bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit of Vascular Access Surgery in A Tertiary Care Hospital
Authors: Arif Anum , Haadi Osama , Bhatti Ahsin Manzoor , Ali Inam Syed Hashim , Baig Zahid Farooq , Cheema Ali Hamza
Published: December 2022

Objective: to analyze the outcomes of arteriovenous fistula (AVF) constructed in our setup.

Study Design: Retrospective observational study.

Place and Duration of Study: Combined Military Hospital, Lahore, from Mar 2019 to Mar 2020.

Methodology: Our study included all the patients who had their arteriovenous fistula (AVF) made during the study period. Data was collected via telephone calls, to inquire about the status of AV fistula after one year of AV fistula construction surgery.

Results: Out of 130 study participants, 97 were successfully contacted. Mean age of patients was 54 .39 ± 12.75 years. Majority were male patients (71.1%) and had their first dialysis via temporary dialysis access catheter. Most of the patients (74.7%) had functional AVF. 35 (36.1%) patients were not alive at the time of contact. In 9 (9.2%) patients, AV fistula failed with the most common cause being thrombosis (77.7%).

Conclusion: Current study is one of the pioneer in Pakistan where we have started to audit our performance as the dedicated access surgeons. It is high time for us to evaluate our performance so that better outcome can be offered to the dialysis dependent patients.
Effect of Intensive Training Programme on the Knowledge and Practice of Infection control among Auxiliary staff in a Tertiary care Hospital of Rawalpindi
Authors: Khan Nazish , Azam Naila , Mahmood Humaira , Iftikhar Asma , Afzal Amir
Published: December 2022

Objective: To determine the impact of health education intervention in the auxiliary healthcare staff regarding infection control knowledge and practices.

Study Design: Quasi-experimental study.

Place and Duration of Study: Inpatient departments, Fauji Foundation Hospital Rawalpindi, from Aug to Sep 2020.

Methodology: Study participants were working as the auxiliary staff at Inpatient departments of Fauji Foundation Hospital. Pre-test was carried out for baseline assessment of knowledge and practice of infection control. There was training session of 3 hours comprising of lecture, practical demonstration and hands-on training regarding WHO five steps of hand hygiene, safe disposal of sharps and use of PPEs. Effectiveness of training intervention was assessed after one month.

Results: Mean knowledge score increased from 8.22 ± 2.83 to 12.43 ± 2.05 after the training (p<0.001). Similarly significant improvement was observed in infection control practices i.e., mean practice score improved from 3.64 ± 1.39 to 6.11 ± 1.27 (p<0.001).

Conclusion: Training brought about significant improvement in both the knowledge and practice in all the three areas of infection control.
Pre-Eclampsia and Intrauterine Growth Restriction (IUGR)Prevention– Is Enoxaparin an Effective Option
Authors: Saeed Saira , Barkat Shafia , Murtaza Badar
Published: December 2022

Objective: To determine the effectiveness of Enoxaparin in preventing pre-eclampsia and intrauterine growth restriction in women with the history of pre-eclampsia and IUGR in an earlier pregnancy.

Study Design: Quasi-Experimental Study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2019.

Methodology: In this study, a total of 186 pregnant females of age 20-40 years with >6 ± 0 and <16 ± 0 weeks gestation were included. They were divided into two groups. In the study group, injection Enoxaparin 40 mg s/c OD was started from 6 weeks to 36 weeks of gestation along with Aspirin 75 mg OD. In the control group, only Aspirin 75mg OD was given. An antenatal check-up was performed, and patients were followed for liquor volume, fetal growth and doppler ultrasound. Study outcomes were noted in terms of pre-eclampsia and intrauterine growth restriction.

Results: The majority of the patients 100 (53.76%), were between 20-30 years of age. The mean gravidity in the study group was 3.84 ± 1.20 and in the control group was 3.83 ± 1.22. In this study, pre-eclampsia was found in 6 (6.45%) patients in the Enoxaparin group and in 17 (18.28%) patients of control group (p-value 0.014). Intrauterine growth restriction was observed in 9 (9.68%) patients of Enoxaparin group and in 28 (30.11%) patients of control group (p-value 0.001).

Conclusion: This study concluded that Enoxaparin effectively prevents pre-eclampsia and intrauterine growth restriction in patients with a previous history....
Effect of Warming Anesthetic Solution on Pain Perception During Maxillary Infiltration: A Split Mouth Randomized Control Trial
Authors: Saeed Shahrukh Ahmed , Mahmood Saad , Baig Nasir Jamal , Khan Nazir Ahmed , Rasheed Nazish , Kakar Naseer Ahmed
Published: December 2022

Objective: To evaluate the effectiveness of using anesthesia at 42°C (107.6°F) for the insight of pain as dental sedative in contrast to its administration at room temperature 21°C throughout the procedure of maxillary infiltration.

Study Design: Double-blind, Split-Mouth randomized clinical trial (Clinical trial number: ISRCTN79560957)

Place and Duration of Study: Department of Armed Forces Institute of Dentistry, Rawalpindi, from Jan to Jun 2021.

Methodology: A total of 38 patients were examined, undergoing maxillary premolar extractions for orthodontic purposes. Group- A received local anesthesia injection with the anesthesia warmed to 42°C (107.6°F) and group- B patients receiving local anesthesia injection with anesthesia at room temperature. The injection point was placed in the mucobuccal fold apically in the middle of maxillary premolars using a 27G short needle and injecting 0.9 mL of the anesthetics at the speed of 0.15 mL/second. Patients were instructed to grade intensity of pain on Visual analogue scale.

Results: According to the Visual analogue scale score, the level of pain perceived with the anesthesia at 42°C (107.6°F) in group-1 was 3.81 ± 1.48 and the level of pain perceived with the anesthesia at temperature 21°C in group-2 was 5.57 ± 1.50 with statistically significant result (p=0.001).

Conclusion: The use of anesthesia at 42°C (107.6°F) significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections.
Comparison Between Intra-Articular Steroid Injection And Ultrasound Therapy in Management of Chronic Knee Osteoarthritis
Authors: Rashid Maimuna , Iqbal Waseem , Butt Amir Waheed , Jamshed Omer , Noor Musab Bin , Mehdi Syed Aoun Abbasi
Published: December 2022

Objective: To compare the mean pain score and range of motion in chronic knee osteoarthritis patients treated with intraarticular Steroid injection versus ultrasound therapy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Rehabilitation Medicine, Combined Military Hospital, Pano Aqil Pakistan, from Oct 2020 to Apr 2021.

Methodology: Patients were divided into two groups (50 patients in each group). One group received ultrasound therapy for six weeks, with three sessions per week. The second group received a single 80mg intraarticular Triamcinolone Acetonide. Patients in both the groups were monitored for six weeks to assess the pain score and range of motion.

Results: A total of one hundred (100) patients with knee pain due to chronic osteoarthritis were included in the study. The mean age in the ultrasound group was 54 ± 4.8 years and in the intra-articular group, the mean age was 54 ± 4.7 years. The mean reduction in pain score and mean improvement in the range of motion were compared between two groups and statistically significant difference was observed (p-value <0.001).

Conclusion: According to our findings, intra-articular Corticosteroid injection is more effective in comparison to ultrasound therapy. However, there were statistically significant reductions in pain scores and improvements in the range of motion in both groups.
Post Covid-19 Sino-Orbital Mucormycosis: A Therapeutic Challange
Authors: Adnan Muhammad , Shahid Muhammad , Awais Muhammad , Naqvi Syed Abid Hassan , Ghani Muhammad Usman , Ijaz Umer
Published: December 2022

Objective: To determine the frequency of sino-orbital mucormycosis outcomes in diagnosed patients of COVID-19 and its association with the duration of the disease.

Study Design: Case series.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Pak Emirates Military Hospital, Rawalpindi, from Feb to Jul 2021.

Methodology: A sample size of 20 was calculated using WHO calculator. Diagnosed patients of COVID-19 who fulfilled the inclusion criteria were selected through consecutive sampling technique. The mode of presentation, in-depth imaging findings, associated co-morbidities and management/follow up details were collected.

Results: Total 20 patients were included in study. There were 12 (60%) male and 8 (40%) female. Mean age of patients was 60.4 ± 9.8 years. Outcomes of study were treatment, still of follow up, mortality and mortality with sepsis, survival and exenteration (15%, 15%, 25%, 5%, 25% 15% respectively). Among all the patients, 2(10%) patients showed intraconal and extraconal orbital involvement, 9 (45%) showed left, 8 (40%) showed right and 1(5%) showed both orbits involvement. Outcomes of sino-orbital mucormycosis showed significant association with COVID-19 duration (p=0.03).

Conclusion: Sino-Orbital mucormycosis is a common and potentially life-threatening complication of COVID-19. Early initiation of anti-fungal treatment as well as surgical intervention are key to decrease both the mortality and morbidity associated with the disease.
Comparison of Bupivacaine Wound Infiltration with Bupivacaine Caudal Block on Postoperative Pain in Pediatric Open Inguinal Herniotomy
Authors: Saleem Muhammad Mudasir , Riaz Azmat , . Javed-Ur-Rehman , Ahmed Naveed , Rehman Shafqat , Anwar Zahid , Afzal Tamoor
Published: December 2022

Objective: To compare the effectiveness of Bupivacaine local wound infiltration with Bupivacaine caudal block on postoperative pain in children undergoing open inguinal hernia repair.

Study Design: Quasi-experimental study.

Place and Duration: Department of Paediatric Surgery, Pak Emirates Military Hospital Rawalpindi, from Jan to Sep 2019.

Methodology: 60 patients (30 each in two groups) fulfilling the inclusion criteria who underwent open inguinal herniotomy were included in this study. Patients in group-A received caudal block with 0.25% Bupivacaine 1 ml/kg body weight, while Group-B received local wound infiltration of 0.5% Bupivacaine 2 mg/kg body weight after the completion of surgery. The post-operative pain score was calculated using Hannallah's objective pain scale at 30 minutes, one, two, four, six and eight hours following the procedure. A total pain score of 3 requiring the rescue analgesia in the form of oral Paracetamol (10 mg/kg body weight) was considered the endpoint.

Results: Mean post-operative pain score was 8.20 ± 1.54 in group-A compared to 7.20 ± 1.88 in Group-B with the p-value of 0.02, which showed a statistically significant difference between the two groups.

Conclusion: We concluded that local infiltration with Bupivacaine after open herniotomy in children is safe, highly effective and easy to perform the procedure, which results in excellent post-operative analgesia compared to caudal Bupivacaine block.
Is an Energy-Based Vessel Sealing Device more Effective Than the Conventional Clamping and Knot Tying Technique in Thyroid Surgery? A Quasi-Experimental Study
Authors: Malik Shahzar , Ibrahim Taseer , Morgan Justin , Law Nick
Published: December 2022

Objective: To evaluate the effectiveness of the energy-based vessel-sealing device versus the conventional clamping and knot tying technique in thyroid surgery by comparing postoperative complications, operative time and hospital stay.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, Royal Free Hospital London and South mead Hospital Bristol between Jan 2016 to Jan 2020.

Methodology: A total of 100 patients that underwent total thyroidectomy were included in the study. Half of these patients having thyroid surgery with energy-based vessel sealing devices were allotted into group-1. While, the other half with conventional clamping and knot tying technique were included in group-2. The demographical characteristics and surgical outcomes of both the groups were compared using statistical analysis.

Results: There were 93 females and 7 male patients. The mean age was 44.6 ± 17.33 years. The mean duration of surgery was significantly shorter in group-1 than group-2 (p-value = 0.001). There was no statistical difference in clinical hypo calcemia, recurrent laryngeal nerve injury, and hospital stay. However, more patients 27 (54%) in group-1 had laboratory hypo calcemia, compared to 19 (38%) group-2, (p-value = 0.02).

Conclusion: Thyroid surgery by an energy-based vessel-sealing device is an effective technique as it reduces the operative time; however, higher laboratory hypo calcemia levels were observed.
Motorcycle Accidents in Punjab: A Critical Analysis
Authors: Rana Asghar , Nasrullah Faran , Hameedi Shahlisa , Janjua Nadeem Iqbal
Published: December 2022

Objective: To determine existing occurrences of motorcycle accidents, to identify the causes of accidents and to suggest measures to prevent these accidents from minimizing the undue loss of life and property.

Study Design: Cross-sectional study.

Place and Duration of Study: Emergency Departments of CMH Rawalpindi, CMH Lahore and CMH Kharian, from Aug 2018 to Jul 2019.

Methodology: A total of 384 individuals, who underwent motorcycle accidents and reported to the Emergency Department, were included in the study. A pretested questionnaire was used for all the relevant information on demographic, social, motorcycle, and accident-related parameters.

Results: The mean age of accident victims was 34.4 ± 10.92 years. Motorcyclists having 6-10 years of driving experience, riding daily between 11-20 km, were most commonly involved in accidents. 67.9% drivers had a motorcycle driving license, while most of them (65.8 %) were not wearing a helmet at the time of the accident. Wet road was the most common cause of accidents (35.6%). Collisions mainly occurred with another car (31.7%). The head (26.8%) was the most common injury site, followed by the back/abdomen (24.2%).

Conclusion: Road traffic accidents place a significant economic burden, especially in a developing country like ours. Observance of safety precautions, strict adherence to traffic rules and regulations, and the Pakistan Highway Code knowledge are mandatory to avoid any possible accident. A national effort is required for the prevention of accidents to conserve human life and the financial resources of the country.
Comparision of Distal Uniplanar Locking with Biplanar Distal Locking in Intramedullary Interlocking Nailing of Fractures Distal Shaft of Tibia
Authors: Ahmad Rana Shahbaz , Amin Muhammad Suhail , Rathore Muhammad Omar , Hassan Bushra , Iqbal Javaid , Qamar Adeel
Published: December 2022

Objective: To study the effects of distal uniplanar locking and distal bi planar locking on union times in uncomplicated fractures distal shaft of tibia managed with an intramedullary interlocking nail.

Study Design: Comparative prospective study.

Place and Duration of Study: Department of Orthopedics and Trauma Combined Military Hospital Rawalpindi from Jan to Nov 2020.

Methodology: Fifty-three patients having fractures distal shaft of tibia managed with intramedullary interlocking nail were studied. Twenty-nine patients were managed using two interlocking screws distally (uniplanar) in coronal plane (group-1). Twenty-four patients were managed with three bi planar screws comprising two coronal and one sagittal distal interlocking screw (group-2). Patients were followed every 4 weeks, and bone union time was assessed. Isolated closed fractures treated with closed reduction were included.

Results: Patients treated with distal bi planar locking (group-2) had significantly reduced union time in weeks (11.25 ± 1.42) compared to uniplanar distal interlocking (group-1) (15.79 ± 1.80) (p<.001).

Conclusion: Union time for distal tibia shaft fractures is significantly reduced when treated with distal biplanar locking; it can be attributed to increased stability of the construct.
Correlation of Placental Thickness Measured Sonographically with the Gestational Age Estimated by Fetal Growth Parameters in Normal Singleton Pregnancy
Authors: Jadoon Rizwan Abdul Malik , Anwar Javed , Khattak Abdul Latif , Khan M Babar , Azam Muhammad khalid , Afzal Farah
Published: December 2022

Objective: To correlate the mean placental thickness with the gestational age estimated by fetal growth parameters in normal singleton pregnancy.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Quetta Pakistan, from Feb to Aug 2020.

Methodology: All patients who fulfilled the inclusion criteria at the Department of Radiology, Combined Military Hospital Quetta were included. After taking informed written consent and history, transabdominal-ultrasonography using a low frequency 3-5 MHz curved array transducer was done to assess the outcome.

Result: A total of 100 women with a singleton pregnancy were included. The mean age of women was 28.100 ± 3.349 years. The mean placental thickness (PT) was 29.785 ± 5.700 mm. A significant positive correlation of placental thickness was noted with gestational age with a Pearson Correlation of 0.985 and p-value of 0.001.

Conclusion: Placental thickness has a linear relationship with gestational age. Placental thickness in millimeters can be an essential parameter for estimating gestational age.
Factors Determining Survival of Patients with Germ Cell Tumor (Single Institutional Experience)
Authors: Khan Shafquat Ali , Azhar Musa , Hamdani Syed Abdul Mannan , Ahmad Umair , Hanif Muhammad Rashid , Iftikhar Jhanzeb , Awan Umme Kalsoom , Siddiqui Neelam , Sheikh Rizwan Masood
Published: December 2022

Objective: To determine the 5-year overall survival of all the germ cell tumour stages and to identify prognostic factors affecting advanced and metastatic disease outcomes in our institution.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from 2008 to 2013.

Methodology: We analyzed the overall survival (OS) of the whole study population and sub-analyzed metastatic disease according to the International germ cell cancer group (IGCCCG), and their overall survival was calculated. Clinical, radiological, biochemical, and histopathological evaluation was used to identify risk factors determining disease outcome.

Results: After analysing 186 male patients with germ cell tumours, 5-year overall survival for stages I, II, and III was 99%, 72%, and 62%, respectively. IGCCCG subgroup analysis showed that five-year overall survival for seminoma was slighter worse than non-seminoma. Five-year overall survival for reasonable risk and intermediate-risk seminoma was 68% and 46%, respectively. For non-seminoma, good, intermediate, and poor-risk categories carried five-year OS as 94%, 61%, and 49%, respectively. The presence of liver/brain metastasis, size of residual disease, primary mediastinal tumour, and tumor marker failure to decline post-chemotherapy were poor prognostic factors for metastatic disease.

Conclusion: While identifying stages in germ cell tumours and classifying metastatic patients according to IGCCCG, individual factors including the location of the primary tumor, brain/ liver metastasis, a failure of tumor markers to decline less than 20% after the first chemotherapy cycle and size of residual disease are considered poor prognostic signs.
Awareness of Dengue Fever in Non-Medical University Students in Punjab
Authors: Ahmed Moeez , Mehmood Mohsin , Tahir Muhammad Junaid , Javed Hashir , Ahmed Shahid
Published: December 2022

Objective: To assess the awareness and knowledge of dengue virus infection in the non-medical university students of Punjab.

Study Design: A cross-sectional survey.

Place and Duration of Study: Rawalpindi and Lahore region from May to Jun 2020.

Methodology: The survey was based on a structured questionnaire, covering general information about dengue fever, its transmission, common symptoms, treatment, prevention and vector control.

Results: A total of 208 students from the engineering and IT graduate programs participated in our study. The mean age of the participants was 21.6 ± 1.8 years. 122 (58.7%) participants knew that dengue fever was a viral disease. 57 (27.4%) had the correct knowledge about breeding places of Aedes egypti. Most of the students knew that headache, fever and body aches were the common symptoms of dengue fever. About 151 (72%) thought every patient with dengue fever was a serious patient and should be taken to the hospital. Out of 200 (96%) students were aware that anti-mosquito measures could prevent the disease. There was no statistically significant difference in the responses of male and female students.

Conclusion: Considering the education level of our participants, we noted some gaps in the important knowledge, such as the timing of the mosquito bite, avoidance of Aspirin and some misconceptions regarding the management of infection. We need to bridge these gaps by making health education campaigns more effective.
Effectiveness of Intratympanic Dexamethasone with Lidocaine for Alleviation of Tinnitus
Authors: Ayub Zeeshan , Ahmed Azeema , Afzal Farah , Latif Majid , Malik Muhammad Sheraz Afzal , Ahmed Naveed
Published: December 2022

Objective: To determine the effectiveness of Intratympanic Dexamethasone with Lidocaine in control of idiopathic tinnitus.

Study Design: Randomized control trial (Clinical Trials. gov Identifier: NCT04798391).

Place and Duration of Study: ENT Department, PAF Hospital, Sargodha Pakistan, from Apr 2017 to Jul 2019.

Methodology: 264 consenting patients with idiopathic unilateral tinnitus presenting at ENT Department PAF Hospital Sargodha were assessed for tinnitus severity using the modified tinnitus handicap inventory. The scores were recorded and subsequently administered intra-tympanicaly 2.0ml (milli-liter) of Dexamethasone and Lidocaine (1.5 ml Dexamethasone ± 0.5 ml 1% Lidocaine). The dose was repeated twice at weekly intervals. All the patients were reassessed on the modified tinnitus handicap inventory two weeks after the third Intra-tympanic administration, with patients divided into responsive and noresponsive groups depending on ten points or more improvement in tinnitus score.

Results: Mean modified tinnitus handicap inventory score pre-therapy was 29.6 ± 5.68, and post-therapy was 17.1 ± 7.45. Independent-sample T-test applied showed a p-value of <0.001.

Conclusion: Intratympanic Dexamethasone with lidocaine has a definitively positive outcome on tinnitus improvement.
COVID-19 Vaccines: Community Myths Vs Facts
Authors: Abbas Syed Waqar , Zareen Syeda Fatimah , Nisar Shazia , Farooq Aliya , Rasheed Abdul , Saleem Muhammad Umer
Published: December 2022

Objective: To determine the reasons for hesitancy regarding COVID-19 vaccines.

Study Design: Cross-sectional study.

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

Methodology: After Ethical Committee approval, 100 respondents were recruited, regardless of vaccination status, and requested to respond to 27 different myths and queries circulating about COVID-19 vaccines.

Results: Mean age of participants was 36.25 ± 5.77 years, ranging from 15-80 years. Fifty-three were males and 47 females. 41% of subjects trusted the Sino-pharm vaccine, and 25% preferred Pfizer Bio N Tech, while 34% could not answer due to the lack of knowledge. 55% subjects showed concern about catching the infection from Vaccination. 54% considered vaccines unsafe for pregnant and breastfeeding women. 29% believed it unsafe for the elderly and those with comorbidities. 14% believed it could cause autism in children and infertility in adults. 62% individuals acknowledged that vaccines have no nano chips to track patients. 46% opined that vaccines were rushed through trials and had doubtful efficacy. 11% individuals thought vaccines could alter DNA, while most were aware of this false concept. 28% considered that vaccines were needless because recovery from COVID-19 was excellent, while 63% emphasised the need for Vaccination. 23% deemed the side effects of vaccines more dangerous than the disease itself. 85% individuals favoured use of mask and social distancing after getting the vaccine.

Conclusion: Strong efforts are needed to support the COVID-19 vaccine and to eliminate negative propaganda on media outlets.
Molecular Diversification and Frequency of mecA Gene in the MRSA Infections of Hospitalized Patients at Islamabad, Pakistan
Authors: Rasheed Yasir , Yasmine Raheela , Gul Ambreen , Imdad Kaleem , Ahmad Aashi , Burair Hassan
Published: December 2022

Objective: To determine the molecular diversification and frequency of mecA Gene in MRSA infections of hospitalised patients at Islamabad, Pakistan.

Study design: Cross-sectional study.

Place and Duration: Pakistan Institute of Medical Science, Islamabad, Pakistan, from Sep 2017 to Sep 2018.

Methodology: To explore the occurrence of pathogenic S. aureus in the hospitalised patients of Islamabad, 500 samples were collected. All the isolates were further characterised by gram staining, catalase test and DNAse media analysis validating the presence of S.aureus. The overall frequency of S.aureus was 19.5% in all the isolates. Six highly distinguished colonies were further evaluated through colony PCR by 16S r RNA analysis, and results revealed 99.9% homology of isolates with S.aureus. The degree of resistance was further evaluated for 12 isolates based on the previous MRSA resistance pattern. The extraction and concentration of DNA were done by the CTAB and Nanodrop methods. Then primers were designed for the presence of the mecA gene of S. aureus.

Results: Results showed 51 (52.7%) MSSA and 45 (47.4%) MRSA among all the isolates. Colony PCR by 16S r RNA analysis results revealed 97 (99.9%) homology of isolates with S.aureus. PCR of all the twelve extracted DNAs of isolates showed the frequency of the mecA gene in all the isolates.

Conclusion: The study is the first report the presence of resistance mecA gene in the hospitalised patients of Islamabad. It has depicted a resistant gene's presence and showed the rising trend of resistance in pathogenic S. aureus.
The Pattern of Diagnosis in NICU Population Presenting With Respiratory Distress
Authors: Ullah Hakeem , Maqbol Asad , Razzaq Asma , Rehman Romisa , Ullah Ihsan , Awais Muhammad
Published: December 2022

Objective: To evaluate the etiology, frequency, and results of respiratory distress in newborns in the intensive care unit.

Study Design: Descriptive cross sectional study.

Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH) in Peshawar, from Aug 2020 to May 2021

Methodology: It included neonates admitted to the Neonatal Intensive Care Unit between the ages of 0 and 28 days

Results: The study included 182 neonates, 107 (58.6%) of whom were boys and 75 (41.4%) were girls. The average age was 68.47 ± 98.60 hours, the average gestational age was 32.6 ± 23.52 weeks, and the average weight was 2.50 ± 2.6 kg. All (100%) of the neonates had a respiratory rate >60 breaths per minute. Regarding symptoms and signs, 110 (60%) reported grunting, 182 (100%) reported nasal flaring and subcostal retractions, and 72 (40%) reported cyanosis. Respiratory distress syndrome, meconium aspiration syndrome, pneumonia, transient tachypnea of the newborn, sepsis, and birth asphyxia was observed in 42 (22.8%), 30 (16.6%), 32 (17.6%), 26 (14.1%), 32 (18.04%), and 20 (10.8%) newborns, respectively. The number of 60 (33.2%) neonates were suffering from respiratory distress.

Conclusion: High frequency of respiratory distress among the neonates was observed along with high rates of mortality in those having respiratory distress, especially in low birth weight and pre-term neonates.
Association of Nrf2 gene polymorphism (rs6721961) with semen parameters in primary male infertility cases in Pakistani population
Authors: Rehman Bushra , Rahim Amena , Afzal Muhammad , Tazarrat Aqsa , Kashif Humaira , Qayyum Sadia
Published: December 2022

Objective: To determine an association of single nucleotide polymorphism of the NRF2 gene (RS6721961) with semen parameters of primary male infertility patients in the Pakistani population.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Biochemistry, Islamic International Medical College, Rawalpindi, in collaboration with two private infertility clinics (American Infertility Center, Rawalpindi and Mother and Child International Hospital and Research Institute, Mirpur, AJK) from Oct 2020 to Sep 2021.

Methodology: A total of 288 participants were included in this study. There were 144 diagnosed cases of primary male infertility and 144 healthy fertile males, age and ethnicity matched controls. Blood samples were collected from participants after obtaining written informed consent. DNA was extracted by the Chelex TM Methodoogy. Multiplex PCR was done to determine the respective allelic frequencies of NRF2 (RS6721961) genotypes using specific primers.

Results: There was no significant association between NRF2 genotypes and semen volume and semn colour in infertile males (p-value 0.32 and 0.84, respectively). Out of 144 cases, 111 (77%) had normal sperm count, 29 (20.1%) had oligospermia, while 4 (2.7%) patients had azoospermia. A significant association was observed between NRF2 genotypes and sperm concentration of infertile males (p-value <0.001). Out of 144 cases, 80 (55.5%) had normal motility, 57 (39.5%) had asthenospermia while 7 (8.4%) patients had necrospermia. A strong association was observed between NRF2 genotypes and sperm motility in infertile males (p-value <0.001).

Conclusion: Single nucleotide polymorphism (RS6721961) of the NRF2 gene is significantly associated with sperm concentration and......
Comparison of Vitamin D Levels in Children with Recurrent Respiratory Tract Infections with Normal Children
Authors: Zaman Saeed , Ahmed Umama , Shah Sajid Ali , Munir Misbah , Nawaz Sadaf , Goheer Lutfullah
Published: December 2022

Objective: To compare Vitamin D levels in children with recurrent respiratory tract infections with normal children.

Study Design: Case-control study.

Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Kharian, from Nov 2018 to Dec 2019.

Methodology: Sixty children fulfilling the inclusion criteria from the indoor department of Paediatrics, Combined Military Hospital, Kharian were included in the study. Thirty patients were in the recurrent respiratory tract infections-group (cases), while 30 were in the normal children- group (control). The blood sample was drawn from all the children included in the study to analyze serum 25 (OH) D levels. Data regarding Vitamin D levels were noted from both groups as per operational definition on an especially designed proforma.

Results: The mean age of cases was 5.63 ± 2.82 years, and controls were 5.66 ± 2.44 years. In cases-group, 20 (66.7%) cases had low vitamin D levels, and 10 (33.3%) cases had normal vitamin D levels, while in control subjects, 11 (36.7%) children had low vitamin D levels and 19 (63.3%) children had average vitamin D level. Cases with low vitamin D levels were statistically higher than controls, with the p-value of 0.02 with a significant odds ratio = 3.455 (95% CI: 1.95–9.99).

Conclusion: This study concludes that children with recurrent respiratory tract infections had low vitamin D levels compared with normal children.
Effect of Patient Understanding of Diabetes Self-Care on Glycemic ControlA Hospital Based Cross Sectional Analytical Study
Authors: Riaz Sidra , Nisar Shazia , Anwer Wasif , Palwa Abdur Rahim , Saeed Farrukh , Hussain Mehmood
Published: December 2022

Objective: To study the effect of patient understanding of diabetes self-care on glycemic control.

Study Design: Hospital-based cross-sectional analytical study.

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

Methodology: A standardized questionnaire comprising nine questions to gauge understanding of diabetes self-care was applied to 216 patients with Diabetes Mellitus (DM) at Pak Emirates Military Hospital, Rawalpindi. Linear regression analysis was conducted to examine the effect of diabetes-related self-care understanding on glycemic control.

Results: 138 patients were males (64%) and 78 females (36%) with a mean age of 40 ± 8 years (range: 18-68 years). The mean duration of having diabetes mellitus was 12 ± 2 years. Patients with a high score on the self-care understanding questionnaire had better average glycemic control than those with lower scores.

Conclusion: Patients' understanding of self-care for diabetes has a significant impact on their glycemic control. This asks physicians to educate patients about their role in disease management for better clinical outcomes.
Comparison of Results After Facial Fat Grafting with Filtered and Washed Fat Versus Centrifuged Fat
Authors: Samuel Tabish , Hameed Shahid , Aslam Rizwan , Ahmed Rao Saood , Butt Wajih Ud Din , Ayub Afia
Published: December 2022

Objectives: To compare the centrifuged fat versus filtered and washed fat for facial fat grafting in terms of patient satisfaction and subjective/objective appearance.
Study Design: Comparative prospective study.
Setting/Duration of Study: Department of Plastic Surgery, CMH, Rawalpindi Pakistan, from Aug 2017 to Jan 2020.
Methodology: A total of 64 patients (32 in each group) requiring facial fat grafting who fulfilled the sample selection criteria were included in the study. Patients who had received facial cosmetic surgery previously had systemic comorbid or were suffering from active infections were excluded. Group-A patients received centrifuged fat grafts, while Group-B patients received filtered and washed fat grafts. All patients were followed for patient satisfaction and subjective/objective appearance.
Results: In Group-A, 23 (71.9%), 3 (9.4%), and 6 (18.7%) patients were happy, just satisfied and unhappy with the overall results of the procedure, respectively, while these numbers were 25 (78.1%), 3 (9.4%), and 4 (12.5%) in Group-B (p=0.785). Patients’ evaluation of their general appearance post-procedure (scored out of 10) showed a mean score of 6.53 ± 2.46 in Group-A and 6.72 ± 2.19 in Group-B (p=0.749). Scoring for a general appearance by an expert panel showed a mean score of 6.72 ± 2.16 in Group-A and a mean score of 7.13 ± 1.81 in Group-B (p=0.418).
Conclusion: There is no difference between centrifugation and filtration/washing of fat grafts for facial grafting regarding patient satisfaction and subjective/objective appearance.
Burden of Depression, Anxiety and Stress; The Psychiatric Burden in COVID-19 Patients at a Tertiary Care Hospital in Pakistan
Authors: Kakar Muhammad Siddique , Sadiq Noman , Rauf Shehzad , Ahmad Asrar , Khattak Haroon , Awais Muhammad
Published: December 2022

Objective: To assess the levels of depression, anxiety and stress in patients diagnosed with COVID-19.

Study Design: Cross-sectional study.

Place and Duration of Study: COVID isolation ward of PNS Shifa Hospital, Karachi Pakistan, from May to Jun 2020.

Methodology: A total of 110 patients whose COVID-19 PCR tests were positive were selected. They had a history of at least one-week admission to the hospital, and all of them were stable or had mild symptoms. Depression, Anxiety and Stress scale (DASS 21) was administered to all the patients through a video call.

Results: The study revealed that 30 (27.3%) of the COVID-19 patients had depressive features, whereas 37 (33.6%) were found to be anxious, and 13 (11.8%) were under stress during this time. Depressive features were more common in the female gender affecting 9 (56.2%) out of 16 females (p=0.011) and unemployed patients affecting 12 (54.5%) out of 22 unemployed patients (p=0.006). Anxiety was more common in the female gender affecting 11 (68.7%) out of 16 females and married patients, affecting 26 (27.6%) out of 94 married patients (p=0.01). Stress was found to be more in females, affecting 8 (50%) out of 16 females (p=0.01).

Conclusion: This study showed that the diagnosis of COVID-19 can lead to psychological effects, and patients should be monitored for depression, anxiety and stress.
Accuracy of Rapid Diagnostic Test for Malaria Compared to Microscopy
Authors: Shah Sanober , Waris Jamal , Mushtaq Hina , Khan Imran , Ali Mashooque , Afridi Nighat
Published: December 2022

Objective: To determine the diagnostic accuracy of the Rapid Diagnostic Test in the detection of malaria by taking routine microscopy as a gold standard.

Study design: Cross-sectional study.

Place and Duration of Study: Department of Haematology, Pakistan Naval Ship Rahat Hospital, Karachi Pakistan, from Aug 2018 to Jan 2019.

Methodology: Patients diagnosed as a case with malaria were included. Malaria was confirmed by using a Rapid detection test and microscopy. Mean and standard deviations were calculated for the quantitative variables like age. Frequencies and percentages were calculated for the qualitative variables like gender. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated.

Results: Out of 175 patients in the study, the mean age was 39.30 ± 11.29 years. 85 (48.6%) were male, and 90 (51.4%) were female. Out of 175 patients, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the rapid diagnostic test for malaria, keeping microscopy as the gold standard was found to be 87.2%, 74.15%, 67.34%, 85.71% and 80.57% respectively.

Conclusion: Rapid immune-capture tests can have excellent applicability in malaria diagnosis. Field workers can reliably read such tests without any supervision. It appears to satisfy the desired criteria of being rapid, easy to perform, interpret and reasonably accurate.
Outcomes of Patients with Stage I Germ Cell Tumour; Adjuvant Chemotherapy vs Surveillance; A Single Institutional Experience
Authors: Khan Shafquat Ali , Azhar Musa , Hanif Muhammad Rashid , Wahab Abdul , Raza Ishaq , Yasmeen Samia , Siddiqui Neelam , Sheikh Rizwan Masood , Baker M Abu
Published: December 2022

Objective: To determine five-year survival and stratify risk factors for disease relapse in the clinical stage I germ cell tumour post orchiectomy.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan, from 2008 to 2013.

Methodology: We analyzed overall survival and disease-free survival in patients with stage 1 Germ cell tumours who either received chemotherapy or were kept on active surveillance after higher orchiectomy. In addition, risk factor stratification for recurrence was determined using the clinical, radiological and histopathological parameters.

Results: Of 88 patients, 51 (58%) received chemotherapy, while 37 (42%) patients were kept on surveillance post orchiectomy for stage I germ cell tumours, including seminoma and non-seminoma histologies. Five-year overall survival and disease-free survivals were 99% and 92%, respectively, for all patients with stage 1 Germ cell tumours. Subgroup analysis showed that DFS was better in the adjuvant chemotherapy arm than the surveillance arm in both subtype histologies; however, five-year overall survival was comparable. Lymph vascular invasion and tumour size (T) was identified as risk factor for disease relapse.

Conclusion: This institutional report suggests that while identifying risk factors, active surveillance post orchiectomy can be an effective treatment option for clinical stage I germ cell tumours and is comparable with adjuvant chemotherapy. Two important factors determining survival in our study were Lymph vascular invasion and T staging.
Comparing Oral Moxifloxacin and Ciprofloxacin Ear Drops Versus Ciprofloxacin Ear Drops Only in Patients with Active Mucosal Chronic Otitis Media
Authors: Khan Amir Ali , Asim Muhammad Umar , Rehman Syed Tehmina , Nadeem Syed Furrukh , Rafique Usman , Khan Muhammad Ahmed
Published: December 2022

Objective: To compare the effects of Oral Moxifloxacin and topical antibiotic ear drops in patients with active mucosal chronic otitis media.

Study Design: Comparative prospective study.

Place and Duration of Study: Combined Military Hospital Bahawalpur, from May 2018 to Apr 2020.

Methodology: A total of 100 patients with Active (mucosal) Chronic Otitis Media were included in the study. These patients were divided into two groups. The first group received oral Moxifloxacin and topical Ciprofloxacin ear drops, while the second group only received topical ciprofloxacin ear drops. Clinical success was compared in both groups regarding patients becoming asymptomatic and having a dry ear on examination.

Results: 45(90%) patients in combined treatment while 35 (70%) in the topical ciprofloxacin ear drops group became asymptomatic. The Chi-square test was applied (6.25). The p-value was .124. We found that oral Moxifloxacin, in addition to topical Ciprofloxacin ear drops, is a superior treatment option in decreasing the symptoms of tubotympanic chronic otitis media (COM) than the topical ciprofloxacin ear drops when used alone.

Conclusion: Moxifloxacin is an effective drug in controlling symptoms of tubotympanic chronic supportive otitis media, and its combination with topical ciprofloxacin ear drops is superior to the ciprofloxacin ear drops when used alone.
Doctors' Communication Skills in Military Hospitals–A Critical Analysis
Authors: Hussain Zakir , Rehman Muneeb Ur , Khan Muhammad Alamgir
Published: December 2022

Objective: To assess the level of communication skills of doctors in military hospitals and compare their own and patient perceptions. We also aimed to determine factors affecting doctors' communication skills and suggest recommendations for improving doctors' communication skills.

Study Design: Cross-sectional study.

Place and Duration of Study: CMH Lahore, CMH Gujranwala and CMH Chunian and Armed Forces Institute of Cardiology, Rawalpindi, from Oct 2016 to Jun 2017.

Methodology: Through non-probability consecutive sampling, questionnaires were distributed to 100 physicians and 100 patients inquiring about various aspects of doctors' communication skills and factors affecting them.

Results: Doctors were asked to judge the overall level of their communication skills, and more than half of them (53%) opined that their communication skills were very good. However, the perception of doctors' communication skills was better by doctors themselves compared to patients' perception. More than half of the doctors strongly agreed that increased workload, use of the hospital management system and extra commitments were major impediments to effective communication skills.

Conclusion: The perception about the communication skills of doctors is not as high as that of the doctors themselves. There is a striking disparity between the physicians' and patient responses. The communication skills of doctors can be improved by formal training of physicians in the form of workshops. In addition, the workload on doctors should be reduced by minimizing extra commitments.
Teratogenic Effects of Bisphenol A Exposure During Maternal Pregnancy and Lactation on Developing Rat Pups Testes
Authors: Khurshid Tooba , Ali Shabana , Ali Hussain , Bano Maleeha , Cheema Hira Waqas , Hussain Nabiha
Published: December 2022

Objective: To study the teratogenic effects of Bisphenol A exposure during maternal pregnancy and lactation on the testicular histology of developing rat pups.

Design of Study: Laboratory-based experimental study.

Place and Duration of Study: Department of Anatomy, Islamic International Medical College Rawalpindi in collaboration with the National Institute of Health (NIH) Islamabad Pakistan from Sep 2018 to Sep 2019.

Methodology: Eight weeks old, ten pregnant female rats were divided into groups, each comprising five pregnant rats. Pups were born by spontaneous vaginal delivery. Control group A consisted of 15 male rat pups delivered from 5 pregnant rats, fed on a standard diet during pregnancy and lactation till the 21st day. Experimental group B consisted of 15 male rat pups delivered from 5 pregnant female rats who were administered subcutaneous Bisphenol A at a dose of during their pregnancy and lactation till the 21st day.

Results: Significant deterioration of quantitative parameters in testes of the experimental group was seen. The seminiferous tubule diameter in group B was 81.99 ± 10.88 compared to group A which was 111.59 ± 8.36. The germinal epithelial height in group B was 10.47 ± 2.34 compared to 30.41 ± 2.43 in group A. The number of Leydig cells in group B was 17 ± 3.45 compared to 47 ± 4.44 in group A. The number of rounded spermatids in group B was 10 ± 3.74 compared to 38 ± 4.02 in group A.

Conclusion: Bisphenol A has teratogenic effects on testicular histology of developing rats............
Diagnostic Accuracy of CHROMagar MRSA for Detection of Methicillin-Resistant Staphylococcus Aureus (MRSA) from Screening Swab Specimens
Authors: Ahmed Farooq , Hussain Wajid , Mirza Irfan Ali , Ali Saad , Khurshid Umar , Sarwar Mariam
Published: December 2022

Objective: To determine the diagnostic accuracy of CHROMagar MRSA for detecting MRSA from screening swab specimens keeping the Cefoxitin disk diffusion test as the reference method.

Study Design: A cross-sectional validation study.

Place and duration of study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Mar to Aug 2019.

Methodology: A total of 243 screening swab specimens, e.g., axillary, nasal and web swabs, each of hospitalized patients and healthcare workers (HCW) submitted for MRSA screening were included in the study and were processed simultaneously on blood agar, MacConkey agar and CHROMagar MRSA. The agar plates were incubated at 35°C ± 2°C for 18-24 hours in ambient air. The cefoxitin disk diffusion test followed the isolation and identification of MRSA according to the latest Clinical and Laboratory Standards Institute (CLSI) guidelines. In CHROMagar MRSA screening, after incubation, plates were examined for the presence of mauve colonies (MRSA detected), and the results were obtained and validated against the reference method of Cefoxitin disk diffusion.

Results: Overall, the diagnostic accuracy of CHROMagar MRSA for detecting MRSA was 97.53%. Diagnostic accuracy of CHROMagar MRSA was 95.1%, 97.5% and 100% in axillary, nasal and web specimens, respectively. The rate of MRSA detection was maximum in axillary swabs, i.e., 40.7%, followed by 29.6% and 9.8% in nasal and web swabs, respectively.

Conclusion: CHROMagar MRSA is found to be accurate for the detection of MRSA. It is reliable, easy to perform, less timeconsuming, and cost-effective. It is an affordable alternative to the conventional..............