bluuebunny/crossref_metadata_2025 huggingface dataset:
AUDIT OF MANAGEMENT OF ADULT CHOLEDOCHAL CYSTS
Authors: Nasir Ammad Ud Din , Khan Muhammad Shoaib , Saif Anas Bin , Butt Qasim , Abbasi Hanif
Published: January 2022

Objective: To analyze the complexity and diversity of type, surgical management and complications in adult choledochal cysts presenting to a Hepatobiliary unit of a tertiary care hospital.

Study Design: Case series.

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2019.

Methodology: All the patients diagnosed with choledochal cyst and underwent surgical procedure between Jan 2017 to June 2019 were analyzed. The clinical features, types, operative procedure and outcomes of the patients in terms of post-operative morbidity and mortality were assessed. Calvin Dindo classification was used to assess complications.

Results: A total of 17 patients were studied, out of which, 13 were females (76.5%) and 4 were males (23.5%) with mean age of 37.41 ± 16.96 years. There were 13 type I (76.5%), 2 type IVa (11.8%) and 1 type II (5.9%) choledochal cysts according to Todani’s classification. Extrahepatic cyst excision with a Roux-en-Y hepatico-jejunostomy was performed on all 17 patients. There was no mortality in the series. Post-operative complications occurred in 4 (23.5%) patients, 2 were grade II, 1 was grade I and 1 grade III according to Clavin Dindo scale. Long-term follow up revealed recurrent cholangitis in 3 (17.6%) patients which settled on antibiotic regime. The median follow up time was 1.5 years.

Conclusion: The total extra-hepatic excision with Roux-en-Y hepaticojejunostomy is the treatment of choice for adult choledochal cyst. The procedure has low morbidity and very low mortality.
NEGATIVE APPENDECTOMIES ARE MORE COMMON IN FEMALES OF REPRODUCTIVE AGE GROUP
Authors: Ali Zahid , Khan Muhammad Rahil , Memon Riyasat Ahmed , Ujjan Ikram Din , Hussain Fida , Nisar Zainab
Published: January 2022

Objective: To compare the negative appendectomy in the females of reproductive and non-reproductive age groups.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Pathology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan, from January 2018 to December 2019.

Methodology: A total of 1126 appendectomy specimens were enrolled irrespective of age and gender. The biodata of patients was retrieved from the database. Statistical analysis was done using SPSS version 22.

Results: Out of total 1126 reported cases, 787 (69.9%) were males and 339 (30.1%) were females. The mean age was calculated to be 24.43 ± 12.42 years ranging from 2-94 years. Histopathological examination revealed cases of acute appendicitis 374 (33.2%), acute appendicitis with peri-appendicitis 478 (42.5%), fibrous obliteration 28 (2.5%) and parasitic infestation 7 (0.6%). Overall negative appendectomies were 219 (19.4%) and were prominent in females 100 (29.5%) than males 119 (15.1%). Also it was higher in females of reproductive age group 77 (30.4%) than in non-reproductive age group 23 (27.9%).

Conclusion: In our study negative appendectomy in females of reproductive age groups was found to be higher than expected. Clinical scoring systems, biochemical markers, imaging modalities, and second opinion from other specialties like internal medicine, gynae and obstetric have been introduced to substantiate the diagnosis of acute appendicitis and thereby decreases the negative appendectomy.
EFFICACY OF METHOTREXATE VERSUS LEFLUNOMIDE VERSUS COMBINATION OF BOTH IN ACTIVE RHEUMATOID ARTHRITIS
Authors: Tirmizi Syed Haider , Fakhr Amer , Amer Ahsan , Sajjad Kaswar , Nawaz Khurram Haq , Sharif Abid
Published: January 2022

Objective: To determine the efficacy of Methotrexate versus Leflunomide versus combination of both among patients managed at Pak Emirates Military Hospital with active rheumatoid arthritis.

Study Design: Prospective comparative study.

Place and Duration of Study: Rheumatology/General Medicine Department, Pak Emirates Military Hospital Rawalpindi, from May 2019 to June 2020.

Methodology: Patient of active rheumatoid arthritis who fulfilled American college of rheumatology criteria of 1997 were included in the study. They were randomly divided into three groups with group A receiving Methotrexate, group B receiving Leflunomide while group C received the combination of both Methotrexate and Leflunomide. Disease activity was assessed by using the Disease Activity Score-28 in all the three groups after three months of treatment.

Results: Mean age of the study participants was 36.919 ± 6.85 years. One hundred and fifty (83.3%) patients were female while 30 (16.7%) were male. Out of 160 (88.9%) patients achieved remission according to Disease Activity Score-28 score at the end of three months while 20 (11.1%) did not achieve remission. Pearson chi-square test revealed that none of the factors studied including the treatment option had any statistically significant relationship with presence of remission among the target population (p-value 0.386, 0.815, 0.194 and 0.145 for age, gender, duration of symptoms and type of treatment respectively).

Conclusion: Remission rate among the rheumatoid arthritis patients in response to treatment was overall good in the study. In terms of efficacy for symptoms of rheumatoid arthritis and achieving remission, after three months of treatment all the three options..................
CROSS-REACTIVITY OF COVID-19 IGG ASSAY WITH KNOWN IMMUNE-MEDIATED AND INFECTIOUS DISORDERS
Authors: Zehra Nayab , Khan Muhammad Dilawar , Batool Hijab , Chughtai Omar Rasheed , Chughtai Akhtar Sohail , Usman Muhammad
Published: January 2022

Objective: To assess the cross-reactivity of COVID-19 IgG assay with known immune-mediated and infectious disorders and evaluate for any false-positive reactions to determine the specificity of the serological assay.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of Chemical Pathology, Chughtai Institute of Pathology, Lahore Pakistan, from Sep to Oct 2020.

Methodology: A total of 116 samples were included in the study of both males and females. Diagnosed cases of typhoid fever, viral hepatitis, systemic lupus erythematosus (SLE), syphilis, multiple connective tissue disorders (MCTD), varicella-zoster infection, rabies, toxoplasmosis, epstein-barr virus (EBV) infection, rubella, rheumatoid arthritis, AIDS, cytomegalovirus (CMV) infection and dengue fever were included in the study. Three samples of multiparous women aged more than 40 years were also included in the study. IgG antibody levels were measured against SARS-CoV-2 with a cut-off index of 1.4.

Results: Out of 116, only 3 (2%) samples were reactive for IgG against SARS-CoV-2. The categories showing cross-reactivity were typhoid, hepatitis C, and CMV. All specimens showing cross-reactivity were of females. Assay under consideration showed a specificity of 97.4%.

Conclusion: Cross-reactivity was seen in pre-pandemic cases of infectious diseases with COVID-19 IgG antibody assay. Medical lab professionals must verify the serological assays before use in the clinical laboratory to avoid false-positive results.
EFFECTS OF UNILATERAL INTRAVITREAL BEVACIZUMAB ON THE CONTRALATERAL EYE HAVING DIABETIC MACULAR EDEMA
Authors: Bashir Aziz Jan , Hannan Abdul , Chaudhary Salman Sohail , Zafar Sarah , Syed Abdullah Naeem , Massana Syed Hassan
Published: January 2022

Objective: To investigate the effect of unilateral intravitreal Bevacizumab on contralateral eye in bilateral diabetic macular edema.

Study Design: Quasi-experimental study.

Place and Duration of Study: Retina Department of Al-Shifa Trust Eye Hospital, Rawalpindi, from Sep to Dec 2020.

Methodology: Thirty-two patients were enrolled with consecutive sampling. All the patients had clinically diagnosed diabetic macular edema having >275µm macular thickness on OCT. They were injected with 1.25mg/0.05mL of Bevacizumab in one eye. Baseline macular thickness was compared with 4 weeks follow up macular thickness, using Optical Coherence Tomography.

Results: The central macular thickness in the untreated eye at baseline was 396.97 ± 29.79 µm and 388.34 ± 30.06 µm at 4 weeks (p-value=0.001). The difference in central macular thickness in treated and untreated eyes were 28.44 ± 4.11 µm and 19.81 ± 5.31 µm respectively (p-value = 0.001). There were statistically significant differences between these measurements.

Conclusion: Injecting Bevacizumab in one eye for diabetic macular edema has statistically significant effect on the contralateral non-injected eye macular thickness.
EFFICACY OF NEGATIVE PRESSURE WOUND THERAPY IN EARLY DIABETIC FOOT ULCER MANAGEMENT IN COMPARISON WITH ADVANCED MOIST WOUND THERAPY
Authors: Sheen Naveed Ahmed , Samar Ali Murtaza , Butt Muhammad Ibrar , Ayub Zeeshan , Nadeem Faisal
Published: January 2022

Objective: To compare negative pressure wound therapy with advanced moist wound therapy in managing early diabetic foot ulcer.

Study Design: Quasi-experimental study.

Place and Duration of Study: Surgical Department, Combined Military Hospital Rawalpindi, from Jul 2016 to Jun 2018.

Methodology: A total of 100 patients of diabetic foot ulcer were randomly allocated into two equal groups for the treatment with negative pressure wound therapy (NPWT) and advanced moist wound therapy (AMWT). Ulcers were reassessed after 4 weeks for presence of granulation tissue covering entire ulcer base and reduction of 3 cm in largest diameter of ulcer.

Results: Mean age of the study participants was 57.08 ± 9.99 years. 33 patients had Wagner grade-I ulcer, while remaining had Wagner grade-II ulcer. Mean ulcer size at presentation was 6.46 ± 1.71 cm. Both study groups were comparable in terms of mean age (p=0.968), wound size at presentation (p=1.000), age (p=0.695), gender (p=1.000) and Wagner ulcer grade (p=0.288). Mean ulcer size was found smaller with negative pressure wound therapy (3.46cm, p=0.061) at follow-up visits. Reduction in ulcer size ≥3cm was achieved frequently with negative pressure wound therapy technique (72.0% vs. 38.0%; p>0.01). Mean healing time was 4.11 ± 1.65 weeks which was lower with negative pressure wound therapy (3.66 weeks vs. 4.56 weeks; p>0.05). Treatment efficacy (healing in ≤4 weeks and ≥3cm reduction in ulcer) was significantly higher with negative pressurewound therapy (72.0% vs. 38.0%; p<0.01) as well.

Conclusion: This study demonstrates superiority of negative pressure wound therapy over advanced moist...............
CENTRAL MACULAR THICKNESS AFTER CATARACT SURGERY IN NON-DIABETICS AND DIABETICS WITHOUT RETINOPATHY
Authors: Shafi Marrium , Khan Muhammad Akmal , Lodhi Yaseen , Aftab Asma , Sarfraz Muhammad Haroon
Published: January 2022

Objective:

To determine the mean change in central macular thickness after cataract surgery and to compare the mean change in central macular thickness after cataract surgery in non-diabetics and diabetics without diabetic retinopathy

Study design:

Case control

 

Study settings and duration:

A case control study was carried out at Ophthalmology department, POF hospital, Wah Cantt. Study duration was 6 months (April 2019-September 2019)

 

Material and methods:

A sample size of 60 patients was calculated by using Open Epi Software. We used non probability consecutive sampling. Patients were divided into two groups; Cases (Diabetic) and controls (non-Diabetic). All patients underwent phacoemulsification and observed after 4 weeks for macular thickness measurement using optical coherence tomography before and after surgery. Data analysis was done with SPSS version 20. Post stratification t test was applied. P value ≤0.05 was considered significant.

 

Results:

Total 60 patients were included. Mean age of patients was 65.31 ±7. 63SD.There were 35 (58.3%) males and 25 (41.7%) female patients in the study. We found a significant increase in central macular thickness in cases and controls [(223.100±15.86SD vs 227.2667±17.9SD, p=0.000) and (221.200±12.16SD vs 226.289±16.7861SD, p =0.001)] before and after phacoemulsification in cases and controls respectively. However, no significant difference was found between the groups (p=0.486).

 

Conclusion:

Central macular thickness was increased after uncomplicated phacoemulsification in both diabetics and non-diabetics without retinopathy for up to a follow-up period of 4 weeks but the thickness did not differ between the two groups.
COMPARISON OF EFFECTS OF DIFFERENT NAIL TIP POSITIONS ON ANTERIOR KNEE PAIN AFTER INTRAMEDULLARY INTERLOCKING NAILING FOR TIBIAL SHAFT FRACTURES
Authors: Hassan Muhammad , Anwar Adnan , Udin Hassan Hassan , Saleem Muhammad Rehan , Arif Usman
Published: January 2022

Objective: To determine the frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures and to compare the intensity of anterior knee pain between positive and negative anterior cortex nail groups.Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi, from Oct 2018 to Apr 2019.

Methodology: 100 cases of tibial shaft fracture were divided into two groups according to anterior cortex nail distance. Patients 18-40 years of age of both genders, closed fractures, Gustilo Andersen I open tibial diaphyseal fractures and nail tip more than 5mm from tibial tuberosity were included. Patients with osteoarthritis, pathological fractures, renal disease, open fracture GA-II & GA-III and knee instability were excluded from the study. Both groups with positive and negative anterior cortex nail distance were compared for pain using the chi-square test.

Results: Frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures was found in 24% of patients. 8 (16%) out of 50 patients in the group with nail tip deep to anterior cortex had anterior knee pain while 16 (32%) out of 50 patients in the group with nail tip protruding from anterior cortex suffered anterior knee pain (p-value = 0.061).

Conclusion: Intramedullary interlocking nailing in tibial shaft fractures with nail tip deep to anterior cortex showed less pain as compared to nail tip protruding from anterior cortex although it was not statistically significant.
DIFFICULTY AND DISCRIMINATION ANALYSIS OF END OF TERM MULTIPLE-CHOICE QUESTIONS AT COMMUNITY MEDICINE DEPARTMENT, WAH MEDICAL COLLEGE
Authors: Ramzan Musarat , Khan Khola Waheed , Bibi Saana , Imran Shezadi Sabah
Published: January 2022

Objective: To perform post analysis of multiple-choice questions given in the 2nd term and send up examinations of the years 2016 to 2018, to establish relationship between difficulty (DF) and discrimination indices (DI) and to find out significant mean difference between the two.

Study Design: Cross sectional study.

Place and Duration of Study: Community Medicine Department, Wah Medical College, Wah, from Nov 2018 to Mar 2019.

Methodology: A total of 390 Multiple-Choice Question of second term and send-up were taken for the study from the year 2016, 2017 and 2018. The response sheets were assessed by Optical Machine Reader (OMR) and the level of difficulty, power of discrimination and reliability were obtained. The data was entered in SPSS version 22.

Results: A total of 315 test items were included. Results of the study showed that the reliability (KR20) for all the examined items was in the acceptable range i.e. ≥0.7 and there was no association was found between difficulty index and year p=0.310. The mean difficulty index was found to be 0.48 ± 0.22 and discrimination index as 0.24 ± 0.14.

Conclusion: The analysis of 390 test items showed that most of the questions were acceptable in terms of difficulty and discrimination. There is still a need to modify and improve the testing ability of the MCQs with negative discrimination and higher difficulty index.
COMPARISON OF SERUM CALCIUM LEVELS AMONG EXTREMELY PRETERM AND SEVERLY PRETERM NEONATES AT A PERIPHERAL MILITARY HOSPITAL
Authors: Aslam Sohail , Khan Fawad Ahmad , Tufail Omer , Mumtaz Naila , Maqsood Syed Uzair , Yousaf Muhammad
Published: January 2022

Objective: To determine the frequency and compare serum calcium levels amongst extremely preterm and very preterm neonates.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Combined Military Hospital, Multan Pakistan, from May to Oct 2018.

Methodology: A total of 217 preterm neonates, born at Combined Military Hospital Multan up to the gestational age of 32 weeks completed from last menstrual period, were included in the study. They were divided in to two group’s i.e. very preterm and extremely preterm neonates. Those born between 28-32 weeks completed of gestation were categorized as severely preterm. Extremely preterm were those born between 24-28 weeks completed of gestation. Venous blood samples were acquired at approximately 36 hours after birth and total serum calcium levels were analyzed. Neonates having total serum calcium levels <7 mg/dL were declared as suffering from hypocalcaemia.

Results: Out of 217 neonates, 117 (53.9%) were male while 100 (46.1%) were female. Mean gestational age was 30.98 ± 2.12 weeks while mean parity of the mothers was 2.82 ± 1.08 children. Mean birth weight was 1510.26 ± 142.38 grams. One hundred and seventeen (53.9%) of the preterm neonates suffered from hypocalcaemia with the mean total serum calcium level being 6.58 ± 0.86 mg/dL. Hypocalcaemia was more common in extremely preterm neonates compared to very preterm neonates (p<0.05).

Conclusion: Hypocalcaemia is a frequent complication encountered in preterm neonates born between 24-32 weeks gestation. Within these neonates, the frequency of hypocalcaemia is higher in extremely preterm compared to severely preterm babies.
DIAGNOSTIC ACCURACY OF MODIFIED EARLY OBSTETRIC WARNING SYSTEM FOR PREDICTION OF MATERNAL MORBIDITY
Authors: Zohra Sadaf , Urooj Uzma , Khalid Nayla , Khan Sumaira , Siraj Asifa , Rana Munawar Jannat
Published: January 2022

Objective: To determine the diagnostic accuracy of modified early obstetric warning system for predicting maternal morbidity keeping ICU admission as “gold standard”.

Study Design: Cross sectional validation study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Pak Emirates Military Hospital, Rawalpindi, from Oct 2018 to Apr 2019.

Methodology: A total of 205 patients of singleton pregnancy, post-natal period <6 weeks, history of hypertension and diabetes were considered in the study. Women were followed up to 6 weeks for maternal morbidity in term of intensive care admission. All the data regarding findings of Modified early obstetric warning system and intensive care admission was noted.

Results: The age range of patients was 18-40 years with mean age of 31.585 ± 3.31 years, mean gestational age was 37.595 ± 1.84 weeks and mean parity was 1.839 ± 1.59. Modified early obstetrics warning system as shown sensitivity of 84.38%, specificity 97.11%, diagnostic accuracy by 95%, positive predictive value of 84.38%, negative predictive value of 97.11%, (p=0.001) for prediction of maternal morbidity.

Conclusion: Modified early obstetrics warning system chart fulfills most of criteria of ideal screening tool making it a significant bedside screening tool which can predict obstetric morbidity and mortality in pregnant patients.
FREQUENCY OF MICROALBUMINURIA IN ABNORMAL LIPID METABOLISM AND SUFFERING FROM TYPE II DIABETES MELLITUS
Authors: Ali Ejaz , Khattak Abdul Latif , Khan Andaleeb , Butt Kamil Rehman , Yousafzai Raheel Akhtar , Tariq Abdul Moeed
Published: January 2022

Objective: To determine the frequency of dyslipidaemia in type-2 diabetic patients and to compare the frequency of dyslipidaemia in patients with and without microalbuminuria in type 2 diabetes.

Study Design: cross-sectional study.

Place and Duration of Study: Department of General Medicine, Combined Military Hospital Quetta Pakistan, from Dec 2018 to Jun 2019.

Methodology: All patients who fulfilled the inclusion criteria and visited General Medicine department of Combined Military Hospital Quetta with type II diabetes mellitus were included in the study. Blood sample following an 8-12 hours fasting over the last night and 24 hour urine sample for microalbuminuria was collected to assess the outcome i.e. frequency of dyslipidaemia and also its frequency with and without microalbuminuria.

Result: A total of 165 patients with type 2 diabetes mellitus were included. Ninety nine (60%) were males and 66 (40%) were females with the mean age of 48.08 ± 7.63 years. Overall, dyslipidaemia was found in 48 (29.1%) patients, dyslipidaemia was noted in 29 (17.6%) with microalbuminuria and 19 (11.5%) without microalbuminuria. Chi-square test revealed that dyslipidaemia was significantly more in patients of diabetes mellites having microalbuminuria than those not having it (p-value=0.01).

Conclusion: Abnormal lipid metabolism was present in significantly more in patients with microalbuminuria as compared to those without microalbuminuria suffering from type II diabetes mellitus.
THE EFFECTS OF INJECTING INTRA ARTICULAR PLATELET-RICH PLASMA ON PAIN SCORES IN KNEE JOINT OSTEOARTHRITIS
Authors: Ahmad Khaleel , Ali Liaquat , Maan Muhammad Aasam Masoom
Published: January 2022

Objective: To determine the effects of intra articular platelet rich plasma (PRP) injection on level of pain of knee joint in patients with knee osteoarthritis.

Study Design: Prospective observational study.

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

Methodology: Forty patients with pain due to knee osteoarthritis for intra-articular injection were included in this observational clinical trial after informed consent and fulfilling inclusion criteria. After measuring pain by numerical rating scale, patients received intra articular platelet rich plasma (10ml) therapy in affected knee under fluoroscopy. Using the Numerical rating scale level of pain was evaluated and recorded for each patient at different intervals.

Results: There was dramatic improvement in pain score after first and second injection of platelet rich plasma. There was 33.33% improvement at 3rd week, 54.32% at 6th week and 71.60% at 6th month.

Conclusion: Platelet rich plasma is safe, cost effective and minimally invasive in reducing pain scores and functional limitation in knee osteoarthritis.
COMPARISON OF ARTHROCENTESIS PLUS PLATELET RICH PLASMA WITH ARTHROCENTESIS ALONE IN THE TREATMENT OF TEMPOROMANDIBULAR JOINT DYSFUNCTION
Authors: Sarwar Humaira , Shah Irfan , Khan Ali Akhtar , Afzal Muhammad , Babar Adnan , Baig Amir Mushtaq
Published: January 2022

Objective: To evaluate the role of combination therapy of platelet rich plasma (PRP) with arthrocentesis and to compare it with arthrocentesis alone in the temporomandibular dysfuction (TMD) patients.Study Design: Quasi experimental study.Place and Duration of Study: Oral and Maxillofacial Surgery department, Armed Forces Institute of Dentistry, Combined Military Hospital Rawalpindi, from Jan 2017 to Jun 2019.Methodology: Forty-two patients diagnosed with refractory unilateral temporomandibular dysfuction, were included in the study. Patients were divided in two groups with 21 temporomandibular joints in each. Arthrocentesis alone was the control group (group I) and arthrocentesis with intra-articular injection of platelet rich plasma (group II) was the study group. Treatment outcomes were assessed and compared for all patients based on clinical parameters of pre and post treatment; for pain, maximal mouth opening and temporomandibular joint clicking sounds.

Results: Out of 42 patients, 33 (79%) were females and 9 (21%) were males with mean age of 34.3 ± 8.4 years. There was statistically significant difference in both groups for all variables. The p-value of maximum mouth opening of both groups before and after treatment was 0.746 and 0.01, joint clicking sounds were present in 69% of our patients before the treament and it reduced to 14% after the treatment. There was marked gradual decrease in pain of both groups, group I (6.48 ± 1.470 to 1.81 ± 0.602) and group II (7.29 ± 1.007 to 1.19 ± 0.402).

Conclusion: Combination therapy of platelet rich plasma with arthrocentesis is more effective treatment method than.......
EVALUATION OF DRUG-PRESCRIBING PATTERNS AT OUTPATIENT CLINICS OF PUBLIC HEALTH FACILITIES IN MIRPUR AZAD KASHMIR
Authors: Omer Saman , Khan Bushra Tayyaba , Jalil Omer
Published: January 2022

Objective: To evaluate prescribing practices in public health facilities of district Mirpur, Kashmir where no previous evidence regarding drug-prescribing behaviours was available.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020.

Methodology: The prescribing pattern analysis was done by objective observations of prescriptions after patient-physician encounter. World health organization defined core and complementary prescribing indicators were evaluated for all the prescriptions.

Results: Among the core prescribing indicator, average number of medicines per prescription were 3.11 (World Health Organization’s standard, 1.6-1.8). Only 2% and 67% of medicines were generic and essential medicines respectively (standard, 100%). Almost half the prescriptions contained antibiotics (standard, 20-26.8%) whereas 8% had injections (standard, 13.4- 24.1%). Among the complementary indicators there was no prescription without medicines and average prescription cost was 479 Pakistani Rupees.

Conclusion: This is the first study to give a snapshot of prescribing behaviours in public health facilities in Kashmir. All the prescribing indicators except injectables were below the standards. A multi-disciplinary approach involving authorities, industry and professionals is required to promote rational prescribing.
THE NEUROPROTECTIVE EFFECT OF CURCUMIN AGAINST TARTRAZINE-INDUCED NEUROBIOCHEMICAL AND HISTOPATHOLOGICAL CHANGES IN THE GRAY MATTER OF MOTOR CORTEX OF BRAIN OF SPRAGUE DAWLEY RATS
Authors: Zafar Maleeha , Ali Shabana , Hussain Nabiha , Khursheed Tooba , Beenish Huma , Yasser Ayesha
Published: January 2022

Objective: To study the neuroprotective effect of curcumin against tartrazine-induced neurobiochemical and histopathological changes in the gray matter of motor cortex of rat brain.

Study Design: Lab-based experimental study.

Place and Duration of Study: Department of Anatomy, Islamic International Medical College, from Sep 2019 to Sep 2020.

Methodology: Forty five adult male albino rats (250-300 gm) were divided randomly into three groups (n=15). Group A, rats were given standard rat diet. Group B, rats were given tartrazine orally by dissolving in tap water in the dose of 7.5 mg/kg body weight. Group C, rats were given 200 mg/kg of curcumin along with tartrazine orally by dissolving in tap water, daily for 28 consecutive days. At the end, all animals were dissected and their brain were removed. The neurobiochemical parameters including lipid peroxidation marker level along with microscopic changes widening of Virchow’s robin space and neuropil vacuolation in neurovascular unit were observed. Results were analyzed using SPSS version 21.

Results: The curcumin administration significantly improved the MDA levels (p-value <0.001 on intergroup comparison) and widening of Virchow’s robin space (group A=3.57 ± 0.78 µm, group B=19.39 ± 0.68 µm, group C12.1 ± 0.83 µm; p-value <0.001). Neuropil vacuolation was reduced to negligible in 60% rats of curcumin treated group.

Conclusion: Curcumin displayed a neuroprotective role in improving the tartrazine induced neurobiochemical and histopathological changes in the motor cortex of rat brain.
UTILITY OF ALBUMIN CREATININE RATIO (ACR) IN MONITORING DIABETIC RETINOPATHY AND NEPHROPATHY
Authors: Haroon Muhammad Aneeq , Javaid Haroon , Haroon Zujaja Hina , Khalid Usama Bin , Bibi Afshan , Haroon Azka
Published: January 2022

Objective: To evaluate Albumin Creatinine Ratio (ACR) as a screening marker for detection of early diabetic retinopathy in parallel with diabetic nephropathy.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Department of Ophthalmology and Chemical Pathology & Endocrinology, Combined Military Hospital, Multan, from Jul 2017 to Jul 2019.

Methodology: A total of 386 diagnosed patients of type II diabetes mellitus who reported for follow up and monitoring in Combined Military Hospital Multan, underwent initial screening with urine dip strip, if protein positive patients were excluded if negative patients were included in the study. Urinary albumin creatinine ratio was calculated as mg/mmol of creatinine. For staging of diabetic retinopathy; participants underwent ocular examinations. Pearson correlation was performed and ROC was constructed at different cut-offs.

Results: Out of the 386 (100%) patients with type II diabetes 284 (74%) had albumin creatinine ratio <3 mg/mmol and 102 (26%) had micro albuminuria i.e. albumin creatinine ratio 3-30 mg/mmol. Among normal albumin uric cases (284) only 52 (18%) patients had mild to moderate non-proliferative diabetic retinopathy.

Conclusion: Albumin creatinine ratio is associated with severity of diabetic retinopathy. Since diabetic retinopathy stages have been identified in normal albumin uric range, there is need to determine a definite cut off value (<3 mg/mmol) of ACR for using it as a screening marker for diabetic retinopathy.
FREQUENCY OF VITAMIN D DEFICIENCY IN PATIENTS PRESENTING WITH FIBROMYALGIA
Authors: Rashid Samina , Nawaz Khuram Haq , Fakhr Amer , Ather Hammad , Hakeem Farzana , Yousaf Rizwan
Published: January 2022

Objective: To determine frequency of vitamin D deficiency in patients presenting with fibromyalgia and its association with various factors.

Study Design: Cross sectional study.

Place and Duration of Study: Medicine department, Pak Emirates Military Hospital Rawalpindi, from Sep 2018 to Feb 2019.

Methodology: Ninety patients of fibromyalgia were included in the study. Diagnosis of fibromyalgia was made by the consultant rheumatologist on the basis of American College of Rheumatology Criteria needed for fibromyalgia diagnosis and classification. Vitamin D levels <20ng/ml were considered as deficient. Age, education, marital status, menstrual abnormallities and body mass index were correlated with the presence of vitamin D deficiency among the patients suffering from fibromyalgia.

Results: Out of 90 patients of fibromyalgia, 57 (63.3%) showed the presence of vitamin D deficiency while 33 (36.7%) had no deficiency of vitamin D. Among the study participants 88 (97.8%) patients were females and only 2 (2.2%) patients were males. Mean age of the patients was 39.4 ± 3.365 years. After applying the binary logistic regression, we found that presence of menstrual abnormalities and high body mass index had significant association with the presence of vitamin D deficiency among the patients of fibromyalgia (p-value<0.05).

Conclusion: Vitamin D deficiency emerged as a common finding among the patients of fibromyalgia in a teaching hospital of Pakistan. Vitamin D deficiency should be screened at the rheumatology clinics and special attention should be paid to the patients who are overweight or obese and female patients with the menstrual abnormalities.
APPLICATION OF AUTOLOGOUS SERUM EYE DROPS AFTER PTERYGIUM SURGERY
Authors: Rathore Hassan Sajjad , Mukhtar Ahsan , Saeed Shahzad , Ijaz Umar , Javaid Mamoona , Ghaus Iqra
Published: January 2022

Objective: To compare the corneal epithelium healing time and post-operative pain after pterygium surgery with and without he use of autologous serum drops.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Eye Department, Combined Military Hospital Quetta, from Jan to Aug 2019.

Methodology: Twenty patients were included in this study and divided into two groups. All patients underwent pterygium excision with conjunctival autograft. Fourteen of them were instilled with autologous serum drops while 14 were given lubricants postoperatively until corneal epithelium healed completely. Corneal epithelium healing time, visual analog scale for postoperative pain assessment, conjunctival inflammation and recurrences were evaluated. Patients were followed up for 6 months.

Results: For corneal epithelial healing, 1 (7.14%) patient showed complete healing on day 2 while 7 (50%) showed healing on day 3 and 6 (42.86%) on day 4. While in non-autologous serum drops group 7 (50%) showed complete healing on day 4 while 4 (28.57%) showed healing on day 5 and 3 (21.43%) on day 6. The mean corneal healing time of autologous serum drops group was 3.36 ± 0.63 days and that of non-autologous serum drops group was 4.71 ± 0.83 days. Patients of autologous serum drops group also experienced significantly less pain as compared to the non-autologous serum drops group. While the recurrence rate and conjunctival inflammation in the two groups was found to be of equal degree.

Conclusion: Patients who used autologous serum eye drops post operatively experienced less pain and their corneal epithelium healed earlier than the.......
HEMATOLOGICAL DISORDERS OF PROPYLTHIOURACIL IN THYROID PATIENTS AT TERTIARY CARE HOSPITAL OF HYDERABAD
Authors: Shaikh Uzma Naz , Ghoto Muhammad Ali , Dayo Abdullah , Arain Mudassar Iqbal , Khan Jibran
Published: January 2022

Objective: To find out the frequency of anemia, agranulocytosis and thrombocytopenia in hyperthyroid patients after the use of propylthiouracil.

Study Design: Cross sectional study.

Place and Duration of Study: Out Door Patients Department and Pathology Laboratory in Liaquat University Medical & Health Sciences, Hospital Hyderabad/Jamshoro, from May 2016 to Apr 2017.

Methodology: Two hundred cases, comprising of adult patients were categorized into five groups, age group 15-30 years 79 (39.5%) patients presenting the highest out of total, age group 31-45 years 68 (34%) patients, age group 46-60 years 36 (18%), age group 61-75 years 14 (7%) patients, age group >75 years 3 (1.5) patients. Complete blood count was analyzed on Sysmex Kx21 and thyroid profiles were analyzed on Elecysis 2010 from the Pathology Department. SPSS version 22 was used for data analysis.

Result: Out of total patients, 32 (16%) were males and 168 (84%) were females with mean age of 37.44 ± 14.82 years. Majority of patients 68 (34%) were anemic, while 4 (2%) had agranulocytosis and 11 (5.5%) had thrombocytopenia. Headache was reported in 111 (55.5%), exophthalmos in 106 (53%), sore throat in 172 (86%), fever in 136 (68%) and weight loss in 95 (47.5%) patients.

Conclusion: Propylthiouracil causes defective hematopoiesis in hyperthyroid patients because propylthiouracil has adverse suppressive effects on bone marrow.
COMPARISON OF PAIN RELIEF EFFICACY OF PLATELET-RICH PLASMA VERSUS CORTICOSTEROIDS IN KNEE OSTEOARTHRITIS
Authors: Sohail Amir , Zaid Ameer Yasser , Feroz Shizan Hamid , Saeed Mohammed , Naseer Syed Khurram , Sultan Muhsan
Published: January 2022

Objective: To compare the pain relief efficacy of platelet rich plasma injection with corticosteroid injection in knee osteoarthritis using numeric rating scale.

Study Design: Quasi experimental study.

Place and Duration of Study: Department of Anesthesia and Pain Management, Combined Military Hospital Peshawar, from Jan 2018 to Dec 2019.

Methodology: Total of 310 patients who underwent knee injection for osteoarthritis were included in this study. Patients were divided into two groups; group A and group B comprising of 155 patients each. Patients in group ‘A’ received intra articular corticosteroid injection while patients in group ‘B’ received intra articular platelet rich plasma injection for knee osteoarthritis. Pain assessment via numerical rating score was done at the start of the treatment and at 6 months.

Results: In group A female to male ratio was 2.69:1 while in group B the female to male ratio was 2.78:1. Mean age of ‘group A’ was 58.52 ± 11.87 years and that of ‘group B’ was 58.79 ± 11.15 years. Numerical rating score pre-treatment in ‘group A’ vs ‘group B’ was 8.35 ± 1.17 vs 8.42 ± 1.14. While numeric rating scale post treatment in ‘group A’ vs ‘group B’ was 5.74 ± 1.37 vs 4.06 ± 1.19, respectively with p-value of 0.001, which is statistically significant.

Conclusion: Patients who received intra-articular platelet rich plasma had significantly more pain relief as compared to patients who received intra-articular steroid on numerical rating score.
POSITIVE ADAPTIVE RESPONSE OF WOMEN IN LOW SOCIO-ECONOMIC CLASS FOR CHANGE OF CONTRACEPTIVE METHOD FROM COMBINED CONTRACEPTIVE PILLS TO COPPER INTRAUTERINE DEVICE
Authors: Yazdani Tehreem , Amin Nabila , Zaheer Fareeha , Karim Farhat , Mukhtar Mohammad Saad , Mukhtar Maryam
Published: January 2022

Objective: To ensure family spacing in our low socio-economic class.

Study Design: Quasi-experimental study.

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

Methodology: Two hundred females using oral contraceptive pills for spacing of children coming to Pak Emirates Military Hospital were selected. The problems of using contraceptive pills were identified. Out of these 87 women agreed to choose an intrauterine copper device (IUCD).

Results: Out of 200 women 87 converted from oral contraceptive pills to intrauterine copper device use. Most of them faced daily dosage problems 168 (84%). Nausea was encountered by 123 (61.5%) women and later settled in 89 (44.5%) women. About 31 (15.5%) were worried about the chances of uterine perforation and 56 (28%) were worried about lost intrauterine copper device resulting in laparotomy. About 65 (32.5%) were afraid of infection, backache and vaginal discharge. About 91 (45.5%) women thought to have gastric problems with the intrauterine copper device. About 71 (81%) agreed to have a spacing of children for about five years and removal whenever desired.

Conclusion: Intrauterine contraception is a very safe and efficient method for contraception as compared to oral pills. If expertise is, available it should be used and couples should be fully educated for its safety.
INDIGENCE OF FORENSIC ODONTOLOGY IN LEGAL PRACTICE OF PAKISTAN
Authors: Mansoor Hashim Bin , Kayani Usman Zafar , Khatoon Reeja , Idrees Erum , Kayani Hira Zafar , Aslam Ayesha
Published: January 2022

Objective: To assess and interpret the utility and need of forensic dentistry in current judicial system of Pakistan.

Study Design: Cross sectional study.

Place and Duration of Study: Twin cities of Rawalpindi and Islamabad, in the month of Jun, 2020.

Methodology: This questionnaire based cross-sectional study was conducted in a 1-month time frame, and a sample of 100 lawyers was recruited using snowball sampling technique and only criminal lawyers were included which had a minimum of 5 years of experience. Data was analyzed using SPSS-24.

Results: The results were quite significant, 81% (81 lawyers) of the population recognized the relationship of forensic dentistry with criminal litigation (p-value=0.006). Furthermore 86% (86 lawyers) believed that there are a limited number of practicing forensic dentists and a massive 96% (96 lawyers) of the population was not able to acquire the expertise of a forensic dentist.

Conclusion: There is a major lack of trained forensic odontologists and training institutes in Pakistan, which has a significant effect on the legal practices of Pakistan. Furthermore, it defines the lack of specialization trend in forensic odontology.
IMPACT OF ANTENATAL CARE ON MATERNAL MORBIDITY IN THREE MILITARY HOSPITALS OF PUNJAB, PAKISTAN
Authors: Akbar Rizwana , Azam Naila , Mughal Fatima Ali Raza , Tariq Ahmed , Wajahat Maira
Published: January 2022

Objective: To determine the impact of antenatal care on maternal morbidity.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Obstetric Departments of three military hospitals in Northern Punjab cities of Rawalpindi, Jehlum and Mangla, from Jan to Mar 2019.

Methodology: Data of all mothers who gave live births in the selected military hospitals were collected. These mothers were classified as booked and unbooked on the basis of number of antenatal care visits. Maternal morbidities and complications of pregnancy were recorded. The data were analyzed using Statistical Packages for Social Science (SPSS) version 20.

Results: In our study, 254 (8.8%) of mothers were unbooked, 2273 (78.8%) were partially booked and 358 (12.4%) were booked. 894 (31%) mothers did not have any co-morbidity while 1991 (69%) mother had co-morbidity. Out of 749 (27.5%) mothers had anaemia, 869 (30.1%) had hypertension, 141 (30.1%) had diabetes mellitus, 24 (0.8%) cardiac disease, 39 (1.4%) had tuberculosis, 9 (0.3%) had liver disease 13 (0.5%) had kidney disease, 69 (2.4%) had allergies while 33 (1.1%) had other diseases. These complications were significantly greater in unbooked patients as compared to booked patients (p<0.001) Out of total 2885 mothers who gave live births in three military hospitals, only one (0.034%) mother died (who was unbooked) in Jhelum Hospital. Its Maternal Mortality Ratio (MMR) was 34.66 per 100,000 live births.

Conclusion: In our study population anemia, hypertension and diabetes were the most common comorbidities in expecting mothers. Unbooked mothers had more morbidities and complications of pregnancy than.........
EFFECT OF INTRAVITREAL TRIAMCINOLONE ACETONIDE IN REFRACTORY DIABETIC MACULAR EDEMA
Authors: Sughra Ume , Gul Anwar Ahmed , Habib Kashif , Khan Zeeshan , Khan Ozeer
Published: January 2022

Objective: To investigate the effects of intravitreal triamcinolone for refractory diabetic maculopathy after 03 unsuccessful intravitreal bevacizumab injections.

Study Design: Prospective observational study.

Place and Duration of Study: Retina department of Al-Shifa Trust Eye Hospital Rawalpindi, from Jun 2016 to Jul 2017.

Methodology: Total 35 eyes of 35 patients who were diagnosed with diabetic maculopathy and having history of minimum three intravitreal Bevacizumab injections were included. Detailed eye examinations included visual acuity, anterior and posterior segment examination and intraocular pressure measurement was performed in all patients. Central macular thickness was also measured. Then intravitreal triamcinolone was administered to eyes by principal researcher (Ophthalmologist). After one month, follow up examination of patient’s eyes was done to assess the effects of injection.

Results: Majority of the participants were males 19 (55%) in this research. There was statistically significant difference between means of intra ocular pressure (mean difference= 4.30 ± 5.41), Visual acuity (mean difference=2.8 ± 2.4) and central macular thickness (mean difference = 236.4 ± 13) pre and post injection was found (p-value<0.05).

Conclusion: There was statistically significant difference of central macular thickness and visual acuity, pre and post intravitreal triamcinolone acetonide injection was found.
USE OF PRELACTEAL FEEDS- STUDY IN TRADITION
Authors: Pirzada Saima , Anwar Zahid , Gul Rafia , Iqbal Nazia , Noor Fatimah
Published: January 2022

Objective: To find the types and frequency of prelacteal use, factors influencing their use and its impact on breastfeeding.

Study Design: Cross-sectional study.

Place and Duration of Study: Fatima Memorial Hospital, Lahore, Pakistan from Jul to Dec 2019.

Methodology: In the study, mothers and female attendants of newborn babies were interviewed following a specific questionnaire. The given answers were recorded and captured data about socio-demographics, knowledge, attitude and actual practices of mothers and families related to use of prelacteals. The results were analysed using SPSS 22.

Results: We interviewed 1601 mothers and female attendants of neonates. The mean age was 32.3 ± 8.2 years. Most of the females were married (1211, 75.6%) and resided in Lahore (1281, 80%). About one third, 581 (36.3%) were either illiterate or had inadequate schooling. Two-thirds (1000, 62.5%) of women wanted to give some prelacteal feed soon after birth. Honey was the most the commonest choice (in 722, 45.1%), seconded by ghutti (107, 6.7%). Most females (1467, 91.6%) wanted to give colostrum, and 1552 (96.9%) would breastfeed the baby. 1221 (75.2%) wanted to start mother-feed immediately or within 2 hours of birth.

Conclusion: The use of prelacteal is common in Pakistan culture. A consistent effort is needed to counter the unsafe prelacteal use.
A FOCUSED EDUCATIONAL PROGRAM FOR FRONT-LINE HEALTH CARE WORKERS DURING COVID -19 OUTBREAK IMPROVES MENTAL HEALTH
Authors: Ikhlaq Urwah , Umair Madiha , Baloch Komal , Ansari Imran , Baker Jawed Abu , Salahuddin Nawal
Published: January 2022

Objective: To determine whether an educational program on personal protective measures can reduce anxiety and depression in Hospital workers exposed to COVID-19.

Study Design: Quasi-experimental study.

Place and Duration of Study: COVID Units & Emergency Room, from May to Jul 2020.

Methodology: Educational tool based on World Health Organization and Pan American Health Organization guidelines including videos on Personal Protective Equipment usage was delivered to hospital staff assigned to areas with COVID-19 patients. Likert scale, Generalised Anxiety Disorder-7 score and Major Depression Inventory were used.

Results: 100 hospital staff were included. About 40% doctors, 41% Nurses. None had preexisting anxiety or depression. 11% reported COVID-19, 46% reported quarantine, and 91% reported contact. About 93% stated insufficient knowledge of usage of personal protective equipment and 35% reported inadequate provision of personal protective equipment. Median score on the likert scale was 5 (IQR 4-7). Mean generalized anxiety disorder score was 6.48 ± 3.4, which improved to 4.65 ± 2.7 post session, p-value <0.001. 41% reported minimal, 34% mild, 24% moderate and 1% severe anxiety. Post session, 62% reported minimal Anxiety, 33% mild, 5% moderate and 0% severe anxiety. Mean major depression inventory score was 16.10 ± 7.05 which reduced to 13.58 ± 5.84, p-value <0.001. Pre-session 59% reported „no/doubtful depression‟, 40% mild, 1% moderate depresssion, while post-session 85% reported „no/doubtful‟, 15% mild and none had moderate/severe depression.

Conclusion: We found an educational program that provided information on personal protective measures significantly reduced anxiety and depression in front-line workers during COVID-19 pandemic.