Antimalarial drug efficacy and resistance in malaria-endemic countries in HANMAT-PIAM_net countries of the Eastern Mediterranean Region 2016-2020: Clinical and genetic studies.

INTRODUCTION: The World Health Organization recommends regular monitoring of the efficacy of nationally recommended antimalarial drugs. We present the results of studies on the efficacy of recommended antimalarials and molecular markers of artemisinin and partner resistance in Afghanistan, Pakistan, Somalia, Sudan and Yemen. METHODS: Single-arm prospective studies were conducted to evaluate the efficacy of artesunate-sulfadoxine-pyrimethamine (ASSP) in Afghanistan and Pakistan, artemether-lumefantrine (AL) in all countries, or dihydroartemisinin-piperaquine (DP) in Sudan for the treatment of Plasmodium falciparum. The efficacy of chloroquine (CQ) and AL for the treatment of Plasmodium vivax was evaluated in Afghanistan and Somalia, respectively. Patients were treated and monitored for 28 (CQ, ASSP and AL) or 42 (DP) days. Polymerase chain reaction (PCR)-corrected cure rate and parasite positivity rate at Day 3 were estimated. Mutations in the P. falciparum kelch 13 (Pfk13) gene and amplifications of plasmepsin (Pfpm2) and multidrug resistance-1 (Pfmdr-1) genes were also studied. RESULTS: A total of 1680 (249 for ASSP, 1079 for AL and 352 for DP) falciparum cases were successfully assessed. A PCR-adjusted ASSP cure rate of 100% was observed in Afghanistan and Pakistan. For AL, the cure rate was 100% in all but four sites in Sudan, where cure rates ranged from 92.1% to 98.8%. All but one patient were parasite-free at Day 3. For P. vivax, cure rates were 98.2% for CQ and 100% for AL. None of the samples from Afghanistan, Pakistan and Yemen had a Pfk13 mutation known to be associated with artemisinin resistance. In Sudan, the validated Pfk13 R622I mutation accounted for 53.8% (14/26) of the detected non-synonymous Pfk13 mutations, most of which were repeatedly detected in Gadaref. A prevalence of 2.7% and 9.3% of Pfmdr1 amplification was observed in Pakistan and Yemen, respectively. CONCLUSION: High efficacy of ASSP, AL and DP in the treatment of uncomplicated falciparum infection and of CQ and AL in the treatment of P. vivax was observed in the respective countries. The repeated detection of a relatively high rate of Pfk13 R622I mutation in Sudan underscores the need for close monitoring of the efficacy of recommended ACTs, parasite clearance rates and Pfk13 mutations in Sudan and beyond. Registration numbers of the trials: ACTRN12622000944730 and ACTRN12622000873729 for Afghanistan, ACTRN12620000426987 and ACTRN12617001025325 for Pakistan, ACTRN12618001224213 for Somalia, ACTRN12617000276358, ACTRN12622000930785 and ACTRN12618001800213 for Sudan and ACTRN12617000283370 for Yemen.

Pilot Study Evaluating Cross-Disciplinary Educational Material to Improve Patients' Knowledge of Palliative Radiation Therapy.

Palliative radiation therapy (PRT) is underutilized, partially due to misconceptions about its risks, benefits, and indications. The objective of this pilot study was to determine if patients with metastatic cancer would gain knowledge from educational material describing PRT and perceive it as useful in their care. A one-page handout conveying information about the purpose, logistics, benefits, risks, and common indications for PRT was offered to patients undergoing treatment for incurable, metastatic solid tumors in one palliative care clinic and four medical oncology clinics. Participants read the handout, then completed a questionnaire assessing its perceived value. Seventy patients participated between June and December 2021. Sixty-five patients (93%) felt they learned from the handout (40% learned "lots"), and 69 (99%) felt the information was useful (53% "very useful"). Twenty-one patients (30%) were previously unaware that PRT can relieve symptoms, 55 (79%) were unaware that PRT can be delivered in five treatments or less, and 43 (61%) were unaware that PRT usually has few side effects. Sixteen patients (23%) felt they currently had symptoms not being treated well enough, and 34 (49%) felt they had symptoms that radiation might help with. Afterwards, most patients felt more comfortable bringing symptoms to a medical oncologist's (n = 57, 78%) or radiation oncologist's (n = 51, 70%) attention. Patient-directed educational material about PRT, provided outside of a radiation oncology department, was perceived by patients as improving their knowledge and adding value in their care, independent of prior exposure to a radiation oncologist.

Impacts of COVID-19 on Transport Modes and Mobility Behavior: Analysis of Public Discourse in Twitter.

This study proposes a framework to analyze public discourse in Twitter to understand the impacts of COVID-19 on transport modes and mobility behavior. It also identifies reopening challenges and potential reopening strategies that are discussed by the public. First, the study collects 15,776 tweets that relate to personal opinions on transportation services posted between May 15 and June 15, 2020. Next, it applies text mining and topic modeling techniques to the tweets to determine the prominent themes, terms, and topics in those discussions to understand public feelings, behavior, and broader sentiments about the changes brought about by COVID-19 on transportation systems. Results reveal that people are avoiding public transport and shifting to using private car, bicycle, or walking. Bicycle sales have increased remarkably but car sales have declined. Cycling and walking, telecommuting, and online schools are identified as possible solutions to COVID-19 mobility problems and to reduce car usage with an aim to tackle traffic congestion in the post-pandemic world. People appreciated government decisions for funding allocation to public transport, and asked for the reshaping, restoring, and safe reopening of transit systems. Protecting transit workers, riders, shop customers and staff, and office employees is identified as a crucial reopening challenge, whereas mask wearing, phased reopening, and social distancing are proposed as effective reopening strategies. This framework can be used as a tool by decision makers to enable a holistic understanding of public opinions on transportation services during COVID-19 and formulate policies for a safe reopening.

Promoting continence in older people.

The prevalence of urinary incontinence (UI) is strongly associated with increasing age. Twenty five percent of women over 80 years of age have clinically significant symptoms in population surveys, but prevalence is as high as 70% in older hospital in-patients and residents of care homes with nursing. UI substantially affects quality of life and well-being, and generates significant economic burden for health and social care. Sadly, UI is considered as taboo by society, leading to isolation, depression and reluctance to seek help. As with all aspects of care of older people, a multi-modal approach to assessment and management is needed. Key to effective management of incontinence is recognition. As a minimum, clinicians should actively ask patients about continence, especially in older adults living with frailty. Careful evaluation and establishment of any underpinning diagnosis and aetiological factors requires comprehensive, multimodal, usually multidisciplinary, assessment. A lack of awareness of the problem and what can be done about it exists in both laypeople and clinicians, this needs correcting. An interdisciplinary approach to research and management must be the way into the future.

Physical activity in Pakistani perspective: issues, implications, and recommendations.

It has been established that the benefits of physical activity on physical, psychological and social aspects of humans are substantially correlated with cardiovascular disorders, obesity, cancer, social anxieties and depressions, and enhanced socio-economic profile. In children and adolescents, physical activity has been correlated with academic achievements, social harmony and mental health. Similarly, in adults/old people, physical activity has been of variable benefits, bringing the chances of prolonged healthier lives. Though substantial work has been reported globally, there still is a paucity of literature in Pakistan regarding various aspects of physical activity. The current narrative review was planned to summarise the research work conducted in, or has emanated from, Pakistan in teens/college/school and university students, and adults from Pakistan on associated aspects of physical activity, its present scenario, pitfalls, future horizons, and to ultimately deduce gaps in research areas which can be taken up for the directional approach to enhance physical activity within the Pakistani community.

Profile and outcomes of in-hospital cardiac arrest in a paediatric emergency department.

A retrospective study was conducted to determine the profile and outcome of patients who experienced in-hospital cardiac arrest (IHCA) in an emergency department (ED), from January to December 2017. Newborns of day one till children 14 years of age who suffered cardiac arrest during their stay in the ED of National Institute of Child Health, Karachi, Pakistan, were included in the study. The outcome variables were the return of spontaneous circulation and survival before final discharge from the ED. IHCA was observed in 935 (4.82%) out of the 19,385 children studied, while in 568 (61%) children spontaneous circulation was restored. Most of the patients who suffered IHCA were infants, i.e. 719 (77%). A significant association of return of spontaneous circulation and survival till final discharge from the ED was observed with age (p-value <0.001) and mode of arrival at the hospital (p-value <0.001). Thus, IHCA was reported in approximately five percent of patients and return of spontaneous circulation was reported in 61 percent.

Transforming universities in interactive digital platform: case of city university of science and information technology.

The purpose of this research was to understand the automation of Higher Education Institutes (HEIs), and to evaluate the automated process from the perspective of developing country. A single case study of City University of Science and Information Technology (CUSIT), Pakistan was selected as a unit of analysis. Mix methodology was used in this research. Semi-structured in-depth interviews were conducted from the top management as a primary source while secondary data regarding usage and functions of LMS was collected for the period of 2 years (four semesters Fall-2017-Spring 2019). Data from both sources was utilized, and triangulated for case building and analysis. It was found that CUSIT has a state-of-the-art automated infrastructure, management information system (MIS) and learning management system (LMS) which facilitates faculty, staff and administration. LMS provides an integrated and digital platform to key stakeholders particularly to the teachers for sharing course outlines, lesson plan, assignment generation and submission, announcements and generating assessment reports. Similarly, the student gets access to all course material, assignments, assessment report, notices, and other relevant information at any point of time. However, the system lacks some of the major E-learning features with limited support to the large file size, real time learning, online classes, real time feedback and query system etc. Furthermore, this study identified few seldomly used functions of automated system as well as few duplications and operational activities which requires consideration by the management. The case of CUSIT proves to be a practical case for all those universities who are facing challenges due to corona virus pandemic and are looking for a solution to continue education through distance learning and e-learning platforms. This study supports the automation of HEIs and provides lesson learned for the academia and management of HEIs by identification of success features as well as limitations of the system.

Outcome of Core Binding Factor Acute Myeloid Leukemia in Children: A Single-Center Experience.

Childhood acute myeloid leukemia (AML) harboring core binding factor (CBF)-associated translocations are considered as a favorable cytogenetic subgroup. The 2 major subtypes of CBF-AML include t(8;21) and inversion of chromosome 16, accounting for ∼25% of patients. Because of expensive and toxic treatment, which may require hospitalization during the entire course of induction chemotherapy, most of the centers in Pakistan neither workup for this low-risk entity nor offer curative treatment. Therefore, we adopted an approach of screening AML cases for the presence of CBF with the rationale of offering curative treatment to this subgroup. Data of 244 cases were reviewed, and translocations were found in 72 (34%) patients among them, 59 (82%) had t(8;21) and 13 (18%) showed inversion of chromosome 16. The event-free survival with and without abandonment was 36% and 40%, respectively. Among 44 patients who completed treatment, 26 (59%) are leukemia-free, while 18 (41%) relapsed. None of the relapsed patients received salvage chemotherapy or hematopoietic stem cell transplant. Treatment-related mortality and abandonment was found in 24% and 10% of patients, respectively. The frequency of CBF-AML is higher in our study; however, poor outcome demands holistic measures in supportive care to improve the survival.

Engineering the optical properties of dielectric nanospheres by resonant modes.

Recent progress in nanoscale optical physics is associated with the development of a new branch of nanophotonics exploring strong Mie resonances in dielectric nanoparticles with high refractive index (HRI). The high-index resonant dielectric nanostructures form building blocks for novel photonic meta-devices with low losses and advanced functionalities. In this work, we investigate the size effect of an HRI cuprous oxide (Cu2O) nanosphere on the optical properties of the structure, such as, scattering and absorption spectrum. We also experimentally demonstrate that the scattering field can be significantly engineered by tuning the radius of Cu2O. It is found that the resonant eigenmodes supported by the nanospheres play the dominant role in the absorption and scattering characteristic of the structure. From the perspective of eigenmodes, we can immediately find the right structure parameters to realize strong absorption (scattering) at either single wavelength or broadband wavelength. Furthermore, the multipole expansion method has been applied to explore the physical nature (i.e. electric mode or magnetic mode) of the eigenmode as well as contributions from different modes.

Ferromagnetism in CVT grown tungsten diselenide single crystals with nickel doping.

Two dimensional (2D) single crystal layered transition materials have had extensive consideration owing to their interesting magnetic properties, originating from their lattices and strong spin-orbit coupling, which make them of vital importance for spintronic applications. Herein, we present synthesis of a highly crystalline tungsten diselenide layered single crystal grown by chemical vapor transport technique and doped with nickel (Ni) to tailor its magnetic properties. The pristine WSe2 single crystal and Ni-doped crystal were characterized and analyzed for magnetic properties using both experimental and computational aspects. It was found that the magnetic behavior of the 2D layered WSe2 crystal changed from diamagnetic to ferromagnetic after Ni-doping at all tested temperatures. Moreover, first principle density functional theory (DFT) calculations further confirmed the origin of room temperature ferromagnetism of Ni-doped WSe2, where the d-orbitals of the doped Ni atom promoted the spin moment and thus largely contributed to the magnetism change in the 2D layered material.

Profile and outcomes of critically ill children in a lower middle-income country.

OBJECTIVE: To determine the clinical profile and outcome of critically ill children presenting to a paediatric ED in a lower middle-income country. METHODS: We performed a retrospective analysis of children (<14 years) presenting to the ED of the National Institute of Child Health, Karachi, between January and December 2014 who were assigned to acuity 1 (requiring immediate life-saving interventions) according to the Emergency Severity Index. Data included demographic variables, presenting complaints, interventions and outcomes in the ED. RESULTS: There were 172 162 visits during the year. Of these, 13 551 (8%) were level 1. 64% of level 1 patients were transported to the ED without ambulance service. Neonates (0-28 days) constituted 48% of level 1 children; their most frequent presenting complaints were respiratory symptoms, followed by fever and reluctance to feed. Above the neonatal age group, the most common presenting complaints were gastrointestinal symptoms (with signs of hypoperfusion), followed by seizures, reluctance to feed and respiratory symptoms. 64% of children of >28 days presenting were malnourished. Interventions included cardiopulmonary resuscitation, application of bubble continuous positive airway pressure and endotracheal intubation. Overall mortality was 13%; 63% of all deaths were in the neonatal age group. CONCLUSION: Children with the highest triage acuity represent 8% of all visits to a paediatric ED. In this group, neonates account for nearly half of all the children, and more than half of all the deaths among critically ill children came in ED. A large proportion of high-acuity children are malnourished.

Factors associated with low birthweight in term pregnancies: a matched case-control study from rural Pakistan.

Low birthweight (LBW) remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy (AOR: 2.68; 95% CI: 1.59 - 4.38), nulliparity (AOR: 1.82; 95% CI: 1.26-2.44), having a previous miscarriage/abortion (AOR: 1.22; 95% CI: 1.06-2.35), having < 2 antenatal care (ANC) visits during last pregnancy (AOR: 2.43; 95% CI: 1.34-2.88), seeking ANC in third trimester (AOR: 3.62; 95% CI : 2.14-5.03), non-use of iron folic acid during last pregnancy (AOR: 2.72; 95% CI: 1.75-3.17), having hypertension during last pregnancy (AOR: 1.42; 95% CI: 1.13-2.20), being anemic (AOR: 2.67; 95% CI: 1.65-5.24) and having postpartum weight of <45 kg (AOR: 3.30; 95% CI : 1.97-4.52) were significantly associated with an increased odds of having a LBW baby. Our study identifies modifiable risk factors requiring immediate commitment from the health authorities.

Synthesis of Ni9S8/MoS2 heterocatalyst for Enhanced Hydrogen Evolution Reaction.

We demonstrate a heterostructure Ni9S8/MoS2 hybrid with tight interface synthesized via an improved hydrothermal method. As compared to pure MoS2, the increased surface area and the shorten charge transport pathway in the layered hybrid significantly promote the photocatalytic efficiency for hydrogen evolution reaction (HER). In particularly, the optimized Ni9S8/MoS2 hybrid with 20 wt % Ni9S8 exhibits the highest photocatalytic activity with HER value of 406 µmolg-1h-1, which is enhanced by 70% compared to that of pure MoS2 nanosheets (285.0 µmolg-1h-1). Moreover, the value is 4 times more than the commercial MoS2 (92.0 µmolg-1h-1), indicating the high potential of the hybrid in the catalytic fields.

Light scattering by subwavelength Cu2O particles.

Novel metamaterials with new capabilities to manipulate light may be used by considering basic building blocks with new optical properties. This is the case with resonant magneto-dielectric particles. In this work, the resonant response of a high-dielectric Cu2O subwavelength particle is analyzed, both analytically and experimentally. The emergence of electric and magnetic resonances and their interferential effects, producing directional behaviors, can be used in a new generation of metamaterials, as well as new integrated optical devices.

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan.

BACKGROUND: Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). METHODS: We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. RESULTS: Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age < 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = < 12 months (AOR 1.7 1.4-2.2), having a parity of >2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach's alpha of 0.85. CONCLUSIONS: This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan.

A mixed methods study to assess the effectiveness of food-based interventions to prevent stunting among children under-five years in Districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol.

BACKGROUND: Maternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to prevent stunting in children under-five years. METHODS: A mixed methods study design will be conducted to evaluate the effectiveness of food-based interventions to prevent stunting among children under-five years in districts Thatta and Sujawal, Sindh Province, Pakistan. The study will include cross sectional surveys, a community-based cluster randomized controlled trial and a process evaluation. The study participants will be pregnant women, lactating mothers and children under-five years. The cross-sectional surveys will be conducted with 7360 study participants at baseline and endline. For the randomized control trial, 5000 participants will be recruited and followed monthly for compliance of food-based supplements, dietary diversity, pregnancy outcomes, and maternal and child morbidity and mortality. Anthropometric measurements and hemoglobin levels will be measured at baseline, quarterly and at endline. The interventions will consist of locally produced lipid-based nutrient supplement (Wawamum) for children 6-23 months, micronutrient powders for children 24-59 months, and wheat soya blends for pregnant and lactating mothers. Government lady health workers will deliver interventions to participants. The effectiveness of the project will be measured in terms of the impact of the proposed interventions on stunting, nutritional status, micronutrient deficiencies, and other key indicators of the participants. The process evaluation will assess the acceptability, feasibility and potential barriers of project implementation through focus group discussions, key informant interviews and household surveys. Data analysis will be conducted using STATA version 12. DISCUSSION: There is considerable evidence on the effectiveness of food-based interventions in managing stunting in developing countries. However, these studies do not account for the local environmental factors and widespread nutrient deficiencies in Pakistan. These studies are often conducted in controlled environments, where the results cannot be generalized to programs operating under field conditions. The findings of this study will provide sufficient evidence to develop policies and programs aimed to prevent stunting in children 6-59 months and to improve maternal and child health and growth outcomes in poor resource settings. TRIAL REGISTRATION: NCT02422953 . Registered on April 15, 2015.

Overcrowding and possible solutions for a busy paediatric emergency department.

OBJECTIVE: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions. METHODS: This retrospective study was conducted at the National Institute of Child Health, Karachi, and comprised data of all patients presenting to the emergency department from November 2014 to January 2015. Data was collected through the health management information system which generates daily report of patients. Patients who stayed at the emergency department for 4 or more hours were included. RESULTS: Of the 6,505 patients, 2,757(42.38%) were discharged straightaway while 2,555(39.27%) were admitted to different wards and subspecialties. Besides, 934(14.35%) patients left the department against medical advice, 147(2.25%) expired, 89(1.36%) were referred to other hospitals, 20(0.30%) were dead on arrival and 3(0.04%) left without being seen by a physician. Of those who were admitted, 1,049(41%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in paediatric and neonatal intensive care units, not using checklist for proper re-assessment of patients and early discharge, overburdened by patients coming in just for nebulisation and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards. CONCLUSIONS: The emergency department of the hospital faced significant overcrowding which overwhelmed efficient standard care.

All-Carbon Ultrafast Supercapacitor by Integrating Multidimensional Nanocarbons.

Ultrafast and high capacity all-carbon supercapacitors with 3D porous aerogel electrode are realized by combining carbon nanostructures of various dimensionalities, including 0D carbon onions, 1D carbon nanotubes, and 2D graphene oxide. The synergistic effects from the different forms of nanocarbons render this hybrid outstanding capacitance with excellent stability, even at ultrafast charge-discharge rates.

Growing and Etching MoS2 on Carbon Nanotube Film for Enhanced Electrochemical Performance.

In this work we directly synthesized molybdenum disulfide (MoS2) nanosheets on carbon nanotube film (MoS2@CNT) via a two-step chemical vapor deposition method (CVD). By etching the obtained MoS2@CNT into 10% wt HNO3, the morphology of MoS2 decorated on CNT bundles was modulated, resulting in more catalytic active MoS2 edges being exposed for significantly enhanced electrochemical performance. Our results revealed that an 8 h acid etching sample exhibited the best performance for the oxygen evolution reaction, i.e., the current density reached 10 mA/cm² under 375 mV over-potential, and the tafel slope was as low as 94 mV/dec. The enhanced behavior was mainly originated from the more catalytic sites in MoS2 induced by the acid etching treatment and the higher conductivity from the supporting CNT films. Our study provides a new route to produce two-dimensional layers on CNT films with tunable morphology, and thus may open a window for exploring its promising applications in the fields of catalytic-, electronic-, and electrochemical-related fields.

Percutaneous Ilio-sacral Screw Fixation for Unstable Pelvic Ring Injuries.

This prospective interventional study was planned to determine the clinical and radiological outcome of percutaneous iliosacral screw fixation for unstable pelvic ring injuries. It was conducted from March 2008 to June 2014 at the Department of Orthopaedic Surgery Combined Military Hospital (CMH) at Lahore, Multan, Rawalpindi and Muzaffarabad. It comprised 50 patients with unstable pelvic ring injuries. Visual analogue scale (VAS), Majeed pelvic score and Lindahl criteria were used for functional and radiological outcomes assessment. The mean age of the patients was 47.82±8.94 years. Moreover, 33(66%) participants were males and 17(34%) were females. The mean pre-operative Majeed and VAS scores were 38.98±6.28 and 9.04±0.67, respectively. Operating time and blood loss were reduced significantly. VAS score for post-operative pain was 3.82±1.26 at 1 month and decreased further to 2.68±1.30 at 12 months post-operatively (p<0.001). Radiological outcome and the post-operative Majeed scores were good to excellent in 43(86%) cases. Thus Percutaneous iliosacral screw fixation of unstable pelvic ring injuries resulted in excellent radiological and functional outcome with significantly decreased post-operative VAS score for SI joint pain.