Safety of Supracostal Percutaneous Nephrolithotomy in Paediatric Population: A Single Centre Experience

Objective The objective of this study is assessment of safety and efficacy of supracostal mini percutaneous nephrolithotomy in pediatric patients. Methodology This is prospective study of patients whose kidney stones were treated with mini percutaneous nephrolithotomy through supracostal approach between February 2019 and Dec 2020.These patients were selected for supracostal puncture based on preoperative ultrasound and CT KUB findings and peroperative assessment of stone burden, stone location and anatomy of pelvicalyceal system. Results Of 80 patients 72(90%) were treated with only one supracostal puncture while additional 2nd puncture was used for 8(10%) patients. Overall stone clearance is 85% only with percutaneous nephrolithotomy and the stone clearance has reached to 95% with ancillary procedures.13% of patient had hydrothorax , 3.75% had urosepsis, 2.75% had bleeding and 1.25 % had perinephric fluid collection. Conclusion This study concludes that the safety and efficacy of supracostal percutaneous nephrolithotomy is same as subcostal pcnl if surgical boundaries are not violated

Outcome of Surgical Management of Chronic Subdural Hematoma

Objective: To determine outcome of surgical management of Chronic Subdural Hematoma.Study Design: Descriptive Study.Materials and Methods: Patients with Chronic Subdural Hematoma diagnosed on CT scan brain admitted to the Neurosurgery Department, Bolan Medical College/Hospital, Quetta Pakistan from January 2008 to December 2017. Patients included in the study were those who presented with CSDH only and all those patients were excluded who had undergone surgery previously elsewhere. At the time of admission the neurological status was classified according to a Grading Scheme which was proposed by Markwalder et al. Radiological evaluation was done by CT Scan before surgery and routine CT Scan of each patient was done one day after surgical inter-vention, one week after and anytime if required. Outcome was determined by GCS and GOS. Good Recovery and Moderate Disability were considered as favorable outcome while Severe Disability, Persistent Vegetative State and Death as unfavourable outcome.Data Analysis: SPSS software was used for data analysis.Results: A total of 145 patients were treated with surgical evacuation of CSDH. 121 (83%) patients were men while 24 (17%) were women with Male to Female ratio of 5:1.10 (7%) patients had Markwalders Grade 1, 57 (39%) had Markwalders Grade 2 while 46 (32%) patients had Grade 3 and 32 (22%) had Grade 4. Recurrence occurred in 20 (14%) patients. 129 (89%) patients had favourable outcome while 16 (11%) had unfavourable outcome.Conclusion: The favourable outcome of surgical evacuation of Chronic Subdural Hematoma is quite high if operated early. Moreover, the course and outcome is affected by several factors particularly the initial neurological status at the time of diagnosis

Surgical Outcome of Chiari-I Malformation

Objective: To determine outcome in patients operated for Chiari-I Malformation.Study: Descriptive case series.Materials and Methods: Patients admitted in the Department of Neurosurgery, Bolan Medical College/ Hospital Quetta Pakistan from January 2013 to June 2017 with Chiari-I Malformation diagnosed on MRI and candidates for surgery based on consistent symptoms. MRI findings regarding cerebellar tonsillar termination in mm were recorded. Surgical Intervention consisted of suboccipitalcraniectomy, C1+/- C2 laminectomy(ies), reduction/ resection of cerebellar tonsil and expansion/augmentation duroplasty. Patients were followed-up after 6 months and outcome was determined by Chicago Outcome Scale for Chiari Malformation.Data Analysis: SPSS version 20 software was used.Results: Out of total of 39 patients 30 (77%) were females and 9 (23%) were males with Female to Male ratio of 3.3:1. Age ranged from 21 to 42 years. 35 (90%) patients presented with Valsalva headache, 34 (87%) with neckache, 25 (65%)with ataxia, 25 (65%) with paresthesia/numbness, 17 (44%) with sleep apnea, 16 (40%) with dysphagia, 15 (39%) with weakness, 12 (31%) with dizziness, 11 (27%) with visual disturbances, 9 (24%) with nausea/vomiting while 7 (18%) with tinnitus. 34 (88%) patients had tonsillar herniation more than 5mm while 5 (12%) had tonsillar herniation more than 10mm. Out of total of 39 patients 30 (77%) had good outcome while 9 (23%) had worse outcome.Conclusions: Surgical decompression in Chiari-I Malformation should be offered to only those patients who are consistently symptomatic and their symptoms correlate with CM1. Surgery has favorable outcome in patients without significant cord damage and less severe neurological deficit before surgery

Effectiveness of clean intermittent self catheterization in patients with recurrent urethral stricture post visual internal urethrotomy

OBJECTIVE :   Objective of the study is to determine the effectiveness of CISC in management of recurrent urethral strictures after visual internal urethrotomy.  METHODOLOGY :  This study   performed in department of urology   Saidu teaching hospital Swat  from June 2016 to July 2019 on 215 patients who were diagnosed as having urethral stricture disease. Patients were counseled  for CISC after removal of catheter 2 times a day for 8 weeks  and  at 8th  week cystourethroscopy performed along with detail  evaluation of symptoms of urethral stricture to know  recurrence of stricture.  RESULTS:   81.39% patients have no urethral stricture on cystourethroscopy  and symptomatic evaluation at 8th week  post visual internal urethrotomy  while 18.60%  patients have recurrent urethral stricture . Length of urethral stricture is the most important prognostic factor, stricture of less than 1 cm has success rate of 62.39% while stricture of more than one cm length has success rate of 20% as shown in table IV.  CONCLUSION:  In this study it has been confirmed that CISC  is safe ,cost effective procedure and most of the patients can do it in home with out any complications.

Servant Leadership and Followers Prosocial Rule-Breaking: The Mediating Role of Public Service Motivation

This research explores the effect of servant leadership on prosocial rule-breaking (PSRB) and the mediating mechanism of public service motivation (PSM) between the association of servant leadership and PSRB. The said phenomenon is examined in the civil service context of Pakistan during the continuing crises of the COVID19 pandemic, a situation where the traditional civil service policy and rule system has become highly complicated for passionate employees’ service performance and efficiency, and where servant leadership has received greater attention for inspiring the attitudinal and behavioral outcomes of frontline workers during the pandemic. Data were collected from 546 frontline workers of the corona relief tiger force. The findings of the study revealed that servant leadership has a significant effect on PSRB and PSM, and that PSM significantly promotes PSRB. The results also revealed that servant leadership has a significant impact on PSRB via engendering PSM

The legal position of community mediation in Khyber Pakhtunkhwa: a critical analysis

Resolving neighbourhood disputes in the community through amicable settlements has been in practice in different provinces of Pakistan in various forms such as Panchayat, Jirga, Faislo. Nevertheless, these traditional dispute settlement mechanisms do not exactly resemble the contemporary community mediation practices. Accordingly, this paper aims to discover the legal status of community mediation in the Pakistani legal system. It can be observed that there is no specific legal framework governing the community mediation, the training and qualifications of community mediators, and the community mediation centres in Khyber Pakhtunkhwa. Thus, this paper proposes that there is a need to legislate a comprehensive legal framework which covers mediation from all dimensions - including community mediation - at the federal level by giving importance to the traditional dispute resolution methods in place in various provinces of Pakistan and also learning experiences from other suitable jurisdictions

Profiling dehydrin gene sequence and physiological parameters in drought tolerant and susceptible spring wheat cultivars.

Physiological and yield traits such as stomatal conductance (mmol m-2s-1), Leaf relative water content (RWC %) and grain yield per plant were studied in a separate experiment. Results revealed that five out of sixteen cultivars viz. Anmol, Moomal, Sarsabz, Bhitai and Pavan, appeared to be relatively more drought tolerant. Based on morphophysiological results, studies were continued to look at these cultivars for drought tolerance at molecular level. Initially, four well recognized primers for dehydrin genes (DHNs) responsible for drought induction in T. durum L., T. aestivum L. and O. sativa L. were used for profiling gene sequence of sixteen wheat cultivars. The primers amplified the DHN genes variably like Primer WDHN13 (T. aestivum L.) amplified the DHN gene in only seven cultivars whereas primer TdDHN15 (T. durum L.) amplified all the sixteen cultivars with even different DNA banding patterns some showing second weaker DNA bands. Third primer TdDHN16 (T. durum L.) has shown entirely different PCR amplification prototype, specially showing two strong DNA bands while fourth primer RAB16C (O. sativa L.) failed to amplify DHN gene in any of the cultivars. Examination of DNA sequences revealed several interesting features. First, it identified the two exon/one intron structure of this gene (complete sequences were not shown), a feature not previously described in the two database cDNA sequences available from T. aestivum L. (gi|21850). Secondly, the analysis identified several single nucleotide polymorphisms (SNPs), positions in gene sequence. Although complete gene sequence was not obtained for all the cultivars, yet there were a total of 38 variable positions in exonic (coding region) sequence, from a total gene length of 453 nucleotides. Matrix of SNP shows these 37 positions with individual sequence at positions given for each of the 14 cultivars (sequence of two cultivars was not obtained) included in this analysis. It demonstrated a considerable diversity for this gene with only three cultivars i.e. TJ-83, Marvi and TD-1 being similar to the consensus sequence. All other cultivars showed a unique combination of SNPs. In order to prove a functional link between these polymorphisms and drought tolerance in wheat, it would be necessary to conduct a more detailed study involving directed mutation of this gene and DHN gene expression

Genetic Effects Assessment through Line × Tester Combining Ability for Development of Promising Hybrids Based on Quantitative Traits in Gossypium hirsutum L.

Line × Tester combining ability analysis involving five lines (cultivars i.e., CIM-446, CIM-473, CIM-506, CIM-554 and SLH-284) and three testers (cultivars viz., CIM-496, CIM-499 and CIM-707) was carried out during 2015 and 2016 to determine the inheritance for earliness, yield and lint traits in upland cotton. Genotypes revealed significant (P≤0.01) variations for all the traits. On average, F1 hybrids showed the significant increase over parental means for yield traits. Mean squares due to general (GCA) and specific combining ability (SCA) were highly significant, which suggested that additive and non-additive gene actions were involved in controlling all the characters. However, the preponderance of non-additive type of gene action observed for majority of the traits. Lines (SLH-284, CIM-473) and pollinators (CIM-707, CIM-496) were leading general combiners for majority of the traits. F1 hybrids (CIM-473 × CIM-496, SLH-284 × CIM-707 and CIM446 × CIM-496) which involve best general combiners, showed the leading performance for yield and lint traits. Heritability was moderate to high with appreciable genetic gain for majority of the traits. Except for lint %, the correlation of seed cotton yield was positive with other traits. The significance of additive and non-additive components suggested integrated breeding strategies with delayed selection for development of cotton hybrids with improvement in earliness and seed cotton yield

Populations of Exotic × Locally Adapted Germplasm - A Potent

Experimental indigenous maize hybrids were evaluated in a series of three maize experiments during 2011, 2012 and 2013 to identify superior hybrids for commercial cultivation. Parental inbred lines of these hybrids were obtained from various indigenous populations, including a new improved maize population PSEV-3 which developed by the crossing of a locally adapted variety to an exotic hybrid obtained from CIMMYT and improved through S1 progeny recurrent selection. Two popular commercial hybrids namely, Babar (Public sector hybrid) and one Pioneer hybrid i.e., P-3025 were included as check genotypes. Results revealed that experimental PESV-3 derived hybrids revealed better performance by comparing with three check hybrids for grain yield (11.35 vs. 8.13 t ha-1, 10.67 vs. 9.60 t ha-1, and 11.69 vs. 11.20 t ha-1), thousand grain weight (372 vs. 338 g, 370 vs. 322 g, and 416 vs. 396 g), shelling % (87 vs. 86.2%, 86 vs. 85%, and 87 vs. 90%) and days to flowering (66.3 vs. 73.6 days, 64 vs. 67 days, and 69 vs. 68 days), respectively in three experiments. Three most superior hybrid combinations developed through exotic × locally adapted germplasm were found too much responsive and suggested their further testing through on-farm trials before releasing as commercial hybrids