The association of ABCB1 gene polymorphism with clinical response to carbamazepine monotherapy in patients with epilepsy.

BACKGROUND: Epilepsy is a common neurological disease but around 30% of patients fail to respond to antiepileptic drug (AED) treatment. Genetic variation of the ATP-binding cassette subfamily B, member 1 (ABCB1) gene, a drug efflux transporter may infer treatment resistance by decreasing gastrointestinal absorption and preventing AED entry into the brain. This study examined the impact of ABCB1 genetic variants on carbamazepine responsiveness. MATERIALS AND METHODS: Genomic DNA was extracted from whole blood of 104 epileptic patients. Genotyping of 3 ABCB1 variants (c.C3435T, c.G2677T/A and c.C1236T) was undertaken using validated TaqMan allelic discrimination assays. Plasma carbamazepine levels were measured at 3 and 6 months following the initial dose using high-performance liquid chromatography (HPLC) alongside clinical outcomes evaluation. RESULTS: Nonresponse to carbamazepine (CBZ) was associated significantly with the ABCB1 variants c.C3435T, c.G2677T/A, c.C1236T and TTT, TTC haplotypes (P < 0.05). There was no significant association between variants and plasma CBZ level (P > 0.05). CONCLUSIONS: Our results showed that variant alleles of the ABCB1 gene and TTT, TTC haplotypes were significantly associated with CBZ resistance without affecting the plasma level of carbamazepine. The findings of this study may help to predict patient's response to treatment ultimately it will improve the personalized and evidence based treatment choice of patients with epilepsy.

Efficient Fault Detection of Rotor Minor Inter-Turn Short Circuit in Induction Machines Using Wavelet Transform and Empirical Mode Decomposition.

This paper introduces a novel approach for detecting inter-turn short-circuit faults in rotor windings using wavelet transformation and empirical mode decomposition. A MATLAB/Simulink model is developed based on electrical parameters to simulate the inter-turn short circuit by adding a resistor parallel to phase "a" of the rotor. The resulting high current in the new phase indicates the presence of the short circuit. By measuring the rotor and stator three-phase currents, the fault can be detected as the currents exhibit asymmetric behavior. Fluctuations in the electromagnetic torque also occur during the fault. The wavelet transform is applied to the rotor current, revealing an effective analysis of sideband frequency components. Specifically, changes in amplitude and frequency, particularly in d7 and a7, indicate the presence of harmonics generated by the inter-turn short circuit. The simulation results demonstrate the effectiveness of wavelet transformation in analyzing these frequency components. Additionally, this study explores the use of empirical mode decomposition to detect faults in their early stages, observing substantial changes in the instantaneous amplitudes of the first three intrinsic mode functions during fault onset. The proposed technique is straightforward and reliable, making it suitable for application in wind turbines with simple electrical inputs.

Effect of Cypermethrin on Blood Hematology and Biochemical Parameters in Fresh Water Fish Ctenopharyngodon idella (Grass Carp).

The insecticide, cypermethrin, adversely affects biochemical parameters in blood and behavior in grass carp (Ctenopharyngodon idella). Fish were obtained from hatchery, reared in the laboratory. Different concentration of cypermethrin were applied. Blood was collected and hematological and biochemical parameters were measured. Biochemical parameters such as, protein levels, cholesterol, phosphorous and calcium in both acute and chronically cypermethrin treated groups decreased, with increasing exposure time from 24h to 15 days with more pronounced effects in the acute groups. Increased glucose, urea, serum glutamic pyruvic transaminase (SGPT), creatinine, and lactate dehydrogenase (LDH) levels were found in both acute and chronic groups with the increasing exposure time. Hematological parameters, such as red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MHCH), and red cell distribution width (RDW) were significantly reduced in both groups as the exposure time increases. However, the numbers of white blood cells (WBC) and platelets were increased. This study established both the acute and chronic toxicity of cypermethrin in grass carp, which likely occurs secondary to altered biochemical and blood parameters.

Impact of the COVID-19 outbreak on mental health status and associated factors among general population: a cross-sectional study from Pakistan.

The recent outbreak of coronavirus disease (COVID-19) has significantly affected the mental health of people globally. This study aimed to investigate the mental health status and associated factors among residents of Pakistan. An online questionnaire survey was conducted from April 3 to May 7, 2020, using convenience and snowball sampling techniques. Data regarding demographics, physical health status and contact history during the last 2 weeks were collected. Furthermore, the Depression, Anxiety, and Stress scales (DASS-21) were utilized to measure the mental health of the participants. The analyses included descriptive statistics and regression analysis. Of the 1663 participants who completed this survey, 1598 met the inclusion criteria. The results revealed mild to moderate depression among 390 participants (24.4%), mild to moderate anxiety among 490 participants (30.7%) and mild to moderate stress among 52 participants (3.3%). A majority of the participants rated their health as good (n = 751, 47.0%). Moreover, students reported significantly higher scores on depression (B = 1.29, 95% CI = 0.71-1.88; p < 0.05), anxiety (B = 0.56, 95% CI = -0.06 to 1.18; p < 0.05) and stress (B = 0.56, 95% CI = -0.12 to 1.23; p < 0.05). Physical symptoms, including fever, cough and myalgia, and contact history in the last 14 days reported significant associations with depression, anxiety and stress (p < 0.05). The mental health status of the people was noted to be affected during the COVID-19 outbreak. Assessment of several factors with significant associations with depression, anxiety and stress may aid in developing psychological interventions for vulnerable groups.

Bringing resistance modulation to epidemic methicillin resistant S. aureus of dairy through antibiotics coupled metallic oxide nanoparticles.

The current study probed methicillin resistant S. aureus from milk of different dairy farms along with its response to multiple antibiotics, assessment of risk factors, and response to antibiotic coupled nanoparticle. XRD of Np was confirmed as miller indices (hkl) values i.e. (101), (100), (002), (110), (012) and (013) while STEM finally revealed 40-60 nm nanorods in aggregated form. Total of 6 preparations viz a viz gentamicin (G), chloramphenicol (C), zinc oxide nanoparticle (Np), gentamicin coupled Np (GNp), chloramphenicol coupled Np (CNp), and simultaneously coupling of gentamicin and chloramphenicol on Np (GCNp) were formulated for their potential to bring resistance modulation. Data analysis of this study revealed 24.59% MRSA from dairy milk appearing potentially associated (OR> 1, p < 0.05) with most of assumed risk factors. MRSA in response to various antibiotics showed highest resistance against amoxicillin (100%), penicillin (100%), vancomycin (100%), and linezolid (90%). Zone of inhibitions were increased by 249.76% (GNp), 184.86% (CNp), and 279.76% (GCNp) in case of coupled preparations. Significant reduced minimum inhibitory concentration was observed in case of GCNp (7.8125 ± 0.00 µg/mL) followed by GNp (15.00 ± 0.00 µg/mL) and CNp (41.67 ± 18.042 µg/mL) as compared to Np alone (125.00 ± 0.00 µg/mL). Minimum bactericidal concentrations for GCNp, GNp, and CNp, and Np were 31.125, 62.5, 125, and 500 µg/mL, respectively. The study thus concluded increased prevalence of MRSA while coupling of ZnO nanoparticles with antibiotics significantly brought resistance modulation to MRSA.

Annotation of AMP-activated protein kinase genes and its comparative transcriptional analysis between high and low lipid producing strains of Mucor circinelloides.

BACKGROUND: AMP-activated protein kinase (AMPK) is an important regulator for lipid accumulation, potentially known to have an inhibitory role in lipid synthesis. It inactivates acetyl-CoA carboxylase (ACC), an important regulatory enzyme required for lipid synthesis. However, in Mucor circinelloides, AMPK and its association with lipid accumulation has not been studied yet. OBJECTIVES: To identify AMPK genes in M. circinelloides and to compare their expression levels in high and low lipid-producing strains of M. circinelloides to predict the possible roles of AMPK in lipid metabolism and to select candidate genes for further studies to enhance lipid accumulation. RESULTS: Two genes for α-subunit, one for ß-subunit and six for γ-subunit were identified and annotated. Bioinformatic analysis confirmed the presence of typical conserved domains in these genes. Furthermore, transcriptional profiling displayed marked differences in expression kinetics of subunits among the selected strains. The expression of AMPK genes decreased rapidly in WJ11, high lipid producer strain during the lipid accumulation phase while contrasting profile of expression was observed in CBS 277.49, low lipid producer strain. CONCLUSION: The present study has shown the association of AMPK genes with lipid metabolism at the transcriptional level. The involvement of Snf-α1, Snf-α2, Snf-ß, Snf-γ1, Snf-γ4, Snf-γ5 subunits were shown to be more pronounced and could potentially be further explored in future studies.

Mitochondrial phylogenetic and diversity analysis in Azi-Kheli buffalo.

NOVELTY STATEMENT: The present study was conducted for the first time in Pakistan to investigate Cytochrome C Oxidase Subunit 1 (CO1) gene and full-length Displacement Loop (D-loop) region of mitochondrial DNA in Azi-Kheli buffalo breed native to northern hilly areas of Khyber Pakhtunkhwa Province of Pakistan. The present study was designed to investigate phylogeny and diversity in Azi-Kheli buffalo, through two mitochondrial DNA regions, i.e., Cytochrome C Oxidase Subunit-I (CO1) and Displacement Loop (D-loop) region. Thirty (30) blood samples were taken from Azi-Kheli pure breed animals from original breeding tract, i.e., Khwazakhela, Swat. Polymerase chain reactions using gene-specific primers were carried out for amplifying 709-bp region of CO1 gene and 1159-bp region of D-Loop for identification, phylogeny, and diversity in Azi-Kheli buffalo, respectively. The sequences of CO1 gene revealed four (04) haplotypes, whereas D-loop sequences revealed five (05) haplotypes. Mean interspecific diversity with related species was 2.56%, and mean intraspecific diversity within Azi-Kheli buffalo was 0.25%, estimated via Kimura-2 parameter. Phylogenetic tree (maximum likelihood) revealed clustering of Azi-Kheli haplotypes with river buffalo and is distinct from swamp buffalo and other related species of genus Bubalus. Mean haplotype and nucleotide diversity of D-loop were Hd = 0.9601 ± SD = 0.096 and π = 0.01208 ± SD = 0.00182, respectively. Phylogenetic tree (neighbor-joining) revealed two main clades, i.e., river buffalo and swamp buffalo clade. The haplotypes of Azi-Kheli clustered with haplotypes of different river buffalo breeds at different positions. The current study suggests that Azi-Kheli has common origin with other river buffalo breeds; hence, it is river buffalo which harbors high genetic diversity.

Risk Factors of Mid-upper Arm Circumference (MUAC) Based Child Malnutrition in the Flood-affected Areas of Pakistan: A Cross-sectional Study.

Low- and middle-income countries are usually at high risk of malnutrition. Not only that but the prevalence of malnutrition is much higher. It is important to evaluate the determinants of malnutrition in flood-affected areas of Pakistan. The present study examined the prevalence and risk factors of MUAC-based child malnutrition in flood-hit regions of Khyber Pakhtunkhwa, Pakistan. Multi-stage sampling was employed to select 656 households. Finally, 298 children of 6-59 months were selected. MUAC, an independent anthropometric parameter, was used to investigate the nutritional status of children. An automated logistic regression model was used to identify the risk factors of MUAC-based malnutrition. The prevalence of MUAC-based malnutrition was found 46%, including 40.5% females and 52.1% males. More than 90% of people had improved water quality and soap hand washing facility. Almost 17% of respondents had no toilet facility. Through automated logistic model, child age, maternal age, family size, income level, mother education, water quality, toilet facility were the significant determinants (P < .05) of MUAC-based undernutrition in flood affecting the area. The findings suggest that MUAC-based malnutrition can be minimized in flood-hit areas by targeting the listed risk factors. Community-based awareness programs regarding guidance on nutrition might be a key to reducing malnutrition in the target areas.

Synthesis of Polycyclic Cyclohexadienone through Alkoxy-Oxylactonization and Dearomatization of 3'-Hydroxy-[1,1'-biphenyl]-2-carboxylic Acids Promoted by Hypervalent Iodine.

Alkox-oxylactonization and dearomatization of 3'-hydroxy-[1,1'-biphenyl]-2-carboxylic acid simultaneously promoted by hypervalent iodine have been developed using stoichiometric PhI(OAc)2 or a catalytic amount of chiral aryl-λ3-iodane generated in situ. This reaction provides a concise method to synthesize diverse polycyclic cyclohexadienones as potential inhibitors of DNA polymerase under mild reaction conditions.

Acaricidal efficacy of Calotropis procera (Asclepiadaceae) and Taraxacum officinale (Asteraceae) against Rhipicephalus microplus from Mardan, Pakistan.

Medicinal plants are used by traditional folk healers, modern physicians, and veterinarians as an alternative to conventional drugs to treat a wide range of disorders including parasitic diseases. Some compounds from these plants have been shown to have acaricidal activity and repel arthropods. The cattle tick Rhipicephalus microplus is one of the most destructive pests to the livestock industry in tropical and subtropical parts of the world. The potential to develop herbal acaricides to control R. microplus infestations is critical in maintaining cattle herd productivity, reducing economic losses, and curtailing the overuse of synthetic chemical acaricides. Calotropis procera, the apple of Sodom, and Taraxacum officinale, the common dandelion, were evaluated for acaricidal activity against R. microplus larvae and adults in vitro. Both plant species tested are common indigenous species of Pakistan where R. microplus infestations are widespread across livestock species including cattle, sheep, and goats. Whole-plant extracts derived from C. procera and T. officinale significantly reduced the index of egg laying (P < 0.01) and increased the percent inhibition of oviposition of adult female ticks at a concentration of 40 mg/mL when assessed by the adult immersion test (AIT). Calotropis procera and T. officinale treatments at the same concentration also resulted in larval mortality of 96.0% ± 0.57 and 96.7% ± 0.88, respectively, as measured using the larval packet test (LPT). An increasing range of extract concentrations was tested to determine the LD50 and LD90 for C. procera, 3.21 and 21.15 mg/mL, respectively, and T. officinale, 4.04 and 18.92 mg/mL, respectively. These results indicate that further studies are warranted to determine the relative contribution of individual phytochemicals from whole-plant extracts on acaricidal activity. This information will guide the design of further acaricidal efficacy tests using livestock infested with R. microplus.

Copper-Catalyzed Oxidative Difunctionalization of Terminal Unactivated Alkenes.

The copper(II)-promoted free-radical oxidative difunctionalization of terminal alkenes to access ketoazides by utilizing molecular oxygen has been reported. A series of styrene derivatives have been evaluated and were found to be compatible to give the desired difunctionalized products in moderate to good yields. The role of molecular oxygen both as an oxidant and oxygen atom source in this catalytic transformation has been unquestionably demonstrated by 18O-labeling studies and a radical mechanistic pathway involving the oxidative formation of azidyl radicals is also designed. This environment-friendly catalytic oxidative protocol can transform aldehyde to nitrile.

Biodegradable Ingredient-Based Emulgel Loaded with Ketoprofen Nanoparticles.

Biodegradable materials are extensively employed to design nanocarriers that mimic extracellular environment in arthritis. The aim of this study was to formulate and characterize biocompatible, biodegradable ketoprofen-loaded chitosan-chondroitin sulfate (CHS-CS) nanoparticles with natural ingredients for transdermal applications. Polymers used in the design of nanocarriers are biodegradable and produce synergistic anti-inflammatory effect for the treatment of arthritis. For transdermal application, argan oil-based emulgel is utilized to impart viscosity to the formulation. Furthermore, naturally occurring argan oil synergizes anti-inflammatory effect of formulation and promotes skin penetration. CHS and CS form nanoparticles by polyelectrolyte complex formation or complex coacervation at pH 5.0. These particles were loaded into argan oil-based emulgel. Employing this method, nanoparticles were formulated with particle size in the range of 300-500 nm. These nanocarriers entrapped ketoprofen and showed more than 76% encapsulation efficiency and 77% release of the ketoprofen at pH 7.4 within 72 h. Drug releases from CHS-CS nanoparticles by mechanism of simple diffusion. Nanoparticle-loaded argan oil emulgel significantly enhanced skin penetration of ketoprofen as compared to marketed gel (p < 0.05). Nanocarriers prepared successfully delivered drug through transdermal route using natural ingredients. Graphical abstract ᅟ.

Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab a comparative overview.

OBJECTIVE: To compare the success in patients having vitreous hemorrhage undergoing pars plana vitrectomy with or without preoperative intravitreal injection of Bevacizumab. METHODS: This Randomized controlled trial was conducted at Department of Ophthalmology, Jinnah Postgraduate Medical Centre. Karachi. Duration of study was six months from January 2010 to June 2010. In this study 56 patients of advanced diabetic eye disease were divided into two groups. Patients in Group-A underwent three ports pars plana vitrectomy with preoperative intravitreal injection of Bevacizumab (Avastin) 1.25mg/0.05ml, 3.5mm from the limbus seven days before surgery and in Group-B patients underwent vitrectomy without preoperative intravitreal Bevacizumab (Avastin). Intraoperative bleeding was monitored in both groups and was graded as no bleeding, mild bleeding and severe bleeding. The results were statistically analyzed through computer software SPSS 17. RESULTS: Twenty eight patients in Group-A who were given an injection of intravitreal Bevacizumab (Avastin) before surgery, intraoperative bleeding monitored was, no bleeding in 17 cases (60.7%), mild was observed in 6 cases (21.4%) and severe bleeding requiring diathermy to stop was observed in only 5 cases (17.9%). 28 patients in Group-B that underwent surgery without Avastin no bleeding was observed in only 2 cases (7.1%), mild in 6 cases (21.4%) and severe in 20 cases (71.4%). CONCLUSIONS: Intravitreal injection of Bevacizumab (Avastin) was effective before vitrectomy in the surgical management of Advanced Diabetic Eye disease.

Incidence and associated risk factors of low birth weight babies born in Shaikh Khalifa Bin Zayad Al-Nayan Hospital Muzaffarabad, Azad Jammu and Kashmir.

BACKGROUND AND OBJECTIVE: Birth weight is the most important factor that affects infant and child mortality. The most common cause of low birth is malnutrition before and during the pregnancy period. The present study was conducted to explore the associated risk factors of low birth weight which will be helpful to undertake effective measures to reduce the incidence of the low birth weight babies. METHODS: The study was conducted at Shaikh Khalifa Bin Zayad Al-Nayan Hospital Muzaffarabad. A sample size of 1603 live births over a period of five months were analyzed. The pregnant women were recruited in the last trimester of their pregnancy and followed up till their delivery. Information regarding maternal age, parity, income of family, gestational age, maternal occupation, degree of illiteracy, birth interval was collected. The birth weight was recorded within 24 hours of delivery. Data analysis was done using Graph Pad Prism version 6.0. RESULTS: Data of 1863 birth out of which 1603 were live births and among these live births, 1442 were normal birth weight babies and 161 number of low birth weight (LBW) were analyzed. The incidence of LBW in this study was (10.04%). LBW was more common in female (n=84) than in male (n=77) babies. However, this difference was statistically insignificant. Among different risk factors maternal age (p<0.05), parity (P = 0.0167), income of family (P = 0.0190), has a statically significant association with incidence of LBW. The gestational age of mother, maternal occupation, degree of illiteracy was found to affect the incidence of LBW babies, however the difference was found to be statistically insignificant for LBW. Birth interval less than three years and low hemoglobin level (P<0.0260) was found to have a significant association with LBW babies. CONCLUSION: LBW a common problem in Pakistan is an important factor for perinatal mortality and morbidity. Among different risk factors maternal age, parity, income of family, gestational age of mother, maternal occupation, degree of illiteracy, birth interval less than three years were found to be the important risk factors contributing to LBW babies born in Shaikh Khalifa Bin Zayad Al- Nayan Hospital Muzaffarabad.

Morbidity analysis in minimally invasive esophagectomy for oesophageal cancer versus conventional over the last 10 years, a single institution experience.

BACKGROUND: There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer. OBJECTIVES: The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute. METHODS: All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Clavien-Dindo classification system. Long-term outcomes are long-term procedure related complications over a minimum follow-up of 1 year. Trends were analysed by visually inspecting the graphic plots for mean number of events in each group each year. RESULTS: Our results showed no difference in mortality, length of hospital and ICU stays and incidence of major complications between three groups on uni- and multi-variate analysis (P > 0.05). The operative time was significantly longer in MIE group (odds ratio [OR]: 1.66, confidence interval [CI]: 2.4-11.5). The incidence of long-term complication was low for MIE (OR: 1.0, CI: 133-1.017). However, all post-operative surgical outcomes trended to improve in both groups over the course of this study and stayed better for MIE group except for the operative time. CONCLUSION: MIE has overall comparable surgical outcomes to its conventional counterpart. Furthermore, the peri-operative outcomes tend to improve in our centre with the maturation of program and experience.

Medical Students' Stress, Psychological Morbidity, and Coping Strategies: a Cross-Sectional Study from Pakistan.

OBJECTIVE: The authors studied the prevalence of psychological morbidity, sources and severity of stresses, as well as coping strategies in Pakistani medical students. METHODS: Medical students in Lahore, Pakistan, completed a cross-sectional, self-administered questionnaire in 2013 on the sources and severity of various stressors. The General Health Questionnaire-12 (GHQ-12) and Brief COPE assessed the psychological morbidity and coping strategies. RESULTS: Out of 1500 students, 527 responded to the survey. The prevalence of psychological morbidity was 23.3%; 52.3% respondents showed evidence of distress. By logistic regression analysis, GHQ-12 caseness was associated with being male and occurrence of health-related stressors. The most common stressors were related to academic concerns. Coping strategies showed variation by GHQ-caseness. CONCLUSION: The significant psychological morbidity and distress warrants establishing support systems to support students and bringing about evidence-based changes to teaching and evaluation systems. Adequate counseling facilities should be made available and students encouraged to seek help.

Clinical profile, treatment and survival outcomes of peadiatric germ cell tumours: A Pakistani perspective.

Germ Cell Tumours (GCTs) are rare tumours. Generally 80% are benign and 20% malignant with a bimodal age distribution. The retrospective study was conducted at Shaukat Khanum Cancer Hospital, Lahore, Pakistan, and comprised all paediatric patients below 18 years of age who received treatment for histology-proven GCT from 2006 to 2014. Of the 207 patients, 98(42.3%) were males and 109(52.7%) were females. The most common GCT was yolk sac tumour in 90(43.5%) children followed by mixed GCT in 40(19.3%) and dysgerminoma in 34(16.4%). Gonads were most commonly involved in 165(79.7%) patients with metastasis in 24(11.6%) at presentation and recurrence in 26(12.5%) patients. Overall, 133(64.3%) patients are well and followed up at regular intervals and 55(26.5%) have been lost to follow-up with an expected overall 5-year median survival of 45%. Despite the distinct clinical profile of paediatric GCT, survival can be improved by early diagnosis, regimented treatment according to set guidelines, protocols and by improving follow-up.

Mother's perceptions of child mental health problems and services: A cross sectional study from Lahore.

OBJECTIVE: To assess the perceptions of mothers regarding child mental health problems, its causes, preferred treatment options, and to determine whom they would consult, if their child had a psychiatric illness. METHODS: Following informed consent, a questionnaire covering perceptions regarding various aspects of child mental illness was used for data collection from mothers. They were asked to identify the symptoms and behaviours they considered psychopathological in children, which treatments they would prefer, where they would turn for help with a mentally ill child, and their understanding of the causes of child psychiatric disorders in addition to ways to increase awareness of child psychiatric issues in the society. RESULTS: Ninety one mothers participated in the study. They equally perceived emotional, behavioural and cognitive symptoms as suggestive of mental ill health in childhood. Mothers perceived multiple causes of child mental health problems, including family problems, economic difficulties, social adversity and possession by evil spirits. A substantial proportion preferred medication, recitation of Holy Quran and psychotherapy as the preferred treatment options. Overall, mothers preferred consulting health professionals than religious scholars and faith healers. They were keen for steps to increase mental health awareness within their society. CONCLUSION: Despite different cultural perspective, mothers exhibit good understanding of symptoms of child mental health issues and appear open to various services and treatment options. Understanding parental perceptions and expectations from child psychiatric services are crucial in increasing families' engagement in treatment.

COMPARISON OF EFFICACY OF SPINAL ANAESTHESIA AND SUB- FASCIAL LOCAL ANAESTHETIC INGUINAL FIELD BLOCK FOR OPEN INGUINAL HERNIA REPAIR-A SINGLE INSTITUTIONAL EXPERIENCE.

BACKGROUND: The use of local anaesthetic for open inguinal hernia surgery has long been restricted to specialist centres. This study aimed to compare the efficacy of spinal anaesthesia and sub-fascial local anaesthetic (LA) for performing open hernia repair and at the same time provide better post op pain relief and early mobilization. Methods: In this randomized clinical trial, 62 male patients aged 16-72 were randomly allocated to two groups. Group A received mixture of 20 ml 0.5% bupivacain,20ml 2% lignocaine with adrenaline, 20m normal saline (N/S), 3 ml NaHCO3 sub-fascially for Local-anaesthetic (LA) inguinal field. block, while Group B received Spinal Anaesthesia (SA) with 0.5% Bupivacaine. Comparison was made in terms of Visual Analogue Score (VAS) recorded intra-operatively at 0 and 30 minutes and post operatively at 2, 4 and 12 hours at rest and on movement. Need for rescue analgesia and total analgesic consumption in both groups were calculated. Interval to pain free ambulation as well as procedural and anaesthesia related complications were compared. Results: Mean VAS in the intraoperative period were significantly high in Group A (p-value 0.011) at the start of operation and at 30 minutes (p-value <0.001). However, it did not correlate with patient satisfaction as 90% of patients in Group A successfully underwent the procedure without need for supplemental analgesia. VAS scores at rest and on movement/cough were comparable in the post op period at 2, 4 and 12 hours in both groups. Interval to pain free ambulation was significantly low in Group A (p-value 0.0012). CONCLUSION: Sub facial LA inguinal field block provides effective anaesthesia with optimum post op analgesia, prompt recovery and fewer systemic side effects compared to SA and can safely be used for routine open inguinal hernia surgery.