bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Unusual Lacrimal Gland Mass
Authors: Singh Manpreet , Kaur Savleen , Gupta Pankaj , Zadeng Zoramthara , Vasishta Rakesh 
Published: February 2021

ABSTRACT

Aim and objective
The present report describes an atypical presentation of a lacrimal gland mass in a young male patient. Symptomatology favored a benign mass that was proven to be malignant on histopathology.

Background
Adenoid cystic carcinoma is the most common epithelial malignancy of the lacrimal gland. The usual presentation of adenoid cystic carcinoma is in either sex at about an average 40 years of age with range from 6 to 79 years. The patient usually complains of a superotemporal orbital mass with rapid progression usually within a year. Uncommonly, these masses may present with longer history as is described in present case report.

Case description
A 17-year-old male patient of Indian origin presented with a mass in the superotemporal part of the right orbit for the last 5 years and 6 months. A firm and smooth orbital mass, approximately 20 mm × 15 mm, was present in superotemporal orbit that was nontender and nonpulsatile. A clinical diagnosis of lacrimal gland pleomorphic adenoma was strongly suggested by the clinical as well as radiological features. The orbital mass was excised en bloc by a right transseptal anterior orbitotomy. Histopathological examination of the excised mass revealed features characteristic of lacrimal gland adenoid cystic carcinoma.

Conclusion
Lacrimal gland adenoid cystic carcinoma can simulate pleomorphic adenoma and can present with history over 5 years. Hence, it should always be kept as a clinical possibility in patients with the painless superotemporal orbital mass and early excision of such orbital masses for appropriate diagnosis and management is vital.

Clinical significance
The duration of 5½ years at presentation in well-localized lacrimal gland adenoid cystic carcinoma is the longest period ever reported. The present article recommends keeping the differential diagnosis of adenoid cystic carcinoma in all patients with the clinically benign superotemporal orbital mass.

How to cite this article
Gupta P, Kaur S, Zadeng Z, et al. An Unusual Lacrimal Gland Mass. Clin Rhinol An Int J 2019;12(2 and 3):49–51.
SPECTRUM OF OPTIC NEUROPATHIES PRESENTING IN NEUROOPHTHALMOLOGY CLINIC AT AFIO
Authors: Ijaz Umer , Habib Asad , Rathore Hassan Sajjad , Sarwar Khan Muhammad Imran 
Published: February 2021

Objective: To study the spectrum of optic neuropathies in patient’s presenting at AFIO Rawalpindi.
Study Design: Descriptive study/retrospective study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan 2017 to Dec 2017.
Methodology: Retrospective analysis of hospital record of patients coming to neuro-ophthalmic clinic of ArmedForces Institute of Ophthalmology (AFIO), Rawalpindi, from Jan to Dec 2017 was done. Only patients with clearfinal diagnosis of neurophthalmic disease were included. Those with vague diagnosis were excluded. Data wasentered in SPSS version 22 and grouped into variables before analysis. Chi-square test was used for statisticalanalysis. The p<0.05 was considered significant.
Results: Forty-five patients were included in study including 33 (73.3%) males and 12 (26.6%) females. Mean age of patients was 41.64 ± 17.74 years. Patients were grouped into ischemic optic neuropathy 20%, toxic optic neuropathies 20%, compressive optic neuropathies 17.7%, inflammatory optic neuropathies 11%, neuroretinitis 6.7%, hereditary optic neuropathies 6.7%, multiple sclerosis (MS) related 4.4%, neuromylitis optics spectrum (NMO-SD) related 4.4%, traumatic optic neuropathies 4.4% and nutritional optic neuropathies 4.4%. Deficiency of vitamin B12 and vitamin D was strongly associated with nutritional optic neuropathies while raised TLC was most common association with inflammatory optic neuropathies (57.14%) and of neuroretinitis (66%). Anti-tuberculosis drugs were most common cause of toxic optic neuropathies (88.88%). Chi square test was used for statistical analysis and p<0.05 was considered significant.
Conclusion: Ischemic optic neuropathy is the most common presentation in our population according to ourstudy. However...........
EFFECT OF SUBCUTANEOUS RECOMBINANT HUMAN ERYTHROPOIETIN ON BLOOD PRESSURE IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE (CKD) PATIENTS
Authors: Hussain Muhammad Sajid , Raza Qasim , Omer Aamir Muhammad , Murtaza Nadia , Naureen Sadia , Razzaq Mehwish 
Published: February 2021

Objective: To determine the effect of subcutaneous recombinant human erythropoietin on blood pressure in predialysis chronic kidney disease (CKD) patients.
Study Design: Case-series descriptive study.
Place and Duration of Study: Combined Military Hospital Peshawar, from Mar 2016 to Sep 2016.
Methodology: A total of 100 cases were enrolled. Inclusion criteria was patients of 18 to 60 years of both gender & estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 having Hb <10g/dL and pre-dialysis while Exclusion Criteria was pregnancy or lactation, BP more than 140/90 mmHg, patients on Haemodialysis and worsening renal function. Baseline BP, body weight and eGFR of anaemic chronic kidney disease patients were recorded prior to EPO Alpha therapy. Erythropoiesis-stimulating agents (ESAs) i.e. EPO Alpha (50-100 Units/kg thrice or once weekly) was administered subcutaneously. Subsequent blood pressure, body weight and eGFR monitoring was done after 2 and 4 weeks post EPO Alpha injection.
Results: Mean age range was 46.71 years with range of 20-60 years, 73 (73%) were male while 27 (27%) werefemales. Mean ± SD for other quantitative variables like eGFR was 23.12 ± 5.28, Hb levels (g/dL) was 8.62 ± 0.85,Weight (kg) was 56.66 ± 6.62 and duration of CKD was 9.87 ± 4.02. Frequency of Hypertension (post EPO) was 2(2%) and p-value was 0.453.
Conclusion: We concluded that the frequency of hypertension in pre-dialysis patients with chronic kidney disease (CKD) receiving recombinant human erythropoietin (rhEPo) subcutaneously (SC) in low doses, is very low, so rhEPo can be used subcutaneously......................
COMPARISON OF SOLIFENACIN VERSUS COMBINATION OF SOLIFENACIN AND TAMSULOSIN IN IMPROVING UNILATERAL DOUBLE-J STENT RELATED LOWER URINARY TRACT SYMPTOMS - A PROSPECTIVE RANDOMIZED CONTROL TRIAL
Authors: Sajid Muhammad Tanveer , Rehman Sami Ur , Akmal Muhammad , Ahmad Hussain , Mirza Zahoor Iqbal , Mahmood Arshad 
Published: February 2021

Objective: To compare Solifenacin versus solifenacin plus tamsulosin in terms of international prostate symptom score (IPSS) for lower urinary tract symptoms (LUTS) in patients with unilateral double-J (DJ) ureteric stents.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi from Sep 2018 to Feb 2019.
Methodology: A total of two hundred (n=200) patients of either gender aged 20-50 years, who underwentunilateral DJ stenting for different endourological procedures, were enrolled after satisfying inclusion/exclusioncriteria and then randomly allocated to group A (Solifenacin 5mg once daily (OD) ± placebo for 2 weeks) or group B (Solifenacin 5mg OD ± Tamsulosin 0.4 mg OD for 2 weeks) respectively. Baseline (1st post-operative day) and Post 02 weeks treatment IPSS was recorded and analyzed.
Results: Mean age of presentation in group A and group B was 41.11 ± 6.45 vs 39.86 ± 5.34 years with p-value 0.14. Majority of patients in both groups were male (34% female in group A while 31% in group B, difference being statistically insignificant p 0.65). Baseline IPSS in group A and group B was 10.33 ± 2.72 vs 10.46 ± 3.12 with pvalue 0.76 (statistically insignificant) while post 02 weeks treatment IPSS in group A and B was 9.20 ± 2.67 vs 7.88 ± 2.63 respectively with p-value <0.001, the difference being statistically significant.
Conclusions: Current study revealed significant advantage of combination therapy (solifenacin ± tamsulosin)compared with solifenacin monotherapy in lowering LUTS based on IPSS in patients having unilateral......
CLINICAL EFFICACY OF RECOMBINANT FACTOR VIII FC FUSION PROTEIN IN HAEMOPHILIA A PATIENT RECEIVING ON DEMAND TREATMENT ONLY
Authors: Zahir Saima , Zafar Tahira , Hussain Altaf , Malik Hamid Saeed , Ahmed Pervez , Khan Saleem Ahmed 
Published: February 2021

Objective: To evaluate the efficacy of recombinant factor VIII FC fusion protein in haemophilia A patientreceiving on demand treatment only.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology and PakistanHemophilia Welfare Society, Rawalpindi, from Jun to Dec 2017.
Methodology: Eighty-nine male patients of Hemophilia A already receiving recombinant factor VIII (20-30 Units/kg) on demand, with no history of inhibitors were included in study. Patients were divided as per age into paediatric and adult group and also on the basis of their basal factor VIII levels into severe, moderate and mild groups. Same patients were switched to recombinant factor VIII FC fusion protein (20-30 Units/kg) and its efficacy was measured and compared with recombinant Factor VIII in terms of dose requirement, injections, bleeds in six month period, presence of inhibitors and side effects.
Results: Eighty nine male patients were studied. There was significant reduction in dose from median value of5750 units for group I to 4000 units for group II. Number of bleed in six month period were reduced from 5.3 ingroup I to 4.5 in group II. Number of injections were reduced on average to 1-2 injection per bleed in group II. No inhibitors were detected in group II.
Conclusion: rFVIII Fc fusion protein has prolong activity and results in reduction of total dose, number of bleed,dose per bleed and has reduced antigenecity.
FREQUENCY OF HYPERURICEMIA IN HYPERTENSIVE PATIENTS AND ITS ASSOCIATION WITH AGE OF PATIENT
Authors: Shah Syed Saif Ul Hassan , Iqbal Usman , Ahmad Ejaz 
Published: February 2021

Objective: To determine the frequency of hyperuricemia in hypertensive patients and its association with the age of patients.
Study Design: Cross sectional analytical study.
Place and Duration of Study: Combined Military Hospital Abbottabad, from Sep 2016 to Feb 2017.
Methodology: All patients of 18-70 years of age with either gender presenting in and out patient departmentswith hypertension were enrolled. Serum uric acid was measured. Analysis of serum uric was done with SelectraXL chemical analyzer having normal references range of 2.52-6.97 mg/dl for males and 1.51-6.0 mg/dl forfemales. Reports were verified by Pathologist.
Results: A total of 137 patients were selected for the study. Mean age of the patients was 56.09 ± 09.36 years.There were 76 (55.50%) patients with >55 years of age while 61 (44.50%) patients were presented with ≤55 years of the patients. Male preponderance was higher 83 (61%) as compared to females 54 (39%). Mean weight, height and Body Mass Index of the patients was 67.99 ± 6.91 kilograms, 1.63 ± 0.08 meters and 25.32 ± 2.15 kg/m2 respectively. Mean systolic blood pressure of the patients was 166.71 ± 13.67 mmHg. Mean Diastolic blood pressure was 100.15 ± 8.84 mmHg. Mean serum uric acid level was 6.96 ± 0.82 mg/dl. Frequency of hyperuricemia was found in 102 (74.45%) while normouricemia in 35 (25.55%) patients.
Conclusion: Frequency of hyperuricemia was found higher in hypertensive patients and it was not associatedwith the age of patients.
ASSESSMENT OF CLINICAL EFFICACY OF COOLING GEL PATCH
Authors: Hussain `Muhammad , Asim Muhammad , Atif Muhammad , Anjum Naveed 
Published: February 2021

Objective: To determine the efficacy of cooling gel patch in various clinical indications and comparison of cooling gel patch with water spray and cold sponging in fever and heat exhaustion.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Garrison Medical Centre Okara Cantt, from Sep to Dec 2018.
Methodology: A total of 48 male patients, age ranges from 20-40 years were assessed with different clinical indications of cooling gel patch. Patients with fever, heat exhaustion, headache, muscle cramps and toothache were included in this study and patients with acute illness other than fever were excluded. A control group of 20individuals was also analyzed against fever and heat exhaustion in which water spray and cold sponging wasused. Frequency and percentages of each indication were calculated and chi square test was applied.
Results: Total of 48 individuals living in plain terrain with various clinical indications of cooling gel patch wereassessed. Cooling Gel Patch was tested on 16 sportsmen with heat exhaustion out of which 2 (12.5%) individualhad minimal effect whereas control group of 10 showed good response in 8 (80%) sportsmen with water sprayand cold sponging with p-value .000578. Six patients with headache and 4 individuals with toothache reportedno reduction in symptoms. Two out of 6 patients with muscle cramps reported mild relief in symptoms. Sixteenpatients reported with high grade fever and out of these, 12 (75%) individuals showed no reduction in temperature after 4 hours of application......
QUANTIFICATION OF RETINAL NERVE FIBER LAYER FOR EARLY DETECTION OF ANTERIOR VISUAL PATHWAY LESIONS
Authors: Malik Noureen , Masud Hannan , Awan Muhammad Manzoor 
Published: February 2021

Objective: To assess the role of quantification of retinal nerve fiber layer for early detection of anterior visualpathway lesions.
Study Design: Case-control study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan to Jul 2019.
Methodology: A total of 100 cases of anterior visual pathway lesions of varying clinical presentations wereincluded in the study. There were 100 matched controls who were selected from the community without anyophthalmological abnormality using non-probability consecutive sampling technique. Retinal nerve fiber layer(RNFL) thickness was measured with the help of optical coherence tomography in both the cases and controls.Mean retinal nerve fiber layer values were compared in both the groups. Student’s t-test was applied to look forany significant difference between the two groups.
Results: Mean age of the patients was 39.14 ± 3.925 years while mean age of the controls was 39.23 ± 2.415 years. Mean retinal nerve fiber layer thickness in the case group was 72.21 ± 9.615 µm while on the control group was 101.34 ± 9.615 µm. A statistically significant difference was observed between cases and controls in terms of mean retinal nerve fiber layer thickness (p<0.001). Subjects with retinal nerve fiber layer thickness <85 µm were more likely to exhibit anterior visual pathway lesions (OR= 15.915 [6.278-40.346]; 95% CI, p<0.001).
Conclusion: Decreased retinal nerve fiber layer thickness can serve as a predictor for anterior visual pathwaylesions. Optical coherence tomography should be incorporated for routine screening of high-risk cases in order.........
D-1 / PD-L1 EXPRESSION IN INVASIVE BREAST CARCINOMA / CANCER
Authors: Salim Sammeen , Asif Muhammad , Ahmed Rabia , Khadim Muhammad Tahir 
Published: February 2021

Objective: To investigate the immunohistochemical expression of PD-1 and PD-L1 in breast cancer cases and itscorrelation with clinicopathological factors.
Study Design: Cross sectional study.
Place and Duration of Study: Histopathology department, Armed Forces Institute of Pathology Rawalpindi, form Jan to Jun 2019.
Methodology: Sixty five cases of breast cancer were retrieved. Clinicopathological parameters like age, gender,tumor grade and receptor status were noted. Immunohistochemistry for PD-1 and PD-L1 was applied. The datawas entered and statistical analysis was done using SPSS version 21. The associations between variables werefound using the Fisher exact test.
Results: Sixty five cases of breast cancer were investigated from tumour registry. The sample included femalepatients, having mean age of 50.86 ± 11.1 Years. Invasive mammary (ductal) carcinoma, NST was the most prevalent subtype 60 (92.3%) and most tumors were grade I/II 53(82%). PD-1 expression was seen in TIL’s 31 (48%) and PD-L1 expression was observed in tumour cells 30 (46%). Expression of PD-1/PD-L1 expression was more common in premenopausal age group and grade I/II tumors. Among molecular subtypes, PD-L1 expression was detected in 11 (52%) TNBC, 5 (71%) in HR-/HER2+ and 12 (32)% in HR + HER2 - and PD-1 expression was observed in 13 (62%) TNBC, 5 (71%) in HR-/HER2+ and 13 (35%) in HR+ HER2-.
Conclusion: A large proportion of breast cancer cases show expression of PD-1 / PD-L1. Anti PD-1 and PD-L1therapy may benefit these patients.
HIGH ALTITUDE AND VENOUS THROMBOSIS: FREQUENCY AND RISK FACTORS
Authors: Choudry Qamar Un-Nisa , Iftikhar Raheel , Qadir Manzur , Satti Tariq Mehmood , Omair Ghassan , Mehmood Syed Kamran 
Published: February 2021

Objective: To determine the effect of high altitude on frequency and risk factors of venous thrombosis inindividuals ascending to high altitude
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Armed Forces Bone Marrow Transplant Centre, Combined Military HospitalSkardu, from Apr 2015 to Aug 2018.
Methodology: High Altitude was taken as height equal to or more than 8000 feet. Polycythemia as hemoglobin>16.5 g/dl OR hematocrit >49%. Medical records of all patients evacuated from high altitude through CombinedMilitary Hospital Skardu were analyzed retrospectively. A proforma was designed to include necessary variables.
Results: We evaluated medical records of 539 individuals and found frequency of 86 (15.9%) for venous thromboembolism (VTE) at high altitude. Cerebral venous sinus thrombosis (CVST) was most common thrombotic complication seen in 39 patients (46%). Majority of thrombotic episodes occurred at >18000 feet (likelihood ratio (LR) 5.99, p-value 0.009). Majority of thrombotic episodes 34 (39%) occurred within first 45 days of ascent to high altitude. Thrombosis was linked to smoking 47 (55%) (likelihood ratio 21.3 and p-value <0.001) and use of melted snow as a source of drinking water 56 (65%) (likelihood ratio 57.6 and p-value <0.001).
Conclusion: This study showed a very high frequency of thrombotic complications at high altitude. There isa need for a robust prospective study covering epidemiology, clinical information and diagnostics in order todevelop appropriate standard operating procedures and guidelines for prevention of thrombosis at HA
OPEN PARTIAL NEPHRECTOMY FOR SMALL RENAL TUMOURS: TECHNICAL AND ONCOLOGICAL OUTCOMES
Authors: Zia Qamar , Sajjad Mudassar , Akmal Muhammad , Kiyani Faran , Nawaz Muhammad , Razzaq Sohail 
Published: February 2021

Objective: To assess the safety and oncological outcomes of Open Partial Nephrectomy in management of small renal tumours.
Study Design: Case series.
Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2015 to Dec 2018.
Methodology: We prospectively studied 61 patients with renal tumours either observed on computerized tomography (CT) scan or magnetic resonance imaging (MRI) having size ≤7cm and underwent open partial nephrectomy. The collected data included demographics, dimension of tumour, indication for surgery, cold ischemia time, hospital stay, complications and histopathological finding including involvement of margins. Patients were followed up for atleast 2 years.
Results: Among 61, 39 patients were male and 22 females. The age of patients ranged from 20-72 years. Mean cold ischaemia time was 24.7 ± 6.37 minutes. Except for 2 patients with Von Hippel–Lindau (VHL) disease, all other patients had solitary renal growth. Nine (14.75%) patients had solitary kidney. The mean of maximum dimension of tumours was 3.84 ± 1.38 cm and mean hospital stay was 3.18 ± 2.19 days. Histopathological results showed 34 tumours to be conventional renal cell carcinoma (RCC) (55.73%) followed by 12 papillary renal cell carcinoma (19.67%). Two (3.27%) patients had positive surgical margin who were operated for >5 cm tumours and later managed expectantly. Twenty one patients had Grade I and II complications while 2 patients were stented post operatively for urine leak. At 2 years follow up there was no recurrence of tumour in any of the patient operated.
Conclusion: Open ..........
THE ATTITUDES OF MEDICAL STUDENTS TOWARDS CLINICAL RELEVANCE OF HISTOLOGY
Authors: Waseem Naureen , Rasheed Aaqiba , Gill Maria , Asad Ayesha , Shamim Muhammad Omar , Waseem Fatima 
Published: February 2021

Objective of Study:
The objective of this study is to have an insight on student’s attitudes regarding histology’s clinical relevance in public and private sector medical college.
Methodology: A cross sectional survey for attitude analysis towards histology’s clinical importance was carried out among 200 third year medical students from private and public sector medical college. Thurdstone and Chave attitude analysis questionnaire was employed to find the attitude score.
Results: Students of both public and private sector medical college show scepticism towards the clinical importance of histology. There was no marked difference in the attitudes of students of public and private sector medical college. Most data remained on the borderline of the attitude scale employed.
Conclusion: This study provided useful information for the teachers that students do not appreciate the clinical importance of histology much. Teachers need to devise strategies and to work on the students helping them comprehend the importance of histology.
ORAL HYGIENE PRACTICES OF FIRST AND FINAL YEAR DENTAL STUDENTS AT FOUNDATION UNIVERSITY: A COMPARATIVE STUDY
Authors: Ahsin Emaan , Ahsin Sadia 
Published: February 2021

Objective: To compare personal oral hygiene practices between first and final year dental students of Foundation University College of Dentistry (FUCD).
Study Design: Cross sectional study.
Place and Duration of Study: Foundation University College of Dentistry, Islamabad, from Mar to May 2019.
Methodology: A pre-structured questionnaire was distributed to students of first and final year BDS classes with questions related to seven basic oral hygiene practices. These included frequency of teeth cleaning, time spent in cleaning teeth, tools used for cleaning teeth, frequency of changing toothbrushes, use of secondary plaque control methods, whether or not students cleaned their tongue, and how often they visited a dentist.
Results: Only 2 out of 7 practices, (i.e. more frequency of brushing, 45/52 (86.5% in final year vs 25/47 (53.1% infirst year and usage of floss 22/52 (42.3%) in final year vs 9/47 (19.1%) in first year) were found to be significantly better in final year students when compared to first year BDS students with a p-value of 0.012 and 0.04 respectively. The remaining differences did not reach statistical significance.
Conclusion: When compared with first year BDS students, only 2 out of 7recommended oral hygiene practiceswere found to be better in final year students. Therefore, there is a need for greater emphasis on oral hygienepractices at undergraduate educational years.