bluuebunny/crossref_metadata_2025 huggingface dataset:
The “Phantasmatic” Chinatown in Helen Hunt Jackson’s “The Chinese Empire” and Mark Twain’s Roughing It
Authors: Hsu Li-hsin
Published: May 2021

This chapter explores Chinatown as an ephemeral site of visual indeterminacy
in the 1870s by looking at a number of Californian Chinatown accounts
in Helen Hunt Jackson’s “The Chinese Empire” (1878) and Mark Twain’s
Roughing It (1872). Late-nineteenth-century Chinatown as an exhibitory
locus of authentic Chinese-ness for Western tourists is paradoxically characterized
by its mutability rather than realism. By examining the accounts
of Jackson and Twain about the Chinese in the 1870s, the decade before the
passing of the 1882 Chinese Exclusion Act, the paper rethinks the “virtual”
existence of Chinatown, its contested nature as a “phantasmatic site” for
Western projections and visual consumption, which manifests the potential
realization of national transformation in the mythic Orient of the new West.
“Show Meets Science:” How Hagenbeck’s “Human Zoos” Inspired Ethnographic Science and Its Museum Presentation
Authors: Jovanovic-Kruspel Stefanie
Published: May 2021

This chapter attempts to explain the role of “human zoos” in the emergence
of scientific ethnography and its display in museums by examining the
case of the private portfolio of the first director of the Natural History
Museum Vienna, Ferdinand von Hochstetter. This vast portfolio includes
photographs of the first Völkerschauen (“peoples’ exhibitions”) by Carl
Hagenbeck (1844–1913). Some of the pictures of the Greenland Inuit appear
to have been the templates for at least two sculptures of “native types”
that the Austrian sculptor Viktor Tilgner used for his Inuit caryatids in
the exhibition hall. This discovery sheds new light on the complex relation
between “human zoos” and early ethnographic science.
The Last Wunderkammer : Curiosities in Private Collections between the Nineteenth and Twentieth Centuries
Authors: Pellegrini Emanuele
Published: May 2021

In his description of the magnificent Vanderbilt collection located on Fifth
Avenue in New York, Earl Shinn pointed out the presence of a medieval
Venetian ivory casket in the Japanese parlor. Wonder serves as the guiding
principle for the display of objects selected according to their provenance
and for their very different chronologies. In this context, eclecticism
concerns more than a mere display of heterogeneous artifacts, it is a
way to create resplendent interiors and to allow visitors sink into a sense
of wonder. This chapter reconsiders the key concepts of curiosity and
eclecticism, not just as a fashion or as display modes, but as new steps in
the long-term history of the Wunderkammer.
Introduction: Staging the Temporary: The Fragile Character of Space
Authors: Murgia Camilla
Published: May 2021

This volume examines a varied number of exhibition devices that are
ephemeral in terms of the precariousness of their structure, but also in
terms of their capacity to adapt to the space in which they develop. Special
attention will be paid to spaces such as curiosity cabinets, portable museums,
show gardens, and a number of unconventional exhibition devices.
These spaces often function as microcosms, small autonomous universes
that operate individually, but also in relation to their environment. The aim
of this volume is to examine their development and relationship to context.
Development Zones in Asian Borderlands
Authors: Chettri Mona , Eilenberg Michael , Schendel Willem , Harris Tina , Murton Galen , Harris Tina , Zhang Juan , Cons Jason , Meehan Patrick , McDuie-Ra Duncan , Plachta Nadine , Hargyono Sindhunata , Mikkelsen Thomas
Published: May 2021

Development Zones in Asian Borderlands maps the nexus between global capital flows, national economic policies, infrastructural connectivity, migration, and aspirations for modernity in the borderlands of South and South-East Asia. In doing so, it demonstrates how these are transforming borderlands from remote, peripheral backyards to front-yards of economic development and state-building. Development zones encapsulate the networks, institutions, politics and processes specific to enclave development, and offer a new analytical framework for thinking about borderlands; namely, as sites of capital accumulation, territorialisation and socio-spatial changes.
Post-disaster Development Zones and Dry Ports as Geopolitical Infrastructures in Nepal
Authors: Murton Galen
Published: May 2021

Economic activity is central to development zones and represents a core
dynamic from which a host of other relationships radiate outwards. While
economic logics consistently motivate and produce the development of
such zones, the resultant activities are always much more than economic.
That is, the development of development zones also sets in motion new
configurations of political power and socio-spatial domination. Following
this line of thinking, this chapter examines the proliferating development
of new import-export dry ports in the Nepal-China borderlands to
understand how geopolitical relationships are grounded, localised, and
reconfigured through infrastructural projects. Taking Nepal’s post-disaster
development landscape as both a point of departure and site of inquiry, I
show that the making of development zones in post-disaster environments
accomplishes interrelated objectives of state-led territorialisation and
economic expansion across a range of social and spatial scales.
Onwards and Upwards
Authors: Harris Tina
Published: May 2021

This chapter explores how airports and airspace can be recognised as
development zones that serve to connect the ground and the air. Through
four “aerial snapshots” (airspace restrictions, a new air route, a binational
airline venture, and the building of the “next” international airport in
Nepal), this paper shows how aerial development takes on a specific
significance in how Nepal positions itself vis-à-vis the borders of India
and China. It argues that a volumetric approach – paying attention to the
spatial production of both land and air – is vital in order to understand
the future shape of aerial development zones in the Himalayas.
Casinos as Special Zones
Authors: Zhang Juan
Published: May 2021

This chapter offers a reflection on the speculative ways in which global
casino hotels become new zones of development in many Asian destinations.
As ultra-modern integrated resorts developed to boost tourism
and foreign direct investment, these casino and entertainment enclaves
carve out exceptional spaces in search of profit and legitimacy. Looking
at casino establishments in Asia’s special economic zones, this chapter
examines the development of casino zones as a strategy for progress in
places still marred by underdevelopment. New casino zones create novel
forms of territorialisation and responsibilisation, enabling differentiated
biopolitics of control.
Thinking the Zone
Authors: Cons Jason
Published: May 2021

This chapter interrogates an emergent genre of development zone in the
India-Bangladesh borderlands that seek to instil resilience in climatevulnerable
populations. Unlike development zones framed in relation to
development as economic growth, these zones venture a darker vision
of life in a warming world – one where portable technologies become
necessary for managing a future of climate chaos. I propose, following
Foucault, understanding these projects as heterodystopias: spaces managed
as and in anticipation of a world of dystopian climate crisis that
are at once, stages for future interventions and present-day spectacles
of climate security. Heterodystopia provides an analytic for diagnosing
the visions of time, space, and development embedded in these and other
securitised framings of the future.
Guillaume Blanc (2020) - L’invention du colonialisme vert. Pour en finir avec le mythe de l’Éden africain
Authors: Hiribarren Vincent
Published: May 2021

Recensé : Blanc, Guillaume, L’invention du colonialisme vert. Pour en finir avec le mythe de l’Éden africain, Paris, Flammarion, 2020, 346 p.
An Intelligent Technique for Solving Timetable Problem
Authors:   PhD Candidate in Operations Research, faculty of graduate studies for statistical research, Cairo University, Egypt., El-Dhshan Abdalla , Zaher Hegazy ,   Professor Doctor in Mathematical statistics, faculty of graduate studies for statistical research, Cairo University, Egypt., Ragaa Naglaa ,   Associate Professor in Operations Research, faculty of graduate studies for statistical research, Cairo University, Egypt.
Published: May 2021

Timetabling problem is complex combinatorial resources allocation problems. There are two hard and soft constraints to be satisfied. The timetable is feasible if all hard constraints are satisfied. Besides, satisfying more of the soft constraints produces a high-quality timetable. Crow Search Algorithm (CSA) as an intelligence technique presents for solving timetable problem. CSA like all meta-heuristic optimization techniques is a nature-inspire of intelligent behavior of crows. The proposed CSA tested using the well-known benchmark of hard timetabling datasets (hdtt). Taguchi’s method used to tune the best parameter combinations for the factors and levels. The tuned parameters of CSA are applied on datasets in separate experiment. The results show that the proposed CSA is superior to generate solutions in reasonable CPU time when compared with other literature techniques.
BLAST LUNG INJURY: OUR EXPERIENCE AT A TERTIARY CARE MILITARY HOSPITAL
Authors: Burki Ahmed Mujadid , Mahboob Saira
Published: May 2021

Objective: To study the management and mortality in patients with blast lung injury at a tertiary care military hospital.

Study Design: Prospective, observational study.

Place and Duration of Study: Intensive Care Unit, Combined Military Hospital, Peshawar, from Jan 2013 to Dec 2014.

Methodology: After approval from Hospital Ethics Committee, 38 patients diagnosed with blast lung injury who were admitted to intensive care unit were included in our study.

Results: The mean age was 29.68 ± 4.3 years and all the patients were male. The incidence of blast lung injury in trauma patients was 38 (10.2%). Most of the patients 18 (47.4%) had severe ARDS due to blast wave and most of the patients 28 (73.6%) required mechanical ventilation with lung protective strategy. The mortality in patients diagnosed with blast lung injury was 2 (5.2%).

Conclusion: Blast lung injury is a common complication in survivors of bomb blast. As military doctors who treat both armed forces as well civilian casualties from blast injuries; the physician treating blast injury should be conscious of risk of patient developing blast lung injury; so that early recognition and prompt management with lung protective strategy can prevent increased morbidity and mortality.
CHRONIC BREAST INFECTIONS: CHALLENGING CONDITION TO DIAGNOSE AND TREAT; AN OVERVIEW OF 70 CASES
Authors: Bano Razia , Chatha Sohail Saqib , Sana Faiza , Latif Humaira , Chatha Umar Farooq , Chatha Abdullah Zakaullah
Published: May 2021

Objective: To share our experience of clinical features and management strategies for treatment of chronic breast infections.

Study Design: Case series.

Place and Duration of Study: Combined Military Hospital Rawalpindi, from Feb 2016 to Feb 2018.

Methodology: We prospectively enrolled patients with diagnosis of chronic breast infections over a period of two years. All patients with infections (less than one month old) were excluded from the study. We studied the demographic characteristics like age, clinical presentation, histopathological features, treatment given and response to the treatment.

Results: A total of 70 patients were enrolled in the study. Patients age was between 21-75 years with mean age of 42 ± 5 years. Most common clinical presentation was lump and in duration with abscess in 23 (33%) cases, mass with discharging sinuses in 16 (23%) cases, while 7 (10%) cases had recurrent abscess. Diagnosis was made on core biopsy in 21 cases and in remaining cases with incision and drainage. Histopathology confirmed diagnosis of Idiopathic Granulomatous mastitis in 30 (43%) cases, acute on chronic mastitis in 27 (38%) and chronic granulomatous mastitis in 13 (18%) cases. Out of all cases 29 (41%) showed response to antibacterial treatment while 27 (38%) cases responded to anti tuberculous treatment. Spontaneous resolution occurred in 11 (16%) cases while 3 (4%) cases responded to antifungal treatment.

Conclusion: Chronic breast infections are a challenging condition to diagnose and treat for breast surgeons and can present with diverse range of clinical features.
COMPARISON OF STEROIDS TO NSAIDS, AND OTHER FORMS OF ANALGESIA IN THE MANAGEMENT OF POST-CHIKUNGUNYA ARTHRITIS
Authors: Alam Hamza , Umer Tahira Perveen , Khanum Iffat , Nazir Lubna , Erum Uzma , Irfan Muhammad
Published: May 2021

Objective: To compare steroids with other treatment options like NSAIDS and other analgesics for management of postchikungunya arthritis based on visual analogue scale (VAS).

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Rheumatology, Liaquat National Hospital, Karachi, from Jan to Jul 2018.

Methodology: A total of 112 patients were included in this study, of both genders. Patients with history of fever >38.5°C and polyarthralgia who had positive chikungunya IgM serology or PCR were included in this study. Patients fulfilling inclusion criteria and who were treatment naïve were given NSAIDs or other analgesics if contraindication to NSAIDs was present. Those who had received 2 weeks of NSAIDs were given a single dose of intramuscular steroids. Response to treatment was characterized by clinical examination according to visual analogue scale (VAS) taken at baseline, 2 weeks and 4 weeks. All analyses will be conducted by using SPSS-20.

Results: Overall, 66 (58.9%) received steroids, 37 (33%) patients were given NSAIDs, and other forms of analgesics were prescribed to 9 (8%) patients. In nearly half of the patients, i.e. 57 (50.89%) partial response was seen, 13 (11.6%) showed complete response, while 42 (37.5%) had persistent arthralgia, which was statistically significant p-value <0.001.

Conclusion: This study shows that improvement in symptoms is seen with a single dose of intra-muscular steroid and it helped bring down the VAS score.
FREQUENCY OF GUILLIAN-BARRE SYNDROME AND ITS VARIANTS AT MILITARY HOSPITAL RAWALPINDI
Authors: Awan Marriam Hussain , Fazal Imran , Lodhi Muhammad Wajahat Alam , Anwer Ayesha , Azhar Rimsha , Qureshi Muhammad Waleed Hassan
Published: May 2021

Objective: To assess the frequency, variants, clinical profile and outcome of patients admitted with the diagnosis of GuillianBarre Syndrome at neurology unit of a tertiary care teaching hospital of Pakistan.

Study Design: Cross-sectional study.

Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Jan to Dec 2018.

Methodology: This study was conducted on 42 patients of Guillian-Barre Syndrome admitted in hospital. Demographic profile included age, gender, and the symptoms with which the patient presented. Medical and neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death.

Results: Out of 42 patients included in the final analysis 25 were male and 17 were female. Most of the patients presented with lower limb weakness followed by numbness. Acute inflammatory demyelinating polyneuropathy was the commonest while cranial nerve variant was least reported. Motor deficit were the commonest complication faced by the patients followed by respiratory involvement. Out of 42 patients, 34 (80.9%) recovered, 4 (9.5%) were shifted to the intensive care unit and 4 (9.5%) died.

Conclusion: This study gives an insight into the pattern of a fairly common neurological illness which if diagnosed and managed in time has a good outcome in our set up. Management of critically ill Guillian-Barre Syndrome patients involves a multidisciplinary team with a need of intensive care unit during the course of management. Variety of types and presentations should be part of training of neurology doctors as well as internal medicine doctors.
FREQUENCY AND CORRELATES OF MYOPATHY IN PATIENTS WITH DIABETES TAKING ATORVASTATIN
Authors: Butt Kamil Rehman , Khan Andaleeb , Muhammad Ali , Khan Jawad , Ali Ejaz , Zubair Usama Bin
Published: May 2021

Objective: To determine the myopathy in patients with diabetes taking atorvastatin and look for the factors correlated with the presence of myopathy among these patients.

Study Design: Cross sectional analytical study.

Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from, Jul to Dec 2018.

Methodology: A total of 166 patients of both genders with type 2 diabetes mellitus taking atorvastatin for at least three to twelve months were included. Blood samples were drawn and Creatinine kinase (CK) levels were determined by automated analysis by colorimetry. Myopathy was taken as muscle symptoms associated with elevations in Creatinine Kinase at least 10 times the upper limit of normal.

Results: Mean age of patients was 51.530 ± 5.70 years with age range from 40-70 years with. Mean duration of diabetes was 6.174 ± 2.27 years, mean duration of taking atorvastatin 7.186 ± 2.17 months and mean creatinine kinase levels were 1760.325 ± 5111.71 IU/L. Males were 68.7% as compare to females 31.3%. Myopathy was seen in 8.4% patients. Long duration of Diabetes Mellitus and atorvastatin use was statistically significantly related with the presence of myopathy.

Conclusion: Myopathy was found in a significant number of patients taking atorvastatin. High risk population in our study emerged out to be patients with long duration of Diabetes Mellitus and long use of atorvastatin.
NOSOCOMIAL URINARY TRACT INFECTIONS, AND THEIR SUSCEPTIBILITY TO ANTIMICROBIAL AGENTS IN SPINAL CORD INJURY PATIENTS AT A REHABILITATION SETTING
Authors: Ali Shah Syed Ali Raza , Naqvi Syeda Sarah , Butt Amir Waheed
Published: May 2021

Objective: To identify frequency of nosocomial urinary tract infections along with their antibiotic susceptibility in spinal cord injury patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Acute Spinal Ward, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from Apr to Oct 2016.

Methodology: Total 120 male and female patients of ages (18-70 years) with acute (>6 months) or chronic (>6 months) spinal cord injury admitted for rehabilitation and developing urinary tract infection 48 hours after admissionwere included. Patients whose culture results have polymicrobic bacteriuria samples, immune deficiency disorder and immunosuppressive therapy were excluded. Urine samples of all admitted patients suspected having urinary tract infections were collected and send to Armed Forces Institute of Pathology for culture sensitivity test showing isolated causative microorganisms and their antibiotics susceptibility.

Results: About 34.58 ± 12.59 years was mean age, 120 patients were included. In these were 97 (80.80%) male and 23 (19.20%) females with male to female ratio of 4.2:1. Frequency of nosocomial urinary tract infections was found in 83 (69.17%) and no nosocomial urinary tract infections in 37 (30.83%) patients. This study shows the frequency of antibiotic susceptibility in spinal cord injury patients as follows; Amikacin in 111 (92.50%), Gentamicin in 108 (90%), Imipenemin 113 (94.17%), Tazocin in 115 (95.83%), Ceftriaxone in 105 (87.50%), Nitrofurantoin in 89 (74.17%) and Ciprofloxacin in 96 (80.0%) patients.

Conclusion: This study shows that frequency of nosocomial urinary tract infections in spinal cord injury patients is high and tazocin and imipenem are the most sensitive antibiotics.
FREQUENCY OF REFRACTIVE ERROR AND AMBLYOPIA IN STRABISMUS IN PEDIATRIC AGE GROUP
Authors: Malik Noureen , Masud Hannan , Basit Imran , Noor Palwasha
Published: May 2021

Objective: To see the frequency and compare the type of refractive error and strabismus in amblyopic versus non amblyopic children.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan to Jul 2019.

Methodology: The sample population comprised of 250 patients of new or previously diagnosed children with refractive error and strabismus presenting at children eye outdoor patient department of armed forces institute of ophthalmology. Strabismus was diagnosed by the consultant eye specialist on the basis of heterotropia at near or distance fixation. Amblyopia and refracttive error was assessed by a trained optometrist. Patients were classified into amblyopia and non- amblyopia groups. The type of squint and refractive error was noted down along with demographic details. Chi square test was used to assess thesignificance of association between various categorical variables.

Results: A total of 250 participants were included with a mean age of 5.00 ± 1.07 years. Out of total, 132 (52.8%) were males while 118 (47.2%) were females. One hundred and fifty (59.5%) patients were suffering from amblyopia while 100 (39.5%) patients were normal with comparable vision in both the eyes. Out of 150 amblyopic patients 134 (89.3%) were suffering from unilateral amblyopia while 16 (10.6%) patients had amblyopia in both the eyes. Out of refractive errors astigmatism was present in 83 (55.3 %) of amblyopia patients while hypermetropia was present in 54 (36%) of the patients. Out of total patients of strabismus, 95 (63.3%) of non-alternating esotropic patients..........
COMPARISON OF SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH PORT SITE INFILTRATION OF LOCAL ANAESTHESIA IN LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Majeed Kaukab , Shaukat Nazish , Muazzam Muhammad Ali , Khalid Usman , Zafar Junaid , . Sajid
Published: May 2021

Objective: To compare the efficacy of ultrasound guided subcostaltransversus abdominis plane block and port site infiltration of local anaesthesia in patients undergoing laparoscopic cholecystectomy.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Anesthesiology department, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jun 2019.

Methodology: A sample size of 62 patients calculated by World Health Organization calculator were randomized in a doubleblind study to undergo Sub costal transversus abdominis plane block or port site infiltration by non-probability, consecutive sampling into two equal groups. Group A received sub costal transversus abdominis plane block and group B local anaesthetic. Postoperative pain perception was measured using visual analogue scale.

Results: The mean age of patients in group A was 33.39 ± 8.91 years and in group B was 33.77 ± 8.45 years. Out of 62 patients 38 (61.29%) were males and 24 (38.71%) were females. Mean pain score in group A (ultrasound guided sub costal transversus abdominis plane block) was 1.61 ± 0.91 while in group B (port site infiltration of local anaesthetic) was 3.61 ± 1.05 (p-value 0.0001).

Conclusion: The mean pain score was less following use of ultrasound guided sub costal transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy as compared to port site infiltration of local anaesthesia.
HAEMATOLOGICAL DISORDERS DIAGNOSED IN ONE HUNDRED AND ONE SUCCESSIVE BONE MARROW EXAMINATION AT A TERTIARY CARE CENTRE IN QUETTA, BALOCHISTAN
Authors: Tashfeen Sunila , Asif Naveed , Nasir Shafia , Azam Muhammad , Irshad Zareen
Published: May 2021

Objective: To determine the frequency of haematological disorders diagnosed by bone marrow examination at a tertiary care centre in Quetta, Balochistan.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Pathology, Combined Military Hospital Quetta, from Jan 2018 to May 2019.

Methodology: A total of 101 one patients, who underwent bone marrow examination, were included in the study. Brief history, clinical examination and indication of procedure were also endorsed in a questionnaire designed for the study.

Results: Bone marrow of one hundred and one patients, included in the study, were evaluated. Mean age of the patients was 32.3 ± 18.4 years. There were 68 males (67%), while 33 were females (33%) with 2:1 male to female ratio. Pyrexia of unknown origin (PUO) was the most common indication for bone marrow examination with frequency of 20.7%. Nutritional anaemia was the most prevalent benign disorder (17%), whereas Acute Lymphoblastic leukaemia (ALL) accounted about 6.8% which is highest in malignant disorders.

Conclusion: This study has concluded that bone marrow examination is a useful technique and findings of bone marrow can modify the treatment. Thus procedure has a great diagnostic value. Both bone marrow aspiration (BMA) and bone marrow biopsy (BMB) are the complimentary techniques and supremacy of one method on other depends on the disorder.
IS RIGHT DONOR NEPHRECTOMY SAFE? OUR EXPERIENCE IN ARMED FORCES INSTITUTE OF UROLOGY
Authors: Khan Haroon Sabir , Mahmood Arshad , Bhatti Ahsin Manzoor , Sabir Sohail , Alvi Sarwar , Kiani Faaran
Published: May 2021

Objective: To identify any adversities in the intraoperative and early postoperative outcome of right live-related donor nephrectomy.

Study Design: Cross sectional study.

Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2013 to Jul 2015.

Methodology: A total of 143 successive patients underwent open live donor nephrectomies (right=41). Perioperative outcome for both sided procedures were analyzed to identify any difference as regard the intraoperative (warm ischemia time, total duration of surgery, peroperative complications) and early postoperative parameters (days of hospitalization, complications).

Results: No statistically significant difference was found in studied parameters like total operative time, the warm ischemia time, duration of hospital stay and the intra- and early postoperative complications amongst both the groups. The mean warm ischemia time was 86 ± 12 seconds (Rt) versus 90 ± 12 seconds (Lt). The mean time for surgery was 110 ± 18.1 minutes (Rt) versus 121 ± 18.2 minutes (Lt). There were only five minor complications and one major complication.

Conclusion: Right live-related donor nephrectomy is equally safe and feasible option with similar intra-and postoperative complications as for left side. Therefore, whenever required, it is safe to leave the donor with a better functioning kidney.
PAX8 EXPRESSION AND ITS ASSOCIATIONS IN PRIMARY RENAL CELL CARCINOMA: A CROSS SECTIONAL STUDY
Authors: Zamir Ahmed , Akhtar Farhan , Waqar Samina , Hanif Aminah
Published: May 2021

Objective: To determine the frequency of PAX8 expression in cases of primary renal cell carcinoma (RCC) and its association with patient demographics and tumor type.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from Jun 2016 to Jun 2017.

Methodology: After ethics approval, 57 cases were selected by non probability consecutive sampling. Inclusion criteria was diagnosis of primary renal cell carcinoma of all histological types, in both genders, among adults aged >18 years. Exclusion criteria were poorly fixed specimens and metastatic renal cell carcinoma. The main outcome measure was PAX8 frequency in renal cell carcinoma. The secondary outcome measure was correlation of PAX8 expression with age, gender, tumor type and grade. Data was entered and analyzed on Statistical Package for the Social Sciences.

Results: Out of 57 cases, majority were males 37, (64.9%). The mean age was 55.35 ± 12.60 years. Clear cell carcinoma was the most frequent histopathologic variant in 47 (81%) cases followed by papillary carcinoma in 6 (10.2%), chromophobe cell carcinoma 2 (3.5%), sarcomatoid renal carcinoma 1 (1.75%) and mucinous tubular and spindle cell carcinoma 1 (1.75%). PAX8 expression was positive in 52 (91.2%). No significant difference was found in the frequency of PAX8 expression across age (p=0.321), gender (p=1.00) and tumor type (p=1.00). There was significant difference seen across tumor grade p=0.03.

Conclusion: PAX8 is an important additional diagnostic marker for renal cell carcinoma. It can be recommended for inclusion in immunohistochemical panel for diagnosis..............
AMELIORATIVE EFFECT OF BERBERIS VULGARIS FRUIT EXTRACT AGAINST GENTAMICIN INDUCED NEPHROTOXICITY IN ALBINO RATS
Authors: Faisal Lubna , Islam Zia -Ul- , Athar Saima , Iqbal Sadia , Rehman ```Fatima , Ullah Syed Shariq
Published: May 2021

Objective: To observe the nephroprotective role of berberis vulgar is on renal parenchyma against microscopic and morphometric changes induced by Gentamicin in albino rats.

Study Design: Lab based experimental study.

Place and Duration of Study: It was conducted in Baqai Medical University in collaboration with department of Anatomy Liaquat National Hospital and Medical College, from Jan to Jul 2017.

Methodology: A total of 40 male adult albino rats were used in the study. Four groups were made. Each group contained 10 rats. Group A was a control group, group B received only berberis vulgaris fruit extract orally per day for 21 days, group C received Gentamicin 100 mg/kg/day intraperitonially daily for 21 days. Group D received Gentamicin 100 mg/kg/day intraperitonially along with berberis vulgaris fruit extract 100 mg/kg/day orally. Both kidneys were removed. H&E and PAS stains were used for observing histological alterations and protective role of berberis vulgaris fruit extract.

Results: Glomerulus and proximal convoluted tubules were observed histologically in all 4 groups. Microscopy of group B showed parameters nearly similar to control group. Microscopy of group C showed significant derangement in all parameters when compared with control group. Group C showed decrease glomerular, proximal convoluted tubular count was noted. Glomerular diameter increases and there was glomerular hypertrophy and tubular necrosis. Microscopy of group D showed significant improvement due to berberis vulgaris which restored normal renal architecture.

Conclusion: Berberis vulgaris has a nephroprotective effect and it can be used as a new medicine against nephrotoxic drugs like Gentamicin.
CLINICOPATHOLOGICAL PATTERN OF TESTICULAR TUMORS A 3-YEARS EXPERIENCE AT A TERTIARY CARE UROLOGY CENTER
Authors: Murtaza Badar , Zafar Muhammad Rafiq , Mirza Zahoor Iqbal , Akmal Muhammad , Ahmad Hussain , Sajid Muhammad Tanveer , Din Hafeez Ud
Published: May 2021

Objective: To evaluate the clinical presentation of testicular tumors and their histological pattern present in our setup.

Study Design: Case series.

Place and Duration of Study: Armed Forces Institute of Urology (AFIU) Rawalpindi, from Jul 2016 to Jun 2019.

Methodology: The documents of all the cases of testicular tumors presenting in the last 3 years were retrieved and their relevant clinical detail: age, clinical presentation, side of involvement, operative procedure conducted and the histopathology report were documented.

Results: Thirty two patients of testicular tumors were documented over a period of three years, making 10.66 cases reporting per year. The mean age was 30.10 ± 15.42 years, with the youngest 3 months old infant and the eldest being 58 years of age. The tumors were commonest on the right (59.3%) with 81.2% presentation as swelling of testis. Radical orchiectomy was performed in 90.6% of the cases and retro peritoneal lymph node dissection (RPLND) in 6.2%. Germ cell tumors were found in 71.8% cases with mixed germ cell tumorbeing the commonest histopathology seen in 31.2% of the cases followed by the seminoma (25%) and non-Hodgkin lymphoma (12.5%).

Conclusion: Testicular tumors were relatively uncommon in our part of the world with a limited number of cases presenting to a tertiary care urology center. The presentation was variable but a rising trend in non-Hodgkin lymphoma results in a decrease in the overall number of germ cell tumors.
COMPARISON OF CLINICAL FAILURES OF LINGUAL RETAINERS BONDED WITH PRIMERLESS FLOWABLE ADHESIVES VERSUS CONVENTIONAL BONDING ADHESIVES
Authors: Akhtar Faheem Nake , Jan Abdullah , Tariq Sana , Khan Mehwish , Saeed Munazza
Published: May 2021

Objective: To compare the frequency of clinical failure of lingual retainers bonded with primerless flowable adhesives and conventional bonding adhesives.

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Orthodontics, Armed Forces Institute of Dentistry Rawalpindi, from Jul 2017 to Jun 2018.

Methodology: As per selection criteria, 76 patients were selected by non-probability consecutive sampling technique. Patients were divided into two groups: the conventional bonding adhesive and the primerless flowable adhesive group with 38 patients in each group. Retainers were bonded using standardized procedure with conventional bonding adhesive in one group and primerless flowable adhesive for bonding in the other group. After bonding of retainers, patients were recalled after 3 months and any bonding failures were recorded.

Results: Failure rate with conventional bonding adhesive was 10.5% while on the other hand, failure with primerless flowable adhesive was 31.6% with a p-value of 0.047 which showed a statistically significant difference.

Conclusion: There was a statistically significant difference of clinical failure rate of lingual retainers bonded with conventional bonding adhesive versus primerless flowable adhesive with greater failure rate of the primerless flowable adhesive.
POSTPARTUM HEALTH-RELATED QUALITY OF LIFE AMONG MOTHERS: AN ANALYTICAL CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL OF RAWALPINDI
Authors: Ramzan Nadia , Misbah Samreen , Baqai Shehla , Mashhadi Syed Fawad , Sharif Imtenan , Ali Mommana
Published: May 2021

Objective: The study was conducted to assess the maternal health related quality of life and its affecting factors in postpartum period.

Study Design: Analytical cross-sectional study.

Place and Duration of Study: The study was done in a tertiary care hospital, Rawalpindi, from Mar to Jun 2019.Methodology: By using non-probability purposive sampling technique, sample of 268 women in post-partum period were interviewed. A validated short form-36 (SF-36) Questionnaire was administered to women aged 15-49 years, who had spontaneous vaginal delivery or cesarean section, and were within six weeks up to six months of postpartum period. Data was analyzed by using SPSS-22. A p-value of ≤0.05 was taken as significant.

Results: Highest median scores were reported in physical functioning 75 (55, 90) and social functioning 75 (75, 62). Lowest median scores were reported in energy fatigue 37 (31, 50) body pain 45 (22, 62) and general health 45 (30, 60). Health-related quality of life scores showed significant difference (p-value <0.05) among subgroups of time since delivery, mode of delivery, education of women, husband’s education and antenatal visits.

Conclusion: The study showed that health related quality of life score of postpartum women was moderately affected; where in physical and social functioning domains strongly contributes in better quality of life. Energy/fatigue, body pain and general health are the weakest domains adversely affecting quality of life. Women in subacute postpartum phase, with cesarean section, lower educational status and less than 04 antenatal visits are associated with poorer HRQOL.
SETTING UP TELE HEALTH FACILITIES AT PERIPHERAL SMALL-SCALE HEALTHCARE SET UPS
Authors: Khan Sikandar Hayat
Published: May 2021

Conventional medicine with direct patient-medic suffers stagnation and may become redundant without any innovative oxygen of ideas. Current healthcare practices will ultimately need newer gateways for evolution, more cost-effective medical businesses and evidence-based healthcare at doorsteps. Though promising, the practice may face additional kick starts for changing patient-physician approach, infrastructural development, ethical and regulatory guidelines to help pave the way forward. In the opinion of author the successful deployment of “Tele-Health” will economize finances, patient referrals, physician/paramedical move to casualty site, improve clinical decisions, quality healthcare provision at country‟s periphery, and can dawn upon new learning avenues by distant learning programs.
EFFICACY OF SACCHAROMYCES BOULARDII IN THE MANAGEMENT OF ACUTE WATERY DIARRHEA
Authors: Munir Misbah , Shah Sajid Ali , Zaman Saeed , Goheer Lutfullah , Bushra Sana , Khan Sajjad Ahmad
Published: May 2021

Objective: To determine the Efficacy of probiotic (saccharomyces boulardii) in children (2 months to 5 years) with acute watery diarrhea.

Study Design: Comparative cross sectional study.

Place and Duration of Study: This study was carried out in the department of pediatrics, Combined Military Hospital, Quetta, from Jan 2017 to Jun 2018.

Methodology: All children (2 months to 5 years) with acute watery diarrhea presenting within 24 hour of illness with no dehydration and some dehydration were enrolled and divided into two groups, study group and control group. Efficacy was assessed by reduced frequency of stools(less than 3 per day) and duration during the study period.

Results: Mean age of the children in probiotic saccharomyces boulardii group was 3.42 ± 1.36 years, while mean age in control group was 3.91 ± 1.16 years (p-value 0.002). Significant difference was also observed in duration of stool and frequency of stool at day 1-5 (p-value <0.05). Statistically significant difference was observed among children in probiotic sacchramyces boulardii group 114 (53%) as compared to controls 101 (47%) (p-value 0.021).

Conclusion: The Efficacy of probiotic (saccrharomyces boulardii) was found satisfactory in children (2 months to 5 years) with acute watery diarrhea. In children with acute watery diarrhea saccrharomyces boulardii may be recommended for better outcome.
ACUTE PANCREATITIS IN PATIENTS WITH DIABETIC KETOACIDOSIS PRESENTING AT A TERTIARY CARE UNIT
Authors: Hassan Zubia , Fazal Imran , Ashraf Nadeem , Hayat Arshad , Sajjad Kaswar , Zaman Asad
Published: May 2021

Objective: To determine the frequency of acute pancreatitis among the patients diagnosed with diabetic ketoacidosis at our tertiary care hospital.

Study Design: Co-relational study.

Place and Duration of Study: Medicine department, Pak Emirates Military Hospital Rawalpindi, from Jun to Dec 2019.

Methodology: A total of 40 cases presenting with diabetic ketoacidosis were included in our study. Diabetic ketoacidosis was diagnosed by consultant medical specialist. All patients underwent baseline investigations including serum amylase, lipid profile and CT scan abdomen in order to diagnose acute pancreatitis. Relationship of age, gender, duration of diabetes mellitus and triglyceride levels was assessed with the presence of acute pancreatitis among the patients of diabetic ketoacidosis.

Results: A total of forty patients were managed as diabetic ketoacidosis in our hospital during the study period. Out of them 8 (20%) had acute pancreatitis while 32 (80%) were not diagnosed with acute pancreatitis. Confusion (55%) was the commonest presenting complaint followed by abdominal pain (25%). With binary logistic regression analysis, we found that female gender and raised triglyceride levels had a statistically significant relationship with presence of acute pancreatitis among the patients of diabetic ketoacidosis included in this study.

Conclusion: Considerable number of patients were diagnosed with acute pancreatitis who presented with diabetic ketoacidosis. Special attention should be paid towards female patients and those with raised triglyceride levels to look for the sign and symptoms of acute pancreatitis in order to diagnose and manage this condition.
EARLY VS LATE CAFFEINE THERAPY IN PRETERM INFANTS: ANALYSIS OF CLINICAL OUTCOME
Authors: Niaz Hafsa , Jalil Jawad , Adil Muhammad , Basheer Faisal , Akhtar Shahzad , Hamid Naila
Published: May 2021

Objective: To study clinical outcome of early versus late caffeine therapy in preterm infants.

Study Design: Prospective comparative study.

Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jul 2018.

Methodology: A total of 40 preterm infants with gestational age <32 weeks and birth weight <1500 grams were randomly divided into two groups on the basis of initiation of caffeine therapy i.e. group A (early caffeine group) and group B (late caffeine group). Infant’s demographic data and clinical outcomes were compared between both groups using SPSS IBM software.

Results: Mean gestational age was 29.9 ± 1.19 weeks with male to female ratio of 1.5:1 Mean birth weight was 1165.3 ± 316 grams. Half (50%) of the infants were delivered by cesarean section while surfactant was given in 29 (72.5%) infants. While comparing both groups we observed that early caffeine shortens duration of Neonatal Intensive Care Unit stay (p<0.05) whereas caffeine therapy initiation timings didn’t influence the risk of development of Respiratory Distress Syndrome or need of mechanical ventilation.

Conclusion: Early caffeine therapy in preterm infants is associated with decrease duration of Neonatal Intensive Care Unit stay. However further work is needed in this regards to establish its efficacy and safety.
BACTERIOLOGICAL PROFILE OF DIABETIC FOOT INFECTIONS AND ITS EFFECTS ON LIMB SALVATION
Authors: Zulfiqar Muhammad Umair , Ghani Umer Fayyaz , Mallhi Ayub Ashraf , Mahmood Khalid , Iqbal Maria , Ans Muhammad
Published: May 2021

Objective: To assess the bacteriological profile of infected diabetic foot and its relationship with limb salvation among the patients treated for diabetic foot infection at a tertiary setup.Study Design: Correlational study.

Place and Duration of Study: Department of Surgery, Pak Emirates Military Hospital Rawalpindi, from Dec 2018 to Mar 2019.

Methodology: A total of 160 cases of infected diabetic foot were included in the study. Diagnosis of diabetic foot was made by the consultant surgeon and bacteriological analysis was done on the specimen by the microbiology laboratory of the same hospital. Relationship of bacteriological profile and other socio-demographic factors was assessed with limb salvation in these patients.

Results: There were 121 (75.6%) male patients while females were 39 (24.4%). Commonest organism found was Staphylococcus aureus 49 (30.6%) which was followed by pseudomonas 39 (24.4%). Out of 160 patients treated for the diabetic foot infection, 71 (48.4%) had to undergo the process of limb salvation while 89 (51.6%) were managed conservatively. Poly-microbial infection and raised body mass index (BMI) were significantly associated with limb salvation in the target populace (p-value <0.05).

Conclusion: This study depicted high frequency of patients undergoing limb salvation due to diabetic foot infections in our setup. Patients with raised body mass index and those with poly-microbial infection on the culture should be specially attended in order to avoid this irreversible damage to the patient in the process of saving his life from the infective process.
EFFECTIVENESS OF BOTULISM TOXIN IN THE TREATMENT OF ANAL FISSURE
Authors: Bashir Umar , Raza Ahmed , Zafar Afsheen , Majeed Farhan Ahmed , Shabbir Hassan , Mumtaz Moazzam
Published: May 2021

Objective: To assess the effectiveness, feasibility and acceptability of botulinum toxin in healing chronic anal fissures in our population.

Study Design: Prospective observational study.

Place and Duration of Study: Combined Military Hospital, Multan, from Jan 2019 till Dec 2019.

Methodology: Eighty patients were enrolled in the study out of which 72 completed the study. 33 IU of botulinum toxin A was injected in the intersphincteric groove in the perianal region. Outcome measures for effectiveness included pain score and fissure healing rates at 2, 6, 16 and 24 weeks after the injection. Healing rate was calculated as percentage and pre and post injection pain scores were compared by using paired sample t-test. Patient acceptability was assessed based on the proportion of patients who accepted the treatment. The average treatment cost was also calculated.

Results: A total number of 250 patients were found to be eligible for the study. A purposive sampling technique was used. Eighty patients took part in the study with an acceptability rate of 32%. Seventy two patients completed the study with a completion rate of 90%. Amongst 72 patients, 47 (65.3%) were female and 25 (34.7%) were male. The complete healing rate after 3 months of botulinum toxin injection was 49 (68.1%). There was a significant reduction in pain scores at 2, 6, 16, and 24 weeks of study (p<0.01).

Conclusion: The study supports that Botulinum toxin is an acceptable and effective treatment for anal fissure.

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OVARIAN MASSES IN WOMEN: A RETROSPECTIVE ANALYSIS IN TERTIARY CARE CENTER
Authors: Urooj Uzma , Zohra Sadaf , Akbar Rabiya , Siraj Asifa , Khan Sumaira , Amin Fatima
Published: May 2021

Objective: To describe the presenting signs and symptoms, clinic-pathological findings of ovarian masses and to establish diagnostic value of clinical examination, ultrasonography and its correlation with histopathological diagnosis.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Rawalpindi Jun 2017 May 2018.

Methodology: Women who underwent surgery for ovarian masses were included. Data was collected from hospital records including; age, presenting symptoms, duration of symptoms, changes in menstrual cycle, and the results of the physical examination. The preliminary diagnoses as well as the final diagnosis were noted.

Results: A total of 83 patients with ovarian masses, who underwent surgery over the period of a year, were included. The most common symptom was abdominal pain in 56 (67.5%) followed by abdominal distention 9 (10.8%), dysmenorrhea 8(9.6%). When both clinical and sonological diagnosis were combined, the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign and malignant ovarian neoplasms were 87.5%, 96.7%, 70%, and 98.88%, respectively.

Conclusion: In this study most, common symptom was abdominal pain both in benign and malignant ovarian masses. Whereas, abdominal distention was more common in malignant masses. Preoperative diagnostic approach should always include careful history taking, physical examination, imaging and evaluation of tumor markers. Early detection, thorough treatment and regular follow-up are the need of time to reduce the morbidity and mortality.