bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitude of General Population Towards People with Physical Disability
Authors: Hisam Aliya , Mashhadi Syed Fawad , Fatima Zainab , Chohan Remesha , Malhi Orooba , Abdullah Muhammad , Asif Muttahar , Abbasi Abdullah 
Published: March 2023

Objectives: To find out the attitude of the general population towards disabled individuals.
Study Design: Cross-sectional study design.
Place and Duration of Study: Rawalpindi/Islamabad, from Nov 2021 to Apr 2022.
Methodology: The attitude towards physical disability was assessed by including 2 separate standardised scales and was divided into 3 parts; i) the Demographics, ii) the ATDP scale, and iii) CDP scale. The data was collected through google forms because of the pandemic. The sample size was 166. The data analysis was performed on SPSS 25.0.
Result: Out of 166(100%) participants in the study, 137(82.5%) lived in urban areas and the mean age was 22 years. Out of which 38(22.9%) participants reported to have higher education. People from various professions participated in the research. The CDP scale showed 104(62.7%) participants had low contact, 45(27.5%) had no contact and 17(10.2%) had a high contact. The mean ATDP score was 72.12% showing a positive attitude overall. The attitude was not significantly associated with contact (p-0.405), education (p-0.342), gender (p-0.870), income (p-0.605), and presence of doctor in the family (p-0.893).
Conclusion: This research concluded that the attitude towards the disabled of the general population of twin cities was positive.Contact, presence of doctors within the family and demographic factors; income, education, and gender had no association in determining the attitude of the general population towards the disabled. Thus, inferring that our education and doctors are not making enough of a difference and moral education should be further stressed upon.
Effect of Weather on Stress Fracture in Runners
Authors: Hashmi Muhammad Tahsin , Rehman Muhammad Hafeez Ur , Taqi Irum , Khatoon Atia 
Published: March 2023

Objective: To compare the effect of cold and warm weather on stress fractures in long-distance runners and athletes.
Study Design: Prospective longitudinal Study.
Place and Duration of Study: Combine Military Hospital, Abbottabad Pakistan, from Nov 2013 to Apr 2017.
Methodology: Male athletes joining training in various institutions in November 2013 (Winter-Group) and May 2014 (SummerGroup) were included in the study and followed during two years of training and one year after training. All participants presenting with stress fracture (SF) symptoms were diagnosed by radiography. MRI or bone scan was done in symptomatic cases with negative radiographs. Most of the SFs were managed conservatively. Patients with complete fractures of long bones were fixedsurgically.
Results: Out of 506 male participants of Winter-Group (WG) and 474 participants of Summer-Group (SG), 57 and 29 were diagnosed to have a stress fracture (p=0.005). There was no significant age difference between the two groups. Among the study subjects, 50.0% were from Punjab, and 26.7% were from KPK. In both groups, most of the SFs were found in the tibia. The stress fractures were more during the initial 16 weeks of training. Most fractures were treated conservatively, and only two cases from each group were operated on. All cases recovered fully after an average period of 11 weeks. Ten runners of Winter-Group had prolonged healing time.Conclusion: Modification in training guidelines may reduce weather-related stress injuries in winter.Keywords: Runners, Stress fractures, Tibia, Weather.
Efficacy of Five Days Nitrofurantoin Therapy versus Fosfomycin Stat Dose in Clinical Resolution of Uncomplicated Urinary Tract Infections
Authors: Tahir Hasham Bin , Azam Khan Malik Nadeem , Khan Raheel , Tariq Rabia , Ahmed Bilal , Khan Hafiz Waleed 
Published: March 2023

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group.
Study Design: Comparative prospective study.
Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020.
Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms(increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B,comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection symptoms and bacteriologic response.
Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026).
Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections.
Electrolyte Imbalance Pattern in Hospitalized Unconscious Patients
Authors: Naveed Muhammad , Azam Khan Malik Nadeem , Shah Syed Umer , Hussain Altaf , Khan Muhammad Shahid , Hussain Muhammad Zahid 
Published: March 2023

Objective: To determine the pattern of electrolyte imbalance and associated etiological factors among the unconscious patients hospitalized at Pak Emirates Military Hospital.
Study Design: Cross-sectional study
Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020
Methodology: A total of 240 cases were included in this study in liaison with other departments where the admitted patients became unconscious. Patients with a Glasgow coma scale score <10 were included in the study. Serum electrolytes, including Sodium, Potassium, Magnesium and Chloride, were measured in the study participants.
Results: Mean age of study participants was 49.10±7.55 years. One hundred and sixty-two (67.5%) patients were from Medicine -Allied Wards while 78(32.5%) patients were from Surgical-Allied Wards. Thirty-eight patients were from the Critical Care Unit. Mean serum sodium was 139.10±11.52 meq/L, while potassium was 4.60±1.06 meq/L. Mean chloride was 809.4±53.55 meq/L, and Magnesium was 1.40±1.05) meq/L. Our analysis revealed that advanced age, underlying medical illness and duration of hospitalization were strongly linked with electrolyte imbalance among the unconscious patients.
Conclusion: Electrolyte imbalance emerged as a common finding in the unconscious patients hospitalized in our tertiary care unit. Patients with advancing age, medical illnesses and long hospitalization should be screened for electrolyte wasting a priority to prevent them from going unconscious.
Significance of Hematological Parameters in Patients with Type-2 Diabetes Mellitus and Its Relationship with Disease Complications
Authors: Rana Faraz Ali , Robert Helen Mary , Ilyas Madiha , Mahmood Asad , Amir Muhammad , Khan Nabeela 
Published: March 2023

Objective: To determine the association of haematological parameters with disease complications in patients with type 2 Diabetes Mellitus.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan from Feb to Aug 2019.
Methodology: In this study, 200 Patients were selected and divided into four groups, 1) Anaemia without Diabetes 2) Diabetes with Anaemia 3) Diabetes without Anaemia 4) Healthy Control Group. All the patients were assessed because of their clinical history and laboratory evidence. The patients' clinical details, type of anaemia, laboratory investigations and complications related to diabetes were recorded on a specially designed proforma.
Results: Diabetes-related complications were highest in diabetes with anaemia Group. It was recorded that diabetes with anaemia Group, 36 patients (50.0%) had microvascular complications and 32 patients (47.8%) had macrovascular complications. In the healthy control group, 8 patients (11.1%) had microvascular complications, and nine patients (13.4 %) had macrovascular complications.
Conclusion: Patients with type 2 Diabetes Mellitus should be evaluated and treated for anaemia routinely to prevent complications
SPEECH AND LANGUAGE IMPAIRMENT AFTER CHILDHOOD ARTERIAL ISCHEMIC STROKE
Authors: Akhtar Muhammad , Khalily Muhammad Athar , Ghani Natasha , Sultan Tipu 
Published: March 2023

Abstract
Objective: Investigate the potential predictors’ dysarthria and dyspraxia of speech and language impairment after childhood stroke.
Study Design: Cross sectional study
Place and duration of study: Study was conducted in the department of Paediatric Neurology, The Children’s Hospital & Institute of Child Health, Lahore for about one year i.e. from 31st August 2019 to 31st August 2020.
Methodology: Seventy children of radiological diagnosed arterial ischemic stroke were selected for study. Prevalence of dyspraxia and dysarthria and language impairment was measured within 2 weeks of stroke. Side of stroke (right, left or both) were assessed and proportion of language impairment, dysarthria, dyspraxia was measured in this study. SPSS version 23 was used for data analysis and determination of variables. P values of ≤0.05 were considered as significant.
Results: Seventy patients were included in this study. The mean age of the patients was 8.11±1.26 years. Stroke effects on left side was noted in 27 (38.6%) cases, stroke effects on right side was noted in 33 (47.1%) cases, while in 13 (18.6%) cases both Hemispheres were involved, dysarthria was present in 50 (71.4%) cases, language impairment was observed in 45 (64.3%) cases and verbal dyspraxia was noted in 12 (17.1%) cases.
Conclusion: Long term cognitive, motor and neurological outcomes are the results of arterial ischemic stroke. Dysarthria, language impairment and dysparaxia are the main affects of stroke that dependant on size and place lesion. Rehabilitation cannot be predicted after childhood stroke.
Keywords: Apraxia; Brain injury; Child; Dysarthria; Language; Stroke; Speech.
Antibiotic Sensitivity Pattern of Carbapenem-Resistant Pseudomonas Aeruginosa
Authors: Ali Fatima , Mirza Ifran Ali , Waseem Hafsa , Zafar Humaira 
Published: March 2023

Objective: To determine the sensitivity of Carbapenem-resistant Pseudomonas aeruginosa (CARP) with the panel of antibiotics according to Clinical and Laboratory Standards Institute (CLSI) 2020 guidelines.
Study Design: Cross-sectional study.
Duration and Place of Study: Armed Forces Institute of Pathology, Rawalpindi from Pakistan, Apr to Sep 2020.
Methodology: All samples received at the Microbiology Department during the study period were included. Various samples such as blood, pus, sputum, Endobronchial washing (EBW), non-directed bronchial lavage (NBL), tissue and urine were processed in the laboratory. Samples were inoculated on appropriate culture media, and bacteria were identified according to their colony morphology, Gram staining characteristics and biochemical tests. Antibiotic susceptibility testing was performed using the Kirby Bauer Disk Diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) 2020 guidelines. However, for susceptibility to Colistin, the agar dilution method was performed.
Results: In our study, fifty-five Carbapenem-resistant Pseudomonas aeruginosa were isolated. Out of these fifty-five isolates,thirteen (23.6%) were sensitive to Tazocin, seven (12.7%) were sensitive to Ceftazidime, fourteen (25.4%) were sensitive to Gentamicin, 7(12.7%) were sensitive to Cefepime, (12.7%) to Aztreonam, 10(18.2%) were sensitive to Amikacin, 7(12.7%) to Ciprofloxacin, 6(11%) to Levofloxacin and forty-two (76.4%) were sensitive to Colistin.
Conclusion: The susceptibility of Carbapenem-resistant Pseudomonas aeruginosa to all the antibiotics tested in this study was low. Isolates displayed the highest susceptibility to Colistin.Keywords: Antibiotic susceptibility profile, Carbapenems, Carbapenem-resistant Pseudomonas aeruginosa (CRPA), Disk diffusion technique.
Validation of Vanillylmandelic Acid (VMA) with Plasma Metanephrine and Normetanephrine for Screening Adrenal Medullary Disorders
Authors: Khalid Usama Bin , Haroon Zujaja Hina , Aamir Muhammad , Ashraf Sana , Bibi Afshan , Javaid Haroon 
Published: March 2023

Objective: To validate urinary Vanillylmandelic acid (VMA) for screening adrenal medullary disorders, taking plasma-free Metanephrine as the gold standard.
Study Design: Cross-sectional validation study.
Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology,Rawalpindi, in collaboration with Armed Forces Institute of Urology, Rawalpindi from Pakistan, Jan 2020 to Mar 2021.
Methodology: One hundred and thirty (130) symptomatic hypertensive patients with adrenal masses on ultrasound were selected Urine and blood samples were collected under specified conditions after taking necessary precautions and subsequently analyzed. Taking plasma Metanephrine as a reference, sensitivity, specificity and predictive values were calculated at predefined cut-off values.
Results: In a young population with a mean age of 28.55±5.54 years, headache, palpitations and sweating were the predominant symptoms having a frequency of 130(100%), 116(89.2%) and 111(85.4%), respectively. Twenty-four hours urinary Vanillylmandelic acid had lower sensitivity (66.3%) than a random urinary VMA/cr ratio (72.1%) but similar specificity(97.7%). On the other hand, plasma-free Normetanephrine had 100% sensitivity but lower specificity (93.2%). ROC curve was plotted, and AUC for 24 hours urinary VMA, urinary VMA/cr ratio and plasma-free Normetanephrine were 0.820, 0.849 and0.966, respectively.
Conclusion: Plasma-free Metanephrine could be used for screening pheochromocytoma and other adrenal medullary disorders like paraganglionoma. In addition, VMA/cr ratio can be used for biochemical confirmation of the disease owing to the high specificity found in our study.
Comparison of Limb Salvage Rate in Early Versus Delayed Presented Patients of Acute Lower Limb Ischemia Undergoing Revascularization
Authors: Ali Sana Sharafat , Asghar Syed Tanseer 
Published: March 2023

Objective: To compare the limb salvage rate in early versus delayed presented patients of Rutherford Class IIB acute lower extremity ischemia undergoing revascularization.
Study Design: Comparative prospective study
Place and duration: Hayat Wali Medical Center, Rawalpindi Pakistan, from Apr 2019 to Mar 2020.
Methodology: This study enrolled 42 patients, aged 20 to 70 years, with Rutherford Class IIB acute lower limb ischemia, which was divided into two groups. Group-I (delayed presented >6 hours) consist of 30 patients, and Group-II (early presented <6 hours) consist of 12 patients. All patients underwent embolectomy. The limb salvage rate was examined in the third postoperative month.
Results: In Group-I, limb salvage was found in 18(60%) patients, while in Group-II, there were 11(91.67%) patients; a significant difference was observed between both groups (p-value <0.05). The mortality rate was high in Group-I (delayed presented) as compared to Group-II (16.67% vs 0%) with a p-value <0.05.
Conclusion: The limb salvage rate was higher in early presented patients than delayed presented patients. Mortality and amputation rates were observed to be higher in delayed-presented patients.
Diagnostic Accuracy of Tympanometry for Diagnosis of Fluid the Middle Ears of Children with Otitis Media with Effusion staking Myringotomy as Gold Standard
Authors: Mehdi Syed Aoun Abbas , Raza Sayed Nusrat , Hassan Zaheer Ul , Khan Amir Ali , Manzoor Matahir , Karim Mohammad Noman 
Published: March 2023

Objective: To determine the diagnostic accuracy of tympanometry for diagnosing fluid in the middle ears of children with Otitis Media with Effusion taking myringotomy as a gold standard.
Study Design: Cross-sectional study
Place and Duration of Study: Department of ENT & Head and Neck Surgery, Combined Military Hospital, Peshawar Pakistan, from Oct 2018 to Sep 2020.
Methodology: A total of 201 patients who underwent tympanometry followed by myringotomy of aged between 3 to 12 years of either gender were included. All patients underwent tympanometry. After that, myringotomy was carried out through a radial incision in the anteroinferior quadrant using a general inhalational anaesthetic agent. The operative findings at myringotomy were recorded. The presence of fluid on intraoperative findings using myringotomy was considered positive for the presence of fluid in the middle ears of children.
Results: The age range of the patients was from 3-12 years, with a mean age of 7.35±2.41 years. Of these 207 patients,133(64.18%) were males, and 74(35.82%) were females. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of tympanometry for diagnosis of fluid in the middle ears of children with Otitis Media with Effusion taking myringotomy as the gold standard was 85.7%, 86.3%, 89.4%, 81.7% and 85.9% respectively.
Conclusion: This study concluded that the diagnostic accuracy of tympanometry for the diagnosis of fluid in the middle ears of children with Otitis Media with Effusion is quite high.
Improvement in Competency and Confidence Level of House Officers in ECG Interpretation after a Goal-Directed ECG Workshop
Authors: Khan Jamal Azfar , Ather Nadia Aziz , Niazi Ghulam Abbas Khan , Khattak Muhammad Irfan , Razzaq Kashif 
Published: March 2023

Objective: To determine if a goal-directed ECG workshop improves ECG interpretation competency and confidence among the house officers in PNS Shifa Hospital.
Study Design: Prospective comparative study.
Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan to Dec 2021.
Methodology: ECG workshops were conducted for House Officers in batches. The participants were asked to complete a questionnaire testing their ECG interpretation competency before and after the workshop and self-report their confidence level in ECG interpretation.
Results: Sixty-eight house officers participated in the workshops and completed the test. There were 41(60.29%) female and 27(39.7%) male participants. The statistics showed significant improvement in ECG competency (p<0.001). In addition, the pre and post-workshop confidence levels also showed significant improvement (p<0.001).Conclusion: A goal-directed ECG workshop improves house officers’ competency and confidence in ECG interpretation.
Comparison of Post-Operative Analgesic Efficacy of Caudal Epidural Block versus Penile Block in Children Undergoing Hypospadias
Authors: Rehman Habib Ur , Iftikhar Hina , Ali Ghazanfar , Aslam Muhammad Sohail , Joya Sana Rehman , Parveen Shaghufta 
Published: March 2023

Objective: To compare the post-operative analgesic efficacy of penile block vs caudal block following hypospadias repair.
Study Design: Quasi-experimental study.
Place and Duration of Study: Pediatric and Plastic Surgery Departments, Combined Military Hospital, Multan Pakistan, from Jul 2019 to Jul 2021.
Methodology: The total of 34 patients undergoing hypospadias operation was booked for this study after approval of the ethical committee. All patients were operated on under General anaesthesia. The booked patients were randomly divided into Groups 1 and 2. For post-operative analgesia, the first group got penile block while the latter was given caudal epidural block.
Results: The mean age of the patients was 3.99±2.68 years. These patients were split into two groups. Group-1 (n=17)underwent a Penile block, and Group-2 (n=17) underwent a Caudal block. There were no serious complications after a penile block or caudal block. A substantial decline in pain scores was noted, more in the penile block group.
Conclusion: For patients being treated for Hypospadias, the penile block is a more effective and simple method of pain control post-operatively. This can be performed by the surgeon.
Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection
Authors: Mahmood Irum , Shahid Muhammad , Awais Muhammad , Manzoor Muhammad , Rauf Abdul , Babar Zaheer Uddin 
Published: March 2023

Objective: To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection.
Study Design: Quasi-Experimental Study
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Mar 2020.
Methodology: Sixty patients of Primary Pterygium with Grades 1, 2, and 3 were included. Pre-Intralesional injection evaluation includes the Ocular surface disease Index (OSDI), grading of Pterygium and ophthalmic examination, refraction,slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. After four weeks of intralesional injection,reassessment was done.
Results: A total of 60 participants with the mean age of the participants was 44.06±14.83 years were included in the study. In 26(43.3%) patients, grittiness, epiphora, redness, and photophobia were reported, and 16(26.6%) patients reported blurring of vision that improved in 100% of patients after intralesional injections. There was statistical significance (p-value ≤0.05) in means of K1, Sim K astigmatism, Surface asymmetry index, Surface Regularity Index, Grade of Pterygium, and Ocular surface disease index before and after the intralesional injection of Bevacizumab. However, no significant difference was recorded in Uncorrected Visual Acuity, Best Corrected Visual Acuity, and K2 parameters in pre and post-injection states (p-value ≥0.05).Only 7(11.6%) patients reported subconjunctival haemorrhage after the procedure.
Conclusions: Treatment of Primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms,Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications.
Serum Prolactin as an Early Biomarker for Detection of Gestational Diabetes Mellitus-An Experience at CMH Quetta
Authors: Ahmed Azeema , Bashir Saima , Lqbal Hamid , Ahmed Naeema , Anwar Muhammad , Ahsan Javaria , Sana Fatima , Nawaz Khurram Haq 
Published: March 2023

Objective: To determine the association between elevated serum prolactin and the development of gestational diabetes mellitus in the first trimester.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Pathology Department, Combined Military Hospital, Quetta Pakistan, from Apr 2021 to Mar 2022.
Methodology: One hundred and twenty-one patients had a measurement of serum prolactin in the first trimester, along with an oral glucose tolerance test in the second and third trimester, at the Pathology Department Combined Military Hospital Quetta Pakistan.
Results: In the study group, serum prolactin levels were raised in 51(42.1%) patients in the first trimester. A total of 44(36.3%) patients with raised serum prolactin had impaired oral glucose tolerance tests. A significant association was found between raised serum prolactin and subsequent development of gestational diabetes mellitus in pregnant females.
Conclusion: Serum prolactin can be an important biomarker for early diagnosis and monitoring of gestational diabetes mellitus.