bluuebunny/crossref_metadata_2025 huggingface dataset:
A RETROSPECTIVE FOLLOW-UP STUDY TO SHOW THE EFFECTIVENESS OF BOOSTER DOSE OF FOAM SCLEROTHERAPY SESSION AT 3RD AND 6TH MONTHS IN PREVENTING THE RECURRENCE OF VARICOSE VEINS
Authors: Farid Ullah Khan  , Nauman Imtiaz Khan  , Muhammad Irfan Khan  , Ghazala Huma Khan  , Khan Uzair Ahmad , Tahir Iqbal Mirza
Published: October 2024

Background: Injection sclerotherapy administration is known to cause a decreased recurrence of varicose vein disease. This research aimed to investigate the recurrence of varicose vein disease after giving booster doses of injection sclerotherapy. The booster doses were given at 3rd and 6th months. Methods: 150 patients participated and all patients included ages were 30-70 in the category of '˜low risk' patients. The patients were both males and females. Patients participating in the study were counselled appropriately and written consent was taken from them. Moreover, the patients selected were volunteers and agreed to be part of the study. Patients who were above 70 years of age, those who were at a high-risk due to some co-morbidities (high-risk patients), patients not willing for being part of the study, those allergic to drugs being used including sclerosant and people with any known psychiatric illness or cardiac arrhythmias, deep venous thrombosis patients, patients having arteriovenous malformation/venous ulcers were all excluded. If the patient was pregnant, the gynaecology team was taken on board and the procedure was carried out. Every procedure was carried out under the direct supervision of the supervisor. Booster dose sessions of Foam Sclerotherapy were held at 3rd and 6th months of the study time. Their effectiveness was clearly observed and documentation was carried out. Results: Since it was a procedure that could be done in the OPD, there was no need for specialized anaesthesia care. It is of significant notice that when a patient of varicose veins was given a booster intravenous sclerosant injection at 3rd and 6th month of treatment, chances of recurrence decreased to 50%.
EFFECT OF PERINEURAL ADMINISTRATION OF DEXMEDETOMIDINE WITH BUPIVACAINE VERSUS BUPIVACAINE ALONE IN ULTRASOUND GUIDED SUPRACLAVICULAR BLOCK FOR UPPER EXTREMITY ORTHOPAEDIC OPERATIONS
Authors: Khan Maliha Khalid , Amran Hafeez  , Faheem Feroze  , Anjum Atique Tahir  , Shehzad Abbasi  , Muhammad Shaheer bin Faheem  , Saeed Farooq
Published: October 2024

Background: During procedures on the upper limbs, the brachial plexus block is usually advised. To increase the length of the block, many medicines have been utilized as adjuvants. The purpose of this study was to compare the effects of dexmedetomidine plus bupivacaine against bupivacaine alone on the onset and duration of the sensory and motor block and the duration of analgesia in the supraclavicular block during upper extremity orthopaedic surgery. Methods: Sixty individuals qualified for orthopaedic operations on the upper extremities, ranging in age from 20 to 60 years, participated in this prospective, randomized investigation. The modified Bromage scale and the pinprick method were used to assess the sensory and motor block. Using a visual analogue pain scale, the postoperative pain was evaluated at 0, 6, 12 and 24 hours after surgery. Results: In patients receiving only bupivacaine, the mean onset time of sensory and motor block was 32.84 minutes and 26.67 minutes respectively; while in those receiving bupivacaine along with dexmedetomidine, it was 23.38 minutes and 14.81 minutes (p<0.005). In the intervention group (bupivacaine and dexmedetomidine), the period between the first request for analgesia and the duration period of sensory and motor block were both longer (p<0.005). The intervention group experienced less postoperative discomfort for 24 hours (p<0.05). Conclusion: Dexmedetomidine added to bupivacaine perineurally prolonged both numbness and immobility while shortening the time it took for sensory and motor blocks to begin. Moreover, dexmedetomidine considerably decreased postoperative pain when combined with bupivacaine for supraclavicular blocks.
BONY LESION ANALYSIS IN CARCINOMA PROSTATE: M.D.P. BONE SCAN VS. GALLIUM-68 PSMA-11 PET/CT
Authors: Haider Ali  , Syed Rashid Ul Amin  , Abdul Hai  , Noureen Nizar
Published: October 2024

Background: Prostate cancer is the cause of the highest cancer-related death in males, 5-year survival is 31% in metastatic disease, and bone is a common site of metastases. Bone scintigraphy is a routinely used imaging modality for detecting skeletal metastases. It has variable sensitivity of 52-100%, whereas PSMA PET/CT scans have better sensitivity approaching 100%, so we determined the diagnostic accuracy, sensitivity, and specificity of planar M.D.P. (methylene diphosphonate) bone scintigraphy. Methods: This analytical cross-sectional study was conducted at the N.M. & molecular imaging department of S.I.U.T. Karachi. Bone scans and PSMA-PET/CT scans of all patients who were visited from Janury-2018 to January 2023 were reviewed and interpreted by a nuclear physician& radiologist team. Inclusion criteria were histopathology-proven prostate cancer patients who had a bone scan and PSMA PET/CT scan within one month and had not received any treatment between scans. Results: Among 70 scans, 38 (54.2%) were positive for bone lesions. A total of 18 (47%) patients had positive bony lesions on both PSMA-PET/CT and Bone scintigraphy. Among 38 bone lesions positive patients, in eleven patients, bone lesions were detected only on PET/CT scans, whereas nine were positive only on Bone scans. The mean S.U.V. max of all bony lesions was 19.15 (range 3.2-57.5). The bone scan's sensitivity, specificity, and accuracy were 62.07%, 78.05%, and 62.87%, respectively. Conclusion:  PSMA-PET/CT is better than bone Scintigraphy for detecting skeletal metastases. However, outcomes of bone scintigraphy may be improved when Tc-PSMA receptor bone scintigraphy is used.
AEROBIC BACTERIAL CONTAMINATION IN PLATELET CONCENTRATES AT THE REGIONAL BLOOD CENTRE, PESHAWAR
Authors: Muhammad Ibrahim  , Muhammad Nisar Khan  , Muhammad Arif  , Syed Abbas Anwar  , Noor e Saba  , Yousafzai Yasar Mehmood
Published: October 2024

Background: Platelet concentrates play a crucial role in transfusion medicine, aiding in the management of various medical conditions, including haemorrhage, thrombocytopenia, and platelet dysfunction. However, their storage conditions at 22° C present an optimal environment for bacterial growth, making them susceptible to contamination. Of particular concern is the transmission of microorganisms from the skin flora during the phlebotomy process, which can lead to the transfusion of contaminated platelet concentrates. Such contamination poses significant risks to patients, potentially resulting in morbidity and mortality. Determining the frequency and identifying causative organisms of bacterial contamination in platelet concentrates. Methods: It was a descriptive cross-sectional study conducted at the Institute of Pathology and Diagnostic Medicine, Khyber Medical University, and the Regional Blood Center in Peshawar from May to October 2021, spanning a duration of six months. The study included 500 participants aged between 18 and 50 years (mean: 28.13±7.67 years. A simple convenient sampling technique was employed. Blood products underwent screening for Hepatitis B, Hepatitis C, HIV, Syphilis, and Malaria. Leaked units were excluded from the study. Platelets were prepared using a Cryofuge and subsequently subjected to culture media. Results: The mean age of the participants included in the study was 28.13±7.67 years, with an age range of 18 to 50 years. Out of the total sample size of 500, there were 483 (96.6%) male participants and 17 (3.4%) female participants. Among the collected samples, bacterial growth was observed in only 11 (2.2%) platelet concentrates. The isolated organisms were Staphylococcus epidermidis, found in 7 (1.4%) platelet concentrates, and Staphylococcus aureus, found in 4 (0.8%) platelet concentrates. Conclusion: Bacterial contamination of platelet bags is higher compared to developed countries. Therefore, implementing quality control procedures is necessary to reduce the risk of bacterial contamination in platelet concentrates. Additionally, employing enhanced skin disinfection techniques at the phlebotomy site can significantly minimize bacterial contamination.
FETO-MATERNAL OUTCOMES OF MATERNAL SEPSIS: A SNAPSHOT OF THE ILLNESS
Authors: Humaira Jadoon  , Iram Sarwar  , Fawad Anisa , Salma Rehman  , Shehla Noor  , Maryam Bibi
Published: October 2024

Abstract:
Background: Maternal sepsis is a life-threatening condition with serious adverse feto-maternal outcomes. This descriptive cross-sectional study aimed to study the incidence of common feto-maternal outcomes of maternal sepsis in our hospital.
Methods: Pregnant females with singleton pregnancy as per inclusion/exclusion criteria were enrolled in the study. A detailed medical history was taken and physical and obstetrical examination was done. They were investigated for the cause of their febrile illness and managed as per department protocols. Data was recorded in a pre-designed pro forma.
Results: The most common cause of infection was UTI (32; 42.6%) followed by genital infections (20; 26.7%) and respiratory tract infections (15; 20%). In 8 (10.7%) patients, the cause couldn't be found. Only one patient developed sepsis and was admitted to the medical ICU. That pregnancy resulted in PROM and an infant with low birth weight was delivered. Both the mother and the child survived and were discharged from the hospital. There was no mortality in our study group.
Conclusion: Though sepsis was associated with adverse feto-maternal outcomes in our study, the study design prevents us from drawing any conclusions from this study concerning maternal sepsis in our region. Further research is needed to determine the true magnitude of the problem.
YOUTH SUICIDES IN PAKISTAN - PRIORITIZING PREVENTATIVE STRATEGIES FOR A RISING PUBLIC HEALTH PROBLEM
Authors: Yousafzai Abdul Wahab , Saman Yousuf
Published: October 2024

Suicide is the third leading cause of death in adolescents worldwide. The World Health Organization (WHO) reports 90% of these suicides occur in lower-and-middle income countries (LMICs). Approximately a quarter of the population of Pakistan is under 19 years of age. Local research shows an alarming rise in suicides among youth and points to a complex set of biological, psychosocial and cultural factors. The time has come to shift our focus to planning culturally appropriate, indigenous preventative strategies engaging multiple sectors of the society to address this problem.
FUNCTIONAL OUTCOME OF BRISTOW-LATARJET PROCEDURE IN POST-TRAUMATIC RECURRENT ANTERIOR SHOULDER INSTABILITY
Authors: Haseeb Saqlain Bajwa  , Uddin Shuja , Zia Uddin  , Hafiz M. Umar  , Rizwan Ul Haq  , Ahmed Umair Asad Khan
Published: October 2024

Background:  Due to its lack of bony support, the shoulder joint has the broadest range of motion out of all the joints in the body. Instead, one of the joints that dislocate most frequently is the shoulder joint. Multiple pathologic abnormalities, including the traumatic separation of the anterior-inferior capsule-labral complex from the glenoid rim, are caused by repeated anterior glenohumeral dislocation. The objective of the study is to ascertain the Bristow-LATARJET procedure's efficacy in situations of recurrent post-traumatic anterior shoulder instability. Methods: From 31 January 2020 to 31 July 2020, a descriptive case series was undertaken in the orthopaedic surgery department of the Lahore General Hospital. For this study, 71 patients who met the inclusion and exclusion criteria were recruited, and all interventions were conducted while the patients were lying in a beach chair while under general anaesthesia. The Delto-pectoral incision surgical technique was applied. For 12 weeks, all patients underwent clinical follow-up, and the results were documented. Results: There were 50(70.4%) males and 21(29.6%) females in this study & the mean age of the patients were 34.64±10.73. There were 37(52.1%) patients among them the outcome of treatment (Rowe Scale at 12th week) was excellent, among 21(29.6%) it was good, among 8(11.3%) it was fair and among 5 (7.0%) it was poor. There was a significant association between the outcome of treatment (Rowe scale at 12th week) and age groups (p-value: 0.000). Conclusion: The Bristow-LATARJET procedure is deemed to be a very productive, safe, and problem-free procedure for curing post-traumatic reoccurring traumatic anterior shoulder instability
ROLE OF GRANISETRON IN MINIMISING USE OF MEPERIDINE AS A RESCUE DRUG FOR POST SPINAL SHIVERING
Authors: Wahid Maheen , Ali Shabana , Noor Mudassar , Farhat Kulsoom
Published: October 2024

Background: Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous detrimental effects on the human body. Hence, its management becomes imperative. Meperidine, an opioid analgesic, is the drug of choice for this condition. However, the use of meperidine is controversial, as it carries the devastating adverse effect of respiratory depression. We explored the role of granisetron, a 5HT3 antagonist and a commonly used antiemetic premedication, in minimising the incidence of post-spinal shivering and decreasing the use of meperidine as a rescue drug. Methods: Overall, 160 parturient patients, between the ages 18-50, undergoing uncomplicated, elective caesarean section, were enrolled in the study, and randomized into two groups with 80 participants each: Group A received 3ml of normal saline, and Group B was administered 3 mg granisetron,15 minutes prior to spinal anaesthesia institution. Incidence of clinically relevant shivering (score of 3 or more) was noted, and it was recorded whether meperidine was used or not. Results: 67.5% of participants in Group A, and 32.5% of patients in Group B, experienced clinically relevant shivering, with 62.5% of patients in Group A and 28.75% in Group B warranting the use of meperidine. There was a statistically significant difference between the two groups in terms of incidence of clinically relevant shivering, and meperidine consumption (p-value <0.001). Conclusion: Premedication with 3 mg granisetron effectively attenuates the occurrence of post-spinal shivering and, hence, lowers the requirement of meperidine as rescue medication.
RISK FACTORS OF ANAEMIA AMONG ZIDOVUDINE-BASED REGIMEN IN PATIENTS WITH HIV INFECTION- A COHORT STUDY
Authors: Ramalingam Pullipalayam Kandaswamy  , Radha Devarajan , Karunanithi Gayathri , Gaur Archana , Geetha Jeganathan , Sindhura Gajula , Sakthivadivel Varatharajan
Published: October 2024

Background: Anaemia in patients with HIV infection is commonly multifactorial in origin. Nutritional deficiencies and the presence of opportunistic infections as well as HIV infection itself can cause anaemia. HIV medications like zidovudine can also cause anaemia in patients with HIV infection. This study aimed to study the prevalence and risk factors of anaemia in patients with HIV infection on a zidovudine-based HAART regimen. Methods: This hospital-based prospective cohort study was done at the ART (anti-retroviral therapy) centre. All adult patients with HIV attending the ART centre were included in the study. After obtaining written informed consent, the patient's demographic data, risk factors, WHO staging, and body mass index (BMI) were noted. Study population was divided into two groups as patients with or without anaemia and compared using appropriate statistical tests. Results: Out of the 202 patients with HIV infection on a zidovudine-based regimen, 52 patients (25.7%) developed anaemia. Anaemia was common in stage 3 or stage 4 of WHO staging (OR-9.94, CI-3.89-25.36) and in patients with low CD4 counts (OR-0.988, CI-0. 982-0.995). Patients with anaemia had significant opportunistic infections. Conclusion: Anaemia is common in patients with HIV on zidovudine-based HAART regimen, which is seen as early as less than 8 weeks. WHO staging, and CD4 count were the primary risk factors for anaemia, which a change of treatment regimen and supportive measures can reverse.
TO DETERMINE THE SURVIVAL OF PATIENTS WITH BRAIN METASTASES AFTER PALLIATIVE WHOLE-BRAIN RADIOTHERAPY - AN EXPERIENCE FROM A SINGLE INSTITUTE
Authors: Misbah Dawood , Muhammad Fawad-Ul-Qamar  , Khaleeq Nadia , Zaidi Alina , Ali Shah Syed Zarak , Sajjad Kashif
Published: October 2024

Background:  Brain metastases are a common complication of cancer and approximately 20% of cancer patients develop them over time. Presently palliative whole-brain radiotherapy is used as a palliative treatment for brain metastases because of its cost-effectiveness and easy availability, especially in patients with multiple metastases who are not candidates for surgery or Stereotactic radiosurgery. This study aims to determine the survival in patients who have received palliative whole-brain radiotherapy for brain metastases and to evaluate some of the prognostic factors determining survival in patients with brain metastases. Methods: It was a cross-sectional study conducted in Shaukat Khanum Memorial Cancer Hospital and Research Centre and all the patients with brain metastases who had completed palliative whole-brain radiotherapy between July 2015 and July 2020 were included. Data was retrospectively collected and analyzed using SPSS 21.0. Overall survival was calculated using the Kaplan-Meier method, taking into consideration the period from the date of diagnosis of brain metastases until death or to the date of last follow-up, whichever was applicable. p-value of <0.05 was regarded as statistically significant. Results: Almost half (45%) of the brain metastases were secondary to breast cancer followed by lung and genitourinary cancers at 16.3% and 15.5% respectively. The median overall survival was lowest in breast carcinoma patients at 5 months followed by lung carcinoma at 7 months. The median overall survival was 5 months in patients having extracranial disease as compared to 12 months in those having no extracranial disease or those in whom the disease status was unknown. Conclusions: Our study revealed that the most common tumour to metastasize to the brain was breast cancer. The younger age group had a poorer prognosis because most of them had breast cancer with triple-negative disease. Controlled extracranial disease significantly prolonged overall survival in patients with brain metastases.
EXPLORING THE LINK BETWEEN OBESITY AND HYPOTHYROIDISM
Authors: Saqib Malik  , Sadia Rehman  , Farhat Naz  , Rehman Najma , Zainab Syed
Published: October 2024

Background: Obesity and hypothyroidism are two common clinical conditions that are often connected. This connection is now more important because of an exceptional rise in the prevalence of obesity around the world. Both of these conditions have a noteworthy impact on human health and well-being. The main objective of this study was to determine the frequency of hypothyroidism in obese patients presenting at Ayub Teaching Hospital, Abbottabad. Methods: This cross sectional study was carried out on 242 patients in the Department of Medicine of Ayub Teaching Hospital, Abbottabad from 1st March to 31st August 2022.  SPSS version 23.0 was used for data analysis. Result: In this study 242 obese patients were included. Mean age of the patients was 39.55±9.361 years. Mean BMI was 41.62±8.099kg/m2 ranging from 31 to 61kg/m2, mean TSH level was 3.04±2.604mU/l, mean T4 level was 8.53±2.215pmol/L and mean T3 level was 1.2195±0.35795nmol/L .Out of total 242 patients, 34(14.0%) were male and 208(86.0%) were female patients. Patients found with overt hypothyroidism were 11(4.5%), subclinical hypothyroidism were 31(12.8%) and euthyroid were 200 (82.6%) Conclusion: The proportion of hypothyroidism among the obese patients was quiet less in our setup and not significantly associated with age and gender of the patients.
UNVEILING THE REALITIES OF ANAL MELANOMA CARE IN A RESOURCE-CONSTRAINED SETTING
Authors: Pragya Mitra  , Deepak Kumar  , Anju Khairwa  , Aneeket Modak
Published: October 2024

A 50-year-old lady presented with complaints of a progressively increasing anal mass and occasional bleeding per rectum for the past 4 months. Examination revealed an ulcero-proliferative growth in the anal canal, whose biopsy was suggestive of malignant melanoma. Inguinal lymph nodes, though enlarged, did not show evidence of malignant deposits on FNAC. Radiological investigations revealed a T3 lesion with no evidence of nodal metastasis. She underwent local excision of the mass with uneventful intraoperative and postoperative periods. The purpose of this report is to highlight the formidable challenges encountered in diagnosing this rare tumour, with potential implications for misdiagnosis, particularly within a resource-poor setting. This case highlights the importance of resource-appropriate approaches and surgical options available in a tertiary care hospital in North India.
COMPARISON OF HEMODYNAMIC EFFECT CAUSED BY INTRATHECAL LOW DOSE ADMINISTRATION OF 0.5% AGAINST 0.75% HYPERBARIC BUPIVACAINE IN PATIENTS UNDERGOING LOWER LIMB SURGERY UNDER UNILATERAL SPINAL ANAESTHESIA
Authors: Khan Maliha Khalid , Amran Hafiz  , Faheem Feroze  , Anjum Atique Tahir  , Saeed Farooq  , Muhammad Shaheer Bin Faheem
Published: October 2024

Background: Spinal anaesthesia has its unique place in modern anaesthetic practice. In past, most of the surgeries, irrespective of the site of surgery, were performed in general anaesthesia but now in the modern anaesthetic field, spinal anaesthesia has markedly replaced general anaesthesia, specifically in obstetrics, lower limbs, and abdominal surgeries. Methods: A total of 100 patients fit to undergo lower limb surgery between the ages of 20 to 70 years were included in the study. 50 patients were in 0.5% hyperbaric bupivacaine (Group A) while 50 patients were in the 0.75% hyperbaric bupivacaine group (Group B). Patients with a history of allergies to local anaesthetics, ischemic heart disease and contraindications to spinal anaesthesia were excluded. At the end of the injection, the patient was immediately laid down and tilted to 30 degrees lateral on the operative side for unilateral anaesthesia. Mean arterial pressure at baseline, 15, 30, 45 and 60 minutes was recorded by trainee anaesthesia. A baseline was taken of mean arterial pressure measured 15 minutes before induction of spinal anaesthesia in a lying position. Results: The mean baseline arterial pressure of patients in group A was 88.72±1.71 mmHg and in group B was 88.94±1.95 mmHg. Mean arterial pressure MAP at 15, 30, 45 and 60 minutes in both groups was as follows; 86.22±2.55 vs 81.78±1.52 mmHg, 83.72±3.36 vs 75.84±1.34 mmHg, 80.02±3.40 vs 70.90±0.97 mmHg and 77.14±4.24 vs 66.06±1.62 mmHg respectively (p-value <0.05). Conclusion: This study concluded that the hemodynamic parameters in terms of mean arterial pressure remained more stable by deviating less from the baseline value with the use of a low dose of 0.5% hyperbaric bupivacaine instead of 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia.
RADIOGRAPHIC COMPARISON OF OBTURATION PERFORMED BY CONVENTIONAL METHOD AND OBTURA II
Authors: Jadoon Sheejia Asif , Shehrayar Akhtar Khokhar  , Aqsa Waheed  , Samia Ejaz  , Ahsen Amin  , Abdal Hidayat
Published: October 2024

Background: Preventing tooth loss is of utmost importance in maintaining optimal mastication, phonation, and aesthetics. Most commonly, pulpitis occurs as a result of caries, while trauma less frequently causes it. In both cases, it can lead to unbearable pain. To alleviate this pain and preserve the tooth without resorting to extraction, root canal treatment is indicated. To compare the radiographic quality of root canal filling sealing achieved with the Obtura II system and the cold lateral condensation technique. Methods: This randomized clinical trial was conducted at the School of Dentistry with a total of 260 participants. The study focused on single-rooted teeth that required endodontic treatment. Group A was assigned the cold lateral condensationwhile Group B received obturation using the Obtura II system. A radiographic assessment was performed to evaluate the presence of voids and the extent of extension at the apex in both groups. The chi-square test was utilized to compare the occurrence of voids and the extent of extension between the two groups. Results: In the Cold Lateral Compaction cold lateral condensation group, 113 cases (86.92%) achieved optimum extension, while in the Obtura II group, 114 cases (87.69%) achieved the same. A statistically significant difference was observed between the groups in terms of extension (p=0.033). Although the difference in extension quality was not statistically significant, it is worth noting that the Obtura II group had a higher incidence of overextension. The cold lateral condensation group had 104 cases (80.00%) with no voids, whereas the Obtura II group had 121 cases (93.08%) without voids. A statistically significant difference was observed between the groups regarding the presence of voids (p=0.004). Conclusion: Obtura II exhibits a denser sealing and fewer voids compared to the cold lateral condensation technique. However, Obtura II showed a slightly higher tendency to extend beyond the apex compared to the CLC technique.
ASSOCIATION OF HEART RATE AT HOSPITAL DISCHARGE AND REHOSPITALIZATION OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION
Authors: Kaleem Ullah Sheikh  , Abeer Sarfaraz  , Amna Janjua  , Sana Sarfaraz  , Sana Shoaib  , Sanjna Devi
Published: October 2024

Background: One of the major causes of cardiovascular morbidity and mortality is heart failure. The study aims to assess the effect of heart rate on the incidence of rehospitalization in patients with heart failure and reduced ejection fraction. Methods: It is a cross-sectional, analytical research conducted over six months, from June to December 2022, at the cardiology department of a tertiary care hospital. Patients who satisfied the modified Framingham heart failure criteria at admission and were discharged with an initial diagnosis of heart failure and those readmitted within 6 months or less of their discharge were included in the study. Pregnant women, patients diagnosed with cognitive impairment, and patients who had contraindications for taking any of the beta-blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker /angiotensin receptor -neprilysin inhibitor, Sodium-Glucose co-transport inhibitor, and mineralocorticoid inhibitors were excluded from the study. Result: A total of 77 patients were included in the study. At discharge, approximately 71 patients had a heart rate of less than 70 beats/min and had no readmissions whereas, 6 patients had a heart rate of greater than 70 beats/min with 5 patients requiring readmission in the following 6 months. This relationship was statistically significant with a p-value of 0.000. Conclusion: According to the study, heart rate is a significant factor in the rehospitalization of individuals with heart failure and a low ejection fraction. At discharge, if the heart rate is not optimized then the rate of readmissions is increased.
A SINGLE CENTRE, RANDOMIZED CONTROL TRIAL OF DONOR SITE WOUND DRESSINGS AFTER SPLIT-THICKNESS SKIN GRAFTING
Authors: Ismail Sarosh , Faisal Akhlaque Ali Khan  , Sadaf Gulzar  , Waqas Sami  , Bushra Zulfiqar  , Suneel Kumar  , Erum Naz
Published: October 2024

Background: Split-thickness skin grafting (STSG) is a widely employed technique for repairing wounds, such as ulcers, trauma, or in reconstructive surgeries. The objective was to compare the efficacy of different dressing materials for healing donor-site wounds after split-thickness skin grafting. Methods: A single center, randomized controlled trial was conducted at the Department of Plastic Surgery, Civil Hospital Karachi, Pakistan, over a period of six months. The study included patients aged 18 years and above, of both genders, who underwent single donor-site wounds after split-skin grafting with a surface area larger than 10 cm². The eligible patients were randomly divided into six groups: Film, Alginate, Gauze, Hydrofiber, Hydrocolloid, and Silicone. Pain, itching, scarring, complications, and patient satisfaction were evaluated after 12 weeks using standardized assessment scales. Results: The median time to complete wound healing and re-epithelialization varied among the different dressing groups, with hydrofiber and silicone dressings demonstrating the shortest healing time. Statistical analysis revealed a significant difference in the median time to complete wound healing among the dressing groups (p-value=0.019). However, no significant differences were observed in pain, itching, scarring (POSAS observer and patient), or patient satisfaction among the different dressings (p-value>0.05). Conclusion: Although the dressing type did not significantly affect pain, itching, scarring, or patient satisfaction, variations were observed in the time to complete wound healing. These findings contribute to the selection of appropriate donor site dressings for optimizing outcomes in split-skin grafting procedures.
PHARMA, PHYSICIAN NEXUS -A PERIL IN THE OFFING
Authors: Yousafzai Abdul Wahab , Fatimah Saeed
Published: October 2024

Pharmaceutical companies and healthcare professionals have long been a subject of scrutiny, as their collaboration plays a pivotal role in advancing medical research, promoting evidence-based practices, and fostering dialogue among healthcare practitioners. Together, they have pushed the boundaries of scientific innovation, paving the way for groundbreaking medical advancements. However, ethical concerns arise when such collaborations cross the line into lavish sponsorships for physicians, including all-expenses-paid trips to international conferences and seminars.  The opaque ties between the pharmaceutical industry and Physicians cast a shadow on the sanctity of impartial medical practice, particularly in a nation like Pakistan where regulatory frameworks are a work in progress. While the undeniable benefits of collaboration between pharmaceutical companies and medical practitioners are evident, it is imperative to address the ethical implications when such partnerships tread perilously close to the line between ethical collaboration and ethically questionable practices.
EFFECT OF TAMOXIFEN ON PLASMA LIPID PROFILE IN PATIENTS OF BREAST CANCER
Authors: Bhunisha Mahadev  , Haider Ghulam , Shaikh Zoya , Kumar Pavan , Memon Paras , Rahul Raja , Parkash Jai , Nouman Maryum , Khalil Mehar  , Shaikh Mehwish Roshan
Published: October 2024

Background: To evaluate the effect of Tamoxifen on plasma lipid profile in breast cancer patients presenting at tertiary care hospital. Methods: It was a longitudinal study conducted at the department of oncology of Jinnah Postgraduate Medical Center from December 2018 to November 2019. Eighty-eight females of age 26-66 years diagnosed with breast cancer were included in the study using non-probability consecutive sampling technique. Detailed gynaecological and clinical investigations and detailed history were taken. The blood samples of all the patients were collected and plasma lipid profile was measured before initiation of Tamoxifen treatment and three- and six-months post treatment at clinical laboratory. The plasma lipid profile includes the measurement of Total cholesterol (mg/dl), Triglyceride(mg/dl), High density Lipoprotein (mg/dl) & Low-density Lipoprotein (mg/dl). SPSS version 23 was used to analyse data. Results: After treatment there was significant reduction in serum cholesterol & Low-density Lipoprotein level by 20.54 mg/dl & 16.46 mg/dl at 3 months (p<0.05), moreover there was significant increase in Triglyceride by 22.14 at 3 months (p<0.05). No significant difference was observed in High density lipoprotein level at 3-months after using Tamoxifen.  At 6 months there was significant reduction in serum cholesterol & Low-density lipoprotein by 32.29mg/dl and 24.11 mg/dl at 6 months (p<0.05), moreover there was significant increase in Triglyceride level by 42.19 mg/dl at 6 months (p<0.05). No significant difference was observed in High density lipoprotein level at 6 months after using Tamoxifen. Conclusion: Total cholesterol and Low-density Lipoprotein levels showed significant reduction over the period of six months from the baseline with the use of Tamoxifen. Hence Tamoxifen should be considered to have an added advantage on lipid metabolism and therefore, can reduce the risk of cardiovascular events.
STONE CLEARANCE AND COMPLICATION RATE OF MICRO PERCUTANEOUS NEPHROLITHOTOMY AND RETROGRADE INTRARENAL SURGERY FOR LOWER POLE RENAL STONE: A RANDOMIZED TRIAL
Authors: Sajjad Kumail , Maisam Ali Shahid  , Mazhar Ali  , Khizar Hayat  , Muhammad Nazir
Published: October 2024

Background: The use of unhealthy food and a sedentary lifestyle increases daily health problems. Renal stones are one among others. Endourology promises the minimum complications and the highest stone clearance rate. Indications of the two procedures overlap micro-PCNL and RIRS. The objective was to evaluate stone clearance and complication rate of micro-PCNL and RIRS for lower pole renal stones. Methods: The research design of this study was a randomized trial and was done after approval of the ethical review committee. The sampling technique was consecutive sampling at the Urology department. Patients included in the study according to inclusion criteria were 96 in number. Randomization into two groups (RIRS vs micro-PCNL) was done by even odd method. All the procedure was done by a single senior urologist. Results: Their ratio among males and females was 2:1. Mean LOS in the RIRS group was 2.89±0.86 days and in the micro-PCNL group 2.58±0.65 days (p=0.047). The complication rate in the RIRS group was 6.2% and 8.3% in micro-PCNL (p=0.695). Mean post-operative haemoglobin was 12.30±1.07 g/dL among the RIRS group and among the micro-PCNL group it was 11.21±1.08 g/dL (p<0.001). There was an average haemoglobin drop in the micro-PCNL group of 1.09±0.01 g/dL. 75% clearance of stone after one session was achieved in the RIRS group while 79.2% was achieved in the micro-PCNL group (p=0.627). Conclusion: Length of hospital stay (LOS) and stone clearance rate (SFR) were similar in both groups with insignificant statistical differences. There is a need to conduct more studies with a large number of study participants and involving multi-centers.
EFFECT OF SGLT2 INHIBITOR DAPAGLIFLOZIN ON SODIUM, POTASSIUM AND CREATININE LEVELS IN PATIENTS WITH ACUTE HEART FAILURE
Authors: Fatima Gilani Fauzia , Shabana Ali  , Mudassar Noor  , Kulsoom Farhat  , Muhammad Bilal Siddique  , Maryam Fatima
Published: October 2024

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) is a new class of medication for the treatment of type 2 diabetes mellitus. Additionally, they have been found to have beneficial effects on heart failure outcomes, convincingly reducing the morbidity and mortality in heart failure. Although the medical data indicates SGLT2i to be safe and cardio-protective, very little attention has been given to the impact of these agents on electrolyte balance particularly in acute heart failure (AHF). We aimed to evaluate the effect of SGLT2i, and dapagliflozin on serum sodium, potassium and creatinine in AHF. Methods: Overall, 160 adult patients of either gender, admitted with AHF were selected for the study. Selected individuals were randomly assigned to receive dapagliflozin 10 mg orally added to standard medical treatment (n=80) or were in reception of standard medical therapy only (n=80). Serum electrolytes and serum creatinine were collected on admission and day 7 or on discharge whichever happened earlier. Results: The mean level of serum electrolytes displayed insignificant differences among both groups on admission. The mean level of serum potassium was higher in the dapagliflozin group compared with the control group (p<0.001) on day 7/discharge. Mean serum sodium level was comparable and showed significant differences between the two groups following treatment (p-value=0.021). Significant higher levels of serum creatinine were observed following treatment in both groups. However, on intergroup comparison, they were statistically insignificant. Conclusion: Dapagliflozin is an effective treatment of heart failure and is not associated with deterioration of serum electrolyte levels and renal functioning when used as add-on therapy in AHF.
A REVIEW OF MRI APPEARANCES OF LIPIODOL IN CONVENTIONAL TACE (cTACE) TREATED HEPATOCELLULAR CARCINOMAS
Authors: Rauf Maria , Atif Iqbal Rana  , Maria Rauf  , Jamshaid Anwar  , Haider Ali  , Ahmad Ammar Afzal
Published: October 2024

Background: The global burden of patients affected by chronic liver disease (CLD) has shown a steady rise over the last few decades and is now considered the 11th most frequent cause of death globally. In addition, as the world population is facing increased obesity rates coupled with alcohol consumption, these rates are predicted to continue to rise. The Objective was to assess the appearance of Lipiodol retention upon different MRI sequences with a special focus on non-contrast sequences. Lipiodol Trans-arterial chemoembolization (TACE) has become the standard treatment for unresectable hepatocellular carcinoma (HCC) without vascular invasion. However, data regarding Lipiodol TACE imaging via MRI is limited and results are not familiar to radiologists for regular assessment of treatment response. Methods:  After IRB and EC approval, we included all those patients who underwent TACE treatment with Lipiodol and chemotherapeutic agent; having both 4-6-week post-treatment CT and MRI imaging. This criterion was fulfilled by a total of 25 patients. Only lipiodol-containing areas within the lesion were noted for signal intensities on all MRI sequences and labelled as hyperintense, isointense, hypointense and mixed intensity. Data was entered and analyzed by SPSS v27. Frequencies and percentages were calculated for qualitative data. Results: The most sensitive sequence in detecting Lipiodol retention was Fat suppressed T1 imaging sequence, with low signal intensity seen on T1 weighted fat-suppressed sequences in up to 76% of lesions. While on non-fat suppressed T1 weighted images, 60% of Lipiodol retention areas appeared hyperintense.  52% of lesions showed a hypointense appearance on the T2 weighted sequence. A much more variable appearance was seen in Diffusion-weighted imaging sequences demanding cautious interpretation. MR patterns were clearer in patients having more than 50% lipiodol retention on CT and lesion size more than 2 cm. Conclusion: While MRI is deemed as a reliable and most useful imaging modality for assessing HCC's following lipiodol TACE it requires cautious interpretation with knowledge of variable signal appearance seen on different imaging sequences.
SYMPTOMATIC INTERARTERIAL COURSE OF CORONARY ARTERIES IN MIDDLE AGED PATIENTS
Authors: Abdul Nasir  , Abid Ullah  , Maryum Masoud  , Rafi ullah Jan
Published: October 2024

Anomalous aortic origin of a coronary artery (AAOCA) is the most common congenital abnormality and is sometimes associated with various life-threatening conditions. We present the cases of a 35-year-old male and 50 years 50-year-old female with complaints of chest pain. Patients had anomalous aortic origin of coronary arteries with the interarterial course and were treated surgically. By literature review, we came to know that the approach to treat patients with anomalous aortic origin of coronary arteries should be largely individualized and there is no ample scientific data to support any specific diagnostic modality and treatment option.
HYPOCALCAEMIA AS A RARE REVERSIBLE CAUSE OF DILATED CARDIOMYOPATHY
Authors: Bilal Ahmad  , Hussain Saddam , Jamal Shah  , Khan Sher Wali
Published: October 2024

Dilated cardiomyopathy is characterized by dilation and enlargement of one or both ventricles with reduced systolic function. Calcium plays a key role in myocardial contraction. Hypocalcaemia can lead to a decrease in contraction, left ventricular systolic dysfunction, and heart failure with reduced ejection fraction (EF). Hypocalcaemia is a rare reversible cause of dilated cardiomyopathy. The author presents a case who presented with complaints of shortness of breath on exertion, orthopnoea, paroxysmal nocturnal dyspnoea, numbness and crampy muscular pains. He had a high JVP, systolic murmur on auscultation, hepatomegaly, pedal oedema and crackles on chest auscultation. His ECG showed sinus rhythm with prolonged QT interval. His echocardiography showed dilated cardiomyopathy with reduced ejection fraction, moderate mitral regurgitation and mild tricuspid regurgitation. His Calcium levels and PTH levels were both low. He was treated with ionotrophes, diuretics, vitamin D and calcium supplements, including both intravenous and oral. With the correction of calcium levels, he was weaned off the ionotrophic support and his ejection fraction improved. Calcium levels if low should be corrected in patients with dilated cardiomyopathy.
THE INTERPLAY OF THE ANGIOTENSIN RECEPTOR BLOCKERS AND HAEMATOLOGICAL ABNORMALITIES: INSIGHTS AND IMPLICATIONS
Authors: Ghada Muthana Ahmed  , Alassaf Fawaz Abdulghani , Abed Mohammed Najim
Published: October 2024

Antihypertensive medications known as angiotensin receptor blockers (ARBs) have become increasingly popular for treating conditions beyond hypertension. The reason for this widespread use is mainly due to its reno-protective and cardioprotective properties in patients with congestive heart failure and diabetes mellitus. There have been conflicting studies on the relationship between ARBs and haematological abnormalities. Using the supplied search terms, we carried out a thorough search for relevant papers written in English and published before January 2024. All of the studies that met the selection criteria were searched for on PubMed, Cochrane Library, and Google Scholar. Based on the examined data from the searched literature, it has been demonstrated that angiotensin II is essential for the stimulation of erythropoiesis and inhibition of it by drugs such as ARBs can lower haematocrit levels, leading to anaemia. Accordingly, dose reduction or stopping the administration of ARBs could be a choice for the correction of anaemia. However, such a decision is based on the clinical situation and the requirements for other management options.
ADDRESSING THE ALARMING SURGE OF NAEGLERIA AND OTHER WATER-BORNE DISEASES IN KARACHI: A CALL FOR URGENT ACTION
Authors: Khan Najam Ahmed , Anas Faheem  , Hania Imtiaz  , Muhammad Ismail  , Sanila Mughal
Published: October 2024

Naegleria fowleri, a thermophilic, free-living organism causes a life-threatening condition called primary amoebic meningoencephalitis (PAM). Naegleria thrives in warm freshwater but the rising number of cases in Karachi has raised concerns about the quality of the city's domestic water supply. Pakistan has dealt with numerous healthcare burdens in the past, including outbreaks of diseases such as diphtheria, and cholera, and is persistently dealing with the challenge of polio. Moreover, bacterial contamination and improper water infrastructure pose a significant public health risk to several other water-borne diseases, prevalent in the city. Furthermore, the surge in cases of Naegleria adds to these ongoing health concerns. This brain-eating amoeba has the potential to spread beyond its current location, posing a significant threat to the nation's healthcare system. While the world is struggling to find an effective treatment for PAM, implementing preventive measures to improve water management, and surveillance can save lives and lessen the burden. The addition of chlorine to the water supply of the city by KWSB is a crucial step toward keeping this infection under control.
ORAL PROTOZOA ENTAMOEBA GINGIVALIS AND TRICHOMONAS TENAX AMONG PERIODONTITIS AND GINGIVITIS PATIENTS IN PERIODONTOLOGY DEPARTMENT DENTAL SECTION QUETTA
Authors: Abdul Samad Gichki  , Maryam Mooen  , Muhammad Tariq Hasni  , Daud Ghilzi
Published: October 2024

Background: a group of eukaryotic organisms that are either free-living or parasitic and feed on organic matter, such as microorganisms or organic detritus. This group is referred to as a polyphyletic classification. They can be found in a wide variety of patterns and sizes, ranging from an amoeba, which can vary its shape, to a paramecium, which has a fixed shape and a complicated structure. The objective was to find out the occurrence of Entamoeba gingivalis and Trichomonas among Dental Patients visiting the Periodontology Department Dental Section, Sandeman, Provincial Hospital Quetta. Methods: The study design was randomized cross-sectional and conducted in the Department of Periodontology Dental Section, Sandeman Provincial Hospital Quetta, from March 2022 to February 2023. A total of 110 known cases of periodontitis and gingivitis were recruited in this study, and further to laboratory work the bacterial biofilm samples were collected from both gingivitis and periodontitis patients. The dental plaque was placed on individual glass microscope slides and a drop of saline and mixed and covered with a coverslip. The wet smear was examined immediately under 40X, and the objective for the presence and absence of motile amoebae or flagellated protozoa was recorded. Results: out of 110 known cases of periodontitis and gingivitis 91 (83%) patients were males and 19 (17%) were females among 110 patients, 40 (36%) patients were periodontitis and 70 (64%) patients were gingivitis. Among 40 (36%) periodontitis patients 3(7.5%) were Entamoeba gingivalis and 4(10%) were Trichomonas Tenax while 70 (64%) cases of Gingivitis 20 (28%) of Entamoeba gingivalis and 1(1%) Trichomonas tenax was recorded. No patient had both species of protozoa were seen in this study. Conclusion: The results of this study revealed the frequency of occurrence of E. gingivalis and   T. tenax and the state of periodontitis and gingivitis. The prevalence of E. gingivalis was higher than T. tenax. We recommended further research with a higher number of patients and may use more advanced and reliable laboratory techniques such as PCR and electron microscopy.