bluuebunny/crossref_metadata_2025 huggingface dataset:
Focused Assessment with Sonography for Trauma (FAST) Scan Versus Exploratory Laparotomy in Patients with Blunt Abdominal Trauma
Authors: Ahmed Umair , Awan Malik Saeed , Ahmed Ghufran , Asad Hafsa
Published: December 2022

Objective: To determine the diagnostic accuracy of FAST scans in patients with blunt abdominal trauma keeping exploratory laparotomy as a gold standard.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Surgical Unit of Combined Military Hospital Kohat from Jan 2019 to June 2019.

Methodology: Trauma patients reporting to the emergency department had a FAST scan using a portable ultrasound machine. The radiologist performed and interpreted the scans within one hour of the patient's arrival. The four standard views were obtained. Those who had positive FAST scans underwent a laparotomy without further evaluation. Patients with negative FAST scans did not have laparotomy unless unstable. Only those patients who underwent laparotomy were included in our study.

Results: Out of 70 cases, comparison of the FAST scans in patients with blunt abdominal trauma keeping exploratory laparotomy as the gold standard to diagnose intra-abdominal injury was recorded as 88.88%, 82.35%, 94.00%, 70.00% and 87.14% for sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy respectively.

Conclusion: Diagnostic accuracy of FAST scan in diagnosing intra-abdominal injury is higher, so it can be used routinely to diagnose intra-abdominal injury as a result of blunt abdominal trauma
Patient Satisfaction with Inpatient Hospital Services: A Cross Sectional Survey of Admitted Patients of Combined Military Hospital, Malir Cantt, Karachi
Authors: Bari Samira Faiz , Siddiqui Hamid Jamal , Qureshi Farhan Muhammad , Zahra Sehrish , Tahir Muhammad , Rizwan Saba
Published: December 2022

Objective: To assess the level of satisfaction regarding the admission process, treatment process, nursing care and general support services amid patients admitted in various hospital departments.

Study Design: Hospital-based cross-sectional survey.

Place and Duration of Study: Combined Military Hospital, Malir Cantt, from Oct 2018 to Sep 2019.

Methodology: Data was collected from 522 participants. An inpatient feedback form was used to assess satisfaction among admitted patients.

Result: Out of 522, 256 (49%) participants ranked health care facilities as excellent and199 (38%) participants ranked health care facilities as good. Out of 53 (10%) participants were satisfied, while only 16 (3%) were discontented with current hospital facilities.

Conclusion: This survey has provided deep insight into the contemporary health care services of the hospital. Being a costeffective organization, CMH Malir Cantt has delivered excellent quality care to patients through continuous efforts towards betterment in every discipline deemed to the medical facility.
LAPAROSCOPIC VS OPEN APPENDICECTOMY: WHAT’S THE BEST FOR PREGNANT PATIENTS
Authors: Khan Kamran Hakeem , Khan Waseem Yar , Khan Zahid , Shahzad Muddasar
Published: December 2022

Objective: To compare the post-operative outcomes in pregnant patients with appendicitis undergoing laparoscopic versus open appendicectomy.

Study Design: Comparative prospective study.

Place and Duration of Study: Surgery Department, Qazi Hussain Ahmed Medical Complex, Nowshera Pakistan, from Jan 2018 to Dec 2019.

Methodology: This study consisted of patients with acute appendicitis during pregnancy who were presented to Surgery Department or referred to it from Obstetrics and Gynecology Department. Patients were divided into 2 groups: Group A had patients who underwent Laparoscopic appendicectomyand Group B had patients who underwent Open appendicectomy. Postoperative outcomes in both groups including fetal loss, preterm delivery, operative time and surgical complications were observed. The p-value of <0.05 was considered significant.

Results: Total of 90 pregnant women were included. Group A consisted of 44 cases and 46 patients were in Group B. The mean maternal age was 24.5 ± 5.2 year (Group A) and 23.5 ± 4.2 years (Group B). About 30 patients (33.33%) were in the first trimester, 38 (42.22%) in second while 22 (24.44%) patients were in the third trimester.Wound infection occurred in two patients in Group B (p=0.08). Fetal loss occurred in one patient in Group A and in 3 patients in Group B (p=0.09). Hospital stay was significantly shorter in Group A (1.4 ± 1.9 days).

Conclusions: Laparoscopic appendectomy is safe with low incidence of post operative maternal as well as fetal complications.
Frequency of Thyroid Dysfunction in Heart Failure Patients with Reduced Ejection Fraction
Authors: Amir Misbah ul Qamar Muhammad , Abbas Shahid , Khan Andaleeb , Ali Ejaz , Butt Kamil Rehman , Rehman Ayesha
Published: December 2022

Objective: To look for the frequency of thyroid dysfunction in heart failure patients with reduced ejection fraction at Medicine/Cardiology Department.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital Sialkot, from Nov 2019 to Apr 2020.

Methodology: The sample population comprised of patients diagnosed with the heart failure and ejection fraction of 40% at Medicine/Cardiology unit. Patients underwent thyroid functions test from the laboratory of our hospital and were diagnosed as hypothyroid, hyperthyroid or euthyroid by consultant cardiologist and medical specialist. Age, gender, body mass index and New York heart association (NYHA) class were associated with thyroid dysfunction among the study participants.

Results: Out of 110 patients with heart failure and low ejection fraction who underwent thyroid function testing during the study period, 92 (83.6%) patients were euthyroid, 14 (12.7%) had thyroid profile parameters showing hypothyroidism, while 04 (3.6%) had laboratory findings of hyperthyroidism. After chi-square, we found that patients with New York heart association class III and IV and high body mass index had a statistically significant relationship with thyroid dysfunction (pvalue 0.017 and <0.001 respectively) among the patients of heart failure with low ejection fraction.

Conclusion: Thyroid dysfunction, especially hypothyroidism, emerged as a common finding among heart failure patients with low ejection fraction. Patients with New York heart association class III and IV and high body mass index should be considered high-risk and may be screened for thyroid problems if present with heart failure
Sagittal Skeletal Discrepancy Evulation by Beta and a Point-Nasion-B (ANB) Angles in a Cephalometric Study Among the Pakistani People
Authors: Mehmood Sundas , Jan Abdullah , Shah Tooba Istiaq , Ashraf Tehreem , Shafique Hafiza Zobia , . Rooma
Published: December 2022

Objective: To compare the role of beta and A point-nasion-B (ANB) angles in evaluating the sagittal skeletal discrepancy in a cephalometric study done in the Pakistani population.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Orthodontics Department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Jul to Dec 2019.

Methodology: A total of 150 subjects between the age of 18 to 25 years were enrolled in the study A point-nasion-B angle was measured using the lateral cephalogram in all the subjects and was divided into classes I, II and III. Beta angle was also measured in all the patients.

Results: Out of 150 subjects, 92 (61.3%) patients were males, and 58 (38.7%) were females. The mean age of the subjects was 19.2 ± 2.138 years. 89 (59.3%) patients were classed in Class-I, 40 (26.7%) in class-II and 21 (14%) in class-III. The mean score of A point-nasion-B angles among the patients was 7.5 ± 1.112. The mean score for beta angles in the study participants was 30.5 ± 2.214. A point-nasion-B and beta angles both had a significant relationship with classes of skeletal discrepancies.

Conclusion: Sagittal skeletal discrepancies can be evaluated with accuracy by using both A point-nasion-B and beta angles. Lateral cephalograms and radiography measures emerged as reliable techniques to classify the patients in various skeletal patterns. Factors like age and gender do not influence skeletal discrepancies.
Plateletpheresis: A Donors Perspective
Authors: Yazdani Muhammad Sajid , Ahmad Shahbaz , Rathore Muhammad Ali , Iqbal Hamid
Published: December 2022

Objective: To determine the plateletpheresis procedure adverse reactions as described by donors in a regional blood transfusion centre.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan, from Oct to Dec 2018.

Methodology: The data of 300 plateletpheresis donors, who underwent the procedure, was collected from the donor record of AFIT. All these donors were contacted through cell phone for interviews. The donors willing to participate were interviewed as per the structured questions.

Results: Out of the 300 plateletpheresis donors contacted, only one was female (0.3%). The 166 (55%) male donors responded and showed willingness for inclusion in the study. The overall experience was described as very good by 89 (54%), good by 52 (31%), satisfactory by 23 (14%) and unpleasant by 2 (1%) donors. No adverse effects were observed in 144 (87%) donors, while 22 (13%) had mild adverse reactions. The 152 (91%) blood donors were willing to donate blood again in future.

Conclusion: Plateletpheresis was considered, by donors, a very safe and pleasant procedure if appropriately performed, taking all necessary precautions. However, chances of adverse reactions exist as in all procedures related to blood donation. Our study shows that the minor common adverse reactions do not limit the donors from future blood donations.
Echocardiographic Abnormalities in Children with Chronic Kidney Disease on Maintenance Hemodialysis
Authors: Adnan Aneeqa , Akhtar Naureen , Jamshaid Abdul Ahad , Kazmi Tehmina , Kazmi Uzma , Chaudary Adeela
Published: December 2022

Objective: To identify the echocardiographic abnormalities in children with chronic kidney disease on maintenance hemodialysis.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Hemodialysis unit of Department of Pediatric Nephrology, The Children’s Hospital and Institute of Child Health, Lahore from Jun to Nov 2020.

Methodology: A total of 75 children of chronic kidney disease on hemodialysis were included. Blood and urine tests, chest x-ray and transthoracic echo cardio-grapy were performed to assess the cardiac morphological and functional abnormalities.

Results: The mean age of patients was 12.14 ± 2.18 years with 54 (72%) males and 21 (28%) females. The mean duration of hemodialysis was 22.54 ± 17.01 months with mean urea reduction ratio (URR) (%) 65.58 ± 4.31 and mean Kt/v 1.3 ± 0.1. Hypertension was noted in 70 (93.3%) patients with mean systolic and diastolic blood pressure 134.07 ± 10.64 and 89.13 ± 6.78 mmHg, respectively. The echocardiography revealed the mean ejection fraction of 58.02 ± 12.40 with mild systolic and diastolic dysfunction noted in 48 (64%) patients, pericardial effusion in 23 (30.7%) cases and left ventricular hypertrophy (LVH) in 52 (69.3%) cases.

Conclusion: As the frequency of left ventricular hypertrophy (LVH) was noted to be high in our chronic kidney disease patients on hemodialysis, there is a need to implement echocardiographic screening of these patients at regular intervals to identify and rectify cardiac complications early.
Focal Resection of Lower Uterine Segment for Morbidly Adherent Placenta. An Alternative to Obstetric Hysterectomy-(Better Modality with Better Outcome)
Authors: Yazdani Tehreem , Zaheer Fareeha , Amin Nabila , Mukhtar Saad
Published: December 2022

Objectives: To focus on the benefits of focal resection of the lower uterine segment as compared to obstetric hysterectomy in patients with morbidly adherent placenta.Study Design: Quasi-experimental study.Place and Duration of Study: Combined Military Hospital Okara, Oct 2019 to Nov 2020.Methodology: Fifty-two women between 34 to 38 weeks of gestation were operated for morbidly adherent placenta. Group-I women (focal resection of the lower uterine segment) and Group-II (obstetric hysterectomy) were twenty-six each. In Group-I, hemostasis was secured by a figure of 8 sutures, purse-string sutures or continuous sutures. In Group-II, hemostasis was secured, and internal iliac artery ligation was done as required.

Results: Group-I undergoing focal resection of lower uterine segment hemostasis was addressed by the figure of 8 sutures in 21 (80%) women and purse-string sutures in 7 women (27%). Hemostasis of the posterior uterine wall was done in 12 (47%) women. Balloon tamponade was used in 10 (40%) women and B-Lynch suture in 5 (20%) women. Internal iliac artery ligation was done in 4 (11%) women, and the bladder was injured in 10 (40%) women. Group-II undergoing obstetric hysterectomy hemostasis was secured for leftover placental tissue in 5 (18%) women, and internal iliac artery ligation was done in 9 (35%) women. Bladder repair was done in 12 (47%) cases. Conclusion: Although time-consuming, focal resection of the lower uterine segment and hemostasis are associated with less morbidity.
Parental and Children Anxiety in Paediatric Dental Procedures Under General Anaesthesia
Authors: Feroze Rehana , Hussain Aftab , Tariq Muhammad , Toor Abdul Wasay
Published: December 2022

Objective: To determine factors responsible for anxiety in children and parents undergoing dental procedures under general anaesthesia.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Anaesthesia, CMH Lahore Medical College, from Sep 2019 to Feb 2020.

Methodology: Ninety-one children aged between 3 to 10 years were included in this study. Parental anxiety was assessed using a visual analogue scale-anxiety before induction of anaesthesia, and child's anxiety was assessed using the modified facial affective scale (3-face) at the time of induction of anaesthesia.

Results: Gender, school-going status and previous exposure to GA were not significant factors in predicting pre-operative anxiety in children with p-values of 0.399, 0.183 and 0.122, respectively. On the other hand, parental anxiety had a very strong impact on children pre-operative anxiety (p-value ˂ 0.001), suggesting that children of anxious parents had high pre-operative anxiety. Moreover, the personality of child also had statistical significance (p-value ˂ 0.001).

Conclusion: Non-social behavior of the child and the anxiety level of parents are major determinants of pre-operative anxiety in children undergoing dental procedures.
Association of Socio-Demographic Factors with Vaccination Status of Children at Gilgit Baltistan
Authors: Khattak Saeed Zaman , Nawaz Sadaf , Ahmed Naheem , Khalid Muhammad , Baloch Hamza , Zubair Usama Bin
Published: December 2022

Objective: To assess the vaccination status of children at Gilgit Baltistan and the association of various socio-demographic factors with none or partial vaccination among these children.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Pediatrics Combined Military Hospital Gilgit, from Oct 2020 to Mar 2021.

Methodology: Children aged 15 months to 10 years presenting with any condition in the Pediatrics OPD were included in the study. Vaccination status regarding basic vaccines, included in the EPI of study participants was confirmed by vaccination card. Education of father, education of mother, type of family (joint or nuclear) and place of living (rural or urban) was correlated with vaccination status of children included in the study.

Results: Out of 600 children presenting at the Pediatrics OPD, 390 (65%) patients were males, and 210 (35%) patients were females The mean age of the patients was 5.554 ± 3.85 years. 242 (40.3%) patients were vaccinated, 190 (31.7%) were partially vaccinated, while 168 (28%) patients were not vaccinated for basic vaccines included in the EPI. After applying the chi-square test, low education of father and mother, living in joint family and rural living were significantly related to non-vaccination or partial vaccination of children (p-value<0.05).

Conclusion: A large group of children from Gilgit-Baltistan remained non-vaccinated or partially vaccinated even for the basic vaccines included in the EPI program. Children born in joint families, rural areas and parents with a low level of education had more chances of skipping the vaccines.
What we need to know about the Delta variant
Authors: Hassan Taimoor
Published: December 2022

As the COVID-19 pandemic is exacerbating around the globe, health pantheons are closely watching various coronavirus mutations and variants which might be more infectious than its parent strain. It is a peculiarity of viruses that viruses instantly adapt and survives to change, and variants come out when a specific strain of virus notice one or more mutations which contradict from other of its kind. The World Health Organization (WHO) and Centre for Disease Control (CDC) closely detect these variations to figure out if the transmission can lead to an escalation in COVID-19 mortalities and cases as well as it also determines that whether the vaccines are effective or not. United States classify these variants as ‘Variant of high consequence’, it compromises the effectivity vaccines and subordinate the treatments; ‘variant of concern’, this variant reported rapid transmission and severe disease; ‘variant of interest’, this kind lead outbreaks widespread.
Fibroscan Compared to Aspartate Aminotransferase to Platelet Ratio Index (APRI) and Aspartate Aminotransferase to Alanine Aminotransferase Ratio (AST to ALT) in the Assessment of Liver Fibrosis in Patients with Non Alcoholic Fatty Liver Disease in a Terti
Authors: Ikram Hasan , Jaffar Syed Raza , Hayat Asma , Khattak Mehnaz , Majeed Nauman , Naeem Afnan
Published: December 2022

Objectives: To compare the extent of liver fibrosis using fibroscan and subsequently compare it with AST/ALT ratio and AST to platelet ratio index (APRI).

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Chemical Pathology Department, Military Hospital Rawalpindi in collaboration with Armed forces institute of Radiology & Imaging and Gastroenterology Department, Military Hospital Rawalpindi from Jan to Apr 2021.

Methodology: A total of 50 patients in group-1 and 24 healthy subject participants in group-2 as controls were studied. Serum AST, ALT, platelet count, APRI and AST to ALT ratio were assessed along with fibroscan results to determine stages of liver fibrosis and results were compared for the association.

Results: There were 49 (66%) males and 25 (34%) females included in the study with the mean age of 49.77 ± 8.3 years. 11 (14.9%) patients had advanced fibrosis. There was a significant negative relationship (p-value <0.001 and r = -0.637) between platelet count and increasing fibroscan score (F1, F2) and a significant positive correlation between fibroscan score and AST (pvalue <0.001 and r=0.623), ALT (p-value <0.001 and r=0.596), fibroscan result and APRI (p-value < 0.001 and r=0.771) and fibroscan scores and AST/ALT ratio (p-value= 0.037 and r=0.243). One third of the study subjects had fibrosis in early and relatively advanced stages (F1, F2 respectively) correlating with serum and blood markers.

Conclusion: Early fibro scan testing and serum markers can help in early diagnosis and timely initiation of treatment.
Analysis of Various Factors Associated with Maternal Near Miss in Karachi Sindh
Authors: Subuktageen Bushra , Raja Ayisha , Subuktageen Rabia , Andleeb Munnaza , Imtiaz Umber , Ghaffar Sadia
Published: December 2022

Objective: To determine the factors associated with maternal near-miss in booked patients managed at tertiary care hospital.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Malir Cantt from Jun 2019 to Jul 2021.

Methodology: A total of 198 pregnant women of were included in the study. All the women were followed until delivery, and data was collected for near maternal miss and types of complications. Relationship of the age of study participants, gestation, parity and presence of comorbid medical illnesses were analysed with maternal near-miss in our study participants.

Results: Out of 198 pregnant women included in the study, 168 (84.8%) did not have near-miss, while 30 (15.2%) had experienced at least one near-miss. The mean age of the women included in our study was 29.236 ± 2.45 years. Cardiovascular complications 14 (7.1%) were the most common in our study participants, followed by renal complications 8 (4.1%). The second and third trimesters and the presence of medical comorbidities were statistically significantly associated with nearmiss (p-value <0.05).

Conclusion: Near miss was a fairly common finding in booked pregnancies managed at our hospital. Women in the second or third trimester of pregnancy and those with any medical conditions had more chances of having near-miss than those in the first trimester or without any medical comorbidities.
Home Quarantine Among COVID Positive Health Professionals: A Cross-Sectional Study From Hyderabad Pakistan
Authors: Parveen Naheed , Abbasi Madiha , Siddiqui Erum , Awan Shazia , Akhtar Muhammad Naveed , Sikandar Raheel
Published: December 2022

Objective: To determine the preference for home quarantine and its reasons among health professionals during the COVID-19 pandemic.

Study Design: Cross-sectional study.

Place and Duration: Department of Obstetrics/Gynecology, Liaquat University of Medical and Health Sciences Jamshoro, and other affiliated hospitals with LUMHS, from Apr to Sep 2021.

Methodology: Eighty home-quarantined health professionals (HPs) at our institute following the exposure to confirm COVID-19 cases were included. A pre-designed questionnaire was used to analyze its reliability using Cronbach's alpha value in SPSS after completing the home quarantine period and analyzed.

Results: We enrolled 80 health professionals. 43 (53.8%) were PG Trainees, followed by consultant (20%), doctors (20.0%), nurses (6.2%), and technicians (6.9%). The mean quarantined period was 15.72 ± 6.15 days (7-20 days). Doctors, PG trainees, and nurses perceived a greater level of irritability than the other health professionals. We found an association between irritability and advanced age, confinement, and being single. Generally, PG Trainee revealed higher physical activity (p= <0.001). Physical activity was significantly lower among respondents who were unmarried (p= 0.004).

Conclusion: Increased satisfaction and a more homelike environment, less aggravation of symptoms, and a mild level of depression and anxiety among health care professionals were associated with home quarantine measures during the COVID19 pandemic.
Burden of Pulmonary Tuberculosis and Its Radiological Pattern, in Asymptomatic Young Males in Karachi, Pakistan
Authors: Zaidi Huma , Shah Haider Hussain , Nasrullah Farhan , Ihsan Hussain Rashid , Khan Muhammad Usman
Published: December 2022

Objective: To estimate the burden of pulmonary tuberculosis among asymptomatic young male applicants in a government organization in Pakistan and to find out the pattern of disease on chest x-ray and high-resolution CT chest.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Pakistan Air Force (PAF) Faisal Base Hospital Karachi, Pakistan, from Dec 2017 to Feb 2019.

Methodology: An active search for detecting pulmonary tuberculosis was conducted in 1819 asymptomatic young male adults between 18 and 30 years who had applied for employment in a government organization with a pay scale ranging from 2 to 14 grade. Screening chest x-ray (CXR) was done as a part of their medical examination. High-resolution CT chest, sputum smear bacilloscopic and GeneXpert mycobacterium tuberculosis/resistance to Rifampicin assay tests were done in cases in which chest x-ray was suggestive of pulmonary tuberculosis.

Results: Chest x-Ray and high-resolution CT of five out of 1819 male applicants were suggestive of pulmonary tuberculosis. Three cases (0.16%) were confirmed as positive on lab tests. Radiographic and High-resolution CT patterns showed upper lobe lesions, consistent with the radiological appearance of the immuno-competent host disease.

Conclusion: The considerable presence of pulmonary tuberculosis was detected among asymptomatic young adults of this region; therefore, formulating a strategy to actively detect and treat analogous populations with high susceptibility to Pulmonary tuberculosis could help reduce this endemic disease.
A Study of Frequency of Low Backache in Pregnant Women
Authors: Shah Syed Fahd , Mumtaz Syed Naveed , Kayani Bushra Afzal , Shah Syed Hussain , Khan M. Wasi Ullah , Khan Abdul Qadir
Published: December 2022

Objective: To find the frequency of backache in our pregnant women and factors increasing the risk of low backache in pregnancy.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Gynecology & Obstetrics, Avicenna Medical College, Lahore Pakistan, from Jan 2018 to Dec 2019.

Methodology: We included 247 consecutive women between 18 and 45 years of age and between 16 and 35 weeks of a single pregnancy. These were evaluated for low backache. Women with comorbid conditions and multiple fetuses who needed elective caesarian sections were excluded.

Results: Mean age of the pregnant women in our study was 27 ± 3.7 years, with an age range of 18 to 45 years. 197 (80.1%) complained about low back pain during their pregnancy, and 75 (30.3%) had a previous history of back pain when not pregnant. Back pain was present in 47 (19.02%) 6 months postpartum. The risk factors present were higher weight gain in 75 (30 %), age >35 years in 62 (25 %), low haemoglobin 38 (15%) and poor socio-economic condition 25 (10.1%).

Conclusion: Low back pain is common in pregnancy and is a less addressed issue of pregnant women. Many factors responsible for low backache in pregnant women were identified. Analgesics and increased physical activity are the main treatment and prevention options.
Effects of Low and Standard Intra-Abdominal Pressure on Postoperative Pain in Laparoscopic Cholecystectomy
Authors: Ali Afaque , Hussain Zaki , Jamal Ayesha , Rahat Fatima , Makshoof Talha , Islam Saqib
Published: December 2022

Objective: To analyze the effects of low and standard intra-abdominal pressure on post-operative pain in laparoscopic cholecystectomy.

Study Design: Comparative prospective study.

Place and Duration of the Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Nov 2019 to Feb 2020.

Methodology: The study comprised 53 patients who underwent Laparoscopic Cholecystectomy and were selected for the study. They were randomly divided into two groups by third-party randomization. The first group was operated on under low pneumatic pressure, i.e. 8-12 mmHg and the second group was operated on under high pneumatic pressure, i.e. (≥15 mmHg). The complaint of post-operative pain was evaluated using a visual analogue scale (VAS) in the next 12 hours.

Results: The group that was operated under high pneumatic pressure showed a higher occurrence of post-operative pain (50.9%) than the group that operated under low pneumatic pressure. On the Visual Analogue Scale, 80.0% of patients with high pneumatic pressure showed a pain of score four or more which is very high compared to the other group (p <0.05).

Conclusion: The patients operated for laparoscopic cholecystectomy under low-pressure pneumoperitoneum would suffer from less post-operative abdominal pain, which needs less analgesia and leads to early hospital discharge.
Frequency of Lymphedema after Complete Axillary Lymph Node Dissection in Patients with Breast Cancer
Authors: Bukhari Neelma , Haider Ghulam , Nouman Maryum , Khan Salahuddin , Yousaf Aveen , Abid Zain
Published: December 2022

Objective: To assess the frequency of lymphedema of the arm and forearm after complete axillary lymph node dissection in patients with breast cancer at one year of follow-up and see its association with body mass index among breast cancer patients presenting at a tertiary care hospital in Karachi.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from Apr 2019 to 2020.

Methodology: One sixty-eight females of age 25-80 years who underwent complete axillary lymph node dissection for breast cancer were included in the study. A breast surgeon performed the axillary lymph node dissection with more than five years of experience. The patients were followed for one year post-operatively to determine the occurrence of lymphedema. All the demographic details and clinic-pathological findings were reported in the predesigned proforma.

Results: About 168 females (97.6%) out of 172 have undergone complete axillary lymph node dissection. Lymphedema was the most common complication among them (38.1%). Common side effect observed after axillary lymph node dissection was pain (66.1%), followed by heaviness (59.5%), firmness/tightness (46.4%) and numbness. The patients with Body mass index ≥ 25 kg/m2, right arm involved, exposure to radiotherapy and moderately differentiated tumour (grade-2) had a significantly higher occurrence of lymphedema (p<0.05).

Conclusion: Lymphedema is higher among breast cancer survivors during the first postoperative year. The risk of lymphedema can be reduced by avoiding potential factors like obesity and carefully selecting patients for postoperative radiotherapy.
Comparison of Light Emitting Diode (LED) Fluorescent Microscopy with Ziehl-Neelsen Microscopy on Sputum Specimens for Diagnosis of Pulmonary Tuberculosis Keeping Culture as ‘Gold Standard’
Authors: Zahra Fatima Tuz , Saleem Muhammad Zeeshan , Mirza Irfan Ali , Sana Fatima , Hussain Ashfaq , Zaman Syed Qamar
Published: December 2022

Objective: To compare LED fluorescence microscopy and Ziehl-Neelsen staining in terms of their diagnostic performance in diagnosing pulmonary tuberculosis, taking sputum specimens from patients suspected of pulmonary tuberculosis.

Study Design: Prospective longitudinal study.

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

Methodology: Sputum samples from patients with clinical suspicion of pulmonary tuberculosis were stained using Ziehl-Neelsen (ZN) stain, fluorescent stain with Auramine O staining (AO) stain and Mycobacterial culture on Mycobacterial Growth Indicator Tube (MGIT 960), to detect Mycobacterium tuberculosis. WHO guidelines were followed to grade positive smears.

Results: Among 206 patients with suspicion of tuberculosis, 143 (69%) were male, and 63 (30%) were female patients. The mean age of the patients was 53.67 ± 14.73 years. Out of 206 sputum samples, 64 were negative by all three techniques used. 142 (68%) specimens detected Mycobacterium tuber-culosison MGIT960. Within 142 culture-positive samples, only 40 samples were positive on Ziehl-Neelsen microscopy, whereas 97 samples were detected positive by LED fluorescent microscopy. In culture-negative samples, three were missed on Ziehl-Neelsen staining, which was positive with Fluorescent microscopy. Sensitivity and specificity for Ziehl-Neelsen smear microscopy were 26.7% and 96.8%, respectively. Sensitivity and specificity for Fluorescent smear microscopy were 64.8% and 92.2%, respectively.

Conclusion: We concluded that the efficacy of LED fluorescence microscopy has proven to have many potential advantages over conventional Ziehl-Neelsen microscopy.
Comparison of Pethidine and Ketamine for the Treatment of Postoperative Shivering
Authors: Farooq Muhammad Umar , Younis Fazeela , Atif Muhammad , Khan Rao Ali Shan , Khalique Abdul , Adnan Ahmed
Published: December 2022

Objective: To compare the effectiveness of Ketamine vs Pethidine for treating postoperative shivering in patients undergoing surgery under general anaesthesia.

Study Design: Quasi-experimental study.

Place and Duration of Study: Operation Theatre, Combined Military Hospital Sialkot Pakistan, from Jan to Apr 2020.

Methodology: Following strict inclusion and exclusion criteria, patients who experienced postoperative shivering in the postanesthesia care unit (recovery) were enrolled through consecutive sampling and randomized into group-A or group B using the lottery method. Group-A received Pethidine 0.5 mg/kg and Group-B received Ketamine 0.2 mg/kg. The shivering grade was evaluated at 0 minutes and 5 minutes after administration of drugs by using a validated four-point scale.

Results: Mean age of the patients was 34.12 ± 9.88 years and 34.83 ± 9.77 years in group-A and group B, respectively. At 5 min, the recovery rate of shivering was significantly higher in the Pethidine group than in the Ketamine group. In group-A, effecttiveness (grade 0) was noticed in 124 patients (86.2%) and in group-B effectiveness (grade-0) was seen in 74 patients (51.4%). A statistically significant difference (p<0.01) was found between the two groups.

Conclusion: Pethidine 0.5 mg/kg is a more effective drug for treating postoperative shivering.
Knowledge, Attitude and Practice of Health Care Professionals Towards Universally Applied Behavior Modification Techniques for Management of Pediatric Patients
Authors: Wahid Maham , Yousuf Ajmal , Ali Shah Pir Jaawad , Shah Dr Jawad Ali , Bhangar Faisal , Shah Muzammil
Published: December 2022

Objective: To evaluate health care professionals' knowledge, preference and experience about various universally applied behaviour modification techniques for managing anxiety in pediatric patients.

Study Design: Cross-sectional survey.

Place and Duration of study: Operative Department Armed Forces Institute of Dentistry Rawalpindi in Apr 2020.

Methodology: An online questionnaire was circulated among 100 Health Care Professionals of Rawalpindi, including general practitioners, consultants and post-graduate residents of different fields of medicine and dentistry involved in the clinical care of pediatric patients, which included socio-demographic details, closed-ended questions about their knowledge about different universally applied behaviour modification techniques for management of anxiety, their preference in usage and factors affecting selection particular behaviour modification techniques for management of anxiety.

Results: 66 (84.61%) of the healthcare professionals were aware of the different universally accepted behaviour modification techniques; 12 (15.38%) were unaware of such techniques. 33 (42%) of the practitioners admitted that pediatric patients showed non-compliance to simple non-invasive procedures while 45 (58%) to invasive procedures. 49 (62.3%) of respondents used universally accepted behaviour modification techniques. 74 (94.87%) of the respondents opted Tell-Show-Do, while the majority opted combination of different behaviour modification techniques as the preferred method of universally accepted non-pharmacological behavior modification technique.

Conclusion: The majority of the health care professionals preferred Tell-Show-Do and positive reinforcement techniques along with the combination of various non-pharmacological techniques as the most commonly adopted techniques for management of anxiety in pediatric patients.
Childhood Adversity and Mental Health Status of Young Adults: A Cross-Sectional Study at the Universities of Islamabad and Rawalpindi, Pakistan
Authors: Fazal Ayesha , Tanvir Seemi , Sikander Siham , Naseem Ayesha , Babar Mariam
Published: December 2022

Objective: To determine the frequency of childhood adversities among the university students of Islamabad and Rawalpindi and compare those adversities with their current mental health by measuring depression and anxiety.

Study Design: Cross-sectional study.

Place and Duration of Study: Quaid-e-Azam University (QAU), Islamabad and ARID Agricultural University, Rawalpindi Pakistan from May to Aug 2019.

Methodology: Survey data of 388 students between 19-25 years of age group was collected from 2 universities in the twin cities using a simple random sampling method for data collection in the form of questionnaires. First, frequencies of adverse childhood experiences (ACE) were determined, followed by a comparison of ACE with common mental disorders, i.e., depression using Patient Health Questionnaire-9 (PHQ-9) and anxiety using Generalized Anxiety Disorder-7 (GAD-7) using the chi-squared test.

Results: The frequency of adverse childhood experiences (ACE) was found to be highest among those students who had an ACE score of 1-3 (74.7%), followed by those with an ACE score of 4-6 (24.7%). Overall, females had more ACE (66.8%) than males (33.2%). Strong association of ACEs with depression (p-value <0.05) and anxiety (p-value <0.005) was found.

Conclusion: Childhood adversity has adverse results not only on the affected individual's life but also on the people around that individual. For example, early life trauma in children of different age groups results in depression for a lifetime, anxiety disorders, cognitive dysfunctions, and lack of effective communication.
Perinatal Outcome of Intrahepatic Cholestasis of Pregnancy
Authors: Shafqat Hira , Ch Abeera , Jannat Munawar , Yasmeen Almas , Abbas Zainab , Almas Yusra
Published: December 2022

Objective: To determine the perinatal outcome of intrahepatic cholestasis of pregnancy and its association with obstetric and biochemical parameters.

Study Design: cross-sectional study.

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

Methodology: Among 3201 obstetric patients, 50 patients of obstetric cholestasis were included in the study. Data was collected on a well-designed proforma. Patients’ characteristics such as age, parity, gestational age at diagnosis and delivery, mode of delivery and co-morbidities were taken along with biochemical markers. Two groups were made based on perinatal outcome, and associations with all variables were checked.

Results: Obstetric cholestasis was found to be 1.6%. The mean age of subjects was 27.36. The itching was the most common presenting complaint. (74%) subjects were primigravida. The majority, 29 (58%), were diagnosed between 34-35 weeks. The mean gestational age at delivery was 37.54 ± 1.96 weeks, with 70% caesarean section. Among perinatal outcomes, 24 (48%) had fetal distress, 2 (4%) had intrauterine growth restriction, 20(40%) had meconium-stained liquor, 2 (4%) had intrauterine fetal demise, 7(14%) had low birth weight babies,16.7% had poor APGAR score and 14 needed intensive care admission. The mean alanine aminotransferase (ALT) was higher among those with the adverse perinatal outcome, with a cut-off value of alanine aminotransferase (ALT) of 93.5 by ROC analysis.

Conclusion: Obstetric cholestasis leads to adverse outcomes. Although no definite marker can rule out the risk of intrauterine demise, increased fetomaternal surveillance with active management induction of labour protocols may reduce the incidence of........
Ewing Sarcoma of Chest Wall: Analysis of 19 Patients
Authors: Majeed Farhan Ahmad , Ali Ghazanfar , Paraccha Muhammad Nadeem , Hameed Shahid , Khan Yasser Saeed , Hussain Zahid
Published: December 2022

Objective: To share the short and long term outcomes of the patients having Ewing Sarcoma of the chest wall.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Thoracic Departments of Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan from Jan 2010 to Jun 2020.

Methodology: In total, 19 patients were enrolled. Inclusion criteria were physiologically fit patients for one-lung ventilation with proven true-cut histopathology. Exclusion criteria were poor performance status and non-compliance to chemotherapy.

Results: Out of 19 cases, 13 males (68.42%) and six females (31.58%) patients. The age range was from 8 to 29 years, with a mean age of 17.6 + 4.16 years. The most common symptom was palpable mass 19, followed by chest pain 8 and one patient presented with fungating mass. All patients showed partial response to neo-adjuvant chemotherapy as per RECIST criteria. Following resection and confirmation of negative margins, primary reconstruction was done. The soft tissue coverage was provided using Latissimus Dorsi Muscle Flap in 16 Cases (84.21%) and in 03 patients (15.79%) Rectus Abdominis muscle was used. Post operatively, less than 02 blood transfusions were needed in six patients. There was no post-operative ventilatory support required, and mortality was zero.

Conclusion: Ewing Sarcoma of the chest wall is a rare tumour in the adult population. An excellent outcome can be achieved through early diagnosis, meticulous surgical technique and good teamwork in a multi-disciplinary setting.
Assessment of Raised Alanine Aminotransferase (ALT) and its Relation with Antibiotic Resistance in Enteric Fever Among Children
Authors: Hussain Irshad , Wahid Sughra , Qureshi Maliha Akhtar , Hashmi Fasih Ul
Published: December 2022

Objective: To study the abnormality of alanine aminotransferase (ALT) in enteric fever among children and to test the association between raised alanine aminotransferase with antibiotics resistance.

Study Design: A descriptive prospective study.

Place and Duration of Study: This study was conducted at the Pediatric department of KRL Hospital, Islamabad from October 2018 to March 2020.

Material and Methods: A total of 100 patients were enrolled as per inclusion criteria. Detailed clinical history was taken and physical examination was done. Laboratory tests i.e. full blood count, liver function tests and blood culture were performed to validate the inclusion, exclusion criteria and to collect the data of required variables mentioned in structured proforma.

Results: Out of 100 culture-proven typhoid fever patients, 57% were male and 43% female. The average age was 7.79 ± 3.3 years. Raised alanine aminotransferase (>45 U/l) was observed in 60%. The alanine aminotransferase is raised in at least 51% of the population having typhoid fever with p-value 0.035. The results also showed that the proportion of extensive drug resistant (XDR) typhoid is greater in the patients having raised alanine aminotransferase as compared to the patients having normal alanine aminotransferase with p-value 0.003.

Conclusion: On the basis of our study, we concluded that high alanine aminotransferase is related with enteric fever. We also observed that those having raised alanine aminotransferase have more chances of extensive drug resistant typhoid.
Disorders Causing Secondary Hypertension in Patients Less Than 45 Years of Age
Authors: Gilani Sayed Tanveer Abbas , Iftikhar Ghazala , Latif Sobia , Ahmed Bilal , Bokhari Syed Aown Shah , Bukhari Airas
Published: December 2022

Objective: To determine the frequency of disorders causing secondary hypertension in patients less than 45 years of age.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Pathology and Medicine, Combined Military Hospital (CMH), Risalpur, Pakistan, along with Armed Forces Institute of Pathology (AFIP)and Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan from Apr 2017 to Apr 2019.

Methodology: A total of 50 patients, less than 45 years of age, newly diagnosed with hypertension (systolic blood pres-sure>140 mm Hg or diastolic BP>90 mm Hg) and reported to CMH Risalpur for the workup of HTN were included. Analysis of serum cholesterol, triglycerides, urea, creatinine, sodium, potassium, calcium, thyroid stimulating hormone, plasma glucose random, urine analysis and renal ultrasonography were carried out. In addition, serum cortisol, 24 hours urinary free cortisol, dexamethasone suppression test, growth hormone level, insulin-like growth factor-1,24 hours urinary vanillylmandelic acid, serum aldosterone and renin levels, Doppler renal ultrasonography, renal arteriogram, CT abdomen, MRI pituitary and MR/CT angiography were carried out.

Results: A total of 50 patients comprised of 82% males and 18% females with a mean age of 36.1±6.2years. Primary hypertension was in observed in 31(62%) cases. Secondary causes of HTN in 19(38%) cases, were obstructive sleep apnea (4, 8%), primary hyperaldosteronism (3,6%), renal parenchymal hypertension (3,6%), renal artery stenosis (1,2%), Cushing's syndrome (2,4%), hyperthyroidism (2,4%), hypothyroidism (2,4%), pheochromocytoma (1,2%) and coarctation of aorta (1,2%) cases.

Conclusion: Obstructive sleep apnea primary hyper-aldosteronism and renal parenchymal diseases were the commonest.........
Assessment of Tumour Budding in Colorectal Adenocarcinomas
Authors: Maqbool Hina , Mushtaq Sajid , Hassan Usman , Hussain Mudassar , Akhtar Noreen , Khan Iram
Published: December 2022

Colorectal cancer (CRC) is the third most common malignancy worldwide. According to

Pakistan Annual Cancer Registry Report, it is the second most common cancer an

males and sixth most common cancer amongst females.There are multiple

histopathological factors which have an impact on prognosis and survival in

CRC.Colorectal cancer (CRC) is the third most common malignancy worldwide.

According to Pakistan Annual Cancer Registry Report, it is the second most common

cancer an males and sixth most common cancer amongst females.There are multiple

histopathological factors which have an impact on prognosis and survival in

CRC.The features of prognostic significance include perineural invasion,

lymphovascular invasion, infiltrating tumor borders, poorly defined clusters, Extra mural

venous invasion (EMVI) and tumor budding.The main purpose of our study is to

calculate tumor budding according to the method proposed by ITBCC in pT2 colorectal

carcinomas and study its association with other prognostic indicators
Effect of Intravitreal Anti-Vascular Endothelial Growth Factor Injection on Intraocular Pressure and Systemic Blood Pressure
Authors: Saleem Beenish , Khizer Muhammad Azeem , Khan Asfandyar , Sarfraz Muhamamd Haroon , Muhammad Shoaib , Ali Dilshad
Published: December 2022

Objective: To determine the effect of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure and systemic blood pressure in the immediate post-injection period.

Study Design: Quasi-experimental study.

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

Patients and Methods: Patients over the age of 21 years receiving the first anti-vascular endothelial growth factor injection for various retinal vascular disorders were included in the study. Intraocular pressure (measured with Tono-pen) and systemic blood pressure were recorded 5 minutes before (baseline) and after, as well as 30 minutes after intravitreal injection.

Results: One hundred and thirty-two patients were included in the study. The median intraocular pressure value in the study population was 14.00 (5) mmHg, while median systolic and diastolic blood pressure values were 147.00 (27) mmHg and 86.00 (19) mmHg, respectively. There was a significant rise in median intraocular pressure up to 29.00 (10) mmHg after 5 minutes and up to 29.00 (9) mmHg after 30 minutes (p≤0.001). Similarly, systolic blood pressure was elevated up to 160.00 (25) mmHg at 5 minutes and 151.00 (32) mmHg after 30 minutes (p≤0.001). No statistically significant correlation between intraocular pressure and blood pressure was seen (p=0.156).

Conclusion: Intravitreal anti-vascular endothelial growth factor injections are associated with a significant rise in intraocular pressure and blood pressure in the immediate post-injection period, so the patients need to be monitored during this period to avoid any ocular or cardiovascular complications.