bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Serum Ammonia Levels with Severity of Grades of Hepatic Encephalopathy in Patients Presenting to er of a Tertiary Care Hospital
Authors: Dawood Muhammad , Ashraf Muhammad Nadeem , Madad Sonia , Khan Andaleeb , Butt Kamil Rehman , Rehman Shahana
Published: December 2022

Objective: To determine the association of serum Ammonia levels with severity of grades of hepatic encephalopathy in patients presenting to the department.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Emergency Department, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021.

Methodology: This study was conducted on 100 patients presenting with hepatic encephalopathy at the emergency department of our hospital. Based on clinical findings and relevant investigations, a consultant gastroenterologist or emergency medicine physician diagnosed hepatic encephalopathy or the underlying cause. In addition, serum Ammonia levels were done on all the patients at the time of presentation and associated with grades of hepatic encephalopathy and other factors.

Results: Out of 100 patients included in the final analysis, 67 were males, and 33 were females. Infection (29%) was the commonest aetiology of hepatic encephalopathy, followed by Constipation (23%). In addition, 59% had normal serum ammonia levels, while 41% had raised ammonia levels in their serum. High grade of hepatic encephalopathy and raised Child-Turcotte-Pugh score were statistically significantly associated with raised ammonia levels in our study participants.

Conclusion: Raised serum ammonia levels were a common finding among patients with hepatic encephalopathy. Therefore, patients with a high grade of hepatic encephalopathy and a high Child-Turcotte-Pugh score at the time of presentation should be considered at a higher risk of having hyperammonemia.
Appraisal of the Effect of Norepinephrine Versus Phenylephrine on Blood Pressure and Heart Rate During Spinal Anaesthesia for a Caesarean Section; A Quasi-Experimental Study
Authors: Iftikhar Hina , Hassan Ali , Rehman Habib Ur , Ayaz Saeed Bin , Ali Zulfiqar , Majeed Kaukab
Published: December 2022

Objectives: To compare the effects of Norepinephrine and Phenylephrine on blood pressure and heart rate during spinal anaesthesia for caesarean section.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Anaesthesia Combined Military Hospital, Multan Pakistan, from May to Nov 2019.

Methodology: Women (age: 18 to 45 years) with singleton pregnancy planned for caesarean section in spinal anaesthesia were included. Women with pregnancy-induced hypertension, placenta previa, placenta accreta, diabetes mellitus, and any other cardiovascular disease were excluded. After distribution into groups, Group-A was given a 20μg Norepinephrine bolus, and Group-B was given a 50μg bolus of Phenylephrine just after spinal anaesthesia. At five time points, systolic, diastolic, and mean blood pressures and heart rate were measured: baseline, block of the highest sensory level, oxytocin injection, delivery, and operation completion. If hypotension developed, the same rescue drug was repeated. Bradycardia was countered by 0.5 mg of Atropine.

Results: The frequency of hypotension in the Norepinephrine group was 5 (16.67%), and in the Phenylephrine Group, it was 19 (63.33%) (p=0.0001). The frequency of bradycardia in the Norepinephrine Group was 6 (20%), and in the Phenylephrine Group, it was 17 (56.67%) (p=0.003).

Conclusion: The frequency of hypotension and bradycardia is less after prophylactic 20 μg of Norepinephrine during spinal anaesthesia for a caesarean section than 50 μg of Phenylephrine.
The Biochemical Pattern of Liver Function Tests in Adult Patients of Diabetes and the Association with Hypoglycemic Medications
Authors: Nageen Ayesha
Published: December 2022

Objective: To study the biochemical pattern of liver function tests in adult patients of diabetes and the association with hypoglycemic medications.

Study Design: Cross-sectional study.

Place and Duration of Study: Creek General Hospital, Karachi Pakistan, from Jun 2021 to Sep 2021.

Methodology: Two sixty patients were enrolled through consecutive non-probability sampling. Adult patients with diagnosed Type 2 diabetes mellitus were included in the study. While Type 1 diabetes patients, pregnant subjects, and people with diabetes with any other systemic disease or on any other non-diabetic medications or any history of drug abuse were excluded from the study.

Results: Raised Alanine transaminase levels were seen in 193 (74%) patients, a high Alkaline Phosphatase in 208 (80%) and a high Aspartate Aminotransferase in 202 (77%) patients. Liver markers were higher in the middle age group, females, hypertensive, and with abdominal obesity. There was no association between glycemic control and the duration of diabetes. The number of subjects having raised ALT and ALP was higher in those taking oral hypoglycemic and lower in those with insulin.

Conclusion: The liver markers are raised in patients with diabetes and can be the predictors of future hepatotoxicity.
Apoptosis in Human Papillomavirus-Induced Cervical Cancer Cells By Higher Doses of Ascorbic Acid
Authors: Baig Zunaira Ali , Rashid Amir , Gul Ambreen , Raza Imran , Majeed Asifa
Published: December 2022

Objective: To assess the anti-cancer role of ascorbic acid using high doses against the cervical cancer cell line and to establish a cell culture facility in the laboratory.

Study Design: In Vitro Study.

Place and Duration of Study: Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi Pakistan, from Aug 2014 to Jul 2015.

Methodology: HeLa cells were grown in Dulbecco’s modified eagle medium, and upon reaching confluency, cells were challenged with different doses of ascorbic acid. The MTT assay was employed to study the cytotoxic effects of increased doses of ascorbic acid on HeLa cells.

Results: An increasing dose of ascorbic acid was found to be cytotoxic toward HeLa cells, and its EC50 was found to be between 5-6µM. A high dose of ascorbic acid is selectively cytotoxic to HeLa cell lines of cervical cancer, which may imply the treatment of cervical cancer patients. NF- kB inducing kinase is a salient protein in TNFα-induced NF-kB activation. Ascorbate has been reported to inhibit that activation which has anti-apoptotic roles in tumour progression. CB-Dock was employed to propose the binding sites for NIK-Ascorbate interaction, which might be a therapeutic target for cancer cells.

Conclusion: The study concludes that high dose ascorbic acid is cytotoxic to cervical cancer cells HeLa and may have important implications in treating cervical cancer patients. Therapeutic intervention of this vitamin may contribute to suppressing cancer development.
Immune Status Against Hepatitis B Infection in Children with Thalassemia Major in Pakistan: A Single-Centre Study
Authors: Fakih Misbah , Basheer Faisal , Khan Qamar uz Zaman , Hashmi Fasih , Asad Hafsa
Published: December 2022

Objectives: To assess the immunogenicity of the Hepatitis B Vaccine in children with thalassemia.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Aug 2018 to Jan 2019.

Methodology: After ethical approval and informed consent, 150 diagnosed patients with thalassemia were selected from the Thalassemia centre at Pak Emirates Military Hospital Rawalpindi. The patients’ transfusion, vaccination history and clinical data were obtained. The patient's sera were tested for Anti-Hepatitis B surface antibodies (anti-HBs) by ELISA. The patients who showed seroprotection (anti-HBs titer>10 IU/L) were taken as a case group.

Results: Out of 150 patients, only 22% (33 patients) showed seroprotection (anti-Hbs titer>10 IU/L). Children younger than four years had significantly positive anti-HBs (p-value=0.067) at a 5% significance level. Time since the last vaccination was also a significant factor, with the 3.76±3.072 years range exhibiting better protection (p=0.002).

Conclusion: Protective Anti-HBs titer was reduced after the age of 4 years in our patients, so we recommend screening patients with thalassemia after four years to assess the need for a booster dose.
Correlation of Mean pH, HCO3 and CO2 Between Arterial Blood Gases and Venous Blood Gases in Critically Ill Patients
Authors: Haneef Sanam , Jaffer Raza , Ijaz Aamir , Ain Qurrat-ul , Aman Saba , Ansari Uzma
Published: December 2022

Objective: To determine the correlation of mean pH, HCO3 and CO2 between arterial and venous blood specimens in critically ill patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Apr to Oct 2015.

Methodology: Forty critically ill patients admitted to the Intensive Care Unit were selected. Analysis of arterial blood gases followed by venous blood gases of the same patient was carried out after collection in lithium heparin tubes. Specimens were analyzed on COBAS 221 fully automated ABGs and an electrolyte analyzer.

Results: Out of 40 patients, 30 (75%) were males. The average age was 57.78±7.64 years. The p-value of pH and HCO3 was 0.259 and 0.921, respectively. The CO2 in VBGs was 58.10±11.35 mm Hg versus 36.32±6.69 mm Hg in ABG, with a p-value of 0.001, which was statistically significant.

Conclusion: In critically ill patients, pH and HCO3 levels of venous blood gases were comparable with ABG. VBG CO2 was significantly higher than ABGs.
The Patterns of Clinical Presentation in Patients with Unsafe Miscarriage
Authors: Khanum Faiza , Tariq Amera , Waseem Syed Majid , Mahmood Tariq
Published: December 2022

Objective: To study the pattern of clinical presentation in patients with unsafe miscarriages.

Study Design: Case series study.

Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2016 to Mar 2017.

Methodology: Thirty patients were included in this study after approval of the Ethical Committee. Detailed clinical assessment and clinical presentations of the cases were noted. Methods of miscarriage and associated complications were also noted. All cases were unbooked and referred cases.

Results: In this study, 30 patients with unsafe miscarriages were studied. The mean ages of the patients were 27.4±7.1 years. Most of the patients were married (93.3%, n=28,) multigravida (73.3%, n=22,) and in 1st trimester (76%, n=23). The method of the abortions was by instrumentations in 90%, (n=27) cases and vaginal tablets in only 10%(n=03) of the cases. The mean hospital delay was of 8.5±10.1 days. Abdominal pain was the commonest presentation in 90% of the patients (n=27). Acute abdomen with abdominal distension and constipation was seen in 53.3%(n=16) cases. There was a history of vaginal bleeding in 43.3%(n=13) cases, and 6.7% (n=2) of patients presented in shock. Mean vitals on admission were as pulse 108.7±13.4 per minute, temperature 99.4+2°F, respiratory rate 24.3±4 per minute, systolic and diastolic blood pressure were 103.5.5±14 mmHg and 68.6±10.4 mmHg respectively.

Conclusion: Illegally induced abortion remains a prominent cause of maternal morbidity in our society. However, high-quality post-abortion care will help a long way in saving many lives.
Anesthetic Efficacy of Intraligamentary Injection Techniques on Mandibular Posterior Teeth Diagnosed with Asymptomatic Irreversible Pulpitis
Authors: . Avinash , Sheikh Abu Bakar , Rashid Saqib , Ali Muhammad , Siddiqui Kishwer Naz , Mujeeb Fauzia
Published: December 2022

Objective: To compare the effectiveness of Intraligamentary Injection with the IANB injection technique for root canal treatment of mandibular molars and premolars in patients with asymptomatic irreversible pulpitis undergoing access opening.

Study Design: Quasi-experimental study.

Place and Duration of Study: Operative Dentistry Department, Fatima Jinnah Dental College Karachi Pakistan, from Nov 2018 to Apr 2019.

Methodology: The study was conducted on 80 patients. Visual analogue scale was used to determine the level of pain. Three groups were made depending on the effectiveness of anaesthesia at 2-sites (Group-A), 4-site (Group-B) and failure of Intraligamentary injection (Group-C). Anaesthesia was successful when the patient revealed no pain symptoms during access opening.

Results: A total of 80 cases were evaluated, out of which 47 were males (58.70%), and 33 were females (41.30%). The most common age groups recorded in our study were 18 – 25 years (33.75%) and 36- 45 years (33.75%). According to our results, the Intra-ligamentary technique was successful in 23(28.75%) cases. The remaining 57(71.25%) cases which received anaesthesia via IANB showed a 100.00% success rate with profound anaesthesia.

Conclusion: Inferior alveolar nerve block was more successful compared to Intraligamentary injections for providing profound anaesthesia to mandibular posterior teeth previously diagnosed with asymptomatic irreversible pulpitis and under-going the procedure of access opening.
Effect of Role-Modeling (Modelling) Clinical Skills and Professional Behavior on the Learning of Medical Students as Measured through Pre and Post-test Assessment
Authors: Khan Niazi Fuad Ahmad , Khaliq Tanwir
Published: December 2022

Objectives: To examine the effect of role-modelling (modelling) clinical skills and professional behaviour on the learning of fourth-year medical students through pre and post-test.

Study Design: Quasi-experimental study.

Place and Duration of Study: Ophthalmology Department, Rawalpindi Medical University, Pakistan, from Jan to Feb 2019.

Methodology: Two Groups were formed, the Study and Control-Group, with 30 students from 4th-year MBBS. The Study- Group was exposed to role-modelling intervention accompanied by the verbal narration of steps after being given a pre-test and retested with a post-test after two weeks. The Control-Group was also given pre and post-tests with a verbal description of steps without modelling the drill. Each test was observed by three different observers.

Results: Total mean score given by observers in the Study- Group was 71.53±12.38 in the pre-test, which was statistically significantly improved to 92.07±13.12 in the post-test (p-value 0.0001), an improvement of 28.71% after modelling intervention. All observers in the Control-Group gave a total mean score was 74.93±12.90 in the pre-test and 74.53±12.83 in the post-test (p-value 0.634). After applying ANOVA on inter-observer difference, there was no statistically significant difference in the mean score given by observers (p>0.05).

Conclusion: Role-modelling or modelling as a means of demonstrating clinical skills and behaviour is effective teaching or instructional strategy measured through pre and post-test.
Associative Factors Involved in Avoidance of Exclusive and Non-Exclusive Breastfeeding after C-section
Authors: Rahman Asbah , Malik Qudrat Ullah , Shafiq Muhammad Faisal , Mumtaz Shaista , Babar Muhammad Waleed , Akram Saira
Published: December 2022

Objective: To look for the associative factors in avoidance of exclusive and non-exclusive breastfeeding among mothers after lower segment Caesarean section.

Study Design: Cross-sectional study.

Place and Duration of Study: Paediatrics department, Pak Emirates Military Hospital, Rawalpindi Pakistan from Oct to Mar 2020.

Methodology: Mothers bringing their infants for vaccination at six weeks of age with babies born with lower segment caesarean section were included in the study. They were asked simple questions regarding exclusive or non-exclusive breastfeeding. Relevant socio-demographic factors were also recorded and compared among mothers breastfeeding their babies and those avoiding it.

Results: A total of 500 mothers were included in the study. The mean age of the study participants was 33.576±9.174 years. 336(67.2%) women were primiparous, while 164(32.8%) were multiparous. 208(41.6%) women were actively breastfeeding their child, while 292(58.4%) avoided breastfeeding their babies. 150(72.1%) women were non-exclusively breastfeeding, while 58(27.9%) showed an exclusive breastfeeding pattern. Pearson chi-square test revealed that low education and working outside the home had a statistically significant association with the avoidance of breastfeeding the babies among our target population (p-value <0.05).

Conclusion: Avoidance of breastfeeding was a common finding after six weeks of birth among women who delivered the babies via lower segment caesarean section. Mothers with low education and duties to work outside the home were more at risk of avoiding this highly beneficial practice for the baby.
Assessment of Pattern of Drug Abuse from Different Clinical Settings in a Reference Laboratory of Pakistan During the COVID-19 Pandemic
Authors: Younas Alveena , Aamir Muhammad , Kirmani Sobia Irum , Haroon Zujaja Hina , Bibi Afshan , Munir Muhammad Usman
Published: December 2022

Objective: To determine the pattern of drug abuse from different clinical settings in a reference laboratory of Pakistan during the COVID-19 pandemic and assess any change from the previous trend.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan from Mar to Dec 2020.Methodology: Out of 6902 subjects tested for drug abuse, 672 subjects with positive results were included in the study. The study population was divided into three main Groups. i.e., Psychiatry, ITC/Emergency and Workplace testing. A pattern of drug abuse was compared in the pre (Mar-Dec 2019) and post-COVID (Mar-Dec 2020) periods.

Results: Out of 672 study subjects, 338(50%) were psychiatry patients. Around 629(94%) subjects were males. Mainly young individuals (306, 46%) were affected. Cannabis was the most frequent drug of abuse detected (357, 53%), followed by Benzodiazepines (BZD) (236, 35%) individuals and Opiates (47, 7%). Compared with pre-COVID data, an overall increase of 3% in the total frequency of drug abuse from 392(7%) to 672(10%) was found in 2020. About 14% decrease, from the frequency of 81(21%) to 47(7%) in Opiates usage, while 8% increase in frequency, from 106(27%) to 236(35%) in Benzodiazepines, was observed. There was significant mean difference (p<0.001) between Psychiatric and ITC patients.

Conclusion: Most frequent drug abuse in our settings is Cannabis, followed by Benzodiazepines and Opiates. An overall increase in drug abuse frequency while a decrease in the frequency of...........Keywords: COVID-19 pandemic, Pakistan, Substance abuse pattern.
Visual Rehabilitation after Phacoemulsification with Rigid Intraocular Lens Implantation at Tertiary Care Hospital-Jamshoro
Authors: Mahesar Mona Liza , Ahmed Noman , Jatoi Asadullah , Nasrani Ashok Kumar
Published: December 2022

Objective: To evaluate the visual rehabilitation after phacoemulsification with rigid intraocular lens implantation.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Institute of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro Pakistan, from Jul to Dec 2020.

Methodology: Ninety-four subjects diagnosed with unilateral cataracts were evaluated completely. Subjects with any other ocular disease were excluded from the study. Pre-operative and post-operative, surgical and visual outcomes along with follow-up of 4 weeks and 12 weeks best-corrected visual acuity, were recorded.

Results: The mean age of study participants was 61.77±7.34 years. Post-operative complications were evaluated within one week of surgery. 22(23.4%) subjects showed striate keratopathy, 2(2.1%) indicated bullous keratopathy, and 7(7.4%) reported residual lens matter as a complication. The difference between good visual outcomes was 33(35.1%) within eight weeks (4th week till 12th week); similarly, the difference between satisfactory visual outcomes was 22(23.4%). The visual outcomes improved more than two folds after phacoemulsification with a rigid intraocular lens.

Conclusion: The foldable intraocular lens is comparatively expensive and unaffordable for many patients in developing countries. Rigid IOL with phacoemulsification is a cost-effective method to remove cataracts and restore patient visual acuity.Accurate diagnosis, evaluation, and surgeon’s experience are important factors in achieving the required results.
Clinical Profile and Induction Outcome of Children with T-cell Acute Lymphoblastic Leukemia and T-cell Lymphoblastic Lymphoma
Authors: Arshed Awais , Nasarullah Faran , Shahid Samra , Tahir Muhammad , Farah Tanzeela , Ghafoor Tariq
Published: December 2022

Objective: To study the clinical profile and induction outcome in children diagnosed with T-cell acute lymphoblastic leukaemia and lymphoblastic lymphoma.

Study Design: Cross-sectional study.

Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2012 to Dec 2020.

Methodology: One hundered and twenty-one diagnosed patients of T-ALL and LBL were evaluated with bone marrow biopsy and Contrast-enhanced CT scan of the active region after induction chemotherapy with Dexamethasone, Vincristine, Asparaginase and Daunorubicin along with intrathecal Methotrexate. This was carried out on days-8 and 29 to determine the early remission status and end of induction response, respectively.

Results: Out of 121 patients, 99(81.8 %) had T–ALL, while 22(18.18%) had LBL. Day-8 assessment showed that 94(77.7%) patients were rapid early responders, 24(19.4%) were slow early responders, while 3(2.4%) patients expired before the day eight assessment. Day-29 bone marrow assessment of 88 T-ALL patients showed complete remission in 77 patients (87.5%), incomplete remission in 5(5.68%) patients and treatment failure in 2(2.27%) patients. 20(93.1%) patients with LBL achieved remission by Day-29, while 2 (0.02%) LBL patients died before the Day-29 assessment.

Conclusion: The remission induction rates and mortality rates in our setup are encouraging and comparable to international data. Further improvements can be made by early management of the affected cases and more accessible pediatric oncology health services.
Safety of Minimally Invasive Percutaneous Nephrolithotmy in High Risk Patients in Lateral Position - A Single Center Study
Authors: Khizar Samina , Nawaz Muhammad , Farooq Umer , Shehzad Khubaib , Murtaza Badar , Akmal Muhammad
Published: December 2022

Objective: To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy with fluoroscopy aided renal access in the lateral position, in patients who were high-risk cases for anesthesia in prone position.

Study Design: Prospective observational study.

Place and Duration of Study: Armed forces institute of Urology, Rawalpindi, from Jan 2018 to Dec 2019.

Methodology: Fifty-three patients with renal stones >1.8cm underwent minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral position. All the patients were obese, some had severe ischemic heart disease, few had diabetes mellitus. All the patients were unfit for the prone position.

Results: Successful renal access was achieved in all the patients (100%). The mean size of stone was 28 + 13.2 mm, with an average operative time being 55 ± 13.56 minutes and the mean hospital stay was 1.8 ± 2.3 days (range 2-4 days). No visceral or pleural injuries were documented. In addition, only two patients required postoperative transfusion. After procedure, the rate of complete stone clearance initially was 90.6%, which improved to 96% after single session of extracorporeal shockwave lithotripsy (ESWL). Only 2 (3.77%) patients had persistent residual stone fragment.

Conclusion: Minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral decubitus flank position, is safe and convenient in high-risk patients where prone position is contraindicated.
Analysis of Change in Body Composition in Diabetic Patients vs non-Diabetic Patients
Authors: Sharif Nazia , Fazal Imran , Alain Noor
Published: December 2022

Objective: To assess the difference in various parameters of body composition between the diabetic patients and non-diabetic controls at Pak Emirates Military Hospital Rawalpindi.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Medicine and Nutrition Department, Pak Emirates Military Hospital, Rawalpindi, from Jul 2018 to Mar 2019.

Methodology: This study was conducted on 100 patients of non-insulin dependent diabetes mellitus under treatment in medicine department and matched controls from the community. Patients with type I diabetes or insulin dependents or having some other com or bid metabolic illness or autoimmune disease or malignancy were not included in the study. Parameters of body composition were measured by using the INBODY machine which works on the principle of electroimpedance.

Results: Cases and controls were matched for age and gender. Hundred cases and hundred controls were recruited for the final analysis Mean age of the cases was 43.41 ± 2.231 years while controls were 43.46 ± 3.122 years. Mean BMI in cases was 29.32 ± 2.561while in controls was 25.62 ± 4.483. BMI, visceral fat and skeletal muscle fat were found statistically significant to be more in cases of non-insulin dependent diabetes mellitus as compared to the controls.

Conclusion: This case control study revealed that diabetes significantly affects the body composition of the patients. It also affects other parameters like skeletal muscle mass and visceral fat. Routine screening of body composition should be made part of the diabetic clinics to pick these changes early and intervene accordingly.
Crimean-Congo Hemorrhagic Fever (CCHF): Our Experience at a Tertiary Hospital
Authors: Khan Zubair Waheed , Ali Gulzar , Ahmed AKhlaq , Tariq Muhammad , Gardezi Adeel , Khan Nauman Sarir
Published: December 2022

Objective: To share our experience of managing Crimean-Congo Hemorrhagic Fever cases at tertiary care hospital.

Study Design: Hospital based case series.

Place and Duration of study: Medicine department Combined Military Hospital Peshawar, from 2017 to 2019.

Methodology: A total of 10RT-PCR positive cases of Crimean-Congo Hemorrhagic Fever were included in the study. Data were collected retrospectively from Stat office of the hospital. All cases which were PCR negative, having multiple co-morbid conditions and having alternative diagnoses were excluded from the study. Demographic, epidemiological, clinical and laboratory parameters were noted on a specially designed Proforma.

Results: All patients were males armed forces personnel employed in the tribal areas of KPK. All patients initially developed fever and generalized body pains. Among them 2 (20%) patients developed petechial rash and 1(10%) suffered from epistaxis, melena and hematuria. All (100%) of the patients’ lab data revealed leukopenia, thrombocytopenia, elevated ALT and LDH. Complete recovery was noted in all patients. 8 (80%) of the patients received ribavirin and platelet transfusion. All patients under study also received oral Vitamin C supplement. Average hospital stay was 14 days.

Conclusion: Crimean-Congo Hemorrhagic Fever is a fatal disease. People visiting to endemic areas are at particular risk such as soldiers. It is manifested by fever, petechial rash and thrombocytopenia. Treatment is supportive. The role of oral vitamin C supplements and ribavirin to hasten recovery needs further high-powerstudies andshould be given to all suspected and confirmed cases.
Frequency of t(4;14) in Multiple Myeloma and Its Clinicopathological Correlation
Authors: Zaheer Saima , Robert Helen Mary , Mahmood Asad , Mahmood Rafia , Khurshid Ayesha , Khan Nabeela
Published: December 2022

Objective: To determine the frequency of t(4;14) in multiple myeloma in Pakistani population and study the clinicpathological correlation of this translocation in myeloma patients.

Study Design: Cross sectional study.

Place and Duration of Study: This study was conducted at Armed Forces Institute of Pathology from Jun 2017 to May 2018 using non probability convenience sampling technique.

Methodology: A total of 53 newly diagnosed cases of multiple myeloma were included in the study. Patients were diagnosed as having multiple myeloma based on diagnostic criteria of international myeloma working group. Fish analysis was done for t (4; 14). Workup for end organ damage /myeloma defining events was done.

Results: Out of 53 patients, 16 (30%) were females and 37(70%) were males; the mean age of the patients was 59.81 ± 11.34 range from 37 to 87 years. Fish for t(4;14) was positive in eight (15%) patients while negative in forty-five (85%) patients. Patients with positive results have significantly deranged renal function tests and raised beta 2 micoglobulins levels as compare to t(4;14)negative patients.

Conclusions: Detection of t (4:14) in multiple myeloma patients not only has diagnostic value but is important in risk stratification of these patients and thus effect treatment decision.
Frequency and Culture Sensitivity for Bacteremia During Febrile Neutropenia in Children with Acute Lymphoblastic Leukemia. Do Age and Gender Matter?
Authors: Bin Mehmood Rana Usama , Aslam Afra , Ayaz Saeed Bin , Choudhry Shehla , Javed Sidra , Ashraf Khaula
Published: December 2022

Objectives: To determine the frequency of bacteremia and its association with age and gender in febrile neutropenic children suffering from acute lymphoblastic leukemia and identify the commonest pathogens and their antibiotic susceptibility identified on blood cultures.

Study Design: Cross-sectional analytical study

Place and Duration of Study: Pediatrics Inpatient Department, Shifa International Hospital, Islamabad Pakistan, from Sep 2018 to Mar 2019.

Methodology: Children with acute lymphoblastic leukemia aged 1-12 years, presenting with temperature >100ºF and absolute neutrophil count of <500 cells/µL were enrolled. An automated blood culture system was used and Clinical and Laboratory Standards Institute Guidelines 2017 were used for susceptibility testing. Antibiotics were started empirically in all cases and changed after susceptibility testing.

Results: A total of 62 children were enrolled. The mean age was 8.6 ± 2.4 years. Majority of the children i.e., 32 (51.6%) were females. The frequency of bacteremia was 16 (25.8%) and there was no significant association with age or gender (p=0.475 and p=0.881 respectively). Majority of the isolates were gram-positive. The organism isolated in the highest frequency was Methicillin-Resistant Staphylococcus Epidermidis (MRSE) 5 (31.25%). Susceptibility to Vancomycin was present in 10 isolates while seven isolates were sensitive to penicillins/cephalosporins.

Conclusion: Bacteremia, primarily caused by gram-positive bacteria was found in 25.8% of our sample and was uninfluenced by age or gender. MRSE was the most frequent isolate. The bacterial isolates were susceptible primarily to vancomycin and penicillins/cephalosporins.
Can Thrombocytopenia be Used to Make a Presumptive Diagnosis of Malaria in Patients with Acute Febrile Illness
Authors: Akram Ammad , Gillani Mehwish , Uttra Khurshid Muhammad , Gillani Mehreen , Atiq Nausheen , Akram Anam
Published: December 2022

Objective: To ascertain the diagnostic accuracy of thrombocytopenia in making a presumptive diagnosis of malaria in patients with acute febrile illness, keeping thick and thin films as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from May to Oct 2017.

Methodology: A total of 145 patients meeting the inclusion criteria i.e., patients with fever of 10 or less days, age of ≥12 and ≤65 years of either sex were included in the study. Sample for a complete blood picture was taken in Ethylenediaminetetraacetic acid (EDTA) vacutainer. Simultaneously, two slides each with a thick and thin blood smears were made to ascertain absence or presence of plasmodium vivax species (smear positive and smear negative). The diagnostic accuracy was measured using two by two table and applying formulae for specificity, sensitivity, negative and positive predictive value. Likelihood ratio and ROC (Receiver operator curve) was also calculated.

Results: Out of 145 subjects, ninety-four patients (64.8%) were males and 51 were (35.2%) females with mean age of 36.76 ± 14.749 years. The specificity, sensitivity, negative and positive predictive value and diagnostic accuracy of thrombocytopenia in making a presumptive diagnosis of malaria in patients having short history of fever, keeping thick and thin films as the gold standard was 68.8%, 81.4%, 64.7%, 84.0% and 77.2% respectively.

Conclusion: Hematological abnormalities are encountered in malaria. Thrombocytopenia has a very good sensitivity and good specificity for malaria.
Late Presentation of Anorectal Malformations - A Dilemma in Modern World: Cross-sectional Analysis from a Tertiary Care Hospital, Pakistan
Authors: Sohail Hamza , Nawaz Tahir , Mirza Mohammad Afzal , Ara Jahan , Nawaz Muhammad Ahsan , Arif Anoshia , Ahmed Moiz
Published: December 2022

Objective: To study the presentation age of children with anorectal malformation and its relationship with complications.

Study Design: Cross-sectional study.

Place and Duration of Study: Children Hospital and Institute of Child Health, Faisalabad, from Jan to Dec 2019.

Methodology: A total of 170 patients were included in the study. All the infants with a positive diagnosis of anorectal malformation from birth to 2 years of age were included in the study. Variables, including age at presentation, gender, diagnosis, length of stay and outcome in the form of discharge or mortality, were recorded.

Results: A mean age of presentation was 3.4 ± 2.1 days. Out of the total 170 patients, 110 (64.71%) were males, and 60 (35.29%) were females. The age of children extended from birth to 2 years of age. It was observed that only 10 (5.88%) infants presented within 48 hours of birth, 110 (64.71%) neonates presented between 48 to 72 hours, while 50 (29.41%) presented after 72 hours. A mortality rate of 3.53% was observed in the late-presentation group, i.e., after 72 hours of birth. The length of hospitalization was longer in groups with late presentation.

Conclusion: The present study reported that the majority of the infants with anorectal malformation were admitted to the hospital with a late presentation, i.e., after 72 hours of birth. Early and timely presentation of these infants can improve patient outcomes and reduce mortality among infants with anorectal malformations.
Impact of Obstetric Cholestasis on Fetomaternal Outcome
Authors: Anwar Rabiah , Razzaq Kashif , Noor Nusrat , Ansari Asma , Imran Ayesha
Published: December 2022

Objective: To evaluate the impact of obstetric cholestasis on maternal and fetal outcomes.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from Jan to Dec 2019.

Methodology: All pregnant women with no comorbid and ladies with symptoms and signs of obstetric cholestasis were included during the study period. Antenatal complications and perinatal outcomes of women having obstetric cholestasis were compared with those of pregnant ladies having no comorbid.

Results: Out of 6932 obstetric patients, 90 (1.29%) had obstetric cholestasis. The cholestatic group had significantly high levels of aminotransferases and alkaline phosphatase. There was higher occurrence of preterm prelabour rupture of membrane (11.11% vs 3.33%, p=0.044), preterm delivery (26.66% vs 4.44%, p<0.001), prelabor rupture of membrane (31.11% vs 13.33%, p=0.004) and emergency cesarean section (16.66% vs 4.44%, p=0.008) in obstetric cholestatic group as compared to control. No difference in the occurrence of postpartum haemorrhage was observed in both groups. Meconium stained amniotic fluid (42.22% vs 8.88%, p<0.001) and neonatal intensive care unit admission (23.33% vs 7.77%, p=0.004) were significantly high in the study group as compared to the control. Whereas occurrences of abnormal cardiotocography, APGAR score at 5 minutes, and intrauterine growth restriction in both groups had no significant difference.

Conclusion: Women with obstetric cholestasis are at increased risk of preterm labour, PPROM, emergency LSCS, and poor neonatal outcome (low APGAR, macrosomia, NICU admission), burdening the health care system; hence early diagnosis with careful clinical examination...
Intravenous Versus Subcutaneous Insulin in Management of Hyperglycaemia in Intensive Care Unit
Authors: Khan Hafiz Waleed , Mansoor Khurram , Khattak Muhammad Irfan , Yousaf Shagufta , Khan Ayesha , Altaf Maria
Published: December 2022

Objective: To compare the efficacy and safety of intravenous Insulin infusion versus subcutaneous Insulin in the management of hyperglycaemia in intensive care.

Study Design: Quasi-experimental study.

Place and Duration of Study: Medical Intensive Care Unit of Combined Military Hospital Malir, from Jul to Sep 2021.

Methodology: 68 individuals admitted to the Medical ICU with the blood sugar levels of more than 180 mg/dl were included. Patients on one side of Intensive Care Unit were administered intravenous Insulin infusion, and on the other side were administered subcutaneous Insulin to control blood sugars. Age, gender, previous history of diabetes and use of Insulin and glycosylated haemoglobin were recorded. Efficacy of regimen was judged based on ability to achieve target glucose levels, mean blood glucose levels and total days of ICU stay. Adverse events like hypoglycaemia and hypokalaemia were recorded.

Results: Out of 68 individuals, 27 (39.70%) were administered intravenous Insulin infusion, and 41 (60.29%) were administered subcutaneous Insulin. In the intravenous Insulin group, 22 (81.5%) individuals achieved target blood glucose compared to 29 (70.7%) in the subcutaneous Insulin group. The mean blood sugars in the intravenous group were 157.11 ± 25.54 mg/dl, whereas 168.32 ± 30.49 mg/dl in the subcutaneous group (p-value=0.164). The frequency of hypoglycaemia and hypokalaemia was more in the intravenous group than in the subcutaneous group.

Conclusion: Optimal blood sugar levels were better achieved with intravenous Insulin than with subcutaneous Insulin. However, the frequency of adverse effects was also more with intravenous Insulin, so better monitoring and management are..............
Diagnostic Accuracy of Extended Focused Assessment with Sonography For Trauma (E-FAST) Keeping Contrast Enhanced CT Chest And Abdomen As Gold Standard
Authors: Gul Bibi , Anwar Javed , Pervaiz Hafiz Khalid , Niaz Ayesha , Sultana Nasira , Tariq Mehwish
Published: December 2022

Objective: To determine the diagnostic accuracy of extended focused assessment with sonography for trauma (E-FAST) for detecting thoraco-abdominal trauma, keeping contrast-enhanced CT chest and abdomen as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Radiology, Combined Military Hospital, Quetta, from Jan 2020 to Aug 2021.

Methodology: A total of (n=196) patients, of age 18-60 years, of both genders, who sustained thoraco-abdominal injuries and were referred for contrast-enhanced Computed tomography of the chest and abdomen were enrolled in the study. Patients were subjected to the thorax and abdomen ultrasonographic examination first and then underwent a contrast-enhanced CT scan of the thorax and abdomen. The findings of both modalities were recorded and subjected to statistical analysis to confirm the accuracy of ultrasound, considering CT-scan as a gold standard procedure.

Results: The mean age of the patients was 35 10.6. There were 164 (83.7%) males and 32 (16.3%) females. Blunt trauma was seen in 131 (66.8%) and penetrating trauma in 65 (32.2%) patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of E-FAST for chest trauma was 79.4%, 94.7%, 87.6%, 90.7% and 89.8% respectively, for abdominal trauma was 68.6%, 95.2%, 88.8%, 84.5% and 85.7% respectively and for combined chest and abdominal trauma was 77.1%, 95.9%, 85.9%, 92.8% and 91.3% respectively.

Conclusion: E-FAST has good diagnostic accuracy for the chest, abdominal and both thoraco-abdominal trauma and can be incorporated into the routine assessment of patients presenting with trauma.
Efficacy of Percutenous Trigger Finger Release
Authors: Ali Muhammad Qasim , Sheikh Saeed Ahmed , Sahito Badaruddin , Arif Muhammad , Jamali AR
Published: December 2022

Objective: To determine the efficacy of trigger finger release with the percutaneous technique.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Orthopedic Surgery, Jinnah Post Graduate Medical Center, Karachi Pakistan, from Mar 2017 to Mar 2018.

Methodology: One hundred and three patients were selected through the outpatient department after they meet the inclusion criteria with one or more trigger fingers in whom percutaneous release was indicated. Patients with previously open release, carpel tunnel syndrome, osteoarthritis of the hand and Dupuytren's contracture were excluded.

Results: The mean age of patients was 34.79 ± 14.08 years with a range of 17-62 years. More patients were male (56.3%), and females were 43.7% with a male to female ratio of 1.27:1. Accordingly, 95 (92.2%) out of 103 had complete relief of symptoms and the procedure was thus efficacious in these patients. Among the remaining 7.8% of patients in whom it was not efficacious, about 2.2% had partial relief while 5.6% had either no benefit or worsening of symptoms as assessed on the 8th week post-operatively. Age was a significant effect modifier (p<0.05).

Conclusion: Overall, the percutaneous technique of trigger finger release is an effective method of treatment
The Public Good of Digital (Academic) History
Authors: Lenihan Rebecca
Published: December 2022

Is digital history public history? It does not have to be, but it probably should be. When we make our digital history products freely and publicly available, we not only make our scholarship more transparent, but also more accessible to a wider audience, in particular an audience who might usually be excluded from readership by paywalls. This article focuses on the author's experience in presenting research and data collected for the Soldiers of Empire project in a digital and public facing way, the reasons for doing so, and the challenges faced.
Channelling a Haunting
Authors: MacDonald Liana , Bellas Kim , Gardenier Emma , Green Adrienne J.
Published: December 2022

The Aotearoa New Zealand’s Histories curriculum will be compulsory in 2023; what and how New Zealand history will be taught is currently up for debate. An innovative approach to engaging key curriculum understandings like colonisation, settlement and power would recognise that settler sensibilities frame national histories, to make visible the ongoing structuring force of colonisation. To this end, we present a model for teaching students how to consider a relationship between national identity, collective memory, and colonial history; to read settler cultural bias embedded in national institutions. Channelling a haunting is a process whereby students are encouraged to think and feel as though absent and silenced histories of colonial violence are not resolved, and to critique how settler memory and forgetting about New Zealand history permeates exhibitions at national institutions. Findings from a small group of student teachers who were channelling a haunting at two museums housing documents of national significance show how lovely and difficult knowledge about colonial history can create a sense of embodied racial comfort that legitimises the status quo. Rather than perceive national institutions as culturally neutral, students of all ages may be taught to critically analyse how they are biased to settler perspectives.
Tupuna Wahine, Saina, Tupuna Vaine, Matua Tupuna Fifine, Mapiạg Hạni
Authors: Greensill Hineitimoana , Taito Mere , Pasisi Jessica , Bennett Jesi Lujan , Dean Marylise , Monise Maluseu
Published: December 2022

From various parts of Te Moana Nui a Kiwa, we have come together as Indigenous scholars to weave stories of our grandmothers in the archives. From our own sea, land and skyscapes to the diasporic realities of generations of movement, migration and contact with ourselves and outsiders, we trace some of the stories and lineage, emanating from our grandmothers, that have led us into the archives. In distinctive ways we acknowledge our grandmothers’ guidance, presence, and inspiration for the research that we do. But we also see that their presence in and beyond the archives can challenge the very notions of what an archive is and how it is imagined from Indigenous worlds. In this article, we navigate from the centre to the edges of our research, attending to the paths we follow and forge as Indigenous researchers inspired by our grandmothers.
Niue Fakahoamotu Nukutuluea Motutefua Nukututaha
Authors: Pasisi Jessica , Aleke Fa'avae Ioane , Henry Zoë Catherine Lavatangaloa , Atfield-Douglas Rennie , Makaola Toliain , Togahai Birtha Lisimoni , Feilo Zora , Pilisi Asetoa Sam
Published: December 2022

Bringing together Niue scholars, creatives and thinkers from various disciplines and fields, this article is the culmination of two conference roundtables, a history panel, and multiple ongoing discussions about critically engaging with and contributing to Niue knowledge in academia. From different standpoints we each explore the vastness of Niue history through lenses that centre, privilege and uphold aga fakaNiue (Niue lifestyle, ways, culture) through cultural values and principles, tāoga (that which is treasured or prized), metaphor and approaches. Engaging in these spaces as tau tagata Niue (Niue people) is inevitably marked by Niue’s connections to Aotearoa and the wider Pacific. While our work may challenge dominant narratives by non-Niue people, we use this space to ask questions that are important to us and to the Niue communities we serve. What counts as Niue history? As tagata Niue how do we see ourselves in our academic and creative work? Who does Niue knowledge and history belong to? How do we make the places where Niue knowledge exists more accessible to the growing Niue populations in and beyond Aotearoa, whilst still maintaining strong connections to Niue? What is the place of Niue history in New Zealand history?
Materteral Consumption Magic
Authors: Pickles Katie
Published: December 2022

With themes of corporate and civic paternalism, magic, Disney-like fantasy and childcare, this article recovers and analyses the Hay’s rooftop playground, the people who invented it and their motivations for luring generations of children up there. The space is placed in the context of the development of modern playgrounds and department stores. Drawing on consumers’ memories, the playground’s main attractions are revealed. The motivations of energetic and innovative store manager Jim Hay are outlined, including his cultivation of workers and customers according to his corporate paternalist beliefs. James Hay’s creation of ‘Aunt Haysl’ and the woman who successfully became her, Edna Neville, is explained. The roof’s storybook character and benevolent orientalism, Neville’s retirement, the roof’s closure and its afterlife are covered. Overall, I argue that the rooftop playground was an important modern, urban commercial space where public history was both made and nostalgically created as part of Christchurch's cultural heritage. I use the term 'materteral consumption magic' to capture the central discourses in the roof's history, to explain its success, and its potent creation as collective memory.