bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-Inflammatory Activity of Crude Extract of Aesculus Indica in Comparison with Aspirin on Carrageenan Induced Paw Edema in Rats
Authors: Faisal Rizwan , Anwar Attia , Khokhar Aamna , Sattar Afeefah , Jamil Ayesha , Jamal Arif
Published: December 2022

Objective: To determine the anti-inflammatory activity of crude extract of Aesculus Indica in rat model.Study design: Comparative studyPlace and duration of study: Pharmacy Department, Bahauddin Zakria University, Multan, Pakistan, from May 2017 to October 2017.Methodology:Twenty four healthy male and female Wistar rats (200-220gm) were included in the study, each rat was given single injection of 0.1 ml of 1% carrageenan, in normal saline in sub-planter region of the right paw for induction of edema. The rats were randomly divided by lottery method in to four groups; Group-1 served as positive control; Group 2 and 3 received crude extract of Aesculus Indica 100 mg/kg and 300mg/kg respectively; Group 4 was given aspirin at the dose of 12 mg/kg. The measurement of paw volume was made immediately by displacement technique using the plathysmometer before and at 1st, 2nd, 3rd and 4th hour after the carrageenan injection.Results: The result of the study confirmed the anti-inflammatory action of crude extract of Aesculus indica both at 100 mg/kg and 300 mg/kg. When group 1 was compared with group 2, 3 and 4, it revealed significant difference with p-value 0.002, 0.042 and 0.002 respectively. Similarly, comparison of group 2 with group 3 showed significant difference with p-value 0.02 while insignificant difference was found between group 3 and 4. Significant difference of p-value 0.03 was found when group 2 and 4 were compared.Conclusion: Crude extract of the Aesculus Indica showed significant anti-inflammatory properties which at high doses were almost comparable with that of aspirin.
Magnetic Resonance Imaging (MRI) Based Diagnosis of Anterior Cruciate Ligament (ACL) TEARS in Patients with Internal Derangements of Knee
Authors: Rahim Reshyl , Balooch Salahuddin , Usman Khan Muhammad , Bokhari Syed Awon Raza Shah , Baqir Hassan Khawaja Muhammad , Niazi Najam Us Saqib
Published: December 2022

Objective: To assess the role of magnetic resonance imaging (MRI) in diagnosing anterior cruciate ligament (ACL) tears in patients with knee internal derangements.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Radiology, Combined Military Hospital, Kharian Pakistan, from Sep 2019 Aug 2020.

Methodology: 40 patients of any age and gender were part of the study with painful or unstable knee joints. A clinical examination was performed after recording demographic data. In addition, MRI was performed, and primary and secondary signs were noted for each case.

Results: The range of patients was 15 to 63, with a mean age of 36.3 ± 12.62 years. Most of the patients were male (n=29; 72.5%), whereas only 11 (27.5%) were females. In total, 27 (67.5%) complete and 13 (32.5%) partial Anterior cruciate ligament (ACL) tears were present. Blumensaat’s angle> 15 degree was present in 10 (37.03%) complete tear cases and 2 (15.38 %) partial tear cases. Anterior tibial displacement was evident in 4 (14.81%) complete tear cases and 3 (23.07 %) partial tear cases. Posterior cruciate line (PCL) angle was apparent in 21 (77.77%) complete tear cases and 12 (92.30 %) partial tear cases.

Conclusion: The use of MRI is advocated for diagnosing Anterior cruciate ligament (ACL) tears in patients with knee internal derangements.
Determining Association of Myopia and Primary Open Angle Glaucoma
Authors: Admani Mohammad Uzair , Maree Ghazi Khan , Mirza Azfar Ahmed , Rajput Arsalan Ahmed , Mahesar Mona Liza , Munawar-Ul-Islam Sanam , Shaikh Adil Ali , Zeba Nudrat
Published: December 2022

Objective: To determine the association between myopia and primary open-angle glaucoma.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Ophthalmology, Liaquat University Hospital Jamshoro from Jan to Jun 2015.

Methodology: A sample of 170 diagnosed cases of myopia and 170 subjects without myopia were selected. Inclusion criteria were age 35-60 years, both genders, cases with myopia >1.0 D and controls - without myopic error. Visual status was determined by the Huwitz autorefractor (model 8800) machine. Retinoscopy, Goldmann's Applanation tonometry, gonioscopy, vertical cup to disc (VCD) ratio and visual field defects were detected.

Results: Age of group – 1 and–2 was 55.7 ± 8.6 and 52.3 ± 7.3 years respectively (p=0.071). VCD ratio in group-1 was 0.6 ± 0.13 compared to 0.5 ± 0.02 in group-2 (p<0.001). Normal and abnormal VCD ratio in cases and control was noted as 161 (94.7%) vs. 168 (98.8%) and 9 (5.2%) vs. 2 (1.1%) respectively (p<0.03). 23 (13.5%) of group–1 show visual field defects compared to 6 (3.5%) in group–2. Intraocular pressure was found elevated in group-1 16.8 ± 2.3 mmHg compared to 14.0 ± 2.7 in group-2 (p<0.001). POAG was observed in 9 (5.2%) myopes group–1 compared to 2 (1.1%) in group–2 (p<0.003).

Conclusion: The present study concludes that myopia is associated with primary open-angle glaucoma, and the risk of glaucoma is high in these patients.
Barriers to the Implementation of Continuous Positive Airway Pressure (Cpap) Ventilation in Neonates at Birthplace in Tertiary Care Teaching Hospitals
Authors: Hussain Shabbir , Hussain Moeez , Ullah Inayat , Shah Syed Awais Ul Hassan
Published: December 2022

Objective: To explore different barriers to the implementation of continuous positive airway pressure ventilation in neonates at the birthplace.

Study Design: Mixed method study.

Place and Duration of Study: Combined Military Hospital and Pak-Emirates Military Hospital Rawalpindi Pakistan, from Jan to Jun 2021.

Methodology: Health care professionals involved in neonatal care at these two hospitals were included. The sample size was predetermined (60 in total). Participants' written response was obtained on an open-ended self-administered questionnaire distributed in person. All enrolled participants responded. Thematic analysis of data was carried out.

Results: The participants were predominantly female (66.66%), aged 20-30 (66.66%). Eight (13.33%) had received CPAP training. The majority (83.33%) think that CPAP is useful, but only 10 (33.33%) have CPAP experience at the delivery suite. The first theme category was "Health professional related". Participants reported lack of awareness, motivation and training, understaffing, communication gap, responsibility conflict and rapid turnover of health professionals as a barricade. The second theme category was "organization/system related". Nonexistence of CPAP written guidelines, Obstetrics/ Gynaecology health professionals' unawareness about CPAP, CPAP implementation inferiority/ subservience/ subordinationand multi-discipline hierarchy were deterrents. The third emerged theme category was "logistics/resources". Shortage, failed continuous equipment supply, and poor infrastructure is major hurdles.

Conclusion: This study has identified weak areas/glitches on which efforts should be focused and suggested recommenddations to overcome hurdles and implement CPAP use at birthplaces.
Complete Blood Count in Preoperative Assessment of Acute Appendicitis -A Different Aspect
Authors: Khawaja Farukh Gulzar , Mahmood Khalid , Siddiqi Ubaid Ullah , Farooq Muhammad Umer , Abdullah Muhammad , Nayyar Afsa
Published: December 2022

Objective: To study the role of neutrophils to lymphocytes ratio in predicting the severity of acute appendicitis among patients managed at tertiary care hospital.

Study design: Cross-sectional study.

Place and Duration of Study: Department of Surgery Combined Military Hospital Rawalpindi, from Jan to Jun 2021.

Methodology: Three hundred patients diagnosed with acute appendicitis by a consultant surgeon were included in the study. The neutrophil to lymphocyte ratio was calculated at the time of diagnosis. The severity of the appendix was assessed at the time of surgery and graded between grades 0 and IV, depending upon the gross clinical findings. The severity grade of acute appendicitis and other factors was associated with the neutrophil-to-lymphocytes ratio in all the patients.

Results: Out of 300 operated patients with the clinical diagnosis of acute appendicitis, 169 (56.3%) were males, while 131 (43.7%) were females. The mean age of the study participants was 31.21 ± 2.127 years. Based on severity, 60 (20%) had grade 0, 100 (33.3%) had Grade-I, 86 (28.7%) had Grade-2, 35 (11.7%) had Grade-III, while 19 (6.3%) had a Grade-IV appendicitis. 192 (64%) had neutrophil-to-lymphocyte ratio < 4.6 while 108 (36%) had more than 4.6. Chi-square test revealed that severity of acute appendicitis and raised C-reactive protein had a statistically significant correlation with raised neutrophil to lymphocyte ratio (p-value<0.05).

Conclusion: Neutrophil to lymphocyte ratio was significantly raised in patients presenting with acute appendicitis. Raised C reactive protein and high grade of appendicitis were found significantly more in patients with raised neutrophil to....
Patterns of Retentive Failures in Dislodged Single Crowns
Authors: Sharif Mubashir , Aslam Samina , Khan Imran , Rehman Abdul , Khan Mansoor , Afzal Muhammad
Published: December 2022

Objective: The study aimed to ascertain the prevalence of retentive failure patterns of single crowns leading to de-cementation of the crowns and to estimate their average length of service.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from May to Nov 2020.

Methodology: 80 patients were selected using the non-probability Consecutive sampling technique. Both male and female patients with only single-unit crowns were included. In addition, the material used for the fabrication of crowns, years of service and site of retentive failure were recorded.

Results: Female patients (41, 51.3%) reported more frequently than males (39, 48.8%). The majority of the dislodged crowns (41, 51.3%) concerned the mandibular posterior region. Almost half of the crowns (44, 55%) dislodged due to fracture occurring at the interface of restoration and the cement. 68.8% of crowns served for 1-3 years before dislodgement. Most of the dislodged restorations (30, 37.5%) were provided by general dentists.

Conclusion: Mandibular posterior crowns were the most prevalent crowns that were dislodged, and the estimated length of most of the crowns was up to 3 years. Therefore, the anatomy of the tooth being prepared must be considered before preparing the tooth so that retentive failure may be reduced, thus improving the overall length of service.
Symptoms, Demographic Parameters and Health Profile of Post-Menopausal Women
Authors: Kiran Ayesha , Yazdani Tehreem , Batool Syeda Sadiqa , Hina Urooj
Published: December 2022

Objective: To determine the symptoms, demographic parameters and health profile of post-menopausal women and factors related to the deranged health profile.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Department of Gynecology and Obstetrics, Pak Emirates Military Hospital Rawalpindi Pakistan, from Jun 2019 to Aug 2021.

Methodology: Five hundred post-menopausal women were included in this study via convenience sampling. Menopause was confirmed based on clinical and laboratory information. A consultant Gynecologist inquired about details of clinical symptoms and demographic profile. Relationship of age, body mass index, use of hormonal replacement therapy and living with husband was assessed with the presence of deranged health profile among the post-menopausal women participating in this study.

Results: Out of 500 post-menopausal women studied in the given period, 323 (64.6%) had at least one clinical symptom of a deranged health profile, while 177 (35.4%) did not report any such symptom. The mean age of the study participants was 58.47 ± 4.561 years. Hot flushes 200 (40%) were the most commonly reported symptoms, followed by urinary tract infections 121 (24.2%) and palpitations 121 (24.2%). After applying the statistical analysis, high body mass index and not using hormonal replacement therapy emerged as factors associated with deranged health profiles in the study participants (p-value <0.001).

Conclusion: Most of the women had at least one clinical symptom after menopause. Hot flushes, urinary tract infections and palpitations were commonly reported symptoms. Patients with high body mass index and no hormonal replacement therapy were more likely to have a........
Patients Eagerness for 2nd Eye External Dacryocystorhinostomy after the Satisfactory Surgery of 1st Eye in Tertiary Care Hospital of Islamabad Suburbs
Authors: Matloob Afia , Akhtar Waseem , Yousafzai Erum
Published: December 2022

Objective: To determine patient satisfaction with successful external dacryocystorhinostomy for one eye and patients' preference time for second eye dacryocystorhinostomy after the first surgery.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Ophthalmology, HBS General Hospital, Islamabad Pakistan, from Jan 2018 to Dec 2020.

Methodology: A sample of 37 patients was calculated. All selected patients underwent bilateral external dacryocystorhinostomy and were followed for six months. Patient satisfaction was measured using a treatment satisfaction scale.

Results: A total of 37 patients were included in the study. The mean age of patients was 33.5 ± 3.1 years. Satisfaction with 1st eye external DCR was extremely satisfied in 14 (37.8%), satisfied in 14 (37.8%), neutral in 2 (5.4%), dissatisfied in 6 (16.2%) and extremely dissatisfied 1 (2.6%). 31 (83.8%) prefer second eye surgery in ≤1 year after first eye DCR, while 6 (16.2%) prefer second eye surgery after more than one year of first eye DCR surgery. The majority of females prefer ≤1 year duration for second eye DCR surgery as compared to males 25 (67.7%) vs 6 (16.2%), (p=0.03). Anatomical success and functional success were insignificantly associated with satisfaction of first eye DCR surgery of patients (p=0.793 and p=0.482)

Conclusions: High satisfaction with first eye dacryocystorhinostomy and greater preference for second eye dacryocystorhinostomy was found in patients coming to tertiary care hospital in Pakistan.
Prolotherapy Improves Anatomical and Clinical Outcomes in Monosodium Iodoacetate Induced Model of Osteoarthritis
Authors: Zahid Aqsa , Qamar Khadija , Qamar Abdullah , Faisal Tayyaba , Iftikhar Zubia , Saleem Saba
Published: December 2022

Objective: To assess the ameliorative effects of Prolotherapy on the pain score of the gait cycle in Monosodium Iodoacetate (MIA) induced osteoarthritis in the rat knee joint.

Study Design: Laboratory-based experimental study.

Place and Duration of Study: Department of Anatomy, Army Medical College, Rawalpindi in collaboration with the National Institute of Health (NIH), Islamabad and Pathology Lab Pak Emirates Rawalpindi, Pakistan, from Aug to Nov 2021.

Methodology: Thirty male Sprague Dawley rats were randomly divided into three groups (n=10 in each group). The control group was Group-A. To induce osteoarthritic changes in Group-B, a single dose of 1mg Monosodium Iodoacetate was injected intra-articularly into the right knee. Group-C received a single dose of 1mg Monosodium Iodoacetate injection in the right knee intra articularly to induce osteoarthritic changes, and was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% Xylocaine, 1ml of injection thiamine, and 1ml of injection Methylcobalamin) at 2, 6 and 10 weeks intra articularly into the right knee joint.  Before euthanasia, Pain scoring schemes for gait in rats of all groups were done at 0, 2 and 14 weeks.

Results: The present study concluded that prolotherapy improved the gait cycle pain score in experimental group C (p-value 0.001 on the intergroup comparison at two weeks and 14 weeks while p-value 0.001 when compared pain score within the Group C at 0, 2 and 14 weeks).

Conclusion: Prolotherapy had ameliorative effects on the pain score of the gait cycle in experimental Group C on Monosodium Iodoacetate......
Pneumothorax and Intrapulmonary Hemorrhage in CT-Guided Transthoracic Biopsy
Authors: Iftikhar Ammara , Zafar Saerah Iffat , Slehria Atiq Ur Rehman , Awan Aamir Aslam , Rahim Raza , Sheraz Atif
Published: December 2022

Objective: To study the frequency of pneumothorax and intrapulmonary haemorrhage in computed tomography (CT) guided transthoracic needle lung biopsy (NLB) and the factors that affect the development of these complications in Pakistan through a representative limited data obtained from a tertiary care centre.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, from Jan 2018 to Feb 2019.

Methodology: A total of 68 patients who underwent CT-guided transthoracic biopsy were evaluated for intra- and immediate (within 04 hours) post-procedural pneumothorax and pulmonary haemorrhage. The factors affecting the development of these complications were evaluated.

Results: Complications developed in 30 patients with the frequency of pneumothorax at 26.5 % and frequency of pulmonary haemorrhage at 19.1%. Significant risk factors for the development of pneumothorax were small lesions less than 2.5 cm in diameter (p-value <0.05), increased needle track path within the lung tissue of more than 21 mm (p-value = 0.05), and presence of emphysema in the surrounding lung tissue (p-value <0.05). In addition, smaller lesion size (p-value <0.05) and increased traversed lung parenchyma (p-value <0.05) were also significant factors in the development of intrapulmonary haemorrhage.

Conclusion: Significant risk factors for pneumothorax and intrapulmonary haemorrhage are smaller lesion size and length of puncture path. The presence of emphysema is related to the development of pneumothorax.
Effect of Posterior Subtenon Triamcinolone Acetonide in Refractory Diabetic Macular Edema
Authors: Habib Muhammad Kashif , Shafqat Rubab , Oozeerkhan Zeeshan Khan , Gul Anwar Ahmed , Jabeen Nighat , Sadiq Muhammad Usman
Published: December 2022

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME).

Study Design: Quasi-Experimental Study.

Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018.Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) >300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient’s best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months.

Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 µm, 332.81 ± 144.69 µm after one month, 292.81±147.59µm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 µm, 364.52 ± 167.95 µm after one month and 323.37±155.74 µm after six months. Similar results were observed for IOP and BCVA.

Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy.
Comparison of Recurrence of High Trans-Sphinteric Anal Fistula After Vaaft and Tight Setons in Military Hospital Rawalpindi
Authors: Akbar Muhammad Haroon , Bashir Umar , Shabbir Hassan , Ans Muhammad , Majeed Farhan Ahmed , Abbasi Shahzad Ahmed , Khan Attayaba , Amjad Muhammad Ammar
Published: December 2022

Objective: To compare the recurrence rate in patients undergoing fistulectomy using tight setons with those using videoassisted anal fistula treatment (VAAFT).

Study Design: Comparative prospective study.

Place and Duration of Study: Department of General Surgery, MH Rawalpindi, Pakistan from May 2018 to Dec 2021.

Methodology: We included 200 patients with high trans-sphincteric anal fistula (simple or complex) of age 18 to 60 years, having ASA I or II. Group- A comprised patients undergoing treatment with VAAFT, while Group- B included patients undergoing treatment with Tight Seton in conventional surgery. Patients were followed for three months after the procedure. Patients having a history of discharge around or in the vicinity of the previous external opening of the anal fistula were labelled as having a recurrence. Recurrence was confirmed on MRI Fistulogram.

Results: The mean age of patients in Group-A was 42.10±8.26 years, and in Group-B was 42.17±7.91 years (p=0.95). There were 58 male patients in Group-A and 55 male patients in Group-B (p=0.67). The mean duration of the fistula was 5.30±1.64 months in Group-A and 5.22±1.61 months in Group-B (p=0.72). Recurrence was diagnosed in 24 patients in Group-B and only 06 patients in Group-A (p<0.001).

Conclusion: Video-assisted anal fistula treatment (VAAFT) has a lower recurrence rate than Tight Setons in conventional surgery in treating high trans-sphinteric anal fistula.
Diagnostic Accuracy of Ultrasound for Small Bowel Obstruction in Paediatric Population Undergoing Laparotomy Keeping Surgical Findings as the Gold Standard
Authors: Liaqat Rabia , Majeed Ayesha Isani , Liaqat Bushra , Shafi Aqeel , Riaz Ramish , Akhtar Samina
Published: December 2022

Objective: To analyze the diagnostic accuracy of ultrasound in small bowel obstruction in the paediatric population and compare it with surgical findings.

Study Design: Cross-sectional study.

Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan from Jun 2018 to Jun 2019.

Methodology: This study enrolled 84 paediatric small bowel obstruction cases who underwent exploratory laparotomy at the Pakistan institute of medical sciences from Jun 2018 to Jun 2019. The clinically suspected cases of small bowel obstruction were referred by paediatric surgery to the Radiology department, where an ultrasound abdomen was performed by a senior resident, exclusively targeting the bowel. The clinical, sonological, and per-operative findings were recorded on a proforma.

Results: The mean age in our study was 3.5±2.7 years. A male gender predominance was noted. The most consistent greyscale feature favouring bowel obstruction was dilated bowel loops, found among 98.7% (76 out of 77) of surgically confirmed cases of bowel obstruction. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasound were 98.7%, 71.4%, 97.4%, 83.4% and 94.6% respectively. The sonological cause of obstruction was readily demonstrated among 51 (67%) out of 76 true positive cases. The most common site of obstruction was the distal ileum, with intussusception being the leading cause found among 32% of true positive cases.

Conclusion: The overall diagnostic accuracy of ultrasound in revealing small bowel obstruction is high among the paediatric population.
Effect of Melasma on Quality of Life of Patients using Dermatology Life Quality Index
Authors: Amar Ali , Nida Sumbal , Mudassir Muhammad
Published: December 2022

Objective: To assess the effect of melasma on the Quality of Life (QoL) of patients using the Dermatology Life Quality Index (DLQI).

Study Design: Cross-sectional study.

Place and Duration of Study: Department of dermatology PAF Hospital, Jacobabad Pakistan, from Jun 2019 to 2020.

Methodology: A total of 103 patients with melasma were enrolled in the study from the dermatology outpatient department after written informed consent. Patients of either gender aged 15 years and above were included in the study. Melasma Area and Severity Index assessed melasma severity. In addition, the impact on Quality of Life was assessed using the Dermatology Life Quality Index questionnaire.

Results: Among the 103 patients, 67 (65%) were females, and 36 (35%) were male. The mean age of patients was 29.50±7.94 years and included 78 (75.7%) married and 25 (24.3%) unmarried individuals. Mean Melasma Area and Severity Index was 22.04±11.23, including 36 (35%) patients with mild, 43 (41.7%) moderate and 24 (23.3%) patients with severe disease, respectively. Overall mean Dermatology Life Quality Index of the sample was 11.25±7.78, while mean scores for the mild, moderate and severe diseases were 5.89±.58, 10.33±5.75 and 20.96±6.62, respectively (p=0.001), indicating that Quality of Life is significantly more impaired with increased disease severity.

Conclusion: Melasma significantly affects the Quality of Life of the patients as measured by Dermatology Life Quality Index. The impact on Quality of Life is directly proportional to the severity of melasma assessed by the Melasma Area Severity Index.
Pulmonary Embolism at High Altitude: Analysis of Risk Factors
Authors: Khan Naimat Ullah , Adil Muhammad , Zaman Muhammad , Palwa Abdul Rahim , Tahir Muhammad , Nawaz Muhammad Rameez
Published: December 2022

Objective: To analyze the risk factors for pulmonary embolism stationed at high altitudes with high altitude as one of the determinants.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Combined Military Hospital Skardu Pakistan, from Jan 2016 to Jan 2020.

Methodology: A total of 25 consecutive cases with pulmonary embolism reported to this hospital during the study period were enrolled. Medical records of all patients were retrospectively analyzed to determine the risk factors. In addition, patient demographic data, clinical features, and laboratory and radiological findings were recorded.

Results: Mean age of the patient was 30.68±5.37 years with a range from 23 to 40 years, the mean height of deployment was 17223.00±3577.00 feet, while the mean duration of stay was 53.92±44.76 days. Dyspnoea (84%) was the commonest clinical presentation followed by palpitation, chest pain, headache and haemoptysis. Most patients (88%) were non-smokers, while no patient had known significant risk factors. Thrombophilia and vascultitic screening were negative for all patients. In the absence of any significant hereditary or acquired risk factor, high altitude remains the only thrombogenic risk factor patients deployed at heights.

Conclusion: Stay at a high altitude is a major risk factor for pulmonary embolism in young patients without any other known risk factor.
Diagnostic Accuracy of Non-Invasive Hepatic Ultrasound Score for Non-Alcoholic Fatty Liver Disease Keeping Computed Tomography as a Gold Standard
Authors: Waheed Sidra , Slehria Atiq Ur Rehman , Tahir Sadia , Ali Dilshad , Nisar Uzma , Raja Waseem
Published: December 2022

Objective: To determine the diagnostic accuracy of non-invasive hepatic ultrasound score for the diagnosis of non-alcoholic fatty liver disease (NAFLD) by keeping computed tomography. (CT) as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi from Dec 2017 to May 2018.

Methodology: All patients from any ethnicity and gender with more than 18 and less than 60 years of age were considered for the study. Hepatic ultrasound score based on the anteroposterior diameter of the right lobe of the liver, deep beam attenuation was calculated, and results were compared with CT scan findings.

Results: A total of 101 patients were included. A total of 69 patients had a total Ultrasound score of 2 or more, fulfilling the study’s criteria to be labelled as Non-Alcoholic Fatty Liver Disease. On a CT scan, 71 patients fulfilled the criteria to be labelled as having Non-Alcoholic Fatty Liver Disease. Keeping the Computed Tomography scan gold standard, 59 patients were true positive, and 10 were false positive. The sensitivity and specificity of this score were 83.09 % and 66.67%, respectively. The hepatic ultrasound score had a Positive Predictive Value of 85.50% and a Negative Predictive Value of 62.5%.

Conclusion: Ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe is a reliable, reproducible and accurate tool for diagnosing Non-Alcoholic Fatty Liver Disease.
Hla-B27 Allele Connotation Amongst Individuals Conjectured of Spondyloarthritis (SPA) In Pakistan
Authors: Javed Annam , Fakhar Amir , Ashraf Nadeem , Ahmed Bilal , Atif Khaula , Javed Amna
Published: December 2022

Objective: To define the link of HLA-B27 with Spondyloarthritis (SPA) among the study population.

Study Design: Cross-sectional study.

Place and Duration of Study: Rheumatology Department Pak-Emirates Military Hospital (PEMH) Rawalpindi Pakistan, from Jun 2019 to Jan 2020.

Methodology: Patients assumed to be suffering from spondyloarthritis (Spa), reporting for routine follow-up at subject OPD, were enrolled. Socio-demographic and clinical variables were measured with HLA-typing.

Results: Among 550 subjects; age and BMI scores were 31.15±10.399 (18-63 years) and 23.39±4.19 (17.2-35.0 kg/m2), respectively. 391 (71.1%) patients were found positive for HLA-B27, which was significantly more amongst 20-40 years aged (p=0.003), those with non-professional education (p=0.003), associated with raised CRP(C-reactive protein, p<0.001) and ESR(erythrocyte sedimentation rate, p<0.001), with 3-6 years since the onset of symptoms (p<0.001), up to 2 years delay in diagnosis(p<0.001), peripheral arthritis(p 0.008), having co-morbidities (p=0.011), less DAL (daily activities of life, p<0.001) with no significant impact of gender, SEC (socio-economic class), pain severity, co-morbidities and formal exercise. Severe pain was stated more by females (p=0.008), low SEC (p=0.003) and overweight patients with BMI 25-29.9 (p=0.001)

Conclusion: There is a strong association between HLA-B27 and spondyloarthritis (Spa), predominance in the 2nd and third decade, and no gender predilection. Auxiliary exploration would be valuable to recognize the predominant subtypes of the HLA-B27 allele in Pakistani patients with spondyloarthritis (Spa).
Is Sevelamer Carbonate Better Than Calcium Acetate in ControllingChroni Kidney Disease-Mineral Bone Disease in Dialysis Patients
Authors: Tahir Taleah , Raja Khalid Mahmood , Azam Malik Nadeem , Butt Batool , Mir Abdul Wahab , Ahmed Naveed
Published: December 2022

Objective: To ascertain the efficacy of Sevelamer Carbonate as a better phosphate binder for controlling mineral bone disease biochemical parameters in dialysis patients of a tertiary care centre compared to calcium acetate.

Study Design: Prospective Quasi-experimental study.

Place and duration of the study: Dialysis unit of Pakistan Emirates Military Hospital Rawalpindi Pakistan from Aug to Dec 2020.

Methodology: The sample population comprised 91 patients undergoing maintenance thrice weekly haemodialysis patients treated with Sevelamer Carbonate or Calcium Acetate. CKD-MBD was assessed by serum calcium, phosphorus, ALP, albumin and PTH at the start of the study and then at the end of three months after being treated with phosphate binders.

Results: Both Groups had reduced serum phosphorus significantly from baseline to 12 weeks but Sevelamer slightly more than calcium acetate. (Group-1 from 6.90±1.35 to 5.10±1.21, while Group-2 from 7.00±1.31 to 5.90±1.48). The mean Calcium × Phosphorus product was also significantly reduced (p<0.005), decreases after 12 weeks, with 50.0 ± 16.0 in the Sevelamer Hydrochloride Group and insignificantly reduced (52.20±5.20mg2/dl) in the calcium acetate Group. The mean serum calcium increased significantly in the calcium acetate Group from 9.55±0.47 to 10.50±0.90) p=0.003 but was unchanged in the Sevelamerhydrochloride Group (9.56±0.60 to 9.57±0.67; p=0.94).

Conclusions: CKD-MBD and its sequelae need special medication, and early detection of biochemical abnormalities and timely intervention with phosphate lowering therapy can abridge the disease burden, thus revamping the quality of life and ultimately abatement of cardiovascular morbidity and mortality.
Clinico-Immunological Profile of Systemic Lupus Erythematosus Patients in Pakistan and Their Correlation
Authors: Khan Zafar Ayub , Mushthaq Samina , Sameera Saba , Salim Babur , Ahmed Syed Nazir , Zahid Pir Muhammad , Gul Haris
Published: December 2022

Objective: To see the clinical and immunological profile of systemic lupus erythematosus (SLE) patients and their correlation with the central nervous system and renal involvement.

Study Design: Cross-sectional study.

Place and Duration of Study: Fauji Foundation Hospital Rawalpindi from Sep 2019 to Sep 2020.

Methodology: One hundred forty patients were selected according to SLE ACR (American College of Rheumatology) criteria. Detailed history and examination, including dermatological examination, were done, and blood samples were taken for baseline investigations and SLE-related autoimmune profile. Statistical analysis was done using SPSS 23 to determine the correlation between skin, central nervous system and renal involvement.

Results: In our study, among the lupus-specific lesions, photosensitivity was most frequent 119 (85%) finding followed by oral ulcers 114 (81.4%), alopecia 112 (80%) and malar rash 81 (57.9%). Among the immunological profile, antinuclear antibody (ANA) was the most frequent 116 (82.9%) finding, followed by anti-double stranded antibody 71 (51.7%). Hypocomplementemia and anti-Sm antibody was significantly associated with lupus nephritis (p-value <0.05). There was no correlation between skin and neuropsychiatric involvement and skin and nephritis.

Conclusion: This study depicts the clinical immune profile of SLE patients in Pakistan. In our patients, autoimmune profile and complement levels could predict renal involvement.
Effect of the COVID-19 Pandemic on Antenatal Care
Authors: Khalil Adiba Akhtar , Amin Nabila , Akhtar Joodi Kizilwarda , Amir Muhammad Ayhan , Amir Suha , Gul Uzma
Published: December 2022

Objective: To assess how the antenatal population of a hospital was affected by the COVID -19 Pandemic.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Antenatal Clinic of Government Hospital, Rawalpindi Pakistan, for the month of August 2020.

Methodology: The population in the antenatal clinic of a hospital were given a questionnaire with simple directed questions after consent.

Results: All (150, 100%) of the antenatal population received their COVID-19 pandemic information from television. Most 147 (98%) did not feel embarrassed if they contracted COVID-19 infection, and 147 (98%) took precautions against it. The majority, 146 (97%) of women, had an antenatal check-up. Out of the total, 126 (84%) had a private check-up, but only 36 (24%) had more private visits than prior pregnancies. A significant number, 56 (37%), had to spend more than in prior pregnancies, but only 28 (18.6%) had fewer antenatal visits than before. Most 141 (94%) of women wanted a higher frequency of antenatal visits than the recommended 08 visits by the WHO.

Conclusion: The COVID-19 pandemic did not affect antenatal care because of a well-established private health care system. The patients in prior pregnancies were already using the private sector.
Comparison of the Impact of Topical Chlorhexidine Versus Methylated Spirion Umbilical Cord Sloughing Time in Neonates
Authors: Hussain Irshad , Wahid Sughra , Qureshi Maliha Akhtar , Hashmi Fasih ul Islam , Fahim Muhammad
Published: December 2022

Objectives: To study the impact of applying topical Chlorhexidine compared with Methylated spirit on umbilical cord sloughing time in neonates.

Study Design: Quasi-experimental study.

Place and Duration of Study: Paediatric Department, KRL Hospital, Islamabad Pakistan from Oct 2018 to Mar 2019.

Methodology: A total of 100 neonates were enrolled in each Group, i.e., Chlorhexidine and Methylated spirit. After taking informed consent from the parents, the treatment was applied twice daily for five days. Parents had telephonic interviews about the signs of umbilical cord infection on day two following enrollment in the study, and then babies were examined for signs of omphalitis during each hospital visit on days-7, 14 and 21. Umbilical cord sloughing time was noted.

Results: Both Groups were independent (statistically insignificant) with respect to neonatal birth weight, gestational age, neonatal sex, mode of delivery and type of feed with p-values of 0.258 and 0.17, 0.066, 0.304 and 0.143, respectively. The result showed that the mean rank of cord sloughing time with the Methylated spirit was significantly less than Chlorhexidine, with the p-value of 0.001.

Conclusion: Based on our results, we concluded that the application of Methylated spirit on the umbilical cord shortens the sloughing time compared to Chlorhexidine, but both treatments have comparable efficacy in preventing omphalitis.
Comparative Study of Detection of Diabetic Neuropathy by Clinical Assessment and Nerve Conduction Study in Type 2 Diabetes Mellitus Patient
Authors: Sarwar Natasha , Raja Khalid Mehmood , Khan Sarah , Uruj Sana , Hussain Amina , Tariq Maria
Published: December 2022

Objective: To compare the detection of diabetic neuropathy by clinical assessment and nerve conduction study in type 2 diabetes mellitus patients.

Study Design: Prospective comparative study.

Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi Pakistan, Jan 2020 to May 2021.

Methodology: A total of 300 patients having type 2 diabetes mellitus for more than ten years were included in the study. Revised neuropathy disability score was calculated by the consultant medical specialist on all the patients to make a clinical diagnosis of neuropathy. Nerve conduction studies were performed in the Department of Neurology. Findings of both methods to diagnose the patterns of diabetic neuropathy were compared.

Results: Out of 300 patients suffering from type 2 diabetes mellitus, 188 (62.7%) were males, while 112 (37.3%) were females. The mean age of the study participants was 53.33±4.55 years, and the mean duration of diabetes mellitus was 11.22±5.71 years. Symmetrical neuropathy, motor polyneuropathy and sensory neuropathy had a statistically significant diagnostic pattern when assessed from clinical method and nerve conduction study (p-value <0.05).

Conclusion: Neuropathy had been a common finding among patients suffering from type 2 diabetes mellitus for more than ten years. A significant difference existed in diagnosing various patterns and types of neuropathies when clinical methods were compared with nerve conduction studies.
Bipolar Affective Disorder in a Patient of Achalasia Cardia: A Case Report of Young Man
Authors: Zubair Usama Bin , Ejaz Khola , Mumtaz Humza , Shoaib Muhammad Shahbaz
Published: December 2022

We present a case of 22-year-old known Achalasia cardia, previously treated for depression, presented with irritable behaviour, aggression, over-talkativeness, ideas of self-importance, running away from home and decreased sleep. He was treated for imperforate anus with anoplasty on the first day of birth and for Achalaisa Cardia with heller myotomy at 17 years of age. His Young Mania Rating Scale score was 22, and his Brief Psychiatric Rating Scale score was 50. He was diagnosed as a case of bipolar affective disorder. Marked improvement in the symptoms occurred after two weeks of the treatment with sodium valproate, olanzapine and clonazepam.
Hemodialysis Access Outcome in Elderly Population and its Association with Mortality
Authors: Arif Anum , Bhatti Ahsin Manzoor , Sohail Aima , Jamil Usman , Nofil Sabih , Riaz Bismah
Published: December 2022

Objective: to determine the outcome of arteriovenous fistula in the elderly compared to the younger age group and its association with mortality so that the best approach to hemodialysis access can be defined.

Study Design: Prospective longitudinal study

Place and Duration of Study: Department of Vascular Surgery, CMH, Lahore Pakistan, from Jan 2020 to Aug 2021.

Methodology: All the Patients who presented to access the Surgical Clinic were categorized into three groups according to their age. Outcome variables like fistula maturation, complications and mortality were compared according to age groups.

Result: A total of 184 patients were recruited. We found that in the age group >70 years, there was male predominance (12, 54.5%), three-quarters of them were on hemodialysis at the time of access surgery, only half of them were functional at one year of follow-up, and 6 (27.3%) were not alive at the time of contact. In addition, the pseudo aneurysm was the most common complication in this group, which was the most dreadful of all access-related complications and further put the already frail at risk.

Conclusion: No single optimal approach can be expected to meet the needs of all, and an extensive patient-centred case-based discussion is required for each patient in the hope that optimal dialysis access can be created. Age cannot be defined as an independent risk factor for access creation.
The Co-Existence of Anaemia in Chronic Psychiatric Disorders: A Study at Tertiary Care Hospital
Authors: Nageen Ayesha , Nisa Zaib un , Tauheed Sidrah , Ara Jamal
Published: December 2022

Objective: To study the frequency of anaemia in various chronic psychiatric disorders in an adult population.

Study Design: Cross-sectional study.

Place and study duration: Creek General Hospital, Karachi Pakistan, from Feb to May 2021.

Methodology: Two hundred and six patients were enrolled in the outpatient clinics after informed consent. Adult patients of 18 to 50 years who were clinically diagnosed with a psychiatric disorder by a certified psychiatrist and had no organicity were included in the study. Anaemia was defined as haemoglobin less than 13 gm/dl for males and less than 12 gm/dl in females. The severity of anaemia was classified into mild, moderate and severe according to the haemoglobin range by WHO criteria. The type of anaemia was categorized into microcytic, normocytic and macrocytic according to the value of mean corpuscle volume.

Results: The overall frequency of anaemia in patients suffering from psychiatric disorders was 126 (61.2%) out of 206 persons. Among the anaemic, 20 (58.8%) had schizophrenia; depression was present in 35 (63.6%), generalized anxiety disorder in 39 (57.4%), somatoform disorders in 20 (62.5%) and 12 (70.6%) in bipolar subjects. Among those who were anaemic, a normocytic value was found in 28 (13.6%) adults, microcytic in 95 (46.0%) patients and macrocytic in 4 (1.9%). The severity of anaemia among anaemic was highest in the mild group. Sixty-nine males (53.6%) and 89 females (65%) were anaemic. (p=0.078). Anaemia was found highest in the 40-50 years age group.

Conclusion: Anaemia was frequently found in adults suffering from chronic psychiatric disorders.
Urinary Sodium and Pregnancy Induced Hypertension; A Unsolved Mystery
Authors: Khattak Muhammad Irfan , Shahid Rana , Khattak Samina Naseem , Khan Jamal Azfar , Naveed Asma , Akram Umbreen
Published: December 2022

Objective: to know the connection between Sodium intake/urinary Sodium excretion and the tendency to develop hypertension during pregnancy.

Study design: Prospective longitudinal study.

Place and Duration of Study: Combined Military Hospital Kharian, District Gujrat Pakistan from Jul 2019 to Dec 2020.

Methodology: The included population was divided into two equal Groups (Normotensive and hypertensive). Blood pressure was measured at a pre-determined interval starting from the initial prenatal visit before 18 weeks of pregnancy to the 36th week of gestation. Urinary Sodium secretion was determined in 24-hours urine accumulated at three stages between 18 and 36 weeks of gestation. The main outcome actions were the implication of the difference in mean between urinary Sodium and alterations in maternal BP.

Results: The mean age of our study population was 32 years ± 6.96 years, and it ranged from 31 to 48 years. The mean urinary sodium was 141.00 ± 24.879, 140.00 ± 29.73 and 139.00±15.17 mEq/day in the normotensive group, which was 142.00 ± 21.90, 143.00 ± 32.03 and 139.00 ± 14.27 mEq/dl in the hypertensive group. In the hypertensive group, systolic Blood pressure was also high with mean systolic BP of 143.00±12.10, 141.00±12.47 and 148.00±16.82 respectively during the three trimesters. As expected, it was normal in the second group.

Conclusion: There was no significant association between sodium intake and pregnancy-induced hypertension.
Comparison of the Outcome of Intramedullary Nailing Versus External Fixator Fracture Repair in Gustilo Type IIIA Tibio Fibular Fracture
Authors: Ali Pervez , Jatoi Fahad , Hussain Muzafar , Muhammad Dost , Matlo Ejaz , Khoso Riaz Ellahi , Sajjad Mian , Kumar Suresh , Baloch Muzafar , Murtaza Kashif
Published: December 2022

Objective: To compare the outcome of intramedullary nailing versus external fixator fracture repair in patients presenting with Gustilo Type IIIA tibiofibular fracture.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Orthopaedics, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Feb to Nov 2020.

Methodology: A total of 200 patients were included. Patients were divided into two Groups. In Group-1, intramedullary nailing was done. In Group-2, uniplanar external fixation was done. Both Groups were followed up for six months for assessment of bone union.

Results: The mean age in the Intramedullary Nailing (IMN) Group was 39.21+6.24 years and in the External Fixator (EF) Group mean age was 37.48+8.41 years. In our study, it was found that 81(81%) patients in the EF-Group showed bone union, while 92 patients in the IMN-Group showed bone union. Malunion occurred in 10 in the EF-Group, while only six in the IMN Group. Non-union of bone was unfavourable in the 18 patients of EF- Group and 7 in the IMN-Group. The infection rate was also higher (16%) in patients treated with EF. We noted a significant association between union, non-union, infection and mode of treatment with the p-value of 0.023, 0.019 and 0.046, respectively.

Conclusion: Bone union outcome of Gustilo IIIA open tibial shaft fractures appear superior when treated by Intramedullary Nailing technique compared to External Fixation.
Kohl (SURMA) on CT Scan – An Incidental Finding
Authors: Junejo Murtaza Sameen , Aziz Pir Abdul Ahad
Published: December 2022

Since long time, Kohl has always been given a priority in ophthalmology for treating multiple eye ailments, and females and children have also used it. There are different reports published in literature against the use of Kohl in eyes that causes high blood levels that may lead to lead poisoning. As part of such findings in the literature, we publish an incidental finding of Kohl in eyes on CT scan.