bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Multivitamin Supplements useAmong General Population of Rawalpindiand Islamabad
Authors: Shahzad Asima , Mashhadi Syed Fawad , Safdar Sarah , Sultan Adil , Osama Hassan , Ali Shah Syed Maaz , Kashaf Noor e , Abbas Sana
Published: October 2023

Objective: To determine the prevalence of multivitamin supplement use among prescribed and non-prescribed population of Rawalpindi and Islamabad Pakistan.
Study Design: It was a Quantitative analytical cross-sectional study.
Place and Duration of Study: The study was carried out among general population of Rawalpindi and Islamabad Pakistan,from Jan till Apr 2022.
Methodology: Nonprobability convenient sampling technique was used. The sample size was 385. The data was gathered through an online survey and was analyzed using IBM SPSS statistics version 25. Chi-square test was applied on qualitative variables with p-value significant at <0.05.
Results: Only 41% of people were prescribed multivitamins by their doctors while 59% were self-medicated. An overall prevalence of multivitamin supplementation among the population was 66.9%. About 48.3% of people are aware of their harmful effects. Majority (88.1%) of population consider vitamins good for their health. 70% of people buy supplements via pharmacist and almost half of the people do not read the leaflets that come with supplements. Male gender was statistically significantly associated with awareness of vitamin supplement use and encouraging its use to others (p≤0.05).
Conclusion: There exists a high prevalence of multivitamins use amongst the twin cities of Rawalpindi/Islamabad. Although most of the population had an awareness of what multivitamins are essentially, half the population do not know about the harmful effects of vitamins. Males had more awareness of multivitamins supplement use as compared to females.
Adverse Effects of Prolonged Sitting Behaviour on the General Health and Posture of Medical Students
Authors: Mashhadi Syed Fawad , Khan Nazish , Shabbir Amina , Islam Qaanitah Binte , Rao Fizza Jamil , Saadat Maham , Amjad Aemen
Published: October 2023

Objectives: To determine the prevalence of musculoskeletal symptoms among Medical students and to correlate the musculoskeletal adverse effects with prolonged sitting and sitting posture.

Study Design: Analytical cross-sectional study.

Place and Duration of Study: Study was conducted online among Medical Students studying in various medical institutions across Pakistan, from Nov 2021 to Apr 2022.

Methodology: Study included 144 Medical and Dental students, recruited through convenience sampling. Any participant currently suffering or recently recovered from a debilitating illness, physical disability, presently undergoing treatment for any chronic muscular or skeletal pain was not included in the study. A close-ended virtual questionnaire containing the Nordic Musculoskeletal Questionnaire (NMQ) was used.

Results: Majority of respondents 100(69.4%) sat continuously for more than 2 hours while 44(30.6%) sat for less than 2 hours in a single seating. Results of the NMQ showed that most people had pain and discomfort in shoulder, upper back, lower back and hip. Pain in the lower back was the most common complaint 93(65%). Prolonged sitting (>2hours) was significantly associated with Lower back pain (p=0.004) and hip pain (p=0.019)

Conclusion: Prolonged sitting behaviour was associated with frequent complaints of lower back discomfort. Poor posture was demonstrated to cause pain in the shoulder and upper back regions. Active workstations, intermittent walks during breaks and usage of negative desks, as well as avoidance of forward leaning posture are suggested to improve working conditions.
Prevalence of Online Fatigue during COVID-19: A Cross-Sectional Study on Academicians of Rawalpindi
Authors: Mashhadi Syed Fawad , Khan Nazish , Shaukat Ibtesam , Saad Anees , Cheema Ali Hassan , Hassan Ali Jan
Published: October 2023

Objective: To determine prevalence of online fatigue among academicians and to analyse factors associated with online fatigue.

Study Design: Analytical, cross-sectional study.

Place and During of Study: The study was conducted online from Nov 2021 to Apr 2022 on academicians belonging to educational institutions and teaching hospitals of Rawalpindi Pakistan.

Methodology: One hundred fifty academicians, aged 20-75 years, belonging to Rawalpindi were enrolled through snowball sampling. Data was collected online by using google forms. A validated questionnaire having an online fatigue scale was used. Partial responses were excluded. Qualitative variables were expressed as frequency and percentage while quantitative variables were expressed as mean and S.D. Chi-square test was applied.

Results: Out of 150 academics, 72(48%) were males and 78(52%) were females. Mean age of participants was 32±9.4 years. Amongst the study participants 27(18%), 67(44.7%), 50(33.3%) and 6(4%) suffered from mild, moderate, severe and extreme online fatigue respectively. The degree of online fatigue was found to be significantly associated with female gender (p=0.000), older age (p=0.005) and higher level of education (p=0.002). Association of online fatigue with factors such as workplace(p=0.054), residence (p=0.129) and amount of technology usage (p=0.995) was found to be statistically insignificant.

Conclusions: Our study showed that online fatigue was prevalent among the academic community of Rawalpindi, especially females. Online fatigue can be reduced by training the academicians about work-life balance and updating their knowledge on practical technology.
Significant Role of Professional Development Center in Healthcare Setup in the Provision of Quality Education, Advance Learning and Patient Care
Authors: Anwar Adina , Irfan Muhammad , Kazi Sarah , Khan Erum , Fatima Mehwish , Kabir Varisha
Published: October 2023

Objective: To define the significant role of Professional Development Center (PDC) at Dow University of Health Sciences in provision of quality education, learning and patient care.

Study Design: Retrospective cohort study.

Place and Duration of study: Professional Development Center, Dow University of Health Sciences, Karachi Pakistan, from 2018 to 2022.

Methodology: Study was conducted through non-probability convenience sampling technique to include all CME workshops and seminar records of PDC. Further feedback forms were also collected from the participants after each training session to analyze their feedbacks.

Results: As per the five year, records a total of 728 CME workshops and 635 CME seminars were conducted by PDC from the 2018 to Feb 2023. Major focus areas of the CME lectures and workshops was Medicine and Allied Health sciences, continuously for the last five years. However, when major focus area of CME workshops was assessed it was that they were mainly related to basic life support where, most of the workshops were conducted to train the students of Dow Institute of Medical Technology. When participants’ feedback was taken regarding the organization and impact of workshop, it was found that most of them agreed that handouts were helpful (77.25%) and questions were adequately responded (77.25%), respectively.

Conclusion: It was found that PDC significantly played its role in enhancing knowledge and skills of the healthcare professionals in healthcare setup, thereby providing quality education, learning and patient care.
Post-Spinal Backache! A Myth or an Overlooked Complication
Authors: Hussain Aftab , Saleem Muhammad Asif , Feroze Rehana , Wahid Faisal , Bajwa Saleem Pervaiz , Akram Muhammad
Published: October 2023

Objective: To find out the difference in the backache when a 27G Quincke needle with no more than two attempts is used for spinal anaesthesia versus general anaesthesia.

Study Design: Prospective comparative study.

Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun 2020 to May 2021.

Methodology: A total of 150 patients were divided into two Groups. C-sections were performed under general and spinal anaesthesia in Group-GA and Group-SA, respectively. General anaesthesia was induced with intravenous anaesthetics following rapid sequence induction. The 27G Quincke needle was used for spinal anaesthesia with no more than two attempts. Post-operative follow-ups for backache were carried out at 24-hours, 1, 4 and 12 weeks.

Results: At 24-hours post-operative follow-up, 8 patients from the GA-Group and 17 from the SA-Group had backache; the difference was significant (p-value of 0.049). At week-1, two patients from the GA-Group and five from the SA-Group complained of backache (p-value 0.246). Similarly, at week-4, only one patient from the GA Group and four from the SAGroup had backache (p-value 0.127). At the 12-week follow-up, only one patient complained of backache, and she belonged to the SA- Group (p-value 0.316).

Conclusion: Spinal anesthesia results in a significantly high frequency of backache as compared to general anaesthesia in the immediate post-operative period; however, there is no long-term difference in backache.
Evaluation of Children with Autism Spectrum Disorder by using Common Brief Core Sets of International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY)
Authors: Tahir Sidra , Maqbool Shazia , Farid Aisha , Ali Anam , Ullah Ehsan , Azhar Hina
Published: October 2023

Objective: To evaluate children with Autism Spectrum Disorder (ASD) by using Common Brief Core Sets of International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY)

Study Design: Cross-sectional study

Place and Duration of Study: Department of Developmental-Behavioural Paediatrics, The Children’s Hospital and The Institute of Child Health, Lahore Pakistan, from Nov 2020 to Jan 2021.

Methodology: This study included 48 children with Autism Spectrum Disorder aged 3-18 years. Common Brief, a Core Set of the international classification of functioning, disability, and health in children and youth (ICF-CY), was administered to assess their functional status. Strengths and weaknesses in body structure, body function, activity and participation and environmental factors were evaluated.

Results: The functioning profile in all categories of body function, activities and participation showed severe impairment other than sleep, involuntary and voluntary functions, while complete impairment in complex interpersonal, recreational and leisure categories. Environmental factors were substantial facilitators 4(10%), moderate facilitators 6(15%), mild facilitators 3(7.5%), mild barriers 5(12.5%), moderate barriers 7(17.5%), severe barrier 1(2.5%) and complete barrier 5(12.5%) among children with Autism Spectrum Disorder (ASD).

Conclusion: Common Brief, Core Set of ICF-CY, is a comprehensive and flexible tool which provides functional information about ASD children beyond the diagnosed criteria used for ASD.Keywords: Autism spectrum disorder (ASD), Common brief core set of the international classification of functioning, disability, and health in children and youth (ICF-CY), International classification of functioning, disability, and health in children and youth (ICF-CY).
Aetiological Factors of Periorbital Hyperpigmentation in Patients Presenting to the Hospital
Authors: Nasar Amna , Habib Aamir , Ud Din Qamar , Naeem Uzma , Mujahid Tanveer Ahmad , Jabeen Maeda
Published: October 2023

Objective: To know the aetiological factors of periorbital hyperpigmentation in patients presenting to the Outpatient Department of Combined Military Hospital, Kharian Pakistan.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Nov 2020 to Sep 2021.

Methodology: We conducted a study of sixty patients with periorbital hyperpigmentation periorbital hyperpigmentation presenting to Skin OPD. A detailed history, clinical examination, and lab investigations like complete blood counts, thyroid function tests, and vitamin B12 and D levels were advised.

Results: Out of 60 patients, 2(3.33%) were male, and 58(96.66%) were females. The mean age of patients was 24.95 years ±6.48. 10(16.66%) had a family history of periorbital hyperpigmentation. Lack of adequate sleep was found in 18(30%) patients, and prolonged daily bright screen exposure was found in 28(46.66%). History of atopy was present in 18(30%). History of seasonal allergies was present in 17(28.33) % of individuals. Other associated pigmented conditions like melasma in 14(23.33%) and post-inflammatory hyperpigmentation were noted in 2(3.33%) patients. 8(13.33%) patients had anaemia, 4(6.66%) had subclinical Hypothyroidism, and low vitamin D levels were found in 6(10%). None of our patients had vitamin B12 deficiency.

Conclusion: Periorbital hyperpigmentation has multiple aetiological factors and associations. Correctable factors need to be addressed for better treatment outcomes. The presence of anaemia, subclinical Hypothyroidism, and low serum vitamin D levels indicate the need to screen periorbital hyperpigmentation patients for these conditions.
Comparison of COVID-19 Rapid Antigen Test Results with PCR Reactive/ Non-Reactive Cases
Authors: Zehra Nayab , Khan Muhammad Dilawar , Batool Hijab , Chughtai Omar Rasheed , Chughtai Akhtar Sohail , Shakeel Muhammad
Published: October 2023

Objective: To evaluate the analytical accuracy of the COVID-19 Ag Rapid Test Device by Abbott PanbioTM using RT-PCR as the reference assay and to detect any false-positive/negative reactions to assess the specificity of this analytical procedure.

Study Design: Cross-Sectional analytical study.

Place and Duration of Study: Department of Chemical Pathology, Chughtai Institute of Pathology, Lahore Pakistan, from Feb to May 2021.

Methodology: This study was comprised of a total of 105 samples. The result of these nasopharyngeal specimens was already established by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR). Then the same (nasopharyngeal) specimens were analysed on Rapid Antigen Detection Test Device.

Results: Out of 105 specimens, we got 88(83%) PCR positive samples and 17(16%) PCR negative, which, when compared with the Abbott PanbioTM Rapid Antigen Test Device, showed 60(57%) positive and 45(42.8%) negative samples having a sensitivity of 75(86%) (CI 67.04%-83.32%) and specificity of 100%(80.49-100%). The accuracy of the test was found to be 78(95%). This assay was found convenient and more appropriate for outdoor settings.Keywords: COVID-19, RT-PCR, Rapid antigen test, Specificity, Sensitivity.
Joint Hypermobility and Musculoskeletal Pain in Paramedical Students and Staff at a Tertiary Care Hospital
Authors: Butt Nauman Ismat , Tareen Muhammad Qasim Khan , Ashfaq Fahmina , Butt Usman Ismat
Published: October 2023

Objective: to determine the frequency of joint hypermobility in paramedical students and staff at National Hospital Lahore.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Center, Lahore Pakistan, from Mar to Sep 2021. Methodology: Two hundred fifty paramedical students and staff of either gender, aged between 16 years to 35 years were enrolled. Localized Joint Hypermobility was defined as <3 Score and generalized Joint Hypermobility were defined as >4 scores on the Beighton Score Scale. Demographic information was obtained from each participant, and joint hypermobility was assessed by using the Beighton score.

Results: Mean age of the study participnats was 26.6±4.6 years with 146(58.24%) females. Mean BMI was 23.9±4.0 kg/m2. Generalized Joint Hypermobility was seen in 51(20.4%), and 31(12.4%) had localized hypermobility. Out of 250 participants, 33 (13.2%) had musculoskeletal pain, while among 51 patients with generalized hypermobility, 12(23.5%) had musculoskeletal pain.

Conclusion: One out of every five young healthy paramedics enrolled had generalized joint hypermobility. One-third of subjects had at least one clinically documented hypermobile joint. Almost every fourth person with generalized joint hypermobility has musculoskeletal pain compared to 1 in 10 persons without generalized hypermobility.

Keywords: Beighton score scale, Generalized joint hypermobility, Localized joint hypermobility, Musculoskeletal pain.
Frequency of Thyroid Disorders in Rheumatoid Arthritis Patients and its Association with Disease Activity: A Hospital Based Study
Authors: Qureshi Safina Hameed , Shah Syed Fahd , Khaliq Taqdees , Qureshi Sania Hameed , Qureshi Aisha Hameed , Shafqat Syed Hassan
Published: October 2023

Objective: To establish the frequency of thyroid disorders among Rheumatoid Arthritis patients and its association with disease severity measured by DAS28-ESR.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Rheumatology, Federal Government Policlinic Hospital, Islamabad Pakistan, from Jan to Jun 2021.

Methodology: The study included 87 consecutive patients either gender with Rheumatoid Arthritis visiting Rheumatology OPD. Thyroid profile and DAS28-ESR were performed in all the patients.

Results: Out of 87 patients, 73(83.9%) were females, and 14(16.1%) were males. The mean age was 45.54±13.50 years. The mean DAS28-ESR was 4.45±0.68, with a minimum DAS28-ESR of 1.25 and a maximum of 8.40. The Disease severity calculated by DAS28-ESR was mild in 19(21.8%), moderate in 44(50.6%) and severe in 24(27.6 %) patients. The thyroid gland was abnormal in 23(26.1%) patients. 18(78.2%) of 23 patients with thyroid disorders belonged to the moderate to severe Rheumatoid arthritis disease activity group.

Conclusion: Thyroid disorders are very common in Rheumatoid Arthritis patients. Thyroid workup should be part of investigations of Rheumatoid Arthritis for early detection of thyroid disorder and better disease control.
Assessment of Osteoporosis with Aspartate Aminotransferase to Platelet Ratio Index Score in Patients of Chronic Liver Disease
Authors: Sher Farrukh , Ali Khan Rao Saad , Akram Sumeera , Khan Muhammad Ahmed , Iqbal Qaiser , Haider Fahd Bin , Hayat Khurram
Published: October 2023

Objective: to assess Osteoporosis with APRI score (aspartate aminotransferase to platelet ratio index) in patients with chronic liver disease.

Study Design: Cross-sectional study.

Study Setting and Duration: Pak Emirates Military Hospital Rawalpindi, Pakistan from Jan to Dec 2021.

Methodology: All Adult patients aged 18 years and above with clinical and imaging features suggestive of chronic liver disease were included in the study. APRI score calculated as the ratio of aspartate aminotransferase to platelet based on the laboratory analysis of Aspartate aminotransferase (AST) and platelet levels was done. Furthermore, a bone density scan (DEXA scan) was also carried out for all the study participants.

Results: One hundred and sixty patients fulfilling the inclusion criteria were included. Of the total 160 cases, 53(33.1%) had normal bone density on DEXA scans, 43(26.9%) had Osteopenia and 64(40%) had Osteoporosis. Twenty-nine cases of chronic liver disease cases (25%) had APRI scores <0.3, 40(25%) had APRI scores>0.3 and<0.5, 37 cases (23.1%) had APRI scores>0.5 and <1.5, 30 cases (18.8%) had APRI score >1.5 and <2 and 24 patients (15%) had APRI score >2. The significant (p<0.001) association was observed between APRI score and bone density, showing bone density decreased with the progression of the disease.

Conclusion: Patients with chronic liver disease almost invariably develop Osteoporosis with the progression of the disease. Early recognition and treatment are pivotal to lessen morbidity and mortality associated with Osteoporosis.

Keywords: Aspartate aminotransferase, Chronic liver disease, Hepatitis C, Osteoporosis, Osteopenia, Platelet.
Association of Paclitaxel Induced Neuropathy with Quality of Life of Patients with Non-Metastatic Breast Cancer
Authors: Masood Masaba , Nadeem Muhammad , Masood Amna , Ali Aamira , Tufail Muhammad Umair
Published: October 2023

Objective: To look for an association of Paclitaxel induced neuropathy with the quality of Life of patients with non-metastatic breast cancer.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Feb 2022.

Methodology: The study included one hundred and twenty patients with diagnosed non-metastatic breast cancer taking Paclitaxel chemotherapy for more than one month. Peripheral neurotoxicity was assessed by a consultant oncologist based on the Eastern Cooperative Oncology Group (ECOG) score. In addition, quality of Life was recorded with the help of the World Health Organization Quality of Life (WHOQOL)-BREF scale in all the study participants and associated with the presence and severity of neuropathy.

Results: Out of 120 non-metastatic breast cancer patients using Paclitaxel for more than one month included in the study, 113 (94.2%) were female, while 7(5.8%) were male. 52(48.3%) had good quality of Life, while 68(51.7%) had poor quality of Life. 34(28.3%) had Grade-0 neuropathy, 54 (45%) had Grade-I, 30(25%) had Grade-II, and 2(1.6%) had Grade-III neuropathy.Statistical analysis showed that the presence and severity of neurotoxicity had a statistically significant relationship with poor quality of Life (p-value=0.001).

Conclusion: Many patients having breast cancer using Paclitaxel had the presence of neuropathy. The presence and severity of neuropathy are strongly associated with poor quality of Life in patients included in our study.Keywords: Breast cancer, Neurotoxicity, Paclitaxel, Quality of life.
Development and Validation of Body Dysmorphic Disorder Scale for Screening General Population
Authors: Shafiq Sameera , Kiran Faiza , Batool Maryam
Published: October 2023

Objective: To develop a reliable and valid Urdu indigenous Body Dysmorphic Disorder Scale (BDDS) for the Pakistani community.

Study Design: Cross-sectional study

Place and Duration of Study: Department of Psychology, University of Gujrat, Gujrat Pakistan, from Jun to Dec 2020.

Methodology: Based on the literature review, DSM-V criteria and semi-structured interviews conducted with psychologists clinical psychologists, and psychiatrists, an item pool of 78 items was generated for BDDS. A panel of five experts evaluated these items for content and revised them based on judgemental remarks. In the pilot study, 40 individuals were purposively selected, and 78 items were administered, yielding 0.94 Cronbach Alpha. Pilot study-I was conducted on 350 participants for Inter-item correlations and Exploratory Factor Analysis (EFA). Pilot study II selected 120 participants conveniently, and Dysmorphic Concern Questionnaire (DCQ) along with a Scale of Adjustment Problems for Adults (SAPA) and BDDS were administered to analyse the validation of BDDS. In the main study, 200 conveniently selected individuals were given BDDS for Confirmatory Factor Analysis (CFA).

Results: Exploratory Factor Analysis yielded three factors with 77 total items of BDDS, each having 19 (Behavioural Slants), 14 (Relational Sensitivity) and 44 (Self-Criticism) items, showing Cronbach Alpha of 0.98 on the present sample. Convergent validity and discriminant validity DCQ and SAPA were satisfactory, respectively. CFA on 200 conveniently selected general population youth yielded 18 items screening BDDS.

Conclusion: Body Dysmorphic Disorder Scale is a reliable and valid indigenous tool developed in Pakistan. Confirmatory factor analysis confirmed to screen the general population.
Association of Modic Changes with Low Chronic Low Back Pain
Authors: Shah Akbar , Ishfaq Asim , Malik Muhammad Jalil , Akmal Muhammad , Javed Amna , Haider Adnan
Published: October 2023

Objective: To determine the association of Modic changes with chronic low back pain in the adult population

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Lahore Pakistan, from Jan to Mar 2022.

Methodology: All the patients who were diagnosed with chronic low back pain by Neurosurgeon were included in the study.Detailed history and physical examination were conducted on all the patients diagnosed with chronic low back pain. MRI spine was performed on all the study participants for Modic changes. Relevant socio-demographic factors were associated with different types of Modic changes in patients included in our analysis.

Results: Out of 300 patients managed for chronic low back pain during the study period, 201(67%) were male, while 99(33%) were female. 172(57.3%) had no Modic changes, 33(11%) had Type-I changes, 80(26.7%) had Type-II changes, and 15(5%) had Type-III Modic changes. Advancing age, female gender and presence of comorbid illness had a statistically significant relationship with Modic changes in study participants (p-value<0.05).

Conclusion: Modic changes were commonly seen in patients with low back pain. Type II Modic changes were most frequently seen in these patients. Elderly and female patients were more at risk of Modic changes than young and male patients. Comorbid medical illnesses also increase the chances of having Modic changes.
Neonatal Outcome of Pregnancies with Oligohydramnios and Polyhydramnios
Authors: Sami Aqeela , Jalil Jawad , Sarfraz Muhammad , Hassan Jawad ul , Khawar Ruhma , Mumtaz Zahra
Published: October 2023

Objective: To asses’ factors associated with neonatal outcome of pregnancies with oligohydramnios and polyhydramnios.

Study Design: Comparative Cross-sectional Study.

Place and Duration of Study: Department of Pediatrics and Gynecology, Fauji Foundation Hospital, Lahore Pakistan, from Oct 2020 to Sep 2021

Methodology: A prospective comparative study was conducted on the babies born to mothers diagnosed witholigohydramnios and polyhydramnios during the course of pregnancy. Neonates were evaluated by neonatologist within first 24 hours of birth. The cases were admitted and well babies were handed over to parents. The neonatal outcome parameters were observed in all these babies for first two weeks of life. Those who lost follow up they were excluded from study. Age of mother, gestational age of baby, maternal hypertension and maternal diabetes were associated with presence of complications among these babies.

Results: Two thousand One hundred and Twenty-nine deliveries took place in given duration. About 322 had either polyhydramnios or oligohydramnios. About 150 cases could be followed completely. Fifty-five (36.7%) showed presence of one or more complications, of which 29(41.4%) cases had oligohydramnios and 26(32.5%) had polyhydramnios. Maternal age and presence of maternal diabetes and maternal hypertension had statistically significant association with complications in neonates (p-value <0.005).

Conclusion: Complications rate was high among neonates born to mothers with oligohydramnios or polyhydramnios. Advanced maternal age, presence of diabetes mellitus and hypertension were factors association with presence of complications in neonates included in our study.
Predictors of Academic Performance among Potential Medical Students: A Cross-Sectional Study from Rawalpindi
Authors: Mustafa Nazia , Shehzadi Kiran , Kiani Shoaib
Published: October 2023

Objective: To compare the potential medical students regarding cognitive intelligence, emotional intelligence, social intelligence and academic performance.

Study Design: Cross-Sectional study

Place and Duration of Study: Army Medical College, Rawalpindi Pakistan, in October 2020.

Methodology: The sample of the study comprised 512 male potential Medical students who completed their High School Education and came for the Entry test at Army Medical colleges with an age range of 17-21 years. All participants were assessed through the group administration of an assessment pack comprised of all tests.

Results: Results revealed that among all 512 students, 390 were finally recommended as selected candidates, and the rest, 122 were finally not recommended. A comparison between recommended and not-recommended groups on study variables was drawn. And result revealed significant mean differences in the variables of Cognitive Intelligence (t=-3.592 and p<0.001) and Emotional intelligence (t=-3.969 and p<0.001) and non-significant differences in the variable of social intelligence and academic performance (t=-1.609; p<0.001; t=-0.900; p<0.001).

Conclusion: Hence, academic performance is proven to be associated with emotional intelligence, IQ and personality characteristics. Better emotional regulation enables the students to develop better peer relations and invest energies in demanding academics owing to their cognitive and non-cognitive skills.
Comparison Between Efficacy and Safety of Oral Azithromycin (250mg) vs Oral Doxycycline (100mg) in Treatment of Meibomian Gland Dysfunction (MGD)
Authors: Yousuf Waseem , Humayun Fakhar , Janjua Teyyeb Azeem , Khan Taimoor Ashraf , Sarfraz Muhammad Haroon , Mehboob Mohammad Asim
Published: October 2023

Objective: To compare the efficacy and safety of oral Azithromycin with oral Doxycycline in patients with Meibomian Gland Dysfunction.

Study Design: Quasi-experimental study.

Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Apr 2021 to Apr 2022.

Methodology: The sample population comprised 172 subjects, including 86 cases in the oral Doxycycline-Group and 86 oralAzithromycin-Group. Meibomian Gland Dysfunction was diagnosed by a consultant ophthalmologist by slit-lampexamination. Schirmer-I test and Tear Break Up Time were performed. Signs and symptoms of Meibomian Gland Dysfunction were assessed before treatment and at six months follow-up.

Results: The study recruited equal numbers of cases and controls. Symptoms scores for burning sensation (2.04±0.5 vs 1.9±0.7) and foreign body sensation (1.8±0.6 vs 1.5±0.8) were significantly higher in patients taking Doxycycline as compared to the Azithromycin-Group (p<0.05). On comparing the signs score between the two Groups, it was seen that total scores (pretreatment and post-treatment) were more significant in the Doxycycline-Group (p<0.05). Treatment with Doxycycline yielded more significant complications, such as diarrhoea (39.5%), nausea (46.5%), and cramps (48.8%). Headache was more associated with Azithromycin treatment (3.4%), whereas Rash (1.1%) and blurring of vision (1.1%) were seen in the Doxycycline-Group.

Conclusion: Meibomian Gland Dysfunction leads to tear film instability and direct damage to the ocular surface epithelium. This study supports the clinical efficacy and safety of oral Azithromycin and Doxycycline therapy for managing refractory or severe Meibomian gland disease.
Comparison of Metformin and Orlistat in Anovulatory, Overweight and Obese Women with Polycystic Ovarian Syndrome
Authors: Gul Uzma , Akhtar Sunarays , Tabassum Humaira , Khalil Adiba Akhtar , Nawaz Qudsia
Published: October 2023

Objective: To compare the efficacy of Metformin and Orlistat in improving ovulation and reducing body mass index in anovulatory, overweight and obese women with polycystic ovarian syndrome.

Study Design: Quasi-experimental study.

Place and Duration of Study: Gynaecology and Obstetrics Department, Pakistan Air Force Hospital, Lahore Pakistan, Sep 2020 to Apr 2022.

Methodology: Eighty women having polycystic ovarian syndrome with anovulation and body mass index ≥25 were randomized to receive either Metformin (n=40) or Orlistat (n=40). Patients in Group-A received Metformin 500 mg thrice daily; Group-B received Orlistat 120mg twice daily for three months. Patients were also given dietary and lifestyle advice. Ovulatory status and body mass index were measured at baseline and after three months of treatment.

Results: Mean age of women was 26.9±5.1 years, and mean BMI was 29.9±2.57 Kg/m2. Ovulation was restored in 10 women (25%) in Group A and 12 women (30%) in Group B (p0.617). Compared to the baseline, women in both groups significantly reduced their BMI (p˂0.001). However, the difference in the change in BMI of both Groups was not statistically significant (p0.668). 26 women (65%) on Metformin experienced gastrointestinal side effects as compared to 11(27.5%) on Orlistat (p=0.001).

Conclusion: Metformin and Orlistat have equal efficacy in improving ovulation and reducing body mass index in women with polycystic ovarian syndrome having anovulation and body mass index ≥25.
Pre-operative Embolization of Meningioma Leads to Reduced Operating Time and Less Intraoperative Bleeding
Authors: Khan Awais Ali , Khan Habib Ullah , Bangash Khurshid Ali , Qasmi Shahzad Ahmed , Ahmed Syed Adeel , Hashmat Asif , Shamim Babar
Published: October 2023

Objective: To determine the efficacy of pre-operative meningioma embolization in terms of operating time and intraoperative bleeding.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2020.

Methodology: Twelve diagnosed cases of intracerebral meningioma were included in the study. The patients were diagnosed cases of meningioma as per pre-operative signs and symptoms, radiological confirmation was done with magnetic resonance imaging, and all were subjected to pre-operative embolization of the tumour with catheter advancement in the arterial system and embolizing the target vessels with polyvinyl alcohol particles, followed by craniotomy and excision of the tumour.

Results: The mean age of the patients was 47±672. 24 years. The mean operating time (from the incision to closure) was 96.17±10.23 minutes. In contrast, the intraoperative blood loss was 325.33±15.43 ml. Six (50.00%) individuals had parasagittal meningioma, 4(33.33%) were of cerebral convexity, while 2(16.66%) had lesions at sphenoid wing.

Conclusion: Meningioma is a quite vascular tumour, and the operative outcome can be improved by pre-operative angioembolization. The reduced vascularity makes the resection easier by decreasing the per-op bleed and operating time.Keywords: Intraoperative bleed, Meningioma, Operating time, Pre-operative embolization.
Maternal Factors and Complications Associated with Morbidly Adherent Placenta: An Experience at a Tertiary Care Hospital in Pakistan
Authors: Rehan Samina , Tabassum Humaira , Tufail Shazia , Nawaz Qudsia , Mushtaq Nazia , Khan Adnan Aqil
Published: October 2023

Objective: To identify the risk factors predisposing to the Morbidly Adherent Placenta and to evaluate maternal outcomes in those patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Obstetrics & Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jan to Dec 2021.

Methodology: A total of 18 females with a clinical diagnosis of the morbidly adherent placenta, irrespective of age and several previous scars, having singleton foetuses with more than 26 weeks gestational age, were included in the study. Patients’ particulars including demographic data, gestational age, number of previous uterine scars, type of placenta, treatment option and the outcome, were collected.

Results: The frequency of morbidly adherent placenta was 4.06 per 1000 deliveries. The mean age of patients was 31.06±2.48 years, whereas the mean gestational age was 35.5±1.15 weeks. The mean parity was 3.5±0.71. Out of 18 patients with morbidly adherent placenta, 3(16.7%) had four caesarean scars, 8(44.4%) had three previous caesarean scars, and 7(38.9%) had two previous caesarean scars. Associated placenta previa was present in 14(77.8%) patients. Hysterectomy was done in 15(83.3%) patients, while in 3(16.6%) patients uterus was preserved. The bladder was repaired in 12(66.6%) patients with post-op catheterisation for three weeks. There was no maternal mortality.

Conclusion: Previous caesarean scar and placenta previa are major risk factors for the morbidly adherent placenta. Wellestablished antenatal diagnosis with timely surgical intervention can prevent long-term complications.Keywords: Caesarean section, Placenta previa, Placenta accreta, Placenta increta, Placenta percreta.
Comparison of Conservative Management versus Drainage in Patients with Pancreatic Pseudocyst
Authors: Zeb Mohammad Usman , Mahmood Khalid , Malik Muhammad Jalil , Anjum Muhammad , Kaiser Rabia , Bin Khalil Huzaifa
Published: October 2023

Objective: To compare the conservative management of pancreatic pseudocyst with active surgical intervention.Study Design: Case series study.

Place and Duration of Study: Department of General Surgery Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Apr 2021.

Methodology: A total of 40 patients with pancreatic pseudocysts were included. The size of the pseudocysts, patients’ age,gender, lifestyle risk factors and possible aetiology were recorded. Conservative management was offered initially. The nonregressing and complicated pseudocysts were treated surgically via radiology-assisted external drainage or surgical drainage. Relevant data via close follow-up was recorded.

Results: The mean age of the patients was 61±8.89 years. The pseudocyst size ranged from 4-17cm (median 10cm). Conservative treatment was efficacious in 15(37.5%) with shorter hospital stays (p-value<0.001). All remained pain-free during the one-year follow-up. Surgical intervention was required in 25(62.5%). Radiology-assisted external drainage employed in 15(60%), proved advantageous in 14(93.4%) patients. Recurrence was seen in one patient (6.6%). Other complications included abscess and sepsis. Surgical drainage was used in 10(40%) individuals. Complications included sepsis, abscess and intractable pain. Cumulative intervention-related complications were far higher than conservative management (14,56%, p-value 0.01).The thirty-day mortality in the study patients was 5%, all following surgical intervention.

Conclusion: Conservative management can be successfully employed to avoid the adverse sequelae associated with active interventions.Keywords: Complications, Conservative management, Pancreatic pseudocyst, Radiological intervention, Surgical intervention
Comparison of Morbidity Associated with the use of Large Versus Small-Bore Chest Tubes in Patients Managed for Stage-I Empyema Thoracis
Authors: Usman Muhammad , Wyne Adeel , Mir Asad Bilal , Majeed Farhan Ahmed , Rahim Kamran , Haider Rehan
Published: October 2023

Objective: To compare pain and other complications with the use of large versus small-bore chest tubes in patients managed for Stage-I empyema thoracis.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Multan Pakistan, from Jan 2015 to Jan 2022.

Methodology: The study was conducted at the Trauma and Surgery Department. Files and charts of patients who were managed for Stage-I empyema thoracic in our hospital during the study period were assessed in detail. Patients were divided into two groups based on the size of the chest tube inserted to manage empyema thoracic. The presence of post-operative pain, obstruction, dislodgment and tube site infection were compared in both groups.

Results: Out of 90 patients of Stage-I empyema thoracic, 43(47.8%) were inserted in small-bore chest tubes, while 47(52.2%) were inserted in large-bore chest tubes. Post-procedural pain was found significantly more in patients inserted in large chest tubes than those inserted in small bore tubes (p-value-0.018). All other complications did not differ statistically significantly in both groups.

Conclusion: Most patients in both groups did not show significant complications after the chest tube insertion. Small chest tubes were better in terms of less post-procedural pain than large chest tubes, but other complications were not significantly different in both groups.Key words: Chest tube, Empyema, Pain, Thoracis.
Prognostic Factor of Outcome in Adults with Altered Mental Status Presenting in Emergency Department
Authors: Batool Syeda Nida , Syeda Fatima Zareen  , Syeda Kiran Batool  , Fahim Liaqat  , Zeeshan Munir  , Syed Waqar Abbas
Published: October 2023

Objective: To determine the prognostic factors which affect the outcome and mortality in patients of Altered Mental Status at the emergency department.
Study Design: Cross sectional study.
Place and Duration of Study: Emergency Department of Combined Military Hospital, Rawalpindi Pakistan, from Dec 2020 to June 2021.
Methodology: A total 90 patients were selected with the age range of 18-75 years who met the inclusion and exclusion criteria. Patients with prior history of trauma, dementia or any other mental illness were excluded. Patient’s complete history and examination was performed by emergency physician. Base lines investigations along with other required tests were performed and analysis of data was done to conclude the prognostic factors.
Results: There were 50(55.5%) males and 40(44.5%) females. Mean age of patients was 52.64±3.21 years. Cerebrovascular events 28(31.1%) patients were the leading cause of AMS followed by infections which causes AMS in 14(15.5%) patients.23(25.5%) patients had died during their hospital stay. The mean PH in Group-A was 7.36±0.06 while in Group-B it was 7.30±0.10, The oxygen saturation was 96.77±3.34% in Group-A while 93.52±7.06% in Group-B and TLC levels were 9.31±4.52 mg/dl in Group A while in group B they were 15.23±4.82 mg/dl which were statistically significant (p-value 0.001).
Conclusion: It is concluded that patients of stroke and cardiovascular diseases had higher mortality rate. Male gender, pH, TLC, mean blood pressure, GCS, and SaO2 were also associated with the increased mortality rate.
Comparison of Efficacy of Nebulized Salbutamol with Salbutamol / Ipratropium Combination in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Ashraf Muhammad Nadeem , Khan Muhammad Arif , Imran Muhammad , Fazal Imran , Hassan Zubia , Alam Laima
Published: October 2023

Objectives: To compare the nebulized salbutamol alone with combination of nebulized salbutamol and ipratropium for acute exacerbation of chronic obstructive pulmonary disease in terms of mean length of stay.
Study Design: Quasi-experimental study
Place and Duration of Study: Department of Medicine, Military Hospital, Rawalpindi Pakistan. Study was carried out over a period of six months from May to Nov 2017.
Methodology: A total of 300 patients of chronic obstructive pulmonary disease (150 in each group) were recruited in the study. Group A received nebulized salbutamol (5mg) alone and Group B received a combination of nebulized salbutamol (5mg) and ipratropium bromide (0.5mg).
Results: Mean age of the patients was 66.4±6.4 years and 65.7±6.8 years in Group-A and B, respectively. In Group-A, there were 136(90.7%) and in Group-B 134(89.3%) were males while 14(9.3%) and 16(10.7%) were females in Group-A and B, respectively. Mean duration of disease in Group-A was 5.2±2.4 years and in group-B 6.0±1.6 years. Comparison of mean length of stay (days) revealed in hospital between nebulized Salbutamol alone 5.0±0.5 days with combination of nebulized Salbutamol and Ipratropium 4.3±0.6 days with p-value <0.001.
Conclusion: In conclusion, the routine addition of nebulized ipratropium bromide to salbutamol appears to be of benefit in the treatment of acute exacerbations of chronic obstructive pulmonary disease and in terms of mean length of hospital stay.
Comparison Between Analgesic Effects of Pre-Operative and Post-Operative Trocar Site Infiltration of Injection Bupivacaine in Elective Laparoscopic Cholecystectomy
Authors: Akhtar Muhammad Usama , Akhtar Muhammad Talha , Hussain Syed Mukarram , Zohra Jabeen Akram  , Muhammad Usman Akram  , Abbas Tanveer
Published: October 2023

Objective: To compare the analgesic efficacy of Local Anaesthetic infiltration with Bupivacaine at Trocar site in Laporoscopic Cholecystectomy when injected preoperatively vs postoperatively.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of General surgery, Combined Military Hospital, Rawalpindi Pakistan, from May to Nov, 2016.
Patients and Methodology: Patients meeting the inclusion criteria were randomly divided into two groups using coin method. Group A received pre-operative injection of Bupivacaine infiltrated at the trocar sites. Patients in Group B received the similar dosage post-operatively. The pain of the patients was assessed post-operatively using Visual Analog Score (VAS) at 6, 12 and 24 hours and compared.
Results: A total of 190 patients were equally divided into Group A and B (95 each). The mean age was 46±13.77 years in Group A and 43±14.80 years in Group B.23.68% (n=45) of patients were aged between 12-24 years, 13.15% (n=25) were of 25-36 years, 22.63% (n=43) were aged 37-48 years and 40.52% (n=77) of the patients were between the age of 49-60 years. 75.78% (n=144) of patients were males, while 24.21% (n=46) were females. The Mean±SD VAS post-operative pain scoring Group A and Group B was 4.5±0.04 vs 5.0± 0.40, respectively. The p-value was <0.001and the difference is statically significant.
Conclusion: We concluded that the use of pre-operative local anesthesia helps reduce post-operative pain in patients undergoing laparoscopic cholecystectomy.
Outbreak Investigation of Cutaneous Lesihmaniasis
Authors: Badar Izza , Ismail Tariq , Baig Mirza Amir , Khan Asghar
Published: October 2023

Objective: to assess the magnitude, evaluate risk factors and recommend control measures for Cutaneous Lesihmaniasis.
Study Design: Cross-sectional study.
Place and Duration of Study: Combined Military Hospital, Landikotal Pakistan, from Jan to Feb 2017
Methodology: Active case finding was conducted amongst entire group of 414 individuals. A case was defined as skin lesion in a person residing in nomadic group of Khar Kamar from October 2015 to January 2017. Age and gender-matched controls were identified at 1:2. Data was collected using a pretested structured questionnaire.
Results: A total of 31 cases were identified with mean age of 26.4±6.5 years (range 18-48). Epi curve showed intermittent exposure. The index case had onset of symptoms in January 2016 with a peak in November 2016, 10(32%) while last case appeared in January 2017. Overall attack rate (AR) was 7.5% while most severely affected age group was 18-27 years 21(9.1%). A total of 17(55%) cases had 2-4 multiple lesions with size of 0.5-3.5 cm. Of the 31 cases, 25 reported sleeping on the ground (OR 3.2, 95% CI 1.2-9.0, p<0.02), however wearing full clothing and use of repellents showed a protective effect.
Conclusion: Most probable cause of outbreak was sleeping on the floor. Awareness lectures were imparted and repellent was issued to entire group.
Hyperhomocysteinemia in Patients of Essential Hypertension Presenting with Acute Ischemic Stroke
Authors: Aslam Ayaz , Khattak Abdul Latif , Syed Karamat Hussain Shah Bukhari  , Yousaf Ali , Rafique Babar , Azam khan Mohammad Khalid
Published: October 2023

Objective: To determine the frequency of Hyperhomocysteinemia in patients of essential hypertension presenting with acute ischemic stroke.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Department of Internal Medicine, Combined Military Hospital, Quetta Pakistan, from Feb 2018 to Jan 2019.
Methodology: The patients of essential hypertension presenting with acute ischemic stroke between 20-70 years of age of either gender were evaluated for the serum homocysteine level.
Results: A total 195 patients of essential hypertension presenting with acute ischemic stroke for ≥24 hours duration, of age between 20-70 years, of both genders were included in the study by non-probability consecutive sampling. Majority of patients were between 50-59 year of age (34.3%) with majority of them were male (66.4%). Out of 195, 70.3% were smokers, 56.4% were diabetics, 60.5% were obese and 71.7% had hyperhomocysteinemia respectively. The statistical significance was also observed for hyperhomocysteinemia in accordance with age (p=0.04), gender (p=0.02), obesity (p=0.03) smoking (p=0.01) and diabetes mellitus (p=0.03).
Conclusion: Hyperhomocysteinemia is more prevalent in patients of essential hypertension with acute ischemic stroke.