bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARISON OF EFFICACY OF SEMONTS MANOEUVRE VERSUS VESTIBULAR SEDDATIVE IN POSITIONAL VERTIGO
Authors: Niazi Muhammad Sohail Babar , Kamal Khawar , Hassan Zaheer Ul , Qaiser Aaisha , Khattak Shahid Farooq , Iqbal Shahid
Published: January 2022

Objective: To carry out the comparison of the effectiveness of Semont manoeuvre and Vestibular Sedative in the management of benign paroxysmal positional vertigo (BPPV).

Study Design: Quasi experimental study.

Place and Duration of Study: Department of ENT, Combined Military Hospital Peshawar Pakistan, from Jan to Jul 2020.

Methodology: The study was conducted on 60 patients who were diagnosed Benign Paroxysmal Positional Vertigo by Dix Hallpike test. The patients were divided into 2 groups of 30 each. Group A was treated with vestibular sedative and group B was treated with Semont manoeuvre. The examination of all patients was done on day 3, day 7 and day 14 and the results were documented.

Results: The study was conducted on 60 patients who were diagnosed benign paroxysmal positional vertigo by Dix Hallpike test the study revealed that the 30 cases which were treated by Semont manoeuvre, 25 cases were completely symptom free after 14 days. Meanwhile out of 30 cases which were managed by oral vestibular sedative, only 4 cases showed complete recovery after 14 days. Chi square test was used to compare the results. The results revealed that Semont manoeuvre is more effective in the treatment of benign paroxysmal positional vertigo than vestibular sedative.

Conclusion: Semont manoeuvre is more effective in the management of benign paroxysmal positional vertigo than vestibular sedative.
DISAPPEARANCE OF ANTIBODIES IN COVID-19 MYTHS ORREALITY
Authors: Raza Maqbool , Raza Muhammed Ali , Cheema De Emmal Asjad , Cheema Maham Asjad , Rafique Atif , Khan Sarim Waleed
Published: January 2022

Objective: To explore the disappearance of neutralizing antibodies from patients, their myths, and facts.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital Multan Pakistan, from Jul 2021 to Aug 2021.

Methodology: A total of 100 blood samples were collected from 100 COVID-19 patients. These 100 patients were followed up for a period of 3 months. Antibodies were determined with the modified neutralization assay method and enzyme-linked immuno-sorbent assay (ELISA).

Results: The antibody level by NA and ELISA peaked on days 30-35 then decreased slightly. In multivariate analysis, patients aged 25-35, 36-56, and 57-84 years had a higher neutralizing antibody level than those aged 10-21 years. The patient with the worst clinical manifestation had a higher neutralizing antibody titer. In serum samples, IgG was undetectable at 18.3% and 11% and the geographical mean reciprocal titers dropped from 244 at 3-month period and neutralizing antibodies, the geographical mean reciprocal titers dropped from 874 at 3 months.

Conclusion: All COVID-19 patients were seropositive and significantly neutralizing antibody response. Neutralizing antibody levels depend on the time after the onset of symptoms, age, and severity of the disease.
MANAGEMENT OF COTTON BUD INDUCED OTITIS EXTERNA BY UNIQUE METHOD
Authors: Bukhari Syed Muhammad Asad Shabbir , Aslam Sohail , Riaz Naeem , Ayub Muhammad Waqas , Saeed Irfan , Asghar Adnan , Khan Muhammad Fahad Wasim
Published: January 2022

Objective: To compare the recovery of patients in both groups having acute otitis externa induced by cotton buds/various objects. One group by old method and second group by unique method.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pakistan Naval Ship Shifa Karachi, from Jan to Dec 2020.

Methodology: Non-probability convenience sampling technique was applied. Out of 50 cases were selected for group 1 management. Fifty cases were selected for group 2 management. A chi-square test was applied to compare the recovery of two groups of patients on the 14th day and 42nd day of follow-up. p-value was kept 0.05 as significant.

Results: A total of 100 cases were treated in 2 groups. The gender distribution of the study was 54 females and 46 males. The mean age of the study population was 33.09 ± 12.93 years. p-value was calculated on the 14th day and 42nd days. A 2x2 table of 14th follow up day showed recovery by both groups with a p-value of 0.041 which is <0.05. This showed that group 2 management was statistically better than group 1 management.

Conclusion: The second group was managed with eardrops containing Betamethasone and Neomycin. This management protocol is unique and better than conventional management as done in the first group.
THYROID SURGERY: A COMPARISON OF COMMON COMPLICATIONS BETWEEN EXPERTS AND SURGEONS IN TRAINING
Authors: Shabbir Bukhar Syed Muhammad Asad , Hassan Zaheer Ul , Butt Kamran Ashfaq , Riaz Naeem , Akram Chaudhry Muhammad Bilal , Shah Amanat Ali
Published: January 2022

Objective: To determine the frequency of common complications of thyroid surgery by two types of surgeons.

Study Design: Comparative cross sectional.

Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Peshawar, from Jan 2013 to Dec 2017.

Methodology: This study was conducted to assess the role of surgical skills in complications of thyroid surgery. Surgeons performing surgery for more than 5 years were considered expert and less than 5 years of experience were considered trainee for this specific surgery. Complications by both were analyzed by SPSS-21 and descriptive statistics were applied.

Results: A total of 482 surgeries were performed. Out of 407 were female and 75 were males. Mean age was 43.55 ± 10.9 years. Expert surgeons performed 300 cases and 16 (5.3%) experienced some complication in 6 months of follow up.182 cases were performed by surgeons with lesser experience and 14 (7.5%) cases developed complications over the period of follow up. Recurrent laryngeal nerve paralysis occurred in 2 (0.67%) of experienced surgeons cases while 6 cases (3.2%) of less experienced surgeons had the similar complication.

Conclusion: While the overall complication rates are not much different between experienced and lesser experienced surgeons, the rate of recurrent laryngeal nerve paralysis is significantly more, though still within the acceptable international complication rate for this particular surgery.
MANAGING MASS CASUALTIES IN LIMITED RESOURCE SETTING: A COMPARISON BETWEEN A PERIPHERAL HOSPITAL AND FORWARD TREATMENT CENTER
Authors: Ikram Mobeen , Mahboob Saira , Zeba Nudrat
Published: January 2022

Objective: To share our experience of handling mass casualties at remote locations with an aim to help formulate a policy regarding future training of doctors.

Study Design: Case series.

Place and Duration of Study: Combined Military Hospital Thal Pakistan, from Jan 2016 to Sep 2018, including three months in Forward Treatment Center in operational areas.

Methodology: The injuries due to war trauma were included in our study. Resource management and changes made to accommodate the influx of mass trauma that required damage control surgery were described.

Results: A total of 16 casualties from two mass casualty incidents at two medical centers were included in our study. There was no difference in triage class (p=0.96). Splinter injury limbs were most common injury. One patient required damage control surgery done at Combined Miliary Hospital with most requiring hemostasis prior to transport (8 at Combined Military Hospital versus 3 at Forward Treatment center), p=0.346.

Conclusion: Most of mass casualties at our hospital were minor injuries requiring immediate first aid. In addition, the damage control resuscitation and surgery done at these remote locations may have helped prevent mortality and morbidity in the more severely injured.
SELF-INFLICTED FIREARM INJURIES AS COMPARED TO THE ACCIDENTAL FIREARM INJURY; A COMPARATIVE ANALYTICAL STUDY TO DETERMINE THE COMMONEST SITE OF NON-SUICIDAL SELF-INFLICTED INJURIES
Authors: Hasnain Syed Shehzad , Ahmed Rizvi Syed Taokeer , Ashraf Imran , Khan Romesa Qaiser , Niazi Waseem Khan , Rao Ali Shan
Published: January 2022

Objective: To determine the commonest site of non-suicidal self-inflicted firearm wound in comparison with accidental firearm wounds.

Study Design: Cross sectional study.

Place and Duration of Study: Combined Military Hospitals Jhelum, Bannu & Kharian, from Nov 2014 to Nov 2018.

Methodology: Sixty-four patients with firearm injuries were observed. All the participants were males between the ages of 18- 60 years. The injuries were determined to be either self-inflicted or accidental by an independent committee. The participants’ replies and responses were assessed by dividing them into five main domains by using quantitative software SPSS version 20. Variables involving demographic characteristics of participants such as age, occupation, marital and socioeconomic status, were associated with mental health variables such as psychological stress, previous history of self-harm and clinical psychiatric illness.

Result: Fifteen subjects were found to have self-inflicted injuries and 50 had accidental injuries. There was a marked preference for left foot and left lower limb as a site for non-suicidal self-inflicted injuries (94.6%) as compared to other sites (left upper extremity 1.8%, chest 1.8% and right lower extremity 1.8%).

Conclusions: Left lower limb and left foot was a more common site for self-injury as compared to the other sites.
A MULTICENTRIC COMPARATIVE STUDY IDENTIFYING ‘RESEARCH OBSTACLES’ AMONG POSTGRADUATE RESIDENTS OF DIFFERENT ‘MEDICAL & DENTAL INSTITUTES OF BALOCHISTAN AND PUNJAB’
Authors: Saeed Nabiha Farasat , Saeed Muhammad , Saeed Imran , Butt Arshad Kamal
Published: January 2022

Objective: To compare the research obstacles including lack of proper training, previous exposure, time management, motivation, faculty research knowledge, skill, social constrains and lack of interest among post-graduate residents of Balochistan with those of Children’s Hospital, Lahore.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Dental College, Bolan University of Medical and Health Sciences, Quetta, Quetta Institute of Medical Sciences & Institute of Public Health of Balochistan, from Mar to May 2018, and Children’s Hospital Lahore, Lahore, from Jul to Aug 2017.

Methodology: A total of 72 postgraduates from three different institutes of Balochistan and 90 from Children’s Hospital, Lahore were recruited in this study. The questionnaire was distributed to the participants of both institutions; data was collected & entered into SPSS version 22.

Results: Female predominance (64.4%) was observed in post-graduates of Children’s Hospital, Lahore in comparison to institutions from Balochistan while there were 61% males. Majority (90%) post-graduate residents of Balochistan recognized time management, deficient laboratory and other facilities followed by lack of mentoring by faculty 59 (83%) and lack of motivation 60 (84%) as the most important factors that hinder their scientific activities. Additionally, 91 (86.6%) postgraduates of Children’s Hospital, Lahore suggested lack of proper research training and 87 (83.3%) suggested lack of previous exposure as the main hindering factors in their research work.

Conclusion: Post-graduate residents of diverse economic, educational and cultural backgrounds present different perceptions about research hurdles. However, those from both provinces identified that lack of..........
A COMPARISON OF SUPRASCAPULAR NERVE BLOCK VS INTRAARTICULAR STEROID INJECTION IN IMPROVEMENT OF HEMIPLEGIC SHOULDER PAIN
Authors: Bin Noor Musab , Butt Aamir Waheed , Iqbal Waseem , Rashid Maimuna
Published: January 2022

Objectives: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular Nerve block and Intra-articular steroid injection in patients with hemiplegic shoulder pain.

Study Design: Randomized Controlled Trial

Place and Duration of Study: Pain Clinic, Armed Forces Institute of Rehabilitation Medicine Rawalpindi from 25th October 2017 to 24th April 2018

Patients & Methods: 60 patients with CVA and shoulder pain on hemiplegic side for at least 2 weeks were included in study after non-probability consecutive sampling after meeting inclusion criteria. Subjects were randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1 ml of 1% Lignocaine injections. Mean change in pain scores on VAS was calculated between score at baseline and at 4 weeks post-intervention

Results: The mean age of patients in group A was 59.17 ± 9.81 years and in group B was 39.96 ± 11.11 years. Out of 60 patients, 34 (56.67%) were males and 26 (43.33%) were females with male to female ratio of 1.3:1. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain change on VAS in Group A (Suprascapular Nerve block) was 3.83 ± 1.12 cm while in Group B (Intra-articular steroid injection) it was 2.17 ± 0.99 cm (p-value = 0.0001).

Conclusion: This study concluded that Suprascapular Nerve block offered better improvement in hemiplegic shoulder pain on Visual Analogue Scale at 4 weeks as compared to intraarticular steroid injection.
OUTCOME OF SALINE WOUND LAVAGE PRIOR TO WOUND CLOSURE IN GYNAECOLOGICAL AND OBSTETRICAL PATIENTS
Authors: Saleem Uzma , Waseem Tayyaba , Babar Malik Waseem
Published: January 2022

Objective: To determine the effectiveness of saline wound lavage in reducing wound infections in patients undergoing gynaecological and obstetrical abdominal surgical procedures.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, Pakistan Navy Ship Shifa Hospital, Karachi Pakistan, from Oct 2018 to Sep 2019.

Methodology: All the patients undergoing gynaecological or obstetrical surgical procedures were enrolled after informed consent. Participants underwent elective or emergency surgery. In Group A with 551 patients, saline wound Lavage was done before closure, whereas in 533 patients in group B saline wound irrigation was not done. Similar post-operative care was provided to both groups. All patients were observed for febrile illness and wound discharge on 2nd, 8th, 15th and 30th postoperative day.

Results: Out of 1084 patients, there were 551 (50.7%) in saline wound irrigation group A, while 533 (49.3%) were in group B where no saline wound irrigation was done. The frequency of febrile illness was observed in 49 (3.8%) patients. Febrile illness was significantly higher in patients without saline wound irrigation as compared to patients with saline wound irrigation (pvalue 0.002). The frequency of wound discharge was observed in 28 (22.2%) patients. Wound discharge was significantly higher in patients without saline wound irrigation as compared to patients with saline wound irrigation (p-value=0.018).

Conclusion: Saline wound irrigation prior to wound closure in obstetrical and gynaecological abdominal procedures can lead to a significant reduction in surgical site infection.
ASSOCIATION OF BODY MASS INDEX AND LIPID PROFILE WITH CHRONIC HEPATITIS C INFECTION
Authors: Younas Amna , Hanif Waqas , Ali Oshaque , Jamal Sumaira , Nawaz Aqsa , Ain Qurat Ul
Published: January 2022

Objective: To find out association of lipid profile and body mass index (BMI) profile among cases having chronic hepatitis C virus (CHCV) infection.

Study Design: Cross sectional study.

Place and Duration of Study: Departments of Medicine and Pathology, Combined Military Hospital, Multan Pakistan, from Mar 2019 to Feb 2020.

Methodology: A total of 320 cases of both genders, aged 18-60 years, having chronic hepatitis C virus infection were enrolled. After taking relevant history and physical examination, venous blood sample of each patient was taken and sent to institutional laboratory for analysis of serum total cholesterol (TC) level, serum triglyceride (TG) level, low density lipoprotein (LDL), high density lipoprotein (HDL) were analyzed. Body mass index among all the study participants was also calculated.

Results: Out of a total of 320 cases, there were 152 (47.5%) male and 168 (52.5%) female. Mean age was 41.7 ± 8.1 years. Most of the cases, 97 (30.3%) were between 41-50 years of group. Dyslipidemia was noted in 144 (45%) cases. Increasing age and increasing Body mass index were found to have statistical significance with the presence of dyslipidemia (p-value <0.05).

Conclusion: Increasing age and body mass index have significant association with dyslipidemia in patients with chronic hepatitis C virus infection. Lipid profile altered among different age and body mass index groups.
ENHANCED RECOVERY PATHWAYS (ERAS) IMPLEMENTATION IN MINIMALLY INVASIVE ESOPHAGECTOMY; AN EARLY EXPERIENCE
Authors: Riaz Aaishah , Umair Bilal , Asghar Asif , Imtiaz Muhammad , Khan Raheel , Bilal Azfar
Published: January 2022

Objective: To evaluate the impact of enhanced recovery pathways (ERAS) on hospital stay and postoperative outcomes in patients undergoing minimally invasive esophagectomy in comparison to conventional pathway.

Study Design: Quasi experimental study.

Place and Duration of Study: Thoracic Surgery Department, Combined Military Hospital Rawalpindi Pakistan, from Jul 2018 to Mar 2020.

Methodology: A total of 80 patients who underwent minimally invasive esophagectomy were divided in two groups. Group A underwent ERAS pathway and group B underwent conventional pathway. Both groups were compared for demographic characteristics, mean ICU stay, length of hospital stay, commencement of oral intake, and time of chest drain removal, readmission rates, postoperative morbidity and mortality.

Results: There was no significant difference in age, gender and diagnostic indication among both groups. ERAS group was found to have shorter mean ICU stay (1.18 ± 0.55 vs 2.06 ± 1.10 days p<0.012), shorter hospital stay (7.50 ± 1.23 vs 11.6 ± 3.65 days, p<.001), earlier commencement of oral feeding (4.30 ± 1.41 vs 9.10 ± 4.26 days, p<0.001) and early removal of chest drains (3.22 ± vs 4.11 ± 1.52 p<0.001); when compared to conventional group. Overall morbidity in ERAS group was 50 (40%) versus 65% (81.25%) in conventional group. Mortality was same in both groups (2.5%). There was no readmission in ERAS group.

Conclusion: ERAS in minimally invasive esophagectomy is safe and has positive impact on postoperative outcomes with marked reduction in overall morbidity in comparison to conventional regime. Results can be enhanced by ensuring better compliance to its.......
VALIDATION OF URDU VERSION OF CENTER FOR EPIDEMIOLOGICAL STUDIES FOR DEPRESSION SCALE FOR CHILDREN IN CONTEXT OF PAKISTAN
Authors: Mustafa Nazia , Maqsood Aneela
Published: January 2022

Objective: To translate and psychometrically validate the center for epidemiological studies for depression scale (CES-DC) for Pakistani children.

Study Design: Cross-sectional study.

Place and Duration of Study: Various schools in Rawalpindi, from Feb to Mar 2021.

Methodology: Present study comprised of translation, cross-language validation and investigation of psychometric properties of the scale into Urdu Language. Urdu translated version and strength and difficulty questionnaire were administered on 154 primary school children from various private schools situated in Rawalpindi district. Cronbach’s alpha reliability, item-total correlation and Pearson’s correlation coefficient were used for analysis.

Results: Results revealed that this scale had good internal consistency and reliability (Urdu-version α=0.73; English-version α = 0.65) along with correlation coefficients over a period of 15 days (r=0.96). Cronbach’s alpha value of scales was found to be fairly high (r=0.78 and r=0.81). Item-total correlation of translated scale was also satisfactory (ranged from 0.04-0.58) and Pearson’s correlation of translated version with strength and difficulty questionnaire indicated good convergent validity (r= 0.54; p<0.01).

Conclusion: Results supported the feasibility, reliability and validity of the Urdu version of this scale to screen depression among Urdu speaking pediatric Pakistani population.
ASSESSMENT OF PSYCHO-SOCIAL IMPACT OF ACNE AMONG YOUNG ADULTS - A CROSS SECTIONAL STUDY AT A TERTIARY CARE HOSPITAL OF RAWALPINDI
Authors: Rashid Zubaida , Mashhadi Syed Fawad , Sharif Imtenan , Zaidi Syeda Urooj , Maroof Saira , Khan Mufliha , Liaqat Umama
Published: January 2022

Objective: To assess the psychosocial impact of acne and to evaluate the quality of life in relation to severity of symptoms among young adults.

Study Design: Cross-sectional – analytical study.

Place and Duration of Study: Outpatient Department, Pak Emirates Military Hospital, Rawalpindi, from Sep 2018 to Feb 2019.

Methodology: We included 300 individuals visiting the hospital and their quality of life was assessed using Acne quality of life Index questionnaire. Data was analyzed using SPSS-23.

Results: Total scores were calculated for three domains of Quality of life in patients with Acne i.e. Self-perception, Emotional well-being and Social life. Out of these three domains, Social Life was most affected by acne (mean score 15.61 ± 7.37out of a total of 30) and Self-Perception was seen to be least affected (mean score 16.90 ± 8.20). There was a strong positive co-relation between the increasing severity of symptoms and impact on Self Perception (r=-0.58, p<0.01), between severity and Impact on Social life (r=-0.581, p<0.01) and between severity of symptoms and Impact on emotional well-being of the patients (r=-0.551, p<0.01). A significant difference was seen between the two genders with reference to the impact on “Social Life”, the meanscore for Males being 13.96 ± 7.55 while that for Females being 17.29 ± 6.81 (p<0.01).

Conclusion: Acne has significant impact on the quality of life of patients treated by primary care physicians. The severity of symptoms had strong positive correlation with self-perception, social and emotional domains.
FREQUENCY OF CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT BY MEANS OF ULTRASONOGRAPHY IN NEONATES AT A TERTIARY-CARE HOSPITAL
Authors: Rasool Uzma , Rehman Saqib Ur , Ayaz Saeed Bin , Tariq Ghulam Rasool , Shah Ghulam Ghaus
Published: January 2022

Objective: To determine the frequency of congenital anomalies of the kidney and urinary tract by means of ultrasound in neonates.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Radiology and Diagnostic Imaging, Rehman Medical Institute, Peshawar, from May 2015 to Jan 2016.

Methodology: A total of 150 neonates reporting for routine abdominal ultrasonography were included. Honda Convex Scanner model HS-2000 with probe of frequency of 5-7 MHz was used for the ultrasonography.

Results: Mean age of the neonates was 13.8 ± 7.5 days. Seventy-six (50.7%) were male and 74 (49.3%) were female. Congenital anomalies of the kidney and urinary tract were observed in 10 (6.7%) neonates. Most neonates had more than one anomaly. The left side was involved in 6 (4%) neonates while right side was involved in 4 (2.7%). Hydronephrosis was the most common abnormality found in 8 (5.3%) cases. The location of kidneys was abnormal (ectopic) in 2 (1.3%) neonates. Abnormal dimension was seen in seven cases and abnormal corticomedullary differentiation was found in 5 (3.3%) cases. Non-symmetrical cases were 5 (3.3%). Hydroureter was observed in 3 (2%) neonates and urinary bladder was abnormal in 2 (1.3%) neonates.

Conclusion: The frequency of congenital anomalies of the kidney and urinary tract in neonates by means of postnatal ultrasonographic scan in our study population was 6.7%. Hydronephrosis was the most common anomaly.
ASSOCIATION BETWEEN ANEMIA AND BONE PROFILE IN NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE ANEMIA AND BONE PROFILE IN CKD
Authors: Kanwal Shamsa , Aamir Muhammad , Mansoor Khurram , Asif Naveed , Tanveer Muhammad
Published: January 2022

Objective: To determine association between iron deficiency anemia and bone profile in cases of chronic kidney disease not undergoing dialysis.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology in collaboration with department of Nephrology, Armed Forces Institute of Urology, Rawalpindi, from Sep 2018 to Oct 2019.

Methodology: A total of 300 chronic kidney disease patients who were not dependent on any kind of dialysis were included in our study. Chronic kidney disease was confirmed according to National Kidney Foundation/Kidney Disease Outcome Quality Initiative criteria. Hemoglobin, Mean corpuscular volume and ferritin levels were used to diagnose iron deficiency anemia. Association of Calcium, inorganic Phosphorous, Magnesium, Alkaline phosphatase and Parathyroid Hormone (PTH) was determined with iron deficiency anemia.

Results: Out of 300 patients studied 201 (67%) were females while 99 (33%) were males. Mean age of participants was 43.51 ± 5.652 years. Mean duration of chronic kidney disease was 4.36 ± 3.712 years. One hundred and forty one (47%) patients had no anemia while 159 (53%) had presence of iron deficiency anemia. After applying binary logistic regression analysis hypocalcemia, hypophosphatemia and hypomagnesemia were noted to have a statistically significant association with iron deficiency anemia in the target sample size.

Conclusion: This study revealed a high frequency of iron deficiency anemia in non-dialysis chronic kidney disease patients. Hypocalcemia, hypophosphatemia and hypomagnesemia were found having strong association with presence of iron deficiency anemia in non-dialysis dependent chronic kidney disease patients.
Is IS PSEUDOEXFOLIATION A SIGNIFICANT RISK FACTOR FOR GLAUCOMA? A CROSSSECTIONAL ANALYSIS OF A PAKISTANI POPULATION
Authors: Rauf Abdul , Abbas Hussnain , Ali Saqib , Javaid Haroon , Naimat Khalid
Published: January 2022

Objective: To determine the association between pseudoexfoliation and glaucoma.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Eye Outpatient department of Combined Military Hospital, Multan from Jan to Dec 2019.

Methodology: A total of 170 patients reporting to the eye outpatient department were examined for the presence of Pseudoexfoliation and glaucoma based on raised intraocular pressure >21mm Hg, increased cup disc ratio and visual field defects. Therefore, a total of 340 eyes were examined.

Results: Out of a total of 252 eyes with pseudoexfoliation, 40 (15.9%) had glaucoma. This frequency of glaucoma was significantly higher in eyes with pseudoexfoliation 87 (98.9%), in comparison to eyes without pseudoexfoliation 1 (1.1%); p<0.01).

Conclusion: Pseudoexfoliation was found to be strongly associated with glaucoma.
EVALUATION OF SUCCESS OF RESIN INFILTRATION TECHNIQUE IN SUPERFICIAL PROXIMAL CARIOUS LESIONS OF POSTERIOR TEETH
Authors: Mahmood Faisal , Munir Muhammad Bader , Altaf Ali , Yousaf Ajmal , Bhangar Faisal , Hussain Syed Muzammil
Published: January 2022

Objective: To determine the effectiveness of resin infiltration technique in arresting superficial proximal carious lesions of posterior teeth.

Study Design: Quasi experimental study.

Place and Duration of Study: Operative dentistry department, de’ Montmorency College of Dentistry Lahore, from Oct 2018 to Mar 2019.

Methodology: Meeting inclusion criteria were selected. Informed consent was obtained. After application of rubber dam; etchant gel was applied to superficial proximal carious lesions in these patients; water-rinsed and air-dried for 30 sec; resin was then infiltrated into each lesion. Patients were recalled after 6 months for follow up.

Results: Total patients were 30 out of which 18 (60%) were males and 12 (40%) were females. Mean age of patients was 25.77 years ranging from 16-35 years. Success of resin infiltration technique in superficial proximal carious lesions in posterior teeth was 86.7% measured by bitewing radiograph taken on follow up after 6 months to see any progression of carious lesion.

Conclusion: Resin infiltration was effective in 86.7% patients in arresting progress of superficial proximal carious lesions with no significant difference for age and gender. Hence it is suggested that resin infiltration being promising micro invasive approach should be considered in addition to non-operative and operative treatment approaches.
ULTRASOUND GUIDED FOAM SCLEROTHERAPY AS A PREFERRED TREATMENT OPTION FOR VARICOSE VEINS IN TERMS OF SAFETY, EFFICACY AND COST EFFECTIVENESS
Authors: Jamil Muhammad , Usman Rashid , Khan Muhammad Irfan , Randhawa Muhammad Afzal , Aman Aaiza , Jamil Areesha
Published: January 2022

Objective: To assess the safety, efficacy and cost effectiveness of ultrasound-guided foam sclerotherapy in superficial venous reflux in Clinical, Etiological, Anatomical and Pathological (CEAP) classification grade 2-6 disease.

Study Design: Retrospective observational study.

Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2018 to Feb 2020.

Methodology: One thousand and sixty-seven patients (1312 legs) with varicose veins were treated by ultrasound-guided foam sclerotherapy using 3% sodium tetradecyl sulphate for truncal veins and 1% for smaller veins in 1:4 ratio with air. After 7 days, leg was assessed clinically and radiologically with Duplex ultrasound for occlusion of veins and complications. Second, third and fourth sclerotherapy sessions were performed for residual/recurrence/new varicosities. Compression bandage was used for at least 3 months after treatment.

Results: The overall eradication of superficial venous reflux and healing of ulcers, was seen in 92.1% (1208 legs). It was 83.5% (1095 legs) after 1st session of UGFS. Second, 3rd and 4th session of UGFS further increases this percentage of benefitted patients Deep vein thrombosis developed post procedure in 2 (0.18%) patients and pulmonary embolus in one patient. Three (0.28%) patients had transient visual disturbances within half an hour of treatment. Retreatment was required due to formation of new superficial venous reflux in 39 (2.9%) legs and recurrence in 93 (7.1%) legs.

Conclusion: Ultrasound guided foam sclerotherapy is a better option of treatment in varicose veins in terms of safety, efficacy and cost effectiveness.
BACTERIAL SPECTRUM AND ANTIMICROBIAL PATTERN OF BLOOD STREAM INFECTIONS ASSOCIATED WITH NON-TUNNELED DOUBLE LUMEN CATHETER IN HEMODIALYSIS PATIENTS
Authors: Hussain Mehmood , Khan Malik Nadeem Azam , Rehman Khalid , Mirza Irfan Ali , Rehman Maryam , Riaz Sidra
Published: January 2022

Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections associated with non-tunneled double lumen catheter in hemodialysis patients.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Nephrology, Pakistan Emirates Military Hospital Rawalpindi Pakistan; Armed Forces Institute of Pathology Rawalpindi, Pakistan, from May 2019 to Apr 2020.

Methodology: A total of 753 patients underwent placement of non-tunneled double lumen catheter (457 femoral, 296 Internal Jugular). Patients with clinically suspected bloodstream infections had their catheters removed with tips being sent for culture along with 2 sets of peripheral blood cultures. Patients were labelled as having bloodstream infection if growth of organism was detected in catheter tip and at least one peripheral blood culture. Susceptibility testing was done for available antimicrobials.

Results: One hundred and thirty six (18.06%) incidences or 5.48 bloodstream infections per 1000 catheter days, with confirmed growth on blood cultures were identified. Gram positive infections were seen in 76 (55.88%) individuals with most common organism being coagulase-negative Staphylococcus (28.68%), followed by Staphylococcus aureus (21.32%). These organisms had low resistance rates to Vancomycin (0%), Tigecycline (0%), Doxycycline (6.6%) and Linezolid (9.5%). Gram negative infections were seen in 60 (44.11%) patients with Klebsiella pneumoniae (13.24%) being the most commonly identified pathogen followed by Acinetobacter baumannii (12.50%) and had relatively higher degree of antimicrobial resistance.

Conclusion: Gram positive organisms were the most common cause of bloodstream infection in this study and were found susceptible to vancomycin and doxycycline whereas gram-negative organisms had high rates of antimicrobial......
EXPOSURES AND RISK FACTORS OF CORONA VIRUS AMONG HEALTH CARE WORKERS AND NEED FOR PREVENTIVE MEASURES IN COMBINED MILITARY HOSPITAL RAWALPINDI
Authors: Siddiqi Fuad Ahmad , Mehreen Sobia , Ahmed Adeel , Bashir Tariq , Ahmad Javed , Hassan Fayyaz , Mahmood Fatima
Published: January 2022

Objective: Prospective To determine the various risk factors and exposures for spread of Corona Virus Disease 2019 (COVID19) among health care workers working at Combined Military Hospital Rawalpindi.

Study Design: Cross sectional study.

Place and Duration of Study: Combined Military Hospital, Rawalpindi, from Apr to Jul 2020.

Methodology: A total of 134 health care workers who were infected with COVID-19, were included in study. A structured questionnaire was attained after informed consent and approval from hospital ethical committee. Data was analyzed using SPSS-19 statistical software.

Results: Overall, 134 of 2591 Health care workers (Health care workers) in Combined Military Hospital Rawalpindi tested positive for COVID-19 during the study period. The infection rate was 5.17%. Among them 25 (18.7%) were women and 109 (81.3%) were men. There was not statistical difference in infection rate between male and female health care workers p=0.156). The infection rate in clinical category was significantly higher than non-clinical category (p<0.001. The infection rate in nursing assistants was significantly higher than the doctors (p=0.021). Personal protective equipment was optimally provided to health care workers except for goggles and face shields whose provision and use were both lacking.

Conclusion: Health care workers are at high risk of developing COVID-19. There is need for extensive training, easy availability of personal protective equipment and strict compliance to infection control policies.
THE IMPACT OF ISOLATED OLIGOHYDRAMNIAS AT TERM ON PERINATAL OUTCOME: A COMPARATIVE STUDY
Authors: Zafar Bushra , Arif Nadia , Arif Ayesha , Ahmed Raja Qaseem , Shahzad Farrukh
Published: January 2022

Objective: To study the impact of isolated oligohydramnios at term on mode of delivery and perinatal outcome.

Study Design: Prospective comparative study.

Place and Duration of Study: Combined Military Hospital Okara, from Aug 2019 to Aug 2020.

Methodology: A total of 250 patients were recruited in the study. They were divided in 2 groups. In group A there was 123 patients, with isolated oligohydramnias at term, amniotic fluid index of ≤5cm, while in group B 127 patients, with normal liquor volume were included through lottery method. Demographic parameters, Intrauterine fetal demise, mode of delivery, perinatal out comes like meconium stained amniotic fluid, low birth weight, APGAR score at 1 and 5 minutes, of two groups were compared.

Results: A total of 57 (46.3%) patients in group A delivered through cesarean section and 27 (21.3%) in group B. Meconium staining of liquor was in 56 (45.5%) in group A versus 13 (10.2%) in group B. As compared to group B the patients in group A lower birth weight babies 2.6 ± 0.34 kg versus 3.0 ± 0.33 kg were delivered. Mortality in group A, intrauterine fetal demise was 4 (3.3%) and still birth was 2.3%. There were no perinatal mortality in controlled group B.

Conclusion: Isolated oligohydramnias at term is not associated with adverse perinatal outcome. Umbilical cord compression, potential utero-placental insuffiency and increased incidence of meconium stained liquor possibly explains the increased perinatal morbidity. The delivery should be routinely advocated as in otherwise uncomplicated pregnancy with appropriately grown fetus.
ASSESSMENT OF EFFICACY OF ELECTRONIC VACUUM ASPIRATION WITH INTRAVENOUS ANALGESIA
Authors: Afsheen Afeera , Shahid Aisha , Iftikhar Bushra , Anwar Rabiah , Nosheen Javaira , Tariq Amera
Published: January 2022

Objective: To assess efficacy of elecrtonic vacuum aspiration in evacuation of retained product of conception with intravenous analgesia.

Study Design: A prospective observational study.

Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan to Jun 2018.

Methodology: All patients who were intended to undergo Electronic Vacuum Aspiration due to retained products of conception, early fetal demise, septic induced abortions and molar (all upto 12 weeks of gestation) were enrolled in this study after obtaining informed consent. Outcome measures of study were efficacy (defined as completeness of the evacuation procedure confirmed by ultrasound), occurrence of complications like uterine perforation, excessive bleeding >200ml and sepsis (diagnosed clinically or biochemically).

Results: A total of 1080 patients underwent Electronic Vacuum Aspiration during the study period. Complete evacuation was achieved in 1026 (95%) cases. Four (<1%) patients experienced post procedure infection while none had uterine perforation. Average blood loss was <100ml while 18 (1.6%) patients had blood loss of >200ml.

Conclusion: Electronic vacuum aspiration is a safe and efficacious method of uterine evacuation. It does not require special equipment. It is easy to learn and is readily available as well as cost effective. Hence it’s a very lucrative alternative to manual vacuum aspiration using I pass or medical termination of pregnancy in resource poor settings.
FREQUENCY OF CUTANEOUS MANIFESTATIONS IN COVID-19
Authors: Sundus Madiha , Akhtar Aisha , Aslam Asim , Iftikhar Nadia , Anjum Muhammad , Suhail Nawal
Published: January 2022

Objective: To provide an insight into the frequency of cutaneous manifestations in patients with Corona Virus Disease of 2019 COVID-19), along with an association of these findings with the severity of the disease.

Study Design: Cross-sectional study.

Place and Duration of Study: Tertiary care hospital, Rawalpindi Pakistan, from May to Jul 2020.

Methodology: We collected data from 412 confirmed cases of COVID-19 patients directly who were >12 years of age. The data included names of patients, their genders, ages, dates of admission, severity category, presence or absence of symptoms and cutaneous findings along with description of cutaneous findings if present. The data was evaluated using Statistical Package for the Social Sciences (SPSS) version 23.

Results: Eleven out of the total 412 patients with COVID-19 included in our study were found to have cutaneous findings. The frequency of cutaneous manifestations associated with COVID-19 was calculated to be 11 (2.7%). Increasing age proved to be positively correlated with increasing severity of the disease whereas no association was found between gender and severity of the disease.

Conclusion: Infection with COVID-19 may result in dermatological manifestations with various clinical presentations, which may aid in better understanding and management of the disease.
EVALUATION OF A NOVEL LIQUID CHROMATOGRAPHY TANDEM MASS SPECTROMETRY BASED METHOD FOR VITAMIN D ANALYSIS IN BLOOD
Authors: Naz Sehrish , Aamir Muhammad , Haroon Zujaja Hina , Kirmani Sobia Irum , Ahmed Nisar , Ali Sadiq
Published: January 2022

Objective: To evaluate a novel liquid chromatography tandem mass spectrometry based method for serum 25 hydroxy vitamin D (D2 and D3 metabolites) analysis.

Study Design: Cross sectional validation study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Pakistan, from Mar 2019 to Mar 2020.

Methodology: Samples were extracted and 25 OH vitamin-D was separated by means of chromatography and finally quantified via mass spectrometer. A quadrupole- tandem mass spectrometer with Electron spray Ionization coupled to high performance liquid chromatography was adopted for detection and quantitation of 25-hydroxyvitamin D2 and D3 in serum.

Results: Limit of detection (LOD) was at the level of 2.49 ng/ml and limit of quantitation (LOQ) was estimated to be 3.9 ng/ml for both the metabolites. The correlation coefficient was 0.99. For D3 observed recovery was 98% and 97.5% respectively while for D2 the recovery was calculated to be 97% and 98%. Percentage relative standard deviation (RSD) was 0.8% and 1.3% respectively. This method has an advantage of less matrix effects, minimal cross-reactivity with 24, 25 hydroxy vit D and 25, 26 di-hydroxy vitamin D metabolite than the routinely used antibody-based assays.

Conclusion: This LC-MS/MS methodology is sensitive, specific and can quantitate Vitamin D2 and D3 quite efficiently. This method may be employed for vitamin D analysis in clinical laboratories.
THE ROLE OF WORLD THE FIGHT AGAINST COVID-19
Authors: Shabbir Muhammad Nadir , Iftikhar Kainat , Mustafa Mudassar , Arshad Muhammad Usman , Ullah Imran , Mustafa Mubashir
Published: January 2022

In under two decades, the world has encountered three flare-ups of fatal Coronaviruses, including the ongoing pandemic of Coronavirus Disease 2019 (COVID-19) in China. COVID-19 represented a crisis of worldwide concerns, and cases have been accounted for more than 200 nations/districts that came about in wellbeing, lives, and monetary misfortunes. China's financial development is anticipated to tumble to 5.6% this year, the International Monetary Fund (IMF) anticipated that arrangement venture and expense strategies to execute $3.3 trillion and contributes further $4.5 trillion. IMF conjectures develop from 3.7% of worldwide total national output (GDP) in 2019 to 9.9% in 2020. Gross domestic product proportion anticipated from 3.0% in 2019 to become 10.7% in 2020, the US proportion expected to increment from 5.8-15.7%. There is a desperate requirement for local and universal co-activity to stretch out hands to forestall further spreading of COVID-19. The IMF has reacted to the COVID emergency with exceptional speed and greatness of financial aid. This paper shows the response of the world against COVID-19. How the countries are helping each other to control the spread and discovering the cure of this virus. Asia has survived usefully and also defending the second wave of virus, but on the other hand, the Europe is the most infected region with the highest rate of death. Why Asia is near to win this fight with a stable economy, but the Europe is not, instead of this the economy is going to be crashed. These questions raises to the Economy, Behavior and...........
WHAT DRIVES YOUNG WOMEN TO JOIN THE PAKISTAN ARMED FORCES? AN EXPLORATORY STUDY OF MOTIVATIONAL FACTORS
Authors: Mustafa Nazia , Kiani Shoaib
Published: January 2022

Objective: To explore the motivational factors for women to join Pakistan army.Study Design: Exploratory study design.

Place and Duration: The study was conducted at Army selection and Recruitment Centre on the female graduates from various universities of Islamabad/Rawalpindi who were coming for induction in army, from March 2018.

Methodology: The study was conducted in two phases; in phase I, Semi-structured interviews of 10 lady officers were carried out to gauge the motivational factors to join Army. In phase II, data of 792 female graduates from various universities of Islamabad/Rawalpindi was collected through socio-demographic form and the checklist about motivational factors developed during phase I to join armed forces.

Results: Results revealed that maximum individuals (22%) graded “Patriotism” as prime reason to join Army while a minor segment (1%) cited financial incentive as driving factor. Percentages of other factors, in order of precedence are; “Feeling Proud” (18%), “Strong Social Standing” (16%), “Quality of Life” (10%), Charm of Uniform (8%), Bright Career (6%), Job Security (5%), Family Lineage (5%), Adventurous Job (5%) and Marriage (4%). Further to this, there were differences in women’s motivation to join Army from various professions.

Conclusion: Motivation for opting military career is a complex phenomenon of inter-related factors. Therefore, we should consider all these factors together to select highly motivated, skilled/qualified and loyal individuals.
VENTILATOR ASSOCIATED PNEUMONIA IN TRAUMA PATIENTS; ASSOCIATED RISK FACTORS, MICROBIAL ETIOLOGY AND OUTCOME
Authors: Manzoor Sohaima , Batool Farzana , Sayeed Muneeba Ahsan , Dhiloo Azizullah Khan , Ismail Humera Muhammad , Baqai Shehla
Published: January 2022

Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients.

Study Design: Prospective observational study.

Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019.

Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia.

Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option.

Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing..................
MEDICAL ERROR, PERSISTENT VEGETATIVE STATE AND OVER NINETEEN LONG YEARS OF MEDICAL CARE
Authors: Baig Zahid Farooq , Khan Aslam , Zaidi Ibrar Hussain , Khan Muhammad Azmat , Ashra Muhammad Salman
Published: January 2022

A medical error is a preventable adverse effect of medical care. Errors can happen in the hospital at the doctor’s office, at the pharmacy, laboratory and ward. These can also occur at home by the patient or the attendant. These errors may lead to death or major/minor injuries or can also be harmless. However these should be recorded, analysed and remedial measures implemented to reduce the risk of being committed in the future. We are reporting the medical care of our patient in persistent vegetative state over nineteen years due to medical error at our hospital resulting in brain anoxia. The key issues faced during the care were recurrent respiratory and urinary tract infections and in last one year kidney calculi leading to chronic kidney disease and its complications. There are no contractures or thrombo-embolic events and above all no bed sore over this period.