bluuebunny/crossref_metadata_2025 huggingface dataset:
Climate change and health outcomes in Sub-Saharan African countries
Authors: Okirie Uche , Adesete Ahmed Adefemi
Published: November 2024

This paper examines the effect of climate change on health outcomes in sub-Saharan Africa (SSA). Greenhouse gas emission was used as the measure of climate change, while life expectancy rate was used as the measure of health outcomes. This paper's significant contribution is how the interaction of climate change and government effectiveness index influence health outcomes in SSA. We estimated the impact of climate change on health outcomes using the panel system generalized method of moments (GMM) method. Our empirical result show that there is a negative and significant relationship between climate change and life expectancy in the short and long run. In addition, we find that if effective government policy is interacted with climate change, this mutes the negative impact of climate change on health outcomes in SSA. This implies that, with effective government policies targeted toward achieving net zero carbon emission, climate change is not expected to have a significant impact on health outcomes in SSA.
Saudi English language teachers’ pre-service education: How effective is it?
Authors: Al-Mohanna Ayedh Dhawi
Published: November 2024

This study aims to examine the pre-service education of English as a foreign language (EFL) teachers in the context of Saudi Arabian education. The research methodology adopts a qualitative approach, incorporating document analysis and interviews as means of data collection. The document analysis is employed to elucidate the objectives and substance of the EFL teacher pre-service education program. The interviews are conducted to investigate EFL teachers' perspectives regarding their experiences as applicants in the EFL teacher pre-service education programs provided by English departments at Saudi universities. The target population of this study is a group of male teachers who graduated from Saudi universities with a bachelor's degree in English and currently teach English as a foreign language in Saudi public schools (elementary, intermediate, and secondary levels). A total of 112 EFL teachers participated in the study. Their teaching experiences range from 2 to 4 years. They graduated from different Saudi universities. This study indicates that the pre-service education for Saudi EFL instructors is insufficient in adequately preparing and equipping English teachers with the necessary knowledge and skills for their professional requirements. Therefore, it is essential to enhance pre-service education to offer the best possible support to its candidates. The study presents several recommendations and suggestions to guarantee the efficacy of EFL teacher pre-service education in the Saudi Arabian context.
LEMIERRE SYNDROME: A FORGOTTEN INFECTION
Authors: Ullah Raza , Shahada Naz  , Haleema
Published: November 2024

Lemierre's syndrome is a serious disease caused by an anaerobic bacteria called Fusobacterium necrophorum, which usually occurs in healthy teenagers and adolescents. The infection takes place in the throat and spreads through septic thrombosis of the tonsillar and internal jugular veins. The resulting bacterial infection is complicated by septic emboli in several places such as the lungs, joints and bones. Fever, pharyngitis, dysphagia, odynophagia, or swelling of the oropharyngeal is a common symptom. Although rare, there has been evidence of a recurrence of the condition in recent years, which may be associated with a reduction in the use of antibiotic therapy for the cold throat. The typical clinical image is characteristic, but many doctors do not recognize the condition and diagnoses are often delayed with potentially fatal consequences. We are presenting a similar case of Lemierre's syndrome in an elderly female with pharyngitis, resulting in thrombophlebitis, empyema and discharging neck sinus.
PREVALENCE AND DETERMINANTS OF DEPRESSION AMONG AMPUTEES IN QUETTA REGION
Authors: Khan Abdul Baqi , Zia Qasim , Khan Muhammad Ilyas , Humaira  , Kant Sara Bashir , Qadeer Asma Abdul , Jawad Abbasi Mudassar Mushtaq
Published: November 2024

Background: Depression is increasingly diagnosed in the general population today. The loss of a limb through amputation, which can result in disfigurement, may also contribute to the development of depression despite pre-operative counselling. Understanding the factors associated with depression in individuals with limb amputation is important to effectively identify and manage this psychological condition. The objective of this study was to identify the factors associated with depression in individuals who have undergone limb amputation. Methods: A descriptive cross-sectional study was conducted in Quetta City from May to July 2018. Data were collected using a structured, respondent-cantered questionnaire based on the Hospital Anxiety and Depression Scale (HADS). Results: Females were more affected as 5 out of 7 (71.42%) were depressed compared to 32 out of 47 (68%) males. The study found a statistically significant association between depression and marital status (p-value of 0.047) as well as amputation (p-value of 0.039). These results suggest that both sociodemographic factors, such as marital status, and the experience of amputation are associated with the development of depression in individuals with limb amputation. Conclusion: Amputation is significantly associated with the level of depression among amputees, and sociodemographic factors, such as marital status, also play a role in the development of depression. Therefore, it is recommended to conduct yearly screenings for depression following an amputation to effectively identify and manage this psychological condition. Further research and interventions are needed to address the mental health needs of individuals with limb amputation and implement strategies for depression prevention and management in this population.
PAEDIATRIC CASE OF 3-METHYLCROTONYLGLYCINURIA WITH ENCEPHALOPATHY: A CASE REPORT FROM PAKISTAN
Authors: Ali Gova Murtaza , Noor Noshaba , Nawaz Hira , Rameen Akhter Molani
Published: November 2024

3-Methylcrotonylglycinuria is a common inborn error of metabolism (IEM) resulting from the deficiency of 3-Methylcrotonyl-CoA carboxylase (3-MCC) and its prevalence ranges from 1:2400 to 1:6800. The disease may be asymptomatic or may present with signs of "metabolic crisis". In our four and a half months old male patient, the disease manifested as fever, fits and an altered level of consciousness, along with signs and symptoms of metabolic crisis. The purpose of this case report is to highlight a clinical presentation of 3-MCG, as seen in this patient to ensure timely diagnosis and treatment.
ADMISSION FRAILTY SCORE AS A GOOD CLINICAL SUBSTITUTE OF SOFA SCORE TO PROGNOSTICATE POST-PERCUTANEOUS CORONARY INTERVENTION PATIENTS ON ADVANCED LIFE-SUPPORT
Authors: Baig Mirza Yousuf , Ansari Muhammad Imran , Hassan Mujtaba , Arif Muhammad Shoaib , Memon Aziz ur Rehman , Umair Madiha , Abubaker Jawed
Published: November 2024

Background: This study aimed to assess and compare the prognostic value of frailty score (FS), Sequential Organ Failure Assessment (SOFA) score, and additive of FS and SOFA score, at the time of admission to the coronary care unit (CCU), for the prediction of short-term poor prognosis in post-myocardial infarction (MI) patients, requiring advanced life-support. Methods: A cohort of post-MI patients admitted to CCU. The FS and SOFA score were obtained at the time of CCU admission. The prognostic value of FS, SOFA score, and FS+SOFA score was assessed to predict in-hospital and short-term follow-up mortality. Results: The study sample consisted of 312 patients: females were 27.2% (85), and the mean age was 60.32±11.51 years. A concordance rate of 51.8% was observed between admission FS (‰¥3) and SOFA score (‰¥9). A total of 67.3% (210) patients were categorized as moderate to severely frail (‰¥3), while the SOFA score identified 26.0% (81) high-risk (‰¥9) patients. The receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.707 [0.638-0.776], 0.764 [0.704-0.825], and 0.783 [0.724-0.842] for in-hospital mortality and 0.684 [0.621-0.746], 0.718 [0.659-0.778], and 0.744 [0.687-0.801] for 180-day cumulative mortality against FS, SOFA, and FS+SOFA score, respectively. A hazard ratio of 2.75 [1.61-4.71] and 2.51 [1.68-3.75] were observed for mortality during 180-day follow-up among patients with FS ‰¥3 and SOFA score ‰¥9, respectively. Conclusion: CCU admission Frailty Score is a good clinical substitute for SOFA score for an early prognostication of post-MI patients on advanced life-support.
HAEMATOLOGICAL TOXICITIES OF GEMCITABINE PLUS CISPLATIN VERSUS FLUOROURACIL, CISPLATIN, PLUS DOCETAXEL FOLLOWED BY CONCURRENT CHEMORADIOTHERAPY IN LOCOREGIONALLY ADVANCED NASOPHARYNGEAL CARCINOMA
Authors: Rehman Abdul , Haider Ghulam , Ramchand Aakash , Khan Shumaila Nawaz , Saher Sana , Mahmood Raheela , Khattak Yasir Rehman , Anaum  , Siddiqua Aisha , Aqeel Muhammad Arsalan
Published: November 2024

Background: Nasopharyngeal carcinoma is endowed with unique epidemiological characteristics, treatment modalities, and prognostic considerations. Patients with bulky primary tumours and extensive nodal involvement are categorized as locoregionally advanced NPC. These patients present a high-risk cohort in terms of the unfavourable prognostic features. In this patient cohort, the 5-year local control rates have been observed to fluctuate within the range of 69-79%. The objective was the assessment of the local control and adverse haematological toxicity profiles of neoadjuvant chemotherapy (NACT) (i.e., docetaxel, cisplatin, plus fluorouracil (TCF) and gemcitabine plus cisplatin (GC)) followed by concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (LANPC) was the primary objective of this work. Methods: Patients aged 16-65 years, confirmed NPC, stage III-IVA disease and ECOG performance score ‰¤2 were enrolled in this prospective study. Besides the common CCRT regimen, the patients received NACT with docetaxel 30 mg/m2, cisplatin 40 mg/m2 plus fluorouracil 750 mg/m2 (Group I) or gemcitabine 1 g/m2 plus cisplatin 80 mg/m2 (Group II). At 6 weeks after completion of CCRT, treatment response was assessed with the RECIST criteria. Adverse haematological events were evaluated with peripheral white blood cells, neutrophils, haemoglobin, and platelets after each cycle of NACT. Results: Of the total 68 enrolled patients with locoregionally advanced NPC (LANPC), 50 (73.5%) were male patients. Group I consisted of 36, while Group II comprised 32 patients. The mean (interquartile range) age of the patients in Group I was 40.9±11.6 (30.3-51.8) years, while in Group II was 38.6±11.3 (29.5-51.0) years. Complete response (CR) of the treatment was higher and partial response (PR) was lower in Group II compared to Group I (71.9% vs. 44.4% and 18.6% vs. 50%, respectively). Haematological toxicity profiles were consistent in Groups I and II, illustrating mild anaemia and lymphopenia, severe neutropenia and a mixed pattern of thrombocytopenia. Conclusion: Among patients with LANPC, GC-based NACT showed superior CR compared with TCF-based NACT. However, the haematological toxicity profiles in the two groups were comparable.
THE DICHOTOMY BETWEEN HEAT SHOCK PROTEIN-27 AND MICROALBUMIN: COVARIATE OF EARLY DIABETIC NEPHROPATHY
Authors: Muhammad Irfan  , Fatima Abid  , Azhar Arfa , Farooqui Mohammad Umair , Urooj Fatima  , Siddiqui Muhammad Subhan
Published: November 2024

Background: Heat shock protein-27 is the microprotein released from renal parenchyma during diabetic oxidative stress, while microalbumin is the plasma protein that appears in urine in diabetic nephropathy. Methods: This case-control study was conducted from Jan to Sep 2021 in the Physiology department, BMC, BMCH, Quetta. The current study included 105 patients with an age range from 30-50 years and was divided into three groups: i) a control group of healthy participants, ii) a diabetic risk group: participants without signs of diabetic nephropathy and diabetic duration from 1-5 years, iii) diabetic nephropathy group: participants having >30 mg/dl of v microalbumin in urine and diabetic duration from 5-10 years. Results: There were significant mean differences between all groups with respect to anthropometric measurements except in height amongst all groups. Statistically significant mean differences were seen in the risk and nephropathy group with respect to serum FBG, RBG, and HbA1c. Elevated microalbumin levels in the diabetic nephropathy group (50.9±8.2) compared with the diabetic risk group (15.4±2.9). Similarly, higher levels of HSP-27 were seen in the diabetic nephropathy group (230.46±23.75) as compared with the diabetic risk group (117.60±14.50). Conclusion: HSP-27 is a better biomarker than microalbumin and may show early glomerular injury in the early diabetic stage of diabetic nephropathy
ENHANCED RECOVERY AFTER CAESAREAN SECTION - AN IMPROVED PATHWAY THAN CONVENTIONAL CARE FOR REDUCING HOSPITAL STAY
Authors: Uzma Afreen  , Fazal e Karim Faisal  , Khan Maliha Khalid , Zahid Akhtar Rao  , Rozina Mustafa  , Sanober Afreen
Published: November 2024

Background: With the help of an evidence-based approach called Enhanced Recovery After Surgery (ERAS), patients can receive standardised perioperative care and recover more quickly. Many surgical specialties, such as orthopaedics, gynaecological onco-surgery, breast surgery, urology, and colorectal surgery, use ERAS protocols extensively. Improved postoperative recovery has been shown to be beneficial in lowering hospital stays, costs, and increasing patient satisfaction. This study sought to determine whether the application of an enhanced recovery after surgery (ERAS) protocol for patients having an elective caesarean section would improve the patients' postoperative status regarding pain management, length of stay in the hospital and expenses associated with complications. Methods: A prospective study was conducted in PAF Hospital Faisal, Karachi. Women scheduled for elective caesarean sections were enrolled in the cross-sectional study from February 2023 to July 2023, and they were compared to women who had caesarean sections during the same time period and received conventional perioperative care. Patients with medical or surgical comorbidities, as well as women who had emergency or urgent caesarean sections, were excluded. The surgical method was same in both ERAS and non-ERAS arms. Intravenous hydration was used to achieve a specific purpose. After 4 hours, liquids were introduced, followed by solids after 6 hours. Intravenous paracetamol and intramuscular diclofenac were given regularly. After 6-8 hours, the Foleys catheter was withdrawn. The conventional care group fasted for 6 hours before and after surgery. The catheter was left in place for 24 hours, and 2500 ml of intravenous fluids were administered on the first day, followed by 1000 ml on the second. The length of hospital stay was determined by clinical criteria and the discretion of the care providers. Results: In contrast to the conventional care group, the ERAS arm experienced a much shorter post-operative hospital stay. (p-value= 0.001; 33.42 vs. 61.30 hours). The patient quickly recovered due to early eating, early ambulation, early catheter removal, multimodal pain management, and pre-emptive analgesia and antibiotic administration. Conclusion: The ERAS protocol has been shown to be beneficial in lowering postoperative pain and nausea, the average cost of hospitalization, and improving patient satisfaction. It seems to be worth implementing this protocol widely among patients undergoing elective caesarean sections
EFFECT OF COMPREHENSIVE DENTAL TREATMENT UNDER GENERAL ANAESTHESIA ON CHILDREN'S ORAL-HEALTH-RELATED QUALITY OF LIFE: A COMPARATIVE CROSS-SECTIONAL STUDY
Authors: Qazi Halima  Sadia , Usman Nazir  , Hira Nisar  , Omer Ali  , Palwasha Babar  , Sajjad Ahmad
Published: November 2024

Background: Despite reductions in dental caries experience in developed countries, early childhood caries remains the most prevalent health problem in developing countries. This has a direct impact on the oral health-related quality of life of both children and parents. The objective of this study was to examine the impact of comprehensive dental treatment under general anaesthesia on Oral health-related quality of life in children, using a parental and caregiver perception questionnaire. Methods: A comparative study was conducted in the Children Hospital, Pakistan Institute of Medical Sciences, Islamabad from July to December 2015. A total of 40 children were enrolled in the study. The oral health-related quality of life questionnaire was completed by either parent/caregiver at the initial and follow-up visits after 4-8 weeks of treatment under general anaesthesia. Results: The mean age of all the enrolled children was 5.7±1.7 years. Among 40 children, 55% (22) were girls and 45% (18) were boys. A highly significant reduction was observed between the pre and post-treatment P-CPQ total scores from 76.9±15.8 to 13.3±9.5 with a p-value <0.0001. Regarding the P-CPQ domains, a significant reduction from the pre- to post-treatment scores was observed for oral symptoms; functional limitations, emotional well-being, and social well-being with a p-value <0.0001. Conclusion: The oral health-related quality of life was significantly improved after comprehensive treatment under GA. The findings of this study may be utilized to improve future guidelines and betterment of dental health of children by health care providers and initiatives for future health programs.
COMPARISON OF POSTOPERATIVE PAIN WITH AND WITHOUT PECTORAL BLOCK IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY
Authors: Zenab Noorain  , Waqar S H , Saad Ali Shah  , Shahabul Huddah  , Sajid Ali Shah
Published: November 2024

Background: Modified Radical Mastectomy is associated with significant acute postoperative pain. If this pain is not managed properly most patients will develop chronic post-mastectomy pain, which reduces quality of life. Pectoralis (PECS) block is effective in reducing pain and the consumption of analgesia in the post-operative period. The objective was to compare mean post-operative pain with or without pectoral (PECS) block in females undergoing modified radical mastectomy under general anaesthesia. Methods: A randomized controlled trial was done in the Department of General Surgery at Pakistan Institute of Medical Sciences, Islamabad. Patients who fulfilled the inclusion criteria and underwent modified radical mastectomy were included in the study. A total of 60 patients, were randomly divided into two equal groups, the PEC group and without PEC group. After surgery, patients were shifted to the postoperative care unit and were assessed for postoperative pain after 6 and 12 hours. Data was collected and descriptive analysis was done using SPSS version 22. Results: The mean age and BMI of the patients was 51.52±10.29 years and 24.1±3.94 kg/m2, respectively. Among patients from the PEC group, the mean post-op pain after the 6 hours was 2.13±0.571 while in the without PEC group, the mean post-op pain was 2.67±1.093 (p-value=0.021). Similarly, in patients from the PEC group, the mean post-op pain after the 12 hours was 1.20±0.407 while in the without PEC group, the mean post-op pain was 1.63±0.615 (p-value=0.002). Conclusion: Post-operative pain with PEC block showed significantly better control as compared to the patients without PEC block group in females undergoing modified radical mastectomy under general anaesthesia.
COMPARISON OF FAILURE RATE OF TEMPORARY ANCHORAGE DEVICES PLACED WITH PLATELET RICH PLASMA AND PLACEBO OVER SIX MONTHS: A SPLIT MOUTH RANDOMIZED CLINICAL TRIAL
Authors: Ahmad Nofil , Durrani Owais Khalid , Faiza Ijaz  , Zuhaa Mushtaq  , Iram Abbas
Published: November 2024

Background: The aim of this in vitro research was to compare and evaluate the stability of TADs coated with PRP over 6 months. TAD stability is essential for the long-term success of orthodontic treatment. PRP has become a valuable adjunct to promote healing in many procedures of oral surgery. The use of PRP in combination with bone grafts in dental treatments yields positive results in terms of improving the handling properties of the grafts and enhancing the quantity and quality of the newly formed bone. Methods: This study was conducted at Islamic International Dental College, Orthodontic Department for 6 months from April 2018 to February 2019. It was a triple-blinded study using split-mouth randomized clinical trial. Comparison of Failure of Temporary Anchorage Devices inserted with Platelet Rich Plasma and Platelet Poor Plasma (placebo) was done on 25 patients with TADs placed on the right and left sides (total of 50 TADs). Patients who had visited for comprehensive orthodontic treatment were screened according to inclusion and exclusion criteria to be included in the study. The consent form was designed in which the procedure and the reason for the study were explained to every patient selected. Each patient was given the consent form which was signed by the patient. Injection of a few drops of PRP into the pilot hole by an 18 gauge needle syringe and similarly PPP (Placebo) onto the opposing site was done. The operator was blinded during the procedure. Patients were advised to report if there was any failure of TAD.TADs were assessed on every orthodontic visit (monthly) for 6 months. Results: The total number of patients was 25, each with TAD on both the right and left sides. In a total of 50 TADs, 5 (10%) failed, 4 (8% of the total) of the left side and 1 (2% of the total) of the right side Out of these 25, 14 (56%) were males and 11 (44%) were females. In 25 patients only 1 (4%) patient showed both left and right side failure while 4 (16%) patients showed only left side failure. In terms of PPP (placebo) and PRP, the rate of failure were 3 (12%) of PPP and 2 (8%) for PRP. The mean days of failure were 46.00±3.22 and 6.50±9.192 for PPP and PRP respectively. Conclusion: From this study, it was noticed that there was no significant difference in the stability of TADs injected with PRP or PPP (placebo). Other factors such as gender, and patient or operator handedness were also not significant.
EPIDEMIOLOGICAL PROFILE AND FETO-MATERNAL OUTCOME OF TWIN PREGNANCY: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Islam Ansa , Iram Sarwar  , Azmat Ali Shah  , Mujahid ul Islam  , Humaira JAdoon  , Attiya Bibi
Published: November 2024

Background: Twin pregnancies are complex and have often been associated with various complications affecting both mother and baby. Understanding the different maternal and foetal outcomes can provide crucial insights for healthcare practitioners. The aim was to determine the maternal and foetal outcomes of twin pregnancies and understand the factors influencing these outcomes. Methods: A prospective observational study was conducted with women experiencing twin pregnancies of more than 28 weeks gestation. Patients were followed up until 7 days postnatally and the outcomes were analyzed against various parameters such as age, foetal presentation, and mode of delivery. Statistical software SPSS V 26 was utilized for data analysis and ethical considerations were duly met. Results: A total of 22,922 deliveries were recorded, with 195 being twin pregnancies. Most twin deliveries were among women aged 20-29 years, with nearly half being first pregnancies. Major findings include a prevalence of preterm deliveries (59.6%), a high incidence of maternal anaemia (54%), and a significant number of neonatal intensive care unit (NICU) admissions (45.45%). No statistically significant difference was observed in the feto-maternal outcomes about the mode of delivery or booking status. Conclusion: Twin pregnancies are associated with a higher likelihood of preterm deliveries, maternal anaemia, and newborn NICU admissions. Importantly, the mode of delivery and booking status did not significantly affect the feto-maternal outcomes. This study underscores the need for individualized patient care in managing twin pregnancies.
COMPARING STRESS LEVELS AMONG MEDICAL EMERGENCY UNIT WORKERS IN TEACHING HOSPITALS ACROSS LAHORE: A QUANTITATIVE ANALYSIS OF PRECISION
Authors: Fizzah Ali  , Fatima Suhaib  , Hajra Talat  , Malik Zain Ul Abideen  , Uzair Abu Bakar  , Maria Javaid
Published: November 2024

Background: Stress is characterized as a condition of anxiety or tension spurred on by challenging circumstances. Stress is a normal human reaction that motivates us to deal with obstacles and dangers in our lives. The study aimed to investigate the levels of stress that employees in the medical emergency unit (MEU) industry face and any possible relationship between work satisfaction, and perceived stress. The objective of the study was to assess and compare the stress levels of MEU workers in different teaching hospitals in Lahore using the PSS-10 stress scale. Our research aims to examine and compare the perceived stress based on gender, profession, and marital status. Methods: The study employed a quantitative cross-sectional design to assess and compare stress levels among MEU workers in teaching hospitals across Lahore. The target population consisted of MEU workers in teaching hospitals across Lahore. The perceived stress levels were measured using the PSS-10 (Perceived Stress Scale) questionnaire, a widely accepted, validated, and reliable instrument for assessing stress perception in individuals. The data was subjected to both descriptive and inferential statistical analyses using the SPSS. Descriptive statistics, including means and standard deviations, were employed to summarize stress levels among medical emergency unit workers in different teaching hospitals. Independent t-tests and ANOVA were utilized to compare stress levels across teaching hospitals. Results: In this study involving 304 medical professionals, participants, on average, were 29.95 years old with a mean stress score of 20.99. The majority were female (62.8%), married (50.7%), and affiliated with Mayo Hospital (17.4%). Occupation-wise, 66.45% were doctors, and no significant difference in perceived stress was observed among professional categories. However, there was a significant difference in stress scores among hospitals, with FMH participants exhibiting lower stress compared to others (p<0.005). Conclusion: The study found significant differences in stress among medical emergency unit staff in teaching hospitals in Lahore. The results highlight the significance of targeted interventions and support initiatives to improve worker resilience and well-being in high-stress healthcare settings. It provides valuable information for improving stress management and preventive tactics.
COMPARISON OF THE ACCURACY OF ULTRASONOGRAPHY AND CONVENTIONAL RADIOGRAPHY IN DETECTING FRACTURES IN INDIVIDUALS WHO HAVE A CLINICAL SUSPICION
Authors: Sadia Naseer Qazi  , Adil Qyyum  , Nisar Ahmed  , Ruqqia Adil
Published: November 2024

Background: Fracture detection plays a crucial role in clinical settings, influencing patient management and treatment decisions. Traditional methods, such as conventional radiography, have been the standard for fracture imaging. However, with advancements in technology, ultrasonography has emerged as a potential alternative, offering benefits such as portability and the absence of ionizing radiation. This study aims to compare the accuracy of ultrasonography and conventional radiography in identifying fractures in individuals presenting with clinical suspicion. The primary objective of this study is to assess and compare the diagnostic accuracy of ultrasonography and conventional radiography in detecting fractures. By evaluating both imaging modalities, we aim to provide insights into the potential utility of ultrasonography as a viable option for fracture diagnosis, particularly in cases where conventional radiography may present limitations. Methods: This prospective comparative study involves individuals with a clinical suspicion of fractures, who will undergo both ultrasonography and conventional radiography. The imaging results will be independently assessed by experienced radiologists blinded to the clinical information. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy will be calculated for both modalities. Statistical analyses, including paired t-tests, will be employed to determine significant differences between the two methods. Results: Preliminary results indicate that ultrasonography demonstrates comparable accuracy to conventional radiography in detecting fractures. Sensitivity, specificity, and overall accuracy will be presented, highlighting the strengths and limitations of each imaging modality. Any statistically significant differences between the two methods will be discussed in detail. Conclusion: This study contributes valuable insights into the comparative accuracy of ultrasonography and conventional radiography in fracture detection among individuals with clinical suspicion. The findings aim to guide healthcare professionals in making informed decisions regarding the choice of imaging modality based on the clinical context and available resources.
ANTIBIOTIC SENSITIVITY SPECTRUM OF ACUTE BACTERIAL CHOLANGITIS: TRENDS FROM A TERTIARY REFERRAL CENTER IN PAKISTAN
Authors: Butt Muhammad Abdurrahman , Khan Maahin Manzoor , Omar Myyra , Atiq Muslim , Badshah Maaz , Mohammad Salih  , Rafique Mehwish , Muhammad Usman  , Kazmi Syed Murtaza
Published: November 2024

Background: Significant morbidity can arise from acute bacterial cholangitis. Key to improving outcomes is the implementation of aggressive antibiotic therapy and prompt biliary decompression through either endoscopic or percutaneous means. However, the challenge in treating these infections is amplified by the evolving patterns of antimicrobial resistance, particularly when determining the appropriate empiric therapy. Methods: The present study was conducted at Shifa International Hospital in Islamabad. The patients with the diagnosis of Acute bacterial cholangitis between July 2016 and June 2022 were included. Data was analyzed using SPSS-26.0 to identify any significant associations or correlations among the study variables. Results: A total of 144 patients with a diagnosis of acute bacterial cholangitis were included in the study. 51 of these patients had a positive blood culture. The most commonly identified organism was E. coli, followed by Klebsiella pneumonia, Pseudomonas aeruginosa, Proteus, Enterococcus spp and others. Antibiotic sensitivity pattern revealed resistance to Ceftazidime in 87%, Piperacillin-Tazobactam in 63.7%, Ertapenem in 34.4%, Meropenem in 26.1%, Imipenem in 25.0% and Colistin in 16.1%. Conclusion: A high resistance pattern for antibiotics was observed in our study. This might, in turn, represent the prior judicious use of antibiotics in our community hospitals before these patients are referred to a tertiary referral center.
COMPARISON OF POSTOPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT WITH AND WITHOUT LONG CPB TIME
Authors: Ajwad Farogh  , Ahsan Arif  , Noman Izhar  , Saima Jabeen  , Muhammad Ali  , Syeda Rabia Bukhari
Published: November 2024

Background: Postoperative atrial fibrillation (POAF) is frequently observed after cardiac surgery, and duration of Bypass Time (CPB) is an independent risk factor for postoperative atrial fibrillation (POAF). The main objective of the current study was to compare new onset Postoperative Atrial Fibrillation (POAF) in patients undergoing coronary artery bypass graft with and without long CPB time. Methods: A prospective comparative study design was used and conducted at the Cardiac Surgery Department in Bahawalpur- Pakistan which is a tertiary care health centre for the period of April 2020 to February 2021, a total of 110 patients were enrolled after getting institutional approval and informed consent from patients. The ethical protocol was followed throughout the study period. Data was entered and analyzed using SPSS version 25.0 and p-value <0.05 taking the level of significant. Results: A total of 110 patients were enrolled for the research, the average age of patients was 48.56±3.11 (age range 30-70), and there were 38(34.55%) & 72(65.45%) male and female patients observed respectively. The atrial fibrillation developed in 3(5.45) patients in without a long CPB time group as compared with the long CPB time group as 8(14.54%) with a statistically significant p-value of 0.043, postoperative IABP support with insignificant p-value of 0.234. Conclusion: Postoperative atrial fibrillation in patients undergoing coronary artery bypass graft is significantly higher with long CPB time as compared with without long CPB time
IMPROVING VTE RISK ASSESSMENT IN HOSPITALISED PATIENTS IN A TERTIARY CARE HOSPITAL IN IRELAND
Authors: Muhammad Irfan Khan  , Aisling O’Brien  , Catriona O’Leary  , Virginia Silvari  , Cleona Duggan  , Susan O’Shea
Published: November 2024

Background: The initial baseline audit showed that only 24% of patients had a documented VTE- RA, this demonstrated an urgent need to improve VTE-RA in hospitalised patients. This quality improvement project (QIP) aimed to achieve 90% compliance in completing the VTE-RA tool and embedding this process into practice. Several measures were carried out which included the development of a TP policy, VTE-RA tool, education sessions and monthly point prevalence audits incorporating Plan, Do, Study, Act (PDSA) cycles.  A follow-up audit was conducted one-year post-implementation using the same methodology as the baseline. Methods: This was a single centre before-after study, using a prospective cross-sectional design for both the baseline and post-intervention studies in a tertiary referral hospital in Cork, Ireland.  All adult inpatients (>18 years) were eligible for inclusion. Documented evidence of VTE-RA and a prescription of TP were recorded. Results: The follow-up audit showed significant (p <0.001) improvement in documentation of VTE-RA from 24% (244/1019) to 57% (612/1070) and the prescription of pharmacological TP increased significantly (p<0.001) from 43% (441/1019) to 67% (713/1070). This improvement in VTE-RA was highest in patients with an increased risk of thrombosis from 21.9% (n=180/819) to 61% (n=493/807). Conclusion: The introduction of a TP policy and VTE-RA tool increased compliance by 33%. However, without a dedicated multidisciplinary thrombosis team to actively implement this, the achievements to date are unsustainable and attaining 90% compliance with VTE-RA is unlikely.
TENZEL ROTATIONAL FLAP IN UPPER AND LOWER LID RECONSTRUCTION IN TERTIARY CARE HOSPITAL OF KARACHI PAKISTAN: A PROSPECTIVE INTERVENTIONAL STUDY
Authors: Ahmed Fatima , Kamil Zeeshan , Khan Muhammad Tanweer Hasan
Published: November 2024

Background: Reconstruction of the lids is a significant challenge for ocular plastic surgeons as it requires the greatest functional and cosmetic outcomes. This study aimed to share the experience of Tenzel rotational flap in upper and lower lid reconstruction of anterior lamella at a tertiary eye care hospital of Karachi, Pakistan. Methods: 10 patients with upper and lower eyelid defects over a period of 6 months were a part of this prospective interventional clinical study. The examination on the subject was performed at tertiary care hospital of Karachi, Pakistan after ethical approval. Pre and post operation evaluation LPS (Levator palpebrae superioris) action MRD-1 (Margin Reflex Distance-1) values central vertical Palpebral Fissure Height (PFH) were recorded. Data was entered and analyzed on SPSS version 23.0. Results: For the upper eyelid the preoperative measurements of MRD-1, LPS action, central palpebral aperture were -1.6±1.63 mm, 4.33±1.21 mm and 4.33±1.33 respectively. The postoperative measurements of these parameters were 3.83±0.25 mm, 13.16±1.17 mm and 10.83±0.68 mm respectively. For the lower eyelid the Mean±SD of MRD-1, LPS action, central palpebral aperture preoperatively was 3.62±0.25 mm, 12.75±0.50 mm and 10.75±0.95 mm respectively. Postoperative values of MRD-1, LPS action, central palpebral aperture before operation were 3.83±0.25 mm, 12.75±0.50 mm and 10.75±0.95 mm respectively. The mean incision length in the upper and lower eyelid was 8.50±0.83 and 9.50±0.91 respectively. Conclusion: Tenzel rotational flap not only helps to heal the upper and lower eyelids but also there is no further requirement of additional surgery for posterior lamella. The study concluded that this technique provides both cosmetically and functionally aesthetics outcomes.
ASSESSING ORONASAL FISTULA RATES: MINIPLATE AS EXTERNAL FIXATOR VS ANTERIOR NASAL SPINE PLATING FOR PALATAL FRACTURES
Authors: Ain-us-Saba  , Muhammad Umar Farooq  , Fouzia Aslam  , Hamza Hassan Mirza  , Abdul Manan Shahid  , Muhammad Asad Javed
Published: November 2024

Background: Palate, a midface bone, shapes the face and supports buttresses. Palatine process of maxilla and horizontal plate of palatine bone constitute it. Palatal bone is thicker anteriorly and laterally than posteriorly and centrally. Palatal fractures occur with maxillary fractures. Palatal-maxillary fractures occur 8-46.4% of the time.2,5 Palatal fractures can cause palatal ecchymosis in closed fractures and upper lip, palatal mucosa, incisor tooth loss, or occlusal disruption in displaced fractures. The objective was to determine the surgical outcome of palatal fractures with locking plates as external fixator vs. alveolar plating in terms of frequency of oronasal fistula formation. Methods: A Randomized control trial was carried out in Department of Oral and Maxillofacial surgery, Pakistan Institute of Medical Sciences, Islamabad. between 14th July, 2017 to 14th July, 2018. Lottery split patients into groups A and B. Data was collected on designed questionnaire and was entered and analyzed using SPSS v22. Chi-square was applied to check the association. Results: A total of 130 patients were enrolled in the trial based on the predefined inclusion criteria.  The average age of participants in the research was 41.16 years with a standard deviation of 10.44. Of the total participants, 88 (67.7%) were male and 42 (32.3%) were female, as per the inclusion criteria. The occurrence rate of oronasal fistula development in both groups, namely palatal fractures treated with locking plates as an external fixator vs alveolar plating, was 1 (1.5%) and 7 (10.8%) respectively. This difference was found to be statistically significant with a p-value of 0.029. Conclusion: Osteosynthesis using 2.0 mm locking plates as external fixator had a lower rate of oronasal fistula than alveolar plating. Future investigations at numerous configurations are needed to determine which approach is best. such that a regular strategy will reduce infection, fistula development, and necrosis afterwards
ADHERENCE TO NUTRITIONAL SUPPLEMENTATION, FOLLOW-UP CARE, AND LOST TO FOLLOW-UP IN POST BARIATRIC SURGERY PATIENTS
Authors: Wali Muhammad Hassaan , Khava Bekova  , Noor Abdulla  , Simhachalam Gurugubelli  , Yi Mon Lin  , Devendar Banoth  , Samia Rauf Butt
Published: November 2024

Background: With the global rise in obesity rates, bariatric surgery has emerged as an effective intervention for weight management and obesity-related comorbidities. Bariatric surgery offers transformative potential but demands lifelong adherence to multifaceted care, including nutritional supplementation and vigilant follow-up. Nutritional deficiencies affect 30% to 70% of patients, encompassing vital elements like vitamins (B12, D, folate), minerals (iron, zinc, calcium), and proteins, necessitating continuous monitoring to prevent complications. This comprehensive review explores the multifaceted challenges in post-bariatric surgery patient care, focusing on adherence to nutritional supplementation, follow-up care, and the prevalence of nutritional deficiencies. Methods: A systematic synthesis of relevant literature was conducted, encompassing studies examining post-operative care practices, adherence to prescribed multivitamin supplements (MVS), rates of follow-up, and nutritional deficiencies in bariatric surgery patients. Nine key studies were analyzed and synthesized to extract critical insights. Results: Findings revealed a complex landscape of post-bariatric surgery care, marked by both promise and pitfalls. Adherence to MVS regimens emerged as a significant challenge, influenced by factors such as forgetfulness, gastrointestinal side effects, cost concerns, and poor follow-up rate. Lost-to-follow-up rates varied across studies, raising concerns about the continuity of care. Nutritional deficiencies were prevalent, underscoring the importance of long-term monitoring. It highlights the need for tailored patient education, improved doctor-patient communication, and shared decision-making processes to enhance adherence and follow-up care. Conclusion: This review underscores the intricate nature of post-bariatric surgery patient care, emphasizing the critical role of adherence, follow-up, and nutritional monitoring. Disparities in care among different regions of the world with varying healthcare systems are acknowledged as a significant challenge; addressing these challenges necessitates a collaborative effort among healthcare providers, patients, and policymakers to optimize the long-term well-being of individuals who undergo bariatric surgery.
ENDOMETRIOMA COEXISTING WITH MATURE CYSTIC TERATOMA IN A SINGLE OVARY: A RARE PRESENTATION
Authors: Fatima Shams  , Ahmed Shahroze , Mudasira Habib  , Abdul Sattar Anjum
Published: November 2024

Mature cystic teratomas, commonly known as dermoid cysts, are prevalent benign ovarian tumors that originate from germ cells and mature into diverse tissue types. They are usually asymptomatic but can lead to complications like torsion, rupture, or malignant transformation. Endometriosis is a condition in which endometrial tissue grows outside the uterus and it is commonly associated with pelvic pain and infertility. We report a case of a  27-year-old woman who presented with a history of lower abdominal pain and dysmenorrhea. Initial ultrasonography revealed a complex cyst in the left ovary which, on a later Magnetic Resonance Imaging (MRI) scan, proved to be two distinct cystic lesions within the same ovary. Subsequently, a laparatomy and ovarian resection was done, and histopathologic examination confirmed the coexistence of a mature cystic teratoma and an endometrioma in the left ovary. This case report highlights the unique occurence of these two conditions simultaneously, the challenges of differentiating these coexisting conditions and emphasizes the importance of utilizing multiple imaging modalities to achieve an accurate pre-operative diagnosis.
EFFICACY OF INTRACAMERAL MOXIFLOXACIN VERSUS TOPICAL MOXIFLOXACIN IN PREVENTING ACUTE ENDOPHTHALMITIS AFTER CATARACT SURGERY BY PHACOEMULSIFICATION
Authors: Anwar Faisal , Nazia Qamar  , Asif Bashir  , Muhammad Tahir Ghaffar  , Mohammad Hasan Bokhari
Published: November 2024

Background: Endophthalmitis is an acute infection of anterior and posterior segment of the eye involving aqueous humour and vitreous cavity along with the other structures. It is classified into many types including bacterial, Fungal, protozoal, viral and atypical forms. Most common route of infection is exogenous either after the surgery or traumatic perforation Objectives were of evaluate the efficacy of intracameral moxifloxacin versus topical moxifloxacin in preventing postoperative acute endophthalmitis after cataract surgery by phacoemulsification. Methods: Patients undergoing cataract surgery by phacoemulsification are divided into two groups. Group A and group B. Cataract surgery was performed by phacoemulsification in both the groups by the same consultant. Group A was given 0.5% intracameral moxifloxacin 0.1ml undiluted at the end of surgery and Group B received topical moxifloxacin eyedrops and no intracameral medicine at the end of surgery. Post-operative medicine in both the groups was same for 1st twenty-four hours that is topical dexamethasone 0.1%. Postoperative assessment was made on the next day or after twenty-four hours of surgery Our primary outcome was incidence of postoperative acute endophthalmitis. Results: The study comprised 150 eyes of patients. There were 75 patients in Group A (intracameral moxifloxacin) and 75 patients in Group B (Topical group). Mean age of the patients was 58 years . No case of endophthalmitis was reported in group A (intracameral moxifloxacin). Three cases in group A had acute toxic anterior segment with moderate corneal oedema and severe anterior chamber reaction which resolved in a week time without intravitreal medication. Group B (Topical Moxifloxacin) did not report any case of endophthalmitis. The difference between the two groups was very mild anterior chamber reaction in intracameral group as compared to topical group. Conclusion: 0.1 ml undiluted intracameral moxifloxacin 0.5% can be given as a last step in cataract surgery by phacoemulsification to prevent postoperative acute endophthalmitis infection. This drug administration is not totally safe as our three cases developed drug reaction with moderate corneal oedema and anterior chamber reaction that resolved in a week time.
THE CLINICAL MANIFESTATIONS OF SCABIES IN PATIENTS PRESENTING TO DERMATOLOGY OUTPATIENTS DEPARTMENT AT AYUB TEACHING HOSPITAL, ABBOTTABAD
Authors: Arshad Pirzada Durreshaehwar , Abdullah Sumaira , Maria Syed  , Zarar Bin Jamil  , Muhammad Khubaib Ullah
Published: November 2024

Background: Scabies is a significant skin problem in the developing countries due to its increased incidence, complications and financial implications. The aim of this study is to highlight the endemicity of scabies in our population and its clinical manifestations including various complications. The study was conducted to determine the frequency and clinical manifestations of scabies in patients presented to dermatology outpatient department (opd), Ayub teaching hospital, Abbottabad. Methods: This cross-sectional study was conducted on 1404 patients suspected to have scabies. The demographic and clinical features of scabies presentation was recorded on a questionnaire by interview. The skin scrapings were observed under microscope after preparing 10% KOH mount. Results:  During the study period, out of 1404 patients, 339 patients with scabies were identified, with frequency 24.14%. The mean age calculated was 21.18 years. The frequency of scabies was 56% (190) in males while 44% (149) in females. All studied patients had pruritis (male =190. female =149). 89.1% had papules, 39.8% had excoriations on their bodies, 15.6% had impetiginization, 12.7% had eczema and only 3.2% of total had blisters. It was observed that complications like impetigo, eczema, blisters were more in patients living in unfavorable conditions. Conclusion: The results of the study showed that scabies is a common skin infestation in our population. It is recommended that awareness programs be implemented at primary healthcare level so that necessary measures can be taken to control this preventable and communicable disease.