In today's world the term "Entrepreneurship" is garnering great attention as it leads to value creation and help the countries on their journey towards achieving economic prosperity. Yet, to date the research determining the combined impact of various environmental, emotional and psycho-social factors on entrepreneurial intentions is scarce. This study examines how the perception of backing and assistance received by social networks; personal as well as professional shape entrepreneurial intentions. Current study explores the mediating role of a cognitive factor that is self-efficacy and a direct relation of a psycho-social factor that is self-esteem on entrepreneurial intention. With a sample of 192 students the model was tested using multiple regression analysis. The findings reveal that social networks and emotional intelligence has a significant role in determining entrepreneurial intentions. Self-efficacy was found to mediate both the relations, while the relation between positive self-esteem and entrepreneurial intention could not be proved. The study creates useful suggestions and awareness for the academic domain as well as policy makers in this region.

Objective: To determine the frequency of anatomical variation of olfactory fossa among the adult Pakistani population by Keros classification on computed tomography (CT) of paranasal sinuses. Study Design: Cross-sectional study Place and Duration of Study: Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from May 2019 to Mar 2020. Methodology: A total of 65 patients of either gender were included. Patients with previous trauma or surgery of the skull base or paranasal sinuses, malignant diseases of the sinuses and congenital anomalies were excluded. All the included patients in the study underwent CT paranasal sinuses. Measurements of the olfactory fossae followed by grouping as per Kero’s classification were done, and CT findings were recorded. Results: The patients included in the study ranged from 18 to 65 years, with a mean age of 33.09±10.86 years and 72.3% of patients 18 to 40 years of age. Of 65 patients, 36(55.4%) were males, and 29(44.6%) were females. The mean CT depth of the olfactory fossa was 6.34 ±4.03mm. Type-I olfactory fossa by Keros classification was found in 17(26.2%), Type-II in 35(53.8%) and Type-III in 13(20%) of patients. Conclusion: This study concluded that Keros Type-II is the most common anatomical variation of olfactory fossa among the adult Pakistani population on CT of paranasal sinuses with an intermsediate risk of intracranial complications during endoscopic sinus surgery involving this region.

Background: Acute appendicitis is an inflammation of the vermiform appendix. Usually, the diagnosis is made on clinical evaluation and elevated leukocyte count (TLC). But in cases when the clinical diagnosis is indeterminate, additional assessment needs imaging. Despite the increased use of modern diagnostic modalities such as Sonography, computed tomography (CT), and diagnostic laparoscopy, the frequency of misdiagnosis of appendicitis has remained constant (15%) as has the rate of appendiceal rupture. Presently, some serum markers such as C-reactive protein (CRP), lactate, and bilirubin have been proposed as a diagnostic tools for appendicitis. When compared CRP, TLC and lactate are found less explicit than bilirubin as predictive markers for acute appendicitis and its complications. Objective: To determine the diagnostic accuracy of hyperbilirubinemia in diagnosing perforated appendix by taking per-operative findings as the gold standard. Material & methods: It is a cross-sectional survey conducted at the Surgery department at PAF Hospital Mushaf, Sargodha. The duration of the study was from 1st June 2018 to 1st December 2018. A total of 160 patients of both gender with acute appendicitis with Alvarado Score ≥ 7 were included. Patients with age less than 12 years, HBsAg & anti-HCV positive, history of jaundice, history of liver disease (e.g.: Crigler-Najjar, Gilbert syndrome, cirrhosis, hepatitis), the patient is alcoholic, history of hemolytic disorders (e.g.: thalassemia, spherocytosis), history of the biliary disease (e.g.: biliary stones, worm infestation, atresia, etc), history of gastrointestinal& hepato-pancreato biliary malignancy, patient with appendicular mass per-operatively and appendectomy performed incidentally or for other indications were excluded. All patients were tested by routine laboratory investigations including LFTs hyperbilirubinemia was recorded. All cases underwent appendectomy by the same surgical team& peri-operative findings were recorded & compared with pre-operative total bilirubin levels. Patients were categorized as true positive, true negative, false positive & false negative. Results: The age range in this study was from 12 to 60 years with a mean age of 35.231± 8.63 years and mean Pre-Op Bilirubin Levels was 0.812±0.72 mg/dl. Laboratory Findings (Bilirubin levels ≥ 1mg/dl) diagnosed 44(27.5%) patients and Per Operative Findings diagnosed 60(37.5%) patients with Perforated Appendix. Laboratory Findings (Bilirubin levels ≥ 1mg/dl) have shown a sensitivity of 50%, specificity of 86%, the diagnostic accuracy of 73%, PPV 68.18%, NPV 74.4%, (p=0.000) in the diagnosis of Perforated Appendix. Conclusion: It is concluded that serum bilirubin level was higher in patients with appendiceal perforation, it s a definite predictive potential in these cases. Therefore, acquiring SB values upon admission can be used in combination with more recent diagnostic tests such as CT scans n, ultrasonography to help determine the presence of perforation and thus assist in timely clinical management. Keywords: Perforated appendix, Hyperbilirubinemia, Diagnostic accuracy

The presence of vermiform appendix as the content of inguinal hernia is termed Amyand’s hernia (AH). It is a very rare entity as most of the time contents of hernia are omentum and small bowel. Very often AH is asymptomatic and diagnosed intra-operatively. Amyand’s hernia (AH) is classified into four sub-types depending on clinical features and the status of the appendix. But this time we encountered per-operatively entirety different findings of Amyand’s hernia. Treatment of Obstructed inguinal hernia is only surgery, but dealing with Amyand’s hernia (AH) is based on the patient condition and type of Amyand’s hernia. So, treatment of this hernia remains controversial, different strategies should be applied to different case

BACKGROUND: Anorectal melanoma (ARM) is an extremely rare, highly aggressive form of a tumor with the worst prognosis. ARM contributes 0.5% of all melanoma cases. Its presentation is similar to that of adenocarcinoma of the rectum, hemorrhoids, or solitary rectal ulcer, the incorrect clinical diagnosis or delayed diagnosis is often made. The definite diagnosis is only made through histopathology in which immunohistochemical stains positive to S-100, Melan A, and HMB-45 which differentiates it from adenocarcinoma of the rectum. Because of the limited number of patients and retrospective design of studies to date, there is no proven efficacy of abdominoperineal resection (APR) over local excision (LE) in terms of survival. Furthermore, this neoplasm is quite resistant to chemoradiotherapy. It has a median survival of 18 months and a 5-year survival rate of only 6%. PRESENTATION OF OUR CASES: Here, we report 5 rare cases of anorectal malignant melanoma presented to our institute between 2018 to 2022, who were treated with APR and diversion colostomy. The first case is a 27-years old young female with typical complaints, she was diagnosed ARM with locoregional metastasis. Only a diversion colostomy was performed and referred to an oncologist for palliation. Our second case is a 68-years old male with a similar complaint who presented relatively early and was diagnosed with localized disease. Conventional APR was performed and referred for adjuvant chemoradiotherapy, but the patient refused. However, the lump recurred after 6 months of tumor excision. The third case is a 29 years old male again early presentation with a similar complaint labeled as localized diseased. The conventional APR was performed followed by adjuvant chemoradiation; patient presented with metastatic disease after 6 months. The fourth case is a 60-years old male with typical history and diagnosed with localized disease. Conventional Extra-levator APR was performed followed by adjuvant therapy, but patient developed recurrence of disease with mets after 4 months. The fifth case is a 39-years old female diagnosed as ARM, had advance disease and metastatic deposits at the time of presentation, refused any palliative treatment. The study aims to evaluate our experience in treating this neoplasm. CONCLUSION: Because of the rarity of this neoplasm, no proper trial has been conducted so far. The role of chemoradiotherapy is questionable and the surgical approach varies from radical APR to conservative LE. No surgical approach has been standardized in terms of survival.