bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the Prognostic Significance of Immune-Nutritional Indices in Esophageal Cancer Patients Following Esophagectomy
Authors: Sajida  , Hira  , Waqas  , Ahmed Saeed , Saeed
Published: May 2024

Background: Esophageal cancer remains one of the most challenging malignancies to treat, with survival rates significantly influenced by various hematological and nutritional markers. Understanding these markers is critical in optimizing treatment approaches and improving patient outcomes.
Objective: This study aimed to investigate the prognostic significance of several markers, including Mean Corpuscular Volume (MCV), Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV), C-Reactive Protein (CRP), Albumin, Total Lymphocyte Count (TLC), CRP Albumin ratio (CAR), and the Prognostic Nutritional Index (PNI), in patients with esophageal cancer undergoing esophagectomy.
Methods: A prospective observational study was conducted involving 43 patients diagnosed with esophageal carcinoma at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Data collection included patient demographics, tumor characteristics, and laboratory results obtained from the Hospital Information and Management Security System (HIMSS). Statistical analysis was performed using SPSS version 25, with Kaplan–Meier survival curves and log-rank tests assessing the impact of hematological and nutritional markers on survival outcomes.
Results: The majority of patients presented with advanced disease (Stage III and IV) and tumor sizes ranging from 5 to 10 cm. Mean survival times and statistical comparisons were analyzed, but no significant differences in survival based on the markers were observed. For example, patients with low and high PNI values did not show significant differences in survival (Log-rank test p-value = 0.382).
Conclusion: The study did not demonstrate significant prognostic differences based on the evaluated hematological and nutritional markers. However, it highlights the importance of considering these factors in the overall management of esophageal cancer, suggesting further research with larger sample sizes and diverse populations is necessary.
Workplace Bullying and Depression, Mediating Role of Insomnia Among Employees
Authors: Liaqat Hafiza Sana , Waqas Mian Muhammad , Hina Summera , Mahmood Ezza
Published: May 2024

Background: Workplace bullying is characterized by unpleasant and unethical behavior, which can manifest directly or indirectly, affecting individuals' mental health. Insomnia is also a known consequence of workplace bullying, which can lead to depression.
Objective: To explore the association between workplace bullying, insomnia, and depression among employees in Lahore, and to determine the mediating role of insomnia in the relationship between workplace bullying and depression.
Methods: This study employed a correlational research design with a purposive sample of 200 employees, both male and female, from Lahore, Pakistan. Data were collected using a demographic form, a 21-item Workplace Bullying Scale, the Insomnia Severity Index (ISI), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The study followed the principles outlined in the Declaration of Helsinki, and statistical analysis was conducted using SPSS version 25, including descriptive statistics, correlation analysis, and regression analysis.
Results: The mean score for workplace bullying was 42.54 (SD = 15.8), for insomnia was 9.88 (SD = 6.26), and for depression was 18.97 (SD = 13.69). There were significant positive correlations between workplace bullying, insomnia, and depression, with correlation coefficients of 0.53, 0.62, and 0.61, respectively (all p < 0.01). Both workplace bullying (B = 0.36, p < 0.001) and insomnia (B = 0.84, p < 0.001) were significant predictors of depression. Insomnia also mediated the relationship between workplace bullying and depression, with an indirect effect of 0.1714 (95% CI: 0.1105, 0.2393).
Conclusion: Workplace bullying contributes to higher levels of depression among employees, with insomnia serving as a mediator. Both workplace bullying and insomnia are significant predictors of depression. These findings highlight the importance of addressing workplace bullying to improve employee mental health.
Herbal Supplements and Fertility: A Comprehensive Review
Authors: Safia  , Lashari Sanam , Khan Taiba , Ali Maaz , Jokhio Dua , Yahya Sumaiya
Published: May 2024

Background: The use of herbal supplements for fertility enhancement has garnered significant interest, blending traditional knowledge with modern scientific research. This systematic review aims to comprehensively evaluate the effects of herbal supplements on fertility and reproductive health.
Objective: The primary objective is to synthesize existing literature on herbal supplements and fertility, elucidating their mechanisms and potential implications for reproductive medicine.
Methods: A systematic literature search was conducted using PubMed, Google Scholar, Scopus, ScienceDirect, Web of Science, BioMed Central, and other sources. PRISMA guidelines were followed. A total of 92 articles were screened, with 60 meeting eligibility criteria for inclusion.
Results: Of the included studies, significant findings emerged, including the enhancement of endurance with Maca supplementation and the reproductive capability improvement with ginsenosides. Concerns regarding safety and regulation were also underscored, emphasizing the need for further research in this area.
Conclusion: The interplay between herbal supplements and fertility presents a complex landscape, with potential benefits and risks. As evidence accumulates, a nuanced understanding is crucial for integrating herbal remedies into modern reproductive healthcare practices.
Tracing Neurogenetic Pathways: SIRT1 Gene's Influence on Autism, Alzheimer's, Type II Diabetes, Dementia, and its role in Neurodevelopmental Dynamics
Authors: Khaliq Hafiz Muhammad Haseeb , Nangdev Pirya , Abbasi Sumera , Hassan Muhammad Yahya
Published: May 2024

Background: Autism Spectrum Disorder (ASD) encompasses a range of neurodevelopmental conditions characterized by challenges in social interaction, communication, and repetitive behaviors. Concurrent conditions such as Type II Diabetes Mellitus (DM) and dementia are prevalent comorbidities that exacerbate the cognitive impairments associated with ASD. The SIRT1 gene, known for its role in neuroprotection and longevity, has been implicated in the pathophysiology of these disorders.
Objective: To determine the expression of the SIRT1 gene in patients with diabetes and dementia and to investigate its potential as a biomarker for cognitive impairment in these populations.
Methods: A cohort of 108 diabetic dementia patients and 32 healthy controls were enrolled. SIRT1 expression levels were quantified using chemiluminescent immunoassay (CLIA) and methylation-specific PCR after bisulfite DNA modification. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and demographic data, along with biochemical parameters such as fasting glucose and HbA1c levels, were analyzed using SPSS version 25.
Results: Diabetic dementia patients exhibited significantly lower SIRT1 levels (4.37 ± 1.38 µg/mL) and MMSE scores (12.26 ± 4.56) compared to healthy controls (SIRT1: 11.37 ± 3.64 µg/mL, MMSE: 24.1 ± 3.12). The relative gene expression of SIRT1 in diabetic dementia patients showed a 6.7-fold decrease compared to healthy individuals. Statistical analysis revealed a significant difference in both SIRT1 levels and MMSE scores between the two groups (P<0.05).
Conclusion: The underexpression of SIRT1 in diabetic dementia patients and its correlation with lower MMSE scores suggest that SIRT1 could serve as a biomarker for cognitive impairment in this population. The findings advocate for further exploration into SIRT1-targeted interventions, which may improve diagnostics and therapeutic approaches for neurodegenerative conditions associated with ASD.
Comparison between Effectiveness of Mets and Static Stretching on Trapezius in Upper Cross Syndrome
Authors: Kashif Muhammad , Ayub Rahat , Nawaz Sufyan , Hanif Nimra , Shahzadi Aiman , Ullah Baseer , Wirda  , Fatima Noor , Asif Mahnoor , Asif Mahrukh , Naveed Tooba , Javed Atika , Zubair Muniba , Rao Bazal , Maqbool Sania
Published: May 2024

Background: Upper cross syndrome involves an imbalance between the muscles of the anterior and upper trunk and the posterior skeletal muscles, leading to postural and functional issues. Muscle Energy Techniques (METs) and stretching exercises are common interventions, but their comparative effectiveness remains unclear.Objective: The study aimed to compare the effectiveness of METs and stretching in treating pain and improving functional status in patients with upper cross syndrome.Methods: This randomized clinical trial was conducted at the Physical Therapy Department of Mayo Hospital, Lahore, over six months. Sixty-two patients with upper cross syndrome were randomly assigned to two groups, each consisting of 31 participants. Group 1 received METs and conventional therapy, while Group 2 received static stretching and conventional therapy. The primary outcome measures were pain intensity, measured by the Visual Analogue Scale (VAS), and functional status, assessed using the Neck Disability Index (NDI). The intervention period lasted four weeks, and statistical analyses were performed using SPSS version 25.Results: In Group 1, the pre-treatment VAS score was 7.41 (± 1.08), decreasing to 3.41 (± 1.11) post-treatment, while in Group 2, the VAS score dropped from 7.16 (± 1.50) to 4.87 (± 1.56). The pre-treatment NDI score in Group 1 was 40.19 (± 6.15), which improved to 32.51 (± 6.16) post-treatment. In Group 2, the NDI score improved from 40.06 (± 5.88) to 35.74 (± 5.82). Both groups demonstrated significant improvement in pain and functional status, with METs showing greater effectiveness (p < 0.05).Conclusion: Muscle Energy Techniques were more effective in reducing pain and improving functional status in patients with upper cross syndrome compared to stretching exercises.
Implementation of Formative Assessment ‘for’ Learning: A Review
Authors: Mushtaq Qurratulain , Aslam Pakeeza , Noor Fraz , Ilyas Tamknat , Maqbool Sania , Sarfraz Junaid
Published: May 2024

Background: Assessment is fundamental to medical education, driving student learning and ensuring that key objectives are met. Formative assessment, in particular, serves as both an instructional strategy and an assessment tool, aiding in the consolidation of learning.
Objective: The objective of this narrative review was to examine the implementation of formative assessment in medical education, with a focus on its role in fostering deep learning, enhancing learning outcomes, and preparing students for real-world clinical challenges.
Methods: This narrative review synthesized existing evidence on formative assessment in medical education. The authors employed a systematic approach to identify relevant literature using search strings such as "formative assessment in medical education" and "assessment for learning." Databases searched included PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria were studies examining formative assessment practices in medical education, while exclusion criteria included studies focusing solely on summative assessment or unrelated to medical education.
Results: The findings highlighted the effectiveness of formative assessment in promoting deep learning, providing feedback, and addressing learning difficulties. Bloom's concept of mastery learning underscored the importance of diagnosing learning difficulties through formative evaluations. Consistent low scores on assessments were attributed to various factors, which were effectively addressed through weekly formative assessments. The review emphasized the need for formative assessment in medical education, balanced with summative assessment, while acknowledging challenges related to faculty training, resource limitations, and cultural emphasis on summative assessment.
Conclusion: Balanced implementation of formative and summative assessments in medical education enhances learning outcomes, promotes intrinsic motivation, and ensures that future healthcare professionals are well-prepared, ultimately contributing to improved healthcare outcomes and patient experiences.
The Literature Review on Curriculum Implementation Problems
Authors: Aslam Pakeeza , Mushtaq Qurratulain , Noor Fraz , Maqbool Sania , Khan Nadeem Yar , Sarfraz Junaid
Published: May 2024

Background: Changes in knowledge and technology are continually shaping the educational environment, thereby influencing curriculum implementation. Innovations are being made to meet the evolving educational goals, which includes overcoming various barriers to curriculum implementation.
Objective: The aim of this study was to examine the existing literature on curriculum implementation problems, particularly focusing on the issues faced by educational institutions in effectively applying educational theories and practices.
Methods: A comprehensive literature review was conducted, utilizing databases such as PubMed, ERIC, Google Scholar, and JSTOR. Articles published from 1997 to 2022 that discussed challenges and strategies in curriculum implementation across various educational levels and settings were included. Thematic analysis was employed to synthesize the data, identifying common themes related to the challenges and solutions of curriculum implementation.
Results: The review identified critical challenges related to four main areas: teachers, students, the curriculum itself, and institutional factors. Teacher-related challenges included inadequate professional development and inefficient teaching methods. Student-related challenges highlighted diverse learning needs and varying levels of engagement. Institutional challenges pointed to resource limitations and insufficient stakeholder support. Curriculum-related challenges were mostly about alignment and compatibility with educational goals.
Conclusion: Effective curriculum implementation is pivotal in educational settings and requires comprehensive strategies to address the myriad of challenges identified. Enhancing teacher training, improving resource allocation, and ensuring curriculum relevance are crucial for improving educational outcomes.
Assessing Feeding Practices and Bottle-Feeding Trends: A Holistic Analysis of Infant and Child Nutrition in Pediatric Department of CMCH Larkana
Authors: Lal Shankar , Mangi Zulifqar Ali , Shaikh Abdul Rehman , Sangi Rumana , Kumar Sagar , Larik Sobia
Published: May 2024

Background: Breastfeeding is recognized as the optimal method for infant nutrition, yet bottle feeding remains prevalent due to various socio-economic and cultural factors. In Pakistan, understanding the dynamics between maternal demographics, infant feeding practices, and healthcare accessibility is essential for improving child health outcomes.
Objective: This study aims to evaluate infant feeding practices, particularly the prevalence of bottle feeding, among mothers in a pediatric department in Pakistan, identifying the socio-demographic factors influencing these practices.
Methods: A cross-sectional study was conducted from March 2023 to March 2024 at the Department of Pediatrics, SMBB Medical University, Children's Hospital, Larkana. We utilized non-probability purposive sampling to enroll 650 mothers. Data were collected through structured proformas focusing on demographics, feeding practices, and healthcare utilization. Statistical analysis was performed using SPSS version 25 to assess correlations between feeding methods and maternal characteristics.
Results: Among the mothers surveyed, 86% reported using bottle feeding. The age distribution of infants showed 43% (0–5 months), 28% (6–11 months), and 29% (12–23 months). Educational status of mothers varied, with 38% having no formal education. Antenatal care was received by 44% of participants, while postnatal care was slightly higher at 45%. Breastfeeding counseling was received by only 41% of mothers, with 31% informed about the disadvantages of bottle feeding.
Conclusion: The high rate of bottle feeding and the substantial gaps in antenatal and postnatal care highlight the need for targeted healthcare interventions to promote breastfeeding and enhance maternal and child health services. Improved counseling on feeding practices and better healthcare access are critical for addressing the health needs of this population.
Drug Coated Balloon vs. Drug Eluting Stent in Multiculprit Primary Percutaneous Revascularization
Authors: Khan Anwar Jamal , Ali Jabar , Safi Shoaib Iqbal , Sajjad Wasim
Published: May 2024

Background: Patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) frequently face multivessel coronary artery disease (CAD). The optimal interventional approach remains debated.
Objective: To systematically review and analyze the effectiveness and safety of drug-coated balloons (DCB) versus drug-eluting stents (DES) in multiculprit primary PCI through a randomized controlled trial.
Methods: This prospective, single-center, randomized controlled trial included 100 patients with STEMI and multivessel CAD at Lady Reading Hospital Peshawar from April 2023 to March 2024. Patients aged 18 years or older requiring revascularization of two or more culprit lesions were randomized into two groups: one received DCBs and the other DES. Exclusions were based on contraindications to dual antiplatelet therapy, allergies to study drugs, bleeding disorders, or life expectancy under one year.
Results: Each group comprised 50 patients. The prevalence of hypertension (56% in DCB vs. 60% in DES, p=0.68) and diabetes (36% in DCB vs. 40% in DES, p=0.72) was similar. TVR rates were 10% for DCB and 8% for DES (p=0.45). MACE rates were 14% for DCB and 12% for DES (p=0.37).
Conclusion: The study supports the use of DCB as an alternative to DES in specific clinical scenarios, emphasizing the need for tailored treatment decisions based on individual patient and lesion characteristics.
A Case Study on the Integrated Rehabilitation of Chemotherapy-Induced Peripheral Neuropathy in a Patient with Stage IV Breast Cancer
Authors: Zainab Baneeha , Lela Um I , Shahzadi Kiran , Manzoor Laiba
Published: May 2024

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a significant complication of cancer treatments, affecting a substantial proportion of patients and severely impacting their quality of life. Current management strategies often fall short in addressing the multifaceted nature of this condition, highlighting the need for integrated approaches that encompass physical, psychological, and social elements.
Objective: This study aimed to evaluate the efficacy of a multimodal rehabilitation program in improving physical function and psychological well-being in a patient with Stage IV breast cancer experiencing moderate CIPN.
Methods: A 40-year-old female with Stage IV breast cancer underwent a 5-week multimodal rehabilitation program, including physical therapy, psychosocial support, and mobility therapy. Assessments of grip strength, knee and shoulder flexion, neuropathic pain (DN4), anxiety and depression (HADS), and overall quality of life were conducted pre- and post-intervention using a hand dynamometer, goniometer, and standardized psychological scales.
Results: Post-treatment results demonstrated significant improvements: grip strength increased from 10 kg to 13 kg (right hand) and 9 kg to 14 kg (left hand); knee flexion improved from 120° to 129° (right) and 125° to 132° (left); shoulder flexion increased from 149° to 160° (right) and 152° to 159° (left). Psychological assessments showed a reduction in anxiety (HADS) scores from 12 to 8 and depression from 10 to 5. The DN4 score decreased from 7 to 4, indicating a reduction in neuropathic pain. Quality of life assessments also noted significant enhancements.
Conclusion: The integrated rehabilitation program was effective in significantly improving both the physical and psychological parameters in a patient with severe CIPN. This case supports the potential benefits of multidisciplinary approaches in managing CIPN, suggesting wider applicability for similar comprehensive care models in oncological rehabilitation.
The Frequency and Associated Factors of Restless Leg Syndrome among Pregnant Women in 3rd Trimester
Authors: Qaiser Nayab , Manzoor Sadaf , Zakaullah Iqra , Khan Mishal , Fazal Nimra
Published: May 2024

Background: Restless leg syndrome (RLS), also known as Willis-Ekbom disease, is characterized by an uncomfortable sensation in the legs, often occurring at the onset of sleep, which triggers an irrepressible urge to move the legs. This condition is particularly prevalent among pregnant women, with symptoms typically worsening during the third trimester. Despite its impact, many pregnant women are unaware of RLS, attributing their discomfort to normal pregnancy symptoms.
Objective: To assess the frequency and associated factors of RLS in pregnant females during the third trimester and to evaluate its impact on their quality of life.
Methods: A cross-sectional study was conducted involving 250 pregnant females in their third trimester, recruited from Shalimar Hospital, Nawaz Sharif Hospital, Zahida Welfare Trust, Alshad Clinic, Ali Hospital, Ahsan Hospital, Nargis Clinic, Manawa Government Hospital, and Sultan Medical Center. Participants aged 15-45 years were included, while those with rheumatoid arthritis, diabetes mellitus, neurological disorders, preeclampsia, and gestational diabetes mellitus were excluded. Data were collected using structured questionnaires incorporating the International Restless Legs Syndrome Study Group (IRLSSG) criteria and the Pittsburgh Sleep Quality Index (PSQI). Ethical approval was obtained, and the study adhered to the Declaration of Helsinki principles. Statistical analysis was performed using SPSS version 25, with descriptive statistics, frequencies, and graphical representations employed to summarize and analyze the data.
Results: The mean age of participants was 26.32 years (SD = 5.08). The prevalence of RLS in the third trimester was found to be 89.2%. The age group most affected was 18-23 years. Factors associated with RLS included inadequate calcium intake (40.4%), insufficient daily water intake (40.4%), poor food intake (48%), mood disturbances (89.2%), lack of movement or light exercise (78%), caffeine consumption (16%), disturbances in sexual activities (48%), and disruption in daily activities (45.2%).
Conclusion: RLS is highly prevalent among pregnant women, particularly in the third trimester, significantly impacting their quality of life. Despite its prevalence, many women remain unaware of RLS, mistaking it for typical pregnancy discomfort. Raising awareness and implementing screening and management strategies during prenatal care could improve the quality of life for affected women.
Quantifying Heavy Metal Accumulation in Soil and Vegetation Surrounding Industrial Areas: A Comprehensive Environmental Toxicology Study
Authors: Raza Abbas , Tasleem Samiyah , Ullah Nabi , Dilshad Muhammad , Maitlo Amjad Ali
Published: May 2024

Background: Industrial activities release significant amounts of heavy metals into the environment, contaminating soil and vegetation. This pollution poses severe risks to ecosystems and human health, making it a crucial area of study.
Objective: To quantify the accumulation of heavy metals in soil and vegetation surrounding industrial areas and assess the ecological risks associated with this contamination.
Methods: The study involved quantitative analysis of soil and plant samples from industrial and control areas. Heavy metals analyzed included lead, cadmium, mercury, arsenic, chromium, and nickel. Methods included atomic absorption spectroscopy for metal quantification, bioaccumulation factor (BAF) calculation for plants, and ecological risk assessment using the ecological risk index (ERI).
Results: Soil samples from industrial zones showed significantly higher concentrations of lead (175 mg/kg), cadmium (8 mg/kg), and chromium (90 mg/kg) compared to control areas (lead: 30 mg/kg, cadmium: 2 mg/kg, chromium: 20 mg/kg). Plant tissues from these areas also revealed elevated levels of lead (12 mg/kg), cadmium (2 mg/kg), and nickel (8 mg/kg), against lower concentrations in control samples (lead: 3 mg/kg, cadmium: 0.5 mg/kg, nickel: 2 mg/kg). The ecological risk index underscored a high risk in industrial zones (ERI = 85) compared to control areas (ERI = 30).
Conclusion: The study highlights the critical contamination of soil and vegetation with heavy metals near industrial zones and the consequent ecological risks. These findings emphasize the need for immediate remediation strategies and stricter regulatory frameworks to mitigate the impacts of this pollution.
Clinical Profile and Risk Factors of Cerebral Venous Sinus Thrombosis
Authors: Khan Huma , Sher Khalid , Ghouri Khawaja Moiz Ullah
Published: May 2024

Background: Cerebral venous sinus thrombosis (CVST) is a rare but serious neurovascular disorder that can lead to life-threatening complications such as hemorrhage and cerebral edema. This condition presents with a wide array of symptoms due to the formation of blood clots in the cerebral venous sinuses, impairing the drainage of deoxygenated blood and cerebrospinal fluid from the brain.
Objective: The aim of this study was to elucidate the clinical profile and risk factors associated with CVST, enhancing the understanding of its epidemiology and facilitating better diagnostic and therapeutic strategies.
Methods: This prospective cross-sectional study was conducted at the Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. A total of 135 participants diagnosed with CVST were enrolled through non-probability consecutive sampling. Participants underwent comprehensive physical and neurological examinations using a structured Clinical Patient Assessment Form. Diagnostic imaging included MRI, MRV, CT, and CT venography, although the principal diagnostic tools were CT and MRV. Data collection focused on demographics, clinical manifestations, and risk factors, with all information analyzed using SPSS version 25.
Results: The study population predominantly consisted of females (74.8%) with the age group of 31-40 years being the most common (31.1%). Headache was the most frequently reported symptom (90.4%), followed by hemiparesis (53.3%) and seizures (40%). Significant risk factors included postpartum status (50.4%), iron deficiency anemia (25.9%), and genetic prothrombotic conditions (9.6%). Imaging studies revealed that the transverse sinus was the most affected site (74.1%).
Conclusion: CVST exhibits a diverse range of clinical presentations and is associated with multiple demographic and physiological risk factors. Early diagnosis and management are crucial to prevent severe outcomes. This study highlights the importance of considering a detailed clinical and risk factor profile in patients presenting with neurological symptoms to aid in timely and accurate diagnosis of CVST.
Optimization of Dual Antiplatelet Therapy in Pakistani Patients Undergoing PCI: A Strategy to Minimize Bleeding Risks and Improve Outcomes
Authors: Fahad Raja khan  , Shakeel Ahmed Memon
Published: May 2024

Background: Percutaneous Coronary Intervention (PCI) is essential for treating coronary artery disease. The use of Dual Antiplatelet Therapy (DAPT) is crucial to prevent thrombotic complications but presents bleeding risks. This challenge is accentuated by the variability in genetic, demographic, and regional factors, particularly in Pakistan, where there is a high prevalence of cardiovascular diseases.
Objective: To optimize DAPT strategies for Pakistani patients undergoing PCI by minimizing bleeding risks while ensuring therapeutic efficacy, aiming to pioneer personalized cardiovascular care.
Methods: A retrospective cohort analysis was conducted at Lady Reading Hospital, Peshawar, involving 500 patients who underwent PCI and received DAPT from January 1, 2023, to January 1, 2024. Comprehensive data collection included patient demographics, clinical histories, specifics of PCI procedures, and outcomes of bleeding and thrombotic events, through a detailed review of medical records.
Results: The cohort predominantly consisted of males (70%), with an average age of 58 years. Most patients (96%, n=480) were prescribed aspirin and clopidogrel, while a smaller fraction (4%, n=20) received aspirin and ticagrelor. Compliance was high, with 90% adherence. Bleeding occurred in 10% of the cohort (n=50), with major bleeds necessitating hospitalization in 4% (n=20). Thrombotic events were noted in 3% of patients (n=15).
Conclusion: The study underscores the importance of personalized DAPT regimens that address individual risks and regional healthcare challenges in Pakistan. Tailored approaches are essential for optimizing treatment efficacy and safety, advocating for advanced, nuanced cardiovascular care practices.
History of Childhood Trauma in Patients Presenting with Conversion Disorder
Authors: Qazi Shandana , Khan Taimur , Nasir Ali Hassan , Khan Javeria , Qazi Laiba
Published: May 2024

Background: Conversion disorder, characterized by neurological symptoms without an identifiable organic cause, has historically posed diagnostic and therapeutic challenges. The role of psychosocial factors, especially childhood trauma, in the development of this disorder is increasingly recognized, yet the relationship remains under-explored in diverse populations.
Objective: This study aimed to investigate the demographic characteristics, clinical features, and prevalence of childhood trauma among patients diagnosed with conversion disorder at a teaching hospital in Peshawar, enhancing understanding of the disorder's psychosocial dimensions.
Methods: This observational study included 55 patients diagnosed with conversion disorder at the Department of Psychiatry, Khyber Teaching Hospital, Peshawar, from May 1, 2022, to April 30, 2023. Participants were diagnosed according to DSM-5 and ICD-10 criteria. Data were collected through detailed reviews of electronic medical records and structured interviews focusing on demographic data, clinical manifestations, and childhood trauma experiences. Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ) and the Adverse Childhood Experiences (ACEs) questionnaire. Statistical analysis was performed using SPSS version 25 to calculate frequencies, means, and standard deviations.
Results: Of the participants, 54.5% were female and 45.5% were male, with a significant number having only primary education (56%). The average age was 37.4 years (SD=10.2). Clinically, 81.8% reported motor symptoms, 54.5% had sensory symptoms, and 36.4% experienced seizure-like episodes. The average duration of symptoms was 18.6 months (SD=7.9). Childhood trauma was reported by 36.4% for physical abuse, 27.3% for sexual abuse, and 45.5% for emotional abuse. High CTQ scores indicated substantial trauma levels among participants.
Conclusion: The study confirms a high prevalence of childhood trauma among patients with conversion disorder and underscores the need for a comprehensive, trauma-informed approach in managing these patients. The findings highlight the importance of considering psychosocial factors in the diagnosis and treatment of conversion disorder to improve patient outcomes.
Quad Shot Palliation, A Considerable Option for Non-Osseous Recurrent or Metastatic Malignancies in Elderly or Frail Patients.
Authors: Saif Ur Rehman  , Shafaq Maqsood  , Aneela Deevan
Published: May 2024

Background: Palliative radiation therapy (RT) is increasingly recognized as a crucial component of care for patients with advanced, incurable malignancies. In Pakistan, where patients often present at advanced stages due to socio-economic barriers and limited healthcare access, efficient and effective treatment protocols are essential.
Objective: This study aimed to evaluate the efficacy of the Quad Shot hypo-fractionated RT protocol for pain palliation in elderly and frail patients with recurrent or metastatic non-osseous malignancies.
Methods: A quasi-experimental study was conducted at the Oncology Department of Ganga Ram Hospital, Lahore. Forty-two elderly patients with histologically confirmed inoperable malignancies and a WHO Performance Status of 2 to 3 were enrolled. Patients with prior RT or a second cancer were excluded. RT was delivered using a Cobalt-60 beam, with a total dose of 14 Gy divided into four fractions over two consecutive days. Pain severity was assessed using a 10-point scale before and four weeks after treatment. Statistical analysis was performed using the Wilcoxon Sign Rank Test on SPSS version 25.0.
Results: The study population comprised 52% males and 48% females, with the majority of primary tumors located in the head and neck (64%). Post-treatment, the mean pain score significantly decreased from 8.04 ± 1.22 to 4.32 ± 0.89 (p < 0.05).
Conclusion: The Quad Shot hypo-fractionated RT protocol effectively reduces pain in elderly and frail patients with advanced malignancies, suggesting its suitability as a quick and effective palliative care option in resource-limited settings.
Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation
Authors: Saif Ur Rehman  , Shafaq Maqsood  , Aneela Deevan
Published: May 2024

Background: Pelvic radiotherapy is a primary treatment modality for organ-confined prostate cancer and early-stage endometrial cancer. While effective in improving survival rates and reducing recurrence, it is associated with a range of side effects that can impact patient quality of life.
Objective: The study aimed to assess the incidence, management, and resolution of acute and chronic side effects of pelvic radiotherapy in prostate and endometrial cancer patients, focusing on bowel and bladder functions.
Methods: This single-center, observational study included 50 patients diagnosed with prostate or endometrial cancer who underwent pelvic radiotherapy with a dose of 66-70 Gy using a four-field technique on a linear accelerator. Patients were assessed for bladder and bowel dysfunction, with follow-up at 6, 12, and 18 months post-treatment. Statistical analysis involved univariate weighted distribution of response frequencies and paired t-tests for ordinal scale scores, using SPSS version 25 for data analysis.
Results: Of the participants, 22% experienced dysuria, 64% reported bladder outlet obstruction, and 20% had constipation. Acute bowel symptoms like diarrhea occurred in 32%, and chronic proctitis developed in 22% of patients. Urinary symptoms appeared by the third week and generally resolved within weeks; however, bowel symptoms persisted longer but returned to baseline by 18 months post-treatment. Approximately 70% of patients reported good tolerance to radiotherapy.
Conclusion: Pelvic radiotherapy is effective in treating prostate and endometrial cancers but requires management of transient side effects to improve patient outcomes. Advanced radiotherapy techniques such as IMRT and 3D CRT have shown potential in reducing these side effects, emphasizing the need for continuous technological advancements and patient-centered care in radiotherapy.
The Impact of Radial Vs Femoral Access on Vascular Complications and Patients Outcomes in Complex PCI
Authors: Ammar Azam Cheema  , Saleha Abbas  , Muhammad Shahid  , Moazama Shakeel Ahmed  , Sauda Usmani  , Syed Muhammad Nayab Ali
Published: May 2024

Background: Percutaneous coronary intervention (PCI) is a primary treatment modality for coronary artery disease, particularly in complex cases involving multivessel disease, chronic total occlusions, or bifurcation lesions. The choice of vascular access site—radial versus femoral—can significantly impact patient outcomes and the incidence of vascular complications. Recent trends favor radial access due to its potential advantages in safety and recovery.
Objective: To evaluate the impact of radial versus femoral access on vascular complications and patient outcomes in complex PCI.
Methods: This randomized control trial was conducted at the Chaudhary Pervaiz Elahi Institute of Cardiology, Wazirabad, Pakistan, over a six-month period from September 2023 to February 2024. A total of 350 patients undergoing complex PCI were enrolled, with 210 assigned to radial access and 140 to femoral access. Baseline characteristics, including age, BMI, and prevalent comorbidities (dyslipidemia, hypertension, and diabetes mellitus), were recorded. Major outcomes measured included periprocedural myocardial infarction, in-hospital mortality, and stent thrombosis. Statistical analysis was performed using SPSS Version 26.
Results: The mean age of participants was 52.90 ± 8.07 years. No significant differences were found in BMI and comorbid conditions between the groups. In-hospital mortality was 1.4% in the radial group compared to 4.3% in the femoral group (P=0.05). Rates of periprocedural myocardial infarction were similar between groups (0.5% radial vs 0.7% femoral, P=0.77). Stent thrombosis was observed in 0.5% of the radial group and was absent in the femoral group.
Conclusion: Radial access in complex PCI was associated with lower in-hospital mortality compared to femoral access, with similar rates of myocardial infarction and stent thrombosis. These findings suggest that radial access may provide a safer alternative, supporting its increasing use in clinical practice.
Prevalence and Antibiotic Susceptibility Pattern of Pseudomonas Aeruginosa from the Foot Ulcer of Diabetic Patients in Hayatabad Medical Complex Peshawar, Pakistan
Authors: Muhammad Qasim  , Arbab Haroon  , Mehboob Ullah  , Noora Amir  , Huma Imtiaz  , Tanveer Tara  , Farah Shireen  , Nabila Qayum  , Muhammad Jawad Ullah  , Inam Ullah
Published: May 2024

Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, affecting 15% of diabetic patients and often leading to severe outcomes like amputation. These ulcers frequently become infected with bacteria such as Pseudomonas aeruginosa, which is known for its robust antibiotic resistance.
Objective: To investigate the prevalence and antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from the foot ulcers of diabetic patients in Hayatabad Medical Complex, Peshawar.
Methods: A total of 103 clinical samples from diabetic foot ulcers were collected and analyzed for the presence of Pseudomonas aeruginosa using culture techniques and biochemical tests. The antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method to identify effective treatments.
Results: Pseudomonas aeruginosa was identified in 48 (46.60%) of the samples. High resistance was noted against amoxicillin-clavulanic acid (100%), and notable sensitivity was observed to gentamicin (79.16%) and cefoperazone-sulbactam (87.5%). The susceptibility to other tested antibiotics varied, with moderate resistance seen in agents like cefotaxime (25%) and trimethoprim-sulfamethoxazole (33.33%).
Conclusion: The study highlights a significant presence of Pseudomonas aeruginosa in diabetic foot ulcers with substantial antibiotic resistance, emphasizing the need for precise susceptibility testing to guide effective treatment strategies.
Incidence of Ischemic Heart Disease (IHD) in Smokeless Tobacco/Naswar Users Versus Non-Users Following Coronary Interventions
Authors: Khan Fahad Raja , Memon Shakeel Ahmed , Rehmat Samra , Khan Bahlool
Published: May 2024

Background: Ischemic heart disease (IHD) is a significant health concern globally, with various risk factors affecting the outcomes of therapeutic interventions like percutaneous coronary interventions (PCIs) and coronary artery bypass grafting (CABG). The use of smokeless tobacco products such as SLT (snus, loose snuff) and Naswar is prevalent in South Asia and poses additional risks due to its cardiovascular implications.
Objective: This study aims to assess the impact of smokeless tobacco (SLT/Naswar) use on the incidence of IHD following coronary interventions, highlighting the need for tailored healthcare strategies to address this modifiable risk factor.
Methods: A prospective observational study was conducted from July 1, 2023, to January 1, 2024, involving 200 participants aged 18 to 80 years diagnosed with IHD. Data collection involved structured interviews and comprehensive reviews of health records. Statistical analyses included Chi-square tests and logistic regression to evaluate the association between SLT/Naswar usage and IHD incidence post-intervention, with SPSS software utilized for all computations.
Results: Among the participants, 40.5% were users of SLT/Naswar. Post-coronary intervention, SLT/Naswar users showed a 66% incidence rate of IHD compared to 48% in non-users, with a statistically significant difference (P=0.032). Successful intervention rates were 62% in SLT/Naswar users versus 78% in non-users. Complication rates such as re-stenosis were higher in SLT/Naswar users (29% vs. 16%).
Conclusion: The study demonstrates that SLT/Naswar use significantly impacts the outcomes of coronary interventions, with a higher incidence of IHD and complications among users. These findings underscore the importance of integrating smokeless tobacco cessation programs into cardiovascular care protocols.
Comparison of Post PCI TIMI Flow Between Diabetic and Non-Diabetic Individuals
Authors: Basit Abdul , Qahir Ashraf Abdul , Yusra  , Mangi Sarfraz Ali , Aslam Muhammad , Mamtani Vickee Kumar
Published: May 2024

Background: Cardiovascular diseases remain the leading cause of morbidity and mortality globally, with diabetes significantly exacerbating the incidence and severity of coronary artery disease. Diabetic patients experience altered coronary blood flow dynamics, which can impact the efficacy of therapeutic interventions like percutaneous coronary intervention (PCI).
Objective: This study aims to compare the post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grades between diabetic and non-diabetic patients to assess the impact of diabetes on the short-term outcomes of coronary revascularization.
Methods: A retrospective observational study was conducted at the National Institute of Cardiovascular Diseases in Karachi, involving 3,000 patients who underwent primary PCI between January 2018 and December 2020. Patients were categorized into diabetic (1,500) and non-diabetic (1,500) groups. Data collected included demographics, coronary artery risk factors, TIMI flow grades before and after PCI, and the use of GPIIb/IIIa inhibitors. Statistical analysis was performed using SPSS version 25, employing chi-square tests, t-tests, and Mann-Whitney U tests for comparative analysis, with a p-value of <0.05 considered statistically significant.
Results: The study found significant differences in postoperative TIMI3 flow rates, with non-diabetic patients achieving a higher rate of TIMI3 (59.4%) compared to diabetic patients (58.1%). The use of GPIIb/IIIa inhibitors was higher in diabetic patients (34.7%) than in non-diabetic patients (1.8%). Additionally, diabetic patients showed a higher incidence of multi-vessel disease and more severe lesion profiles, including higher rates of triple branch lesions (45.9% vs. 39.9%) and left main lesions (53% vs. 43.9%).
Conclusion: Diabetic patients exhibit worse post-PCI TIMI flow grades and more complex coronary lesions compared to non-diabetic patients, suggesting that diabetes adversely affects the outcomes of coronary revascularization. These findings underscore the need for tailored therapeutic approaches to improve PCI outcomes in diabetic patients.
Role of Home Based Educational Intervention on Illness Perception and Health Services Utilization among Chronic Obstructive Pulmonary Disease Patients
Authors: Yasmin Farzana , Ain Quratul , Liaqat Ayesha , Danish Abdul Haseeb , Saddique Humaira
Published: May 2024

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a significant public health challenge globally, particularly affecting middle-aged and older adults. Effective management of COPD requires not only clinical interventions but also patient-centric educational programs that enhance illness perception and encourage appropriate health services utilization.
Objective: This study aimed to evaluate the effectiveness of a home-based educational intervention in improving illness perception and health services utilization among COPD patients.
Methods: A quasi-experimental study was conducted at the Pulmonology Out-Patient Department of a public hospital in Lahore. From an initial screening of 200 participants, 130 met the inclusion criteria based on their illness perception scores. Following random sampling, 84 participants were enrolled and divided into control and intervention groups. The intervention group received a structured educational program on COPD management. Data on demographics, illness perception, and health services utilization were collected pre and post-intervention. Statistical analyses were performed using SPSS version 25, employing t-tests to compare the outcomes between the groups.
Results: The study consisted predominantly of participants aged 30-60 years, with the majority (57.1%) in the 30-40 year age group. Post-intervention, the illness perception in the intervention group showed a significant improvement, with the mean score increasing from 54.24 ± 5.905 to 75.24 ± 7.564 (t = -14.183, p < 0.000). Health services utilization also saw a notable enhancement in the intervention group, with the mean score rising from 12.38 ± 1.396 to 20.07 ± 2.202 (t = -19.117, p < 0.000).
Conclusion: The home-based educational intervention significantly improved both the illness perception and health services utilization among COPD patients. Such interventions can be pivotal in managing COPD effectively, reducing hospital readmissions, and promoting self-management.
Knowledge about Administration and Regulation of High Alert Medication among Nurses in Oncology Department
Authors: Aziz Shifra , Saddique Humaira , Tasneem Syeda Sidra
Published: May 2024

Background: High alert medications (HAMs) are associated with a higher risk of causing significant patient harm when used in error. Understanding the administration and regulation of these medications within oncology settings is critical due to the complex nature of cancer treatment regimens and the severity of potential medication errors.
Objective: To assess the knowledge of nurses regarding the administration and regulation of high alert medications in an oncology department of a tertiary care hospital.
Methods: A descriptive cross-sectional study was conducted among 133 registered nurses in the oncology department of Jinnah Hospital, Lahore. Data were collected using a structured questionnaire designed to evaluate nurses' knowledge of HAMs. Participants included both male (29.3%) and female (70.7%) nurses, with varying educational backgrounds and work experiences. Statistical analysis was performed using SPSS version 25, focusing on descriptive statistics such as frequencies, percentages, means, and standard deviations.
Results: The results revealed moderate knowledge levels among nurses with significant gaps in critical areas. Only 20.3% correctly identified the protocol for fast IV push of 1:1000 epinephrine in mild allergic reactions, and 33.8% mistakenly believed that 10% calcium gluconate and 10% calcium chloride were interchangeable. Additionally, 44.4% incorrectly used 'Amp' or 'Vial' for dose expression instead of 'mg' or 'gm', and 53.4% failed to recognize the importance of distinctive labeling on look-alike drugs.
Conclusion: The study highlights the need for enhanced educational programs and standardized protocols to improve the safe administration and regulation of HAMs in oncology settings. Strengthening nurses' knowledge and practices regarding HAMs is essential to reduce medication errors and improve patient outcomes.