bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital Supply Chain Exploration (DSC) in Rural and Sub-Urban Livestock Ventures
Authors: Rosli Muhammad Syahrul Deen Ahmad , Samori Zakiah , Rani Mohd Afandi Mat
Published: December 2022

In both the domestic and global markets, the rapid development of the digital economy has become a major distraction. As well as middle economic units that bear business risks, small and medium enterprises (SMEs) are also affected. Nonetheless, SMEs can take advantage of the disruption in order to compete with large, industrial businesses rather than invest overseas. Amidst a very gloomy economic climate, digitalization is considered one of the best alternatives and suggestions to ensure that businesses can survive. Agricultural and livestock sectors, especially micro-farmers in suburban and rural areas, have been hardest hit. As well as the challenges they have long faced with digitalization, the number of products they require has decreased drastically as well. From this point of departure, this study is conducted to assess the readiness of micro-farm entrepreneurs (MLEs) towards digitalization embrace digitalization and examine the impact of digital adoption on their business operations. A random sampling method was employed on the MLE in various sub-towns in Selangor, namely Kuala Selangor, Sabak Bernam and Hulu Selangor, from 2020 to 2021. Using the method of analysis, instruments are verified and coefficients tested. The results showed that MLEs are using digital platforms to promote their products and connect with their business ecosystem. In spite of this, they face the challenge of ensuring further improvements to their infrastructure and the capabilities of digitalization in contributing to value without posing high risks or costs. This study suggests that further studies have to look at and evaluated rural entrepreneurs using a triangulation approach of data and broader subjects.
NUOVI SCAVI A CARTAGINE.RAPPORTO PRELIMINARE SULLASECONDACAMPAGNA DI SCAVI (2022)DELL’INSTITUT NATIONAL DU PATRIMOINEE DELL’UNIVERSITÀ DI ROMA «LA SAPIENZA»
Authors: Nigro Lorenzo , Cappella Federico , Fantar Mounir , Achour Moez
Published: December 2022

Within the framework of the scientific cooperation agreement between the Institut National du Patrimoine and the University of Rome«La Sapienza», the secondarchaeologicalseason of excavationtook placefrom 31stMay to 15thJune 2022.In the area of the archaeological parkof Antonin’s thermal Baths beside the Borj-Jedid hill, under the remains of a domestic building (Building A), an important Punic industrial installation of the late 5thcentury BC was discovered south of the area of the Phoenician and Punic necropolis of Dermech. In the meantime, north of the Antonin’s thermal Baths, in the area of the Roman villas on the Odeon Hill, eleven tombs of the 5th-2ndcenturies BC have been unearthed by the Tunisian-Italianteam of the Archaeological Mission to Carthage (MAC).
Neuropathophysiological Mechanisms and Treatment Strategies for Post-Traumatic Epilepsy
Authors: Ali Muhammad Munwar , Khaskheli Muhammad Asif , Awan Inayatullah , Shaikh Khairunisa , Arain Safdar Hussain , Shaikh Abrar
Published: December 2022

Aim: To understand and analyze neuropathophysiological mechanisms and treatment strategies for post traumatic epilepsy. Study design: Cohort clinical trial study Place and duration of study: Department of Neurosurgery, Chandka Medical College Hospital, Larkana 1st January 2021 to 31st March 2022. Methodology: One hundred and twenty cases of traumatic brain injury were enrolled. In 1st sub group there was 20 cases were given either Sodium valproate (SG1a) while 20 were given its placebo (SG1b). Similarly in subgroup 2nd and 3rd, each had 20 cases who were given Levetiracetam (SG2a) or Phenytoin (SG3a) respectively or other given its respective placebo (n=20/SG2b, SG3b). Primary and secondary outcomes were measured. Results: The mean age was 30.1±3.3 years. There was almost equal number of both genders with slightly higher number of males than females with no significant variance. Around 40.83% of the cases were suffering from traumatic brain injury as a result of fall from a higher/raised building or structure. Conclusion: The sodium valproate had a highest efficacy in controlling of the post-traumatic brain injury epileptic seizure not only for a short duration but for longer duration as well. Keywords: Treatment strategies, Post-traumatic epilepsy, Neuropathophysiological mechanisms
Frequency of Healing of Fistula in Patients Undergoing Video Assisted Anal Fistula Treatment in High Lying Fistula in Ano
Authors: Afzal Muhammad , Shah Muhammad Junaid , Khan Mujeeb Alam , Ullah Aftab
Published: December 2022

Background: Fistula-in-ano is an abnormal tract that usually connects rectal mucosa and perianal skin thus accounting upto 90% cases with an incidence of 5.6/100.000 in women while 12.3/100.000 in men. Aim: To determine the frequency of healing in patients with high lying fistlua in ano undergoing VAAFT. Study design: Cross-sectional study. Methodology: Patients (n=153) were enrolled during study. All enrolled patients had DRE and proctoscopy before start of treatment. Fistuloscope was used to diagnose high lying fistula during examination. Metronidazole antibiotic was given to all patients both pre and post-surgery. SPSS v.26 analyzed the data. Stratification of healing data was done with respect to age and gender. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. Results: Almost 77% were males while rest (23%) patients were females. Results showed healing in 70% of patients while 30% patients failed to heal. Practical Implication: This study showed that VAAFT procedure is safe as a treatment modality in comparison to Anal Fistula Plug and conventional Seton placement for complex fistulas or high anal fistulas thus advocated sphincter saving procedure in our setups. Conclusion: It was concluded that this new surgical technique has advantages like sphincter-saving with small surgical wounds. However, fistuloscopy identifies secondary tracts or chronic abscesses. Keywords: Healing, High Lying Fistlua and VAAFT.
Effects of Open and Closed Chain Exercises on Dynamic Balance and Range of Motion in Patients with Knee Osteoarthritis: RCT
Authors: Ehtisham ul Haq Raza Muhammad , Hassan Zainab , Edwin Wishal , Faisal Sidra , Saleem Fiza , Hayyat Mashar
Published: December 2022

Background: Osteoarthritis is a combination of mechanical problems characterized by degradation of articular cartilage, articulating joints and subchondral space. Aim: To compare the effects of open chain kinetic exercises and closed kinetic chain exercises in improving dynamic balance and range of motion in patients with knee osteoarthritis. Study Design: Randomized controlled trial. Methodology: Study was conducted at Chugtai Medical center Lahore and sample of 46 patients were recruited and were randomly allocated in two groups. One group performed OKC exercises and the other group was asked to perform CKC exercises, while both of the groups received a common baseline treatment prior to corresponding intervention. Two session a week were given for a period of one month. Goniometry and Y-balance scale were used to assess ROM and dynamic balance pre and post treatment, respectively. Data was evaluated by using SPSS version 23. Results: In this study, the intra-group analysis illustrated that the increase in range of motion and improvement in dynamic balance was statistically significant in both groups with p-value<0.05. Whereas, the inter-group analysis showed that both interventions were clinically effective in treating knee osteoarthritis with p-value>0.05 during the treatment session of four weeks. Practical Implication: This study highlighted that physical training that includes open kinetic chain (OKC) and closed kinetic chain (CKC) exercises were found to be effective in improving balance and in increasing range of motion by reducing pain among osteoarthritis patients. Conclusion: It was concluded that patients with OKC exercises have shown equal improvement in ROM and dynamic balance compared to those who have been treated with CKC exercises. Keywords: Osteoarthritis, Exercises and Dynamic Balance.
Estimation of Serum Thyroid Stimulating Hormone and Anti-Thyroid Antibodies as Biomarkers of Malignancy in Thyroid Nodule Patients
Authors: Qureshi Khaulah , Rathore Mushayyada , Waheed Noor-Ul-Ain , Yasmin Nighat , Lodhi Sehrish , Gondal Aamir Jamal , . Nakhshab
Published: December 2022

Aim: To find out association of Serum Thyroid Stimulating Hormone (TSH) and Anti-Thyroid Antibodies (ATA) i.e., anti Tg-Ab & anti TPO-Ab with thyroid carcinoma in thyroid nodule patients presented in Mayo Hospital Lahore. Study design: It was a comparative cross-sectional study. Methods: It wasconducted in Biochemistry Department and Department of Biomedical Sciences KEMU, Lahore from February 2018 to May 2019. Seventy patients were included in the study based on selection criteria and data was recorded on a preformed questionnaire. The study participants were classified into benign (n=36) and malignant categories (n=34) based on histopathological & radiological investigations. Serum levels of TSH and anti- thyroid antibodies (TPO-Ab&Tg-Ab) were measured employing ELISA (Enzyme Linked Immunosorbent Assay) technique. Results: Thyroid nodules were found to be more prevalent in females (n=64, 91.4%). The mean age of the study subjects was 38.46±12.92 years and there was a significant association of older age with thyroid carcinoma (p=0.001). Moreover, Serum TSH, Anti-Tg-Ab and TPO-Ab were higher in malignant than in benign thyroid nodules and were significantly associated with thyroid cancer (p=<0.05). Furthermore, a binary logistic regression analysis concluded that higher serum TSH levels may increase the risk of malignancy in thyroid nodule patients (OR=5.124). Conclusion: Older age and higher levels of serum TSH, Tg-Ab and TPO-Ab showed a significant association with thyroid carcinoma in thyroid nodule patients. Keywords: Thyroid carcinoma, Thyroid stimulating hormone, Anti- thyroglobulin Antibody, Anti-TPO antibodies, Thyroid nodule
Pregnancy Related Thyroidal Dysfunction and its Feto-Maternal Outcomes
Authors: Kazi Amna , Hameed Sidra , Fatima Farheen , Waseem Maham
Published: December 2022

Aim: To detect the thyroidal dysfunction during pregnancy and the related outcomes. Study Design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, S. Z. Hospital Lahore from 01-01-2021 to 30-06-2022 Methodology: One thousand pregnant women in third trimester were enrolled for thyroid function test and screening, analysis of TSH, free T3 and T4 level. Results: Only 30 (3%) was having thyroid dysfunction while the dysfunction was reported highest in the women within 29-38 years of age. Most of the cases suffering from thyroid dysfunction are suffering from the subclinical hypothyroid condition (43%). The reduction in Apgar score was observed up to almost 3.59 times in newborns of thyroid dysfunction women. The risk of preeclampsia and cesarean section was also significantly raised in thyroidal dysfunction women. Odds ratio for low birth weight was observed as 6.32 with a significant association with thyroid dysfunction in pregnancy. Conclusion: There are poor feto-maternal outcomes of thyroid dysfunction during pregnancy with 43% of the cases as having subclinical hypothyroidism. Key words: Pregnancy, Thyroid dysfunction, Feto-maternal outcome
Clinical Association and Detection of Cervical Cancer with Pap Smear Screening Test
Authors: Pirzada Hina , Fatima Farheen , Rafiq Seema , Habib Sadia
Published: December 2022

Aim: To find the clinical association of the cervical cancer with pap smear test. Study Design: Prospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, AJK Medical College Muzaffarbad Azad Kashmir from 1st January 2021 to 30th June 2022. Methodology: Five hundred women were screened who were between 20-55 years of age. Sampling was performed by ecto-cervix through wooden Ayre spatula rotation at 360 degrees. The sample was preserved in a formalin jar and sent for glass slide formation. Cytopathological examination presented lesions as negative intraepithelial neoplasia as well as epithelial-cell abnormalities including squamous in addition to glandular cells. Results: The mean age was 41.5±5.6 years. The epithelial abnormalities were diagnosed in 6% of low grade squamous-intraepithelial lesion cases and 1% in high grade squamous intra-epithelial lesion through pap smear. No case of squamous cell carcinoma was identified while 40% showed inflammation presence Most of the females within 31-40 years were having normal cervical morphology while 36%cases inflammation was noticed in 21-30 years of age. Low grade squamous-intraepithelial lesion was noticed in 63.3% of the women within an age group of 14-50 years while high grade squamous intra-epithelial lesion L was observed within 60% of the similar age women. Majority (148.45%) of the women had white discharge from vaginum followed by cervical erosion seen in 19.21% of the cases Conclusion: Pap smear is a highly specific and efficient test for determining pre-cancerous cervical lesions as well as cervical cancers. Key words: Association, Detection, Cervical cancer Pap smear screening test
Evaluation of Different Types of Gallstones Extracted by Endoscopic Retrograde Cholangiopancreatography
Authors: Naich Muhammad Ayub , Hussain Sagheer , Qamar Adeel , Zamir Hina , Mustafa Zia Ul , , Cheema Fatima
Published: December 2022

Objective: To study frequency of various types of gall stones extracted from bile duct using ERCP Study design: This is a cross sectional study Study place and duration: Study was conducted in the department of Gastroenterology Sir Ganga Ram Hospital Lahore. Study was completed in six months duration from January 2022 to June 2022. Materials and methods: Diagnosed cases of bile duct stones were underwent ERCP and extracted stones were analyzed to determine their composition. Ages of the patients were 20-70 years. Cases of either gender irrespective of residential area were included in this study. Patients with ischemic heart disease, asthma, liver cirrhosis, malignancy, tuberculosis, chronic obstructive pulmonary disease, interstitial lung disease and pregnancy were excluded from the study. During ERCP gross findings of the stones were noted. Results: Total 140 cases were studied having bile duct stones including 55(39.3%) male and 85(60.7%) females. There were 80(57%) cases with the age ≤50 years and 60(42.9%) cases above 50 years. Mean age of the patients was 46 ± 4.72 years. 58(41.4%) cases were from rural area and 82(58.6%) from urban area. Diabetes, hypertension and obesity was found in 38(27%), 47(33.6%) and 49(35%) cases respectively. Cholesterol stones were found in 51(36.4%), mixed stones in 70(50%) and brown pigmented stones in 19(13.6%) cases. Conclusion: Mixed cholesterol gall stones were most commonly found followed by pure cholesterol and brown pigmented stones. Keywords: Gallstones, Bile duct stones, ERCP, Endocscopy, Cholesterol stones,
Healthcare-associated infections and drug resistance in immunocompromised children with cancer in a low income country
Authors: Ain Rajat Ul , Faizan Mahwish , Zafar Huma , Aqeel Rabia
Published: December 2022

Aim: It was a clinical audit conducted over 6 monthsperiod in order to determine the clinical characteristics of healthcare-associated infections (HAIs) in immunocompromised children with cancer in a developing country. Methods: It was a descriptive, cohort study conducted in the department of Pediatric Hematology/Oncology, University of Child Health Sciences, The Children’s Hospital Lahore. All patients age less than 16 years, admitted in the pediatric oncology unit, having neutropenia and any culture-proven HAI were included. Data was analyzed in SPSS 16.0. Results: The total number ofHAIs was 101 while the total number of infected patients was 83. The number of infections per 1000 patient days was 6.66. The most common HAI was bloodstream infection (BSI). Sixty-nine percent of HAIs were gram-negative while 31% were gram-positive. Klebsiella species was the most common gram-negative and Staphylococcal Aureus was the most common gram-positive organism. Pan-resistance was encountered in 25.74%, Carbepenam-resistant Enterobacteriaceae in 16%, Vancomycin-resistant Enterococci in 3%, and Methicillin-resistant Staphylococcus Aureus in 2%. Mean hospital stay was 20.22 days, 60.25% of patients were discharged, and 39.75% expired. Conclusion: Drug resistance is seen in about half of the HAIs. Gram-negative infections are the most common cause of HAIs in our setup.HAI and drug resistance areassociated with significant morbidity and mortality in immunocompromised children with cancer and a pose major challenge in their management especially in a resource-limited setting. Keywords: Childhood cancer, Drug resistance, Healthcare-associated infections, Low-middle-income country
Surgical management of Gastro-duodenal Artery Pseudoaneurysm: A Case Report
Authors: Haseeb Abdul , Arif Amina , Hamayun Sana , Karam Alvina , Khan Waseem , Nawaz Haq
Published: December 2022

Gastro duodenal artery (GDA) Pseudo aneurysm is a rare cause of Upper GIT bleeding. It can be fatal in case of a rupture and has a very high risk of Mortality. Advanced Diagnostic techniques like CT Angiography should be carried out earlier in the disease course for Prompt Diagnosis. Here we discuss a case of a successfully surgically treated GDA pseudo aneurysm Keywords: GDA Pseudo aneurysm; surgical resection; Embolization; Visceral artery Aneurysm
Patient Satisfaction: Evaluating Nursing Care for Patients Hospitalized with Cancer
Authors: Asghar Rozina , Ghani Mansoor , Noor Nazi , Sharif Sumaira , Farhana Ayyazada , Khatoon Tahira
Published: December 2022

Patient’s satisfaction is an indicator of quality care and it encompasses the different aspects of nursing care leading to cancer patient’s satisfaction like information given by nurses. Aim: To assess the level of satisfaction with nursing care among hospitalized cancer patients. Study design: Cross-sectional descriptive study. Methodology: A sample of 158 patients in two hospitals was selected from Jinnah hospital Lahore and INMOL by using method of non-probability convenient sampling. Data was collected by adopted questionnaire. Data was analyzed by SPSS software, version 20. Chi square was used for qualitative variables like satisfaction, educational status. A p-value of ≤ 0.05 was considered as statistically significant. Results: The results of this study indicated that a majority of the cancer patients were satisfied with different aspects of nursing care such as information given by nurses, 60.28% of patients were satisfied but interpersonal relations between nurses and patients were found to have mixed response as only 60.61% patients were satisfied. Regarding the technical quality of nurse 68.07% of patients were satisfied. Practical Implication: This study identified the lacking among health care providers regarding nursing care that make a barrier for patient’s satisfaction and helped in Program planning for monitoring and improving the nursing care services at health care setups. Conclusion: We concluded that majority of the patients were satisfied by the nursing care but there is a need to improve the information given by nurses and interpersonal relationship in the nursing care provided by the selected hospitals to improve patients’ overall satisfaction. Keywords: Patient Satisfaction, Nursing Care and Cancer.
Safety and Efficacy of Transurethral Cystolithotripsy in Pediatric Population: A Single Center Study
Authors: Ahmad Tariq , Shabbir Sohail , Ahmad Mushtaq , Ammar Muhammad Asif
Published: December 2022

Introduction: Bladder stone treatment in children is evolving rapidly. Vesicolithotomy has now been rarely used except in very large stone and even larger stones are treated with percutaneous cystolithotripsy, which is still more invasive compared with transurethral cystolithotripsy. We have evaluated a series of 150 case of bladder stone in children with this minimal approach through natural orifice i.e. urethra to assess its feasibility, efficacy and complications. Objective: To assess the safety and efficacy of transurethral cystolithotripsy for bladder stone in pediatric population. Material and Methods: This study was conducted in the Institute of Kidney Diseases and Transplant HMC Peshawar Pakistan from Jan 2020 to Apr 2022. A series of 150 patients were assessed with a mean age of 7.5+-2.9 years and mean stone size of 11.2+-3.6mm. Mean operative time was 28.1+- 5.8 minutes, mean hospital stay was 0.2+-1. A total of 89.33% of were treated as a day case. Two patients (1.3%) needed re-cystolithotripsy while in none of the cases were converted to open or PCCL. Postoperatively 16 (10.67%) patients developed Clavien grade 1 complications and 2(1.33%) patients developed Clavien grade III complication. Conclusion: Trans-urethral cystolithotripsy is feasible and effective in pediatric population with acceptable clearance rate and low grade complication for stones up to 20 mm. However comparison with open method is needed. Keywords: Bladder stone, Trans-urethral, Cystolithotripsy.
Prevalence and Risk Factors of Delirium and Subsyndromal Delirium in Older Adults
Authors: Nasir Faiqa , Batool Shehrbano , Nasir Anam , Bacha Muhammad Faisal , Mushtaq Aysha
Published: December 2022

Background and Aim: Delirium is the most prevalent geriatric issue that is independently associated with poor outcomes in terms of discharge, length of hospital stay, and increased mortality. Subsyndromal delirium (SSD) is defined by the presence of delirium symptoms that do not yet meet the definition of full-blown delirium. The present study aimed to determine the incidence and delirium-related risk factors in older adults. Method: This prospective study was conducted on 420 elderly patients (>60 years) in the Department of Medicine of Benazir Bhutto Hospital Rawalpindi and Liaquat University Medical and Health Sciences, Jamshoro Hyderabad, from April 2021 to December 2021. Study protocol was approved from research and ethical committees of the institutions. The purpose of the study was explained to the participants after taking written informed consent. Patients were classified into three categories are as follows: delirium, subsyndromal delirium, and cases without both delirium and subsyndromal delirium. Detailed history taking, comprehensive geriatric assessment, and clinical examination from each individual were recorded. All the collected data were analyzed using SPSS version 26. Results: Of the total 420 elderly patients, the incidence of delirium and subsyndromal delirium was 96 (22.9%) and 72 (17.1%) respectively. There were 264 (62.9%) male and 156 (37.1%) females. The overall mean age was 68.4± 4.8 years. Delirium and subsyndromal delirium cases were distributed based on the patient’s age were as follows: 62 (64.6%) and 42 (58.3%) in 60-70 years, 24 (25%) and 22 (30.6%) in 71-80 years, and 10 (10.4%) and 8 (11.1%) in >81 year. Of the 96 delirium cases, the incidence of hypoactive type, hyperactive type, and mixed type was 54 (56.3%), 18 (18.8%), and 24 (24.9%) respectively. Based on cognitive assessment, about 36 (8.6%) MMSE score <23, 78 (18.6%) had MMSE score <18, and 54 (12.9%) did not respond to MMSE. The incidence of common comorbidities such as hypertension, chronic liver disease, asthma, ischemic heart disease, cerebrovascular disease, diabetes, and malignancy was 144 (34.3%), 82 (19.5%), 26 (6.2%), 120 (28.6%), 24 (5.7%), 184 (43.8%), and 14 (3.3%) respectively. Conclusion: The present study found that the incidence of delirium and subsyndromal delirium was 22.9% and 17.1% respectively. Adverse outcomes such as increase in length of hospital stay, mortality, and discharge are independently associated with delirium. Efforts to prevent disease may identify patients who require clinical attention. Keywords: Delirium, subsyndromal delirium, risk factors
Effect of Indomethacin on Blood Pressure Managed by Captopril and Losartan in Hypertensive Patients
Authors: Arjumand Sabeen , . Fareeha , Ali Liaqat , Nazish Gul E , Ghafoor Zarish , Bhatti Maira
Published: December 2022

Objective: Determine the role of indomethacin on blood pressure lowering by captopril and losartan in hypertension patients. Study design: Randomized study design. Methodology: 200 patients with known hypertension problems including women and men were treated in this study. The complete protocol for the study was approved by the research center and committee of the hospital. Patients were randomly treated with losartan 50mg/day, and captopril 25mg two times/day. . Indomethacin 65 mg /day was given to patients in week six. Results: Among the 200 patients 68 (50%) females received losartan and 68 (50%) females received captopril. Captopril was given to a total of 100 patients including 68 females and 32 males. Their first-week follow-up systolic BP Mean ± S.E measured value was 152.02 ± 0.9, Diastolic BP measured value was 94.5 ± 0.5, Pulse, bpm = 86.6 ± 2.0 with a significant p-value. The fifth week measured reading was 141.04 ± 0.7 = systolic BP, 86.05 ± 1.2 = Diastolic BP, Pulse, bpm = 86.6 ± 2.0. A significant reduction in BP was observed with a p-value of 0.001. At sixth-week captopril and indomethacin combination results show a lesser reduction in BP systolic/ diastolic = 146.06 ± 0.2/89.01 ± 2.0 mm Hg, pulse rate measured 81.7 ± 1.0 with significant p-value 0.05. Losartan first week follow-up shows a BP of 153.01 ± 0.3/92.6 ± 0.6, pulse reading was 79.3 ± 2.0 with a p-value of 0.001. In the fifth week, BP was 139.5 ± 0.1/ 84.03 ± 0.3, pulse = 77.6 ± 3.0 showing a significant reduction in BP. The sixth week Losartan + indomethacin results show a lesser decrease in BP with 145.4 ± 0.1/ 91.02 ± 0.4 mm Hg, and 79.01 ± 3.1 value was measured for Pulse, bpm. Conclusion: The results of this study show that losartan and captopril are more effective in controlling BP than in combination with indomethacin. So, indomethacin reduced the antihypertensive effect of losartan and captopril. Keywords: captopril, losartan, indomethacin, antihypertensive, blood pressure
Patient Characteristics, Procedural Details, and Outcomes of Contemporary Percutaneous Coronary Interventions
Authors: Shah Kashif Ullah , Khan Irfan Ali , Rehman Zia Ur , Amin Qazi Najeeb Ullah , Ullah Farman , Ullah Sami
Published: December 2022

Background: The prevalence and success of percutaneous coronary intervention (PCI) varies widely between regions, with South Asia displaying some of the greatest regional differences. Objectives: Examining PCI procedures and their outcomes in Pakistan over time and comparing this information to that from other countries is the goal of this study. Methods: Throughout the course of a year, information was collected from several cardiac catheterization laboratories in Pakistan. An in-depth history of each patient was recorded, along with data on their procedures, the tools and drugs they required, their outcomes, and any complications that may have arisen. Results: The study contained information from 22,741 patients. Their average age was 64.2 years (11.7) and they were predominantly male (70%). Acute coronary syndrome was the most prevalent symptom (57%), while ST-elevation myocardial infarction was the most common type of heart attack (28%). Multivessel disease was present in nearly two-thirds of patients, and 11% of those patients also had substantial left main stenosis. Almost half of these procedures (44.2%) opted for the transradial route. In spite of the high complexity of the lesions (56.9% class C lesion), the operative success rate was quite good at 95.2%. There was a 5.3% rate of procedure-related complications and a 2.8% rate of in-hospital deaths. Conclusion: The collected data shed light on the state of PCI in the United States, both in terms of its implementation and its results. Despite the complexity of the lesions being treated, the success rate was high, and problems were minimal.
Predicting the Frequency of Pregnancy Induced Hypertension in Early Pregnancy by Maternal Serum Beta Human Chorionic Gonadotropin Levels
Authors: Ashique Fakhra , Nadeem Ammara , Rehmatullah Nasreen , Mumtaz Javaira , Saleem Anisa , Gul Rizwana
Published: December 2022

Background: During early pregnancy raised beta human chorionic gonadotropin (β-HCG) level occurs during placental development. It may be used for identifying the pregnancy induced hypertension. There are certain factors that causes pregnancy induced hypertension and preeclampsia. However, many of the associated factors and specific cause is not known. Some common risk factors for preeclampsia are nulliparity, preeclampsia in a previous pregnancy, family history, history of hypertension, renal disease and antiphospholipid antibody syndrome or thrombophilia. However no single lab investigation can be done cost-effectively to make the early diagnosis of pregnancy induced hypertension. The objective of this study was to determine the frequency of Pregnancy induced hypertension in patients with high maternal serum β-HCG at early pregnancy ( 13-20 weeks of gestation). Methodology: A descriptive cross sectional study was conducted on Out Patient Department and in patient wards of the Obstetrics and Gynecology Department of KRL General Hospital, Islamabad. The study was done from 28th December 2018 to 27th June 2019. A total of 75 pregnant women, primary gravida and multi gravida with age range from18-40years with raised β-HCG at 13-20 weeks of gestation were included. All patients were observed during their stay in the hospital for the development of any complications of pregnancy induced hypertension. Results: Mean age of pregnant females was 32.12 ± 5.29 years. Mean gestational period was 17.31 ± 2.05 weeks. Mean β-HCG levels was 7.63±3.71. Pregnancy induced hypertension (PIH) in patients with high maternal serum β-HCG at 13-20 weeks of gestation was found in 64 (85.33%) patients, however there was no Pregnancy induced hypertension in 11 (14.65%) ladies. Conclusion: The outcome of this study concluded that frequency of pregnancy induced hypertension in pregnant femal with high maternal serum β-HCG at 13-20 weeks of gestation was high. Early screening of raised β-HCG can be made for the prevention of complications due to pregnancy induced hypertension. Keywords: Beta Human chorionic gonadotropin, pre-eclampsia, pregnancy induced hypertension.
Enzyme Immunoassay for the Detection of Human Chorionic Gonadotropin (HCG) and Placental MRNA Marker a Practical Technique for Forensic Pregnancy Identification in Bloodstains
Authors: Shabbir Sheeba , Ali Nusrat , Ahmad Iftikhar , , Khurshid Aina , Siddiq Rao Muhammad Farhan , Hussain Sabika , Rizwan Muhammad
Published: December 2022

Introduction: The diagnosis of pregnancy from forensic bloodstains can be useful in cases of infanticide, criminal abortions and missing person identification. Objective: This research illustrated the use of a rapid, precise, and tremendously responsive enzyme immunoassay kit designed for medical usage, which is put to good use in our lab for qualitative HCG detection in blood stains and has proven to be a useful tool in forensic pregnancy identification. Methods: HCG concentrations had previously been generally known, and total eighty whole blood samples were taken: forty expectant females (every single one between months one to six of pregnancy), twenty healthy young males, and twenty postmenopausal females with good health ration has been cleared in all data. Results: Enzyme immunoassay is a useful forensic technique for detecting human chorionic gonadotropin hormone in pregnant women. In the forty sample batch that was dated for six months, 37 samples (92.5%) yielded positive results, 38 of which (95%) yielded good outcomes in the qualitative analysis, most of them within the sensitivities boundary. The samples that were diluted to 1/100 and 1/200 and kept at room temperature for one week and six months period, respectively, produced just two (5.0%) and five (12.5%) successful results and the samples showed negative results when diluted to 1/200 and stored for six months. Practical implication This paper reports on human chorionic gonadotropin (HCG) detection in bloodstains based on enzyme immunoassay. Conclusion: Enzyme immunoassay has proven to be a suitable method intended for detecting an hCG hormone in blood stains, allowing for the qualitative assessment of hCG, and making it particularly interesting for use in forensic science applications. Keywords: Enzyme immunoassay, human chorionic gonadotropin (hCG), pregnancy, bloodstain
The Feto-Maternal Outcomes and Incidence of Early-and Late-Onset Preeclampsia
Authors: Naeem Ayesha , Jan Sadiq , Ali Muhammad , Mubashir Hafsa , Hanif Sadia , Abbasi Sughra
Published: December 2022

Hypertensive disorders in gestation are categorized as hypertension in pregnancy, chronic hypertension, eclampsia and pre-eclampsia. The World Health Organization states: “There are 529,000 maternal deaths annually worldwide due to pre-eclampsia and eclampsia. This study will help in determining pregnancy outcomes in early vs late-onset pr-eclampsia. Aim: To access the pregnancy outcomes of early and late onset pre-eclampsia. Study Design: A retrospective, descriptive and cross-sectional study Place and Duration: In the Obstetrics and Gynecology department of Allama Iqbal Memorial Teaching Hospital Sialkot and Islamic International Medical College, Rawalpindi for one-year duration form January 2021 to December 2021. Methods: A total 130 were admitted to the gynae ward with pre-diagnosis of pre-eclampsia were included. The cut-off value of the early and late onset PE was thirty-four weeks. Pre-eclampsia analysed < 34 weeks was labeled as early-onset pre-eclampsia and if diagnosed after 34 weeks will be labeled as late-onset pre-eclampsia. Obstetric and perinatal outcomes were assessed with version 21 of the Social Sciences Statistical Package. Results: A total 130 were admitted to the gynae ward with pre-diagnosis of pre-eclampsia were included. The severe pre-eclampsia was observed in 48(36.9%) pregnant women and 82 women (63.1%) had no symptoms of severe pre-eclampsia. In 38 (29.2%) cases; early-onset pre-eclampsia was detected and late-onset PE in 92 (70.7%) cases. The rate of severe PE in early-onset PE has been documented in 22 (57.8%) of 38 cases, and severe PE has been reported in late-onset PE in 29 (31.5%) of 92 cases. Adverse maternal outcomes occurred in 20 cases, including 7 cases of placenta abruptio and 3 cases of eclampsia with seizure disorders. Conclusions: The results indicate that in addition to intensive fetal monitoring in women with early-onset pre-eclampsia, attention should be paid to neurological, cardiopulmonary, and haematological parameters. Keywords: late onset, early onset; pregnancy outcome and preeclampsia.
Ultra Sonographic Measurement of Placental Thickness during Pregnancy as a Parameter for Estimating Gestational Age of the Fetus
Authors: Rashid Shamoona , Mumtaz Uzma , Naeem Ayesha , Hanif Sadia , Khalid Amna , Bangash Madiha
Published: December 2022

Background: The most effective prenatal care and successful births are always dependent on accurate gestational age estimation (GA). The gestational age play important role in biochemical tests interpretation. Objective: The study was carried out to find the ultra-sonographic measurements done to check the placental thickness. It is an important factor for the gestational age estimation. Study design: This is a cross-sectional study conducted at Al Nafees Medical College and Hospital, Islamabad for the duration of one year from June 2021 to May 2022. Material and Methods: The study was conducted on 325 pregnant women that visited tertiary care unit for a period of one year. All women were fully aware of the study and written consent was taken from them. Results: the thickness of placenta found at different gestational age. From 15 to 39 weeks of gestation the data was collected and no. of cases having placental thickness were recorded. Maximum and minimum placental thickness in mm was measured and average was taken. The age range of the women was 18-36 years. The 26 years was the mean age. The statistical significance was found by SPSS tool Conclusions: In this study there was found a strong link between week of gestational age and thickness of placenta. Placental thickness along with other parameters were studied in each week by ultrasound and the results were analyzed. In case where the exact duration of pregnancy is unknown, placental thickness can give information about age of fetus and other features like intrauterine stunted growth. Keywords: Placental thickness and gestational age.
Implementation Strategies to Reduce Gynecological Surgical Site Infections
Authors: Saleh Hira , Khan Yahya , Khan Sheeba , Safdar Sabah , Gul Sara , Kumari Saweeta
Published: December 2022

Surgical site infection (SSI) is a widespread issue that raises expenditures, duration of hospital visits, readmissions, but also death. This original study objective was to compare the SSI incidence prior to and after the introduction of the BIs as well as to assess the intervention's effectiveness in decreasing the relative SSI incidence. Method.This study was carried out at Department of Gynecology in Hayatabad Medical Complex, Peshawar, Pakistan from January 2021 to October 2021. Following 30 days following surgery, the prevalence of SSIs was studied. Of the 850 participants with GM who were diagnosed, 630 had laparotomies prior to (PRE) and 220 following (POST) the installation of BI. Result The most frequent suggestion was OC. There was a substantial decrease in the SSI frequency between OC laparotomies, including those without BR (PRE 11% (45/395) vs. POST 4.3% (7/162); RRR 81.7%; OR 0.14, 95% CI 0.06-0.52; p value less than 0.002) also those through BR (Pre 67.3% (31/46) against Post 14.2% (2/14; RRR 86.7%; OR 0.06, 95% CI 0.02–0.57; p = 0.003). the total SSI incidence within UC decreased from 25.8% (47/182) to 15.3% (6/39; RRR 48%; OR 0.46, 95% CI 0.17-1.34; p = 0.133). Overall SSI rates among CC decreased from 17.6% (6/34) to 0 (0/15). Conclusion Most commonly, conventional bundles of implementation interventions are used in SSI prevention. The rate of SSI in GM significantly decreased once BI was implemented. Keywords: Surgical site infection, laparotomies, gynecological cancers, gynecology oncologist.
Robson Ten Group Classification System and Fetal Distress as the Indication for Caesarean Section
Authors: Bano Nosheen , Tufail Nazia , Ali Saima , Salman Nosheen Wahab , Ghafoor Nosheen , Naeem Ayesha
Published: December 2022

Background: The marked increase in the rates of CS has not only raises the challenges for the medical professional but also became a debatable issues for many gynecologists. In order to explain the increasing rates of CS it is necessary to identify which group of women is more frequently undergoing CS. Objective: The study aimed to evaluate the role the fetal distress and Robson ten group classification play for the indication of caesarean section. Study design: It is a retrospective study conducted at Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital Sialkot, from January 2022 to June 2022. Material and Methods: 5787 women were admitted in tertiary care unit for delivery. Among these 2031 went through caesarean and the remaining delivered normally. Most of the population was included in group 1 and 5, where 501 and 535 individuals were present. Results: The group having the most contribution towards CS was group 5. And the group showing least contribution towards CS was group no.10. Group 5 also showed high contribution towards CS. The evaluation was carried out for 205 patients, the mean age of the patients was 26 years in this study. Most of the patients belonged to gestation week greater than 36 weeks. Conclusion: The group that has low risk had more chances to contribute to the CS rate. The indication for CS was most of the time fetal distress which was seen at the time patients were admitted in hospital. Keywords: Caesarean section and fetal distress.
Frequency of Urinary Tract Infection in Febrile Children without Any Focus on Infection
Authors: Jogezai Atiya , Zahra Varda Tuz , Fatima Ambreen
Published: December 2022

Background: In newborns and young children, a urinary tract infection is a frequent hidden cause of fever. Children younger than a year old who appear with fever and symptoms of UTI are usually given treatment for something else. Objectives: The objective of this study was to assess the prevalence of UTI in children presenting to a tertiary care hospital between the ages of 1 month and 36 months with nonspecific fever. Duration and study settings: The Children's Hospital Pakistan Institute of Medical Science, SZABMU, Islamabad, was the site of this trial, which ran from Jan 2018 to June 2018. Study design: Descriptive cross sectional Methodology: After a complete medical history and physical examination, a urine sample was taken for testing and culture using a soft tube in younger children and a clean catch approach in older children or those who are cooperative. Urisys 2400 was used to analyse the urine samples. Larger children's urine samples were grown on CLED agar plates (cysteine lactose, electrolyte deficient). Clinitek Siemens, a haematology analyser, was used to determine the number of white blood cells in the blood. The Pakistan Institute of Medical Sciences in Islamabad is home to a state-of-the-art laboratory where tests including leucocyte count, urine DR, and culture were conducted. A pre-designed proforma was used to record the patient's demographic information, medical history, diagnosis, and laboratory results. Results: In this study, 6.47 percent (n=18) of 278 children aged 1 to 36 who presented to a tertiary care hospital with a fever and no other obvious signs of infection were found to have a urinary tract infection. Conclusion: Children arriving to a tertiary care hospital with a fever and no other signs of infection are not likely to have a urinary tract infection. Keywords: UTI in children with diffuse fever and no obvious source of infection.
Thyroid Ultrasound Features and Risk of Carcinoma: A Systematic Review and Meta-Analysis of Observational Studies
Authors: Bilal Hazrat , Shabbir Ghulam , Lutfi Irfan Amjad , . Kainat , Siyal Nadeem , Ali Sajid
Published: December 2022

Objective: This study was performed to evaluate how well thyroid nodules with nonspecific fine needle aspiration cytology and nonrandom nodules performed symptomatically for thyroid cancer. Study Design: Cross-sectional & observational study. Place and Duration: The study was conducted at Jinnah Hospital in July 2012. Methodology: We included individuals with thyroid nodules who had thyroidectomy after having their nodules assessed by the US were taken into consideration. We only took into account studies where surgical samples have been diagnosed by histology. For full-text evaluation, all of the chosen studies were accessed. Stata v11.0 software was used for all statistical analyses. Results: There were 52 observational studies totaling 12,816 nodules. 10 studies classified 1852 nodules that had uncertain cytology as a different group. With probabilities ranging from 2.15 to 3.77, all US characteristics of nonrandom nodules were substantially linked with cancer; micro calcifications, discontinuous edges, and a taller than broad form had significant particularities (Sp; 89.8 %, 85.3 %, and 98.1 %) and favorable probability ratios (LHR; 5.16, 4.19, 10.17). The one aspect with the better diagnostic efficacy was lack of flexibility (sensitivity 89.1 %, Sp 88.3 %, and positive LHR 8.19). Conclusions: Ultrasound characteristics are not an effective way to identify nodules that require fine needle aspiration cytology. To standardize elastography procedures and assess results, particularly in nodules with an undetermined cytology, more research is necessary. Keywords: Thyroid Ultrasound Features, Risk Of Carcinoma, Systematic Review, Meta-Analysis.
Analyze the Rate of Late Arrival in Patients with Acute Myocardial Infarction and the Factors That Cause it
Authors: Yaqoob Naveed , Din Iqtidar Ud , Shahid Muhammad , Mansoor Yasir , Tareen Mujeebullah , Khalid Fahad
Published: December 2022

Objective: Explore the causes of patients' delayed hospital visits after presenting with acute myocardial infarction to better understand this issue. Study Design: Cross-sectional Place & Duration: Department of Cardiology, Rawal Institute of Health Sciences, Islamabad during the period from February, 2022 to July, 2022. Methods: Seventy patients of both sexes were enrolled in this study, all of whom had been diagnosed with acute myocardial infarction. Ages of patients ranged from 18 to. A patient's age, sex, place of residence, level of education, and socioeconomic position were meticulously noted. It was recorded how often people were running late. Reasons for the late arrival were calculated. Results: There were a total of 70 patients, 48 (70%) of whom were male and 22 (30%) female. Patients between the ages of 41 and 50 made up the largest age group, followed by those between the ages of 51 and 65. It was found that 42 patients (62.9%) arrived more than 2 hours after their symptoms had begun. The use of public transportation was the leading cause of arrival delays (51.4%), followed by large distance (more than 20 km) (38.5%) and the lack of an attendant (38.5%). Conclusion: We found that a significant proportion of patients with acute myocardial infarction had a delayed arrival. The most common causes of late arrival at the hospital were the use of public transportation, travel distance, lack of education, and low socioeconomic level. Keywords: Delayed arrival, Risk factors, Acute myocardial infarction,
Usefulness of Carotid Ultrasonography in the Diagnosis of Coronary Artery Disease Patients
Authors: Hussain Tahir , Khan Rafeah , Qamar Ishaqi Muhammad Saqib , Hyder Syed M Shahnawaz , Kumar Manoj , Ihtisham Sheema
Published: December 2022

Objective: The research aimed to examine whether the carotid condition is linked to coronary artery disease in sufferers sent to exercise echocardiography and when it raises the exercise echocardiography capability to forecast coronary artery disease. Place and Duration: During the last five years, continuous subjects over eighteen years with diagnosed coronary artery disease underwent exercise echocardiography and carotid ultrasound at Indus Hospital Karachi. Study Design: Cross-sectional Methodology: We studied 312 participants without past heart disease who experienced exercise echocardiography, coronary angiography, and carotid ultrasonography over five years. Specific variables had been described as proportions, and evaluation among groups was according to Fisher’s exact and chi-square tests. Constant variables had been described as mean or median whenever their distribution deceased from average, and variations had been evaluated through the un-paired t-test. Continuous and binary quantitative variables have been likened to utilizing binary logistic regression. IBM SPSS, Version 20 was utilized. Results: 178 (57.1 percent) participants had substantial coronary artery disease. Components linked to CAD in multi-variate evaluation were FPG (OR 2.04, p=0.062), pre-test possibility of CAD greater than 65 percent (odds ratio 7.42, p less than0.004), positive exercise echocardiography (odds ratio 42.04, p less than 0.004) and carotid plaque presence (odds ratio 5.8, p= 0.052). There wasn't a statistical factor in the area below the curve after the inclusion of carotid plaque to exercise echocardiography results (3.08 vs. 3.24, p=1.05) nor the level of sensitivity, uniqueness, predictive efficiency, or values. Conclusion: Carotid plaque is linked to CAD in sufferers going through exercise echocardiography (EE), although its inclusion to EE doesn't improve coronary artery disease (CAD) prediction, most likely because of inadequate mathematical power. Carotid plaque reclassified 1 / 3 of sufferers to high risk class in spite of negative exercise echocardiography (EE) or absence of coronary artery disease; these subjects take advantage of aggressive primary prevention treatments. Keywords: Carotid Ultrasonography, Coronary Artery Disease, echocardiography