bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Strongly the Body Mass Index (BMI) Is Associated with Inter Arm Blood Pressure Difference
Authors: Alam Muhammad Absar , Rehman Anam , Manzoor Javaria , Zafar Zafar Ali , Jawed Shireen , Altaf Benash 
Published: December 2022

Objectives: To explore the association between the body mass index (BMI) and inter arm difference (IAD) blood pressure and to understand how these factors influence blood pressure.
Study Design: Cross-sectional study.
Place and Duration of Study: Aziz Fatimah Medical and Dental College Faisalabad Pakistan, from Nov to Dec 2020.
Methodology: Total 100 healthy medical students aged 19-21 years were included in the study. Height in meters and weight in kilograms were documented by stadiometer (ZT-100). BMI was assessed by Quetelet's index (BMI=weight in Kg/height in m2). Blood pressure was recorded simultaneously in both arms by the auscultatory method. Inter arm difference in blood pressure was estimated by calculating differences in diastolic and systolic pressures between the right and left arm.
Results: Mean age of the participants was 19.83 ± 1.23 years. Significant difference was noted in systolic and diastolic interarm blood pressure among obese and non-obese groups (p-values <0.001). BMI was positively associated with diastolic and systolic inter-arm blood pressure (p-values <0.001).
Conclusion: Body mass index is positively associated with inter arm difference in blood pressure, and both positively impact the blood pressure.
Histo-Pathological Findings of Critical COVID-19 Pneumonia: A Case Series
Authors: Shehzad Farrukh , Naseem Arshad , Din Hafeez Ud , Sajjad Kaswar , Khan Asad Zaman , Zafar Bushra 
Published: December 2022

Objective: To study the histo-pathological findings in lung biopsies of critical COVID-19 cases.
Study Design: Case series.
Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2020.
Methodology: Deceased patients who remained on ventilatory support with a confirmatory diagnosis of SARS-CoV-2 both by PCR and radiological evidence on HRCT and clinically established severity of disease as per CALL scoring were included in the study. Written informed consent for lung biopsy was taken from the deceased's next of kin
Result: Mean age of the study group was 67.20 ± 6.01 years. The patients had a mean high resolution computed tomography score of 36.73 ± 1.59, and the mean CALL score was 12.73 ± 0.691 on admission. The average time after intensive care unit admission to intubation was 1.23 ± 0.50 days. Histopathological examination of the lung biopsy showed 27 (87.1%) patients had the exudative stage of adult respiratory distress syndrome while three (9.7%) patients had a proliferative stage of adult respiratory distress syndrome.
Conclusion: Histopathological findings of an exudative stage of adult respiratory distress syndrome in the lung biopsies of critical COVID-19 showed no significant difference with typical adult respiratory distress syndrome and are correlated with very high mortality rates in critical COVID-19.
Assessment of Microsatellite Instability in Endometrioid Carcinoma by Immunohistochemistry At Armed Forces Institute of Pathology, Rawalpindi
Authors: Arif Ayesha , Akhtar Farhan , Ahsan Ahmed , Din Hafeez Ud , Ahmed Rabia , Ahmed Aminah 
Published: December 2022

Objective: To assess microsatellite instability in endometrioid carcinoma by immunohistochemistry expression of MLH1, PMS2, MSH2 and MSH6.
Study design: Case series.
Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from Jun to Dec 2018.
Methodology: Thirty-two cases of endometrioid carcinoma were included in the study. Patient age and menopausal status were recorded. The grade of the tumour was ascertained by microscopic examination. Immunohistochemistry for MLH1, PMS2, MSH2 and MSH6 assessed microsatellite instability.
Results: In our study, eight females (25%) had premenopausal status while 24 (75%) had postmenopausal status. Out of 32 cases, 25 (78.1%) females had grade-I tumours, 4 (12.5%) had grade-II tumours, and 3 (9.45%) had grade-III endometrioid carcinoma. MMR status was proficient in 8 cases (25%) while deficient in 24 cases (75%). Among the 24 cases of MMR deficient endometrioid carcinoma, loss of expression of MLH1 was most frequent n=15 (62.5%), followed by PMS2 n=14 (58.3%) MSH2 n=7 (29.2%). MSH6 was retained in all cases. The most common pattern was a combined loss of MLH1/PMS2 in 12 cases (50%).
Conclusion: As depicted by the high percentage of MMR deficient tumours, microsatellite instability is observed in many endometrioid carcinomas. Patients suffering from endometrioid carcinoma should be screened for Lynch syndrome by testing for MMR status.
Burden of Vitamin D Deficiency in Patients of Chronic Liver Disease
Authors: Manzoor Waqas , Khalid Muhammad Tanveer , Karim Shahid , Kalwar Hamid Ali , Mujtaba Ghulam , Faryal Asheen 
Published: December 2022

Objective: To determine the frequency of vitamin D deficiency in chronic liver disease patients.
Study design: Cross-sectional study.
Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital and Medical College, Karachi Pakistan, from Jan to Dec 2020.
Methodology: Patients between the age of 18 to 50 years, of either gender, already diagnosed case of chronic liver diseases for 6 months and had sun exposure of at least 15 minutes twice weekly were included in this study. History was taken after taking informed written consent, the clinical assessment was done, and blood samples were sent for serum vitamin D levels to determine the results.
Results: The study included 177 patients with chronic liver disease. One hundred eleven patients (62.7%) were males and 66 patients (37.3%) were females, with the mean age of 45.0 ± 6.306 years. Vitamin D deficiency was observed in 100 patients (56.5%).
Conclusion: The frequency of vitamin D deficiency was quite high. It increases with age and body mass index and is predominant in the male gender, while no association was noted with sun exposure time.
Sweeping of Membranes for Induction of Labour in Low Risk Term Pregnancy
Authors: Pirzada Hina , Shabir Rabia , Ehsan Ambreen , Tahir Noreen , Saifuddin Zainab , Fatima Ambreen 
Published: December 2022

Objective: To determine the frequency of spontaneous labour in the swept and non-swept groups.
Study Design: Quasi-experimental study.
Study and Duration of Study: Department of Gynaecology and Obstetrics, Sheikh Khalifa bin Zayed Hospital, SKBZ Hosp/AK CMH Muzaffarabad, from Nov 2019 to Apr 2020.
Methodology: Patients were randomly divided into two groups (with lottery method). Group-A underwent a sweeping membrane while group-B was the control group. Spontaneous labour and other outcomes were observed in both groups.
Results: A total of 250 women were included in the study. There were 125 women in each group. The mean age of women was 23.4 ± 1.3 years in swept-group and 24.5 ± 1.7years in the non-swept group. The swept-group showed a high frequency of spontaneous labour compared to the non-swept group (24.8% vs 15.2%, p=0.01). Swept-group showed less postpartum haemorrhage (p=0.001), pain (p=0.001), pre-labour membrane rupture (p=0.03) and admission to neonatal intensive care unit (p=0.01).
Conclusion: Sweeping of the membrane is a safe and beneficial procedure for labour induction among low-risk term pregnant women. It is an effective procedure preventing women from reducing the incidence of post-term pregnancy with minimum complications.
In-Vitro Antimicrobial Drug Susceptibility Pattern of Methicillin Resistant Staphylococcus Aureus (MRSA)
Authors: Mubariz Rabia , Yasmin Shahina , Taj Shazia , Butt Tariq , Ellahi Ayesha , Mussarat Uzma 
Published: December 2022

Objective: To determine the in-vitro antimicrobial susceptibility pattern of Methicillin-resistant Staphylococcus aureus (MRSA) isolates using an automated VITEK-2 compact system.
Study Design: Cross-sectional study.
Place and Duration of Study: Pakistan Railway Hospital (PRH) Rawalpindi collaborates with the Armed Forces Institute of Pathology (AFIP) Rawalpindi, from Sep 2018 to Aug 2019.
Methodology: 100 MRSA samples were isolated from tissue, pus, urine, blood, high vaginal swabs (HVS) and ear swabs using standard microbiological techniques. MRSA isolates' antimicrobial susceptibility pattern was made using an automated VITEK-2 compact system.
Results: Among 100 MRSA isolates, 63% were obtained from pus and 17% from tissue, respectively. MRSA isolates showed 100% sensitivity to Vancomycin, Teicoplanin and Linezolid. Susceptibility to other drugs has shown wide variation, i.e., Tigecycline 97%, Rifampicin 95%, Clindamycin 86%, Tetracycline 79%, and Cotrimoxazole 78%. The minimum inhibitory concentration (MICs) of Vancomycin and Linezolid against MRSA isolates revealed that 41% had 0.5 µg/ml, 46% had one µg/ml, and 13% had two µg/ml for Vancomycin. Whereas for Linezolid, 38 isolates had MIC 1 µg/ml, then 62 isolates had MIC 2 µg/ml.
Conclusion: All the isolates showed 100% sensitivity to Vancomycin, Teicoplanin and Linezolid. Moreover, being less costly, Clindamycin, Tetracycline and Cotrimoxazole are good oral choices for empirical therapy against minor MRSA infections.
Comparison Between Glasgow Score and CTSI in Predicting the Severity of Acute Pancreatitis Based on Modified Atlanta Classification 2012
Authors: Kamran Fatima , Sheikh Irfan Ali , Haroon Samra , Ashraf Yusra , Mehmood Khalid , Haroon Faaraea 
Published: December 2022

Objective: To compare the Glasgow scoring system and modified CTSI scoring system regarding its ability to predict the severe nature of acute pancreatitis according to the revised Atlanta classification in a tertiary care hospital in Pakistan.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: General Surgery Department, Combined Military Hospital, Rawalpindi from July 2020 to Jul 2021.
Methodology: Forty patients ranging from 30 to 70 years of age with acute pancreatitis, some of them were admitted to our hospital and others were received in the Emergency Department. Glasgow and modified CTSI scores were calculated for all cases.
Results: Glasgow and CTSI scoring systems were compared according to the Atlanta Classification. The data in our study showed a mean Glasgow score of 2.475 ± 2.975, whereas the mean CTSI score was 5.575 ± 2.458. In predicting severe acute pancreatitis using the AUC graph, the CTSI scoring system had a higher accuracy (0.994) than Glasgow score (0.987). For mild and moderately severe acute pancreatitis, both Glasgow and CTSI showed significance (p<0.01).
Conclusion: CTSI scoring is more accurate in detecting the severity of acute pancreatitis. Glasgow was close behind, but it is not an accurate indicator
Concordance and Discordance of Mitotic Count, Ki-67 Proliferative Index and Phosphohistone H3 Count in Grading Neuroendocrine Tumors of Gastrointenstinal Tract
Authors: Humayun Saba , Asif Muhammad , Khadim Muhammad Tahir , Din Hafeez Ud , Ahsan Farah , Rashid Farhat 
Published: December 2022

Objective: To determine the grades of gastrointestinal neuroendocrine tumours using World Health Organization criteria and Phosphohistone H3 mitotic index and to determine the concordance between the two methods.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Mar to Oct 2019.
Methodology: Forty-two (n=42) patients of either gender between the ages of 18-70 years were enrolled. All the enrolled patients were diagnosed with primary gastrointestinal neuroendocrine tumours and underwent either surgical or endoscopic resection. Tumour grades were determined using World Health Organization criteria and Phosphohistone H3mitotic index. The results obtained with both methods were compared, and the concordance rate was calculated.
Results: When mitotic counts were determined through PHH3, MI resulted in a change of grade of 12 (28.6%) tumours, which were graded by the current WHO system. 11 (26.2%) were changed from grade II to grade I and 1 (2.4%) from grade I to grade I1. The agreement (concordance rate) between the two systems was moderate and statistically significant (71.4%, n=30/42, κ= 0.51, p= 0.001).
Conclusion: In the present study, we observed a moderate agreement between the Ki-67 labelling index and the PPH3 mitotic index, and both correlate well with the mitotic counts. The PPH3 mitotic index demonstrated a better correlation with mitotic counts when compared with Ki-67 LI. Hence, the inference can be drawn that the mitotic index with Phosphohistone H3is associated more closely with mitosis in gastrointestinal neuroendocrine tumours.
Effectiveness of Sub-Conjunctival Bevacizumab After Pterygium Excision at Armed Forces Institute of Opthalmology
Authors: Arsalan Zahra , Zafar Omar , Akram Amjad , Zamir Quratulain 
Published: December 2022

Objective: To determine the effectiveness of sub-conjunctival Bevacizumab after pterygium excision.
Study Design: Quasi-experimental study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Aug 2019 to Jan 2020.
Methodology: Thirty-six patients were included and divided into two groups. In group A (n=18), pterygium excision with conjunctival auto-graft was followed by injection of 0.3ml of 7.5mg of Bevacizumab. Patients of Group B (n=18) did not receive any Bevacizumab. All the patients were followed up after 7 days, two weeks, 4weeks and 24 weeks after the start of management. The visual analog score was used for pain assessment, Snellen chart for visual acuity and intraocular pressure was measured with applanation tonometry.
Results: After six months the recurrence rate was less in Group-A (n=3, 16.6%, p=0.005) than Group-B (n=4, 22.2%, p=0.01) The recurred pterygium size was also greater in Group-B (mean=0.27 ± 0.28mm, p=0.006) than Group-A (mean=0.11 ± 0.21mm, p=0.006). Patients of Group-A experienced less pain post-surgery. The intraocular pressures were same in both the groups. Visual acuity improvement was seen in the Group-A (n=11, 61%, p=0.008)) than group B (n=4.22%, p=0.008).
Conclusion: Administration of Bevacizumab under the conjunctiva after pterygium excision may be useful in averting lesion relapse, less post-op pain, and improved visual acuity.
Cephalometric Analysis Difference Between Skeletal and Soft Tissue Measurements
Authors: Mehmood Sundas , Jan Abdullah , Ijaz Muska , Ghaffar Fareena , Bibi Khadija , Tariq Alaina 
Published: December 2022

Objective: To compare the skeletal and soft tissue measurements of the dento-facial region in a cephalometric study done in the Pakistani population.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb to Aug 2019.
Methodology: Total 160 subjects were enrolled in the study. Lateral cephalograms were recorded for all the study participants in natural head position. Patients were divided into Class I, II, and III according to the skeletal pattern. The distances of skeletal and soft tissue landmarks relative to the respective norm values and the angles between the Nasion Sella line and Frankfurt horizontal to the natural head position were measured and compared in the three classes using chi-square.
Results: Out of 160 patients, 96 (60%) patients were males, and 64 (40%) were females. In our study, 92 (57.5%) patients were classed in class I, 46 (28.75%) in class II and 22 (13.75%) in class III. The mean score of A point, Nasion, and B point angle was 7.5 ± 1.112, while the beta angle was 30.5 ± 2.214. The mean score of facial convexity angle was 14.1 ± 2.124, while the mean vertical height ratio was 1.05 ± 0.11. Both skeletal and soft tissue measurements significantly predict the skeletal pattern and discrepancy (p-value <0.001).
Conclusion: Lateral cephalograms and radiography measures emerged as reliable techniques to classify the patients in various skeletal patterns. Factors like age and gender do not influence skeletal discrepancies.
The Association of Serum Sodium Levels with Intraventricular Hemorrhage in Preterm Infants: A Prospective Longitudinal Study from Pakistan
Authors: Bhanbhro Bakhtiar Ahmed , Bharo Mumtaz Ali , Baloach Kamran Ali Shahani , Abbas Kiran 
Published: December 2022

Objective: To evaluate the association of hypernatremia with intraventricular haemorrhage in preterm infants in a local setting.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Neonatal Intensive Care Units (NICU), Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat Khaipur Mirs from Sep 2018 to Mar 2020.
Methodology: All the infants with the gestational age of <32 weeks of pregnancy were included, while infants who died <12 hours of life were excluded from the study. All relevant maternal and neonatal data were extracted from patient files and recorded in electronic form. The infants were further stratified into three groups: i) infants without intraventricular haemorrhage, ii) mild intraventricular haemorrhage, and iii) severe intraventricular haemorrhage.
Results: The intraventricular haemorrhage was 40%. 84 (29.2%) infants had a mild intraventricular haemorrhage, and 32 (11.1%) had a severe intraventricular haemorrhage. The highest sodium level was 145.91 ± 6.98 mEq/L and 143.51 ± 5.93mEq/L in the mild IVH and severe intraventricular haemorrhage groups, respectively. The fluctuations in serum sodium levels from week 1 to week 2 were significantly more prominent in infants without intraventricular haemorrhage compared to intraventricular haemorrhage groups (12.31 ± 6.67 mEq/L, 10.11 ± 9.32 mEq/L, and 6.54 ± 7.53 mEq/L, respectively; p:0.001).
Conclusion: The fluctuation of serum sodium in infants with severe Intraventricular haemorrhage was significantly greater than in infants with mild intraventricular haemorrhage or without intraventricular haemorrhage.
Rh Alloantibodies in Rh D Negative Blood Group Pregnant Women - A Regional Transfusion Centre Study
Authors: Bajwa Hussan , Alam Maqbool , Rathore Muhammad Ali , Yazdani Muhammad Sajid 
Published: December 2022

Objective: To determine the frequency of Rh alloantibodies in pregnant women of the Rh-D negative blood group.
Study Design: Cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT) Rawalpindi, from Jan to Dec 2017.
Methodology: The blood samples of pregnant women received for blood grouping, cross matching and antibodies screening were included in the study. The blood was typed for Rh-D along with ABO blood groups by Column Agglutination Technique (CAT), commonly known as the gel card method. Then, the samples included in the study were subjected to antibody screening by three cell antibody screening panel (Dia Cell, a product of Bio-Rad) by Column Agglutination Technique. The samples with positive antibody screening were further processed by 11 cell antibody screening panel (Dia Cell, BioRad) for Rh antibody identification by Column Agglutination Technique, the same as the indirect antiglobulin test (IAT).
Results: 453 Rh-D negative pregnant women were screened for alloantibodies during the study period. Rh alloantibodies were present in 55 (12.08%) cases. The most common alloantibody identified was anti-D in 48 (87.3%) samples, followed by anti-C in 6 (10.9%) and anti-E in 1 (1.8%) case.
Conclusion: The most prevalent Rh alloantibody identified in Rh-D negative pregnant women was anti-D, while the anti-C and anti-E were less prevalent. However, no case of anti-c and anti-e alloantibody was identified.
The Perspective of Pakistani Adults Regarding the Consequences of Missing Teeth
Authors: Abbasi Maria Shakoor , Ahmed Naseer , Ahmad Maira , Tahir Maira , Mandhan Nikki , Vohra Fahim 
Published: December 2022

Objective: To determine the recognition level of the consequences of missing teeth in Pakistani adults.
Study Design: Cross-Sectional study.
Place and Duration of Study: Altamash Institute of Dental Medicine, Karachi Pakistan, from Jul to Dec 2019.
Methodology: A well-structured and validated questionnaire filled by 652 partially dentate patients was included in the study.
Results: Despite having some education, the individuals showed poor knowledge of the consequences of missing teeth. Only 184 (28.2%) and 221 (33.9%) were aware of supra-eruption and drifting, respectively. 330 (50.6%) and 269 (41.3%) were unaware of the temporomandibular joint problems and speech difficulties. However, the majority were aware of masticatory problems, 562 (86.2%) and 460 (70.6%) self-confidence issues. There was no significant association (r=-0.70, p=0.7) and (0.03, p=0.9) between gender with number and aetiology of missing teeth. At the same time, a moderate relationship (rho=0.7) with no significant difference (p=0.08) was found between gender and knowledge of consequences. A negative relationship (r -0.12)with a significant difference (p<0.02) was found between education level and aetiology. Moreover, no significant association was found (rho -0.03, p=0.3) and (-0.06, p=0.6) between education level with number and knowledge about the consequences of missing teeth.
Conclusion: The knowledge and understanding of the general population on matters that are so important and relevant in the long run to each individual’s Oral Health-Related Quality of Life are of special concern. Therefore, it is essential for dentists and other health care providers to educate and remember the importance of knowing the inevitable consequences of.....
Multidrug-Resistant Uropathogens, An Emerging Threat: Observational Study in a Tertiary Care Hospital of Azad Kashmir
Authors: Zeb Muhammad Aurang , Nadeem Muhammad , Tariq Tufail Hussain , Siddiq Shazia , Zaib Jahangir , Mahmood Muhammad Arif , Akbar Adiba 
Published: December 2022

Objective: To detect the resistant pattern of uropathogens and find the association of different factors with the resistance in the Poonch District of Azad Kashmir.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Department of Medicine, Shaikh Khalifa Bin Zayed Hospital, Rawalakot, from Mar to Aug 2019.
Methodology: Patients having signs and symptoms of urinary tract infection and growth of bacteria on urine culture were included in the study. The antimicrobial susceptibility of the isolates was determined by using the standard, modified Kirby Buer disc diffusion method. Zone sizes were interpreted following Clinical Laboratory Standards Institute (CLSI) 2019 guidelines.
Results: 68 culture-positive patients were included in the study, 45 (66%) patients were female. There was a previous history of urinary tract infection in 44 (64.7%) patients, and 52 (76.5%) gave a history of antibiotic use in the last three months. E. coli was the commonest organism isolated, followed by Klebsiella, Proteus and Pseudomonas. All patients were resistant to at least one antibiotic, 48 (72%) isolates were multi-drug resistant. Uropathogens showed the highest resistance to Ampicillin in 67 (98.5%) patients and the lowest resistance to Piperacillin/Tazobactam 2 (3%) patients only. Resistance was significantly higher in patients having a history of recurrent urinary tract infection (p=0.028) and the use of antibiotics in the last three months (p<0.001).
Conclusion: Resistance to antimicrobial agents is increasing in community-acquired urinary tract infections. Resistance is significantly higher in patients having a history of recurrent urinary tract infection and the use of antibiotics in the..........