bluuebunny/crossref_metadata_2025 huggingface dataset:
TYMPANOPLASTY TYPE-1: DIFFERENT APPROACHES AND THEIR SURGICAL OUTCOMES
Authors: Wahid Fazal I , Manan Abdul , Saleem Muhammad , Zada Bakht , Rehman Habib -Ur- , Haq Naseem Ul , Javaid Muhammad
Published: January 2022

Objective: To calculate the surgical outcomes of different approaches of tympanoplasty type 1 in terms of air bone gap closure, wound healing, and postoperative pain.

Study Design: Prospective cross-sectional study.

Place and Duration of Study: Department of ENT, Head and Neck Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, Pakistan from Jun 2018 to May 2020.

Methodology: Size of sample was 75 patients divided into three groups. Consent was obtained from all the patients included in study. After proper evaluation and relevant investigation pre- and post-operative PTA was performed. Tympanoplasty type-1 was performed by the same surgeon by the three approaches following established otological surgical protocol. Collected data was entered in SPSS-25 for analysis.

Results: All 75 patients were divided into three equal groups. Male were 55 (73.3%), females were 20 (26.7%). Male: female ratio was 2.7:1. Majority of patients presented in 2nd and 3rd decades of life 31 (41.33%) and 28 (37.33%) respectively. Preoperative mean ± SD, ABG in groups A, B and C were 37.60 ± 11.28 dB, 37 ± 9.68 dB and 31.80 ± 12.40 dB, respectively. No significant difference was found amongst the three groups regarding pre-operative and post-operative ABG (p=0.85 and p=0.4), respectively. Mean ± SD, wound healing time in Groups A, B and C were 1.00 ± 0.00, 1.80 ± 0.40 and 1.76 ± 0.43 respectively with p=0.0001 and similarly postoperative pain with p=0.001. The wound healing time and post-operative was statistically better (p<0.05) in group A (Transmeatal approach) than other groups........
EARLIEST SYMPTOMS OF PRESENTATION IN COVID-19 PATIENTS IN TERTIARY CARE HOSPITAL
Authors: Raza Maqbool , Raza Muhammad Ali , Cheema De Emmal Asjad , Cheema Maham Asjad , Rafique Atif , Khan Sarim Waleed
Published: January 2022

Objective: To determine the frequency of earliest symptoms of COVID-19 infection among patients with confirmed SARSCOVID-19 infection.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Combined Military Hospital Multan, from Jun to Dec 2021.

Methodology: Data from 299 patients admitted in tertiary care settings was collected on a questionnaire. Patients regardless of gender and age who had confirmed COVID-19 infection through Real Time Polymerase Chain Reaction (RT-PCR) were included in the study. A nonprobability consecutive sampling technique was used to select samples. Data was entered and analyzed through SPSS version 22. Frequencies and percentages of various presenting symptoms were calculated. Sample size calculated at 95% level of confidence, 1% required precision, and 27% anticipated population proportion were 299. The overall difference in frequencies of symptoms in various groups was compared by using chi-square test. p-value <0.05 was taken as significant.

Results: A total of 299 participants were included in this analysis. The median age for participants (interquartile range [IQR]) was 46 (36-54) years. Among 299 adults the reported symptoms were cough 238 (79.6%), fever 176 (58.7%) and, dyspnea 113 (37.8%). Only 78 (26.1%) of participants with confirmed infection reported having all three symptoms of cough, fever, and dyspnea. Other reported symptoms in patients were diarrhea 54 (18.1%), fatigue 128 (42.8%), myalgia 113 (37.8%), and anosmia 98 (32.8%). There was no significant difference in the frequency of symptoms across both genders.

Conclusion: The most frequent symptoms of COVID-19 are cough, fever, and dyspnea.
SELF CLEANING OF EARS BY VARIOUS OBJECTS CAUSES MULTIPLE DISEASES OF EXTERNAL EAR
Authors: Bukhari Syed Muhammad Asad Shabbir , Aslam Sohail , Afzal Mahrukh , Riaz Naeem , Abbas Asim , Afridi Jehangir Ahmed , Khan Muhammad Fahad Wasim
Published: January 2022

Objective: To find out the association of multiple diseases of external ear with the use of various objects and cotton buds.

Study Design: Case control study.

Place and Duration of Study: Ear Nose Throat Department, Pakistan Naval Ship Shifa Karachi, from Jan to Oct 2020.

Methodology: All the patients having multiple diseases of external ear were included as cases. Controls were selected from the healthy volunteers from general populations.

Results: Total number of subjects in this study was 140 with the mean age 25.11 ± 11.21 years (2-55 years of age range). Out of them, 82 were male and 58 were female. Odds ratio was 16.07.

Conclusion: There is a solid relationship of illnesses of external ear with the utilization of cotton buds. This detrimental practice should be incapacitated by featuring the notice by brands owners of cotton bud and safety instructions at different instructive levels.
COMPARISON OF 128-SLICE SPIRAL COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY (CTPA) FINDINGS WITH PLASMA D-DIMER LEVELS IN PATIENTS WITH CLINICAL SUSPICION OF PULMONARY EMBOLISM
Authors: Nisar Uzma , Nasir Hina , Slehria Atiq Ur Rehman , Palwa Abdur Rahim Rahim , Hussain Rashid , Khan Danish Hassan
Published: January 2022

Objective: To compare the effectiveness of plasma D-dimer levels with findings of 128-slice spiral computed tomography pulmonary angiography (CTPA) in patients with clinical suspicion of pulmonary embolism.

Study Design: Retrospective observational study

Place and Duration of Study: Department of Computed Tomography, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2018.

Methodology: A total of 59 patients were inducted who presented in Emergency Department, Pak Emirates Military Hospital Rawalpindi with clinical suspicion of Pulmonary Embolism. The main symptoms were shortness of breath and chest pain. Plasma D-dimer levels of all patients were sent to laboratory and CTPA was performed at Computed Tomography department, Armed Forces Institute of Radiology & Imaging using 128-slice spiral computed tomography.

Results: 36 patients (61%) were males and 23 (39%) were females with an average age of 48.03 ± 18.06 years (range 23-85 years). Out of 59 patients, D-dimer levels were raised in 28 cases (47.4%) while 31 patients (52.6%) showed normal levels. Pulmonary Embolism was detected by CTPA in 30 cases (50.8%) while 29 patients (49.2%) were without obvious abnormality.

Conclusion: Plasma D-Dimer levels show low sensitivity, specificity and negative predictive value and cannot exclude Pulmonary Embolism without CTPA. Computed Tomography Pulmonary Angiography (CTPA) remains diagnostic modality of choice for definitive assessment of Pulmonary Embolism in patients reporting at the emergency reception.
THE SPEECH SOUND ERRORS AND LITERACY SKILLS IN CHILDREN WITH OROFACIAL CLEFTS
Authors: Khan Arooj Karim , Yousaf Aasma , Tarer Sharmeen Aslam , Kausar Rukhsana
Published: January 2022

Objective: To investigate the speech sound errors and literacy skills in children with orofacial clefts (cleft palate& cleft lip and palate).

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Centre for Clinical Psychology, University of the Punjab, Lahore, from Mar 2016 to Feb 2017.

Methodology: A sample of 42 participants (cleft lip & palate: n=18 and cleft palate: n=24) was collected. Two stage sampling strategy was used. Each child was individually screened through Slosson intelligence test revised checklist of orofacial cleft and diagnostic statistical Manual-V checklist. Then children were provided with assessment measures which included demographic informational questionnaire, community developed VPI Screener, word list for articulation and phonological processes, annual status of education report (ASER) and curriculum-based measurement (Written Expression). Manual SODA (substitution, omission, distortion and addition) analysis was done to know about the type of speech sound errors.

Results: Independent sample t-test was used to compare the differences of speech sound errors (52.11 ± 25.08), (47.29 ± 25.38), reading skills (3.67 ± 1.14), (3.75 ± 1.26) and writing skills (14.61 ± 13.49), (25.14 ± 29.16) in cleft lip & palate and cleft palate respectively, indicated that there were no differences; with p-value: p=0.54, 0.83, 0.13.

Conclusion: Results indicated no significant differences in speech sound errors, reading, writing skills and resonance between children with cleft lip & palate and cleft palate.
COMPARISON OF ULTRASOUND GUIDED MODIFIED PECTORAL NERVE BLOCK WITH LOCAL ANAESTHESTIC INFILTRATION FOR ANALGESIA IN BREAST CANCER SURGERY
Authors: Saqib Usman , Iqbal Rashid , Usman Sana , Hanif Rashid
Published: January 2022

Objective: To compare the frequency of pain and mean analgesia requirement after breast surgery under general anaesthesia when comparing pectoral nerve block with local anaesthesia infiltration.

Study Design: Comparative prospective study.

Place and Duration of Study: Combined Military Hospital, Rawalpindi from Mar 2018 to Sep 2019.

Methodology: A total of 60 patients undergoing modified radical mastectomy were included in the study. Group A (n=30) received pectoral nerve blocks while Group B (n=30) received local anaesthetic infiltration. Outcome was assessed at 12 hours after injection of local anaesthetic.

Results: Pain in 7 (23.33%) patients in Group A (Pectoral nerve blocks) and in 20 (66.67%) patients in Group B (Local anaesthetic infiltration), p-value of 0.001 which was considered statistically significant. Mean analgesic requirement was found to be 80 ± 33.73 mg in the Group A (pectoral nerve blocks) compared with 141.67 ± 47.50 mg in Group B (Local anaesthesia infiltration) patients with a p-value of <0.001 which was statistically significant.

Conclusion: Pectoral nerve block significantly reduces early postoperative pain and analgesia requirement when compared with Local anaesthesia infiltration after breast surgery.
COMPARISON OF THE EFFICACY OF TOTAL LARYNGEAL ANESTHESIA AND SIMPLE LOCAL ANESTHESIA DURING AWAKE FIBEROPTIC BRONCHOSCOPY
Authors: Khan Asif Ullah , Khan Muhammad Khalid Azam , Khattak Abdul Latif , Naz Shazia , Shah Bukhari Syed Karamat Hussain , Ibrahim Muhammad Tahir
Published: January 2022

Objective: To compare the efficacy of total laryngeal anesthesia and simple local anesthesia during awake fiberoptic bronchoscopy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Pulmonology, Combined Military Hospital Lahore, from Jan to Jul 2020.

Methodology: A total of 70 patients, who were undergoing fiberoptic bronchoscopy were divided into two groups. Group-I patients were given topical anesthesia with 2% Lignocaine while group-II patients, in addition to topical Lignocaine, had 2% Lignocaine injected into bilateral internal laryngeal nerves for total laryngeal anesthesia. Assessment of efficacy of anesthesia was evaluated by Reasoner scale.

Results: In group-I, 26 (74.28%) patients showed mild or moderate cough and gagging during stage-1. Fifteen (42.85%) patients showed moderate cough and gagging that interfered with the procedure during stage-2 and 19 (54.28%) patients showed mild cough or gagging that did not interfere with the procedure in stage-3. In group-II, 17 (48.57%) patients exhibited mild cough or gagging during stage-1. Sixteen (45.71%) exhibited mild cough or gagging that did not interfere with the procedure during stage-2 with all the patients showing either no cough or mild cough and gagging that did not interfere with the procedure during stage-3. More patients of group-II 32 (91.42%) agreed to a repeat test if required medically as compared to group-I 28 (80%).

Conclusion: Patients undergoing fiberoptic bronchoscopy who underwent total laryngeal anesthesia and sedation, in addition to topical anesthesia experienced less cough and gagging than those receiving only local anesthesia.
MATERNAL OUTCOMES OF PREGNANCY-RELATED ACUTE KIDNEY INJURY
Authors: Khattak Irfan , Khattak Samina Naseem , Imran Ayesha , Kamal Khawar , Yaqoob Umairah
Published: January 2022

Objective: To determine the frequency of Pregnancy-related acute kidney injury in the Pakistani population and its effect on maternal health.

Study Design: Cross-sectional study.

Place and Duration of the Study: Department of Nephrology and Obstetrics and Gynecology, Combined Military Hospital Kharian, from Jan 2018 to Dec 2020.

Methodology: All pregnant women with normal renal functions at the time of enrolment in the study and no previous history of any kidney disease or renal procedure in the recent past (at least 3 months) before conception were included in our study at Combined Military Hospital Kharian. All participants had serum creatinine tested at enrolment and were inquired specifically about any history of renal disease or any renal procedure in the recent past (at least 3 months old).

Results: Mean maternal age in the study was 29 ± 7.67 years however it ranged from 16-41 years. Around a quarter of acute kidney injury cases occurred in the first and second trimesters combined, with 26 (12%) and 24 (11%) cases in the first and second trimesters, respectively. Thirty percent of acute kidney injury cases were diagnosed in the third trimester. A substantial number 58 (27%) of cases developed azotemia which persisted beyond three months and developed chronic kidney disease of various stages. Regarding maternal outcomes, 166 (77%) mothers recovered completely. However, 43 (20%) patients had some degree pf azotemia, a few cases required permanent renal replacement therapy.

Conclusion: Acute kidney injury is a common problem in our community leading to suboptimal maternal outcomes..............
THE SURVIVAL RATE OF CHICK EMBRYO INFLUENCED BY NICOTINE AND ANTIOXIDANT GREEN TEA (CAMELLIA SINENSIS)
Authors: Shan Maryam , Muazam Shazia , Shan Hina , Atta Fahad , Iftikhar Zubia , Khalil Amna
Published: January 2022

Objectives: To study the effects of Nicotine on the survival rate of chick embryo and to evaluate the preventive role by the antioxidant green tea camellia sinensis.

Study Design: Laboratory-based experimental study.

Place and Duration of Study: Army Medical College, Rawalpindi, from Nov 2011 to Nov 2012.

Methodology: A total of 75 Fayoumi fresh fertilized eggs were kept at Poultry Research Institute, Rawalpindi. Experimental solutions were injected to the eggs of four groups at forty-eight hours of incubation and the effect on the growth was recorded and compared with the control group. The control and experimental groups were observed to assess the effects of Nicotine and the role of antioxidant green tea Camellia sinensis on the survival rate and growth of chick embryo’s femur.

Results: The control group (group-1) showed 100% survival rate of embryos. The experimental group-2 showed survival rate of 100% embryos and the group-3 and group-4 showed survival rate 50% and 70% of embryos, respectively.

Conclusion: It was concluded that green tea decreases the oxidative stress caused by the Nicotine.
IMMUNOGENICITY AND SAFETY OF INACTIVATED SARS-COV-2 VACCINE (VERO CELL), BBIBP-CORV (SINOPHARM); AN OBSERVATIONAL STUDY FROM PAKISTAN
Authors: Farooq Muhammad , Malik Muhammad Fayyaz , Hussain Ashfaq , Latif Majid , Rathore Muhammad Usman , Lodhi Rehan Ahmad Khan
Published: January 2022

Objective: To ascertain the immunogenicity and short-term safety of inactivated SARS-CoV-2 Vaccine (Vero Cell), BBIBPCorV (Sinopharm) in our setup.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital Sialkot Pakistan, from Feb to Apr 2021.

Methodology: A total of 227 health care workers (HCWs) between 18 to 59 years of age were included in the study. Two doses of Inactivated SARS-CoV-2 Vaccine (Vero Cell), BBIBP-CorV were administered to all individuals 21 days apart and they were monitored for any vaccine-related adverse reactions for 7 days after each dose. Neutralizing antibodies (NAbs) in study subjects were detected in three samples i.e. before 1st dose of vaccine, 21 days after 1st dose and 14 days after 2nd dose by Elecsys Anti- SARS-CoV-2 S (Roche Diagnostics).

Results: Mean age of individuals in the study was 36.70 ± 18.08 years and most individuals were in the 31-45 years age group. Fatigue and drowsiness were the most common adverse effects experienced by study subjects after 1st and 2nd dose of the vaccine followed by malaise and headache. Only 42 (39%) individuals developed positive neutralizing antibody titers in a sample taken 21 days after 1st dose while all individuals except one (99%) developed positive neutralizing antibody titers in a sample taken 2 weeks after 2nd vaccine dose.

Conclusion: Inactivated SARS-CoV-2 Vaccine (Vero Cell), BBIBP-CorV is safe and well-tolerated with very few adverse reactions. Immunogenicity was well achieved as the seroconversion rate was 99% two weeks after 2nd dose of the vaccine.
ASSOCIATION OF IRON DEFICIENCY ANEMIA WITH ACUTE LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN
Authors: Nawaz Raazia , Hussain Shabbir , Khushdil Arshad , Tanveer Sidra , Javed Maria , Akram Saira
Published: January 2022

Objective: To establish association between acute lower respiratory tract infection and iron deficiency anemia.

Study Design: Case-control study.

Place and Duration of Study: Pediatrics Department, Pak Emirates Military Hospital, Rawalpindi, from Dec 2017 to May 2018.

Methodology: A total of 100 children with age ranging from 6-60 months were selected for this study with 50 being in each group. Study group constituted of children presenting with acute lower respiratory tract infection and healthy children presenting to outpatient were taken as controls. Hemoglobin levels (<11g/dl), mean corpuscular volume (<70fl), Serum Ferritin (<30ng/ml) and red blood cell Morphology were used to determine iron deficiency anemia. Patients meeting the WHO criteria were labeled to have acute lower respiratory tract infection.

Results: The frequency of iron deficiency was found to be 40 (80%) in cases and only 34 (17%) in healthy controls. A significant association was found between iron deficiency anemia and acute lower respiratory tract Infection with an odds ratio of 7.76 and a significant p-value of <0.01.

Conclusions: Iron deficiency anemia has an increased association of up to seven times in children with acute lower respiratory tract infections as compared to healthy children thus highlighting it as a significant risk factor.
SEVERITY OF DEPRESSION AND ANXIETY AMONG CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY AND THEIR CORRELATION WITH FUNCTIONAL CAPABILITIES OF THE CHILDREN
Authors: Khan Sikandar Ali , Saeed Fazal Ur Rahman , Ayaz Saeed Bin
Published: January 2022

Objective: To evaluate the severity of depression and anxiety among caregivers of children having cerebral palsy and correlate severity with the type of cerebral palsy and functional capability of the child.

Study Design: A cross-sectional study.

Place and Duration of Study: Department of Psychiatry and Rehabilitation Medicine, Combined Military Hospital, Gujranwala, from Oct 2015 to Aug 2018.

Methodology: Through consecutive sampling, 186 caregivers diagnosed with anxiety and/or depression based on the diagnostic criteria of International Classification of Diseases version 10, and their cerebral palsy children were recruited. Symptom severity was assessed using Beck Depressive Inventory for depression and Beck Anxiety Inventory for anxiety. The functional capabilities of the children were assessed through gross motor function classification system (GMFCS). For correlation, Pearson’s chi square test was used using SPSS version 20.

Results: The mean age was 30 ± 3.3 years. Fourteen (7.5%) were fathers of cerebral palsy children and 172 (92.5%) were mothers of cerebral palsy children. Majority of the cerebral palsy children 74 (39.8%) had spastic diplegia and the functional level I of gross motor function classification system 53 (28.5%). Most of the caregivers had mild anxiety and minimal depression (33.9% and 38.7% respectively). Significant correlation existed among the gross motor functional capability and the level of anxiety but not with depression (p<0.01 and p=0.155 respectively). No statistical association was found between the type of cerebral palsy and the level of anxiety or depression (p=0.240 and p=0.102 respectively).

Conclusion: Most caregivers in our study had mild anxiety and minimal depression..............
SPECTRUM OF RHEUMATOID ARTHRITIS PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL IN PAKISTAN
Authors: Khan Muhammad , Mushtaq Muhammad Salman , Salim Babur , Mushtaq Sumera , Gul Haris , Samreen Saba
Published: January 2022

Objective: To describe the demographic, clinical, serological and radiological scores in patients with rheumatoid arthritis (RA) presenting in a tertiary hospital in Pakistan.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Rheumatology, Fauji Foundation Hospital (FFH), Rawalpindi, from Sep 2018 to Feb 2019.

Methodology: The study included 52 female patients with RA between the ages of 18 and 80 years. Data were obtained from FFH Rawalpindi's outpatient department. Demographic details, reference data, and serological status were recorded. The joints involved in the onset of the disease, joint deformities, clinical disease activity index (CDAI) and overall functional status were evaluated. Extra-articular manifestations of rheumatoid arthritis have also been examined during a detailed physical examination. The patient's bone mineral density was calculated by the use of dual energy absorptiometry (DEXA scan). Radiological scores were evaluated using modified sharp score.

Results: Mean age of the patient was 55.08 ± 8.79 and mean duration of disease 9 .73 ± 7.54. The most common co-morbidity in rheumatoid arthritis patients was hypertension 20 (38.5%). Twenty four (11.7%) patients had osteoporosis. Wrist was the first joint involved in 17 (32.7%) patients. Ulnar deviation was the most common deformity in 12 (23.1%) patients. Sharp score for joint space narrowing was 61.09 ± 36.90 and sharp score joint erosions were 36.90 ± 42.41. Most common extra articular manifestation was anemia.

Conclusion: Rheumatoid arthritis as a variable spectrum of disease with different manifestations. Patients had radiological damage as demonstrated by high sharp score even before starting.................
COMPARISON OF NEONATAL APGAR SCORES AND PATIENT SATISFACTION LEVELS IN SPINAL VERSUS GENERAL ANESTHESIA IN ELECTIVE CESAREAN SECTIONS
Authors: Naseer Syed Khurram , Ali Aijaz , Feroz Shizan Hamid , Danish Dr , Sohail Amir
Published: January 2022

Objective: To compare patients undergoing cesarean section under spinal and general anesthesia in terms of neonatal APGAR scores and patient satisfaction.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Departments of Anesthesia and Gynecology and Obstetrics, Combined Military Hospital Peshawar, for six months from Mar to Aug 2019.

Methodology: In this study, 120 females with a singleton pregnancy of 36-40 weeks, and requiring a non-emergency elective cesarean section were enrolled through consecutive sampling in the study. The patients were randomly allocated into two equal groups of 60 women each through random table numbers. Group A received spinal anesthesia and group B general anesthesia. APGAR score was assessed at 5 minutes after delivery, and score of ≥7 was taken as satisfactory. Patient's satisfaction level regarding anesthesia was recorded on a visual analogue scale of 0 (extremely unsatisfied) to 10 (completely satisfied), and score of ≥7 was taken as satisfactory.

Results: Women receiving general anesthesia were more satisfied as compared to receiving spinal anesthesia (95% vs. 78.3%; p-value 0.007). There was no significant difference in terms of APGAR scores in general anesthesia and spinal anesthesia (83.33% versus 90%; p-value 0.283).

Conclusion: After an elective caesarean section, more mothers were satisfied after receiving general anesthesia as compared to spinal anesthesia. However, both types of anaesthesia were found to be equally safe for babies born in terms of APGAR scores at 5 minutes.
ANAESTHESIOLOGY AS A FUTURE SPECIALTY
Authors: Mahmood Khalid , Shamim Asad , Khan Muhammad Umair , Alam Tasneem , Khalid Usman , Jaffery Asad Ullah
Published: January 2022

Objective: To ascertain the various aspects directing the undergraduates at Quetta Institute of medical sciences towards anesthesiology as future profession/specialization.

Study Design: Cross sectional study.

Place and Duration of Study: Quetta Institute of Medical Sciences, Quetta Pakistan, from Mar to Apr 2019.

Methodology: Study was conducted among final year medical students with the help of a printed questionnaire consisting of 15 Multiple Choice Questions. The questionnaire provided the required database to explore various factors that influence undergraduates to select their future specialization based on demography and specialty preferences.

Results: A total of 65 undergraduates completed the response sheet. While 45 (68.8%) participants were females and 20 (31.2%) were males, 62 (95.4%) were single (unmarried or divorced) and had no children 63 (96.9%). Medicine proved to be the most favourate specialty with 20 (31.4%) student opting for it whereas anesthesiology was chosen by 4 (6.1%) students.

Conclusion: Anesthesiology still remains a less popular choice among the medical students of Pakistan particularly Quetta Institute of Medical Sciences due to multifaceted factors. Inferior prestige of the specialty was the most significant factor in deciding against anaesthesiology.
ASSOCIATION OF DENTAL CARIES AND ORAL HEALTH RELATED QUALITY OF LIFE (OHRQOL) IN DISABLED CHILDREN
Authors: Jawed Rubab , Khan Zohaib , Younus Maryam , Abid Khadijah , Saleem Momina , Kibria Zeeshan
Published: January 2022

Objective: To assess the association of dental caries and oral health related quality of life in mentally or physical disabled children studying in schools of Karachi.

Study Design: Cross sectional study.

Place and Duration of Study: Public and private sector special needs schools of Karachi, from Sep to Nov 2017.

Methodology: This study was conducted on 196 disabled children (mental/physical) in Karachi Pakistan. Children aged 6-18 years and having a disability was included in the study. We calculated the prevalence of dental caries through an examination of the oral cavity using the Decayed, missing and filled teeth index. Data were analyzed in SPSS version 20.

Results: Dental caries was found in 114 (58.2%). “Oral symptoms” score was (4.46 ± 0.85 vs. 4.95 ± 0.79; p<0.001), “functional limitation” (4.12 ± 1.0 vs. 4.63 ± 0.82; p<0.001), “emotional wellbeing” (4.40 ± 0.92 vs. 4.97 ± 0.70; p<0.001) and “parental distress and family function” (3.65 ± 0.97 vs. 4.03 ± 0.96; p<0.001) in children with and without dental caries respectively. All the oral health related quality of life score domains showed statistically significant association between mentally and physical disabled children with and without dental caries.

Conclusion: All the oral health related quality of life related domains had a significant negative impact on the quality of life in mentally and physical disabled children
REPRODUCTIVE OUTCOMES AFTER ABDOMINAL MYOMECTOMY
Authors: Fatima Yasmin , Amir Mumtaz
Published: January 2022

Objective: To determine the frequency of reproductive outcomes after abdominal myomectomy in infertile women.

Study Design: Case series.

Place and Duration of Study: at Combined Military Hospital, Multan Pakistan, from Sep 2015 to Feb 2017.

Methodology: This study included 60 women who underwent myomectomy to retain their capabilities of reproduction. Inclusion criteria were infertile women with uterine fibroids. Routine investigation was done to all patients like ultrasound and hysterosalpingogram before and after the procedure. The procedure of abdominal myomectomy was done under general anesthesia. All fibroids were enucleated and large blood vessels were tied. Vicryl no.1 was used to close the uterine defect. All patients were followed up for 3, 6 and 12 months interval and data was collected for conception, spontaneous conception, and conception with assisted reproductive technique, live birth and miscarriage.

Results: In this study mean age was 27.33 ± 4.03 years, mean number of fibroid was 1.366 ± 0.48 and mean size of fibroid was 7.06 ± 1.64 cm. Twenty eight (46.7%) women had conceived after myomectomy, in which 92.9% had spontaneous conception and 7.1% by assisted reproductive technique.

Conclusion: Abdominal myomectomy should be the standard treatment of infertile women with uterine fibroids if no other underline cause of infertility. Moreover, this study results also showed that younger patients might be benefited more in term of reproductive outcomes after abdominal myomectomy.
PREVALENCE, ASSOCIATED FACTORS AND AWARENESS OF BULLYING AMONG STUDENTS OF PUBLIC AND PRIVATE SCHOOLS OF LAHORE, PAKISTAN
Authors: Salman Fariha , Sharjeel Muhammad , Abdullah Mohammad Salman
Published: January 2022

Objectives: To find out prevalence of bullying, its associated factors and extent of awareness against bullying among th students of public/private schools of Lahore and to compare them.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Study was carried out in different schools of Lahore, Pakistan, from May to Nov 2019.

Methodology: A total of 294 students of public/private schools (8-10th grade students) of Lahore were recruited in study by purposive sampling. The students filled a pretested and pre-structured questionnaire consisting of questions about bullying, number of bullies, forms of bullying, its causes and consequences, reaction of students towards bullying and if anybody was informed about it.

Results: A higher frequency of bullying was reported in public schools (54%) than in private (46%). Students mostly suffered bullying in the form of humiliating remarks (56.3%) and verbal abuse (25.3%). Causes of bullying in public schools were physical appearance (48.9%), illness (19.1%) and imbalance of power (19.1%) whereas in private schools, physical status (45.0%), imbalance of power (25.0%) and low socioeconomic status (22.5%) were common. Bullying was associated with loss of concentration on studies (19.5%) and behavioral changes (18.4%). The students usually reported bullying incidents to teachers (36.8%) and parents (28.7%). A majority of students walked away from the bully (45.4%).

Conclusion: Bullying is relatively more prevalent in public schools and predominantly manifested in the form of humiliating remarks & verbal abuse. Majority of students show no appropriate resistance towards the bully while bullying causes a critical psychological distress inthem.
COMPARISON OF ENDOTRACHEAL INTUBATION VERSUS SUPRAGLOTTIC AIRWAY DEVICE IN PATIENTS UNDERGOING CORNEAL TRANSPLANTATION UNDER GENERAL ANAESTHESIA
Authors: Abbas Sana , Zafar Omar , Abbas Beenish , Mehmood Basit , Hayat Umer , Javaid Hassaan
Published: January 2022

Objective: To compare endotracheal intubation versus Suraglottic airway device in patients undergoing penetrating keratoplasty under general anaesthesia.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan 2018 to Mar 2020.

Methodology: Total 28 patients enrolled with a mean age of 42.82 ± 7.86 years and age-range of 18-55 belonging to American Society of Anesthesiology I, II & III undergoing penetrating keratoplasty under general anaesthesia. The airway was secured with I–Gel and Endotracheal tube in group A (n=14) and group B (n=14) respectively. Pre anaesthesia assessment along with informed written consent performed. General Anesthesia is given and patients monitored as per standard protocols. Postextubation incidence of cough, sore throat, bronchospasm, stridor and blood on device recorded in addition to surgery and recovery duration.

Results: Twenty-eight patients were enrolled in the study with a mean age of 42.82 ± 7.86 years. There were 9 (32.1%) females and 19 (67.9%) males in the study group. The recovery time was significantly lower for group A as compared to group B (72.64 ± 5.06 vs 80.43 ± 3.75, p<0.001). Similarly, a significantly lesser number of patients experienced post-extubation complications i.e. cough, among group A as compared to Group B [1 (7.1%) vs 8 (57.1%) p0.005].

Conclusion: I-Gel provides smooth recovery with reduced mean recovery time and decreased potential of raised intraocular pressure, when compared with endotracheal intubation in patients undergoing penetrating keratoplasty under general anaesthesia.
CIS-ATRACURIUM WITH MASSETER MUSCLE SPASM: AN UNANTICIPATED DIFFICULT ENDOTRACHEAL INTUBATION AND TEMPOROMANDIBULAR JOINT DISPLACEMENT: A CASE REPORT
Authors: Yousuf Muhammad Saad , Shabbir Ahmed Syed , Samad Khalid
Published: January 2022

Masseter muscle spasm and displacement of temporomandibular joint under anaesthesia could be life threatening if an anaesthesiologist is not prepared. We present a case of 23 years old young lady, who otherwise healthy, having symptoms of abdominal pain and vomiting. Initial baseline workup showed a solitary gallstone and was then planned for urgent laparoscopic cholecystectomy. The challenges faced in the perioperative period were the management of unanticipated masseter muscle spasm and difficult endotracheal intubation after administration of cisatracurium, and temporomandibular joint displacement.
DIAGNOSTIC ACCURACY OF C-14 UREA BREATH TEST FOR DETECTION OF HELICOBACTER PYLORI IN PATIENTS WITH GASTRITIS
Authors: Dar Zaigham Salim , Butt Suniya Arshad , Mir Khurram Hayat , Hussain Fida
Published: January 2022

Objective: To evaluate the diagnostic accuracy of C-14 Urea Breath Test for detection of helicobacter pylori infection in patients with gastritis.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, from Feb to Aug 2016.

Methodology: After fulfilling inclusion and exclusion criteria, 110 patients of both genders, aged between 18-50 years, were enrolled. Prior written informed consent was obtained from each patient. First, they were assessed by C-14 Urea Breath Test, followed by endoscopic biopsy and histopathology. Results of C-14 Urea Breath Test were compared to histopathology diagnosis which was taken as gold standard.

Results: Patients’ ages ranged from 18-50 years with a mean ± SD of 37.45 ± 10.21 years. Seventy four (67.3%) of them were males and 36 (32.7%) were females. Sixty four (58.2%) patients were suspected of helicobacter pylori on C-14 Urea breath test. However, histopathology of endoscopic biopsy confirmed helicobacter pylori in 66 (60%) patients yielding 64 true positive, 44 true negative and 2 false negative cases. Calculated sensitivity was 96.97%, specificity 100% and accuracy was 98.18% for C-14 Urea Breath Test with negative and positive predictive values of 95.65% and 100% respectively.

Conclusion: C-14 Urea Breath Test is highly accurate, sensitive and specific test for detection of helicobacter pylori infection, irrespective of patient’s age and gender.
DETERMINATION OF NORMAL THYROID TECHNETIUM-99M UPTAKE VALUE IN A SINGLE CENTRE PAKISTANI POPULATION
Authors: Malik Asad , Hussain Fida , Ashraf Muhammad , Seher Saima , Jamal Ali , Akbar Shahzad
Published: January 2022

Objective: To determine the normal value of thyroid Technetium-99m uptake value in a single centre Pakistani population.

Study Design: Cross-sectional study.

Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, Rawalpindi, from Feb 2019 to Apr 2020.

Methodology: A total of 90 patients who presented to Nuclear Medical Centre for parathyroid dual radiopharmaceutical scintigraphy were included in study and selected by non-probability consecutive sampling technique. Thyroid uptake studies were calculated via gamma camera acquisition. Pre injection counts were taken from the Technetium-99m pertechnetate filled syringe, thyroid counts were taken from the anterior thyroid image 20 minutes post injection and to look for any residual radiopharmaceutical counts of the empty syringe were also taken.

Results: Out of total of 90 patients, 32 (35.6%) were male while 58 (64.4%) were female with male to female ratio of 1:2. The mean age was 38.4 ± 12.7. Mean Thyroid Stimulating Hormone values were 1.6 ± 0.8 and mean T4 values were 11.9 ± 3.5. The 5th-95th percentile range was 0.4-2.2% and median was 1.2%. The interquartile range was calculated to be 0.9-1.5%.

Conclusion: Normal value of thyroid Technetium-99m uptake value in a single centre Pakistani population values varies significantly as compared to global figures i.e. 0.3-4.5% and is different than the one used in our own department i.e. 0.5-2.0%.
ROLE OF DOPPLER INDICES IN THE PREDICTION OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA
Authors: Tabasam Shakra , Malik Zaib , Siraj Asifa , Afroz Sadaf
Published: January 2022

Objective: To determine diagnostic accuracy of systolic/diastolic ratio and cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2017.

Methodology: A total of 191 patients with preeclampsia were included. Doppler ultrasound (including doppler wave forms obtained from free floating portion of umbilical artery and doppler waveform from middle cerebral artery at the level of circle of Willis) examination was done after gestational age 30 weeks and Doppler study repeated at 2-4 weeks interval depending on severity of preeclampsia and abnormalities of waveform. Cases were followed and results of last Doppler examination within 10 days of delivery were considered and perinatal outcome noted.

Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of systolic/diastolic ratio in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 82.35%, 86.52%, 87.50%, 81.05% and 84.29% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 78.67%, 92.24%, 86.76%, 86.99% and 86.91% respectively.

Conclusion: The diagnostic accuracy of systolic/diastolic ratio, cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia is quite high.
COMPARISON OF EFFECTIVENESS OF INTRAARTICULAR INJECTIONS OF HYALURONIC ACID AND CORTICOSTEROIDS IN THE TREATMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS SYMPTOMS
Authors: Tirmizi Syed Haider , Fakhr Amer , Amer Ahmed , Yusuf Rizwan , Sajjad Kaswar , Khan Shah Muhammad
Published: January 2022

Objective: To compare the effectiveness of intraarticular injections of hyaluronic acid and corticosteroids in the treatment of patients with knee osteoarthritis symptoms.Study Design: Prospective comparative study.Place and Duration of Study: Rheumatology/General Medicine department, Pak Emirates Military Hospital Rawalpindi, from May 2019 to Jun 2020.Methodology: Patient of knee osteoarthritis with active symptoms of pain and stiffness who fulfilled American college of rheumatology criteria of 1997 were included in the study. They were randomly divided into two groups with group A receiving intraarticular hyaluronic acid. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was administered before and three months after the management to assess the efficacy of treatment in both the groups. Student ttest was applied to ascertain that the difference in the WOMAC scores before and after the management has been statistically significantly different in both groups.

Results: A total of 150 patients of osteoarthritis of knee joint were included in the study. Mean age of the study participants was 58.439 ± 7.35. 85 (56.7%) patients were female while 65 (43.3%) were male. 81 (54%) received the intraarticular hyaluronic Acid while 69 (46%) received the intraarticular steroids. Mean difference before and after the management in WOMAC score in corticosteroids group was 9.295 ± 1.24 while in hyaluronic Acid group was 5.41 ± 4.556 (p-value <0.01).

Conclusion: Both hyaluronic Acid and corticosteroids were effective to reduce the symptoms of osteoarthritis knee in our target population, but intraarticular steroids emerged as the better option from the two in terms of.......
COMPARISON OF METFORMIN AND ORAL CONTRACEPTIVE PILLS IN THE TREATMENT OF POLYCYSTIC OVARIAN SYNDROME
Authors: Mushtaq Rabia , Iqbal Sadaf , Abbas Afroza , Iftikhar Bushra , Ahmed Waqas , Afsheen Afeera
Published: January 2022

Objective: To compare metformin and oral contraceptive pills in terms of mean change of serum testosterone levels and body mass index in polycystic ovarian syndrome.

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Gynecology and Obstetrics, Sargodha Medical College, Sargodha Pakistan, from Apr to Dec 2019.

Methodology: A total of 64 patients presenting with polycystic ovarian syndrome between 15-35 years were included. All patients were divided into two groups i.e. group 1 received oral contraceptive pills, and group 2 received metformin. Patients were clinically evaluated at baseline and 6 months after initial presentation to address the primary aim of evaluating the change in mean serum testosterone levels and body mass index after treatment.

Results: The mean age of patients was 20.30 ± 4.92 years. The mean body mass index of patients at presentation was 30.32 ± 2.66 kg/m2. The mean reduction in the level of testosterone in group 1 was 5.14 ± 0.35ng/ml while in group 2 it was 2.58 ± 0.41 ng/ml (p˂ 0.001) which was statistically significant. Mean decrease in body mass index in group 1 was 1.51 ± 0.71 kg/m2 while in group 2 was 1.29 ± 0.46 kg/m2 (p=0.148) which was statistically insignificant.

Conclusion: Oral contraceptive pills were better than metformin in terms of mean decrease in serum testosterone levels in women presenting with polycystic ovarian syndrome while the mean reduction in body mass index in both the groups was similar.
DIAGNOSTIC ROLE OF ENDOBRONCHIAL WASHINGS AND BIOPSY IN SMEAR NEGATIVE PULMONARY TUBERCULOSIS AND ITS CORRELATION WITH HIGH RESOLUTION COMPUTED TOMOGRAPHY CHEST FINDINGS
Authors: Hussain Maryam , Kamran Sultan Mehmood , Azam Rizwan , Khan Asifullah , Ahmed Sohaib , Ali Usman Bin
Published: January 2022

Objective: To determine role of endobronchial washings/biopsy in diagnosis of smear negative pulmonary tuberculosis and evaluate their association with computed tomography findings.

Study Design: Cross-sectional - analytical study.

Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2020.

Methodology: Patients having symptoms of pulmonary tuberculosis and abnormal findings on chest imaging with negative sputum smears for acid fast bacilli were selected for endobronchial washings. Bronchoscopy for washings was carried out in these patients and sample was sent for Acid fast bacilli stain, Mycobacterium tuberculosis gene Xpert and acid fast bacilli culture and sensitivity bacterial culture and fungal hyphae. In case of mass lung endobronchial and/or transbronchial lung biopsy was done and sample was sent for histopathology Active pulmonary tuberculosis was labelled as per definition.

Results: Out of 105, 75 (71.4%) were male and 30 (28.6%) were female. Mean age was 55.69 ± 17.33 years. Total 40 (38.09%) were diagnosed with pulmonary tuberculosis (based on smear, genexpert, culture and histopathology). In these 40 patients, computed tomographic findings showed consolidation in 10 (25%) cases, cavity in 7 (17.5%), bronchiectasis in 3 (7.5%), mass in 1 (2.5%), pleural effusion in 2 (5%), lymphadenopathy in 1 (2.5%) and tree-in-budappearance in 12 (30%) cases.

Conclusion: High resolution computed tomography and endobronchial washing both combined together increase the diagnostic yield in smear negative cases.
COMPARISON OF EFFECTIVENESS OF CARBAMAZEPINE VERSUS TOPIRAMATE FOR THE MANAGEMENT OF TRIGEMINAL NEURALGIA
Authors: Tariq Ramish , Janjua Omer Sefvan , Mehmood Sana , Khalid Muhammad Usman , Zafar Khurram Jah , Hameed Saad
Published: January 2022

Objective: To compare the effectiveness of Carbamazepine versus Topiramate for the management of trigeminal neuralgia.

Study Design: Comparative prospective study.

Place and Duration of Study: Oral and Maxillofacial Surgery department, Allied Hospital, Faisalabad Pakistan, from Nov 2017 to Nov 2018.

Methodology: A total of 60 patients (30 in each group) were included. Group A was treated with Carbamazepine 100mg TDS and group B with Topiramate 25mg TDS. Visual analogue scale was used to access pain and was calculated at 1st visit (baseline), at 7th day, at 14th day and at 28th day.

Results: Out of 60 patients, mean of age was 54.78 ± 8.49 years. Right and left side of the face was involved in 41 (68.3%) and 19 (31.7%) patients respectively. Maxillary branch was involved in 24 (40%) and mandibular branch was involved in 36 (60%) patients. The mean of visual analogue scale after 7 days in group A was 4.53 ± 0.93 and in group B was 7.1 ± 1.07, after 14 days mean of visual analogue scale in group A was 3.7 ± 1.02 and in group B was 4.03 ± 1.27. Mean of visual analogue scale after 28 days in group A was 3.27 ± 1.01 3.93 ± 1.28. The results were statistically significant with p-value of 0.03.

Conclusion: Topiramate has comparable efficacy as that of Carbamazepine at dose of 75-100mg with lesser side effects. So Topiramate can be used as first line of treatment in trigeminal neuralgia.
OUTCOMES OF LAPAROSCOPIC CHOLECYSTECTOMY IN DIFFERENT GRADES OF GALL BLADDER INFLAMMATION A TERTIARY CARE CENTRE EXPERIENCE
Authors: Ali Amir , Syed Mukarram Hussain , Khan Taimoor Ashraf , Aslam Farheen , Ahmad Gufran , Akbar Afnan
Published: January 2022

Objective: To find the outcomes of laparoscopic cholecystectomy in gall bladders with all grades peri-operative inflammation.

Study Design: Prospective observational study.

Place and Duration of Study: Combined Military Hospital, Rawalpindi, from Nov 2018 to Aug 2019.

Methodology: All patients with symptomatic gall bladder disease who underwent laparoscopic cholecystectomy (emergency/elective procedure) and American Anesthesiology Society (ASA) Score 1 or 2 were included in the study.

Results: A total of 330 patients with a mean ± SD age of 48.01 ± 14.13 years underwent laparoscopic cholecystectomy. Out of 330 patients, 129 (39.1%) had acute inflammation of gall bladder while 201 (69.9%) cases were operated electively. The rate of conversion and complications were somehow lesser in both categories as the overall conversion rate was 15 (4.5%).

Conclusion: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gall stones. Moreover, it is safe option in acute and chronic inflammation of Gall bladder if performed by a experienced laparoscopic surgeon.