bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Patient Cooperation During Biometry Be A Predictor of The Type of Anesthesia For Phacoemulsification Cataract Surgery
Authors: Abbas Hussnain , Rauf Abdul , Hamid Shahid , Perveen Shagufta , Hussain Irshad , Shahid Muhammad
Published: December 2022

Objective: To assess any association between the cooperation of patients during biometry and cataract surgery by phacoemulsification in order to predict the type of anesthesia for the subject surgery.

Study Design: Cross-sectional study.

Place and Duration of Study: Eye Department, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2019.

Methodology: A total of 332 patients requiring cataract surgery by phacoemulsification were recruited from the Eye department of Combined Military Hospital Multan. Patient cooperation level was measured during A-scan biometry. The cooperation level of same patient, assessed during biometry was used to plan the type of anesthesia to be administered during cataract surgery by phacoemulsification.

Results: There were 209 male and 122 female patients with the mean age of 65.14 ± 0.57 years. A significant association was found between the cooperation of patient during biometry and cataract surgery by phacoemulsification appointments (p=0.02). A significant proportion of the patients 162 (81.4%) maintained their good cooperation during surgery. Out of the 133 patients, exhibiting poor cooperation during biometry procedure, 88 (66.3%) showed an improvement in their status by having good cooperation in surgery procedure.

Conclusion: In the light of favorable clinical observation, the cooperation of the patients at the biometry procedure may be considered as a significant predictor of the type of anesthesia to be administered during cataract surgery by phacoemulsification.
Clinico-Pathological Association of Haemoglobin At The Time of Presentation: A Predictive Tool of Survivorship in COVID-19
Authors: Warraich Imran Samee , Khan Irfan , Abid Muhammad , Fatima Sarah , Irshad Zareen , Hanif Saima
Published: December 2022

Objective: To determine the clinico-pathological association of haemoglobin at the time of presentation as a predictor of survivorship in patients suffering from COVID-19.

Study Design: Prospective observational study.

Place and Duration of Study: Combined Military Hospital Hyderabad Pakistan, from Mar to Sep 2020.

Methodology: Two hundred and four patients who were symptomatic and PCR positive for COVID-19 were included in the study. Informed consent was taken from patients and approval from the institutional ethics committee was obtained. Haemoglobin values were analyzed using SPSS version 22.

Results: In our study, 186 (91.2%) patients survived the disease and 18 (8.8%) patients died. The mortality rate was high in patients who presented with low haemoglobin levels at time of presentation.

Conclusion: This study concluded that hemoglobin level at time of presentation could be a predictor of survivorship.
Evaluation of Speech Intelligibility And Factors Influencing Its Outcome in Patients with Tongue Reconstruction Using Radial Forearm Free Flap
Authors: Malik Sakina , Sarwar Saad Ur Rehman , Rashid Mamoon , Khan Muhammad Ibrahim , Qureshi Mehreen Masud , Khan Hala
Published: December 2022

Objective: To study the speech outcomes in patients undergoing tongue reconstruction after tumour resection in terms of intelligibility and to examine the factors influencing the outcome.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad, Jan 2015 to Jan 2020.

Methodology: A total of 109 patients diagnosed with tongue cancer meeting the inclusion criteria were included in the study. All the participants underwent tumor resection followed by adjuvant radiotherapy (unless refused by the patients). Patients were followed for six months and then underwent speech evaluation via the Functional Intra-oral Glasgow Scale score and Likert scale.

Results: Thirty (27.5%) patients could be clearly understood at all the times, while 27 (24.8%) and 42 (38.5%) required some and frequent repetition, respectively. Nine (8.3%) patients could only be understood by close relations and one patient was completely unintelligible. Advancing age (p=0.01), male gender (p=0.01), tumour stage (p=0.004), presence of comorbidities (p=0.004) and degree of resection (p=0.004) had a significant statistical relationship with speech outcome. Addiction (p=0.32), adjuvant radiotherapy (p=0.97) and the development of complications (p=0.59) had no effect on speech.

Conclusion: The provision of a mobile reconstructed tongue gives speech intelligibility in a majority of the patients however, the degree of speech recovery is directly dependent on advanced age, disease stage, the presence of comorbidities and degree of resection.
Effects of Salbutamol and Furosemide in The Treatment of Transient Tachypnea of Newborn - A Randomized Controlled Trial
Authors: Khushdil Arshad , Ahmed Zeeshan , Ahmed Madiha , Nazir Sajid , Waqar Talal
Published: December 2022

Objective: To assess and compare the effect of Salbutamol and Furosemide therapy in the management of transient tachypnea of newborn.

Study Design: Randomized controlled trial (Registered with Clinical Trials.gov: NCT03208894).

Place and Duration of Study: Neonatal Intensive Care Unit of Pakistan Emirates Military Hospital Rawalpindi from Oct 2019 to May 2020.

Methodology: A total of 100 newborns were included in the study. They were divided into 4 groups. Group-A received nebulized 0.1ml Salbutamol. Group-B was given single intravenous dose of injection Furosemide at the dose of 2mg per kg. Group-C received both IV Furosemide and nebulized Salbutamol. Control group-D received only supportive care.

Results: There were 48 male babies and 52 female babies. The average gestational age was 38.8 ± 6.2 weeks and the average birth weight was 2558 ± 620 grams. Administration of both Salbutamol and IV Furosemide together (group-C) showed significant reduction in the mean duration of oxygen dependency compared to control-group (13.40 ± 3.342 vs 83.64 ± 68.546 hours respectively (p<0.001), as well as the need for mechanical ventilation. The mean duration of oxygen dependency in other two groups (A and B) were also reduced compared to control group, but the results were not statistically significant.

Conclusion: Salbutamol and Furosemide when given together tend to reduce the duration of oxygen dependency and need for invasive mechanical ventilation in babies with transient tachypnea of newborn.
Therapeutic Efficacy of Topical Olopatadine 0.1% Versus Ketotifen Fumarate in Allergic Conjunctivitis
Authors: Abidin Farooq Ul , Sarfraz Muhammad Haroon , Javaid Hassaan , Khan Asfandyar , Khan Summaya , Javaid Haroon
Published: December 2022

Objective: To compare the therapeutic efficacy of topical Olopatadine 0.1% versus Ketotifen Fumarate among the patients diagnosed with allergic conjunctivitis at Armed forces institute of ophthalmology.

Study Design: Prospective comparative study.

Place and Duration of Study: Armed forces Institute of Ophthalmology, Rawalpindi, from Jan 2020 to Jan 2021.

Methodology: Patients diagnosed with allergic conjunctivitis by consultant ophthalmologist fulfilling the exclusion/inclusion criteria were included in the study. They were divided into two groups by block randomization with group A receiving Olopatadine 0.1%, while group B just received the Ketotifen Fumarate. Symptoms were assessed on a symptom severity score upon diagnosis before the start of medication and then after 72 hours of treatment by a different consultant ophthalmologist who was unaware of the group of patients.

Results: A total of 100 patients were included in each group. The mean age of the study participants was 30.944 ± 3.349 years. 148 (74%) patients were males while 52 (26%) were females. The difference in mean score of symptoms in group A was 5.76 ± 1.39 while in group B was 3.33 ± 2.51. Application of t-test revealed that topical Olopatadine 0.1% was superior to Ketotifen Fumarate in reducing the symptoms of acute allergic conjunctivitis on the third day of treatment (p-value<0.001).

Conclusion: Seasonal allergic conjunctivitis was the commonest type of allergic conjunctivitis seen in our study participants. Topical Olopatadine 0.1% emerged as a better treatment option when compared to Ketotifen Fumarate for immediate management of acute allergic conjunctivitis among patients managed at a tertiary...................
Acute-On-Chronic Liver Failure-Outcome and Its Predictors in A Tertiary Care Hospital
Authors: Shadab Rao Saad , Khan Muhammad Shoaib , Saeed Farrukh , Kazmi Syed Kumail Hasan , Siddiqi Fuad Ahmed , Din Rafi Ud
Published: December 2022

Objective: To determine the characteristics and outcome of acute-on-chronic liver failure patients being managed at PakEmirates Military Hospital Rawalpindi.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Gastroenterology at Pak-Emirates Military Hospital, Rawalpindi, from Sep 2018 to Jan 2021.

Methodology: In this study, 1559 patients diagnosed with cirrhosis were studied. Patients with pre-existing chronic kidney disease, chronic obstructive pulmonary disease, cardiac failure, dementia, and stroke were excluded. All the relevant features of each case were recorded in the proforma.

Results: Out of 1559 patients, 67 had Acute-on-chronic liver failure. The majority of patients who presented with acute-onchronic liver failure were in grade Ib (55%), followed by grade II (30%). Hepatitis C virus related liver cirrhosis was the commonest underlying liver disease (78.4%). Drugs were the commonest triggering factor (33%), followed by acute viral hepatitis (27%). However, a large number of patients had no identifiable cause (25.4%).

Conclusion: Acute-chronic-liver failure is common in patients presenting with acute decompensation of liver cirrhosis. Patients undergoing liver transplantation in the correct window period, have good prognosis.
Impact of Aqueous Neem Leave Extract on Erythromycin Induced Hepatotoxicity
Authors: Jamshed Nausheen , Raza Iffat , Rasheed Aqiba , Jamshed Naureen , Akhtar Lubna , Rashid Nadia
Published: December 2022

Objective: To examine the protective effect of aqueous neem leaves extract against damage induced by erythromycin on liver enzyme alkaline phosphatase.

Study Design: Laboratory-based experimental study.

Place and Duration of Study: Anatomy Department, Baqai Medical University, Karachi Pakistan, from Mar to Jun 2018.

Methodology: Eighty male albino wistar rats were taken and were divided randomly into 4 groups. Group-A served as a control group with no drug given. Group-B animals received the drug erythromycin 100 mg/kg body weight orally through gastric lavage. Group-C animals received erythromycin 100 mg/kg body weight and neem leaves extract in a dose of 500 mg/kg body weight orally through gastric lavage. Group-D received only neem extract at the dose of 500 mg/kg body weight orally. After 14 days, blood samples were collected via cardiac puncture and sent to laboratory for the investigation of alkaline phosphatase enzyme.

Results: The alkaline phosphatase enzyme levels of group-B (Erythromycin treated group) were found to be 176.98 ± 10.53 IU/L. When treated with aqueous neem leaves extract the alkaline phosphatase levels decreased to 150.10 ± 2.28 IU/L seen in group-C. The comparisons of group-B and group-C showed statistically significant (p<0.01), showing protective effect of aqueous neem leaves on hepatocytes.

Conclusion: Aqueous neem extract showed protective effect on erythromycin induced hepatic damage.
Effect of obestatin on pituitary gonadal axis, leptin and MDA levels in type 2 diabetic Sprague Dawley Rats
Authors: Latif Nadia , Rasul Amina , Ali Sajid , Mazloum Fauzia , Aleem Shoaib Bin , Farooq Amber
Published: December 2022

Objective: To demonstrate the effect of Obestatin supplementation on oxidative stress and serum levels of testosterone, follicular stimulating hormone, luteinizing hormone and leptin in type 2 diabetic rats.

Study Design: Laboratory-based experimental study

Place and Duration of Study: Physiology Department, Army Medical College Rawalpindi from Mar-June 2015.

Methodology: Forty-five healthy male Sprague Dawley rats were randomly divided into three groups. Group-I (healthy rats) were fed with regular pellet diet (NPD). Group-II (diabetic rats) and group-III (Obestatin treated diabetic rats) were fed with high-fat diet (HFD) followed by a single IP injection of Streptozotocin in the dose of 35 mg/kg on 15th day. After ten weeks, group-III was treated with intraperitoneal Obestatin (1 nmol/100ml). Blood samples were obtained by terminal intra-cardiac sampling for bioassays of Insulin, testosterone, FSH, LH, MDA and leptin by ELISA.

Results: Obestatin supplementation in diabetic rats resulted in significant increase in FSH (9.4 ± 0.74 ng/dL), LH (3.89 ± 0.10 ng/dL) and testosterone levels (2.01 ± 0.09 ng/dL) in comparison with non-treated diabetic rats (7.04 ± 0.50 ng/dL), (1.70 ± 0.28 ng/dL) and (1.10 ± 0.40 ng/dL) respectively. Whereas leptin (3.91 ± 0.24 ng/dL) and MDA levels (1.75 ± 0.22 ng/dL) were reduced significantly when compared to the healthy rats (6.10 ± 1.29 ng/dL) and (1.96 ± 0.07 ng/dL) respectively.

Conclusion: Testosterone levels are increased by Obestatin supplementation in type 2 diabetic rats by stimulating the pituitary-gonadal axis due to a decrease in circulating leptin levels and oxidative stress.
Epidemiology of Celiac Disease in The Children Presenting at The Tertiary Care Hospital of Pakistan
Authors: Lodhi Munir Akmal , Saleem Zeeshan , Ayub Amara , Munir Tehmina , Hassan Shamama
Published: December 2022

Objective: To determine the epidemiology of coeliac disease in the children presenting at the tertiary care hospital.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2015 to Jul 2016.

Methodology: Ninety-five consecutive children presenting with the suspicion of celiac disease were included in this study after taking written informed consent. A pre-designed proforma was used to record the patient's demographic details and the presenting complaints, laboratory, endoscopic and histological findings.

Results: The mean age of the patients was 6.48 ± 3.20 years and the majority 53 (55.8%) of the children, were aged between 5 to 10 years. Failure to thrive was the most frequent presenting complaint and was recorded in 53 (55.8%) children, followed by pallor (54.7%), chronic diarrhoea (34.7%), short stature (29.5%), pain abdomen (28.4%) and recurrent vomiting (6.3%). The patients' haemoglobin ranged from 5.3 g/dl to 12.8 g/dl with a mean of 8.81±1.24 g/dl. The serum Anti-tTG level ranged from 8.0 U/ml to 759.0 U/ml with a mean of 298.75 ± 225.51 U/ml. Upon endoscopy, atrophic mucosa was revealed in 60 (63.2%) children, while 24 (25.3%) children had normal mucosa. Partial villous atrophy was the most frequent histological diagnosis (37.9%). Normal duodenal mucosa was reported in 4 (4.2%) children, while 21 (22.1%) children had mild non-specific duodenitis. Frequency of pallor (p=0.025), anaemia (p=0.017) and complete villous atrophy on histology (p=0.004) were significantly higher in patients with higher anti-tTG levels.

Conclusion: Celiac disease has a diverse presentation for age, gender and clinical and biochemical markers.
Success Rate of Goniotomy in Terms of Intraocular Pressure Control in Pediatric Glaucoma Patients
Authors: Hussain Muhammad Usman , Mahmood Muhammad Asif
Published: December 2022

Objective: To determine the success rate of goniotomy in terms of reduction in intraocular pressure.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Ophthalmology, at Faisalabad Medical University/Allied Hospital Faisalabad from Apr 2016 to Aug 2017.

Methodology: A total of 65 patients were enrolled in our study. The patients with intraocular pressure greater than 21 mm Hg and corneal diameter less than 13 millimetres were included. Intraocular pressure was measured before and four-weeks after goniotomy. Intraocular pressure measurement of less than 21 mm Hg four- weeks after surgery was considered successful.

Results: Out of 65 patients, 35 (53.8 %) were male, and 30 (46.2%) were female. The age of patients ranged from 3 months to 33 months, with a mean age of 15.25 ± 7.66 months. Among 65 patients operated for goniotomy, the procedure was found successful in 55 (84.6%) patients, and only 10 (15.4%) patients did not show improvement following goniotomy. The fall in intraocular pressure from baseline to post-operative values of intraocular pressure was statistically significant (p-value < 0.01).

Conclusions: Goniotomy is an effective procedure for lowering intraocular pressure in childhood glaucoma patients and can be offered as a primary and initial procedure at an early age.
Maternal and Neonatal Outcomes of Preterm Premature Rupture of Membranes (PPROM) with Amniotic Fluid Index More Or Less than 5 in a Tertiary Care Setting In Pakistan
Authors: Shams Mehwish Ara , Amin Nabila , Syed Humna
Published: December 2022

Objective: To explore the morbidity and mortality associated with preterm pre-labour rupture of membranes in the presence of amniotic fluid index (AFI) greater than or less than 5 in a tertiary care setting in Rawalpindi, Pakistan.

Study Design: Cross-sectional study.

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

Methodology: Data was collected from the patients presenting to the Department of Gynecology and Obstetrics at Pak emirates Military Hospital in Rawalpindi, Pakistan. Maternal and child outcomes were compared with an amniotic fluid index of less than or more than five among the patients with preterm premature rupture of membranes.

Results: 1562 deliveries took place in our department, among them 73 (4.67%) cases were diagnosed as PPROM. Caesarean deliveries and the development of chorio-amnionitis were observed statistically significantly more with an amniotic fluid index <5 (p-value <0.001). Neonatal complications such as sepsis, respiratory distress syndrome, hypoglycemia, jaundice and hypothermia were also significantly observed in the group with amniotic fluid index <5 (p-value <0.05). Neonatal mortality was also significantly higher in the group with an amniotic fluid index <5 (p-value: 0.004).

Conclusion: Preterm premature rupture of membranes was a relatively common finding among the patients managed at our labour unit. Such patients with an amniotic fluid index of less than five are at a high risk of maternal and fetal adverse outcomes.
Morphological Features of Ewing Sarcoma Post-Neoadjuvant Therapy and Their Impact on Prognosis
Authors: Atique Usman , Mushtaq Sajid , Rana Iftikhar Ali , Hassan Usman
Published: December 2022

Objective: To study the effect of chemotherapeutic response on resection specimens and to assess their effect on prognosis.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar Pakistan, from Jan 2010 to Mar 2018.

Methodology: This study included 42 cases of Ewing sarcoma diagnosed, treated and followed at our institute. Various diagnostic parameters were noted and were assessed for their impact on two-year overall survival, development of distant metastasis, recurrence and cancer-related death.

Results: This study included 28 males and 14 females. The majority involved long bones followed by the axial skeleton and soft tissue. Nine cases (9) were confirmed by molecular testing. On the post-neoadjuvant chemotherapy resection specimens, 45% cases had Huvos grade I necrosis, 17% had grade-II, 12% had grade-III and 26% cases had Huvos grade-IV necrosis. Increasing Huvos grade was associated with improved disease-free survival (21%, 43% and 69% for grades-I, II and III/IV respectively). The site and size did not significantly affect the development of recurrence, development of metastasis, or twoyear survival (p>0.05).

Conclusion: Meticulous assessment of post neoadjuvant resection specimens for necrosis provides helpful information about the prognostic outcome. Increasing grade of tumour necrosis was associated with increasing disease-free survival. The response to chemotherapy in our study population was worse than Western data, which may be linked to a variety of factors.
monitor mean changes in intraocular pressure following intravitreal injection of bevacizumab in exudative age related macular degeneration and proliferative diabetic retinopathy
Authors: Rajar Rebecca , Jatoi Shafi Muhammad , Shaikh Fahad Feroz , Shahid Muhammad
Published: December 2022

Objective: To monitor the effect of Intravitreal injection of bevacizumab on intraocular pressure in order to know whether intraocular pressure lowering medication or paracentesis is required prophylactically or thereafter.

Subjects and methods: A prospective intervensional case series of 90 eyes with proliferative diabetic retinopathy and exudative Age related macular degeneration was done who received intravitreal injection of bevacizumab. Intraocular pressure was recorded with Goldman applantaion tonometer at baseline, and then after procedure at 5min, 30 min, 01 hours and 01 weeks. The pateints data was recorded of age, gender, disease, intraocular pressure, history of glaucoma, previous surgery, phakic status and topical and systemic medications.

Results: The mean baseline intraocular pressure was found to be 13.54±2.1 in Proliferative diabetic retinopathy and 12.76±1.8 in Exudative Age related macular degeneration (p-value 0.046). The mean intraocular pressure elevation following Intravitreal bevacizumab at 5min was 32.89±6.3 in proliferative diabetic retinopathy and in exudative Age related macular degeneration was 32.18±5.7 (p-value 0.510), at 30 min was 16.71±2.6 and 15.53±2.4 (p-value <0.024), at one hour was 14.20±2.0 and 13.47±1.9 (p-value 0.095) and at one week 13.82±1.7 and 13.06±1.7 (p-value 0.126) in proliferative diabetic retinopathy and exudative Age related macular degeneration respectively. So there was no significant difference between the two diseases.

Conclusion: There is abrupt and transient rise in the intraocular pressure following intravitreal injection of bevacizumab, but it did not remain elevated for longer duration hence there was no need of intraocular pressure lowering medication and paracentesis.
Comparison of the Sublingual and Vaginal Misoprostol for Medical Termination of Pregnancy in Cases of First and Second Trimester Abortion: A Quasi Experimental Study
Authors: Khan Umber Imtiaz , Iftikhar Bushra , Jabeen Syeda Suraya , Akram Nuzhat Aisha , Subktageen Bushra , Fatima Arwa
Published: December 2022

Objective: To compare the success rate of sublingual and vaginal Misoprostol for medical termination of pregnancy in the first and second trimesters.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Malir Pakistan, from May 2019 to Nov 2019.

Methodology: Two hundred patients in their first or second trimester of pregnancy with different indications for termination of pregnancy were included through consecutive sampling. Spousal consent was also taken along with wife consent. Patients were randomly assigned to one of the two groups. Group-A received sublingual Misoprostol 600 mcg stat followed by 400 mcg four hourly and group-B received the same dose of Misoprostol vaginally. The success rate was assessed through complete termination of pregnancy within 72 hours. Age, parity, induction to expulsion interval (IEI) and each patient's medical history was also noted.

Results: After 24 hours success rate was 93% in the sublingual group compared to 78% in the vaginal group. After 48 hours sublingual group achieved a 100% success rate compared to 84% in the vaginal group, which was improved to 92% after 72 hours. The difference in success rates of both groups remained significant at 24, 48 and 72 hours IEI (p-value = 0.003, p-value <0.001, p-value=0.004 respectively).

Conclusion: Both sublingually and misoprostol are effective for medical termination of pregnancy in the first and second trimesters. However, the sublingual route showed clear supremacy over the vaginal route, as evident by success rates in the present study.
Point Prevalence of Delirium and Its Subtypes in the Patients Admitted with Acute Coronary Syndrome in Cardiac ICU and Its Impact on Mortality
Authors: Taimoor Lalarukh , Baloch Komal , Ikhlaq Urwah , Abubaker Jawed , Ansari Imran , Ud Din Nawal Salah , Khan Musa
Published: December 2022

Objective: To measure the point prevalence of delirium in the patients admitted to the cardiac ICU with acute coronary syndromes, with particular attention to the most commonly noted delirium and the impact on ICU mortality and length of ICU stay.

Study Design: Prospective cohort study.

Place and Study Duration: National Institute of Cardiovascular Diseases, Karachi Pakistan, from Mar and Jul 2021.

Methodology: Consecutive adult patients with age >18 years admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the confusion assessment method (CAM)-ICU tool and Richmond agitation sedation score (>-3). The types of delirium were also assessed.

Results: 201 patients were enrolled, half of patients with ST-elevation MI (51.2%) and shock (45.8%). Delirium was identified in 71 (35.3%) patients, 30 (42.2%) had hypoactive delirium and 41 (57.7%) had hyperactive delirium. In multivariable regression, independent risk factors for delirium were: sepsis 3.19 (1.15-8.87), uremia 4.12 (1.18-14.46), mechanical ventilation 7.58 (1.2-47.99), and non-invasive ventilation 8.55 (2.9-25.2). Overall mortality was 35 (17.4%); 27/71 (38%) vs. 8/130 (6.2%); p 0.001 in patients with and without delirium, respectively. In multivariable regression, delirium was an independent risk factor for mortality at 7.12 (2.16-2.23). The mean ICU stay was 7.772.36 days vs. 3.91.44 days; p 0.001 for patients with and without delirium.

Conclusion: The deleterious effect of delirium in terms of higher morbidity and mortality cannot be overemphasised. Hypoactive delirium is as common as the hyperactive type, with the same mortality risk. Assessment for delirium is mandatory for all patients admitted..............
Awareness about Hospital Waste Management System Among Janitorial Staff in Public and Private Hospitals of Hyderabad a Comparative Analysis
Authors: Mahmood Khalid , Ahmed Farah , Ashraf Viqar , Satti Luqman
Published: December 2022

Objective: To assess and compare the knowledge, attitude and practices of janitorial staff regarding the hospital waste management system in public and private hospitals of Hyderabad.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Public and Private Hospitals of Hyderabad, from Oct 2017 to Mar 2018.

Methodology: All 47 male and female janitorial staff of private and 47 public hospitals, aged 18 years were given a semistructured questionnaire about knowledge, attitude and practices regarding healthcare waste management. Scoring adequate knowledge, positive attitude and good practices were done to draw the results.

Results: Out of the 94 included, 62 were male, and 32 were females. The majority of workers, 52 (55%), had working experience <5 years, whereas 27 (29%) and 15 (16%) of workers had working experience of >10 years and between 5-10 years, respectively. In most of the knowledge and attitude-related questions, scoring of adequate knowledge and positive attitude was significantly higher in staff working in private than in the public hospital. In contrast, the scoring of practice-related questions was found to be significantly higher in staff working in a public hospital compared to those working in a private hospital.

Conclusion: Knowledge, Attitude and Practices among janitorial staff working in public and private hospitals were not up to the mark and were not following the standard operative procedures while handling the healthcare waste. Hospital administration to formulate and implement refresher comprehensive training programs for the janitorial staff.
Etiological Agent and Their Antibiotic Susceptibility Pattern Causing Adult Septicaemia in a Critically Ill Patients in a Tertiary Care Setting
Authors: Zahra Fatima Tuz , Mirza Irfan Ali , Saleem Muhammad Zeeshan , Hussain Wajid , Sana Fatima , Ahmed Aisha
Published: December 2022

Objective: To determine bacterial profile in adult sepsis with their antimicrobial susceptibility pattern in our setup.

Study Design: Cross-sectional study.

Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Dec 2018 to Dec 2019.

Methodology: Paired blood culture was collected in automated bottles and was processed as per standard protocol. The isolates were further identified and their susceptibility was performed according to Clinical and Laboratory Standards Institute (CLSI) 2019 guidelines.

Results: A total of 580 suspected septicaemia cases were taken into consideration. 169 (29.4%) were positive on blood cultures. Among culture-positive samples, Gram-negative bacilli (GNB) accounted for 113 (66.3%) isolates, while the remaining 56 (33.1%) were gram-positive isolates. Within gram-negative isolates, the most common species were 36 (31.8%) Klebsiella pneumonia, followed by 27 (23.8%) Acinetobacter species and 15 (13.2%) Escherichia coli. Multi-drug resistance (MDR) was observed in 98 (86.7%) isolates. Extended-spectrum beta-lactamase production (ESBL) was reported in 73 (64.6%) of enterobacterial. Among 56 Gram-positive bacterial isolates, 25 (44.6%) were Methicillin-resistant Staphylococcus aureus (MRSA), 23 (41%) were Methicillin-resistant coagulase-negative Staphylococcus (MR-CONS). Of the isolates, 8 (14%) were Methicillin sensitive Staphylococcus aureus (MSSA). None of the MR-CoNS and S. aureus strains was resistant to vancomycin.

Conclusion: Gram-negative bacilli outnumbered Gram-positive organisms in adult septicaemic patients. The majority of these organisms were multidrug-resistant, necessitating the need for timely culture and adjusting antimicrobials according to susceptibility profile.
Platelet Indices in Pregnant and Non Pregnant Females: A Comparative Study at a Tertiary Care Diagnostic Laboratory
Authors: Nayyar Muhammad Wasi , Mahmood Asad , Zohra Sadaf , Khurshid Ayesha , Ali Sadia , Zahir Saima
Published: December 2022

Objective: To compare the platelet indices in pregnant and non-pregnant females at a tertiary care diagnostic laboratory.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jul to Dec 2020.

Methodology: 166 healthy pregnant females were included in group-1, and 166 non-pregnant healthy females were recruited in group-2. 5 ml of fresh venous blood from the antecubital vein was collected under aseptic conditions in EDTA anticoagulant tubes. This sample was analyzed to determine complete blood counts (TLC, RBC, HB, and Platelet Count) and platelet parameters, namely Platelet distribution width (PDW), Mean platelet volume (MPV) and Plateletcrit (PCT), using an automated haematology analyzer Sysmex XN-3000.

Results: A total of 332 patients with a mean age of 26.5 ± 5.12 years were included in the study. Platelet count, PCT and PDW values were higher among group-2 than the pregnant females (p=0.001). MPV was higher among the group-1 females than the group-2 females (p=0.001). The distribution of platelet parameters across the trimesters showed that platelet count and PDW among the trimesters showed a statistically significant difference (p=0.001).

Conclusion: Pregnancy brings along many physiological changes in the female body. Various haematological and biochemical changes accompany these changes. MPV, PDW and PCT values were decreased in the pregnancy group. However, MPV was found to be increased as compared to group-2.
Thrombocytopenia in Pregnancy: A Cross-Sectional Study in Northern Pakistan
Authors: Ellahi Ayesha , Khan Muhammad Wasiullah , Shahid Samra , Usman Javaid , Ikran Hassan , Naveed Safoora
Published: December 2022

Objective: To determine the association of thrombocytopenia (mild, moderate & severe) with pregnancy-related disorders.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Haematology of Pakistan Railway Hospital, Rawalpindi Pakistan, in collaboration with the Departments of Obstetrics and Gynecology of Pak Emirates Military Hospital and Fuji Foundation Hospital, Rawalpindi Pakistan, from Oct 2018 to Oct 2019.

Methodology: Seventy-five pregnant females with platelet count <150x109/l were included. Blood samples were taken and analyzed for complete blood count, peripheral blood smear, manual count by Neubauer chamber, uric acid, urinary proteins, liver function tests (bilirubin & aspartate aminotransferase), lactate dehydrogenase, coagulation profile and viral serology (Hepatitis B & C).

Results: Out of a total of 75 thrombocytopenic pregnant females, gestational thrombocytopenia was most common (74.7%), followed by preeclampsia (17.3%), HELLP syndrome (4%), immune thrombocytopenic purpura (4%) respectively. Mild thrombocytopenia was frequently observed in patients of G.T. (62.5%), while moderate thrombocytopenia (84.6%) was generally detected in preeclampsia patients. Severe thrombocytopenia was mostly identified in patients with HELLP syndrome (66.7%) and immune thrombocytopenic purpura (66.7%).

Conclusion: Mild thrombocytopenia is mostly presented in gestational thrombocytopenia. Moderate thrombocytopenia was frequent in patients with preeclampsia, and severe thrombocytopenia was usually diagnosed in patients with HELLP syndrome and immune thrombocytopenic purpura, which require apposite and judicious management for the safety of mother and fetus.
Outcome of Intravenous Levetiracetam Versus Intravenous Phenytoin in Management of Children with Status Epilepticus"
Authors: Zaman Saeed , Shuaib Ayesha , Shah Sajid Ali , Zahid Muhammad , Khan Qamar Uz Zaman , Murad Masud
Published: December 2022

Objective: To compare the outcome of intravenous Levetiracetam versus intravenous Phenytoin in the management of children with status epilepticus

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Pediatric Medicine, Combined Military Hospital, Kharian, from Jan to Dec 2020.

Methodology: Ninety children fulfilling the inclusion criteria were included in the study from emergency. Then patients were randomly divided into two groups by using the lottery method. In group A, patients were given Phenytoin (20 mg/kg) at presentation. In group B, patients were given Levetiracetam (20 mg/kg). These children were admitted to the pediatric ward and followed up until the resolution of symptoms. Duration of resolution of symptoms was noted. Then children were followed up further for 24 hours. If there was no recurrence of seizures, then it was noted.

Results: The mean duration of resolution of symptoms in Group A and Group B was 22.24 ± 3.85 and 16.40 ± 4.50 seconds, respectively. No significant difference was seen in both treatment groups regarding recurrence, i.e., Group-A: 5 (11.1%) vs Group-B: 7 (15.6%), p-value=0.932.

Conclusion: Based on the results of this study, it can be concluded that with Levetiracetam, the resolution of symptoms was faster than with Phenytoin. But recurrence rate showed no significant difference in children with status epilepticus.
Chlamydia Trachomatis–A Cause of Infertility at Tertiary Care Hospital, Pakistan
Authors: Yousuf Sana , Ikram Aamir , Ikram Sadia , Nadeem Saman , Hussain Syed Saddam , Ali Syed Salman
Published: December 2022

Objective: To determine the association of Chlamydial infection with infertility in patients reporting to tertiary care set up for evaluation.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Pathology, from Jun 2015 to Jun 2016.

Methodology: A total of 100 women with primary or secondary infertility were included. Endo cervical swabs were taken. PAP smear was performed. One drop of anti-chlamydial monoclonal antibody was added to each slide, incubated at 37oC for 10 minutes, and examined for Chlamydia trachomatis under the fluorescent microscope.

Results: The mean age was 29.878±3.48 years. 89.0% of the patients had primary infertility, and 11.0% had secondary infertility. The mean age of primary infertile patients was 29.98 ± 3.51 years, while the same was 29.00 ± 3.28 years among patients with secondary infertility. Chlamydial infection was detected positive by direct immunofluorescence (Elementary Bodies) in 6 patients with mean age of 27.17 ± 1.72 years and positive in 13 patients by polymerase chain reaction with mean age of 28.38 ± 1.85 years, having a significant p-value (<0.05).

Conclusion: There was an association between Chlamydia trachomatis infection and female infertility.
Extensively Drug-Resistant Typhoid Outbreak in Pakistan, Experience at a Tertiary Care Hospital in Lahore; A Tip of An Iceberg
Authors: Imtiaz Anam , Mirza Irfan Ali , Fahim Qanita , Sabir Nargis , Bashir Ayesha , Saleem Salman
Published: December 2022

Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at a tertiary care hospital in Lahore during the ongoing outbreak.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Mar 2018 to Jun 2019.

Methodology: All positive blood culture samples that yielded the growth of Salmonella Typhi were included in the study. The samples were dealt with according to standard microbiological procedures. Antimicrobial susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: During the study period, (377) Typhoidal Salmonellae were isolated, of which 327 (86.7%) were Salmonella Typhi and 50 (13.3%) were Paratyphi A. The percentage of XDR Salmonella isolates was 41.9%.

Conclusion: Extensively drug-resistant typhoid fever cases reported in this study represent just the tip of an iceberg. Therefore, nationwide surveillance efforts must be undertaken along with implementing effective preventive measures.
Anaemia in Chronic Kidney Disease
Authors: Ali Imran , Khan Malik Nadeem Azam , Ali Asif , Hussain Muhammad Zahid , Khan Muhammad Shahid , Ahmed Syed Nazir
Published: December 2022

Objective: To gauge the frequency of iron deficiency anaemia among chronic renal disease patients and factors related to the presence of anaemia at our hospital.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, Nine months, Sep 2019 to May 2020.

Methodology: Three hundred patients suffering from the chronic renal disease were included in the study. Iron deficiency anaemia was diagnosed based on haemoglobin and ferritin levels. In addition, the relationship between age, gender, duration of chronic kidney disease and stage of chronic kidney disease was assessed with the presence of iron deficiency anaemia among the patients suffering from chronic kidney disease.

Results: Out of three hundred patients studied, 139 were males, and 161 were females. Out of 300 patients with chronic kidney disease included in our study, 159 (53.0%) showed the presence of iron deficiency anaemia, while 141 (47.0%) had no anaemia. Chi-square analysis showed that female gender, long duration of illness and more severe illness had a significant association with iron deficiency anaemia among the patients with chronic kidney disease.

Conclusion: High frequency of iron deficiency anaemia among the patients of chronic kidney disease in a tertiary care hospital of Pakistan. Routine screening for anaemia should be done, especially on female patients and patients with more severe and long-standing illnesses.
Sars-Cov-2 Specific Antibody Detection in Health Care Workers in Tertiary Care Hospital
Authors: Anwar Muhammad , Javed Mirza Waseem , Parvez Nadia , Latif Majid , Rafiq Muhammad Yasir
Published: December 2022

Objective: To estimate the sero-positivity of SARS-CoV-2 in health care workers based on specific antibodies in a tertiary care hospital.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Combined Military Hospital Kohat Pakistan, Jun to Jul 2020.

Methodology: 292 Health Care Workers from different departments were included by non-probability consecutive sampling. They were divided into three groups (High risk, Intermediate risk and low risk) according to the exposure risk to COVID-19 patients. In addition, serum samples for SARS- CoV-2 specific quantitative antibodies were collected. The odds ratio for SARSCoV-2 Ab risk was calculated for different risk groups and male and female health care workers.

Result: Out of 292 Health Care Workers, 243 (83.22%) were male, and 49 (16.78%) were female, with a mean age of 34.64 ± 7.25 years. SARS- CoV-2 specific Ab was detected in 43 (14.72%) individuals. The risk of sero-positivity was higher in the high-risk group than the intermediate-risk group (Odds ratio 1.171 vs 0.878) and higher in the intermediate-risk group than the low-risk group (odds ratio 1.120 vs 0.747). The risk was also higher in females than in males (Odds ratio 1.676 vs 0.878).

Conclusion: The sero-positivity of SARS-CoV-2 in healthcare workers in tertiary care hospitals is high. The results indicate that we must improve our local hygiene and protective standards.
Rubber Band Ligation (RBL) vs Standard Hemorrhoidectomy (SH) for Treatment of Haemorrhoids
Authors: Liaqat Fahim , Butt Muhammad Qasim , Ghani Usman , Tariq Mansoor , Khan Muhammad Shoaib , Asif Abeer
Published: December 2022

Objective: To compare rubber band ligation (RBL) vs standard hemorrhoidectomy for the treatment of haemorrhoids.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Feb 2020 to Jan 2021.

Methodology: A total of 200 patients with 2nd and 3rd-degree haemorrhoids who met the inclusion and exclusion criteria were included in the study. Group-A patients underwent rubber band ligation, while in Group-B, Milligan Morgan hemorrhoid-dectomy was done.

Results: There were 200 patients (100 in each Group). There were 135 males (67.5%) and 65 females (32.5%). The female to male ratio was 1:2.01. Mean age was 44.73 ± 8.36 years in Group-A and 43.48 ± 8.98 years in Group-B. Mean duration of complaints was 8.72 ± 4.32 months in Group-A and 10.89 ± 3.80 in Group-B. Post-procedure patients were called for follow up in a third and eighth week. The most common complication seen in Group-A was recurrence which was 18% (p-value 0.001), and pain in Group-B, 82% (p-value 0.001), which was statistically significant.

Conclusion: We concluded that Rubber band ligation is a quick, safe and cost-effective procedure for the outpatient department for Grade II and III haemorrhoids. The recurrence rate is high compared to standard hemorrhoid-dectomy, but its advantages make it a first-line procedure for Grade II and III haemorrhoids in the outpatient departments.
QTC Changes Associated with Tyrosine Kinase Inhibitors in Cancer Patients
Authors: Khattak Rahimullah , Ahmad Riaz , Nadeem Muhammad , Amjad Huma , Khan Amjad , . Ibtisam
Published: December 2022

Objective: To look for QTc changes associated with Tyrosine Kinase inhibitors and factors related to these changes among patients suffering from cancer.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Oncology Department, CMH Rawalpindi Pakistan from Dec 2020 to Apr 2021.

Methodology: The study included one hundred and eighty patients with solid or haematological malignancies taking Tyrosine Kinase inhibitors for more than three months. They underwent 12 lead ECGs inside the oncology department. QTc interval was calculated on the ECG of all the patients, and they were evaluated for the presence of prolonged QT interval. Age, gender, duration of Tyrosine Kinase inhibitor use and presence of comorbid illness were correlated with the presence of QTc changes in our study participants.

Results: Out of 180 cancer patients using Tyrosine Kinase inhibitors for more than three months included in the study, 96 (53.3%) were male, while 84 (46.7%) were female. One hundred and eighteen (65.5%) had normal QTc intervals, while 62 (34.5%) had prolonged QTc intervals in our study participants. Chi square test revealed that the advanced age of the patient and prolonged use of Tyrosine Kinase inhibitors was statistically significantly associated with QTc prolongation in our study (p-value<0.001).

Conclusion: Significant number of cancer patients using Tyrosine Kinase inhibitors had prolonged QTc intervals in our study. Special attention should be paid to cancer patients with advancing age and prolonged use of Tyrosine Kinase inhibitors.
Osteoporosis/Osteopenia in Post-Menopausal Breast Cancer Patients Receiving Hormonal Therapy
Authors: Khattak Rahimullah , Ahmad Riaz , Nadeem Muhammad , Tufail Umair , Khan Amjad , Ahmad Assam
Published: December 2022

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy.

Study Design: Comparative Cross-sectional Study.

Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021.

Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants.

Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorp- tiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants.

Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted.........