bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of Recently Poor Glycemic Control as Assessed by Hba1c in Diabetics Presented with Acute Coronary Syndrome
Authors: Ijaz Bhatti Muhammad , Razzaq Mehak , Iqbal Nasir , Abbas Abdullah Hassan , Liaqat Rajia , Jahan Amna , Javed Iqbal Usman
Published: December 2021

Aim: To find the frequency of recently poor glycemic control as assessed by HbA1c in diabetic patients with acute coronary syndrome Study design & Setting: Observational study. Methods: The study included 60 diabetic patients presented with acute coronary syndrome. Diagnosis of acute coronary syndrome was based on patient’s symptoms, ECG changes and cardiac enzyme results. HBA1c level report was collected for all patients from their hospital record. SPSS 21 version was used to analyze the collected data. The qualitative data was presented in the form of graphs while the quantitative data was presented by simple descriptive statistics in the form of mean, range and standard deviation. Results: Out of sixty patients enrolled in this study 2(45%) were females and 33(55%) were males. 28(46.67%) patients presented with ST-elevation MI (STEMI) whereas 25(41.66%) patients presented with non ST-elevation MI. 7(11.66%) had unstable angina. Out of sixty patients 21(35%) patients were having poor glycemic control (HBA1C >7%) whereas 39(65%) patients had fair glycemic control (HBA1C< 7%). Fifty eight (96%) patients were using oral anti diabetic tablets whereas 2(3.33%) patients were using insulin before hospital admission. Conclusion: This study shows that amongst patients admitted with acute coronary syndrome a significant proportion of patients (35%) had poor glycemic control over past three months as assessed by HBA1C implying that recent poor glycemic control is a significant risk factor for acute coronary events in diabetic patients. Keywords: Acute coronary syndrome, Glycemic control, Diabetes mellitus.
Severity of Disease and Outcomes in Vaccinated and Non Vaccinated Covid patients in District Muzaffarabad AJK
Authors: Nazir Munazza , Raja Sohail Khan , Kareem Qureshi Noman , Ali Bukhari Syed Sajid , Ahmed Farooq , Hafiz Awan Mudasar
Published: December 2021

Aim: Covid infection after first and second dose of vaccination was assessed in comparison to unvaccinated SARS-CoV-2 infection patients. Methodology: Patients were divided into two groups: those who had not got any immunizations and those who had received vaccines that were prescribed. Individuals who have taken second dose of either the mRNA vaccine or the viral vector vaccine and have a positive COVID-19 within 14 days of receiving their second dose are deemed fully immunised. Results: Among 180 patients, the males were 75% and 25% was females. In our study, 16.7% (30/180) patients still suffered from COVID-19 despite of the fact that they were vaccinated, but the ratio of immune patients was greater i.e. 83.3% (150/180).The severity of the symptoms in vaccinated patients was much lesser and in some cases almost nil. 144/180 (80%) patients did not suffer from any severe symptoms after vaccination. 33/180 (18.3%) patients showed moderate symptoms while 3/180 (1.7%) showed severe symptoms. In the analysis of severity of symptoms of non vaccinated patients, 70% (126/180) showed severe symptoms, 25% (45/180) showed moderate and 5% (9/180) patients showed low symptoms. Conclusion: People without vaccination have more severe symptoms whereas COVID patients with vaccination had a reduced mortality rate and milder symptoms. Keywords: SARS-COV-2, vaccination, without vaccination
Risk Factors Associated with Peritoneal Involvement in Acute appendicitis in Territory of Punjab, Pakistan
Authors: Siraj Fauzia , Manzoor Malik Rabbiah , Iqbal Zafar , Shamim Rifat , Zaheer Attya , Ara Nighat
Published: December 2021

Aim: To study the frequency and factors associated with peritoneal involvement among patients operated for acute appendicitis in a tertiary care hospital. Place and duration of study: Department of Surgery, Benazir Bhutto Hospital Rawalpindi Pakistan from 1stJuly 2020 to 30thJune 2021. Methodology: This comparative cross-sectional study 500 patients diagnosed as acute appendicitis and operated by consultant surgeon were included. Peritoneal involvement was defined as signs of inflammation or infection on abdominal lining observed by operating surgeon during the time of surgery. Factors like age, gender, presence of comorbid illnesses and history of previous abdominal surgeries were associated with presence of peritoneal involvement. Results: There were 305 (61%) males while 195 (39%) were females with mean age was 32.331±4.544 years.Four hundred and forty two (88.4%) did not show any peritoneal involvement at the time of surgery while 58 (11.6%) had peritoneal involvement. Chi-square test revealed that history of previous abdominal surgeries and advancing age had statistically significant association with peritoneal involvement among the study participants (p-value<0.05). Conclusion: Peritoneal involvement was found in considerable number of patients operated as acute appendicitis by the treating surgeons. Patients with previous history of abdominal surgeries and advancing age were more at risk of having peritoneal involvement in our study. Keywords: Acuteappendicitis, Peritonitis, Risk factors, Frequency
Acute Appendicitis in Pre-School Children
Authors: Khan Mohammad Dawood , din Moyud , Khan Khusal , Bari Abdul
Published: December 2021

Background: Appendicitis is an emergent condition in young children which can cause serious illness. Aim: To identify features related with appendicitis in pre-school children. Study design: Retrospective study Place and duration of study: Department of Paediatric Surgery, Bolan Medical College Hospital Quetta from 1st April 2020 to 31st March 2021. Methodology: Fifty two children between 5-15 years were admitted for appendectomy. All demographic and clinical information including earlier diagnosis, symptoms, biochemical, histopathological as well as radiological imaging were properly documented. The operational technique was open appendecectomy. Results: There were 61.53% boys and 38.46% girls with mean age 8±0.8 years. Abdominal pain was presented in 90.3% while nausea in 82.7% with nausea/vomiting children. There were 51.9% children having perforated appendix with majority between 8-10 years of age. Misdiagnosis was common in 44.2% patients. Conclusion: Appendicitis in pre-school children is difficult and challenging to diagnose which requires careful diagnosis. Key words: Appendectomy, Pre-schoolers, Perforated, Misdiagnosis
Role of Fingolimod in Attenuation of LCL to Reduced Apoptosis in Myocardial Ischemia Reperfusion Injury
Authors: Ahmed Naseer , Achakzai Humaira , Anwar M. Naveed , Perveen Shahida , Irfan M. Malik , S. Sami , Yusuf M. Z. , J. Azam , R. Alessio
Published: December 2021

Background: FTY720 (Fingolimod) is a drug having immune-regulatory properties. It is a structurally analogous to Sphingosine-1-phosphate. S1P is a biologically active lipid mediator in various inflammatory pathways. Aim: To investigate the effects of FTY720 on myocardial ischemia reperfusion (IR) injury in cardiac surgery. Study design: Experimental study Place and duration of study: Aga Khan University, Karachi and Khyber Medical University, Peshawar Pakistan from 1st January 2017 to 31st December 2020 with collaboration of University of Verona, Italy. Methodology: Twenty Sprague-Dawley rats were segregated into two groups; treatment and control. In treatment group received FTY720 at 1 mg/kg, intravenously 15 minutes prior to the experiment. Both groups were exposed to myocardial ischemia (30 m) reperfusion (2 h). Blood gas analysis, lymphocyte count, myeloperoxidase assay and TUNEL assay were performed and analyzed to observe the effect of FTY720 on neutrophil infiltration and apoptosis. Results: FTY720 treated group had improvement in blood gas levels in contrast to the control, treatment group also experienced decrease in neutrophil infiltration, lymphocyte count and myeloperoxidase enzyme expression. Conclusions: FTY720 pre-treatment reduce lymphocyte count that leads to reduce the level of apoptosis and salvage the myocardial damage incurred by ischemia reperfusion. Keywords: Fingolimod, Cardiopulmonary bypass, Lymphocyte, Neutrophil, Myeloperoxidase
Frequency of different symptoms in patients with COVID-19
Authors: Akram Ali , Qaisrani Kaleemullah , Ullah Nadeem
Published: December 2021

Background: COVID-19 is a wide spreading disease starts from Wuhan a city of China in east. Earlier symptoms include fever, cough and fatigue later on patients may present with loss of smell and taste, sore throat, nasal congestion and muscle or joint pain. Its long term effects may include respiratory distress and neurological symptoms. Aim: To determine the frequency of different symptoms in patients with COVID-19 presenting at outpatients department of Nishtar Hospital Multan. Methodology: This cross sectional study was conducted at department of medicine, Nishtar Medical University, Multan, from September 2020 to September 2021. This study was carried out on 200 patients presenting with symptoms of COVID-19 and diagnosis was confirmed after admission. Main variables of study were symptoms of COVID-19 like cough, fever, running nose, breathlessness, headache and palpitations. SPSS version 22 was used for data analysis. Results: Majority of the patients were (60.0%) between age group 46-60 years. The most common symptoms were fever and cough, (79.0%) and (65.0%), respectively. The symptoms recorded between both male and female were almost equal, (standardized residuals<1.96 and p>0.05). But, fever and running nose were most common among the females, (p=0.028) and (p=0.050), respectively. Conclusion: COVID-19 presents with variety of symptoms and fever and cough were most common among these symptoms. COVID-19 positive patients can be present asymptomatically. All persons who come into contact with COVID19 patients should be go through the PCR lab test. Keywords: Novel COVID 19, Acute Respiratory Distress Syndrome, Contagious, Pandemic
Evaluation of Quality of Life among Kidney Transplant Patients- A Cross Sectional Study
Authors: Jabeen Rashida , Perveen Kousar , Afzal Muhammad , Khan Sadia
Published: December 2021

Kidney transplantation is the famous and most important choice of treatment of renal replacement therapies (RRTs) because of its positive impact on morbidity, survival and cost. The health related quality of life is becoming important outcome. Quality of life is usually impaired in patients who have renal transplant because of renal transplant patients have anxiety, lack of social, physical and emotional support and diminished ability to take care of themselves. The basic purpose of renal transplantation is to achieve maximum quality of life with minimum side effects. Methods: A cross sectional study was conducted at Rukhsana Akhtar Bahria International Orchard Hospital Lahore after approval from institution board of university of Lahore. 36 patients were enrolled in study by using purposive sampling technique. After taking informed consent all Kidney transplant patients aged between 18 years to 60 years, visited the post-transplantation OPD and continuously in follow-up sessions were included in study. A validated and standard WHO questionnaire of “Kidney Disease and Quality of Life (KDQOL-36™)” was used for data collection. Data was entered and analyzed in SPSS version.21.Chi-square test was applied to find out significant association between qualitative variables. P -Value < 0.05will be considered as statistically significant. Results: Majority of patients were from 40-49 years 10(27.0%). Females were more as compared to men (20(55.6) vs 16(44.4%)). 10(27.8) patients can read and write and 8(22.2%) have done matriculation. More patients live in Urban area as compared to rural area(19(52.8%) vs 17(47.2%)).8(22.2%) patients have less than 1 year of post kidney transplantation time and 19(52.8%) have 1 to 3 years. All the seven domains of KDQOL show poor QOL. General Health, Physical function and physical and emotional function shows average QOL and Emotional, social, daily activities and overall KDQOL shows poor QOL. There was insignificant association with age, gender, education; residential area and Post kidney transplantation length of time (years)(p-value > 0.05). Conclusions: After renal transplantation HRQOL becomes very important factor. After kidney transplantation HRQOL depends on many factors. It was concluded from current study that the HRQOL was not as good as it should be. Over the period of transplantation time patient’s quality of life remain same. The society, government, family, and medical staff need to support patients so they can also improve their QOL. Key word: Renal Diseases, Kidney transplant, Quality of life, KDQOL-36
Evaluation of Family functioning among parents of epileptic patients
Authors: Kousar Rukhsana , Sarwar Hajra , Perveen Kousar , Khan Sadia
Published: December 2021

Epilepsy has aggregate of risk characteristic’s as, age of onset, triggering factors, genetics, natural history, prognosis, and it is not a condition based on single aspect or cause. Due to social problems, family functioning of epileptic patients suffers badly. The basic purpose of the study is to investigate the role of family functioning of the parents who has epileptic patients. Methods: Across-sectional study was conducted at Muzaffargarh Hospital Neurology OPD department. Total 36 parents were enrolled. All parents of children, who have 8 to18 years of age, which are diagnosis of epilepsy, were included in current study Data was collected on a predesign questionnaire and for family functioning the Family Assessment Device (FAD) was used. Statistical analysis was performed by using the Statistical Package for Social Sciences (spss) version 26. The frequencies, proportions were calculated for Qualitative variables and Mean + SD were calculated for quantitative variables. Results: The mean age of parents was 38.58+7.55 and children were 12.31+3.34. Out of 36 participants 12(33.3%) were males whereas 24(66.7%) were females. Majority of parents were holding secondary degree 13(36.1%), were unemployed 24(66.7%), 21(58.3%) were from rural area and dealing with generalized seizure type children 24(66.7%). The average seizures frequency per month was 2.64+1.15. The families of epileptic patients were more dysfunctional, especially in terms of problem solving (2.66+0.43), behavior control (2.68+0.49), affective involvement (2.62+0.64) and also family’s faces difficulties in finding their role (2.48+0.56). Conclusion: The families of epileptic patients have more dysfunctional, especially in terms of problem solving, behavior control, affective involvement and also families faces difficulties in finding their role. Therefore educational programme focusing on the importance of family functioning should be provided so that the aspect of treatments and social life of patients get improved. Keywords: Epilepsy, Family functioning, Social Support, Family support
Diagnostic Accuracy of Ultrasonography for Detection of AT by Taking Surgical Findings as Gold Standard
Authors: Rafique Iqra , Manzoor Anam , Naseer Sana
Published: December 2021

Objective: To assess the diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard. Design of the Study: It was a descriptive cross-sectional study. Study Settings: This study was carried out at Department Of Diagnostic Radiology And Diagnostic Imaging Combined Military Hospital, Lahore from 23rd December 2017 to 22nd June 2018. Material and Methods: A total of 70 patients of age 20-70 years, of either gender presenting with severe pain and swelling in area of Achilles tendon were included. Patients with heel pain having concurrent heel ulcer, eczematous changes or calcaneal fractures, muscular dystrophy and previous surgery were excluded. All the patients were then underwent ultrasonography and findings were noted for presence or absence of Achilles tendinopathy. Each Ultrasonographic finding were compared with surgical findings. Results of the Study: Mean age was 41.24 ± 10.34 years. Out of these 70 patients, 46 (65.71%) were male and 24 (34.29%) were females with male to female ratio of 1.9:1. In USG positive patients, 40 (True Positive) had Achilles tendinopathy and 04 (False Positive) had no Achilles tendinopathy on surgical findings. Among, 26 USG negative patients, 03 (False Negative) had Achilles tendinopathy on surgical findings whereas 23 (True Negative) had no Achilles tendinopathy on surgical findings. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard was 93.02%, 85.19%, 90.91%, 88.46% and 90.0% respectively. Conclusion: This study concluded that diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy is quite high. Keywords: Achilles tendinopathy, ultrasonography, sensitivity.
Elevated Serum Alanine Transaminase (ALT) in Patients of Type 2 Diabetes Mellitus
Authors: Shah Nasir , Jahangir Saqib , Ahmed Naeem , Saleem Hasan Muhammad , Zaidi Yasir Abbas , Khalid Saira
Published: December 2021

Objective: The objective of this study was to determine the prevalence of raised serum alanine transaminase level in patients of type 2 diabetes mellitus. Design: cross-sectional study Study Settings: This study was conducted at Department of Internal Medicine Abbas Institute of Medical Sciences Muzaffarabad from November 2020 to April 2021. Material and Methods: Total 144 patients were included in the study having age from 18 to 60 of both genders with Type 2 DM. It was labeled as elevated if it was ≥50 IU/L. A written informed consent was taken from each patient. Results: Patient’s age ranged from 36 to 70 years having mean value of 44.4±8.3 y. BMI ranged from 21.2 Kg/m2 to 34.7 Kg/m2 with a mean of 27.2±3.7 Kg/m2. Disease duration was from 2 to 14 years with a mean of 7.1±3.8 years. Elevated serum ALT was noted in 38 (26.4%) patients with type-II diabetes. Conclusion: Elevated serum ALT was noted in a substantial proportion of patients with type-II diabetes and was significantly more frequent in patients with poor glycemic control which warrants good glycemic control to prevent and routine screening of such patients in future practice to timely identify and manage this complication to improve the outcome. Keywords: Type 2 Diabetes Mellitus, Serum Alanine Transaminase, Prevalence
Comparison of Post-Operative Morbidity and Mortality in Patients Undergoing On-Pump versus Off-Pump CABG
Authors: Rahman Mati Ur , Farogh Ajwad , Iftikhar Sadaf , Ahmad Naseem , Bashir Gohar , Mahmood Hamid , Afshan Shamila , Shafqat Amna
Published: December 2021

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump
Relationship of Psychological well-being with Depression and Anxiety among Heart Patients
Authors: Javaid Babar , Ahmed Abrar , Arshad Gohar Ali , Akhtar M Shoaib , Taj Shazia , Iqbal Raheel , Akhtar Shehwar , Zainab Farah , Batool Hifsa
Published: December 2021

The study was designed to investigate the relationship of psychological well-being with depression and anxiety among heart patients.1 For this purpose, a sample of 200 patients was taken, including 100 men and 100 women, educated uneducated, employed and unemployed volunteers. The sample was taken from Nishtar Hospital, Combined military hospital and other private hospitals in Multan. The age range from 25 to 60 (mean age 43.085).2,3 Objective: To observe the effect of demographic variables (age, education, gender and source of finance) on psychological well-being and depression, anxiety in heart patients. Methods: 1. Low psychological well-being would be positively correlated with depression and anxiety. 2. Older age (above 50) heart patients would have low sense of psychological well-being as compared to younger age (above 35) heart patients. Results: Different statistical procedures were used to determine the relationship of psychological well-being with depression and anxiety among heart patients. Correlation was computed to see the relationship among variables. It was found that there is negative correlation between psychological well-being with depression and anxiety. Since the p-value in less than α (p-value < 0.01), so we reject null hypothesis Ho, and conclude that low psychological well-being is positively correlated with depression and anxiety. Conclusion: This study also finds out important findings on the role of stresses, feeling of worthlessness in depression and anxiety disorder. It is concluded that psychological well-being, depression and anxiety are not significant correlated with each other. Source of income or job and sex of the heart patients have significant effect on psychological well being. However there is no significant difference between men and women regarding the rate of depression and anxiety. Keywords: P-Value, Correlation, Null Hypothesis , Depression
Frequency of Low Birth Weight in Pregnant Women with Anemia
Authors: Mahmood Naveed , Jamil Shazia , Haque Israr-Ul- , Mahmood Kinza , Haque Rabiah , Imran-Ul-Hasan Muhammad
Published: December 2021

Objective: To determine the frequency of low birth weight in pregnant women with anemia. Methodology: This descriptive cross-sectional survey, was conducted at OMC Hospital, Jail Road, Lahore and Medicine Deptt. of Lahore General Hospital during March 2020 to November 2020. We included 320pregnant females with gestational ages between 30 to 36 weeks with hemoglobin level of <10g/dl and further classified as moderate anemia with (Hb levels 8-9.9g/dl) and in severe anemia for those having Hb 8g/dl. All cases with known systemic diseases/abnormalities like hemoglobinopathies (sickle cell anemia/thalassemia), diabetes, hypertension, smoking, renal problems, oligo/polyhydramnios were excluded from the study. The neonates were examined after the delivery is done with the help of pediatrician and all protocols for neonates assessment were followed. All findings were recorded, low birth weight was considered if the neonatal weight was <2500g. These neonates were followed until they are discharged from the hospital or mortality (if any). Routine informed consent was also obtained from the patients attendants to use their data in the study. Results: In our study, 32.5% of the cases were low birth weight whereas 67.5%(n=216) cases had normal birth weight. Conclusion: Frequency of low birth weight is higher in mothers presenting with anemia. Keywords: Maternal anemia, low birth weight, association
Outcome of Intermittent Kangaroo Mother Care in Neonatal Intensive Care Unit
Authors: Jamil Sana , Rehman Abdul , Shahman Muhammad , Irfan Saleem Muhammad , Hafeez Rubab , Akram Sara
Published: December 2021

Objective: To find out the outcome of intermittent Kangaroo Mother Care KMC) in terms of weight-gain among low birth weight (LBW) neonates in Neonatal Intensive Care Unit (NICU). Study Design: A randomized controlled trial. Place and Duration of the Study: This study was conducted at Department of Pediatrics Gulab Devi Hospital, Lahore from March 2020 to February 2021. Methodology: A total of 226 (113 KMC Group and 113 controls) neonates of both genders with birth weight between 1500 grams to 2499 grams admitted to NICU with their mothers available for KMC application were enrolled. KMC Groups received KMC whereas controls were given conventional care. KMC was started from 8th post-natal day and a separate block of NICU was dedicated for the implementation of KMC. Body weight of all the neonates was measured from day-zero (8th post-natal day) up to day-7 (15th post-natal day). Results: Out of a total of 226 neonates, 121 (53.5%) were boys and 105 (46.5%) girls, Overall, mean gestational age was calculated to be 34.8±2.6 weeks. Most frequent main diagnosis at the time of admission was pneumonia, 64 (28.3%) neonates. Mean body weight was significantly increased among neonates of KMC Group in comparison to control at day-4, day-6 and day-7 (p<0.05). Total weight gain from day-0 to day-7 was found to be 0.24±0.1 kg in KMC groups and 0.15±0.1 kg among controls (p<0.0001). Mean duration of hospital stay was noted to be 17.5±2.9 days in KMC Group versus 20.7±3.4 days among controls (p<0.0001). Conclusion: In comparison to conventional care, intermittent KMC was found to significantly more effective in terms of improvement in weight gain and reduction in duration of hospitalization. Keywords: Exclusive breast-feeding, Kangaroo mother care, neonatal intensive care unit, pneumonia.
The Impact of Standard in-Patients Exposure on Clinical Judgement among Undergraduate Nursing Students at SNC Lahore
Authors: Khan Mehdi Hayat , Yaqoob Adnan , Sarwar Hajra , Khan Sadia
Published: December 2021

Background: Clinical judgment skills development of nursing professional is essential and vital during clinical education. This quasi experimental study hasevaluated the impact of standardizedIn-patient’s exposure on clinical judgment among under graduate nursing students using observational measures. Method: A single group of undergraduate students was recruited with purposive sampling at College of Nursing, Shalamar Hospital Lahore, Pakistan and Tanner’s clinical rubric model was used. A total 78 under graduate nursing students accomplished in five In-patients exposure within 45 clinical hours. Two Clinical Nursing Instructors were hired to evaluate the outcome of nursing students; clinical judgment at the end of each standardized in-patient exposure session. The inter-rater reliability ranged 0.830 to 0.90 for the session. Results: Clinical judgment outcome were improved from first in-patient exposure to last patient exposure compared with pre and post data of clinical judgement of patient second, third, fourth and fifth. The debriefing method was helpful for the undergraduate nursing students to improve their critical thinking. The undergraduate nursing students confessed that in-patient exposure has not only uplifted their clinical experience but also strengthened the critical thinking in emergency situation and improve the ability to notice, interpret, and respond suitably. The clinical nursing faculty also highlighted and valued the newly learned knowledge and commented that exposure of In-patients to under graduate nursing students is essential for clinical skills preparation. Conclusion: Standardized In-patient exposure has potential to support the undergraduate nursing student for the development of clinical judgement. No doubt, the clinical instructor has enhanced nursing professional’s intrinsic motivation but standardized in-patient presented a true picture, while learning to complete assessment skills.A difference may exist between high fidelity simulator and standardized in-patient exposure among undergraduate nursing students, so further research can explore this phenomenology. Key words:Nursing students, Clinical Judgment, Standardized in-patients, Nursing professionals.
Role of Probiotics in Neonates with Hyperbilirubinemia Receiving Phototherapy
Authors: Tariq Bushra , Shahman Muhammad , Mateen Amna , Taha Kamal Mohammad , Nawazish Ali Anum , Hassan Shah Syed Awais Ul
Published: December 2021

Study Objectives: To compare the mean duration of phototherapy in neonates with hyperbilirubinemia receiving phototherapy with vs. without probiotics. Study Design and Settings: It was a randomized controlled trial carried at Department of Pediatrics, DHQ Hospital Kasur from Jan 2021 to June 2021. Patients and Methods: The present research involved 94 neonates of both genders aged between 2 to 28 days of life diagnosed of neonatal hyperbilirubinemia (serum bilirubin level ≥15mg/dL and direct bilirubin level ≤1.5 mg/dL). These neonates were allocated into two groups randomly. Neonates in Group-I were given probiotics along with conventional treatment of phototherapy whereas neonates in Group-II received conventional phototherapy alone. Study outcome was described in terms of mean duration of phototherapy (phototherapy was stopped when serum bilirubin level was less than 10 mg/dl during the ﬁrst week and less than 11 mg/dl after the first week) which was recorded and compared between the groups. An informed written consent was taken from parents of every neonate. Results of the Study: The mean age of the neonates was 6.54±4.96 days while the mean gestational age was 37.31±2.04 weeks. There were 55 (58.5%) baby boys and 39 (41.5%) baby girls with a boys to girls ratio of 1.4:1. The mean weight of the neonates was 2.89±0.49 Kg while the mean serum bilirubin level upon admission was 16.73±1.19 mg/dl. The mean duration of phototherapy was significantly shorter in neonates receiving probiotics along with phototherapy as compared to phototherapy alone (3.13±0.92 vs. 3.81±1.12 days; p=0.002). Similar significant difference was observed across various subgroups based on age, gender, gestational age, weight and serum bilirubin level upon admission. Conclusion: Addition of probiotics to conventional practice of phototherapy alone in jaundiced neonates was found to hasten the recovery evident from significant reduction in the mean duration of phototherapy advocating its routine use in future practice. Keywords: Neonatal Hyperbilirubinemia, Phototherapy, Probiotics
Frequency of Post Dural Puncture Headache with Quincke 25g and Quincke 27g Spinal Needle after Spinal Anaesthesia
Authors: . Gulsher , Zahid Riffat , Mehmood Ali Syed , Shahzad Muhammad Naveed , Latif Amer , Ali Irfan , Sarwar Muhammad , Khan Wali
Published: December 2021

Objective: To compare the frequency of post dural puncture headache with Quincke 25G and Quincke 27G of spinal needles for spinal anesthesia. Design of the Study: It’s a Randomized control trial. Study Settings: This study was carried out Department of anesthesiology and Intensive Care Unit, Shaikh Zayed Hospital Lahore from 29-08-2020 to 01-03-2021. Material and Methods: In this prospective study 100 patients were enrolled who were decided to undergo spinal anesthesia. Two groups were made by randomization. In patients of group I, anesthesia was administered by using 25G quincke needle while 27G quincke needle was used for patients in group II. Evaluation of patients was with regard to development of postoperative PDPH within 3-days. Groups were compared by using Chi-square test and a P-value<0.05 was taken statistically significant. Results of the Study: PDHD was seen in 14 (28%) patients in group I and in 4 (8%) patients in group II. Statistically, the difference between the two groups was significant (p<0.05).. Conclusion: Due to less frequency of PDPH with 27G needle, it should be given preference for applying spinal anesthesia over 25G needle. Keywords: Spinal anesthesia, post dural puncture headache; quincle needle.
Evaluation of Oral Health Related Quality of Life in Patients Diagnosed with Head and Neck Cancer Receiving Radiotherapy
Authors: Maqbool Shahida , Siddique Sobia , Mehak Ayesha , Ali Qaiser , Asghar Syeda Kinza , Shahid Faiza
Published: December 2021

Objective: To evaluate the oral health related quality of life in patients diagnosed with head and neck cancer receiving radiotherapy. Design of the Study: It’s a case control study. Study Settings: The study was conducted at department of Oncology Holy Family Hospital, Rawalpindi and District Headquarters Hospital, Rawalpindi from Feb 2021 to Sep 2021. Material and Methods: Total 300 patients aged 18 years and above diagnosed with head and neck cancer undergoing radiotherapy for a minimum period of 1 month were included in this study. Oral Health Impact Profile (OHIP-14) is a 14 item pre-validated questionnaire graded on five point Likert scale used to assess Oral Health related Quality of Life based on seven dimensions of impacts of oral conditions on people’s OHRQoL. Pearson correlation and Spearman’s correlation were used to find out correlation between oral health status and quality of life. Results of the Study: Among Head and neck cancer group: 45(30.0%) were 35 to 44 years; 44(29.3%) were 45-64 years and 41(27.4%) were 65-74 years age group. Among Head and neck cancer group: 99(66.0%) were males and 51(34.0%) were females. The overall Mean SF-12 scores of head and neck cancer patients was significantly lower as compare to control patients (30.89±4.66 36.14±3.75<0.001). Mean oral health-related quality of life (OHIP-14) was significantly lower in head and cancer group patients as compared to controls (18.35±7.48 vs. 11.14±8.18; <0.001). Conclusion: It is proved that radiotherapy have a serious influence on oral health of the patients. Considering the influence of radiotherapy on oral health of the patient, assessment of the oral cavity should be done in routine assessment by the dentistry consultant. The OHIP-14 questionnaire has evident to be consistent and valid instrument for assessment of quality of life related to oral health in cancer patients. Among cancer patients this questionnaire should be considered in the protocol of the treatment about complications of oral health and for their optimal well-being. Keywords: cancer, quality of life, oral-health, head and neck cancer
Microbial spectrum and antibiotic sensitivity in cirrhotic patients with spontaneous bacterial peritonitis
Authors: Ahmad Irfan , Shahbaz Hussain Muhammad , Shoaib Akhtar Muhammad
Published: December 2021

Objective: There are reports of changing microbial profile of ascitic fluid in spontaneous bacterial peritonitis (SBP) and developing resistance of these bacteria to commonly used antibiotics. This study was done to determine the micro-organism causing SBP and their sensitivity to various antibiotics. Setting and Methods: This observational study was done in Medical department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from March to November 2019. Thirty five cirrhotic patients with ascites admitted in ward for various reasons and having positive ascitic fluid culture were included in the study. Exclusion criteria was presence of secondary bacterial peritonitis. Ten ml of ascitic fluid was inoculated in blood culture bottle and sent immediately to hospital laboratory. Results: The mean age of these 35 patients was 48.94 ± 13.51 years with a range of 19 to 80 years. Twenty (57.1 %) patients were male and 15 (42.9 %) were female. Bacteria that had caused SBP were E.coli (62.9 %), staph aureus (11.4 %), klebsiella (8.6 %), streptococci (8.6 %), gram positive cocci (5.7 %) and pseudomonas aeruginosa (2.8 %). Imipenem had high sensitivity rate (100 %) along with amikacin (82.9 %) and cefoperazone-sulbactam (68.6 %). Sensitivity of these organisms to other commonly used antibiotics were: ciprofloxacin 57.1 %, ofloxacin 40 %, norfloxacin 37.1 %, ceftazidime 34.3 %, ceftriaxone 31.4 % and piperacillin-tazobactam 25.7 %. Conclusion: We found that E.coli was the commonest bacteria causing SBP, and ceftriaxone and ciprofloxacin have significantly high resistance rate in these patients. Key words: cirrhosis, ascitic fluid, spontaneous bacterial peritonitis, antibiotic sensitivity
Urinary Incontinence in Women with Low Back Pain After Post Partum Period
Authors: Tabassam Faiza , Rehm M Hassam , Zafar Anam , Mustafa Mian Tayyaba , Usman Riaz Muhammad , Shaheen Robina
Published: December 2021

Background: Urinary incontinence is a very common problem in postpartum women. In the literature, about 38 to 43% of postpartum females experience urinary incontinence (UI). Postpartum UI usually occurs due to bladder injury, nerve injury, pelvic floor muscle dysfunction or damage to urethra during delivery. In women having C-section, UI is most probably occurs due to instability of detrusor muscle resulting from vesical denervation. Others risks factors involve in development of UI are fetal factors, operative vaginal delivery and antenatal bladder neck mobility due to pelvic floor muscles (PFM) dysfunction and connective tissue weakness. Lower backache (LBP) is also very common in postpartum females due to joint laxity, weakness of connective tissue, loosening of ligaments and strained abdominal muscles due to enlargement of uterus. There’s a coexisting link between low back pain and UI in postpartum females. Objective: To find association between the severity of urinary incontinence and low back pain in women after postpartum period. Methodology: In this study Quota sampling technique was used. Participants divided into two groups, one group with females having low back pain after postpartum period while other group was having females without low back pain after postpartum period. Participants were provided with questionnaires for urinary incontinence to find out the association between severity of UI and LBP. The questionnaires were self-administered and were provided in English language. Some participants were illiterate, thus questionnaires were filled from them by asking questions verbally. Results: Statistics of ICIQ-UI score was checked by applying Fisher’s exact test, The null hypothesis was not rejected because the p-value was > 0.05, indicating that there was no significant association between UI and LBP in females after their postpartum period Conclusion: It is concluded from this study that there is no significant association found between UI and low back pain in women after postpartum period. Keywords: Postpartum period. Urinary incontinence (UI), Stress urinary incontinence (SUI), Urgency urinary incontinence (UUI), Low back pain (LBP), Pelvic girdle pain (PGP), Pelvic floor muscles (PFM), Pelvic floor dysfunction (PFD)
Fungal Urinary Tract Infection; A Study Conducted On Patients With Liver Cirrhosis
Authors: Sarwar Fartash , Sheikh Raheel , Zahra Arooj , Iqbal Kashif , Habeeb Bilal , Roman Mohammad
Published: December 2021

Objective: To determine frequency of fungal infection of urinary tract in patients with liver cirrhosis Design & duration: This is a cross sectional study. This study was completed in duration of six months. Setting: Study was conducted in Margalla Hospital Gulshan Colony PMO, Taxila. Patients & Methods: Patients admitted in study hospital with liver cirrhosis having child class A, B and C were evaluated for fungal urinary tract infection, belonging to any gender, having age above 40 years. All data was documented and analyzed using SPSS software version-20 and means, frequencies, standard deviation and p-value were calculated. Results presented in the form of tables and graphs. Results: Total 400 cases were evaluated for fungal urinary tract infection having liver cirrhosis admitted in study hospital in given duration of study. Fungal cause of UTI was found in 260 cases including 29.3% male and 70.7% female cases. While other causes were found in 140 cases. According to child classification out of 260 cases with fungal UTI, 11 cases were in class B and 249 cases were in class-C while no case belonged to class-A. Most of the cases (42%) with UTI were in age interval of 40-50 years. Duration of CLD was 2-4 years in most of the cases (30%). Conclusion: Fungal cause of urinary tract infection is very common among patients with liver cirrhosis and older age as these cases have week immunity Key words: Liver cirrhosis, chronic liver disease, urinary tract infection, fungal infection, immunocompromised
Association of Oral Lichen Planus with Dyslipidemia in Patients Of Rahim Yar Khan
Authors: Hanif Nazia , Hassan Tahir , Shahzad Muhammad Khurram , Tahir Raheel , Anwar Madiha , Zaka Zara
Published: December 2021

Introduction: Oral lichen planus (LP) is a chronic inflammatory condition and this inflammation leads to alteration in lipid metabolism and increase the cardiovascular risk factors. Objective: To determine the prevalance of dyslipidemias in patient with oral lichen planus coming in dermatology outdoor of Sheikh Zayed Hoapital Rahim Yar Khan. Methods: It was a case control study that was conducted at Department of Dermatology, Sheikh Zayed Hospital Rahim Yar Khan during October 2016 to April 2017. In this study there were total 50 cases of oral LP and 50 controls of both genders with age range of 15 to 60 years. The cases of both the groups underwent fasting lipid profile in terms to look for serum total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol. Results: In this study there were total 100 cases out of which 50 were cases of oral LP and 50 were controls. In cases groups there were 27 (54%) males and 23 (46%) females while in control group there were same number of males and females were taken with p= 0.85. The mean age in case group was 37.22±8.15 years while in control group was 35.66± 7.78 years while the mean BMI was 24.42±2.21 and 25.11±3.01 respectively. The mean difference in cases and controls in terms of serum total cholesterol, TG, HDL Cholesterol and LDL cholesterol was found statistically significant. Conclusion: Dyslipidemias are common in cases with oral lichen planus and all its parameters have significant association with it especially TG. Keywords; LP, Dyslipidemia, LDL, HDL, TG
Effectiveness of Aloe Vera Mouthwash in Comparison with Triamcinolone Acetonide 0.1% in Patients with OLP at A TCH
Authors: Hassan Tahir , Shahzad Muhammad Khurram , Hanif Nazia , Anwar Madiha , Ambreen Ayesha , Waheed Muhammad Umar
Published: December 2021

Objective: To compare the efficacy of Aloe Vera Mouthwash versus 0.1% Triamcinolone Acetonide in patients presenting with oral lichen planus at a tertiary care hospital. Introduction: Oral lichen planus is a chronic immune mediated dermatosis with periods of remissions and relapses. There are many treatment options to treat this condition; aloe vera mouth wash is one of the newer and safer options. Methodology: A total of 100 patients with oral lichen planus (OLP) were randomly divided into two groups (group A and B, each having 50 patients).The patients in group A were given aloe vera mouth wash and in group B were given triamcinolone acetonide paste (0.1%). Efficacy was observed after 2 months of treatment completion. Results: Overall Efficacy was noted in 58(58%) of all study cases. In group A 37 patients (74%) showed efficacy and in group B 21 patients (42%) showed efficacy.More efficacy was noted in female patients (87%) treated with Aloe Vera Mouth wash than those of treated with triamcinolone acetate paste (45%). Patients belonging to old age group (36-50 year) showed more efficacy (75%) to aloe vera mouth wash than that of triamcinolone acetonide paste (36%) Conclusion: In our population Aloe vera mouth wash is more efficacious than triamcinolone acetonide (0.1%) in the treatment of oral lichen planus Keywords: Oral lichen planus, Aloe vera, Triamcinolone acetonide
Retrospective Analysis of Intra-Departmental Requests for Consultation To Hematology Department
Authors: Khan Irfan , Muneeb Muhammad , Ahmed Shahzeb , Haseeb Muhammad , Usman Muhammad Bin , Usman Ommyya
Published: December 2021

Aim: To investigate how much information a specialist hematologist receives at the time of initial assessment of referred patients through a referral letter. Study design: Retrospective study Place and duration of study: Haematology department BVH, October 2020 to February 2021 (5 months) Methods & Results: Among the 96 referral letters received, Majority 45 (47%) was referred from medicine department. Most common reason for referring the patient was evaluation of Pancytopenia n=19 (19.8%), Request for bone marrow biopsy n=14 (14.6%), being the second most common. The reason for referral was not properly stated in n=9 (9.4%) of patients in our study. Majority of referred patients were above 46 years of age n=22 (22.9%). CBC was mentioned only in n=35 (36.5%). Conclusion: Our study concludes that quality of referral letter was well below the acceptable standards. A well-documented protocol for referral letter is the need of hour to improve the quality of a referral process. Keywords: referral letter, pancytopenia, bone marrow, hematology clinics
Intercultural Formation and the Leadership Practicum: Competencies in Doctor of Ministry Education
Authors: Snulligan Haney Marsha
Published: December 2021

This essay affirms the value of experientially based leadership formation in Doctor of Ministry theological education as a hallmark of developing religious leadership for the African American context. It suggests envisioning leadership practicum goals so students gain intercultural competencies for all ministry contexts. The essay argues it is possible to increase cultural and ethnic literacy, personal formation and development, attitude and values clarification, multiethnic and multicultural social competence, basic ministry skills proficiency, educational equity and excellence, and empowerment for intercultural engagement through focused competency goals. It encourages experiences of cultural disorientation as the context in which students best learn the need to affirm ethnic identity, to be inclusive, to appreciate diversity, and to overcome fear of human diversity. Stated differently, through intentional comprehension of commonalities of human community, DMin students journey more rapidly toward intercultural competence. Keywords: Doctor of Ministry, Intercultural Competencies, Ministry Context, Leadership Formation