bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia
Authors: Haq Aqsa Ikram ul , Naseem Ulfat , Sadiq Nadia , Batool Syeda Maryam , Khalid Tahira , Bashir Shama
Published: July 2023

INTRODUCTION: Eclampsia contributes to maternal mortality in developing, underdeveloped world. Various drugs have been tried to treat eclampsia. Magnesium sulphate has become the drug of choice due to various advantages and is associated with adverse outcome for both mother and fetus if not used correctly.
OBJECTIVE: To compare the efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia
STUDY SETTING: The study was conducted at Gynecology and Obstetrics Department unit II, Holy Family Hospital, Rawalpindi, from June 20, 2020 to December 20, 2020. Study design was Randomized Controlled Trial.
SUBJECTS & METHODS: Patients were randomly distributed into two groups, group-A (IM Group) and group-B (IV Group). Group-A patients received a loading dose of 4 gm IV MgSO4 over 5-10 minutes+10 gm MgSO4 deep intra-muscular injection (5 gm in each buttock) and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly. Group-B patients received MgSO4 4 gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO4 per hour as continuous intravenous maintenance infusion. Clinical response to therapy for both drugs was calculated in terms of efficacy and safety. All the data were entered & analyzed by using SPSS v25.0. Both the groups were compared in terms of efficacy and safety by using Chi-Square test. A p-value less than 0.05  was taken as significant.
RESULTS: A total of 160 patients with eclampsia were enrolled for this study. Patients were divided into two groups i.e. Group-A (IM MgSO4) and Group-B (IV MgSO4). In group-A, there were 45(56.3%) in 18-30 years age group and 35(43.8%) in 31-40 years age group, while in group-B, there were 48(60.0%) in 18-30 years age group and 32(40.0%) in 31-40 years age group. In IM MgSO4 group, prevention from recurrence of seizure was noted in 74(92.5%) and 78(97.5%) in IV MgSO4 group, which is statistically insignificant with a p-value of 0.147.
CONCLUSION: Both IM and IV regimen are equally effective in controlling the recurrence of convulsions. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflex. Both IM and IV regimen are equally effective but IM Magnesium Sulphate is associated with a higher incidence of toxicity.
KEY WORDS: Eclampsia, Intramuscular MgSO4, Intravenous MgSO4.
Frequency of mortality in patients with high AIMS65 score presenting with upper GI bleed
Authors: Khan Javeria Zahid , Ambreen Saima , Jahangir Sidra , Malik Aimen , Khaar Bushra , Umar Muhammad
Published: July 2023

Introduction:
Upper gastrointestinal bleeding is a common reason for hospitalisation across the world, with a UK frequency of 10% and a death rate of 8-14 percent. [1] Several risk assessment scores have been created to predict clinically relevant outcomes like death, the requirement for hospital-based care, rebleeding, and hospital stay length
Objective: To determine frequency of mortality in patients with high AIMS65 score presenting with upper gastrointestinal bleeding.
Setting: Gastroenterology Department –removed for blind review---
Material & Methods: It was a cross-sectional, prospective, observational research study. Patients having a high AIMS score were recruited in the study. The patient's medical history, physical examination, and biochemical data were all properly recorded. Patients were observed for the outcome variable, which was hospital mortality.
Results: 119 patients fulfilling the inclusion criteria were included. There were 77 (64.7%) males and 42 (35.3%) females. The mean age was 43.10 ± 14.213 years On analysis of demographic data, it was observed that 61 (51.3%) patients were below 40 years of age. On analysis of organ dysfunction 79 (66.4%) had cardiovascular dysfunction, 55 (46.2%) had respiratory dysfunction, 39 (32.8%) had renal dysfunction. On outcome variable, It was observed that 81 (68.1%) of the people had died.
Conclusion: Majority of the patients with high AIMS had mortality. Majority of the patients were males and had cardiovascular dysfunction.
Key words: GERD, endoscopy, gastroduedonal disease, carcinoma, gastritis.
Hamstring Shortness among Undergraduate Students, Using Knee Extension Angle Test
Authors: Ishaque Farhan , Bano Saira , Khan Hamna , Kumar Suneel , Qaiser Saeed , Khan Muhammad Asif
Published: July 2023

Objective: To examine the causes and incidence of hamstring tightness/shortness among undergraduate physical therapy students. Cross-sectional study. Institute of Physical Medicine & Rehabilitation, DUHS during the period of Jan 2019 to Jun, 2019.
Material and Methods: The subjects sample size (n=248) was estimated by open EPI software. Male and female both are included. Hamstring muscle shortness was assessed by a gold standard assessment tool i.e. passive knee extension angle test. Descriptive statistical analysis was done by using SPSS version 24.
Results: The hamstring muscle tightness was measured by using knee extension angle test. It results conclude that among (248) students (62.90%) had hamstring muscle tightness / shortness and (37.10%) did not show any muscle shortness. Out of (216) females participants (136) have hamstring shortness. On the other hand out of (32) male participants (20) had hamstring shortness/tightness out of total (248) students. It was also evident from the study that 27% of physiotherapy students having low back pain was because of clinical exposure and tight hamstrings muscles.
Conclusion: Hamstring tightness/shortness is very much prevalent among the undergraduate physiotherapy students. The reason might be the prolong study durations and lack of physical activities. The result showed statistically significant difference between hamstring muscle extensibility in both male and female
Key words:   Extension Angle, Flexion, Contracture, Fascitis
Comparison of Primary Simple Closure and Limberg Flap Technique in Pilonidal Sinus
Authors: Butt Hafiza Kiran Saleem , Nazir Aamna , Khan Muhammad Atif , Anwar Muhammad Idrees , Waris Hira , Maqbool Shahzaib
Published: July 2023

Introduction
Pilonidal sinus is a disease affecting the intergluteal region. Many surgical techniques have been described for the treatment of this condition. The objective of this study was to compare Limberg flap technique and primary simple closure in terms of postoperative discharge.
Materials and methods
It was a randomized prospective study conducted at the Department of Surgery—removed for blind review-- from December 2018 to June 2021. Sixty male patients aged 15-30 years presenting with pilonidal sinus for the first time were included in the study. Patients with comorbidities and the American Society of Anesthesiologists (ASA) class three and above were excluded from the study. Patients were divided into two groups by lottery method. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 23.0. Chi-square tests were applied. A p-value of ≤ 0.05 was considered significant.
Results
The postoperative discharge was found in just five (16.3%) of the patients in group A (Limberg flap technique), while the discharge was present in 12 (40%) of the patients in group B (primary simple closure; p = 0.045).
Conclusion
Limberg flap technique is superior to primary simple closure in terms of postoperative discharge.
Comparison of open vs Plastibell techniques of circumcision for surgical outcomes and cosmetic satisfaction;A randomized control trial
Authors: Iqbal Muhammad , Ijaz Sadaf , Zafar Muhammad Hassan , Malik Naveed Akhtar
Published: July 2023

Objective of the study: To compare the results of circumcision by open technique and the Plastibell
technique in male babies.
Methods: In this randomized controlled interventional study, 1440 babies whose circumcision
was done as religious rite were divided into two groups. Group A underwent circumcision by open
technique whereas group B underwent circumcision by Plastibell method.
Results: Majority 720 (50%) were in age group 6-8 weeks. Compared with open method,
significantly less number of patients in plastibel method experienced moderate pain (47.91% versus 35% p value .00001 and severe pain 31.94% versus 9.02% p value .00001.Rate of wound infection was significantly less in plastibell method 2.77% versus 4.86% p value .020. However more patients in plastibell technique needed re-do circumcision 4.02% versus 1.94% p value .0202. Overall greater parent’s satisfaction was attained with plastibel method.
Conclusion: Plastibell technique has many advantages over open method in terms less post op pain, wound infection, and greater cosmetic  satisfaction however more patients will need re-do circumcision in this technique compared with conventional method.
Keywords: Circumcision, open technique, Plastibell, post-op complications
Common Organisms causing surgical site infection(SSI) in Postoperative patients in a tertiary care Hospital
Authors: Mustafa Fatima , Khan Mumtaz Ahmed , Mustafa Abdullah , Manzoor Asifa , Safa Safia , Khogyani Samiullah
Published: July 2023

Objective:

To investigate the types and frequency of organisms causing surgical site infections in postoperative patients and their association with other factors.

Study Design:

Cross-sectional

Duration and Place of Study:

Surgical Unit-II of –removed for blind review---and from 1st March 2021 – 31st July 2021.

Patients and Methods:

There were 391 surgeries in this study, but only 27 patients met the inclusion criteria. A diagnosis of SSI was based on specific parameters, including the detection of two or three cardinal signs of inflammation and the surgeon's confirmation of the diagnosis. This data was analyzed using IBM SPSS 23.

Results:

Among 391 patients, 242 had elective surgeries (male:female, 1.6:1), and 149 had emergency surgeries (male:female, 1:3.4). The mean length of stay for elective surgeries was 2.19 ± 1.8 days and 4.2 ± 3.7 days for emergency procedures.

There were 98 abdominal procedures (65.77%) performed in emergency settings. Only 9 (3.71 %) elective procedures and 18 (12.08 %) emergency procedures reported surgical site infections. Escherichia coli was the most commonly isolated organism from SSI during the study. The rate of SSI in postoperative patients was 6.9%.

There was a statistically significant association between SSI and type of surgery (p=0.002). The mean length of stay (LOS) was longer for patients with SSI (mean=12.5, p=.000).  Emergency cases had a longer LOS compared with elective cases (mean= 4.21 days vs 2.19 days, p=.000).

Conclusion:

According to our study, our unit's SSI were comparable to other developing countries. SSI are more frequent in emergency cases, men, and diabetics, and are the primary cause of longer hospital stays. 

Keywords:

Surgical Site Infection; E.Coli; Length of stay;
Assessment of derangement in biochemical profile in primary open angle glaucoma patients presenting at a tertiary care hospital
Authors: Zuhra Fatima Tuz , Khattak Mehnaz , Nadeem Sana , Atzaz Noreen , Khalid Attika , Saeed Sami
Published: July 2023

Objective: To assess the changes in high sensitivity C Reactive protein (hs-CRP), serum cholesterol, uric acid, creatinine, bilirubin and ALT in patients of primary open angle glaucoma.

Material and methods: Comparative cross-sectional study conducted between April 2021 and October 2021 at departments of Ophthalmology and Pathology, --removed for blind review----44 POAG patients and 54 healthy controls volunteered to participate in the study. POAG was diagnosed as per criteria. Venous blood was drawn for analysis of serum cholesterol, uric acid, creatinine, bilirubin, ALT and hs-CRP.  hs-CRP was performed on ELISA plate reader Platos R496 while spectrophotometric analysis of serum uric acid, creatinine, and cholesterol was carried on Beckman Coulter AU-700.

Results: Mean hemoglobin (Hb), Total leukocyte count (TLC), serum urea, creatinine, uric acid, ALT, bilirubin, cholesterol and HbA1c were 12.80 ±1.50g, 8.88±1.92 mm3, 5.95±5.47 µmol/l, 92.19±21.81 µmol/l, 305.85±79.92 mmol/l, 34.31±18.26 IU/L, 9.26±3.11 µmol/l, 5.18±0.96 mmol/l,6.70±1.28 %respectively whereas the Mean IOP in POAG patients was 28mmHg, mean CCT was 516.6 µm, and mean vertical CDR was 0.6.

High frequency of hs-CRP positivity (50 percent) was reported in our patients. Significantly lower uric acid levels were observed in primary open angle glaucoma patients versus controls ie 305.85±79.92 mmol/l vs 344.36±37.24 mmol/l (P value < 0.05). Serum creatinine was significantly different between mild and severe groups i.e. 88±14.7 vs 113.1±32.4. (p value <0.001*)

Conclusion: High frequency of hs-CRP positivity and low uric acid levels suggest the presence of para inflammation in patients of POAG.

Key words:

Primary open angle glaucoma (POAG), intraocular pressure (IOP), high sensitivity CRP (hs-CRP), uric acid (UA)
PSYCHOSOCIAL ILLNESS IN CHILDREN WITH THALASSEMIA: A CASE-CONTROL STUDY
Authors: Afzal Erum , Sheikh Muhammad Aslam , Bhaba Sajjad Hussain , Ahmed Tanveer , Iqbal Imran , Iqbal Muhammad Khalid
Published: July 2023

INTRODUCTION: Thalassemia is the most common hemolytic autosomal recessive disorder. Pakistan has significant number of thalassemic children .The children with chronic disorders like thalassemia are prone to develop psychosocial illness including depression, anxiety, intellectual and behavioral issues. 
OBJECTIVE: To assess the psychosocial illness in children with thalassemia and to compare these problems in children with and without Thalassemia  
PLACE & DURATION: The Children’s Hospital and the institute of child health, Multan. From January to September 2021. 
STUDY DESIGN: Case-control 
MATERIAL AND METHOD:   In this study 50 children with Thalassemia and 50 normal children were enrolled as case & control according to inclusion and exclusion criteria. After approval from institutional ethical committee, detailed history ,Socioeconomic status, educational status of parent and child, age of diagnosis of disease, and whether thalassemia is well controlled or not and complications were noted. A Pediatric Symptom Checklist was used for psychosocial problems in all children. Data was analyzed by using SPSS version 22. Mean and standard deviation for quantitative data, while frequencies and percent for qualitative data was calculated. P-value was calculated by Chi square test. Prevalence ratio (ODDS ratio) with 95%confidence interval of all variables were calculated. 
RESULTS: Out of 100 patients 50 were in case group (Thalassemia) and 50 control (non-thalassemic.Male female ratio was 1.2:1. 60 %( n=30) cases, 78 %( n=39) control patients were age ranges between 5 to 10 years. Educational level of parents of 40%(n=20),and 56%(n=28) was below matric,42%(n=21) and 90%(n=45) patients were going to school in case and control group respectively.82%(n=41) patients belonged to low socioeconomical status in each group. Regarding characteristics of thalassemia 74 %( n=37) patients were diagnosed within 1st year of life, while 26 %( n=13) after 1st year.64 %( n=32) had well controlled and 36 %( n=18) poor controlled disease. 20%(n=10) had developed Diabetes mellitus,2%(n=1) heart failure,74%(37) growth failure,76%(n=38) hemolytic facial features and 72%(n=36)skin discoloration. Psychosocial problems were statistically significant in children with Thalassemia as compared to healthy ones (p-value<0.001).Poorly controlled thalassemia and complications of heart and growth failure were found statistically significant risk factors. 
CONCLUSION: Psychosocial problems are common in children with thalassemia as compared to healthy ones. So these patients must be referred for detailed psychological evaluation and management along with medical treatment.
VARIATION IN INTERNAL CAROTID ARTERY PROTRUSION AND DEHISCENCE IN A SUBSET OF KARACHI POPULATION
Authors: Lakhani Mubina , Raza Iffat , Mohiuddin Maria , Khan Rosheena Nabeel , Sidhwani Santosh Kumar , Hassan Nuzhat
Published: July 2023

Objective: To find out the frequency of protrusion of Internal Carotid artery in sphenoid sinus and dehiscence of carotid canal in a subset of Karachi population. 
Study design: This was a Cross-sectional study conducted at Radiology department of Ziauddin university. 
Methodology:  We analyzed 270 head and neck CT scans 270 Head and neck CT scans (540 sides) were analyzed. CT was performed on a 16 slice Toshiba Alexion at Ziauddin Hospital, Karachi —removed for blind review---. SPSS version 20 was used for data analysis. 
Results: Out of 270 CT scans analyzed, 28 (10.3) scans showed protrusion of ICA in sphenoid sinus. Out of 45 (16.6) of the subjects showed dehiscence of carotid canal. Out of total dehiscence present unilateral cases were more frequent as compared to bilateral. Unilateral protrusion was also more common as compared to bilateral protrusion of ICA. 
Conclusion: Knowledge of dehiscence and protrusion related to ICA and sphenoid sinus anatomy is essential to avoid complications in endoscopic sinus surgery.
Early Breast-Feeding Initiation Using Point of Care Quality Improvement Model at Tertiary Care Hospital in AJK
Authors: Khan Aftab Hussain , Khan Mumtaz Ahmed , Akbar Abrar , Mumtaz Sehrish , Abbasi Yasira , Meraj Lubna
Published: July 2023

ABSTRACT: Urgency and solely utility of breast feeding for six months is better for the provision of a healthy start to newborn and reduces infant mortality and morbidity. The prevalence of late lactation and other ways to formula or animal milk feeding the neonate in Pakistan is often observed other than the WHO recommendations. Early initiation of breast feeding is one of the indicators to express quality of Care in Maternal, and newborn Health. Among many approaches, point of care Quality improvement initiative (POCQI) is a simplified tool for learning the basics of quality improvement in the health care facilities. This study aimed to assess the prevalence and associated factors of early initiation of breastfeeding among mothers in a tertiary care hospital in AJK, where POCQI has been piloted. 
Methods: A quality improvement, cross sectional study before and after the implementation of POCQI model on two independent samples was carried out from August to November 2019. A total of 100 women (50 before intervention and 50 after intervention) who delivered neonates of 0-7 day’s age were included in study by using non-probability convenience sampling technique. The relevant information was gathered by using questionnaire. Mothers who did not start breast feeding within first hour did not receive any health education during antenatal visits. such women lack knowledge about benefits of colostrum. Hence an intervention was introduced by Researcher jointly in collaboration with POCQI team of the hospital by using Plan-Do-Study-Act (PDSA) cycle. Slogans and health education messages for promotion of early initiation of breast feeding were developed and message was spread to pregnant mothers who visited hospital for antenatal care or came for delivery in labor room. 
Results: A total of 100 women (50 before intervention and 50 after intervention) who delivered newborn babies of 0-7 day’s age were selected purposively. Before POCQI intervention out of fifty only eleven (22 %) women breastfed their new born within one hour after birth. After POCQI intervention, out of fifty, thirty-seven women (74%) exclusive breastfed their new born within one hour. Thus, total increase in term of percentage was 54%. 
CONCLUSION: The study gives evidence for more needs to enhance breastfeeding uptake in AJK. The prevalence of EIBS was low before implementation of POCQI model but it improved significantly after its application
CAN SHOE SIZE CORRECTLY PREDICT THE SIZE OF COMPONENTS OF TOTAL KNEE REPLACEMENT PRE-OPERATIVELY
Authors: Furqan Ahmed , Hafeez Sohail , Khan Fahim , Asghar Ali , Manzoor Mahin , Kareem Talha
Published: July 2023

Objective: To ascertain the correlation between shoe size and sizes of femoral and tibial components of total knee replacement preoperatively in patients undergoing total knee arthroplasty.
Study design: Prospective cohort study
Study settings and duration: This study was conducted at department of orthopedic surgery, Shifa International Hospital, Islamabad from July 2020 – December 2020.
Material and methods: Sample size was calculated using WHO calculator and it was 43 patients in total. Patients were approached through non-probability consecutive sampling. Shoe size of patients was measured using a Brannock device. During surgery, Implant model and sizes of the femoral and tibial components implanted during knee replacement were noted. Data was analyzed with the help of SPSS version 24. We applied Pearson’s correlation cofficeint. P value ≤ 0.05 was considered significant.
Results: Out of 43, there were 9(20.9%) male and female 34(79.1%). Mean age of patients was 51.7±6.8 (SD). We found good positive correlation between shoe size and tibial component (p=<0.001). Positive co relation was found between femoral component and shoe size (p=0.001). Shoe size predict 72% of Tibial component and 65% femoral component.
Conclusion: Shoe size is effective and safe predictors of total knee replacement components pre-operatively. This procedure is more accurate and less labor intensive. Accurate templating result in less surgical duration and provide several benefits to patients and health care providers.
A rural community-based investigation to assess mHealth for family planning advice in district Multan
Authors: Farooq Naveen , Alvi Nadia Rehman , Mangrio Sana , Rahim Syed Aftab , Riaz Zunaira
Published: July 2023

Background: Globally, Pakistan is the 5th populous country. To increase the use of family planning services by public private business model, Punjab Population Innovation Fund selected “Connect4fp” project implemented by International Rescue Committee organization. The purpose of this research was to determine the impact of mobile health(mHealth) advice on family planning in project area. This project was implemented in 9 Union councils of district Multan, Pakistan. The innovative idea of this project was the use of mobile phones to spread family planning knowledge among community in the form of Interactive Voice Response (IVR) as well as Short Message Service (SMS) (i.e., text messages).
Methods: A cross-sectional study targeted 197 men as well as women (mostly married women of reproductive age) receiving mobile messages or recorded robocalls from the project area. The purpose was to assess their family planning knowledge and awareness by using structured Likert scale questionnaire. Secondly the viewpoint about mHealth and its effect on family planning was determined from 40 private providers and 27 Family planning Champions (who were part of the project) by telephonic interviews. Their response was quantified by using Likert scale. Descriptive statistics were calculated of the study’s main variables. The association of family planning knowledge of community members was determined to their contraceptive use by using Chi square.
Results:  The results specified that 60% community members included in this study told that their family planning knowledge is increased due to this mHealth program. 36% Private providers while 75% FP Champions were agreed that family planning patients are increased due to this mHealth program.
Conclusion: Mobile messages and robocalls about family planning sent in local language positively contributed to increase FP knowledge and awareness in community. This may trigger communication about family planning within couples, as a result increase use of family planning services.
Effectiveness of Tocilizumab in reducing inflammatory response associated with COVID-19 pneumonia at Islamabad Medical Complex, Islamabad
Authors: Naeem Abdul , Meraj Lubna , Shams Nadia , Rizvi Mehr Fatima , Kamal Muhammad , Amir Muhammad
Published: July 2023

Objective: To determine the effectiveness of Tocilizumab in covid-19 related severe pneumonia.
Introduction: COVID-19 is a global health problem causing respiratory infection. This is triggered by IL-6 characterized by raised inflammatory markers that is called cytokine release storm. Severe disease leads to hospitalization, oxygen requirement and poor outcome.
Methods: This interventional study (descriptive analytic) was conducted from July-December 2021 at Intensive Care Unit, after ethical approval. Seventy cases of COVID-19 pneumonia with cytokine storm were included. Twenty cases were dropped either refusal to tocilizumab, pregnancy or having contraindication to tocilizumab, leaving 50 study participants. The patient’s demography, clinical, laboratory and radiological findings, timing and response variables of tocilizumab were recorded. The temporal readings of inflammatory markers, oxygen requirement and clinical status were compared at admission and after tocilizumab. SPSS version 25 was used for data analysis. Chi-square test was applied with significant p-value < 0.05.
Results: There was male predominance of 66% with mean age of 58.6±14.8 years. Mean day of illness and hospital stay was 8th day and 17.56 days respectively. C-reactive protein levels improved in all cases 50(100%) (p <0.0001), ferritin in 31(62%) (0.019), D dimers in 28 (56%) (p0.014), LDH in 30(60%) (p 0.02) and interleukin-6 in 32(64%) (0.017. Survival benefit with tocilizumab was significant in patients that received within 10th day of illness (p 0.021). At discharge, 66.6% were off oxygen and 33.3% required domiciliary oxygen.
Conclusion: COVID-19 Pneumonia with cytokine release storm bears high mortality. Significant improvement in inflammatory markers like CRP, ferritin, D-dimers and LDH shows effectiveness of tocilizumab. Early administration within 10 days of illness has survival benefits.
PLASMA DONATION AND PERCEPTION, ATTITUDE, BEHAVIOR OF COVID-19 PATIENTS: A CROSS SECTIONAL STUDY
Authors: Meraj Lubna , Munir Muhammad Wajad , Shams Nadia , Andaleeb Hina , Basharat Ayesha , Dar Savida Ilyas
Published: July 2023

BACKGROUND: Current study aims to identify the perception, attitude and behavior about Covid and plasma donation in the Covid cases.
METHODOLOGY: This descriptive cross-sectional study was conducted ---removed for blind review---Adult COVID-19/post-Covid patients were included by consecutive sampling. The critically ill, mechanically ventilated cases were excluded. Special questionnaire was developed including the demographic variables, mode of transmission, personal hygiene, prevention, post covid immunity, re-infection, psychosocial factors, financial reservations and post covid life. Willingness for plasma donation, laboratory diagnostics and blood groups inquired. Data was collected by direct interview by researcher and analyzed by SPSS V.20.
RESULTS: Mean age was 39.8+15 years; 122(54%) females and 104(46%) males. Total 163(73%) participants said Covid has impact on health, economy, social, mental and psychological state. 188(83%) considered Covid a threat to human life. 142(63%) had a close Covid contact and 15(6.6%) had recently travelled. 131(58%) said they could have prevented getting infected. 171(75.7%) considered handwashing and 208(92%) cleanliness and158(77%) considered natural, herbal remedies as preventive. 191(84.5%) wore mask for most/all of the time. 130(57.5%) said they will be immune to Covid post-recovery. 179(79.2%) were aware of re-infection. 169(74.8%) considered smoking as a risk for Covid and137(60.6%) aimed to quit smoking. 204(93%) committed to hand washing and 210(92.9%) to wearing masks post-Covid. 127(56%) were concerned about their food, 78(34.5%) about finances, 103(45.6%) about their family getting infected. 213(94%) expected life to normalize post-Covid. Most frequent blood group was B+ 67(29.6%) followed by A+ 42(18.6%) and O+ 41(18.1%). 128(66.6%) participants showed willingness to donate their plasma after recovery. 24(10.6%) refused the donation. 134(59.3%) agreed that plasma donation won’t reduce their immunity. 186(82.3%) were clinically recovered at the time of interview.
CONCLUSION: Our Covid patients had a positive approach towards plasma donation. They expected normalization of life post Covid and showed commitment toward continuation of preventive habits and smoking cessation. However, there were significant concerns about finances, safety of loved ones and mental health.
Evaluating the learning environment in Dental colleges from students’ perspective; a qualitative exploratory research
Authors: Orakzai Gulmina Saeed , Gillani Syeda Munazza , Irshad Saima , MahRukh  , Tiwana Madeeha Nazar , Shaukat Sidra
Published: July 2023

Objective: Learning environment has a great role in students learning, achievement and success. It is also essential for the development of curriculum. The aim of this study is to document the perception of dental students regarding their learning environment.
Material and methods: This qualitative research were conducted from Dec 2021 to May 2022, at four dental colleges of Rawalpindi. A total of 16 students from all these college who were regularly enrolled and voluntary participating in the study were included. Focus group interview (n=4 in each group) comprised of students from both basic sciences year (1st and 2nd year BDS) and clinical years (3rd and final year BDS). Data was transcribed verbatim and thematic analysis was done.
Result: Students overall expressed a good level of satisfaction with the learning environment but pointed out some issue which were summed up under major themes identified such as issues in lectures, issues in clinical teaching, issue in the dental curriculum and lack of academic motivation.
Conclusion: This study suggests that the dental students generally hold a positive perception towards their learning environment, but they pointed out the short comings in their lectures, clinical teaching, dental curriculum and dearth of motivation. Taking students view point regarding their learning environment will help the stake holders and policy makers to provide better learning environment with more facilities and support system for the students to enhance their learning.
Clinicopathological features of different Histopathological Subtypes and Stages of Wilms Tumor
Authors: Ahmad Alia , Anjum Aysha , Hashim Imran , Hussain Mahvish , Zaman Samina , Sahrish Fariha
Published: July 2023

Introduction: Wilms tumor is the most common pediatric renal neoplasm. Following preoperative therapy, various histological subtypes, risks and clinical stages are determined as per following SIOP 2001 protocol. To determine the clinicopathological features of different histopathological subtypes and stages of Wilms tumor after completing course of preoperative as well as postoperative chemotherapy following SIOP 2001 protocol.
Methodology: This is a retrospective cross-sectional study and sample size calculated by non-probability technique. Ninety-three patients with abdominal masses in the Hematology/Oncology Department were included. After radiological and histopathological diagnosis, four weeks of preoperative chemotherapy, given to patients, followed by partial and radical nephrectomies by surgical team. Specimens received in Histopathology Department grossed and microscopically examined for different post chemotherapy histological subtypes. Further risk categorization and clinicopathological staging in accordance with SIOP 2001, done after completion of treatment. Patients called for yearly follow up for the next five years. Categorical variables are presented as frequencies and percentages.
Results: Mean age of ninety-three children was 44.4 months + 30.92with predominance of males (55.9%) and more common in right sided kidney (55.9%). Majority patients completed the entire course of treatment (77.4%). Majority were intermediate risk tumors (76.3%) and most common histological subtype was Mixed Tumor subtype (23.4%). In our study majority, tumors were stage III (48.3%) and patients died due to febrile neutropenia (9.6%)
Conclusion: In our study the majority of patients completed the entire course of treatment and relapse was fairly less. Patients lost to follow up after nephrectomy and deaths at home caused by febrile neutropenia were our major challenges.
Diagnostic Accuracy of Serum Prostate Specific Antigen and Gleason Score in Determining the Presence of Skeletal Metastasis in Prostate Cancer Patients: a Pakistani Perspective
Authors: Nasir Taimoor , Aamer Syeda Neha , Waqar Saman , Omer Wafa
Published: July 2023

Objective:

To determine the cut-off values for serum Prostate Specific Antigen and Gleason score for predicting bone metastasis of Prostate cancer.

Methodology:

This diagnostic accuracy study was conducted in Pakistan Institute of Medical Sciences (PIMS), Islamabad from 2015 to 2018. 330 patients of Prostate cancer were enrolled in the study. Prostate Specific Antigen (PSA) and Gleason Scores (GS) were determined using commercially available ELECSYS® assays in the Modular Analytics E170 (Roche Diagnostics) and histopathology respectively. Tc99m methylene diphosphonate (MDP) was used to perform the Bone scan. Any correlation between these variables was nvestigated to determine a cut-off value for PSA and GS.

Results:

Out of the total 330 patients included in the sample, BS was positive for metastasis in 186 (56.4%) patients and negative in 144 (43.6%) patients. Amongst these 186 positive patients, 5 (2.7%) had PSA < 20 ng/ml, 174 (93.5%) had PSA between 20 and 90 ng/ml, and 9 (4.8%) had PSA > 90 ng/ml. Out of the 144 patients with negative BS, 142 (98.6%) had PSA < 20ng/ml. Only 2 (1.4%) had PSA in the range of 20 and 90 ng/ml, while none had PSA > 90 ng/ml. In the 147 patients with PSA < 20 ng/ml, 142 (96.6%) did not have any skeletal metastases. Of the 183 patients with PSA > 20 ng/ml, 181 (98.9%) had positive bone scans. Using a cut-off value of 20 ng/ml for serum PSA, 142 unnecessary scans would have been unnecessary.

Out of the 186 patients with positive bone scan (BS), 3 (1.6%) patients had GS < 7, 160 (86.0%) patients had GS between 7 and 9, and 23 (12.4%) patients had GS > 9. Out of the 144 patients with negative BS, 84 (58.3%) had GS < 7, 60 (41.7%) had GS between 7 and 9, and none of the patients had a GS more than 9. Of the 87 patients with GS < 7, 3 (3.4%) patients had a positive BS while 84 (96.6%) patients had a negative BS. Of the 243 patients with GS > 7, 183 (75.3%) had a positive BS while 60 (24.7%) patients had a negative GS. These results indicate that a GS > 7 cannot be reliably used to rule in the need for a BS in patients with Prostate cancer.

 

 

 

 

Conclusion:

Our study reports that serum PSA < 20 ng/ml can be safely used to omit a bone scan. It also suggests that Gleason Score < 7 nullifies the need to conduct a bone scan. However, serum PSA is a better and more reliable indicator of bone metastases as it has better sensitivity and specificity values as compared to GS. If these results are applied in hospitals all over the country, we can significantly reduce the burden on our resources and prevent unnecessary, low-yield diagnostic tests from being carried out.
Covid-19 vaccine acceptance and hesitancy among medical students of Faisalabad
Authors: Din Mohi Ud , Shahid Umer , Qudoos Abdul , Ahmed Roman , Sohail Muazzama , Javed Saima
Published: July 2023

Objectives: The study was conducted to determine the Covid-19 vaccine acceptance and hesitancy among the medical students who are more susceptible to be infected being the frontline workers.
Methodology: This analytical cross sectional study was conducted in medical students of 1st to final year MBBS of various medical institutions of Faisalabad. Study duration was 3 months (August 2021 to October 2021). The sample size was 391 and divided in 2 age groups i.e. above and below 21 years and 245 (62.7%) comprised of females. The inclusion criteria were those students who gave consent and filled out the questionnaire and the exclusion criteria was who didn't concede. The data was analysed on SPSS 25. Confidence interval was set to be 95% with 5% margin of error.
Results: More than half of the participants i.e. 214 (54.7) have got Sinopharm vaccine. Vaccine hesitancy was found in 28 (7.2%) students and major reason was concern about vaccine safety. Significant relationship (p = < 0.05) was found in all factors related to ‘concerns regarding Covid-19 vaccines and trust of official information’; in all except one in factors related to ‘awareness and overall attitude regarding vaccine acceptance’ and in all except one in factors related to ‘perception of vulnerability to COVID-19 and attitude regarding usefulness of vaccine for community’.
Conclusion: Covid-19 vaccine hesitancy was found in one out of every 14 medical students. They were concerned about the efficacy of Covid-19 vaccines. Most of the participants also showed concerns regarding severe adverse effects of these vaccine and on vaccine trials also before making it available for general public. At the same time, participants showed trust on information about Covid-19 vaccine from government and public health experts. Although vaccine hesitancy was present in only 7.2% of participants, health education programmes should be arranged to improve awareness and trust on Covid-19 vaccine. Concerns of medical students should be addressed on priority as future health care providers.
Keywords: Covid-19, medical students, vaccine acceptance, hesitancy
Prevalence Of Parafunctional Habits And Temporomandibular Disorder Symptoms In Young Individuals Reporting To Watim Dental Hospital
Authors: Khan Aleshba Saba , Sana Aleeza , Sufian Zarah , Afreen Ammarah , Shakoor Asma , Shuja Eruj
Published: July 2023

Objective: This study aims to identify the prevalence of parafunctional habits and common symptoms of temporomandibular disorders in young individuals reporting to the Watim Dental College
Materials and methods: This cross-sectional study was carried out by a survey and clinical examination over a period of six months from September 2021 to February 2022. Data from 103 patients, who fulfilled the inclusion criteria, were collected using a structured questionnaire and clinical examination regarding their parafunctional habits and temporomandibular joint symptoms. Informed consent was filled out by all the participants. Data were analyzed using SPSS version 23. A descriptive analysis was calculated for both quantitative and qualitative variables.
Results: The prevalence of oral parafunctional habits among the study sample was quantified on a binary scale (yes/no) where nail-biting was observed to be highly prevalent (38%), followed by mouth breathing (27%). The most frequently reported temporomandibular joint symptom was noise (clicking or crepitation)  which was 66%. Difficulty in mouth opening was the least common (20%) of all the symptoms noted.
Conclusion: It may be concluded from our study that amongst parafunctional habits nail biting is the most common habit amongst young individuals and amongst the temporomandibular joint disorder clicking and crepitation is the most common symptom persistent with the condition.
Keywords: clicking, nail-biting, parafunctional habits, temporomandibular joint symptoms
Frequency Of Depression In Patients With Vitamin B12 Deficiency
Authors: Fatima Anam , Shah Faridullah , Khan Hareema Saeed , Rauf Kashif , Ali Safdar , Khan Shahid Ali
Published: July 2023

Objective: To determine the frequency of depression in patients with vitamin B12 deficiency.

Methodology: This cross-sectional study was carried out from January 2020 to March 2021 on a total sample size of n=100 patients (age 49.84 ± 0.91 years) using a simple random sampling technique, visiting the medical department of the federal government polyclinic hospital, in Islamabad. Patients presenting with macrocytic anaemia secondary to vitamin B12 deficiency were included while the patients with previously diagnosed depression were excluded from the study. Serum vitamin B12 levels were measured through the ELISA technique. Patient Healthcare Questionnaire-9 (PHQ-9) was designed and presented to patients with vitamin B12 deficiency for depression assessment. Patients with PHQ-9 score ≤5 were rated as having no depression and the patients with score ≥5 were rated as having depression. Data were analyzed using GraphPad Prism and the correlation coefficient was measured through non-linear fit and linear regression curves while ordinary ANOVA (non-parametric) was applied for study variables.

Results: The average level of vitamin B12 in the serum and PHQ-9 score were recorded as 158 ± 4.94 (pg/uL) and 5.85 ± 0.30, respectively. Vitamin B12 levels and PHQ-9 score depicted an inverse correlation, however, no association was found between gender and PHQ-9 score.

Conclusion: Data depicted that the patients presenting low levels of vitamin B12 in their serum have shown corresponding high PHQ-9 scores which is an indicator of depression. However, depression prevails in all age groups without any discrimination of gender.
Effects Of Phototherapy On Serum Calcium	Level In Neonates With Hyperbilirubinemia
Authors: Javaid Qura-tul-Ain , Aziz Salma , Noor-ul-Ain  , Abid Uzma , Afzal Ayesha , Javaid Umer
Published: July 2023

Objective: To study the frequency of hypocalcemia in neonates receiving phototherapy with indirect hyperbilirubinemia Materials and Methods: Descriptive case series study was conducted from September 5, 2018, to March 5, 2019, in the NICU of the Paediatric Department Benazir Bhutto Hospital, Rawalpindi.

Approval was sought from the hospital’s ethical committee. Neonates fulfilling inclusion criteria were enrolled in the study after obtaining informed consent from the parents. Before giving phototherapy, serum calcium levels were checked. Phototherapy was given for 48 hours. Serum calcium levels were reassessed after 48 hours of phototherapy. Data was entered on a structured proforma and statistical analysis of data was performed.

Results: Out of 150 patients enrolled in the study 83(55.33%) were male and 67(44.67%) were female. The mean age of patients was 52.52 hours with minimum and maximum ages of 26 hours and 80 hours. The mean Indirect serum bilirubin level was 15.59 ± 2.36. A total of 50(33.33%) cases had hypocalcemia after 48 hours of phototherapy, all of these neonates had normal calcium levels before phototherapy. When hypocalcaemia was stratified for gestational age, birth weight and serum bilirubin levels at baseline, there was no significant difference in the frequency of hypocalcaemia concerning these effect modifiers.

Conclusion: It is concluded that the frequency of hypocalcemia is higher in neonates with indirect hyperbilirubinemia after receiving phototherapy. One needs to be vigilant in dealing with neonates in this context, while serial measurements of calcium levels and monitoring for complications of hypocalcaemia should be included in every institution’s policy
Efficacy Of Tranexamic Acid in Reducing Blood Loss in Primary Total Knee Replacement
Authors: Younas Muhammad Inaamullah , Rauf Faizan , Mustafa Muhammad Sheraz , Janjua Sarmad Nasir , Iqbal Shaheen , Habib Khurram
Published: July 2023

Objective: To determine the efficacy of tranexamic acid in reducing blood loss in primary total knee replacement.

Material and Methods: A total of 96 patients having a diagnosis of primary knee osteoarthritis made up the population sample. The Total Knee Replacement patients were separated into two groups. Patients in Group B used Intra venous tranexamic acid, but those in Group A did not use tranexamic acid during the course of the operation or afterwards.

Results: Mean age of the patients recorded in group A 63.79±6.60 (years) and in group B 62.96±7.89 (years). The majority of the patients in both groups were females. After surgery, Group B patients who received tranexamic acid reported less blood loss and less haemoglobin reduction as compared to the control group.

Conclusion: From our study, we conclude that Tranexamic acid used intravenously during total knee arthroplasty considerably lowers postoperative blood loss.
Platelet Distribution Width: A Severity Marker Of Pre Eclampsia, Experience At Tertiary Care Hospital
Authors: Zahir Mariam , Sial Shagufta Saeed , Noreen Humaira
Published: July 2023

Objectives: To determine mean platelet distribution width in patients with pre-eclampsia.

Study design: This is a cross-sectional, descriptive study performed in the Department of Obstetrics and Gynecology, Benazir Bhutto Hospital, Rawalpindi, retrospectively from 01 May 2017 to 01 November 2017 by non-probability consecutive sampling technique.

Materials & Methods: A total of 150 pregnant females with mild and severe pre-eclampsia with gestational age > 20 weeks, and an age limit of 18-40 years were included in the study. Patients having deranged coagulation or multiorgan involvement were excluded. Blood and urine samples were collected at the time of presentation. All the blood pressure readings were confirmed by two readings 4-6 hours apart. Mean ± SD was used to express data values. The mean PDW value was calculated for pregnant females with mild and severe preeclampsia.

Results: In our study Mean PDW in patients with preeclampsia was 15.86± 0.34. The mean PDW for mild preeclampsia was 15.8± 0.35 and for severe preeclampsia 15.98±0.28..

Conclusion: PDW is a useful marker for the prediction of the severity of preeclampsia before the disease progresses to severe preeclampsia and HELLP. Raised values can help the obstetrician to actively manage the patients in time to reduce maternal and fetal mortality.
Association Between Diabetic Control And Anti-Diabetic Medication Adherence Using 8-Point Morisky Medication Adherence Scale In Local Population Of Khyber Pakhtunkhwa
Authors: Siddiqi Fuad Ahmad , Saeed Bilal , Hussain Mehmood , Anwar Wasif , Riaz Sidra , Abbas Naveed
Published: July 2023

Abstract:

Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications.

Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar

Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI <25kg/m2.

Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients.

 In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c <7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17.

Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c.

Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medications