bluuebunny/crossref_metadata_2025_split huggingface dataset:
PLASMAPHERESIS IN THE TREATMENT OF MYASTHENIA GRAVIS: OUTCOME AND COMPLICATIONS
Authors: Abbas Maryam , Robert Helen Mary , Mahmood Asad , Khan Saleem Ahmed , Naeem Mohammad Abdul , Ayaz Muhammad Ahsan 
Published: May 2021

Objective: To assess the outcome and complications of plasmapharesis in treatment of myasthenia gravis and factors linked to poor outcome at hematology unit of a tertiary care teaching hospital of Pakistan
Study Design: Prospective comparative study.
Place and Duration of Study: Pak Emirates Military Hospital/Armed Forces Institute of Pathology, Rawalpindi, from Jan 2018 to Jul 2019.
Methodology: A prospective study was conducted on patients of myasthenia gravis presented at our neurology department. All the complications of the procedure were recorded. Outcomes included recovery, shifting to intensive care unit and death. Pearson chi-square was applied to relate the factors with presence of complications or poor outcome.
Results: Hypotension 3 (6%) was the commonest complication faced by the patients followed by chest discomfort 2 (4%) during or after the plasmapharesis. Out of 50 patients, 47 (94%) recovered, 8 (16%) had minor complications, 2 (4%) were shifted to the intensive care unit and 1 (2%) died. Long duration of time between onset of symptoms and first session of plasmapharesis had a significant relationship (p-value <0.05) with presence of complications or poor outcome among the patients of myasthenia gravis undergoing plasmapharesis.
Conclusion: Plasmapharesis emerged as effective treatment for this immune based neurological disorder with limited side effects. A neurologist should be aware of these common minor and rare major side effects and pay special attention to the patients with generalized myasthenia gravis and those with long duration of time between onset of symptoms and first session of plasmapharesis.Keywords: ,.
EFFICACY OF MAGNESIUM SULPHATE ON MATERNAL MORBIDITY AND MORTALITY IN ECLAMPSIA
Authors: Arif Nadia , Ahmed Raja Qaseem , Zafar Bushra , Shehzad Farrukh 
Published: May 2021

Objective: To study efficacy of Magnesium Sulphate in reducing maternal morbidity and mortality in patients presenting with eclampsia.
Study Design: Prospective observational study.
Place and Duration of Study: Gynae/Obs Department, Combined Military Hospital Bannu, from Jan 2018 Sep 2019.
Methodology: A total of 134 patients fulfilling inclusion criteria were included in the study. Patient management was multidisciplinary. Convulsions were controlled by 4gram magnesium sulphate intravenously over 20 minutes as a loading dose, followed by 1gram per hour of maintenance infusion. Blood pressure was controlled with injection Labetalol 10 milligram followed by injection Hydralazine repeated after every 20 minutes till the blood pressure was controlled.
Results: A total of 134 patients had eclampsia constituting 6.8% of obstetric admissions. Case fatality was 14 (10.4%) while 120 (89.55%) of the cases responded well to treatment and survived the event. Mean age of patients was 22 years. Thirty patients 22.4% were booked and 104 patients 77.6% were un-booked. Mostly patients 122 (91%) came from rural area and only 12 (9%) were from urban areas with booked pregnancies having regular antenatal visits. One hundred and twenty six (94%) patients with eclampsia presented in antenatal period and only 8 (6%) presented in post natal period. Mode of delivery was cesarean section in 87 (64.9%) and 47 (35.1%) delivered vaginally. Frequency of patient requiring ventilator support, acute renal failure,disseminated intravascular coagulation, adult respiratory distress syndrome, HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome was 11 (8.2%), 46 (34.3%), 43 (32.1%), 35 (26.1%), 7 (5.2%) respectively..........
RELUCTANCE OF PATIENTS WITH DIABETES MELLITUS TO INSULIN THERAPY; PSYCHOLOGICAL INSULIN RESISTANCE
Authors: Ali Umair , Munir Muhammad Wajid , Maqsood Jahanzeb , Jamil Mahwash , Rehman Syed Saif Ur , Ansari Abida Mateen 
Published: May 2021

Objective: To evaluate factors resulting in reluctance of initiation of insulin therapy in patients with type 2 diabetes mellitus.
Study Design: Cross sectional study.
Place and Duration of Study: Medical OPD of a private tertiary care multi-specialty hospital in Islamabad, from Apr to Jul 2019.
Methodology: Patients with diabetes mellitus between age of 30-70 years, who had poor glycaemic control on two oral antidiabetic drugs having HbA1c>9% and were insulin naïve, were included in this study. A validated questionnaire was developed which had two sections; first including the demographic data of the study populations and second having closedended dichotomous questions which were asked from patients by the treating physicians
Results: A total of 180 patients with diabetes mellitus eligible for insulin therapy were included in the study, among them 52 (28.9%) were agreed to initiate the insulin. Negative attitude and beliefs include painful way of administration 85 (66.4%), difficult insulin storage 98 (76.6%), risk of hypoglycemia 82 (64.1%).The mean negative perception Score was 7.35 (SD 0.98).
Conclusion: Psychological insulin resistance is present in significant diabetic population, and it is a big obstacle in insulin therapy initiation and compliance.
RISK OF DEVELOPMENT OF HYPERTENSION AFTER DONOR NEPHRECTOMY
Authors: Mansoor Khurram , Sabir Sohail , Rana Sumbal , Munir Ali Arslan , Yasrab Muhammad , Shahzad Kaubaib , Sajid Tanveer , Haider Naqvi Syed Ehtesham 
Published: May 2021

Objective: To assess live donor nephrectomy for development of hypertension.
Study Design: Retrospective observational study.
Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020.
Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor’s workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score.
Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace.
Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively................
EFFICACY OF SALBUTAMOL DELIVERED THROUGH A METERED DOSE INHALER & SPACER IN CHILDREN WITH ACUTE EXACERBATION OF ASTHMA
Authors: Tahir Ali Mujtaba , Akhtar Waqas , Balooch Salah Ud Din , Ahmed Waqas , Samar Ali Murtaza , Sohail Amina 
Published: May 2021

Objective: To assess efficacy of salbutamol delivered through metered dose inhaler (MDI) - spacer in paediatric patients with acute exacerbation of asthma.
Study Design: Prospective observational study.
Place and Duration of Study: Department of Paediatrics, Pakistan Naval Ship, Shifa Hospital, Karachi-Pakistan, from Jan to Dec 2018.
Methodology: Ninety Five patients aged ≥6 to ≤12 years, with acute asthma exacerbation were enrolled. Any patient with fever, clinical asthma score (CAS) >7, on home treatment with drugs delivered through nebulization or on oral steroids was excluded. Clinical asthma score recorded on presentation, followed with salbutamol via Metered Dose Inhaler & spacer at dose of 400 µgm (4 x puffs of 100 µgm). Clinical asthma score rechecked after 20 min. Response to salbutamol was then compared in relation to the presenting Clinical asthma score.
Results: Out of 95 children, 45 (47.9%) were male & 50 (52.1%) female with 67.4% having positive family history for asthma. Average premedication clinical asthma score was 2.44. Sixty nine (72.9%) patients had an adequate response as they exhibited clinical asthma score of 0 or fall in score of ≥2. Patients with adequate response had average clinical asthma score of 2.07 on presentation in contrast to 3.42 with inadequate response.
Conclusion: Salbutamol delivered via Metered Dose Inhaler & spacer at dose of 400 µgm is an effective medication for quick relief in children with acute exacerbation of asthma. Moreover, its administration at a point where exacerbation is not much severe steers us towards more favourable outcome.
A COMPARISON OF EFFICACY OF INTRADERMAL TRANEXAMIC ACID WITH TOPICAL 20% AZELAIC ACID IN THE TREATMENT OF MELASMA
Authors: Komal Sayyida , Mashhood Asher Ahmed , Farooq Muhammad , Qayyum Nida 
Published: May 2021

Objective: To compare the efficacy of Intradermal Tranexamic acid and topical 20% Azelaic acid cream in the treatment of melasma.
Study Design: Comparative prospective study.
Place and Duration of Study: Dermatology department, Combined Military Hospital Peshawar, from Sep 2018 to Mar 2019.
Methodology: A total of 116 female patients, at the outpatient department of dermatology at Combined Military Hospital Peshawar, were randomly assigned into two groups; group A (intradermal tranexamic acid) and group B (topical azelaic acid) by lottery method. Patients in group A received intradermal injection, while the participants of group B received topical azelaic acid only, fortnightly for 6 weeks. Melasma area severity index score was calculated for each patient in both groups at the start and at the end of the treatment.
Results: The mean Melasma area severity index score in group A (intradermal tranexamic acid) before and at 6 weeks of treatment was 7.10 ± 2.94 and 5.27 ± 2.44, respectively. The mean Melasma area severity index score in group B (topical azelaic acid) before and at 6 weeks of treatment was 7.56 ± 2.57 and 5.76 ± 2.89, respectively. Efficacy of intradermal tranexamic acid, as poor response, good response and excellent response was 27.6%, 41.4% and 31% respectively. While, efficacy of topical azelaic acid group as poor response, good response and excellent response was 62.1%, 20.7% and 17.2% respectively. The difference was statistically significant, (p=0.001).
Conclusion: It can be concluded that intradermal tranexamic acid is more effective as compared to topical 20% azelaic acid in..................
MEDICAL PRFESSIONALISM: COMPARING VIEWS OF PUBLIC AND DOCTORS
Authors: Bano Uzma , Ahmed Anis , Tassadaq Noreen 
Published: May 2021

Objective: To compare the views of public and doctors about importance of attributes of medical professionalism.
Study Design: cross-sectional comparative study.
Place and Duration of Study: Study was carried out at Fauji Foundation Hospital Rawalpindi from Oct 2019 to Mar 2020.
Methodology: Study included 115 public participants and 115 doctors. Their perceptions about the importance of different attributes of medical professionalism were recorded on a structured questionnaire by rating on a 5-point Likert scale of importance. Independent samples t-test was used to compare the mean scores of the public group to the mean scores of the doctors for every attribute.
Results: View of public and doctors were very similar. “Honesty and integrity, sound judgment and decision making, responsible behavior, confidentiality, professional development, abiding professional rules, and being reliable” were ranked among the top ten important attributes by both groups. On the other extreme “maintaining a high standard of living” was ranked at the bottom of list by both groups. Significant differences in views of public and doctors were found regarding attributes of social justice among doctors (4.4 vs 4.09, p=0.012) and among patients (4.43 vs 4.09, p=0.05) and autonomy (4.42 vs 4.2; p=0.042).
Conclusion: The opinions of public and doctors on what constitutes medical professionalism are similar with integrity and honesty being the most important attribute and to maintain a high standard of living being the least important attribute.
ENDOSCOPIC FINDINGS IN PATIENTS PRESENTING WITH DYSPEPSIA AND ASSOCIATION OF AGE AND GENDER WITH ORGANIC DYSPEPSIA
Authors: Batool Safia , Sajid Muhammad Usman , Waris Jamal , Satti Shahzeb Ahmed , Hassan Fayyaz , Aziz Faisal 
Published: May 2021

Objective: To determine frequency of general and specific endoscopic findings in patients diagnosed with dyspepsia and to determine association of age and gender with organic dyspepsia.
Study Design: Cross sectional study.
Place and Duration of Study: Gastroenterology department, Combined Military Hospital, Kharian, from Jul to Dec 2018.
Methodology: A total of 180 patients participated in the study after being selected through non probability consecutive sampling. Age, gender and history of dysphagia, weight loss, gastrointestinal bleeding, and smoking were recorded. All underwent standard electronic video upper gastrointestinal endoscopy. Abnormal findings of inflammation, narrowing, strictures, furrowing, erosions, ulcers, atrophy, nodularity, polyps, masses and malignancy were recorded. The abnormal findings were presented as frequency and percentages. On the basis of endoscopic findings the sample was divided into two groups of functional (normal endoscopy) and organic dyspepsia. Chi-square test was selected to compare the frequencies of organic and functional dyspepsia with age and gender.
Results: Majority 99 (55%) of the patients with dyspepsia had a normal endoscopic finding while in organic dyspepsia, reflux esophagitis 41 (22.8%) was the most common finding followed by gastritis 16 (8.9%), duodenal ulcer 12 (6.7%) and gastric ulcer 9 (5%). Three patients with organic dyspepsia had malignancy. Most common specific findings were non erosive esophagitis 25(30.8%). Age above 40 years and male gender was found to be statistically significantly associated with organic dyspepsia (p<0.01).
Conclusion: Majority of the patients with dyspepsia have a normal endoscopic finding. There is a higher incidence of organic dyspepsia in males and in patients..................
ANTENATAL CARE AND NEONATAL MORTALITY AND MORBIDITY IN THREE HOSPITALS OF PUNJAB, PAKISTAN
Authors: Akbar Rizwana , Azam Naila , Mughal Fatima Ali Raza , Rahman Mahmood Ur , Tariq Ahmed , Wajahat Maira 
Published: May 2021

Objective: To find out the association between neonatal morbidity & mortality and the number of ante-natal visits of the mother of the newborn.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Neonatal Intensive Care Units (NICUs) of three military hospitals of the Punjab province, from Jan to Mar 2019.Methodology: Data of all newborns (total of 3065 neonates) delivered in selected Military Hospitals, and all newborns admitted to Neonatal Intensive care units, of Military Hospitals born in same hospital (in born) and born outside the Military Hospital (out born) during this period along with their mothers was collected. Neonatal morbidity and mortality in the selected hospitals was recorded. Mothers were classified as booked and unbooked according to the number of antenatal care visits. Data was analyzed by Statistical Packages for Social Science (SPSS) version 20.
Results: Neonatal morbidity including prematurity, low birth weight, birth asphyxia, neonatal sepsis, pneumonia, diarrhoea, congenital malformation, and fits was significantly less (p-value <0.001) in children whose mothers had at least 4 or more antenatal visits (booked) than those newborns whose mothers had less than 4 antenatal visits (unbooked). The neonatal mortality in booked mothers was less than half of that in unbooked mothers.
Conclusion: Booked mothers had better outcomes in terms of neonatal health and survival, and the neonatal health and survival was strongly correlated with the number of antenatal visits of the mother.
DETERMINATION OF CEPHALOMETRIC SOFT TISSUE NORMS FOR LOCAL POPULATION WITH NORMAL OCCLUSION USING HOLDAWAY ANALYSIS
Authors: Panezai Saadia , Mengal Nasrullah , Ahmed Khalil 
Published: May 2021

Objective: To assess soft-tissue values in a group of local ethnic population with Class I occlusion by Holdaway‟s soft tissue cephalometric analysis, and to verify the pertinence of Holdaway‟s norms to local sample subjects.
Study Design: Cross sectional study design.
Place and Duration of Study: Orthodontics department, Bolan Medical College, Civil Sandman Hospital, Quetta, from Jun 2018 to Dec 2018.
Methodology: Cephalometric radiographs of 69 Adults (33 males and 36 females) aged between 18-28 years, with normal occlusion and well aligned arches, were measured. Cephalometric landmarks were identified as stated by Holdaway analysis. On each radiograph two angular and nine linear measurements were evaluated.Results: Local ethnic population showed more convex profiles with higher skeletal convexity (1.97 ± 1.85) and H angles (15.05 ± 3.31), greater nose prominence (18.25 ± 3.73), upper lip thickness (13.43 ± 1.64), and soft tissue chin thickness (12.64 ± 1.94) compared to Holdaway‟s values. All values showed sexual dimorphism, amongst these statistically significant values (p<0.05) were of soft tissue subnasale to H line, total upper lip thickness, nose prominence, soft tissue chin thickness and inferior sulcus to H line.
Conclusion: Racial variance was present in sampled population, compared to Caucasian norms. These differences must be kept in the mind when planning and executing orthodontic therapy.
DONOR SITE MORBIDITY OF FIBULAR FLAP
Authors: Ali Ghazanfar , Majid Abdul , Almas Danish , Hameed Shahid , Aslam Rizwan , Khan Zubair Ahmad 
Published: May 2021

Objective: To present the early and late outcomes related to donor site morbidity of Free Fibular Flap.
Study Design: Prospective observational study.
Place and Duration of Study: Plastic surgery department, Combined Military Hospital Rawalpindi, from Jan 2009 to Jan 2020.
Methodology: In total 361 patients were enrolled for the study through consecutive purposive sampling. All patients requiring free fibula flap for reconstruction of the defect were included in the study. However, the patients with Diabetes Mellitus, Smoking or peripheral vascular disease were excluded from the study. The patients were asked to visit on second week and then at three months for late outcomes. The results were entered SPSS-24 for analysis and interpretation of data.
Results: Out of total 361 patients enrolled for study 293 (81.16%) were male and 68 (18.83%) were female. The men age was 51.43 years SD 14.6 (range 4 year to 68 years). In early outcomes, graft loss 29 (8.03%) and sensory deficit 19 (5.26%), are the commonest adverse outcomes. Results of late follow up revealed chronic pain in 29 (8.03%), ankle instability in 24 (6.64%), gait abnormality in 29 (8.76%) and claw toe in 33 (9.14%) patients. The American Orthopedic Foot and Ankle Society (AOFAS) score was 88.45%. Majority (52.63%) patients were very satisfied.
Conclusion: The free Fibula is excellent choice for reconstruction of a wide range of osseous defects with minimum donor site morbidity and high satisfaction rate among the patients.Keywords:
CLINICAL AND RADIOLOGICAL OUTCOMES OF MANDIBULAR CONDYLAR FRACTURES AFTER CONSERVATIVE TREATMENT
Authors: Sarwar Humaira , Shah Irfan , Khan Ali Akhtar , Babar Adnan , Mehmood Saad , Meraj Wajid 
Published: May 2021

Objective: To assess the clinical as well as radiological outcomes of the conservative management of mandibular condyle fractures.
Study Design: Cross-sectional comparative study.
Place and Duration of Study: Department of Oral and Maxillofacial Surgery (OMFS), Armed Forces Institute of Dentistry (AFID), Rawalpindi, from Feb 2018 to Aug 2019.
Methodology: A total of 60 patients diagnosed as isolated mandible trauma with unilateral condyle fractures were studied. All patients were assessed radiologically on orthopantomogram (OPG) before the start of treatment. They were assessed clinically for maximum mouth opening (MMO), occlusion, pain and masticatory satisfaction before the start of treatment and after conservative management. Conservative Management includes soft diet only or maxillomandibular fixation (MMF) followed by active physical therapy. After 6 months of follow up, pre-treatment and post-treatment clinical parameters and radiological finding were compared.
Results: Sixty patients were managed conservatively, among them 37 (62%) were male and 23 (38%) were female with age range of 21-53 years. There was statistically significant decrease in pain (p-value 0.002) and improvement in mastication (pvalue 0.079) before and after the conservative treatment of mandibular condylar fractures. Overall 46 (77%) patients treated with conservative management were satisfied with their mastication and 40 (67%) patients had mild pain on mastication. All the patients showed satisfactory occlusion and had no occlusal discrepancy on last follow up visit. Maximum mouth opening improved from 32.38 ± 4.54 to 40.90 ± 1.75 after treatment. The mean of preoperative ramus length difference of both sides of the mandible was 4.23 ± 2.3 mm............
COMPARISON OF OLFACTORY DISTURBANCE IN COVID-19 POSITIVE CASES WITH NON COVID-19 RHINITIS CASES
Authors: Sheikh Zeeshan Ayub , Ahmed Azeema , Ashfaq Ahmed Hasan , Riaz Naeem , Ahmed Naveed , Ahmed Naeema 
Published: May 2021

Objective: To determine association of anosmia as an early symptom of COVID-19 infection.
Study Design: Comparative cross sectional study.
Place and Duration of Study: ENT department, Combined Military Hospital, Quetta, from Apr to Oct 2020.
Methodology: A total of 6411 consenting patients with symptoms of viral upper respiratory tract infection presenting at ENT department, Combined Military Hospital Quetta, from Apr to Oct 2020 were tested for COVID 19 via PCR studies.
Results: Out of 6411 individuals 1109 (17.3%) were found to be COVID positive and 5302 (82.7%) were COVID negative. Of the COVID positive cases 611 (55.1%) of COVID positive individuals had anosmia, whereas only 68 (1.2%) of COVID negative individuals had anosmia, this observation was statistically significant (p<0.001 on chi square test). Whereas only 33 (2.9%) patients had nasal obstruction in COVID positive group, and 68 (1.2%) cases in COVID negative group had nasal obstruction, this observation was not statistically significant (p>0.05 on chi square test).
Conclusion: Anosmia has a definite association with COVID 19 infection.