bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison and Prediction of Irrational Beliefs and Cognitive Functioning Among Depressed and Non-Depressed Adults in Gujrat, Pakistan
Authors: Naz Iram , Ahmed Laiba , Ishaq Amna , Ayyaz Maryyam
Published: December 2022

Objective: To compare and predict the irrational beliefs and cognitive functioning among depressed and non-depressed adults in Gujrat, Pakistan.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Zulfiqar Hospital, Akram Hospital and Aziz Bhatti Hospital, Gujrat and Department of Psychology, the University of Gujrat from Dec 2017 to Mar 2018.

Methodology: The data was collected from 200 adults, 100 depressed adults and 100 non-depressed adults using consecutive sampling. The non-depressed adults with no past psychiatric history were recruited from the community. The irrational beliefs were assessed using the Evaluative beliefs scale, and cognitive functioning was measured using the Montreal cognitive assessment scale.

Results: The independent sample t-test indicated that there was a statistically significant difference (p<0.001) in the irrational beliefs of depressed and non-depressed adults, and the irrational beliefs of depressed were more (37.83 ± 8.12) than the nondepressed adults (4.33 ± 4.64). The comparison of cognitive functioning of the depressed and non-depressed was also significantly different (p<0.001). The cognitive functioning of depressed adults was poorer (12.44 ± 3.85) than the nondepressed adults (26.92 ± 2.55). Further-more, irrational beliefs predict cognitive functioning [R²=0.729; F (1,198) = 532.763, p<0.001].

Conclusion: The study findings indicated a difference in the irrational beliefs and cognitive functioning of depressed and nondepressed adults. Further, the depressed had more irrational beliefs and worsened cognitive functioning.
Comparison of Streptokinase and Urokinase for Thrombolysis in Blocked Tunnel Cuffed Catheter Among the Patients of Chronic Renal Failure Undergoing Hemodialysis
Authors: Tahir Taleah , Raja Khalid Mehmood , Azam Malik Nadeem , Arshad Abdul Rehman , Mir Abdul Wahab , . Salahuddin
Published: December 2022

Objective: To compare the efficacy of Streptokinase and Urokinase for thrombolysis in blocked tunnel cuffed catheter among the patients with chronic renal failure undergoing hemodialysis.

Study Design: Comparative prospective study.

Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2019 to Mar 2020.

Methodology: A total of 100 cases were included in the study which was undergoing hemodialysis in the nephrology department and had a poorly functioning or blocked tunnel cuffed catheter. These patients were either given Urokinase or Streptokinase in standard doses for thrombolysis. The lottery method was used to designate the patient either in the Streptokinase or Urokinase groups. The primary endpoint was the resolution of blocking and regain of proper functioning of the catheter.

Results: In our study, 54 (54%) patients were males, and 46 (46%) were females. The mean age of the study participants was 44.63 ± 3.782 years, and the mean duration of chronic kidney disease was 2.19 ± 6.814 years. 43 (43%) patients were given Urokinase, while 57 (57%) were given Streptokinase. After applying the logistic regression, we found that the use of Streptokinase had a significant association with the resolution of blocking and regain of proper functioning of the catheter compared to the use of Urokinase.

Conclusion: This study concluded that most catheters regain the proper functioning after thrombolysis with either Urokinase or Streptokinase. However, Streptokinase emerged as a better agent for this purpose in our study.
Comparison of Feasibility, Efficacy and Patient Acceptability of Manual Vacuum Aspiration Vs Sublingual Misoprostol in Early Pregnancy Loss
Authors: Arif Nadia , Zafar Bushra , Ahmed Raja Qaseem , Shehzad Farrukh
Published: December 2022

Objective: To compare feasibility, efficacy and patient acceptability of manual vacuum aspiration with sublingual Misoprostol in early pregnancy loss.

Study Design: Comparative prospective study.

Place and Duration of Study: Gynecology and Obstetrics Department, Combined Military Hospital Okara Pakistan, from Aug 2019 to Apr 2020.

Methodology: 200 Patients with early pregnancy loss (missed, incomplete abortion) at gestational age 6 to 12 weeks were randomly allocated to Manual vacuum aspiration (group A) and oral Misoprostol (group B) by lottery methods. Manual vacuum aspiration was done in the outpatient department. While in Group B, oral Misoprostol was given with a protocol 600 micro gram sublingual stat observe for 1 hour for any complication. Afterwards, they were given Misoprostol 600 micrograms sublingual, 3 hourly total of 2 doses. Patients from both groups were called for follow-up after one week.

Results: Efficacy, feasibility and patient acceptability was 88%; p-value <0.001, 95%; p-value <0.001 and 97% respectively in manual vacuum aspiration group as compared to 64%, 68% and 70% in sublingual Misoprostol group. There were fewer systemic side effects and fewer visits in manual vacuum aspiration group 1 vs 3 in the sublingual Misoprostol group.

Conclusion: Manual vacuum aspiration is more effective than Misoprostol as it has no systemic effects. Both options are cheap and can be achieved in outpatient settings. However, manual vacuum aspiration provides complete evacuation and is a good option for low resource settings and a developing country like Pakistan with frequent electricity disruptions. It offers a substantial saving on resources, cost and...
Salicylic Acid Versus Glycolic Acid Peel in Active Acne
Authors: Aftab Kanza , Iftikhar Nadia , Hussain Majid , Zainab Zarnab , Mumtaz Maimoona , Obaid Shanza
Published: December 2022

Objective: To compare the efficacies of Salicylic acid and Glycolic acid peel in patients with active acne.

Study Design: Quasi-experimental study.

Setting and Duration of Study: Department of dermatology, Pak Emirates Military Hospital, (PEMH) Rawalpindi Pakistan, Dec 2018 to Jan 2020.

Methodology: A total of 300 patients with active acne were included in this study. Patients were randomized into groups by lottery method. Group-A was given 30% Salicylic acid, while Group-B was given 70% Glycolic acid to control active acne. A grading system developed by Hayashi et al, was used to assess the response. A score less than six after 12 weeks was considered a positive response. In addition, the type of treatment and other factors were compared in the patients with and without a positive response after the designated treatment.

Results: Out of 300 patients with active acne included in the study, 172 (57.3%) had a positive response, while 128 (42.7%) had not achieved a positive response after the twelve-week treatment. Use of 30% Salicylic acid, lesser duration of acne and more minor age of the patients had a statistically significant relationship with a positive response in the study population (p-value 0.010, 0.005 and 0.001, respectively).

Conclusion: A significant number of patients did not respond to standard therapy of acne vulgaris. However, chances of achieving a positive response increase with 30% Salicylic acid instead of 70% Glycolic acid, lesser duration of acnes and young patients have more chances of getting a positive response at the end of the therapy.
Efficacy of Sofosbuvir and Daclatasvir in Achieving the End Treatment Response and Sustained Viral Response in Patients infected with Hepatitis C Virus Genotype 3
Authors: Ullah Zabih , Khan Sultan Zeb , Lodhi Hassam , Khan Hafizullah , Hidayat Rania , Ahmed Moiz
Published: December 2022

Objective: To ascertain the efficacy of sofosbuvir combined with daclatasvir against hepatitis C genotype 3 infection.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Ayub Teaching Hospital, Abbottabad, Pakistan, from Nov 2018 to Jan 2020.

Methodology: About 262 patients were treated during the study. Patients with symptoms associated with liver failure, including ascites, uncontrolled bleeding, encephalopathy and other comorbidities, were excluded from the study. Patients with diagnosed hepatitis C genotype 3 infection were given daclatasvir and sofosbuvir combined with follow-up visits at 12 and 24 weeks of treatment. Primary outcome variables were end treatment response, sustained viral response, nonresponders, and relapse rate. In addition, secondary outcomes of patient variables including age, gender, and baseline viral load were observed.

Results: The mean age of patients was 39.8 ± 8.2 years. The twelve-week course of Sofosbuvir and Daclatasvir produced an end treatment response (ETR) of 98.9%, while the sustained virological response was 95.8%. The combination had no adverse effects, and none of the patients reported treatment discontinuation. There were no deaths due to treatment.

Conclusion: The current study indicates that using Sofosbuvir in conjunction with Daclatasvir is an effective drug regime against the Hepatitis C virus, type 3 infection.
Geriatrics Breast Cancer: Stage at Presentation and Relationship of Various Factors with Advanced Stage
Authors: Shahbaz Shanzah , Cheema Ahmed Ammar , Hussain Muhammad Zahid , Ikram Farooq
Published: December 2022

Objective: To determine the frequency of various stages of breast cancer at presentation and the relationship of various factors with advanced stage in geriatric patients in Pakistan.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Oncology, Hameed Latif Hospital, Lahore Pakistan, from Feb to Jul 2018.

Methodology: A total of 130 geriatric breast cancer patients between the ages of 60-80 years were included. A biopsy report was noted, which was done in the surgical ward and histopathology was done in the institutional pathology department. The researchers evaluated all the reports. In addition, the stage of the breast cancer documented (stage documented by CT scan chest abdomen and pelvis and bone scan. Chest X-ray and ultrasound abdomen and pelvis report were reviewed in case of CT scan report not available) as per American joint committee on Cancer (AJCC) TNM staging system for breast cancer 8th edition.

Results: Mean age was 69.10 ± 5.89 years. 106 (81.54%) patients were between 60 to 70 years of age. The mean duration of disease was 7.48 ± 3.87 months. 52 (40.0%) geriatrics patients presented in stage IV followed by stage III, II, I as 48 (37.00%), 30 (23.0%) and 00(0.0%) respectively. The long duration of illness has a significant relationship with advanced disease (pvalue<0.05).

Conclusion: Stage IV is the most common stage of breast cancer at presentation in geriatric patients, followed by stages III, II and I, respectively and the long duration of illness has a significant relationship with advanced disease.
Knowledge and Attitude Towards Sexual Practices During Pregnancy
Authors: Fatima Sadia , Shafiq Nighat , Muzaffar Tabassum , Abbas Syed Waqar , Zohra Sadaf , Safdar Isma
Published: December 2022

Objective: To explore the knowledge, attitude and sexual practices among pregnant women reporting to a tertiary care hospital

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Antenatal clinic of Obstetrics & Gynaecology Department, Combined Military Hospital Rawalpindi Pakistan, from Jan to Jun 2020.

Methodology: Three hundred and seventy women who attended the antenatal clinic during the study period were interviewed. The responses to chosen preferences were recorded on a structured questionnaire.

Results: The majority of participants believed that intercourse could be done throughout pregnancy, it does not result in complications, and improves marital relationships. However, it was difficult due to the changed physical appearance, but it was not unpleasant for the husband. Only 51.1% of participants agreed to decreased libido. 77.6%, 71.6% and 75.4% were of the opinion that it was not prohibited in religion, neither influence baby nor labour respectively.

Conclusion: Most pregnant women maintain sexual activity during pregnancy. The majority had adequate knowledge and a positive attitude.
Clinical Presentation, Complications and Early Predictors for Poor Outcomes in Pediatric Myocarditis in a Tertiary Care Hospital
Authors: Khalid Adeel , Kamraan Amber , Rafiq Nida , Kumari Veena , Sheikh Abdul Sattar , Patel Najma
Published: December 2022

Objective: To evaluate common clinical presentation, complications and poor prognostic outcomes in children with acute myocarditis.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Pediatric Cardiology Department, National Institute of Cardiovascular Disease Karachi Pakistan, from Feb to Aug 2020.

Methodology: The children aged one month to 16 years were included in the study. Clinical, demographic features, Electrocardiogram, Echocardiography, management, complications, and immediate outcomes were recorded.

Results: The total number of patients enrolled was 161. The median age was 5.01 ± 3.38 years for 66.4% of males and 33.5% females, mean Duration of symptoms was 8.35 ± 3.49 days. Upper respiratory tract infection was present in 84 (52.2%) and diarrhea in 8 (5%) in the preceding illness. Symptoms and signs include loss of appetite in 153 (96.27%), irritability in 148 (91.9%), vomiting in 132 (82%) and abdominal pain in 112 (69.6%), tachycardia in 148 (91.9%) and pallor in 143 (88.8%). Low voltage ECG was present in 125 (77.6%), arrhythmias in 12 (7.45%) and heart block in 6 (3.7%). Left ventricle end-diastolic dimensions (LVIDD)>4SD were present in 30.2% and LV end-systolic dimensions (LVIDS)>4SD in 19.5%, Left ventricular ejection fraction (LVEF)mean was 21.13 ± 5.07 vs 23.45 ± 3.31 at discharge. 9.21% of patients expired, out of which 78.5% had Left bundle branch block (LBBB), mean LVEF was 16.24 ± 3.16, LVID d>4SD in 78%, and LVIDs>4SD in 30%.

Conclusion: The most frequent presentations were loss of appetite, difficulty breathing, irritability and abdominal pain. Tachycardia and pallor were......
Can Steroid Response in Idiopathic Childhood Nephrotic Syndrome be Predicted? A Single Center Quasi-Experimental Study
Authors: Rehman Madeeha , Asghar Ali , Ehsan Afshan , Aziz Madiha , Khatri Sabeeta , Hashmi Seema
Published: December 2022

Objective: To predict the role of clinical risk factors and urinary β2-microglobulin levels as a biomarker for steroid-resistant nephrotic syndrome.

Study Design: Quasi-experimental study.

Place and Duration of Study: Paediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi Pakistan, from Jun 2019 to Nov 2020.

Methodology: All children (3 months to 12 years) with either first episode or relapse of the nephrotic syndrome were included. A stored urine sample was used on 100 patients with steroid-sensitive (group-1) and 35 patients with steroid-resistant nephrotic syndrome (group-2). In addition, histopathology of all patients with steroid-resistant nephrotic syndrome was recorded.

Results: Both groups and those who had focal segmental glomerulosclerosis were compared and analysed to evaluate the predictability of steroid response. There was a significant association in both groups for microscopic haematuria, hypertension, heavy proteinuria (urine spot protein to creatinine ratio >10 g/g) and increased β2-microglobulin levels (> 3× normal) as individual risk factors (p<0.01). The sensitivity of β2-microglobulin levels was 78% and a positive predictive value of 80%. Multivariate regression analysis on steroid-resistant nephrotic syndrome as a group did not confer a higher risk; however, for children with focal segmental glomerulosclerosis, the likelihood of steroid unresponsiveness was significantly higher for the same parameters.

Conclusion: The addition of biomarker measurement and known clinical risk factors helped predict steroid-resistant focal segmental glomerulosclerosis. However, further studies are warranted before these results can be generalized.
Frequency of Hypertension in Children Presenting at Combined Military Hospital Malir Cantt Karachi
Authors: Zaidi Syed Taqi Hassan , Maqsood Almas , Ali Arshad , Saba Ameena , Ali Wasif Shujaat , Afzal Warda
Published: December 2022

Objective: To determine the frequency of hypertension in our children and explore its relation to obesity to emphasize the importance of routine blood pressure check-ups in outpatient departments and clinics.

Study Design: Cross-sectional study.

Place and Duration of Study: Pediatric Outpatient Department and Child Ward of the Combined Military Hospital Malir Cantt Karachi Pakistan, from May to Dec 2020.

Methodology: A total of 1000 children of 3-13 years selected on consecutive sampling methods with no history of hypertension were enrolled. Three blood pressure readings were recorded using an aneroid sphygmomanometer using the standard protocol, and their weight and height were measured to calculate their BMI.

Results: Out of 1000 children, 62 (6.20%) were found hypertensive, out of which 42 (67.7%) were male, and 20 (32.3%) children were females. Overall 42/622 (6.75%) male children and 20/378 (5.87%) female children developed hypertension. Obesity was found in 6.45% of positive cases, while 3.22% of hypertensive children were overweight. The frequency of hypertension linearly increased with increasing age. In addition, 12.9% of cases had a positive family history of hypertension.

Conclusion: The frequency of hypertension in the Pediatric population was 6.20%. Male predominance was found in hypertensive cases. Hypertension was more prevalent among children of preadolescent age. Obese and overweight children were more likely to develop hypertension than normal-weight children.
Klippel-Trenaunay-Weber Syndrome – A Rare Case with Visceral Manifestation and Thrombosed Marginal Vein of Servelle
Authors: Ibrahim Muhammad Imran , Hussain Awan Leena , Khan Babar , Javed Koukab , Mariam Zehra Syeda , Hussain Mariam
Published: December 2022

Klippel-Trenaunay-Weber syndrome is a rare congenital syndrome characterized by capillary, venous or lymphaticmalformation and hemihypertrophy. Only 1000 cases of this syndrome have been reported in the literature. A rare case of this syndrome is presented here, who presented with its visceral and vascular complications and was diagnosed for the first time.
Comparison of Creatinine, Cystatin C and Combined Creatinine-Cystatin C for Renal Function Assessment in Patients with Diabetes
Authors: Umar Saba , Sabir Sohail , Azam Nadeem Malik , Aamir Muhaamad , Bibi Afshan , Altaf Ashfaq , Siddiqui Faud Ahmed , Sabir Haroon , Raja Khalid Mehmood , Butt Batool
Published: December 2022

Objective: To compare the estimated glomerular filtration rate (eGFR) assessed through the CKD-EPI equations based on creatinine, Cystatin C and creatinine-Cystatin C levels for estimating kidney function among patients with diabetes.

Study Design: Cross-sectional analytical study.

Duration and Place of Study: Nephrology Department, Armed Forces Institute of Urology, Rawalpindi Pakistan, from Aug 2020 to Mar 2021.

Methodology: A total of 70 patients were recruited. Serum samples were collected for creatinine and Cystatin C levels and 24 hours of urine for creatinine clearance. The eGFR values were calculated using the creatinine, Cystatin C and combined creatinine-Cystatin C CKD-EPI equations and compared with 24 hours of urinary creatinine clearance.

Results: A total of 22 (31.4%) patients had early stage, while 48 (68.6%) had late-stage chronic kidney disease (CKD). The highest Spearman correlation coefficient was found for eGFR CKD-EPIcr-cys (rho=0.844), followed by CKD-EPIcys (rho= 0.835) and CKD-EPIcr (rho=0.709).

Conclusion: CKD-EPIcr-cys is the most accurate, recommended method of calculating eGFR.
The Comparison of Hand Sewn and Stapled Anastomoses
Authors: Hussain Tanweer , Jabbar Abdul , Ahmed Naveed , Shah Naqeeb , Zulfiqar Mujahid , . Anita
Published: December 2022

Objective: To compare hand-sewn and stapled sutures and the influence of intestinal excision on postoperative complications.

Study Design: Retrospective comparative study.

Place and Duration of Study: General Surgery Department of CMH Peshawar, from Jan 2020 to Jan 2021.

Methodology: Once receiving consent, all individuals hospitalized in the medical facility for ileostomy closure were included in our investigation. In a questionnaire, postoperative complications were documented.

Result: This study involved a total of 60 subjects. Individuals were scheduled for surgery after receiving clearances and a loopogram distally. Thirty patients had their wounds hand-sewn shut, while 30 others had their wounds stapled shut. The mean operating time for the hand-sewn method was 2.46 ± 0.29 hours, compared to 1.86 ± 0.17 hours mean for the stapled method. In both categories, the anastomotic leak was comparable. Thirty patients in the hand-sewn group took a mean of 2.42 ± 0.25 days to return bowel sounds after surgery, whereas it took 1.83 ± 0.20 days to return bowel sounds.

Conclusion: The stapler method greatly decreases the duration of surgery, promotes rapid recovery, and has a lower fatality rate. Stapling is a simple procedure that can be performed in inaccessible locations, such as a low colorectal anastomosis. In elective gastrointestinal procedures, stapler anastomosis can be utilized safely and successfully.
Examination Stress During COVID-19 and Its Coping Interventions Used by Medical Students of Pakistan
Authors: Sadaf Sana , Ishtiqa Sania , Jahan Musarrat , Farooq Fareeha , Mushtaque Saher , Sukhia Dr
Published: December 2022

Objective: To determine the examination stress and anxiety score during COVID-19 pandemic and to identify coping mechanisms adapted by medical students.

Study Design: Cross-sectional study.

Place and Duration of Study: Sir Syed College of Medical Sciences for Girls, Karachi, from Apr-May 2021.

Methodology: A total of 250 students were recruited in the study and validated questionnaire was used for data collection. Test anxiety scores were calculated from a previous study scale by Nist and Diehl (1990). Data was analyzed by using SPSS-23.

Results: The mean age of students was 20.1 ± 0.6 years. 74 (29.6%) students felt stress sometimes, 40 (16.0%) students felt always and 30 (12.0%) students never felt stressed before examination. Students who reported improved performance during the examination due to stress were 121 (48.4%). 76 (30.4%) students reported decrease in performance and 53 (21.2%) reported that their stress did not affect their performance. Students were inquired regarding the methods to cope the stress. 78 (31.2%) students reported that they took study break, 66 (26.4%) students spent time with family and friends, 49 (19.6%) found solace in sleep, 30 (12.0%) students listened to music, 13 (5.2%) used beverages (tea, coffee), 11 (4.4%) used numerous combinationsof methods, and only 3 (1.2%) students exercised. It was found that 158 (77%) students experienced healthy anxiety, 68 (27.2%) unhealthy anxiety, and 22 (8.8%) students were anxiety-free.

Conclusion: Examination stress among medical students has increased during COVID-19 and various coping methods are used by the students to prevent anxiety. College.....
Frequency of Different Neuropsychiatric Manifestations of Systemic Lupus Erythematosus at a Tertiary Care Hospital in Pakistan
Authors: Ullah Naeem , Adnan Saqib , Mustafa Syed Hassan , Khan Suleman , Hussain Ibrar , Ullah Saleem
Published: December 2022

Objective: To determine the frequency of different neuropsychiatric manifestations of systemic lupus erythematosus

Study Design: Cross-sectional study.

Place and Duration of Study: Division of Rheumatology Lady Reading Hospital, Peshawar Pakistan, from Sep 2020 to Feb 2021.

Methodology: 31 patients who fulfilled the 2019 ACR/EULAR criteria for SLE diagnosis were included in the study. Different features of neuropsychiatric manifestations of systemic lupus erythematosus were recorded on a proforma.

Results: Our study sample included 27 females and four males. Most of the patients were young, with a mean age of 23.12 ± 10.74 years. All patients had positive Anti-nuclear antibodies (100%), while anti-double standard DNA antibody was found in 21 patients (67. 74%). Seizures were the most common neuropsychiatric feature, i.e., found in 18 patients (58%), followed by headache (25.8%), acute confusional state (25.8%) and CNS demyelinating disease (19.3%).

Conclusion: We found that seizures, headache and acute confusional state were the most common neuropsychiatric manifestations of systemic lupus erythematosus.
Association of Time-Lines of COVID-19 Seropositivity with Antibody Ratio Levels
Authors: Mushtaq Saadiya , Din Nasir Ud , Shah Abid Hussain , Riaz Omair , Azam Khalid , Khan Sara Waqar
Published: December 2022

Objective: To determine the persistence of IgG antibodies against SARS-CoV-2 and the association of timelines of COVID-19 seropositivity with antibody ratio levels.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Lahore, from Apr to Sep 2020.

Methodology: The serum of 250 patients recovered from COVID-19 was collected to detect anti-SARS-COV-2 IgG antibodies. Anti-SARS Cov-2 IgG was measured by Semi-Quantitative Enzyme-Linked Immuno-Sorbent Assay (ELISAs), and the association of timelines of COVID-19 seropositivity with antibody ratio levels was determined.

Results: Out of 250 study participants, males were 220 (88%) while females were 30 (12%), mean age being 35.25 years ± 9.096 years. In the timeline of 31-60 days after the first positive COVID-19 PCR, 27 out of 44 (61%) were seropositive. In the 61-90 days’ timeline, 79 out of 155 (51%) were seropositive, in the timeline of 91-120 days after the first positive PCR, 52 out of 76 (68%) were seropositive, and in the timeline of 121-150 days, 12 out of 15 (80%) of the study participants were seropositive for COVID-19.

Conclusion: Serological IgG immune response against SARS-CoV-2 persists up to five months after active COVID-19 infection in most individuals in the Pakistani population.
Association of Hypertension with Raised Serum Homocysteine Levels
Authors: Ikram Hasan , Jaffar Syed Raza , Hayat Asma , Kahttak Mehnaz , Ellahi Ayesha , Naeem Afnan
Published: December 2022

Objective: To study the association of hypertension with raised serum homocysteine levels.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Army Medical College Rawalpindi in collaboration with Armed Forces Institute of Pathology and Military Hospital Rawalpindi, from Mar to May 2021.

Methodology: Total study participants were four hundred in number. Two hundred patients with hypertension aged between 35-55 years were included in Group-1, whereas two hundred non-hypertensive patients with the closest possible age and sex matching were included in Group-2. Strict adherence to inclusion and exclusion criteria was ensured.

Results: The mean age of patients with hypertension (Group 1) was 42.60 ± 9.95 years, and without hypertension, i.e., healthy participants (Group 2), was 42.26 ± 10.03 years. Systolic BP was 157.92 ± 8.07 mmHg among Group 1 (hypertensive subjects) and 114.60 ± 4.58 mmHg among Group 2 (healthy participants). Mean diastolic blood pressure in patients with hypertension (Group 1) was 104.95 ± 5.87 mmHg, whereas it was 74.20 ± 4.74 mmHg among non-hypertensive healthy participants (Group 2). Mean serum homocysteine level was significantly correlated with hypertension (p-value <0.001, r=0.804 for systolic and p-value <0.001, r=0.792 for diastolic blood pressure) and was higher in Group 1(20.64 ± 4.40 µmol/L) than that of healthy Group 2(9.48 ± 2.38 µmol/L).

Conclusion: Our study concludes that serum homocysteine had a significant positive correlation with hypertension and can be used as an early marker for hypertension assessment in addition to regular blood pressure measurements.
Predictive Value of Plasma Hematocrit Level in Early Diagnosis of Pre-Eclampsia
Authors: Saeed Saira , Akram Hina , Awan Shazia Mahmood , Murtaza Badar
Published: December 2022

Objective: To determine whether hematocrit level is associated with pre-eclampsia and assess its predictive value in diagnosing pre-eclampsia.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Department of Obstetrics and Gynecology, CMH Quetta, from Jul 2019 to Jan 2020.

Methodology: A total of 561 pregnant women with a singleton pregnancy were included in the study. The diagnosis of preeclampsia was made as per operational definition. The samples were collected by non-probability consecutive sampling. Pregnant females with a parity of 0-4, gestational age > 16 weeks on last menstrual period (LMP) and singleton pregnancy on ultrasound were included in the study. In addition, data on plasma hematocrit findings and incidence of pre-eclampsia (positive/negative) were recorded.

Results: The age range in this study was from 18 to 40 years, with a mean age of 28.805 ± 2.41 years, mean parity of 1.258 ± 1.07 and mean gestational age was 11.352 ± 2.22 weeks. Plasma hematocrit findings predict 26 (4.6%) patients, and the incidence of pre-eclampsia was in 35 (6.2%) patients. Plasma hematocrit findings had shown a sensitivity of 60%, specificity 99%, diagnostic accuracy by 97%, PPV 80.7%, NPV 97.3%, (p<0.001) in diagnosis of preeclampsia.

Conclusion: Haematocrit can be valuable as a screening test for the timely diagnosis of pre-eclampsia in health centres. Women with a hematocrit above the cut-off of 38% must be scrutinized prudently for the signs of pre-eclampsia.
A Comparative Study of Negative Pressure Dressing with and without Silver Alginate to Promote Faster Wound Healing in Chronic Wounds
Authors: Ali Mehak , Ali Hyder , Akhlaq Faisal , Adil Faraz , Naseem Aiman , Ali Urooj
Published: December 2022

Objective: To determine the effectiveness of negative pressure dressing with silver alginate hydro-fibre dressings in managing chronic wounds compared to negative pressure dressing without silver alginate hydro-fibre dressings.

Study Design: Cross-sectional analytical study.

Place and Duration of the Study: Department of Plastic and Reconstructive Surgery at Dr Ruth K.M. Pfau Civil Hospital Karachi, from Jan to Jul 2021.

Methodology: All patients above 18 years of age of either gender presented with more than six weeks of wound duration, hemoglobin levels more than 10 g/dl, platelet count above 150 x 10E9/L, and size of the wound more than 10*10cm were consecutively enrolled. Negative pressure dressings with and without hydro-fibre dressings were applied. A team of plastic surgeons monitored the wound site to assess granulation tissue by noting the size of the wound and pain severity. The outcome was assessed at four weeks.

Results: Of 62 patients, the median age was 43 (32.5-56.7) years. There were 37 (59.67%) males and 25 (40.32%) females. The outcome assessment at four weeks showed that overall pain was observed in 34 (54.83%) patients. Pain severity (p-value <0.001) and low granulation score (p-value 0.025) were found significantly higher in patients who received negative pressure dressing without silver alginate as compared to the patients who received negative pressure dressing with silver alginate. A significant median difference in granulation days was observed between groups (p-value <0.001).

Conclusion: Combining negative pressure dressings with silver alginate dressing has positive effect on the chronic wound compared to using negative pressure dressings alone.
Why do Patients Refuse Pre-Prosthetic Procedures? A Qualitative Study in a Private Sector Dental Teaching Institute
Authors: Sana Aleeza , Saleem Tayyaba , Aziz Anbreen , Abbas Maira
Published: December 2022

Objective: To explore the factors leading to patient non-compliance toward pre-prosthetic mouth preparation.

Study Design: Qualitative exploratory study.

Place and Duration of Study: Prosthodontic Department of Islamabad Dental Hospital, Bara khau Islamabad Pakistan, from May to Jul 2020.

Methodology: Semi-structured interviews were conducted from purposively selected fifteen partially dentate patients who were advised but had refused to get pre-prosthetic mouth preparation. Five content experts validated interview questions. After thematic analysis, the authors developed a consensus regarding themes and subthemes of factors that cause noncompliance of patients toward pre-prosthetic mouth preparation.

Results: Eight themes emerged. Patients were afraid of extraction and scaling and were concerned about cross-infection control, and they were short of time due to busy schedules and lengthy procedures. Few diabetic patients could not go for extraction of their teeth immediately. Patients also refused due to financial constraints and lack of awareness regarding treatment protocols. Some believe myths that removing the teeth results in other diseases such as cancer. Few quoted previous bad dental experiences and were not willing for any pre-prosthetic procedure. In addition, patients were not satisfied with the treatment plan and the associated treatment cost.

Conclusion: Fear or anxiety related to extraction or scaling, time and financial constraints, fear of delayed wound healing, and improper guidance regarding treatment protocols were central factors in refusing pre-prosthetic procedures. Patient counselling must be done regardless of patient refusal, and patient concerns should be addressed.
Outcome of COVID-19 Patients Receiving 6mg vs 12mg Dexamethasone at a Tertiary Care Hospital in Pakistan
Authors: Bari Saba , Naseem Arshad , Khan Asad Zaman , Sajjad Kaswar , Ali Muhammad , Shehzad Farrukh
Published: December 2022

Objective: To compare the outcome in COVID 19 patients on oxygen managed with 6mg and 12 mg Dexamethasone at Pak Emirates Military Hospital Rawalpindi.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2020 to Aug 2021.

Methodology: Patients diagnosed with COVID-19 on PCR and were oxygen-dependent but not mechanical ventilation dependent were included in the study. They were randomly divided into two groups. Group-I received 6mg Dexamethasone, while Group-II received 12 mg Dexamethasone for ten days. They were followed up for 30 days to look for the outcome (prolonged admission, high dependency unit admission, intensive care admission, death). The difference in outcome in both groups was studied using the Pearson chi-square test.

Results: Out of 600 patients included in the study, 401 (66.8%) were male, while 199 (33.2%) were female. The mean age of the study participants was 47.81 ± 8.716 years. 306 (51%) were given 6mg of Dexamethasone for ten days, while 294 (49%) were given 12mg of Dexamethasone for a similar time. prolonged admission (p-value-0.178), high dependency unit admission (pvalue-0.409), intensive care admission (p-value-0.176) and mortality (p-value-0.588) were not statistically significantly different in both the groups.

Conclusion: All the outcome variables, including mortality and admission to the critical care unit, were not statistically significant in groups taking 6mg or 12 mg of Dexamethasone, so it could be concluded that a high dose of this medication is not superior in terms of efficacy when compared to the low dose.
Discordance of Diagnostic Core Biopsy and Final Histopathology Performed after Surgical Resection of Breast Cancer
Authors: Khan Said Zaman , Qamar Syeda Rifaat , Nadeem Muhammad Sohaib , Khan Ayesha , Mushtaq Afroz , Jan Maria Mir
Published: December 2022

Objective: To determine the frequency of discordance of receptor status in our breast cancer patients, find out its causes, and suggest remedial measures.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Breast clinic and Radiation Oncology Department of Combined Military Hospital Rawalpindi Pakistan from Jan 2018 to Nov 2021.

Methodology: Estrogen Receptor, Progesterone Receptor and Her2 Neu status differences between diagnostic tru-cut biopsy and surgical specimen were compared.

Results: Receptor status between initial core biopsy and final histopathology of 63 patients were compared. Discordance rates of 05 (7.90%), 13 (20.60%) and 12 (19%) were noted for Estrogen receptor, progesterone receptor and Her2, respectively. The highest discordance noted was for the progesterone receptor, followed by the HER2 receptor and the Estrogen receptor.

Conclusion: The highest discordance noted was for the progesterone receptor, followed by the HER2 receptor and the Estrogen receptor. Further studies are required to know more about the causes of receptor status discordance, its impact on treatment decisions and its impact on disease progression and survival.
COMPARISON OF MEAN PLATELET VOLUME IN NEONATES WITH AND WITHOUT SEPSIS
Authors: Ayub Ammara , Usman Najmi , Batool Ayesha , Shakeel Usman , Ahmed Shoaib , Shafiq Muhammad Faisal
Published: December 2022

ABSTRACT

Objectives

To compare mean platelet volume (MPV) in neonates with and without sepsis. 

Study design

Cross sectional descriptive study.

Place & duration of study

Neonatal Unit, Department of Paediatrics, Military Hospital, Rawalpindi from 2nd July 2017 to 22nd January 2018.

Material and Methods

140 neonates, of either gender with ages between 0-28 days, suspected of neonatal sepsis presenting with any two of the signs: core body temperature of > 38.5°C or < 36°C at time of presentation, pulse rate beyond the range of 100-200 beats/minute, leukocyte count beyond the range of 4000 to 30,000/mm3 or > 10% immature neutrophils on peripheral smear, tachypnea (>60 breaths/minute) and oxygen saturation (< 90%) on pulse oximeter, were included; while neonates having taken > 2 doses of antibiotics in last 48 hours as per history and clinical record were excluded. 3ml of blood was drawn and sent for culture, while another 3ml of blood sent for peripheral smear and MPV.  All the data along with demographic details of the patients were noted. Same laboratory was used for all samples and the peripheral smear was done by the same pathologist each time to eliminate bias.

Results

        31 neonates were culture positive for neonatal sepsis. Mean MPV(fl) was 7.31+0.92(fl). MPV was 8.52+0.51(fl) in septic neonates and 6.97+0.70(fl) in neonates without sepsis. The p value was significant (0.0001).

Conclusion

MPV was significantly raised in patients with sepsis.

KEYWORDS

 Neonates,  Sepsis,  Mean Platelet Volume
Clinicopathological Analysis of Biopsy-Proven Glomerulonephritis in the Pediatric Patients : A Study from Tertiary Care Centre
Authors: Safdar Rabia Saleem , Khan Afsheen Asghar , Mehar Muhammad Faisal , Riaz Shazia , Hussain Nusrat , Abbas Kiran
Published: December 2022

Objective: To evaluate the clinic-pathological characteristics and their association with biopsy-proven glomerulonephritis in pediatric patients.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Pediatric Department Nishtar Medical University, Multan Pakistan, from Jan 2014 to Dec 2019.

Methodology: During the study, a total of 211 renal biopsy reports of different age groups were studied and analyzed for clinic-pathological features and patterns of direct immunofluorescence.

Results: The mean age of 8.6±3.25 years was observed. The most common pathology was focal segmental glomerulo-sclerosis in 86 (40.76) of the patients, followed by mesangio-proliferative glomerulonephritis in 41 (19.43) of the patients. Minimal change disease was seen in 26 (12.32) cases. It was observed that the majority of the patients with diffuse proliferative glomerulonephritis were younger than 11 years old, whereas; 10 (11.2), patients with lupus nephritis, 11 (15.1) and membranous nephropathy, 10 (12.2) were comparatively older.

Conclusion: Glomerulonephritis presents a diversified group of diseases with overlapping clinic-pathological features. The present study has reported many significant characteristics which could help diagnose a particular disorder among the pediatric population.
Maternal Serum Uric Acid as a Marker of Predicting Low Birth Weight at Term Pregnancy: A Study Based in CMH Lahore
Authors: Ghaffar Sadia , Nawaz Qudsia , Shaheen Zubaida , Shakeel Shazia , Shafiq Sadia , Tufail Nazia
Published: December 2022

Objective: To determine the association of hyperuricemia with adverse pregnancy outcomes in terms of low birth weight at term pregnancy registered at CMH Lahore.

Study Design: Prospective cohort study.

Place and Duration of Study: Department of Obstetrics and Gynecology of CMH, Lahore Pakistan, from Aug 2018 to Feb 2019.

Methodology: A total of 60 pregnant women with a singleton pregnancy were included in the study. Patients with serum uric acid levels greater or equal to 360 umol/L were included in Group-A or the at-risk Group, and Patients with serum uric acid levels less than 360 umol/L were included in Group-B or the control Group. All women were followed till the delivery. Data regarding adverse pregnancy outcomes (low birth weight) was noted.

Results: Mean Serum uric acid levels of 380.33±12.92 umol/L in the Exposed Group and mean Serum uric acid levels of 265.66±29.44 umol/L in the Control Group were noted. Low birth weight was seen 12 (40%) in Exposed Group as compared to 7(23.3%) in Unexposed Group (p=0.165) (RR=1.71).

Conclusion: Low birth weight at term was not associated with hyperuricemic pregnancy more than normouricemic pregnancy in our study, probably due to the small sample size.
Assessment of Physician Burnout and its Association with Musculoskeletal Disorder
Authors: Saleem Saad , Khaliq Taqdees , Adil Mohammad Hammas , Hashmi Fasih
Published: December 2022

Objective: To assess burnout among doctors and to determine its association with a musculoskeletal disorder.

Study Design: Cross sectional study.

Place and Duration of Study: Government and Private Hospitals of Islamabad and Rawalpindi Pakistan, from Jun to Aug 2020.

Methodology: Two hundred and forty doctors were included through two-stage cluster sampling from different departments of the selected hospitals. Maslach Burnout Inventory (MBI) was used to assess burnout. Second, Nordic Musculoskeletal Questionnaire (NMQ) was used to assess the musculoskeletal disorder.

Results: There were one hundred thirty-five males and one hundred and five females participants with an average age of 31.64±6.21 years. There was an association between burnout, and Musculoskeletal Disorder (MSD) assessed through "Depersonalization" and "Personal Achievement" components with p-values of 0.005 and 0.017. In contrast, burnout assessed through the Emotional Exhaustion (EE) component was not associated with Musculoskeletal Disorder (MSD) and had a pvalue of 0.817. The logistic regression analysis showed that marital status, age and burnout assessment through depersonalization were significant confounders for musculoskeletal disorders.

Conclusion: Musculoskeletal disorder is related to the presence of burnout assessed through depersonalization. Nearly half of the doctors had at least one component of burnout.
The Immune Response after Double Dose Hepatitis B Vaccination in Hemodialysis Patients: Influence of Age and Hepatitis C Virus
Authors: Asghar Muhammad Rashid , Abbasi Tanzeel , Bashir Khurram , Hashmi Nauman , Anwar Shumaila
Published: December 2022

Objective: To determine the efficacy of Hepatitis B vaccination among the candidates of maintenance hemodialysis due to chronic kidney disease and to measure the impact of ageing and Hepatitis C infection upon immune seroconversion.

Study Design: Cross-sectional study.

Place and Duration of Study: Nephrology Department, Multan Institute of Kidney Diseases (MIKD), Multan Pakistan from Jan to Jun 2020.

Methodology: Two hundred male and female patients diagnosed with end-stage kidney disease on maintenance dialysis (more than three months) with the range of age, 15 to 70 years, were selected by non-probability consecutive sampling. Already treated patients of HB virus and those with HB virus detectable by ELISA were excluded from the study. Data was accessed through hospital management software records. Three months after the three or four completed doses, antiHBs titer was assessed by ELISA. Cut off the value of anti-Hbs titer was 10U/L to differentiate between responders and non-responders of HBV.

Results: Among the 117 responders, 109 (93%) cases received four double doses of the vaccine, while only 8 (7%) were those who received three double doses. Among 83 non-responders, 52 (63%) were above age 40 years, while 31 (37%) were of age 40 years or below. In addition, among the non-responders, 63 (76%) were Hep C positive, while 20 (24%) were Hep C negative patients.

Conclusions: Four double-dose vaccines have been effective for haemodialysis patients with end-stage kidney disease. Vaccine response is inversely correlated with age and Hepatitis C virus.
Accuracy of Rapid Antigen Detection Test Device (COVID-19 Ag Rapid Test Device) in Diagnosis of Acute COVID-19 Infections
Authors: Shakoor Noman , Ghani Eijaz , Niazi Saifullah Khan , Noor Misbah , Ahmed Faraz , Hussain Hammad
Published: December 2022

Objective: To evaluate the accuracy of the COVID-19 Ag Rapid test device for detection of SARS-CoV-2 with Reverse Transcriptase Polymerase Chain Reaction as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Virology, Armed Forces Institute of Pathology, Rawalpindi, in the month of Sept 2020.

Methodology: A total of 106 patients suspected of COVID-19 were tested, including 63 patients admitted to the COVID-19 ward of Pak Emirates Military Hospital and 43 from the emergency department of Combined Military Hospital, Rawalpindi Pakistan respectively. The samples were transported to the Virology department and subjected to Polymerase Chain Reaction and Antigen testing. In addition, the diagnostic accuracy of the COVID-19 Ag Rapid test device was compared to Reverse Transcriptase Polymerase Chain Reaction for detection of SARS-CoV-2 infection.

Results: Out of 106 nasopharyngeal swab samples tested, 48 (45.2%) samples were positive by Rapid test device and Reversed Transcriptase Polymerase Chain Reaction, and 52 (49.0%) samples tested negative by both methods. Inconsistent results (False Negative) were obtained in 6 (5.6%) samples. COVID-19 Ag Rapid test device has detected the maximum number of cases, 41 (85.4%), during the first week of illness. Its sensitivity decreases as the duration of infection progress.

Conclusion: The overall sensitivity of the Rapid test device is much less than the Polymerase chain reaction due to potential false negative results. However, it can be helpful in the early isolation of cases in an outbreak in a closed community and for case management in peripheral setups....