bluuebunny/crossref_metadata_2025 huggingface dataset:
Applicability of Virtual Reality Interventions for COVID-19 Pediatric Patients
Authors: Arkalgud Sahana
Published: November 2022

The emergence of the Delta variant led to an increase in the number of children infected with SARS-CoV-2 [1, 2]. Research has shown that this age group is more susceptible to developing severe symptoms due to Delta variant infection, including hypoxia and severe shortness of breath. [1]. One study supported that two COVID-19 vaccine doses are approximately 88% effective at preventing symptomatic Delta variant disease [3]. However, research on the efficacy of COVID-19 vaccines in preventing this in young children is limited. Currently, children under 12 are not eligible to receive the COVID-19 vaccine [4]. From the start of the pandemic through September 2021, approximately 5.9 million children were diagnosed with COVID-19 in the U.S. Over the past two weeks, the number of pediatric cases has increased by 7% [5]. Thus far, only 0.1-1.9% of infected children and adolescents have required hospitalization; however, this group of patients, especially those who develop multisystem inflammatory syndrome (MIS-C), may require critical measures. These include non-invasive ventilation, invasive ventilation, and intravenous medications, namely, Remdesivir and inotropes [6-8]. The monoclonal antibody has been issued an Emergency Use Authorization (EUA) for high-risk adolescents over the age of 12 and is therefore not indicated for the treatment of younger children [9]. Though hospitalized pediatric patients are currently receiving life-saving treatments for COVID-19, they may be subject to stressful, uncomfortable, and potentially painful medical procedures [7,10]. The ensuing sensation of discomfort that children feel often leads to attempts to escape, which can cause poor procedure outcomes, extended procedure time, medical anxiety, and trauma due to a perceived lack of control [7,10]. Furthermore, these patients may develop feelings of stress and isolation during their hospital recovery, potentially impeding their social development [11]. Thus, an intervention that curbs these outcomes in ill pediatric patients may improve their hospital stay. Studies have shown that virtual reality (VR) could abate children’s pain perception in emergency and intensive care settings, mitigate feelings of stress in intensive care and recovery units, and provide an engaging environment that promotes mobility during hospitalization [12]. This pharmacologic alternative involves immersing patients in simulated 3D spaces, engaging their visual and auditory pathways [13]. Although the exact mechanism of pain relief is unknown, VR sessions may decrease selective attention to painful stimuli and reduce activity in brain regions involved in pain perception networks, including the anterior cingulate gyrus and thalamus [14]. Some articles have reported the potential for dizziness, nausea, and eye strain in application users. More research is needed to quantify these risks [15].
Brazil and a Tragedy Foretold
Authors: Almeida Marcela
Published: November 2022

The way Brazil handled their pandemic crisis has been an active matter of discussion worldwide. Researchers across the country, as well as the international press, have highlighted that the grim outcomes the country is experiencing are largely a consequence of the current administration’s approach to minimize the impact of the pandemic, undermining science and neglecting basic public health needs. Fifteen months into the pandemic, while many parts of the world are starting to see a return to normalcy, in Brazil, an unjustifiable delay in vaccine availability and refusal to implement or advocate for mitigating strategies has led to a continuous surge in the number of cases and deaths. The country comprises numerous areas of highly vulnerable populations, marginally protected by a fragile healthcare and social system. Behind the mantra of “The economy must come first”, individuals were discouraged from staying home, avoiding crowds, or even wearing masks (1).
An Epidemic Within a Pandemic: The Impact of COVID-19 on Substance Use in the United States
Authors: MacEachron Sierra , Watt Payton
Published: November 2022

The year 2020, marked by social distancing, mask mandates, lockdowns, economic downfall, and death, will forever be remembered as the year COVID-19 spread across the world. In the U.S., states were left to set their own guidelines and regulations, with Michigan earning a reputation as one of the stricter states1 while other states declined to implement any lockdown measures at all. Efforts to slow the spread of the virus resulted in Michigan’s lockdown from March 23rd to June 1st and businesses did not begin reopening until June 8th1.2 Despite the importance of lockdowns in reducing the transmission of COVID-19, these public health mitigation efforts contributed to a new health crisis: social isolation. In an attempt to deal with these difficulties and life changes, many Americans turned to substance use.3 This is significant, as mental health and substance use behavior have been shown to worsen due to the stress and isolation brought on by the pandemic.
Evaluation of various clones of Populus deltoides for root and shoot characters under nursery conditions
Authors: Singh Rajbir , Bangarwa K.
Published: November 2022

Fifteen clones were planted during January 2000 in nursery area of the Department of Forestry, CCS Haryana Agricultural University, Hisar, in randomized block design with three replications. Analysis of variance indicated presence of variation for basal girth, shoot length, fresh shoot weight, dry shoot weight, root length, root spread, fresh root weight, dry root weight, root length: shoot length ratio and root weight: shoot weight ratio in fifteen clones of Populus deltoides under nursery conditions. Little difference between genotype coefficient of variation and phenotypic coefficient of variation and medium to high estimates of heritability for all the characters under study revealed the heritable nature of variability present. Estimates of genotypic advance as percentage of mean were observed high for all the characters under study. The clones viz., 146 and 154 of M/s WIMCO Seedlings Ltd., were observed as best clones and the clones viz., 28, 156, 139 were considered as potential clones.
Evaluation of mulberry germplasm based on morphological and yield attribute for selection
Authors: Tikader A. , Roy B.
Published: November 2022

Fifteen Mulberry germplasm accessions were evaluated based on morphological and yield attributes. Before analysis the data, both quantitative and qualitative traits were ranked as suggested by Kendall and Spearman (1904). Simple and rank correlation analysis revealed that leaf appearance, leaf surface, leaf yield and total biomass weight are positively and significantly associated with each other. The rank value vs. rank value and rank value vs. numeric data were also analysed and a group of combination of characters showed relationship with each other. Thus, the result indicates a wide spectrum of relationship providing ample scope for indirect selection of accessions for further crop improvement.
Note on an interesting wood rot fungi from Dalma Wildlife Sanctuary, Jharkhand
Authors: Dash Puspa , Lele N. , Joshi P. , Roy P.
Published: November 2022

The Kingdom Fungi includes some of the most important organisms, both in terms of their ecological and economic roles. It composes about 4% of the known species of life on earth and about 8% of estimated unknown species. In spite of their importance, less than 5% of the estimated 1.5 million fungi have been identified (Anon., 2004). Wood rot fungi are important elements of tropical forest ecosystem as they take care of decomposition of fallen woody branches, trunks and stumps.
Social Autopsy a Tool for Maternal and Perinatal Death Surveillance and Response (MPDSR) Reporting in Pakistan
Authors: Idrees Fahmeeda , Ahmad Saeed , Waheed Eman , Rubab Bisma , Abbas Faiza
Published: November 2022

Social autopsy is a relatively new technique to report non-biological causes of death along with biological causes, which accounts for 12/15 maternal deaths in Pakistan, through direct interaction with the community. Pakistan had a highest neonatal mortality in the entire world. A significant number of unreported cases contributed to the high prevalence of neonatal and maternal mortality. Pakistan is one of the top 10 nations that contribute to 60% of maternal and perinatal deaths worldwide which demands social autopsy adoption in Pakistan. Information acquired by social autopsy will therefore be useful in developing any efforts to stop or treat causes linked with death. Social autopsy is a way of health promotion as it encourages individual and communal behavioral change and contributes in achieving United Nations Sustainable Development Goal (SDG) 3.1 by reducing maternal and perinatal death mortality by 2030 and 2035 respectively. In discussion with the family of a woman and community, health workers examine the social reasons of death and pinpoint reforms that are required. In Bangladesh, Brazil, Tanzania, India and Nigeria, maternal and perinatal deaths have been lowered due to adoption of social autopsy. Pakistan has embraced verbal autopsy, but it is an ineffective technique which just deals with the medical cause of death. Maternal and perinatal deaths are not just because of medical causes, it is also the result of interactions between several social, cultural and economic factors. Government of Pakistan is just spending 0.8% of its GDP on health. Standard of primary maternity care is generally unsatisfactory. Only 25% basic health units have qualified staff. Government of Pakistan should create a provincial MPDSR committee, strengthen the health care network and pilot social autopsy in Pakistan to meet SGD goal 3.
The Comparative Efficacy of Imipenem and Meropenem On Different Bacterial Strains Obtained from Clinical Samples
Authors: Ahmed Hunjra Nouman , Ashraf Aqeela , Niamat Humaira
Published: November 2022

The most serious threat to patient's and the public's health is the resistance of clinically relevant microorganisms to antimicrobials. Objective: This study's primary objective was to compare the susceptibility profiles of imipenem and meropenem on various bacterial strains. Methods: 101 distinct patients' positive samples of blood and pus were collected and sent to a pathology lab in Lahore (Mughal Diagnostic and Research laboratory Lahore). On Macconkey, CLED, and Blood Agar media, five bacterial strains; E. coli, P. aeruginosa, Enterococcus species, Klebsiella species and S. typhi were isolated and resurrected. Following microscopical (gram staining) and biochemical tests to identify these bacterial strains, the antibiotic sensitivity of these bacterial strains was assessed. Results: The findings of this investigation clearly demonstrated that imipenem is more sensitive than meropenem. Imipenem demonstrated improved sensitivity to all of the bacterial strains included in the study, especially E. coli, P. aeruginosa, various Enterococcus, Klebsiella, and S. typhi, imipenem showed a sensitivity of 84.15%, while meropenem showed a sensitivity of 40.59%. Conclusions: The current investigation came to the conclusion that antibiotics (imipenem and meropenem) are becoming more resistant to bacteria as a result of their growing and frequent use. Physicians started to worry about the developing antibiotic resistance due to the indiscriminate use of these treatments after more than a decade of increased antibiotic consumption in the era
Intensive Care Nurses' Knowledge and Practice of Endotracheal Suctioning Intubated Patients in Tertiary Care Public Sector Hospitals in Karachi, Pakistan
Authors: Fauzia Rafiq  , Badil  , Hussain Mehwish , Saeed Muhammad Farooq Saeed , -- Gohar Ur Rehman
Published: November 2022

Endotracheal suctioning is a prime and most common invasive procedure accomplished by inserting an artificial tube in the patient's airway. Objectives: To evaluate nurses' knowledge and practice regarding intubated patients' endotracheal suctioning in the intensive care units in the tertiary care hospital of Karachi, Pakistan. Methods: The descriptive cross-sectional study design was accomplished on intensive care unit nurses from two tertiary care public sector hospitals. A validated and adopted questionnaire was used to collect data. Data were entered and analyzed by using SPSS version 21. A p-value ≤ 0.05 was considered as significant. Results: Out of a total of 80 nurses, 57.5% of the participants were males. Male participants' mean knowledge level of ES was 9.0 with SD 2.1 and females with 9.9 with SD 2.3. The mean knowledge level of the female participants was higher than male.  Insignificant differences were found among the mean knowledge levels of the male and female participants, with a p-value of p=0.075. Furthermore, the mean score (11.4 ± 1.1 SD) of the practice level of male participants was higher than the mean score (10.8 ± 1.3 SD) of female participants. An insignificant difference was found between the mean practice level of males and females, with a p-value of p=0.126. Conclusions: It was concluded that the study's participants working in ICUs of tertiary care hospitals have good knowledge and practice of endotracheal suctioning
Neonatal Disease Distribution and Admission Outcomes at the District Hospital
Authors: Talreja Washdev , Aman Suhail , Hussain Wajid , Hussain Zahid , Jhatial Irfan Ali , Kewalani Sapna , Baloch Zainab , Parial Shahani Muhammad
Published: November 2022

The most vulnerable time for a newborn is during the neonatal period. The important factors affecting neonatal mortality during the first 28 days of life include poor antenatal care for mothers, inadequate treatment during birth, or lack of skillful care. With a rate of 48 per 1000 live births, Pakistan is ranked third in the world. This is because it accounts for 7% of all neonatal deaths globally. In Pakistan one in every 22 newborns dies within the first month of life. Objective: To evaluate the frequency and distribution of neonatal morbidity patterns and admission outcomes in district hospital Dadu, Sindh, Pakistan. Methods: A descriptive cross-sectional study was conducted at the Civil Hospital Dadu which is a district hospital in Sindh. The data was obtained in 2020. Using universal sampling method, neonates’ gender, age at the time of the birth, disease patter and admission outcome were recorded. Data was analyzed in Microsoft Excel 2010. Results: Out of total 1637 admitted neonates there were 411 (25.1%) case of sepsis, BA 17.16%, preterm 14.9%, LBW 13.81%. Amongst, 789 (48.1%) were discharged after improvement, and 251(15.3%) neonates died. Conclusions: Less than half of the newborns who were admitted could improve during the admission. More than 15% of newborn deaths are alarming. The policymakers should take action to reduce early neonatal mortality by effectively managing neonatal illnesses
Prevalence and Correlates of Comprehensive HIV/AIDS Knowledge among Women Aged 15–49 Years in Pakistan
Authors: Siddique Hira , Abbas Saira , Rizwan Safdar Muhammad , Atif Ayoub Muhammad , Shahzad Mahnoor
Published: November 2022

Pakistan is ranked second among the countries in pacific Asia where the AIDS epidemic is spreading rapidly. Objectives: This study examines the comprehensive HIV/AIDS knowledge and measures the relationship between knowledge and socio-demographic characteristics of women aged 15-49 in Pakistan. Methods: It is based on secondary data analysis of the Pakistan Demographic and Health Survey 2017-2018. Data were collected from 50,495 married women aged 15-49 through the questionnaire. Descriptive statistics were applied to summarize the data while bivariate analysis was conducted to find out the correlations. Results: The study found that Pakistani women have a low level of knowledge regarding HIV/AIDS. Moreover, a significant relationship was found between comprehensive HIV/AIDS knowledge and wealth index as well as with the level of access to information.  It shows that women from the richest households with moderate access to information had a high level of HIV/AIDS knowledge. Conclusions: Social stigmas regarding HIV/AIDS are rooted in Pakistani traditional society which is consequently the cause of the lack of knowledge regarding this epidemic among people in Pakistan
Effect of Nursing Guidelines On Practices of Nurses Caring for Traumatic Brain Injury Patients in A Tertiary Care Hospital Lahore, Pakistan
Authors: Zafar Saima , Shahzadi Uzma , Abdul Rehman Sania , Khurshid Uzma , Bashir Fouzia , Khurshid Zummorrad
Published: November 2022

Traumatic brain injury (TBI) is one of the top causes of disability and deaths in the world. However, Pakistan has 81 TBI cases for per 100,000 residents, with a 15% death rate. In order to lower excessive intracranial pressure in brain injury patients, external ventricular drains (EVDs) are frequently used to remove cerebrospinal fluid (CSF). Nursing practices with reference to the care of patients with EVD are greatly improved by EVD care guidelines. Therefore, it is crucial to implement EVD care guidelines in order to enhance their current procedures for EVD care. Objective: The aim of the study was to assess the effect of nursing guidelines on practices of nurses caring for traumatic brain injury patients with external ventricular drain in a public hospital of Lahore, Pakistan. Methods: A quasi experimental study was conducted. Sample size contained 50 registered nurses. Purposive sampling technique was used to collect the data. A four-week education intervention was delivered to the participant nurses. Through the use of validated questionnaires, information on nurses' practices was gathered twice, before and after the intervention. Results: The study found that nurses' practices had significantly improved (p< 0.001) following the education. The practices had been competent as post- intervention practices are improved to 32 (64%) from pre- intervention practices 12(24%). Conclusions: Guidelines for the care of External Ventricular Drains (EVDs) have a statistically significant impact on nurses' education in EVD care. Guidelines for EVD care considerably improve the nursing practices and reduced EVD consequences in patients with traumatic brain injuries.
Quality of Multiple Choice Questions (MCQs) as perceived by the postgraduate residents appearing in Mid Training Assessment (MTA) during January 2022 at Rawalpindi Medical University
Authors: Shahid Rizwana , Asad Muhammad , Khalid Rabbia
Published: November 2022

Impartiality and reliability of Multiple-Choice Questions (MCQs) render them an ideal assessment tool for measuring higher order cognition. Objective: To determine the perception of postgraduate medical trainees pertinent to the quality of MCQs administered in Mid Training Assessment (MTA) January 2022. Methods: A cross-sectional descriptive study was carried out among 40 postgraduate trainees who appeared in MTA during January 2022. About 23, 12 and 05 of these trainees were doing MS and MD training at Benazir Bhutto Hospital, Holy Family Hospital and DHQ Hospital Rawalpindi respectively. Trainees were enrolled in the study through consecutive non-probability sampling. The feedback from the trainees about quality of MCQs was gathered by means of a structured questionnaire based on 5-point likert scale. Data analysis was done by using SPSS version 25.0. Results: About 67% of the trainees were pleased with the quality and construct of MCQ in their assessment in terms of illustration of the information in their stems needed to understand the clinical problem. More than 82% trainees satisfied with the time allocated for attempting MCQs papers. Only 55% trainees agreed with alignment of MCQs with given Table of Specification (TOS). Most (32.5%) wanted to have difficulty level of the MCQs in accordance with level of training. Around 27.5% and 22.5% of the residents proposed to incorporate more clinical reasoning and problem solving MCQs respectively. Conclusions: Trainees were substantially contented with the standard of MCQs. They suggested for inclusion of more clinical reasoning and problem-solving type questions in alignment with TOS.
Risk Factors of Eclampsia and Its Maternal and Perinatal Effects at A Tertiary Hospital: A Retrospective Study
Authors: Bano Erum , Mahar Tahmina , Malhi Pushpa , Hashmi Saira , Soomro Anbia , Khoso Sumaira
Published: November 2022

Eclampsia is responsible for 34% of maternal mortality in Pakistani tertiary care hospitals among women admitted for delivery. Objective: To evaluate risk factors associated with eclampsia patients as well as the perinatal maternal effects in patients. Methods: Overall, 250 patients were involved in this research who were diagnosed with eclampsia. The data were collected from the medical records of the patients. The medical records contained information related to the patient's pregnancy history, characteristics, medical history, obstetric history, information related to admission to the hospital, maternal outcomes, and treatment provided at the hospital. For statistical analysis, SPSS version 21.0 was used. Results: There were 21689 women who gave birth in the hospital during the research process and 250 patients (1.15%) were diagnosed with eclampsia out of which 4 women died and had a case fatality rate of 1.6 %. The major risk factors associated were young age, already existing medical conditions, education level being low, low antenatal attendance, and nulliparity. HELLP syndrome was the most common consequence with a percentage of 15.6. All patients were provided with medication of magnesium sulfate. However, there was an absence of parenteral antihypertensive therapy. A total of 46 women (18.4 %) gave birth through vaginal delivery. Conclusions: According to our findings, eclampsia is still a key risk to maternal survival. Poor socioeconomic status, lack of education, and inadequate antenatal care were found as major risk factors
Establishing Pediatric Cardiac Surgery Unit in Underprivileged Area. An Audit of First 100 Cases & Challenges Faced
Authors: Hussain Pathan Iqbal , Parkash Jai , Kumar Naresh , Farhan Khan Muhammad , Nek Naveed
Published: November 2022

Nevertheless, congenital anomalies predominantly cardiac are still leading cause of under five-year-old mortality. There is significant global improvement has been observed in declining of under 5-year mortality from 93 deaths per 1,000 births in 1990 to 39 in 2017 (58%).Objective: The aim of this audit was to present our experiences of first hundred cases of congenital heart defects surgeries along with the challenges faced during the establishment of new pediatric cardiac surgery center in underprivileged area. Methods: This was an audit of the first 100 cardiac surgeries performed for congenital heart defects at Gambat Institute of Medical Science from 15- 3- 2021 to1-10-2022. During the period challenges other then related with surgical interventions; more than an investment of money but political, cultural, and social faced. Results: The mean age was 9+/-6.5 years, with female predominance of 57. Sever pulmonary hypertension was present in 6 patients.  The majority of our patients were from RACHS1 score category 1. Out of 100 patient open heart surgeries were 89(89%) and close heart were 11(11%). We have single mortality of patient underwent Tetralogy of Fallot correction developed massive stroke and expired at 5th postoperative day. Three patients were re explored for bleeding while one required emergency reopening in PICU for cardiac arrest. Post clamp removal arrhythmias were observed in 7(7%) patients. We received three patients in emergency from Pediatric cardiology post intervention including device embolization, device malposition and acute Mitral regurgitation post intervention. Conclusions: Providing Pediatric cardiac surgery services to the children of remote and socioeconomically deprived area is a greatly rewarding. It has many challenges other than providing direct patient care.
Effectiveness of Educational Program on Knowledge and Practices of Nurses Regarding Prevention of Diabetic Foot Ulcers at Tertiary Care Hospital, Lahore
Authors: Ramzan Sonober , Sarwar Hajra , Afzal Muhammad , Khan Sadia
Published: November 2022

Diabetes is a chronic disease that affects 4.2% of the world's population. Nurses effectively prevent foot ulcers and lower limb amputations by providing educational intervention and health care. Objective: To evaluate the effectiveness of a training program on nurses' knowledge and practices related to diabetic foot ulcer prevention. Methods: A quasi-experimental pre-post study was conducted in the diabetes clinic and medical departments of Sir Ganga Ram Hospital in Lahore, Pakistan. A total of 36 nurses were randomly selected. After obtaining informed consent, all female nurses aged 23 to 35 years with inadequate knowledge of diabetic foot ulcer prevention were included in the study. The nurses received a 16-week intervention. Nurses' knowledge was assessed using a validated instrument called the Nurses Knowledge Questionnaire related to Diabetic Foot Management Care and an observation checklist for nurses' practice related to neurovascular assessment of diabetic patients before and after the intervention. Data were entered and analyzed using SPSS version 24.0. Results: The results showed that most of the participants were from 26 to 30 years, 19 (52.8) were single with educational level of nursing diploma (50.0%). Participants were having 2 to 5 years of experience. After the intervention there were 4 (11.1%), 13 (36.1%) and 19 (52.8%) participants having poor, moderate and good knowledge respectively regarding prevention of diabetic foot ulcers. There was a significant difference between pre and post interventional score of practice and knowledge among nurses (p value <0.001). Conclusions: Nurses have poor knowledge and practice regarding diabetic foot care but after the intervention it increases significantly.
Determination of Parental Concerns about Seizures among Children with Epilepsy
Authors: Kousar Rukhsana , Samreen Rehana , Yasmeen Tahira , Ayub Tabeeta , Naz Shakila , Yasmin Musarrat
Published: November 2022

Epilepsy is often misunderstood and not taken seriously as compared to other diseases the reason behind it is a lack of health-related knowledge, poor economic condition, and shortness of health facilities in remote areas. Objective: To determine the parental concerns about seizures among children with epilepsy. Methods: A cross-sectional study was carried out in the Neurology division of a public hospital. After receiving informed consent, the current study involved 36 parents of epileptic patients. The parents of children with epilepsy who visited the neurology clinic (OPD) were included. The parent's concerns about seizures scale was used to measure parental worry about seizures in children with epilepsy. Results: 36 parents of epileptic patients were enrolled in the current study. There were 33.3% male and 66.7% female participants. The majority of the participants dealt with children having generalized seizure types. Parents were more concerned about seizures can lead to underlying disease 23(63.9), they are often concerned that their child’s epilepsy has unknown cause 14(38.9), brain damage 13(36.1), loss of intelligence 17(47.2), and child developing emotional problems 13(36.1). They also show concern sometimes when a seizure may be triggered due to if they do or don’t do something 22(61.1) and they also think that their child may have learning issues 11(30.6). Conclusions: The current study shows that parents play a vital role in improving the family functioning of epileptic families. Parents played an important role in helping children with epilepsy cope with their differences from other children.
Frequency of Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma
Authors: Shafqat Muhammad Nabeel , Saeed Najam us Sehar , Javed Salman , Chouhdary Muhammad Adil , Shafqat Ghania , Aftab Muhammad Asad
Published: November 2022

The hepatocellular carcinoma (HCC) is a frequent complication of liver. Portal vein thrombosis is common in HCC patients and associated with poor prognosis. But evidence lacks for local population. Objective: To assess the frequency of portal vein thrombosis in diagnosed patients of hepatocellular carcinoma presenting at DHQ hospital, Gujranwala. Methods: After permission from the ethical committee, this cross sectional study was done at the Department of Gastroenterology, DHQ hospital, Gujranwala from 19-03-2021 to 19-09-2021. Total 125 patients were selected from OPD. Informed consent was taken. All patients underwent Doppler ultrasound to diagnose the portal vein thrombosis. All data was analyzed in SPSS 22. Results: Total of 125 patients, 16.8 %( n=21) were in age group of 20-40 years and 83.2 %/(n=104) were in age group of 41-60 years. Mean age was 45.52+45.05 years. Distribution of size of hepatocellular carcinoma was 4.03+0.906 cm. There were 72.0 %( n=90) male whereas 28.0% (n=35) were females. According to the type of hepatocellular carcinoma, 64.8% (n=81) had naive and 35.2% (n=44) recurrent hepatocellular carcinoma. Total of 125 patients, 64.0% (n=80) had single and 36.0% (n=45) had multiple hepatocellular carcinoma. Frequency of portal vein thrombosis was 29.6% (n=37) in patients with hepatocellular carcinoma. Conclusions: We concluded that portal vein thrombosis is common in patients with HCC. An early diagnosis of Portal vein thrombosis along with the evaluation of the volume of portal vein thrombosis on CT and an early intervention is necessary.
Diagnosis of Acute Appendicitis: Ultrasound as First-Line Imaging Modality
Authors: Chaudhary Waiz , Ahsan Muhammad Adnan , Hashim Muhammad , Ather Azeem Shams Rana Muhammad , Haider Muhammad Arslan , Zahra Syeda Iman , Zahid Warda , Kazmi Fizza , Arshad Zainab , Zainab Anosh
Published: November 2022

The most prevalent abdominal emergency is acute appendicitis. Atypical manifestations may lead to diagnostic uncertainty and a delay in therapy, even if the clinical diagnosis may be simple in patients who exhibit conventional signs and symptoms. When laboratory results are presented, they often show a left shift and an increased leukocytosis. The chance of increased C-reactive protein measurement is high. Imaging modalities have become extremely important in the diagnostic work-up of patients with suspected acute appendicitis in order to maintain the low rate of negative appendectomy because the clinical diagnosis of acute appendicitis continues to pose a challenge to emergency physicians and surgeons. Ultrasound, computed tomography and magnetic resonance imaging modalities are used in diagnosis but we feel that all patients with suspected appendicitis should get an ultrasound. Because ultrasound has outstanding specificity, readily available, no ionizing radiation and cost is low.
Epidemiology and Resistance Pattern In Microbial Pneumonia: A Review
Authors: Naveed Adil Muhammad , Royaidar Jawad , Wadie Yassa Ramy Rafaat , GonzagaLeong-on Ma. Socorro , Iqbal Faisal , Hussain Abrar , Ali Qamreen , Rasheed Arsalan
Published: November 2022

The pneumonia is a significant public health issue because it raises the mortality and morbidity in people of all ages (2.56 million deaths worldwide each year) and has high medical and financial expenses. The two types of pneumonia i.e. community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). The incidences of multi-drug resistance in gram negative bacteria create difficulty in treatment and have negative effect on patients’ results. Antimicrobial resistance has also increased with passage of time. The goal of the current study was to describe microbial pneumonia with a focus on the pathogens’ etiology, pathogenicity, epidemiology, resistance pathways, diagnosis updates, and vaccine issues in order to address the issue before it has serious consequences. When choosing an antibiotic medication, clinicians face a significant challenge due to the emergence of novel illnesses, the increase in bacteria with multiple medication resistance, and germs that are challenging to cure. It is demonstrated that the effectiveness of first antimicrobial treatment is a critical issue for mortality in pneumonia, it is imperative to manage and effectively guide adequate antibiotic treatment. This requires the knowledge of engagement of the numerous pathogens in etiology of pneumonia. Additionally, until microbiological data are known and prompt de-escalation cannot be conducted; broad-spectrum antibiotic therapy may occasionally be administered. An overview of the epidemiology, resistance trends, microbiological etiology, and microbial diagnostics of pneumonia is given in this review.
Reasons for Non-compliance with medication and Disease severity among heart failure patients at Benazir Bhutto Hospital Rawalpindi
Authors: Saeed Ali Imran , Shahid Rizwana , Asad Muhammad
Published: November 2022

Heart failure is a silent epidemic that is growing exponentially among both genders. Objectives: To determine the reasons for non-compliance with medication and severity of illness among heart failure patients. Methods: A cross-sectional descriptive study was done among 277 heart failure patients who visited Cardiology department of Benazir Bhutto Hospital during 2020 and enrolled in study through consecutive non-probability sampling. Data was gathered pertinent to demographics, hospital stay, comorbidities, drug compliance, physical activity and reasons for expiry. Severity of disease was categorized by using NYHA classification. Variations in mean age of the both genders and length of hospital stay between recovering and expiring patients were statistically determined by independent sample t-test. P-value ≤ 0.05 was taken significant. 95% CI were also computed. Results: Of the 277 patients, 56% and 44% were males and females respectively with mean age 56.5 ± 15.9 years. Most (65.7%) were illiterate. There was significant difference (P 0.003) (95%CI (1.85 – 9.35) in mean age of both genders. About 71.8% and 25.6% patients belonged to low and middle social class respectively and 68% of them were non-compliant with medication. 59.3% were non-compliant due to unawareness while 23.4% and 15.9% had non-compliance due to non-affordability and adversity of medicines respectively. Out of 15 expiring cases, 13 succumbed to cardiac arrest. Mean length of hospital stay was 5.92 ± 3.7 days. About 122 and 112 cases were in NYHA heart failure class III and IV respectively. Conclusion: Incognizance about the medication was the prime reasons for non-compliance
Self-Esteem And Its Impact On Academic Performance Among Undergraduate Nursing Students Of Khyber Pukhtankhwa Pakistan; A Correlational Study
Authors: Khan Salma , Anwar Nasir , Khan Imran , Ullah Shakir , Suliman Muhammad , Sultan Amir
Published: November 2022

Self-esteem is defined as self-value and the combination of skills and emotional states that describe how highly people respect themselves or think about themselves. Objective: To identify the correlation between self-esteem and academic performance.  Methods:  The study design was correlational descriptive, which was conducted from August 2022 to September 2022, with a sample size of 185 nursing students and a non-probability sampling technique. The self-esteem of the participants was assessed through a valid and reliable scale. Results: Among the study participants, the majority of the students were male (64.5%). In the collected data, the majority of students’ self-esteem was average (91.90%), while the academic performance of the participants was average (61.1%). The most frequent answers to the scale questions were "agree" and "strongly agree. The overall self-esteem of male participants was higher compared to female participants, while the 4th year students’ self-esteem was higher compared to other years' students. In the academic performance, the performance was best and average. The academic performance of males were higher than female participants. The findings show that there is no correlation between self-esteem and academic performance and also no correlation with selected demographic variables. Conclusions: The study demonstrates that students with higher self-esteem are more confident, have a lower stress level, and are energetic, good problem solvers. Senior students’ self-esteem has higher self-esteem compared to other class students
Coronavirus 2019 Affliction Vaccine Response in Pregnant and Lactating Women - A Disciple Learning
Authors: Nida Badar Ghulam Fiza , Usman Gulzar , Nizamani Wali Muhammad , Ayyub Fakhra , Ahmed Shaheer , Ishfaq Jawaria
Published: November 2022

Vaccines have become more popular and influential in fighting against new viruses as the COVID-19 universal vaccine alongside the SARS-CoV-2 coronavirus began. Although high-quality approaches for blocking mortality exist, impoverished pregnant girls are included in composed tests. Cure safety should be taken into account when designing a mathematical, as well as when dealing with blast spheres and baby remnants. A concerted effort has been made to reassure pregnant women that there is a low risk of their child becoming infected with the flu. Given that COVID-19 has impacted people of all ages, a post-hoc dossier group should determine the effects of COVID-19 on future generations. Most people who receive COVID-19 injection responses experience injection-site erythema, discomfort, lump, fatigue, problem, fever, and lymphadenopathy. These symptoms can occur before or during birth. We have looked at some of the first-production fervid vector and mRNA COVID-19 vaccines known to cause adverse side effects, including backlashes in pregnant women and babies. We have looked at the potential implications of using the COVID-19 model to discover the enduring consequences of immunization against COVID-19 during the fetal and newborn ages
Impact of Occupational Musculoskeletal Disorders on Dentists
Authors: Shakoor Asma , Saba Khan Aleshba , Naz Fariha , Ali Waqar , Sultan Dilawar , Ahmad Maaz
Published: November 2022

Dentists are particularly vulnerable to ergonomically borne musculoskeletal diseases (MSDs), which decrease efficiency, productivity, and career longevity because to the exact and minute nature of their work. Objective: To determine different consequence of work related disorders among dentist of Lahore, Pakistan. Methods: In this cross-sectional survey 450 dentist of Lahore were approached and a structured proforma based survey was conducted using convenience sampling technique. In the study, dentists between the ages of 24 and 65 were included. Musculoskeletal Disorder has been presented in the form of frequency and percentage whereas age has been shown as mean and standard deviation. Chi square test has been applied to determine the association between musculoskeletal disorder and different study variables. P-value of 0.05 has been deemed significant. Results: In this study out of 450 dentists 236 (52.4%) were male and 214 (47.6%) were females. Mean age of the males were 37.08 ± 9.27 years and females were 33.43 ± 10.42 years. Among the subject’s musculoskeletal disorders were reported by 393(87.3%) dentist. Sick leave was availed by 278 (70.7%) whereas 373 (94.9%) seek medical treatment and 325 (82.7%) prevent daily activity. According to Dentist 388 (98.7%) believes that the disorder is caused by Dental Clinic I.e. Ergonomic issue. Conclusions: With two thirds of dentists taking sick time owing to musculoskeletal disorders, combined with the mental stress, it would appear that dentistry is not an easy profession. This would significantly limit the career of dentists.
Role of a Learning Management System in Medical Curriculum; Students’ initial perception about the use of LMS-Moodle at Fazaia Ruth Pfau Medical College
Authors: Faisal Rahim Muhammad , Ahmed Skaikh Masood , Ul Haque Sama , Jabeen Shah , Ansari Tahir
Published: November 2022

The modern medical curriculum has to deliver a great amount of educational content and knowledge to the learners as changes in content delivery are occurring at a very high speed. New technology and tools are introduced each day for this purpose. MS Moodle helps in students` learning mainly through tools which provides students` interactions like discussions forums, timed assignments, and use of computer-based testing as e-assessment tools. During implementation of e-learning platform LMS-Moodle, it was felt necessary to examine students’ perception about Moodle. Objectives: To assess students initial perception of about the use of the learning management system Moodle in integrated modular systems at FRPMC. Methods: The study design was cross-sectional and observational in nature with a quantitative data collection method . The study was conducted at Fazaia Ruth Pfau Medical College during 2021 to 2022. Total number of participants was 100. The instrument used in the research was a questionnaire consisted of 17 statements presented with 1-5-point Likert scale for responses. The Cronbach alpha test was employed for reliability test. The analysis was done by SPSS version 23. Results: By analyzing overall received feedbacks of participants, the cumulative mean on 5-point Likert scale was 3.3 where 1 considered as strongly disagree and 5 as strongly agree. Conclusions: It was concluded that majority of participants studying in Fazaia Ruth Pfau Medical College have positive perception and experience of using Learning Management System Moodle in medical curriculum
Association between Vitamin D Status and Diabetic Foot in Patients of Type 2 Diabetes Mellitus
Authors: Kanwal Marium , Soomro Aqsa , Hussain Waqar , Sonam . , Yousuf Tanveer , Shaikh Zuhaib
Published: November 2022

Vitamin D not only perform endocrine role in body but also it have strong immunomodulatory properties. Approximately 20% of diabetic people diagnosed foot infections each year. Objective: To find the link between vitamin D status and diabetic foot in patients suffering from type 2 diabetes mellitus. Methods: A cross-sectional study conducted at the Diabetic OPD medical unit II ward 6 in Jinnah Postgraduate Medical Centre, Karachi for the duration of six months from June 2021 to May 2022. 172 patients were selected for the study and groups were divided into DF and non DF. The body mass index and age in these patients was evaluated. Results: The average age of patients was 67 in case of DF group and 65 in case of non DF group. There were 67 non-smokers in non DF group and 30 reported about smoking as per our data. The features like TG, TC, HDL-C, LDL-C was checked and analyzed in both groups. There were 57 patients having diabetes for more than 10 years in non DF group and 20 patients had diabetes for more than 10 years in DF group. Conclusions: The low serum level of vitamin D was reported in diabetic foot patients. The patients who had diabetic foot had more chance to have vitamin D deficiency as compared to control group. Therefore, low level of vitamin D is linked with diabetic foot patients significantly.
Renal Function Status in Patients with Diabetes Mellitus Having Diabetic Foot Infection and Role of Antibiotics
Authors: Hussain Shabab , Arrham . , Javeriya Saeed Syeda , Murtaza Anwar Ahmad , Khan Asif , Brohi Saifullah
Published: November 2022

It has been shown that antibiotic therapy in diabetic foot ulcers has a toxic effect on renal function. Objective: To assess the renal function among patients with diabetes mellitus having diabetic foot infection. Methods: It was a cross-sectional retrospective study in the surgical Unit of DHQ Teaching Hospital KDA Kohat for six-month duration from January 2022 to June 2022. 130 patients with diabetic foot ulcers were selected for this study. The patients receiving antibiotic with a low renal toxicity risk were included in Group-A and patients receiving antibiotics with an increased renal toxicity risk were included in group B. GFR was calculated and measured from Cockcroft-Gault equation and serum creatinine levels. SPSS 20.0 was applied for data analysis with paired t-tests, t-test and chi-square tests.
Results: In group A there were 65 (50%) participants and 65 (50%) in group B. GFR after and before antibiotic therapy was 58.30±31.13 cm3 / min and 65.98±35.76 cm3 / min (p = 0.004), correspondingly. The GFR in group B was reduced significantly after antibiotic therapy (p = 0.003). Conclusions: Conferring to this study, renal function decreased and nephrotoxicity was noted after antibiotic treatment, the percentage of decline in GFR being greater in patients who received higher nephrotoxic antibiotics.
Malignant Transformation of the Mature Cystic Teratoma of the Ovary
Authors: Sid Ahmed Mohamed , Ahmedou Abderrahman
Published: November 2022

The mature cystic teratoma of ovary is most prevalent type of neoplasm of ovarian germ cells. It accounts for the almost 20% of the neoplasm. Objective: To find the malignant transformation of mature cystic teratoma of ovary. Methods: The study was conducted on the 28 patients who visited Cheikh Zayed Hospital Mauritania for the duration of six months from July 2018 to December 2018 and patients who underwent surgery related to ovarian cancer. All the patients underwent tumor marker tests to see the level of cancer antigen in their serum. The level of serum SCC antigen was also tested in all patients before carrying out any surgery. The level of CA-19-9 was also measured. CEA level to check the carcinoembryonic antigen was also carried out. Results: Among these 28, there were 15 patients that had malignant transformation from MCT. The age of patients was ranging from 28 to 74 years. The median age was 50 years. There were 9 patients that were on a post-menopausal state. There were 4 patients that were reported as nulliparous, the remaining were parous. Almost all the patients were presented with symptoms like lower abdominal pain and feeling of palpable mass in the lower abdomen. Conclusions: Malignant transformation in case of MCT is rare but it has poor prognosis. Its quick detection and proper treatment is very important. The use of surgical operation along with adjuvant treatment and chemotherapy have role in controlling the malignancy
Chewing Gum And Postoperative Ileus In Children After An Appendectomy In Terms Of Early Gut Motility, Resumption Of Feed, And Hospital Stay
Authors: Rehana Gulshan , Hanif Sameen , Tasneem Kausar Syeda Sidra , Raza Zeeshan , Peter Lubna
Published: November 2022

Chewing gum usage decreases the postoperative ileus in kids who have had appendicectomies in terms of quick gut motility, feeding resumement, and hospital stay. Objective: The goal of this study was to determine how chewing gum affects early intestinal motility and how to avoid postoperative ileus in children who have had appendicectomies. Methods: In this study, children who had appendicectomies at a children's hospital in Lahore underwent a randomized control experiment. This study included elderly pediatric patients between the ages of 5 and 18. Two groups—one serving as the control group and the other as the interventional group—were formed. 51 patients made up the study's sample size, as determined by G power. In this study, 25 patients were placed in the control group and 26 patients were divided into the intervention and control groups. Results: In terms of early gut motility, early flatus pass, early bowel motions, early appetites, and early stool pass, gum chewing produced favorable effects in patients. Gum chewing can be effective in preventing intestinal paralysis or as a technique to improve gut motility after surgery, as it demonstrated early flatus, early bowel movements, early appetites, and early stool pass, protecting our children from the suffering of postoperative ileus. These metrics demonstrate how successful chewing gum is in preventing post-operative ileus in pediatric patients.Conclusions: The findings of this study demonstrated that chewing gum is one method for promoting oral intake, enhancing intestinal movement, and shortening the interval between the first flatulence and bowel movement