Papillary thyroid carcinoma is the most prevalent endocrine malignancy of the head and neck region. It makes up to 80% of all thyroid cancers, and has a 10-year survival rate of up to 95%. Differentiated thyroid carcinomas have good prognosis after a complete surgical extirpation as long as it is not associated with invasion of the surrounding structures. The advanced papillary thyroid carcinoma can invade the neighbouring structures of the thyroid gland, such as strap muscles, recurrent laryngeal nerve, trachea, oesophagus, larynx, pharynx, and carotids. Whenever papillary thyroid carcinoma is associated with invasion of aerodigestive tract it is difficult to excise the tumour. We report a patient with stage IV invasive papillary thyroid carcinomas as per Shin Staging system. The surgery was deferred from several hospitals considering the advanced stage of the disease with tracheal extension making it a problematic airway for both the anaesthesiologist and the operating surgeon. The patient underwent total thyroidectomy, modified radical neck dissection, tracheal resection, and primary anastomosis. Successful intubation was done with video laryngoscopy. Intermittent apnoea technique was used for ventilation during the repair of posterior tracheal wall. The patient was extubated on the table and shifted to the recovery room. The histopathologic diagnosis was reported as papillary thyroid carcinoma classic variant with tracheal invasion.

Background Health authorities in Pakistan in collaboration with local and foreign non-government organizations are working hard to achieve the targets set by World Health Organization in 2012, that is, to reduce anemia prevalence and its related factors. However, due to the prevailing COVID-19 crisis, all resources and attention were diverted toward it, which led to ignorance of existing basic health issues. Objective This study assesses anemia prevalence and its related factors among women of childbearing age in the period of global pandemic. Methods A time-lagged, cross-sectional survey was conducted using a self-administered questionnaire among 1,702 volunteer women aged between 15 and 49 years across five major cities of Pakistan from January 2021 to December 2021 using the non-probability consecutive sampling technique. Blood sample results were analyzed to determine prevalence and anemia severity. The chi-squared test and multiple logistic regression were performed to examine the relationship and effect of related factors with hemoglobin levels using SPSS version 26. Results Among the 1,702 respondents, 788 (46.3%) were non-anemic and 914 (53.7%) were anemic. Anemia prevalence in Karachi was slightly greater (n=294, 55.48%) compared to other cities, and the mean hemoglobin level was 11.98 ± 0.92 g/dL. The chi-square test and multiple logistic regression indicated that the respondents' employment status, mother's profession, family income, living conditions, chronic health conditions, use of iron and folic acid supplements, junk food, source of drinking water, and knowledge about anemia and its preventive measures were associated significantly with anemia during the pandemic. Conclusion Results confirmed that anemia is a multi-factor health problem and that it was totally ignored during the COVID-19 pandemic, as the prevalence increased during the pandemic. Therefore, more attention should be paid to anemia surveillance, anemia awareness programs, and mobilization of community health workers and volunteers to reach a wide range of the population, including women of childbearing age even during the pandemic.

The recent SARS‐CoV‐2 pandemic has resulted in significant morbidity and mortality worldwide. The healthcare systems, including pharmacies, faced unique challenges, such as managing  an overwhelming patient influx, clinical workforce management, transitioning to remote or online work, medication procurement and several others. The purpose of this study is to describe our hospital pharmacy’s experience dealing with the COVID-19 pandemic and to present solutions to the challenges that arose. We retrospectively reviewed and consolidated strategies, interventions, and solutions that were implemented by our pharmaceutical institute in response to the challenges that arose during the COVID-19 pandemic. The study period was from March 1 to September 30, 2020. We reviewed and organized our hospital pharmacy response to the COVID-19 pandemic into different categories. In inpatient and outpatient satisfaction surveys, physicians and patients expressed a high level of satisfaction with pharmacy services. The close collaboration between the pharmacy team and other clinicians was demonstrated through the number of pharmacist interventions, participation in the COVID-19 guidelines reviews, involvement in local and international research, and innovative solutions to inpatient and outpatient pharmacy medication management challenges. This study highlights the crucial role that our pharmacists and pharmaceutical institute played in ensuring continuity of care during the COVID-19 pandemic. We implemented several key initiatives, innovations, and collaborations with other clinical disciplines to successfully overcome the challenges faced.

Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Background and aim Chronic patients with thalassemia major were mainly recognized as more prone to poor mental health during this global pandemic. This study aims to evaluate causal relationships leading to poor outcomes and how they manage to tackle this. Methods In-depth face-to-face semi-structured interviews were conducted with 21 thalassemia patients selected through probability consecutive sampling from Pakistan Thalassemia Welfare Society Centers. The following criteria served as the basis for the interview: (1) solitude at home, (2) interruption of transfusion services, (3) alteration of appetite and interests, (4) lack of control and uncertainty, (5) extensive media coverage, (6) deterioration of pre-existing health issues, difficulty in sleeping, (7) practicing gratitude, (8) participation in activities and hobbies, (9) connectivity with others, and (10) ability to recognize social support. All interviews were recorded, transcribed, and analyzed with reflexive thematic analysis. Results The commonly described mental health conditions were depression and concern about the overall health status. The following seven elements associated with the pandemic contributed to the deterioration of mental health: (1) isolation at home, (2) disruption in transfusion services, (3) change in appetite and interests, (4) lack of control and uncertainty, (5) intensive media reporting, (6) worsening of pre-existing health problems, and (7) difficulty in sleeping. The following four coping strategies were identified for maintaining mental issues: (1) practicing gratitude, (2) involvement in activities and hobbies, (3) connectivity with others, and (4) discerning social support. Conclusions Thalassemia major patients had been negatively affected during the pandemic. Only a small number of people modified their management techniques to maintain steady well-being.

Background In early 2020, the rapid global spread of coronavirus disease 2019 (COVID-19) presented healthcare workers (HCWs) with an unprecedented challenge. The constant influx of new information about the virus created knowledge gaps, and the relentless demands of their work schedules left many feeling overwhelmed. This paper explores the knowledge, attitudes, anxiety levels, and preventive behaviors of HCWs in the twin cities of Pakistan, Rawalpindi and Islamabad, related to the COVID-19 pandemic. In the face of this crisis, it is essential to gain insights into the experiences and needs of these frontline heroes. Methodology We conducted a descriptive web-based cross-sectional study among healthcare professionals to delve into the multifaceted aspects of their experiences. This included analyzing sociodemographic characteristics, knowledge levels, attitudes, practices, and the psychological implications of the pandemic. By employing both quantitative and qualitative analysis, we aimed to provide a comprehensive understanding of these parameters. Results Out of the 1150 responses collected, it became evident that breathing problems were the most recognized symptom of COVID-19 among HCWs. Impressively, 95.7% of participants believed in the primarily symptomatic nature of treatment, although 37% held the misconception that antibiotics were effective against the virus. Another noteworthy discovery was that 68.2% of HCWs favored testing before initiating treatment, yet a concerning 22.7% of treated patients received no testing. A significant proportion, approximately 19.6%, experienced heightened anxiety levels during the pandemic, leading to an increased frequency of handwashing. In terms of preventive behaviors, a majority of respondents displayed a heightened sense of caution. Nearly 59.1% reported avoiding the use of others' accessories and emphasized not reusing face masks. Furthermore, 84.1% of participants preferred staying at home during quarantine. Conclusion The study reveals the profound impact of COVID-19 on healthcare providers in Pakistan's twin cities, highlighting elevated anxiety levels among most. This underscores the urgent need for mental health support. Beyond physical effects, the pandemic significantly strains their psychological well-being. To address this stress, vital strategies include workload reduction, structured shifts, stressor minimization, and improved knowledge sharing. Cultivating a healthy work environment is equally crucial for healthcare providers' overall well-being. These insights are essential for crafting policies and interventions to better protect and support frontline workers in a developing nation like Pakistan, demonstrating healthcare professionals' resilience and dedication amid unprecedented challenges.

Covid-19 pandemic has taken the world by a storm, pushing the boundaries of human endurance and intellect. Caught at the horns of dilemma, humanity is still struggling with the management of the established symptoms not to mention the novel symptoms. In this regard, the novel symptoms must be highlighted to ensure proper and timely management. Viral aetiology has been an established entity for neurological deficits; hence, it would not be a huge leap to consider the correlation between Covid-19 and Sensorineural hearing loss (SNHL). Here, a case is being presented where the patient developed sudden sensorineural hearing loss after Covid-19 infection.

Background Diabetes mellitus is a chronic illness which is becoming more prevalent in developing countries, and it is being managed mostly in hospitals or clinics in underdeveloped nations. Other strategies for treatment delivery in emerging nations must be considered as the number of diabetic patients grows. Community pharmacists are a valuable choice for diabetes care. However, only developed countries have data on community pharmacists' diabetes treatment practices. Methodology A non-probability consecutive sampling strategy was used to gather a self-administered questionnaire from 289 community pharmacists. Six points Likert scale was employed to score current practices and pharmacists' perceived role. A response rate of 55% was attained. Characteristics associated with present behaviors and perceived roles were analyzed using Chi-square and logistic regression. Results The majority of the respondents were males, 234 (81.0%). Out of 289, 229 (79.2%) were of 25-30 years of age and were pharmacists as well as qualified persons (QP) 189 (65.4%). A QP is one who has the legal authority to sell drugs to customers. The majority had <5 years of working experience as a community pharmacist, 268 (92.7%), and did not have diabetes training, 237 (82.0%). Most community pharmacies were stand-alone, 110 (38.1%), and had a single or a group of proprietors, 248 (85.8%). Open hours of most of the pharmacies were 16-20 hours per day, 202 (69.8%), and most had one pharmacist, 243 (84.1%), i.e., working as a pharmacist as well as a qualified person. Approximately 203 (70.2%) of the pharmacies had customers >2000 in a month and >100 customers purchased anti-diabetes medications per month. Only 44 (15.2%) community pharmacies had a designated room or space for patient counselling. The majority of pharmacists were also in favor of providing services other than dispensing such as counselling the patients about prescribed medicines, direction of use, use of devices for insulin administration, training on self-monitoring of glucose, and healthy lifestyle and diet practices. Pharmacy setting, ownership, patient counseling area, and the number of customers per month were key factors in the provision of diabetes services. The main obstacles identified were a lack of pharmacist availability and academic competency. Conclusion In Rawalpindi and Islamabad, most community pharmacies only provide a basic dispensing service for diabetes patients. Most of the community pharmacists agreed to extend their duties. The expansion of pharmacist professional responsibilities would help control the rising diabetes burden. The facilitators and hurdles identified would serve as a foundation for the introduction of diabetic care in community pharmacies.

Mucosal melanomas can occur at various different sites and have an incidence of about 1% among all melanomas. They are usually diagnosed at an advanced stage with a poor prognosis, mostly because it is quite difficult to catch the early signs and symptoms of a mucosal melanoma due to its anatomic localization. In addition, the prognosis of oral melanomas is worse than the melanomas of skin as local recurrence is very common in patients with oral melanomas. Meticulous surgical excision with clear margins is the only potential curative option for mucosal melanoma. Here, we present a rare case of an oral mucosal melanoma of the left lower alveolar mucosa in a 32-year-old male patient.

OBJECTIVE: To inspect the effects of naproxen sodium pre-operatively on the potency of Inferior alveolar nerve block in patients suffering from symptomatic irreversible pulpitis.METHODOLOGY: A cross-sectional study was conducted at Operative Department, Hamdard University Dental Hospital Karachi, from July 2018 to February 2019 using a non-probability consecutive sampling technique, including patients between 18-45 years of age. One hundred patients with symptomatic irreversible pulpitis in the posterior teeth of the mandible were randomly given 550 mg naproxen sodium or similar placebo capsules 60 minutes before the delivery of a conventional inferior alveolar nerve block. Patients having allergies, contraindications to naproxen sodium, pregnancy, lactating mothers, not giving consent, patients experiencing only mild pain (verified with Visual Analog scale) or taking pain medication in the last 6 hours were excluded. Fifteen minutes after the inferior alveolar nerve block delivery, sufficient lip numbness was confirmed, and endodontic therapy was commenced. Success determined if the subjects remained pain-free or showed mild pain (<= 54mm on a 170mm Visual analog scale) on access or instrumentation. SPSS version 22 was utilized for data analysis. RESULTS: The success of the inferior alveolar nerve block demonstrated by the placebo group was 40%, and the experimental group was remarkably 98%. A substantial significant difference was evident between the two research groups.CONCLUSION: Variations in the two groups support that a significant rise in the success rate of the inferior alveolar nerve block was observed in subjects who consumed a pre-operative dose of 550 mg naproxen sodium with symptomatic irreversible pulpitis.

Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously. Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained. Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study. Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI. Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

Lactobacilli are the most common probiotics used in food and other industries because of their capability of producing bacteriocins. Bacteriocins are compounds that are used to kill pathogenic microorganisms. As most bacteria have become resistant to synthetic antibacterial tools, the importance of using probiotics as antibacterial agents has increased. This work was done to check the bacteriocin effect on some common pathogens and the influence of mutation on the bacteriocin activity of Lactobacilli was also investigated. Four strains were isolated, identified from meat and pickles samples via culturing methods, staining, biochemical tests, and ribotyping. Preliminary tests, including Gram staining and catalase test, were done for the confirmation of Lactobacillus species. All strains were gram-positive and catalase-negative. Antibacterial activity was checked against Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus thuringiensis, Escherichia coli, and Salmonella enteritis via agar well diffusion method. The mutations were done using ethidium bromide and the influence of wild and mutants were also checked. Interestingly, mutants developed more virulence than wild ones. It was also observed that they all were sensitive to pepsin. Protein estimation was done via Bradford method. Ribotyping of GCU-W-PS1 revealed 99 % homology with Lactobacillus plantarum and GCU-W-MS1 to Lactobacillus curvatus (99 % homology). Curvacin A, sakacin P, and plantaricin A genes were also amplified using specific primers. Gene sequence showed the presence of curvacin A gene in GCU-W-MS1. It was concluded that lactic acid bacteria could be used as antibacterial tools against common pathogens.

Schwannoma of parapharyngeal space is an uncommon benign tumour of head and neck region. These are slow-growing and usually well-encapsulated masses arising from Schwann cells of cranial nerves. The majority of schwannoma in parapharyngeal space arise from vagus; however, cases have been reported with origin from other cranial nerves. Complete surgical excision is the treatment of choice. We recently experienced a case of schwannoma arising in parapharyngeal space of lingual nerve origin which was treated by transcervical excision.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare and life-threatening complication that can occur after COVID-19 vaccination. After the first reports of VITT and CVST in 2021 after Ad26.COV2.S vaccination, the FDA and CDC recommended an emergency pause on 13 April 2021, and after extensive safety reviews, on 23 April 2021, the CDC's Advisory Committee on Immunization Practices (ACIP) reaffirmed its original recommendation for use of the Ad26.COV2.S vaccination. As of 31 August 2021, in the United States, 54 cases of VITT following Ad26.COV2.S vaccination (37 female, 17 male) have been reported out of 14.1 million total shots given, 29 of which had cerebral venous sinus thrombosis (CVST). With more data, on 16 December 2021, the CDC endorsed the ACIP recommendations for individuals to receive an mRNA COVID-19 vaccine in preference over the Ad26.COV2.S vaccination. We report a rare case of a male with confirmed VITT and CVST following Ad26.COV2.S vaccination.

Mastitis in dairy animals is the primary concern of dairy farmers, which is the most common disease that causes huge economic losses in the dairy industry. The economic losses due to mastitis are from a reduction in milk yield, condemnation of milk with antibiotic residues, veterinary treatment costs, and death. In addition, some mastitis pathogens also cause serious human diseases associated with the contamination of milk or milk products with bacteria or their toxins. Bovine mastitis is mainly caused by a wide range of environmental and contagious bacterial mastitis pathogens. Contagious pathogens are those whose main reservoir is the infected udder. Contagious pathogens mainly spread among animals during milking process whereas environmental pathogens spread from environment to udder at any time. The source of the environmental pathogens is the surrounding environment of an animal. The major contagious pathogens include Staphylococcus aureus, Streptococcus agalactiae, and Mycoplasma spp. and the minor contagious pathogens include Corynebacterium bovis and others. Major environmental pathogens include coliform bacteria (Escherichia coli, Klebsiella spp., Enterobacter spp. and Citrobacter spp.), environmental streptococci (Strep. dysgalactiae, Strep. uberis). This chapter covers detailed review of published data on contagious and environmental pathogens responsible for bovine mastitis.

OBJECTIVE:To determine all types and severity of Otolaryngology consultation requests at our tertiary care center and spectral records of problems related to otorhinolaryngology come across initially by residents which will help in re-shaping residency programmes and enhance patient related care.METHODOLOGY:All otorhinolaryngology consultation received over a three-month period were recorded prospectively. Information collected for each encounter included the time, date, reason for consult at primary service and admission with final ENT diagnosis, any surgical or non-surgical intervention, and basic patient demographics.RESULTS:A total of 127 consults for inpatients were reviewed from April 2020 to June 2020. Out of total, 84 (66.1%) patients were male and 43 (33.8%) were females. Adult patient consultations amounted to 87(68.5%) while 18(14.1%) were in the age range of 6-18 years. Only 4(3.1%) consultations were raised for neonatal patients. Routine consultation were had for 64(50.3%) while 45(35.4%) patients were reviewed as an emergency. Operative interventions were required by 43(33.8%) among which tracheostomy was the most common operative procedure performed in 26(20.7%) patients. If we broadly classified ENT consultations, 40 (31.4%) were of problems related to head and neck region while 38 (29.9%) were related to the laryngology sub-specialty. Most common consultation was for airway assessment in 26(20.7%) patients followed by otorrhoea, in 15 (11.8%) patients.CONCLUSIONS:In inpatients, upper airway assessment, aural discharge and epistaxis were the most frequent complaints for seeking ENT review. This study should prove to be beneficial in forming a curriculum of educational programme for junior residents.

Hospitals are considered to be safe havens as they have to remain functional during an earthquake or any other natural calamity. However, in past, the performance of the hospitals in high seismic regions is seen to be poor, raising the intensity of life lost in such calamities. To prevent disruption in functionality or any damage to the infrastructure of the hospital, it is mandatory to perform pre and post-earthquake assessments and evaluate the integrity of structural as well as functional aspects of the hospital. This research paper outlines a modified Rapid Visual Screening (RVS) procedure with FE analytical method similar to ASCE41-17. The developed procedure is a three-tier process that is tested on three major hospital buildings in the city of Karachi, a metropolitan city known as the financial hub of Pakistan. The developed procedure begins with the RVS process that considers the structural elements and their vulnerability either at full structure or at the element level. This process then further combines with the evaluation of Demand-Capacity Ratios (DCR) for the entire structure to obtain a physical model with the vulnerabilities that need further non-linear evaluation or physical interventions are developed.

BackgroundChronic patients with thalassemia major were mainly recognized as more prone to bad mental health during COVID-19 pandemic. However, why this populace has confronted these detrimental effects, how they have skilled them and the way they have coped, stays under-explored.AimThe aim was to evaluate the aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major and to identify the coping strategies to overcome the effects.MethodsThe present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 21 patients with thalassemia major selected through probability consecutive sampling. All interviews were recorded, transcribed, and analysed with reflexive thematic analysis.ResultsThe most commonly described mental health condition was depression and concern of overall health status.Seven associated pandemic elements contributed in deterioration of mental health: i) Isolation at home, ii) Disrupt transfusion services, iii) Change in appetite and interests, iv) Uncertainty and lack of control, v) Intensive media coverage, vi) Worsening of chronic health problems, vii) Difficulty in sleeping.Four coping strategies were identified for maintaining mental health: i) Practicing gratitude ii) Engaging in hobbies and activities, iii) Stay connected with others, iv) Discern social support.ConclusionsThalassemia major patients had been negatively affected during the pandemic. However, it seems a temporary respite for few, drew upon reserves of resilience and tailored their coping techniques to hold high quality wellbeing.

A four-level N-type $$^{87}$$ Rb atomic system driven by probe field and two interacting control fields is used to control and manipulate the energy density of the probe pulse. Interesting modification and fluctuation in the energy density is investigated with detunings of probe and control fields, Rabi frequency, phase angle between two interacting waves and position. The stored energy density shows periodic features and spatial localizations appearing due to coherence effect. The energy density varies from 30 to 100% with probe detuning and position versus wavelength of light in free space. The energy density varies from 0 to 100% with control field Rabi frequency. This modified work is useful for the unidirectional optical interfaces and the quantum spin-Hall effect of the light beam and absorption of probes particles.

A four-level N-type atomic configuration driven by two interacting control fields and a probe field. Control fields are used to manipulate and control the spin density of the probe field and its spin angular momentum vector field arrows. Significant variation of spin density of probe field is investigated with the angle between two interfering waves and the Rabi frequency of the control field. Spin distribution and spin density of circularly, diagonal, and linearly polarized probe light field is coherently controlled and modified. The control field parameters and probe field detuning play important roles in the modification of spin density and spin vector field distribution of the probe field. The modified works of this manuscript are useful for unidirectional optical interfaces and the quantum spin Hall effect of the light beam.