bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Mode of Delivery and Number of Parity on Abnormal Placental Location
Authors: Shams Mehwish Ara , Amin Nabila , Syed Humna 
Published: December 2022

Objective: To determine the effect of mode of delivery and number of parity on abnormal placental location encountered at Pak Emirates Military Hospital Rawalpindi.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Gynaecology & Obstetrics, Pak Emirates Military Hospital Rawalpindi, from Jun 2019 to May 2020.
Methodology: The study included all the antenatal patients with any abnormally placed placenta on ultrasound or MRI, if required, at the 32nd week of gestation. On ultrasound examination, controls were an equal number of antenatal women with the customarily located placenta. Factors like age, parity, previous mode of delivery, and iron deficiency anaemia were compared in both groups.
Results: The mean age of the study participants was 32.11 ± 8.29 years. Out of 70 cases of abnormal placental location in pregnant women, 40 (57.1%) had placenta previa, 20 (28.6%) had accreta, while 10 (14.3%) had placenta percreta. Pearson chisquare test revealed that multiparity and previous deliveries by caesarean section had a statistically significant relationship with abnormal placental location among the study participants (p-value<0.05).
Conclusion: Placenta previa is the commonest abnormal placental location in our study, followed by accrete and percreta. Previous deliveries by cesarean section and multiparty were independent risk factors related to abnormal placental location in our target population.
Association of Panel Reactive Antibodies (PRA) with Complement Dependent Cytotoxicity (CDC) Cross-Match in Pre-Renal Transplant Recipients
Authors: Hussain Dr. Muhammad , Bashir Muhammad Mukarram , Tipu Hamid Nawaz , Dawood Muhammad , Afshan Noor , Arooj Ayesha 
Published: December 2022

Objective: To determine the association of panel reactive antibodies (PRA) with complement-dependent cytotoxicity (CDC) cross-match in Pakistani pre-renal transplant recipients.
Study Design: Cross-sectional study.
Place and Duration of Study: Immunology Department, Armed Forces Institute of Pathology, Rawalpindi from Oct 2017 to Oct 2018.
Methodology: A total of 162 patients referred to the Department of Immunology for pre-transplant workup for renal transplantation were included. Informed consent was taken, and detailed history was recorded. Frequency and percentages were calculated for cross-match positivity and most frequent anti-HLA antibodies.
Results: Panel reactive antibodies (PRA) were present in 48 patients (30%), while complement-dependent cytotoxicity (CDC) cross-match was positive in 16 patients (10%). Out of 141 male patients, 35 (25%) were positive for PRA, while 10 (7%) had positive CDC cross-match. Out of 21 female recipients, 13 (62%) were positive for PRA, and 6 (28%) had positive CDC crossmatch. One male patient positive for CDC cross-match was negative for PRA. Patients positive for both CDC cross-match and PRA have an average mean fluorescent intensity (MFI) of more than 4000. CDC cross-match and PRA were strongly associated, whereas no significant association was found between CDC cross-match and anti-MIC antibodies.
Conclusion: Complement dependent cytotoxicity (CDC) cross-match and panel reactive antibodies (PRA) should be routine in patients undergoing renal transplants as alone CDC cross-match can give false negative or false-positive results. At the same time, CDC cross-match lacks detection of anti MIC antibodies involved in graft rejection.
Hyperglycemia and its Association with Patients’ Mortality Among the Patients Presenting with Acute Stroke in Tertiary Care Hospital
Authors: Rana Maryam , Khattak Abdul Latif , Khan Muhammad Khalid Azam , Khan Raees Iqbal , Shah Bukhari Syed Karamat Hussain , Mehmood Faisal 
Published: December 2022

Objectives: To estimate the occurrence of hyperglycemia in patients with cerebrovascular accident (ischemic) to compare the frequency of mortality among the patients with and without hyperglycemia presenting with acute CVA.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: Department of General Medicine, Combined Military Hospital Quetta Pakistan, from May 2018 to May 2019
Methodology: A total of 347 patients of both genders diagnosed with acute stroke were included. Blood glucose levels were evaluated and hyperglycemic and normo-glycemic patients were identified. CT scan was performed. Standard treatment was provided to the patients according to the type of stroke (ischemic or hemorrhagic). These patients were discharged.
Results: Patients in this study was having age range of 20 to 70 years.SO mean age of 53.76 ± 9.08 years. Many patients 283 (81.56%) were of 45-71 years of age. 183 (52.74%) were of male gender and 164 (47.26%) were females. We have found hyperglycemia in 96 (27.67%) patients. There was no hyperglycemia observed in 251(72.33%) patients. Frequency of hyperglycemia was 12.97%. Frequency of mortality was 30.21% in hyperglycemic patients vs. 6.37% in normo-glycemic patients (p=0.0001).
Conclusion: Frequency of hyperglycemia with acute stroke is high with high mortality among the patients presenting with acute stroke as compared to normo-glycemic.
Alteration of Coagulation Profile in Malaria Patients and its Correlation with The Degree of Parasitemia
Authors: Jabeen Shehneela , Naeem Samina , Uddin Nasir , Farooq Muhammad , Rabbani Sahar , Basharat Maria 
Published: December 2022

Objective: To determine the alteration of coagulation profile (PT, APTT, D-dimers) in malaria patients and its correlation with the degree of Parasitemia.Study Design: Cross-sectional study.
Place and Duration of Study: Pathology department of Combined Military Hospital Lahore, from Jan to July 2018.
Methodology: A total of 92 patients were included in the study. The malarial parasite was identified using thick and thin smears. Hemoglobin, Red blood cell, White blood Count, Prothrombin Time, Activated Partial Thromboplastin Time, and Ddimer levels were measured using automated analyzers Sysmex KX-21 and CA-600.
Results: The mean age of the patients was 23.35 ± 14.4 years with 53 (57.6%) males and 39 (42.4%) females. Plasmodium falciparum was identified as the causative species in 33 (35.9%) of the cases, 59 (64.1%) cases were caused by Plasmodium vivax. Based on parasitic load, 50 (54.3%) patients were found to have a mild degree of parasitemia whereas 26 (28.3%) had moderate and 16 (17.4%) had severe parasitemia. A significant association was found between the degree of parasitemia and coagulation parameters.
Conclusion: Partial thromboplastin time, activated partial thromboplastin time and D-dimer levels were positively correlated with the degree of parasitemia specifically in plasmodium falciparum as compared to the other species. Therefore, special care should be exercised in patients having an underlying inherited bleeding disorder and a strict prevention protocol should be made.
Efectiveness of Therapeutic Plasma Exchange in Patients Suffering from COVID-19 Requiring Admission in Critical Care Setting
Authors: Ali Muhammad , Naseem Arshad , Sajjad Kaswar , Zaman Asad , Bari Saba , . Naveem 
Published: December 2022

Objective: To determine the efficacy of therapeutic plasma exchange in patients suffering from COVID-19 requiring admission in the critical care setting.
Study Design: Comparative cross-sectional study.
Setting and Duration of Study: Critical Care Unit, Pak Emirates Military Hospital Rawalpindi, from Apr 2020 to Jun 2020.
Methodology: The study was carried out on 160 patients managed at the Critical Care setting of our hospital in three months. Data were extracted from the record regarding the patients who underwent therapeutic plasma exchange and others who were only given supportive management. Overall mortality, duration of hospital stay, duration of Intensive Care Unit stay and duration of oxygen supplementation was compared in both the groups.
Results: A total of 160 patients met the inclusion/exclusion criteria. Of these, 100 (62.5%) underwent therapeutic plasma exchange, while 60 (37.5%) did not undergo this procedure. The mean age of participants was 62.19 ± 5.192 years. Out of 15 (15%) patients died who underwent therapeutic plasma exchange, while 51 (85%) patients died who did not undergo plasma exchange (p-value <0.001). Length of hospital and Intensive Care unit stay and duration of oxygen supplementation were significantly less among those who underwent therapeutic plasma exchange than those who did not undergo this procedure (pvalue <0.05).
Conclusion: Therapeutic plasma exchange emerged as an effective procedure for patients of COVID-19 requiring Critical Care admission and organ support due to complications of this infection. Overall mortality and other clinical parameters were also significantly improved among patients undergoing therapeutic plasma exchange.
A Year of Endoscopic Retrograde Cholangiopancreatography (ERCP) At a Glance. Indications, Interventions, Complications
Authors: Kazmi Syed Kumail Hasan , Ali Khan Rao Saad , Alam Laima , Saeed Farrukh 
Published: December 2022

Objective: To determine the demographics, indications and frequency of interventions and complications endoscopic retrograde cholangiopancreatography (ERCP).
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2019.
Methodology: The study included all the elective and emergency ERCP procedures from January 2019 to December 2019.
Results: Out of 1030 patients who underwent endoscopic retrograde cholangio-pancreaticography, 903 were enrolled. Sixtyone percent of the participants were males. The mean age was 56 ± 16 years, with the majority of the patients lying in the age range of 41-65 years. The most common indication for ERCP in this study was choledocholithiasis (47%), the most common complication encountered was acute pancreatitis (2.1%), and a mortality rate of 0.2% was reported. The complication rate was statistically related to the intervention rather than the age and gender of the patients.
Conclusion: The most common indication for ERCP remains choledocholithiasis, with the most common ERCP complication being acute pancreatitis followed by stent migration. Biliary fistulae, post-surgical biliary leaks and strictures, pancreatic pseudo cysts, acute cholangitis, choledocholithiasis and cholestasis secondary to as cariasis were found in a relatively younger group. The success rate was above 95% for high volume centres.
Role of Pie Crusting Technique on Soft Tissues in Preventing Soft Tissue Complications Compared to Conventional Closure of Wound in Fractures of Distal Tibia (PILON) and Fibula
Authors: Ahmad Rana Shahbaz , Amin Muhammad Suhail , Hassan Bushra , Rathore Muhammad Omar , Rehan Muhammad , Javid Mohsin 
Published: December 2022

Objective: To demonstrate the effect of performing pie crusting on skin bridging two incisions used for open reduction and fixation to reduce wound complications compared to conventional wound closure.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Orthopedics and Trauma, Combined Military Hospital Rawalpindi from Jan to Nov 2020.
Methodology: Forty-seven patients, managed primarily with open reduction and internal fixation for type-43 fractures per AO/OTA classification, were studied. Group-1 comprised patients in whom the pie crusting technique was used during the closure of the wound. Group-2 included patients in whom conventional closure of the wound was performed. Evaluation of complications in the presence or absence of superficial and deep infection and necrosis was done. The time from injury to surgery was 6 hours to 72 hours. Patients were followed for an average of 12 weeks.
Results: In group-1 (pie-crust technique), there were 23 patients, whereas group-2 (classic wound closure) comprised 24 patients. In group-1, only 1 (4%) patient had a superficial infection, and no deep infection was reported. Whereas in group-2, six patients (25%) had superficial infection, and two patients (8%) had the deep infection.
Conclusion: Results indicated that pie-crust technique significantly reduces the risk of superficial and deep wound complications compared to classic wound closure because it reduces skin tension and allows the drainage of subcutaneous fluids.
Adherence of Facemask During COVID Pandemic Among South Asian CountriesA Web-Based Cross-Sectional Study
Authors: Abid Khadijah , Imran Abira , Bari Yashfika Abdul , Zaidi Tooba , Younus Maryam , Khambati Zainab Pervez , Baki Billah Abul Hasan Md. Khaza , Khura Bikash , Jabar Abdul 
Published: December 2022

Objective: To investigate the facemask adherence rate among South Asian countries and to examine association between face mask adherence and socio-demographic factors.
Study Design: Cross-sectional study.
Place and duration of study: South Asian countries (Pakistan, India and Bangladesh), from Jul to Sep 2020.
Methodology: A total of 1579 individuals of age more than 14 years, of either gender, who had internet accessibility and understood English, participated in the study. The study was designed on Google forms and distributed through social media networks. The three South-Asian countries, Pakistan, India and Bangladesh, were targeted. Data regarding socio-demographics and type of facemask adherence was collected.
Results: The mean age of the participants was 31.32 ± 9.83 years. Of all the participants, there were 826 (46.3%) males, and 959 (53.7%) were females. Univariate analysis showed that females, Muslims, education level till graduate, employed, monthly income ≤$300, and Bangladeshis participants had higher odds of face mask adherence (p<0.05). Multivariate analysis showed that females, Muslims, urban residents, secondary level education, employed, family monthly income $100-$300, and Bangladeshis were strongly associated with face mask adherence (p<0.05).
Conclusion: Among the three countries, Bangladeshis had higher facemask adherence than Pakistan and India. The sociodemographic factors associated with facemask usage were gender, religion, locality, education, employment status, family monthly income, and nationality.
Clinical, Socio-Demographic Characteristics and Gender Disparity in Patients with Tuberculosis Infection in Pakistan
Authors: Khan Shameem Behram , Ijaz Raafia , Salahuddin Naseem , Shah Rabeea , Sarfaraz Samreen , Hussain Aneela 
Published: December 2022

Objectives: To assess the clinical, environmental, and socio-demographic characteristics leading to gender disparity in tuberculosis in Pakistan.
Study Design: Prospective Comparative study.
Study Setting and Duration: The Indus Hospital, Karachi Pakistan, from Jul 2020 to Dec 2020.
Methodology: A sample of 200 patients with diagnosed tuberculosis (detected on an acid-fast bacillus (AFB) smear with radiographic abnormalities) irrespective of gender, sensitivity, or site of tuberculosis, were included in the study. Data of gender, personal history, substance abuse history, and dietary habits was documented.
Results: Pulmonary tuberculosis was significantly more common in female patients than in males (p<0.001). The mean age of male patients was 30.16 ± 9.47 years. Male patients were significantly older than their female counterparts (p=0.003). The diabetes mellitus in male patients was significantly higher than in female patients with TB (p=0.01). Similarly, substance abuse history was more frequently positive in male patients as compared to female patients, 28 (40.60%) vs 9 (6.70%); p-value <0.001. There was no significant difference in the occurrence of drug-resistance tuberculosis between the two genders. However, pulmonary tuberculosis was significantly more common in female patients than in males (p<0.001).
Conclusion: We reported some distinctive differences between male and female tuberculosis patients. Young females had more predilections toward tuberculosis as compared to men. Diabetes mellitus and substance abuse history were more common in male tuberculosis patients than in females.
Effectiveness of Intralesional Triamcinolone Acetonide (TA) and Incision and Curettage (I & C) for Chalazia
Authors: Iqbal Nazia , Sarfaraz Muhammad Haroon , Muzaffar Waqar , Abbas Hussnain , Nisar Maryam , Khan Amna 
Published: December 2022

Objective: To evaluate the efficacy of intralesional Triamcinolone Acetonide (TA) injection and incision and curettage (I&C) and their complications in chalazia.
Study design: Quasi-experimental study.
Place and duration: Combined Military Hospital Multan Pakistan, from May to Nov 2019.
Methodology: We selected individuals with primary chalazion having a size of 2mm or more, with a duration of at least one month and not resolving with conservative treatment. Our sample was divided into two groups. Group-A was given a 5mg/ml Triamcinolone injection under aseptic conditions, and the group-B had incision and curettage.
Results: The overall frequency of lesion in the upper lid 53 (66%) was more than in the lower lid 27 (34%), p=0.004. The complete resolution of the lesions after the repetition of the procedure was found to be almost the same in the two groups. In comparison, the resolution duration was longer in group-A versus group-B. The complications were more in the surgical group 6 (p=0.001) than in the Triamcinolone Acetonide group 11, (p=0.004).Conclusion: Our study signifies that intralesional Triamcinolone Acetonide injection is a safe procedure, having fewer complications. For individuals with poor compliance with conservative management, Triamcinolone Acetonide injections provide an alternative with an almost equal success rate and minimal complication.
Estimation of Blood Glucose Levels And Hemodynamic Changes During Laparoscopic Cholecystectomy: A Comparison of Dexmedetomidine and Nalbuphine
Authors: Fayaz Fakher-e- , Asad Naila , Khurshid Hana , Butt Zulqarnain , Awan Nazir , Saeed Aisha 
Published: December 2022

Objective: To compare the effect of Dexmedetomidine and Nalbuphine premedication on changes in hemodynamics and neuroendocrine stress response under general anaesthesia by analyzing the variation of perioperative serial blood glucose levels.
Study Design: Prospective comparative study.
Place and Duration of Study: Services Hospital, Lahore Pakistan, from Oct to Dec 2020.
Methodology: Total 90 patients aged between 30-and 65 years were allocated randomly into three groups. Group-D patients (n=30) were administered Dexmedetomidine 0.5 μg/kg in 100 ml normal saline, group-N (n=30) were given Nalbuphine 0.1 mg/kg in 100ml saline, and group-S received saline (100ml) throughout 15 minutes before induction of anaesthesia for laparoscopic cholecystectomy. General Anaesthesia was administered. Intra-abdominal pressure was maintained after abdominal insufflation with carbon dioxide between 12-15 mmHg. Blood glucose levels were analyzed preoperatively, 30 minutes after the beginning of surgery, at extubation and 2.5 hours postoperatively. Hemodynamic changes were recorded after premedication, 15 and 30 minutes after pneumoperitoneum and extubation.
Results: Random mean blood sugar levels were 135.23 mg/dl with Dexmedetomidine and 123.33 mg/dl with Nalbuphine and 122.53 mg/dl in saline group (p<0.05). There was a greater decrease in hemodynamic parameters with group-D than with groups N and S (p<0.01).
Conclusion: During laparoscopic cholecystectomy, intravenous Dexmedetomidine premedication attenuates the hemodynamic stress response better than Nalbuphine but does not suppress the neuroendocrine response as estimated by a rise in random blood glucose level.
Radiological Spectrum of Cerebral Venous Sinus Thrombosis in Soldiers at High Altitude: A Four-Year Analysis
Authors: Palwa Abdur Rahim , Adil Muhammad , Riaz Sidra , Muhammad Dost , Liaqat Muhammad Muddasar , Nisar Uzma 
Published: December 2022

Objective: To assess the spectrum of radiological findings of cerebral venous sinus thrombosis (CVST) in soldiers serving at high altitudes.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Combined Military Hospital, Skardu Pakistan, from Jan 2016 to Jan 2020.
Methodology: Thirty-three consecutive soldiers evacuated to Combined Military Hospital, Skardu, with radiologically proven cerebral venous sinus thrombosis on CTV brain were enrolled in the study. Plasma D-dimer levels of all the patients were sent to the laboratory, and clinical data were noted.
Results: Mean age of patients was 28.88 years ± 5.189 (range 20 to 40 years) with a mean duration of stay at high altitude of 59.8 ± 39.3 days and the average height of deployment as 17094 ± 3285 feet. Left transverse sinus was the most commonly involved sinus in 21 (63.6%) patients, followed by left sigmoid sinus 18 (54.5%) and superior sagittal sinus 16 (48.5%). Sixteen cases demonstrated associated findings of venous infarction on CT brain (48.5%). Headache was the most common clinical presentation 13 (93.9%), followed by vomiting 12 (36.4%).
Conclusion: Prolonged stay at high altitude is a key risk factor for cerebral venous sinus thrombosis in young individuals showing a predilection for posteriorly and inferiorly located venous sinuses.
DIAGNOSTIC ACCURACY OF D-DIMER ASSAY IN PULMONARY EMBOLISM USING CTPA AS GOLD STANDARD
Authors: Aziz Sadaf , Junaid Meena , Ibrahim Nadeem , Shoaib Sonia , Iftikhar Amian , Awais Lubaina 
Published: December 2022

Objective: To determine the sensitivity and specificity of D-dimer assay for the diagnosis of PE in resource limited settings using CTPA as a gold standard for comparison.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Radiology, Combined Military Hospital, Peshawar, from Feb 2019 to Jul 2020.
Methodology: A sample of 114 cases of clinically suspected PE presenting in ED were collected by non-probability sampling as per QUADAS 2 domains. D-dimer and CTPA reporting done by separate teams, compilation of data by third team. Using SPSS 23.0, 2×2 contingency table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of D-dimer in diagnosing PE.
Results: Age range 20-50 years (mean: 40.54 ± 5.02 years). Sixty patients were female (52.3%). D- Dimer levels for the diagnosis of PE: Sensitivity: 92.86%, specificity 89.66%, positive predictive value (PPV): 89.66% and negative predictive value (NPV): 92.86%.
Conclusion: The D-Dimer levels are significantly sensitive and specific in the diagnosis of PE: however keeping in view the high mortality of PE, diagnostic accuracy may be further improved by using D-Dimer levels in conjunction with pretest clinical probability rules.