Background High value of neutrophil lymphocyte ratio (NLR) is a strong independent predictor and biomarker of ongoing vascular inflammation in various cardiovascular disorders. Objective The main focus of the study is to investigate the effect of nebivolol on NLR in mild to moderate hypertensive patients in comparison with metoprolol. In addition, BMI, blood pressure, TLC count, blood sugar, and lipid profile were also assayed before and after treatment. Materials and Methods In this 12-week prospective double-blinded randomized study, 120 patients with mild to moderate hypertension were randomly divided into two groups to prescribed daily dose of tab nebivolol 5–10 mg and metoprolol 50–100 mg, respectively, for 12 weeks. The data were analyzed using SPSS 16 software. Results A total of 100 patients completed the study. Both drugs lowered blood pressure significantly, nebivolol 20.5/10.5 and metoprolol 22.5/11.2 (p < 0.001) from baseline. Regarding inflammation, nebivolol reduced total leukocyte count (p = 0.005) and neutrophil count (p = 0.003) and increased lymphocyte count (p = 0.004) as compared to metoprolol. Similarly, nebivolol but not metoprolol significantly reduced NLR ratio (p = 0.07). Nebivolol improved lipid profile and blood sugar compared to metoprolol, but values were nonsignificant. Conclusion Nebivolol has a strong impact on reducing NLR, a marker of subclinical inflammation in hypertensive patients. Moreover NLR can be used as a disease and drug monitoring tool in these patients.

Background: The proportion of female students is increasing progressively in medical schools, but concern remains about differing performance in exams. A limited data is available on comparison of academic performance of male and female students from developing countries. Aim: To compare them regarding their academic performance in the subject of pharmacology. Methods: This comparative study was conducted at Pharmacology departments of Sheikh Zayed medical college Rahim yar khan and Quaid-e-Azam medical college Bahawalpur among 3rd yr MBBS students of sessions 2019 and 2020. The overall attendance of students was counted and compared as well as all the pharmacology test results were evaluated and compared on the basis of previous record of fortnightly, end of module, midterm and end term examinations. Results: Girls outnumbered boys (528 girls vs 437 boys) in medical admissions. The girls were having better attendance and test results ( 92% vs 65% for better attendance & 26% vs 19% for better results) in both sessions 2019 and 2020. The results also showed that students from literate background and urban areas got more admission in medical college but more number of boys are boarders compared to girls who prefer to be day scholars due to social circumstances of South Punjab. Conclusion: The female students tend to perform better than boys in pre clinical subjects. The number of female medical students is increasing progressively and they out perform their male counterparts both in attendance and internal assessments. The study is documentation of this fact, for future measures that can be done for improvement of male students performance. Keywords: Gender difference, pharmacology, performance

Background: Pakistan has been working on Antimicrobial Resistance (AMR) for a decade; unfortunately, there is a lack of concept of antibiotic stewardship in most health setups, especially in the public sector. This study aims to analyze the knowledge and perception of junior physicians towards antibiotic stewardship programs. The need for this knowledge and impact of antimicrobial resistance on antibiotic stewardship ascertain barriers to stewardship acceptance. Methodology: A cross-sectional study was conducted at different clinical departments of Sheikh Zayed Hospital, Rahim Yar Khan, including 50 junior physicians recruited via convenience sampling technique. The data was collected using a structured questionnaire comprising physician's hospital associated data and questions regarding the knowledge, perspectives, and practices concerning antibiotic stewardship programs (ASP) to reduce AMR. Statistical analysis was done using SPSS version 22.0, and data were presented using frequencies and percentages. Results: Most of the enrolled physicians knew AMR and agreed that it is a serious global health issue. However, all the medical officers were completely unaware of the antibiotic stewardship program, while 42.9% of house officers and only 25.7% of PGs knew about the program. Conclusion: Our study shows support from doctors for expanded stewardship implementation and provides an important understanding of the current attitudes of doctors regarding stewardship execution. A better understanding of perceptions and attitudes is dire for healthcare stakeholders to expand stewardship activities into healthcare settings.

. Objectives To document the frequency of esophageal varices and their importance in a tertiary care hospital of SouthernPunjab. Design: Observational. Setting: Endoscopy unit of Sheikh Zayed Medical College/Hospital. Period: From Nov 2005 to May 2007.Materials & Methods The data of 500 patients who underwent upper GI endoscopy was analyzed. Demographic features, reasons for referraland endoscopic diagnoses were noted. Results: Among 500 patients, 57% were referred due to upper GI bleeding, 9% due to dysphagia, 8%due to persistent vomiting and 7% due to dyspeptic symptoms. Common endoscopic diagnoses were esophageal varices (44%). Conclusion:Major Endoscopic finding in our study was esophageal varices. Gastric or duodenal ulcers, congestive gastropathy, obstructive lesions ofesophagus and stomach were the next most common observations.

Organophosphate (OP) compounds are insecticides whose toxicity is well reported. They can virtually involve any organ and cardiac and renal complications are one of the most dreadful ones. Objectives: To determine the frequencies of acute renal failure and cardiac complication in patients with Organophosphorus poisoning. Study Design: Cross Sectional study. Setting: Department of Medicine, Sheikh Zayed hospital, Rahim Yar khan. Period: January 2015 to December 2015. Material & Methods: All adult cases with documented history of Organophosphorus poising either trans-dermally or oral ingestion with either accidental or intentional intake were included. The cases then underwent ECG and renal function tests. The abnormalities in ECG were documented and the urea more than 30 mg/dl and creatinine more than 1.5 mg/dl was labeled as acute renal failure. Results: In this study there were 100 cases, 58 (58%) were females and 42 (42%) males. The mean age was 22.58±48 years and mean duration of OP taken was 7±0.24 hours. Complications were seen in 35 (35%) cases out of which 6 had ARF and 29 had cardiac arrhythmias. IA, 6 had prolonged QT and remaining 3 observed ventricular tachycardia (VT). ARF was common in females but there was no significant association with any study variables. However a near significant was seen in cases that presented with more than 4 hours of toxicity (p= 0.07). Cardiac arrhythmias were also more common in females. There was significant association of it with oral intake and with suicidal intention with p= 0.001 and 0.001. Conclusion: OP poisoning is common and cardiac complications are more than acute renal failure. Oral intake and with suicidal intention are significantly associated with cardiac complications.