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Background: Hemoglobin D Iran is frequently misdiagnosed as Hb E or Hb D Punjab if only one method of screening is used. The objective of our study was to highlight the importance of using two different screening techniques in diagnosis of a hemoglobin variant, Hb D Iran in our case. Hematological parameters of heterozygous Hb D Iran and compound heterozygous β/Hb D Iran were also compared. Methods: A descriptive study was carried out on results of 52,379 subjects which were part of thalassemia extended family cascade screening from 36 districts of Punjab from October 2019-March 2021. Cases of Hb D Punjab and Hb E were run on both CE-HPLC (cation exchange-high performance liquid chromatography) and CZE (capillary zone electrophoresis). Resulting Hb D Iran cases were confirmed by ARMS-PCR (Amplification refractory mutation system-polymerase chain reaction). Results: Forty cases of Hb D Iran were detected out of 160 initially suspected Hb D Punjab cases and 126 Hb E cases. Diagnosis was confirmed by molecular analysis. Statistical significance was found between RBC count, MCV, MCH, Hb F and diagnosis of “heterozygous Hb D Iran” and “compound heterozygous for β/ Hb D Iran”. Conclusion: Hb D Iran can be easily missed and misdiagnosed as Hb E or Hb D Punjab, if two screening methods are not used. This maybe a reason why Hb D Iran remains unreported in our region. CBC and HPLC indices can also be suggestive if a case is of heterozygous D Iran or compound heterozygous β/Hb D Iran. Keywords: Hb D Iran, Hb E, Hb D Punjab, Cation exchange High performance liquid chromatography, Capillary zone electrophoresis

Beta Thalassemia is the most common genetic disorder in Pakistan. This study was conducted to assess the knowledge, attitudes and practices of parents of children suffering from Thalassemia with regards to disease prevention. It also determined the degree of social and religious opposition faced by these parents during implementation of preventive practices Methods: A descriptive cross-sectional survey was conducted in the 36 districts of Punjab via nine regional centers of Punjab Thalassemia Prevention Project. 248 parents of Beta Thalassemia Major and Intermedia were interviewed using a pre-designed pre-tested structured questionnaire. All statistical analyses were conducted using Statistical Package for Social Sciences (IBM SPSS 23.0) Results: 83.5% of the respondents had adequate knowledge and 98.4% had positive attitudes. Knowledge and attitude were positively correlated (p=0.00). 93% opted for prenatal diagnosis and 91% opted for termination of affected fetus. Among these individuals 12% faced opposition from their family members when they went for diagnostic testing and this opposition rose to 20% when they had to opt for termination. The local religious clerics opposed prenatal diagnosis in 3% of the cases and termination in 7% of the cases Conclusion: When compared to previous studies the knowledge, attitudes and practices of our study population was better. Thus, population screening programs have a positive impact on knowledge, attitudes and practices of caregivers of Thalassemia patients. However, social and religious opposition needs to be countered for further implementation of effective preventive practices.

Background: Working with microscopes requires accuracy and the capacity for sustained concentration. Users of microscopes in this profession frequently need to maintain a static work position, which puts strain on the musculoskeletal system. Since pathologists frequently combine using a magnifying glass and a computer, in addition to the strain on the musculoskeletal system, magnifying lens work can cause eye strain, which is consequently known as strong strain. This can indicate an additional musculoskeletal risk. Arm, neck, and shoulder complaints cover a wide range of grievances with varying degrees of seriousness. Objective: The objective was to discover whether neck pain was common and whether microscope users were aware of ergonomics. Methods: 161 participants took part in this cross-sectional questionnaire-based study, which was executed in Lahore from February to July 2019. The participants including both men and women aged 25 to 55 were included following their signed informed consent. The study excluded those with any neck pathology, recent trauma, or surgery. Using SPSS 22.0, data analysis was carried out. The mean and standard deviation for quantitative variables were computed. Frequency and percentages were determined for qualitative variables. Results: Out of 161 survey participants, 150 (93.2%) were discovered to have musculoskeletal disorder, primarily affecting the neck region, 83 (51.6%), and only a few 53 (32.9%) were found to be aware of workplace ergonomics. Conclusion: There was a significant amount of neck pain between microscope users. Additionally, it was found that professionals generally have very little awareness of workplace ergonomics and sitting positions.

Background: It can be very stressful for students to be under constant pressure to succeed in becoming highly qualified healthcare professionals. Postgraduate and professional students were found to experience higher levels of stress than usual when age and gender were compared with populations of the same type. Negative effects of stress include poor academic performance, diminished reasoning ability, decreased coping and difficulty following graduate courses.  Objective: To learn about coping mechanisms and stress among postgraduate medical students in Lahore. Methods: This study included 101 postgraduate medical students from the campuses of private universities in Lahore and Islamabad. Informed consent forms were used to include participants. Google forms were used to create an online survey, which was then shared on Instagram and WhatsApp. A perceived stress scale was used to access the various stressors and the brief COPE inventory was used to look at the students' efficient coping mechanisms. An analysis of postgraduate students' coping mechanisms and the relationship between stress and gender was done. The data from Google forms were processed, placed into Microsoft Excel and analyzed with SPSS version 25. The findings were presented in the form of tables and graphs. Results: Among postgraduate medical students or nearly one-fourth (21.8%) of participants reported high stress, while 72.3% reported moderate stress, with men reporting higher levels of stress than women. The most common coping strategies were active coping, acceptance, planning and religion. Conclusion: It seems that graduated students are under more stress and positive psychological approaches should be made available by university administration and professors to help students deal with the demands of pursuing a degree in the medical field. Ignoring these elements would not give students the best chances for learning and employment.