bluuebunny/crossref_metadata_2025 huggingface dataset:
Upper and Lower Respiratory Tract Infections: One Year Based Observational Study in Pediatric Population
Authors: Ahmed Imran , Kazi Naheed Haroon , Bhand Sikandar Ali , Memon Yasirarfat
Published: May 2022

Background: Pediatric population is the most common among the populations at higher risk for infections and respiratory infections are the most common among the infections due to many reasons. Aim: To assess the nature of various respiratory infections in pediatric population. Study Design: Cross sectional study. Place and duration of study: Department of Pediatrics, Muhammad Medical College Hospital, Mirpur Khas from 1stJanuary 2018 to 31st December 2018. Methodology: Two thousand and ninety nine children with respiratory illness were included irrespective gender. Results: The males were more affected 1175 (56%) in comparison to 924 (44%) females and most cases were below the age of 5 years age 1428(68%) whereas children above the age of 5 years were 671 (32%). Common upper respiratory tract infections observed were pharyngitis, tonsillitis and otitis media which were collectively 1576 (75.10%) of the cases followed by lower respiratory tract infections (pneumonia) which was found in 523 (24.90%) patients. Conclusion: Upper respiratory infections were more common than lower respiratory infection in children and males are more affected than females. Keywords: Upper respiratory infections, Lower respiratory infections, Pediatric population
Exploring the Experiences of Undergraduate Medical Students with Online Open-Book Exams: An Exploratory Qualitative Study
Authors: Jawed Khaulah , Sadiq Tahira , Rashid Azhar , Khan Rehan Ahmed , Yasmin Raheela
Published: May 2022

Background: During COVID-19 medical education system in our ever-burgeoning societies thus saw a paradigm shift from in-person interactions to a virtual ones. In Pakistan, HEC also preferred online open-book exams (OBE) to closed-book exams (CBE) as an assessment strategy; issued guidelines accordingly. The absorption of this new assessment strategy proved daunting for undergraduate (UG) medical students. Careful understanding of their experiences proffers a seamless integration of online OBE in online assessment as a whole. Methods: The Qualitative exploratory design has been utilized. The sampling technique includes purposeful sampling with maximum variation in sampling type. The sample size was eighteen students for three FGDs (six students in each group). Online FGDs were conducted and thematic analysis was done with verbatim transcription of data. Result: Eight themes have been extracted from the data. The themes include understanding of students with online OBE, practice and training for online OBE, preparation for students for OBE, attempting online OBE, the spectrum of emotions, educational impact and benefits of online OBE, difficulties encountered during online OBE, and anticipated future of OBE in medical education. Conclusion: Experiences of UG medical students in online OBE indicate its potential in future applications, such as formative assessment, teaching strategy, complementing conventional exams, and assessing real-life workplace situations. Relevant findings have enabled the furnishing of one model for the effective utilization of online OBE for institutions and students. Keywords: Online Open-book exams, synchronous, undergraduate medical education, application of knowledge, problem-solving skill.
Comparison of Chest Computed Tomography Differential Diagnosis of Ground Glass Opacities in the COVID-19 Patients
Authors: Ullah Inayat , Memon Imran Khan , Rasul Muhammad Rashid , Das Bhagwan , Sohu Din Muhammad , Phul Akhtar Hussain
Published: May 2022

Aim: To compare chest computed tomography (CT) diagnosis of ground glass opacities in the COVID-19 patients. Study design: Retrospective study. Place and duration of study: Department of Radiology, Ghulam Muhammad Mahar Medical College Sukkur from 1st July 2020 to 31 August 2021. Methodology: Fifty patients on differential CT diagnosis of ground glass opacities seen in COVID 19 patients were enrolled. Thoracic CT images by applying auto exposure-control settings and ranges of scan were done. The noise-index was kept as 12.3. Using helical 16 slice Alexion CT-Toshiba. Keeping a comparison with viral infection CT images a list of 7 signs which were positive for Covid CT scan were recorded. Peripheral lesions meant any lesions which effects peripheral area up to 3 to 4 cm lung periphery with/without having central dispersal. A hazy-opacity was termed as ground glass. Results: Mean age of the patients was 49.1±10.2 years with 27 (54%) males and 23(46%) females. Mix ground glass opacitites and consolidation were also the features of the CT imaging in coronavirus posisitve cases. Man-Whitney test results showed that combined-CT scoring had a SE value as 0.044 with a confidence interval between 0.756-0.927. Comparing the differential CT values within COVID and non COVID patients based on RT PCR results it was observed that posterior region lower lobe involvement was a feature of COVID-19 patients while crazy paving pattern and peripheral distribution was also seen in corona patients. Conclusion: Present study highlights that chest CT helps in differentitaing corona virus from other causes of pneumonias and grond glass opacities. Key words: Chest CT; Differential diagnosis; COVID-19; Ground glass opacities (GGO)
Comparison of effects of open kinetic chain exercises with closed kinetic chain exercises on quadriceps strength and knee functional activity level after ACL reconstruction - a randomized controlled trial.
Authors: Nadeem Nimra , Asghar Hafiz Muhammad Uzair , Fazal Ishrat x , Fazal Muhammad Irfan , Sarfraz Ahmad Humayun , Maqbool Sania
Published: May 2022

Aim: To compare open kinetic chain exercises with closed kinetic chain exercises on strength of quadriceps and knee functional activity level after reconstruction of ACL. Methods: The study design is randomized controlled trial. Data of 36 patients was collected with subjective consent: 36 patients were distributed in 3 groups and each group had 12 patients with age limit from 17-39 years, treatment was given for 6 weeks including 3 days a week with conventional RICE therapy, conventional treatment with open kinetic chain exercises and conventional treatment with closed kinetic chain exercises. Results: SPSS 21 is used to generate results. Significant p value for post treatment ONE WAY ANOVA showed for knee injury and osteoarthritis outcome score is less than 0.05 which means the treatment technique is effective in reducing pain and disability in patients after ACL reconstruction. Significant difference was showed by ONE WAY ANOVA post treatment values for strength of all the muscles of quadriceps and knee functional activity in GROUP A, GROUP B and GROUP C. Vastus Medialis muscle showed p value 0.000, vastus lateralis muscle showed p value 0.000, vastus intermedius and rectus femoris both muscles showed p value 0.000 which are less than 0.05 showing significant difference between three groups. Conclusion: Closed kinetic chain exercises are conclusively better in improving quadriceps strength and Functional status of patients suffering from Anterior cruciate ligament reconstruction than open kinetic chain exercises. Keywords: Open Kinetic chain Exercises, Closed Kinetic chain Exercises, Anterior Cruciate Ligament.
Assessment of Nutritional Status for Identifying Nutritional Rickets in Children Less Than Five Years of Age
Authors: Khan Sanaullah , Zahid Sehar , Anwar Muhammad , Rafique Arshad , Siddique Shazia , Yaseen Imran
Published: May 2022

Aim: To assess the nutritional status for identifying nutritional rickets in children less than five years of age. Study design: Prospective study Place and duration of study: Department of Medicine Paediatrics, Arif Memorial Teaching Hospital Lahore from 1st April 2021 30th September 2021. Methodology: Sixty children suffering from rickets were enrolled. Blood sample 3cc was taken from each child and serum was separated by centrifugation. The serum was stored at -20°C until analysis. Biochemical tests including 25-OH vitamin D3, serum calcium and alanine phosphatase were done. The radiological imaging (X-ray) pictures completely demonstrated the rickets status. Demographical information, age, body mass index of each child was documented on a well-structured questionnaire. Food frequency charts related to vitamin D rich foods as well as calcium rich diet was used for assessing the nutritional status of children. Results: The mean age of the children was 3.5±1.9 years. The clinical symptoms of the enrolled children showed that sweating was most common symptoms in all sixty children suffering from rickets. Forty-eight percent cases were under weight and stunting was presented in 73% while wasting was observed in 23% of the cases. The radiological x ray imaging showed Cupping of the bones was presented in 51% of the cases followed by wrist widening in 24%. The food frequency results also presented similar findings in which serum calcium was observed inadequate in 86.6% of cases while ALP and vitamin D3 was inadequate in 90% and 100% of cases respectively. Conclusion: Vitamin D status of Pakistan children was very alarming as 100% of the cases was vitamin D deficient. Calcium deficiency was also significantly associated with nutritional rickets. Keywords: Nutritional rickets, Vitamin D deficiency, Geological location, Bone deformities
Association of Diabetes Mellitus and Hypertension with Angiographic Profile of Acute Coronary Syndrome Patients
Authors: Ahmed Salik , Abbas Uzair , Khowaja Sanam , Shah Shahbaz Ali , Hashim Muhammad , Hulio Amjad Ali
Published: May 2022

Background: Cardiovascular diseases are the leading cause of death worldwide while ischemic heart disease is a major contributor of cardiovascular diseases and diabetes mellitus is one of the major risk factor for ischemic heart diseases. Cardiac involvement in diabetes commonly manifest as coronary artery disease (CAD) of different extent which has an impact on disease outcome and prognosis. Aim: To compare the angiographic profiles between diabetic and non-diabetic patients with acute coronary syndrome (ACS). Place and duration of study: National Institute of Cardiovascular Diseases, Karachi, Pakistan from 1st Feb. 2020 to 31st Jan. 2021. Methodology: Two hundred and ninety eighty patients with acute coronary syndrome were enrolled. Demographic profile, personal and family history was taken through questioner. Angiography was performed to assess the angiographic profile in terms of extent of the disease, left main disease (LMD) involvement, severity of disease, and localization of disease to see the association with variables. Results: The mean age was 56.38±8.90 years and 240 (81%) were males and 58 (19%) were females. The diabetic patients have higher frequency of three vessels involved, localization of left anterior descending (LAD) and right coronary artery (RCA) with significant difference (p<0.0001 respectively). Left main disease was noted in 21 (25.3%) of diabetic participants and severe disease was found among 119 (56.4%) of diabetic participants with significant difference compared to non-diabetics (p<0.001). Angiographic profile was also found to be significantly different among hypertensive and non-hypertensive participants (p<0.05) Conclusion: There is higher frequency of diabetes in patients with ACS and most of them are male. While severity of disease, involvement of RCA and LAD in patients with acute coronary syndrome is quite high in patients with diabetes mellitus as compared to non-diabetic patients. Hypertension was also found to be associated with angiographic profile. Keywords: Coronary artery disease, Coronary angiography, Diabetic, Non-diabetic, Acute coronary syndrome
Association of Night Hypoxia with Otolith Dysfunction Patients Having Obstructive Sleep Apnea
Authors: Mahmood Zafar , Raza Hammad , Ullah Ikram , Ahmed Salman Niaz , Tirmizi Sohail , Shakil Saad
Published: May 2022

Aim: To find the association of night hypoxia with otolith dysfunction patients having obstructive sleep apnea. Study design: Prospective study Place and duration of study: Department of ENT and Head & Neck Surgery, Liaquat College of Medicine & Dentistry, Karachi from 1st January 2021 to 30th September 2021. Methodology: Fifty cases underwent polysomnography (PSG) for diagnostic purposes in context to suspicion of the night hypoxia were enrolled. Analysis for PSG was based on the variables as apnea hypopnea indexing, minimal level of oxygen of saturation, average level of oxygen-saturation, time of sleep as well as 3-4% de-oxygen saturation-indices. The vestibular-function test was performed by including vHIT and cVEMP as well as ocular VEMPs. Head impulses in horizontal method were used for quantitative assessment of the vestibular ocular reflexes. Results: Mean age of the study participants was 50.9±10.9 years. Age and body mass index of the participants were not significantly differed from obstructive sleep patients. Male gender appeared to be prominent in gender distribution. Incidence of hypertension and diabetes especially appeared to be higher in patients who had AHI ≥15. Conclusion: No considerable association was found between sleep apnea and vestibular function. Key words: Sleep apnea, Vestibular functions, Desaturation, Sleepiness
To Determine Mean Changes in Intraocular Pressure during Hemodialysis in patients of End Stage Kidney Disease
Authors: Mehmood Salman , Ahmad Muhammad , Nabi Ijaz , Sheikh Nouman Hameed , Javed Bilal , Hafeez Rana Zahid
Published: May 2022

Aim: To determine mean changes in intraocular pressure (IOP) during hemodialysis (HD) in patients of chronic renal failure Study design: Descriptive case series Place and duration of study: Department of Nephrology, Allied Hospital, Faisalabad, from 15/06/2016 to 15/09/2016 Methodology: End stage renal patients meeting the inclusion criteria on hemodialysis were included in the study. Written informed consent was obtained. After taking detailed history and clinical examination, intraocular pressure was measured just before and one hour after the initiation of HD using perkin’s hand held tonometer. Results: The mean± SD age of patients was 53.8±8.81. The minimum IOP was 11.20mmHg before hemodialysis and maximum was 16.80mmHg. Mean±SD was 14.08±1.38. Similarly minimum IOP after dialysis was 12 mm Hg and maximum was 19.0mm Hg, with a mean of 15.3. IOP in males before HD was 14.09±1.33. However after dialysis was 15.56±1.7. Thus the change in IOP seen in males was 1.6 ± 0.89 and in females was 14.08±1.46 and after dialysis was 15.13±1.45. Thus the calculated IOP change in females was 1.37±0.98. Chi square value was 2.67. p value observed was 0.263. Conclusion: There is significantly increased IOP during hemodialysis. Keywords: CRF, end-stage renal disease (ESRD), IOP, hemodialysis (HD).
Efficacy of Febuxostat with Allopurinol in Chronic Kidney Disease Patients: A Comparative Study
Authors: Ahmad Muhammad , Nabi Ijaz , Mehmood Salman , Sheikh Nouman Hameed , Hafeez Rana Zahid , Iqbal Rashid
Published: May 2022

Aim: Efficacy of febuxostat with allopurinol in patients of chronic kidney disease Methods: 80 subjects with chronic kidney disease, 20 to 70 years of age with both gender were included. Patients of acute kidney injuries (AKI), acute nephritis, or rapidly progressive glomerulonephritis, liver dysfunction and alcohol abuse were excluded. Group A received febuxostat 40 mg/day for 3 months. Group B patients received allopurinol 100 mg/day for 3 months. Blood samples were sent to the laboratory for serum uric acid level. Results: The mean ± SD age of women in group A and B was 41.8 ± 12.8 and 41.2 ± 10.8 years respectively. Out of 80 cases, 53 (66.3%) were between 20 to 40 years of age. In this study, 55 cases (68.8%) were males and 25 (31.3%) were females. M:F ratio was 2.2:1. This study showed that febuxostat is more effective in reducing uric acid as compared to allopurinol i.e. 72.5% and 45% respectively with p-value of 0.012. Conclusion: Febuxostat is more effective in reducing uric acid as compared to allopurinol in chronic kidney disease cases. Keywords: chronic kidney disease, serum uric acid, febuxostat
Success of Endoscopic Surgery in Nasal Polyposis
Authors: Javaid Waqas , Andleeb Hira , Rashid Abid , Akbar Raana Amir , Bukhari Syed Tauseef , Khan Tarique , Jafri Syed Qasim Ali , Fatima Maryam
Published: May 2022

Background: Endoscopic Sinus Surgery is a minimally invasive procedure that involves the use of an endoscope to improve sinus airflow and drainage as well as the removal of polyps. The extent of surgery varies depending on the severity of the condition and the surgeon's experience. This method has been utilized to treat sinonasal problems for over a decade. Aim: To find the frequency of success of Endoscopic Surgery in patients of Nasal Polyposis. Study design: Descriptive (Prospective) case series. Setting & duration: Department of ENT Unit II, Sir Ganga Ram Hospital, Lahore from 27-01-2021 to 26-07-2021. Methods: In current study, 80 patients of Nasal Polyposis were enrolled. All Patients were undergone Endoscopic Surgery procedure, following the patient at 3 weeks post-operatively as per operational definition addressed by success. Post-stratification chi-square test was applied. Results: Regarding age distribution, mean age was observed 37.60±4.479 years ranged from 30 to 45 years.35 patients were below 38 years of age whereas 45 patients were either 38 years or above. Out of 80 patients, 44 patients (55%) were male while remaining 36 patients (45%) were female. Frequency of patient success after Endoscopic surgery in Nasal polyposis was 64(80%). Conclusion: In conclusion, the success of the patients was considered to be high and comparable to recent literatures both local and international. The percentage of success of patients was higher i.e. 80%. Key words: Success, Endoscopic sinus surgery, Nasal Polyposis.
Frequency of Rectal Cancer among Young and Older patients
Authors: Bhurgri Ashfaque A. , Khatti S. N, , Danish A. A, , Shaikh M. , Seerani N. Lal , Memon A.  Salam , Shaikh M. Khalid , Raza S. , Shah S. Z. Ali
Published: May 2022

Aim: To determine the frequency of rectal cancer among young and older patients. Methods: All patients determined to have rectal carcinoma at tertiary consideration from January 2018 to December 2019 were recruited for this cross sectional study. Segment just as clinicopathological information of the rectal cancer patients were gathered reflectively and recently analyzed histologically affirmed instances of either sexual orientation remembered for this investigation while the patient critical ill and unstable patients, pregnant and lactating ladies and patient with hemorrhoids were rejected from the study. Patient information included age, sex, nationality, tumor morphology, tumor stage and separation, carcinoembryonic antigen (CEA) levels at show, and so forth. Results: Among all the fifty (50) patients under study, 30(60%) were below 40 years and 20(40%) were ≥40 yr of age. The mean age (yrs) at presentation was 46.64±8.74 the youngest patient was 18 years old. More than 70% of the patients were belonged to rural area of province including tribal and non-tribal population. Of the 50 patients, 45 were diagnosed with rectal adenocarcinoma, while five patients in the ≥40 yr age group had squamous cell carcinoma. The ulcerative morphology was identified as 20(40%) and 5(10%) in young and older patients whereas the polypoid morphology was seen in 10(20%) and 15(30%) young and older patients respectively. Among young and older population the level of tumour was also studied and observed as low 10(20%) and 12(24%) and high 8(16%) and 20(40%). In younger population the well, moderate and poorly differentiated cells was seen in 3(6%), 7(14%) and 6(12%) while in older patients the well, moderate and poorly differentiation was seen in 9(18%), 12(24%) and 13(26%). Conclusion: The young patients had transcendence of low rectal tumors, progressed T-stage and poorly differentiation tumor and advance level stage of illness stage when contrasted to older patients. Keywords: Liver abscess, C-reactive protein, and Inflammatory marker
Evaluation of Cerebral Infarction in Diabetic Patients With the history of Hypertension on Magnetic Resonance Imaging
Authors: Siddique R. , Farooq S. M. Yousaf , Abidin S. Z. , Qayyum S. , Shahzadi R. , Arif S. , Ali M. , Iqbal A. , jabeen Mah , Fatima M. , Gilani S. Aima
Published: May 2022

Background: Mortality rate of individual in later age is increasing due to Cerebral infarction among the diabetic and hypertensive patients that leads towards the complexity within the patients. This study Considered to determine Cerebral Infarction in Diabetic patients with the history of hypertension on Magnetic Resonance Imaging. Aim: To Determine the Evaluation of Cerebral Infarction in Diabetic Patients with the history of Hypertension on MRI Duration of study: 01-May-2021 to 01- September-2021 Methodology: The study will be supervised in 162 Diabetic as well as Hypertensive patients comprising Genders for evaluation cerebral infarction through MRI. Results: In our study different groups of patients formed on the basis of their age and calculated the minimum and maximum age of the patients which are 41years and 91years respectively out of 162 patients. Also calculated the mean age as well as the value of standard deviation among the patients which is 67.35 and ±8.905 respectively. Different groups of patients also formed on the basis of their gender and also calculated their frequency 77 males and 85 females as well as percentages 47.5% males and 52.5% females. Based on data calculated the single infarction 27(16.7%) multiple infarction 48(29.6%) and also calculated the frequency and percentage of collectively patients appeared with the cerebral infarction 75(46.3%) and in which cerebral infarction absent 87(53.7%) out of 162 Patients. Conclusion: It is conducted a Survey on minute level and observed all the data related to cerebral infarction and concluded that the MRI is the good imaging device for the evaluation of Cerebral Infarction. It provides a pattern which ideal designate tried with likewise exploration as well as assessment upon a Larger population. Keywords: Cerebral Infarction, DWI, PWI, Hypertension, Magnetic Resonance imaging, Diabetes mellitus
Effect of Intrathecal Dexmedetomedine as Adjuvant to Bupivacaine in Caesarian Section: A Double Blind Study
Authors: Azam M. , Kazmi Itrat Hussain , Asad Naila , Rehman Ali , Wasim M. , Amjad Ali , Jodat Azal
Published: May 2022

Aim: To explore the impact of dexmedetomedine as adjuvant to hyperbaric bupivacaine 0.5% in spinal anaesthesia in caesarian section. Methods: This study was conducted in Services Hospital, Lahore from 23-2-21 to 31-05-21. Two groups of 30 each were made by dividing patients randomly. Group B was given hyperbaric bupivacaine 0.5% (10mg) diluted in normal saline and in Group BD dexmedetomedine 5µg (0.5 ml) was added to 10mg hyperbaric bupivacaine (0.5%). Spinal Anaesthesia was administered with 25G spinal needle. Haemodynamic changes, onset and duration of sensory and motor block were documented. Inadequate perioperative analgesia was relieved with ketamine. Comparison of hemodynamics was done by independent sample t-test. Characteristics of motor and sensory block, analgesic time period were all presented as median (IQR) and compared by Mann Whitney U test. Comparison of categorical variables was done by Chi square. p< 0.05 was considered significant. Results: The median time for sensory block onset was 2.0(2.0 - 3.0) in Group B vs 2.0(2.0 - 3.0) BD. The median time to reach maximum sensory block was not significantly different. (p-0.151). The two segment sensory regression time was significantly longer in group BD with median time 2.2(2.0 – 3.0) vs 1.5(1.3 – 2.0) hours in group B. Significant increase in analgesic duration was seen in group BD (p<0.001). Onset of motor block was higher in group BD significantly (p-0.04). Significant increase in motor block duration was seen (p<0.05) in BD vs B group with respective median times 6.0(5.5 – 7.0) and 3.5(3.0 – 4.0). Conclusion: Intrathecal Dexmedetomidine 5 µg with hyperbaric bupivacaine significantly prolongs both sensory and motor block and prolongs the duration of analgesia in lower segment caesarian section. Keywords: Dexmedetomedine, Spinal Anaesthesia, Sensory block, Motor block
Association of Drinking Water and Enteric Fever: A Disguised Source of Infection
Authors: Zahra Fatima Tuz , Saleem Sidrah , Imran Muhammad , Javed Nida , Ghazal Ayesha , , Ch. Saadia
Published: May 2022

Background: Enteric fever is an illness caused by Salmonella enterica serovars Typhi and Paratyphi A and B. The mode of transmission is the ingestion of contaminated food and water. Aim: To check that whether drinking water is the source of infection or not. Methodology: 202 water samples were collected from the various areas of Lahore. 120 samples were taken from houses and the neighbourhood of confirmed typhoid patients and 82 samples were randomly collected. The samples were centrifuged, enriched and then subcultured on XLD media. The isolated colonies were identified by biochemical reactions. The sero-typing confirmed Salmonella species were done. Results: The results showed that 23% of the drinking water in Lahore was fit for drinking, 76% samples were contaminated. The organisms isolated were Serratia spp. 22%, Enterobacter spp. 22%, E. coli 16%, Citrobacter spp. 12%, Pseudomonas spp. 9%, Proteus spp. 6%, Klebsiella spp. 4%, Salmonella Paratyphi A and Salmonella Rubislaw as 1%. No Salmonella Typhi was isolated from any water sample. Conclusion: The presences of large coliforms in drinking water were indicative of sewerage contamination. The Salmonella Paratyphi A might be source of infection in that specific area but overall the results suggested that drinking water of Lahore was not acting as a source of infection for Enteric caused by Salmonella Typhi. Keywords: Water-borne , Infection, Enteric fever, coliforms.
Prevalence of Musculoskeletal Disorders among Pregnant Women: Cross-Sectional Study
Authors: Khattak Hafsah Gul , Arshad Hafsah , Anwar Kinza , Hanif Sidra , Kiani Nida , Sultana Bushra
Published: May 2022

Aim: To identify the prevalence of most common musculoskeletal disorders in pregnant women according to trimester. Method: A cross-sectional study was conducted from September 2019 to February 2020. The study was conducted after taking approval from the study setting and by the research ethics committee. The data was collected from the Family health hospital Islamabad. Data was raised through non-probability convenient sampling technique. Pregnant females with the age group of 20 to 40 years were included in the study. Those who had a chronic musculoskeletal conditions and previous history of orthopedic surgery were excluded. Data was collected after taking written informed consent. Data was collected using semi structured questionnaire which included demographic information, questions related to pregnancy and questions about musculoskeletal problems during pregnancy. Results: The mean age of 385 participants was 27±4.76. Low back pain (38.7%) was the most prevalent musculoskeletal disorder among pregnant women. In first trimester, low back pain and muscle cramps were found to be (33.3%) and (20%). In second trimester the most frequent problem was low back pain (37.6%), leg muscle cramps (17.6%), pedal edema (10.3%) and carpel tunnel syndrome (9.1%) respectively. Whereas, in third trimester 40.5% mentioned pain in low back, 16.3% leg muscle cramps, 10% pedal edema, 8.4% had reported carpal tunnel syndrome. Conclusion: Low back pain, leg muscle cramps and pedal edema were the most experienced musculoskeletal problems in pregnant woman. Key words: Pregnancy, Low back pain, muscle cramps, musculoskeletal disorders, ankle swelling.
Complications Associated with Emergency Obstetric Hysterectomy: A two year review at Lahore General Hospital, Lahore
Authors: Aslam Lubna , Soail Nudrat , Ayyub Nazia , Sarwar Aiyza , Shah Azher Abbas , Gul Mehreen
Published: May 2022

Background: Emergency obstetric hysterectomy is removal of the uterus to stop life threatening obstetric hemorrhage when all other measures fail. The life threatening hemorrhage and unavoidable emergency removal of the uterus is associated with considerable morbidity and mortality. Aim: To review the complications associated with the potentially avoidable procedure of EOH. Methods: All the women, regardless of booking status, presenting in emergency labor room and OPD of Gynae Unit 3 from January 2020 to December 2021, who underwent EOH were included in the study. Preventive measures and complications associated with the EOH were reviewed. Results: Total number of births recorded in two years, between January 2020 and December 2021 were 6809. Out of these, vaginal deliveries were 3669 (53.8%) and remaining were the Caesarean sections, 3140 (46.1%). Out of 48 EOH performed, majority of the complications (61.5%) encountered were hypovolemic shock, coagulopathy, re-exploration, and visceral injuries, each being 15.38% of the complications. Conclusion: EOH being the life-saving surgical procedure is associated with significant complications. Improving the antenatal care and health education of women can reduce the maternal morbidity and mortality especially in the developing countries. Key words: Obstetric hemorrhage, EOH, complications.
Role of Laparoscopy in Evaluation of Primary Infertility
Authors: Akhtar Shamim , Malik Naila Nasr , Baig Asma Amin , Bibi Humaira , Nasreen Rizwana , . Marghalara
Published: May 2022

Background: Most of the couples conceive during first year of marriage and majority of the rest conceive during the second year. Few misfortune couples unable to conceive. Female factor are most common. Laparoscopy is a useful tool to evaluate female factor of infertility. Aim: To find out the frequency of common causes of primary infertility in females undergoing laparoscopy. Method: This is a retro respective cross sectional study, conducted in Health Care Centre (pvt) Ltd, Peshawar from July 2020-December 2021.All medically fit females having regular unprotected intercourse for at least one year and normal semen analysis report presented with infertility underwent laparoscopy after taking informed consent. Females with previous surgeries were excluded. Data was collected. Frequency and percentages of different causes of infertility calculated. Data was analyzed on SPSS. Result: Primary infertility was seen in 140 out of 210 patients. Among primary infertility 36 patients had normal laparoscopic finding. The common finding were PCOs 44 (31.4%), tubal factor, 23 (16.4%), fibroid 14 (10%), pelvic adhesions 10(7%), endometriosis 6 (4.3%), simple ovarian cyst 4(2.5%) & PID 3(2%). Conclusion: Life style modification should be advised at early ages. Laparoscopy has a beneficial role in evaluation of primary infertility. Keywords: Primary infertility, laparoscopy, conceive,
An Overview of Rate of Infection and Mortality in Femur Fracture Patients and its Fixation during Covid-19 Pandemic
Authors: Ayub Muhammad Ali , Ahmad Ali Ijaz , Ansari Hizbullah Riaz , Aziz Mohammad Omar , Akram Rizwan , Aziz Amer , Ahmed Ashfaq
Published: May 2022

Aim: To observe the workload of fractures of the femur (shaft and distal femur) and their fixations along with complications in terms of infection and mortality at our hospital during COVID 19 pandemic. Study design: Prospective study. Place and duration of study: Dept of Orthopaedic, Ghurki Trust Teaching Hospital, Lahore from 01-03-2020 to 31-07-2020 Methodology: One hundred and thirty-one diagnosed patients with femur fracture (shaft and distal) during pandemic period of COVID were enrolled. Demographic data included (age, sex, implant type, surgical site infection (SSI) and mortality).Since study was done during COVID-19 pandemic, positivity of COVID symptoms was noted as yes/ no on data collection proforma. Results: There were 105 (80.15%) males while 26 (19.84%) were females with mean age was 39.20±13.02 years. Majority of the surgical interventions were done based on Intramedullary nailing 74.05%, the second prevalent surgeries were done on AO external fixation 8.4%. Infection rate was observed in 7(5.32%) patients. No mortality was seen in any of the cases. Four infected cases were observed after intramedullary nailing procedure, two from AO external fixation and one after locking plate. Conclusion: There is no significant higher complication rate due to COVID-19 pandemic to patients whom femur fracture fixation was done. None of admitted patient suffered COVID-19 symptoms during hospitalization. It was only pointless fear about orthopaedic intervention during this interval. Key words: COVID-19, Femur, Infection
Conservative Management Techniques for Ideal Grooming and Upbringing of Downs Syndrome Children
Authors: Fajar Ibtesam-E- , Sheikh Taimur Khalil , Janjua Huma Bashir , Ahmed Daniyal , Baig Iman , Baig Sundus Asghar , Khokhar Aamna
Published: May 2022

Background: Down syndrome are slow learners having mild to moderate intellectual disability with co-morbidities, we need to pay special attention on conservative management techniques like early intervention programs, speech therapies, physiotherapies, exercises, sports, schooling and education etc. to make these children intellectual compatible for a normal life. Aim: To identify the conservative management techniques for improving the quality of life for down syndromes. Methodology: A descriptive cross-sectional survey (designed after literature search) was conducted from the parents of Down Syndromes at special children’s schools in Islamabad and Rawalpindi according to inclusion criteria i.e., school going down syndromes and residents of Islamabad and Rawalpindi, in an interactive counselling session conducted by authors in collaboration with pediatrician, keeping the questionnaire anonymous. Results: For the management of Down Syndromes, out of 44 parents, 36(81.8%) agreed on home based teaching, 34(77.3%) agreed on exercise, gym and sports for down syndromes. Around 38(86.4%) agreed on speech therapy and social interactions, 31(70.5%) parents agreed on controlled and healthy diet and 34(77.3%) parents said brain storming and learning new things should be in practice for down syndromes. Conclusion: Down syndrome is a complex condition requiring a multi-disciplinary team of professionals to manage the myriad of problems faced by the patients. Aside from these, a vital role is played by parents, teachers & the community itself in taking care of these special individuals. Also, Down syndrome is characterized by learning disabilities as its hallmark feature but their learning abilities can be improved through certain conservative management techniques. Keywords: Down Syndrome, School, Exercise
Trends in BMI and Obesity Prevalence among School Going Students with Down Syndrome in Islamabad and Rawalpindi
Authors: Janjua Huma Bashir , Fajar Ibtesam-E- , Sheikh Taimur Khalil , Ahmed Daniyal , Baig Iman , Baig Sundus Asghar , Khokhar Aamna
Published: May 2022

Background: Down syndrome is present in every 1 in 700 births, associated with developmental disability and comorbidities, like obesity which significantly contributes to morbidity and mortality in these children. Aim: To identify the trends in body mass index and prevalence of obesity in school going down syndromes. Methodology: A descriptive cross-sectional survey conducted at special children’s schools in Islamabad and Rawalpindi. A questionnaire was designed after literature search and was filled by the parents of the selected candidates according to inclusion criteria i.e., school going down syndromes and residents of Islamabad and Rawalpindi, in an interactive counselling session conducted by authors in collaboration with pediatrician, with parents at respective schools of their child, keeping the questionnaire anonymous. After data collection it was entered in SPSS v25 for statistical analysis in terms of frequencies and percentages. Results: Our survey included 44 candidates in which majority was between the age group 11 years to 20 years i.e., 23(52%) and 12(27%) were below 10 years. This survey showed that 42(95%) of our selected candidates have Normal BMI while 2(4.5%) of our candidates fall in Overweight (High BMI) category. Conclusion: Most of our selected Down syndrome individuals are protected from obesity as they indulge in different sports, physical activities, physiotherapy and maintain a balanced diet. It is therefore recommended to emphasize the importance of physical activities, active participation in sports, gymnastics, regular exercises and maintaining a healthy diet plan to avoid obesity in these individuals so that further complications of obesity can be prevented thus improving the quality of life of these individuals. Keywords: Body Mass Index, Down Syndrome, Obesity
Knowledge and Practice about COVID-19 among Medical Students
Authors: Hussain Rafia , Arif Mehwish , Ayub Saadia , Daud Seema
Published: May 2022

Background: Covid-19 pandemic has brought the world to a standstill where the only hope to end this is the prevention and control of the disease. Medical students hold significant importance in this crisis as being the individuals at increased risk as well as future health care providers. Aim: To assess the knowledge and practice regarding Covid-19 Methods: A cross-sectional study was conducted at Lahore Medical and Dental College, Tulspura. The duration of study was three months from Feb 2021 till April 2021 after the approval of synopsis by IRB committee, LMDC. Study Population included final year MBBS students. Sample size was n=113.Sampling technique used was non-probability convenience sampling technique. Data collection was done using a structured questionnaire consisting of three sections viz socio demographic characteristics, knowledge and practice about Covid-19. Data entry and analysis was done using IBM SPSS version 21. Results: Study participants included 48.7% males and 51.3% females. Most of the students 99.1% were aware of the Covid-19 pandemic. About 99.1% students also knew that it is an infectious disease and 96.5% knew that a virus is the causative agent of Covid-19. However, 84.1% had correct knowledge regarding the incubation period of the disease. Maximum respondents 73.5% believed that everyone is equally susceptible to get infected with Covid-19. Fever and cough are the most common symptoms of the disease and internet and electronic media are most common source of information regarding Covid-19. Majority 46% of respondents did not adopt good practice of regular washing of hands. Nearly 63.7% ate healthy food and 73.5% maintained healthy life style focusing on outbreak Conclusion: The medical students had adequate basic knowledge regarding the disease, electronic media and internet being the most common source of knowledge. The practices of mask wearing and adoption of healthy lifestyle were widely adopted yet the practice of hand hygiene and reduced social mobility was poorly conducted. Keywords: Covid-19, knowledge and practice, medical students
Perception of the Quality of Life amidst HIV/Aids Positive Individuals in Tertiary Care Hospitals of Lahore
Authors: Navied Umbreen , Sarmad Rubina
Published: May 2022

Background: The Quality of life (QOL) as defined by WHO is that individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. The intimacy about illness depends upon whether an individual relates and perceives that he or she has a good life, which would be worthwhile to review in relation to QOL. Aim: To determine the perception of QOL of people affected with HIV/AIDS. Methods: This was an exploratory research conducted by non-probability convenient sampling of 139 HIV/AIDS positive and registered cases at the Voluntary Counseling Testing Centers (VCT center’s) at Services and Jinnah hospitals, Lahore, in 6 months in 2019. The WHOQOL BREF Questionnaire was used for data collection. Data compilation and analysis was done through SPSS software. The interviews were taken with informed consent by the investigator. Results: In 139 cases of HIV/AIDS positive registered individuals mean age was 32.12±8.54, with 78.4% males and 21.6% females. Regarding their perception of current illness (intake of medicine other than HIV), only 19.4% claimed that they were ill. However when asked about their perception about self-health as many as 85.6% claimed that they were suffering from some illness. The remaining did not perceive their problem as illness. The response of the study participants towards their perception of quality of life (QOL) was considered to be good/ very good (33.1%) and poor/ very poor (53.9%). Whereas 12.9% thought it was neither poor nor good. The current illness and quality of life scores were not statistically significant in all domains, except social relationship domain. Conclusion: The perception of QOL of HIV/AIDS person needs to be explored, especially in Pakistan. It is necessary to determine and address all the associated aspects which affect the QOL of HIV/AIDS patients.. Keywords: Perception, Quality of life, HIV/AIDS positive individuals, Tertiary Care Hospitals, Lahore
Frequency of Factor V Deficiency (F5d) among patients with Bleeding Complaints
Authors: Aziz Noor-Ul-Ain , Qureshi Qurat-Ul-Ain , Kadir Sidra , . Maleeha , Abbasi Noureen , Ujjan Ikram Din
Published: May 2022

Background: Commonest genetic defect includes mutation of F5 gene on the long arm of chromosome1q23 thus both parents carry defective gene. Aim: To evaluate the frequency of inherited Factor V deficiency among patients presenting with bleeding at T.C hospital. Study design: Cross sectional study. Methodology: A total of 300 patient presented with complain of bleeding were included in this study. Detailed history was noted. PCR was performed. After preparation of PCR reaction mixture, incubate tubes into thermal cycler having specific cycling condition. Primer was use for both PCR amplifications and sequencing reactions was designed. Applied bio-system was used for mutation detection. The collected data was analyzed by using SPSS version 25. Results: The average age of the patients was 36.87±9.40 years. There were 213(71%) male and 87(29%) female. Frequency of inherited factor V deficiency in patients presented with complains of bleeding was 3.33% (10/300). Conclusion: It was concluded that frequency of inherited factor V deficiency in present study was low. Conclusion: frequency of inherited factor V deficiency in present study was low (3.33%). Keywords: Mutation, Factor V deficiency, bleeding, PCR reaction.
Frequency and Clinical Spectrum of Von Willebrand Disease among Females with Bleeding Complaints at TCH-Hyderabad
Authors: Kadir Sidra , Aziz Noor-Ul-Ain , Mazhar Neelam , Ujjan Ikram Din , . Maleeha , Kadir Sadia
Published: May 2022

Background: Women with von Willebrand disease experiences more postpartum hemorrhage or the bleeding followed by surgery than the healthy women. Aim: To determine the frequency of Von Willebrand disease among females presenting with bleeding complaints at tertiary care hospital. Study Design: Cross sectional study. Methodology: Complete Blood Count, Bleeding Time, Prothrombin time, Activated Partial Thromboplastin Time were performed on the same day. Blood sample for CBC collected in EDTA tubes and for coagulation assays in tubes containing (3.2%) trisodium citrate. Von Willebrand’s factor: Ag and Factor VIII were analyzed on Sysmex automated blood coagulation analyzer CA (600) while Ristocetin cofactor assay (RiCoF) was performed on Aggregometer. The collected data was analyzed by using SPSS version 25. Chi square ware applied with P-value< 0.05 as significant. Results: Out of 80 patients, 56 patients were unmarried and 24 were married. VWD was found in 22/80 patients (27.5%). Type 3(50%) was the most frequent subtype followed by type2 (22.7%) and type 1(22.7%). In VWD, Menorrhagia (63.6%) was the most frequent symptom. APTT was prolonged in type3 VWD (50%). The mean VWF: Ag 18.5±20, VWF: RICOF 27.7±19 and factor VIII 74.9 ± 62.3 was noted in patients with VWD. Conclusion: It was concluded that VWD is the most common inherited bleeding disorder in females presented with bleeding complaints. Awareness about the disorder is the need of time in order to prevent life threatening bleeding. Keywords: Von Willebrand Disease, Menorrhagia and Bleeding Complaints
Legal protection of medical personnel during the COVID-19 pandemic in Indonesia
Authors: Mangku Dewa Gede Sudika , Yuliartini Ni Putu Rai , Hartana Hartana , Darayani Ni Made Celin
Published: May 2022

The purpose of this research is to investigate the legal protection of medical staff in Indonesia during the Covid-19 outbreak. This study is a descriptive qualitative study that examines the legal protection of medical staff in Indonesia using positive law. Secondary legal materials, such as books, journals, articles, and other written works, as well as field phenomena, are used to write the article. According to the study's findings, the Covid-19 outbreak in Indonesia has placed a significant strain on the country's healthcare system, especially on healthcare employees. The most evident issue is the safety of medical staff at the frontline, who are extremely vulnerable to being exposed to Covid-19, risking their lives. Furthermore, issues of mental health, such as the danger of burnout syndrome, pose significant concerns. Unfortunately, there are no guidelines or practices in place to protect their mental health.  Legal protection for health workers during the Covid-19 pandemic consists of preventive protection efforts and repressive protection efforts. The government provides preventive protection through a vaccination program. Repressive protection is given by the Government by imposing sanctions for perpetrators of violence and discrimination against health workers who are on duty. Besides, the Government has provided incentives and death benefits.
Comparison of classification techniques in the diagnosis of acute myelogenous leukemia
Authors: Ramya V. Jeya , Lakshmi S.
Published: May 2022

The leukemia blood cell discriminates from other blood cells by geometrical structure and cellular material by hematologist with microscope. In conventional color imaging system, the granular region in leukemia cells classify false negatively by experts due to micro geometrical and morphological changes in leukemia cell. Hence, a computer aided decision support system (CADSS) employs for automatic classification of leukemia blood cells. This paper gives the comparative study   of various methods of classification of Acute Myelogenous Leukemia (AML) with improved accuracy and their results are compared. In this paper, the classification techniques such as Convolutional Neural Networks (CNN), Support Vector Machines (SVM), Fraction Black-Widow Optimized Neural Network (FB-NN), Deep CNN with Arithmetic Optimization and Hybrid Convolutional Bi-LSTM based RNN are made with blood microscopic images, in which according to measures, Deep CNN with Arithmetic Optimization has the best accuracy.