI were more likely to develop scoliosis or lateral curvature of spine. Our findings show that the association of BMI with the medial longitudinal arch of the foot, and lateral curvature of the spine in school-going children is statistically significant with the p-value<0.005. Also, there is a positive weak association of BMI with the medial longitudinal arch of the foot, and lateral curvature of the spine. Conclusion: This study demonstrated that BMI is found to be strongly associated with MLA of the foot, and lateral curvature of the spine in school-going children. Lower medial longitudinal foot arch (flat foot) development is more likely to occur in children who are overweight or exhibit obesity. While children with low body mass index are more likely to develop lateral curvature of the spine (scoliosis). Keywords: Flat foot, Medial arch, Lateral curvature, Scoliosis, BMI, MLA

DOI:https://doi.org/10.52587/njmhs.v5i2.72 Objective: The present study was conducted with the aim to determine plasma expression levels of angiogenic biomarkers including HIF-1α, VEGF-A, ANG-2, FGF-2 and uPA in peripheral blood in breast cancer patients to establish if they could be used as potential biomarkers for breast cancer advanced disease assessment is relation to clinicopathological association. Materials and Methods: Blood samples of 112 Breast cancer patients and 25 healthy females were obtained, their RNA was extracted, reversed transcribed into cDNA and then analyzed using RT-qPCR. A correlation was observed among angiogenic and metastatic factors according to classical clinical-pathological risk factors. Results: The plasma angiogenic (HIF-1, VEGF-A, ANG-2, FGF-2, and uPA) biomarkers levels were significantly elevated. Observed elevations were in significant association with well-known clinicopathological variables. Conclusion: Higher expression levels of suggest that these genes can be considered as major culprits in causing angiogenesis and metastasis. Being potential biomarkers, a gene signature can be developed for determining the severity of breast tumor; therefore, can be exploited as novel therapeutic approaches to block tumor metastasis and angiogenesis. Keywords: Breast cancer, Metastasis, Angiogenesis, Expression profiling, Therapeutics Biomarkers

DOI:https://doi.org/10.52587/njmhs.v5i2.71 Objective: The present study investigated the antibiotic resistance patterns and characteristics of enteric bacteria found in drinking water of Quetta district, Pakistan. Material and Methods: A cross-sectional study was conducted in Quetta District, located in the Balochistan province of Pakistan. A total of 150 water samples were collected from wells, taps and bottled water. water samples were processed for bacterial isolation and identification. Chi-square tests were employed to identify significant associations between bacterial contamination, resistance patterns, and potential risk factors. Results: A total of 150 water samples were collected from wells, taps and bottled water. Of these, 52% (78/150) were positive for pathogens. The main organisms identified were Escherichia coli (57.7%) and Salmonella spp. (19.2%), Shigella spp. (12.8%) and Klebsiella pneumoniae (10.3%). Antimicrobial susceptibility testing showed high resistance to amoxicillin (93% for E. coli, 87% for Salmonella, 90% for Shigella, and 88% for K. pneumoniae). Resistance to ciprofloxacin is rare, with a resistance rate of 22% in E. coli. E. coli, Salmonella 13%, Shigella 10%, Klebsiella pneumoniae 13%. The main factors associated with infectious diseases include groundwater (OR = 5.4, 95% CI: 2.1-13.9, p<0.001), lack of purified water (OR = 4.8, 95% CI: 2.3- 10.0, p<0.001), poor sanitation practices (OR = 3.2, 95% CI: 1.5-6.8, p = 0.003) and Inadequate Water Storage Conditions (OR = 2.7, 95% CI: 1, 2-5.9, p = 0.018). Conclusion: Over half of the water samples were polluted and contaminated, The source of water from the wells being the most affected. Among all bacterial species, E. coli was the most prevalent species identified. High resistance rates to amoxicillin were observed, with ciprofloxacin showing lower resistance rates. These findings underscore the urgent need for improved water quality and targeted public health interventions to combat drug resistance. Keywords: Antimicrobial Resistance, Drinking Water, Enteric Bacteria, risk factors, Public Health

DOI: https://doi.org/10.52587/njmhs.v5i1.65 Objective: Renal failure is a condition that occurs when renal damage reaches to a severity level and kidneys are unable to filter even the 15% of the waste materials from the blood effectively. Hemodialysis is a sort of renal replacement treatment which clear away waste products from the body circulation such as urea, creatinine, and free water when the kidneys are impaired. Material and Methods: Comparison of urea, creatinine and glomerulus filtration rate (GFR) of pre and post dialysis patients with healthy individuals was done from February to March 2022 from Dialysis Center at Lahore-Pakistan. Venous blood (5mL) was collected from dialysis patients (n= 100) suffering from renal failure and other co-morbid diseases, and from normal volunteers (n= 100) to analyze the serum urea and creatinine level by reference methods. Results: Concentration of urea and creatinine were higher in males than females in both groups. Values of post dialysis urea and creatinine were significantly (p < 0.01) lower than their pre dialysis values but were still significantly higher than health group as urea 27 ± 4.7 mg/dL and 1.5 ± 0.07 mg/dL creatinine. Furthermore, GFR was also increased in patients after dialysis procedure, but it was sill significantly lower than control group. Conclusion: It could be concluded that hemodialysis technique significantly (p<0.05) decreased the urea and creatinine in kidney failure patients, but these constituents are higher at post dialysis phase in compared to healthy group. So, more advancement is required to improve this procedure to improve the life of renal failure patients. Keywords: Renal Failure, Hemodialysis, wastes, GFR, Renal Function Tests

DOI:https://doi.org/10.52587/njmhs.v5i1.63 Objective: Children usually suffered from fever which is one of the main complaints of childhood illnesses, and this is a discomfort for the kids as well as their caregivers. The main objective of the study is to find the efficacy of cooling gel patch versus sponging in febrile children. Material and Methods: This randomized control trial was conducted at Paediatrician Department, Khyber Medical Complex, Peshawar from January 2023 to May 2023. Data were collected from 250 febrile children. Patients presenting with fever were enrolled in the study. Participants were randomly assigned to one of two intervention groups: the cooling gel patch group or the sponging group. Children aged 6 months to 12 years with a documented fever (axillary temperature ≥ 38.0°C) of infectious or non-infectious origin were included in the study.Participants underwent a standardized assessment, including a detailed medical history, physical examination, and baseline temperature measurement. Results: Data were collected from 250 patients according to criteria and designed of the study. Mean age was 6.5±2.1 and 6.3±2.3 years respectively, with a comparable distribution of gender. Weight and height measurements also showed negligible differences between groups. Baseline temperatures averaged 38.5°C in both groups. At 0.5, 1, and 2 hours post-intervention, the cooling gel patch group demonstrated greater temperature reductions compared to the sponging group (1.2°C ± 0.4°C vs. 0.9°C ± 0.3°C, 1.5°C ± 0.5°C vs. 1.2°C ± 0.4°C, and 1.8°C ± 0.6°C vs. 1.4°C ± 0.5°C, respectively), all with p-values < 0.05 Conclusion: It is concluded that cooling gel patches exhibit superior efficacy compared to sponging in reducing fever and achieving fever resolution within a 2-hour timeframe in febrile children. Keywords: Gel patches, Cooling, Efficacy, Febrile, Children.

DOI: https://doi.org/10.52587/njhms.v5i2.80 Objective: The health status of the community markedly depends upon the healthy livestock industry. This does not only contribute major role in the economic but also in health of human being worldwide. In the One Health perspective, the current research work was designed to develop four (04) sets of multiplex polymerase chain reactions (mPCR) for the concomitant recognition of bovine infections. Material and Methods: The current research work was designed to develop four (04) sets of mPCR for the concomitant recognition of bovine abortive infections, including Salmonella spp. (mPCR1); Campylobacter fetus, Aspergillus spp. and Salmonella spp. (mPCR2); Salmonella spp., Campylobacter fetus, Brucella spp., Leptospira spp. and Listeria monocytogenes (mPCR3); Bovine viral diarrhoea virus (BVDV), Bluetongue virus and Bovine herpesvirus-1 (BoHV-1) (mPCR4). The procedure was evaluated on positive controls obtained commercially as well as from Microbiology Department of University of Veterinary and Animal Sciences, Lahore-Pakistan. These positive controls were optimized first by singlet PCR followed by multiplex PCR using specific forward and reverse primers. Results: Results obtained from each multiplex PCR reaction were 100% compatible and in agreement with the respective PCR assays in which single genes were targeted. Conclusion: It could be concluded that for the concomitant recognition and identification of the major bovine infectious abortive agents, these proposed sets of multiplex PCR assays will be more suitable which might help to proper timely management of such infectious diseases in the livestock an healthcare industry. Keywords: Infectious diseases, Diagnostic techniques, multiplex PCR, Zoonosis

DOI: https://doi.org/10.52587/njhms.v6i1.81 Objective: The present study was conducted with the aim to determine plasma expression levels of metastatic genes like E-cad, MMP-2, MMP-9, TIMP-1, TIE-2 in peripheral blood of breast cancer patients to establish if they could be used as potential biomarkers for breast cancer metastasis assessment in relation to clinicopathological association. Materials and Methods: Blood samples of 86 Breast cancer patients and 24 healthy females were obtained, their RNA was extracted, reversed transcribed into cDNA and then analyzed using RT-qPCR. A correlation was observed among angiogenic and metastatic factors according to classical clinical-pathological risk factors. Results: The plasma metastatic (E-cad, TIE-2, MMP-2, MMP-9 and TIMP-1) biomarkers levels were significantly elevated. TIE-2 and MMP-9 expression levels were significantly increased in tumor Grade 3. TIMP-1 overexpression in advanced stage disease seemed independent of MMP-2 and MMP-9 expression. MMP-2 and MMP-9 expression was increased by aggressive molecular subtypes. Observed elevations were in significant association with well-known clinicopathological variables. Conclusion: The studied genes showed potential to be used as gene signature for determining the metastatic potential of breast tumor and E-cad, MMP-2, MMP-9 and TIMP-1 can be used as prognostic biomarkers in Breast cancer patients in order to design personalized therapeutics. Key Words: Breast Cancer, Metastasis, Expression Profiling, Biomarkers, Therapeutics

DOI: https://doi.org/10.52587/njhms.v5i2.67 Abstract Objective: Chronic urothelial inflammation associated with urinary tract infections (UTIs) in women presents a significant clinical challenge, often leading to recurrent episodes and potential complications. The main objective of this study was to find the clinicopathological correlation of chronic urothelial inflammation associated with UTI in women. Material and Methods: This cross-sectional study was conducted in Urology Department, Shifa International Hospital Islamabad from 2022-2023. Data were collected from 220 female patients suffering from UTI. Data were collected from 220 female patients according to inclusion and exclusion criteria. All the demographic and clinical data were noted on systematically designed questionnaire. Medical history, clinical symptoms and imaging findings were also extracted from hospital record. Results: Data were collected from 220 female patients. Mean age was 45.6 ± 10.2 years and mean BMI was 26.8 ± 3.5kg/m2. Hypertension was the most prevalent comorbidity at 35%, followed by diabetes mellitus at 20% and chronic kidney disease at 10%. Recurrent UTIs were reported by 60% of participants, while 40% experienced their first-time UTI. The treatment outcomes were predominantly favorable, with 90% of patients showing a positive response. Symptoms resolved within 7-10 days for most cases, indicating an effective therapeutic intervention. However, 10% of patients required hospitalization, suggesting the severity of their condition or the need for more intensive management strategies. Conclusion: Chronic urothelial inflammation is prevalent among women with urinary tract infections (UTIs), characterized by lymphocytic infiltrate and a microbiological profile dominated by Escherichia coli. Keywords: UTI, Women, Infection, Inflammation, Therapeutics

DOI :https://doi.org/10.52587/njmhs.v5i2.83 Abstract Objective: Diabetes mellitus has been reported to be a metabolic condition that increases the risk of TB. Tuberculosis is 2 to 5 times more prevalent in diabetic people than in those without diabetes. This study aimed to compare the biochemical and hematological parameters of patients with TB and diabetes to those of healthy persons. Material and Methods: An Observational study was conducted to evaluate and to compare the biochemical and hematological parameters of patients with TB and diabetes to those of healthy persons. The venous blood samples of TB with diabetic patients (n=50) who presented to Gulab Devi Chest Hospital (Lahore) were taken. The sample of healthy individuals (n=20) were also included in the study. Blood samples of TB and Diabetic patients (test) and healthy individuals (control) were collected, analyzed by colorimetric method and kit method. Results: In comparative evaluation of the hematological and biochemical markers in control and test patients, it was found that the hematological parameters such as WBC, neutrophils, monocytes, eosinophil and ESR significantly variations (significant at p≤0.05) While the biochemical parameters such as fasting glucose, random glucose, albumin, globulin, albumin/globulin ration and urea significantly (p≤0.05) varied. TB with diabetic patients indicated non-significant variations (p >0.05) in hemoglobin, lymphocytes, total protein, calcium, and phosphorus levels. Conclusion: The study concluded that there were substantial alterations in hematological and biochemical markers tested in TB-affected diabetic individuals. An infection with tuberculosis disturbed glycemic control, it is suggested that manage controls strategies of TB along with diabetes Keywords: Tuberculosis, Diabetes Mellitus, Biochemical parameters, Hematological Markers

DOI: https://doi.org/10.52587/njhms.v6i1.85 Objective: Diarrhea remains a leading cause of morbidity and mortality among children under five years old worldwide, particularly in low- and middle-income countries. The basic aim of the study is to find the knowledge and practices on the prevention and management of diarrhea in children under-5 years in Pakistan. Material and Methods: This cross-sectional study was conducted at Lady Reading Hospital MTI, Peshawar during August 2022 to May 2023. Data were collected from 230 children under-5 years suffering from diarrhea. Participants were selected based on the criterion that they had at least one child under the age of five who had experienced diarrhea in the past six months. Healthcare providers included pediatricians, general practitioners, nurses, and community health workers involved in child health services. Results: The study comprised 180 participants, with a majority being female (70%) and the rest male (30%). Most participants were aged between 20 and 29 years (50%), followed by those aged 30-39 years (40%), and a smaller group aged 40-49 years (10%). The mean age of their children was 3.5±1.2 years. The participants' knowledge on various aspects of diarrhea was evaluated, with significant awareness shown in certain areas. Regarding the causes, 65% (117 participants) identified poor sanitation, while 55% (99 participants) recognized contaminated water as a cause. Conclusion: It is concluded that targeted educational interventions are needed to bridge knowledge gaps among parents, particularly regarding the importance of exclusive breastfeeding and recognizing danger signs of severe diarrhea. Adherence to recommended practices, such as proper oral rehydration salts (ORS) preparation and timely healthcare seeking, should be emphasized to improve child health outcomes. Socioeconomic factors must be addressed to ensure equitable access to healthcare services and support for vulnerable populations. Keywords: Knowledge, Practices, Prevention, Diarrhea

DOI: https://doi.org/10.52587/njhms.v6i1.77 Objective: Diabetes mellitus (DM) is a metabolic disorder with increase prevalence around the globe and linked with multiple complications. Diabetic foot ulcer is most lethal complication of diabetes mellitus (DM). The aim of this study is to determine the microbiology profile of diabetic foot ulcers and the antimicrobial susceptibility of Cinnamomum zeylanicum (Darchini) against isolated bacteria. Material and Methods: This study was conducted on 100 patients with diabetic foot ulcer from different diabetic centers of Lahore, Punjab. Samples were obtained from wound using sterilized techniques. Different microbiological techniques like colony morphology, specific media, gram staining and biochemical parameters were used to isolate and identified the bacteria. Disc diffusion and well-diffusion methods were performed for antimicrobial susceptibility of standards antibiotics and cinnamon extract. Results: Various bacteria like S. aureus (78), P. aeruginosa (50), E. coli (44), K. pneumonia (28) P. mirabilis (14), S. epidermidis (17) were identified on the base of colony morphology, gram staining and biochemical testing. . Antibacterial analysis revealed sensitivity of the C. zeylanicum extract against S. aureus (12mm), P. aeruginosa (50), E. coli (44), K. pneumonia (28) P. mirabilis (14), S. epidermidis (17). Selected extracts against isolates showed significant (p<0.05) antimicrobial activity comparable to synthetic antibiotics. Conclusion: The lemon extract showed moderate antibacterial activity against S. epidermidis (8mm), P. aeruginosa (10mm) Bacillus (10mm), and P. mirabilis (11mm). Similarly, pomegranate also showed moderate sensitivity against all isolated bacteria. Jamun leaf extract showed antibacterial activity against S. epidermidis (12mm), K. pneumonia (10mm), E. coli (12mm), S. aureus, (11mm) and P. mirabilis (10mm). Hence plants may be used as an alternative to synthetic antibiotics with modifications to achieve better results. Keywords: Diabetic foot, Bacterial profile, C. zeylanicum, Antibacterial Potential

DOI: https://doi.org/10.52587/njhms.v6i1.86 Objective: This study aims to investigate the factors associated with knowledge, attitude, and practice (KAP) in relation to antibiotic use and antimicrobial resistance (AMR) prevention among nurses in secondary and tertiary care hospitals in Multan, Pakistan. Materials and Methods: A cross-sectional survey was conducted from March 2023 to January 2024 using a self-administered, semi-structured questionnaire. The questionnaire included demographic characteristics and selected components on antibiotic use and AMR prevention. Results: A total of 341 nurses, predominantly female (86.8%), participated and completed the questionnaires. Regarding knowledge, 59.3% of nurses were unaware that antibiotics cannot treat viral infections. Additionally, 68% of nurses did not know about the association between antibiotic efficacy and resistance. Overall, 54.8% of nurses had a moderate level of knowledge regarding antibiotic resistance, 26.9% had good knowledge, and 18.1% had poor knowledge. In terms of attitude, participants scored a mean of 2 on a scale of 1 to 5 regarding self-administration of antibiotics for general flu symptoms and a mean score of 2.1 for using antibiotics without a prescription. The results revealed a non-significant association (p>0.05) between knowledge and attitude (r=0.021 and p=0.169) of nurse regarding antimicrobial resistance Conclusion: The findings of this study highlight the urgent need for tailored educational interventions, antibiotic stewardship, and training programs for healthcare providers in Pakistan. Keywords: Antibiotic Abuse, Antimicrobial Resistance, Prevention, Nurses

DOI: https://doi.org/10.52587/njhms.v6i1.84 Objective: The objective of the study was to analyze the association of breakfast skipping with social, academic, emotional behavior and cognitive health of school-going children of 7-14 years of age in a cross-sectional study. Material & Methods: In a descriptive cross-sectional study, data were collected from 200 participants via a structured questionnaire. The breakfast skipping questionnaire consisted of 4 items; never skippers, sometimes skippers, often skippers, and always skippers. Cognitive ability was assessed using the Mini-Mental State Examination (MMSE) (an 11-item scale). Social, academic, and emotional behavior were measured using The Social, Academic and Emotional Behaviour Risk Screener (SAEBRS) (a 19-item global screening tool). Results: There was a statistically significant (0.05) correlation between breakfast skipping (BS) with Social Behaviour (SB; -0.346), Academic Behaviour (AB; -0.571), Emotional Behaviour (EB; -0.776) and with Cognitive Performance (CP; -0.213). SB, AB, EB, and CP of children who skipped breakfast (Always Skippers) had lower mean scores as compared with Never Skippers and Sometimes Skippers and these differences were statistically significant (p=0.000). Conclusion: The study concluded that breakfast skipping is negatively associated with social behavior, academic behavior, emotional behavior, and cognitive health of school-going children of 7-14 years of age. Keywords: breakfast skipping, social behaviour, academic performances, psychological aspects, cognitive aspects

Background: Achieving full knee extension within the first few weeks following total knee replacement (TKR) is crucial, and physical therapy plays a pivotal role in the rehabilitation process. However, the compliance of current physical therapy practices in Pakistan with international guidelines remains uncertain. Objective: This study aimed to evaluate the physiotherapy practices for patients undergoing total knee replacement in Pakistan. Additionally, it sought to determine whether these practices are aligned with contemporary international standards. Methodology: A descriptive cross-sectional study was conducted, employing a convenience sampling technique to collect data from 259 physical therapists. A questionnaire was developed based on standard guidelines for total knee replacement rehabilitation. Results: The majority of participants were male (60%), with a mean age of 33 ± 4 years and an average clinical experience of 5 years. In preoperative rehabilitation, the most commonly used modalities were ultrasound (42.67%) and strengthening exercises (40.67%). During postoperative Phase I, cryotherapy (42.67%) was favoured, along with a regimen that included an active range of motion exercises, gait training, and continuous passive motion. In Phase II, hot packs were the preferred modality, while electrical muscle stimulation (EMS) was utilized in Phase III. Strengthening exercises and functional training were the primary postoperative exercise regimens in both Phases II and III. Conclusion: In Pakistan, modalities were favoured over exercises in every phase of rehabilitation following total knee replacement. In contrast, international guidelines emphasize exercises over modalities. Keywords: Total Knee Replacement, Preoperative Rehabilitation, Postoperative Rehabilitation