bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of Serum Inhibin-A Levels in Differentiating Pre-Eclampsia and Gestational Hypertension
Authors: Shah Shahrukh , Aamir Muhammad , Haroon Zujaja Hina , Bibi Afshan , Akber Rabiya , Khalid Usama Bin
Published: December 2022

Objective: To determine the association of serum Inhibin-A levels in differentiating Pre-eclampsia and gestational hypertension.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) Rawalpindi, in collaboration with the Gynaecology and Obstetrics Department at Combined Military Hospital (CMH), Rawalpindi Pakistan, from Jul 2020 to Jun 2021.

Methodology: Nulliparous women with single pregnancy in the third trimester admitted to evaluate high blood pressure in the Department of Gynaecology and obstetrics CMH Rawalpindi were selected after getting their informed written consent. Forty women with pre-eclampsia, forty with gestational hypertension, and 40 normotensive pregnant healthy women receiving routine antenatal care were matched for parity, age, and gestational age.

Results: The concentration of inhibin A [Median (IQR)] in women having preeclampsia were significantly higher [1745 pg/ ml (1601.2–1821.7)] than subjects with gestational hypertension [895 pg/ml (834.5-977.5)] and normotensive pregnant women [637pg/ml (589-684.7)] with p-value 0.001. Further, Women with severe preeclampsia had a considerably greater serum concentration of inhibin A [Median (IQR)] [1895 pg/ml (1827.2-1955.7)] than those with mild preeclampsia [1686 pg/ml (1537.5-1762.7)].

Conclusion: As per our study, median serum Inhibin A concentrations were higher in pre-eclampsia subjects than in gestational hypertension. In clinical situations, serum Inhibin A levels may be used to differentiate between pre-eclampsia and gestational hypertension.
Neonatal supporative parotitis - A case report
Authors: Hussain Shabbir , Alam Samina Shamas , Hussain Moeez
Published: December 2022

A 9-day old male neonate was admitted for fever. He was born at term with normal antenatal records and a smooth transition from in utero to ex utero. He was febrile and had a left-sided pre auricular hot, tender, erythematous swelling and oral purulent discharge from Stensen’s duct. The septic profile was suggestive of sepsis. Ultrasonography revealed parotid gland enlargement with pus collection. Empirical antibiotics started, and parotid swelling pus drained. Culture of Pus from parotid swelling and Stensen’s duct yielded growth of Staphylococcus Aureus. According to the sensitivity report, antibiotics continued for ten days, and the patient was discharged after complete resolution of signs and symptoms.
The Correlation of Platelet Indices; Platelet Count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Platelet-Large Cell Ratio (P-LCR) with Mortality in Patients Admitted to PICU
Authors: Nadeem Muhammad Tariq , Hassan Syed Arsalan , Basit Abdul , Siddiqui Abdul Wahab , Awan Aamir Aslam , Ahdi Saher Gul
Published: December 2022

Objective: To determine the correlation of platelet indices; platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) with mortality in patients admitted to PICU.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Pediatric Intensive Care Unit (PICU) of CMH Lahore from Jun 2019 to May 2020.

Methodology: Cases (mortality group) were the 81 consecutive patients who died in the PICU during the study period and fulfilled inclusion criteria. The control group comprised 81 surviving patients admitted to PICU contemporarily. Both groups' mean values of platelet indices (PC, MPV, PDW and P-LCR) were compared.

Results: The mortality rate was 10.42%. Infants were the largest sub-group (45.68%) in the mortality group. Mean platelet counts were significantly low, while mean MPV, PDW and P-LCR were significantly higher in children in the mortality group compared to the control group (p-value <0.001). The correlation coefficient 'r' was -0.682,0.598,0.671 and 0.355 for platelet count, PDW, MPV and P-LCR, respectively, showing a negative correlation between platelet count and positive correlation of mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) with mortality.

Conclusion: Deranged platelet indices, as manifested by lower platelet count and higher values of MPV, PDW and p-LCR, were significantly correlated with higher mortality in children admitted to PICU and can be used to predict/anticipate the severity of illness.
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy with a History of Previous Surgery of Suicidal Intake of Hydrochloric Acid
Authors: Qayum Mamuna , Akhtar Salman , Ali Osama , Ali Waleed , Waheed Nomira , Fatima Tatheer
Published: December 2022

A patient with a history of previous abdominal surgery is at increased risk of visceral injury due to adhesion and excessive bleeding, which may require surgical repair. The optimal outcome can be achieved with the inter-professional team, patient care after being discharged from the hospital, and follow-up after surgery for eight weeks. Here we present as case of total abdominal hysterectomy with bilateral salpingo-oophorectomy with a history of previous surgery of suicidal intake of Hydrochloric Acid.
Comparison of Sphenopalatine Block and Intravenous Paracetamol for the Treatment of Post-Dural Puncture Headache
Authors: Khan Abid , Feroz Shizan Hamid , Iqbal Sana , Sultan Muhsan , Munir Sajid , Ahmed Waqas
Published: December 2022

Objective: To compare the effect of topical sphenopalatine block and intra venous Paracetamol in the management of post-Dural puncture headache.

Study Design: Quasi-experimental study.

Place and Duration of Study: Combined Military Hospital Peshawar Pakistan, from Jan to Aug 2021.

Methodology: This experimental study was conducted on 153 patients who underwent lumbar puncture for any procedure and then suffered from post-Dural puncture headaches. Patients were randomized into two groups. Group A received the topical sphenopalatine block, while group B received the intravenous Paracetamol three doses 12 hours apart. Headache was recorded on Numeric pain score (NPS) 24 hours after the surgical procedure. Comparison in pain relief was compared in both groups at 1 hour, 12 hours, 24 hours and 48 hours.

Results: Out of 153 patients randomized into two groups, 76 (49.7%) were categorized into Group-A, and 77 (50.3%) were categorized into Group-B. 63 (41.2%) were male, while 90 (58.8%) were female. The mean age of patients included in our study was 34.34 ± 4.33 years. Gynaecological/obstetric procedures 70 (45.7%) were the most common indication for lumbar puncture in our study. At 1, 12, 24 and 48 hours, pain relief was statistically significantly better in Group-A than in Group-B (p- value<0.005).

Conclusion: Sphenopalatine ganglionic block emerged as a better option for pain relief among patients suffering from post-Dural puncture headache than intravenous Paracetamol. In addition, immediate and short-term relief was better among patients who used sphenopalatine block.
Perception of Undergraduate Medical and Health Sciences Students Regarding Online Formative Assessments During COVID-19
Authors: Ain Noor Ul , Jan Sadiq , Yasmeen Rahila , Mumtaz Hassan
Published: December 2022

Objective: To look into the experience of undergraduate medical and health sciences students regarding perceptions of online formative assessments.

Study Design: Online cross-sectional survey.

Place and Duration of Study: Riphah International University, Islamabad Pakistan, from Aug to Dec 2020.

Methodology: Three hundred fifty-one pre-clinical and clinical students of disciplines including MBBS, BDS, and Pharm-D participated in the study. Data was collected through a convenient sampling technique. An online questionnaire containing 22 closed-ended questions with a three-point Likert scale on five themes related to online formative assessments and one openended question was used.

Results: 86 (24.5%) students agreed that online formative assessments improved their learning. The motivation for learning was increased in 120 (34.2%) students. 214 (61%) students felt that online formative assessments were stressful, and the majority were well aware of the use of technology except for connectivity and login issues highlighted by the students. Regarding the question paper, the majority were comfortable with the construct of online formatives. 158 (45%) students were not satisfied with the allotted time to complete the formative assessments. 163 (46.4%) students were satisfied with the feedback provided, yet 258 (73.5%) students recommended formal feedback provided on the same day to improve their learning by knowing their deficiencies.

Conclusion: The study results support the contention that well-designed online formative assessments have considerable untapped potential to assist learning by motivating students. Their problems and challenges need to be addressed to improve the online assessments that help in the learning of undergraduate students.
Assessment of Safety and Efficacy of Anesthesia using Sevoflurane with Supraglottic Airway Device In Pediatric Patients Undergoing Magnetic Resonance Imaging
Authors: Tiwana Azmat Riaz , Hafiz Amran , Gulrez Amna , Majeed Kaukab , Adnan Ahmed , Maqsood Shahid
Published: December 2022

Objectives: To determine the safety and efficacy of Sevoflurane anaesthesia with a supraglottic airway device for MRI.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Anaesthesiology, of Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul to Dec 2019.

Methodology: A sample size of 152 patients were calculated, including both genders from birth to 12 years. After applying inclusion and exclusion criteria, patients were chosen to undergo inhalational anaesthesia with Sevoflurane, including supraglottic airway device (SAD) insertion. After MRI, SAD was removed upon awakening and patients were shifted to the post-anaesthesia care unit (PACU) for further monitoring.

Results: The mean age of patients was 4.07±2.312 years. Out of 152 patients, ninety (60%) were males, and sixty patients (40%) were females. Hypoxemia was seen in 1.3% cases, laryngospasm in 1.3%, and apnoea in 8% and coughing in 5% patients. There were no any other complications.

Conclusion: The study concluded that Sevoflurane anaesthesia with SAD is a safe and reliable technique for artefact-free MRI of paediatric patients.
Frequency of Hepatitis C Virus and Human Immunodeficiency Virus Coinfection among Intravenous Drug Abusers; Experience from A Single Rehabilitation Center
Authors: Saeed Khawar , Khan Asadullah , Khanam Afshan , Lashari Naveed Aslam , Khan Hajra , Khan Ahsan
Published: December 2022

Objectives: To determine the frequency of Hepatitis C virus and Human Immunodeficiency Virus (HIV) Coinfection among Intravenous drug abusers in a rehabilitation Centre.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Medical and Rehabilitation Centre of District Jail, Lahore Pakistan, from Jul to Dec 2019.

Methodology: A total of 220 participants with a history of intravenous drug abuse were screened for Human immunodeficiency virus, Hepatitis C virus, and hepatitis B virus, with positive cases confirmed by polymerase chain reaction tests.

Results: The median was age 27(8.0) years. Only 12 (5.5) had above higher secondary education. Injectable heroin and metamphetamine used by the respondents were 182 (82.7) and 41 (22.5), respectively. Human immunodeficiency virus infection was present in 163 (74.1), Hepatitis C infection in 149 (67.7), Hepatitis B infection in 9 (4.09), and co-infection of human immunodeficiency and hepatitis C virus infections in 118 (53.6) respectively. Human immunodeficiency virus infection showed a significant association with education level (p<0.01) and drug use (p=0.01). Hepatitis C infection showed association with marital status (p=0.04), religion (p<0.01) and drugs used, while Co-infection showed association with religion and drug used (p=0.01 and p=0.004 respectively).

Conclusion: Intravenous drug users have a significantly higher prevalence of Human immunodeficiency and hepatitis C infection and their co-infection, occurring in more than half of injectable users. In addition, these infections show significant association with education status, marital status and type of injectable drug used.
Diagnostic Accuracy of Prostatic Specific Antigen Densityin Different Prostatic Disorders
Authors: Bashir Qamar , Haroon Zujaja Hina , Asif Naveed , Haroon Azka , Asif Muhammad , Jaffar Syed Raza
Published: December 2022

Objective: To determine the diagnostic accuracy of PSA density in Prostate Cancer, Benign Prostatic Hyperplasia (BPH) and Prostatitis, taking biopsy as the gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Chemical Pathology and Endocrinology Department, Armed Forces Institute of Pathology (AFIP) in collaboration with Histopathology department, AFIP, Armed Forces Institute of Urology (AFIU) and Institute of Radiology (AFIRI) Rawalpindi Pakistan from Mar 2019 to Mar 2020.

Methodology: Prostate-specific antigen was analyzed on a fully automated random-access immunoassay-ADVIA® Centaur XP. Prostate volume was measured through transrectal imaging technique, and prostate density was obtained by dividing total Prostate-specific antigen by prostate volume. Specificity and sensitivity, along with the positive predictive and negative predictive value of both Prostate-specific antigen and Prostate-specific antigen density (PSAD), were calculated. In addition, the Receiver Operating Characteristic (ROC) curve was plotted for total Prostate-specific antigen and Prostate-specific antigen density PSA separately.

Results: Overall, 129 subjects were registered in the study. Out of these 129 individuals, 59 (45.7%) had prostate cancer, 52 (40.3 %) were benign prostatic hyperplasia (BPH), and 14% of subjects had other prostatic disorders. Total Prostate-specific antigen (PSA) had a sensitivity of 75.61% with a specificity of 76% while Prostate-specific antigen density showed 88% sensitivity and 86% specificity. The area under the curve (AUC) for total Prostate-specific antigen was 0.66, while that for total Prostate-specific antigen density (PSAD) was 0.87.

Conclusion: Prostate-specific antigen density is a better predictive and non-invasive diagnostic marker for different prostatic disorders than total Prostate-specific antigen. It has.......
Perceived Stress, The Sources, Severity and Coping Mechanisms Among Undergraduate Medical Students in a Pakistani Medical School
Authors: Rahman Dania Khawar , Nadeem Amina , Riaz Bushra
Published: December 2022

Objective: To assess the perceived stress, its sources, and severity and evaluated the relationship between causes of perceived stress and their coping mechanisms.

Study Design: Cross-Sectional Survey.

Place and Duration of Study: Army Medical College Rawalpindi and Fuji Foundation University Medical College, Islamabad Pakistan from Jun 2018 to Jun 2019.

Methodology: Four hundred undergraduate medical students of the first and second-year MBBS were included in this study. Voluntary consenting students filled the questionnaires regarding perceived stress, its sources, and severity, along with the coping mechanisms.

Results: Among 400 participants, the male and female students were 55.3% and 44.8%, respectively. Three hundred and forty (85%) students were stressed. Perceived stress was not statistically associated with academic stress (p-value=0.77). The coping mechanisms that were found significant were the 'use of tranquillizer' and 'positive reframing' with p-value of 0.018 and 0.025.

Conclusion: A higher level of perceived stress was found in the medical students. Mostly the stressors were associated with the academic domain and not related to health and psychosocial domains. The coping mechanism used by the medical students were tranquillizers and positive reframing.
Trends of Different Gynaecological Cancers at Combined Military Hospital Lahore; An Overview of Last Five Years
Authors: Baqai Shehla M , Ashraf Viqar , Sajjad Rabia , Qayyum Aqsa
Published: December 2022

Objective: To observe trends of gynaecological malignancies at Combined Military Hospital Lahore.

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jan 2015 to Dec 2019.

Methodology: Data was retrieved from patient admission and discharge notes and their records at the pathology department. Variables like trends of gynaecological malignancies, mean age, common presenting complaint, and common malignancy with histopathology type were collected.

Results: A total of 107 patients were selected from 2015-2019. Commonest malignancy observed was carcinoma endometrium 51 (47.6%) followed by carcinoma ovary 32 (29.9%), and gestational trophoblastic disease 17 (15.8%), carcinoma cervix 6(5.6%) with one case of carcinoma vulva (0.9%). The common presentation was postmenopausal bleeding 27 (25.2%). Among endometrial carcinoma, adenocarcinoma was the common histopathological type (92.1%). The mean age observed with carcinoma endometrium was 46.9 ± 9 years, ranging from 45-65 years.

Conclusion: Endometrial malignancy was the commonest malignancy observed in our study. Most patients presented with postmenopausal bleeding. Trends of different gynaecological malignancies were reviewed.
Impact of a 20-Minute Counselling Session on Smoking Cessation in an Outpatient Clinic; A Cohort Study
Authors: Naseer Umer , Nisar Shazia , Saleem Taimoor , Qamar Mahnoor , Naseer Fatima , Ashraf Taimoor
Published: December 2022

Objective: To assess the smoking abstinence rate after a twenty-minutes structured counselling session.

Study Design: Prospective Cohort Study.

Place and Duration of Study: Respiratory Clinic, Pak Emirates Military Hospital, Rawalpindi Pakistan from Jun to Dec 2020.

Methodology: A total of 400 active smokers visiting respiratory clinics were inducted into counselling sessions of twenty-minute duration for a structured smoking cessation counselling advice during which additional information regarding age, motivation status, duration of smoking, previous cessation attempts etc., was also recorded. All candidates were followed by telephone for six months for subject-reported abstinence status.

Results: All the study participants were males between 39 to 64 years of age (mean age: 52.27 ± 4.78 years), of which 23 lost to follow-up, 102 (25.5%) remained quitters successfully, while the remaining 305 candidates relapsed at the end of 6 months. The highest relapse was observed at the end of 3 months, while the lowest relapse rate was observed in the fifth and sixth months since the quit date. Younger age had more odds of successful cessation rate than others (OR=6.13 CI 95%, p<0.001). Those with a motivation score of 8 or more had more probability of abstaining (OR=5.38, CI 95%, p-value=0.001)

Conclusions: The smoking abstinence rate in these counselling sessions was as significant as in other smoking cessation programs. The probability of quitting was more in younger adults and highly motivated ones.
Frequency of Cervical Ribs in Healthy Asymptomatic Adolescents and Adults, Detected on Chest Radiograph for Medical Fitness Examination at CMH Lahore
Authors: Ahmed Nisar , Hasnain Muhammad Ali Zul , Riaz Hassan , Arshad Zimar , Kubra Khadijah Tul , Fatima Khushboo
Published: December 2022

Objective: To determine the frequency of cervical ribs on chest radiographs of asymptomatic candidates undergoing medical fitness.

Study Design: Cross-sectional study.

Place and Duration of Study: Radiology Department Combined Military Hospital Lahore Pakistan from Feb 2020 to Mar 2021.

Methodology: The study was conducted on 4247 chest radiographs of candidates who reported to CMH Lahore for medical examination. The latest chest radiographs of candidates reporting for medical examinations in the CMH Lahore were included. Technically poor radiographs were excluded.

Results: The frequency of cervical ribs was 136 (3.2%) with 14 (5.6%) females and 122 (3.1%) male cases. Among cervical ribs cases, 85 (62.5%) were bilateral, and 51 (38%) were unilateral. Among unilateral cervical ribs, 28 (55%) were right-sided, and 23 (45%) were on the left side.

Conclusion: The frequency of cervical ribs is comparatively higher than in most international studies. The frequency of bilateral cervical ribs and type 4 cervical ribs are higher in females than males.
Relationship of Superstitious Beliefs and Self Efficacy with the Role of Education and SocioEconomic Status; A study at Garrison University Lahore Pakistan
Authors: Sehar Hifza , Razaq Noshaba , Kanwal Shamsa , Ashraf Muhammad Tanveer , Mumtaz Shahana , Tehzeeb Muhammad
Published: December 2022

Objective: To determine the relationship between superstitious beliefs and self-efficacy among participants and explore selfefficacy, age, education, gender and socioeconomic status as the significant predictors of superstitious beliefs among participants.

Study Design: Cross-sectional study.

Place and Duration of Study: Garrison University, Lahore Pakistan, from May to Nov 2020.

Methodology: Total number of 200 study participants, age ranged of 18 to 50 years, were selected. The questionnaires; (1) a measure to superstitions scale and (2) general self-efficacy scale, were used to analyze the relationship between superstitious beliefs and self-efficacy with the role of ageing, education and socioeconomic status among participants.

Result: Out of 200 male and female participants, study results reveal that superstitions belief and self-efficacy were correlated positively in a very small to moderate direction. Moreover, the study result showed that age (β=0.10), gender (β=0.05), socioeconomic status (β=0.91), and self-efficacy (β=0.24) were positively predicting superstitious beliefs while education (β=- 0.09) was negatively predicting the superstitious beliefs among participants.

Conclusion: The results of the study showed the positive correlation between superstitious beliefs and self-efficacy among participants. Furthermore, the study concluded that participants' age, gender, socioeconomic status and self-efficacy were positive predictors of superstitious belief.
Hearing Loss Due to Occupational Exposure: An Analysis of Cases at Lahore
Authors: Khan Muhammad Khalid Azam , Ahmed Atique , Azam Khan Muhammad Khalid , Akhtar Sunarays , Najam Atif , Mushtaq Saadiya
Published: December 2022

Objective: To study the severity of noise-induced hearing loss and noise levels in the environment in occupationally exposed individuals at Pakistan air force base Lahore.

Study Design: Prospective longitiginal study.

Place and Duration of Study: Pakistan Air Force base Lahore Pakistan, from Dec 2019 to Jun 2020.

Methodology: The noise levels and duration of exposure to loud noise were measured at various exposure points to define ways and means for future prevention.

Results: Out of 3000 patients reporting to the ENT outpatient department for various problems, 33.3% had ear problems. Out of 1000, 750 had hearing loss with normal tympanic membranes. Among 750, 200 (26.6%) had conductive hearing loss, while 550 (73.3%) had sensorineural hearing loss. Out of 550, 70 (12.72%) were related to occupational exposure in service and 480 (87.2%) were due to various causes. Most patients reported from the security wing (40, 57.14%) being exposed to the loud noise of gunfire as a pulsed exposure, followed by patients in the telecommunication field (20, 28.57%) being exposed to persistent noise.

Conclusion: Occupational exposure to loud noise in the workplace poses significant health issues, including an economic burden on an individual. NIHL related to occupational exposure to loud sounds is frequently reported worldwide. Education and prevention are two vital steps which can reduce the number of such cases significantly, thus preventing this lifelong disability, ensuring health and reducing the economic burden.
A Study on the Clinical Profile, Blood Profile and Culture Sensitivity Pattern of Salmonella Typhi in Paediatric Patients
Authors: Ullah Hakeem , Razzaq Asma , Ahmad Asad Maqbool , Rehman Romisa , Ateeq Saad , Aziz Atif
Published: December 2022

Objective: To study clinical profile, blood profile and culture sensitivity patterns of Salmonella typhi in paediatric patients and factors associated with multi-drug resistant pattern.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Paediatrics and Microbiology Department, Combined Military Hospital Peshawar from Jan 2021 to Jan 2022.

Methodology: A total of 97 paediatric patients with a confirmed diagnosis of Salmonella typhi were included in the study. A detailed clinical proforma was designed to document all the symptoms this patient had since admission. In addition, all baseline blood investigations and culture sensitivity analysis were requested during clinical evaluation. Basic demographic factors were associated with the presence of multi-drug resistant disease patterns in study participants.

Results: Out of 97 children in the study, 65 (67.1%) were males, while 32 (22.9%) were females The mean age of the children in our study was 9.82±3.26 years. 61 (62.8%) patients had Salmonella typhi, which was not multi-drug resistant, while 36 (37.2%) had multi-drug resistant disease. Fever was the commonest symptom reported by our study participants. No organism was found resistant to Meropenem. Statistical analysis revealed that raised C-reactive protein levels at the time of assessment had a statistically significant relationship with the presence of multi-drug resistant disease (p-value=0.001).

Conclusion: A considerable number of pediatric patients with typhoid had multi-drug resistant illnesses in our study participants. Therefore, special attention should be paid to children who had raised C-reactive protein levels at the time of initial assessment.
Frequency of Histological Patterns of Renal Allograft Biopsies– One Year of Renal Allograft Experience
Authors: Ahsan Farah , Asif Muhammad , Chauhan Ishaque , Khan Ahmed Ahson , Aslam Maria
Published: December 2022

Objective: To ascertain the frequency and spectrum of histopathological findings in renal allograft rejection cases received in one year.

Study Design: Cross-sectional study.

Place and Duration of Study: Histopathology Department of Armed Forces Institute of Pathology, Rawalpindi Pakistan from Jun 2020 to May 2021.

Methodology: Renal allograft rejection biopsy cases of 62 male and female patients between the ages of 15-60 years having undergone renal transplant with prior end-stage renal disease over one year were collected. Frequency and histopathological findings were studied after classifying them according to the Banff Classification.

Results: Cellular (T-cell mediated) rejection accounted for more than half of the cases under study, making it the most common cause of transplant rejection in our demographical area. It accounted for 28 (45.2%) slides of all the biopsies studied. Antibody-mediated rejection followed next with 17 (27.4%) slides, with seven slides (11.3%) of the cases borderline for changes accounting for a T-Cell mediated rejection. About 10 (16.2%) were non-specific changes negative for transplant rejection criteria.

Conclusion: Our study was instrumental in establishing rejection patterns and major rejection sub-types while classified under the Banff Classification in our demographical area. The cataloguing of the cases and the major underlying cause would help minimize rejection rates resulting in better clinical outcomes and increased patient survival.
Histopathological Outcome of Oral Lesions in Pakistani Population with Special Emphasis on Oral Cancer
Authors: Waheed Amna , Sarfraz Tariq , Kaleem Fatima , Riaz Rubina
Published: December 2022

Objective: To evaluate varying histopathological outcomes of oral lesions in different age groups and locations of the lesions, with special emphasis on oral cancer.

Study Design: Cross-sectional study.

Place and Duration of Study: Histopathology Department, Foundation University Medical College Islamabad Pakistan, from May 2019 to May 2021.

Methodology: A total of 99 cases of oral lesions which were biopsied and were adequate in size were included in the study. Biopsies were evaluated histologically for non-neoplastic, neoplastic and premalignant lesions about age, nature and location of the lesions. Data collection was through Medix Online Histopathology Reporting System (MOHRS).

Results: A total of 99 cases were included in the study, out of which 41 cases (41.4%) were non-neoplastic, 56 cases (56.6%) were neoplastic, and 2 cases (2.0%) were premalignant lesions. Out of 41 non-neoplastic lesions, the majority were inflammatory (14 cases), followed by fibroepithelial polyps (5 cases), pyogenic granulomas (4 cases), and hyperplasia (3 cases). Out of 56 neoplastic lesions, 39 (69.6%) were confirmed as carcinomas, squamous cell carcinoma being the most common malignancy in 29 cases (74.3%), followed by verrucous carcinoma in 5 cases (12.8%). In addition, there were two cases (11.7%) of potentially premalignant lesions. Buccal mucosa and tongue were more predominant sites of oral pathologies than other sites.

Conclusion: In our setup, most of the oral lesions evaluated histologically turn out to be neoplastic and that too malignant, mostly squamous cell carcinomas. Most of the oral lesions occur in the fifth and sixth decade. Buccal mucosa and tongue.........
Assessment of Internal Quality Control of Blood Products; Experience at a Regional Transfusion Centre from Northern Pakistan
Authors: Khan Maria , Tariq Junaid , Rathore Muhammad Ali , Mahmood Asad , Raja Mansoor Ishaq , Bashir Saima
Published: December 2022

Objective: To analyze internal quality control of blood components, including red cell concentrates, fresh frozen plasma, cryoprecipitate and random donor platelets, to measure our blood bank performance.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan from Jul to Dec 2021.

Methodology: Whole blood units were separated into red cell concentrates, fresh frozen plasma and random platelets by the platelet-rich plasma method. Cryoprecipitates were prepared from FFPs. Quality control was done on representative components. For red cell concentrates, hematocrit was measured. For platelet concentrates, pH and platelet yield were measured. For fresh frozen plasma, Factor-VIII assay and for cryoprecipitate, Factor VIII and fibrinogen assays were done. The blood components were also tested for bacterial cultures.

Results: A total of 1130 units were analyzed for quality control, including 360 red cell concentrates, fresh frozen plasma, random donor platelets each and 50 cryoprecipitates. Red cell concentrates had a mean hematocrit of 68.5±3.7%. Random donor platelets had a yield of 10.1±1.4× 1010 / unit and a mean pH of 6.7±0.2. Fresh frozen plasma had a Factor VIII level of 2.2±0.98 IU/ml. Cryoprecipitate had a mean fibrinogen level of 202.8±27.8 mg/unit and Factor VIII132.5±54.1IU/unit. All blood components met internal quality control standards. Blood cultures were negative in 99.2% of random donor platelets tested.

Conclusion: The internal quality control of blood products was in concordance with the national and international standards for quality control in blood banks.
Clinical Spectrum and Drug Sensitivity Pattern in Multi Drug-Resistant Typhoid Fever
Authors: Afzal Warda , Saba Ameena , Zaidi Syed Taqi Hasan , Siddiqui Hamid Jamal , Tahir Muhammad
Published: December 2022

Objectives: To study the clinical presentation, complications and drug sensitivity patterns of multi drugs- resistant enteric fever.

Study Design: Prospective longitudinal study.

Place and duration of study: Combined Military Hospital, Malir Cantt Karachi Pakistan, from Mar to Oct 2019.

Methodology: A hundred cases of multi-drug resistant enteric fever were enrolled. Their demographic data, clinical and laboratory features and drug sensitivity pattern was recorded.

Results: Out of 100 cases, 67 were within 5 to 11 years of age. Twenty-one patients presented with loose motion and splenomegaly each. Seventy cases had a fever of 1 to 2-weeks duration. Complications were seen in 42 cases, out of which hepatitis was most commonly observed (in 27 cases). Ciprofloxacin and Ceftriaxone sensitivity were found to be only 3% and 9%, respectively. Sensitivity to Azithromycin was 95%, while all cases were sensitive to Meropenem and Imipenem.

Conclusion: Very high frequency of extensively drug-resistant typhoid fever was found. Most cases of enteric fever had a fever as the only presenting feature. Typhidot test has very low sensitivity.
Degloving Injury: Evaluation and Management
Authors: Mumtaz Syed Naveed , Shah Syed Fahd , Kayani Bushra Afzal , Shah Syed Hussain , Khan Muhammad Wasiullah , Khan Abdul Qadir
Published: December 2022

Objective: To study the frequency, clinical presentation, management and outcome of degloving soft-tissue injuries.

Study Design: Case series.

Place and Duration of Study: Department of Surgery, Federal General Hospital, Islamabad Pakistan, from Jan 2018 to Dec 2019.

Methodology: This study included 28 consecutive patients with degloving injuries. Patients with degloving injuries of the soft tissue were included. Initial assessments of all patients were done according to advanced trauma life support. Regular clinical examination for abnormalities such as excessive local pain that was out of line with the intensity of the trauma, extensive ecchymosis or hematomas, and especially, local and regional hypermobility of the skin, capillary refill and perfusion of the area.

Results: Out of 28 patients, there were 25 males (9.28%) and three females (10.72%). The mean age was 33.07±9.04 years with a range of 6-50 years. The thigh was the most frequently involved area by degloving injury (25.00%). The back was involved in 17.85% of patients. Leg (10.71%) and foot (10.71%) were involved in 21.42% of patients. From the management point of view, 42.85% of patients had some form of debridement and healing by secondary intention, 17.85% patients were managed conservatively, and 10.71 % of the patients' primary closure was successful.

Conclusion: Degloving soft-tissue injury is debilitating and, if not taken care may lead to ischemia necrosis, infection and septicemia of the tissues, which needs extensive debridement, prolonged use of broad-spectrum antibiotics, which result in disability and protracted course of rehabilitation.
Diagnostic Accuracy of Doppler Ultrasound in Testicular Torsion Keeping Surgical Findings as the Gold Standard
Authors: Shafi Aqeel , Zameer Shahla , Liaqat Bushra , Liaqat Rabia , Riaz Ramish , Liaqat Maria
Published: December 2022

Objective: To determine the diagnostic accuracy of ultrasound with Doppler analysis in testicular torsion, keeping surgical findings as the gold standard.

Study Design: Cross-sectional validation study

Place and Duration of study: Radiology Department of Pakistan Institute of Medical Sciences, from Dec 2017 to Dec 2019.

Methodology: The study included 58 candidates of acute scrotum who were clinically equivocal with a strong suspicion of testicular torsion and were referred by the concerned surgery department to Radiology, where a senior resident performed the testicular ultrasound. The grey scale features, along with doppler findings, were noted. Only those cases that underwent surgical exploration were included. The clinical, sonological, and per-operative findings were recorded.

Results: The mean age of our study was 18.00±6.02 years. The sensitivity, specificity, positive predictive value and negative predictive value of Doppler ultrasound were 98%, 86%, 98% and 86%, respectively. The most consistent Doppler ultrasound feature was absent intra-testicular flow, found among 46 out of 50 surgically confirmed cases of testicular torsion, while four had reduced intra-testicular flow. Similarly, heterogeneous testicular echotexture was the most frequently met grey scale feature. The sonological Whirlpool sign in our study came had 69% sensitivity and 100% specificity.

Conclusion: The overall diagnostic accuracy of ultrasound is significantly high, especially when both greyscale and colour Doppler findings are simultaneously interpreted. The sensitivity of ultrasound in diagnosing testicular torsion is far more than its specificity.
Barriers Faced by Medical and Dental House-Officer During Research in Twin Cities of Pakistan
Authors: Arshad Komal , Ahmed Ayesha , Ibrahim Aqeel , Rehman Abdul , Haroon Zainab , Iqbal Ayousha
Published: December 2022

Objective: To determine the research activities and perceived barriers among house officers working in different institutions in Rawalpindi/ Islamabad.

Study Design: Cross-sectional study.

Place and Duration of Study: Private and Government Hospitals in Rawalpindi and Islamabad Pakistan, from May to Oct 2019.

Methodology: A questionnaire based on thirteen questions with close-ended answers was administered to house officers at different dental hospitals in Rawalpindi and Islamabad to observe the attitudes toward research and perceived difficulties in doing research.

Results: A total of 126 participants with the mean age of 24.26±2.192 years participated in the study. Out of 126, 68(58.3%) participants showed research interest, and 86(68.25%) participants reported no previous experience with research. In addition, barriers/difficulties in the research were noted regarding personal interests, funding, future job commitment and the data collection process.

Conclusions: Within the limitations of this study, it is concluded that the barriers identified in this study need to be addressed in order to enhance students' participation in research and improve the quality of research done in our country: these barriers such as lack of interest, lack of funding, poor availability of research mentors and proper awareness should be removed. Amendments may be required in the dental undergraduate curriculum to overcome these barriers.
Comparison of Post-Operative Results of Early Versus Delayed Open Reduction and Internal Fixation of Isolated Mandibular Fractures
Authors: Hassan Amna , Shafqat Yumna , Babar Adnan , Mahmood Saad , Muzaffar Amna , Afzal Muhammad
Published: December 2022

Objective: To evaluate the impact of treatment time of open reduction internal fixation of mandibular fractures in post-operative complications.

Study Design: Quasi-experimental study.

Place and Duration of Study: Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2019.

Methodology: A hundred and four patients with isolated mandibular fractures diagnosed clinically and radiologically were included in the study. Group-I was the early Group consisting of cases reported under 72 hours, and Group-II was the delayed Group consisting of patients after 72 hours and within fourteen days. Treatment outcomes were assessed and compared for all patients based on clinical parameters in the post-operative period during follow-up.

Results: One hundred and four patients with mandibular fractures were treated with open reduction internal fixation. On a periodic follow-up of 6 months, all patients were evaluated for malocclusion, surgical site infection, hardware exposure, and non-union complications. Group-I showed six patients (11.70%) with malocclusion, whereas three patients (6.10%) in Group-II had malocclusion (p-value=0.295). Surgical site infection was present in 2(3.84%) patients in Group-I and 3(5.76%) patients in Group-II (p-value=0.647). There was no case of non-union and three patients (5.76%) of hardware exposure in Group-I and two patients (3.84%) in Group-II (p-value=0.647). No statistically significant increase in post-operative complications in malocclusion, surgical site infection, hardware exposure, and non-union was found in Group-II with comparison Group-I.

Conclusion: Delay in the surgical intervention of mandible fractures does not lead to increased post-operative complications.
Comparison of the Efficacy of Intravenous Lignocaine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation
Authors: Nand Raja , Feroz Shizan Hamid , Ahmed Mirza Sijeel , Jafri Syed Asad Ullah , Sultan Muhsan , Ahmed Niaz
Published: December 2022

Objective: To study the effect of intravenous Lignocaine and Dexmedetomidine to attenuate cardiovascular stress reaction to laryngeal manipulation.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Peshawar Pakistan, from Oct 2019 to Apr 2020.

Methodology: Patients were randomly divided into two Groups by lottery method. Seventy-three were in the intravenous Lignocaine-Group-(A), while 73 patients were in the intravenous Dexmedetomidine-Group-(B). Blood pressure, Pulse rate and ECG were documented at the start of general anaesthesia and after 1, 3 and 5 minutes of intubation. Efficacy was defined if systolic pressure and pulse remained within 20% of the patient's native findings between 1 and 5 minutes after endotracheal intubation.

Results: A total of 146 patients were included in the stud. The mean baseline systolic BP of Group-A was 121.34±4.47mmHg and mean baseline diastolic BP was 80.31±3.57mmHg. While mean Baseline Systolic BP WAS 121.19±4.37mmHg in Group-B and mean baseline diastolic BP was 80.04±3.66mmHg. Efficacy was seen 74% patients of Group-A and 90.4% of Group-B (p=0.009).

Conclusion: Dexmedetomidine 1 microgram/kg blunts the cardiovascular sympathetic reaction to laryngeal manipulation more pronounced than Lignocaine 1.5 milligram/kg without any harmful outcomes.
Effect on Cuff Pressure of Various Endotracheal Tube Cuff Inflation Methods
Authors: Khan Tanveer Ahmed , Iqbal Muhammad Rashid , Ranjha Chaudhry Raheel , Rukh Mah , Bhalli Hafiz Ahmed Hassam , Raza Muhammad Ahmed
Published: December 2022

Objective: To compare mean endotracheal tube cuff pressures generated using two endotracheal tube cuff inflation methods;just-Seal versus Stethoscope-Guided in patients undergoing elective surgery under general Anaesthesia.

Study Design: Quasi-experimental study.

Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021.

Methodology: A total of 100 patients undergoing elective surgery under general endotracheal tube anaesthesia between 18–60 years of age of either gender were included. Patients were equally allocated (n=50 each) to two Groups, A (Just Seal Group) and B (Stethoscope Guided Group). In the Group-A method, the air was injected until no air leak could be heard. The pressure was measured using a “Portex cuff pressure manometer”. In the Group-B method, a stethoscope bell was placed on the thyroid lamina, and harsh breath sounds were auscultated during ventilation. Cuff was inflated till the sounds changed to smooth sounds. The pressure was measured and then noted down.

Results: Among 100 patients, 39 % were males, and 61 % were females. The mean endotracheal cuff pressure in Group-A was 39.90±3.19 centimetres of water and 28.42±3.52 centimetres of water, with Group-B (p-value of 0.001).

Conclusion: Post-intubation cuff pressure measured in patients undergoing elective surgery under general anaesthesia of the just seal group is higher than that in the stethoscope-guided group.

Keywords: Cuff pressure, Stethoscope-guided, Tracheal intubation.
Altered Mental Status and Its Causes: Commonest Dilemma of Residents and Emergency Physicians
Authors: Khan Jamal Azfar , Mehmood Hassaan , Khattak Muhammad Irfan
Published: December 2022

Objective: To assess the frequency of the various medical conditions in patients presenting with altered mental status (AMS) in the Emergency Department of Pakistan Naval Ship (PNS) Shifa Hospital.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Emergency Department, Pak Naval Ship Shifa Hospital, Karachi Pakistan from Feb-Jul 2021.

Methodology: Adult patients who have presented with altered mental status (Glasgow coma scale score less than 15) or who have the diagnosis "AMS" written in their notes were included in the study. Patients were observed in the wards until a definitive diagnosis could be made.

Results: Sixty patients presented with AMS at the Emergency Department of PNS Shifa, during the study period. The causes of AMS were sepsis (20, 33.33%), CVA (12, 20%), metabolic (hepatic/uremic) encephalopathy (8, 13.33%), diabetic complications (7, 11.66%), seizures (5, 8.33%), drug intoxication (4, 6.66%) and respiratory failure due to lung pathology (4,6.66%). The overall mortality rate was 20%.

Conclusion: Sepsis is the most frequently encountered cause of altered mental state in emergency department patients,followed by CVA, metabolic encephalopathy, and diabetic complications.
Radical Nephrectomy for Renal Cell Carcinoma in a Tertiary Care Hospital in Islamabad
Authors: Roman Mohammad , Habib Bilal , Anwar Khursheed
Published: December 2022

Objective: to identify the demographic, laboratory, radiological and histological features of RCC patients presenting to a tertiary care hospital in Islamabad.

Study Design: Cross-sectional study.

Place and Duration of Study: Pakistan Atomic Energy Commission General Hospital, Islamabad Pakistan, from Jan 2014 to Aug 2021.

Methodology: All the patients who underwent radical nephrectomy for histologically confirmed RCC at PAEC General Hospital Islamabad were included in the study. Demographic variables, ultrasound features, laboratory measures, histological types and Fuhrman grading were noted.

Results: A total of 65 consecutive patients were included, which included 38(58.5%) males. The mean age of the patients was 52.6±8.6 years. The most common symptom was flank pain (42.2%). The diagnosis was made incidentally in 26 patients. The most common ultrasound feature was capsule involvement (23, 35.3%), and most cases were Fuhrman Grade-II (22, 48.9%). On histology, clear cell carcinoma was the most common RCC (40, 61.5%). Post-operative early RFT deterioration was noted in 32(49.2%) patients. This was significantly associated with greater tumour size, Fuhrman Grade-III/IV, renal vein thrombosis, gerota fascia, and ureteric involvement. There was no mortality in our study during the admission days until discharge.

Conclusion: Renal cell carcinoma was more common among males and at a later stage of life (5th decade). The most common type was clear cell carcinoma. Post-operative early RFT deterioration was noted in 49.2% of patients. It was associated with greater tumour size, Fuhrman Grade III and IV, renal vein thrombosis, gerota fascia, and ureteric involvement.