bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 Update: Evusheld Unlikely to Neutralize XBB.1.5 Omicron Variant
Authors:   Editors from The Medical Letter
Published: February 2023

The FDA has warned that the investigational long-acting monoclonal antibodies tixagevimab and cilgavimab (Evusheld – AstraZeneca) are unlikely to neutralize the XBB.1.5 Omicron variant of SARS-CoV-2.
The Efficacy and Safety of Oral Ferrous Gluconate in Premenopausal Women with Severe Iron Deficiency Anaemia
Authors: Tazeen Fatima Munim  , Shaista Rashid
Published: February 2023

Objective: To evaluate the efficacy and safety of ferrous gluconate, given orally thrice daily for three months, to pre-menopausal women with severe iron deficiency anaemia.

Method:   A phase IV non randomized single arm open label drug trial was conducted at Gynaecology and Obstetrics Unit II in Abbasi Shaheed Hospital from Feb 2013 to March 2014, which is a 950 bedded public sector tertiary care hospital.

Total fifty premenopausal women with documented severe iron deficiency anaemia, haemoglobin (Hb) between 6-8 g/dl were enrolled after taking written informed consent. Clinical evaluation and lab in- vestigation for serum ferritin and haemoglobin  levels  were  conducted  at  baseline  and  after  comple-  tion of treatment. A standardized proforma for data collection was developed. Ferrous  gluconate  soft gelatin capsules were given as one capsule during or after the meal 3 times daily, for three months. All patients were evaluated four times during study first at the time of enrolment and after 30, 60, and 90 days for clinical efficacy and safety assessment.

Results: In our study all fifty premenopausal women completed iron treatment. Analysis of therapeutic efficacy parameters i.e. haemoglobin, and serum ferritin levels showed improvement that was sta- tistically significant. By the end of treatment with oral ferrous gluconate, significant improvement in Hb   levels was observed (7.574 ± 0.559  g/dl  vs  11.020  ±  0.718,  p<0.0001).  Significant  changes  were  noted in serum ferritin level (10.058 ± 5.059 ng/ml vs 27.136 ±  13.803,  p<0.0001)  after  3  months  therapy. Ferrous gluconate proved to be safe in women  with  severe  iron  deficiency  anaemia.  The  treated women did not exhibit any major side effect,  only  one  serious  side  effect  was  reported  (erythema nodosum). Mild self-limiting side  effects  including  black  discolouration  of  stool  in  54%  cases, nausea in 6%, constipation in 2% and diarrhoea in 2% was observed.

Conclusion: Oral ferrous gluconate treatment for severe iron deficiency anaemia is well tolerated and highly effective in premenopausal women.
Patient Satisfaction from Dental Services Provided by Multan Medical & Dental College
Authors: Ejaz Hussain Sahu  , Muhammad Umer Abdullah  , Rai Tariq Masood
Published: February 2023

Objective: The aim of this study was to assess the level and factors influencing the level of patient satisfaction from dental services provided by Multan Dental Hospital.

Methods: Study was carried out at Multan Dental hospital from 1st June to 30th July 2015. Total  256 patients over 18 years of age, participated  in  this  cross-sectional  study.  Convenient  sampling  tech- nique was used to  select  the  patients.  The  Hogan  Patient  Satisfaction  Questionnaire  was   customised, personalised and used for this dental patient satisfaction study,  and  response  through  a Likert scale including answer categories very satisfied, satisfied, neutral, not satisfied, not at all satisfied and do not know, was completed by the participants. SPSS software version 17  was  used  for  analysis. The relationship between level of patient satisfaction and the demographic variables was determined, Chi-square test was performed to  establish  the  level  of  patient  satisfaction  and  if  af-  fected by the demographic variables.

Results: Total 29.3% patients said that they were very satisfied with the services. About 43.4% partici-  pants were satisfied with the services. Not satisfied with service  were  8.6%.  A  very  low  proportion  (5.9%) of patients were completely dissatisfied with the services. There were 42% males and 30% fe-  males who were satisfied with the services. About 49% of patients having an education between 6-14    years were satisfied from  the  hospital  services  while  only  9%  of  patients  having  higher  education  level were satisfied. The major proportion of  the  patients  showed  satisfaction  from  the  services  of-  fered at the hospital.

Conclusion: Majority of the patients were satisfied  with  the  services  regarding  hospital  care,  dental staff provided by Multan Medical and Dental College.
Glycaemic Control and Complications of Type II Diabetes Mellitus - At Two Public Sector Diabetic Clinics
Authors: Kulsoom Jawed  , Nighat Nisar  , Mehwish Hussain
Published: February 2023

Objective: To determine the frequency of complications including retinopathy, nephropathy,  cardiovas- cular diseases and neuropathy and to determine the relationship between poor glycaemic control and complications among diabetic patients visiting outpatient clinics of tertiary care hospitals of Karachi.

Methods: A cross-sectional descriptive study was conducted  for  a  period  of  six  months  from  April  2015 to September 2015 at the diabetic clinics of Civil Hospital and National Institute of Diabetes and Endocrinology after taking the ethical approval from the  Dow  University  of  Health  Sciences  (DUHS). Type II diabetic patients (n=400) were included through  purposive  sampling  technique  after  taking  written consent. Pregnant/lactating  women  and  terminally  ill  diabetic  patients  were  excluded.  Data  was collected through a pre-designed questionnaire. Data was entered and analyzed by SPSS

v.21.00. Frequencies and Percentages were calculated. Regression analysis was  performed  to  deter- mine the relationship between glycaemic control and complications of diabetes.

Results: Out of 400 diabetic patients, 323 (90%) participants were above 40 years of age, 278

(69.5%) were females and 122 (30.5%) were males. About 28.8%  had  cardiovascular  complications, 19.2% had renal complications, 65.3% had visual problems and 58% experienced loss of sensation. Approximately 59.5% patients had poor glycaemic control while 39.5% had good glycaemic  control.  Patients with poor glycaemic control (HbA1c  >8.0)  were  at  a  higher  risk  of  developing  hypertension and numbness of hands and feet.

Conclusion: This study concluded high frequency of complications among Type II diabetes mellitus patients. Proportion of poor glycaemic  control  was  found  high.  Diabetic  complications  were  associ-  ated with poor glycaemic control.
Awareness Regarding Breast Cancer a Global Health Problem - A Study amongst Adult Women in Karachi
Authors: Yasmin Mumtaz  , Nusrat Iqbal
Published: February 2023

Objective: To determine the level of knowledge regarding breast cancer amongst women  and  their  practice of breast self-examination.

Methods: A Knowledge, Attitude and Practice (KAP) study was conducted in the community of Gulshan Town,  Karachi, during July 2013 to June 2014 through non-probability convenient sampling technique after taking written consent. The sample size of 560 was calculated by using World Health Organization (WHO) calculator. All women aged 20-40 years were included except those who had breast cancer and any type of swelling in the breast. Data was collected through semi-structured questionnaire. Data was entered and analysed on SPSS 16.  For  descriptive  statistic  mean  ±  SD  and  frequencies  were calculated.

Results: A total of 559 women participated.  Mean age of women was 30 ± 1.5 years. About 84% fe-  males were married, 37% attained education in universities and 71% were housewives. Around  34% women thought that frequency of breast cancer was present in one out of every 9 women, while, 60%    said breast cancer is a genetic disease. Those who said breast cancer is not accompanied by painful swelling were 61%. While 79% women said a swelling in the breast is not always breast cancer and 64% said that mastectomy is the only treatment of breast cancer. The women who said that use of contraceptives was closely associated with breast cancer were 69% women, 83%  thought  breast feeding decreases the risk of breast cancer while 45% women did not know what precautions to take  against breast cancer. Only 40% women said consumption of fruits and vegetables decreases the in- cidence of breast cancer. Regarding awareness of the breast self-examination, 56.9% responded  negatively.

Conclusion: The study concluded that overall knowledge regarding breast cancer was low. The practice of breast self-examination in this cohort of subjects was only 40%. We recommend public awareness regarding the risk and screening modalities for breast cancer, and breast self-examination be emphasised using mass media.
Bullous Impetigo Case Series: An Updated Review
Authors: Mariam  Hasan  Rizvi  , Sina Aziz
Published: February 2023

Impetigo also known as pyoderma is a common paediatric skin infection presenting  to  clinics  and  hospitals in summer season. The illness is acquired from  close  skin  contact  with  the  victim  and  is  highly contagious. The lesions are fluid filled vesicles that leave crust after  rupture  and  usually  heal without treatment. The infection is classified as bullous and non-bullous impetigo, the latter one having the least occurrence and is most commonly associated  with  complications,  therefore  prompt  treatment is necessary.

The case series holds a brief literature  review  of  bullous  impetigo,  its  clinical  course,  treatment  op- tions and complications. The author reports two cases presenting with bullous impetigo in the month of June. A five-year old boy and fifteen months old girl; both  presenting  with  similar  rashes  involving limbs, trunk and neck with slight  differences  in  the  clinical  symptoms.  Both  were  treated  with  fluids, oral and topical antibiotics. The climatic conditions of Karachi  favours  the  incidence  of  impetigo. Also, poor sanitation and overcrowded areas have further more increased the incidence  of  the  disease.  Families are unaware of these types of skin infections and hence do not isolate the victim which, in case of highly contagious illnesses like impetigo,  is  of  great  importance.  Furthermore,  not  getting  prompt treatment is another factor that cannot be ignored  and  results  in  complications  in  case  of  bullous impetigo. The most important conclusions which can  be  drawn  from  our  case  series  are  the lack of paediatric centres that treat dermatological conditions promptly and effectively. Lack of proper guidance convinces families to switch to self-medication and sometimes neglect. The role  of  a  paediatrician is vital when creating understanding with the patient's attendant by explaining  them  the clinical features and course  of  treatment  of  bullous  impetigo  to  avoid  self-medication  while  dealing  with skin diseases in children.
Dry Eye Syndrome and Associated Risk Factors among Computer Users in Karachi, Pakistan
Authors: Naveed Mansoori  , Nabeel Qamar  , Syed Muhammad Mubeen
Published: February 2023

Objective: To assess the frequency of presence of dry eyes and its associated risk factors among employees working in call centres and software houses in Karachi.

Methods: A cross-sectional study was done during July to October 2014 at Hamdard College of Medicine and Dentistry, Karachi. By convenient sampling  technique,  data  was  collected  from  employees  aged 20 to 40 years of call centres and software houses. Demographic information was recorded on pre-designed questionnaire and Schirmer's test strips were used to measure production of tears. De- scriptive analysis was done for categorical variables using SPSS  version  20.  Cross-tabulation  of  different variables was done with dryness of eyes experienced. The frequency of various eye complaints was determined and Chi square test was used to observe the association with Schirmer's test. P- value<0.05 was considered as significant.

Results: Out of 150 employees 42 (28%) were found to have dry eyes. Mean age was 27 ± 3.5 years. The majority of employees  117  (78%)  were  males  and  77  (51.3%)  were  using  corrective  spectacles for refractive errors. The most common eye complaints  among  the  computer  users  were  burning  of  eyes (44%), redness of eye (41.3%), dryness  of  nose  (36%),  dryness  of  mouth  (34.7%),  discharge  from eye (10.7%) and foreign body sensation (10%). Statistically  significant  (p<0.05)  relationship  has been observed between presence of eye burning and positive Schirmer's test.

Conclusion: This study indicated that 28% of the individuals had dry eye, along with other symptoms of eyes among computer users in call centres and software houses.
Caffeine Consumption and Academic Performance among Medical Students of Dow University of Health Science (DUHS), Karachi, Pakistan
Authors: Muhammad Sami Khan  , Nighat Nisar  , Syed Arsalan Ahmed Naqvi
Published: February 2023

Objective: To determine the frequency of caffeine consumption and  its  effect  on  academic  perfor-  mance among medical students of DUHS, Karachi, Pakistan.

Methods: A cross-sectional study was conducted at Dow Medical College, DUHS. About 400 medical undergraduate students from first to final  year  MBBS  were  included  through  systematic  sampling.  Those students who were on leave on  the  day  of  interview  and  addicted  to  substance  abuse  other than caffeine and those who were on drug use rehabilitation were excluded from the study. The dura-       tion of study was from January 2016 to May 2016. The data was collected by self-administered struc-   tured questionnaire which included the information regarding socio-demographic characteristics,  perceptions regarding caffeine consumption on academic performance. The data were entered and analysed by using SPSS version 16. Frequency and percentages were calculated  and  multivariate  analysis was performed to determine the association of caffeine consumption  and  academic  perfor-  mance of medical students.

Results: The mean age of the medical students were 20.83 ± 1.57 years. About 58.5% were females, 46.3% of the students scored less than 3 Grade Point Average (GPA). Majority (94%) of the students consume caffeine in any form such as tea, coffee. About 68% students reported that caffeine use in- creases their academic  performance.  On  multivariate  analyses,  caffeine  consumption  did  not  show  any significant association with academic performance.

Conclusion: High proportions of medical students were found to be consuming caffeine due to the misconception that caffeine increases academic performance. This study found  no  significant  asso-  ciation with academic performance and caffeine consumption.
Assessment of Vitamin D Levels in Healthy Infants: A Cross-Sectional Survey Highlighting the Relationship of Vitamin D with Feeding Habits
Authors: Shujauddin Quazi  , Jalaluddin Akbar  , Syed Zafar Mehdi
Published: February 2023

Objective: To know and assess the levels of Vitamin D in healthy infants without having the signs of  Vitamin D deficiency on radiological and clinical aspects.

Methods: This was a cross-sectional study carried  out  at  Baqai  Medical  University  Hospital  Karachi. The sampling  technique  used  was  non-probability  consecutive.  Total  145  infants  were  included  in  this cross sectional study that were apparently healthy and  showed  no  features  of  Vitamin  D  defi-  ciency clinically and radiologically within the age of two to six month. Sample size calculated was 145. Infants on Vitamin D  supplementation,  with  renal,  hepatic  or  congenital  heart  disease,  gastrointesti-  nal problems, low birth weight and intrauterine growth retardation were excluded from the study.

Results: The feeding habits were breast  feeding,  formula  feeding  and  mixed  feeding  as  62  (72.7%), 41 (28.3%) and 42 (29%) respectively. Vitamin D level were defined in three categories in which 57   (39.3%) were deficient, 39 (27%) were insufficient and 49 (33.8%) were found to be sufficient. Vitamin         D levels were compared with weight to know the significance. It was discovered that Vitamins D and   weight had a significant association with p-value of 0.02. There was no difference observed in length      and Vitamin D levels with a p-value of 0.155 and OFC (occipital-frontal circumference) and Vitamin D    levels with p-value of 0.491.

Conclusion: Frequency of Vitamin D deficiency and insufficiency is quite common even in apparently healthy infants. The levels of Vitamin D in normal healthy infants of two to six month of age were defi-    cient. Furthermore, Vitamin D deficiency was related to the feeding habits of the infants. The infants           on breast feeding had sufficient Vitamin  D  levels  in  most  cases  whereas  it  was  deficient  in  formula and mixed feed of infants.
Exercise-Induced Headache - A Case Report
Authors: Qudsia Anjum
Published: February 2023

Headache is one the commonest presentation in primary care settings and it presents a challenge to  the treating physician. As the complaint becomes chronic, it affects quality of life of the patient. Individuals and patients experiencing headaches take medications undergo meditations and non-invasive investigations and yet no complete cure is attained. Various  factors  have  been  identified  as  to  the  cause of headache, and classification of headache has been identified in medical literature. Case re-    ports in literature have discussed sports-related headache, and avoidance has been the short term preventive management offered. Keeping in view the diversity of the common complains of headache, we came across an interesting case and which has been reported. A 43 years old male Gulf Co-op-   eration Council (GCC) Member, experiencing intermittent frontal headache after gym exercises with no constitutional symptoms. He was an average built healthy adult, non-smoker and no associated co- morbidity. Counselling and warm up before gym exercises was advised.
Split Cord Malformation - A Diagnosis Missed
Authors: Nimrah Mairaj  , Abdul Ali  , Zainab Juzer
Published: February 2023

In this report, we describe the case of an 8 year old female child who presented with complaints of swelling in sacral region since birth and left leg weakness since 2 years of age. She presented with left clubbed foot to an orthopaedic surgeon and was treated at 1 year of age with serial plasters. The child was presented for club foot, rather than identifying the cause of deformity. When child was presented to our tertiary care hospital her workup was done and an incidental finding of split cord malformation on Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) myelogram was revealed along with left gluteal sebaceous cyst. The child underwent surgery and tethering of cord by the fibrous septa was relieved along with excision of left gluteal  sebaceous  cyst.  The  post-operative course was uneventful. Spinal cord malformations usually present with number of presentations  for  example hypertrichosis, lipoma, dermal sinus or tail. Therefore, a  thorough  examination  can  result  in early diagnosis of the malformation and the complications can be prevented. In our case hypertrichosis at the back was missed, prior to child being referred to us. Hence, this case is being reported as a diagnosis missed of split cord malformation due to lack of complete head to toe evaluation of child by a subspecialty expert.
Impact of Measles Vaccination on the Acquisition and Frequency of Measles Infection in Province of Sindh
Authors: Ammarah Jamal  , Yousuf Yahya  , Agha Muhammad Ashfaq
Published: February 2023

Objective: To determine the status of vaccination  among  confirmed  measles  cases  and  to  determine the association of vaccination status with the occurrence of measles infection.

Methods: A cross-sectional survey was carried out in the province of Sindh from January 2016 to April 2016. The study included patients of both gender, ³9 months of age, fulfilling the case  definition  of measles by World Health Organization (WHO), who were reported to and/or picked by the measles

surveillance officers. A sample of 3-5 ml of blood was collected from each registered patient between       day 4 and day 28 of the  rash  to  test  for  measles  IgM  antibodies.  The  samples  were  labelled  and  sent to National Measles Laboratory, National  Institute  of  Health  (NIH)  Islamabad  in  reverse  cold  chain. Patients who tested positive for IgM antibodies were grouped as confirmed measles while patients negative for measles IgM antibodies were grouped as  suspected  measles.  Data  of  both  the  groups was analysed using windows SPSS 21 for vaccination status, for frequency of measles infection against the number of doses of measles vaccine received. Frequencies of vaccination among  confirmed measles cases were compared with suspected measles for statistical significance using Chi-square. P-value of <0.05 was taken as significant.

Results: A total of 572 out of 915 study subjects were confirmed measles  cases,  of  which  258  (45%)were never vaccinated against the disease as compared to 72 (12.6%) who were completely vaccinated. Overall, 128 (37.3%) were  fully  vaccinated  amongst  suspected  measles.  Vaccination  sta- tus was not known in a quarter of patients in  both  groups.  A  significant  association  was  found  be- tween the vaccination status and measles infection with higher frequency of measles in unvaccinated as compared to the vaccinated (p<0.001).

Conclusion: We conclude that the vaccination rate  among  measles  patients  was  significantly  lower  than among non-measles patients. A sizable 12.6% got the disease in spite of completing measles vaccination.
Comparison of the Mean Serum Ferritin Levels in Thalassaemia Major Patients after Giving Deferasirox and Deferoxamine
Authors: Seema Aftab  , Amber Kamran  , Shahina Hanif
Published: February 2023

Objective: To compare the mean serum ferritin levels in thalassaemia major patients after giving  deferasirox and deferoxamine. This is a randomised control trial conducted at the Department of Paediatrics, Civil Hospital, Karachi from 29th January 2014 to 28th July 2014.

Methods: A total of 160 patients of either gender, with age between 1 to 14 years, who received blood transfusion at least once a month for one  year  and  had  serum  ferritin  >1000  mcg/L  were  included. Each enrolled patient was randomly allocated to group-A (deferoxamine) or group-B (deferasirox). Pre-    and post-treatment iron profile was done in both groups to assess the iron  status  in  the  body.  De- scriptive statistics were applied to calculate mean  and  standard  deviation  for  the  quantitative  vari-  ables.  Frequencies  and  percentages  were  calculated  for  the  qualitative  variables.  Independent  sample t-test was applied to compare mean change in serum ferritin  level  in  both  groups.  Effect  modifiers were controlled by  stratification.  Paired  t-test  was  also  applied  post  stratification  and  p-  value £ 0.05 was considered as significant.

Results:  Overall there were 96 male and 64 female patients. The overall mean age of study subjects was 7.54 ± 4.21 years. In the deferasirox group, mean age was 6.35 ± 4.11 years, mean weight wasv18.01 ± 6.74 kg, mean height was 102.04 ± 19.48 cm, and mean duration of transfusion was 7.48 ± 3.99  months/year.  In  the  deferoxamine  group,  mean  age  was  8.74  ±   3.97  years,  mean  weight  was 20.44 ± 6.77 kg, mean height was 102.19 ± 20.85 cm, and mean duration of transfusion was 8.14 ± 3.55 months/year. In the deferasirox group, before treatment mean serum ferritin level was 1385.73 ± 117.01 mcg/L. After treatment mean serum ferritin  level  was  reduced  to  1047.59  ±  117.08  mcg/L.  In the deferoxamine group, before treatment mean  serum  ferritin  level  was  1362.58  ± 134.42  mcg/L. Af- ter treatment mean serum ferritin level was reduced to 1124.36  ±  134.52  mcg/L.  Post-treatment  the serum ferritin level between two groups was significantly different with p<0.01. The mean difference in serum ferritin level in pre- and post-treatment among two groups was highly significant with p<0.01.

Conclusion: Deferasirox is an effective, safe and tolerable chelation therapy for the treatment of thalassaemia major with iron overload due to its ability to provide constant chelation  coverage  and  potential to improve compliance.
Yield of Urinary Pathogens and their Sensitivity Pattern at Paediatric Tertiary Care Facility, Karachi
Authors: Syed Furqan Hasan  , Khemchand Netaram Moorani  , Taj Muhammad Laghari
Published: February 2023

Objective: To determine the yield of common pathogens isolated from urine specimens and  their  sensitivity pattern in children at National Institute of Child Health (NICH), Karachi.

Methods:  This was a retrospective descriptive study conducted in the department of paediatric neph-  rology and pathology, National Institute of Child Health over a period of two years, from January 2014 to December 2015. All urine samples received in our laboratory from children admitted to nephrology and other departments during the study period were processed for culture and sensitivity. All samples were inoculated with cystine lactose electrolyte deficient (CLED) agar plates and biochemical charac- teristics of the specific pathogen were identified on biochemical tubes. The plates and tubes were in- cubated for 24 hours at 37ºC and growth of more than 105 CFU was considered as significant. These colonies were identified by morphology, lactose fermentation, Gram stain  and  biochemical  tests. Anti- biotic sensitivity was performed by Kirby-Bauer method as  per  CLSI  (Clinical  and  Laboratory  Standards Institute) guidelines and sensitivity was recorded after 24 hours' incubation at 37ºC.

Results: Out of 4107 samples processed, 1442 were positive giving a yield of 35% with 66% in girls and 34% in boys. E. coli was the most common pathogen (55%), followed by Pseudomonas (13.6%), Klebsiella (13,5%) and Candida albicans (11%). Majority of pathogens were sensitive to piperacillin- tazobactam (80-100%). Quinolones and  aminoglycosides  sensitivity  was  found  in  65  to  85%  and  in  65 to 90% cases, respectively. Most of the pathogens (75%) were resistant to 3rd generation cepha- losporins except Citrobacter species.

Conclusion: A high yield of common pathogens in urine samples and high resistance to common antibiotics was observed.
Quality of Life in Subjects Suffering from Severe Skeletal Malocclusion before Orthodontic Treatment
Authors: Tahira Kulsoom  , Syed Shah Faisal  , Syed Sheeraz Hussain
Published: February 2023

Objective: The objective of this study was to determine the occurrence of oral health impacts among patients with severe skeletal malocclusions and dentofacial skeletal deformities before orthodontic treatment.

Methods: A cross-sectional study comprising of 45 adult patients referred for orthodontic or surgical- orthodontic treatment to the orthodontics department, Karachi Medical and Dental College,  Abbasi  Shaheed Hospital Karachi were  included.  The  study  group  consisted  of  29  females  and  15  males  with a mean age of 21.5 ± 5.4 years. Study was conducted for six months from 30th  Oct 2016 to 30th April 2017. A purposive sampling was done on the bases of  survey  base  study  design.  A  self-com- pleted Oral Health Impact Profile (OHIP)-14 questionnaire was used to measure the quality of life before orthodontic treatment.

Inclusion criteria were subjects seeking  orthodontic  treatment  at  the  department  of  orthodontics,  den- tal OPD Karachi Medical and Dental  College,  Abbasi  Shaheed  Hospital,  Karachi,  Pakistan.  Patients  who had perceived a need for orthodontic treatment and  who  were  about  to  undergo  orthodontic  therapy were included.

Subjects with chronic medical conditions, previous orthodontic  treatment,  and  craniofacial  anomalies  such as cleft lip and  palate,  untreated  dental  caries,  and  poor  periodontal  health  status  as  indicated by a community periodontal index score of 3 or more were excluded. The frequency, extent, and sever-      ity scores were calculated from the  OHIP-14.  Malocclusions  were  registered  at  clinical  examination.  The frequency and mean extent and severity scores were compared among malocclusion groups and between genders. Descriptive and inferential statistical method was applied.

Results: Frequency of oral impact in malocclusion patient was  27.3%  though  test  value  was  56  (p  value >0.00). Mean value for male and female patients with malocclusion is 22.06 + 7.1 and 21.34 + 4.4 (p value >0.626), respectively, which shows no significant difference present. Mean value for class I, II and III was 24.5, 28.9 and 30.5 (p  value  >0.44),  respectively,  which  shows  no  significant differ- ence.

Conclusion: There was no difference noted in the class of skeleton malocclusion in quality of life of  patients and there was no gender difference noted in oral health impact of patients.
Adoption of Robson's Ten Group Classification System (RTGCS) to Analyse Caesarean Section Rates at a Tertiary Care Centre in Pakistan
Authors: Rahila Imtiaz  , Samia Husain  , Rubina Izhar
Published: February 2023

Objective: To assess the utility of Robson's ten group classification system (RTGCS) as an auditing tool for cae- sarean section rates.

Methods: The present study was conducted by collecting data retrospectively from hospital records of Gynaecology and Obstetrics Unit 3, Abbasi Shaheed Hospital for the years 2013 and 2016. The rates of both years were com-  pared in terms of RTGCS. After the initial audit in 2013, a three point strategy was implemented and the audit cycle repeated.

Results: During the year 2013, 1986 women delivered in the hospital, 610 underwent caesarean section. The cae- sarean rate for the year was 30.7%. In the year 2016, 1560 women delivered at the unit, out of which, 412 births    were by caesarean section. After the implementation of the three point strategy, which was formulated in the light of RTGCS, the caesarean rate was 26.4% in the year 2016.

Conclusion: The adoption of RTGCS is the first step to analyse the obstetric practice in a standardised manner.
Priapism in Scorpion Stings within the Kingdom of Saudi Arabia: A Case Report
Authors: Shabbir Ahmed Mallick  , Sameer Ahmed
Published: February 2023

We report a 2-year-old Saudi boy who presented  with  an  acute  onset  of  asymmetric  pulmonary  oedema, moribund state and priapism. He was living in the desert  and  was  referred  to  our  hospital during the summer. He  was  mislabelled  as  a  patient  with  sickle-cell  disease  as  a  very  high number of patients come with a crisis  of  same  presentation,  and  haemoglobinopathies  are  not  uncommon  in the Kingdom of Saudi Arabia. On careful examination of the child, there were multiple tiny lesions on both of his feet and abdomen which led to high suspicion of scorpion stings. The index of suspicion was high due to two reasons;(i) it was the summer, during which the incidence of scorpion stings is high and, (ii) the child was habitated in the desert area where scorpions are common. The child was successfully salvaged with symptomatic support and the specific anti-venom  was  given.  The  presen- tation of severe or heavy scorpion intoxication mimics the presentation of sepsis.
A Case Report on Recurrent Dermatofibrosarcoma protuberans (DFSP), Successful Surgical Excision is Treatment of Choice
Authors: Arshadullah Khan  , Sumayya Tajwar
Published: February 2023

A 23-years-old male patient came to the Surgical Oncology clinic in Saudi National Hospital, Makkah with complaint of non-healing wound present on the medial side of the right thigh since three months. A detailed history wastaken and it was revealed that this was a fast growing lesion and recurred im- mediate after surgical excision. The previous surgery had been carried out three months back in India. On the clinical examination it was revealed that it wasan irregular, ill-defined lesion, hard  in  consistency, not adherent to the underlying structures, and hence highly suspicious of malignancy. Diagnostic workups were done including  biopsy,  metastatic  workup  including  computer  tomography  (CT) scan chest abdomen and pelvis. On the basis of histopathology, it was diagnosed as dermatofi- brosarcoma protuberans (DFSP). The case was presented in the Sarcoma  Tumour  Board  and  ac-  cording to Tumour Board's recommendation, surgical excision was conducted.Patient was sent for anaesthesia assessment and  after  complete  blood  workup,  and  pre-anaesthesia  assessment,  pa-   tient was booked for elective resection of tumour. The tumour was successfully excised with all negative margins confirmed on the frozen section and finally the sample was sent for histopathology.

Post-excision, patient was followed in surgical oncology clinic for local and systemic recurrence and it was concluded after three years follow-up, that there was no local and systemic recurrence.

The dermatofibrosarcoma has high potential for local recurrence and  surgical  excision  with  2  cm  negative margins is the treatment of choice without adjuvant radiotherapy.
Decline in Age of Nutritional Rickets, Need for Routine Vitamin D Supplementation in Young Infants
Authors: Ammarah Jamal  , Hira Raheem  , Samar Sajid  , Wajeeha Batool
Published: February 2023

Objective: To  determine the age at the diagnosis of rickets in children in a tertiary care hospital of Karachi and to assess the association of age at the diagnosis of rickets with serum levels of vitamin D. 

Methods: This cross-sectional descriptive study was carried  out  from  January  2016  to  July  2017  on 240 patients >1 month to 36 months of age, both genders, admitted in the paediatric ward, Civil Hospital, Karachi for various  reasons.  Children  having  clinical  signs  suggestive  of  rickets  were  confirmed to have the disease by radiological evidence, raised serum alkaline phosphatase and reduced serum  vitamin D levels. Children with rickets secondary to chronic  diarrhoea,  non-nutritional  aetiologies  and those taking anticonvulsants, corticosteroids, or vitamin D supplements were excluded from the study.    Data was analysed using SPSS 16 for frequencies of age at the time of diagnosis of rickets and for classification of vitamin D  levels  into  severely  deficient,  deficient,  insufficient  and  normal.  Association of the age at the diagnosis of rickets was  tested  with  serum  levels  of  vitamin  D  by  applying  chi-  square test of independence. Statistical significance was considered at p-value <0.05.

Results: Mean age was 6.2 ± 5.9 months. A total of 130 (54.2%) subjects were £6 months of age, in- cluding 84 (35%) £3 months. Serum Vitamin D levels were done in  210  (87.5%)  cases. Total  of  168 (80%) cases were either deficient [141 (67.1%)] or severely deficient [27 (12.9%)] in vitamin D while 42 (20%) had insufficient levels. There was significant association of age at diagnosis of rickets with     serum vitamin D levels. Rickets was an incidental diagnosis in most patients.

Conclusion: Nutritional rickets was most common in cases £ 6 months age with a sizable number £3 months. Vitamin D deficiency was the cause in all patients. Significant association was  established  between serum vitamin D levels and age at diagnosis of rickets. Most of the subjects remained unde-   tected until they were investigated on basis of clinical suspicion.
Personality of Children and Classroom Bullying: The Role of Parental Physical and Psychological Aggressio
Authors: Syed  Afzal Shah
Published: February 2023

Objectives: To explore the impact of parental aggression (physical and psychological) on  classroom bullying and to explore the effect of parental aggression on personality traits viz. neuroticism, extraver-   sion, and agreeableness factors of personality of secondary school students.

Method: A survey was conducted in the secondary schools of Mansehra, Abbotabad, and Haripur dis-   tricts of Hazara Division from October, 2013 to March, 2014. A sample of 1438 students was selected to collect data by using three questionnaires.  One  questionnaire  was  about  bullying  while  the  other  was about parental aggression. The third questionnaire was about the big five factors  (BFF)  of  per- sonality and focused on only three factors of personality viz. extraversion, neuroticism, and agreeable-  ness. This questionnaire  was  adopted.  Analysis  of  collected  datawas  done  through  descriptive statistics such as mean, standard deviation, whereas for  the  prediction  of  effect  of  independent  vari- able on dependent variable, multiple regression model using SPSS version 20.

Results:  The mean and standard deviation value of physical aggression of parents was (3.96 ± 1.23)   while that of psychological aggression was  (3.97  ±  1.08).  Additionally,  the  education  level  of  father  was negatively correlated with their physical aggression (r= -0.29, a= 0.000) as well as psychological aggression (r=- 0.28, a= 0.000). Similarly, mothers' level of education was significantly negatively cor- related with both physical aggression (r= -0.16, a= 0.000) and psychological aggression (r= -0.14, a= 0.000). The results further indicated that parental physical aggression (b= 0.16, t= 5.20, a= 0.000) positively predicted classroom bullying. Moreover, parental psychological aggression proved as signifi-    cant negative predictor of extraversion (r= -0.067,  a= 0.021), whereas parental psychological aggression demonstrated significant positive predictor of neuroticism (r= 0.106, a= 0.001).

Conclusion: A high level of aggression both physical  and  psychological  is  expressed  by  parents  against their adolescent children. Among them, more  educated  parents  use  less  aggression  towards their children. This physical and psychological aggression from parents cause damaging effects on extraversion factor of personality while psychological cause neurotic tendencies in secondary school students.
Child-Pugh Score Predicts Mortality Better than Model of End Stage Liver Disease: A Study in a Tertiary Care Hospital in the Periphery of Karachi
Authors: Ashok Kumar  , Ajeet Kumar  , Syeda Urooj Riaz  , Rajesh Kumar  , Muhammad Ishaq Ghauri  , Naresh Kumar Setlani
Published: February 2023

Objective: To  observe the scores of the model of end-stage liver diseaseand Child-Pugh (CP) scores on hospital admission in patients of cirrhosis.

Methods: A cross-sectional study, in 6 months from September 17th  to March 18th, using non-probabil-      ity convenience sampling was conducted, in which we  inducted  165  patients  with  diagnosed  cirrhotic liver disease in aninpatient department.  We  noted  the  demographics  and  staged  the  patient  for  chronic liver disease according to Child-Turcotte-Pugh classification using ascites, encephalopathy, prothrombin time, serum albumin and serum bilirubin levels and compared it with MELD (Model for End-Stage Liver Disease) score  using  serum  bilirubin,  creatinine  and  change  in  INR.  We  predicted  the outcome of patient according to both scores.

Results: Out of 165 patients, 127 (76.96%, 84 males and 43 females) patients improved, while  38  (23.04%, 29 males and 9 females) patients expired. Correlation of CP and MELD scores was done by Pearson's bivariate correlation test and it gave  the  correlation  coefficient  of  0.626  with  highly  signifi- cant value of p<0.0001. The area under curve (AUC) was slightly more for CP (0.961) as compared to MELD (0.911).

Conclusion: The MELD score compared to the CP score does not appear to offer a clear advantage in predicting mortality in patients with  decompensated  cirrhosis,  but  comparatively  CP  score  per-  formed better than the MELD with significantly higher AUC.
Determining the Relationship Between Motivation Towards Learning and Academic Performance Among Medical Students
Authors: Khursheed Anwer  , Qasim Saleem  , Qurrat-Ul-Ain Mehfooz
Published: February 2023

Objective: To find out significant parameters to  measure  student's  learning  motivation  and  examine their relationship with academic performance.

Methods: A quantitative correlational study was conducted on 225 MBBS students from May 2018 to     June 2018 to examine above mentioned relationship. Stratified random sampling technique was used to draw sample out of accessible population. Data  were  collected  after  informed  consent  from  stu-  dents using a demographic survey and Modified Archer's Health Professions  Motivation  Survey (MAHPMS). Information regarding student's scores  in  their  professional  examinations  was  obtained  from examination department with due permission. Data were analysed using IBM SPSS 21. Pearson co-efficient of co-relation of four scales of MAHPMS and scores of students were calculated. Scatter plots were used to calculate  relationship  for  each  scale  of  MAHPMS  i.e.  goal  orientation,  preference for difficult or easy task, learning strategies and locus of control (independent variables) and marks of students (dependent variable).

Results: Goal orientation and marks were 91.7% positively correlated, preference for difficult or easy was 45.6% positively correlated with marks, learning strategies and marks were 48.2%  and  locus  of control and marks were 25.7% positively correlated.

Conclusion: Results of the study confirmed that there is positive relationship between student's learning motivation as measured  by  four  sub-scales  of  MAHPMS  and  academic  performance  of  students as measured by marks.
Frequency and Pattern of Dyslipidaemia in Pakistani Females with Coronary Artery Disease
Authors: Shazia Nazar  , Ambreen Qamar  , Hira Ahmed  , Shazia Fahmi  , Afshan Mehboob  , Wajiha Iffat
Published: February 2023

Objective: To  determine the frequency and pattern of lipid abnormalities in diagnosed female patients        of coronary artery disease in a tertiary care hospital of Karachi.

Methods: This cross-sectional study was conducted from January 2016 to August 2016. A total of 300 female patients of Coronary Artery Disease (CAD), diagnosed on the basis  of  angiography  were  in- cluded in the study. For detection of lipid profile abnormalities five ml of fasting venous sample of 10-

12 hours was obtained from the left median cubital vein under aseptic conditions. The blood was  centrifuged for 5 minutes. Automated  chemistry  analyzer  was  used  for  lipid  profile  measurement  via kits of the CYPRESS Laboratory (Langdorp, Belgium). Statistical analysis was done via SPSS version       17 and results were expressed as percentage and mean ± standard deviation.

Results: Mean age of recruited females was 51.36 ±  13.71  years.  About  81.39%  of  patients  were  found with abnormal lipid profile. The frequency of low high-density lipoprotein cholesterol in studied population was 61.66%, high  triglycerides  19.33%  whereas;  high  low-density  lipoprotein  cholesterol  was 17.33% respectively. Combined two parameter dyslipidaemia patterns was  found  in  41.32%  fol- lowed by  mixed  dyslipidaemia  in  19.33%,  while  isolated  high-density  lipoprotein  hypocholesteraemia  in 12.00% of study population.

Conclusion: We conclude that low levels  of  high-density  lipoprotein  cholesterol  and hypertriglyceridemia, in both combined and isolated pattern,  are  more  prevalent  in  Pakistani  females with CAD.The data from the current study may increase the knowledge of the guidelines for lipid low-     ering need in females.
Effect of Chorioamnionitis on Neonatal Outcome: A Hospital-Based Study
Authors: Atika Sher  , Syed Kashif Abbas  , Shiyam Sunder Tikmani  , Falak Abro  , Muhammad Jameel Ashraf
Published: February 2023

Objective: The aim of this study was to determine the impact of chorioamnionitis on neonatal outcome.

Methods: This cross-section descriptive study was conducted in the neonatal intensive care unit (NICU) of the Department of Pediatrics, Liaquat National Hospital Karachi from June 1st, 2016 to December 31st, 2016. Neonates (infants < 28 days of age) with maternal risk factors indicative of chorioamnionitis (maternal febrile illness in last trimester, high WBC count in maternal blood, lower abdominal pain or tenderness, and foul-smelling discharge) were included in the study. The neonates with an inborn error of metabolism and congenital anomalies were excluded from this study. The neonates were further categorized by gestational age as a term (gestational age >37 weeks) and preterm (gestational age <37 weeks). The neonatal outcome is classified into binary categories; dead or alive. Data were recorded by the data collectors in the predesigned proforma. The data were entered and analyzed using SPSS version 22.

Results: During the study period, 1200 women delivered a singleton baby, out of which 400 were admitted at NICU. Of 400 infants, a total of 68 neonates of mothers with the indication of chorioamnionitis were enrolled in the study. The mean age of enrolled neonates was 2.55 ± 1.22 days. Out of 68 neonate babies, 33 (48.5%) were males and 35 (51.5%) were females. Only 43 (63%) were delivered, pre-term babies. The morbidities identified were respiratory distress syndrome (33.8%), sepsis (27.9%), intraventricular hemorrhage (10.3%), persistent pulmonary hypertension of newborns (11.8%) and necrotizing enterocolitis (7.4%). A total of 16 (23.5%) neonates died. Out of 16 newborns who died, 32.6% were preterm and 8% were born at term. It was noted that weight, body mass index, fronto-occipital circumference, and gestational age were significant contributors to the mortality.

Conclusion: In conclusion, chorioamnionitis is an important contributor to neonatal mortality and morbidity. The neonates of a mother with indications of chorioamnionitis are at an increased risk of respiratory distress syndrome.
Magnitude of Sodomy on Clinical and Chemical Analysis
Authors: Talpur Mir Ghulam Ali , Khan Iqbal Ahmed , Waheed Abdul , Ram Hari , Nezam Shahid , Alam Syed Pervaiz
Published: February 2023

Objective: The objective of this study was to assess the age groups of sexually abused victims which was reported at the different police stations of Karachi.Subject and Methods: This was a single centre, retrospective study on 54 patients by using non-probability sampling technique. The duration of study was from January 2016 till January 2018 at Abbasi Shaheed Hospital, Karachi. The data was collected from the Medico legal Section from more than 45 policestation cases that were reported in Abbasi Shaheed Hospital (ASH) and the data was analysed in statistical package for social sciences (SPSS) version 22. Simple frequency distribution of the gender, age, clinical assessment and the lab DNA analysis were identified. The stratification tables were madethereafter for the gender, age, lab DNA analysis and clinical assessment.Results: Only one female was reported to be the sexual abuse victim and rest of 53 sexual abuse victims were males.Age groups i.e. 10-14 years and 30-39 years were reported to be with the greater number of sexual abuse victims 16 (29.6%) and 9 (16.7%) respectively). It was found to be common among males in the comparison of females.Conclusion: In conclusion sexual abuse was common in younger age group i.e. 10-14 years. It seems the children are targeted for the sodomy may be because they are unaware of these sexual activities.