bluuebunny/crossref_metadata_2025 huggingface dataset:
Perinatal Stroke; Risk Factors and Outcome. A Study from Aga Khan University Hospital Karachi
Authors: Baloch Fozia , Abro Falak , Khalid Qurat-Ul-Ain , Chand Prem
Published: December 2022

Objective: To determine the frequency, risk factors and the outcomes of a perinatal stroke.

Study Design: Cross-sectional study.

Place and Duration of Study: Neonatal Intensive Care Unit, Department of Pediatrics, Aga Khan University Hospital, Karachi Pakistan, from Jan to Dec 2019.

Methodology: Neonates with perinatal stroke confirmed on the neuroimaging, were included in the study. The primary outcomes were risk factors, divided into 3 groups, maternal, placental and neonatal. The secondary outcome was the condition at the time of the discharge.

Results: A total of 58 patients were included in the study. Maternal risk factors identified in the study, were intrauterine infections 10 (17.2%), anti-phospholipid syndrome, gestational diabetes 8 (13.8%) and preeclampsia 7 (12.1%). Chorioamnionitis 9 (15.5%), antepartum hemorrhage 6 (10.3%), and placenta previa 4 (6.9%) were the placental risk factors. Neonatal risk factors were birth asphyxia 35 (60.3%), sepsis/meningitis 8 (13.8%), premature birth 6 (10.3%) and fetal bradycardia 4 (6.9%). Resuscitation was needed in 35 (60.3%) neonates with birth asphyxia. Haemorrhagic stroke was observed in 38 (65.5%) cases, ischemic stroke in 14 (24.1%) cases and mixed type of stroke was found in 6 (10.3%) patients. The total mortality rate in our study was13.8%.

Conclusion: Haemorrhagic stroke was more common than ischemic or mixed stroke among the patients of perinatal stroke at our healthcare facility. Patients with low APGAR score at 5 minutes, birth asphyxia and male gender, were most affected.
The Analgesic Effect And Functional Improvement Produced by Radio-Frequency Ablation of Genicular Nerves in Patients with Advanced Knee Osteoarthritis
Authors: Akhlaque Uzma , Ayaz Saeed Bin , Ahmad Khalil , Shoaib Muhammad , Younas Umer , Tassadaq Naureen
Published: December 2022

Objective: To study the efficacy of radiofrequency ablation for treating pain in patients with advanced knee osteoarthritis.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pain Clinic of Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Sep 2019 to Feb 2020.

Methodology: Patients of more than 50 years of age, with grade III and IV Kellgren-Lawrence grades of knee osteoarthritis and at least a score of 4 for three months on the numerical rating scale were included in the study. Measurements were taken on the numerical rating scale and Western Ontario and McMaster universities osteoarthritis index before and four weeks after fluoroscopy-guided radiofrequency ablation of three genicular nerves around the knee joint. .

Results: Fifty patients (mean age: 62 ± 6.5 years) were included in the study. The median numerical rating scale scores before and after intervention were 9 (Interquartile range: 7-10) and 5 (Interquartile range: 2-8), respectively (p<0.001). The mean Western Ontario and McMaster universities osteoarthritis index scores before and after intervention were 76.7 ± 13.4 and 50.3 ± 18, respectively (p<0.001). No complications were reported. The reduction in numerical rating scale, Western Ontario and McMaster universities osteoarthritis index scores after the intervention were significantly better in females than in males (p=0.023 and p=0.012 respectively); however, no significant change was observed for the right and left knee or grades of knee osteoarthritis (p>0.05).

Conclusion: Radiofrequency ablation of genicular nerves around the knee joint significantly improves pain, stiffness and body function in patients with advanced knee osteoarthritis .........................
Clinicohematological Parameters and Assessment of Post Induction Status in Acute Myeloid Leukemia–Experience at A Tertiary Care Center
Authors: Zaidi Sara Ali , Mahmood Asad , Mahmood Rafia , Khurshid Ayesha , Ali Sadia , Latif Aamna
Published: December 2022

Objective: To evaluate the role of clinical, hematological and genetic parameters in acute myeloid leukemia (AML) as the predictors of response to induction chemotherapy.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, from Jun to Jun 2019.

Methodology: All the newly diagnosed cases of de-novo AML were included in the study. Clinical, haematological and immunophenotypic parameters were noted. Cytogenetic and molecular analyses were performed. Response to first course of standard induction chemotherapy was assessed.

Results: A total of 58 patients were included in the study. The median age was 19 years. Thirty-one (53.4%) were adults while 27 (46.6%) were in the pediatric age group. Thirty-six (62.1%) were males while 22 (37.9%) were females. The most common clinical presentation was fever. The most common French-American-British classification (FAB) subtype was AML-M2. The blast percentage was 78%. Forty-six (79.3%) patients had a normal karyotype. Of the 58 patients, 38 (65.5%) achieved complete remission while 20 (34.5%) did not achieve complete remission after induction chemotherapy.

Conclusion: AML was seen in a younger age group in our population. There was statistically significant association of high white blood cell (WBC) count with remission status. Increasing age was associated with a poor response to induction chemotherapy, while translocation t(8;21) was associated with a good response. Assessment of prognostic parameters is vital in the initial diagnostic workup of AML patients to predict response to induction chemotherapy.
Impact of Enhanced Lipid Peroxidation on Carotid Artery Intima Media Thickness Ratio in Patients Receiving Maintenance Hemodialysis
Authors: Rehman Sadia , Mahboob Tabassum , Kumar Santosh , Ali Syed Hidayat , Khan Muhammad Tassaduq , Rehman Suniya
Published: December 2022

Objective: To determine the impact of increased lipid peroxidation on carotid intima media thickness ratio in patients receiving maintenance hemodialysis.

Study Design: Comparative prospective study.

Place and Duration of Study: Jinnah Post Graduate Medical Center Karachi in collaboration with University of Karachi, Pakistan, from Jan to Dec 2018.

Methodology: The hemodialysis patients were selected from the dialysis center where as the controls were recruited from normal healthy population. The cases taken were receiving maintenance hemodialysis thrice a week. Doppler ultrasonography technique was employed to detect the intima media thickness (IMT) ratio of common carotid artery of study subjects as well as controls. Lipid peroxidation was detected by serum oxidized LDL (ox-LDL) levels.

Results: The mean of right common carotid artery of group A samples was 0.45 ± 0.04 mm, left common carotid artery was 0.42 ± 0.01mm, and mean intima thickness was 0.43 ± 0.02 mm, the mean of right common carotid artery in group B was 0.93 ± 0.09 mm and mean of left common carotid in group B was 1.07 ± 0.14 mm and mean intima thickness of group B samples was 1.0 ± 0.09 mm. In group A mean Ox-LDL was 24.87 ± 5.23 U/ml while in group C samples mean Ox-LDL was 73.77 ± 6.77 U/ml.

Conclusion: Lipid peroxidation is much enhanced in patients on maintenance hemodialysis and leads to an increased carotid artery intima media thickness ratio which is a sign of development of atherosclerosis. This study will help the nephrologists in determining the causes..................
Intrahepatic Cholestasis of Pregnancy Between 34 Weeks And 40 WeeksWhen To Intervene
Authors: Yazdani Tehreem , Imran Ayesha , Amin Nabila , Zaheer Fareeha , Mukhtar Saad , Yaqub Umairah
Published: December 2022

Objective: To find the appropriate timings for intervention in women with intrahepatic cholestasis of pregnancy.

Study Design: Prospective observational study.

Place and Duration of Study: Gynaecology and Obstetrics Department Combined Military Hospital Okara, from Oct 2019 to Nov 2020.

Methodology: Patients between 34-40 weeks of gestation with intrahepatic cholestasis were included in the study. With clinical and biochemical findings patients were monitored and conventional treatment was given. Intervention by delivery was done when required. Maternal and fetal outcome were followed.

Results: Out of 380 patients with pruritus between 34-40 weeks of gestation, intrahepatic cholestasis was found in 53 patients. Most of the patients 27 (51%) were delivered at 37-completed weeks. At 35-weeks of gestation 6 (11%) patients were delivered, at 36-weeks 8 (15%) patients were delivered, while 2% patients delivered at 39 and 40 weeks of gestation. The number of intrauterine deaths was 1 at 34 weeks of gestation and 2 at 35 weeks of gestation. Transient tachypnea of newborn was observed in 23% neonates. Respiratory Distress Syndrome was observed in 6 (12%) newborns. Neonatal sepsis was observed in 5 and hyperbilirubinaemia was observed in 4 (8%) neonates.

Conclusion: Patients with intrahepatic cholestasis should be preferably delivered between 37 to 38 weeks for a better foetal outcome.
Association of Fok 1 (Rs10735810) Gene Polymorphism with Dental Caries in Pakistani Adolescents
Authors: Karim Bilal , Rahim Amena , Afzal Muhammad , Ashfaq Sidra , Javed Muhammad Fahad
Published: December 2022

Objective: To determine the association of single nucleotide polymorphism of vitamin D receptor gene Fok 1 (rs10735810) with dental caries in Pakistani adolescents.

Study Design: Case-control study.

Place and Duration of Study: Biochemistry Department, Islamic International Medical College, Rawalpindi in cooperation with Pathology Department, Railway General Hospital, Rawalpindi Pakistan, from Sep 2019 to Aug 2020.

Methodology: A total of 304 participants were included in the study. There were 152 dental caries cases and 152 normal agematched controls. After taking written informed consent, blood samples were collected from each participant. DNA extraction was done by Chelex Method. PCR was carried out to determine the respective allelic frequencies of Fok 1 (rs10735810) genotype using specific primers.

Results: Out of 304 study participants, there were 26 males (17.1%) and 126 females (82.9%) in case-group; and 37 males (24.3%) and 115 females (75.7%) in control-group. No significant association of Fok 1 (rs10735810) genotype with DMFT score was found in dental caries case-group. Regarding genotypic and allelic frequencies, there was no significant association of Fok 1 (rs10735810) genotype with dental caries case-group.

Conclusion: Single nucleotide polymorphism of vitamin D receptor gene Fok 1 (rs10735810) is not associated with dental caries in Pakistani adolescents.
Efficacy of Timolol Maleate (0.5%) in Preventing Rise of Intraocular Pressure (IOP) Post Neodymium: Yttrium Aluminum Garnet (Nd: YAG) Capsulotomy
Authors: Iqbal Nazia , Muzaffar Waqar , Sarfaraz Muhammad Haroon , Khan Saim , Yasin Ubaid Ullah , Abidin Farooq Ul
Published: December 2022

Objective: To determine the efficacy of 0.5% Timolol eye drops in preventing rise of intraocular pressure following Neodymium: Yttrium-Aluminum-Garnet laser posterior capsulotomy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Outpatient Department of Ophthalmology, Combined Military Hospital Multan Pakistan, from May to Nov 2019.

Methodology: Patients presenting with posterior capsule opacification, undergoing elective Neodymium: Yttrium Aluminum Garnet (Nd: Yag) Capsulotomy were enrolled in the study. Patients were alternatively assigned to two groups; group-1 was administered 0.5% Timolol Maleate eye drops, while group-2 was administered placebo natural team eye drops. Intraocular pressure for all the patients was measured at three-time points a). First measurement was baseline intraocular pressure at presentation/before the treatment. Second measurement was 1-hour post laser capsulotomy and third measurement was 3 hours post laser capsulotomy.

Results: At 1-hour follow up, the mean intraocular pressure was significantly raised in the patients belonging to control group as compared to treatment group (21.45 ± 8.33 mm Hg vs 15.33 ± 3.37 mm Hg, p<0.001). At 3-hours follow-up the mean intraocular pressure decreased a bit for control group but still was significantly higher than the treatment group (17.40 ± 3.00 mm Hg vs 15.60 ± 2.30 mm Hg, p<0.001).

Conclusion: Prophylactic use of Timolol successfully reduces the post-procedural acute rise in intraocular pressure due to Neodymium: Yttrium Aluminum Garnet laser posterior capsulotomy.
Effect of Global Posture Re-Education Versus Static Stretching on Pain, Range of Motion And Quality of Life in Post-Menopausal Women with Chronic Neck Pain
Authors: Anum Hina , Anwar Naveed , Tauqeer Sana , Khalid Kehkhshan
Published: December 2022

Objective: To compare the effects of global posture re-education and static stretching on pain, range of motion and disability in post-menopausal women with chronic neck pain.

Study Design: A quasi-experimental study.

Place and Duration of Study: Sheikh Zayed hospital Rahim Yar Khan, from Jun to Dec 2020.

Methodology: A total of 36 female patients between 45-65 years of age were included in the study. Patients who had received physiotherapy or manual therapy treatment for neck pain in the previous six months or had any tumour infection were excluded. There were two groups, the global posture re-education group (n=18) performed muscle chain stretching, while the static stretching group (n=18) performed conventional static muscle stretching. Visual analogue scale, neck disability index and goniometer were used for outcome measurement.

Results: The results showed significant improvement in visual analogue scale score, neck disability index, flexion and extension range at four weeks and three months follow up (p<0.05). There was no significant improvement in NDI score at three months follow up (p-value >0.05).

Conclusion: There was a significant difference in pain, function and disability in both groups, but the global posture reeducation group showed a maximum decrease in pain and disability and gain in ROM as compared to the static stretching group.
Investigation of Insomnia Among Students At The University Level: A Cross-Sectional Analysis
Authors: Fatima Fozia , Ali Sabir , Qamar Khadija , Bibi Safia , Fatima Sobia
Published: December 2022

Objective: To investigate the students’ perception of insomnia at the university level and to determine the effects of demographic factors on their perception.

Study Design: Cross-sectional study

Place and Duration of Study: Department of Education and Department of English, International Islamic University, from Sept 2020 to Feb 2021.

Methodology: This study involved twelve hundred and fifty (1250) university students. The insomnia questionnaire was developed after the exploratory factor analysis.

Results: The findings of this study revealed that students at the university level suffer from a high rate of insomnia, but they did not take any steps to address it because they had a neutral perception toward the problem. There was no significant effect of semester-term and the type of department with insomnia (p=0.864 and p=0.648).

Conclusion: Students were neutral about their insomnia problem at the university level.
Hyperbaric Oxygen: A Lifesaver During COVID-19?
Authors: Shahzadi Maria , Bilal Muhammad
Published: December 2022

Coronavirus (COVID-19) has become a worldwide pandemic after its emergence in late December 2019. The virus has evolved through mutations such as alpha, beta, gamma, delta, and epsilon variants. The one becoming variant, becomes precarious. COVID virus spiked a surge in hospitalizations and equipment utilization, as well as a scarcity of critical care resources. The precautionary measures, such as the use of masks and hand sanitizers, are advised to contain the virus.
Evaluation of canal configuration and frequency of second canal in mandibular lateral incisor using Cone Beam Computed Tomography (CBCT)
Authors: Moorpani Prena , Rehman Qazi Fazal Ur , Ahmed Shahbaz , Akhtar Hira , Shah Marina , Aziz Munazza
Published: December 2022

Objective: To categorize root canal configuration according to Vertucci’s classification and determine the frequency of second canal in mandibular lateral incisors of Pakistani subpopulation (Karachi based) by using Cone Beam Computed Tomography.

Study Design: Cross sectional study.

Place and Duration of Study: Out-patient department of Oral and Maxillofacial Surgery and the department of Radiology at Dow University of Health Sciences, Karachi Pakistan, from Jan to Jul 2019.

Methodology: Study was conducted on 160 extracted permanent mandibular lateral incisors. After extraction, teeth were randomly arranged in wax models and imaged via CBCT. Each tooth sample was analyzed in axial and sagittal sections. The images were investigated by two blinded examiners and data on canal morphology was recorded.

Results: The frequency of single canal mandibular incisors was recorded as 107 (66.9%) whereas 53 (33.1%) of teeth showed two canals. Females presented with a higher frequency of two canalled incisors, although the results were statistically insignificant. The most prevalent canal anatomy detected was Type I (105, 65.6%) followed by Type III (33, 20.6%), Type II (12, 7.5%) and Type V (10, 6.3%). Mandibular lateral incisors presenting with two canals anatomy, Type III (32, 97%) morphology was most commonly detected followed by Type II (12, 100%) and Type V (9, 90%).

Conclusion: CBCT scans are an effective tool for identification of root canal morphology. Mandibular lateral incisors most frequently presented with Type I canal anatomy whereas incisors with two canals most frequently presented with Type III configuration.
Breast Cancer Among Different Ethnicities (A Single Institution Study)
Authors: Ahsan Mahnoor , Haider Ghulam , Taj Asra , Mahr Khalil , Aslam Batool , Mubashir Saima
Published: December 2022

Objective: To study the socio-demographic factors, medical history, histological type, hormonal status with the different ethnic groups of Pakistani breast cancer patients.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Medical Oncology Department of Jinnah Postgraduate Medical Centre, Karachi Pakistan, from Aug -Nov 2019.

Methodology: Two hundred female patients aged 20-50 years with histopathologically confirmed breast cancer visited OPD for the treatment or were admitted to the ward. The information regarding socio-demographics was noted in the pre-designed proforma. Divisions such as Muhajir (Urdu speaking), Sindhi, Balochi, Punjabi and Pathan were created to analyse breast cancer frequency within different ethnic classes in Pakistan. SPSS version 23 was used to analyse the data.

Results: Out of 200 patients with breast carcinoma, 94 females were Urdu speaking (47%), 39 were Sindhi (19%), 25 were Punjabi (12%), 13 were Pathan (7%), seven were Baloch (4%), and 22 (11%) belonged to minority ethnic groups. The results showed a significant association of ethnicity with family history (p=0.053), residence (p=0.001) and employment status (p=0.010).

Conclusion: The results of this study demonstrated that there is difference in breast cancer occurrence among ethnic groups.
Topical Use of Gentamicin in Potentially Contaminated Laparoscopic Cholecystectomy After Bile Spillage During Gall Bladder Retrieval
Authors: Ali Afaque , Hussain Zaki , Jamal Ayesha , Rahat Fatima , Shoof Talha Mak , Islam Saqib
Published: December 2022

Objective: To observe the effects of topical Gentamycin as a prophylactic measure to control post-operative port site infection after bile spillage during gall bladder retrieval in patients undergoing laparoscopic cholecystectomy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi, from Feb to Aug 2019.

Methodology: The study population comprised 80 patients (divided into two groups) diagnosed with cholelithiasis and underwent elective laparoscopic cholecystectomy. Seven surgeries were converted into open cholecystectomies, and bile spillage was recorded in 42 patients who underwent uneventful surgery. These patients were then examined for 30 days to evaluate port site infection.

Results: It was seen that EPSI was more common in patients in the fourth decade of their life even after Gentamicin prophylaxis 6 (14.29%). A deeper analysis of the study showed that EPSI was more common in patients with Class-I obesity and their fourth decade of life. When compared to the gender, we found that the ratio of EPSI was higher in the female population (1:2) as compared to males (1:4).

Conclusion: In our research, topical use of Gentamicin in potentially contaminated laparoscopic cholecystectomy after bile spillage during gall bladder retrieval proved beneficial.
Assessment of Diagnostic Accuracy of Real Time Shear Wave Elastography in Detecting Liver Cirrhosis Keeping Histopathology as Reference Standard
Authors: Saleem Sultan , Slehria Attique ur Rehman , Rauf Muhammad Haris , Sohail Marium , Taufiq Nida , Khan Muhammad Usman
Published: December 2022

Objective: To determine the diagnostic accuracy of real-time Shear Wave Elastography (SWE) in detecting liver cirrhosis among patients suffering from diseases predisposing to it, keeping histopathology as the reference standard.

Study Design: Cross-sectional study.

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

Methodology: A total of 114 patients were recruited, and relevant history taken from patientsreal-time shear wave elastography (SWE) of the liver was performed, followed by USG guided liver biopsy. Patients having clinically suspected diseases predisposing to hepatic fibrosis were sent to the Radiology department for ultrasound or ultrasound-guided liver biopsy. Elasticity values using sheer waves of 14.9 kPa (2.23m/s) or more was taken as suggestive of cirrhosis. Elastography findings were compared with histopathology findings.Results: Real-time SWE showed high diagnostic accuracy for detecting liver cirrhosis with sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 92.86%, 89.66%, 89.66%, 92.86% and 91.23%, respectively.

Conclusion: This study concluded that the diagnostic accuracy of RTSW elastography in detecting liver cirrhosis is relatively high.
Role of Magnetic Resonance Neurography on 3-Tesla in Brachial Plexus Injury Management
Authors: Mansoor Palwasha , Aslam Muhammad Rizwan , Ahmed Rao Saood , Hameed Shahid , Nafees Abu-ul-Ala , Khadim Rehana
Published: December 2022

Objective: To study the effect of magnetic resonance neurography on 3 Tesla (MRN-3T) on the outcome of brachial plexus injury management.

Study Design: Prospective comparative study.Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2017 to Mar 2019.

Methodology: Two groups of brachial plexus injury (BPI) were studied over two years. Group-A (n=29) cases whose operative intervention was decided based on history, examination, NCS/EMG and CT scan. Second group-B included (n=33) patients in which MRN-3T (magnetic resonance neurography on 3 Tesla) was the critical diagnostic tool. The comparison of preoperative diagnosis with intraoperative findings and outcome of surgery were made.

Results: Out of 29 cases in group-A, 11 (37.93%) were explored. In these 11, neurolysis was done in one case, direct repair in one case, nerve grafting in 4 patients, nerve transfers with bridging grafts in 2 cases, whereas three patients had negative exploration. Of 33 cases in group-B, 21(63.64%) were explored. From these 21 cases, neurolysis was done in four patients; the direct repair was possible in 7 and in 10 cases bridging nerve grafts were used along with primary nerve transfers.

Conclusion: MRN-3T brachial plexus has significantly improved the diagnosis, preoperative planning and surgical outcome of patients with brachial plexus injury.
The Accuracy of Transabdominal Ultrasound (TAUS) in Detection of Choledocholithiasis Keeping Magnetic Resonance Cholangiopancreatography (MRCP) as Gold Standard
Authors: Palwa Abdur Rahim , Nisar Uzma , Shafique Mobeen , Aamir Omer , Riaz Sidra , Bukhari Aown Raza Shah , Razzaq Mehwish
Published: December 2022

Objective: To assess the diagnostic accuracy of trans-abdominal ultrasound (TAUS) in detecting choledocholithiasis, keeping MRCP as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Magnetic Resonance Imaging, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2018 to May 2019.

Methodology: 102 patients of either gender, age 20-85 years with the clinical suspicion of choledocholithiasis and obstructive jaundice were included. Trans-abdominal ultrasonography was performed for radiological detection of disease. All selected cases then underwent MRCP for confirmation of findings.

Results: Mean age of the patients was 54.27 ± 15.14 years. 47 patients (46.1%) were males, and 55 (53.9%) were females. All patients were subjected to trans-abdominal ultrasound and MRCP. TAUS showed choledocholithiasis in 82 (80.3%) patients. MRCP confirmed choledocholithiasis in 81 (79.4%) cases, whereas 21 (20.5%) revealed no choledocholithiasis. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of TAUS were 96%, 80.9%, 95%, 85% & 87.86%, respectively.

Conclusion: Diagnostic accuracy of trans-abdominal ultrasonography in detecting choledocholithiasis is significantly high enough to be used as a first-line imaging modality as MRCP is available only in specialised care centres.
Effect of Mode of Delivery and Number of Parity on Abnormal Placental Location
Authors: Shams Mehwish Ara , Amin Nabila , Syed Humna
Published: December 2022

Objective: To determine the effect of mode of delivery and number of parity on abnormal placental location encountered at Pak Emirates Military Hospital Rawalpindi.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Gynaecology & Obstetrics, Pak Emirates Military Hospital Rawalpindi, from Jun 2019 to May 2020.

Methodology: The study included all the antenatal patients with any abnormally placed placenta on ultrasound or MRI, if required, at the 32nd week of gestation. On ultrasound examination, controls were an equal number of antenatal women with the customarily located placenta. Factors like age, parity, previous mode of delivery, and iron deficiency anaemia were compared in both groups.

Results: The mean age of the study participants was 32.11 ± 8.29 years. Out of 70 cases of abnormal placental location in pregnant women, 40 (57.1%) had placenta previa, 20 (28.6%) had accreta, while 10 (14.3%) had placenta percreta. Pearson chisquare test revealed that multiparity and previous deliveries by caesarean section had a statistically significant relationship with abnormal placental location among the study participants (p-value<0.05).

Conclusion: Placenta previa is the commonest abnormal placental location in our study, followed by accrete and percreta. Previous deliveries by cesarean section and multiparty were independent risk factors related to abnormal placental location in our target population.
Association of Panel Reactive Antibodies (PRA) with Complement Dependent Cytotoxicity (CDC) Cross-Match in Pre-Renal Transplant Recipients
Authors: Hussain Dr. Muhammad , Bashir Muhammad Mukarram , Tipu Hamid Nawaz , Dawood Muhammad , Afshan Noor , Arooj Ayesha
Published: December 2022

Objective: To determine the association of panel reactive antibodies (PRA) with complement-dependent cytotoxicity (CDC) cross-match in Pakistani pre-renal transplant recipients.

Study Design: Cross-sectional study.

Place and Duration of Study: Immunology Department, Armed Forces Institute of Pathology, Rawalpindi from Oct 2017 to Oct 2018.

Methodology: A total of 162 patients referred to the Department of Immunology for pre-transplant workup for renal transplantation were included. Informed consent was taken, and detailed history was recorded. Frequency and percentages were calculated for cross-match positivity and most frequent anti-HLA antibodies.

Results: Panel reactive antibodies (PRA) were present in 48 patients (30%), while complement-dependent cytotoxicity (CDC) cross-match was positive in 16 patients (10%). Out of 141 male patients, 35 (25%) were positive for PRA, while 10 (7%) had positive CDC cross-match. Out of 21 female recipients, 13 (62%) were positive for PRA, and 6 (28%) had positive CDC crossmatch. One male patient positive for CDC cross-match was negative for PRA. Patients positive for both CDC cross-match and PRA have an average mean fluorescent intensity (MFI) of more than 4000. CDC cross-match and PRA were strongly associated, whereas no significant association was found between CDC cross-match and anti-MIC antibodies.

Conclusion: Complement dependent cytotoxicity (CDC) cross-match and panel reactive antibodies (PRA) should be routine in patients undergoing renal transplants as alone CDC cross-match can give false negative or false-positive results. At the same time, CDC cross-match lacks detection of anti MIC antibodies involved in graft rejection.
Hyperglycemia and its Association with Patients’ Mortality Among the Patients Presenting with Acute Stroke in Tertiary Care Hospital
Authors: Rana Maryam , Khattak Abdul Latif , Khan Muhammad Khalid Azam , Khan Raees Iqbal , Shah Bukhari Syed Karamat Hussain , Mehmood Faisal
Published: December 2022

Objectives: To estimate the occurrence of hyperglycemia in patients with cerebrovascular accident (ischemic) to compare the frequency of mortality among the patients with and without hyperglycemia presenting with acute CVA.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Department of General Medicine, Combined Military Hospital Quetta Pakistan, from May 2018 to May 2019

Methodology: A total of 347 patients of both genders diagnosed with acute stroke were included. Blood glucose levels were evaluated and hyperglycemic and normo-glycemic patients were identified. CT scan was performed. Standard treatment was provided to the patients according to the type of stroke (ischemic or hemorrhagic). These patients were discharged.

Results: Patients in this study was having age range of 20 to 70 years.SO mean age of 53.76 ± 9.08 years. Many patients 283 (81.56%) were of 45-71 years of age. 183 (52.74%) were of male gender and 164 (47.26%) were females. We have found hyperglycemia in 96 (27.67%) patients. There was no hyperglycemia observed in 251(72.33%) patients. Frequency of hyperglycemia was 12.97%. Frequency of mortality was 30.21% in hyperglycemic patients vs. 6.37% in normo-glycemic patients (p=0.0001).

Conclusion: Frequency of hyperglycemia with acute stroke is high with high mortality among the patients presenting with acute stroke as compared to normo-glycemic.
Alteration of Coagulation Profile in Malaria Patients and its Correlation with The Degree of Parasitemia
Authors: Jabeen Shehneela , Naeem Samina , Uddin Nasir , Farooq Muhammad , Rabbani Sahar , Basharat Maria
Published: December 2022

Objective: To determine the alteration of coagulation profile (PT, APTT, D-dimers) in malaria patients and its correlation with the degree of Parasitemia.Study Design: Cross-sectional study.

Place and Duration of Study: Pathology department of Combined Military Hospital Lahore, from Jan to July 2018.

Methodology: A total of 92 patients were included in the study. The malarial parasite was identified using thick and thin smears. Hemoglobin, Red blood cell, White blood Count, Prothrombin Time, Activated Partial Thromboplastin Time, and Ddimer levels were measured using automated analyzers Sysmex KX-21 and CA-600.

Results: The mean age of the patients was 23.35 ± 14.4 years with 53 (57.6%) males and 39 (42.4%) females. Plasmodium falciparum was identified as the causative species in 33 (35.9%) of the cases, 59 (64.1%) cases were caused by Plasmodium vivax. Based on parasitic load, 50 (54.3%) patients were found to have a mild degree of parasitemia whereas 26 (28.3%) had moderate and 16 (17.4%) had severe parasitemia. A significant association was found between the degree of parasitemia and coagulation parameters.

Conclusion: Partial thromboplastin time, activated partial thromboplastin time and D-dimer levels were positively correlated with the degree of parasitemia specifically in plasmodium falciparum as compared to the other species. Therefore, special care should be exercised in patients having an underlying inherited bleeding disorder and a strict prevention protocol should be made.
Efectiveness of Therapeutic Plasma Exchange in Patients Suffering from COVID-19 Requiring Admission in Critical Care Setting
Authors: Ali Muhammad , Naseem Arshad , Sajjad Kaswar , Zaman Asad , Bari Saba , . Naveem
Published: December 2022

Objective: To determine the efficacy of therapeutic plasma exchange in patients suffering from COVID-19 requiring admission in the critical care setting.

Study Design: Comparative cross-sectional study.

Setting and Duration of Study: Critical Care Unit, Pak Emirates Military Hospital Rawalpindi, from Apr 2020 to Jun 2020.

Methodology: The study was carried out on 160 patients managed at the Critical Care setting of our hospital in three months. Data were extracted from the record regarding the patients who underwent therapeutic plasma exchange and others who were only given supportive management. Overall mortality, duration of hospital stay, duration of Intensive Care Unit stay and duration of oxygen supplementation was compared in both the groups.

Results: A total of 160 patients met the inclusion/exclusion criteria. Of these, 100 (62.5%) underwent therapeutic plasma exchange, while 60 (37.5%) did not undergo this procedure. The mean age of participants was 62.19 ± 5.192 years. Out of 15 (15%) patients died who underwent therapeutic plasma exchange, while 51 (85%) patients died who did not undergo plasma exchange (p-value <0.001). Length of hospital and Intensive Care unit stay and duration of oxygen supplementation were significantly less among those who underwent therapeutic plasma exchange than those who did not undergo this procedure (pvalue <0.05).

Conclusion: Therapeutic plasma exchange emerged as an effective procedure for patients of COVID-19 requiring Critical Care admission and organ support due to complications of this infection. Overall mortality and other clinical parameters were also significantly improved among patients undergoing therapeutic plasma exchange.
A Year of Endoscopic Retrograde Cholangiopancreatography (ERCP) At a Glance. Indications, Interventions, Complications
Authors: Kazmi Syed Kumail Hasan , Ali Khan Rao Saad , Alam Laima , Saeed Farrukh
Published: December 2022

Objective: To determine the demographics, indications and frequency of interventions and complications endoscopic retrograde cholangiopancreatography (ERCP).

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2019.

Methodology: The study included all the elective and emergency ERCP procedures from January 2019 to December 2019.

Results: Out of 1030 patients who underwent endoscopic retrograde cholangio-pancreaticography, 903 were enrolled. Sixtyone percent of the participants were males. The mean age was 56 ± 16 years, with the majority of the patients lying in the age range of 41-65 years. The most common indication for ERCP in this study was choledocholithiasis (47%), the most common complication encountered was acute pancreatitis (2.1%), and a mortality rate of 0.2% was reported. The complication rate was statistically related to the intervention rather than the age and gender of the patients.

Conclusion: The most common indication for ERCP remains choledocholithiasis, with the most common ERCP complication being acute pancreatitis followed by stent migration. Biliary fistulae, post-surgical biliary leaks and strictures, pancreatic pseudo cysts, acute cholangitis, choledocholithiasis and cholestasis secondary to as cariasis were found in a relatively younger group. The success rate was above 95% for high volume centres.
Role of Pie Crusting Technique on Soft Tissues in Preventing Soft Tissue Complications Compared to Conventional Closure of Wound in Fractures of Distal Tibia (PILON) and Fibula
Authors: Ahmad Rana Shahbaz , Amin Muhammad Suhail , Hassan Bushra , Rathore Muhammad Omar , Rehan Muhammad , Javid Mohsin
Published: December 2022

Objective: To demonstrate the effect of performing pie crusting on skin bridging two incisions used for open reduction and fixation to reduce wound complications compared to conventional wound closure.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Orthopedics and Trauma, Combined Military Hospital Rawalpindi from Jan to Nov 2020.

Methodology: Forty-seven patients, managed primarily with open reduction and internal fixation for type-43 fractures per AO/OTA classification, were studied. Group-1 comprised patients in whom the pie crusting technique was used during the closure of the wound. Group-2 included patients in whom conventional closure of the wound was performed. Evaluation of complications in the presence or absence of superficial and deep infection and necrosis was done. The time from injury to surgery was 6 hours to 72 hours. Patients were followed for an average of 12 weeks.

Results: In group-1 (pie-crust technique), there were 23 patients, whereas group-2 (classic wound closure) comprised 24 patients. In group-1, only 1 (4%) patient had a superficial infection, and no deep infection was reported. Whereas in group-2, six patients (25%) had superficial infection, and two patients (8%) had the deep infection.

Conclusion: Results indicated that pie-crust technique significantly reduces the risk of superficial and deep wound complications compared to classic wound closure because it reduces skin tension and allows the drainage of subcutaneous fluids.
Adherence of Facemask During COVID Pandemic Among South Asian CountriesA Web-Based Cross-Sectional Study
Authors: Abid Khadijah , Imran Abira , Bari Yashfika Abdul , Zaidi Tooba , Younus Maryam , Khambati Zainab Pervez , Baki Billah Abul Hasan Md. Khaza , Khura Bikash , Jabar Abdul
Published: December 2022

Objective: To investigate the facemask adherence rate among South Asian countries and to examine association between face mask adherence and socio-demographic factors.

Study Design: Cross-sectional study.

Place and duration of study: South Asian countries (Pakistan, India and Bangladesh), from Jul to Sep 2020.

Methodology: A total of 1579 individuals of age more than 14 years, of either gender, who had internet accessibility and understood English, participated in the study. The study was designed on Google forms and distributed through social media networks. The three South-Asian countries, Pakistan, India and Bangladesh, were targeted. Data regarding socio-demographics and type of facemask adherence was collected.

Results: The mean age of the participants was 31.32 ± 9.83 years. Of all the participants, there were 826 (46.3%) males, and 959 (53.7%) were females. Univariate analysis showed that females, Muslims, education level till graduate, employed, monthly income ≤$300, and Bangladeshis participants had higher odds of face mask adherence (p<0.05). Multivariate analysis showed that females, Muslims, urban residents, secondary level education, employed, family monthly income $100-$300, and Bangladeshis were strongly associated with face mask adherence (p<0.05).

Conclusion: Among the three countries, Bangladeshis had higher facemask adherence than Pakistan and India. The sociodemographic factors associated with facemask usage were gender, religion, locality, education, employment status, family monthly income, and nationality.
Clinical, Socio-Demographic Characteristics and Gender Disparity in Patients with Tuberculosis Infection in Pakistan
Authors: Khan Shameem Behram , Ijaz Raafia , Salahuddin Naseem , Shah Rabeea , Sarfaraz Samreen , Hussain Aneela
Published: December 2022

Objectives: To assess the clinical, environmental, and socio-demographic characteristics leading to gender disparity in tuberculosis in Pakistan.

Study Design: Prospective Comparative study.

Study Setting and Duration: The Indus Hospital, Karachi Pakistan, from Jul 2020 to Dec 2020.

Methodology: A sample of 200 patients with diagnosed tuberculosis (detected on an acid-fast bacillus (AFB) smear with radiographic abnormalities) irrespective of gender, sensitivity, or site of tuberculosis, were included in the study. Data of gender, personal history, substance abuse history, and dietary habits was documented.

Results: Pulmonary tuberculosis was significantly more common in female patients than in males (p<0.001). The mean age of male patients was 30.16 ± 9.47 years. Male patients were significantly older than their female counterparts (p=0.003). The diabetes mellitus in male patients was significantly higher than in female patients with TB (p=0.01). Similarly, substance abuse history was more frequently positive in male patients as compared to female patients, 28 (40.60%) vs 9 (6.70%); p-value <0.001. There was no significant difference in the occurrence of drug-resistance tuberculosis between the two genders. However, pulmonary tuberculosis was significantly more common in female patients than in males (p<0.001).

Conclusion: We reported some distinctive differences between male and female tuberculosis patients. Young females had more predilections toward tuberculosis as compared to men. Diabetes mellitus and substance abuse history were more common in male tuberculosis patients than in females.
Effectiveness of Intralesional Triamcinolone Acetonide (TA) and Incision and Curettage (I & C) for Chalazia
Authors: Iqbal Nazia , Sarfaraz Muhammad Haroon , Muzaffar Waqar , Abbas Hussnain , Nisar Maryam , Khan Amna
Published: December 2022

Objective: To evaluate the efficacy of intralesional Triamcinolone Acetonide (TA) injection and incision and curettage (I&C) and their complications in chalazia.

Study design: Quasi-experimental study.

Place and duration: Combined Military Hospital Multan Pakistan, from May to Nov 2019.

Methodology: We selected individuals with primary chalazion having a size of 2mm or more, with a duration of at least one month and not resolving with conservative treatment. Our sample was divided into two groups. Group-A was given a 5mg/ml Triamcinolone injection under aseptic conditions, and the group-B had incision and curettage.

Results: The overall frequency of lesion in the upper lid 53 (66%) was more than in the lower lid 27 (34%), p=0.004. The complete resolution of the lesions after the repetition of the procedure was found to be almost the same in the two groups. In comparison, the resolution duration was longer in group-A versus group-B. The complications were more in the surgical group 6 (p=0.001) than in the Triamcinolone Acetonide group 11, (p=0.004).Conclusion: Our study signifies that intralesional Triamcinolone Acetonide injection is a safe procedure, having fewer complications. For individuals with poor compliance with conservative management, Triamcinolone Acetonide injections provide an alternative with an almost equal success rate and minimal complication.
Estimation of Blood Glucose Levels And Hemodynamic Changes During Laparoscopic Cholecystectomy: A Comparison of Dexmedetomidine and Nalbuphine
Authors: Fayaz Fakher-e- , Asad Naila , Khurshid Hana , Butt Zulqarnain , Awan Nazir , Saeed Aisha
Published: December 2022

Objective: To compare the effect of Dexmedetomidine and Nalbuphine premedication on changes in hemodynamics and neuroendocrine stress response under general anaesthesia by analyzing the variation of perioperative serial blood glucose levels.

Study Design: Prospective comparative study.

Place and Duration of Study: Services Hospital, Lahore Pakistan, from Oct to Dec 2020.

Methodology: Total 90 patients aged between 30-and 65 years were allocated randomly into three groups. Group-D patients (n=30) were administered Dexmedetomidine 0.5 μg/kg in 100 ml normal saline, group-N (n=30) were given Nalbuphine 0.1 mg/kg in 100ml saline, and group-S received saline (100ml) throughout 15 minutes before induction of anaesthesia for laparoscopic cholecystectomy. General Anaesthesia was administered. Intra-abdominal pressure was maintained after abdominal insufflation with carbon dioxide between 12-15 mmHg. Blood glucose levels were analyzed preoperatively, 30 minutes after the beginning of surgery, at extubation and 2.5 hours postoperatively. Hemodynamic changes were recorded after premedication, 15 and 30 minutes after pneumoperitoneum and extubation.

Results: Random mean blood sugar levels were 135.23 mg/dl with Dexmedetomidine and 123.33 mg/dl with Nalbuphine and 122.53 mg/dl in saline group (p<0.05). There was a greater decrease in hemodynamic parameters with group-D than with groups N and S (p<0.01).

Conclusion: During laparoscopic cholecystectomy, intravenous Dexmedetomidine premedication attenuates the hemodynamic stress response better than Nalbuphine but does not suppress the neuroendocrine response as estimated by a rise in random blood glucose level.
Radiological Spectrum of Cerebral Venous Sinus Thrombosis in Soldiers at High Altitude: A Four-Year Analysis
Authors: Palwa Abdur Rahim , Adil Muhammad , Riaz Sidra , Muhammad Dost , Liaqat Muhammad Muddasar , Nisar Uzma
Published: December 2022

Objective: To assess the spectrum of radiological findings of cerebral venous sinus thrombosis (CVST) in soldiers serving at high altitudes.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Combined Military Hospital, Skardu Pakistan, from Jan 2016 to Jan 2020.

Methodology: Thirty-three consecutive soldiers evacuated to Combined Military Hospital, Skardu, with radiologically proven cerebral venous sinus thrombosis on CTV brain were enrolled in the study. Plasma D-dimer levels of all the patients were sent to the laboratory, and clinical data were noted.

Results: Mean age of patients was 28.88 years ± 5.189 (range 20 to 40 years) with a mean duration of stay at high altitude of 59.8 ± 39.3 days and the average height of deployment as 17094 ± 3285 feet. Left transverse sinus was the most commonly involved sinus in 21 (63.6%) patients, followed by left sigmoid sinus 18 (54.5%) and superior sagittal sinus 16 (48.5%). Sixteen cases demonstrated associated findings of venous infarction on CT brain (48.5%). Headache was the most common clinical presentation 13 (93.9%), followed by vomiting 12 (36.4%).

Conclusion: Prolonged stay at high altitude is a key risk factor for cerebral venous sinus thrombosis in young individuals showing a predilection for posteriorly and inferiorly located venous sinuses.
DIAGNOSTIC ACCURACY OF D-DIMER ASSAY IN PULMONARY EMBOLISM USING CTPA AS GOLD STANDARD
Authors: Aziz Sadaf , Junaid Meena , Ibrahim Nadeem , Shoaib Sonia , Iftikhar Amian , Awais Lubaina
Published: December 2022

Objective: To determine the sensitivity and specificity of D-dimer assay for the diagnosis of PE in resource limited settings using CTPA as a gold standard for comparison.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Radiology, Combined Military Hospital, Peshawar, from Feb 2019 to Jul 2020.

Methodology: A sample of 114 cases of clinically suspected PE presenting in ED were collected by non-probability sampling as per QUADAS 2 domains. D-dimer and CTPA reporting done by separate teams, compilation of data by third team. Using SPSS 23.0, 2×2 contingency table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of D-dimer in diagnosing PE.

Results: Age range 20-50 years (mean: 40.54 ± 5.02 years). Sixty patients were female (52.3%). D- Dimer levels for the diagnosis of PE: Sensitivity: 92.86%, specificity 89.66%, positive predictive value (PPV): 89.66% and negative predictive value (NPV): 92.86%.

Conclusion: The D-Dimer levels are significantly sensitive and specific in the diagnosis of PE: however keeping in view the high mortality of PE, diagnostic accuracy may be further improved by using D-Dimer levels in conjunction with pretest clinical probability rules.