bluuebunny/crossref_metadata_2025 huggingface dataset:
FREQUENCY OF PANCYTOPENIA AMONG PATIENTS WITH VITAMIN B12 DEFICIENCY
Authors: Taj Niazi Humaira , Safiullah Jan Zahish , Safiullah Jan Nayab , Bahadur Laila , Abdullah Khan Khizar , Ali Mohsin
Published: March 2023

Objective: To determine the frequency of pancytopenia among patients with vitamin B12 deficiency in a tertiary-care hospital, in Peshawar.
Materials and Methods: A descriptive cross-sectional study was carried out at the Department of Hematology, Hayatabad Medical Complex, Peshawar from 18/4/2021 to 18/10/2021. In this study, a total of 252 patients were observed. From all patients, a sample of venous blood was obtained and sent to the hospital laboratory for the peripheral smear examination. Pancytopenia was diagnosed based on a peripheral smear showing Hemoglobin below 10g/dL, Total leukocyte counts less than 4,000 cells per mL, platelets count less than150,000 cells per mL, and reticulocyte count <2%. All the peripheral smears were done by an expert hematologist.  Strictly exclusion criteria were followed to avoid cofounders and make the study results clear of any bias.
Results: In this study mean age was 42 years with a standard deviation of ± 15.84. Thirty-eight percent of patients were males and 62% of patients were females. Moreover, 5% of patients had pancytopenia and 95% of patients didn’t have pancytopenia.
Conclusion:  The frequency of pancytopenia was 5% among the local patients with vitamin B12 deficiency.
Keywords: pancytopenia, B12 deficiency, Peshawar, Pakistan.
ASSESSMENT OF IMMEDIATE PERINEAL COMPLICATIONS OF NORMAL VAGINAL DELIVERY VERSUS VAGINAL DELIVERY WITH EPISIOTOMY IN TERM PREGNANCY IN A TERTIARY CARE HOSPITAL
Authors: Wahab Samdana
Published: March 2023

Objectives: To assess immediate intra and postpartum perineal complications following normal vaginal delivery versus vaginal delivery with episiotomy in term pregnancy.
Material and methods: This Cross-sectional study, was conducted in Peshawar, Lady Reading Hospital, Gynae ward from 1st November 2019 to 31st January 2020 after approval from Institutional Research Board. A total of 250 patients (125 in each group), 120 in group A with normal vaginal delivery, 115 in group B (vaginal delivery with an episiotomy), and 15 patients were excluded due to different modes of delivery (instrumental delivery/cesarean section). All patients with full-term pregnancies were included. Patients who refused to give consent or had bleeding disorders and indications for instrumental delivery or cesarean section were excluded. Non-probable convenience sampling technique, P-value <0.05, 95% confidence interval, and Chi-square test used for statistical analysis
Results: In the group, A mean age of 22 years, primigravida (PG) 84 (70%) multigravida (MG) 36 (30%) mean period of gestation (POG) 38 weeks, 96(80%) spontaneous, 24 (20%) induced labor. In group B the mean age was 21.8 years, PG 77 (66%), MG 38(33%), mean POG 41 weeks, 97 (84%) spontaneous, and 18 (15%) induced labor. Group A vaginal tears 6 (5%), cervical tears 4 (3%), mixed tears 9 (7.5%), para-urethral tears 2 (1.6%), and perineal tears 9(7.5%). Group B vaginal tears 3 (2.6%), cervical tears 3 (2.6%), mixed tears 2 (1.7%). No significant post-natal pain difference was observed in the groups.
CONCLUSION:  Routine practice of episiotomy should be discouraged as no significant difference was observed in both groups.
KEYWORDS: Episiotomy, Term pregnancy, Vaginal delivery.
Cytotoxic Effect of Combination Treatment of Vitamin D and Pitavastatin on the MCF7 Breast Cancer Cells
Authors:   Department of Biochemistry, Faculty of Medicine-Universty of AlBatana, Soudan, Al Tawil Sanaa , Adris Abdulla Mohamed , Aliwaini Saeb ,   Department of Biology and Biotechnology, Islamic University of Gaza
Published: March 2023

Breast cancer is the most common cancer among women. Several common approaches to cancer management are being used, but many cancer patients develop resistance to chemotherapy drugs. Here we describe the antiproliferative effect of the combination of vitamin D and pitavastatin against breast cancer cells. Aims: To determine the combined cytotoxic effect of both vitamin D and pitavastatin on the MCF7 breast cancer cell line and to study the mechanism of action behind this effect. Methods: In vitro experimental study using the MCF7 estrogen receptor-positive breast cancer cells. The effective doses of the combinations were determined by MTT, and western blotting was used to determine the different protein levels. Results: The 50% inhibitory concentrations (IC50s) of vitamin D and pitavastatin on MCF7 cells were 5.1 μM and 5.5 μM, respectively. However, when the cells were pre-treated with a low dose of vitamin D (1μM) the new pitavastatin IC50 was 1.1 μM. In addition, the combined treatment inhibited the phosphorylation of STAT3 protein in MCF7 cells and increased p53 and p21 protein levels. Conclusion: The combination of pitavastatin and vitamin D showed a synergistic cytotoxic effect by inducing cell cycle arrest and apoptosis.
Evaluating Cybersecurity Capacity Building of ASEAN Plus Three through Social Network Analysis
Authors: Yu Kyung Kim Yu Kyung Kim , Myong Hyun Go Myong Hyun Go , Sonyong Kim Sonyong Kim , Jaeyeon Lee Jaeyeon Lee , Kyungho Lee Kyungho Lee
Published: March 2023

The strategic rivalry between the United States and China is out in full swing in Southeast Asia. As the result, ASEAN is emerging both as a key player as well as a playground for pivotal global and regional actors. South Korea, Japan, and China known as ASEAN Plus Three, have strong economic, political, and technological ties with the region, and have leveraged their cyber capabilities to compete for influence in the region. This study evaluates the relative performances of the Plus Three’ cyber outreach efforts to the region by visualizing the complex web of actors and cyber cooperation and assistance activities with network analysis tools and open-source databases. We quantitatively analyze national cyber security cooperation of ASEAN including South Korea, Japan, and China through capacity building indicators and social network methodology. This study (1) analyzes cybersecurity cooperation in ASEAN Plus Three, (2) explores factors that influence cooperation, and (3) lays out a quantitative basis for establishing national information policy and cybersecurity strategy. We find that the Plus Three, despite the outward similarity in their respective regional strategies, are a study of contrasts, with one of them emerging as an influential yet silent power in the regional cyber diplomacy domain.
A New Vertical Handover Prediction Method for Heterogeneous Wireless Networks
Authors: Abd ELWahab M. Ibrahim Safa , Ali H. Abbas Mohammad
Published: March 2023

Long Term Evolution (LTE) is the fourth generation (4G) cellular network technology that provides improved performance that related to data rate, coverage and capacity compared to earlier cellular systems. The addition of many small cells in a heterogeneous network configuration provides a means to enhance capacity through extreme frequency reuse. The heterogeneous environment of different network technologies can provide high data rate and enhance multimedia services, but it is challenging to provide optimized handover (HO). In this paper, a new method is proposed to select the optimal network from available networks to which a UE may be handed over to achieve better QoS performance. The aggregation of multiple criteria for calculation of overall ranking of networks is obtained by Analytical Hierarchy Process (AHP) [1] and is combined with the history of previously visited cells and regression analysis of the Layer 1 (L1) and Layer 3 (L3) filtered Received Signal Strength (RSS) data for prediction of future values. The AHP is used to calculate the weights for the system attributes and to rank the available networks based on multiple criteria Multiple Attribute Decision Making (MADM). The sequence of visited cells is used in target network selection as it reduces frequent handover. The sequence of visited cells would be modeled as a Markov Chain. To assess RSS, beside L1, L3 filtering RSS prediction and smoothing is used to predict future signal samples to hasten the process of HO. RSS forecasting is used to predict handover necessity so as to reduce the handover delay. The results show that the number of handovers is reduced by up to 50% compared to the conventional AHP. The results also show that the threshold crossing rate and average duration of fades are reduced by 47% compared with the AHP. Handover delay is also reduced by up to 40 ms due to RSS forecasting.
Scaling of Transient Natural Convection Cooling in Side-Cooled Cavity: The Effect of Variable Viscosity
Authors: Younis O. , Xu F. , Lei C. , Pallares J. , Grau F. X.
Published: March 2023

The transient natural convection of variable and constant viscosity fluids in a side cooled cubical cavity is studied experimentally. The convective flow in the cavity is visualized by the shadowgraph technique. The fluid was initially preheated and enough time is allowed to assure uniform temperature distribution. Temperature difference is introduced by a sudden cooling of the two side walls. The results indicate that the transient flow development is characterized by the following distinct processes: the initial growth of the vertical boundary layer and horizontal intrusions, the interaction of the horizontal intrusions and the stratification. New scaling relations are introduced to include the effect of the viscosity variation with temperature. The new suggested scalings showed good agreement with the measurements based on the shadowgraph images.
A Comparison Study of WLAN “IEEE802.11ac” and “IEEE802.11ad” Standards
Authors: S. M. Elbasher Wafa , B. A. Mustafa Amin , A. Osaman Ashraf
Published: March 2023

The modern communications is one of the most critical elements of modern cultures depicted in the 21th century. All of the recent civilizations depend on electronics and communication. Mobile wireless communication system is identified by ability to transfer information without using any current carrying conductor. The wireless fidelity WI-FI is the first step towards the adoption of IEEE802.11 standards which include the “IEEE 802ac” and “IEEE 802.11ad” sets. There standards permits wireless throughput rates in the gigabit levels. In this paper, a discussion of these standards will be detailed
Time Series Analysis of H.264 Video
Authors: H. S. M. Ali Hiba , M. Sharif Sami
Published: March 2023

The aim of this paper is to investigate the statistical properties of H.264/AVC video sequences. The stationarity, dependence properties and self-similarity are investigated. Analysis of the H.264/AVC video sequences variable bit rate (VBR) traffic has shown that this data has strong self-similarity properties as well as noticeable long range dependence (LRD) and short range dependence (SRD). The stationarity of H.264 video sequences is investigated by applying the fractional differencing technique and implemented with Haar maximal overlap discrete wavelet transform. The results indicate that the H.264 video is 2nd order stationary.
Modeling and Simulation of Water-Gas Shift Reactors with and without Membrane
Authors: A. Abbas Wesam , M.Wagiallah Kami , A. Elsheikh Fathelrahman
Published: March 2023

The objective of this study is to investigate the usage of membrane reactor technology in the water-gas shift reaction. Furthermore an assessment of the optimum parameters for the maximum conversion of carbon monoxide was carried out. The water-gas shift reaction is a well-known step for upgrading carbon monoxide to carbon dioxide in the production of purified Hydrogen gas. More recently, a renewed interest in the water-gas reaction carried out in hydrogen selective membrane reactors has been observed, because of the growing use of polymeric electrolyte membrane fuel cells, that operate using high-purity hydrogen. Membrane reactors are viewed as an interesting technology in order to overcome the equilibrium conversion limitations in non-membrane reactors. Firstly, the modelling and simulation of the reactor without membrane was carried out, and the obtained results were validated against the experimental published results, then the membrane reactor was simulated by employing a Hydrogen-selective Palladium membrane. A one dimensional steady state model was developed; mass and heat balances were solved simultaneously using MATLAB software. It was found that the conversion of carbon monoxide reaches a maximum of 29% for the non-membrane reactor and 90% for the membrane reactor, which represents an improvement of 210%. It was found that the optimum operating condition for membrane reactor were temperatures of 740 K, pressure of 10 atm and a reactor length of 115 cm.
Experimental Study of Geotextile Effect on Bearing Strength and Permeability of Sudanese Cohesive Soils
Authors: M. E. Zumrawi Magdi , I. A. Abdalgadir Eslam
Published: March 2023

This paper focuses on the influences of geotextile on bearing strength and permeability properties of cohesive soils. Experimental investigation was conducted on three soils reinforced with geotextile sheets in one or more layers. The soil samples are compacted at optimum moisture content and maximum dry density in five layers with or without geotextile sheets. The California Bearing Ratio (CBR) and the permeability tests have been carried out on natural soils and soils with geotextile sheets. The experiments results have showed a significant decrease in the CBR and the permeability values of the three soils with the inclusion of geotextile sheets. The CBR values of geotextile reinforced soils have decreased by 70% for 4 layers of geotextile sheets. Also, the average reduction in the permeability of the three soils reinforced with 1-layer geotextile sheet is about 60% of the natural soils. Hence, it is concluded that provision of geotextile sheet with an activator such as lime or fly ash to increase the soil strength will be beneficial and economical option in earth dams and canal banks.
Use of Polypropylene Waste Plastic Pellets as Partial Replacement for Fine Aggregate in Concrete
Authors: M. AbdelMoti Hind , A. Mustafaa Mustafa
Published: March 2023

This study aims to evaluate the effect of using polypropylene plastic pellets as partial replacement of fine aggregate with percentages of 5% and 10% by volume on the properties of fresh and hardened concrete. For this purpose, three mixes were prepared, 18 cubes were cast for compressive strength, fresh density and dry density, also 9 cylinders were cast for splitting tensile strength and 9 beams were cast to determine the flexural strength. The resulting slump of the mixes increases as the plastic percentage increases. The fresh density, dry density compressive strength and splitting tensile strength values decrease compared to the control. The flexural strength increases with the percentage increase.
Evaluation of Air Quality in Sudanese Gold Mining Fields
Authors: AbdElbage Abazar Ahmed Hunaida , Eldin Eltayeb Yassin Kamal
Published: March 2023

This study intended to provide a base line and describe the current air quality in Sudanese Gold mining fields. It covers 21 gold marketing centers in 5 states; namely Northern, River Nile, Gadaref, Red Sea and Kurdofan state. The main objectives of the survey is the detection of any significant concentrations that exceed Occupational Safety and Health norms and specifying the key emission sources, and also identification and assessing of the health hazards and environmental impacts. The tests were carried out by using electronic portable devices to measure the concentrations of pollutants in air. The measured pollutants were: Dust or Particulate Matter (PM), Nitrogen Dioxide (NO2), Volatile Organic Components (VOCs), Sulphur Dioxide (SO2), Ammonia (NH3), Carbon Monoxide (CO) and Ozone (O3). National Ambient Air Quality Standards (NAAQSs) and Sudanese Standards for Ambient Air Pollutants were used for comparison purposes. In addition to that, Air Quality Index (AQI) was applied for the average concentrations of each pollutant. It was found that, all gold marketing centers suffered from very high concentration of PM2.5 and PM10. 90.5% of those centers had higher NO2 concentration than the standards, 37% of it was increased by 200% and 42% of it was increased by 150%. In addition to that, 48% of gold marketing centers had higher SO2 concentration than the standards. On the other hand, concentrations of other pollutants obtained were found within the allowable limits. Finally, it was concluded that all those centers are contaminated with one or more air pollutants. Therefore, it was recommended to improve the environmental conditions by mitigating emissions from point sources. Supervisors have been advised to assume their responsibilities in controlling the use of Personal Protective Equipment (PPE) in addition to the dissemination of safety culture through psychological approach.
Anemia and Mineral Bone Disorder in Patients with End Stage Renal Diseases on Maintenance Hemodialysis
Authors: Riaz Muhammad Mohsin , Rahman Aziz Ur , Raza Syed Hyder , Zehra Farheen , Naeem Nabeela , Orakzai Gulmina Saeed
Published: March 2023

Background: Chronic kidney disease characterised by urinary disturbances or excretory kidney dysfunction, which is likely to result in functional nephron damage. Glomerulonephritis is an immune-mediated kidney inflammation that affects both the glomerulus and other parts of the kidney. The most common cause of end-stage renal disease is glomerulonephritis. The aim of this study to determine the anemia, mineral bone disorder and high low PTH level during hemodialysis. Study Design: This was cross-sectional study and conducted in the Ali Fatima Hospital Lahore, for six months March 2022 to August 2022. Materials and Methods: There were total 350 participants. The participants were selected by sampling technique were interviewed in the Khyber teaching hospital Peshawar. We analyzed dependent and independent variables. Data analysis statistically by SPSS 20 version. Results: There were total 350 participants which include71.4% males and 29% females in this research. The majority of the participants were in the age group (40-60) years or (n=350) 87% in the hemodialysis. The majority participants were mean age 49.2 ± 0.59 years. The participants were 69% financially depend upon family dialysis. The dialysis frequency of patients about 76% thrice per week and 24.2% were on twice per week. The hemoglobin level was <11 g/dL or mean 12.19±2.65 g/dL which show significantly reduced Hb level. The mean value of serum calcium, sodium, phosphorous and parathyroid levels in bone diseases were 165.40±6.91, 6.675±0.79, 6.89±2.64, and 255.63±233.71, which significantly changed in hemodialysis patients. Anti HCV is 80% positive in hemodialysis patients as compared to general population. Conclusion: The participants who suffered to maintained hemodialysis for > 3 months, majority have low level of Hb which cause anemia, low PTH which associate with the mineral bone diseases and also reduced serum Ca, P, k, Na and albumin level. Keywords: End stage renal disorder (ESRD), chronic kidney disorder (CKD).
Treatment Outcome of Liquid Nitrogen (LN) Cryotherapy in Patients Presenting Recalcitrant Alopecia Areata (AA) at Tertiary Care Hospital, Karachi
Authors: Mahar Arif Sattar , Ghafoor Rabia , Kumar Sagar , . Sonam , Cader Muhammad Ishaque Fayyaaz , , Bukhari Amina
Published: March 2023

Objective: To determine the treatment outcome of liquid nitrogen (LN) cryotherapy in patients presenting with recalcitrant alopecia areata (AA) at tertiary care hospital, Karachi. Material and Methods: This Descriptive study was conducted in the department of Dermatology, JPMC, Karachi. The duration of study was Six months after the approval of synopsis from 15 December 2021, to 14 June 2022. Total 88 patients were included in the study. The patients were assessed for treatment outcome at 8 weeks and were labeled as having excellent, good, moderate, poor and no response. Results: Total 88 patients were included in the study. Mean ± SD of age was 38.3±12.5 years. In distribution of gender, 58 (65.9%) were male while 30 (34.1%) were female. Outcome of liquid nitrogen showed excellent response in 5 (5.7%), good response in 29 (33.0%), moderate 19 (21.6%), poor 9 (10.2%) while no response of liquid nitrogen was noted in 26 (29.5%) patients. Practical implication: The treatment given is mainly for cosmetic reasons and to halt the progression of the disease. Previously, therapeutic outcomes of these treatment options were dealt with in many studies. At the same time, long treatment duration, high cost, invasiveness and inconvenience of application have hindered the utmost treatment outcome and patient satisfaction. Conclusion: It is to be concluded that good response of liquid nitrogen was noted in most of the patients followed by moderate and poor response. More prospective and well-controlled trials are needed to validate the current findings. Keywords: Alopecia Areata, Cryotherapy, Liquid Nitrogen, Prevalence
Correlation of Endoscopic Findings with Meld Score in Patients with Cirrhosis
Authors: . Noor , Khan Abdurrehman , Tahir Muhammad , Hameed Marya , Siddique Muhammad , Ashraf Amna
Published: March 2023

Background: Liver cirrhosis is reduced liver function caused by the growth of scar tissue known as fibrosis. The injury to hepatic tissues leads to the creation of scar tissue, which, over time, can replace normally functioning tissues. Objectives: The study evaluated the correlation of endoscopic findings with MELD and NIEC scores in patients with liver cirrhosis in Lahore. Methods: MELD scores were assessed based on the results of the biochemical laboratory tests using the equation. 9.57 x log(creatinine) + 3.7 x log(bilirubin) + 11.2 x log(INR) +6.43, while the endoscopy in assessing variceal characteristics was demonstrated according to the NIEC scoring system. Results: The etiological factors underlying the cirrhosis were hepatitis B (35.03%), hepatitis C (23.78%), Wilson disease (19.94%), autoimmune disorders (10.48%) and 3.58% with idiopathic etiology. The major clinical manifestations were jaundice (73.91%), followed by ascites (69.30%), gastrointestinal bleeding (34.27%), etc. The patients were classified as per the MELD scoring index into Group A (<18) and Group B (>18). The patients of Group A were significantly high 67.01% (262/391), (p<0.05) than Group B 32.99% (129/391) out of which 39 patients died. Endoscopic findings were also studied according to scoring at the NIEC index and the patients were classified into different risk assessment classes. Conclusion: Being a potentially life-threatening illness, cirrhosis necessitated prompt evaluation and action to minimize the death rate. In individuals with liver cirrhosis, NIEC and MELD scores appeared to be reliable predictors of esophageal varices. Keywords: Ascites; Endoscopy; Gastrointestinal bleeding; Icterus; Risk assessment.
Comparative Evaluation of Implants with Different Surface Treatments Placed in Human Edentulous Mandibles
Authors: Khan Muhammad Irfan , Shah Syed Abdul Rauf , Sajjad Batool , Shaikh Waheed Gul , Quraeshi Sameer , Ali Waqar
Published: March 2023

Background: Dental implants have reorganized the field of renewing dentistry by providing a greatly successful and authentic surgery option for the patients with missing teeth. Surface characteristics of the implant are very vital for the success of the implant. This greatly affects the osseointegration and long term stability. Study design: It is a prospective study conducted at Lady Reading Hospital, MTI, Peshawar and Altamash Institute of Dental Medicine, Karachi for the duration of one year from December 2021 to November 2022. Material and Methods: The study was done on patients visiting the tertiary care unit for a period of one year. There were 12 male and 13 female patients that participated in the study. The average age of patients was 56 years in case of men and 53 years for women. The data of number of implants was also analyzed and 12 patients went for 2 implants and 13 patients opted for 3 implants. The study was approved by the review and ethical board committee of the hospital. Results: The ISQ score of the patients that had two implants was 68.5±4.3, whereas the patients who went through 3 implants had ISQ score as 72.1±4.5. Those who had molar region implanted had ISQ score 72.1±2.1, while premolar patients had ISQ score as 72.3±3.1. Acid itching group had ISQ score as 68.4±2.4, the LASER group had ISQ score as 73.4±2.4. Conclusion: After the comparison of different implant surfaces used in human edentulous mandibles treatment. It was concluded that the LASER+HA and LASER are the most effective method for implants. These methods accelerates the Osseointegration process. Keywords: Dental implants and edentulous mandibles.
Rationale for the Use of Radiological Investigations; Assessment of Awareness Among Healthcare Workers of a Tertiary Care Hospital in Southern Punjab
Authors: Naveed Navera , Musharaf Rameesha , Sadiq Rizwan , Sajjad Talha , Sufyan Mohammad , Rabbani Asia
Published: March 2023

Background: During recent times, radiological investigations have been playing a very beneficial role in diagnosis, confirmation and surveillance of multiple diseases in the medical science; thus increasing our diagnostic and management skills in a positive manner which was not previously possible. Now-a-days, these radiological investigations have become an integral part of our management system due to their easy availability. But this easy availability has increased the chances of misuse of these modalities as well. This cross-sectional study was aimed to assess the rationale for the use of these radiological investigations among our healthcare providers serving at Sheikh Zayed Hospital, Rahim Yar Khan. The study data was collected from study subjects via a pre-designed questionnaire from January 2022 to April 2022. Then the collected data was analyzed through SPSS software. Results of this study, including 250 study subjects (56% males and 44% females; 38.8% consultants and 61.2% PGRs/MOs), showed that the consultants primarily decide about the radiological investigations needed for the patients while the senior PGR/MO play the role in their absence. Majority of the study subjects (90%, n=225) were found well aware of the radiation hazards related to different radiological investigations. Conclusion: The healthcare providers working in different departments of SZH,RYK have enough awareness and knowledge about the rationale for the use of radiological modalities; but were not able to specify the exact limitations for the radiation doses per exposure or total dosage allowed per year to the patients associated with their harmful effects. Keywords: Knowledge; Radiological Investigations; Health Hazards; Healthcare Workers
Clinical Significance of Serum Iron in the Diagnosis of Iron Deficiency Anemia in Patients from Local Population of Punjab-Lahore
Authors: Farheen Neelum , Malik Hina , Anwar Khalida , Zahid Sara , Zahid Fatima , Zahid Ayesha , Shuja Naveed , Malik Arif
Published: March 2023

Background: The main cause of anemia in one-third of the world's population is a lack of iron (ID). Anemia affects between 700 and 800 million individuals globally. Methodology: Only the patients diagnosed with iron deficiency anemia was selected from Ali Fatima Hospital Lahore and Jinnah Hospital Lahore for determination of serum iron concentration in comparison with healthy controls. Results: In our study male patients were 67% and females were 33%. Frequency of children with beta thalassemia major under 5 year of age is 19%, 5-9 year is 24%, 9-15 years is 31% and above 15 years is 26% Practical implications: The current study aims to spread the awareness among community about clinical significance of serum iron in the diagnosis of iron deficiency anemia in patients and ways to control the iron deficiency. This investigation will assist in determining the severity of the condition in our community as well as the status of serum iron levels in individuals with iron deficiency anemia. The evaluation of serum iron levels in anemic individuals will be helpful to medical experts in determining the best course of treatment. Conclusion: We concluded that renal tubular damage and hepatocellular injury may be secondary to oxidative lipid peroxidation mediated by the iron overload. However further investigations are extremely necessary for this interpretation. A better evaluation of iron toxicity and regular monitoring of renal functions, liver functions, accompanied by an improvement in chelation therapy along with the administration of selective antioxidants (vitamins E and C), may protect different organs against oxidative stress and its consequences, specifically endocrine problems. Keywords: Anemia, Iron deficiency, Ferritin, Hemoglobin, Thalassemia, hepatocellular injury.
A Retrospective Study on the Prevalence of Iron Deficiency Anemia Frequency in Rural Areas of Disrict Faisalabad
Authors: Anjum Amin , . Nida , Kiran Shabana , Malik Tariq Mahmood , Ashraf Hamza
Published: March 2023

Objective: To evaluate the prevalence of different anemic grades in patients to give better treatment and to improve quality of life of patients. Material and Methods: This retrospective study was conducted to analyze the immensity of Deficiency of Iron Anemia in DHQ Hospital Faisalabad, and the duration of this study was from February 2021 to January 2022 to evaluate the prevalence and different stages of anemic patients. Two hundred patients were included in this study who met all the criteria needed to this study. In this study we examined blood tests, CBC reports of all patients in the laboratory. Moreover, including detailed patient’s history, previous diseases, current diseases, anemia history in family, gynecological history of women were examined. Results: In all two hundred anemic patients, we found one hundred and seventy (85%) patients had deficiency of iron and 30 (15%) patients had inadequacy of non-iron (lack of other minerals) anemia. Most of the patients (58.8%) who had less volume of iron were aged of 21 to 32 Years. On basis of serum ferritin level (SFL), We observed the intensity of deficiency of iron and classify into modest, mildest and acute groups. We found 120 (70.6%) patients had modest IDA (iron deficiency anemia), 20 (11.8%) patients had acute and rest (17.6%) had mildest deficiency of iron anemia. In 160 IDA patient’s women were 95 (55.9%), 40 (23.5%) were men > 19 years and 35 (20.6%) were growing children had an aged < 14 years. Practical implication: This study was conducted to evaluate the frequency of IDA to maintain a better treatment and to reduce the death ratio and to improve quality of life of patients affected by anemia. Conclusion: In this study, we observed deficiency of iron is the most frequent cause in patients of anemia, especially in females. Keywords: blood, Anemia, oxygen, Deficiency of Iron, hemoglobin level,
Correlation of Duke Treadmill Score with Coronary angiographic Findings in Patients with Stable Ischemic Heart Disease
Authors: Ahmad Shehzad , Ali Asif
Published: March 2023

Aim: To determine the correlation of Duke treadmill score with angiographically determined obstructive coronary artery disease (CAD) Study design: observational cross sectional study, comparative type Place and duration: The study was done at Cardiac Center Bahawalpur from August 2020 to July 2021. Methods: The patients who had stable angina and underwent exercise tolerance testing as well as coronary angiography were included in the study. The data was collected on a predesigned proforma. The difference in the prevalence of obstructive CAD with regards to Duke treadmill score (DTS), gender, diabetes mellitus, hypertension, smoking and family history was determined with Chi square test using SPSS 20; ap value of < 0.05 was taken as significant. Results: Total 71 patients were enrolled for study. Mean ageof the participants was 48.25 ± 8.7 years. It was a male dominant population. A significant difference in the prevalence of obstructive CADwas noted in low, intermediate and high risk groups according to DTS. The prevalence of obstructive coronary artery disease was not significantly different with regards to gender, diabetes mellitus, hypertension, smoking and family history. However obstructive CAD was more prevalent in those who presented with typical angina as compared to those who had atypical symptoms. Conclusion: Obstructive CAD significantly differs in low, intermediate and high risk groups according to DTS. Keywords: Duke treadmill score, coronary artery disease
Calcium and Bone Disorders in Pregnancy and Post-Partum Assessed through Radiological Imaging
Authors: Daseja Kailash Kumar , Fatima Kaneez , Phul Akhtar Hussain , Bozdar Naimatullah , Dodani Jia , . Shahzeb
Published: March 2023

Aim: To determine the calcium and bone disorders in pregnancy assessed through radiological imaging. Study design: Prospective study. Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st July 2022 to 31st December 2022 Methodology: One hundred pregnant women were enrolled. The blood calcium levels were assessed through serum calcium at these stages through 3 cc blood withdrawal. Dietary intake of calcium was also assessed through food frequency charts. Urinary-excretion of calcium was analyzed through cross-linked N-telopeptides (NTx) type I collagen. Each participant was assessed at 3 points including baseline assessment at 1st trimester, then at 2nd trimester and finally at post-partum 4 weeks. At the 2nd trimester ultrasound bone measurement was conducted at distal radius. Quantitative ultrasound was used for this purpose. In the post-partum women, a radiological imaging including DEXA (Dual-energy X-ray absorptiometry) bone scan was performed. Results: The mean age was 26.9±5.5 years. The mean pregnancy was 2.0±1.1 while the mean number of children was 0.9±0.7. The previous months of breast feeding as mean were 6.8±7.9. The calcium intake from food as well as serum calcium levels was below recommended levels in women during their pregnancy and post-delivery. Through the quantitative ultasound and bone density DEXA scan images presented obvious osteoporotic changes in bone density. There were 24% had 2.5 or less meant osteoporosis formation. Conclusion: Women often lead to calcium deficiency during gestation and lactation and thus chances of musculoskeletal disorders escalate manifolds. Radiological imaging can facilitate in detecting these calcium deficiencies. Keywords: Hemostasis, Regulation, Pregnancy, Mineral absorption
Identification and Incidence of Spina Bifida during Gestation and its Pregnancy Outcomes
Authors: Daseja Kailash Kumar , Fatima Kaneez , Phul Akhtar Hussain , Bozdar Naimatullah , . Shahzeb , Dodani Jia
Published: March 2023

Aim: To identify the incidence of spina bifida during gestation and its pregnancy outcomes. Study design: Cohort study Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st October 2020 to 30th September 2022 Methodology: One thousand pregnant women who were screened for the identification of spina bifida. Doppler based ultrasonography was performed in each patient. The fetus body was examined during sonography Doppler between 18-24 weeks. The body of the fetus was focused and visualized longitudinally in midsagittal section. Spinal cord was traced from neck to sacral, cervical vertebra and thorax. A tram track appearance was observed. Spinal nerve positioning was also observed. In spina bifida nerve tethering was seen. The primary outcomes in reference to baby weight and maturity were recorded while secondary outcomes of the fetuses in terms of any disability were followed up to 12 months of age. Results: The mean age of the women was 25.6±5.6 years. The incidence of spina bifida was 1.1%. Within the primary outcomes observed birth weight ranged within 3.1-3.5kg. Around 81.81% cases were born full term while 18.18 were premature. On 06 months’ follow-up of the spina bifida cases it was observed that 45.45% of new born suffered from skin problems as sores, calluses or and blisters while 36.36% had hydrocephalus with excessive CSF which needed monitoring. Mobility issue and disability was observed in 27.27% cases. Conclusion: Spina bifida cases are identified successfully within gestational period. Prematurity can be significantly noticed in spina bifida cases. The lumbosacral and lumbar lesions are most common as well as skin conditions and hydrocephalus. Key words: Incidence, Spina bifida, Gestation, Outcome
Association of Adverse Perinatal Outcome with Oligohydramnios during Third Trimester of Pregnancy
Authors: Mustafa Sadia , Saif Mahwish , Amjad Maliha , Iqbal Faiza
Published: March 2023

Background: For the growth and development of the unborn child, amniotic fluid is absolutely necessary. Strong interactions between the fetus, placenta, and parts of the mother are given their volume1. Oligohydramnios is defined as having an amniotic fluid index (AFI) <5th percentile or AFI 5 cm during pregnancy and no water at a depth of 23 cm before the cornea. This is a common problem that occurs in 35% of pregnancies during childbirth2. Aim: To determining the correlation between oligohydramnios in pregnant women who are late in pregnancy (3rd trimester) and adverse birth outcomes such as partial surgery, decreased Apgar score, and lower birth weight. Study design: Cohort study Study set up: Obstetrics and Gynecology Department, Fatima Memorial Hospital Lahore. Study period: six months starting15-01-2022 to 14-07-2022 Methods: 242 females were enrolled. Two groups of participants were created: group II had normal AFI and group I had oligohydramnios. Females given intra venous fluids to group I after ruling out any contra indication. The perinatal result was then documented. SPSS version 20 was used to enter and evaluate all of the gathered data. Results: In exposed group the mean age was 27.79±6.72 years, whereas in unexposed group the mean age was 28.25±6.77 years. The C-section was done in 124(51.2%) females. RR = 0.693 [1.25-3.49] While the Low Birth Weight and poor APGAR score has shown protective effect. Practical implication: Oligohydramniosmeans decreased amniotic fluid around the fetus. There is deficiency of amniotic fluid < 200 ml at a time. Approximately 8-10% of pregnant ladies may have decreased level of amniotic fluid but 5% have been confirmed diagnosis of oligohydramnios. Conclusion: So complications of surgery are directly related to the severity of oligohydramnios in pregnant women while low birth weight and poor APGAR scores has shown protective effect in women presented in last trimester of pregnancy. Keywords: Oligohydramnios, Low Birth Weight, Perinatal Outcome, APGAR SCORES, Pregnancy
IL 6 levels in Periodontitis Induced Rabbits after Treatment with Neem Bark Extract
Authors: Nazish Gul e , Nawaz Rai Sadaf , Shmakh Ayesha , Afridi Arshadullah
Published: March 2023

Background: IL-6 has crucial role in the response to microbial insults. It acts as pro-inflammatory and anti-inflammatory agent. Hence IL 6 is an important inflammatory marker of periodontal disease. Levels of IL6 in Gingival crevicular fluid strongly indicate presence of periodontal disease which ultimately results in many health hazards. Aims: To measure levels of IL 6 in periodontitis induced rabbits after treating animals with neem bark extract and amoxicillin at doses of 500mg/kg and 20mg/kg and to see anti-inflammatory effects of neem bark extract. Methods: Forty eight white New Zealand rabbits were divided in four groups A, B, C and D. Group A was healthy control. Group B was disease group. Group C was neem treated. Group D was amoxicillin treated. Periodontitis was induced and rabbits were given treatment with neem bark extract and amoxicillin for 10 days. Samples were obtained with the help of periopaper absorbent strip and marginal auricular vein and analyzed in laboratory. ELISA test was performed to find levels of IL 6 in all four groups. Practical implication: To gain the evidence that neem can be used in maintenance of oral hygiene and prevention of oral diseases. Results: Treatment with neem bark extract and amoxicillin equally reduced IL 6 levels among group c and D after treatment (0.033±0.003) in gingival crevicular fluid when compared with diseased group B (0.089±0.007).P value was less than 0.001. Conclusion: Neem bark extract has significant effects on reduction of IL 6 levels in gingival crevicular fluid of periodontitis induced rabbits Neem bark extract possess anti-inflammatory and anti-microbial action. Keywords: IL6, Periodontitis, GCF, Inflammation, Neem
Clinical Risk Factors affecting the Pregnancy Outcome using Pakistan Maternal Mortality Survey (PMMS) 2019
Authors: Saleem Sehar , Nazir Sana , Yasin Seyab , Kamal Asifa , Aslam Maria
Published: March 2023

Background: South Asia is the world's most populous region, and it also has the highest rate of pregnancy loss. It is necessary to understand the risk factors for pregnancy loss in South Asian countries like Pakistan for reducing the global burden of pregnancy loss. Aim: To determine the potential clinical factors affecting pregnancy outcomes of Pakistani women aged 15-49 years during 2016-2019. Study design: This study was conducted using Pakistan Maternal Mortality Survey (PMMS 2019) during 2020-2021. All eligible ever-married women (n=7096) aged 15-49 were selected for this study. In this study, the clinical risk factors considered are fever, unconsciousness, high blood pressure, diabetes, vaginal bleeding, problems associated with the placenta, problems associated with the position of the baby, and preeclampsia. The response variable was pregnancy outcome comprising four categories that are live-birth, stillbirth, miscarriage, and abortion. A multinomial logistic regression model was applied to test the relationship between the dependent variable and each of the eight risk factors. Results: Multinomial logistic regression model identified that fever (OR=0.723), vaginal bleeding(OR=1.614), high blood pressure (OR=1.473), and problems associated with the position of the baby (OR=0.396)are significantly associated with a stillbirth at a 10% level of significance. Additionally, unconsciousness (OR=1.019) appears as a potential risk factor for abortion. Practical implication: Understanding the most significant risk factors that contribute to negative pregnancy outcomes, it can prioritize resources to improve maternal health. Also, assistance to healthcare providers and policymakers in making informed decisions regarding maternal health in Pakistan can be provided. Conclusion: Fever, vaginal bleeding, high blood pressure, problems associated with the position of the baby are significant risk factors of stillbirth. However, unconsciousness identified a risk factor of abortion. It is concluded that in Pakistan pregnancy loss can be reduced by controlling the prevalence of diseases during pregnancy. Keywords: Abortion, Clinical risk factors, Miscarriage, Multinomial logistic model, Pregnancy loss, Stillbirth
Effect of Structured Training Workshop on Nurses’ Drug Dosage Calculation Competence at Tertiary Care Hospitals of Faisalabad
Authors: Komal Mehreen , Javed Hafiza Saba , . Namra
Published: March 2023

Background: Drug administration is a major component of patient care provided by nurses at hospitals. Appropriate drug administration ensures patient safety, as incorrect or unsafe administration can result in adverse patient health and hospital outcomes. Drug dosage calculation errors are the most common, threatening patient safety, lengthening patients' hospital stay and increasing associated costs worldwide. Aim: To evaluate the effectiveness of structured training workshop at enhancing nurses’ competence in drug dosage calculations. Methods: One group pre-test post-test quasi-experimental study was conducted on a convenient sample of 73 staff nurses working at public tertiary care hospitals of Faisalabad, Pakistan. Staff nurses aged 21-60 years who provide direct patient care, were included in the study.The study duration spanned over 04 months from July to October 2020. A structured questionnaire was used for the pre-test and post-test competency level of nurses in drug dosage calculations. The study intervention consisted of a structured training workshop focusing on basic mathematical skills for drug dosage calculation using the correct mathematical formula for unit conversions and linking the correct dose to the patient case scenario. SPSS version 26 was used for with-in group analysis employing t-test statistics. Results: Pre-test results revealed common errors in the application of basic mathematical principles for drug concentration unit conversions and complex calculations involving patient-age, weight and other variables.Post-test results demonstrated a significant improvement in level of competence of participant nurses in this regard, indicated by significant difference (p-value 0.000). Structured training workshop was found effective in enhancing nurses’ competency level in drug dosage calculations. Practical implication Conclusion: Structured training improved nurses' ability to identify drug calculation errors, understand the use of the correct formula, and calculate drug dosage accurately. This study emphasizes the importance of structured education and training of nurses aimed at reducing medication errors and improving patient health and hospital outcomes. Keywords: Competence; Drug dosage calculation; Nurses; Quasi experimental study; Pakistan; Workshop.
Supine Percutaneous Nephrolithotomy Under Spinal Anaesthesia: Our Experience Of 365 Cases
Authors: Jamil Muhammad Nasir , Asif Muhammad , Ashraf Hamza , Islam Ehsan-ul- , Azam Akbar , Bibi Romana
Published: March 2023

Aim:To determine the safety and efficacy of supine PCNL under spinal anesthesia (SA). Methods: It’s a review of secondary data of 365 caseswho underwent supine PCNL under Spinal anesthesia from April 2015 to December 2021. We determined the Outcomesof the procedure in terms of the operation time,stone clearance rate, hospital stay, analgesia requirements,and perioperative complications rate. Results: Out of 365patients 66.3% were male and the rest were female. The mean age was 47.80 ± 10.46 SD and the mean stone size was 3.4 cm±1.04 SD.Multiple or staghorn stones were found in 57.3% of cases. The majority of stones 57.5% were located in the renal pelvis and calyces. The mean operation time was 65 min ± 2.9 SD, and the stone clearance rate was 87%. Analgesia after surgery was given in 23% of the cases. Fever was noted in 11.23%, and blood was transfused in 3.5% of cases. No case of urinary leakage was observed and angioembolizationwas not needed in any case. The complications associated with spinal anesthesia were spinal headache in 3.56%, hypotension in 3%,and nausea and vomiting in 1.56% of the cases. Conclusion: Supine PCNL under spinal anesthesia is associated with good clinical outcomes lesser operative time and fewercomplications. Moreover, it is cost-effective as well. Keywords: Percutaneous nephrolithotomy, supine position, spinal anesthesia