bluuebunny/crossref_metadata_2025_split huggingface dataset:
STRESS AND COPING SKILLS AMONG UNDERGRADUATE MEDICAL STUDENTS- A CROSS SECTIONAL STUDY
Authors: Javed Kainat , Absar Nazir  , Zeeshan Malik  
Published: May 2023

Objective: This study aims to assess the stress and coping skills among undergraduate medical students.
Methods: A quantitative cross sectional study conducted from September to November 2022, in University College of medicine and dentistry, UOL. The participants were MBBS students of 1st year until final year. The data was collected by using three questionnaires: demographic form, suanprung stress test and COPE inventory and was analyzed by using SPSS25. Associated factors of stress were analyzed by Kruskal-wallis and chi square test.
Results: Data was collected from 675/780 undergraduate medical students with a response rate of 86.5%. Female students responded (53%) in majority as compared to males (47%). According to the association between general demographic characteristics and coping strategies, gender, scores, religion, and illness have been found to have significant correlation with adaptive coping strategies. These demographic characteristics may influence how an individual responds to stress and may affect their ability to use adaptive coping strategies.
Conclusion: Usually medical students have flexible coping skills. Adaptive coping mechanisms were significantly correlated with gender, education and health problem.
Keywords: undergraduate; medical; stress; coping skills
DIAGNOSTIC ACCURACY OF RDWI TO DIFFERENTIATE IRON DEFICIENCY ANEMIA AND THALASSEMIA TRAIT IN BORDERLINE HBA2
Authors: Mazher Naghmana , Ali Khan Maleeha , Salman Maryam , Imran Fareeha , Bashir Shabnam 
Published: May 2023

Background: Thalassemia is an inherited hemoglobin disorders in which there is reduction or absence of α or β chains due to mutations in α or β genes. Microcytic hypochromic anemia is hallmark of beta thalassemia trait and the patient is usually asymptomatic. It is important to differentiate it from iron deficiency anemia (IDA) which also shows similar peripheral blood picture. The diagnosis is based on quantification of HbA2 and serum ferritin. If the level of HbA2 is more than 3. 5%, then diagnosis of beta thalassemia trait is made. The problem arises with borderline HbA2 i. e 3.1% - 3.4%. There is also diagnostic difficulty when concomitant iron deficiency anemia is present.
Objectives: To determine the diagnostic accuracy of RDWI in borderline HbA2 to distinguish the beta thalassemia trait from IDA and to diagnose beta thalassemia trait when genetic analysis is not easily available.
Methods: It was a cross sectional validation study. A total of 90 patients were included in this study, having HbA2 between 3.1-3.4%. Tests for serum ferritin, serum iron and total iron binding capacity (TIBC) were done on all samples. RBC morphology, RBC count, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC) and RDW of all samples were noted. RDWI of all samples was calculated. Mutational analysis by ARMS- PCR was done for confirmation of β thalassemia trait.
Results: Out of 90 samples with borderline HbA2, 30 cases were diagnosed as β thalassemia trait. Out of these, 15(50 %) had concomitant IDA along with beta thalassemia trait and 15 were non iron deficient beta thalassemia carriers. 43 samples were not iron deficient and were also negative for β thalassemia trait, whereas 17 samples had only IDA without beta thalassemia trait. The sensitivity of RDWI was 76.6% and specificity was 56.6% in borderline HbA2.
Conclusion: RDWI is a good indicator to differentiate between IDA and beta thalassemia trait (sensitivity 76.6% specificity 56.6%). But in all cases of borderline HbA2 genetic analysis should be done to see the mutation and to confirm the diagnosis.
FREQUENCY OF PARESTHESIA DUE TO INFERIOR ALVEOLAR NERVE DAMAGE AFTER EXTRACTION OF MANDIBULAR THIRD MOLAR AMONG PATIENTS SHOWING DARKENING OF ROOT IN ORTHOPANTOMOGRAM
Authors: Irfan Hassan , Uzair Bin Akhtar  , Abdul Ali Khan  , Mahrukh Nisar  , Sarmad Saif ur Rehman  , Asrar Ahmed  
Published: May 2023

Background: Paresthesia is an abnormal dermal sensation with no apparent physical cause. One of the everyday practices in any oral surgery setup is the extraction of the impacted mandibular third molars surgically. Precise measurement of the bone present for support of the implant coronal to the inferior alveolar nerve (IAN) canal is the pertinent way to prevent IAN injuries.
Objective: To assess the frequency of paresthesia due to IAN damage after mandibular third molar’s surgical extraction in patients with darkening of root on orthopantomogram.
Material & Methods: It was a descriptive case series study which took place in the department of Oral and Maxillofacial Surgery at Sharif Medical and Dental College, Lahore in a time frame of 6 months i.e. from December 2020 till May 2021. After meeting the inclusion/exclusion criteria, 200 patients were made part of the study program. Informed consent and demographic information was recorded. Surgical procedure of all these patients was done. Assessment was done post-operatively first after one week when patient came for suture removal by inquiring about the subjective perception of abnormal feeling or sensation on lower lip and chin area. Patients were then reappointed for a follow-up visit after 1 month as well.
Results: Patients’ mean age was 28.05±3.94 years. There were 104 (52%) males and 96 (48%) females in the study population. There were 38 (19%) patients of distoangular impaction, 39 (19.5%) had horizontal impaction, 55 (27.5%) had mesioangular impaction while 68 (34%) had vertical impaction. The IAN paresthesia after 1st month of surgery was found in 13 (6.5%) patients.
Conclusion: According to this study, the frequency of paresthesia after 1st month of surgery was 6.5% due to IAN injury after mandibular third molar surgery in patients with darkening of root as observed on orthopantomogram.
Keywords: Inferior Alveolar Nerve, Orthopantomogram, Paresthesia, Third Molar Surgery.
CURRENT TRENDS IN BLOOD STREAM INFECTIONS-PATHOGENS AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN
Authors: Inam Saima , Sadia Ikram  , Iram Yousaf Malik  , Kokab Jabeen  , Muhammad Tahir Saeed  , Gul-e-Nazish  
Published: May 2023

Objectives: To identify the bacteria responsible for blood stream infections and evaluate the antibiotic susceptibility pattern of isolated bacteria in a tertiary care hospital.
Methods: It was a Prospective Cross-sectional study conducted in the Pathology Laboratory, Sharif Medical City Hospital, Lahore from January 2019 to December 2020. The blood samples received in Microbiology laboratory, Sharif Medical City hospital, were evaluated. The blood cultures were processed for identification of pathogens and their susceptibility. Two subcultures, on day 1 and day 5 were inoculated on Blood agar and MacConkey agar. Bacterial identification was established by gram staining, bench tests, and biochemical tests. API 20E was used for Enterobacteriaceae and API 20NE for non fermenting gram negative bacilli (NFGNB). The antimicrobial sensitivity testing of the causative bacteria was conducted, using commercially available discs, by Kirby Bauer disc diffusion assay and reported in accordance with Clinical & Laboratory Standards Institute (CLSI) 2019.
Results: Out of 754 blood cultures, 123 exhibited positive growth yielding 76(61.78%) gram negative rods, 43(34.95%) gram positive cocci while 4 (3.2%) Candida sp. Among gram positive cocci, the commonest bacterial pathogen is Staphylococcus aureus (51.1% ), followed by Enterococcus sp and CONS each constituting 18.6%, and Streptococcus sp consisting of 11.6%.These bacteria exhibited varying resistance to all drugs being 100% susceptible to Vancomycin and Linezolid. Among Gram negative pathogens, Pseudmonas aeruginosa constitutes 38.2%, followed by E. coli (25%), Acinetobacter 14.5%, Salmonella typhi (10.5%), and others. An alarmingly poor susceptibility was observed by Gram negative bacteria (GNB) against all the drugs. Only 21.4%, 35.7%, and upto 39.7% isolates were sensitive to Ampicillin and Co-amoxiclav and third generation cephalosporins respectively. Results for carbapenem sensitivity being around 56.6%-61.8% for imepenem and meropenem respectively.
Conclusion: The study reports inadequate effectiveness of commonly used drugs which are part of empiric regimes of our clinicians. Even the broad spectrum drugs like aminoglycosides and carbapenems which were considered last therapeutic resort previously haven’t proved to possess satisfactory antimicrobial activity against majority of bacteria.
Key words: Blood stream infections, Kirby Bauer disc diffusion assay, Enterobacteriaceae
OPTIMAL USE OF BIRAD DESCRIPTORS FOR BREAST CANCER DETECTION BY EMPLOYING DATA MINING WITH CORRELATION OF BIOPSY OUTCOME
Authors: Majeed Khan Imran , Hussain Farooq Mazhar , Mehmood Aisha Nazish 
Published: May 2023

Background: Breast cancer (BC) is commonest among cancer patients, required early detection to be cured. Multiple techniques are used for the diagnosis of BC but mammography is a commonly available and effective tool around the world due to its ability to diagnose BC before it becomes palpable, in reward treatment cost also decreases. Computer-aided diagnosis (CAD) is advanced research to support medical practitioners in cancer diagnosis.
Methods: In comparison to the segmentation technique our research has used “extracted BIRAD characteristics information” from the mammograms. A novel data mining approach for the BIRAD lexicon has been researched in connection with the interactive medical experience. A globally recognized dataset (DDSM) has been used. The characteristics extracted from the mammograms are processed by the data mining method to achieve critical ranges for cancer detection. Multiple classification models with peculiar characteristics have developed to detect BC at the curable stage.
Results: A total of 1863 patients with an average age of 61 years were evaluated, 48% indicated with malignancies, and 52% with benign lesions, proved with truth biopsy. Critical ranges, by the development of multiple CAD tools, showed remarkable improvement in the recall (NB; 26.9%) and precision (CART; 17.6%) along with reduced FP rate (CART; 16.7%).
Conclusion: The proposed method is profitable because of the individuality of CAD with four classification models along with the practitioner’s experience and radiologist’s opinion in the early detection of BC. For avoiding unnecessary biopsies and differentiating benign and malignant tumor the BIRAD features extraction was benevolent.
THE TRANSIENT EFFECTS OF TRANS-CATHETER PATENT DUCTUS ARTERIOSUS CLOSURE ON LEFT VENTRICULAR SYSTOLIC FUNCTION
Authors: Talat Sidra , Abdul Malik Sheikh  , Hina Sattar  , Asma Kanwal  , Tauqeer Akbar  , Hissana asghar  
Published: May 2023

Objectives: This study aims to measure changes in left ventricular systolic function after closure of patent ductus arteriosus and to find out echocardiographic predictors for LV dysfunction.
Methods: A prospective study was conducted from July 01, 2021, till June 30, 2022. The study included all patients who experienced percutaneous closure of PDA in this duration. LV function was assessed before and then one day, one month and three months after the transcatheter closure. Patients with preexisting LV dysfunction and significant associated cardiac lesions were excluded from study.
Results: PDA was occluded in 86 children by transcatheter intervention. Average age of the cohort was 65 ± 58 months with 70% female patients. The mean size of the ductus was 3.67 ± 1.78. LV systolic function remained normal in 65 patients (86%) while 21 patients (24%) suffered from a fall in systolic function of left ventricle after PDA occlusion. LVEDd, FS, and EF significantly dropped within 24 hours after occlusion of the ductus. LV- systolic dysfunction improved in almost all the patients at 3 months follow up except for 4 (4.6%) patients who had persistently poor systolic function of LV.
Conclusion: Trans-catheter closure of PDA can cause a significant but temporary decline in LV systolic function. Large PDAd, LAd, higher PDAd/AOd, LAd/AOd and larger LV dimensions can predict LV dysfunction in high-risk patients. More prospective studies are imperative to verify these observations and to determine the predicting parameters for dysfunction of left ventricle after closure of PDA.
MATERNAL RISK FACTORS OF COEXISTED SEVERE ACUTE AND CHRONIC MALNUTRITION IN CHILDREN OF AGE 6 – 59 MONTHS
Authors: Kaleem Rameeza , Muhammad Adnan  , Maqsood Maryam 
Published: May 2023

Background and Objective(s)
Mothers’ sociodemographic characteristics, nutrition status and food diversity are important determinants of acute and chronic malnutrition in children less than five years. Therefore, the study aimed to explore the maternal characteristics as risk factors of coexisted severe acute and chronic malnutrition in children of age 6 – 59 months.
Methods
The cross-sectional analytical study included children (n=70) who attended the hospital for wasting during September 2022 to February 2023 and their mothers (n=70). Using the WHO child growth standards, children were categorized into moderately and severely wasted, stunted and underweight. Crosstabs analyses and binary logistic regression performed to assess maternal characteristics as risk factors of acute and chronic malnutrition in children.
Results
Mean age was 13.3±11.5 (range 6-42 months). The participation of males was higher than females (55.7 vs. 44.3%). The frequency of coexisted severe acute and chronic malnutrition was (71.4%). Young mothers [aOR = 2.299, 95% CI 0.670-7.891], working mothers [aOR = 3.638, 95% CI 0.369-35.895], mothers with no kitchen autonomy [aOR = 1.345, 95% CI 0.421-4.301] and mothers with inadequate food diversity [aOR = 1.301, 95% CI 0.296-5.722] had higher risk of coexisted severe acute and chronic malnutrition in children.
Conclusion(s)
The children who attended the hospital for wasting also had a high burden of stunting. Mothers’ young age, working status, no autonomy and inadequate food diversity demonstrated higher risk of coexisted severe acute and chronic malnutrition in children.
EFFECT OF SITAGLIPTIN ON BLOOD PRESSURE IN PRE-HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES
Authors: Ali Zulqarnain  , Rabia Rathore  , Butt Nasir Farooq , Hina Latif  , Mariam Azeem  , Adil Iqbal  
Published: May 2023

Objective: To determine the effects of Sitagliptin on pre-hypertensive type-2 diabetes mellitus patients.
Methods: This Quasi-Experimental study was conducted at Medical inpatient and outpatient department and Diabetic Clinic of Mayo Hospital, Lahore, from February 2019 till January 2020. A total of 146 patients were included in study. Blood pressure (BP) was recorded at baseline and then at 3, 6 and 12 months of treatment. Patients were called for follow up at 3 and 6 months, their BP was checked and haemoglobin A1c (HbA1c) was also sent to check for glycemic control. At 12 months, final follow up was called. BP and HbA1c of every patient were checked and recorded. The blood pressure values at baseline, 3 months, 6months and 12 months were comparatively analyzed by using a paired t-test and p-value of 0.05 was considered significant.
Results: Total 146 patients of type-2 diabetes with HbA1c ≤ 9 % not taking sitagliptin previously were selected for this study. Mean age of the patients was 57.5±10.7 years. Total 93(63.7%) were males and 53(36.3%) females. There was statistical difference of HbA1c, systolic and diastolic blood pressure values (p<0.05) after 3 months, 6 months and 12months of sitagliptin therapy as compared to baseline.
Conclusions: Sitagliptin therapy significantly decreases blood pressure and levels of HbA1c in type 2 diabetic-hypertensive patients.
FREQUENCY OF THROMBOCYTOPENIA IN CONFIRMED CASES OF MALARIA IN CHILDREN
Authors: Nayab Waseem  , Hina Nasir  , Khawaja Amjad Hassan  
Published: May 2023

Objective: To determine the frequency of thrombocytopenia in confirmed cases of malaria in children
Methods: This cross sectional study was conducted in Pediatric Department of Mayo Hospital Lahore from January to June 2018. A total of 80 Children between two years- 12 years of age, of both the genders with confirmed malaria were included by non-probability consecutive sampling. A blood sample was taken within 48 hours of admission and their complete blood count was reviewed for the presence of thrombocytopenia after malaria was confirmed on positive peripheral smear. Thrombocytopenia was defined as platelet count of less than 150,000/µl of blood. All collected data was entered and analyzed in SPSS version 22. Data was stratified for age and gender to address effect modifiers. Presence of thrombocytopenia was presented as frequencies and percentages.
Results: Out of total 80 patients with positive malarial parasite (MP) slide, 65 cases (81.25%)were of Plasmodium Vivax,12(15%) were of Plasmodium Falciparum while 3 cases (3.75%) were of Mixed infection. 44 patients( 55%)were having low platelet count (less than 150,000/µl) while 36 patients(45%) had no thrombocytopenia. Out of 44 patients with thrombocytopenia, 16 patients (20%) had mild thrombocytopenia, 21 patients (26.3%) had moderate thrombocytopenia while 7 patients (8.8%) had severe thrombocytopenia. There was no significant association of thrombocytopenia with age, gender or duration of malaria.
Conclusions: Frequency of thrombocytopenia in confirmed cases of malaria in children is 55% hence; presence of thrombocytopenia in febrile patients can raise the possibility of malaria leading to early diagnosis and management.
PREVELANCE OF REFRACTIVE ERRORS AMONG 4TH YEAR MEDICAL STUDENTS OF D.G.KHAN MEDICAL COLLEGE, DERA GHAZI KHAN, PUNJAB, PAKISTAN
Authors: Rozina Shahadat Khan  , Abid Alam  , Sidra Batool  
Published: May 2023

Background: A refractive error is a very common eye disorder which occurs when the eye cannot clearly focus outside world images ending up with blurred vision but timely detection and intervention can enormously enhance student’s potential during his or her formative years. Medical student’s Refractive status is of immense importance considering the burden of medical studies and their role as future health care providers. Aim: To assess the Prevalence of Refractive errors among 4th Year Medical students of D.G. Khan Medical College, Dera Ghazi Khan, Punjab, Pakistan. Study Design was Cross sectional Comparative. Place of study was D.G Khan Medical College, Dera Ghazi Khan Duration: Six months. Results: Myopic were 42/80 (52.5%) out of which 2/42(4.76 %) also had Astigmatism while 1/80(1.25%) had Hyperopia. Severe Myopic were 3.0/80 (3.8%) in both right and left eyes while 10/80 (12.5%) and 11/80(13.8%) fall in moderate category in right and left eyes respectively. Mild were 29/80 (36.3%) in right while 28/80(35.0%) in left eye. Only 2.0/80(2.5%) were having Astigmatism in both eyes along with mild Myopia. Significant association found between Age and sex of medical students with the Refractive errors. Conclusion: According to currents study findings High prevalence of Refractive Errors especially Myopia among female medical students tends to be alarming. It demands implementation of more structured student awareness campaigns focusing genetic factors to help prevent and control more cases of eye defect among medical students, society and Nation at large. Future study can be focused on causes of high Refractive Errors among female medical students.
Key Words: Refractive Error, Myopia, Hypermetropia, Astigmatism and Medical Students.
MPOX: A RE-EMERGING INFECTION
Authors: Afzal Muhammad Faheem 
Published: May 2023

World Health Organization (WHO)'s declaration on July 23, 2022 regarding Mpox (previously Monkey pox) outbreak appeared as Public Health Emergency of International Concern (PHEIC). Although, WHO, in May 2023 declared an end to the global health emergency for Mpox, but still, it is still prevalent and public awareness should continue.1 This viral Zoonotic contagious disease was first discovered in 1958 when two outbreaks occurred in monkeys kept for research in Denmark, hence the name “monkeypox”. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo.2
Orthopoxvirus infections can cause a spectrum of febrile rash illnesses in humans, ranging from fairly benign, localized skin infections to severe systemic infections. Other diseases confused with vesicular rashes are smallpox, generalized vaccinia (vaccinia is the virus used in smallpox vaccination), disseminated herpes zoster, disseminated herpes simplex, drug eruptions, erythema multiforme, buffalopox, scabies, enteroviral infections, insect bites, impetigo, molluscum contagiosum, meningococcemia, and idiopathic thrombocytopenic purpura. The most striking feature that distinguishes Mpox from others is the presence of cervical lymphadenopathy, while in all other orthopoxviral infections this feature is absent.3,5
When suspicion is strong, nucleic acid amplification testing (NAAT), using real-time or conventional PCR Polymerase chain reaction (PCR) is the preferred laboratory test. The recommended specimen type for laboratory confirmation of Mpox is skin lesion material, including swabs of lesion surface and/or exudate, roofs
from more than one lesion, or lesion crusts. Many individuals infected with Mpox virus have a mild, self-limiting disease course in the absence of specific therapy. However, in the case of severe disease, treatment after infectious diseases consultation should be considered with vaccinia immunoglobulin intravenous (VIGIV), and antivirals brincidofovir or tecovirimat.2 The prognosis for Mpox depends on multiple factors such as previous vaccination status, initial health status, and concurrent illnesses or comorbidities.6 In addition to infection control measures, people need to get vaccinated, where available, for the best protection against mpox.2
National Institute of Health (NIH), Islamabad, Pakistan, under guidance of Ministry of National Health Services Regulations & Coordination (NHSR&C) has issued the National Guidelines for Mpox. NIH has also developed the bottom-up approach for the flow of information and reporting.7 The relationship between Mpox and smallpox has raised anxieties and misperceptions among the public, patients, and healthcare providers. Misinformation about Mpox has already begun to circulate. The public need to be engaged. Targeted risk-communication strategies should be developed. There is also need for regions to maintain public health preparedness and response. This warrants the strongest medical, scientific, and political global effort.
DIVERSE NEUROLOGICAL MANIFESTATION OF HYPERIMMUNOGLOBULIN-E SYNDROME: A CASE SERIES
Authors: Javeria  , Areeba Wasim  , Natasha Ghani  , Tipu Sultan  
Published: May 2023

Hyper-immunoglobulin E (IgE) is a disorder of immune system characterized by assemblage of symptoms including recurrent skin and pulmonary infections, skeletal anomalies and elevated serum IgE (>2000 IU/ml). More recently, apart from the typical features, neurological manifestations have also been described including central nervous system infections, facial nerve palsy and demyelinating disorders. Here we describe three patients with hyper IgE syndrome having diverse neurological manifestation varying from CNS infection to basal ganglia stroke and progressive leukoencephalopathy.