bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Accuracy of Magnetic Resonance Spectroscopy in Differentiating Malignant and Benign Brain Lesions
Authors: javed Khalid , Butt Hira Ashfaq , Jamil Hafiz M. Amir , Kamran Asad Ullah , Nadeem Beenish , Shahid Fareeha , Uddin Islah
Published: January 2023

The aim of this study is to determine the diagnostic ability of magnetic resonance spectroscopy in separating malignant and benign cerebral masses, when histopathology taken as gold standard. The results of my study will not only resolve this controversy but also If MRS diagnostic accuracy will be found high in distinguishing ring enhancing lesions of brain, then this non-invasive modality can be applied routinely in our general practice for proper treatment selection the lesions in order to reduce the morbidity and mortality of these particular patients. Materials & Methods: We included around 141 cases presenting to us at the Radiology department of Sir Ganga Ram Hospital, Lahore, fulfilling the inclusion criteria was selected after we got approval for the study from IRB committee of university. Informed consent was taken from each patient. We performed magnetic resonance spectroscop in each case using 1.5 Tesla MR system having graded power of 33 mT/m and results of MRS were read and reported by one radiology consultant. Malignant or benign lesions were noted on MRS. After this, each patient was undergone biopsy in the concerned ward by the consultant neurosurgeon and tissue was sent to institutional pathology laboratory for histopathology. Histopathology results were interpreted by the consultant histopathologist (at least 3 years of post-fellowship experience) and benign or malignant lesion was noted Results: All the included cases underwent standard magnetic resonance spectroscopy (MRS) of brain. MRS strengthened the suspicion of malignant brain lesions in 94 (66.67%) cases. Histopathology findings confirmed malignant brain lesions in 90 (63.83%) cases. Conclusion: This study concluded that MRS is the non-obstrusive method of imaging with greater diagnostic accuracy in differentiating malignant and benign brain lesions, and that it has not only made drastically better our capability to identify malignant brain lesions preoperatively, and moreover assists neurosurgeons in taking much better decisions. As a result, we urge that MRS be performed habitually in all suspected instances of intracranial mass lesion for reliable pre-operative identification of malignant brain lesions and selection of appropriate surgical technique. Keywords: MRS. MRI. Brain lesions, brain tumor, CNS tumor, Magnetic resonance spectroscopy
Evaluation of Dapagliflozin's Impact in Type 2 Diabetes Management as A Supplement to Metformin
Authors: Azhar Salman , Chaudhary Ahmed Jamal , Jafri Syeda Hira , Ejaz Umar
Published: January 2023

Objective: to analyzing the efficacy and safety of dapagliflozin in type 2 diabetics already taking metformin. Methodology: In this observational study at Madinah Teaching Hospital Faisalabad during July 2021 to October 2022, we enrolled 100 cases of either gender with 40-70 yrs, the impact of dapagliflozin 10 mg once daily in diabetics already taking metformin 1.5-2.5 g/day (DAPA + MET), and who had a follow-up visit at 6 months. The effectiveness was measured by the change in HbA1c at baseline at 12 months, as well as the change in BMI, creatinine and microalbumin levels at 6 months. Results: The effect and safety of Dapagliflozin was evaluated in terms of BMI before treatment 11.52+5.87 which reduced to 27.11+8.63 with significant difference, HbA1c(%) before treatment was 8.78+0.68 which reduced to 7.26+0.85 with a significant difference, sCr(μmol/L) was also reduced from baseline 147.76+6.92 to 142.76+6.41, Microalbumin(μg/mg) was 126.60+4.90 before treatment and 124.48+7.42 after treatment, showing a significant reduction. Conclusion: Patients with type 2 diabetes who received dapaglifozin as an add-on medication is found with a significant reduction in their HbA1c level as well as their FBG during a 6-month treatment period. Keywords: Type 2 diabetes
Prevalence and Factors Associated with Significant Rebound Hyperbilirubinemia after Phototherapy Among Neonates: A Cross Sectional Survey
Authors: . Sindhu , Naz Falak , Kumar Manoj , Raza Ambreen , Usman Muhammad , Lohana Mahesh
Published: January 2023

Objective: The study was conducted to determine the frequency of post-phototherapy rebound hyperbilirubinemia in neonates. Background: Serum total bilirubin is rapidly reduced in newborn hyperbilirubinemia following intensive phototherapy. With this approach, there is a worry that the bilirubin level frequently rises slightly after stopping phototherapy, a condition called as rebound hyperbilirubinemia. In preterm newborns, those receiving phototherapy for fewer than 72 hours, and those whose Coombs test is positive, post-phototherapy rebound hyperbilirubinemia occurs most frequently. Materials and Methods: A cross sectional survey was conducted in postnatal wards, NICU, Neonatal step down unit, and Pediatric wards at the Agha Khan University Hospital, Karachi, Pakistan from July to December 2016. Using a consecutive sampling method, 178 neonates were included in the study. Data included basic demographic information, along with the gestational age, gender, mode of delivery, and details of phototherapy. Besides, frequency, percentages and descriptive statistics, we employed Chi square test of association considering p-value ≤0.05 as significant. Results: There were 50.6% male and 49.4% female neonates. Total 15.7% neonates were found with rebound hyperbilirubinemiaMean age was 66.21±53.92 hours. Mean length of stay in hospital was 3.14±2.08 days. Mean phototherapy duration was 37.90±6.52 hrs. Practical implication: this study is done to check for rebound hyperbilirubinemia in neonates after phototherapy. Conclusion: Our study found 15.7% neonates with rebound hyperbilirubinemia and was also found significant with age at admission, birth weight, and hospital stay length. Keywords: Post-Phototherapy, Rebound Hyperbilirubinemia, Neonates, prevalance
Remdesivir May Be Associated with Acute Kidney Injury in Covid-10 Patients: A Cohort Study
Authors: Amir Amani , Ali Syed Tajammul , Sheikh Farzana Adnan , Sadaf Maleeha , , Anwar Sadiqa
Published: January 2023

Objective: To assess the outcomes of coronavirus disease-2019 patients with acute renal damage who received remdesivir against placebo at a private hospital in Karachi, Pakistan. Methodology: At the COVID-19 ICU of Hussain Lakhni Hospital, a cohort study was conducted from July 2021 to February 2022. Male and female study participants with COVID-19 and acute renal injury ranged in age from 40 to 80. Remdesivir-treated individuals with COVID-19 acute kidney injury were exposed, but placebo-treated patients with COVID-19 acute kidney injury were not exposed. In-hospital mortality, elevated serum creatinine levels, and prolonged hospital stays were the results. The data was analyzed using SPSS version 23. Results: Patients who took remdesivir had a lower mortality rate than those who were placebo (32.2% vs 67.8%, OR=0.38, 95 percent CI=0.27-0.52), with a p-value of 0.001. Remdesivir was also associated with a shorter hospital stay (4.2% versus 95.8%, OR=0.005, 95 percent CI=.003-0.009) with a p-value of 0.001). However, increased serum creatinine revealed statistically insignificant differences between groups. The odds of in-hospital mortality were 0.376 times lower (AOR=0.376, 95 percent CI=0.275-0.514, p=0.0001) and the odds of a prolonged hospital stay were 0.030 times lower (AOR=0.030, 95 percent CI=0.012-0.074, p=0.001) in the remdesivir group than in the placebo group after controlling for covariates. Practical implication: In literature Remdesvir was associated with acute kidney injury (rise in serum creatinine ) and in many centres ,it was not used in patients with acute kidney injury although it has very beneficial effect in patients of severe covid pneumonia,many centres were not using it in patients of acute renal failure. in our study , rise in serum creatinine was not significant in remdesvir group in patient with acute kidney injury ,so remdesvir must not be withheld in this group of patients as it can decrease the severity of covid pneumonia and saves patients lives Conclusion: Remdesivir is an effective medicine in COVID-19 patients with acute renal damage in terms of in-hospital mortality and duration of stay. Keywords: Acute kidney injury, coronavirus, COVID-19, in-hospital mortality, kidney damage, remdesivir, renal function, serum creatinine
Gender Perspective in Motivation to Study Medicine and Option of Future Practice; A Cross-Sectional Survey in Two Medical Colleges of Karachi, Pakistan
Authors: Mustafa Sheena , Shah Mahwish , Khan Saba , Rashid Sadia , Shaikh Najma Bano , Hassan Sarosh-Ul
Published: January 2023

Objective: To access the reasons that are the driving force for joining the medical field, whether willingly, by parents' wish, or because clinicians are the role models and the career choice of the medical students, Methods: This cross-sectional questionnaire-based study was conducted at Jinnah Medical & Dental College and Dow University, Karachi, from May 2018 to November 2018. All the undergraduate medical (MBBS) students were randomly selected, choosing 40 students from each class in an equal number according to gender (20 female students and 20 male students), first to final years from both of the colleges. Consent to participation was obtained verbally from all of the individuals. A questioner was structured regarding demographic information along with reasons for choosing the medical profession and specialty choice for a future career. All the information was collected by using the questioner based self-made study proforma. Results: A total of 400 students were studied. The majority of the students 59.6% were aged 20–22 years, while 40.5% were 23–26 years old. According to the reasons for choosing the medical profession, 37.0% were due to personal interest and parental wishes, 6.8% said their parents are doctors and they are following them, 28.5% students choose the medical profession to serve humanity, 10.5% chose it for high income, 10.3% followed it as a role model, and 7.0% had multiple other reasons. Most common career choices were 26.5% medicine, 30.0% surgery, 5.3% gynaecology, and 7.5% public health, while 8.0% of students still had not decided. Reasons for choosing the medical profession were statistically significant according to age and gender (p = 0.001). Conclusion: The choice of medical education in Pakistan is still affected by stereotypes thoughts with typical eastern influences. Parental wish is a strong and prevailing factor, followed by to serve humanity. Lack of career counselling and guidelines results in the health industry losing many future doctors every year, as well as loss of potential resources for their training. Keywords: Factors, medical profession, gender, career choice
To Assess the Outcome of Temporo-Mandibular Joint Arthrocentesis in the Treatment of Internal De-Arrangement of Temporo-Mandibular Joint
Authors: Zuberi Shoaib , Iqbal Asad , Niazi Ammar Azim Khan
Published: January 2023

Background: The two joints connecting the jawbone to the skull are called the temporomandibular joints. The TMJs are another name for these joints (TMJ). It's a connection between the mandible (at the bottom of the skull) and the temporal bone (at the top of the skull). Internal derangement of the temporomandibular joint (TMJ) is a condition in which the disc in the TMJ is displaced out of its normal functional relationship with the mandibular condyle and the articular region of the temporal bone. The problem is within the TMJ, where it can cause serious problems. Pain from an internal condition can be effectively treated with arthrocentesis, or AC (ID). Objectives: The purpose of this study is to evaluate the effectiveness of arthrocentesis of the temporomandibular joint in the management of temporomandibular joint internal derangement. Study Design: Descriptive case series. Setting: Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore. Duration of Study: Six months after approval of synopsis i.e. 22-12-2018 to 22-06-2019 Methodology: 60 Patients matched the inclusion criteria selected from OPD of department of Oral and Maxillofacial Surgery, Mayo hospital Lahore. Informed consent was obtained. Demographic details also obtained. Patients were undergone surgery by senior consultant under LA. After surgery, patients were shifted in post-surgical wards and discharged from there after 48 hours. Patients were advised to present after 1 week of surgery in OPD. After 1 week, patients were evaluated for postoperative maximal mouth opening. Patients were also asked for presence of postoperative pain by using VAS and score was noted (as per operational definition) by researcher himself. All this information was recorded through proforma (attached). Results: Total of 60 patients, 46.7 % ( n=28) were male and 53.3 %( n=32) were female, Mean age of patients was 37.38±15.11. Sixty percent, or n=36, of the patients were found to be between the ages of 18 and 35, and forty percent, or n=24, were found to be between the ages of 36 and 60. Mean duration of TMJ Internal derangement was 49.86±19.12. Mean maximal mouth opening was 35.55±3.51mm. (p-value 0.001) and mean post-operative pain was 2.23± 1.06. (P-value 0.001). Practical Implication: This study will help to understand the effectiveness of arthrocentesis of the temporomandibular joint in the management of temporomandibular joint internal derangement Conclusion: Finally, we decided that arthrocentesis is a straightforward, minimally invasive treatment. Internally dislocated temporomandibular joints (TMJ) can be corrected with this method. For those who have closed-lock internal derangement, TMJ arthrocentesis appears to be a risk-free alternative with a reduced potential for consequences. Keywords: Temporomandibular Joint, Arthrocentesis, Post-operative Pain, Derangement, Arthrocentesis, Arthroscopy.
Outcome of Unengaged Fetal Head at Term in Nullipara
Authors: Sara Bibi , Sadiq Farkhanda , Ghafoor Saira
Published: January 2023

Introduction: Engagement of fetal head is usually regarded as a phenomenon of labor in nullipara. It commonly occurs during the last few weeks in nullipara, in majority by 38 weeks or even during the first stage of labor. The aim of this study was to determine the outcome of unengaged fetal head at term in nullipara. Materials And Methods: This study was conducted at obstetrics and gynecology unit, tertiary care teaching hospital, Peshawar. This was a descriptive cross-sectional study which was conducted during 12th Jan 2021 to 10th April 2022, in which a total of 111 patients were included in the study using 16.89% proportion of caesarean section¸95% confidence level and 7% margin of error under WHO software for sample size determination. Results: In this study, patients were in age range 19-35 years and heights of the patients were 140-160cm. Among 111 patients, normal vaginal delivery occurred in 71.71% patients, instrumental delivery in 10.8% and 18.2% patients underwent low segment caesarean section. Total number of nullipara with unengaged head were divided into four groups based on fetal head station in early labor. Total number of nullipare in each group of which 30.6% were free head, 43.2% at -3 station group, 21.62%-2 station group and 45% in -1 group Practical implication in nulliparous patients a high station at the onset of labour is not necessarily an omnious finding, even though the incidence of arrest disorders are higher when station is -3,or floating ,obstetricians can still be optimistic towards vaginal delivery. Conclusions: Nullipara with unengaged head at term during labors should be regarded with suspicion and as such should be regarded with apprehension in labor. Dysfunctional labor occurs in only small proportion of patients with unengaged head. It is concluded that the incidence of active surgical intervention in nullipara with unengaged fetal head at term is quite high. Keywords: Primigravidae, engagement of head, delivery, LSCS, Head station.
Pattern of Organism and Drug Sensitivity on Culture and Sensitivity of Pus from Soft Tissue Abscesses in Pediatric Patients
Authors: Ismail Saqib , Ismail Tahseen , Shah Syed Zakir Hussain , Saqib Aqdas , Uzair Muhammad , Sharfi Masroor Hussain
Published: January 2023

Background: Soft tissue abscesses is one of the most commonly observed complication in children. This infection may impart the longer stay at hospital and also increase the cost of medical care. Objective: The study was carried out to find the pattern of organisms and the sensitivity of drugs from the pus produced in soft tissue abscesses among patients. Study design: It is cross-sectional study conducted from January 2020 to November 2022. Material and Methods: The study was conducted at the pediatric department of the Div. HQ teaching hospital Mirpur, Azad Jammu and Kashmir. The study was carried out on 160 patients having at least one abscess on their body. The study also collected information about the predisposing factor that could have led to abscess formation. The site of distribution of the abscess was also analyzed. The abundance of microorganisms that were isolated from the samples of abscesses was also studied. Results: it was found that in most of the patients (45.5%) the blunt trauma was the main cause of formation of abscess. The common cause of abscess at extremities was blunt trauma. The common cause of abscess at head and neck site was upper respiratory tract infection and lymphadenitis. The head and neck area along with lower limb was the site that had most of the abscess. Conclusion: In our study the blunt trauma at extremities was found to be main factor leading to pus formation from smooth tissue abscess among infants. The most common region where pus was formed was extremities, head and neck area and lower limb area. Keywords: klebsiella pneumonia and Soft tissue abscesses.
A Comparative Study of Lateral Sphincterotomy Vs Topical Application of Glyceryl Trinitrate 0.2% in the Treatment of Chronic Anal Fissure an Observational Study
Authors: Azhar Raheel , Salim Aabya , Ramzan Raazia , Mahmood Areeba , Aslam Saad , , Riaz Sidra
Published: January 2023

0.2% Glyceryl trinitrate is vastly used for treatment of chronic anal fissure and it has proven its effectiveness by decreasing anal tone and promoting healing. However, lateral sphincterotomy is considered a standard treatment for anal fissures. OBJECTIVE: The aim of our study was to compare application of 0.2% GTN and lateral sphincterotomy as a treatment for chronic anal fissure. STUDY DESIGN: It was an observational prospective cohort study. METHODOLOGY: This study was conducted in General Surgery unit 2 of Dow University Hospital Ojha, Karachi. A total of 192 participants were included in the study with their signed consent 96 of whom were given GTN and the remaining 96 were advised lateral sphincterotomy RESULTS: Both treatment modalities showed promising results. Upon follow up after 2 and 4 weeks, patients’ symptoms decreased more in the lateral spincterotomy group. Around 29.17% patients became asymptomatic at 2weeks and 87.5% at 4 weeks in the lateral spincterotomy group. While 11.46% became asymptomatic at 2 weeks and 87.5% at 4 weeks in the conservative management group. CONCLUSION: Lateral sphincterotomy shows more effective results in treating chronic anal fissure as compared to application of 0.2% GTN however, as 0.2% GTN has quite comparable results as well, surgeons should opt for it as the first line of management before resorting to lateral sphincterotomy. Keywords: Chronic anal fissure, 0.2% Glyceryl Trinitrate, lateral sphincterotomy.
Perception of Dental House Officers Regarding the Management of Medical Emergencies in CMH Lahore Medical College & IOD
Authors: Javed emoona , Khalid Saria , Ali Sarah , Asim Ayesha , Chohan Arham Nawaz , Afzal Muhammad , Khan Junaid Sarfraz
Published: January 2023

Objective: The main purpose of this study is to assess the knowledge, attitude, experience, and perception about the management of medical emergencies in dental clinics amongst house officers at CMH LMC & IOD. Study Duration: This questionnaire-based descriptive cross-sectional study was conducted between May 2022 and June 2022 at CMH Lahore Medical College and Institute of Dentistry. Material & Methods: A previously tested questionnaire comprised of three parts was used for data collection. A total of 62 house officers were present. All of them responded to the questionnaire. The questionnaire consists of three sections; Section A: Contains the questions related to the understanding of the dental house officers in managing medical emergencies. Section B: Includes the evaluation of experiences and skills they have in managing medical emergencies if it occurs in dental clinics. Section C: Includes their perceptions related to the betterment of emergency management was evaluated. Data was analyzed using IBM SPSS Version 24. Data was analyzed using IBM SPSS Version 24. Results: Concerning Basic life support training, 64.5% had been given training during house job only. At least 67.7% of House officers came across 1-5 medical emergencies during their house job. Syncope was one of the most common (62.9%). Hypoglycemia was the second most common (35.5%) and asthma was reportedly the third most common medical emergency (1.6%). When facing a medical emergency, 90.3% report that they seek help. 96.8% reported that they can take a patient’s blood pressure, 72.4% can take a patient’s pulse, 27.4% can measure blood sugar level, only 38.7% can maintain an IV line, 41.9% can perform the Heimlich maneuver, 53.2% can carry out ventilation through a bag or mask and 35.5% are capable of performing CPR. Only 3.2% of house officers believe that their undergraduate training is sufficient to prepare them to manage medical emergencies. Though, 71.0 % think that house officers should undertake medical emergency training before starting their house job. Practical implication:There is scarcity of literature on how prepared dental house surgeons are to deal with medical emergencies so this study give future directions to dental house surgeons. Conclusion: It was concluded that practical training is lacking among dental house officers in managing medical emergencies and that there is a need to not only include medical emergency training at the undergraduate level but also allot a rotation to medical emergencies at the start of the house job. Keywords: Dental house officers, medical emergencies, management, training
Attribution and Health Seeking Behavior of Family Members towards Conversion (Dissociative) Disorders
Authors: Farooq Rizwan , , Jawad Unaiza , , Mehdi Muntazir , Malik Madiha , Khan Adil Umer , Huma Shafqat
Published: January 2023

Introduction: Patients with conversion disorder (dissociative disorder) are common in various hospitals and communities in Pakistan. What people think about the disease decides what treatment they receive. Therefore, this analysis was held to determine the attribution and health seeking behaviours for conversion disorder. Study Design: A cross-sectional and exploratory hospital study. Place and Duration: In the department of Psychiatry and Behavioral Sciences PGMI /AMC / LGH, Lahore Pakistan for the duration from February 2022 to July 2022. Methods: A total of 60 patients were included in this study and selected with purposive sampling method. Conferring to the criteria of ICD 10; the analysis of dissociative disorder was made. A self-developed questionnaire was used. The help seeking behavior and knowledge regarding dissociative disorder was assessed by self developed questionnaire. Results: The results exhibited that the frequency of dissociative convulsions (26.8%) and possession and trance (33.3%) were higher than in the other groups. Similarly, 8 (13.3%) had stupor, 6 (10%) has motor disorders in all movement and (3.3%) has sensory disorders and (5%) had mixed dissociative disorder. It was found that the majority of family members seeking treatment from faith healer (63.3%), trailed by paramedics (11.7%) and doctors (25%). Of all subjects, 46.6% visited a mental health professional for more than 2 weeks, 31.7% visited them within 48 hrs to two weeks, and 21.7% within 48 hours. 38.3% of members answered to ailment as a physical cause. About 43.3% of participants said conversion disorder was a mental condition. The participants who replied disease as a supernatural problem were 40%. Solitary 35% of contributors believed that counseling, psychotherapy and medicine could cure conversion disorder, while 46.7% believed that a faith-healer might cure it. Conclusion: Societies in Pakistan still have their roots in ethnic practices and faith healing. It is very important to run the awareness program and work in co-operation with faith healers is significant. Keywords: Conversion (Dissociative) Disorder, Attribution, health seeking, attribution
Effectiveness of Small Group Discussion Sessions in Teaching Biochemistry for Undergraduate Medical Students
Authors: Hassan Muhammad Muizz , Mastoor Maryam , Khawaja Imran , Fatima Saman , Avais Muhammad Abdullah
Published: January 2023

Background and aim: Teaching is an important part of the medical curriculum. Different teaching methods include small group discussions, demonstrations, inquiry approaches, lectures, problem solving methods, and tutorials. Group discussions are at the core of medical education because they help students learn more effectively. As a result, the current study sought to analyze the efficacy of small group discussions in teaching biochemistry to undergraduate medical students. Place and Duration: Gomal Medical College MTI, Dera Ismail Khan and Department of Biochemistry of Amna Inayat Medical College Lahore for the duration from March 2022 to August 2022. Method: This study included 50 undergraduate medical students of first year registered in international medical program. Prior to study conduction, ethical approval and informed written consent was taken. Student’s perception regarding small group discussion sessions were elicited based on unknown questionnaires provided to them. Likert scale was used to show their level of agreement with the questionnaire's claims. Results: Of the 50 undergraduate medical students, 28 (56%) were male and 22 (44%) were females students. About 64.6% (n=32) students believed that their grasp over the study material improved with small group discussion and 52.4% (n=26) agreed to the facilitation of active learning in small group discussion. Communication skills and clinical reasoning improved by small group discussion were claimed by 36% (n=18) medical students. Majority of undergraduate medical students 68% (n=34) strongly agreed to the claims that small group discussion helped them to correlate medical problems with biochemical concepts. Conclusion: The present study concluded that small group discussion in combination with lectures appears to provide the best instruction for the learner or medical students. Mostly students emphasized on importance of small group discussion in terms of topic better comprehension, promoting knowledge, correlation of biochemical ideas with medical issues, and interest. Similarly, they discussed the need of developing effective communication skills, as well as leadership and teamwork abilities. Keywords: Medical students, Undergraduate, Small group discussion, Biochemistry, Effectiveness
Clinical Profile and Management of Prosthetic Valve Thrombosis in Tertiary Cardiac Centre
Authors: Tareen Huma Naeem , Saad Maliha , Bashir Muhammad Ahsan , Memon Tariq , Hussain Iftikhar , Khan Muhammad Rehan
Published: January 2023

Background and Aim: Prosthetic valve thrombosis is a potentially fatal outcome of valve replacement surgery. A proportion of patients suffer with thrombotic problems, mostly as a result of inadequate anticoagulation status and irregular INR checks. The present study aimed to investigate the clinical profile and prosthetic valve thrombosis management in tertiary cardiac centers. Patients and Methods: This prospective study was carried out on 58 prosthetic valve thrombosis patients in AFIC, Rawalpindi and Punjab Institute of Cardiology, Lahore from January 2022 to June 2022. The study protocol was approved by the institutional research and ethical committee. All the enrolled patients provided informed written consent. Patients’ demographic details, clinical profile, in-hospital complications, and outcome during one year follow-up were recorded. SPSS version 28 was used for data analysis. Results: Of the total 58 PVT patients, there were 22 (37.9%) male and 36 (62.1%) females. The overall mean age was 32.84± 8.4 years with an age range 10-65 years. About 34 (58.6%) patients had sub-therapeutic INR values during admission time whereas 28 (48.3%) patients had atrial fibrillation. Breathing difficulties was the predominant complaint in 54 (92.8%) of the patients who came within one week after the beginning of symptoms. Approximately 51 patients (88.4%) had streptokinase thrombolysis, while four required surgery. Valve thrombosis was most prevalent in 49 (84.5%) of the individuals. In-hospital mortality was 9.8% (n=6), with no significant bleeding episodes or new strokes seen. Conclusion: The present study concluded that PV thrombosis is a medical emergency associated with a high mortality rate. Low socio-economic level leads to poor adherence to anticoagulation medication. The prosthetic valve thrombosis patients had poor compliance and sub-therapeutic INR. Prosthetic valve thrombosis can be effectively treated with thrombolysis. Keywords: Prosthetic valve thrombosis, Clinical profile, Thrombosis
Success Rate in Patients with Atrioventricular Nodular Re-Entrant Tachycarida (AVNRT) Slow Pathway Catheter Ablation with and without Junctional Rythym
Authors: Ahmad Salman , Khan Zahoor Ahmad , Ullah Ikram
Published: January 2023

Background and Aim: For successful radiofrequency ablation of atrioventricular nodal reentrant tachycardia (AVNRT), slow-pathway radiofrequency catheter ablation leads to junctional rhythm (JR) is now being considered as a very sensitive substitute end goal. During AVNRT RF ablation, a favorable result could be predicted based on the pattern of JR produced. Patients and Methods: This cross-sectional study was conducted on 64 patients presenting with symptomatic AVNRT and undergoing slow-pathway RF ablation in the Department of Cardiology, Hayatabad Medical Complex, Peshawar for the duration from January 2022 to June 2022. RF ablation of slow pathway was performed using a combined anatomical and electrogram mapping approach. Ablation was performed by controlling the temperature and delivering energy over 60 seconds at 60°C. In order to determine if the developed JR was successful, isoproterenol infusion was performed after every ablation pulse. Four different patterns of AVNRT inducibility were considered: intermittent, continuous, sparse, and transient. Position, pattern, and number of junctional beats were used to assess the success rate of ablation. SPSS version 28 was used for descriptive statistics. Results: Of the total patients, there were 36 (56.2%) women and 28 (43.8%) men. The overall mean age was 38.64 ± 18.36 years with an age range 16-80 years. The most prevalent symptom during AVNRT was palpitation found in 41 (64.1%) cases. The prevalence of pre-syncope, dyspnea, and syncope was 3.8%, 3.8%, and 3.4% respectively. The incidence of more than one symptoms were found in 21 (32.8%) patients. Almost all the patients displayed antegrade AH jumps and indicated dual AV nodal conduction. Out of total 156 RF, it took 114 (73.1%) RF energy applications to successfully ablate 38 (59.4%) patients with loss of AVNRT inducibility. About 126 (80.8%) patients developed JR with given specificity 42.6%, sensitivity 89.6%, and negative predictive value 61.8%. Conclusion: The present study found that the JR predicts the success of AVNRT RF ablation at a high level of sensitivity, but not to a specific degree. However, the findings indicate that its specificity may rise with the appearance of > 14 total tight junctions beats. Furthermore, if the forecast of effective slow-route RF ablation in relation to the existence of JR remains not consistent adequate, its absence might be a trustworthy marker of the pathway needing greater energy application delivery to be abolished. Keywords: Atrioventricular nodular re-entrant tachycardia (AVNRT), Slow pathway catheter ablation, Junctional rhythm, success rate
Prevalence of new Onset Right Bundle Branch Block in Acute Myocardial Infarction and its Coronary Angiographic Findings in Patients Attending NICVD
Authors: . Asfandyar , Khan Mati Ullah , Farooq Muhmmad Umar , Maqsood Saeed , Khan Muhammad Rehan , Bashir Muhammad Ahsan
Published: January 2023

Background and Aim: Acute myocardial infarction patients with left and right bundle branch block significantly contributes to higher risk of mortality. Right bundle branch block (RBBB) has clinical implications in acute myocardial infarction setting. The present study aimed to determine the prevalence of new onset RBBB in acute myocardial infarction and its association with coronary angiographic findings. Methodology: This cross-sectional study was conducted on 82 acute myocardial infarction (AMI) patients in National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2022 June 2022. Study protocol was approved from the institution research and ethical committee. All the patients of either gender with an age range 25 years to 85 years having acute myocardial infarction were included. Written informed consent was taken. Patients with previous RBBB, had implanted pacemaker, and presentation of symptoms >24 hours were excluded. Detailed history and clinical examination of each individual was done. Patients’ angiographic findings after eligibility based on coronary angiography was done and recorded. All the data were entered into pre-designed profroma. SPSS version 26 was used for data analysis. Results: Of the total 82 AMI patients, there were 48 (58.5%) male and 34 (41.5%) females. Age-wise distribution of AMI patients were as follows; 17 (20.7%) 25-45 years, 28 (34.2%) 46-65 years, and 37 (45.1%) 66-85 years. The overall mean age was 54.62±6.82 years. The prevalence of new onset RBBB and without RBBB was 17 (20.7%) and 65 (79.3%) respectively. Of the 17 AMI with RBBB patients, the incidence of single vessel disease, double vessel disease, triple vessel disease, and left main stem disease was 3 (17.6%), 5 (29.4%), 6 (35.3%) and 3 (17.6%) respectively. Majority of patients aged 46 years to 65 years had RBBB in 9 (32.1%), followed by 6 (16.2%) in patients 66-85 years and 2 (11.8%) in patients aged 25-45 years. Conclusion: The present study concluded that the prevalence of new onset RBBB was 20.7% among acute myocardial infarction patients. The incidence of triple vessel disease was prominent in acute myocardial infarction patients with RBBB followed by double vessel disease. Also, elderly patients of acute myocardial infarction patients were more susceptible to RBBB than younger one. Keywords: Right bundle branch blockage, Acute myocardial infarction, Coronary angiography
Mothers Knowledge Toward Correct Infant Sleep Practices and Sudden Infant Death Syndrome In Al-Najaf Provence
Authors: Mohammed Alzubaidi Miaad Jasim , Abdullah Abeer Miri , Hashem Farah Sadiq Abd , Ali Alaq Hameed
Published: January 2023

Objective: "The current study aims to assess the proportion of newborns that sleep well and investigates the awareness and comprehension of SIDS and its associated risk factors among mothers of infants in Al Najaf Provence". Methodology: In order to accomplish the study's goals, a descriptive cross-sectional study was used throughout. The study took place between November 2021 and February 2022. a Non-Probability (Purposive Sample) of 100 moms who arrived with infants (under 1 year old) at the Hospital for Maternity and Children and the primary healthcare facilities in Al-Najaf Provence. Results: The study's findings revealed that (49%) of newborns were found to be sleeping on their sides, (37%) were found to be dozing off, and (14%) were found to be sleeping on their prone backs. Participants as a whole (60%) stated that (40%) child doctors were the main information source they used to learn about SIDS. Conclusion: In our study, women had limited understanding about sudden infant death syndrome, and a substantial percentage of them were unaware that smoking exposure during pregnancy and after delivery had been linked to an elevated risk of SIDS. In our study, a large percentage of moms were unaware that giving their babies pacifiers while they slept reduced the risk of SIDS. Keywords: knowledge, mother, sudden infant death syndrome.
Comparison of Ultrasound-Guided Ankle Block Versus Anatomical Landmark-Guided Ankle Block in Ankle and Foot Surgery Under Regional Anesthesia
Authors: Khan Muhammad Javed , Babar Abdullah , Haq Imran Ul , Wadud Roheena , Farid Khayyam , Waheed Abdul
Published: January 2023

Background: As more patients undergo foot and ankle surgery, regional anesthesia's significance in postoperative treatment has grown. Anesthesiologists and pain specialists have adopted regional anesthesia in large numbers. Numerous techniques, such as nerve stimulation, anatomical markers, and ultrasonography, have been used to block the saphenous nerve. Objective: The present study aimed to assess the traditional anatomic landmark-guided approaches in lower limb surgery performed under regional anesthesia with ultrasound-guided ankle blocks in surgical anesthetic methods. Method: This randomized control study is carried out at the hospital. A total of 60 participants with scheduled foot and ankle surgery were randomly divided into two study groups (each n=30), Ultrasound-guided ankle block (USG) and anatomical landmark-guided ankle block (ALG). Results: Recruited participants had a mean age of 50.2± 14.02, with 39 (65%) male and 21( 35%) female. A total of 49 patients (82%) were able to undergo anesthesia successfully, with 26 (86.60%) of those patients belonging to the USG block group and 23 (76.60%) of those patients belonging to the ALG block group undergoing anesthesia successfully (p-value = >0.999). Practical implication: This study will help to comprehend either ultrasound-guided ankle block or anatomical landmark-guided ankle block in foot surgeries give better results. Conclusion: The results of this research indicate that the success rates of the two procedures are statistically insignificantly different; however, the USG ankle block for surgical anesthesia performed under regional anesthetic had a greater success rate than the anatomic landmark-guided technique. Keywords: Foot surgery, USG ankle block, anesthesia, ALG Block, postoperative treatment
Association of Vitamin D with Obesity in Premenstrual Syndrome: A Study of Female Population of Hyderabad, Sindh
Authors: Naeem Aqsa , Batool Sarwat , Bhatti Urooj , Shaikh Khalida , Uqaili Arsalan , Rani Keenjher
Published: January 2023

Introduction/Objectives: The affiliation between decreased vitamin D and obesity is well built up. Females with Premenstrual Syndrome (PMS) are more prone to gain weight. Obese women's low calcifediol levels are impacted by diets and inactive lifestyles. The study focused to discover out the relationship between vitamin D and obesity in premenstrual syndrome females. Study design: Cross-sectional study Place and Duration: OPD-Gynecology, Liaquat University of Medical &Health Sciences (LUMHS), Jamshoro and Hyderabad in collaboration with Physiology Department LUMHS Jamshoro and Diagnostic and Research lab Hyderabad. Materials & Methods: Two hundred fifty (250) females between15-45 years with a history of PMS were selected for this study. Information was collected on marital status, vitamin D3 levels, PMS intensity, and BMI. The Chi-square test compared the vitamin D levels with BMI and PMS scores. Results: Mean age of the patients was 29.89±5.206 years. 64.8% of patients were married. 42.8% had normal weight and 40.8%were obese. 35.2% of patients had mild PMS scores and 36.4% had extreme PMS. 61.2% of patients had vitamin D lack with only 4.8% having adequate serum vitamin D levels. 22.8% of normal-weight patients had inadequate serum vitamin D levels. 35.6% of obese patients had vitamin insufficiency in their blood. The relationship between obesity and vitamin D levels was significant (P-value: 0.001). 18.8% of patients who had mild PMS scores had deficient serum vitamin D levels. The relationship between PMS scores and vitamin D levels was remarkable (P-value: 0.001). Practical implication The advantages of 25(OH) D supplementation/repletion on bone health are well known. Although there is a biological plausibility linking the status of vitamin D and obesity supported by basic and clinical research findings, basic research is necessary to know the molecular pathways involved in this association. Also this study will help the community to decrease the PMS symptoms by taking vitamin D supplements. Those females who take the vit D prior their PMS stage will be prevented from severe symptoms. Conclusion: We found a significant, inverse relationship between vitamin D levels and BMI, showing that losing weight through vitamin D and calcium-enriched diets may result in typical vitamin D levels, and so PMS may be treated. Keywords: Vitamin D (Vit D), Premenstrual Syndrome, body-mass index (BMI), obesity, women
Strategy For Improving The Performance of State Civil Service In Developing Employee Performance Targets In The Government Environment of Tanah Bumbu District
Authors: Dahliansyah Dahliansyah , Tenri Sompa Andi , Riduansah Syafari M.
Published: January 2023

This study aims to describe the strategy of improving the State Civil Apparatus (SCA) performance in preparing Employee Performance Targets (EPT) within the Tanah Bumbu Regency Government. This research is motivated by the low ability of SCT in the practice of EPT in the Tanah Bumbu Regency Government. Through this research, it is hoped that strategies that have been carried out can be identified, evaluated, and provide recommendations for systems that can be used. The theory used to answer the problem is the theory of employee performance improvement strategies in EPT preparation. This research method uses a qualitative approach with a descriptive research type. The research subject is the Head of Human Resources Agency of Tanah Bumbu Regency. The research locus, namely Human Resources Agency as the best agency in preparing EPT, and the Health Office as the lowest agency to prepare EP. The data collection type is primary and secondary data, and data collection techniques are carried out through interviews, documentation, and observation. This study indicates that the Human Resources Agency applies a strategy to create a harmonious organizational climate and effective leadership. In contrast, the Health Office involves a pleasant organizational environment, effective leadership, and career development. Based on the comparisons made, the Department of Health needs to optimize the strategies that have been carried out. The suggestions that can be given to the Tanah Bumbu Regency Government are to improve the performance of SCT in the preparation of EPT by optimizing the strategy of creating a harmonious organizational climate, maximizing the role of effective leadership, and developing ASN careers
Implementation of Covid-19 Vaccination Policy At Bhayangkara Hospital Banjarmasin, As An Effort To Maximize The Role of Police In The Community
Authors: Kulle Hasnilawati , Alim Bachri Ahmad , Tenri Sompa Andi , Jamaluddin Jamaluddin , Arbain Taufik
Published: January 2023

The critical role of the police in a pandemic situation, of course, makes the vaccine implementation program at Bhayangkara Hospital very crucial. The National Police is one of the spearheads in dealing with COVID-19. The protection of the apparatus is an important thing that needs to be considered, including implementing the vaccination policy at Bhayangkara Hospital Banjarmasin. The purpose of this study was to determine the implementation of the COVID-19 vaccination policy. The research focuses on the effectiveness and obstacles faced in implementing vaccinations to handle the COVID-19 Pandemic in South Kalimantan. This research uses a qualitative approach, with the basis of case study research, namely research that is carried out intensively, in detail, and in-depth on a problem that is the object of research. This research is a case study of the COVID-19 vaccination policy, including policy formulation and vaccination implementation. The qualitative approach was carried out using the desk study method, active observation participation, semi-structured interviews, and documentation. This study uses Weimer and Vining's theory because this theory can briefly summarize the various factors that influence policy implementation. These factors include the characteristics of the policy itself, its resources, and the policy environment. The theory can provide an overview for the government in formulating policies so that the established policies can be implemented because the implementation (implementation) of policies is an activity to generate results (output), impact (outcome), benefits (benefits), and impact (impact) that can be enjoyed. By the target group. Implementation of policies vaccines in RS Bhayangkara Banjarmasin already performing well. Even so, keep in mind that vaccines do not automatically mean that COVID-19 will disappear quickly. It takes time to vaccinate the entire population, and The realization of vaccine distribution will have its challenges with the geographical conditions of South Kalimantan, which have various typographical areas. The availability of the vaccine itself is also one of the keys related to its production capacity, affecting the timing of vaccine production for several residents in South Kalimantan
Family Empowerment In Patients With Severe Mental Disorders In Banjarmasin, Indonesia
Authors: Irmah Setia Waty  , Setia Budhi  , Andi Tenri Sompa
Published: January 2023

Family empowerment is a process or effort that aims to increase families' awareness of and willingness to care for their health. The purpose of this study was to determine, examine, and analyze family empowerment and the factors that inhibit it in patients with severe mental disorders in Banjarmasin City, Indonesia, in 2021. This study employed qualitative methods to elicit descriptive data in a written or spoken form from individuals and observed behavior to gain a better understanding of field phenomena through the collection of data or information obtained directly. At the Banjarmasin City Health Office, data were gathered through interviewing, documenting, and collecting secondary data. Interviews were conducted with key stakeholders, including families of patients with mental disorders, patients with mental disorders, and puskesmas mental health program management officers. The findings indicated that family empowerment was still suboptimal in patients with severe mental disorders; families lacked knowledge about caring for patients, impeding the healing process properly.