bluuebunny/crossref_metadata_2025 huggingface dataset:
Fostering Inclusivity and Body Positivity: An AI-Driven Fashion Recommendation System for Mitigating Body Dysmorphic Disorder Effects
Authors: Wei Yishen , Azadi Kian
Published: October 2023

This paper addresses the pervasive issue of body image concerns, particularly in the context of Body Dysmorphic Disorder (BDD), and the potential for fashion to either exacerbate or alleviate these concerns [1]. To tackle this problem, we propose ProportiStyle Tips, an AIpowered fashion recommendation system. The background to this problem lies in centuries of body shaming and the contemporary challenges posed by BDD, a condition affecting individuals of all body types and preferences. ProportiStyle Tips utilizes advanced machine learning algorithms to calculate users' body ratios from images, laying the foundation for highly personalized fashion suggestions [2]. Key technologies include image processing, machine learning, and user-centric design. Challenges encompass accurate ratio detection, user comfort, and dataset availability, all of which were methodically addressed during development. Experimental scenarios demonstrated that ProportiStyle Tips could provide recommendations with a 90% user comfort and satisfaction rate. These results signify a positive impact on users' confidence and emotional well-being, making ProportiStyle Tips a valuable tool for empowering individuals to feel comfortable and confident in their own skin, regardless of their body type or preferences [3].
Securing E-Commerce Deliveries: An Integrated Mobile Application and Parcel Locker System for Mitigating Porch Piracy
Authors: Chen JonathanZiqi , Li Matthew Xuehao , Sahagun Jonathan
Published: October 2023

With the rapid surge in porch piracy, largely fueled by the proliferation of online shopping, there is an urgent need for innovative solutions to secure package deliveries [8]. This paper addresses the pressing issue of package theft through the development of a comprehensive solution that integrates a mobile application and a secure parcel locker system. Recognizing the limitations of existing methodologies, our proposed solution places a strong emphasis on technical robustness, user experience, and security. Our approach revolves around a user-friendly mobile application catering to both consumers and couriers. This application seamlessly interfaces with a network of secure parcel lockers, creating a robust ecosystem. Leveraging Google Firebase for data storage and Android Studio Code for programming, our system ensures secure and efficient access [9]. Overcoming challenges like efficient communication with Raspberry Pi and optimal locker design layout, we utilized wireless technology and innovative design concepts [10]. Rigorous experimentation encompassing usability, effectiveness, and user satisfaction assessments has demonstrated the solution's efficacy in thwarting unauthorized access. The results underscore the significance of a user-centered design, technical feasibility, and comprehensive security measures. By offering a multifaceted approach that prioritizes convenience, security, and user-friendliness, our solution presents a compelling remedy to the pervasive problem of porch piracy.
Evaluation of Hydrocarbon Charge and Leakages using Chimney Cube: Examples from the Deep Offshore Niger Delta Basin, Nigeria.
Authors: Eje E. O , Ideozu R. U , Ugwueze C. U
Published: October 2023

This research investigated hydrocarbon charge and leakages using chimney cube in Woda Oil Field, Western Offshore Niger Delta. The data sets used include well logs and 3D Post Stack Depth Migration (PSDM) seismic volume. The reservoir zone was identified, using well log data (gammaray, resistivity, and Vp sonic logs). The Chimney cubes generated from Supervised Neural Network (SNN) validated the identified chimney morphologies, gas zones and was overlain on interpreted reservoir surfaces D, G and I. Majority of the chimney morphologies identified are type I and II that nucleated in the lower part of the faulting system below the partially permeable portion of the fault planes and across the regional partially permeable barrier as revealed by thin fault likelihood attribute (TFLA) and fault polygons. Gas expulsion occurring along the lower portion of the complex faulting system may have preconfigured the spatial organization of the chimney morphologies. The anisotropic stress pattern around the tectonic and anisotropic polygonal faults coupled with the partially permeable faults may have determined the directions of long-term gas migration pathway and linear geometries of the chimney morphologies. Pockmarks formed above the chimney morphologies may have inherited the same linear planform geometry that recorded the timing of gas leakage and paleo-stress pattern of the study area and thus used as a tool to reconstruct the orientations of stress patterns in the sedimentary successions within the Woda oil field. The character of the chimneys and well log interpretation were used to evaluate the petroleum system in the study area.
Recent Application of Machine Learning Algorithms in Petroleum Geology: A brief review
Authors: Blessing Elosionu .O. , Onyinyechi Umekwe. B. , Chiamaka Gbulie. G.
Published: October 2023

In petroleum geology, machine learning (ML) has shown promise as a method for improving exploration and production. Current uses of ML algorithms in this area have significantly improved data analysis, modeling, and prediction, allowing for better decision-making and cost reductions. ML is utilized for a number of activities, including well-log interpretation, reservoir characterization, seismic data processing, drilling optimization, and production forecasting. The interpretation of well logs is one of the main uses of ML in petroleum geology. Using well logs, ML algorithms can categorize different types of rocks, identify lithology, and calculate porosity and permeability. In order to predict fluid distribution, identify the existence of hydrocarbons, and calculate reservoir parameters like thickness and depth, ML models are also employed for reservoir characterization. To better characterize reservoirs and make well placement decisions, ML algorithms are employed in seismic data processing to locate faults, fractures, and other geological features. ML models have been applied in conventional oil fields and unconventional shale plays in places like the Permian Basin in the United States and the North Sea in Europe. It has also being used in complex geological settings, such as tight gas deposits in the Marcellus Shale and fractured carbonate reserves in the Middle East. By forecasting drilling performance, spotting abnormalities in drilling data, and choosing the most effective drilling parameters, ML is also used to optimize drilling operations. The optimum production techniques are found, the remaining recoverable reserves are estimated, and production rates are predicted using machine learning (ML) in production forecasting. Cost-saving manufacturing optimization is possible with the help of this information. Overall, recent ML applications in petroleum geology have yielded encouraging results, allowing for better decision-making, cost reduction, and increased productivity. The oil and gas sector is expected to see ML approaches play a more significant role as they advance.
Effect of Dexamethasone on Post-Operative Delirium in adults following General Anaesthesia
Authors: Qureshi Kazi Iftikhar , Aftab Ali , Ghauri Muhammad Asim , Yawar Reema , Saifee Hatim , Mahmood Tariq
Published: October 2023

Objective: To determine the effect of Dexamethasone on post-operative delirium in adults following general anaesthesia among patients operated at Pakistan Navy Hospital Shifa.

Study Design: Prospective comparative study.

Place and Duration of Study: Anaesthesia and Pain Medicine Departments, Pakistan Navy Hospital Shifa, Karachi Pakistan, from Oct 2019 to Jan 2021.

Methodology: Patients operated in the main operation theatre of our hospital during the study period without any complication fulfilling the exclusion/inclusion criteria, were included in the study. They were randomly divided into two groups, with Group-A receiving 4mg Dexamethasone and other routine pre-anaesthetic medications. In contrast, Group-B just received the routine pre-anaesthetic medications but no Dexamethasone. An independent assessor assessed post-operative delirium using the Confusion assessment method (CAM).

Results: A total of 250 patients were included in the study, which met the inclusion criteria. The mean age of the study participants was 34.419±4.329 years. 27(10.8%) patients showed post-operative delirium, while 223(89.2%) did not show postoperative delirium on the Confusion assessment method. The chi-square test revealed that none of the factors studied, including the administration of pre-operative Dexamethasone, had any statistically significant relationship with the presence or absence of delirium among the target population (p-value >0.05).

Conclusion: Delirium was a fairly common finding in adult patients 24 hours after routine surgical procedures. None of the factors studied, including Dexamethasone, was related to the presence or absence of delirium in our study.
17p Deletion in Patients with De Novo Acute Myeloid Leukemia and their Clinico-Haematologic Features
Authors: Jalil Saniya , Robert Helen Mary , Malik Hamid Saeed , Abbasi Asad Mehmood , Fatima Sarah , Niaz Hina
Published: October 2023

Objective: To determine the frequency of 17p deletion in patients with Acute Myeloid Leukemia and their clinical-hematologic features using fluorescence in situ hybridization.

Study Design: Cross-sectional study.

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

Methodology: All diagnosed cases of Acute Myeloid Leukemia of all ages and genders were included. Interphase FISH testing was performed using blood or bone marrow specimens using 10μL of the Meta systems XL p53 probe, and a total of 500 nuclei per assay were analyzed using a fluorescent microscope. Del 17p positivity and negativity were noted. Clinico-haematologic features of the patients with and without del 17p were also noted.

Results: In our targeted population of 84 patients, there were 25(29.8%) females and 59(70.2%) males. The mean age of presentation was 36.3±1.6 years. The mean total leucocyte count(TLC)was 31.2±4.2×109/L, and the mean platelet count was 69.3±4.5×109/L. Del 17p was detected in a total of 8(9.5%) patients. The median age of patients with del 17p at diagnosis was 33 years, the mean TLC was 12.32±10.36x109/L, and the mean platelet count was 80±26.73*109/L. Prominent clinical features among patients with del 17p included fever and pallor.

Conclusion: Our study suggests a relatively low frequency of del 17p in AML (9.5%), which is consistent with international data.
Impact of Gluten on Irritable Bowel Syndrome
Authors: Uruj Sana , Ali Muhammad Zafar , Sarwar Natasha , Hussain Amina , Waseem Muhammad
Published: October 2023

Objective: To assess the impact of a gluten-free diet on the quality of life of patients managed for irritable bowel syndrome at a tertiary care hospital

Study Design: Prospective comparative study.

Place and Duration of Study: Department of Medicine/Gastroenterology, Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul 2020 to May 2021.

Methodology: Two hundred patients with irritable bowel syndrome and diagnosed on the basis of Rome-IV criteria were included in this study. They were divided into two groups via a lottery method. Group-1 received treatment as usual, depending upon the type of irritable bowel syndrome. Group-2 received treatment as usual and a gluten-free diet. Quality of life was assessed after one month using the World Health Organization Quality of Life-Brief scale.

Results: Out of 200 patients with irritable bowel syndrome included in the study, 93(46.5%) were male, while 107(53.5%) were female. 125(62.5%) had good quality of life after one month of treatment, while 75(37.5%) had lesser quality of life. Statistical analysis revealed that irritable use of a gluten-free diet had a statistically significant relationship (p-value<0.001) with good quality of life after one month of treatment in study participants.

Conclusion: After one month of treatment, good quality of life was found in many patients with irritable bowel syndrome. The use of a gluten-free diet in addition to treatment, as usual, was associated with good quality of life than routine treatment in these patients.
Efficacy of Glargine Insulin Compared with Neutral Protamine Hagedorn Insulin in Patients with Type 2 Diabetes not Controlled with Oral Hypoglycemics: A Cohort Study
Authors: Bilal Ebtihal , Burney Shamaila , Sajid Muhammad Usman , Shaukat Nabila , Farooq Muhammad
Published: October 2023

Objective: To compare the efficacy of Glargine Insulin with Neutral Protamine Hagedorn (NPH) Insulin in patients with uncontrolled type 2 diabetes with oral hypoglycemic.

Study Design: Prospective cohort study.

Place and Duration of the Study: Railway Hospital, Rawalpindi Pakistan, from Nov 2020 to Jul 2021.

Methodology: All patients aged 30-70 years of either gender, presented with uncontrolled diabetes mellitus on oral hypoglycemic for ≥1 year were enrolled. Patients were divided into Insulin Glargine and injection NPH subcutaneously by lottery method. In both groups, patients were compared for a reduction in HbA1c level after three months of treatment with Insulin. The efficacy was achieved after three months based on a>1% HbA1c level reduction compared to baseline HbA1c.

Results: The efficacy of Glargine Insulin was found to be significantly higher, 66(66%), as compared to NPH Insulin, 43(43%) (p-value = 0.002). After adjusting for all other covariates, the efficacy of Glargine Insulin was 3.81 times higher as compared to NPH Insulin (aOR 3.81, 95% CI 1.93-7052). Furthermore, efficacy was 6.95 times higher in patients with ≤25 kg/m2 BMI (aOR 6.95, 95% CI 3.16-15.30), 2.52 times higher in patients with ≤16 years of type 2 diabetes (aOR 2.52, 95% CI 1.30-4.87), 2.77 times higher in patients living in urban areas (aOR 2.77, 95% CI 1.43-5.36).

Conclusion: The efficacy of Glargine Insulin was found to be considerably higher than NPH Insulin in patients with type 2 diabetes not controlled with oral hypoglycemia.Keywords: Efficacy, Glargine insulin, NPH insulin, Type 2 diabetes.
Manipulation Under Anesthesia with Intra-Articular Steroid Injection versus Manipulation under Anesthesia in Idiopathic Adhesive Capsulitis of the Shoulder in terms of Functional Outcome
Authors: Munshi Naseem , Khalid Muhammad , Aziz Sobia , Abid Khadijah
Published: October 2023

Objective: To compare the outcome between manipulation under anaesthesia with intra-articular steroid injection in patients with shoulder adhesive capsulitis.

Study Design: Retrospective longitudinal study

Place and Duration of Study: Ziauddin Hospital, Karachi Pakistan, from Sep 2019 to Feb 2020.

Methodology: A total of 70 patients diagnosed with primary ACS were distributed into two groups, i.e., Group-M (35 in manipulation under anaesthesia only) and Group-MI (35 in manipulation under anaesthesia with an intra-articular steroid injection). All patients were assessed for shoulder pain and disability index along with the pain severity on the visual analogue scale at each subsequent visit on the first week, 1st, third and sixth months after the intervention.

Results: The results indicated a significant time effect (p=0.001) in both groups. The mean shoulder pain, disability index and pain on the visual analogue scale were lesser in the MI-Group than in the M-Group. Further, we found a statistically significant difference in mean shoulder pain (p=0.001) and disability index (p=0.016) between groups at six months.

Conclusion: In the initial post-procedure period and over six months of follow-up, MI showed improved outcomes than M. These patients require additional counselling and motivation for long-term physical therapy programs even after intervention for optimal results.Keywords: Adhesive capsulitis of the shoulder, Intra-articular steroid injection, Manipulation under anaesthesia
Comparison of Survival Analysis of COVID-19 Patients with Known Diabetes
Authors: Bashir Saira , Malik Sarwar , Khan Gohar , Ul Islam Fasih
Published: October 2023

Objective: To compare the survival rate of COVID-19 patients with diabetes versus without diabetes COVID-19 patients.

Study Design: Comparative, prospective study.

Place and Duration of Study: The patients were selected from the special ward established for COVID-19 patients came in Federal Government Polyclinic Hospital, Islamabad Pakistan, from Dec 2020 to May 2021.

Methodology: 50 without diabetes (control) and 50 with diabetes (study) confirm cases of COVID-19 patients, who fulfill the inclusion and exclusion criteria, were included in the study through consecutive sampling. Independent sample t test, chi square test and Kaplan-Meire survival analysis was used to compile the results.

Results: Out of 100 majority 75 patients were male. The average age of the patients was 52.08±14.85 years. Both the groups were equal with respect of gender with p-value >0.05. The average age of the patient was significantly higher in study group with p-value <0.001. Overall percentage of patients of oxygen dependency, mechanical ventilation required, and use of Angiotension receptor inhibitor were higher in study group as compared to the control group patients with p-value <0.001. The survival rate was lower in study group as compared to the control group but the difference was not significant with pvalue >0.05.

Conclusion: The COVID-19 patients with diabetes, need extra care and attention before and after infection in the current COVID-19 pandemic. They are at higher risk and with respect of prolong hospital stay due to severe attack of COVID-19 and also higher risk of mortality too.
Efficacy and Toxicity of Hypofractionated Palliative Radiotherapy for Breast Cancer Patients with Skin Invasion
Authors: Maqsood Talha , Zeb Adnan , Alvi Zeeshan Ahmed , Hussain Sameed , Wajid Muhammad Imran , Riaz Omer
Published: October 2023

Objectives: To determine the efficacy and toxicity of palliative radiotherapy for locally advanced breast cancer patients with skin invasion.

Study Design: Quasi-experimental study.

Place and Duration of Study: Radiotherapy Department Combined Military Hospital, Rawalpindi Pakistan, Jan 2019 to Jun 2020.

Methodology: Patients who received palliative radiotherapy for the breast cancer and received radiation of 24 Gray in 3 fractions to the breast/ chest wall were included. Radiation toxicity was assessed using RTOG criteria as the primary outcome of the study. Radiotherapy efficacy in controlling bleeding/discharge and improving pain and odour scores were the secondary outcomes.

Results: Twelve (80%) patients reported improvement in pain, 13/18(72.2) patients reported improvement in bleeding and 24/25 (96%) patients a decrease in pain level (p-value < 0.001). 11/25(44%) developed Grade-2 skin toxicity, and 8/25 (32%) developed Grade-3 skin toxicity. No patient experienced Grade-4 skin toxicity.

Conclusion: Our study has shown that hypofractionated radiotherapy is effective and safe for palliation of patients with locally advanced breast cancer and skin invasion.
Surgical Excision: An Effective Modality for Intradermal Melanocytic Nevus
Authors: Tahir Moizza , Ahmed Najia , Javaid Sidiqua , Malik Sadia , Rahman Atiya , Iqbal Shahid
Published: October 2023

Objective: To evaluate the effectiveness of fusiform surgical excision of intradermal melanocytic nevus and to document the aesthetic outcome of post-excisional surgical scar.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Tertiary Care Hospital, Gujranwala Pakistan, from Apr to Oct 2021.

Methodology: Patients with intradermal melanocytic nevus were enrolled after informed consent. Close-up photographs of the nevus and the site post-excision were taken. Local anaesthesia was injected with 2% Lignocaine with Adrenaline under aseptic measures. An elliptical incision with scalpel blade-15 was made around the nevus. The length of the incision was almost three times its width. Nevus and the involved tissue were removed to its full depth. A visual analogue scale was used to assess the scar cosmesis.

Results: A total of 37 intradermal melanocytic nevi, were included in the study. The size of the intradermal melanocytic nevus ranged from 0.5-2cm with a duration of 3-10 years. The mean visual analogue scar scale on day 5 of surgical excision was 7.23±1.423, and on day seven was 5.37±0.575. Surgical sutures were removed on day 5 in 13(35.1%) cases and day-7 in 24(64.9%) cases.

Conclusion: Surgical excision is an effective treatment modality for intradermal melanocytic nevus.
Bone Mineral Density in Symptomatic Patients with Comparison to Asymptomatic Patients
Authors: Akhtar Muhammad , Zaheer Sidra
Published: October 2023

Objective: To evaluate bone mineral density in symptomatic and asymptomatic patients.

Study design: Cross-sectional study.

Place and Duration of Study: Radiology Department, Pakistan Naval Ship, Shifa Hospital, Karachi Pakistan, from Aug 2017 to Aug 2019.

Methodology: The symptomatic individuals included in this study were those referred by a treating physician with complaints related to the skeletal system, such as bone pain. Asymptomatic individuals that were included were volunteers who had no symptoms related to bones. These individuals were evaluated by using dual-energy X-ray absorptiometry (DEXA).

Results: Five hundred twenty-nine individuals were included. Our study showed that the percentage of osteopenia and osteoporosis was 39.61% and 37% in symptomatic and asymptomatic individuals, respectively. These observations show that asymptomatic patients also suffer from osteopenia and osteoporosis. The percentage of asymptomatic patients suffering from osteopenia and osteoporosis was 2.0% and 35%, respectively.

Conclusion: The frequency of osteopenia and osteoporosis is increasing in symptomatic and asymptomatic patients in Pakistan. An alarming fact is that most of these positive asymptomatic patients are below 50 years.
Urdu Translation and Cross-Cultural Validation of Mood Disorder Questionnaire on Patient Engaging in Self-Harm
Authors: Yaqoob Naila , Ahsan Sadaf
Published: October 2023

Objective: to translate Mood Disorder Questionnaire and examine cross-cultural validation and estimate the reliability of the Urdu translated scale.

Study Design: Cross-sectional study.

Place and Duration of Study: Foundation University, Rawalpindi , from Jun to Sep 2020.

Methodology: Forty patients with self-harm, aged 18 to 35 years, were recruited from different Mental Health Departments of Rawalpindi, Multan and Jhelum hospitals. The study was conducted in two phases. The Mood Disorder Questionnaire was translated into Urdu using Brislin 1970 guidelines in Phase-I. In Phase-II, cross-language validation was conducted through test-retest Cronbach alpha reliability estimation and item-total correlations.

Results: Current research revealed that the Urdu-Group had higher correlation coefficients (α=0.80) than English-EnglishGroup (α=0.78) with acceptable Cronbach alpha reliabilities ranging between -1 to +1. Moreover, a significant positive item correlation (p<0.01) was found with the Mood Disorder Questionnaire composite score.

Conclusion: Current research findings established that the Urdu-translated version of the Mood Disorder Questionnaire was reliable and valid in Pakistani culture.
The Pattern of COVID-19-related Pneumonitis on High-Resolution Computed Tomography Chest in Post-Vaccination Patients
Authors: Ullah Hidayat , Saleem Humaira , Mahmood Rashid , Afzal Tayyaba , Saleem Rabia , Mahmood Asad
Published: October 2023

Objective: To find the changing radiological pattern of COVID-19 on HRCT chest in vaccinated patients.

Study Design: Observational, cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Sialkot Pakistan, from Jan to Feb 2022.

Methodology: All patients referred for High-resolution computed tomography (HRCT) chest were included. All participants underwent HRCT chest after recording the demographic data. Computed tomography (CT) images were reviewed by an experienced radiologist for pulmonary involvement and determining the computed tomography severity score, which ranged from 0-40 points.

Results: A total of 90 patients were included in the study. The mean age was 35.8±13.2 years. The number of partially vaccinated, fully vaccinated patients, and those with booster doses were 10(11.1%), 62(68.9%) and 18(20%), respectively. Patients with normal or non-specific findings on HRCT were 74(82.2%), and those with findings suggestive of COVID-19 pneumonitis were 16 (17.8%). The mean CT severity score among positive cases was 4.69±8.01, while the most frequent pulmonary finding was ground glass opacities found in 11(68.8%) cases.

Conclusion: Vaccination reduces the frequency and severity of pulmonary involvement in cases with breakthrough COVID-19 though the presentation of the disease and pattern of the pulmonary involvement does not show much change.
Comparison between Polypropylene Suture and Skin Staples for Securing Mesh in Lichtenstein Inguinal Hernioplasty
Authors: Bukhari Usman Shah , Ali Aamir , Ilyas Sohail , Pervaiz Hafiz Khalid , Shahid Farooq , Durrani Kamran
Published: October 2023

Objective: To compare Polypropylene suture versus skin Staples for securing the mesh in patients undergoing Lichtenstein inguinal hernioplasty in terms of operative time, post-operative wound infections and pain.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Surgical Department, Combined Military Hospital, Quetta Pakistan, from Dec 2018 to Jun 2020.

Methodology: A total of 220 patients with unilateral inguinal hernia were included in the study and divided into two equal groups of 110 patients each and were assigned either to the Polypropylene-Group or the Staples-Group. All the patients underwent Lichtenstein hernioplasty on the elective operation list. Both groups were compared regarding operative time, post-operative pain and wound infections.

Results: The mean operative time was 58.8±3.31 minutes in the Polypropylene-Group vs. 49.87±2.67 minutes in the StaplesGroup. The mean post-operative pain score was 2.73±2.07 in the Polypropylene-Group and 1.95±2.18 in the Staples-Group. Wound infection was observed in 26 patients (23.64%) of the Polypropylene-Group vs. eight patients (7.27%) of the StaplesGroup, respectively, (p<0.001).

Conclusion: In patients undergoing Lichtenstein inguinal hernioplasty, skin staples are better than Polypropylene sutures for securing mesh. Staple application is a swift and painless procedure with lesser post-operative pain and less frequency of wound infections.
Pregabalin as an Adjunct Analgesic in Multimodal Pain Management in Patients Presenting with Acute Peri-Anal Fissure
Authors: Raza Vishal Farid , Mahmood Qaiser , Waris Iqra , Malik Muhammad Shahwaiz , Irshad Khalid , Khan Khalid Javeed
Published: October 2023

Objective: To assess whether Pregabalin has a role as an adjunct analgesic in anal fissures along with standard conservative treatment.

Study Design: Quasi-Experimental Study.

Place and Duration of Study: Sir Ganga Ram Hospital, Lahore Pakistan, from Nov 2021 to Mar 2022.

Methodology: Thirty patients that fulfilled the inclusion criteria presenting to the Outpatient Department of General Surgery were enrolled in the study and assigned to either the standard Treatment-Group or the Pregabalin-Group. Patients were given standard treatment consisting of 0.2% topical GTN cream, stool softeners and analgesics in the form of NSAIDs and Paracetamol for their acute anal fissure, or they were given standard treatment with adjunct Pregabalin 50mg twice a day. The numerical pain score was recorded at enrollment after one week of follow-up.

Results: There was a significant difference between the change in visual analogue scores from baseline between both groups, (p-value of 0.008). There was a significant difference between days till maximum pain relief was achieved between the two groups (p-value of 0.01). 29(96.6%) of fissures were caused due to constipation.Conclusion: Pregabalin provides modest analgesic effects in anal fissures and may be used as an adjunct analgesic in patients with severe pain.
Diagnostic Accuracy of Magnetic Resonance Cholangio-Pancreatography (MRCP) in Evaluating Obstructive Jaundice, Keeping Endoscopic Retrograde Cholangio-Pancreatography(ERCP) as Gold Standard
Authors: Qaisar Irum , Nasrullah Faran , Haq Intisar Ul , Younas Rabia , Shakeel Yasar , Aamir Muhammad Omer
Published: October 2023

Objective: To determine the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography in evaluating obstructive Jaundice, taking Endoscopic Retrograde Cholangiopancreatography as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging in collaboration with the Gastroenterology Department of Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2019.

Methodology: Ninety patients with a history of obstructive Jaundice referred to the Armed Forces Institute of Radiology and Imaging for Magnetic Resonance Cholangiopancreatography were included in the study. Magnetic Resonance Cholangiopancreatography was followed by Endoscopic Retrograde Cholangiopancreatography within 48 hours. Magnetic Resonance Cholangiopancreatography results were compared with Endoscopic Retrograde Cholangiopancreatography and diagnostic accuracy was calculated.

Results: The mean age was 57.58±14.65 years. The study constituted 40 male (44.4%) and 50 female (55.6%) patients. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of Magnetic Resonance Cholangiopancreatography, keeping Endoscopic Retrograde Cholangiopancreatography as the gold standard, were calculated as 91.04%, 89.04%, 95.31%, 76.90% and 90.0%, respectively. The positive likelihood ratio was 7, while the negative likelihood ratio was 0.10.

Conclusion: Magnetic Resonance Cholangiopancreatography is a non-invasive and safe investigation with excellent diagnostic accuracy in evaluating obstructive Jaundice. Thus, Magnetic Resonance Cholangiopancreatography may be an alternative to Endoscopic Retrograde Cholangiopancreatography, especially in cases without intervention or in pregnant females, as it is free from ionizing radiation.
Comparison of Therapeutic Effects in terms of Menstrual Irregularities between Statins and Metformin in Unmarried Patients with Polycystic Ovarian Syndrome
Authors: Nawaz Sobia , Mushtaq Naila , Waheed Aisha , Nawaz Samia , Ajaib Sadaf , Butt Suniya Arshed
Published: October 2023

Objective: To compare therapeutic effects in terms of menstrual irregularities between Statins and Metformin in unmarried patients with polycystic ovarian syndrome.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Zhob Pakistan, from Sep 2021 to Feb 2022.

Methodology: A study sample of 60 unmarried women aged 18-35 years diagnosed with PCOS having menstrual irregularity was collected and randomly allocated into two treatment groups. Women in Group-A were given simvastatin, while Group-B received Metformin. The outcome variable was an improvement in menstrual irregularity, assessed after three months of treatment in terms of the spontaneous normal menstrual cycle (28-35 days).

Results: The mean age of the patients was 27.43±4.72 years, while the mean duration of the disease was 23.63±5.99 months. The mean BMI of these women was 26.78±3.47 Kg/m2, and 20 (33.3%) women were obese. The frequency of improvement in menstrual irregularity was significantly higher in women receiving Simvastatin as compared to Metformin [24 (80.0%) vs. 10 (33.3%); p-value<0.001)].

Conclusion: In the present study, simvastatin was found more efficacious in the treatment of women with polycystic ovarian syndrome than Metformin in terms of normalization of menstrual irregularities regardless of patient’s age, duration of disease and BMI, which advocates the preferred use of statins in the management of future gynaecological practice.
Acute Kidney Injury in Neonates who Develop Asphyxia at the Time of Delivery
Authors: Zamir Saba , Nadeem Muhammad Tariq , Goheer Lutfullah
Published: October 2023

Objective: To determine the frequency of acute kidney injury in neonates who develop asphyxia at delivery.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Paediatrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, Aug 2021 to Feb 2022.

Methodology: This study was based on 69 patients diagnosed with birth asphyxia on the basis of APGAR score at 5 minutes. Patients underwent testing for serum creatinine levels at 24 hours post-delivery, as well as the monitoring of urine output, and acute kidney injury was classified according to the KDIGO classification, based on the increase in serum creatinine levels and urine output.

Results: Acute kidney injury was observed in 12(17.4%) cases and 3(4.3%) neonates died. Lower gestational age at birth was associated with acute kidney injury (p=0.038), and acute kidney injury was associated with a higher chance for mortality (p<0.001). Additionally, male infants had a lower head circumference (p=0.001), a lower total body length (p<0.001) and a lower APGAR score at birth (p=0.004) when compared to females. However, they did not appear to have a higher risk for acute kidney injury (p=0.121).

Conclusion: Acute kidney injury following the development of birth asphyxia is a common occurrence in our population efforts should be made to identify pregnancies at risk to mitigate this potentially devastating complication.
Uropathogens and their Culture Sensitivity Pattern in Children with Urinary Tract Infection.
Authors: Jamal Muhammad Musarrat , Arif Asad , Sarfaraz Amna , Jamal Javeria , Mahmood Sohaib , Musarrat Maniha
Published: October 2023

Objective: To determine the frequency of bacteria causing Urinary Tract infections and their susceptibility to antibiotics in children of Sialkot.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Pediatrics Islam Teaching Hospital, Children Complex Hospital, and Islam Central Hospital, Sialkot Pakistan, from Jan to Dec 2020.

Methodology: All patients presenting with Urinary Tract infections, aged one month to 15 years were included in the study. Inclusion criteria were clinical suspicion of Urinary Tract infections and positive urine culture of a single bacterium. Antibiotic susceptibility was performed on all culture-positive samples.

Results: A total of 300 children were included, but 248 fulfilled the criteria of culture-positive Urinary Tract infections. Fiftytwo children were excluded as they had non-pathogen growths, multi-organisms or were already on antibiotics. Gramnegative bacilli were most frequently isolated, accounting for 236(95.2%), whereas Gram-positive cocci comprised only 12 (4.8%) of cases. E. coli was the most frequent isolate among gram-negative rods, followed by Klebsiella, Proteus and Pseudomonas. All gram-negative rods were sensitive to Imipenem, whereas most were resistant to Ampicillin and TMP-SMX. Gram-positive cocci were sensitive to Vancomycin, Linezolid, Meropenem and Tazobactam.

Conclusion: Increasing resistance of uropathogens to commonly prescribed antibiotics is highly alarming. Therefore, the strategy of empirical treatment of Urinary Tract infections in children should be reevaluated based on regional studies.
Folate Deficiency: Is it Related to the Development of Depression
Authors: Bajwa Asif Azeem , Ali Sohail , Khan Sikandar Ali , Raza Hassan , Hussain Fayyaz , Nazir Tashfeen Bin
Published: October 2023

Objectives: To determine the frequency of serum folate deficiency among patients with depression and to compare mean serum folate levels with the severity level of depression.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Mental Health, Rawalpindi Pakistan, from Sep 2021 to Feb 2022.

Methodology: We consecutively recruited 155 study subjects. Basic demographic data were recorded. The severity of depression was assessed using the Hamilton Depression Rating Scale–Urdu version (HAM-D U). Blood samples were collected to determine serum folate before commencing any treatment for depression; serum Folate levels were assessed at the Armed Forces Institute of Pathology.

Results: The mean HAM-D score was 17.14±4.29, with minimum and maximum scores of 8 and 22. 97(62.6%) cases had mild– moderate depression, and 58(37.4%) patients had severe depression. The mean serum folate levels were 3.10±1.40 ng/ml. There were 57(36.8%) cases that had normal folate levels, 45(29%) cases that had borderline folate levels, and 53(34.2%) cases that had folate deficiency. The frequency of borderline folate deficiency was statistically higher in cases with severe depression, (p-value<0.001).

Conclusion: Results of this study highlight that the frequency of borderline–folate deficiency was statistically higher in cases with moderate and severe depression.
Etiological Spectrum and Outcome of Acute Kidney Injury in Children: A Tertiary Care Experience
Authors: Anjum Muhammad Atif , Akhtar Naureen , Parveen Shahida , Chaudry Adeela , Ain Noor ul , Saud Muhammad Sahir
Published: October 2023

Objective: To determine the aetiologies and outcomes which would help reduce preventable deaths from acute kidney injury.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Paediatric Nephrology unit at University of Child Health Sciences, The Children’s Hospital Lahore Pakistan, from Aug 2021 to Jul 2022.

Methodology: A total of 149 children who fulfilled the selection criteria were included in the study. Kidney Disease: Improving Global Outcomes guidelines were used for defining and staging acute kidney injury. The aetiology for each case of acute kidney injury was determined using standard workup/protocol and classified as pre-renal, renal and post-renal. Outcome parameters were recovery, improvement, death and progression to chronic kidney disease.

Results: The mean age of children was 61.79±52.26 months, predominantly boys (68.5%). The most common etiological group was renal (73,49%), followed by pre-renal (53,35.6%) and post-renal (23,15.4%). It was observed that the majority of children had stage-3 AKI (63.8%), with kidney replacement therapy (KRT) given in 92(61.7%) cases. Mortality was seen in 30.9%, while recovery, improvement and death occurred in 69(46.3%), 44(29.5%) and 36(24.2%), respectively, at the time of discharge. At three months of follow-up, recovery, progression to chronic kidney disease, and death occurred in 73(49.0%), 20(13.4%) and 10(6.7%) children, respectively.

Conclusion: Intrinsic renal disease was the most common etiological group occurring primarily in the form of AGN, and sepsis was found to be the most common underlying aetiology. Most patients presented in Stage 3 of acute kidney injury, and recovery was seen in many patients.
Histological Outcome of Needle Core Biopsies in Breast Lesions and Advantage of Using Reporting Categories of Royal College of Pathologists, London (UK)
Authors: Sarfraz Tariq , Aneeqa Saba , Tariq Humaira , Wahid Yasmin , Ramzan Rehana , Khattak Tania , Afzal Salma , Riaz Rubina
Published: October 2023

Objective: To determine the frequency of various categories of lesions in needle core biopsies done in breast lumps and the utility of using the reporting categories (B1 – B5) of the Royal College of Pathologists London (United Kingdom).

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Histopathology, Foundation University Medical College, Islamabad Pakistan, from Jan to Dec 2021.

Methodology: The study included one hundred cases of needle core biopsies done on breast lumps. After processing the tissue, the slides were made and stained with Hematoxylin and Eosin. Microscopic evaluation was done by the consultant Histopathologist. The frequency of various breast lesions was analyzed, and they were categorized into different ‘B’ categories according to Royal College of Pathologists guidelines.

Results: The lesions included in B1 category (Normal tissue) comprised five cases (5%), B2 category (Benign) twenty cases (20%), B3 category (Uncertain malignant potential) twelve cases (12%), B4 category (Suspicious for malignancy) three cases (3%) and B5 category (Malignant) sixty cases (60%).

Conclusion: Reporting of needle core biopsies, according to the reporting categories of the Royal College of Pathologists, London (B1–B5), gives a precise diagnosis of most lesions and provides the clinician with a clear road map for further management. B5 Category (Malignant) lesions are needle core biopsies' most common histological outcomes.
Association of Smoking with Dental Caries and Periodontal Health Status Among Incarcerated Women in Karachi
Authors: Shah Hina , Khan Imran , Khan Sibghat Ullah , Kershan Jai , Ahmed Sanaa , Ayaz Sumbul
Published: October 2023

Objective: To assess the association of smoking with dental caries and periodontal health status among incarcerated women in Karachi facility, Sindh, Pakistan.

Study Design: Cross-sectional study.

Place and Duration of study: Department of Community, Sindh Institute of Oral Health Sciences, Karachi Pakistan, from Dec 2021 to Feb 2022.

Methodology: All female inmates between the ages of 18-65 years, serving various jail terms, including those sentenced to life, prisoners condemned to death and awaiting trial, were included in the study. For each participant, dental caries and periodontal status examinations were performed. Dental caries was scored using the DMFT index, while periodontal status was scored using the CPI index. Smoking status (yes or no) and duration of smoking were observed.

Results: Out of 131 women, 76(58%), 42(32.1%), and 13(9.9%) had a DMFT score between 0-5, 6-10, and 11 or higher, respectively. 14(63.6%) and 2(9.1%) women smokers had moderate to severe periodontitis. The association between smoking and severe periodontitis was statistically significant (p=0.023). Employment status prior to incarceration was significantly associated with smoking (p=0.02).

Conclusion: We concluded that the rate of severe periodontitis was higher among incarcerated women who were smokers. Women in prison require regular oral health assessment and increased awareness about oral health management. Smoking was not a significant factor associated with dental caries or periodontal disease.Keywords: CPI index, Dental caries, DMFT, Oral health, Periodontitis, Smoking, tobacco.
Comparison of Hemodynamic Stability of Patients Undergoing Appendectomy under Spinal Anesthesia versus Blend of Ketamine and Midazolam with Spinal Anesthesia
Authors: Kayani Kaukab Majeed , MALIK Usman Eijaz , Hafiz Amran , Hussain Fayyaz , Munir Humayun , Saqib Najm us
Published: October 2023

Objective: To compare appendectomy under spinal anaesthesia versus combining Ketamine and Midazolam with spinal anaesthesia.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jan to June 2022.

Methodology: A sample of 100 patients fulfilling the inclusion/exclusion criteria was collected. A random segregation was made into two equal groups through the lottery method resulting in fifty patients in each Group-50. The Group A patients received spinal anaesthesia while and were given 0.25mg/kg Ketamine and 2mg Midazolam 2 minutes before incision. Group B patients only received spinal anaesthesia. Patients’ hemodynamics were monitored throughout surgery. The primary parameter studied was hemodynamic stability, and the secondary parameter was conversion into general anaesthesia.

Results: The primary outcome was hemodynamic stability. 48(96%) patients remained hemodynamically stable in Group A. Only 2(4%) patients showed hemodynamic instability. The Group B patient had lower hemodynamic stability as 29(58%) patients were hemodynamically unstable versus 21(42%) being stable (p-value <0.001).

Conclusion: Using Ketamine and Midazolam as adjuvants to spinal anaesthesia improves hemodynamic stability and success for open appendectomy.Keywords: Anesthesia, Ketamine, Midazolam, Spinal anesthesia.
A modified anal eversion technique for colorectal anastomosis in laparoscopic rectal cancer surgery
Authors: Aslan Mehmet , Karaköse Oktay
Published: October 2023

Aims: This study presents a modified colorectal anastomosis method that consists of multi-task use of a circular stapler and anal eversion to perform a safer anastomosis. We aimed to describe the anorectal eversion and anastomosis techniques in detail and compare the results of the modified technique with those of the standard laparoscopic surgical technique.
Methods: This retrospective study was conducted with fifty-five patients who underwent laparoscopic TME for middle and distal rectal cancer between 2016-2022. The patients were divided into two groups: those who underwent standard laparoscopic transabdominal surgery and those who underwent anorectal eversion (Modified ASET Method). The baseline features of the patients and the distribution of surgical outcomes between the two groups were statistically compared.
Results: The Modified ASET group consisted of twenty-one patients. The morbidity rate associated with this procedure was 14.2%. CRM was positive in 9.5% of patients, and a safe distal surgical margin was achieved in all patients. The local recurrence rate is 4.7%. No statistically significant difference was observed between the Modified ASET and standard TME groups in terms of oncological outcomes (p = 0.828).
Conclusion: Anorectal stump eversion and extra-abdominal transection-based modified colorectal anastomosis are reliable approaches that provide satisfactory surgical outcomes.
Evaluation of the methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes in Turkish patients with microtia
Authors: Pehlivan Sacide , Nursal Ayşe Feyda , Oyacı Yasemin , Pehlivan Mustafa , Bekerecioğlu Mehmet
Published: October 2023

Aims: Microtia is defined as a congenital malformation of the middle and external ears. DNA methylation is the major epigenetic modification of genomic DNA that is regulated in the early embryonic stage. In this study, we analyzed the methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes in patients with microtia.
Methods: The blood samples were taken from microtia patients and healthy controls. Genomic DNA was isolated using a commercial kit. The methylation status of the MB-COMT, APC2, NR3C1, and DRD2 genes was analyzed using the methylation-specific polymerase chain reaction (MS-PCR) method. The results were evaluated statistically.
Results: The DRD2 methylation status was found to be associated with microtia (p?0.001). We found that the DRD2 gene was partially methylated in all patients with microtia. There was no significant difference between the methylation status of the MB-COMT, APC2, and NR3C1 genes and microtia.
Conclusion: To our knowledge, this is the first study in our country to evaluate the relationship between the methylation of these genes and the risk of microtia. Our results demonstrate the presence of epigenetic changes in the DRD2 gene during microtia development. Methylation may have contributed to the pathogenesis of microtia as it affects gene expression. Studies with larger sample sizes and in different ethnic groups are needed to further investigate the role of these genes in microtia.