bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of Risk Factors Associated with Myopia in Medical Students: A Case-Control Study
Authors: Bibi Jamila , Umar Haddaya , Azhar Ayesha , Tariq Ammarah , Khan Muhammad Rizwan , Niazi Faud Ahmed Khan
Published: February 2022

Background: Myopia has emerged as a serious vision-threatening disease globally. Due to its increasing prevalence in the last few decades, it is now considered that along with genetics, environmental and lifestyle factors are also playing some role in the development of myopia. Thus, this study was planned to evaluate the effects of various risk factors in the development and progression of myopia by comparing them with people without myopia.Materials and Methods: A case-control study was conducted on 330 medical students (males=140 and females=190) of a public institute from April to September 2019. Cases include students who were diagnosed with myopia and wear glasses or contact lenses for it. Whereas controls were the students without any visual defect. Data was collected through non-probability convenience sampling from participants between 18 to 25 years from all five years of MBBS. Those with vision defects other than myopia, like hypermetropia, keratoconus, glaucoma, etc., were excluded. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25 by applying the non-parametric tests and descriptive statistics.Results: Among 330 participants, 185 (56%) had myopia, which increased rapidly between the age of 15 to 20 years in the majority (58.4%) of them. 52.5 % of myopics had a positive family history of myopia. Males were less likely to develop myopia than females (OR=0.65). There was no statistically significant difference in sleeping hours (p-value=0.46), screen exposure time (p-value=0.78) or study hours (p-value=0.15) between myopics and non-myopics. Both groups often take breaks during the study. However, non-myopics were significantly more physically active than myopics (p-value=0.025), which shows that low physical activity is associated with the development of myopia.Conclusion: There is not any significant effect of sleeping hours, screen exposure time, study hours, or breaks during the study on myopia. Myopia is more prevalent in people with a family history of myopia, females, and those with little physical activity.
Histomorphological patterns of lesions in lymph node biopsies
Authors: Bibi Sidra , Ali Kainaat , Niazi Aasiya
Published: February 2022

Introduction: Lymph node biopsies are routinely performed for the evaluation of lymphadenopathies. Tuberculosis and other infections are the major causes of lymphadenopathy in developing countries. The pattern of lymph node enlargement is different for different age groups. Malignancies are common in adults as compared to children.Objective: To document the incidence of diseases causing lymphadenopathy along with the demographics of the population under study, and to correlate site and size of lymphadenopathy with the histopathological diagnosis.Materials and Methods: A total of 163 patients whose lymph nodes biopsies were performed from January 2015 to June 2018 were included in the study. All demographic and laboratory data were recorded on a proforma and analyzed using SPSS version 22.Results: A total of 163 biopsies were studied with ages ranging from 03 to 96 years. Female patients were 57.05% and male patients 42.94%. In the studied cases, 74.84% were found to be non-neoplastic, 13.5% neoplastic while 11.65% of cases biopsies were either unremarkable or non-lymphoid tissue was biopsied. Reactive hyperplasia was the commonest lesion accounting for 50.3% of cases, followed by tuberculosis (23.3%), metastatic carcinoma (6.2%), lymphoproliferative disorders (1.84%), Hodgkin’s lymphoma (3%), non-Hodgkin’s lymphoma (2.45%) and non-caseating granulomatous lymphadenitis (1.22%) respectively. Lymph node size was found to be greater than 2cm in only 25.7% of cases.Conclusion: Reactive hyperplasia and tuberculosis are the most common diagnosis in lymph node biopsies. Lymph node biopsy is a diagnostic and reliable histologic investigation to differentiate non-neoplastic lesions from neoplastic lesions, and further classify the disease based on microscopic findings in both cases.
Patterns and Outcomes of Illnesses in Medical Patients Admitted to Holy Family Hospital in a period of Three Months
Authors: Idrees Fareeha , Atique Hamna , Haider Mujtaba , Khurrum Muhammad
Published: February 2022

Background: Health policy makers often use data describing prevalence, morbidity and mortality to assess the burden, requirements of resources and quality of the health service. The aim of this study is to recognize the patterns and treatment outcomes of diseases in a medicine unit of Holy Family Hospital, Rawalpindi.Objective: To assess the pattern and treatment outcomes of illnesses presenting in a medicine department of Holy Family Hospital, Rawalpindi in period of three months.Materials and Methods: This descriptive cross-sectional study was undertaken from 1st March to 31st May of 2019, when all the patients admitted in Medical Unit were approached for consent to participate in the study. Data were collected using a self-administered questionnaire-based interview of respondents. Data were analyzed by using Statistical Package for Social Sciences Version 23. Results: A total of 579 participants were enrolled into the study, out of which 374 (64.6%) were male and 205 (35.4%) were female with mean age 52.23. Majority of participants were admitted via emergency (92.23%). The most prevalent illnesses were chronic renal disease, asthma, decompensated chronic liver disease and stroke; with hypertension being the commonest co-morbid condition (6.2%). Of those admitted to the facility, 53.5% patients after treatment according to advice and 22.5% left the hospital against medical advice. Mortality rate was 23.8%.Conclusion: Patients with a wide variety of diseases were admitted to the medical unit mainly through emergency.1 in 5 patients admitted in acute medical unit suffered mortality.
Comparison of Oral Ivermectin and Permethrin 1% Shampoo in the Treatment of Pediculosis Capitis
Authors: Afridi Mehvish , Inayat Sara , . Zaib , Kakar Saifullah , Panezai Anila , Ghani Sehrish
Published: February 2022

Objective: To compare the efficacy of Oral Ivermectin with Permethrin 1% Shampoo in the treatment of Pediculosis Capitis

Study Design: Randomized controlled trial

Setting & Study duration: This study was conducted at the Department of Dermatology, Bolan Medical College/ Sandeman Provincial Hospital, Quetta from December 24, 2016 to June 23, 2017 (6 months)

Materials and Methods: All children of either gender having age 5 and above weight more than

15 kg presented with head-lice infestation confirmed by combing the wet hair with a fine-toothed detection comb were enrolled. All patients were randomly allocated into two groups. Patients in group A received oral Ivermectin in dose of 200mcg/kg while patients in group B received application of 1% Permethrin Shampoo. They were called after one week and they received second dose of oral Ivermectin in same dose of 200mcg/kg and application of Permethrin 1% Shampoo and re-evaluated after one week. Treatment was considered effective by absence of live lice by day 15 of treatment.

Data was analyzed in SPSS version 17.Mean age of the patient in the sample was calculated. Male to female ratio was determined in the sample. In both the groups, frequency of patients having no live louse in the head on 15th day was calculated. The frequency in both groups was compared by applying chi square test keeping p-value≤ 0.05.

Results: Majority of the patients presented were females in both group, i.e. 20 (66.7%) and 23 (76.7%) respectively. Insignificant difference was observed in the mean age in between group (p- value 0.482). Efficacy was found significantly higher in oral Ivermectin group 26 (86.7%) as compared to 1% Permethrin Shampoo. (p-value <0.001).

Conclusion: The efficacy of oral Ivermectin group was considerably higher as compared to 1% Permethrin Shampoo in our cohort.
Frequency and Risk factors of Low Birth Weight in Rawalpindi, Pakistan
Authors: Zafar Usman , Zafar Sadia , Tariq Nadia , Rashid Farah , Hassan Khalid
Published: February 2022

Background:

Low birth weight is a key determinant of infant survival, health and development. There are many maternal and biological risk factors for it. The objective of this study is to determine frequency and associated risk factors of Low birth weight.

Methods:

This cross-sectional study was carried out in department of obstetrics and gynecology; al Razi hospital, Rawalpindi from June 2016 till June 2020. Total sample size was 20,681 which was the total births during these years in this hospital setting. A structured pre tested questionnaire was used for data collection. SPSS version 23 was used for data analysis. Frequencies and percentages were calculated. Chi square test was used to determine association between LBW and socio demographic variables

Result:

The overall frequency of LBW was found to be 8.9%. Female babies were more likely to have LBW as compared to male babies (p=0.000). LBW babies had poor APGAR scoring as compared to normal weight (p=0.000). The frequency of LBW was higher amongst the mother who were <20years of age and >30years. Maternal weight had a direct while parity had inverse relationship with LBW.

Conclusion:

Low birth weight babies have poor APGAR scoring and associated with maternal risk factors.
An Evaluation of Haematological Changes in Paediatric Dengue Fever Patients at a Tertiary Care Hospital Rawalpindi During 2019 Outbreak
Authors: Asghar Rai Muhammad , Ashraf Rai Rijjal , Saheel Khalid , Hussain Abid
Published: February 2022

Objective: The study aimed to evaluate the hematological parameters of patients with dengue fever in order to increase the sensitivity of screening for early diagnosis and as an aid to the early institution of appropriate treatment.

Materials and Methods: This study was conducted in Peadiatrics Department Benazir Bhutto Hospital, Rawalpindi for a period of 6 months from July 2019 to December 2019.

Results: During the study period of 6 months, 438 dengue serology-positive children were admitted, amongst which 254 were male (58%), and 184 were female (42%). The children's age ranged from 1 month to 12 years, with a mean age of 8.03 years (SD + 3.13 years). Out of 438 children, 254 (58%) were uncomplicated dengue fever (DF), 119 children (27%) developed dengue hemorrhagic fever (DHF). 65 children (15%) went into dengue shock syndrome (DSS). The predominant findings in the complete blood picture (CBC) were Thrombocytopenia (80.1%) and leucopenia (65.1%). Normal leucocyte count was seen in 59 cases (13.68%). Thrombocytopenia (platelets less than 100,000) was seen in 351 patients (80.1%) out of which 30 cases (6.9%) had a platelet count less than 50,000. Leukopenia was found in 285 (65.1%) patients. Most of the patients were positive for NS1 (70.3%). IgM was positive in 62.1% and IgG was positive in 14.8%. Enteric Fever as co-infection was found in 30(6.8%) children.

Conclusion: Careful assessment and interpretation of hematological changes in dengue patients allow early diagnosis and institution of appropriate treatment.
Oral Health Status Among Pregnant Women Attending Gynae OPD of Tertiary Care Hospital in Rawalpindi
Authors: Anjum Samina , Azam Naila , Mughal Fatima Ali Raza , Huma Sadia , Jabeen Wajeeha
Published: February 2022

Objective:

The objectives of this study were to determine the oral health status and treatment needs using DMFT & CPITN indices in pregnant women attending Gynae OPD of tertiary care Hospital in Rawalpindi, to Determine Association of Oral health status using DMFT and CPITN with socioeconomic status and to determine oral health status of various trimesters of pregnancy

Materials and methods: An analytical cross-sectional study was carried out to assess the oral health status and treatment needs among pregnant women at Tertiary Care Hospital, Rawalpindi from April’ 2020 to September’ 2020. Consecutive sampling was used to select the study participants. An adaptive version of WHO questionnaire was used. Results were presented in the form of frequency tables. Chi square test of statistics was applied to assess the association between categorical DMFT and CPITN with the sociodemographic characteristics of the participating females.

Results: The mean DMFT score pregnant females was 2.41 + 2.30 and were belonged to a middle socioeconomic status 43.8% (n=173). About 61.8% (n=244) of participants had DMFT total score 1-7. Whereas, majority of the participants were reported bleeding gums on probing 30.6% (n=121) on assessment by CPITN. The participating pregnant females also depicted the worsening of periodontal tissues (P=0.00) and dentition status (P=0.02). Socioeconomic status was not significantly associated with dentition (P=0.39) and periodontal status (P=0.69).

Conclusion: The study revealed that oral health status was deteriorated during pregnancy. Education and gestational period were strong indicator for oral health status among pregnant women. Bleeding gums were reported in majority of participants during second trimester of pregnancy. Socioeconomic status was not significantly associated with oral health status by CPITN and DMFT score.
Spectrum of surgical site infection on the surgical floor; Increasing resistance to routine antibiotics
Authors: Iqbal Muhammad , Malik Naveed Akhtar , Hanif Muhammad
Published: February 2022

Objective: To know the spectrum of surgical site infections in general surgical patients so that specific strategies can be developed to decrease the morbidity caused by these infections.Material and Methods: All the patients who underwent general surgical operations on an emergency basis at the surgical unit of the District headquarters teaching hospital Rawalpindi from 01-01-2016 to 31-12-2017 were evaluated for surgical site infections. Surgical site infections suspected clinically were confirmed by culture and sensitivity. Involved flora and their sensitivity to various antibiotics were also determined.Results: Among 2202 emergency operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, the twenty-nine patient underwent laparotomy for penetrating and blunt abdominal trauma. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the commonest Gram-ve micro-organism (70.95%). Forty-six patients (19.40%) were sensitive to Cefoperazone sodium followed by twenty patients (8.43%) to Piperacillin sodium and twenty-one (8.86%) each to Amikacin and Linezolid.Conclusion: Surgical site infection causes a significant rise in morbidity on the surgical floor. Most of the causative microorganisms are becoming resistant to routine antibiotics. Sensitivity to the broader spectrum of antibiotics like Cefoperazone and Linezolid is increasing.
Neonatal sepsis and resistance pattern of isolates in Tertiary level neonatal unit: Time to evaluate the empirical antibiotics selection
Authors: Ehtizaz Lubna , Haider Shahzad , Fayyaz Madiha , Ansar Ambreen , Nazir Sajid , Rafique Saima
Published: February 2022

Objective: To find out the most common organisms involved in neonatal sepsis origination and observe the pattern of antibiotic sensitivity and resistance of bacterial isolates. Materials and Methods: This descriptive cross-sectional study was conducted at the Department of Paediatrics Izzat Ali Shah Hospital, Wah Cantt. Out of 420 patients admitted with sepsis in NICU, 19.5% of patients with positive blood cultures were included in the study. A consecutive, non-probability sampling technique was used. Results: Out of 82 positive blood cultures gram-positive bacteria were observed in 19 patients (23.2%) and gram-negative bacteria were seen in 63 patients (76.8%). The most common gram-negative pathogens isolated were Acinetobacter (29.3%) and Klebsiella (24.4%). Staphylococcus aureus (12.2%) was the commonest gram-positive organism isolated. Gram-negative organisms showed maximum sensitivity to Tigecycline and Colistin and were resistant to Cefixime, Aztreonam, Amoxicillin, and Ceftriaxone. Gram-positive bacteria were sensitive to Teicoplanin, Linezolid, and Vancomycin while resistance was shown to penicillin and amoxicillin.Conclusion: The current study showed that gram-negative bacteria were the major contributors to sepsis in the respective setup and showed resistance to first-line antibiotics such as Penicillins and Cephalosporins. Strict infection control measures need to be implemented to avoid the emergence of resistant strains of pathogens in NICUs. This will help to reduce the incidence of neonatal sepsis leading to mortality.
Frequency of Post-Operative Bleeding after Dental Extraction among Patients on Chronic Low Dose Aspirin
Authors: Ahmed Naseer , Gul Sunia , Shuja Eruj , Maqbool Arsalan , Ibrahim Wasim , Asim Muhammad Adil
Published: February 2022

Introduction: Anti-platelet drugs are widely used for primary and secondary prevention of cardiovascular and cerebrovascular diseases. The purpose of this study was to determine the frequency of post-operative bleeding after dental extraction among patients on chronic low-dose aspirin.

Materials and Methods: This is a descriptive case series in which a total of 378 patients on low-dose aspirin of( 75-100mg) for various cardiovascular causes were included in the study. The duration of the study was from November 2016 to May 2017 total of 6 months.

Results: Out of 378 cases, 247 patients (65.4%) were male while 131 patients (34.6%) were female. The mean age of the patients was calculated as 54.8±13.1 years. Regarding pre-morbid, 127 patients (33.6%) were diabetic and 109 patients (28.9%) were hypertensive. The mean duration of taking aspirin was calculated as 3.5±1.7 years. Post-extraction bleeding was noted in 16 patients (4.2%). This was statistically insignificant i.e p-value >0.005.

Conclusion: We concluded that simple tooth extraction is safe in patients on a long-term maintenance dose of aspirin, without discontinuation of the drug as it doesn’t cause any significant postoperative bleeding.
Role of Modified Biophysical Profile in Prediction of Fetal Asphyxia
Authors: Sadiq Nadia , Shabana Nargis , Ul Haq Aqsa Ikram , Bashir Shama , Waheed Nabeela , Faisal Jaweria
Published: February 2022

Objective   

To determine the diagnostic accuracy of Modified Biophysical Profile (MBPP) in determining fetal asphyxia in high risk pregnancies keeping actual birth asphyxia on Apgar Score as gold standard.      

Patients and Methods

After written informed consent from patients, 235 patients with high risk pregnancies admitted to obstetric ward unit 2 Holy Family Hospital were enrolled in study. BPP was done by modified method in high risk patient at > 36 week gestation. Amniotic fluid index was calculated by measuring 4 quadrant vertical pockets and if sum of 4 pockets was< 5 it was considered as abnormal. Total score in MBPP is 4.Out of which 2 score for CTG and 2 score of AFI. These patients were followed till delivery and newborn will be assessed at the time of delivery for fetal asphyxia. Fetal asphyxia was assessed on the basis of Apgar score at 5 min after birth. All patients delivering beyond 7 days of MBPP was excluded from the study.

Results

Mean age (years) in our study was 27.11+1.47 whereas mean parity was 2+1.06 with ranges from nulliparous to para four. The sensitivity, specificity, positive predicative value and negative predicative value of Modified Biophysical Profile (MBPP) in determining fetal asphyxia in high risk pregnancies keeping actual birth asphyxia on Apgar score as gold standard was 95.02%, 71.43%, 98.13% and 47.62% respectively.

Conclusion

MBPP was found to have high sensitivity and positive predictive value in predicting fetal asphyxia as assessed by Apgar score at birth.

Key words:

            Modified Biophysical profile, Perinatal outcome, High risk pregnancies, Non stress test
Identifying the problems, solutions, and challenges in referral writing: A Scoping Review
Authors: Azhar Faryal , Fatima Tausief , Khan Rehan Ahmed , Yasmin Raheela , Mehboob Usman
Published: February 2022

Abstract

Background

Both primary care physicians and other specialists are not satisfied with the quality and content of written communication between colleagues(1).  There is need of identifying the factors that lead to this dissatisfaction. Many of these are discussed in literature such as communication skills, teaching and assessment of referral writings to undergraduates, and lack of validated tool for evaluation of referral(2). This article is scoping review of literature for finding the problems, solutions, and challenges in referral writing.

Methods

The databases utilized for finding various referral systems are PubMed, ERIC, Pakmedinet and Google scholar. The article included in the study was 12 which were identified through PRISMA. These 12 articles were reviewed by two authors. (FA and TA) The first step was the application of Qualsyst criteria and then the two authors analyzed the final 12 articles for thematic analysis independently.

Results

The problems, solutions and challenges in referral writing were found after the thematic analysis by two authors. The multiple challenges regarding referral writing include the fact that details about the inadequate data written in referral letters, lack of teaching and learning strategies and lack of proper communication between physicians. There are many solutions like teaching and assessing the referral writing skills, introducing reflection and feedback to improve the skill among young doctors. Moreover, teaching the art of referral writing should include in the medical curriculum.

Conclusion

Referral writing is an important part of medical communication. A good quality referral will save time in management of patients. It will also enhance the outcome of patient management. There is need of teachings about communication skills in undergraduates and postgraduates students.
Emerging Trends in Peripartum Hysterectomy; A High Alert in Obstetrics
Authors: Ikram-ul-haq Aqsa , Sadiq Nadia , Bashir Shama , Waheed Nabeela , Shabana Nargis , Aqsa Umme
Published: February 2022

Introduction: The high incidence of lower segment caesarean section (LSCS) leading to morbidly adherent placenta and making it a leading cause of peripartum hysterectomy.Objective: Peripartum hysterectomy is one of the major obstetrical procedures that need to be performed electively/emergency in patients having morbidly adherent placenta (MAP) for the sake of the patient’s life. Need to conduct this study arises because we want to highlight the increasing rate of peripartum hysterectomy secondary to MAP, the emerging trend of increased LSCS in our socio-demographic strata, and its effects on maternal morbidity and mortality.Materials and Methods: This was a retrospective study which was carried out in the Department of Obstetrics and Gynaecology Unit II, Holy Family Hospital, Rawalpindi. All patients who underwent peripartum hysterectomy were included in the study. Data was collected from record files and labor room registers in accordance with ethical guidelines.Results: Out of 11,440 deliveries in one year, 60 patients underwent peripartum hysterectomy with an incidence of 5.2 per 1000 deliveries. The majority of patients (87%) fell in the age group of 25-33 years. 4(6.6%) patients undergone peripartum hysterectomy for postpartum hemorrhage (PPH) due to uterine atony, 3(5%) due to the ruptured uterus, and 53(88%) due to MAP. All patients who had undergone a peripartum hysterectomy due to MAP were previously scarred for LSCS (100%). 5% with previous 1 LSCS, 31% with previous 2 LSCS, 44% with previous 3 LSCS and 18% with previous 4 LSCS.Conclusion: The high incidence of peripartum hysterectomies in young patients secondary to MAP highlights the need for critical review and audit of indications of primary LSCS and repeat LSCS. It also highlights the need for expertise at the time of surgery to decrease the rate of maternal morbidity and mortality.
The efficacy and safety of Topiramate in the Treatment of Refractory Epilepsy in children in Paediatric Neurology clinic at Izzat Ali Shah Hospital
Authors: Haider Shahzad , Pervaiz Kiran , Noor Komal , Fayyaz Madiha , Nazir Sajid , Ehtizaz Lubna
Published: February 2022

Objectives: This study has been performed to observe the efficacy & safety of Topiramate in refractory epilepsies in children in Pakistan.Materials and Methods: A cross-sectional prospective consecutive series of children age between (1-14 years) with refractory epilepsy were recruited from the Paediatric Neurology clinic of Izzat Ali Shah Hospital. Epilepsy was classified into Generalized, Focal, and Unknown based on ILAE Classification. Topiramate was added in patients who were refractory to at least two anti-epileptic drugs. The outcome was recorded in four categories i.e total remission, >50% seizure reduction, <50% seizure reduction, and no improvement.Results: Fifty-eight patients were enrolled in the study, but 5 patients were dropped out due to significant side effects. Most of the children were in the age group ranging from 5 to 10 years with predominant boys (n=32). The major type of epilepsy was 53% (n=28) was Unknown, while 36% (n=19) children had Generalized epilepsy and 11% (n=6) had Focal epilepsy. 25% children had total remission, 38% had >50% seizure reduction, 28% had < 50% seizure reduction and 9% had no improvement. Total remission was mostly seen in Focal epilepsy (50%) and least shown in Unknown type (14%) and the difference was significant (Chi-Square test p=0.039). Adverse effects to Topiramate were found in 33 (62%) of the total enrolled patients. Common adverse effects were weight loss in 14(26%), poor appetite in 13(24.5%), and behavioral issues in 6(22.5%) children.Conclusion: Topiramate is an effective anti-epileptic drug (AED) in refractory epilepsy especially with Focal and Generalized onset but is not as effective in other types of Refractory epilepsy. Weight loss and poor appetite were the commonest adverse effects that were reversible after dose reduction.
Comparison of Open versus Closed Reduction and Intramedullary Nailing in cases of Closed Tibial Shaft Fractures
Authors: Napar Abdul Rasheed
Published: February 2022

Objective: To compare the frequency of various post-operative complications in open versus closed reduction and intramedullary nailing in cases of closed tibial shaft fractures.Study Design: Comparative prospective study.Settings: Orthopedic Surgery Department, Khairpur Medical College, Khairpur Mirs.Study Duration: 1st February 2019 till 30 June 2020.Materials and Methods: Hundred and seventy patients selected for this study were divided into Group C (Closed percutaneous) and group O (Open). A closed percutaneous procedure was performed through a small stab incision. Reduction and stabilization of fracture were accomplished with large forceps and manual traction. Open reduction was achieved through an adequate incision for exposure and then directly reducing the fracture. The reduction was maintained with the help of clamps. Follow-ups were carried out to look for surgical site infection, deep infection, mal-union, delayed union and nonunion, iatrogenic nerve injury.Results: Surgical site infection was seen in 5 (5.88%) patients in group C and 9 (10.58%) in group O (p-value=0.404). Deep infection was seen in 3 (3.53%) patients in group C and 7 (8.34%) in group O (p-value=0.329). Mal-union was seen in 4 (4.71%) and 2 (2.35%) patients in group C and O respectively (p-value=0.682). Delayed union was seen in 4 (4.71%) and 3 (3.53%) patients in group C and O respectively (p-value=1.0). Non-union was seen in 2 (2.35%) and 1 (1.18%) patients in group C and O respectively (p-value=1.0). Iatrogenic nerve injury was not seen in either group.Conclusion: It is concluded in our study that there is no significant difference in the rate of post-operative complications in open versus closed reduction and intramedullary nailing in cases of closed tibial shaft fractures.
Clinical and Metabolic Profile of Obese Children at a Tertiary Care Hospital
Authors: Ashraf Sohail , Mushtaq Saba , Mahmood Tahir , Bibi Sanaa , Safdar Shameen
Published: February 2022

ABSTRACT

Objective: The aims of our study were to find out the physical features and biochemical complications of obese children presenting to our hospital.

Methodology: This Cross-sectional study was conducted in outpatient department (OPD) of POF hospital Wah Cantt from January 2019 to June 2020.Non probability convenient sampling was used to include obese children less than 14 years of age. Child was labeled obese as per W.H.O. criteria. History and complete physical examination was done according to pre designed proforma of all the participants. Blood samples were sent for analysis after taking consent.

Results: Total of 100 obese children was included in the study out of whom 62 % were females and 38% were males. Majority were under 10 years of age (70%). Arthralgia (55%) was the most common complaint and Acanthosis Nigricans (31%) was the most common physical finding. Vitamin D deficiency was present in 60% of the cases. Iron deficiency was found more in females (64.5 %) (p value 0.01) and children under 10 years of age (62.8 %) (p value 0.02).

Conclusion: Obesity can lead to various health complications. Early detection and prevention of these complications can decrease the associated morbidities and mortalities in adulthood.

Key words: Obesity, vitamin D deficiency, Iron deficiency, Anemia, Acanthosis Nigricans
High-Risk Factors causing Mortality in Pediatric Burn Patients, admitted in Burns Centre of Karachi
Authors: Riaz Lubna , Shahid Riaz Ahmed , Rashid Muhammad Noman , Batool Roomana , Abro Saleem Ullah , Saleem Qurratulain
Published: February 2022

ABSTRACT

Background: Different risk variables that lead to mortality of a burn victim. The most important categories for assessment of severity in burns among pediatric age group is, total body surface area (TBSA) involved, age and type of burn which can lead to increased deaths. The current study was performed to analyze the various factors of causing risk of burns and leading to mortality.

Methods: It is a cross-sectional non-probability descriptive study, performed of Pediatric Burns unit Ruth Pfau Civil hospital, Karachi. Clinical recordof 227 Patients of both sexes135 males and 92 females was analyzed after receiving approval from Burn Center, Ruth Pfau Civil Hospital Karachi. Statistical analyzes was carried out using version 20.00 of SPSS.

Results: Largest percentage of mortality was in age between 1 and 5 years. In 139 patients, Scalding due to hot water was the most common form of burn. Major cause of mortality was due to multiple burns with > 50% involvement of TBSA was the most common category constituting 68.7% among the patients in the current study. Significant association was analyzed between the nutritional status of patients as assessed by albumin levels and mortality (p=0.004). However, total mortality among the reported cases in between 2016 until 2018 was 28.2% being in 1-5years of age with above-mentioned associations.

Conclusion: Current research indicates that an increasing mortality in pediatric burn patients is linked with the proportion of total body surface area (TBSA) exposed to burns, duration of the exposure, decrease total protein content due to damage of tissues and muscles. This leads to prolonged protein and intravenous fluid replacement. One of the most common complication is progression to respiratory failure.

Keywords: Burns, burns etiology, burns mortality rate.
Septocolumellar Suture Technique for Correction of Septal Caudal Dislocation
Authors: Murtaza Ghulam , Syed Sarwat Hassan , Sarwar Mirza Muhammad , Nadeem Sana , Baig Faisal Amin , Iftikhar Mazhar
Published: February 2022

Objective: To describe this technique for treatment of caudal septal dislocation and to evaluate the effectiveness of this technique in terms of correction of cosmetic deformity and relief of nasal obstruction.Methods: This was a descriptive case series study performed at ENT department of Services Institute of Medical Sciences (SIMS), Services Hospital, Jail Road, Lahore. 30 Cases of mild to moderate degree of septal caudal dislocation were selected and operated. The septum was fixed by sutures to the anterior nasal spine. Columellar pocket was made and septum was sutured in the pocket by two sutures at upper and lower levels to increase the stability of corrected septum.Results: We performed this suturing technique on 30 septoplasty cases during 3 years from Jan-2016 to Jan-2019. Among them 12 (40%) were male and 18 (60%) were female. Total follow up period ranged between 3 to 6 months. Anterior rhinoscopy showed no persistence of deviation or dislocation in 25 patients. 5 cases had mild deviation of septum on non-operated side.Conclusion: Two level septocolomellar suture technique is very effective, easy to learn & perform and shows long term reliability in correction of caudal septal dislocation. This is effective in improving cosmesis and nasal air flow.
The Burnout amongst doctors of obstetrics and gynecology department during covid-19 pandemic
Authors: Ahmed Khansa Iqbal , Ahmed Saira , Kahloon Lubna Ejaz , Noureen Humaira , Iftikhar Tallat , Bilqees Humaira
Published: February 2022

Abstract : Burnout is a state of physical and mental exhaustion that results from long term involvement in work situations that are emotionally demanding. Doctors in emergency fields like obstetrics & gynecology of a tertiary care hospital, have to work vigilantly at odd times under immense pressure during long duty hours, thus are more likely to burnout, especially in the tedious time of COVID-19 pandemic. This study measured the burnout in doctors of the department of OB/GYN at RMU allied hospitals by using Questionnaire based on Copenhagen Inventory with addition of questions about PPE, COVID testing facility and family burnout. Results showed inadequate provision of PPE & Covid testing, fear of transmission of infection to family and friends, effect on care of elderly at home, relationship with partner and increased mood irritability. Personal burnout was 54, work related burnout 49.6, and patient related burnout was 37

There is significant family and personal burnout but still patient burnout is not present, showing high professionalism in our doctors. Facilitation in the form of reduced working hours, safer working environment, appreciation of work, financial incentives, social support and care of psychological well-being by cognitive behavioral therapy & counselling must be offered to the doctors of the department of obstetrics and gynecology.
The Impact of COVID-19 Pandemic on Final Year Medical Students: Single Center Study
Authors: Ussaid Ahmad , Pervaiz Farwa , Rafai Wajid Ali , Baig Faisal Amin , Syed Sarwat Hassan , Masud Ahsan
Published: February 2022

Introduction: The COVID-19 health emergency led to adoption of unprecedented measures that have never been seen in recent times. The study examines the effect of COVID-19 on final year medical students’ final professional examination preparedness, transition to house job and earlier assistantship.Methodology: This descriptive cross-sectional survey was conducted in September – October 2020 after institutional review board approval at University College of Medicine and Dentistry (UCMD) in Lahore, Pakistan. A total of 112 final year medical students responded to this survey whereas 13 did not. Data was analyzed using SPSS 25. Chi square test was applied to evaluate the impact of COVID 19 on variables of interest (p-value< 0.05 considered significant). Results: Postponement of clinical rotations, written exams, OSPEs and clinical ward tests was reported by 62%, 78%, 71% and 48% students respectively whilst 29%, 13%, 18% and 21% students respectively stated it to be formatted. A statistically significant impact (p<0.05) was observed for final professional examinations preparedness and confidence to assist earlier.Conclusion: The study demonstrated the significant impact of COVID-19 on final year medical students’ examination preparedness and confidence to assist earlier in hospital. Improvised teaching methodology is urgently needed to fill in the lapses in their education.Keywords: COVID-19, Medical Education, Final year MBBS professional examination, OSPE, Earlier Assistantship, House Job.
Perception of Fourth Year Medical Students on Task-Based Learning in Clinical Teaching
Authors: Sohail Shaherzad , Dar Lubna Raiz
Published: February 2022

Background Clinical teaching is always challenging. Different teaching strategies are used for effective teaching and learning in a clinical environment. Task-based learning (TBL) is the teaching strategy where tasks are used for the learning of students. We conducted this study to explore student’s perceptions about Task-based learning.

Method This descriptive study was carried out for the academic year 2019-2020 in Shalamar medical college Lahore.TBL taught 4th-year MBBS students during a clinical rotation in Gynae/Obs, and at the end of rotation, they were asked to fill a questionnaire regarding their perceptions about TBL.

Results 87 students participated in the study. All the students agreed that TBL is an effective teaching approach, and they have a positive response towards TBL in clinical setting.85%students said TBL improve communication skills, 89.6% Said TBL provide the opportunity of direct encounter with patients, 71.2% find it helpful and informative and 40.2%said that it promotes the active involvement of students.

Conclusion: Students found TBL as an effective teaching approach in a clinical setting and find it more advantageous because it involves them more in teaching and learning and help them to improve their communication skills, and provide them opportunities to deal with patients.
A Viewpoint on Clinical Approach towards Assessment of Chronic Shoulder Pain
Authors: Khan Muhammad Shahid , Lie Denny Tijauw Tjoen , Chye Andrew Tan Hwee , Azzam Wael
Published: February 2022

The shoulder joint offers a wide range of motion and therefore pathologies leading to restriction of its movements affect the routinely performed activities. Symptoms of the shoulder pathologies are often overlapping and usually are not specific to certain pathology. However, as discussed in this manuscript, with a targeted history, still a diagnostic algorithm can be made which can then be further guided by related clinical examination and appropriate investigations to conclude a diagnosis.
LkHα 225 (V1318 Cyg) South in Outburst
Authors: Hillenbrand Lynne A. , Isaacson Howard , Rodriguez Antonio C. , Connelley Michael , Reipurth Bo , Kuhn Michael A. , Beck Tracy , Perez Diego Rodriguez
Published: February 2022

Magakian et al. called attention to the current bright state of LkHα 225 South, a well-known highly embedded, intermediate-mass young stellar object that over the past two decades has brightened visually from >20
m
to <13
m
. We present recent optical photometric monitoring showing colorless, nonsinusoidal, periodic brightness oscillations occurring every 43 days with amplitude ∼0.7 mag. We also present new flux-calibrated optical and near-infrared spectroscopy, which we model in terms of a Keplerian accretion disk, and high-dispersion spectra that demonstrate similarity to some categories of “mixed-temperature” accretion-outburst objects. At blue wavelengths, LkHα 225 South has a pure absorption spectrum and is a good spectral match to the FU Ori stars V1515 Cyg and V1057 Cyg. At red optical and infrared wavelengths, however, the spectrum is more similar to Gaia 19ajj, showing emission in TiO, CO, and metals. Sr ii absorption indicates a low-surface-gravity atmosphere. There are also signatures of a strong wind/outflow. LkHα 225 South was moderately bright in the early 1950s as well as in the late 1980s, with evidence for deep fades during intervening epochs. The body of evidence suggests that LkHα 225 South is another case of a source with episodically enhanced accretion that causes brightening by orders of magnitude, and development of a hot absorption spectrum and warm wind. It is similar to Gaia 19ajj, but also reminiscent in its long brightening time and brightness oscillation near peak to the embedded sources L1634 IRS7 and ESO Ha 99.
On the Emergence of a New Instability during Core Collapse of Very Massive Stars
Authors: Kalashnikov Ilia , Baranov Andrey , Chardonnet Pascal , Chechetkin Valery , Filina Anastasia
Published: February 2022

The process of uniform supernovae (SNe) explosions is well investigated for all their types. However, observational data suggests that the SNe may be not spherically symmetric. Modern multidimensional simulations of SNe demonstrate development of hydrodynamical instabilities during the explosion phase. But the configuration of a star and inhomogeneities prior to explosion could strongly affect how the SN develops. A number of papers on numerical modeling of pair-instability SNe explosion considered the case when thermonuclear energy in the central region of a massive star is introduced by a series of several hot spots. It leads to the appearance of many fragments of hot matter behind the divergence shock wave. An observable manifestation of this may be the presence of peaks on light curves of gamma-ray bursts associated with explosions of massive stars. The physical nature of such inhomogeneities is not evident and the number and size of spots is conjecture. In this work, we study the possibility of formation of these inhomogeneities at the stage of core collapse (CC) in a massive star. To check this assumption, we chose an analytic self-similar model of CC and investigated the stability of solutions obtained from it with respect to small multidimensional perturbations. It shows there are no conditions where the collapse of a very massive star may remain stable, although, for a less massive star, it is possible. Using the relations obtained, we found characteristic features of developing instability, thereby making it possible to estimate the amount and characteristic size of the inhomogeneities.
Estimating the Ages of Open Star Clusters from Properties of Their Extended Tidal Tails
Authors: Dinnbier František , Kroupa Pavel , Šubr Ladislav , Jeřábková Tereza
Published: February 2022

The most accurate current methods for determining the ages of open star clusters, stellar associations, and stellar streams are based on isochrone fitting or the lithium depletion boundary. We propose another method for dating these objects based on the morphology of their extended tidal tails, which have been recently discovered around several open star clusters. Assuming that the tidal tails originate from the stars released from the cluster during early gas expulsion, or that they form in the same star-forming region as the cluster (i.e., being coeval with the cluster), we derive the analytical formula for the tilt angle β between the long axis of the tidal tail and the orbital direction for clusters or streams on circular trajectories. Since at a given Galactocentric radius β is only a function of age t regardless of the initial properties of the cluster, we estimate the cluster age by inverting the analytical formula β = β(t). We illustrate the method on a sample of 12 objects, which we compiled from the literature, and we find a reasonable agreement with previous dating methods in ≈70% of the cases. This can probably be improved by taking into account the eccentricity of the orbits and by revisiting the dating methods based on stellar evolution. The proposed morphological method is suitable for relatively young clusters (age ≲300 Myr), where it provides a relative age error of the order of 10%−20% for an error in the observed tilt angle of 5°.
Measuring the Expansion or Contraction of Galaxies
Authors: Loeb Abraham
Published: February 2022

Galaxies lose mass as a result of their luminosity or gaseous outflows. I calculate the resulting radial migration of stars outwards and show that it could potentially be measured with high resolution spectrographs on the next generation of large telescopes. Substantial accretion of matter in dense cosmic environments could trigger inward stellar migration that would be even more easily measurable.
Detecting Oceans on Exoplanets with Phase-dependent Spectral Principal Component Analysis
Authors: Ryan Dominick J. , Robinson Tyler D.
Published: February 2022

Stable surface liquid water is a key indicator of exoplanet habitability. However, few approaches exist for directly detecting oceans on potentially Earth-like exoplanets. In most cases, specular reflection of host starlight from surface bodies of water—referred to as ocean glint—proves to be an important aspect of liquids that can enable detection of habitable conditions. Here, we propose that spectral principal component analysis (PCA) applied to orbital phase-dependent observations of Earth-like exoplanets can provide a straightforward means of detecting ocean glint and thus habitability. Using high-fidelity, orbit-resolved spectral models of Earth, and for instrument capabilities applicable to proposed exo-Earth direct imaging concept missions, the extreme reddening effect of crescent-phase ocean glint is demonstrated as the primary spectral component that explains phase-dependent variability for orbital inclinations spanning 60°–90°. At smaller orbital inclinations where more-extreme crescent phases cannot be accessed, glint can still significantly increase planetary brightness but reddening effects are less pronounced, and as a result, glint is not plainly indicated by phase-dependent spectral PCA. Using instrument models for future exoplanet direct imaging mission concepts, we show that brightness enhancements due to glint could be detected across a wide range of orbital inclinations with typical exposure times measured in hours to weeks, depending on system distance and mission architecture. Thus, brightness increases due to glint are potentially detectable for Earth-like exoplanets for most system inclinations, and phase-dependent spectral PCA could indicate reddening due to glint for a subset of these inclinations.
Elizabethkingia miricola Recovered from a Peritoneal Fluid Sample – A Clinical Case Report with Diagnostic Challenges
Authors: Kalchev Yordan , Petrova Atanaska , Lengerova Gergana , Ivanov Ivan , Murdjeva Mariyana
Published: February 2022

Background: Elizabethkingia spp. are Gram-negative, non-spore-forming bacteria that used to be rarely encountered but now they are of growing clinical significance. Furthermore, the diagnostic challenges to identification impede the complete elucidation of their epidemiology and association with human diseases. Case report: A 64-year-old man with liver cirrhosis due to alcohol abuse presented with fatigue, abdominal swelling, and bilateral scrotal edema. A peritoneal fluid sample was cultured and subject to a number of identification methods – API 20 NE (bioMerieux), automated Vitek-2 Compact (bioMerieux), MALDI-TOF MS (Vitek-MS, bioMerieux), and 16S rRNA gene sequencing. A final diagnosis of bacterascites was made on the basis of clinical, laboratory, and microbiological findings. Conclusion: To the best of our knowledge this is the first report of Elizabethkingia miricola being cultured from a peritoneal fluid sample in an immune-compromised host thus pointing to the emerging pathogenic role of the bacterium in patients with liver cirrhosis and ascites.