Frequency of Distribution and Relationship of Nail Changes and Oral Mucosal Involvement in Classical Lichen Planus (LP)

Introduction: LP is an itchy dermatosis. It is of different types with classical LP being a common type. It most commonly affects the skin of the limbs, however, it can affect the mucous membranes, genitals and nails as well. Materials and Methods: 100 patients of classical LP presenting in Dermatology OPD of Benazir Bhutto Hospital were enrolled to assess the involvement of nails and oral mucosa in the disease. Statistical Analysis was done using SPSS version 23. Results: Out of 100 patients, 70% were free from any oral mucosal or nail involvement, whereas, 7% had both oral mucosal as well as nail involvement with classical LP. 18% had oral mucosa affected but nails spared and only 5% had nails affected without oral mucous membrane involvement with the diseases. 25% had oral mucosal involvement with reticular pattern being most common type and 12% showed nail changes with longitudinal ridging being the most common. Fisher’s exact test computed a two tailed p value of 0.0093 showing a significant association of nail changes in classical LP with oral mucosal involvement. Conclusion: Classical LP is an itchy condition which most commonly affects the skin, mucous membranes and nails. However, if oral mucous membranes are involved, the risk of having nails affected by the disease is quite significant. The distribution frequency of nail and oral mucosal changes as well as their predominant subtypes associated with classical LP in South Asians is comparable with rest of the world & other types of L

Distress Risk and Stock Returns in An Emerging Market

This study examines the link between financial distress and market performance of firm in the form of share performance by using Z-Score bankruptcy prediction model as the proxy of distress risk and the subsequent realized stock returns of the distress-listed companies as a proxy of systematic risk. The sample is drawn from Karachi Stock Exchange listed companies. We found that distress risk is not significant enough to explain the expected stock returns in the case of the Pakistani distress listed-firms. Altman’s (1968) measure of distress is operationalized to test the financial health of firms. The results show that distressed firms outperform as compare to healthy firms. This study deduces that distress risk is a systematic risk in relation to the Pakistani stock market to some extent. Keywords: Financial distress, Share returns, KSE, Distressed companies, Bankruptcy risk, systematic ris

Pre-operative Anxiety Compounding Intra-operative Hypotension in Parturient women undergoing Cesarean Deliveries under Spinal Anesthesia

OBJECTIVE: To assess the relation of intra-operative hypotension with severity of pre-operative anxiety in patients undergoing caesarean section under spinal anesthesia. STUDY DESIGN: Prospective observational study. PLACE AND DURATION OF STUDY:  This study was carried out from June 2017 to May 2018 at anesthesia department of Combined Military Hospital Lahore. METHODOLOGY: One hundred and twenty patients belonging to America Society of Anesthesiology class I and II, undergoing caesarean section under spinal anesthesia were selected.  Verbal Analogue Scale for anxiety (VASA) and Straight Trait Anxiety Inventory (STAIs) questionnaire were used to measure pre-operative anxiety. Patients were divided into three groups as mild (VASA<3or STAIs<44), moderate (VASA 4-7 or STAIs 44-55) and severe (VASA 7-10 or STAIs>55) anxiety. Baseline mean arterial pressure was measured. Patients were placed in supine position immediately after induction of spinal anesthesia at L3-L4 or L4-L5 level with 12mg bupivacaine. Blood pressure was measured every two minutes until the delivery of baby. Hypotension was labeled when mean arterial pressure dropped by 20% below the baseline. The effect of level of anxiety on drop in MAP was assessed. RESULTS: Seventeen (14.17%) patients had mild pre-operative anxiety; out of which four (23.53%) developed hypotension. Seventy three (60.83%) patients had moderate anxiety; out of which twenty seven (36.99%) developed hypotension. Thirty (25%) patients had severe anxiety; out of which twenty two (73.33 %) developed hypotension. P-value (0.001) was quite significant. CONCLUSION:  It was concluded in our study that severity of pre-operative anxiety has significant effect on intra-operative spinal hypotension

Two cases of primary laryngeal amyloidosis

The larynx is a rare site of involvement of amyloidosis. We report two cases of laryngeal amyloidosis. Both patients were middle aged females with history of persistent hoarseness. Fibreoptic laryngoscopy used for diagnosis in both and debulking of the tumour was performed. Histopathological examination confirmed the diagnosis of amyloidosis. Appropriate follow up is an important part of the long-term management of the disease

Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements

Factors affecting Perceived Organizational Politics among Elementary School Teachers’ in Lahore, Pakistan.

This study aimed at exploring the role of workforce diversity as a key indicator in shaping perception of organizational politics (POP).  This study is carried out in elementary schools of Lahore, Pakistan. The study design was essentially cross sectional and for analysis quantitative technique was contended. A survey method was used as a research tool to gather primary data using snowball-sampling technique and a sample of 350 elementary level teachers from six different schools was examined. Findings of the study revealed that workforce diversity has a moderate (significant) positive impact on perceived organizational politics of public and private elementary level teachers in schools of Lahore, Pakistan. Additionally, dimensions of workforce diversity were investigated with organizational politics exclusively and discovered the significant relationship. Then, regression and multiple linear regression analysis were used to validate the extent of relationship between both variables and the dimensions of independent variable with dependent variable respectively. All of the dimensions had shown a significant positive impact on perception of organizational politics (POPs), whereas demographics show no statistical significant impact on both variables. This research is conducted in a developing country like Pakistan that is a turn-up for the books and have added to the body of knowledge