bluuebunny/crossref_metadata_2025 huggingface dataset:
The Importance of Screening Critical Congenital Heart Disease By Pulse Oximetry During Routine Neonatal Examination; Two Cases Reports
Authors: Hussain Shabbir , Naseer Nauman , Hussain Moeez , Mehmood Rana Usama Bin
Published: December 2022

A male neonate was admitted for jaundice on the third day of life. On examination, baby was active, jaundiced, systemic examination revealed no abnormality except pulse oximetry difference of more than eight between pre and post ductal oxygen saturation. Later on, echocardiography revealed the diagnosis of hypo plastic left heart syndrome. The second case was a term female delivered by elective lower segment caesarean section. The first neonatal examination showed oxygen saturation of 70% with pre and post ductal difference of seven on routine pulse oximetry. Later on, pulmonary atresia, tricuspid atresia and patent duct us arteriosus were diagnosed on echocardiography. The patient was managed with prostaglandin to keep the duct open, followed by duct stenting.
Comparison Between Glasgow Score and CTSI in Predicting the Severity of Acute Pancreatitis Based on Modified Atlanta Classification 2012
Authors: Kamran Fatima , Sheikh Irfan Ali , Haroon Samra , Ashraf Yusra , Mehmood Khalid , Haroon Faaraea
Published: December 2022

Objective: To compare the Glasgow scoring system and modified CTSI scoring system regarding its ability to predict the severe nature of acute pancreatitis according to the revised Atlanta classification in a tertiary care hospital in Pakistan.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: General Surgery Department, Combined Military Hospital, Rawalpindi from July 2020 to Jul 2021.

Methodology: Forty patients ranging from 30 to 70 years of age with acute pancreatitis, some of them were admitted to our hospital and others were received in the Emergency Department. Glasgow and modified CTSI scores were calculated for all cases.

Results: Glasgow and CTSI scoring systems were compared according to the Atlanta Classification. The data in our study showed a mean Glasgow score of 2.475 ± 2.975, whereas the mean CTSI score was 5.575 ± 2.458. In predicting severe acute pancreatitis using the AUC graph, the CTSI scoring system had a higher accuracy (0.994) than Glasgow score (0.987). For mild and moderately severe acute pancreatitis, both Glasgow and CTSI showed significance (p<0.01).

Conclusion: CTSI scoring is more accurate in detecting the severity of acute pancreatitis. Glasgow was close behind, but it is not an accurate indicator
Concordance and Discordance of Mitotic Count, Ki-67 Proliferative Index and Phosphohistone H3 Count in Grading Neuroendocrine Tumors of Gastrointenstinal Tract
Authors: Humayun Saba , Asif Muhammad , Khadim Muhammad Tahir , Din Hafeez Ud , Ahsan Farah , Rashid Farhat
Published: December 2022

Objective: To determine the grades of gastrointestinal neuroendocrine tumours using World Health Organization criteria and Phosphohistone H3 mitotic index and to determine the concordance between the two methods.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Mar to Oct 2019.

Methodology: Forty-two (n=42) patients of either gender between the ages of 18-70 years were enrolled. All the enrolled patients were diagnosed with primary gastrointestinal neuroendocrine tumours and underwent either surgical or endoscopic resection. Tumour grades were determined using World Health Organization criteria and Phosphohistone H3mitotic index. The results obtained with both methods were compared, and the concordance rate was calculated.

Results: When mitotic counts were determined through PHH3, MI resulted in a change of grade of 12 (28.6%) tumours, which were graded by the current WHO system. 11 (26.2%) were changed from grade II to grade I and 1 (2.4%) from grade I to grade I1. The agreement (concordance rate) between the two systems was moderate and statistically significant (71.4%, n=30/42, κ= 0.51, p= 0.001).

Conclusion: In the present study, we observed a moderate agreement between the Ki-67 labelling index and the PPH3 mitotic index, and both correlate well with the mitotic counts. The PPH3 mitotic index demonstrated a better correlation with mitotic counts when compared with Ki-67 LI. Hence, the inference can be drawn that the mitotic index with Phosphohistone H3is associated more closely with mitosis in gastrointestinal neuroendocrine tumours.
Effectiveness of Sub-Conjunctival Bevacizumab After Pterygium Excision at Armed Forces Institute of Opthalmology
Authors: Arsalan Zahra , Zafar Omar , Akram Amjad , Zamir Quratulain
Published: December 2022

Objective: To determine the effectiveness of sub-conjunctival Bevacizumab after pterygium excision.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Aug 2019 to Jan 2020.

Methodology: Thirty-six patients were included and divided into two groups. In group A (n=18), pterygium excision with conjunctival auto-graft was followed by injection of 0.3ml of 7.5mg of Bevacizumab. Patients of Group B (n=18) did not receive any Bevacizumab. All the patients were followed up after 7 days, two weeks, 4weeks and 24 weeks after the start of management. The visual analog score was used for pain assessment, Snellen chart for visual acuity and intraocular pressure was measured with applanation tonometry.

Results: After six months the recurrence rate was less in Group-A (n=3, 16.6%, p=0.005) than Group-B (n=4, 22.2%, p=0.01) The recurred pterygium size was also greater in Group-B (mean=0.27 ± 0.28mm, p=0.006) than Group-A (mean=0.11 ± 0.21mm, p=0.006). Patients of Group-A experienced less pain post-surgery. The intraocular pressures were same in both the groups. Visual acuity improvement was seen in the Group-A (n=11, 61%, p=0.008)) than group B (n=4.22%, p=0.008).

Conclusion: Administration of Bevacizumab under the conjunctiva after pterygium excision may be useful in averting lesion relapse, less post-op pain, and improved visual acuity.
Cephalometric Analysis Difference Between Skeletal and Soft Tissue Measurements
Authors: Mehmood Sundas , Jan Abdullah , Ijaz Muska , Ghaffar Fareena , Bibi Khadija , Tariq Alaina
Published: December 2022

Objective: To compare the skeletal and soft tissue measurements of the dento-facial region in a cephalometric study done in the Pakistani population.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb to Aug 2019.

Methodology: Total 160 subjects were enrolled in the study. Lateral cephalograms were recorded for all the study participants in natural head position. Patients were divided into Class I, II, and III according to the skeletal pattern. The distances of skeletal and soft tissue landmarks relative to the respective norm values and the angles between the Nasion Sella line and Frankfurt horizontal to the natural head position were measured and compared in the three classes using chi-square.

Results: Out of 160 patients, 96 (60%) patients were males, and 64 (40%) were females. In our study, 92 (57.5%) patients were classed in class I, 46 (28.75%) in class II and 22 (13.75%) in class III. The mean score of A point, Nasion, and B point angle was 7.5 ± 1.112, while the beta angle was 30.5 ± 2.214. The mean score of facial convexity angle was 14.1 ± 2.124, while the mean vertical height ratio was 1.05 ± 0.11. Both skeletal and soft tissue measurements significantly predict the skeletal pattern and discrepancy (p-value <0.001).

Conclusion: Lateral cephalograms and radiography measures emerged as reliable techniques to classify the patients in various skeletal patterns. Factors like age and gender do not influence skeletal discrepancies.
The Association of Serum Sodium Levels with Intraventricular Hemorrhage in Preterm Infants: A Prospective Longitudinal Study from Pakistan
Authors: Bhanbhro Bakhtiar Ahmed , Bharo Mumtaz Ali , Baloach Kamran Ali Shahani , Abbas Kiran
Published: December 2022

Objective: To evaluate the association of hypernatremia with intraventricular haemorrhage in preterm infants in a local setting.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Neonatal Intensive Care Units (NICU), Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat Khaipur Mirs from Sep 2018 to Mar 2020.

Methodology: All the infants with the gestational age of <32 weeks of pregnancy were included, while infants who died <12 hours of life were excluded from the study. All relevant maternal and neonatal data were extracted from patient files and recorded in electronic form. The infants were further stratified into three groups: i) infants without intraventricular haemorrhage, ii) mild intraventricular haemorrhage, and iii) severe intraventricular haemorrhage.

Results: The intraventricular haemorrhage was 40%. 84 (29.2%) infants had a mild intraventricular haemorrhage, and 32 (11.1%) had a severe intraventricular haemorrhage. The highest sodium level was 145.91 ± 6.98 mEq/L and 143.51 ± 5.93mEq/L in the mild IVH and severe intraventricular haemorrhage groups, respectively. The fluctuations in serum sodium levels from week 1 to week 2 were significantly more prominent in infants without intraventricular haemorrhage compared to intraventricular haemorrhage groups (12.31 ± 6.67 mEq/L, 10.11 ± 9.32 mEq/L, and 6.54 ± 7.53 mEq/L, respectively; p:0.001).

Conclusion: The fluctuation of serum sodium in infants with severe Intraventricular haemorrhage was significantly greater than in infants with mild intraventricular haemorrhage or without intraventricular haemorrhage.
Rh Alloantibodies in Rh D Negative Blood Group Pregnant Women - A Regional Transfusion Centre Study
Authors: Bajwa Hussan , Alam Maqbool , Rathore Muhammad Ali , Yazdani Muhammad Sajid
Published: December 2022

Objective: To determine the frequency of Rh alloantibodies in pregnant women of the Rh-D negative blood group.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT) Rawalpindi, from Jan to Dec 2017.

Methodology: The blood samples of pregnant women received for blood grouping, cross matching and antibodies screening were included in the study. The blood was typed for Rh-D along with ABO blood groups by Column Agglutination Technique (CAT), commonly known as the gel card method. Then, the samples included in the study were subjected to antibody screening by three cell antibody screening panel (Dia Cell, a product of Bio-Rad) by Column Agglutination Technique. The samples with positive antibody screening were further processed by 11 cell antibody screening panel (Dia Cell, BioRad) for Rh antibody identification by Column Agglutination Technique, the same as the indirect antiglobulin test (IAT).

Results: 453 Rh-D negative pregnant women were screened for alloantibodies during the study period. Rh alloantibodies were present in 55 (12.08%) cases. The most common alloantibody identified was anti-D in 48 (87.3%) samples, followed by anti-C in 6 (10.9%) and anti-E in 1 (1.8%) case.

Conclusion: The most prevalent Rh alloantibody identified in Rh-D negative pregnant women was anti-D, while the anti-C and anti-E were less prevalent. However, no case of anti-c and anti-e alloantibody was identified.
The Perspective of Pakistani Adults Regarding the Consequences of Missing Teeth
Authors: Abbasi Maria Shakoor , Ahmed Naseer , Ahmad Maira , Tahir Maira , Mandhan Nikki , Vohra Fahim
Published: December 2022

Objective: To determine the recognition level of the consequences of missing teeth in Pakistani adults.

Study Design: Cross-Sectional study.

Place and Duration of Study: Altamash Institute of Dental Medicine, Karachi Pakistan, from Jul to Dec 2019.

Methodology: A well-structured and validated questionnaire filled by 652 partially dentate patients was included in the study.

Results: Despite having some education, the individuals showed poor knowledge of the consequences of missing teeth. Only 184 (28.2%) and 221 (33.9%) were aware of supra-eruption and drifting, respectively. 330 (50.6%) and 269 (41.3%) were unaware of the temporomandibular joint problems and speech difficulties. However, the majority were aware of masticatory problems, 562 (86.2%) and 460 (70.6%) self-confidence issues. There was no significant association (r=-0.70, p=0.7) and (0.03, p=0.9) between gender with number and aetiology of missing teeth. At the same time, a moderate relationship (rho=0.7) with no significant difference (p=0.08) was found between gender and knowledge of consequences. A negative relationship (r -0.12)with a significant difference (p<0.02) was found between education level and aetiology. Moreover, no significant association was found (rho -0.03, p=0.3) and (-0.06, p=0.6) between education level with number and knowledge about the consequences of missing teeth.

Conclusion: The knowledge and understanding of the general population on matters that are so important and relevant in the long run to each individual’s Oral Health-Related Quality of Life are of special concern. Therefore, it is essential for dentists and other health care providers to educate and remember the importance of knowing the inevitable consequences of.....
Multidrug-Resistant Uropathogens, An Emerging Threat: Observational Study in a Tertiary Care Hospital of Azad Kashmir
Authors: Zeb Muhammad Aurang , Nadeem Muhammad , Tariq Tufail Hussain , Siddiq Shazia , Zaib Jahangir , Mahmood Muhammad Arif , Akbar Adiba
Published: December 2022

Objective: To detect the resistant pattern of uropathogens and find the association of different factors with the resistance in the Poonch District of Azad Kashmir.

Study Design: Cross-sectional analytical study.

Place and Duration of Study: Department of Medicine, Shaikh Khalifa Bin Zayed Hospital, Rawalakot, from Mar to Aug 2019.

Methodology: Patients having signs and symptoms of urinary tract infection and growth of bacteria on urine culture were included in the study. The antimicrobial susceptibility of the isolates was determined by using the standard, modified Kirby Buer disc diffusion method. Zone sizes were interpreted following Clinical Laboratory Standards Institute (CLSI) 2019 guidelines.

Results: 68 culture-positive patients were included in the study, 45 (66%) patients were female. There was a previous history of urinary tract infection in 44 (64.7%) patients, and 52 (76.5%) gave a history of antibiotic use in the last three months. E. coli was the commonest organism isolated, followed by Klebsiella, Proteus and Pseudomonas. All patients were resistant to at least one antibiotic, 48 (72%) isolates were multi-drug resistant. Uropathogens showed the highest resistance to Ampicillin in 67 (98.5%) patients and the lowest resistance to Piperacillin/Tazobactam 2 (3%) patients only. Resistance was significantly higher in patients having a history of recurrent urinary tract infection (p=0.028) and the use of antibiotics in the last three months (p<0.001).

Conclusion: Resistance to antimicrobial agents is increasing in community-acquired urinary tract infections. Resistance is significantly higher in patients having a history of recurrent urinary tract infection and the use of antibiotics in the..........
Role of Sonographic Measurement of Fetal Foot Length in Estimating Gestational Age: A Hospital Based Study in South Punjab
Authors: Nadeem Syed Farrukh , Babar Taimur Hussain , Khan Amir Ali , Asim Muhammad Umar , Malik Muhammad Jalil , Ahmad Muhammad Iftikhar
Published: December 2022

OBJECTIVE:  To highlight the usefulness of ultrasonographic measurement of fetal foot length in determining fetal gestational age.

 STUDY DESIGN: Prospective validation study

PLACE AND DURATION OF STUDY:   Radiology Department Combined Military Hospital Bahawalpur from 01July 2020 to 31Dec 2020.

METHODOLOGY:    Women referred from our obstetrics OPD for antenatal ultrasound between 16 to 40 weeks were scrutinized through inclusion and exclusion criteria for selection in the study.  Record of their age, parity, gestational age by LMP and sonographic measurement of fetal foot length were endorsed on a study proforma. After the end of study period, the data was entered in SPSS version 20 to measure Pearson correlation coefficient and R2 values for highlighting the correlation between two variables. P value < 0.01 is taken as significant.   

RESULTS:  A total of 153 patients were included in the study. Mean age of patients in our study is 28.64 years and second parity is most frequent being 41.8%. Data entered in SPSS version 20 for regression analysis. Pearson correlation coefficient (R) is 0.988 and R2 value is 0.977 (P- 0.000) which shows powerful linear correlation between our two variables.

 CONCLUSION:  The results of our study shows excellent reliable linear correlation between fetal foot length and gestational age by LMP. Therefore, the fetal foot length so measured by ultrasonography can be used confidently for determination of gestational age in routine or when other ultrasonographic measurement parameters become unreliable.

KEYWORDS:  Fetal foot length, Gestational age, Ultrasonographic age estimation.
Comparison of Kangaroo Mother Care with Conventional Care in Newborns in Terms of Frequency of Successful First Breastfeeding and Time to Initiate Breast Feeding
Authors: Iqbal Amjad , Iqbal Tehreem , Bashir Faisal , . Bilqees , Aslam Shahid , Anjum Sehrish
Published: December 2022

Objective: To compare kangaroo mother care with conventional care in newborns regarding the frequency of successful first breastfeeding and time to initiate breastfeeding.

Study Design: Quasi-experimental study.

Place and Duration of Study: Departments of Pediatrics and obstetrics CMH Bahawalpur from Feb 2019 to Jun 2020.

Methodology: 120 infant-mother couples were included in the study. Sixty infant-mother couples were randomly allocated to each group (120 infants). Group A was nursed with kangaroo mother care (KMC), and Group B was nursed with conventional care (CC). The frequency of the first successful feed was assessed, and the time taken to initiate breastfeeding was documented.

Results: There was no statistically significant difference in weight, gestational age and gender distribution between the two groups. 65 (54.25%) infants had successful first breastfeeding in the study population. 38 (63.3%) of the infants had first successful breastfeeding as per the Infant Breast feeding Assessment Tool (IBFAT) in group A (KMC) as compared to 27 (45%) in group B (Conventional Care). The difference between the two groups was statistically significant, with a p-value of 0.044. Mean time for first successful breastfeeding was significantly less for the KMC group as compared to the conventional group with a p-value of <0.001. Kangaroo mother care resulted in a higher frequency of successful first feed, and meantime for initiation of feeding was also less than conventional care.
Challenges Faced by Post-Treatment Childhood Cancer Patients and Families; The Children's Hospital, Lahore Experience
Authors: Kashif Muhammad , Faizan Mahwish , Zafar Huma , Saeed Maria , Shahid Fatima
Published: December 2022

Objective: To assess challenges faced by post-treatment childhood cancer patients and families in a developing country.

Study Design: cross-sectional study.

Place and Duration of Study: The Children's Hospital and the Institute of Child Health Lahore, from Jul to Dec 2020.

Methodology: 105 children and their parents were enrolled on OPD of the Department of Paediatric Hematology and Oncology. The parents were questioned regarding the duration of follow-up after treatment and the challenges they faced during this interval in association with socioeconomic dynamics, education and awareness of parents, travelling distance from the hospital, behavioural changes in children, toxicities/disabilities due to treatment, effect on other siblings, and various factors.

Results: In this study, the mean age of children was 9.40 ± 2.90 years. There were 55 (52.4%) males while 50 (47.6%) females. There were 35 (33.3%) children who had acute lymphocytic leukaemia, while 15 (14.3%) with Hodgkin Lymphoma, 12 (11.4%) with Wilms tumour, 10 (9.5%) with Non-Hodgkin Lymphoma, 9 (8.6%) with germ cell tumour and 7 (6.7%) with acute myeloid leukaemia. Mostly, 89 (84.8%) children received chemotherapy, while 12 (11.4%) children received chemotherapy as well as radiotherapy, and 4 (3.8%) children underwent surgery along with other treatments. The distance from the hospital was more than 50 km in >90 cases. Moreover, 42 (40.0%) children were found malnourished. Out of 105, 71 parents reported that the treatment affected their jobs, while 52 (49.5%) parents had to change their residence. The family's economic status wasaffected in 77 (73.3%) cases because of the treatment...........
The Burden of Gastrointestinal, Hepatobiliary and Pancreas Related Diseases and Their Causes at Tertiary Care Hospital in Karachi
Authors: Zakir Muhammad Fahad , Karim Shahid , Kalwar Hamid Ali , Wadhwa Rajesh kumar , Furqan Muhammad , Baloch Muhammad Hussain
Published: December 2022

Objective: To determine the burden of gastrointestinal, hepatobiliary and pancreas-related disease, frequencies and their presentations.

Study Design: Cross-sectional study.

Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital, Karachi from Oct 2020 to Jul 2021

Methodology: Patients aged ≥18 years, having diagnosis related to gastrointestinal, hepatobiliary and pancreas were included in the study. Demographic features, reasons for admission, and length of stay were recorded.

Results: A total of 2183 patients were enrolled. Nearly half of the patients were ≥60 years. 43% of patients were presented with abdominal pain. The most frequent diagnosis includes decompensated chronic liver disease followed by upper gastrointestinal bleed. The proportion of female patients was significantly higher for gastritis (p=0.009) and acute cholecystitis (p=0.036), while males with Hepatitis-B (p=0.019) and liver abscesses (p=0.018) were significant. Admissions through emergency were higher for gastrointestinal bleeding and decompensated chronic liver disease (p<0.001) in monitoring setup (p=0.034), ward admission via OPD were significant for upper gastrointestinal malignancy (p=0.011) and hepatocellular carcinoma (p=0.038). Extended length of stay and expiry was significant among acute liver failure (p=0.047) and gastric outlet obstruction (p=0.030).

Conclusion: Notably, highly evitable diseases are still a foremost reason of clinical importance, lack of awareness and low cure rate, especially in rural areas progress to high fatality as most patients do not seek medical assistance until significant manifestation. This appeals to more effective measures, including eradicating the potentially life-threatening disease.
Topical Betamethasone Valerate 0.1% W/V vs. Topical Ketoconazole 2% W/V: A Comparison of Efficacy in Patients of Seborrheic Dermatitis
Authors: Rizwan Muhammad , Ali Amanat , Ahmad Najia , Tahir Moizza
Published: December 2022

Objective: To compare the efficacy of topical Betamethasone valerate 0.1% w/v and topical Ketoconazole 2% w/v in patients of seborrheic dermatitis.

Study Design: Comparative prospective study.

Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital Rawalpindi Pakistan from Feb to Aug 2019.

Methodology: A total of 80 patients of both genders with seborrheic dermatitis were included. Patients were divided into two groups randomly, with 40 patients in each group. Group-A patients were given topical Betamethasone valerate 0.1% w/v, while patients in Group-B were given topical Ketoconazole 2% w/v for 12 weeks. Data regarding efficacy was assessed after 12 weeks per operational definition from both groups and noted.

Results: The mean age of patients in group A was 34.45 ± 6.73 years, and in the Group-B was 32.18 ± 6.07 years. The majority of the patients, 54 (67.50%), were between 15 to 35 years of age. Efficacy of Group-A (topical Betamethasone valerate 0.1%) was seen in 35 (87.50%) patients while in Group-B (topical Ketoconazole 2%) efficacy was seen in 25 (62.50%) patients (p-value = 0.010).

Conclusion: This study concluded that the efficacy of topical Betamethasone valerate 0.1% w/v is higher than topical Ketoconazole 2% w/v in patients with seborrheic dermatitis.
Association Between Oct-Based Microangiography Perfusion Indices and Diabetic Retinopathy Severity in Patients with Diabetes in Pakistan
Authors: Tahir Tooba Bint , Muzaffar Waqar , Ashraf Ammarah
Published: December 2022

Objective: To assess the relationship between capillary perfusion of retinal vessels and severity of diabetic retinopathy with the help of Optical Coherence Tomography angiography.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Feb 2020 to Apr 2021.

Methodology: Seventy-three eyes of 37 subjects suffering from diabetes had their imaging done with Rtvue Avanti OCT angio system. Socio-demographic and clinical data was gathered. Subjects were divided into three groups depending upon the severity of diabetes. The perfusion index (PI) was taken as percent area coverage by retinal vessels with the flow.

Results: Out of a total of 73 eyes, 31 (42.5%) had none to mild Non-Proliferative Diabetic Retinopathy, 19 (26%) with moderate to severe Non-Proliferative Diabetic Retinopathy and 23 (31.5%) with Proliferative Diabetic Retinopathy. The mean age of the participants was 58.09 ± 10.32 years, with best corrected visual acuity as 0.35 ± 0.35 and Blood Sugar Random as 200.46 ± 70.71. BCVA showed a significant positive correlation with Perfusion Index (p=0.026). No significant association/relationship was found between the severity of diabetic retinopathy and perfusion index in this data (p=0.26).

Conclusion: No statistically significant relationship was found between Perfusion Index (PI) and severity of diabetic retinopathy.
The Spectrum of Toxicological Analysis in a Tertiary Care Setting-Pakistan
Authors: Fatima Safia , Hafeez Ayesha , Aamir Muhammad
Published: December 2022

Objective: To determine the frequency of opiate, cannabinoid, amphetamine, benzodiazepine, barbiturate, organophosphate, alcohol and related drugs of abuse poisonings in the tertiary care setting.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Toxicology & Therapeutic Drug Monitoring, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2014 to Mar 2019.

Methodology: Random sampling was done, and specimens of blood in an EDTA bottle, urine in a plain container and gastric lavage in a syringe were collected for drugs of abuse (Opiate, Cannabinoid, Amphetamine, Benzodiazepine, Barbiturate, Organophosphate) and alcohol. The screening was done on fluorescence immunoassay and Microarray Technology, while confirmation was done on Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) for all drugs of abuse except alcohols and Gas Chromatography (GC-Head space) for alcohols.

Results: 146,601 toxicological tests were divided into two categories according to request forms; clinical toxicological cases 92,333 (63 %) and forensic toxicology 54,268 (37%). The maximum no of cases were routine toxicological analysis of blood, urine, and gastric lavage, 89,169 (60.8%) tests, and emergency toxicology cases were only 1,708 (1.2%) tests in clinical toxicology. Forensic toxicology included a maximum of no cases of routine workplace testing (two drug panel testscannabinoid and opiate) 43,850 (29.9%), and post mortem toxicology cases were only 6912 (4.7%). The frequency of benzodiazepine poisoning was maximum 1390 (28.5%) than cannabinoid and opiate poisoning, i.e., 180 (3.7%) and 210 (4.3%) respectively, in clinical toxicology cases. The frequency of benzodiazepine poisoning was still maximum 501 (22.2%) than Cannabinoid, Amphetamine and opiate poisoning, which were....
Determine the Effect of Tramadol Injection as Adjuvant Anesthetic and Analgesia Following Surgical Removal of Mandibular Third Molar
Authors: Khan Kaleem Ullah , Babar Adnan , Yasir Syed , Meraj Wajid
Published: December 2022

Objective: To establish the efficacy of mean pain control after submucosal tramadol injection compared to placebo after surgical removal of the impacted third molar.

Study Design: Quasi-Experimental Study.

Place and Duration of Study: Department of Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb to Aug 2018.

Methodology: All the patients had symmetrical bilateral impactions of the third molar on an orthopantomogram. The surgical site was randomly selected, and those in Group-T received Tramadol injection submucosally adjacent to the extraction socket immediately after the first tooth extraction, and Group-P received Saline. After the second extraction, Group-T received a Saline injection, and Group-P received Tramadol in the same manner. Patients were followed 24 hours post-operative for pain grading at 2, 4 and 24 hours, frequency and concentration of analgesic intake and duration of anaesthesia.

Results: Mean age of participants was 23.80±2.80 years. Means of pain intensity of Group without Tramadol after 2, 4 and 24 hours of extraction are 8.40±0.90, 6.30±0.40 and 2.10 ± 0.40, respectively, and those with Tramadol are 5.90±0.50, 4.50±0.30 and 1.60±0.40 respectively.

Conclusion: Our study concluded that Tramadol was more effective in providing analgesia after third molar surgery than local anaesthesia alone.
Efficacy of Voided Urine Cytology Compared to Cystoscopic Findings in the Detection of Bladder Cancer- A Pakistani Perspective
Authors: Khizar Samina , Mirza Zahoor Iqbal , Ahmed Hussain , Murtaza Badar , Yasrab Muhammad , Shahzad Khubaib
Published: December 2022

Objective: To compare the efficacy of voided urine cytology with findings of cystoscopy and histopathology of biopsy specimens in the diagnosis of bladder cancer.

Study Design: Comparative cross-sectional study

Place and Duration of Study: Armed forces Institute of Urology (AFIU), Rawalpindi Pakistan from Jan 2019 to Jan 2020.

Methodology: All patients presenting to the urology clinic with complaints of haematuria, visible and non-visible, and any radiologic evidence of bladder growth were included in the study after informed consent. Urine cytology was performed for all patients, followed by cystoscopy under anaesthesia, transurethral resection was conducted, and biopsy was taken where needed.

Results: 170 patients were included in the study134 (78.8%) were males, while 36 (21.2%) were females. The mean age was 54 ± 9.47 years (range 36 to 73 years). The overall sensitivity of voided urine cytology was 46.7%, while specificity was 79.2%. The positive predictive value was 85.1%, and the negative predictive value was 36.9%.

Conclusion: Bladder cancer is a disease which demands an early diagnosis, prompt treatment, and long-term follow-up. Cystoscopy remains the gold standard for this purpose; urine cytology can be used as a supplement as it is non-invasive, more specific and cost-effective.
Post-Operative Infection Rate Between Single Dose Versus Multiple Dose Antibiotic Therapyin Patients Undergoing Laparoscopic Cholecystectomy
Authors: Haider Rehan , Masud Mannan , Hasnain Mohammad Rashhid , Khan Muhammad Tariq , Wyne Adeel , Ehsan Ayesha , Kazmi Zahra , Raza Syed Asim
Published: December 2022

Objective: To compare the frequency of post-operative infection rate between single dose versus multiple dose antibiotic therapy in patients undergoing laparoscopic cholecystectomy.

Study Design: Comparative prospective study.

Place and Duration of Study: Surgical Department, Combined Military Hospital, Lahore Pakistan from Oct 2017 to Feb 2020.

Methodology: Patients of both genders undergoing laparoscopic cholecystectomy for simple cholelithiasis were included. Group-A patients underwent laparoscopic cholecystectomy using single-dose prophylactic antibiotic therapy with 2-gram 3rd generation cephalosporin at the time of induction of anaesthesia. In contrast, Group-B patients underwent laparoscopic cholecystectomy using 2-grams of 3rd generation Cephalosporin intravenously at the time of induction of anaesthesia followed by intravenous 1-gram Ceftriaxone two doses 12 hours apart. All patients were followed up on the first postoperative day, and then 1-week and 2-week follow up were done for any surgical site infection.

Results: Patients in Group-A had a mean age of 37.12±6.53 years, while patients in Group-B had a mean age of 37.74±6.40 years. The post-operative infection rate in Group-A (single dose antibiotic therapy) was seen in 08 (4.28%), while in Group-B (multiple dose antibiotic therapies) was seen in 18 (9.63%) patients (p-value = 0.042).

Conclusion: This study concluded that the single-dose prophylactic antibiotic is as good as multiple-dose antibiotic therapy used as prophylaxis for the prevention of post-operative infection rate among patients with cholecystectomy done via the laparoscopic method.
Comparison of Respiratory Complications of COVID-19 among Patients with Rheumatological Conditions Taking Biological Disease-Modifying Anti-Rheumatic Drugs and Conventional Synthetic Disease-Modifying Antirheumatic Drugs
Authors: Cheema Ahmed Ammar , Fakhr Amer , Khan Muhammad Shahid , Shahbaz Shanzah , Ahmed Syed Nazir , Hussain Muhammad Zahid
Published: December 2022

Objective: To compare the respiratory complications of COVID-19 among patients with rheumatological conditions taking bDMARDs and csDMARDs at Pak Emirates Military Hospital Rawalpindi.

Study Design: Comparative prospective study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Mar to May 2020.

Methodology: Patients diagnosed with COVID-19 on polymerase chain reaction having previously rheumatological conditions managed either with bDMARD or cs DMARD were included in the study. They were followed up for three weeks after the positive polymerase chain reaction. Complications leading to the use of oxygen or ICU support or death were compared in both groups of patients.

Results: A total of 82 patients with any rheumatological condition managed either with bDMARD or csDMARD tested positive for covid-19 on polymerase chain reaction and were included in the final analysis. 30 (36.6%) patients were taking bDMARDs while 52 (63.4%) were taking csDMARD. In addition, 4 (4.8%) low dose oxygen therapy, 5 (6.1%) required moderate dose oxygen therapy, while 5 (6.1%) required severe dose oxygen therapy or intensive care unit support. 2 (2.4%) patients died within the three weeks. The requirement of moderate or severe dose oxygen and intensive care unit support was found statistically significantly more in the group taking csDMARDS.

Conclusion: The presence of complications of COVID -19 and the requirement of oxygen and intensive care unit support were present in some of the patients taking DMARDs. Among the DMARDs, bDMARDs were less linked with complications, but large studies with better design required better results.
Comparison of Outcomes in Primary Extensor Tendon Repair of Hand Treated in a Tertiary Care Hospital
Authors: Khursheed Roqayyah Munawwer , Akhlaq Ali Khan Faisal , Ali Hyder , Kumar Suneel , Zahid Zaara , Ansari Muhammad Kamran Ullah
Published: December 2022

Objective: To determine different treatment outcomes of early extensor tendon repair according to the zone of injury.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Plastic Surgery, Dr Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Jun 2019 to May 2020.

Methodology: Seventy-four patients, more than 17 years of age and either gender, presenting to the emergency department of a tertiary care hospital for repair of lacerated extensor tendons of hand were enrolled in the study. All the procedures were performed in an operating room under general or local anaesthesia by a consultant plastic surgeon with experience of 5 years. Tendon repairs were performed using modified Keisler's technique. After wound closure, hand splinting was provided for six weeks. Outcomes were assessed per Miller's Classification at six weeks, two months, and three months post repair and classified as excellent, good, moderate and bad.

Results: The mean age of study participants was reported as 30.69±12.86 years. Zone II (36.4) and VI (47.2) were the most common location of laceration. Of all patients with Zone II lacerations, 33.3 achieved excellent outcomes, and 29.5 achieved a good outcome. Further, in patients with zone VI, 68.5 of the patients achieved good to excellent outcomes.

Conclusion: According to Miller's Classification, the study showed excellent results with zone IV and II injuries. Zone V and 8 had good outcomes, whereas zone I and II showed moderate to bad outcomes. There was no statistical association between the proportions of outcomes and zone of injury.
Coronary Artery Ectasia in Patients with and Without Diabetes: A Study from Northern Pakistan
Authors: Saleem Qaiser Mehmood , Bari Abdul Mannan , Mushtaq Muhammad Salman , Ahmed Bashir
Published: December 2022

Objectives: To determine the association of coronary artery ectasia in terms of its severity and vessels involved in diabetes patients and non-diabetes patients.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Cardiology, PAEC General Hospital, Islamabad Pakistan from Jun 2018 to Jun 2020.

Methodology: All patients who underwent coronary angiography were included in this study. Two hundred patients (100 patients having diabetes and 100 patients not having diabetes) who presented with chest pain and chest heaviness were diagnosed with coronary artery ectasia on coronary angiography included in this study.

Results: Two hundred patients, 100 patients had diabetes, and 100 patients had no diabetes. 71 (35.5%) of the patients were males, and 29 (14.5%) were females. The left anterior descending artery alone was responsible for 23% of Coronary Artery Ectasia, followed by the right coronary artery (16%) in diabetic patients. In patients with diabetes with multiple vessels, the left anterior descending artery and left circumflex artery were most frequently (21%) involved vessels, while left anterior descending and right coronary artery were observed to have Coronary artery ectasia in 16% of diabetes patients.

Conclusion: No significant difference in the severity of coronary artery ectasia was noted among diabetes and non-diabetes patients. Left anterior descending was most frequently involved vessels in diabetes patients and right coronary artery in nondiabetes patients. Left anterior descending and left circumflex artery both had coronary artery ectasia in most of the diabetes patients and non-diabetes patients.
Spectrum of Disorders Leading to Sudden Cardiac Death
Authors: Gilani Sayed Tanveer Abbas , Khan Dilshad Ahmed , Iftikhar Ghazala , Khan Kumail Abbas , Rauf Amer , Siddiqui Abdul Hameed
Published: December 2022

Objective: To determine the frequency of disorders leading to sudden cardiac death (SCD).

Study Design: Cross-sectional study.

Place and duration of study: Pathology Lab in collaboration with the Cardiology Department, AFIC & NIHD, Rawalpindi Pakistan, from Jan 2017 to Dec 2018.

Methodology: A total of 305 cases of sudden cardiac death reported within the last 24 hours of a death to AFIC Rawalpindi were included consecutively. Cases with a history of extracardiac diseases leading to sudden death were excluded. Most of the included cases were diagnosed phenotypically based on clinical examination, biochemistry, ECG, echocardiography, angiography, thallium scan, electro-physiological studies, cardiac CT scan, MRI and routine autopsy whenever recommended.

Results: Out of 305 cases, 197 (65%) were males and 108 (35%) females. Disorders leading to SCD were found in 178 (58.3%) cases due to ischemic heart disease (IHD), aortic dissection (0.7%), hypertrophic cardiomyopathy (HCM) (0.3%), dilated cardiomyopathy (DCM) (10.5%), congenital heart disease (12.1%) and valvular heart disease (7.9%). While in cardiac channelopathies, catecholaminergic polymorphic ventricular tachycardia (CPVT) in 5 (1.6%) and congenital long QT syndrome (LQTS) in 2 (0.7%) cases. However, 24 (7.9%) cases remained as sudden unexplained deaths (SUD).

Conclusion: In our setup, ischemic heart disease and dilated cardiomyopathy were the commonest causes of sudden cardiac death, followed by congenital heart disease and valvular heart diseases.
Implementation Plan and Solutions to the Challenges Faced by Medical Faculty During COVID-19 Pandemic: Transition to the New Normal
Authors: Hameed Ammara , Fakhir Shazia , Ahmed Shakeel
Published: December 2022

Objective: To assess faculty perception regarding the transition from traditional to online classrooms and highlight the problems and devise possible solutions for these problems.

Study Design: Cross-sectional study.

Place and Duration of Study: Two Public and five Private Sector Medical Institutes in the month of September 2020.

Methodology: An online questionnaire comprising three sections, including consent, personal information and questions related to the experience regarding online teaching, was designed. The questionnaire was posted online, and medical faculty of public and private sector medical universities in Karachi were invited to participate in the study. As a result, the MBBS, BDS, and DPT teaching faculty of two public sectors and three private sector medical colleges/universities who took the online classes participated in the study.

Result: 41.2% response rate was recorded. 42 (61.8%) participants felt training given by their institutes was satisfactory. 67 (98.5%) of participants felt that a user-friendly system was employed for online teaching. 61 (89.7%) participants changed teaching strategy, although 49 (72.1%) were unprepared. 67 (98.5%) participants felt student feedback was essential, and 86.8% felt the interaction was vital. 66 (97.1%) participants said clinical teaching was compromised. Student behavioural issues were identified by 22 (32.3%) of faculty members. Problems with technology was faced by 33 (48.5%) participants.

Conclusion: Online teaching and learning is expected to continue in the new normal post-COVID-19 era. The transition was difficult, but faculty training programs promise improvement to continue this strategy in future.
Frequency of Respiratory Distress Syndrome in Preterm Infants Delivered at Pak Emirates Military Hospital, Rawalpindi
Authors: Bashir Junaid , Ahmed Zeeshan , Ghafoor Muzammal , Hussain Murtaza , Zaman Saeed , Babar Muhammad Waleed
Published: December 2022

Objective: To determine the frequency of Respiratory Distress Syndrome among preterm neonates born at the Pak Emirates Military Hospital.

Study Design: Cross-Sectional Study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2020 to Mar 2021.

Methodology: One hundred and sixty-nine neonates with a gestational age of ≤34 weeks of either gender were included in this study. RDS was confirmed by reviewing neonatal medical charts. The frequency of RDS was seen in different groups according to gestational age, gender, weight, hypothermia, sepsis and jaundice.

Results: There were 169 patients; among them were 94 (55.6%) males and 75 (44.4%) females. 105 (62.1%) were born by caesarean section, and 64 (37.9%) were normal vaginal delivery. There were 26 (15.4%) neonates, with RDS, and 143 (84.6%) did not have RDS. Among our 169 sample, 26 (15.4%) were in <28 weeks, 96 (56.8%) were in the 28 to 32 weeks and 47 (27.8%) were in >32 week gestational groups. There were 34 (20.1%) who were <1000 g, there were 96 (56.8%) were between 1000 to 1500 g, and 39 (23.1%) were > 1500 g. Hypothermia was found in 43 (25.4%) of neonates; 126 (74.6%) did not have hypothermia. 63 (37.3%) neonates had sepsis, and 39 (23.1%) had jaundice.

Conclusion: RDS is a serious problem in our country. Health care providers must plan cost-effective and efficient strategies to detect and treat RDS in the developing world.
Patient Satisfaction with Clinical Laboratory Services in Public Health Sector Hospitals of Azad Kashmir, Pakistan
Authors: Khalid Bilal , Ayyub Fareeha , Nasim Midhet , Babar Ayesha , Khan Saad Alam
Published: December 2022

Objectives: To determine patient satisfaction and factors affecting patient satisfaction with laboratory services in Azad Jammu & Kashmir (AJK).

Study Design: Cross-sectional study.

Place and Duration of Study: Seven District Headquarter Hospitals, DHQ Neelum, DHQ Hattian Bala, DHQ Pallandari, DHQ Bagh, DHQ Kotli, DHQ Bhimber and DHQ Mirpur, Kashmir Pakistan from Dec 2019 to Feb 2020.

Methodology: The patients who were referred from the Outdoor Patient Department of the hospital for undergoing investigative tests were included, and patients of age less than 18 and critically ill patients were excluded.

Results: The total number of respondents included in the study was 400, with the median score of patient satisfaction with laboratory services being 59 (19), ranging from 32 to 100. Statistically significant disparities in client satisfaction were observed in different DHQ hospitals (p-value=0.01) with Mirpur (63) and Pallandri (40) showing the extreme variation. Residential area, age, and education level were also identified as statistically significant determinants of patient satisfaction (p-value <0.05).

Conclusion: patient satisfaction with laboratory services in public hospitals of AJK was very low, and targeted strategies are needed to improve the overall quality of these services.
Seasonal Variation in Psychiatric Disorders Among Patients Admitted at Armed Forces Institute of Mental Health Rawalpindi
Authors: Saleem Nida , Qayyum Rashid , Hamdani Syed Muhammad  Akram , Saleem Summaya , Ullah Saleem , Hassan Ammad
Published: December 2022

Objective: To determine the seasonal variation in psychiatric disorders among patients admitted to the Armed Forces Institute of Mental Health.

Study Design: Retrospective longitudinal study.

Place and Duration of the Study: Armed Forces Institute of Mental Health Rawalpindi from Jun 2014 to May 2019.

Methodology: A total of 3120 cases diagnosed according to ICD-10 criteria were included after evaluating a 5-year indoor hospital record. Around 30 psychiatric disorders among males and females aged 12-65 were included. Cases of adjustment disorder in the military and those without any diagnosis were excluded. Disorders were allocated to 4 seasonal groups according to the months of admission, and Seasonal variation among them was evaluated.

Results: The 5-year disease burden showed predominance for bipolar affective and depressive disorder with 887 (28.4%) and 728 (23.3%) frequency, respectively. The higher number of admissions 825 (26.4%) took place in autumn, followed by 809 (25.9%) in winter. Admissions for the depressive disorder were highest during autumn 212 (29.1%). Peak admissions in winter included bipolar affective disorder 233 (29.53%), acute mania 23 (36.5%), and mania with psychosis 12 (34.28%). Psychotic disorders like schizophrenia and schizoaffective disorder were found prevalent in 2 seasons, 76 (26.0%) during the autumn and winter seasons each and 14 (29.0%) during the autumn and spring season each, respectively. Delusional disorder 4 (50.0%), paranoid psychosis 10 (45.0%) and acute and transient psychosis 17 (34.6%), and disorders with physical symptoms like dissociative 23 (36.0%) and conversion disorder 5 (33.0%), were especially widespread during spring.

Conclusion: Significant seasonal...........