bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECTS OF LUMBAR SNAG AND MECHANICAL TRACTION IN PATIENTS WITH DISCOGENIC LUMBOSACRAL RADICULOPATHY
Authors: Ahmed Muzammal , Anwar Naveed , Tauqeer Sana , Khalid Kehkhshan , Shakeel Hammad
Published: January 2022

Objective: To compare the effects of lumbar sustained natural apophyseal glide and Mechanical Traction in patients with discogenic lumbosacral radiculopathy.

Study Design: Quasi experimental study.

Place and Duration of Study: Kanaan Physiotherapy and Spine Clinic, from Mar to Sep 2020.

Methodology: A total of 44 patients were included in study in 2 groups of 22 each. Patients between ages 30-60 years having chronic radiating pain in one or both legs, patients with minimum of 25 score out of 100, on low back pain index and patients having radiculopathy were included. Exclusion criteria were history of low back pain treatment in last 90. Complications such as cancer, spine pathology and joint disease. Dice roll method was used for group allocation. Group classification was as group 1, sustained natural apophyseal glide group, and group 2, mechanical traction group. NPRS and oswestry disability index were used. Data analysis was done with SPSS version 21.

Results: There is statistically significant improvement in pain as mean post treatment value for sustained natural apophyseal glide group is 2.55 ± 1.503 and for mechanical traction group is 4.05 ± 1.864, oswestry disability index and shober test results in sustained natural apophyseal glide group were also significant as compared to mechanical traction with p-value <0.05. Although pain was also decreased in mechanical traction group patients but overall sustained natural apophyseal glides were more effective.

Conclusion: Sustained natural apophyseal glide are more effective in the treatment of lumber radiculopathy patients as compared to mechanical traction. Further studies.............
MEAN PLATELET VOLUME AS A PREDICTIVE BIOMARKER FOR RETINOPATHY IN PATIENTS WITH TYPE 2 DIABETES
Authors: Tasneem Asma , Naeem Samina , Din Nasir Ud , Robert Helen Mary , Farid Maria , Niazi M. Khizar
Published: January 2022

Objective: To determine the association of mean platelet volume with diabetic retinopathy in our population.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Hematology & Ophthalmology, Combined Military Hospital Lahore, from Jul to Dec 2020.

Methodology: A total of 146 known patients with type 2 diabetes were enrolled in this study. They included 78 patients with diabetic retinopathy (group 1) and 68 without diabetic retinopathy (group 2). Five (5ml) of whole blood was extracted from patients through clean venipuncture in a tube containing EDTA and mean platelet volume was generated through automated haematological analyzer Sysmex KX-21 and HbA1c was generated through automated analyzer Cobas c501.

Result: A total of 146 patients with type 2 diabetes were included in this study. The age of patients ranged from 25-70 years (Mean age: 53.3 ± 0.02 years). Out of 146 patients 66 (45.2%) were males and 80 (54.8%) were females. Among patients with type 2 diabetes 78 (53.4%) has retinopathy while 68 (46.6%) have no retinopathy. A statistically significant difference (p<0.005) was observed in mean platelet volume and platelet distribution width among patients with retinopathy to those without retinopathy.

Conclusion: Mean platelet volume plays a significant role in the determination of retinopathy with type 2 diabetes and helps to monitor progression of disease.
COMPARISON OF EMERGENCY SURGERIES UNDER SPINAL ANESTHESIA IN COVID-19 PANDEMIC WITH PRE-COVID PERIOD IN A TERTIARY CARE HOSPITAL OF A DEVELOPING COUNTRY
Authors: Kashif Sanum , Khan Taimur Azam , Parveen Naheed , Khan Najm Us Saqib , Ahmed Saad
Published: January 2022

Objective: To compare emergency surgeries under spinal anesthesia in COVID-19 pandemic with pre-COVID period in a tertiary care hospital of a developing country.

Study Design: Prospective observational study.

Place and Duration of Study: Main Operation Theatre, Frontier Corps Hospital Quetta, from Mar to May 2020.

Methodology: All emergency surgeries done under Spinal Anesthesia, were compared to emergency cases done in the preCOVID period. Anesthesia notes were reviewed. Emergency cases done under general anesthesia and personal protective equipment worn were also noted. Ages of the patients were from 18-75 years. Spinal anesthesia was performed by consultant anesthesiologist.

Result: Among total cases, 260 emergency cases were performed in the main operation theatre during the 3 months of preCOVID period as compared to only 89 cases in the 3 months duration of COVID-19. Spinal anesthesia was used in 154 (59.2%) cases in the pre-COVID study period, while in COVID-19 pandemic 77 (86.5%) emergency cases were performed under spinal anesthesia.

Conclusion: Spinal anesthesia has a significant role in the surgical management of patients in pre-COVID and especially in COVID pandemic. It provides high-quality perioperative care for patients whilst minimizing exposure to staff and utilization of scarce resources of personal protective equipment.
AMELIORATIVE EFFECTS OF PUNICA GRANATUMON RENAL TUBULAR NECROSIS INDUCED BY NANDROLONE DECANOATE IN MICE MODEL
Authors: Ali Humaira , Ali Liaqat , Shaukat Sadia , Yousaf Maria , Umbreen Faiza , Zakria Iram
Published: January 2022

Objective: To observe the effects of nandrolone decanoateon renal tubules and its protection by punicagranatum (pomegranate) in mice.

Study Design: Lab based experimental study.

Place and Duration of Study: One year in Anatomy department, Army Medical College, Rawalpindi, in association with National Institution of Health, Islamabad.

Methodology: Forty healthy BALB/c mice of both sexes with weight range of 2 5-30gms were equally disseminated into four groups, A as control while B, C and D as trial groups. Three trial groups were inoculated Nandrolone Decanoate 1mg per 100gm of body weight, through intramuscular injections in the hind limb, once weekly for eight weeks. Pomegranate nector was administered in animals of trial group C (3ml per kg of body weight) en route oral gavage tube daily, whereas animals in trial group D was administered pomegranate peel extract (200mg per kg body weight) via oral gavage tube daily for eight weeks. Evaluation of the outcomes of trial groups B, C & D was done amongst them and with control group A.

Results: In nandrolone decanoate injected experimental group B, tubular necrosis were appreciated in comparison with control group A (p˂ 0.001), and showed statistical improvement when evaluation was done with pomegranate nectar and pomegranate peel extract treated trial groups C (0.001) and D (p=0.001), correspondingly.

Conclusion: Punicagranatum in two forms, as nectar and peel extract, has almost identical curative effects on steroid administered renal tubular mutilation.
THROMBOCYTOPENIA AMONG TRAUMA PATIENTS ADMITTED IN ICU: FREQUENCY AND RELATIONSHIP WITH OUTCOME
Authors: Farukh Aamir , Ahmad Ejaz , Baig Zahid Farooq , Siddique Umair Ahmad , Tareen Tariq Bashir , Khan Aslam
Published: January 2022

Objective: To assess the frequency of thrombocytopenia among the patients of trauma at an intensive care unit and to look for its relationship and other socio-demographic factors with the outcome.

Study Design: Cross-sectional study.

Place and Duration of Study: Intensive Care Unit, Combined Military Hospital Peshawar, from Mar to Aug 2017.

Methodology: Thrombocytopenia was defined as platelet count of <150,000/μl and was performed on the fifth day of admission in the Intensive Care Unit. Age, gender, presence of thrombocytopenia, history of platelet transfusion, and length of stay in the Intensive Care Unit were correlated with the outcome in our study population.

Results: A total of 107 patients admitted to intensive care unit with traumatic injuries during the study period were included in analysis. Mean age of the patients was 37.93 ± 6.697 years. Thrombocytopenia developed in 35 (32.7%) of the patients while 72 (67.3%) had normal platelet count. Less than 18% patients died in the intensive care unit. Long duration of Intensive Care Unit stay and presence of thrombocytopenia were statistically significantly associated (p<0.05) with the presence of poor outcome in our sample population.

Conclusion: Frequency of thrombocytopenia was high among patients admitted with trauma in intensive care unit and was also related to poor outcome in these patients.
LIFE SATISFACTION AMONG OLD AGED PEOPLE ATTENDING FAUJI FOUNDATION HOSPITAL
Authors: Riaz Mehwish , Sultana Abida , Tariq Aisha
Published: January 2022

Objective: To determine life satisfaction in old age people attending Fauji Foundation Hospital and to assess relationship of socio-demographic variables on life satisfaction of old aged people.

Study Design: Cross sectional study.

Place and Duration of Study: Fauji Foundation Hospital Rawalpindi from Feb to Aug 2018.

Methodology: A total of 347 individuals were included by using non-probability consecutive sampling. The participants of the 60 years or more attending Fauji foundation hospital, being mentally sound and having comprehensive under-standing without hearing aid were included in the study. Questionnaire was given to respondents including demographic profile and Urdu version of Life Satisfaction Scale for assessing the life satisfaction in old age.

Results: The total sample mean life satisfaction score was 14.95 ± 6.54. 5 (1.5%) people were extremely satisfied, 27 (8.4%) were satisfied, 117 (36 %) were dissatisfied and 63 (19.1%) were extremely dissatisfied.

Conclusion: Life satisfaction was found statistically significant with female gender, older age 70-80 years, being un married, primary education, monthly income of less than 10,000 and being unemployed.
EFFECTIVENESS OF KINESIOLOGICAL TAPE IN MYOFASCIAL PAIN SYNDROME OF GASTROCNEMIUS MUSCLE
Authors: Gill Riffat Asghar , Bashir Muhammad Salman , Khalid Kehkshan , Anwar Naveed
Published: January 2022

Objective: To see the effectiveness of kinesiological tape in myofascial pain syndrome of gastrocnemius muscle for the early recovery after injury and thus increase functional outcome.

Study Design: Quasi-experimental study.

Place and Duration of Study: National cricket academy Lahore and Sports and Spine Professional’s Clinic, Defense Phase-IV Lahore Pakistan, from Aug 2017 to Oct 2017.

Methodology: Consecutive sampling technique was used to enrol the patients of myofascial pain syndrome based on the predefined inclusion and exclusion criteria. Patients were selected and the kinesiological tape was applied thrice a week for two consecutive weeks. the patient was then re-evaluated after every two days of previous kinesiological tape application in terms of the visual Analogue Scale.

Results: It was observed that kinesiological tape had a significant effect on pain reduction of the myofascial pain syndrome of the gastrocnemius muscle (p<0.001). There was a significant reduction of pain level after application of Kinesio tape till 4th application with pre-treatment means 6.70 ± 1.45 that was reduced to 2.98 ± 2.24 in post-treatment (p<0.05). In addition, there was no significant reduction of pain between the 5th and 6th application with mean for the 6th session as 2.96 ± 2.27 (p>0.05).

Conclusion: The Kinesiological tape has a significant effect on pain reduction of gastrocnemius muscle suffering from myofascial pain syndrome. The application of kinesiological tape has maximum effect up to its 4th application. After 5th session of taping, the effect was almost constant.

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HYPONATREMIA AS A PROGNOSTIC INDICATOR IN LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN ADMITTED IN PAEDIATRIC INTENSIVE CARE UNIT
Authors: Hamid Naila , Shafique Muhammad Faisal , . Qamar-uz-Zaman , Niaz Hafza
Published: January 2022

Objective: To study the serum sodium levels in patients of lower respiratory tract infections admitted in the paediatric intensive care unit with their prognosis.

Study Design: Prospective observational study.

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

Methodology: Eighty patients suffering from lower respiratory tract infections who were admitted to the paediatric intensive care unit were selected at consecutive sampling. The outcome was recorded in the form of discharge or mortality. Serum sodium was done at the time of admission and then periodically after every 24-48 hours. The Association of patients’ serum sodium with their prognosis was studied using chi-square test and p-value was calculated.

Results: A total of 80 patients were enrolled in our study out of which 50 (62.50%) were males and 30 (37.50%) were females. Out of the total, 48 patients suffered from hyponatremia. These 48 patients had a mean serum sodium concentration of 131.24 ± 3.31 mEq/L. The mean age of patients suffering from hyponatremia was 5.78 ± 3.4 years. Mortality occurred in 5 (80.12%) of patients suffering from severe hyponatremia.

Conclusion: There was a significant association of hyponatremia with mortality in children admitted in paediatric intensive care settings with lower respiratory tract infections. Therefore, proper management hence correction of serum sodium levels can improve survival in, particularly children admitted in a pediatric intensive care setting.
ATTITUDE OF CLINICIANS TOWARDS CLINICAL DECISION-MAKING IN PROSTHODONTICS
Authors: Khan Danish Azeem , Azad Azad Ali , Aslam Ayesha , Ishfaque Qamar
Published: January 2022

Objective: To assess the attitude of resident and consultant Prosthodontists towards clinical decision-making in complete denture prosthodontics

Study Design: A cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Nov 2019 to Jan 2020.

Methodology: Fifty trainee and consultant prosthodontists from all over the country were included in the study. A questionnaire consisting of 10 questions aimed at assessing the approach towards clinical decision-making in complete denture prosthodontics was circulated among the study subjects using Google Forms. Data was analyzed using SPSS version 24.

Results: Around 20 (40%) prosthodontists regarded patient’s personal values and preferences to be “very important” in clinical decision-making in contrast to their own values. Most of the clinicians 47 (94%) believed their patients were quite satisfied with them and around 31 (62%) prosthodontists believed that “choice of the best treatment results from negotiation between patients and clinicians after they have shared technical information as well as their values and preferences about the options”. No significant difference was observed in choice of response between males and females or between prosthodontists with varying clinical experience for any of the questions asked (p>0.05).

Conclusion: Prosthodontists participating in the present study demonstrated a positive attitude towards shared decisionmaking in complete denture prosthodontics. No differences were observed between males and females in terms of attitude towards shared decision-making practices.
THE EFFECT OF HIGH DOSE AND LOW DOSE PREGABALIN AS PREMEDICATION ON PREOPERATIVE ANXIETY AND SEDATION LEVELS
Authors: Zafar Ayman , Farhat Kulsoom , Saeed Mobasher Ahmed , Khan Waqar Aslam , Ali Shabana , Ata Nausheen
Published: January 2022

Objective: To assess the role of pregabalin as premedication for preoperative sedation & anxiolysis with two different doses in laparoscopic cholecystectomy patients.

Study Design: Prospective, randomized control study

Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi in collaboration with Department of Anesthesiology, CMH, Rawalpindi from February 2019 to July 2019.

Patients & Methods: 96 patients of either gender, aged between 18 to 60 years with ASA grade I-II, undergoing elective laparoscopic cholecystectomy were enrolled in this study. They were randomly divided into three groups having 32 patients each. Group 1 received oral placebo drug, Group 2 received oral pregabalin 150 mg, whereas Group 3 received oral pregabalin 300mg with sip of water 90 mins before the induction of general anesthesia. The effects of drugs on the patient’s level of sedation and anxiety were evaluated at baseline and before the induction of anesthesia using Ramsay Sedation Score and Beck Anxiety Inventory respectively.

Results: Premedication with pregabalin 150mg and 300mg significantly produced sedation as compared to placebo. Though, pregabalin 300mg exhibited more sedation than pregabalin 150mg but the difference between them was statistically insignificant (p >0.05). Preoperative administration of pregabalin was related with anxiolysis, with the most prominent results shown by pregabalin 300mg (p <0.05) whereas pregabalin 150mg couldn’t alleviate anxiety and the results were statistically insignificant (p >0.05).

Conclusions: Premedication with pregabalin 300mg, 90 mins before the induction of general anesthesia is an effective regimen to alleviate preoperative anxiety and sedation.
CHALLENGES FACED BY VASCULAR SURGEONS IN ACCEPTANCE OF THEIR SPECIALTY BY MEDICAL COMMUNITY OF PAKISTAN
Authors: Jamil Muhammad , Jamil Brekhna , Aman Aaiza , Usman Rashid
Published: January 2022

Objective: To determine the challenges being faced by vascular surgeons in acceptability of their specialty by the medical community of Pakistan.

Study Design: Qualitative case study.

Place and Duration of Study: Various training institutes & teaching hospitals all over the Pakistan, from Sep 2019 to Feb 2020.

Methodology: Semi structured interview format comprising of a series of open ended and broad questions to get maximum relevant information, were sent to 13 surgeons (vascular and part time vascular surgeons) practicing vascular surgery at least for the last five years in various training institutes and teaching hospitals of Pakistan. Interviews were audio recorded on telephone and in persons. The data was transcribed, cleansing was done, and analyzed through inductive and thematic content analysis.

Results: Handful of qualified vascular surgeons, inadequate vascular training program, part time vascular surgery and unawareness/misconceptions/myths about vascular diseases, were the major challenges being faced by the vascular community for their separate identity.

Conclusion: The vascular community is facing great challenges of shortage of qualified vascular surgeons and technicians, inadequate training centers, part time vascular surgery and misconceptions/myths/unawareness about vascular diseases.
ULTRASOUND MEASUREMENTS OF ROTATOR CUFF TENDONS IN MALE ADULTS
Authors: Hassan Khawaja Muhammad Baqir , Slehria Atiq Ur Rehman , Hassan Tathir Baqir , Sarwar Shakil , Sheen Irfan Najam , Manzoor Shamaila , Bokhari Syed Aown Raza Shah
Published: January 2022

Objective: To establish the normative ultrasound values of tendons of rotator cuff muscles in local healthy male population.

Study Design: Cross sectional study.

Place and Duration of Study: Department of Radiology, Combined Military Hospital Malir, from Oct 2019 to Mar 2020.

Methodology: The sample of study was 456 shoulders of 228 patients. All the patients went under ultrasound shoulder in standard positions. Data analyzed with statistical analysis program (‘Statistical Package for the Social Sciences” version 23).

Results: In right dominance the mean thickness of the supraspinatus, infraspinatus, subscapularis and biceps tendons were tendon 4.63 ± 0.45 mm, 3.90 ± 0.73 mm, 4.55 ± 0.74 mm and 3.55 ± 0.54 mm respectively. The acromio-humeral interval was 12.63 ± 2.005 mm. In left dominance the mean thickness of the supraspinatus, infraspinatus, subscapularis and biceps tendons were 4.88 ± 0.69 mm, 4.17 ± 0.63 mm, 5.04 ± 0.26 mm and 3.62 ± 0.45 mm respectively. The acromio-humeral interval was 13.65 ± 2.98mm.

Conclusion: The study showed that there was insignificant difference between the dominant and non-dominant shoulders.
TABOOS AND MYTHS REGARDING BREASTFEEDING PRACTICES IN PREGNANT POPULATION
Authors: Ibrar Faiza , Khursheed Naila , Qamar Saima , Masud Atikka , Ifthikhar Bushra , Gul Seema
Published: January 2022

Objective: To determine the taboos and myths regarding breastfeeding practices in our pregnant population.

Study Design: Cross-sectional study.

Place and Duration of Study: Obstetrics and Gynecology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Oct 2018.

Methodology: A total of 100 pregnant women attending antenatal clinics were included in the study using non-probability purposive sampling technique. Taboos and myths regarding breast feeding practices were determined using self-administered questionnaire on 2-point Likert scale (1=agree & 2=disagree).

Results: A total of 100 pregnant women participated in the study. Mean parity was 2.89 ± 1.75 and gravidity was 4.17 ± 2.04. Most of the mothers (90%) were house wives and received information regarding breast feeding from family members (81%). Mothers were aware of the nutritious value of breast milk as compared to formula milk. However, there were myths that were not evidence based. These include: breasts sag with breast feeding (48%), it is not necessary to breast feed the baby during night time (43%), breast milk alone was not sufficient to satisfy the child (51%), small size breast produce insufficient milk (27%).

Conclusion: Participants of this study are aware of the importance of breast feeding. However, there are certain taboos and myths prevailing in our population which are not proven scientifically.
STRATEGIES FOR ANESTHESIA MANAGEMENT OF CESAREAN DELIVERIES WITH ABNORMAL PLACENTAL PLACEMENT–ANESTHETIST’S PERSPECTIVE
Authors: Ahmad Maqsood
Published: January 2022

Objective: To discuss problems faced in the management of emergency and elective cesarean sections with known or unknown abnormal placental placement and their management.

Study Design: Retrospective observational study.

Place and Duration of Study: Different Hospitals for the last 7 years from 2013 to 2020.

Methodology: This retrospective observational study of 120 cases was selected for data collections that underwent anesthesia. Variables under study were age, weight, type of abnormal placenta, fluid, blood/blood products given during surgery, hysterectomy done, general surgeon help required, anesthesia type, and redo of operations.

Results: A total of 120 patients were operated having abnormal placentation. The frequency of placenta previa 90 (75%), and accreta was 30 (25%). Primigravida patients were 19 (15.8%) and multigravida patients were 101 (84.1%). hysterectomy was done in 28 (23.3%) patients. Spinal anesthesia was given in 50 (41%) patients while 70 (58.3%) patients have general anesthesia. The spinal anesthesia was later on converted to general anesthesia in 32 (26.6%) patients out of 50 (41%). Only 12 (10%) patients were reopened for uncontrolled bleeding and 4 (3.3%) patients were sent to tertiary care hospital for further management. The general surgeon was called for help in 24 (20%) of patients and bladder injury occurred in 25 (20.8%) patients. No mortality was found during this period.

Conclusion: Abnormal placental placement is a threat to mother life as well fetus and team of dedicated doctor is required to deal with this emergency. Use of inotropes can help to save the precious lives.
FIRST REPORTED CASE OF MAJEED SYNDROME FROM PAKISTAN
Authors: Malik Qudrat Ullah , Rahman Asbah , Ikram Farooq , Shoaib Muhammad , Akhlaque Uzma , Khalil Muhammad Tawab
Published: January 2022

Majeed syndrome, characterized by chronic recurrent multifocal osteomyelitis and congenital dyserythropoeitic anemia, is a rare disease reported in children. We report a case of Majeed Syndrome in a 9-year-old boy, born of consanguineous marriage reporting to us for treatment of anemia, requiring blood transfusion. He underwent below-knee-amputation due to unresolving recurrent osteomyelitis at multiple sites. There was history of pain insensitivity and fever during hot weather as well. His interleukin-6 levels were raised. This is the first case of Majeed Syndrome from Pakistan and first in the world with Hereditary Sensory Autonomic Neuropathy type 4 as an associated feature.
DIAGNOSTIC ACCURACY OF PANBIO COVID-19 RAPID ANTIGEN METHOD FOR SCREENING IN EMERGENCY CASES
Authors: Afzal Raja Kamran , Ali Saad , Ahmad Farooq , Nasir Shafia , Younas Muhammad , Ahmad Taiba
Published: January 2022

Objective: To determine the diagnostic accuracy of PANBIO COVID-19 rapid antigen method in nasopharyngeal swab, for screening of COVID-19 infection in emergency cases.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Multan, from Jan to Mar 2021.

Methodology: After taking approval from institutional ethical review committee, total 1539 patients were included in this study according to sample size. With informed consent, nasopharyngeal swab specimens were taken for PANBIO COVID-19 rapid antigen method from each patient presenting as emergency medical/surgical case to Combined Military Hospital Multan as well as for Polymerase Chain Reaction for SARS CoV-2 RNA. PANBIO COVID-19 rapid antigen method and polymerase chain reaction for SARS CoV-2 RNA were performed simultaneously on swabs. Polymerase chain reaction for SARS CoV-2 RNA was considered to be the gold standard for comparison with the PANBIO COVID-19 rapid antigen method.

Results: A total of 21 patients had SARS CoV-2 RNA detected by polymerase chain reaction indicating COVID-19 infection. Out of polymerase chain reaction positive patients, PANBIO™ COVID-19 Ag test was able to detect 19 cases. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was calculated and found to be 90.47%, 100%, 100%, 99.8% and 99.8% respectively.

Conclusion: PANBIO™ COVID-19 rapid antigen method was found to have excellent diagnostic accuracy in detection of COVID-19 infection. It can provide as a good alternate test for screening of masses with a short turn around time of only 15 minutes.
CORRELATION BETWEEN SERUM LEVELS OF FOLLICLE STIMULATING HORMONE AND GRAAFIAN FOLLICLE VASCULARITY ON DOPPLER IN INFERTILE FEMALES OF LAHORE
Authors: Iqbal Amjad , Gilani Syed Amir , Hanif Asif
Published: January 2022

Objective: To determine correlation between serum levels of Follicle Stimulating Hormone and Graafian Follicle vascularity on Doppler ultrasound in infertile females of Lahore, Pakistan.

Study Design: Cross sectional study.

Place and Duration of Study: Prime Ultrasound center, 2-Shalamrar Link Road, Mughalpura, Lahore, Pakistan From Mar 2018 to Sep 2019.

Methodology: A total of 100 infertile females using simple random sampling were taken. All the married women of reproductive age and married for >12 months who have not conceived despite regular unprotected intercourse, having no other uterine and endometrial or ovarian pathology were taken. The patients who fail to provide serum hormone laboratory reports were excluded. Transvaginal ultrasonography was done for all females and graafian follicle vascularity on Doppler was measured on day 12 of the cycle.

Results: The Median age of females was 28 (30-25) years range from 19 and 46 years. The median Follicle Stimulating Hormone levels at day 12 was 6 (8.25-5.22) mlU/ml with minimum and maximum FSH values as 3.20 and 40 mlU/ml. The median follicle size was 13.65 (16.04-10.84) (mm) with minimum and maximum size as 10 mm and 26 mm. There were 61% females who had Grade–1 perifollicular vascularity, 24% females had grade-2 and 15% females had grade-3 of perifollicular vascularity. There was significant positive correlation between perifollicular vascularity grades and Follicle-stimulating hormone levels day 12 (mm) i.e., r=0.309, p-value <0.001.

Conclusion: It is concluded that perifollicular vascularity was found to correlate with serum Follicle-stimulating hormone levels, so graafian follicle vascularity on.......
EFFECTIVENESS OF MISWAK AS COMPARED WITH TOOTHBRUSH: A CROSS-SECTIONAL STUDY
Authors: Mir Hassam Anjum , Sharif Mubashir , Asif Ali , Shamim Maleeha , Qureshi Maaz , Akhtar Aqsa
Published: January 2022

Objective: To determine if the traditional chewing stick Miswak was as effective in cleaning teeth as Toothbrush.

Study Design: Cross sectional study.

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Aug 2020 to Jan 2021.

Methodology: A total of 300 subjects were included which were divided in two groups on the basis of whether they used miswak or toothbrush as a cleaning aid. Group A was toothbrush users and group B was Miswak user. Plaque Index was used to determine the cleanliness of teeth. The scores were recorded and data analyzed using SPSS-23.

Results: The means and standard deviations of Plaque Index score for group A and B were 0.96 ± 0.58 and 0.98 ± 0.56 respectively. The comparison of Plaque Index score for both groups was insignificant with the p-value of 0.083.

Conclusion: Within the limitations of this study, it is concluded that, no significant difference was found in the effectiveness of traditional miswak and tooth brush. It is recommended that if the technique of teeth cleaning is good then any of the abovementioned means of teeth cleaning can be used.
ROLE OF THE CULTURAL CONTEXT IN DETERMINING THE USE OF PATIENT SAFETY; A MIX METHOD STUDY
Authors: Saqib Khan Najm Us , Hafeez Assad , Khadim Rehana , Haider Anam , Hisam Aliya , Butt Tahir Mahmood
Published: January 2022

Objective: To compare the role of the cultural context in determining the use of patient safety by participants from private and public sector hospitals of Karachi, Pakistan.

Study Design: Mix method study.

Place and Duration of Study: In two tertiary care hospitals (one private and one public sector) of Karachi from Nov 2016 till Nov 2017.

Methodology: A sample size of 153 was enrolled by consecutive convenient sampling technique. The role of the cultural context of both hospitals was compared by asking questions from the hospital's staff. Data were collected by the researcher using an open and closed-ended questionnaire.

Results: Data of 153 successful and filled questionnaires were analyzed. Out of 153, 78 (51%) cases were for private hospitals and 75 (49%) cases were for public hospitals. The role of the cultural context in determining the use of the patient safety concept was not sufficiently understood by participants of both hospitals, and most of the participants gave vague answers.

Conclusion: Cultural context is one of the key factors in patient safety as with collective mindfulness about safety issues, and health care can be delivered safely.
EVALUATION OF CHONDROPROTECTIVE EFFECTS OF HYALURONIC ACID IN A RAT MODEL OF OSTEOARTHRITIS
Authors: Ishaq Noaman , Ali Shabana , Aslam Khan Muhammad Waqar , Farhat Kulsoom , Ata Nausheen , Mehdi Quratulain
Published: January 2022

Objective: To evaluate the chondroprotective effects of hyaluronic acid in a rat model of osteoarthritis.

Study Design: Laboratory based experimental study.

Place and Duration of Study: Department of Pharmacology, Army Medical College, Rawalpindi, in alliance with National Institute of health, Islamabad and Department of Pathology, Army Medical College Rawalpindi, from Apr to Jun 2019.

Methodology: Sixteen (16) rats of Sprague Dawley breed were procured in this study. Osteoarthritis was induced in right knee joint of rats by surgical resection of medial meniscus and anterior cruciate ligament. They were allocated into two (02) groups with eight (08) rats in both groups. Group-I was control group that was treated with 0.2 ml intra articular saline once weekly for four weeks. While group-II was treatment group that was intra particularly administered with 0.2ml hyaluronic acid once weekly for four weeks. One week after the last dosage, gait pattern of the animals was scored. Then animals were sacrificed and a part of proximal tibia was obtained for histopathologic analysis.

Results: Mean gait score of control group and treatment group was 3.25 ± 0.707 and 1.00 ± 0.756 respectively with a statistically significant p-value of <0.001, while mean histopathological Modified Mankin score of control and treatment group was 11.5 ± 1.195 and 5.50 ± 1.195 respectively with a significant p-value of <0.001.

Conclusion: Intra articular viscosupplementation of hyaluronic acid in rat model of osteoarthritis resulted in improved gait pattern and histopathology.
EVALUATION OF CHOROID THICKNESS CHANGES AFTER UNEVENTFUL PHACOEMULSIFICATION SURGERY USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AT A TERTIARY CARE EYE HOSPITAL
Authors: Rafique Aisha , Zafar Omar , Khan Summaya , Javaid Hassaan
Published: January 2022

Objective: To analyze the effects of uneventful phacoemulsification surgery on choroidal thickness using spectral domain optical coherence tomography.

Study Design: Prospective comparative study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2018 to Jun 2019.

Methodology: In this prospective study, 300 eyes of 300 patients undergoing phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including measurement with optical biometry, intraocular pressure and choroid thickness. The choroidal thickness was measured perpendicularly at the fovea using spectral domain optical coherence tomography preoperatively and 1 month postoperatively. Changes in intraocular pressure and choroid thickness after surgery were evaluated.

Results: There was a statistically significant increase in the choroid thickness in early postoperative period (p-value <0.01). This increment was prominent in sub foveal regions. The intraocular pressure decreased significantly 1 month after surgery (p-value <0.01). The change in intraocular pressure was correlated with the choroid thickness change at sub foveal region.

Conclusion: Uncomplicated phacoemulsification induces non-pathologic increase in sub-foveal choroid thickness probably due to the inflammatory insult of the surgery. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.
A CASE REPORT OF JUVENILE FORM OF METACHROMATIC LEUKODYSTROPHY
Authors: Sajjad Muhammad Mohsin , Yousaf Sidra
Published: January 2022

Metachromatic Leukodystrophy is a lysosomal storage autosomal recessive disease characterized by arylsulphatase enzyme deficiency, with central and peripheral demyelination. We report a case of a 15-year-old girl with 6 months history of progressive muscular weakness, poor school performance, gradual memory loss and gait disturbance. Neurological examination was grossly normal, except mild muscle wastage in both upper and lower limbs and slight reduction of power globally in all limbs. Routine bloods including a lumbar puncture was normal and the diagnosis of metachromatic leukodystrophy was made on the findings of magnetic resonance imaging (MRI) brain.
OUTCOME OF PATIENTS TREATED WITH BLADDER PRESERVATION PROTOCOL IN UROTHELIAL CARCINOMA OF URINARY BLADDER
Authors: Hussain Sameed , Syed Abdus Samad , Samad Fouzia Abdus
Published: January 2022

Objective: To explore trimodality treatment with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy as an alternative approach to neoadjuvant chemotherapy followed by radical cystectomy, for the treatment of non-metastatic muscle invasive bladder carcinoma.

Study Design: Retrospective observational study.

Place and Duration of Study: Combined Military Hospital Rawalpindi Pakistan, from 2006 and 2015.

Methodology: A total of 122 patients were evaluated in a retrospective manner. Primary endpoint was overall survival. Patients received four courses of neoadjuvant chemotherapy followed by radical concurrent chemoradiotherapy with Cisplatin as radiation sensitizer.

Result: 5-year overall survival was 80 (66%) in this population and a complete response following completion of treatment was seen in 93 (76.3%) patients. Subset analysis showed markedly increased 5-year overall survival of around 104 (85%) in patients having complete response after neoadjuvant chemotherapy.

Conclusion: The study concludes that bladder preservation is an acceptable alternative to radical cystectomy in selected population especially among those who had a complete response to the initial four courses of chemotherapy.
EFFECTIVENESS OF COMPREHENSIVE CAMPAIGN FOR DENGUE CONTROL IN SOUTHERN PUNJAB, PAKISTAN - AN EXPERIENCE OF 2 YEARS
Authors: Younas Muhammad , Aziz Muhammad Asif , Afzal Raja Kamran , Iqbal Hamid , Hussain Mohsin , Mir Rabia Salar
Published: January 2022

Objective: To determine the effect of comprehensive campaign for dengue control in Southern Punjab, Pakistan.

Study Design: Cross sectional study.

Place and Duration of the Study: Station Health Organization Multan and Departments of Pathology, Combined Military Hospital Multan, from Mar 2019 to Dec 2020.

Methodology: This study was conducted by implementing a comprehensive campaign by involvement of public health workers in high risk dengue area of Multan. There were five phases of this campaign; awareness, situation analysis, vector surveillance, indoor residual sprays where vector was found and contact tracing of dengue fever cases. The system was developed in 46 Mohallas/localities of Multan. Hot spot for mosquitoes breeding were identified at 15 places. Total of 23 health workers were recruited including 3 female workers. Insecticide spraying was carried out by indoor residual spray pumps & thermal foggers in a cyclic pattern.

Results: During 2019, 42 larvae were identified followed by insecticide sprays & follow up visits; 26 cases of dengue fever were diagnosed and treated at CMH Multan in a dedicated dengue ward. Contact tracing was carried out and indoor residual sprays were carried out in 20 houses around residence of these cases. In 2020, 5 larvae were identified followed by sprays & follow up visits; 2 cases of dengue fever were diagnosed and treated.

Conclusion: Comprehensive campaign against dengue fever was quite successful to control spread of dengue fever.
EXPLORING THE KNOWLEDGE AND PRACTICES OF AUSTRALIAN MEDICAL STUDENTS REGARDING INFECTION PREVENTION AND CONTROL IN HOSPITALS: A PILOT STUDY
Authors: Pervaz Iqbal Maha , Uebel Kerry , Islam Md. Saiful , Jabbour Victoria , Jabbour Dr. Victoria , Hall John , Chughtai Abrar A
Published: January 2022

Objective: To assess the knowledge and practice of medical students regarding standard precautions in an Australian undergraduate medical programme.

Study Design: Cross sectional study.

Place and Duration of Study: University of New South Wales, Australia, duration of study was six-years.

Methodology: Fifty medical students who were involved in clinical practice, were invited to complete a comprehensive questionnaire on standard precautions.

Results: The majority of participants agreed that hand hygiene was the most important factor in infection control. Only 32 (16%) knew to use a full personal protective equipment for Ebola. Regarding sharps disposal, 46 (92%) students always disposed used needles in the recommended bin, 27 (54%) indicated they sometimes recapped used needle while 25 (20%) sometimes bent used needles.

Conclusion: This study showed that there is a gap between knowledge and practice of medical students regarding hand hygiene and other infection control measures. There is a need for standardized and regular student training in the use of standard precautions in infection prevention and control.
IN SILICO CHARACTERIZATION OF HUMAN INTERFERON ALPHA/BETA RECEPTOR 2 (ISOFORM A, B AND C) PROTEIN
Authors: Javed Ambreen , Trali Gulshan Ara , Abbas Hassan Burair , Sadiq Alia
Published: January 2022

Objective: To predict the tertiary structure of human interferon alpha/beta receptor 2 protein.

Study Design: Structure prediction by using bio informatics tools.

Place and Duration of Study: Department of Biochemistry, Swat Medical College (STMC), Saidu Shareef, Swat, Pakistan, from Aug 2019 to Dec 2019.

Methodology: All protein sequences of human interferon alpha/beta receptor 2 (isoforma, b and c) (IFNAR-2) were retrieved through the BLAST search (The Basic Local Alignment Search Tool) from available databases ‘NCBI’ (National Centre for Biotechnology Information) and ‘Uni Prot KB’ (The Universal Protein Resource). Sequence alignment was conducted by using Clustal Omega, to get the consensus sequence for IFNAR-2 protein. Consensus protein sequence of human IFNAR-2 was used for the prediction of the three-dimensional structure by employing Swiss-Model Server. Moreover, subcellular localization analysis was also performed by using CELLO2GO program.

Results: Structural model of human IFNAR-2 protein was predicted and evaluated by Ramachandran dimension. Cellular localization of tertiary topological domains of the predicted models were revealed probability of localization of IFNAR-2 protein (isoform a, b & c) is highest in the plasma membrane due to the presence of the transmembrane alpha helical regions.

Conclusion: This study predicted the tertiary structural dimensions of human IFNAR-2 protein, including the specific topological domains that contribute towards the subcellular compartmentalization and functional characteristics.
ISOLATION AND IDENTIFICATION OF MICROBIAL FAUNA IN UTI PATIENTS
Authors: Ilyas Muhammad , Riaz Saffora , Hassan Ali
Published: January 2022

Urinary tract infection caused by bacteria leads to inflammation. It is an important infection which can cause a highly morbidity rates in both males and females. The aim of the present study was determine the percentage prevalence of the UTI among the general population and the percentage of the bacterial isolates in the Urine samples. Among 150 samples bacterial isolates were obtained which included Escherichia coli, Klebsiella pneumonia, Proteus vulgaris, Pseudomonas aeruginosa. The highest prevalence of specific bacteria was found to be Escherichia coli recorded among all the UTI patients to be (55.55%) the least percentage among the bacteria were Klebsiella pneumonia, Proteus vulgaris, Pseudomonas aeruginosa and Enterobacter aerogenes which recorded 16.66%, 5.55%, 11.11% and 11.11% respectively. Results of the study showed that of femaleshad UTI more than the males.
DEPRESSION AND ANXIETY AMONG PATIENTS SEEKING RHINOPLASTY
Authors: Khan Sikandar Ali , Ali Ghazanfar , Raza Maqbool , Tariq Muhammad , Adeel Imran , Butt Ahsan Masood
Published: January 2022

Objective: To evaluate the presence and relation of depression and anxiety among patients seeking rhinoplasty

Study Design: A cross-sectional study.

Place and Duration of Study: Departments of Psychiatry, department of Plastic Surgery and ENT, Combined Military Hospital Multan, from Jan 2019 to Mar 2020.

Methodology: A total of 102 patients were recruited that reported to Plastic surgery and ENT unit. Patients were divided equally in two groups of 51 each. One group included patients seeking rhinoplasty while other group included those patients that reported in Plastic surgery and ENT unit for reasons other than rhinoplasty. Symptom were assessed using Beck Depressive Inventory for depression and Beck Anxiety Inventory for anxiety.

Results: A total of 102 participants were included in the study, of these 51 were patients seeking rhinoplasty and 51 were controls. Significant correlation exist between anxiety and depression (p<0.00).

Conclusion: There is a very high frequency of anxiety and depression among patients seeking Rhinoplasty along with significant positive correlation.
ENT SURGEONS AS MASTER TRAINERS OF CRICOTHYROIDOTOMY WILL SAVE PRECIOUS LIVES IN EMERGENCIES
Authors: Shabbir Bukhari Syed Muhammad Asad , Aslam Sohail , Riaz Naeem , Abbas Asim , Raza Maqbool , Fareed Ghulam
Published: January 2022

Objective: To train young doctors and paramedical staff on needle cricothyroidotomy and surgical cricothyroidotomy and provision of kits in trauma centers, main operation theatres and medical reception centers of the hospitals.

Study Design: Quasi experimental study.

Place and Duration of Study: Combined Military Hospital Peshawar and Pakistan Naval Ship Shifa, Karachi Pakistan, from Nov 2017 to Oct 2020.

Methodology: Doctors and paramedical staff were selected on volunteer basis. Small groups were trained in 2-3hours. The participants were shown two videos of two procedures in Urdu language first and then were trained on mannequin.

Results: A total of 345 participants including 205 males and 140 females were trained with mean age was 28.2667 ± 6.24 (SD) years. Out of 61 residents, 54 medical officers, 143 house officers, 35 nurses and 52 paramedical staff were participants.

Conclusion: ENT surgeons must arrange mannequins and conduct training sessions of small groups after every 1 to 2 months.
INCIDENCE OF RECURRENT LARYNGEAL NERVE PALSY IN CERVICAL ANASTOMOSIS AFTER ESOPHAGECTOMY FOR CARCINOMA ESOPHAGUS
Authors: Hussain Zahid , Majeed Farhan Ahmed , Raza Maqbool , Shahbaz Aaisha , Rafique Atif , Farhan Nabeela
Published: January 2022

Objective: To study the incidence of Recurrent Laryngeal Nerve Palsy (RLNP) in cervical anastomosis after esophagectomy for carcinoma of the esophagus.

Study Design: Prospective observational study.

Place and Duration of Study: Military Hospital’s Thoracic surgery departments, Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan, from Jan 2010 to Sep 2020.

Methodology: Designated proformas were used to collect data. Histopathologically proven, operable cases of carcinoma esophagus with normal phonation were included, all of which underwent cervical anastomosis. All cases of benign pathologies and per-operative macroscopically advanced loco-regional disease were excluded. Recurrent laryngeal nerve (RLN) was identified in all cases and follow-up of 6 months for recovery period was executed.

Results: 220 cases were included out of which 121 (55%) were males while 99 (45%) females. The age range was 14-81 years (mean is 38.7 ± 16.78). Out of 29 (13.6%) cases underwent minimally invasive esophagectomy (MIE) while thoracophreno laparotomy was performed in 100 (45.4%) cases, McKeown in 46 (20.9%) and Trans-hiatal esophagectomy (THE) in 45 (20.4%) patients. Recurrent Laryngeal Nerve Palsy was found in 19 patients (8.6%), tracheal injury in 3 (1.3%) and bronchial injury in 1 (0.4%) patient. Recurrent Laryngeal Nerve Palsy was transient in 14 cases and permanent damage persisted in 5 patients.

Conclusion: Recurrent Laryngeal Nerve Palsy after esophagectomy is related to increased morbidity due to respiratory complications. With Sharp dissection technique, adequate surgical skill and equipment, the incidence of Recurrent Laryngeal Nerve Palsy can be decreased. In our study, it is less............
El aprendizaje basado en escenarios como estrategia de desarrollo de competencias para afrontar el proceso de selección de personal
Authors: Prieto Preboste Silvia Nazareth , Chamorro Laborda José Manuel
Published: January 2022

Este trabajo ha obtenido un Accésit del Premio Estudios Financieros 2021 en la modalidad de Educación y Nuevas Tecnologías.
Esta investigación versa sobre el diseño e implementación de un juego online de simulación, cuyo objetivo es ayudar al desarrollo de competencias en 54 estudiantes (hombres y mujeres) universitarios de grado y máster para afrontar con éxito un proceso de selección de personal.
La base teórica en que se sustenta la herramienta desarrollada es el aprendizaje basado en escenarios (ABE), que permite recrear diferentes pruebas de evaluación de competencias de un proceso de selección (dinámica de grupo, role playing y entrevista), propiciando que el estudiante conozca mejor dichas pruebas y, a través de un ejercicio de autoevaluación situacional, que reflexione sobre la importancia de desarrollar determinadas capacidades en su perfil.
Las conclusiones son muy positivas, ya que, tras participar en el juego, la mayoría consideró que sus conocimientos sobre cómo se desarrolla un proceso de selección habían mejorado, que el juego les permitía reflexionar sobre las debilidades y fortalezas de su perfil y que eran más conscientes de qué aspectos concretos debían mejorar para afrontar un proceso de selección.