bluuebunny/crossref_metadata_2025 huggingface dataset:
PREVALENCE AND DETERMINANTS OF INTRAVENOUS ADMIXTURE PREPARATION ERRORS. A PROSPECTIVE OBSERVATIONAL STUDY IN HOSPITAL
Authors: Sana Ayesha , Hamza Muhammad , Awan Muhammad Ammar , Bilal Muhammad , Sahar Najam Us , Iqbal Kashif , Khan Robaica
Published: December 2024

Background: Intravenous admixture preparation errors (IAPEs) are critical issues in healthcare, involving incompatible diluents, incorrect mixing techniques, and wrong volumes of diluents and IV fluids. These errors compromise patient safety, with significant risks of adverse effects due to the rapid bioavailability of intravenous drugs. Despite the known dangers, insight into the prevalence, determinants, and severity of these errors in hospital settings is limited, underscoring the need for targeted preventive measures to enhance IV therapy safety.
Objective: This study aimed to determine the prevalence, types, and severity of IAPEs, identify the major determinants causing these errors, and propose strategies for minimizing their occurrence in hospital settings.
Methods: A prospective observational study was conducted across three private hospitals in Islamabad. Data were collected from various wards, including inpatient, emergency, general, infectious, gastroenterology, and respiratory wards. Observations of IV admixture preparation were performed covertly to avoid altering staff behavior. A structured data collection sheet was used to record errors related to diluent selection, volume, labeling, and mixing techniques. Demographic and professional information of staff, as well as ward-specific conditions, were documented. Statistical analysis was performed using descriptive statistics to evaluate the prevalence, types, and severity of errors.
Results: Of the observed IV admixtures, 60% were prepared by nurses, while 24.6% were prepared by pharmacists. The most common errors included incorrect diluent volume (58%), incomplete mixing (44.8%), and improper labeling (65.9%). Normal saline was used in 55.2% of preparations, while 53.6% of admixtures contained powdered antibiotics. Only 41.8% of staff adhered to sterile area protocols, and 71.5% had received IV admixture preparation training. Major determinants included insufficient knowledge, lack of training, poor working conditions, and excessive patient load.
Conclusion: IAPEs are prevalent in hospital settings, largely driven by insufficient training, knowledge gaps, and suboptimal working conditions. Comprehensive training, adherence to standardized guidelines, and implementing centralized IV admixture preparation programs can significantly reduce these errors and enhance patient safety.
PILLOW CHARACTERISTICS AND SLEEPING HABITS AMONG PATIENTS WITH CERVICOGENIC HEADACHE
Authors: Wafa  , Mir Shakeel Ahmad  , Aslam Zahra , Atta Salwa , Safdar Nabeela
Published: December 2024

ABSTRACT
Background: Cervicogenic headache is a chronic headache originating from the upper cervical spine and atlanto-occipital joint. It has a prevalence of 2.5–4.1%. Poor pillow support can lead to neck stiffness, fatigue, and radiating neck pain, which may exacerbate cervicogenic headache, scapular pain, or arm pain. Sleep quality plays a vital role in managing these symptoms, yet the relationship between pillow characteristics and sleep quality in this population remains inadequately explored.
Objective: This study aimed to evaluate the relationship between pillow characteristics and sleep quality in patients with cervicogenic headache.
Methods: A descriptive cross-sectional study was conducted on 61 participants aged 30–45 years with diagnosed cervicogenic headache and symptoms persisting for over six months. Participants were selected using convenience sampling. Patients with comorbidities or previous cervical trauma were excluded. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while pillow height was self-reported. Data were analyzed using SPSS version 21.0 and presented as descriptive statistics in tables and graphs.
Results: The mean age of participants was 35.72 ± 3.625 years, with 85.2% (n=52) being female and 14.8% (n=9) male. Most respondents (91.8%, n=56) used regular pillows, while 8.2% (n=5) used cushions. Participants reported taking an average of 39.91 ± 33.2 minutes to fall asleep and slept for 7.685 ± 1.22 hours daily. Sleeping positions included right side (78.69%, n=48), left side (16.39%, n=10), straight (3.28%, n=2), and belly (1.69%, n=1). The PSQI highlighted moderate dissatisfaction with pillow support, particularly in neck and shoulder areas.
Conclusion: This study underscores the high prevalence of sleep disturbances among patients with cervicogenic headache. It highlights the role of ergonomic pillow design in improving sleep quality and managing symptoms effectively.
Keywords: Cervicogenic headache, fatigue, pillow characteristics, Pittsburgh Sleep Quality Index, sleep disturbances, sleep posture, sleep quality
EFFECT OF SMARTPHONE USAGE ON REFRACTIVE ERRORS AND OCULAR HEALTH IN TEENAGERS
Authors: Nasir Khurram , Shafiq Ummarah , Zarin Kashmala , Tahir Subhan , Fariha ambreen
Published: December 2024

Background: The widespread adoption of smartphones has transformed communication and entertainment, particularly among teenagers. However, prolonged smartphone use has been associated with adverse effects on ocular health, including myopia and symptoms of Computer Vision Syndrome (CVS). As teenagers' visual systems are still developing, they are more susceptible to refractive errors and eye fatigue due to extended screen exposure. This study aimed to investigate the relationship between smartphone usage patterns, refractive errors, and ocular symptoms in teenagers.
Objective: The study aimed to assess the impact of smartphone usage on refractive errors and ocular symptoms, focusing on the association between screen time duration and the prevalence of myopia and CVS-related symptoms in teenagers.
Methods: This observational, cross-sectional study included 200 participants aged 13–18 years. Smartphone usage was categorized as shorter use (<2 hours/day), intermediate use (2 hours/day), and excessive use (>2 hours/day). Continuous use was defined as screen time without breaks for 20 minutes or more. Data were collected using a structured questionnaire, including information on smartphone habits, refractive errors (myopia, hyperopia, astigmatism), and ocular symptoms (headache, eye strain, redness, and inflammation). Comprehensive eye examinations, including visual acuity and refraction tests, were performed. Statistical analysis was used to determine the associations between smartphone usage patterns and ocular health outcomes (P ≤ 0.05).
Results: Excessive smartphone users showed a higher prevalence of myopia (54 cases) compared to shorter users (5 cases). Headaches (51 cases), eye strain (50 cases), redness (16 cases), and inflammation (15 cases) were significantly more frequent in excessive users compared to shorter users (P ≤ 0.001). A significant association was observed between continuous smartphone use and multiple ocular symptoms, with 72% of continuous users reporting headaches and 70% experiencing eye strain (P ≤ 0.01).
Conclusion: Excessive smartphone use is strongly associated with myopia progression and CVS symptoms in teenagers. The findings emphasize the need for preventive measures, including healthy screen habits, early screening for refractive errors, and regular visual breaks, to safeguard ocular health in this vulnerable population.
META-ANALYSIS OF PERIODONTAL INTERVENTIONS IN REDUCING SYSTEMIC INFLAMMATION: EVALUATING THE CARDIOVASCULAR BENEFITS OF MANAGING PERIODONTAL DISEASE
Authors: Shaheer Ahmad  , Sareen Ikram  , Eisha Fatima  , Syeda Hejab Fatima Rizvi  , Mohammad Alherani  , Mohammed Alshawafi  , Teqwa Grib  , Gulnaz Bibi  , Syeda Amtul Razeeqa  , Syeda Ramsha Bukhari
Published: December 2024

Background: Periodontal disease, a chronic inflammatory condition affecting the supporting structures of teeth, has systemic implications, particularly for cardiovascular health. Systemic inflammation arising from periodontal infections is thought to contribute to cardiovascular disease (CVD) by elevating inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6), which impair vascular function. Managing periodontal disease through effective interventions may reduce systemic inflammation, offering a potential strategy for mitigating cardiovascular risks and improving overall cardiovascular health.
Objective: To evaluate the efficacy of periodontal interventions in reducing systemic inflammation and improving cardiovascular outcomes, thereby assessing their potential as a preventive approach to cardiovascular disease.
Methods: A systematic search of PubMed, Scopus, and Google Scholar databases was conducted for studies published up to June 2024. Following PRISMA guidelines, randomized controlled trials and observational studies investigating the effects of periodontal interventions on cardiovascular outcomes were included. Primary outcomes assessed were reductions in systemic inflammatory markers (CRP, IL-6) and cardiovascular-related mortality. Data were synthesized using a random-effects model to calculate pooled effect sizes with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I² statistic, and subgroup analyses explored variations across treatment modalities and patient populations.
Results: Twelve studies involving 1,091 participants across diverse populations were included. Periodontal interventions were associated with significant reductions in systemic inflammatory markers, with a pooled effect size of 0.5 (95% CI: 0.30–0.70, I² = 35%). Cardiovascular mortality was moderately reduced, with a pooled effect size of 0.4 (95% CI: 0.20–0.60, I² = 20%). Subgroup analyses revealed that comprehensive periodontal treatments demonstrated greater reductions in inflammatory markers compared to standard care. Sensitivity analyses confirmed the robustness of these findings, with minimal publication bias detected.
Conclusion: This meta-analysis supports the hypothesis that periodontal interventions reduce systemic inflammation and may provide cardioprotective benefits, particularly in at-risk populations. These findings underscore the importance of integrating periodontal care into cardiovascular risk reduction strategies. Further randomized controlled trials are warranted to clarify underlying mechanisms and optimize treatment protocols for maximizing cardiovascular benefits.
RELATIONSHIP BETWEEN ANEMIA, CRP AND HELICOBACTER PYLORI IN ELDERLY MALE POPULATION
Authors: Qureshi Muhammad Waqas Ahmed , Khalid Elaf , Khan Faryal Riaz , Chaudry Hadia , Sarfraz Sakina , Ahmed Maria
Published: December 2024

Background: Anemia is a prevalent medical condition in elderly populations, contributing significantly to morbidity and healthcare burden globally. Helicobacter pylori (H. pylori) infection and systemic inflammation, indicated by elevated C-reactive protein (CRP), are potential contributors to anemia. Understanding the relationship between anemia, H. pylori, and CRP in elderly males can enhance diagnostic and therapeutic strategies, particularly in resource-limited settings where these conditions are highly prevalent.
Objective: To determine the association between anemia, CRP levels, and H. pylori infection in elderly males.
Methods: This cross-sectional observational study was conducted over six months from January 1 to June 30, 2023, at a tertiary care hospital in Rawalpindi. A total of 300 male participants aged above 65 years were recruited. After informed consent, 2cc venous blood samples were collected and analyzed for hemoglobin levels, red blood cell indices, and CRP-Q levels using Sysmex XP-100 and Beckman Coulter automated analyzers. Stool samples were tested for H. pylori antigen using the H. PYLORI QUIK CHEK enzymatic immunoassay. Data were statistically analyzed using SPSS version 22.
Results: Out of 300 participants, 270 (90%) were anemic, with 90 (33.3%) classified as mild anemia, 145 (53.7%) as moderate, and 35 (12.9%) as severe anemia. Microcytic anemia was the most common subtype (60.7%), with 158 (96.3%) of the 164 microcytic anemia cases testing positive for H. pylori. CRP-Q was elevated in 237 (87.7%) individuals, with a strong correlation observed between elevated CRP levels, H. pylori positivity, and microcytic anemia. H. pylori stool antigen was positive in 242 (89%) participants, particularly among those with anemia.
Conclusion: This study highlights a strong association between anemia, H. pylori infection, and CRP levels in elderly males, emphasizing the importance of addressing H. pylori infection as part of anemia management in this population.
PREVALENCE OF SACRO-ILIAC JOINT DYSFUNCTION AND ITS ASSOCIATION WITH LOW BACK PAIN AND RELATED FUNCTIONAL DISABILITIES AMONG DAIRY FARMERS
Authors: Farooq Maryam , Bashir Arash , Hussain Tayyab , Sarwar M Saad , Zafar M Noman , Munir Aroma , Menahil Ahmed
Published: December 2024

Background: Sacroiliac joint dysfunction (SIJD) is a significant contributor to low back pain (LBP), often leading to functional disabilities that affect daily activities. Dairy farmers are particularly vulnerable due to the physical demands, repetitive tasks, and prolonged postural stresses inherent in their occupation. These factors contribute to a heightened risk of musculoskeletal disorders, with SIJD being a key factor influencing LBP and its associated functional impairments.
Objective: To assess the prevalence of sacroiliac joint dysfunction and its association with low back pain and related functional disabilities among dairy farmers.
Methods: This cross-sectional survey was conducted from April 28, 2024, to May 15, 2024, at dairy farms registered with the Pakistan Agriculture and Dairy Farmers Association (PADFA). The sample comprised 75 male participants aged 20–50 years, with at least one year of work experience and a minimum of six daily working hours. Purposive sampling was used to select 65 participants with LBP and 10 without. Data were collected using validated tools, including the Numeric Pain Rating Scale, the Urdu version of the Oswestry Disability Index, and the 5-Test Cluster of Laslett for SIJD diagnosis. Statistical analysis was performed using SPSS version 29 to determine associations between LBP, SIJD, and functional disabilities.
Results: Of the 75 participants, 65 (86.7%) reported LBP, and 19 of these (29.2%) were diagnosed with SIJD. Among all participants, SIJD prevalence was 25.3%. Functional disability scores among those with LBP revealed the highest impact in pain intensity (67.7%) and lifting tasks (32.3%), with minimal impact on personal care and employment. Statistically significant associations were found between LBP and SIJD (p = 0.048), LBP and functional disabilities (p = 0.000), and SIJD and functional disabilities (p = 0.019).
Conclusion: Sacroiliac joint dysfunction was highly prevalent among dairy farmers with low back pain, significantly contributing to related functional disabilities. The findings emphasize the need for targeted ergonomic interventions and preventive measures to address occupational risk factors.
EFFECTS OF DEEP TRANSVERSE FRICTION MASSAGE ALONG WITH NERVE GLIDING EXERCISES IN THE MANAGEMENT OF CARPAL TUNNEL SYNDROME PATIENTS
Authors: Abid Aemen , Maryam Safdar  , Minahil Abid  , Attia Abbas  , Hanna Zubair  , Hadia Saleem  , Kinza Saifullah
Published: December 2024

Background: Carpal Tunnel Syndrome (CTS) is a prevalent condition characterized by discomfort, pain, and functional impairment due to median nerve compression. Conservative treatment approaches aim to manage symptoms and improve functionality. Among these, manual therapies such as Deep Transverse Friction Massage (DTFM) and Nerve Gliding Exercises (NGEs) have shown promise in addressing both neural and mechanical dysfunctions. This study evaluates the combined effects of DTFM and NGEs in alleviating CTS symptoms and enhancing functional outcomes.
Objective: To investigate the effects of Deep Transverse Friction Massage combined with Nerve Gliding Exercises in the management of Carpal Tunnel Syndrome.
Methods: This randomized clinical trial employed a non-probability purposive sampling technique to recruit 56 participants aged 20–40 years with CTS, confirmed by positive Phalen’s, Tinel’s, and Duncan’s tests, and moderate pain levels (VAS 4–7). Patients were randomly assigned to Group A (DTFM + NGEs) or Group B (NGEs alone). The intervention spanned four weeks, with two sessions per week. Outcome measures included pain (Visual Analog Scale), wrist range of motion (goniometer), grip strength (handheld dynamometer), and functional disability (Boston Scale). Statistical analyses were conducted using SPSS version 20, employing the Friedman test for intragroup analysis and the Mann-Whitney U test for intergroup comparisons.
Results: Group A showed significant improvements across all variables compared to Group B. Pain reduction demonstrated a highly significant difference (p < 0.000) post-intervention, with improved wrist flexion (p = 0.05) and extension (p = 0.056). Grip strength increased significantly (p < 0.000), and functional disability scores were notably better in Group A (p < 0.000). The findings indicate the superior efficacy of the combined intervention over nerve gliding exercises alone.
Conclusion: The combination of Deep Transverse Friction Massage and Nerve Gliding Exercises proved significantly more effective than NGEs alone in managing pain, improving wrist mobility, enhancing grip strength, and reducing functional disability in patients with Carpal Tunnel Syndrome.
CORNEAL ASTIGMATISM BEFORE AND AFTER SURGICAL EXCISION FOR PTERYGIUM
Authors: Israr Mohammad , Ullah Naz , Tahir Asna , Karim Samina , Nuzhat  , Romaisa  , Shehzada
Published: December 2024

Background: Pterygium, a fibrovascular growth extending onto the corneal surface, is a prevalent ocular condition that disrupts corneal morphology and induces astigmatism, resulting in visual impairment. The etiology is multifactorial, involving ultraviolet radiation, chronic irritation, and genetic predisposition. Surgical excision, particularly with conjunctival autografting, is a widely accepted treatment, aiming to correct induced corneal astigmatism and enhance visual acuity while minimizing recurrence and complications.
Objective: To evaluate the impact of pterygium excision with conjunctival autografting on corneal astigmatism and visual acuity by comparing preoperative and postoperative outcomes.
Methods: A quasi-experimental study was conducted at the Clinical Ophthalmology Unit, Hayatabad Medical Complex, Peshawar, between May 2023 and April 2024. Sixty-eight patients with primary pterygium underwent excision surgery under topical anesthesia, followed by conjunctival autografting. Corneal astigmatism was measured preoperatively and one month postoperatively using automated keratometry. Data collected included demographic details, pre- and postoperative best-corrected visual acuity (BCVA), and postoperative complications. Statistical analysis was performed using SPSS 23.0, with significance set at p ≤ 0.05.
Results: The mean age of participants was 48.6 ± 14.3 years, with a majority being male (90%). Preoperative mean corneal astigmatism was 2.71 ± 1.02 diopters (D), which significantly reduced to 1.25 ± 0.73 D postoperatively (p < 0.001). Postoperative improvement in BCVA was observed in 88.2% of patients, with 64.7% improving by one line and 23.5% by two lines or more. Minimal complications were reported, including mild conjunctival inflammation in three cases, and no recurrences were documented during the one-month follow-up.
Conclusion: Pterygium excision with conjunctival autografting effectively reduces corneal astigmatism, enhances visual acuity, and poses minimal risk of postoperative complications or recurrence. This technique remains a reliable and safe option for the management of primary pterygium.
COMPLICATIONS DUE TO POST OPERATIVE KINESIOPHOBIA IN PATIENTS FOLLOWING MODIFIED RADICAL MASTECTOMY
Authors: Hassan Zainab , Hussain Syed Ali , Tabassum Muhammad Nouman
Published: December 2024

Background: Breast cancer remains a significant health challenge, particularly in developing countries, where late-stage diagnosis and limited access to care contribute to poor outcomes. In many cultures, cancer is perceived as a lifelong disability, and surgical interventions, such as mastectomy, are seen as compounding this tragedy. Kinesiophobia, the fear of movement, may exacerbate physical inactivity and delay rehabilitation following mastectomy, potentially leading to a higher prevalence of post-operative complications. Addressing these complications is critical for improving recovery and quality of life.
Objective: The study aimed to determine the frequency and types of complications due to post-operative kinesiophobia in patients who underwent modified radical mastectomy for breast cancer.
Methods: A cross-sectional study was conducted at Jinnah Hospital, Lahore, over six months from August 2015 to January 2016. A total of 77 female patients aged 15 to 60 years who underwent modified radical mastectomy were recruited using non-probability convenience sampling. Kinesiophobia was assessed using the Tampa Scale, and complications such as pain, lymphedema, and decreased shoulder range of motion were documented. Data analysis was conducted using SPSS version 20, with numerical data presented as means and standard deviations, while qualitative data was summarized using frequencies and percentages.
Results: All 77 participants experienced pain associated with kinesiophobia, with 89.6% (n=69) reporting sharp pain, 6.5% (n=5) experiencing burning pain, and 3.9% (n=3) presenting with neuropathic pain. Lymphedema was reported by 96.1% (n=74) of the patients, while decreased shoulder range of motion was observed in 100% of participants. Axillary web formation was less frequently reported. The mean age of participants was 37.19 years, with a standard deviation of 4.133.
Conclusion: Pain, particularly sharp pain, lymphedema, and reduced shoulder range of motion were the most common complications following modified radical mastectomy. The findings highlight the pervasive impact of kinesiophobia on post-operative recovery and emphasize the need for targeted interventions to manage these complications effectively.
EFFECTS OF CONCENTRIC EXERCISES WITH AND WITHOUT MULLIGAN WRIST MOBILIZATION ON PAIN, GRIP STRENGTH, RANGE OF MOTION AND FUNCTION AFTER DISTAL RADIUS FRACTURE
Authors: Shehzadi Iqra , Raza Tahreem , Najeeb Muneeba , Mehmood Nimra , Iftikhar Aqsa , Shafi Fizza , Irshad Ammara , Manzoor Urooj
Published: December 2024

Background: Distal radius fractures are among the most common orthopedic injuries, often requiring effective rehabilitation strategies to restore function and mobility. Mulligan’s mobilization with movement (MWM) is widely used in musculoskeletal rehabilitation but requires further investigation to understand its effectiveness in improving outcomes following distal radius fractures. This study aimed to evaluate the effects of adding MWM to a conventional concentric exercise regimen on pain, grip strength, range of motion (ROM), and wrist function in patients with distal radius fractures.
Objective: To determine the impact of Mulligan’s mobilization with movement combined with concentric exercises on pain, ROM, grip strength, and wrist function compared to concentric exercises alone in patients with distal radius fractures.
Methods: A single-blinded randomized controlled trial was conducted at DHQ Hospital Sheikhupura. Twenty patients with distal radius fractures were randomly divided into two groups: Group A (n=10) received concentric exercises combined with MWM, and Group B (n=10) received concentric exercises alone. Treatment was administered three times a week for one month. Pain, wrist function, grip strength, and ROM were assessed using the Numeric Pain Rating Scale (NPRS), Patient-Rated Wrist Evaluation (PRWE), dynamometer, and goniometer, respectively. Assessments were conducted pre- and post-intervention. Statistical analysis was performed using SPSS, with significance set at p<0.05.
Results: Group A showed significantly better improvements in all variables except ulnar deviation. NPRS scores improved from 5.40±1.42 to 1.50±0.52 in Group A compared to 6.50±1.35 to 2.50±1.08 in Group B (p<0.05). PRWE scores decreased from 54.6±9.53 to 30.6±7.18 in Group A and from 63.10±14.75 to 44.40±13.85 in Group B (p<0.05). Grip strength increased from 3.30±0.94 to 11.20±1.39 in Group A versus 2.10±0.73 to 4.20±1.22 in Group B (p<0.05). ROM significantly improved in Group A for flexion, extension, radial deviation, pronation, and supination (p<0.05), while ulnar deviation showed no significant difference between groups (p>0.05).
Conclusion: Adding Mulligan’s mobilization with movement to a conventional concentric exercise regimen significantly improved pain reduction, wrist function, grip strength, and most ROM measures compared to concentric exercises alone, except for ulnar deviation. This approach can be an effective rehabilitation strategy for patients with distal radius fractures.
DETERMINATION OF MACRONUTRIENTS CONCENTRATION IN DRY FOLLIAGE OF SOPHORA MOLLIS TO USE GREEN LUMEN AS ORGANIC FERTILIZER
Authors: Batool Sumaira , Hussain Zakir , Bano Abida , Batool Azmat , Pervez Iqbal
Published: December 2024

Background: Optimal plant growth and successful crop production rely on the availability of essential macronutrients, which include nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), and magnesium (Mg). These nutrients play critical roles in plant metabolism, soil fertility, and sustainable agriculture. Sophora mollis, a small deciduous shrub of the Fabaceae family, holds potential as an organic fertilizer due to its nutrient-rich foliage. Investigating its macronutrient profile provides insights into its suitability for addressing soil nutrient deficiencies and enhancing agricultural productivity.
Objective: The aim of this study was to evaluate the macronutrient concentrations in the dry foliage of Sophora mollis and to assess its potential as an organic fertilizer for improving soil fertility and supporting sustainable agriculture.
Methods: The research involved the collection of dry foliage from Sophora mollis plants in various regions of Skardu, Gilgit-Baltistan. The samples were dried, powdered, and analyzed in the laboratory. Nitrogen content was determined using the Kjeldahl method, which involved digestion, neutralization, distillation, and titration processes. The concentrations of phosphorus, potassium, calcium, and magnesium were analyzed using UV-Visible spectrophotometry. Appropriate standards were prepared for calibration, and the macronutrient concentrations were calculated based on established protocols.
Results: The dry foliage of Sophora mollis demonstrated macronutrient concentrations of 3.9% nitrogen, 0.6% phosphorus, 4.2% potassium, 2.4% calcium, and 0.8% magnesium. These values closely aligned with the sufficient ranges required for plant growth. The results highlighted the nutrient-rich profile of Sophora mollis, indicating its potential as a sustainable organic fertilizer.
Conclusion: The study concluded that the dry foliage of Sophora mollis is a promising source of essential macronutrients and can serve as an effective organic fertilizer. Its use in sustainable agricultural practices can improve soil fertility and support crop productivity, particularly in tropical and subtropical regions.
CLINCIOPATHOLOGICAL VALUE OF SOX10 EXPERSSION IN TRIPLE NEGATIVE BREAST CARCINOMA. A COMPHEHENSIVE REVIVEW
Authors: Ahmad Jamil , Faryal Gohar  , Siyab Ahmad  , Saba Humayun  , Afia Shafiq  , Ghafar Fazal
Published: December 2024

Background: Triple-negative breast cancer (TNBC) is a biologically heterogeneous subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and HER2/neu amplification. TNBC poses significant therapeutic and prognostic challenges due to its aggressive nature, high recurrence rates, and limited targeted treatment options. SOX10, initially identified as a neural crest marker, has emerged as a potential biomarker with diagnostic and prognostic value in TNBC. Understanding its role could provide insights into tumor biology and therapeutic approaches.
Objective: This review aims to evaluate the clinicopathological significance of SOX10 expression in TNBC by synthesizing data from recent studies to understand its diagnostic, prognostic, and therapeutic implications in diverse patient populations.
Methods: A systematic review was conducted of studies published up to June 2024 from databases including PubMed, Embase, Google Scholar, Scopus, ScienceDirect, and the Chinese Biomedical Literature Database. Keywords such as "breast carcinoma," "SOX10," and "triple-negative breast cancer" were used. Inclusion criteria were original studies from 2018 to 2024, investigating SOX10 expression using immunohistochemical (IHC) methods and its association with clinical features and prognosis in TNBC. Review articles, expert opinions, case studies, duplicates, letters, and animal studies were excluded. A total of 28 studies involving 3,178 TNBC cases were included in the final analysis.
Results: Among the 3,178 TNBC cases, 1,796 (56.51%) were SOX10 positive, while 1,382 (43.48%) were negative. Analysis of 17 studies involving 1,987 Caucasian cases showed 1,226 (61.7%) were SOX10 positive, and 761 (38.3%) were negative. In contrast, 11 studies with 1,191 Asian cases revealed 570 (47.81%) SOX10 positivity and 621 (52.19%) negativity. SOX10 positivity was associated with aggressive tumor behavior, including higher tumor grade and lymph node involvement, suggesting its potential as a prognostic biomarker.
Conclusion: SOX10 is a promising biomarker for TNBC, with significant diagnostic and prognostic implications across diverse populations. The observed racial differences in SOX10 expression underscore the importance of incorporating biomarker profiling into clinical practice to guide personalized treatment strategies. Further research is needed to explore its molecular mechanisms and therapeutic potential, particularly in racially diverse cohorts.
Audit of Vaccination of Newborns in Labour Room of Tehsil Headquarter Hospital Ferozewala
Authors: Dr Sana Sattar  , Dr Komal Mannan  , Dr Muhammad Dawood
Published: December 2024

Background: In Pakistan, Hepatitis B and polio remain serious public health concerns. National guidelines recommend immediate vaccination of newborns to prevent these diseases. However, compliance with these guidelines has been suboptimal at Tehsil Headquarter Hospital Ferozewala, necessitating a thorough audit and re-audit to address the gaps.
Objective: To evaluate the effectiveness of implemented interventions aimed at improving vaccination rates for Hepatitis B and OPV in newborns, and to ensure compliance with national health standards.
Methods: An initial audit was conducted over two months, followed by a re-audit after implementing specific recommendations. Data collection involved a retrospective review of medical records and vaccination registers to assess the administration of vaccines, parental consent, and documentation practices.
Results: Initial compliance rates were 80% for Hepatitis B and 88% for OPV. Following interventions, these rates improved significantly in the re-audit, with Hepatitis B vaccinations at 98% and OPV at 100%. Parental consent improved from 65% to 94%, and documentation compliance reached 100%.
Conclusion: The implementation of targeted interventions significantly improved vaccination rates and compliance with documentation practices. These findings underscore the importance of continuous monitoring and quality improvement initiatives in achieving health standard compliance.
DETECTION OF NODAL METASTASIS IN BREAST CANCER PATIENTS: ROLE OF APPARENT DIFFUSION COEFFICIENT RATIO BETWEEN AXILLARY LYMPH NODE AND PRIMARY TUMOR
Authors: Tayyaba Nisar  , Nazia Dildar  , Ahmarin Zahid  , Uzma Nisar  , Mufliha Khan  , Syeda Mariam zehra  , Humaira Amir
Published: December 2024

Background: Breast cancer is the leading type of cancer affecting women across the world thus there is a need to have accurate and efficient diagnostic and staging tools. The present investigation aimed to evaluate the diagnostic performance of the ADC ratio of the axillary Lymph nodes and primary breast tumors for nodal metastasis prediction in breast cancer.
Objective: The objective of the study was to evaluate the diagnostic accuracy of the ADC ratio in detecting nodal metastasis in breast cancer patients using MRI.
Methods: This case-control study was performed in the radiology department of Combined Military Hospital, Rawalpindi Pakistan. The study involved 66 women who were above 18 years of age with primary breast cancer, planned for surgical treatment, and who had preoperative. MRI exams and ADC measurements of breast cancer patients were analyzed by three senior radiologists to evaluate the ability of the ADC ratio in nodal metastasis detection. The data analysis for this study was conducted in Statistical Package for Social Sciences (SPSS) version 26.
Results: The Mean ADC and ADC ratios both were significantly lower in Metastatic axillary Lymph Nodes as compared to Benign lymph nodules. The result of the analysis indicated that there are differences that are statistically significant (P<0.05). Moreover sensitivity, specificity, PPV and NPV at the cut of the value of 1.04 were 89. 87%, 83. 11%, 80. 76%, and 79. 90%, respectively.
Conclusions: The study findings indicate that the ADC ratio is a reliable and accurate biomarker for identifying metastatic axillary lymph nodes in breast cancer patients, providing a non-invasive diagnostic alternative with high sensitivity and specificity.
FREQUENCY OF LOW VITAMIN D LEVELS IN CHILDREN WITH ACUTE EXACERBATION OF ASTHMA
Authors: Ahsan Hameed  , Abdul Hafeez Soomro  , Saima Ahsan  , Tanveer Ahmad Chaudhry  , Sabir Khan  , Quratulain Riaz  , Muhammad Farrukh Habib
Published: December 2024

Background: Asthma is one of the most common chronic respiratory diseases in children and adolescents, and is associated with inflammation and hyper-responsiveness of the airways. Multiple studies have suggested a potential link between lower levels of vitamin D and increased severity & frequency of asthma exacerbations.
Objective: To find out the incidence of low vitamin D in children with signs of acute exacerbation. Methods: This was a cross-sectional study conducted at the Pediatrics department of PAEC General Hospital, Islamabad from January, 2023 to March, 2024. 94 pediatric patients aged 5 – 16 years, with clinical diagnosis of asthma according to the Global Initiative for Asthma (GINA) guidelines, and admission with an acute exacerbation of asthma were included into the study. Blood samples were taken for serum vitamin D levels and levels <20ng/ml was considered vitamin D deficiency.
Results: Mean age was 10.5 ± 3.2 years. Male and female patients were 58.5% and 41.5%, respectively. The hospitalization rate was slightly higher (60.3%) but the difference was not statistically significant (p=0.18). Mean 25(OH)D levels were significantly lower in patients with severe asthma (12.7 ± 3.5 ng/mL). Vitamin D deficient patients were 58 (61.7%) and insufficient were 25 (26.6%).
Conclusion: The findings of this study highlight the importance of vitamin D in pediatric asthma severity and clinical outcomes in children, and role of vitamin D supplementation for prevention of acute episodes.
PREVALENCE AND COMPARISON OF UVEITIS IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS WITH POSITIVE AND NEGATIVE ANTI-NUCLEAR ANTIBODIES AT A TERTIARY CARE HOSPITAL
Authors: Murtaza Ayesha , ShafiqurRehman  , Faiza Ghuman  , Tabe Rasool  , Wajid Ali  , Arshad Ali Bhutto  , Rabia yamin  , Erum Ahmad  , Sajid Atif Aleem
Published: December 2024

Background: Juvenile Idiopathic Arthritis (JIA) is the most common pediatrics rheumatic disease, with uveitis as a masquerading and severe extra-articular manifestation causing major incidence of ocular morbidity if left untreated. JIA patients with ANA (Anti-Nuclear Antibodies) positivity have an elevated likelihood of uveitis. Recognizing this relationship is important, to prevent complications in early life. The aim of this study was to compare the prevalence of uveitis in JIA patients with positive and negative ANA as a reminder for screening timely detection, and intervention.
Methods: A cross-sectional study conducted at the Department of Rheumatology at JPMC Karachi over a period of six months. The study population consisted of children younger than 16 years age, suffering from Juvenile Idiopathic Arthritis (JIA) were included in the study. ANA levels were measured using immunofluorescence. Uveitis was diagnosed when slit lamp examination showed inflammation of the anterior and posterior uveal layers (iris, ciliary body, vitreous, retina, and choroide). Uveitis laterality was reported as right, left, or bilateral. Clinical parameters determine uveitis type (anterior, middle, or posterior). SPSS version 26.0 was used to analyze the data. Descriptive statistics in terms of Mean± SD and frequency were calculated.
Results: The mean age of the patients was 10.31 ± 3.46 years among them 37 patients (56.9%) being male, and 28 patients (43.1%) are female. The most frequent symptom was joint pain, present in 96.9% of the patients, followed by joint swelling (73.8%). Morning stiffness was reported by 69.2%, and fever in the past from 35.4 %. Rash was seen in only 9.2% of patients, and weight loss was reported by 15.4%. Among 65 individuals, 27 (41.53%) tested positive for ANA, with uveitis present in 15 (23.1%). In contrast, only 3 (4.6%) of the 38 (58.46%) ANA-negative patients had uveitis (p=0.0001).
Conclusion: It is to be concluded that the strong relationship between ANA and uveitis in JIA was noted. Moreover, the results emphasize the importance of screening, especially with ANA positivity as untreated uveitis can cause considerable morbidity. Further studies of other potential risk factors, e.g., sex and genetic background, are needed for establishing screening and treatment protocols for JIA-associated uveitis.
Comparison of Effects of Conventional Constrained Induced Movement Therapy Versus Proprioceptive Neuromuscular Facilitation Technique to Improve Functional Motor Skills and Spasticity for Hemiparetic Upper Limb in Sub-Acute Stroke Patients.
Authors: Shahid Zohaib , III Poblete Dioso Regidor , Muhammad Asghar
Published: December 2024

Background: Patients' independence and quality of life were greatly impacted by sub-acute strokes, which frequently caused decreased motor function and stiffness. Proprioceptive Neuromuscular Facilitation (PNF) and Constraint-Induced Movement Therapy (CIMT) are two popular rehabilitation approaches meant to enhance motor recovery and lessen stiffness.
Objective: This study aimed to compare the effects of Constrained Induced Movement Therapy versus proprioceptive neuromuscular facilitation technique to improve functional motor skills and spasticity for hemiparetic upper limb in sub-acute stroke patients.
Methods: An accessor blinded randomized clinical trial was conducted on 50 sub-acute stroke patients. Patients with age range 40 or above were included. Excluded patients had recurrence history of stroke, chronic stroke, heart disease, and presented with any type of skin discoloration. Group A (n = 25) underwent CIMT for two hours every day, five days a week, following up to five weeks. For five weeks in a row, Group B (n = 25) underwent PNF techniques for 1.5 hours per day, five days a week. The Action Research Arm Test (ARAT) was used to assess functional motor abilities, and the Modified Ashworth Scale (MAS) was used to quantify spasticity. These measures were taken both before and after the intervention.
Results: Both groups showed marked improvement in functional motor abilities and spasticity scores post-treatment. However, Group A (CIMT) demonstrated significantly greater improvements in functional motor skills (P>0.05), while Group B (PNF) showed significantly better outcomes in reducing spasticity (P>0.05).
Conclusion: Both treatment modalities were found to be efficacious, however group A (CIMT) exhibited improved motor recovery and group B (PNF) showed reduced spasticity; a p-value (p>0.05) indicated statistically significant differences between the two groups. This study results provide evidence for further use of these approaches in Stroke management.
Prevalence of Text Neck Syndrome and its Association with Forward Head Posture and Aerobic Capacity Among Medical Students
Authors: Rashid Areeb , Sahry Sana , Tabasum Hania , Farooq Maryam , Ali Zain , Waqar Younas Muhammad
Published: December 2024

Background: To find the prevalence of text neck syndrome and its association with forward head posture and aerobic capacity.
Objective: The objective of the study is to determine the prevalence of text neck syndrome and its association with forward head posture and aerobic capacity among medical students using electronic devices frequently.
Methods: A cross-sectional study was conducted at the University of Medical and Dental College Faisalabad on undergraduate medical students in Pakistan, from April 12, 2024, to June 12, 2024. The sample size collected was 203 using a convenient sampling technique, with participants randomly selected based on specific criteria. Upon obtaining consent, participants were administered a screening form to gather information about their age, discipline, and duration of phone or tablet usage. A goniometer was then used to calculate the Craniovertebral Angle (CVA), where a CVA of less than 49 degrees indicated forward head posture. This was followed by the performance of a 6-minute walk test to assess aerobic capacity.
Results: The total sample size was 203 and the mean age of the subjects was 18-25 years. 27.09% of participants found reduced aerobic capacity while 66.50% showed forward head posture. There was a strong significant association between forward head posture and aerobic capacity with a p-value of 0.000.
Conclusion: This study finds a high prevalence of text neck syndrome and a significant association with forward head posture and aerobic capacity. Most participants face neck pain, neck discomfort, headache, and reduced aerobic fitness due to using electronic gadgets.
ATYPICAL SITES OF OCCURRENCE OF ORAL SQUAMOUS CELL CARCINOMA IN ORAL CAVITY: A CASE SERIES
Authors: Nauman Rauf Khan  , Sultan Rizwana , Hashir Muhammad Zahid , Bhatti Farwa Shabir , Azhar Huma , Jabbar Maria , Butt Hira
Published: December 2024

Background: Oral squamous cell carcinoma (OSCC) often presents in recognized sites such as the tongue and buccal mucosa; however, its manifestation in less common anatomical areas can complicate diagnosis and treatment. This case series explores OSCC in atypical locations to illustrate diagnostic challenges and emphasize the importance of broad clinical vigilance.
Case Details: Three cases are reported highlighting unusual presentations of OSCC. The first involves a 78-year-old male with a non-healing ulcer of the right mandibular alveolus diagnosed as moderately differentiated OSCC. The second case details a 51-year-old female presenting with growths on her alveolus and palate, identified as well differentiated OSCC. The third case describes a 52-year-old patient with a non-healing ulcer in the retro-molar trigone, diagnosed as moderately differentiated OSCC. These cases underscore the variable presentations of OSCC and the need for comprehensive evaluation in atypical sites.
Conclusion: The identification of OSCC in non-traditional locations underscores the need for clinicians to maintain an expansive differential diagnosis when evaluating oral lesions. Awareness and education on the variability of OSCC presentations are crucial for timely and accurate diagnosis, which can significantly influence treatment outcomes.
Role of Dexamethasone in the Management of Acute Ischaemic Stroke in a Tertiary Hospital: A Randomized Clinical Study
Authors: Al Amin Muhammad Abdullah , Mumin Abdul , Kabir A.K.M Shahariar , Ara Noor Rifat , Rahman Md Atiqur , Rahman Urmi , Marzia Nur Fatema
Published: December 2024

Bangladesh is a country of large population, a number of preventable deaths occur due to stroke in this country. The mortality rate due to stroke increased in recent years. Individuals in Bangladesh aged more than 40 years or more have increased rate of stroke prevalence. The majority of stroke patients are suffering from ischaemic stroke. Brain oedema is the usual accompaniment around the infarct or haemorrhage. It develops around the perilesional area within few hours and gets maximal within 2-4 days and then decreases to resolve usually within 2 weeks. This study determined the clinical outcome after using of injectable Dexamethasone as a treatment option in the management of acute cerebral ischaemic stroke. It is a randomized prospective clinical trial, a total of N=110 patients with acute ischaemic stroke, excluding those with having clinical suspicion of acute ischaemic stroke but no radiological evidence, Computed Tomography (CT) scan showing haemorrhage in the brain, patients of diabetes mellitus and H/O peptic ulcer disease, decrease level of consciousness due to other causes i.e. hyponatraemia, diabetic ketoacidosis, infections etc. and including those above 30 years of age admitted in Medicine units of Sher-E- Bangla Medical College Hospital, Barisal on the basis of consecutive sampling technique for the study. Following standard procedures and protocols, after taking history, doing physical examination, calculating Glasgow Coma Scale score and taking opinion about Computed Tomography (CT) Scan of brain the study was done. After getting written and informed consent two groups were selected. Group A were treated with injectable Dexamethasone and other supportive drugs and group B were treated without injectable Dexamethasone, then regular follow up was taken clinically with Glasgow Coma Score in every 1st, 3rd and 5th day after treatment. Case record form was filled in at hospital. Out of 110 patients, 70 were females and 40 males. Mean age at admission was 54.35± 8.029 years. In this study, group-A patients were 55 (50%) and group-B patients were 55(50%) in number which were randomly selected. During hospitalization, mean Glasgow Coma Scale (GCS) score of group-A was 6.44±1.65 and group-B 6.47±1.53 was. On 3rd day treatment, mean GCS score of group-A increased to 9.70±2.89 and of group-B increased to 9.48±3.35. On 5th day of treatment, mean GCS score of group-A increased to 12.57±3.46 and of group-B increased to 11.21±3.53 .On the basis of cerebral oedema seen on Computed Tomography of brain treatment group-A shows 12.73% and group-B shows 5.45% improvement in 110 patients. Overall clinical improvement in group A was 43.63% and in group B 37.27%. The Dexamethasone causes improvement in the level of consciousness as evidenced by improvement in GCS level. The improvement was more evident when the patients were suffering from cerebral oedema.
Nagarjuna's poetic language
Authors: Chaudhary Divakar ,   सहायक प्राध्यापक,हिन्दी-विभाग, श्री राधाकृष्ण गोयनका महाविद्यालय,सीतामढ़ी,बिहार
Published: December 2024

भाषा अभिव्यक्ति का सबसे सशक्त माध्यम है। इसलिए जिसकी भाषा जितनी समर्थ और सशक्त होगी उसकी अभिव्यक्ति उतनी ही प्रभावी होगी। साहित्य ही नहीं जीवन के किसी भी क्षेत्र में इसके महत्व का निदर्शन किया जा सकता है। भाषा अभ्यास और प्रयोग से सिद्ध होती है। हिन्दी साहित्य के इतिहास में कुछ साहित्यकार अपने भाषागत वैविध्य के कारण विशेष स्थान रखते हैं। हिंदी के उन्हीं लब्ध प्रतिष्ठित साहित्यकारों में से एक नाम है- वैद्यनाथ मिश्र, जिन्होंने मैथिली में ‘यात्री’ और हिंदी में ‘नागार्जुन’ नाम से कालजयी रचनाएँ की हैं। यों तो इन्हें मुख्यतः प्रगतिवादी और मार्क्सवाद का समर्थक माना जाता है लेकिन, इनके रचनागत वैविध्य के कारण सम्पूर्ण आधुनिक हिन्दी साहित्य इनके बिना अधूरा लगता है। चाहे बात प्रयोग की हो, प्रगतिवाद की हो, भाषा की हो, यथार्थ की हो, विषय- विविधता की हो- नागार्जुन सर्वत्र ही अपनी विशेष भंगिमा के लिए जाने जाते हैं।