bluuebunny/crossref_metadata_2025 huggingface dataset:
AWARENESS REGARDING DIABETES AND ITS MANAGEMENT AMONGST PATIENTS VISITING TERTIARY CARE HOSPITALS AND ITS IMPACT ON GLYCEMIC CONTROL
Authors: Khan Anum , Arshad Abdul Rehman , Farooq Asif , Raashid Sheharyar
Published: January 2022

Objective: To assess factors affecting disease awareness in diabetics, and its association with glycemic control.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from Jan to Apr 2019.

Methodology: Outdoor patients with type-II diabetes mellitus were selected using a consecutive sampling technique. Disease awareness was assessed with a modified Diabetes Knowledge Questionnaire, with scores >70% considered satisfactory. Recent HbA1c levels were used to determine glycemic control (<7% reflecting good glycemic control). Demographic data, including age, gender, level of education, residence, duration of diabetes, mode of treatment, smoking status and co-existing hypertension, were also recorded.

Results: There were 212 patients with equal gender distribution and mean age of 55.90 ± 11.96 years. Of these, 117 (55.18%) lived in rural areas, 77 (36.32%) were educated, 34 (16.03%) were smokers and 121 (57.07%) had co-existing hypertension. The mean duration of diabetes was 81.72 ± 71.67 months (range 3-360 months) and mean HbA1c levels were 9.55 ± 2.56%. Higher HbA1c levels were associated with poorer DKQ scores. The level of education and the duration of diabetes significantly predicted DKQ scores.

Conclusion: Lack of disease awareness leads to poor glycemic control. Better education and longer disease duration impact the understanding of diabetes.
EFFECTIVE THERAPEUTIC INTERVENTIONS TO PROMOTE RECOVERY FROM FIRST PSYCHOTIC EPISODE AND MINIMIZE ITS RELAPSE: A QUALITATIVE STUDY FROM PAKISTAN
Authors: Khalil Rehana , Naeem Zahid , Jameel Nazia , Talib Uroosa
Published: January 2022

Objective: To explore effective therapeutic strategies to promote recovery from first episode of psychosis and minimize its relapse.

Study Design: Qualitative study.

Place and Duration of Study: Karwan-e-Hayat Psychiatric Care and Rehabilitation Center, Karachi, from Mar to Jun 2019.

Methodology: Seventeen participants were recruited through purposive sampling and data was collected through in-depth interviews. Qualitative thematic content analysis was done through generation of a coding scheme.

Results: Almost half i.e., 8 (47%) had experience of 10 years, while 7 (41%) had 15 years’ experience, and 2 (12%) had 30 years’ experience as psychiatrists. Analysis of the interview transcripts revealed three main themes related to psychiatrists’ views on interventions for first episode of psychosis to prevent relapse: (1) duration of first episode of psychosis (2) compliance and rate of recovery after first episode (3) effective interventions for first episode psychosis.

Conclusion: The effective interventions to promote recovery from first psychosis episode and minimize its relapse included multiple combinations of integrated stage-specific approaches necessitating antipsychotics (pharmacological) and psychosocial support (non-pharmacological).
EARLY VERSUS DELAYED ORAL INTAKE IN PATIENTS AFTER CESAREAN SECTION UNDER REGIONAL ANESTHESIA
Authors: Hassan Laiqa , Tufail Shazia , Aslam Farheen , Mustafa Nilofar , Ahmed Arub , Qamar Saima
Published: January 2022

Objective: To compare the outcome in early versus delayed oral intake in patients after cesarean section under regional anesthesia.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, from Dec 2017 to May 2018.

Methodology: A total of 352 women undergoing elective cesarean section under regional anesthesia, nil by mouth for at least 8 hours before surgery were divided in 2 groups. In group 1, patients were given sips of clear oral fluid (water) <5 hours after cesarean section and in group 2, patients received sips of water 8 hours following surgery. Bowel motility was assessed after surgery on hourly basis. Data about time interval to first bowel movement and ileus were noted.

Results: Mean age of patients was 32.329 ± 3.44 years and 33.051 ± 3.64 years in group 1 and 2 respectively. Mean gestational age and body mass index was 38.50 ± 0.93 weeks and 29.824 ± 4.97 kg/m2 in group-1 versus 37.937 ± 0.98 weeks and 27.779 ± 2.81 kg/m2 in group 2. Mean duration of surgery was 47.096 ± 6.65 minutes in group-1 and 47.647 ± 8.76 minutes in group 2. Ileus was seen in 17% patients in group-1 and 34.1% in group-2 (p<0.001). Mean time interval for first bowel movement was 8.323 ± 1.20 hours in group-1 and 13.034 ± 2.54 hours in group 2 (p<0.001).

Conclusion: Early feeding after an uncomplicated cesarean section has reduced rate of ileus symptoms and mean time interval for bowel......
COMPARISON OF OPTICAL BIOMETRY AND A SCAN FOR CALCULATION OF INTRAOCULAR LENS POWER IN AGE RELATED NUCLEAR CATARACT AT TERTIARY CARE EYE HOSPITAL
Authors: Rafique Aisha , Zafar Omar , Khan Summaya
Published: January 2022

Objective: To compare optical biometry and A-scan for calculating intraocular lens power in patients with nuclear cataract at tertiary care eye hospital.

Study Design: Cross sectional comparative study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Pak Emirates Military Hospital, Rawalpindi, from Jul to Dec 2018.

Methodology: In this study 70 eyes of 70 patients planned for cataract surgery by phacoemulsification underwent both optical biometry with intraocular lens master and ultrasound biometry applanation by A scan after informed consent. Intraocular lens power calculated by these two methods of biometry was compared. Phacoemulsification surgery was performed through a 2.3 mm superior temporal clear corneal incision. All patients underwent in the bag implantation of the same intraocular lens type.

Results: The mean age of the patients was 62.89 ± 6.69 years. A significant (p-value<0.001) difference in intraocular lens power calculation was noted (20.96 ± 1.76 vs. 22.03 ± 1.61) with optical biometry and A-scan respectively. Association on the basis of age groups showed a significant (p-value<0.001) difference in both strata that was among patients having age ≤65 years and patients having age >65 years.

Conclusion: Optical biometry was found efficient and safe method for calculation of intraocular lens power. Optical biometry is noncontact method having very less chance of infection and suitable for most of the eye types.
UNILATERAL PROPTOSIS - A DIAGNOSTIC DILEMMA
Authors: Yasin Ubaid Ullah , Yaqub Muhammad Amer , Naqvi Syed Abid Hassan , Shahid Muhammad , Habib Asad , Awais Muhammad
Published: January 2022

Objective: To study epidemiology, presentation and management of cases with unilateral proptosis presenting at a tertiary care hospital.

Study Design: Case series.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2016 to Dec 2017.

Methodology: Retrospective analysis of hospital record of patients with unilateral proptosis was carried out. Data was entered and analyzed in SPSS version 22. Chi square test was used for statistical analysis.

Results: Thirty-three cases of unilateral proptosis with a mean age of 41.79 ± 3.87 years were included in the study. Pain was the most common association. Proptosis was mild in 42.4%, moderate in 48.5% and severe in 9.1% cases. In 61% cases, diagnosis was made on excisional or incisional biopsy and on the basis of radio imaging in 39% cases. Most common cause of proptosis found was pleomorphic adenoma (12%). Patients with axial and non-axial proptosis were 48.5% and 51.5% respectively. Fourteen cases (42.5%) were managed surgically and 2 cases (6%) were observed. Total of 22 cases (67%) improved after treatment, 8 cases (24%) went into remission, 2 (6%) deteriorated, and 1 (3%) died in the study period.

Conclusion: Unilateral proptosis is a diagnostic challenge. Pertinent history taking and detail examination is the key, but associated signs or symptoms not always point towards correct diagnosis. Tissue biopsy provides a conclusive diagnosis especially where radio imaging is doubtful.
ESSENTIAL LEADERSHIP DOMAINS AND STRATEGIES TO ENHANCE LEADERSHIP SKILLS AMONG UNDERGRADUATE MEDICAL STUDENTS: A MIXED METHODS STUDY
Authors: Abbas Syed Muslim , Ashar Abid
Published: January 2022

Objective: To explore medical undergraduate students’ perceptions pertaining to the key domains of leadership and highlight strategies to enhance leadership skills in undergraduate studies.

Study Design: Mixed methods study.

Place and Duration of Study: Fatima Memorial Hospital College of Medicine & Dentistry, Lahore, from Sep to Oct 2019.

Methodology: A total of 207 medical students were recruited from the first and final year by purposive sampling to fill out a structured questionnaire. Three focus group discussions were conducted comprising of twelve students in each group. All focus groups were audio-recorded, anonymized and transcribed verbatim before the analysis by framework analysis technique.

Results: Total fifty percent of the first-year students were of the view that ensuring patient safety was an important component of the leadership domain of improving services whereas only 11% responded as critically evaluating as a component of this domain. The themes that emerged pertaining to the strategies to enhance leadership skills included increasing awareness, role models depicting change, cultural challenges, and supplementing existing practices.

Conclusions: The validated essential domains of leadership and its associated competencies should be streamlined strategically and prioritized in accordance with the level of training of the undergraduate medical students. A multicentre study is suggested to gather data at the national level which could inform further development of inclusion of leadership domains within undergraduate MBBS curriculum.
AWARENESS AND PRACTICE OF PHYSICAL ACTIVITY AMONG MALE MEDICAL UNDERGRADUATES AT MAJMAAH UNIVERSITY, SAUDI ARABIA
Authors: Farhan Muhammad Asad , Kazmi Syed Yousaf , Irfan Abdul , Sami Waqas , Faraz Ali , Ali Muhammad Imram
Published: January 2022

Objective: To probe the level of awareness and practice of the WHO recommendation for physical activity among male medical undergraduates at Majmaah University, Saudi Arabia.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: College of Medicine, Majmaah University, Kingdom of Saudia Arabia from Oct to Dec 2018.

Methodology: The study was conducted amongst 150 undergraduate medical students using a self-validated questionnaire.

Results: A total of 53 (35.33%) participants were found to be physically inactive while only 18 (12%) participants were adherent to WHO recommendations of physical activity for health benefits. Only 31 (20.66%) participants were correctly aware of the WHO guidelines for physical activity with health benefits. Football (n=47) and table tennis (n=20) were the sports played by the majority i.e., in 67 (44.66%) participants. The physically active participants encouraged peers for physical activity and preferred social media as a mean of spreading awareness about physical activity.

Conclusion: The awareness and the level of adherence of our male medical undergraduate students of physical activity according to the WHO’s guidelines are at par with the results of the national studies but much lower than the developed countries like the USA.
DENGUE FEVER OUTBREAK IN TWIN CITIES; A TERTIARY CARE CENTER EXPERIENCE
Authors: Khan Taimoor Ashraf , Nisar Shazia , Qureshi Muhammad Mahad , Samiullah Muhammad , Israr Muhammad
Published: January 2022

Objective: To characterize the clinical presentations and laboratory markers (as disease predictors and markers) and severity of disease in patients admitted with dengue fever.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Infectious Diseases, Pak Emirates Military Hospital Rawalpindi, from May to Oct 2018

Methodology: In our study, we included the patients treated for dengue fever. Data were recorded on predesigned proforma and analyzed using Microsoft excel 365 and Social Package for Statistical Sciences version 23.

Results: A total of 160 patients were included in this study, all were males. All cases were positive for Nonstructural Protein 1 Antigen. Symptoms seen in abundance were fever with rigors, chills, backache, retro-orbital pain, nausea and vomiting. Manual platelet count at admission ranged from 15-396 x 103 (mean 107.5 ± 6.8 x 103). Platelet count on discharge ranged from 102-577 x 103 (mean 207.9 ± 95.4 x 103). A total of 34 (21.25%) patients out of 160 confirmed and admitted dengue fever cases had Dengue Hemorrhagic Fever (Nonstructural Protein 1 Antigen positive, thrombocytopenia and leukopenia) and 2 patient went into dengue shock syndrome. The derangement in alanine aminotransferase and alkaline phosphatase levels were shown in 98 (61.2%) and 62 (31.2%) of patients. All these patients were immunoglobulin M and Nonstructural Protein 1Antigen positive.

Conclusion: Raised serum alanine aminotransferase and alkaline phosphatase levels along with early positive Nonstructural Protein 1 Antigen is a marker of disease severity.
EVALUATION OF CHANGES IN VISUAL ACUITY AND CONTRAST SENSITIVITY IN PATIENTS WITH KERATOCONUS AFTER CORNEAL COLLAGEN CROSS-LINKING
Authors: Javaid Hassaan , Zafar Omar , Akram Seemal , Khan Asfandyar , Abbas Sana , Rafique Aisha
Published: January 2022

Objective: To evaluate changes in visual acuity and contrast sensitivity in patients with keratoconus after corneal collagen cross-linking.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from May 2019 to Apr 2020.

Methodology: A total of 48 eyes of 30 patients with progressive keratoconus were included in this study. Baseline uncorrected distance visual acuity, corrected distance visual acuity and contrast sensitivity were recorded, following which transepithelial corneal collagen cross-linking with topical riboflavin and ultraviolet A light was performed. Uncorrected distance visual acuity, corrected distance visual acuity and contrast sensitivity measurements were repeated and recorded 6-months postoperatively.

Results: Mean preoperative uncorrected distance visual acuity was 0.56 ± 0.27 logarithm of the minimum angle of resolution which improved to 0.51 ± 0.26 at 6 months after the procedure (p=0.002). Mean corrected distance visual acuity was 0.30 ± 0.19 preoperatively, improving to 0.24 ± 0.18 (p=0.001) at 6 months after corneal collagen cross-linking, thereby depicting a statistically significant improvement. Treated eyes also showed a significant improvement in contrast sensitivity (p=0.001) of 0.05 ± 0.08 logarithmic units of contrast sensitivity, from a mean preoperative contrast sensitivity of 1.72 ± 0.10 to 1.77 ± 0.09 when evaluated 6 months after corneal collagen cross-linking.

Conclusion: Corneal collagen cross-linking is a promising advancement in the treatment of keratoconus. It was found effective in significantly improving visual acuity as well as contrast sensitivity, thus enhancing visual outcomes in keratoconus.
TREATMENT-RESISTANT EPILEPSY AND TREATMENT-RESISTANT SCHIZOPHRENIA; A REAL CHALLENGE FOR THE PSYCHIATRIC TEAM
Authors: Zubair Usama Bin , Breen Eugene G , Zubair Hamza Bin , Elhassan Haytham , Coyne Cathal P , Khair Ibtihal
Published: January 2022

Schizophrenia and epilepsy may exist together, but it is very rare to have a resistant form of both illnesses in one patient. We present a case report of a 49-year-old woman who was managed at our psychiatric facility suffering from treatment-resistant schizophrenia and epilepsy. She presented with suspiciousness, fearfulness and with a belief that people in the hostel wanted to harm her and were putting hair on her bed. She was also having recurrent seizures weekly due to her refractory epilepsy secondary to mesial temporal sclerosis. She was non-compliant with medication and refused surgical management of mesial temporal sclerosis. Whilst in the hospital was on five antiepileptic drugs prescribed by the neurology team and these control the seizures. Olanzapine and paliperidone depot was used for schizophrenia which had a partial response. Clozapine was notconsidered in view of her severe uncontrolled epilepsy. Concerns were raised regarding her capacity to decide about treatment options. The possibility of an organic cause for both schizophrenia and epilepsy were considered.
EXPERIENCE OF SURGICAL TRACHEOSTOMY IN COVID-19 HOSPITAL
Authors: Niazi Saleem Asif , Riaz Yausra , Maqbool Shahzad , Khan Zafar Ullah , Sharif Asjad , Aasim Muhammad Umar , Sajjad Kaswar , Zaman Shafaq
Published: January 2022

Objective: To share our experience of tracheostomy in COVID-19 positive patients.

Study Design: Prospective observational study.

Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Apr to Jul 2020.

Methodology: A total of 94 COVID-19 positive cases admitted to the Intensive Care Unit of this hospital, placed on ventilatory support and who ultimately underwent tracheostomy (whether percutaneous or surgical) were included in the study. Patients were included irrespective of any age group or gender.

Results: Out of 94 patients placed on ventilator, tracheostomy was performed only in 17 patients. Male predominance was 13 (76%), with mean age of patients as 55.59 ± 12.93 in 12 patients, surgical tracheostomy was performed (70.58%) whereas in 5 (29.4%) cases percutaneous tracheostomy was done. On post-operative follow-up 8 out of 17 (47%) patients recovered and were successfully decannulated whereas 9 (52.9%) patients could not survive. Tracheostomy was successfully performed as early as 8th day of mechanical ventilator support. Health Care Workers (HCWs) involved were subjected to RT-PCR and remained negative for SARS- CoV-2. There was statistically significant association between the type and indication oftracheostomy, p=0.002.

Conclusion: Tracheostomy, in COVID-19 positive patients, being aerosol- generating procedure remains a medical hazard for the HCWs. By following strict safety protocols according to the medical resources available and training of the HCWs, it can be performed with complete safety. It can be done as early as 8th day of ventilator support.
MAINTENANCE OF ANTI-RETROVIRAL THERAPY (ART) TO HIV PATIENTS AND THEIR PREVENTIVE PRACTICES AGAINST COVID-19 PANDEMIC - A SYNDEMIC PERSPECTIVE FROM A HIV CENTER IN PAKISTAN
Authors: Maroof Saira , Mahmood Humaira , Nigar Hira , Mashhadi Syed Fawad , Arshad Syma , Iftikhar Asma
Published: January 2022

Objective: To see the implementation of designed strategy for uninterrupted supply of HIV treatment at time of COVID-19 Pandemic along with the knowledge and preventive practices regarding COVID-19 among HIV positive patients to have baseline data for future interventions to control HIV-COVID-19 syndemic.

Study Design: Cross sectional study.

Place and Duration of Study: HIV Center at Benazir Bhutto Shaheed Hospital, Karachi Pakistan, from Mar to May 2020.

Methodology: 100 patients who visited the center for medicines were interviewed. Participants were inquired about the availability of Antiretroviral Therapy (ART) during lockdown, discontinuity in treatment suffered during this pandemic, their preventive behaviour against COVID-19, most adopted prevention and source of information for this behavior.

Results: Among all the participants 72% have achieved viral suppression. As far as multi month dispensing was concerned 10% received ART for one month, 64% for 2 months and 18% for 3 months as per the strategy devised by Pakistan AIDS control in collaboration with UNAIDS. Out of 11% developed symptoms but later on tested negative on PCR test. Most commonly adopted personal protection adopted was face mask among 68% participants followed by hand washing and social distancing. All the participants were of the opinion that they received sufficient information regarding COVID-19, its prevention and mode of spread. The source of information was TV 60%, HIV center 30% and both TV and HIV center 10%.

Conclusion: It was found that all the patients got uninterrupted supply of anti-retroviral medicines. Despite sufficient knowledge regarding disease they couldn’t comply with........
EFFECT OF SINGLE-DOSE PREGABALIN ON POSTOPERATIVE PAIN IN DACRYOCYSTORHINOSTOMY SURGERY
Authors: Abbas Sana , Naeem Saquib , Akram Amjad , Abbas Beenish , Iqbal Rashid
Published: January 2022

Objective: To evaluate the analgesic potential of pregabalin in ambulatory dacryocystorhinostomy surgeries under general anaesthesia.

Study Design: Quasi-experimental study.

Place and Duration of Study: Tertiary Care Hospital Rawalpindi, from Nov 2019 to Sep 2020.

Methodology: A total of 110 patients undergoing ambulatory dacryocystorhinostomy surgery at our hospital were included in the study. Participants were divided into two groups, group A (n=55) were administered 150 mg oral pregabalin, while a placebo was given to participants of group B (n=55). Post-operative pain was assessed at recovery, four and eight hours after surgery with the help of the visual analogue scale.

Results: Mean age of participants was 43.05 ± 7.5 years. Gender wise distribution showed 62 (56.4%) males and 48 (43.6%) females. At recovery, four and eight hours after surgery the mean pain scores in group A (pregabalin) vs group B (placebo) were (2.98 ± 0.8 vs 4.98 ± 0.8, p<0.001, 2.67 ± 0.6 vs 5.02 ± 0.8, p<0.001 and 1.49 ± 2.9 vs 2.95 ± 0.8, p<0.001 respectively). Opioid administration frequency in trial versus placebo group was [11 (20%) vs 32 (58.2%), p<0.001].

Conclusion: Pregabalin has analgesic potential moreover decreased postoperative consumption of opioids and associated adverse effects such as nausea and vomiting. Hence making it a suitable agent for pain relief in ambulatory surgeries.
EFFECT OF PART-TIME PATCHING THERAPY ON VISUAL OUTCOME IN PATIENTS WITH ANISOMETROPIC AMBLYOPIA VISITING AFIO RAWALPINDI
Authors: Ashraf Ammarah , Masud Hannan , Rabbani Shafaq , Noor Palwasha
Published: January 2022

Objective: To determine the effect of amblyopia patching therapy on visual outcome in young and adults at 6th and 12th week.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi, Pakistan, from Sep 2018 to Jan 2020.

Methodology: Out of 110, follow up was successfully completed by 91 eyes. Subjects were divided into young and adult based on age. Age ranging from 5-12 years included in the young group and adult group included those ranging from 13-20 years. Anisometropic amblyopia was considered. Amblyopia due to any other disease were excluded. Subjects were advised patching therapy daily for 4 hours in the affected eye. Follow up was 3 weekly for 12 weeks and the effect of patching therapy was assessed by visual improvement. Statistical analysis was done with SPSS version 21.

Result: Out of 91 eyes with amblyopia, 51 (56.6%) were included in the young group while 40 (43.4%) were included in the adult group. In the young group, visual improvement was seen in 40 (78.4%) while in the adult group 24 (60%) showed improvement in vision. Mean visual improvement in young was 1.66 ± 1.099 while 1.03 ± 0.944 in the adult group. Maximum visual improvement in both groups was seen till the 6th week of patching.

Conclusion: Patching therapy is effective even at later ages too. However, continuing patching for more than 6 weeks doesn’t show much improvement in vision.
IMPACT OF ENDEMICITY OF ASCARIASIS ON DIAGNOSIS OF ACUTE APPENDICITIS
Authors: Ahmed Naveed , Gul Mian Sarfraz , Pervaiz Hafiz Khalid , Ahmed Iftikhar , Ali Mujahid Zulfiqar , Ali Shafaqat
Published: January 2022

Objective: To determine the impact of endemicity of ascariasis in the manifestation of acute appendicitis.

Study Design: Prospective observational study.

Place and Duration of Study: General Surgery Department, Combined Military Hospital Skardu, from May 2012 to Apr 2015.

Methodology: Patients presenting with symptoms of acute appendicitis were included in the study. Patients were diagnosed after taking detailed history, clinical examination and blood chemistry. All the patients underwent open appendectomy under general anesthesia. Per-operatively presence of worms was assessed in terminal ileum and after that in the lumen of the appendix initially by palpation and then by opening its lumen after it was removed. Histopathologic diagnosis could not be confirmed due to its non-availability as the surgeries were performed in a remote and resource constraint area of the country.

Results: A total of 224 patients were included in the study. Out of these, 143 (63.8%) were male and 81 (36.1%) female patients. The mean age of patients was 22 ± 6 years. Per-operatively, 21 (9.3%) patients had worms in both ileum and appendicular lumen while 22 (9.8%) patients had worms only in the terminal ileum and there were no worms seen in either ileum or appendix in 181 (80.8%) patients.

Conclusion: There is a relation of parasitic infestation especially Ascaris lumbricoides in the manifestation of acute appendicitis in endemic areas.
A STUDY ON COMPARATIVE YIELDS OF STANDARD SHORT TERM ELECTROENCEPHALOGRAM AND LONG TERM ELECTROENCEPHALOGRAM RECORDING IN SUSPECTED EPILEPSY PATIENTS
Authors: Shafait Saima , Alamgir Wasim , Ahmad Imran , Arif Saeed , Liaqat Jahanzeb , Hashmat Asif
Published: January 2022

Objective: To compare the yield of interictal epileptiform discharges on prolonged (1-2 hours) electroencephalogram (EEG) as compared to standard routine (30 minutes) electroencephalogram (EEG).

Study Design: Comparative observational study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi from Oct 2019 to Sep 2020.

Methodology: A total of 364 outdoor patients with suspected epilepsy were recruited for the study. Out of these 55 electroencephalograms were excluded after applying exclusion criteria and 309 were included for final analysis. Electro-encephalograms were recorded using a 10-20 international system of electrode placement. The duration of each standard electroencephalogram was 30 minutes. It was followed by recording for an extended period of 60 minutes at least. The time to the appearance of the first abnormal interictal epileptiform discharge was noted. For analytical purposes, epileptiform discharges were classified as “early” if they appeared within the first 30 minutes and as “late” if appeared afterward. All electro-encephalograms were evaluated independently by two neurologists.

Results: A total of 309 electroencephalograms were included for final analysis. Interictal epileptiform discharges were seen in 48 (15.6%) recordings. The mean time to appearance of first interictal epileptiform discharge was 14.6 ± 19.09 minutes. In 36 (11.7%) cases, discharges appeared early (within the first 30 minutes) whereas in the remaining 12 (3.9%) cases, discharges appeared late. This translates into a 33% increase in the diagnostic yield of electroencephalogram with an extended period of recording.

Conclusion: Extending the electroencephalogram recording time results in a significantly better diagnostic yield of outdoor electroencephalogram.
IMMUNOHISTOCHEMICAL EXPRESSION OF BRAFV600E IN MELANOMA CASES
Authors: Ch Muhammad Umer , Akhtar Farhan , Jamal Nighat , Ahmad Rabia , Bukhsh Sumaira , Mansur Hamza
Published: January 2022

Objective: To evaluate the diagnostic value of Immunohistochemistry (IHC) for finding BRAFV600E mutation in melanoma patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, Jan 2018 to Apr 2019.

Methodology: Hundred histologically confirmed cases of melanoma aged between 18-80 years were included over a period of one year. To create the tissue microarray and to conduct immunohistochemistry with VE1 antibody melanoma lesion samples were selected.

Results: Ninety-four cases out of 100, were melanoma positive for BRAFV600E detected on immunohistochemistry (IHC) using a monoclonal antibody. The skin was the primary site in seventy-nine (79%) patients, unknown (metastatic) in nineteen and uveal was only in two cases. The diagnostic significance of immunohistochemistry (IHC) for detecting the BRAFV600E mutation in melanoma patients was independent of age, site and stage at diagnosis (p-value <0.05).

Conclusion: Testing of BRAV600E mutation by immunohistochemistry is a rapid, reliable and cost-effective tool in melanoma patients which may further help clinicians in initiating targeted therapy for these patients.
SPECTRUM OF HISTOPATHOLOGICAL PATTERNS OF DUODENAL BIOPSIES IN PATIENTS WITH UNEXPLAINED ANAEMIA AND CHRONIC DIARRHEA AND THEIR CORRELATION WITH ENDOSCOPIC FINDINGS AND SEROLOGICAL MARKERS
Authors: Yasin Muhammad Awais , Farooq Muhammad Asif , Uddin Nasir , Parveen Bushra , Asghar Asma , Ahsan Javeria
Published: January 2022

Objective: To evaluate different histopathological patterns and correlate them with indications, findings of Esophagogastroduodenoscopy Esophago-gastro-duodenal (EGD) and serological markers in patients presenting of unexplained anemia and chronic diarrhea.

Study Design: Cross sectional study.

Place and Duration of Study: Departments of Pathology and Gastroenterology, Combined Military Hospital Lahore Pakistan, from Jul to Dec 2020.

Methodology: Histopathological patterns of endoscopic duodenal biopsies, submitted for evaluation of unexplained anemia and chronic diarrhea were studied. Hemoglobin and anti-tTG levels were recorded. Adults with history of unexplained diarrhea and anaemia were included. Biopsies with malignant diagnosis or unfit for evaluation were excluded. Histopathological patterns were correlated with indications and findings of Esophagogastroduodenoscopy and serological markers of celiac disease.

Results: The most common indication for Esophagogastroduodenoscopy in 145 patients was chronic diarrhea. Upper gastrointestinal endoscopy in 2/3rd of patients revealed no pathology. Histopathological patterns of duodenal biopsies revealed only 15% cases suggestive of celiac disease. Only 12 patients were suggestive of celiac disease both on Esophagogastroduodenoscopy and histopathology combined. Half of patients with anti tTG level >100 u/ml, showed histopathological features of celiac disease on. There was no correlation between histopathological patterns, indications of Esophagogastroduodenoscopy, morphology of Esophagogastroduodenoscopy and serological markers of celiac disease.

Conclusion: Indications for Esophagogastroduodenoscopy, Esophagogastroduodenoscopic findings and histopathological patterns cannot diagnose celiac disease alone.
THE EFFICACY OF PLASMA EXCHANGE IN COVID-19 PATIENTS WITH COMORBID DIABETES MELLITUS
Authors: Arshad Komal , . Zill-e-Humayun , Kamran Sultan Mehmood , Khaliq Ikram , Asif Muhammad Raza , Tanveer Saman
Published: January 2022

Objective: To explore the use of therapeutic plasma exchange as adjunctive therapy in COVID-19 patients with and without diabetes mellitus.

Study Design: Prospective, observational study.

Place and Duration of Study: Pakistan Emirates Military Hospital Rawalpindi, from Jan to Feb 2021.

Methodology: A total of 90 male patients with laboratory-confirmed coronavirus infection were selected based on our inclusion criteria and their management and outcomes were recorded. The data were analyzed using SPSS-22 and Microsoft Excel.

Results: The mortality rate was lower in patients who received 1 or more sessions of plasma exchange compared to those who did not receive plasma exchange (7.5% vs 12%). A lower mortality rate was seen in patients without diabetes who received therapeutic plasma exchange in addition to standard therapy compared to patients who received standard therapy alone (0 vs 14.82%, p=0.112). In patients with diabetes, a higher mortality rate was found in the group that had received therapeutic plasma exchange in addition to standard therapy instead of standard therapy alone (20% vs 8.7%, p=0.365).

Conclusion: Overall our study supports the use of therapeutic plasma exchange in COVID-19 patients. However, although statistically insignificant, there appears to be a higher mortality rate in patients with diabetes who received therapeutic plasma exchange in addition to standard therapy. As such, we recommend further investigation of this aspect.
OUTCOMES OF REFRACTORY STATUS EPILEPTICUS IN CHILDREN
Authors: Alvi Javeria Raza , Wasim Areeba , Ali Mohsin , Khalily Muhammad Athar , Rehman Zia -Ur- , Sultan Tipu
Published: January 2022

Objective: To determine the outcome of Refractory Status Epilepticus (RSE) in children and the factors affecting the outcome.

Study Design: Cross-sectional study.

Place and Duration of Study: High Dependency Unit of Pediatrics Neurology Department at the Children’s Hospital and Institute of Child Health, from Aug 2019 to Mar 2020.

Methodology: This study was conducted on the children presenting with refractory status epilepticus. Structured proforma was used for recording predictive factors. Modified Rankin scale prior to the presentation and Glasgow Coma Scale at presentation were documented and compared with the discharge scores.

Results: Out of 75 children, 46 (61.4%) were males with mean age of 4.43 ± 3.47 years. Common etiologies were acute symptomatic in 37 (49.3%), progressive encephalopathy in 19 (25.3%), static encephalopathy in 9 (11.9%), remote symptomatic in 4 (5.3%), acute on remote symptomatic in 3 (4.0%), idiopathic and unclassified in remaining patients. Mean time between seizures onset and first benzodiazepine injection was 44 ± 36 minutes. Duration of RSE was <24 hours in 17 (22.7%), 24-48 hours in 15 (20.0%), 48-72 hours in 14 (18.6%), 72-96 hours in 12 (16%) and >96 hours in 17 (22.7%). At discharge 33 (44%) returned to baseline, 31 (41%) developed neurological disability while 11 (15%) expired during the stay. Etiology and duration of status epilepticus had significant impact on outcome with p-value of 0.021 and 0.041, respectively.

Conclusion: Acute etiology was associated with higher mortality whereas return to baseline was also fair among survivors. This poses implications for emergency management to significantly............
MICRO NEEDLING VERSUS CARBON DIOXIDE FRACTIONAL LASER IN MANAGEMENT OF ACNE SCARS
Authors: Obaid Shanza , Iftikhar Nadia , Mashhood Asher , Khokhar Ayesha , Zainab Zarnab , Aftab Kanza
Published: January 2022

Objective: To compare the effectiveness of carbon dioxide fractional laser with micro needling in acne scarring.

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital Rawalpindi, from Jun 2019 to Mar 2020.

Methodology: Overall 40 patients with acne scars assessed by consultant dermatologist were made part of study. The patients were divided into two treatment groups through lottery method. Group A, was managed by micro needling technique, while Group B was managed by carbon dioxide fractional laser, each to be done monthly for a total of three sessions. The response was measured by the dermatologist and patients in both the groups. The side effects were also compared in both the groups.

Results: Out of 40 patients with acne scars included in study, 17 (42.5%) underwent micro-needling while 23 (57.5%) underwent carbon dioxide fractional laser treatment after randomization. Thirty (75%) patients were female while 10 (25%) were male. The patients with acne scars responded better in carbon dioxide fractional laser group as compared to micro needling in opinion of dermatologists (p-value=0.01) and also patients themselves (p-value=0.03). Side effects were significantly higher in carbon dioxide fractional laser group as compared to micro needling (p-value=0.02).

Conclusion: Significant number of patients respond well to carbon dioxide fractional laser treatment and the response included both expert opinion and patients own opinion, but adverse effects were seen more in same group. Therefore, better response but at the cost of more adverse effects was noted.
EVALUATION OF DEXMEDETOMIDINE ON HEMODYNAMIC STRESS RESPONSE DURING LARYNGOSCOPY AND INTUBATION
Authors: Jamal Abdul Raafeh , Yaseen Bilal , Saeed Mohammad , Khan Rao Ali Shan , Ali Shah Syed Hamid , Akbar Muhammad Zeeshan
Published: January 2022

Objective: To compare the efficacy of Dexmedetomidine (Precedex) in addressing the mean haemodynamic stress response to laryngoscopy and endotracheal intubation (L&I).

Study Design: Quasi-experimental study.

Place and Duration of Study: Anesthesiology Department, Combined Military Hospital, Rawalpindi, from Jun 2019 Jun 2020.

Methodology: The patients were divided into two groups. Group A was given Inj. Dexmedetomidine and group B (placebo). Operation theatre assistant randomly assigned the patients to either group A or group B each day. The second person administered the drug or placebo. The third person (researcher) recorded all the parameters mentioned in the proforma.

Results: There were 100 patients with an age range of 18-60 years. The majority of the patients were ASA-I physical status. The main surgical procedure was laparoscopic cholecystectomy. Recording of heart rate and systolic blood pressure during laryngoscopy and intubation, after administration of drug or placebo, showed mean heart rate less than mean basal value in group-A and 22% above mean basal value in group-B, and it was statistically highly significant (p-value <0.001). Whereas mean systolic blood pressure in group-A was 122.42 ± 14.91 (less than the mean basal value) as compared to group B, 155.00 ± 18.32/min (20% above mean basal value). This change was also statistically highly significant (p-value <0.001).

Conclusion: It is concluded that dexmedetomidine showed statistically significant stabilizing effects on the expected changes of the hemodynamic stress response.
PRIMARY CNS LYMPHOMA MIMICKING TUBERCULOSIS INFECTION - A CASE REPORT
Authors: Mumtaz Hassan , Ahmad Shahzaib , Yasin Fatima , Shafiq Muhammad Ahsan
Published: January 2022

Primary central nervous system lymphoma (PCNSL) is a rare variety of extra nodal non-Hodgkin lymphoma that reportedly involves leptomeninges, the brain, spinal cord, eyes, or may involve other organs systemically. We present a case of 46-yearold woman with complaints of headache and fever for three weeks, associated with right-sided weakness & altered state of consciousness for one week. The most common presentation of primary central nervous lymphoma is diffuse or multifocal supratentorial masses causing cognitive deterioration and involvement of vitreous, retina, and optic nerve. Most cases ofPCNSL are left undiagnosed due to uncommon
EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA
Authors: Niazi Saleem Asif , Maqbool Shahzad , Riaz Yousra , Khan Zafarullah , Zaman Shafaq , Akhtar Rubab
Published: January 2022

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement.

Study Design: Quasi-experimental study.

Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020.

Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17.

Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........
POST-TRAUMATIC STRESS DISORDER IN COVID-19 PCR POSITIVE PATIENTS; ITS FREQUENCY AND PSYCHOSOCIAL RISK FACTORS HAVE BEEN OBSERVED IN ENT AND NEUROLOGY OUTPATIENT’S CLINICS
Authors: Mahmood Kausar , Feroz Shanila , Udaipurwala Iqbal Hussain , Anwar Aaqil , Tareen Owais Khan , Nisa Zaib Un
Published: January 2022

Objective: To find out the occurrence and psychosocial risk factors of post-traumatic stress disorder in COVID-19 polymerase chain reaction (PCR) positive patients presented to ENT and neurology clinics of a tertiary care hospital.

Study Design: Cross-sectional study.

Place and Duration of Study: Creek General Hospital, Karachi, Pakistan, from Sep to Dec 2020.

Methodology: Total 60 patients with positive COVID-19 PCR test were included. After taking written and informed consent, they were evaluated using a semi-structured questionnaire. Questionnaire comprises of four main parts; first part includes demographic data, second part includes information about the course of COVID-19 in patient and other members of family, third part comprised of reasons of anxiety during COVID-19 and fourth part consist of Impact of Event Scale-revised (IES-R). Data was entered and analyzed through SPSS-23.

Results: Out of total 60 patients, 36 (60%) had post COVID stress disorder. Females were affected more than the males (63% vs. 57%), above 50 years of age were affected more than below 50 years of age (81% vs 52%), singles were affected more than married (72% vs 38%) and lower socio-economic status were affected more than higher (65% vs 50%).

Conclusion: PTSD was observed as long-term psychiatric problem leading to significant morbidity and mortality in patients with COVID-19 infection.
ANOSMIA AND AGEUSIA IN PATIENTS WITH COVID-19
Authors: Abbas Tahir Ghulam , Siddiqui Atif Hafeez , Zaidi Syed Hasan Abbas , Rahim Danish -Ur- , Shaikh Irfan Ahmed , Soomro Arfat Bashir , Farrukh Muhammad Shuja , Kamal Jahanzeb
Published: January 2022

Objective: To evaluate the prevalence and diagnostic significance of anosmia and ageusia among COVID-19 positive patients of Karachi, Pakistan.

Study Design: Cross-sectional study.

Place and Duration of Study: Dr Ruth K. M. Pfau Civil Hospital, (Dow University of Health Sciences), Karachi Pakistan, from Jan 2021 to Feb 2021.

Methodology: The data were collected prospectively from 265 COVID-19 positive patients. Some patients were interviewed over the telephone, while for patient's ease, an online Google form was also formed, facilitating the online data collection. The patient's demographics, comorbidities, allergies, and COVID-19 associated characteristics were inquired. The statistical analysis was performed on SPSS version 23.

Results: The observed frequency of anosmia and ageusia in COVID-19 patients was 49.1% & 43.8% respectively. The median time to recovery was 8-8.5 days (median) for both symptoms. We found no significant difference for gender, BMI, marital status, residential area, comorbidities and reason for long-standing breathing difficulties between patients with or without both anosmia and ageusia (p>0.05). Furthermore, most of the cigarette smokers reported none of the two symptoms (anosmia and ageusia), 24% and 25.2% of COVID-19 positive cases with smoking history were presented without anosmia and ageusia, respectively (p<0.05).

Conclusion: Loss of sense of smell and taste was reported in almost half of the studied population infected by the SARS-CoV-2 virus. Therefore, screening for anosmia and ageusia must be considered while COVID-19 suspicion as an important diagnostic clue.
EAR RECONSTRUCTION SURGERY: OUTCOME ANALYSIS OF 108 PATIENTS
Authors: Ali Ghazanfar , Khan Sikandar Ali , Rehman Habib Ur , Rafique Atif , Fareed Ghulam , Raza Maqbool
Published: January 2022

Objective: To find out the outcome of the ear Reconstruction and its association with improvement in psychological wellbeing along with physical benefits.

Study Design: A cross-sectional study.

Place and Duration of Study: Department of Plastic Surgery and ENT, Combined Military Hospital Quetta and Multan in liaison with the department of Psychiatry, from Jan 2017 to Jan 2021.

Methodology: A sample size of 108 was estimated while keeping level of significance 5%, confidence level 90%, estimated true proportion 63% based on the observation made in the study by Steffen, and 5% of absolute precision. Specific performas were filled by the patient pre and post operatively and data analysis was performed using SPSS-20.

Results: The mean age was 20 ± 8.75 years with a range of 12-29 years. Thirteen (11.11%) were male and ninety-five (87.8%) were females, 14 (12.9%) were married, 94 (86%) were un-married and all (100%) had social support. Fifty-two (48.1%) had primary education. Ninety-four (94%) were un-employed. Fifty-five (50.9%) of participants had congenital ear defect. Ninetyeight (90.7%) of the participants showed confidence in surgical procedure and would go for the same procedure if required, 5 (4.6%) said no to the same procedure while 8 (7.4%) did not know whether to opt for same procedure.

Conclusion: Ear Reconstruction is a very rewarding procedure for surgeon and patients. Apart from aesthetic and functional improvement it also enhances the self-esteem of the patients.
El impacto de las tecnologías de la información y la comunicación en la educación. La importancia de la formación, la información y la sensibilización
Authors: Garrido Antón María José , García-Collantes Ángel
Published: January 2022

Profesorado y progenitores deben promover el uso responsable de las nuevas tecnologías al objeto de proteger la seguridad y ciberseguridad de los menores. Al igual que en otras disciplinas y campos, la importancia de la formación, la información y la sensibilización (FIS) se convierte en algo fundamental para evitar comportamientos delictivos o preocupantes. Los profesores (hombres y mujeres) deben estar suficientemente informados y sensibilizados para poder detectar comportamientos relacionados con la violencia cometida a través de las tecnologías de la información y la comunicación (TIC). El cyberstalking, el sexting, el cyberbullying o la sextortion son, lamentablemente, comportamientos que se dan con frecuencia, pero con cuyas conductas el profesorado no está familiarizado, por lo que suponen un factor de riesgo a la hora de detectar situaciones de violencia entre niños, niñas y adolescentes y alertar sobre ellas. El propósito principal de este trabajo es elaborar material detallado sobre la descripción de estos comportamientos, además de informar sobre qué hacer y qué no si se observan señales de alarma y/o situaciones de riesgo que vulneren los derechos de los menores.