bluuebunny/crossref_metadata_2025 huggingface dataset:
Redefining ‘Legitimate’ Dependencies in a Panjabi Riyāsat: Local and Colonial Perspectives
Authors: Joshi Girija
Published: November 2022

This essay traces the changing contours of a Panjabi state during the eighteenth and nineteenth centuries. It focuses on the Kalsia principality, founded by a family of rural warlords who had transformed themselves from village elders to the rulers of a distinct principality within a generation. Using a chronicle left by a retainer and scribe of the Kalsia administration, it studies a handful of the chiefly lineage’s dependents (tābeʻīn), to try to understand what their position within the ruling household was, what rendered them dependent, and what kept them loyal. It argues that jural status was of some, but not determinant, importance in creating deeply hierarchical bonds; just as important was the value that patron and client, master and slave alike attached to such unequal relations, as a source of honour, status, and influence. This value was moreover shared across and attached to a range of relationships, from kinship bonds to servitude, blurring the distinction between family and service. This began to change, at least in law, in the wake of colonization, as the British sought to impose fixed boundaries on the household, to progressively strip ruling houses of their land.
Impact of Hydroxyurea on Blood Transfusions and Its Safety in β-Thalassemia patients
Authors: Hussain Malik Asif , Asif Ayesha , Gorsi Usama , Mushatq Aamir , Gohar Umar Farooq , Shah Asad Iftikhar
Published: November 2022

Background: Thalassemia is a genetic defect characterized by abnormal hemoglobin in red blood cells and resultant anemia. Currently, regular blood transfusion or fetal hemoglobin inducers or a combination of these is clinically used to manage these patients. Aim: To observe effectiveness of Hydroxyurea in β-Thalassemia patients, particularly focusing on change in frequency of blood transfusions. Methods: This study analyzed data of the patients registered with thalassemia society of Pakistan and Sundas Foundation of district Lahore, Punjab, Pakistan. Eighty seven patients were selected for analysis based on available data and specific inclusion criteria. The results were calculated using “dependent/paired sample t test” and presented in form of graphs. Results: Out of eighty seven patients, 72 % of the patients were diagnosed with thalassemia major, 26% with thalassemia intermedia and 1% with thalassemia minor. Additional analysis showed more cases in males (57 %); dominance of cases in cousin marriages (87 %) and majority of patients were 1-10 years (60 %) old. In this study, the impact of hydroxyurea was observed on reduction of blood transfusions in thalassemia patients. Overall, 11.5% patients showed excellent response, 65.5 % were good responders and 25% patients did not show clinical improvement with hydroxyurea use. The dosage of hydroxyurea was based on weight of the patients. Conclusions: It is hence concluded that Hydroxyurea is safe and effective drug for thalassemia patients, as it reduces the blood transfusion need of the patients and help to improve their quality of life. Keywords: Blood transfusion, Anemia, Hydroxyurea, Thalassemia.
Comparison between Mulligan Sustained natural apophyseal glides (snags) VS McKenzie exercises in Chronic Mechanical Low back pain
Authors: Salik Sumbal , Rani Shaista , Hayat Rehana , Manzoor Sana , Malik Amber Usama , Maqbool Sania
Published: November 2022

Background: Low back pain is a common musculoskeletal problem of the modern society as 70-80% people of any age and gender get affected by this in their lifetime which affect their normal activities of daily living. Aim: To compare the efficacy between Mulligan SNAGs and McKenzie exercises in improving pain level, range of motions and functional status in chronic mechanic al low back pain patients. Method: A randomized control trial study was conducted on 45 patients suffering from chronic mechanical low back pain at Physiotherapy Department of Mayo Hospital Lahore from16th December to 21th January 2021.The patients were randomly allocated in three group’s i.e; Conventional and two trial groups by computerized generated list. In Conventional group; 15 patients were treated with conventional therapy. In trial groups; one was treated with Mulligan SNAGs and Conventional therapyand the other trial group were treated with McKenzie exercises and Conventional therapy 3 sessions per week. Pain measured by Numeric Pain Rating Scale (NPRS), Lumbar spine's ranges measured by Goniometer and functional status measured by Oswestry Disability Index (ODI) at the completion of the 4 weeks treatment session. Results: NPRS scoring and Ranges showed significant improvement in all groups but NPRS significantly improved in McKenzie exercises group and significant improvement in ROM showed in Mulligan SNAGs group in all movements but there was no significant difference found between three groups comparison in improving the functional status with p-value =0.243. Practical implication: The study provides the opportunity to the patients to consider physiotherapy as an effective treatment for the mechanical low back pain. It also provides the statistical knowledge about these physiotherapy techniques and their effectiveness in treating the low back pain. Conclusion: Both the Mulligan SNAGs and McKenzie exercises are effective in treatment of Chronic lumbar pain as pain is most reduced through McKenzie exercise (3.33±1.29, p<0.000) while ranges of spine is improved through Mulligan SNAGs mobilization in all directions. Keywords: Chronic Mechanical Low back pain, Mulligan SNAGs mobilization, McKenzie exercises
Incidence of Burnout and its Relationship with Musculoskeletal Disorders among Healthcare College Students in Lahore, Pakistan
Authors: Ilyas Tamkanat , Anwar Mamoona , Tabassum Muhammad Nouman , Maqbool Sania , Ain Quratul , Asghar Madiha
Published: November 2022

Background: Burn-out is a syndrome defined as the result of chronic workplace stress that has not been successfully managed. It has three dimensions: 1) energy depletion or exhaustion 2) feelings of negativism about one's job3) reduced professional efficacy. Burn-out& musculoskeletal disorders (MSD) are the most common health problem associated with work in Europe, affecting millions of workers. Several studies have found a high prevalence of burnout among medical and dental students. Aim: To determine the prevalence of burnout syndrome & its association with MSK disorders among health care students of Lahore, Pakistan. Methods: This was a cross sectional survey among 259 students from different health care colleges studied in different semesters using the sample of convenience. The Nordic Musculoskeletal Questionnaire&Mashlach burnout inventory questionnaire were used for data collection. Results: The frequency and percentage of our outcome according to the report, 149 of the total students and 57.5% of respondents have neck disorder. Due to burnout during their medical studies, 50 students (19.3% of respondents) have shoulder problems, and 59 students (22.8% of our sample size) have upper back problems. There are 40 students with mild neck pain among the 259 students, 86 students with moderate neck disorder, 23 students with severe neck disorder, and 149 students with no neck disorder. There were 50 students with shoulder disorders and 59 with upper back disorders in total. As a result of burnout, the majority of students suffer from neck disorders. Pearson Chi square test value is 13. it shows the validity of research as it is more than 5. The majority of the participants shows high levels of emotional exhausation ,desperation& low occupational effectiveness .This suggests if preventions are not taken & interventional strategies not guided , there will be symptom progression & reduced professional effectiveness may occur among targeted population Conclusion: There is a strong association between B.O and MSD. The cervical and neck area is more prevalent then the upper back and shoulder , out of 259 students 149 suffer from neck pain. Keywords: Burnout syndrome , MSD/musculoskeletal disorder, WMDs/work related musculoskeletal disorders.
Frequency of Recurrence of Hepatic Encephalopathy in Patients of Chronic Liver Disease Treated With Rifaximin
Authors: Arif Kanwal , Butt Nauman Ismat , Ali Farman , Ashfaq Fahmina , Habib Osama , Tufail Khan Kakar Aniqa Anser
Published: November 2022

Aim: To determine the frequency of recurrence of hepatic encephalopathy in patients treated with Rifaximin. Study design: Observational cross-sectional study. Setting & duration: Department of Medicine, Services institute of Medical Sciences Lahore for duration of 12 months. Methodology: Hepatic encephalopathy was diagnosed using West-Haven classification in patients of chronic liver disease. Recurrence was considered if a new episode of hepatic encephalopathy occurred within 3 months after initiation of treatment. A total 120 patients of chronic liver disease having had an episode of recent hepatic encephalopathy within the last 3 months, of both genders, above 20 years of age with hepatic encephalopathy were included in the study. The patients were followed for 3 months after initiation of therapy and any episode of recurrence of hepatic encephalopathy was recorded. Results: Mean age was 51.5±12.2 years and 52.3±12.8 years respectively in Rifaximin and Placebo groups. Fourteen (23.3%) patients in Rifaximin group and 17(28.3%) in placebo group were younger than 40 years of age. Thirty-three (55%) patients in Rifaximin group were male versus 29(48.3%) patients in Placebo group. Fifteen (25%) patients in Rifaximin Group developed hepatic encephalopathy by 3 months of follow up as compared to 31(51.7%) patients in Placebo Group Conclusion: Frequency of recurrence of hepatic encephalopathy is significantly lower in Rifaximin treated patients. Keywords: Hepatic Encephalopathy, Recurrence, Rifaximin.
A Study of Plasma Anti-Thyroperoxidase Antibodies and Anti-Thyroglobulin Antibodies in patients with Hypothyroidism
Authors: Saeed Umer , Saeed Saman , Mehmood Qanita , Ayyub Asima
Published: November 2022

Aim: To determine the plasma anti-thyroperoxidase antibodies (Anti-TPO) and anti-thyroglobulin antibodies (ATG) in hypothyroid patients Methods: This study was carried out at Arif Clinical Laboratory and Diagnostic center, Lahore. Samples were collected from 750 patients diagnosed with hypothyroidism. The blood samples were analyzed for the levels of anti-thyroperoxidase antibodies (n=450) and anti-thyroglobulin (n=300) antibodies. Depending upon the serum levels of these antibodies, the obtained titerswere categorized as normal, mildly elevated, moderately elevated and highly elevated. Duration of study was around08 months, extending from November 2021 to May 2022. Results: Among the total 750 patients with hypothyroidism, 450 were estimated for Anti-TPO antibodies, whereas, 400 patients were analyzed ATG antibodies. Anti-TPO antibodies were normal in 191 patients (42.44%) and high levels were observed in 259 patients (57.55%), indicating a greater role of these antibodies in the causation of hypothyroidism. In contrast, among the 300 patients analyzed for ATG antibodies, 213 patients had normal levels (71%), while 87 has high plasma levels of these antibodies (29%) Practical Implications: Current study provides an insight into the more frequent incidence of Anti-TPO antibodies, thus indicating its more crucial role in causing hypothyroidism in the given population. Therefore, estimation of these autoantibodies earlier in the disease can serve as better indicators of the severity and response to treatment, compared with Anti-TGB antibodies, which are present less frequently in patients with hypothyroidism Conclusion: Anti-TPO antibodies were found to be high in 57.55% patients (n=450) with hypothyroidism, indicating its greater role in the causation of hypothyroidism, whereas, ATG were high in only 29% patients (n=300). The results stress the need to evaluate all patients of hypothyroidism with plasma antibody levels for early diagnosis and a prompt management plan. Keywords: anti-thyroglobulin, anti-thyroperoxidase, hypothyroidism, Thyroxine, Triiodothyronine
Socio-Economic and Demographic Factors Associated with Raw Alcohol Consumption
Authors: Abbasi Zain Ul Abidin , Siddiqui Muhammad Ilyas , Usman Gulzar , Memon Sikander Munir , Deeshak Aftab Haider , Luhana Mahesh K.
Published: November 2022

Aim: To determine the socioeconomic and demographic characteristics that influence raw alcohol intake. Methods: It was a cross sectional study, conducted at community level at Badin district for 3 months from 1st September 2019 to 30th November 2019. The study included all of the cases that met the inclusion criteria. All responders or their relatives provided written consent. A complete history of alcohol intake and associated factors was obtained. Performa was used to record all of the data. For data analysis, the SPSS v.22 was utilized. Results: A total of 115 individuals participated in the study. Their mean age was 37.11 years, with a standard deviation of 8.096. The majority of the individuals (89.6%) were Sindhi; in terms of religion, 43(37.4%) were Muslin, 6(55.7%) were Hindu, and 8(7%) were Christians; roughly 53(46.1%) of the study participants were illiterate and had no education. About 44.3% started to drink as an adult, 26.1% drank more than five times per day, 61.7% drank more than two pegs/glasses of raw alcohol on a daily basis, % liked to drink at night, and around 45.2 % drank alcohol as a habit. The majority of drinkers (46%) were encouraged by their friends. Practical implication From point of practical implication, it is important to know that drinking alcohol increases the chance of developing mental and behavioral disorders, including alcohol dependency, as well as severe non-communicable illnesses such as liver cirrhosis, several malignancies, and cardiovascular disease. Conclusion: Raw alcohol intake (ethanol) can have major effects for people's current and future health and quality of life; our findings give critical new information regarding this public health issue. Keywords: Alcoholism, Consumption, Demographic factors, Ethanol, Raw alcohol.
The Utility of Brain CT in Highlighting the Etiological Patterns and Incidental Findings of Traumatic Brain Injury
Authors: Mobeen Arifa , Malik Maheen Asif , Sajid Mahnoor , Ali Talha , Babar Tuba , Maqbool Sania , Ilyas Tamkanat , Hameed Tamsal
Published: November 2022

Aim: To find the utility of brain CT in highlighting the etiological patterns and incidental findings of traumatic brain injury. Methods: From January 2022 to March 2022, 110 patients presenting to emergency department of Pakistan Institute of Neurosciences with brain traumatic injury was present in this study. Patients go through long clinical evaluation and computed tomography on every trauma criteria. Results: The most affected age (group) was 30 to 42 years (37.05%) male (78.2%) to female (21.8%) ratio was 8:2. Injuries were predominantly caused by RTA (72.7%), less commonly caused by fall (11.8%), pedestrial (6.4%), assault (5.5%), and sports (3.6%). Among those with RTA less than 6% people was wearing helmet. The common CT scan evaluation was brain contusion (35%), fracture (13%), Edema (13%), SDH (10%), EDH (8%), SAH (4%), pneumocephalus (5%) and others (3%). Prediction of true prevalence of incidental findings is tough. In this study, we found that enlarged cisterna magna (3.6%) and calcification (3.6%) were the common incidental (findings), and brain tumor (0.9%) and hydrocephalus (0.9%). Conclusion: Road traffic accidents (RTA) are a major cause of TBI. This can be avoided by wearing helmet, but it is less used. Moreover, there is a proper need to put strict system amongst hospitals citywide to lessen the effects of severe TBI. At last every person had to check up on themselves for any minor physical or mental change. Keywords: Traumatic Brain Injury, CT scan, Etiological patterns, Incidental findings.
Alloimmunization and Autoimmunization in Multi-Transfused Thalassemic Patients: A Single Center Study
Authors: Fateen Tooba , Saqlain Nazish , Mazhar Naghmana , Arshad Sundus , Butt Seema , Malik Jannat Zahid
Published: November 2022

Aim: To determine frequency of alloimmunization and autoimmunization among the patient of thalassemia with history of multiple blood transfusions. Methods: This study was conducted by consecutive sampling in six months duration from September 2020 to August 2021 at the department of Hematology and blood Transfusion Medicine, of University of Child Health Sciences, The Children's Hospital Lahore. Any patient with a positive Direct antiglobulin test (DAT) was labeled as auto-immunized and a positive indirect antiglobulin test (IAT) was labeled as alloimmunized. Results: Total 90 cases were enrolled with 62% male and 38% females with a mean age 6.04 + 3.3 years (range of age: 7 months to 14 years). Antibody screening and auto-antibodies were positive in 4.4% (n= 4) cases each, and allo-antibodies in 6.7% (n=6) cases (anti-E in 2, anti-C in 2, anti-K and anti-e in 1 each). Among all these patients of beta thalassemia, spleen was enlarged in 71% cases; around half of these were <5 years old. Around 96% had first transfusion <2 years. The frequency of patients positive on DAT, IAT and on anti-body screening was significantly related to the frequency of blood transfusion Practical Implications: Autoantibodies produce a positive direct antiglobulin test (DAT), resulting in hyperhemolysis of red cells in thalassemic patients, which exacerbates the existing alloantibodies factor in children who have received several blood transfusions. The gap between transfusions will be shortened. Routinely, greater emphasis is placed on the identification of allo-antibodies, but auto-antibodies should also be evaluated so that this phenomena may be better understood and handled. This study was conducted to examine the link between a greater transfusion demand and the existence of auto or allo antibodies in Thalassemia patients. I Conclusion: We found Alloimmunization and autoimmunization together not very uncommon in transfusion dependent patients of Thalassemia. The frequency of transfusions is affected in co-existing states. Extended matching, as well as early diagnosis and control of Auto and allo-antibodies both can improve the efficacy of blood transfusion. Keywords: Autoantibodies, IAT, DAT, Coomb’s test, Thalassemia, Allo-immunization
Computed Tomography Scan Findings in Various Modes of Head Injury, using Ge Optima 128 Slice CT Scanner
Authors: Khattak Nadia , Riaz Muhammad , Iqbal Raheel , Hussain Sana , Jawad Muhammad , Ahmed Fayaz
Published: November 2022

Background: Head injury is a global health problem that can cause disability and may result in death. CT scan detects and precisely localizes the skull fractures, epidural/subdural/subarachnoid hemorrhages, brain contusions and cerebral edema etc. CT has proven to be a valuable tool in the early diagnosis and prompt management of head trauma patients. Methods: A descriptive cross-sectional study, including 380 patients, presented to the radiology department of Hayatabad medical complex witha history of head trauma for computed tomography examination, from October 2019 to October 2020. The nature of the brain and skull lesions was analyzed in our study and the frequency of various findings was recorded. Results: Among 380 patients, the majority were males (248) making the male to female ratio to be around 2:1. The most prevalent finding was skull fractures (23.4%) followed by cerebral contusions (17.1%). Among extra-axial brain hemorrhages, extradural hematoma (15.2%) was observed more than subdural hematoma (6.8%) while only 3.4% presented with subarachnoid hemorrhages which also included intraventricular hemorrhages. Practical Implication: As road traffic accidents are the most common cause of head injuries so road traffic safety measures ought to be strictly enforced. Most of the CT scan done during head injuries were normal so CT guidelines for ordering should be implemented to scale back extra patient irradiation, unnecessary waste of resources Conclusion: Our study concluded that younger populations and males are more prone to head injury and road traffic accident is the most common mode of head trauma. So, ensuring proper traffic rules along with educating the more prone population will significantly reduce the incidence of serious head injuries. Keywords: Head Injury, Computed Tomography (CT), Road Traffic Accidents (RTA), Skull Fractures, Epidural Hematoma.
Otolaryngology specialty choice among the 4th year MBBS students
Authors: Umar Mumtaz Ahmad , Mushwani Mohibullah , Arshad Naveed
Published: November 2022

Background: The discipline of otorhinolaryngology specialty is a very promising field all over the globe. This field is equipped with modified lifestyle as compared to general surgery field. However, otolaryngology is a flexible, promising and important field but still its trend is decreasing all over the world across the undergraduate’s professionals. Aim: To determine the frequency of otolaryngology specialty choice being taken by 4th year MBBS students. Methods: A descriptive cross-sectional study was conducted in otorhinolaryngology department of Islamabad Medical and Dental College, Islamabad from January to December 2020. The answers were obtained through the Likert scale-5 having the following components, as strongly agree, agree, not sure, disagree, strongly disagree. Results: A 100 undergraduate students participated in this survey. All students were of 4th year MBBS. 20% students were agreed and 40% not sure about the question regarding taking up otorhinolaryngology as a career choice and 15% strongly agreed for this. Conclusion: The study concluded that the graduates are not sure whether they want to choose otorhinolaryngology as their final career choice. We suggest that it should be one of the compulsory rotations during the internship. Keywords: Otorhinolaryngology; Specialty; Undergraduate medical education; Postgraduate; Career choice.
Assessment of Predictors of Mortality in COVID-19 Patients Treated with Tocilizumab
Authors: Rana M. Asim , Qayyum M. Ahad , Siddiqui M. Hasan , Siddiqui R. Omer , Waseem M. , Javed M. , Pervaiz R. , Hafeez M. Mansoor
Published: November 2022

Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim: To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Results: 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78±12.86 vs. 51.65±11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion: Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Keywords: Tocilizumab, Motility predictors, Co-morbid conditions, COVD-19, Procalcitonin, D. Dimer
Pyknotic Nuclei and Change in N/C Ratio of Heptocytes by Consumption of Allicin Present in Garlic Extract
Authors: Siddique Asma , Aslam Muhammad Sohail , Amjad Saba , Zulfiqar Asma , Mansoor Saqib , Fatima Sibgha
Published: November 2022

Background: Garlic (allium sativum) is given as herbal medicine due to its antimalignanat effect. It has been reported that allium vegetables have marked anticancer effect against stomach and colorectal carcinomas. Organosulfur compounds in garlic activate the metabolizing enzymes and cytochrome P450s to detoxify carcinogens and other foreign compounds like lead. These components act as anticarcinogenic for gastrointestinal tract, lungs and mammary gland in experimental animals. Aim: To evaluate the dose range of garlic (allium sativum) to induce the antitumor effect. Study design: Experimental study Place and duration of study: Department of Anatomy, Shaikh Zayed Postgraduate Medical Institute, Lahore from 1st October 2013 to 31st March 2014. Methodology: Forty five Wistar albino rats of both sexes weighing between 250-350 grams were selected randomly. Two different doses of 500 and 1000 mg/kg of fresh garlic extract were given to the animals by orogastric tube for thirty days. After this period the analysis of quantitative parameters including the diameter of the hepatocytes and hapatic nucleus were recorded and nucleus to cell ratios (N/C Ratios) were calculated. Results: The atrophic changes on the size of hepatocytes and their nucleus is noted in both experimental group B and C as compared to control group A (P<0.001). Conclusion: There is a significant atrophic change, appearance of pyknotic nuclei indicating the apoptosis. That is leading to decrease in N/C ratio, beneficial in producing the anticarcinigen effect. Keywords: Garlic (allium sativum), hepatocytes, atrophy, pyknotic nuclei, albino rats
Clinical Evaluation of Respiratory-triggered 3D Magnetic Resonance Cholangiopancreatography with Navigator Echoes Compared to Breath-hold Acquisition Using Compressed Sensing and/or Parallel Imaging
Authors: Das Bhagwan , Nangdev Pirya , Daseja Kailash Kumar , Hussain Shaiq , Qadir Sushma , Kumar Aneel
Published: November 2022

Aim: To investigate image quality of respiratory triggered 3D MRCP with compressed parallel and sensing imaging in clinical setting. Study design: Cross-sectional study Duration and place of study: Study was conducted in the duration of1st July 2021 to 31st December 2021 at Department of Radiology, Chandka Medical College Hospital, Larkana. Methodology: Ninety patients with age between 40-70 years were enrolled. The patients got three various kinds of MRCP 3 dimensional as a protocol of their diagnosis plan. Four point scoring system was adapted for quality assessment. Results: The mean age of the patients was 66.9±8.6 years. There were almost similar number of males and females. Minimally invasive-intraductal papillarymucinous carcinoma was presented only in 2.22%. Comparison of three magnetic resonance cholangiopancreatography techniques showed that signal quality, was better as longer time involved in 1st magnetic resonance cholangiopancreatography case while blurring was also seen in breath holding magnetic resonance cholangiopancreatography. Conclusion: Better imaging quality of ductal system is obtained through respiratory triggered 3D magnetic resonance cholangiopancreatography against breath hold. Keywords: Magnetic resonance cholangiopancreatography, 3D Imaging, Compressed Sensing, Parallel imaging
Correlation between Admission Criteria and Academic Performance in Medical and Dental Colleges of Khyber Pakhtunkhwa
Authors: Khan Imran Zaman , Mahboob Usman , Yasmeen Rahila
Published: November 2022

Aim: To evaluate the connection among admission criteria and academic performance amongst medical and dental scholars of different institutes of Khyber Pakhtunkhwa. Study design: Quantitative-cross-sectional study. Study setting: Department of Medical Education of Khyber Medical University, Peshawar from 15th February to 15th July 2017. Methodology: Ten thousand and sixty one students attending 10 Medical colleges of KP from entering for qualification who were registered in the 2017, 2018, 2019, 2020, 2021 and 2022 academic sessions. Results: Intermediate marks (with median =0.22) have noteworthy correlation (both at 0.05 & 0.01 points) with all 5 professional exam marks of all medical sample scholars, trailed by Merit and Entrance test (0.33 and 0.19 median marks). The relationship for merit and entrance marks was also noteworthy for all of the cases excluding for 3rd year. Conclusion: All the forecasters (intermediate, entrance test and merit marks) were meaningfully linked with all 5 MBBS examination marks of all the medical colleges, in nearly all the six units. Though, stepwise regression analysis uncovered that amongst the analysts, from 1st to 4th year, Intermediate was establish the finest analyst, tracked by merit and entrance score whereas for the fifth year; merit was the finest analyst, trailed by entrance test and Intermediate scores. Key words: Educational Testing and Evaluation Agency (ETEA), Predictive validity,
Role of Multislice CT Imaging in Predicting the Visibility of the Round Window during Cochlear Implantation
Authors: Daseja Kailash Kumar , Qadir Sushma , Das Bhagwan , Memon Imran Khan , Nangdev Pirya , Hussain Shaiq
Published: November 2022

Aim: To envisage the visibility of round window nichein pediatric cochlear implantation by using computed tomography. Study design: Retrospective study Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st July 2021 to 31st March 2022. Methodology: Fifty five patients underwent the procedure of unilateral-cochlear implantation. Slices of round window niche and round window membrane were selected for visualization through HRCT imaging. The temporal bone imaging through high resolution computed tomography scans; before and after the operation were examined in detailed and scored. Each round window membrane and round window niche was then visualized for its visibility. The sensitivity as well as specificity of high resolution computed tomography imaging in prediction of round window membrane visuality were calculated. Results: The comparison of predictive values showed that the positive-predictive value of RWM was 73.1% and negative as 91.2%. The sensitivity as well as the specificity of HRCT identification in prediction difficulty in visualizing RWM was 79% and 87% respectively. Conclusion: Pre-operative high resolution computed tomography was proved helpful in visualization of detecting round window niche. Key words: CT scan; Cochlear implantation; Round window niche; Pediatrician
The Outcome of Single Stage versus Two Stage Repair in Anorectal Malformations with Recto-Vestibular Fistula
Authors: Rehman Shafiq-Ur , Haq Muhammad Riaz-Ul , Fazal Zarlish , Makki Yasir , Anwar Muhammad , Ishtiaq Fareena
Published: November 2022

Background: Imperforate anus with recto-vestibular fistula is one of the most common anorectal malformations in females. Wound infection and disruption after recto-vestibular fistula repair may affect the fecal continence and functional outcome. Fecal incontinence may cause long term social, economical and psychological problems in children. Although a protective colostomy reduces the infectious complications and dehiscence, it is also associated with many problems. Aim: To compare the safety, feasibility, post operative complications and functional outcomes of limited posterior sagittal anorectoplasty with or without colostomy. Study design: Prospective descriptive study. Place and duration of sudy: Department of Pediatric Surgery, Sahiwal Teaching Hospital Sahiwal, from 1st January 2019 to 31st December 2021. Methodology: Forty-one patients with congenital recto-vestibular fistula were managed by two techniques. Patients were divided into two groups. Group A (19 patients): were operated by single stage limited posterior sagittal anorectoplasty without covering colostomy. Group B (22 patients): were operated by two stage technique. Limited posterior sagittal anorectoplasty and covering colostomy in first stage and stoma closure was done in second stage. The patients in both groups were evaluated for hospital stay, operation time, postoperative complications, fecal continence, constipation, bowel function. Results: The age of patients ranged from 11-56 months (mean 26.93 months) in Group A and 9-60 months (mean 27.03 months) in Group B. The total length of hospital stay in Group A ranged from 7-11 days (mean 9.20 days); however, in Group B, it ranged from 4-6 days (mean 5.01 days) for first stage procedure and 8-11 days (mean 9.27 days) for second stage colostomy closure procedure. In Group A, complications were, wound infection 03 (15.78%), anal stenosis 02 (10.52%), mucosal prolapse 01 (5.26%), constipation 04 (21.05%), soiling 04 (21.05%), perineal excoriation 03 (15.78%) and recurrent H-type recto-vestibular fistula 01 (5.26%). In Group B, during the first stage of repair, one patient (4.54%) developed wound infection. Mucosal prolapse was observed in one patient (4.54%). Constipation was reported in 03 (13.63%) and soiling in 01 (4.54%). Peri stoma skin excoriation was seen in five patients (22.72%). Stomal prolapse was observed in two patients (9.09%). Two patients (9.09%) developed wound infection after colostomy closure. Conclusion: Single stage repair of congenital recto-vestibular fistula increases the risk of postoperative complications. Two stage approach is associated with less postoperative complications. However it is associated with lengthy hospital stay, long operation time and complications related to stoma formation and closure. Keywords: Recto-vestibular fistula, Limited posterior sagittal anorectoplasty, Single stage technique, Two stage technique.
Effect of Out of Pocket Cost on Following Mammography Screening
Authors: Hussain Shaiq , Nangdev Pirya , Das Bhagwan , Daseja Kailash Kumar , Qadir Sushma , Kumar Aneel
Published: November 2022

Aim: To analyze the effect of out of pocket cost on subsequent mammography screening. Study design: Retrospective observational study Place and duration of study: Department of Radiology, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat from 1st April 2021 to 31st March 2022. Methodology: One hundred female patients having ages 40-65 years with health insurances were followed from their baseline mammography screening up to their 12-36 months screening was enrolled. The clinical recorded, adjusted clinical group and other related information were documents. Results: 69% supported by a low deductible health policy while 31% were supported with a high deductible health policy The Adjusted Clinical Group score showed 74% within 0.3 scoring. For baseline mammography a decreased by 3.4% up to 12-24 months time was noticed. Conclusion: Out pocket cost has a significant effect of decreasing patient’s number for subsequent mammography screening. Keywords: Breast carcinoma, Mammography, Screening
Clinical Epidemiological Study of Children with Cleft Lip and Palate
Authors: Iqbal Shawana , Adil Shahab , Gillani Syed Riaz , Shah Syed Salman , Sami Asma
Published: November 2022

Aim: To determine the frequency of different types of cleft lip and palate and to investigate the possible relation of some risk factors to cleft lip and palate. Study design: Descriptive study. Place and duration of study: Peshawar Dental College, Peshawar Pakistan from 1st August 2017 to 31st January 2019. Methodology: One hundred and seven patients with congenital cleft lip and cleft palate deformities, either gender and age ranged from 1 day to 720 days were enrolled. Cleft types were categorized as bilateral cleft lip and palate (BCLP), left cleft lip and palate (LCLP), right cleft lip and palate (RCLP), cleft alveolus (CLA) and bilateral incomplete cleft (BICLP). Results: There were 73(68.2%) males and 34(31.8%) females. The highest number of patients from Peshawar 30(28%) followed by Swat 21(19.8%) and Charssada by 11(10.3%). Forty two (39.3%) patients’ parents had consanguineous marriages. There were 89(83.2%) of mother haven't used folic acid during their pregnancy. Forty 40(37.4%) cases had a positive family history of cleft deformities. Most common systemic disease was anemia 25(23.2). Eighty five (79.4%) of cleft lip and palate patients were belonging to poor class family. Conclusion: The households of cleft lip and palate children demonstrated low socioeconomic status. The incidence of cleft lip and palate should be reduced to enhance the conditions of women during pregnancy by maintaining a balanced diet and giving them folic acid. Keywords: Epidemiology, Children, Cleft lip, Palate, Risk factors
Recurrence of COVID-19 Infection in Healthcare Workers after complete Vaccination
Authors: Naseer Aqsa , Nazar Madeeha , Khan Jamila , Nasim Humera , Khan Mujeeb , Anjum Nida , Umar Muhammad
Published: November 2022

Background: COVID-19 is a novel infection. Since its first case report in 2019, it has affected population globally. Healthcare workers are at most risk as they are in direct contact with patients. Aim: To record recurrence of symptomatic COVID 19 after complete doses of Sinopharm vaccine among healthcare workers. Study design: Descriptive case series Place and duration of study: Department of Gastroenterology, Holy Family Hospital, Rawalpindi from 12th December 2021 to 11th June 2022. Methodology: Twenty four healthcare workers and between 20-60 years who had COVID-19 infection previously and despite receiving two doses of Sinopharm vaccine, again developed symptomatic COVID-19 diseases were enrolled. The severity was graded as per guidelines provided by CEAG. The extent of exposure during work was documented. Results: No significant association was found with any of the healthcare workers with duration and extent of vaccination. Upto 66% of the front line workers got COVID at 5th month and no considerable variation was noticed in other months of the vaccination. Similarly, three PGs also got COVID at 5th month and at 5th month highest number of frontline workers got COVID-19. Conclusion: COVID-19 reinfection can occur even after vaccination though symptoms remain relatively mild and Sinopharm provides protection against severe infection for prevention of COVID-19. Keywords: COVID, Recurrence, Health workers, Vaccination, Infection
Paramedics’ knowledge, attitudes, and practices regarding the use of personal protective equipment against COVID-19
Authors: Gangaram Padarath , Pillay Yugan , Alinier Guillaume
Published: November 2022

The risk of novel coronavirus disease (COVID-19) transmission in the confined mobile ambulance compartment is increased during aerosol-generating procedures and close proximity. Paramedics are encouraged to increase body-surface-isolation by donning additional personal protective equipment (PPE) during patient encounters. This study aimed to better understand paramedics’ knowledge, attitudes, and practices related to PPE use during the COVID-19 pandemic in the prehospital setting with a focus on mitigating risks associated with infection control.

This prospective quantitative study collected descriptive data using a specifically designed data collection tool. The survey data was then cleaned and analyzed with Microsoft Excel® and the latest version of the Statistical Package for Social Sciences.

One thousand frontline paramedics employed by the Hamad Medical Corporation Ambulance Service () were invited via email to participate in the study. A total of 282 (28.2% of frontline paramedics) paramedics completed the online survey, of which 80.1% completed the mandatory online infection control training program within the last year, and 17.0% between one to two years ago. Approximately 83% of the participants had completed an N95 mask fit test at within the past five years, and 91.5% completed the hand hygiene training.

The study found that 98.2% of the paramedics were knowledgeable about COVID-19 and its transmission, while 96.1% agreed that aerosol-generating procedures increased airborne transmission. The paramedics’ attitudes were mainly positive toward the use of PPE to prevent the spread of the virus, which was synchronous with their practice. The sample population demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitudes and good infection control practices were demonstrative of efforts to mitigate risks associated with the spread of the virus.
Association of ultrasonographically determined anatomical location of Bethesda 3 thyroid nodules with differentiated thyroid cancer
Authors: Gezer Emre , Demirkan Halil , Cantürk Zeynep , Selek Alev , Çetinarslan Berrin , Sözen Mehmet , Çalişkan Mustafa , Çağrı Karci Alper , Bilgen Özcan Tevhide , Topaloğlu Ömercan , Yaprak Bayrak Büşra , Demirkol Özge
Published: November 2022

Background: The size of a thyroid nodule and certain sonographic features, such as marked hypoechogenicity, microcalcifications, taller-than-wide shape, microlobulated, or irregular margins, indicate the greater malignancy risk. The frequency of the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category among cytology reports from thyroid fine-needle aspirations ranges from 0.8% to 28%, whereas the risk of malignancy of these nodules varies from 6% to 97%. This retrospective analysis investigated whether the preoperative ultrasonographic location of Bethesda 3 thyroid nodules is a predictive risk factor for differentiated thyroid cancer (DTC).

Methods: A total of 387 patients who underwent total thyroidectomy for a nodule with AUS/FLUS cytology and diagnosed with a DTC at five tertiary referral centers between 2010 and 2020 were retrospectively analyzed. The location of the thyroid nodule with AUS/FLUS cytology was categorized into two groups: one group was composed of the isthmus, upper lobe, middle lobe, and lower lobe, whereas the latter consisted of right lobe, left lobe, and isthmus.

Results: DTC was diagnosed in 40.6% (n = 157) of the operated nodules. Multiple logistic regression analysis has revealed that hypoechogenicity of the nodule (odds ratio [OR] = 2.929, p < 0.001) was the only independent predictive factor for the malignancy of the nodules with AUS/FLUS, whereas the location of the nodule, age, and sex were not significantly independent risk factors. Multifocality and contralateral benign nodules were independent predictive factors for multicentricity (OR = 3.5, p = 0.002; OR = 5.5, p = 0.001, respectively).

Conclusion: As the first study investigating the association between a Bethesda 3 nodule location and the risk of malignancy by evaluating postoperative cytology reports, the results showed that nodule location with AUS/FLUS on fine-needle aspiration biopsy was not a predictive risk factor for the diagnosis of DTC.
Maternal risk factors of COVID-19-affected pregnancies: A comparative analysis of symptomatic and asymptomatic COVID-19 from the Q-PRECIOUS registry
Authors: Minisha Fathima , Farrell Thomas , Abuyaqoub Salwa , Abdel Rahim Abubaker , Ahmed Huda , Omer Mai , Abraham Merlin , Teunissen Franciscus , Gassim Mahmoud , group Q-PRECIOUS
Published: November 2022

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has had consequences on the pregnant population, as disease severity is associated with the quality of maternal health and pregnancy complications, increasing maternal and neonatal morbidity. Worldwide descriptive data help describe risk factors that could predict symptomatic and severe COVID-19 in pregnancy.

Objectives: To describe demographic features and risk factors of pregnant women with COVID-19 in Qatar and compare symptomatic versus asymptomatic disease.

Study design and methodology: Clinical characteristics and risk factors of pregnant women with COVID-19 in Qatar from March 2020 to March 2021 was retrospectively reviewed, comparing the cohort with the general pregnant population. Crude and adjusted odds ratios (aORs) were computed, comparing symptomatic versus asymptomatic infection.

Results: Of the 500 women, 347 reported at least one symptom at diagnosis (347/500; 69.4%). The majority fell in the 30–39 years age group (241/500; 48%), with more than half in the obese body mass index (BMI) category. The cohort was 66% (332/500) Qatari women, compared with the 26% expected in the population (26.4% vs 66.4% p < 0.001). Compared with the 2019 national statistics, the number of women was higher in the >40 years age group (5% vs 7.6%, p = 0.027) and grand multiparous group (5.4% vs 13.6%, p < 0.001). The symptom most commonly reported by the symptomatic group was cough (276/500; 55%), followed by fever, fatigue, and myalgia. In the adjusted analysis, the symptomatic group had 2.7 times higher odds of being asthmatic (OR = 2.67, 95% CI 1.1–6.7, p = 0.037). Women aged >40 years had 6.6 times higher odds of symptomatic disease (aOR = 6.6, 95% CI 1.08–39.73, p = 0.041). A history of contact with a patient with symptomatic COVID and earlier gestational age at diagnosis increased the odds (aOR = 2.06, 95% CI 1.2–3.54, p = 0.009; aOR = 0.73 95% CI 0.57–0.96; p = 0.017).

Conclusions: This study cohort included significantly more Qatari women, older women, grand multiparous women, a higher proportion with pre-existing and gestational diabetes, and higher BMI than national data. In addition, contact to a patient with symptomatic disease, history of asthma, older age, and earlier gestational age at diagnosis were significantly associated with symptomatic disease.
Back pain as an initial feature of advanced gastric cancer mimicking multiple myeloma: A case report and literature review
Authors: Ata Fateen , Yousaf Zohaib , Al Kalaji Bilal N. , Ashour Anas A. , Fael Mohamad , Eun Kim Gi , Bint I Bilal Ammara , Elaiwy Orwa , Jones Akhnuwkh
Published: November 2022

Background: Back pain is a rare initial presentation of gastric cancer. Isolated back pain with red flags in middle-aged patients might indicate multiple myeloma. However, it is rarely present in advanced gastric adenocarcinoma; hence, data are limited to case reports only. For a timely diagnosis of the underlying malignancy, endoscopy should be considered if the initial workup for this backache is unrevealing.

Case Presentation: We present a 34-year-old previously healthy gentleman with severe unremitting backache. He was ultimately diagnosed with gastric adenocarcinoma stage IV and received palliative treatment. The manuscript also reviewed relevant literature.

Conclusion: In rare cases, gastric malignancy can initially present as back pain with lytic bone lesions, mimicking multiple myeloma. Endoscopy early in the course of investigations may help reduce associated morbidities. Further, more extensive studies are required to understand better the clinical characteristics, demographics, and management of such patients.
El espacio en la vivienda social y calidad de vida
Authors: Sepúlveda Mellado Orlando
Published: November 2022

El problema de la definición de la calidad de vida en los asentamientos populares, es un tema de gran preocupación y debate en este último tiempo, en que se reconoce el derecho fundamental de las personas a la vivienda, pero la calidad que debe poseer dicha solución desde el origen, aparece como un problema secundario frente a la escasez de recursos financieros y a la distribución de ellos. Inserto en esta discusión, aparece el presente artículo, presentado por el profesor Orlando Sepúlveda M. a las jornadas "Aplicación de las Ordenanzas de Edificación en Barrios Populares", organizadas por la Escuela de Arquitectura y Bellas Artes de la Pontificia Universidad Católica de Chile.