Aim: To determine the outcomes of phacoemulsification also examine the complications associated to phacoemulsification combined with pars plana vitrectomy. Study design: Observational study Place and duration of study: Department of Ophthalmology, Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital, Sialkot, from 15th July 2020 to 14thJanuary 2021. Methodology: Twenty patients of both genders whom had undergoing phacovitrectomy were included. Patient’s ages were ranging from 20 to 80 years. Patient’s detailed medical histories were examined after taking informed consent. Patient’s retinal diagnosis, intraocular pressure, visual acuity, intra and post-operative complications were recorded. All the patients had received clear corneal phacoemulsification and 23-guage pars plana vitrectomy. Results: There were 15(75%) male patients while 5(25%) female patients with mean age was 54.52±12.45 years. Five patients (25%) had vitreos hemorrhage, 7(35%) patients had rhegmatogenous retinal detachment, 3(15%) patients had intraocular foreign body, 2(10%) had epiretinal membrane, 2(10%) had macular hole and 1(5%) had tractional retinal detachment. Miosis and rupture of posterior capsule were the most common intraoperative complications found in 85% and 10%. Fibrin was found in 3 (15%) cases, posterior synechia was found in 2 (10%) cases. Conclusion: The phacoemulsification with pars plana vitrectomy is safe and effective treatment modalities in patients with cataract coexist with vitreoretinal disease. Keywords: Phacoemulsification, Pars plana vitrectomy, Cataract, Complications, Outcomes

Introduction: Moyamoya disease (MMD) is a chronic cerebral hypoperfusion state with increased narrowing of the intracranial internal carotid artery. Objectives: The main objective of the study is to analyses the delta-like factor 1 negatively regulates angiogenesis as a target gene of miR-126-5p after indirect revascularization surgery in patients with moyamoya disease. Material and methods: This retrospective study was conducted in Akhtar Saeed Medical College Lahore during 2020 to 2021. First, we compared the DLK1 expression in DM tissues from patient with moyamoya disease (n = 8) and unruptured aneurysms (n = 8, control group). DM samples (1.0 × 0.5 cm) were collected from patients with moyamoya disease during revascularization procedures. DM samples were harvested from the temporal part of the head and stored for further use. Results: EPC markers CD31, VE-cadherin, and VEGFR-2 were strongly expressed in cultured cells, while hematopoietic marker CD133 did not display remarkable expression, suggesting highly purified EPC isolation. Practical implication: This study will be helpful in EC proliferation and angiogenesis. Conclusion: It is concluded that DLK1, a target gene of miR-126-5p, negatively regulates EC proliferation and angiogenesis and that downregulating DLK1 expression potentially promotes angiogenesis in chronically ischaemic brains. Keywords: DLK1, EC, Proliferation, Angiogenesis

Introduction: The decision of a patient for leaving the hospital against medical advice (AMA)affects the patient management adversely by increasing morbidity, mortality and escalates the cost of treatment. Objectives: The main objective of the study is to find the factors predicting leaving against medical advice in neurosurgery. Material and methods: This cross-sectional study was conducted in King Edward Medical University during February 2022 to July 2022. Data was collected with the permission of ethical committee of hospital. Data on gender, age, marital status, day and time of admission and discharge, duration of stay, primary specialty for care, reason for leaving against medical advice, prior history of hospitalizations, mode of payment, medication and follow-up advice at time of LAMA, revisit to the hospital and development of morbidity at follow-up was collected from patient charts and the LAMA form. Results: Data was collected from 300 patients of both genders. There were 142 male and 158 female patients from age range 0 to 75 years. During the same period, 263 patients were discharged from the neurosurgical service and the rate of LAMA in the neurosurgery department was calculated to be 16.73%. Practical implication: This study will be helpful in neurology department of the hospital and used for the betterment of results. Conclusion: It is concluded that leaving AMA rates are high in neurological in-patients. Low income and level of health literacy were the most common causes of LAMA in this neurosurgical patient population. Keywords: LAMA, Patients, Surgical. Population, AMA, Health

Aim: To examine the outcomes of trabeculectomy followed by mitomycin C in term of mean change in intra-ocular pressure in patients presented with primary congenital glaucoma. Study design: Cross-sectional/observational Place and duration of study: Department of Ophthalmology, Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital, Sialkot from 7th July 2020 to 6thJanuary 2021. Methods: Fortypatients of both genders with ages up to 5 years presented with primary congenital glaucoma were enrolled in this study. Patients demographics were recorded after taking written consent from parents/guardians. All the patients were receivedtrabeculectomy with 0.4mg/ml Mitomycin C was applied below the flap for 2 to 3 minutes. Intraocular pressure was examined preoperatively and at 12th day after surgery. Results:Twenty-four (60%) were males while 16 (40%) were females. 30 (75%) patients were ages <2yearsand 10 (25%) patients had ages >2 years. A significant difference was observed regarding mean change in intra-ocular pressure (pre-operatively 30.48±3.62 versus post-operatively 16.35±2.86) with p-value <0.001. Conclusion: Trabeculectomy with Mitomycin C is very effective for reducing intraocular pressure. A significant decrease in intra-ocular pressure was observed post-operatively. Keywords: Primary congenital glaucoma, Intra-ocular pressure, Trabeculectomy, Mitomycin C