bluuebunny/crossref_metadata_2025_split huggingface dataset:
Covid-19 Vaccination and Routine Childhood Vaccinations: Comparison of Hesitancy among Parents
Authors: Mashhadi Syed Fawad , Khan Nazish , Ilyas Ubaida Bin , Farooq Omer , Waseem Aashir , Cheema Abdullah , Murtaza Sahab 
Published: October 2023

Objectives: To assess perceptions of parents regarding vaccinating their children against COVID-19 and to assess the prevalence of COVID-19 vaccine hesitancy as compared to routine childhood vaccinations.
Study Design: Analytical, cross-sectional, quantitative study
Place and Duration of Study: Study was conducted in Rawalpindi/Islamabad Pakistan, from Nov 2021 to Apr 2022.
Methodology: Parents having children of either gender, 12 to 18 years of age, residents of Rawalpindi/Islamabad Pakistan were included in the study. Study was conducted online using Google forms. Sample size of 303 was taken and participants were enrolled through non probability convenience sampling. Modified Vaccine Hesitancy Scale (VHS) was used. Parental attitudes towards routine childhood vaccinations versus COVID-19 vaccines were compared using paired sample T test.
Results: Among 303 parents, 196(64.5%) were willing to vaccinate their child with COVID-19 vaccine. Reasons for COVID-19 vaccine hesitancy included insufficient vaccine safety information (16.8%), avoidance of vaccines/ medications in general (8.9%), inconvenient / painful vaccine administration (7.9%), perceiving child as not at high risk of developing complications of he gets infected by COVID-19(6.3%) and concerns of getting COVID-19 through the vaccine (4.6%). An encouraging attitude was seen among parents for routine childhood vaccination as compared to COVID-19 vaccination with higher mean VHS 2.68±0.44 vs. 2.52±0.43 respectively (p<0.001).
Conclusions: A large proportion of parents were hesitant regarding the COVID-19 vaccine as compared to routine childhood vaccines. Relying on the national authorities regarding the immunization information is a much better option to limit hesitancy.
Short-term Efficacy and Safety of Secukinumab in Pakistani Patients with Ankylosing Spondylitis and Psoriatic Arthritis
Authors: Ghani Sumera , Saeed Muhammad Ahmed , Malik Tashia , Din Zia ud , Raja Sumaira Farman , Ahmad Nighat Mir 
Published: October 2023

Objective: To determine the short-term efficacy and safety of Secukinumab in Pakistani patients with ankylosing spondylitis and psoriatic arthritis in regular clinical practice.
Study Design: Case series.
Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Centre, Lahore Pakistan from Aug 2019 to Feb 2021.
Methodology: Patients diagnosed with ankylosing spondylitis according to assessment of spondyloarthritis International Society criteria and psoriatic arthritis according to classification criteria for psoriatic arthritis (CASPAR), who were started on Secukinumab, were enrolled. Disease activity scores and adverse events were recorded in the 12th and 24th weeks. The primary outcomes were remission and low disease activity, and the secondary outcomes were the recording of Adverse events on each visit.
Results: There were 42 patients registered. The mean duration of disease was 11.86±7.31 years for AS and 9.19±4.87 years for PsA patients. At 24 weeks of follow-up, 10% of patients discontinued treatment, 73.7% of AS patients, and 94.7% of PsA patients achieved complete remission or low disease activity. No significant AEs were noted at 24 weeks, except for upper respiratory tract infections. One patient developed a lower respiratory tract infection after 24 weeks of treatment, and one died during treatment (possible myocardial infarction).
Conclusion: Secukinumab was effective and safe in patients with Ankylosing Spondylitis and Psoriatic Arthritis in this study,despite advanced disease with long disease duration.Keywords: Ankylosing spondylitis, Efficacy, Psoriatic arthritis, Safety, Secukinumab.
Short-Term Efficacy and Safety of Subcutaneous Tocilizumab in Rheumatoid Arthritis Patients in Pakistan: A Real-World Experience
Authors: Malik Tashia , Saeed Muhammad Ahmed , Ghani Sumera , Butt Nauman Ismat , Raja Sumaira Farman , Ahmed Nighat Mir 
Published: October 2023

Objective: To determine the real-world efficacy and safety of subcutaneous Tocilizumab in patients with rheumatoid arthritis.
Study Design: Case series.
Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Centre, Lahore Pakistan, from Aug 2019 to Dec 2020.
Methodology: In this study, 33 patients receiving subcutaneous Tocilizumab 162 mg every two weeks as monotherapy or with conventional synthetic disease modifying anti-rheumatic drugs were followed per standard study protocol. Increasing or decreasing the dosing interval was allowed according to disease activity at the discretion of the treating rheumatologist. The primary outcome was patients achieving Low Disease Activity as per Clinical Disease Activity Index (>2.8-10.0) and Disease Activity Score-28(>2.6-3.2). The secondary outcome was a clinically meaningful improvement in Disease Activity Score -28 (reduction of ≥1.2 units in Disease Activity Score-28 score). Adverse events were recorded at each follow-up visit.
Results: Of the 33 patients, 25(75.8%) were biologics-naive, 9(27.2%) patients achieved the target of Low Disease Activity as per Clinical Disease Activity Index (2.9-10.0) and 8(24.2%) patients achieved Low Disease Activity as per Disease Activity Score-28(2.7-3.2). At six months, the proportion of patients achieving clinically meaningful improvement (decrease ≥1.2) in Disease Activity Score -28 was 13(54.2%). Overall, 14(42.4%) patients developed adverse events and 3(9.1%) patients discontinued Tocilizumab owing to adverse events.
Conclusion: Tocilizumab has been seen to be an effective biologic in only one-third of patients, and it was tolerated in twothirds of the patients.Keywords: Conventional synthetic disease modifying anti-rheumatic drugs, Efficacy, Rheumatoid arthritis, Safety, Subcutaneous tocilizumab.
Comparison of HRCT Chest Findings of COVID-19 Patients Having Clinical Co-morbid to Those Without Co-morbid Disease
Authors: Qayyum Adil , Adil Ruqqayia , Balooch Salahuddin , Khan Sara , Amin Zafar , Mahmood Rashid 
Published: October 2023

Objective: To determine the severity of High-Resolution Computed Tomography Chest findings of COVID-19 patients having co-morbid in comparison to those without co-morbid.

Study Design: Comparative cross sectional study.
Place and Duration of the Study: Radiology Department Combined Military Hospital, Multan Pakistan, from Mar to Sep 2020.
Methodology: Data was collected through the medical record system of positive COVID-19 tests. Patients were divided into patients with no co-morbidities and others having co-morbidities. Two radiologists interpreted High-Resolution Computed Tomography chests independently to assess the disease severity in these two Groups. Co-morbidities included diabetes mellitus, hypertension, chronic renal disease, heart disease, Chronic Obstructive Pulmonary Disease and liver diseases.
Results: A total of 200 patients were included. Out of 121 male patients, 85 had co-morbidities (71 had moderate to severe lung involvement; 14 had mild lung involvement); while 36 had no co-morbidities (5 had moderate to severe lung involvement; 31 had mild lung involvement). Out of 79 female patients, 47 had co-morbidities (15 had moderate to severe lung involvement; 32 had mild lung involvement); while 32 had no co-morbidities (3 had moderate to severe lung involvement; 29 had mild lung involvement).
Conclusion: The severity of lung involvement was remarkably higher in patients with associated co-morbidities compared to no co-morbidities. Older age male patients having co-morbidities pose a risk factor for the severity of disease progression as compared to younger age female patients having no co-morbidities
Impact of COVID-19 Pandemic on the Medical Oncology Department of a Tertiary Care Hospital
Authors: Mehmood Faisal , Ali Shehrbano , Ashraf Amna , Khattak Abdul Latif , Mashhadi Syed Fawad , Murtaza Muhammad Murad 
Published: October 2023

Objective: To assess the degree of impact the pandemic had on the Oncology Department regarding patient visits and elective procedures.
Study Design: Comparative pre-post analysis study.
Place and Duration of Study: Medical Oncology Department of Combined Military Hospital, Lahore Pakistan, from Oct to Dec 2019 before the pandemic, and then 2020 during the pandemic.
Methodology: Data was collected from the Department regarding the number of outpatient visits, indoor admissions, new cases diagnosed, chemotherapies administered, blood transfusions, and various procedures like lumbar puncture, ascitic fluid paracentesis, pleural fluid drainage, etc.
Results: Our study showed an overall decrease in all the study parameters. The average monthly Outpatient visits fell by 395 patients (55.6%). The new cases decreased by 25 patients (36.2%). The indoor admissions also came down by 17 patients (42.5%). Furthermore, the procedures performed in the Oncology department were also observed to have decreased.
Conclusion: Oncology has suffered dramatically in the face of the COVID-19 pandemic, with fewer patients visiting the hospital for their consultations, follow-ups, as well as treatments. This has resulted in a delay in diagnosis and treatment and has had a severe adverse psychological impact on the patients.Keywords: COVID-19, Elective procedures, Pandemic, Oncology.
Comparison of Dynamic Hip Screw and Proximal Femoral Nail in Cases of Unstable Intertrochanteric Fractures of the Femur, in Terms of Blood Loss and Operative Time: Experience in a Tertiary Care Hospital
Authors: Khan Ahmed Mustaq , Anwar Syed Faraz , Saif Anas Bin , Jaffary Asad Ullah , Rathore Muhammad Omar 
Published: October 2023

Objective: To compare Dynamic Hip Screw with Proximal Femoral Nail in unstable Inter Trochanteric femur fractures.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Malir Pakistan, from Dec 2020 to Aug 2021.
Methodology: This study comprised patients aged 40 to 80 years with unstable inter Trochanteric proximal femoral fractures (AO Classification 31A2, 31A3). These patients were randomised into two Groups. Group-A patients underwent Dynamic hip screw fixation, and Group-B patients were subjected to Proximal Femoral Nailing. Follow-up was done at 2,6,12 weeks postoperatively. Two variables, namely operative time and blood loss, were evaluated.
Result: Thirty patients were recruited in this study, with 18 patients in each Group. The average blood loss for Group-A Dynamic Hip Screw was measured to be 193.3±29.10 ml, and for Group-B Proximal Femoral Nail was 79.44±17.98 ml (p< 0.001). Group-A (DHS) scored an average operative time of 51.56±7.76 min, and Group-B Proximal Femoral Nail was 36.89±3.66 min (p<0.001).
Conclusion: Proximal femoral nailing is a better choice in unstable proximal femoral fractures regarding operative time and blood loss.Keywords: Blood loss, Dynamic hip screw, Intertrochanteric fractures, Operative time, Proximal femoral nail.
Comparison of Extraglycemic effects of Dapagliflozin and Empagliflozin
Authors: Aziz Haroon , Noor Mudassar , Ahmad Bilal , Ali Shabana , Farhat Kulsoom , Siddiqi Fuad Ahmad 
Published: October 2023

Objective: To compare extra glycaemic effects of dapagliflozin and empagliflozin in Type 2 Diabetes mellitus.
Study Design: Quasi-experimental study.
Place and Duration of Study: Pharmacology Department, Army Medical College, in collaboration with Endocrine Department, Pak Emirate Military Hospital, Rawalpindi Pakistan, from Sep 2021 to Jan 2022.
Methodology: One hundred and twenty diabetic patients were recruited strictly according to inclusion and exclusion criteria. They were randomly alienated into two groups (A & B) by lottery method and were prescribed oral dapagliflozin and empagliflozin 10 mg/day each for four weeks, respectively. Serum uric acid, erythropoietin levels, and weight were recorded on day 0 and after four weeks of treatment.
Results: There were statistically significant differences in weight (p-value=0.004) and erythropoietin levels (p-value=0.027). However, an inconsequential variance was observed in serum uric acid levels Uric Acid (p-value=0.365) between the two groups after four weeks of treatment with dapagliflozin and empagliflozin.
Conclusions: Dapagliflozin and empagliflozin have significantly improved weight, erythropoietin and serum uric acid levels. Moreover, Dapagliflozin is superior to Empagliflozin in improving weight and erythropoietin levels and has almost equivalent efficacy in improving uric acid levels in T2DM patients.Keywords: Dapagliflozin; Empagliflozin; SGLT2 inhibitors; Type 2 diabetes mellitus.
Epidemiological Trends of Lung Tumours on Endobronchial Biopsy in Patients Presenting to Tertiary Care Hospital
Authors: Anjum Naveed , Mirza Muhammad Zill -e- Humayun , Satti Shahzeb Ahmed , Ahmed Sohaib , Raza Hassan , Mughal Zulqarnain Mustafa 
Published: October 2023

Objective: To determine the epidemiological trends of lung tumours on endobronchial biopsy in patients presenting to our hospital.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Jun 2022.
Methodology: Two hundred eighty-seven patients who exhibited clinical and/or radiological signs of a lung mass were enrolled in this study. Bronchoscopy was done to identify endobronchial lesions, followed by endobronchial biopsies submitted for histopathology and immunohistochemistry to diagnose the exact type of tumour. Patients who underwent bronchoscopy for some other indication but were found to have an endobronchial mass incidentally were also included in the study.
Results: Squamous cell carcinoma was the most common 107(37.3%), followed by small cell carcinoma 76(26.5%). Adenocarcinoma was diagnosed in 75 patients (26.1%). Diagnosis of carcinoid tumour was made in 6 patients (2.09%). There were 5 cases (1.7%) of poorly differentiated carcinoma and metastatic adenocarcinoma each. Large cell carcinoma was present only in 2 cases (0.7%). Strangely, two patients (0.7%) had small and Squamous cells simultaneously, and one had adenosquamous carcinoma. Other tumours, including mantle cell lymphoma, Rhabdomyosarcoma, mucoepidermoid carcinoma, neuroendocrine tumours, spindle cell carcinoma and sarcomatoid carcinoma, were found in 8 cases (2.8%).
Conclusion: Squamous cell carcinoma is the most common centrally arising tumour in our population in both genders, followed by small cell carcinoma and adenocarcinoma.Keywords: Epidemiology, Endobronchial mass, Lung cancer, Squamous cell carcinoma.
Diagnostic Accuracy of Bedside Index for Severity in Acute Pancreatitis and Modified Computed Tomography Severity Index in Determining the Severity of Acute Pancreatitis using Revised Atlanta Classification as the Gold Standard
Authors: Khattak Muhammad Bilal , Ali Khan Rao Saad , Khan Rao Zaid Ali , Din Rafi Ud , Shabbir Khawar , Karim Rahida , Munir Arshia 
Published: October 2023

Objective: To determine the diagnostic accuracy of modified computed tomography severity index (CTSI) and Bedside index for severity in acute pancreatitis (BISAP) scoring system in predicting severity in acute pancreatitis, keeping the Revised Atlanta Classification (RAC) as the gold standard.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi Pakistan, Pakistan from Jan to Jul 2022.
Methodology: This study was conducted on 100 patients with acute pancreatitis, both genders and ages. Patients with chronic pancreatitis, pancreatic calcifications, dilated pancreatic duct, areas of atrophy and pseudocysts were excluded. Detailed history and physical examination, and laboratory investigations were performed. Modified CTSI, BISAP and RAC were calculated. RAC was used as the gold standard. Sensitivity, specificity and other diagnostic parameters were calculated using R programme.
Results: The mean age was 42.42±18.07 years. The males were 53%, and the females were 47%. CTSI was sensitive at 100%, specific at 58.43%, and overall diagnostic accuracy at 63%. BISAP was sensitive at 100%, specific at 68.54%, and overall diagnostic accuracy at 72%.
Conclusion: BISAP and modified CTSI can assess severe acute pancreatitis (SAP) at primary and secondary care levels, enabling early triage and referral to higher centers.
Comparison of Early Versus Delayed Oral Feeding after Resection and Anastomosis of Gut
Authors: Siddiqi Ubaid Ullah , Nasir Ammad Ud Din , Ilyas Sohail , Sarfraz Khurram , Farooq Muhammad Omar , Rehman Shafqat 
Published: October 2023

Objective: To compare the outcomes of early versus delayed postoperative oral feeding in patients undergoing resection and anastomosis of the gut.
Study Design: Quasi-experimental study
Place and Duration of Study: Surgical Department of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2020 to May 2021.
Methodology: A total of 30 patients fulfilling the selection criteria were enrolled after taking written informed consent and were randomly divided into two groups of equal numbers. Patients in Group-A received early oral feeding, and in Group-B had delayed oral feeding postoperatively, and the outcome measures were assessed till the patients were discharged.
Results: The mean duration of hospital stay in Group-A versus Group-B was 50.94 days vs. 60.74 days (p=0.005), the mean time to passage of the first flatus was 30.61 days vs. 50.48 days (p<0.001), and the mean time to passage of the first stool was 40.59 days vs. 50.48 days (p<0.001), respectively.
Conclusion: Early oral feeding following gut resection and anastomosis was significantly associated with the early passage of flatus and stool and shorter hospital stay than delayed oral feeding postoperatively.
Effect of Anterior Chamber Depth and Axial Length on Corneal Endothelial Cell Density After Phacoemulsificatio
Authors: Iqbal Atiya , Naeem Saquib , Khan Taimoor Ashraf , Ahmad Jawwad , Humayun Fakhar , Naimat Khalid 
Published: October 2023

Objective: To assess the average amount of corneal endothelial cell density reduction in patients with various anterior chamber depths and axial lengths after phacoemulsification.
Study Design: Quasi-experimental study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jul 2022 to Dec 2022.
Methodology: Ninety-four patients with cataract who underwent uneventful phacoemulsification surgery with IOL Implantation were included in the study. Patients were divided into two groups on the basis of anterior chamber depth and axial length values. All patients underwent surgery, and corneal endothelial cell density was measured and compared pre and post-operatively at pre-specified time points.
Results: A significant decrease in the number of corneal endothelial cells was found between both the groups at pre and postop measurements. The mean CED decreased to 2420.04±296.73 post-operatively from 2608.44±237.22 (p<0.001) among patients belonging to group 1, while for group 2 the mean CED decreased to 2484.02±254.89 from 2646.19±205.52 (p<0.001), post and pre-operatively respectively. There was no significant difference found between postoperative reduction in mean CED value between group 1 and 2.
Conclusion: In current study we conclude that there is a reduction in endothelial cell density after phacoemulsification surgery for cataract, but we failed to support the fact that anterior chamber depth or axial length can be used as potential predictors to predict the loss of endothelial cells post-operatively.
Comparative Analysis of Human Cystatin C Levels in Migraine without Aura and Healthy Controls
Authors: Mariyam Khan  , Maham Tahir  , Sunia Hameed  , Muhammad Umar Ali Khan  , Mehwish Qamar  , Mamoona Shafiq  
Published: October 2023

Objective: To compare the levels of human cystatin c (novel biomarker) as well as the association of other parameters in migraine patients without aura and healthy controls.
Study Design: Cross-sectional, comparative study.
Place and Duration of Study: The research was conducted at IMBB Physiology Department, University of Lahore, Lahore Pakistan, from May 2021 to Jun 2022.
Methodology: After taking history, a detailed clinical examination was conducted of participants in both cases and controls of the study. A proforma was filled and a non-probability convenience sampling technique was used. The blood samples weredrawn, centrifuged to isolate serum and analyzed concentration of serum cystatin C levels were measured by using enzyme linked immunosorbent assay (ELISA). SPSS version 22 was used for statistical analysis. Mann-Whitney U test was used to determine the median IQR values of both groups and p-value<0.05 was considered significant.
Results: Among cases 19(47.5%) were male and 21(52.5%) were female. Mean age of cases and controls was 25.57±5.93 and 26.15±7.19 years. The most frequent occupation among cases and controls was student, doctors, nurses and house wives. Among cases only 3(7.5%) patients were currently smokers while among controls 3(7.5%) were currently smokers. Among cases body mass index of 11(27.5%) patients were 30 and 4(10%) participants in controls had body mass index as 30. The most frequent symptom was photophobia followed by nausea, phonophobia, vomiting and atypical features. All these features were significantly higher
Conclusion: Study concluded that patients with migraine without aura have elevated levels of cystatin C in their
Self-Directed Learning Versus Traditional Learning in Clinical Setting: A Study at Armed Forces Institute of Ophthalmology
Authors: Omar Zafar  
Published: October 2023

Objective: To compare the outcome of self directed learning to the traditional learning in terms of academic performance in clinical setting by using diabetic ocular fundus findings among fourth year MBBS students.
Study Design: Quasi-experimental study.
Place and Duration of Study: Armed Forces institute of Ophthalmology, Rawalpindi Pakistan, from May to Nov 2019.
Methodology: After taking consent, data was collected from 50 students through multiple choice questions based pre-test and post-test by non probability convenient sampling. The data was analyzed using SPSS version 22.0.
Results: Out of total students, 28 (56%) students were male and 22 (44%) were females. Mean age was 22.15±3.26 years. Both the groups showed improvement in their academic performance as p-value <0.001, but SDL group showed more improvement as compared to the traditional learning group.
Conclusion: Self directed learning is better as compared to the traditional teaching as it promotes conceptual learning so it is important to work on this issue.