bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Supplementation of Acacia Honey and Pioglitazone on Blood Glucose Levels in Streptozotocin-Induced Type 2 Diabetic Rats
Authors: Khan Mahvash , Khan Umar Ali , Asad Munazza , Ashfaq Mehvish , Riaz Bushra
Published: December 2022

Objective: To determine the effect of combined supplementation of Pioglitazone and Acacia Honey on blood glucose levels in Streptozotocin-induced type 2 diabetic rats.

Study Design: Laboratory-based animal study.

Place and Duration of study: Al-Nafees Medical College, in collaboration with the National Institute of Health, Islamabad Pakistan, from Jan 2016 to Jun 2017.

Methodology: The study was conducted on 150 male Sprague Dawley rats, divided into five groups with 30 rats. Group-I was the control Group. Groups II-V were given Streptozotocin 65 mg Streptozotocin intraperitoneally to make them diabetic. Group II was diabetic control. Group-III was given acacia honey for three weeks. Group-IV received an intraperitoneal injection of Pioglitazone (oral hypoglycemic) 15 mg/kg body weight per day plus Acacia honey, and Group-V was given Pioglitazone intraperitoneally for the same dose and duration. Fasting blood glucose levels were measured after three weeks of supplementation.

Results: After three weeks of supplementation, the blood glucose levels were significantly (p-value <0.001) lower in all Groups (Group- III: 228.33±40.60 mg/dl, Group-IV: 132.50±22.67 mg/dl and Group- V: 120.73±14.19 mg/dl) as compared to Group-II (Diabetic Controls) (290.13±52.60 mg/dl).

Conclusion: Combined supplementation of Acacia honey and Pioglitazone reduces blood glucose levels in Streptozotocin-induced type 2 diabetic rats.
Designing Cast Partial Dentures in Relation to Partial Edentulism
Authors: Aslam Samina , Khan Imran , Sharif Mubashir , Bangash Azhar Ali , Afzal Muhammad , Khan Mansoor
Published: December 2022

Objective: To determine the pattern of partial edentulism and the cast removable dental prosthesis design in relation to the Classes recorded.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Prosthodontics, Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Apr to Sep 2021.

Methodology: A total of 67 partially dentate male and female patients presenting to the Prosthodontics Department requiring partial cast dentures were included in the study. Visual inspection of the master casts and partial denture frameworks was carried out in the laboratory. Kennedy's Classification, modification areas, type of major connector, direct retainer, rest and use of indirect retention were recorded.

Results: The most prevalent Class of partially dentate arch was Kennedy Class-II in maxilla 10 (45.5%) and Class-I and III in mandible 15 (33.3%) each. Major connectors most frequently encountered were anteroposterior palatal strap (59.1%) and lingual bar (57.8%). Circumferential clasp (35.8%) was the most used retainer type in Classes II and III, whereas RPI was mostly found in Classes I and II (32.1%). Occlusal rests were most commonly used (72.4%). Indirect retention was mostly used in Class-I and II denture frameworks (95.9%).

Conclusion: The most commonly encountered partial edentulism pattern was Kennedy's Class I and II. Following basic principles of RPD design can help elevate the standards of removable denture treatment.
Burnout Among Basic Sciences Faculty; A Mixed Method Research
Authors: Ayub Ayesha , Choudry Zafar Ali , Ehsan Sumera Badar , Farooq Hafiz Umer , Tahir Muhammad Munaim
Published: December 2022

Objective: To study the burnout and its associated factors among the faculty of basic sciences in Faisalabad.

Study Design: Mixed-method research.

Place and Duration of Study: Basic sciences faculty of Public and Private Sector Medical Institutes of Faisalabad Pakistan, from Sep to Dec 2021.

Methodology: Oldenburg Inventory was used to assess burnout among the faculty of basic medical sciences after taking the authors' permission. SPSS version 23:00 was used to analyze data, and those who had shown a higher level of burnout were interviewed. Recorded interviews were later own transcribed, and thematic analysis was done.

Results: The mean exhaustion score for the whole basic sciences faculty was 2.35 ± 0.27, while for disengagement from work, it was 2.24 ± 0.24. Value was 0.62 and 0.144 for exhaustion and disengagement, respectively, showing no difference between the burnout level of faculty members in public and private sectors in both domains. Lack of acknowledgement, Lack of resources, Motivational factors and Lack of progress system were the main themes that emerged after an in-depth exploration of faculty members.

Conclusion: The faculty from basic sciences are facing burnout, and the major causes are lack of acknowledgement and appreciation, decreased number of faculty, inadequate resources and ambiguity about future growth in basic sciences. The faculty member advocated the need to develop faculty training, mentoring and post-graduation programmes for the survival and strengthening of basic sciences.
Comparison between Desarda's Inguinal Hernia Repair and Lichtenstein Hernioplasty in terms of Complications, Operative time and Cost-effectiveness
Authors: Ali Aamir , Bukhari Syed Usman Shah , Awan Saeed Akhtar , Ahmed Umair , Ahmed Ali , Babar Malik Waseem
Published: December 2022

Objective: To compare Desarda tissue-based repair with the traditional Lichtenstein hernioplasty in terms of complications, operative time and cost-effectiveness.

Study Design: Comparative Cross-sectional Study.

Place and Duration of Study: Surgical Department Combined Military Hospital, Mailsi Pakistan, from Dec 2019 to Dec 2020.

Methodology: Lichtenstein (Group-I) and Desarda (Group-II) were randomly allocated to 140 patients with inguinal hernia, 70 in each Group, respectively. Both Groups were compared in terms of postoperative complications, cost evaluation and operative time.

Results: The mean operative time in Group-I was 54.5±4.09 minutes, whereas in Group-II, it was 70.24±5.30 minutes. The mean cost estimated in Group-I was 4400±225 rupees, while in Group-II, it was 850±150 rupees, respectively. Desarda's repair was comparable to Lichtenstein's hernioplasty in terms of postoperative complications.

Conclusion: Desarda's hernia repair is more cost-effective than the Lichtenstein procedure for treating inguinal hernia. Reduced surgical time, faster restoration to normal gait, and return to work are all the possible benefits of the Lichtenstein repair. Furthermore, Lichtenstein hernioplasty is a better option in patients with weak external oblique aponeurosis.
Small Dense Low-Density Lipoprotein Cholesterol as a Novel Biomarker of Coronary Heart Disease
Authors: Saleem Iffat , Aamir Muhammad , Haroon Zujaja Hina , Yasir Afshan , Munir Muhammad Usman , Anwar Muhammad
Published: December 2022

Objective: To compare serum small dense low-density lipoprotein cholesterol levels in coronary heart disease (CHD) patients and healthy controls.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, in collaboration with AFIC Rawalpindi from Feb to Dec 2021.

Methodology: A total of 220 participants were selected for the study, 120 healthy controls and 100 CHD patients. Fasting blood samples after 12 hours of fast were collected for lipid profile and small dense low-density lipoprotein cholesterol (sdLDL-C) levels. SdLDL-C levels were analyzed by automated, standardized enzymatic assay on Siemens Advia 1800 automated chemistry analyzer using Ex Denka Seiken kits.

Results: Among the total participants, 154 (70%) were males, and 66(30%) were females. The median age of all participants was 55(IQR: 52 -56) years, while their median sdLDL-C was 0.93 (IQR: 0.56-1.08) mmol/L. Results showed that small, dense LDL cholesterol serum levels were significantly raised in CHD patients compared to healthy controls (p-value <0.05).

Conclusion: The current study showed that patients with CHD had elevated small, dense LDL-C levels compared to the healthy control group.
Significance of Immature Platelet Fraction in Diagnosed Patients of the Immune Thrombocytopenic Purpura
Authors: Haider Mohammad Shabih , Mahmood Asad , Bozdar Manzar , Zahir Saima , Muzafar Saadia , Bukhari Maliha Batool
Published: December 2022

Objective: Determination of significance of immature platelet fraction (IPF%) in diagnosed patients of Immune thrombocytopenic purpura (ITP).

Study Design: It was a cross-sectional study.

Place and Study Duration: Haematology department, Armed forces Institute of Pathology (AFIP), Rawalpindi Pakistan June 2021 to December 2021.

Methodology: Patients of all ages and genders diagnosed with ITP and platelets less than 100 x 109/L after a review of peripheral blood film were included in the study. Detailed history and examination were made, complete blood count (CBC) test was done on Sysmex XN-3000 automated haematology analyzer. Peripheral blood was stained with Leishman stain and examined under a microscope to rule out pseudo thrombocytopenia and the presence of abnormal cells and dysplasia. After adequate quality and control, the immature platelet fraction was performed on Sysmex XN 3000.

Results: Seventy-two diagnosed cases of immune thrombocytopenic purpura were part of the study. The mean age of the patients was 21.00±14.50 years. 34 (48%) patients were males, and 38 (52%) were females. The mean platelet count was 49.40±24.60. Mean IPF was 17.90±9.50 per microliter. Immature platelet fraction (IPF%) was raised in all the patients with immune thrombocytopenic purpura, confirming our hypothesis that IPF% was an independent predictor for the detection of ITP.

Conclusion: Immature platelet fraction is a unique parameter that can pick patients having thrombocytopenia due to peripheral destruction, including immune thrombocytopenic purpura.
Assessment of Patient-Centered Care with Reference to Minimum Service Delivery Standards in District Headquarter Hospitals of Azad Jammu Kashmir
Authors: Khalid Bilal , Babar Ayesha , Ahmad Sohail , Ayyub Fareeha , Bukhtawer Nadia
Published: December 2022

Objective: To assess the existing healthcare and delivery services and to evaluate the factors that affect the effectiveness of the care of patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Seven Districts Headquarter Hospitals of Azad Jammu and Kashmir Pakistan from Dec 2020 to May 2021.

Methodology: The data were collected using a questionnaire based on the Material Safety Data Sheet (MSDS) set standards by Punjab Healthcare Commission (PHC) for monitoring and evaluating the services delivery at the hospitals. Data were collected by observing every department of the hospital, interviewing the concerned person of every department, and checking the medical record of the hospital.

Results: All the seven DHQ hospitals including DHQ Neelum, DHQ Hattian Bala, DHQ Pallandari, DHQ Bagh, DHQ Kotli, DHQ Bhimber, and DHQ Mirpur were working throughout the week and service delivery was ensured for 24 hours in all health facilities. It was observed in this study that the management of medication was the area with the highest degree of compliance (76.2%). On the other hand, the area involving patient rights and education showed the lowest level of compliance with an average score of 6 and a percentage compliance of 25%.

Conclusion: The compliance of health delivery services with respect to MSDS was very low in district headquarter hospitals of AJK. Targeted strategies are needed to improve the overall quality of the service delivery.
Frequency and Pattern of Thyroid Dysfunction in Patients with Polycystic Ovary Syndrome
Authors: Naz Sadaf , Khan Khurshid Ahmad , Umer Amina , Raza Muhammad Tabish , Nasir Khalid Mehmood , Hussain Imtiaz
Published: December 2022

Objective: To determine the frequency and pattern of thyroid dysfunction in patients with polycystic ovary syndrome.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Endocrinology, Jinnah Hospital, Lahore Pakistan, from Jan from Jun 2017.

Methodology: Seventy-seven patients diagnosed with PCOS, based on Rotterdam criteria, were enrolled in the study. Thyroid function status was evaluated using measurement of serum thyroid-stimulating hormone (TSH), free T3, T4 and anti-thyroperoxidase (anti-TPO) antibodies.

Results: The mean age of the study population was 29.0±9.2 years. Out of 77 females with PCOS, 63(81.8%) were euthyroid, five (6.5%) patients were diagnosed with primary hypothyroidism, and nine (11.7%) were found to have subclinical hypothyroidism. Anti-TPO antibodies were detected in 18 patients (23.4%), including 12(19.0%) euthyroid females.

Conclusion: Thyroid dysfunction was found among patients with PCOS. Evidence of autoimmunity was seen even in euthyroid patients.
Gallbladder Perforation with Conventional Monopolar Diathermy Versus Harmonic Scalpel in Laparoscopic Cholecystectomy at Combined Military Hospital, Quetta
Authors: Ahmed Ghufran , Ashraf Imran , Jabbar Abdul , Muazzam Muhammad Ali , Ahmed Umair , Ali Amir
Published: December 2022

Objective: To estimate the frequency of gallbladder perforation with conventional Monopolar Diathermy versus Harmonic scalpel in laparoscopic cholecystectomy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Surgery, Combined Military Hospital, Quetta Pakistan, from Sep 2018 to Sep 2019.

Methodology: A total of 160 patients undergoing laparoscopic cholecystectomy for symptomatic gallstones were included in the study and were randomly allocated into two groups based on the surgical technique of dissecting gall bladder from the liver bed. In Group-A, Monopolar Diathermy was used, and in Group-B Harmonic scalpel was used. Frequency of gall bladder perforation and demographic details were recorded on predefined proforma.

Results: In our study, mean age was 48.21±8.94 years and 49.14±9.31 years in Group-A and Group-B respectively. Comparison of Gallbladder perforation in both groups showed 17(21.25%) cases in Group-A and 5(6.25%) cases in Group-B, (p-value <0.001).

Conclusion: In laparoscopic cholecystectomy, the frequency of gallbladder perforation with conventional monopolar diathermy is significantly higher compared to the harmonic scalpel.
Bacteremia in Pediatric Oncology Patients; A Single-Center Experience
Authors: Shaukat Zunaira , Wali Rabia , Khan Saadiya Javed , Nizamuddin Summiya , Qazi Romena , Memon Kainat , Shaheen Najma
Published: December 2022

Objective: To study organisms causing bacteremia and their outcome in cancer children with febrile neutropenia (FN) admitted at our centre.

Study Design: Retrospective longitudinal study. 

Place and duration of study: Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, from Feb to Dec 2017. 

Methodology: All pediatric oncology patients with febrile neutropenia admitted to the inpatient department were included. Data fields included age, diagnoses, demographics, organism types, time to positivity, multi-drug resistance, antibiotics, and outcome.

Results: A total of 391 episodes of febrile neutropenia were documented among 86 patients. The mean age was 4.7±2.7 years. Twelve (14.0%) patients had intensive care admission, and 9(10.5%) of them died. Fifty-four (63.0%) children had primary diagnoses of haematological malignancies. Sixty-five percent had mucositis, central catheter, or both as risk factors. Thirty-nine isolates were cultured in 391 febrile-neutropenic episodes. Escherichia coli was the most frequently isolated organism in 16(41.0%) cultures, followed by Pseudomonas and Streptococcus pneumoniae in 4(10.3%) each. Poly-microbial isolates were seen in 6(15.4%) cultures. Multi-drug resistance was found in 12(30.8%) isolates. Thirty-four (87.0%) patients with positive cultures received appropriate antibiotics. Majority organisms were sensitive to Piperacillin/Tazobactam (14,35.9%) followed by Meropenem (10, 25.6%) and Colistin (6, 15.4%).

Conclusions:  Rapid identification of organisms from positive blood cultures combined with antimicrobial stewardship can have improved antibiotic treatment and outcomes.
Comparison of Frequency of Sore Throat and Cough after Prophylactic Lignocaine and Beclomethasone in Adults
Authors: Ali Ahsan , Ahmed Niaz , Shafqat Huda , Hussain Aftab , Sultan Muhsan , Akram Muhammad
Published: December 2022

Objective: To compare the frequency of sore throat and cough after prophylactic Lignocaine versus Beclomethasone in adults undergoing tracheal intubation.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2019.

Methodology: A total of 180 patients of both gender scheduled for elective surgery under general anaesthesia with endo-tracheal intubation were recruited for this study. Ninety patients of Group-A received Lignocaine, while 90 patients of Group-B received Beclomethasone. After 24 hours of the procedure, sore throat and cough were assessed from both groups and noted.

Results: The age range in this study was from 18 to 50 years, with a mean age of 34.22±5.31 years in Group -A while 36.57±7.22 years in Group-B. Sore throat was seen in 22(24.4%) patients in Lignocaine-Group (Group-A) as compared to 9(10.0%) patients in Beclomethasone-Group (Group-B) (p=0.010). Cough was seen in 18(20.0%) patients in the Lignocaine-Group as compared to 5(5.6%) patients in the Beclomethasone-Group (p=0.003).

Conclusion: This study concluded that spraying Beclomethasone on the endotracheal tube reduces the frequency and severity of postoperative sore throat and cough in patients given general anaesthesia with endotracheal intubation.
The Association between Vitamin D and Wheezing
Authors: Hussain Murtaza , Malik Qudratullah , Khan Qamar uz Zaman , Bashir Junaid , Abbas Muhammad , Ijaz Maryam
Published: December 2022

Objective: To determine the association between vitamin D status and recurrent wheezing.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Aug 2019 to Aug 2020.

Methodology: Sixty infants with recurrent wheezing and 60 healthy age-matched infants without acute or chronic illness were inducted into the study. 25 (OH) Vitamin D, immunoglobulin E (IgE) levels and eosinophil counts were measured. In addition, data were analyzed to find the association of vitamin D levels with recurrent wheezing.

Results: In the Control-Group, the mean 25 (OH) vitamin D levels were 25.90±7.57 ng/ml and in the Recurrent Attack- Group was 13.90±4.63 ng/ml (p= 0.02). The mean IgE levels of the Control-Group were 22.80±2.67 IU/ml, and the Recurrent Attack-Group was 149.20±30.60 IU/ml (p=0.001). Eosinophil count in Recurrent Attack-Group was 150.40±23.11 cells/uL and 338.95±33.50 cells/uL in Control-Group respectively (p= 0.08)

Conclusion: There is a strong association between low vitamin D levels and recurrent wheezing.
Influence of Operator Experience on Clinically Achieved Convergence Angle of Tooth Preparations for Metal-Ceramic Crowns
Authors: Naseem Ayesha , Ishaq Waleed , Aziz Sara , Ahmed Salman , Ghafoor Aamir
Published: December 2022

Objective: To compare clinically achieved convergence angle values of teeth prepared by operators having different experience levels and relate them with recommended values.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of Prosthodontics, Islamic International Dental Hospital, Islamabad Pakistan, from Dec 2018 to May 2019.

Methodology: A total of 100 crown dies of molars prepared by House Officers (Group-I) and Postgraduate Residents (Group-II) of the Prosthodontics department were collected retrospectively. Auto CAD 2007 software was used for the measurement of convergence angle. One sample t-test was applied to compare the mean convergence angle values with theoretical values. In addition, independent samples t-test was applied to compare convergence angle values among Clinician Groups with different experience levels.

Results: Significant difference (p <0.001) was found between the tooth preparations performed by both study Groups. Greater convergence angles were achieved by operators having lesser experience, i.e., Group-I (House Officers) in contrast to Group-II (Post-graduate Residents). The convergence angle achieved by both study groups was far greater than the recommended values (4-14 degrees).

Conclusion: Significant discrepancy exists between the recommended guidelines and the clinically achieved convergence angle values recorded in this study. The recommended values were rarely achieved. Operator experience seems to be an important determinant for achieving better convergence angle values.
Level of General Stress in Doctors Community in Pre and Post Covid-19 Scenario in Different Hospitals of Pakistan
Authors: Nayyar Shaista , Niaz Asif , Abbas Naseer Ahmed , Lashari Naveed , Ahmad Jawad , Khan Shahid
Published: December 2022

Objectives: To find out the level of stress among the doctor community before and during the COVID-19 pandemic in different public sector hospitals.

Study Design: Cross-sectional study.

Place and Duration of Study: Divisional Headquarters DHQ Teaching Hospital, Sahiwal Pakistan and two Public Sector Hospitals at Okara and Islamabad Pakistan, from Aug 2019 to Aug 2020.

Methodology: A total of 320 doctors in two Groups were included in the study. Group-1 included 197 doctors in pre-COVID-19 time i-e from Aug 2019 to Jan 2020, while Group-2 included 123 doctors working in the COVID-19 scenario. The stress was assessed according to responses on a structured questionnaire and patient health questionnaire (PHQ-9) scores.

Results: Three hundred and twenty doctors participated in the study, out of which 78(39.8%) doctors in the First Group and 49(40.4%) in Second Group developed depression during their duties. More female doctors participated in the study, most of whom were young doctors who were actively involved in COVID-19 patients.

Conclusion: There is no significant rise in stress among the doctors working in the COVID-19 situation in public sector hospitals of Pakistan.
Association of Apolipoprotein B and Triglyceride Levels with Coronary Artery Disease
Authors: Habib Hunain , Haroon Zujaja Hina , Aamir Muhammad , Bibi Afshan , Javed Haroon , Jaffer Syed Raza
Published: December 2022

Objective: To find the association of Apolipoprotein B and triglycerides with coronary artery disease.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, in collaboration with HITEC Institute of Medical Sciences, Taxila Pakistan, from Mar 2019 to Mar 2020.

Methodology: Four hundred and forty-four individuals of either gender and 18-70 years were included in the study. According to CT angiography, participants were differentiated into those with coronary artery disease and without coronary artery disease. In addition, serum triglycerides were analysed by glycerol phosphate enzymatic endpoint method on ADVIA 1800R Clinical Chemistry Auto analyzer, and apolipoprotein B was analysed on BT1500 Clinical Chemistry turbidimetric analyzer.

Results: The sample population had 144(32.0%) females and 300(68.0%) males. 164(37.0%) patients had coronary artery disease. 120(27.0%) participants were between 35 and 45 years of age, and 96(22.0%) were between 56 and 65 years. 126(30.0%) patients had hypertension, 352(79.3%) had apolipoprotein B levels >130 mg/dl. Positive Pearson’s correlation was found between apolipoprotein B and triglycerides with coronary artery disease.

Conclusion: There is a strong association between apolipoprotein B and non-fasting triglyceride levels with coronary artery disease. The apolipoprotein B can be used as a routine biomarker for screening and treatment monitoring coronary artery disease along with other lipid profile parameters.
Clinical Features and Outcome of SARS-CoV 2 Virus Infection in Patients with Autoimmune Diseases
Authors: Perveen Shahida , Salim Babur , Faisal Mohammad Jamal , Samreen Saba
Published: December 2022

Objectives: To evaluate the clinical features, outcome and poor prognostic factors of COVID-19 in rheumatic disease patients.

Study Design: Cross-sectional study.

Place and duration of Study: Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, from Mar to Sep 2020.

Methodology: The study included rheumatic disease patients with COVID-19. Patients' age, gender, smoking status; details of rheumatic disorder; method of COVID-19 diagnosis, treatment and outcomes were recorded.

Results: The study included 46 patients. Overall mortality rate was 23.8%. The most common symptoms were fever (35, 83.3%), cough (26, 61.9%) and myalgia (23, 54.8%). Dyspnea was associated with mortality (p=0.013), ICU admission (p<0.001), ventilation (p=0.02) and hospitalization (p<0.001). NSAIDs increased the risk of ventilatory support (p= 0.02). Long term steroids predicted mortality (p=0.02), hospitalization (p=0.014) and intensive care admission (p=0.004). Steroid and Hydroxy-chloroquine treatment for COVID-19 was associated with intensive care admission (p= 0.001 and 0.006, respectively) and ventilation (p=0 .007 and 0.03, respectively). Mycophenolate Mofetil was related to intensive care admission, ventilation and hospitalization (p=0.03, 0.03 and 0.02, respectively), whereas Cyclophosphamide was related to hospitalization (p= 0.03). Systemic lupus erythematosus was associated with all poor outcomes except ventilation (p<0.05)

Conclusion: Systemic lupus erythematosus, long-term steroids, Mycophenolate Mofetil, Cyclophosphamide and Dyspnea are associated with severe COVID-19.
Antenatal Diagnosis, Surgical Approach and Maternal Morbidity with Placenta Accreta
Authors: Arif Nadia , Zafar Bushra , Ahmed Raja Qaseem , Shehzad Farrukh
Published: December 2022

Objective: To emphasize the importance of antenatal diagnosis of the morbidly adherent placenta, employ management options accordingly and their impact on the patient’s outcome.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Okara Pakistan, Jan 2018 to Aug 2020.

Methodology: One hundred and twenty-four patients were enrolled in the study. Diagnosed morbidly adherent placenta was made through trans-abdominal ultrasound, and a Doppler study in selected cases of posterior placenta previa magnetic resonance imaging (MRI) was performed. The surgical approach was either a high transverse placenta sparing or a classical incision on the uterus. After delivery of baby, conservative management included resection of part of uterus with adherent placenta followed by reconstruction of the lower uterine segment, segmental resection of myometrial tissue and hemostatic sutures, and over sewing of placental bed. The requirement of blood transfusion, intensive care unit stay, post-operative recovery, and day of discharge, along with all demographic and surgical details, was noted.

Results: In 87(70%) patients, high transverse or placental sparing incision was made to assess the baby. Over sewing of the placental bed was done in 37(29.8%) patients, and myometrial segment resection was done in 57(46%) patients. An obstetrical hysterectomy was carried out in 30 patients. Blood transfusion of > 4 units RCCs was required in 92(74%) patients. 16% the patients required intensive care management.

Conclusion: Antenatal diagnosis of morbidly adherent placenta through useful imaging modality allowed for a planned surgical approach and minimized......
Assessment of Serum Biochemical Changes in Hepatic Encephalopathy
Authors: Rauf Amna , Rauf Sidra
Published: December 2022

Objective: To analyze the association of various biochemical changes with different grades of hepatic encephalopathy among patients of hepatitis C-related decompensated liver disease presenting at Pak Emirates Military Hospital. Rawalpindi, Pakistan.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Medicine and Gastroenterology Department of Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Mar 2020 to Feb 2021.

Methodology: This study was conducted on 100 patients with hepatitis C-related decompensated liver. A consultant medical specialist or gastroenterologist graded hepatic encephalopathy according to the West Haven criteria. Serum urea, creatinine, albumin and international normalized ratio were performed in all the patients at the time of grading of encephalopathy and derangement in the level of these parameters was analyzed with Grades of encephalopathy.

Results: Out of 100 patients, in the final analysis, 66 were males, and 44 were females. The commonest aetiology of hepatic encephalopathy was Infection (33%) followed by Constipation (29%). 15 patients had Grade-1 encephalopathy, 43 had Grade-2, 26 had Grade-3 while 16 had Grade-4 encephalopathy. Deranged serum creatinine, international normalized ratio and albumin levels were significantly associated with a higher grade of hepatic encephalopathy (p-value<0.05) in our study participants.

Conclusion: Biochemical markers studied in patients with hepatic encephalopathy secondary to hepatitis C-related decompensated chronic liver disease were deranged. In addition, creatinine, albumin and International normalized ratio were found to be more deranged in higher grades of encephalopathy.
Death Anxiety Scale for Pre-Surgical Patients
Authors: Khan Rabia Noor , Dar Rafiq
Published: December 2022

Objective: To develop a scale for assessing death anxiety in pre-operative patients.

Study Design: Cross sectional study.

Place and Duration of Study: District Head Quarters Gujranwala, Fazal Hospital Gujranwala, Gondal Hospital Gujranwala and Mayo Hospital, Lahore Pakistan, from Apr to Nov 2020.

Methodology: Three hundred and fifty patients were included in the study. The one-factor solution was run on the data as the data was homogenous, and multiple factors were not elicited. The severity level of the patients’ symptoms was explored using the subjective rating scale. The developed scale's validity was compared with the translated Arabian version of death anxiety.

Results: Varimax rotation and scree plot showed that one component solution best fit the indigenously developed scale. The severity level of the patients on the subjective rating scale for each item showed that patients in Pakistani culture would face more psychosomatic symptoms of death anxiety rather than emotional ones.

Conclusion: The indigenously developed scale would help manage pre-surgical patients' psychosomatic symptoms of death anxiety.
Rise CKMB and Myoglobin Levels in Non-Cardiac Patients of Ischemic Stroke Presenting to Emergency Department of a Tertiary Care Hospital
Authors: Dawood Muhammad , Abbas Yasir , Hashmat Asif , Khan Andaleeb , Butt Kamil Rehman , Rehman Shahana
Published: December 2022

Objective: To assess the rise in CKMB and Myoglobin levels and associated factors in non-cardiac patients of ischemic stroke presenting to the Emergency Department of a Tertiary Care Hospital.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Dec 2020 to May 2021.

Methodology: A total of 150 patients with ischemic stroke diagnosed by the consultant Emergency physician or medical specialist based on clinical and neuro-radiological findings were included in this study. Serum CKMB and myoglobin levels were assessed along with other baseline investigations among the study participants. In addition, the relationship of age, gender, the severity of the stroke and the presence of non-cardiac comorbidities was assessed with the rise in CKMB and myoglobin levels among the target population.

Results: Out of 200 patients with ischemic stroke included in the study, 114(67.0%) were males, while 86(43.0%) were females. 75(37.5%) patients had either raised CKMB or Myoglobin levels, while 125(62.5%) patients had both biomarkers within range. On the National Institutes of Health Stroke Scale, 110(55.0%) patients had mild, 55(22.5%) had mild to moderately severe, 25(12.5%) had severe, and 10(5.0%) had very severe symptoms. Statistical analysis revealed that increased stroke severity had a statistically significant relationship (p-value<0.001) with raised CKMB/Myoglobin levels in the target population.

Conclusion: Raised CKMB or myoglobin levels were found in many patients with acute ischemic stroke. The stroke severity was associated with raised levels of these biomarkers.
Comparison of Nebulized Ketamine with Nebulized Magnesium Sulfate for the Prevention of Postoperative Sore Throat
Authors: Ranjha Chaudhry Raheel , Saeed Muhammad , Shah Syed Qasim Ali , Iqbal Muhammad Rashid , Buland Khalid , Terrence Arona
Published: December 2022

Objective: To compare the effects of nebulized Ketamine versus nebulized Magnesium Sulfate to prevent post-operative sore throat.

Study Design: Quasi-Experimental Study.

Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2020 to Feb 2021.

Methodology: A total of 154 patients who underwent general anaesthesia for elective procedures were randomly included in the study. These patients were divided into two equal Groups, i.e., Group-A (n=77), who received Magnesium Sulphate 250mg in 5ml saline and Group-B (n=77), who received Ketamine 50mg in 5ml saline, respectively. The effects of nebulized Ketamine versus nebulized Magnesium Sulfate to prevent post-operative sore throat, were observed in both the Groups.

Results: Both drugs were effective in the prevention of sore throat after extubation. Our study showed that Ketamine nebulization was more effective than Magnesium Sulfate nebulization in preventing sore throat. The frequency of sore throat in Group-A was 54.5% (42 out of 77 patients) as compared to 31.2% (24 out of 77 patients) in Group-B, which was statistically significant (p=0.003).

Conclusion: Post-operative sore throat is more effectively controlled with Ketamine as compared to Magnesium Sulfate
Comparison of Scoring Systems for Prognosis in Cirrhotic Patients Admitted with Hepatic Encephalopathy
Authors: Mujahid Muhammad Mamoon , Fazal Imran , Siddiqi Umair AhmEd , Waheed Arsalan , Faheem Muhammad , Mir Abdul Wahab
Published: December 2022

Objective: To compare various scoring systems to predict the prognosis in patients of cirrhosis presenting with hepatic encephalopathy at Pak Emirates Military Hospital Rawalpindi.

Study Design: Cross-sectional study.

Place and Duration: Gastroenterology Department, Pak Emirates Military Hospital Rawalpindi, from Sep 2018 to Feb 2019.

Methodology: This study was conducted on 55 patients suffering from liver cirrhosis and presetting with hepatic encephalopathy at our hospital. Diagnosis of liver cirrhosis and hepatic encephalopathy was made by a consultant gastroenterologist based on clinical findings and relevant investigations. Chronic liver failure-sequential organ failure assessment (CLIF-SOFA), Model for end stage liver disease (MELD), and Child-Turcotte-Pugh (CTP) scores were calculated for all patients within the first 24 hours of presentation. Outcome in the study was patient either discharged or deceased at the end of study. Comparison was made between the three scores that which is a better predictor for prognosis of these patients.

Results: Out of 55 patients included in the final analysis 35 were male and 20 were female. Commonest etiology of hepatic encephalopathy was Infection followed by Constipation.10 patients had grade 1 encephalopathy, 15 had grade 2, 20 had grade 3 while 10 had grade 4 encephalopathy. CLIF-SOFA emerged as better predictor for prognosis followed by MELD and CTP.

Conclusion: CLIF-SOFA was the best of all scores in predicting the prognosis of patients suffering from liver cirrhosis presenting with hepatic encephalopathy. MELD and CTP were also significant in this regard but less as compared to CLIFSOFA.
Frequency and Risk Factors of Meconium Aspiration Syndrome in Babies Delivered to Mothers with Meconium Stained Amniotic Fluid
Authors: Tanveer Sidra , Basheer Faisal , Khushdil Arshad , Motlaq Fady MA , Nawaz Raazia , Javed Maria
Published: December 2022

Objective

To determine the frequency and risk factors of meconium aspiration syndrome in babies delivered to mothers with meconium stained amniotic fluid attending neonatal unit of tertiary care hospital. 

Study design

Prospective cross sectional study 

Place and duration of study

Neonatal Unit “Pak Emirates Military Hospital”, Rawalpindi from 1st January to 30th September 2018

Patients and methods

All pregnant women with cephalic presentations with either spontaneous vaginal delivery (SVD) or lower segment cesarian section (LSCS) mode of delivery and having light-yellow to thick dark-green color liquor after spontaneous or artificial rupture of membrane were enrolled. Meconium aspiration syndrome along with risk factors like gestational age, weight, gender, mode of delivery, grades of meconium, and mortality was noted. 

Results

Of 384 patients, meconium aspiration syndrome was observed in 37 (9.6%) patients. Meconium aspiration syndrome was 2.97 times higher among patients with >36 weeks of gestation (AOR: 2.97, 95% CI: 1.12-7.89), 61% higher among patients with ≤3 kg weight (AOR: 0.39, 95% CI: 0.19-0.85), 89% higher among females (AOR: 1.89, 95% CI: 0.91-3.95), 83% higher among patients with SVD (AOR: 1.83, 95% CI: 0.89-3.75), 4.12 times higher among patients with grade III (AOR: 4.12, 95% CI: 0.51-33.45) and 8.65 times higher among patients with grade II color liquor (AOR: 8.65, 95% CI: 1.11-67.45). 

Conclusion

Meconium aspiration syndrome frequency was found considerably higher. In particular, newborn having higher gestational age, increased weight, female gender, SVD as the mode of delivery, grade III and grade II meconium were reported as the significant risk-factors.
Spinal Dysraphism: A Three Year Experience at Armed Forces Institute of Radiology and Imaging
Authors: Nasir Hina , Nisar Uzma , Slehria Atiq Ur Rehman , Iftikhar Ammara , Halim Aliya , Nisar Shahana
Published: December 2022

Objective: To review all the patients of spinal dysraphism referred to our center over a three year period in order to identify the most typical neuro-radiological appearances on Magnetic Resonance Imaging.

Study Design: Cross sectional study.

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi from Jan 2016 to Dec 2018.

Methodology: MR spine reports of 144 patients of spinal dysraphism were retrospectively analyzed. Age, gender, indication for MRI, operative status, and neuro-radiological features (including site and type of lesion) were recorded for these patients.

Results: Congenital spinal malformations were more frequent among females87 (60.4%) and between 0-20 years 135 (93.9%) of age. Tethered cord 97 (67.4%) was the most common congenital spinal abnormality followed by spina bifida, diastematomyelia, vertebral segmentation anomalies, myelomeningocele, menigocele. Lip-myelomeningocele, lipoma of filum terminale, and sacral agenesis. Frequently observed associated abnormalities included scoliosis 61 (42.4 %), syrinx 47 (32.6%) and dural ectasia 40 (27.8 %).

Conclusion: Congenital spinal malformations are usually complex with variable radiological appearances. Modern high resolution MRI screening is the examination of choice for identification, preoperative evaluation, and long term follow up of such congenital anomalies.
Comparison Between Cephalometric Measurements Derived from Cone Beam Computed Tomography and Lateral Cephalogram
Authors: Khan Mehwish , Khan Azhar Bangash , Amin Erum , Ejaz Fatima , Tariq Sana , Akhtar Faheem Nake
Published: December 2022

Objective: To compare the mean craniofacial linear and angular measurements derived from cone beam computed tomography synthesized lateral cephalogram and those obtained from conventional cephalogram.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Feb 2017 to Nov 2018.

Methodology: Sample size was 32. Following linear measurements were evaluated; anterior facial height, right side and left side of mandibular length, nasal spine length, Upper and lower incisors to A-Pog distance. These measurements were obtained by both means i.e., conventional cephalogram and cone beam computed tomography synthesized cephalogram. Each of the measurement were taken twice by the single operator with a difference of two weeks.

Results: No significant difference was found among measurements obtained through lateral head film cephalograph and cone beam synthesized cephalograph except for mandibular length (for which p=0.04).

Conclusions: Cone beam computed tomography synthesized lateral cephalogram can be suggested as a substitute to conventional lateral cephalogram. Especially in conditions when cone beam computed tomography is already required for treatment planning thus reducing supplementary x- ray exposure and expenditure of an additional x-ray.
Comparison Between Ferguson's Technique and Mitchelle Bank Technique for Inguinal Herniotomy in Children
Authors: Rehman Shafqat , Ahmed Iftikhar , Awan Safdar Hussain , Anwar Zahid , Saleem Muddasir , Afzal Tamoor
Published: December 2022

Objective: To assess the safety of the Mitchelle bank technique for herniotomy in children by comparing its recurrence rate with conventional Ferguson's technique.

Study Design: Quasi-experimental study.

Place and Duration of Study: Paediatric Surgery Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Sep 2019.

Methodology: Children below the age of 6 years coming to Paediatric Surgery Outpatient Department with inguinal hernia were included in the study. The patients were divided into two groups. Group-I underwent herniotomy by Mitchelle bank technique (MBT-group) while Group-II by Ferguson's technique (FT-group). The demographic characteristics of the studied population, operative time, and intra-operative and post-operative complications were recorded.

Results: The mean age of the patients was 25.94 ± 17.06 months in Ferguson's technique-group and 24.76 ± 16.63 months in the Mitchelle bank technique-group. The mean operative time was less in the Mitchelle bank technique-group (13.17 ± 1.47 minutes) as compared to Ferguson's technique-group (16.23 ± 1.51 minutes) (p<0.05). Early complications such as hydrocele, seroma and hematoma were seen in 5 (2.3%), 6 (2.6%) and 3 (1.3%) cases in Ferguson's technique-group, and 15 (6.9%), 8 (3.7%), and 9 (4.1%) cases in the Mitchelle bank technique group, respectively. Late complications such as orchitis, testicular atrophy, and recurrence were seen in 5 (2.3%), 6 (2.6%), 2 (0.9%) in Ferguson's technique group, and 6 (2.6%), 4 (1.8%), and 3 (1.3%) in the Mitchelle bank technique group (p>0.05).

Conclusion: Mitchelle bank technique is safe for herniotomy in children with less operative time and no increase in...
Comparison of Fetal Outcome in Patients of Gestational Diabetes Treated with Met Formin and Insulin
Authors: Sajjad Fatima , Usman Shaheera , Choudhry Abeera , Baloch Shaheen Aslam , Aslam Qurat Ul Ain , Shahid Ghana
Published: December 2022

Objective: To compare frequency of fetal outcome in patients of gestational diabetes being managed with Metformin and Insulin.

Study Design: Comparative prospective Study.

Place and Duration: Department of Obstetrics and Gynecology, Pak Emirates Military Hospital, Rawalpindi, from Apr to Dec 2016.

Methodology: This study involved 286pregnant women aged between 18-40 years presenting after 24 weeks of gestation and diagnosed with gestational diabetes which were randomly allocated into two treatment groups. Patients in Group-A were treated with met for min while those in Group-B were treated with Insulin. Outcome variables were various fetal outcome measures which were noted and compared between the study groups.

Results: The mean age of met for min group (32.71 ± 6.54 years) and Insulin groups (32.85 ± 6.10 years) was comparable. Mean APGAR score was similar between met for min and Insulin groups at 1 minute (7.56 ± 1.12 vs. 7.40 ± 1.13; p=0.229) and 5 minutes (8.34 ± 0.60 vs. 8.24 ± 0.67; p=0.231) after birth. The frequency of good APGAR (≥7) was significantly higher in met for min group at 1 minute (82.5% vs. 69.2%; p=0.009). Frequency of hyper-bilirubinemia (8.4% vs. 11.9%; p=0.327), respiratory distress syndrome (18.9% vs. 25.9%; p=0.156) and Neonatal Intensive Care Unit (NICU) admission (16.1% vs. 16.8%; p=0.873) showed no significant association with treatment method.

Conclusion: The efficacy of met for min and Insulin was found to be comparable in the management of pregnancy with diabetes. Metformin was as safe as Insulin in treating gestational diabetes considering the fetal outcome.
Efficacy of Oral Doxycycline in Reducing the Size of Pterygium lesions
Authors: Rabbani Shafaq , Akram Amjad , Yaqub Amer , Ashraf Ammara , Khan Fatima
Published: December 2022

Objective: To assess the efficacy of oral Doxycycline in reducing the size of pterygium lesions in a Pakistani population

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Sep 2018 and May 2019.

Methodology: Sixty patients above 20 years of age were enrolled in the study. Oral Doxycycline 200m/day was given for thirty consecutive days. Photographs of the lesions were taken at the time of recruitment and at the end of the study for assessment of pterygium size. Difference between pre-treatment and post-treatment size was analysed and comparison was made with age, gender and initial lesion size.

Results: Twenty-two females and thirty-eight males were examined. The mean age of the participants was 48.8 ± 13.8 years. The mean size of the pterygium lesions before commencing the treatment was 12.24 ± 6.28 mm2. The mean size of the lesions after the treatment was 11.24 ± 5.39 mm2. The mean difference size was 1.00 ± 1.62 mm2 (p <0.001). The relative change in size (i.e. post-treatment size divided by pre-treatment size) was 0.94 ± 0.09 which was found to be statistically significant (p<0.001). There was correlation between larger initial lesion size and greater relative reduction in size (r = -0.42, p = 0.001).

Conclusion: The change in the size of pterygium lesions produced by Doxycycline was found to be statistically significant but was not deemed clinically significant. Therefore, oral Doxycycline is not recommended for the treatment of pterygium in our population.