bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visual Rehabilitation after Phacoemulsification with Rigid Intraocular Lens Implantation at Tertiary Care Hospital-Jamshoro
Authors: Mahesar Mona Liza , Ahmed Noman , Jatoi Asadullah , Nasrani Ashok Kumar 
Published: December 2022

Objective: To evaluate the visual rehabilitation after phacoemulsification with rigid intraocular lens implantation.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Institute of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro Pakistan, from Jul to Dec 2020.
Methodology: Ninety-four subjects diagnosed with unilateral cataracts were evaluated completely. Subjects with any other ocular disease were excluded from the study. Pre-operative and post-operative, surgical and visual outcomes along with follow-up of 4 weeks and 12 weeks best-corrected visual acuity, were recorded.
Results: The mean age of study participants was 61.77±7.34 years. Post-operative complications were evaluated within one week of surgery. 22(23.4%) subjects showed striate keratopathy, 2(2.1%) indicated bullous keratopathy, and 7(7.4%) reported residual lens matter as a complication. The difference between good visual outcomes was 33(35.1%) within eight weeks (4th week till 12th week); similarly, the difference between satisfactory visual outcomes was 22(23.4%). The visual outcomes improved more than two folds after phacoemulsification with a rigid intraocular lens.
Conclusion: The foldable intraocular lens is comparatively expensive and unaffordable for many patients in developing countries. Rigid IOL with phacoemulsification is a cost-effective method to remove cataracts and restore patient visual acuity.Accurate diagnosis, evaluation, and surgeon’s experience are important factors in achieving the required results.
Clinical Profile and Induction Outcome of Children with T-cell Acute Lymphoblastic Leukemia and T-cell Lymphoblastic Lymphoma
Authors: Arshed Awais , Nasarullah Faran , Shahid Samra , Tahir Muhammad , Farah Tanzeela , Ghafoor Tariq 
Published: December 2022

Objective: To study the clinical profile and induction outcome in children diagnosed with T-cell acute lymphoblastic leukaemia and lymphoblastic lymphoma.
Study Design: Cross-sectional study.
Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2012 to Dec 2020.
Methodology: One hundered and twenty-one diagnosed patients of T-ALL and LBL were evaluated with bone marrow biopsy and Contrast-enhanced CT scan of the active region after induction chemotherapy with Dexamethasone, Vincristine, Asparaginase and Daunorubicin along with intrathecal Methotrexate. This was carried out on days-8 and 29 to determine the early remission status and end of induction response, respectively.
Results: Out of 121 patients, 99(81.8 %) had T–ALL, while 22(18.18%) had LBL. Day-8 assessment showed that 94(77.7%) patients were rapid early responders, 24(19.4%) were slow early responders, while 3(2.4%) patients expired before the day eight assessment. Day-29 bone marrow assessment of 88 T-ALL patients showed complete remission in 77 patients (87.5%), incomplete remission in 5(5.68%) patients and treatment failure in 2(2.27%) patients. 20(93.1%) patients with LBL achieved remission by Day-29, while 2 (0.02%) LBL patients died before the Day-29 assessment.
Conclusion: The remission induction rates and mortality rates in our setup are encouraging and comparable to international data. Further improvements can be made by early management of the affected cases and more accessible pediatric oncology health services.
Safety of Minimally Invasive Percutaneous Nephrolithotmy in High Risk Patients in Lateral Position - A Single Center Study
Authors: Khizar Samina , Nawaz Muhammad , Farooq Umer , Shehzad Khubaib , Murtaza Badar , Akmal Muhammad 
Published: December 2022

Objective: To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy with fluoroscopy aided renal access in the lateral position, in patients who were high-risk cases for anesthesia in prone position.
Study Design: Prospective observational study.
Place and Duration of Study: Armed forces institute of Urology, Rawalpindi, from Jan 2018 to Dec 2019.
Methodology: Fifty-three patients with renal stones >1.8cm underwent minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral position. All the patients were obese, some had severe ischemic heart disease, few had diabetes mellitus. All the patients were unfit for the prone position.
Results: Successful renal access was achieved in all the patients (100%). The mean size of stone was 28 + 13.2 mm, with an average operative time being 55 ± 13.56 minutes and the mean hospital stay was 1.8 ± 2.3 days (range 2-4 days). No visceral or pleural injuries were documented. In addition, only two patients required postoperative transfusion. After procedure, the rate of complete stone clearance initially was 90.6%, which improved to 96% after single session of extracorporeal shockwave lithotripsy (ESWL). Only 2 (3.77%) patients had persistent residual stone fragment.
Conclusion: Minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral decubitus flank position, is safe and convenient in high-risk patients where prone position is contraindicated.
Analysis of Change in Body Composition in Diabetic Patients vs non-Diabetic Patients
Authors: Sharif Nazia , Fazal Imran , Alain Noor 
Published: December 2022

Objective: To assess the difference in various parameters of body composition between the diabetic patients and non-diabetic controls at Pak Emirates Military Hospital Rawalpindi.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Medicine and Nutrition Department, Pak Emirates Military Hospital, Rawalpindi, from Jul 2018 to Mar 2019.
Methodology: This study was conducted on 100 patients of non-insulin dependent diabetes mellitus under treatment in medicine department and matched controls from the community. Patients with type I diabetes or insulin dependents or having some other com or bid metabolic illness or autoimmune disease or malignancy were not included in the study. Parameters of body composition were measured by using the INBODY machine which works on the principle of electroimpedance.
Results: Cases and controls were matched for age and gender. Hundred cases and hundred controls were recruited for the final analysis Mean age of the cases was 43.41 ± 2.231 years while controls were 43.46 ± 3.122 years. Mean BMI in cases was 29.32 ± 2.561while in controls was 25.62 ± 4.483. BMI, visceral fat and skeletal muscle fat were found statistically significant to be more in cases of non-insulin dependent diabetes mellitus as compared to the controls.
Conclusion: This case control study revealed that diabetes significantly affects the body composition of the patients. It also affects other parameters like skeletal muscle mass and visceral fat. Routine screening of body composition should be made part of the diabetic clinics to pick these changes early and intervene accordingly.
Crimean-Congo Hemorrhagic Fever (CCHF): Our Experience at a Tertiary Hospital
Authors: Khan Zubair Waheed , Ali Gulzar , Ahmed AKhlaq , Tariq Muhammad , Gardezi Adeel , Khan Nauman Sarir 
Published: December 2022

Objective: To share our experience of managing Crimean-Congo Hemorrhagic Fever cases at tertiary care hospital.
Study Design: Hospital based case series.
Place and Duration of study: Medicine department Combined Military Hospital Peshawar, from 2017 to 2019.
Methodology: A total of 10RT-PCR positive cases of Crimean-Congo Hemorrhagic Fever were included in the study. Data were collected retrospectively from Stat office of the hospital. All cases which were PCR negative, having multiple co-morbid conditions and having alternative diagnoses were excluded from the study. Demographic, epidemiological, clinical and laboratory parameters were noted on a specially designed Proforma.
Results: All patients were males armed forces personnel employed in the tribal areas of KPK. All patients initially developed fever and generalized body pains. Among them 2 (20%) patients developed petechial rash and 1(10%) suffered from epistaxis, melena and hematuria. All (100%) of the patients’ lab data revealed leukopenia, thrombocytopenia, elevated ALT and LDH. Complete recovery was noted in all patients. 8 (80%) of the patients received ribavirin and platelet transfusion. All patients under study also received oral Vitamin C supplement. Average hospital stay was 14 days.
Conclusion: Crimean-Congo Hemorrhagic Fever is a fatal disease. People visiting to endemic areas are at particular risk such as soldiers. It is manifested by fever, petechial rash and thrombocytopenia. Treatment is supportive. The role of oral vitamin C supplements and ribavirin to hasten recovery needs further high-powerstudies andshould be given to all suspected and confirmed cases.
Frequency of t(4;14) in Multiple Myeloma and Its Clinicopathological Correlation
Authors: Zaheer Saima , Robert Helen Mary , Mahmood Asad , Mahmood Rafia , Khurshid Ayesha , Khan Nabeela 
Published: December 2022

Objective: To determine the frequency of t(4;14) in multiple myeloma in Pakistani population and study the clinicpathological correlation of this translocation in myeloma patients.
Study Design: Cross sectional study.
Place and Duration of Study: This study was conducted at Armed Forces Institute of Pathology from Jun 2017 to May 2018 using non probability convenience sampling technique.
Methodology: A total of 53 newly diagnosed cases of multiple myeloma were included in the study. Patients were diagnosed as having multiple myeloma based on diagnostic criteria of international myeloma working group. Fish analysis was done for t (4; 14). Workup for end organ damage /myeloma defining events was done.
Results: Out of 53 patients, 16 (30%) were females and 37(70%) were males; the mean age of the patients was 59.81 ± 11.34 range from 37 to 87 years. Fish for t(4;14) was positive in eight (15%) patients while negative in forty-five (85%) patients. Patients with positive results have significantly deranged renal function tests and raised beta 2 micoglobulins levels as compare to t(4;14)negative patients.
Conclusions: Detection of t (4:14) in multiple myeloma patients not only has diagnostic value but is important in risk stratification of these patients and thus effect treatment decision.
Frequency and Culture Sensitivity for Bacteremia During Febrile Neutropenia in Children with Acute Lymphoblastic Leukemia. Do Age and Gender Matter?
Authors: Bin Mehmood Rana Usama , Aslam Afra , Ayaz Saeed Bin , Choudhry Shehla , Javed Sidra , Ashraf Khaula 
Published: December 2022

Objectives: To determine the frequency of bacteremia and its association with age and gender in febrile neutropenic children suffering from acute lymphoblastic leukemia and identify the commonest pathogens and their antibiotic susceptibility identified on blood cultures.
Study Design: Cross-sectional analytical study
Place and Duration of Study: Pediatrics Inpatient Department, Shifa International Hospital, Islamabad Pakistan, from Sep 2018 to Mar 2019.
Methodology: Children with acute lymphoblastic leukemia aged 1-12 years, presenting with temperature >100ºF and absolute neutrophil count of <500 cells/µL were enrolled. An automated blood culture system was used and Clinical and Laboratory Standards Institute Guidelines 2017 were used for susceptibility testing. Antibiotics were started empirically in all cases and changed after susceptibility testing.
Results: A total of 62 children were enrolled. The mean age was 8.6 ± 2.4 years. Majority of the children i.e., 32 (51.6%) were females. The frequency of bacteremia was 16 (25.8%) and there was no significant association with age or gender (p=0.475 and p=0.881 respectively). Majority of the isolates were gram-positive. The organism isolated in the highest frequency was Methicillin-Resistant Staphylococcus Epidermidis (MRSE) 5 (31.25%). Susceptibility to Vancomycin was present in 10 isolates while seven isolates were sensitive to penicillins/cephalosporins.
Conclusion: Bacteremia, primarily caused by gram-positive bacteria was found in 25.8% of our sample and was uninfluenced by age or gender. MRSE was the most frequent isolate. The bacterial isolates were susceptible primarily to vancomycin and penicillins/cephalosporins.
Can Thrombocytopenia be Used to Make a Presumptive Diagnosis of Malaria in Patients with Acute Febrile Illness
Authors: Akram Ammad , Gillani Mehwish , Uttra Khurshid Muhammad , Gillani Mehreen , Atiq Nausheen , Akram Anam 
Published: December 2022

Objective: To ascertain the diagnostic accuracy of thrombocytopenia in making a presumptive diagnosis of malaria in patients with acute febrile illness, keeping thick and thin films as the gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from May to Oct 2017.
Methodology: A total of 145 patients meeting the inclusion criteria i.e., patients with fever of 10 or less days, age of ≥12 and ≤65 years of either sex were included in the study. Sample for a complete blood picture was taken in Ethylenediaminetetraacetic acid (EDTA) vacutainer. Simultaneously, two slides each with a thick and thin blood smears were made to ascertain absence or presence of plasmodium vivax species (smear positive and smear negative). The diagnostic accuracy was measured using two by two table and applying formulae for specificity, sensitivity, negative and positive predictive value. Likelihood ratio and ROC (Receiver operator curve) was also calculated.
Results: Out of 145 subjects, ninety-four patients (64.8%) were males and 51 were (35.2%) females with mean age of 36.76 ± 14.749 years. The specificity, sensitivity, negative and positive predictive value and diagnostic accuracy of thrombocytopenia in making a presumptive diagnosis of malaria in patients having short history of fever, keeping thick and thin films as the gold standard was 68.8%, 81.4%, 64.7%, 84.0% and 77.2% respectively.
Conclusion: Hematological abnormalities are encountered in malaria. Thrombocytopenia has a very good sensitivity and good specificity for malaria.
Late Presentation of Anorectal Malformations - A Dilemma in Modern World: Cross-sectional Analysis from a Tertiary Care Hospital, Pakistan
Authors: Sohail Hamza , Nawaz Tahir , Mirza Mohammad Afzal , Ara Jahan , Nawaz Muhammad Ahsan , Arif Anoshia , Ahmed Moiz 
Published: December 2022

Objective: To study the presentation age of children with anorectal malformation and its relationship with complications.
Study Design: Cross-sectional study.
Place and Duration of Study: Children Hospital and Institute of Child Health, Faisalabad, from Jan to Dec 2019.
Methodology: A total of 170 patients were included in the study. All the infants with a positive diagnosis of anorectal malformation from birth to 2 years of age were included in the study. Variables, including age at presentation, gender, diagnosis, length of stay and outcome in the form of discharge or mortality, were recorded.
Results: A mean age of presentation was 3.4 ± 2.1 days. Out of the total 170 patients, 110 (64.71%) were males, and 60 (35.29%) were females. The age of children extended from birth to 2 years of age. It was observed that only 10 (5.88%) infants presented within 48 hours of birth, 110 (64.71%) neonates presented between 48 to 72 hours, while 50 (29.41%) presented after 72 hours. A mortality rate of 3.53% was observed in the late-presentation group, i.e., after 72 hours of birth. The length of hospitalization was longer in groups with late presentation.
Conclusion: The present study reported that the majority of the infants with anorectal malformation were admitted to the hospital with a late presentation, i.e., after 72 hours of birth. Early and timely presentation of these infants can improve patient outcomes and reduce mortality among infants with anorectal malformations.
Impact of Obstetric Cholestasis on Fetomaternal Outcome
Authors: Anwar Rabiah , Razzaq Kashif , Noor Nusrat , Ansari Asma , Imran Ayesha 
Published: December 2022

Objective: To evaluate the impact of obstetric cholestasis on maternal and fetal outcomes.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from Jan to Dec 2019.
Methodology: All pregnant women with no comorbid and ladies with symptoms and signs of obstetric cholestasis were included during the study period. Antenatal complications and perinatal outcomes of women having obstetric cholestasis were compared with those of pregnant ladies having no comorbid.
Results: Out of 6932 obstetric patients, 90 (1.29%) had obstetric cholestasis. The cholestatic group had significantly high levels of aminotransferases and alkaline phosphatase. There was higher occurrence of preterm prelabour rupture of membrane (11.11% vs 3.33%, p=0.044), preterm delivery (26.66% vs 4.44%, p<0.001), prelabor rupture of membrane (31.11% vs 13.33%, p=0.004) and emergency cesarean section (16.66% vs 4.44%, p=0.008) in obstetric cholestatic group as compared to control. No difference in the occurrence of postpartum haemorrhage was observed in both groups. Meconium stained amniotic fluid (42.22% vs 8.88%, p<0.001) and neonatal intensive care unit admission (23.33% vs 7.77%, p=0.004) were significantly high in the study group as compared to the control. Whereas occurrences of abnormal cardiotocography, APGAR score at 5 minutes, and intrauterine growth restriction in both groups had no significant difference.
Conclusion: Women with obstetric cholestasis are at increased risk of preterm labour, PPROM, emergency LSCS, and poor neonatal outcome (low APGAR, macrosomia, NICU admission), burdening the health care system; hence early diagnosis with careful clinical examination...
Intravenous Versus Subcutaneous Insulin in Management of Hyperglycaemia in Intensive Care Unit
Authors: Khan Hafiz Waleed , Mansoor Khurram , Khattak Muhammad Irfan , Yousaf Shagufta , Khan Ayesha , Altaf Maria 
Published: December 2022

Objective: To compare the efficacy and safety of intravenous Insulin infusion versus subcutaneous Insulin in the management of hyperglycaemia in intensive care.
Study Design: Quasi-experimental study.
Place and Duration of Study: Medical Intensive Care Unit of Combined Military Hospital Malir, from Jul to Sep 2021.
Methodology: 68 individuals admitted to the Medical ICU with the blood sugar levels of more than 180 mg/dl were included. Patients on one side of Intensive Care Unit were administered intravenous Insulin infusion, and on the other side were administered subcutaneous Insulin to control blood sugars. Age, gender, previous history of diabetes and use of Insulin and glycosylated haemoglobin were recorded. Efficacy of regimen was judged based on ability to achieve target glucose levels, mean blood glucose levels and total days of ICU stay. Adverse events like hypoglycaemia and hypokalaemia were recorded.
Results: Out of 68 individuals, 27 (39.70%) were administered intravenous Insulin infusion, and 41 (60.29%) were administered subcutaneous Insulin. In the intravenous Insulin group, 22 (81.5%) individuals achieved target blood glucose compared to 29 (70.7%) in the subcutaneous Insulin group. The mean blood sugars in the intravenous group were 157.11 ± 25.54 mg/dl, whereas 168.32 ± 30.49 mg/dl in the subcutaneous group (p-value=0.164). The frequency of hypoglycaemia and hypokalaemia was more in the intravenous group than in the subcutaneous group.
Conclusion: Optimal blood sugar levels were better achieved with intravenous Insulin than with subcutaneous Insulin. However, the frequency of adverse effects was also more with intravenous Insulin, so better monitoring and management are..............
Diagnostic Accuracy of Extended Focused Assessment with Sonography For Trauma (E-FAST) Keeping Contrast Enhanced CT Chest And Abdomen As Gold Standard
Authors: Gul Bibi , Anwar Javed , Pervaiz Hafiz Khalid , Niaz Ayesha , Sultana Nasira , Tariq Mehwish 
Published: December 2022

Objective: To determine the diagnostic accuracy of extended focused assessment with sonography for trauma (E-FAST) for detecting thoraco-abdominal trauma, keeping contrast-enhanced CT chest and abdomen as the gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Radiology, Combined Military Hospital, Quetta, from Jan 2020 to Aug 2021.
Methodology: A total of (n=196) patients, of age 18-60 years, of both genders, who sustained thoraco-abdominal injuries and were referred for contrast-enhanced Computed tomography of the chest and abdomen were enrolled in the study. Patients were subjected to the thorax and abdomen ultrasonographic examination first and then underwent a contrast-enhanced CT scan of the thorax and abdomen. The findings of both modalities were recorded and subjected to statistical analysis to confirm the accuracy of ultrasound, considering CT-scan as a gold standard procedure.
Results: The mean age of the patients was 35 10.6. There were 164 (83.7%) males and 32 (16.3%) females. Blunt trauma was seen in 131 (66.8%) and penetrating trauma in 65 (32.2%) patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of E-FAST for chest trauma was 79.4%, 94.7%, 87.6%, 90.7% and 89.8% respectively, for abdominal trauma was 68.6%, 95.2%, 88.8%, 84.5% and 85.7% respectively and for combined chest and abdominal trauma was 77.1%, 95.9%, 85.9%, 92.8% and 91.3% respectively.
Conclusion: E-FAST has good diagnostic accuracy for the chest, abdominal and both thoraco-abdominal trauma and can be incorporated into the routine assessment of patients presenting with trauma.
Efficacy of Percutenous Trigger Finger Release
Authors: Ali Muhammad Qasim , Sheikh Saeed Ahmed , Sahito Badaruddin , Arif Muhammad , Jamali AR 
Published: December 2022

Objective: To determine the efficacy of trigger finger release with the percutaneous technique.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Orthopedic Surgery, Jinnah Post Graduate Medical Center, Karachi Pakistan, from Mar 2017 to Mar 2018.
Methodology: One hundred and three patients were selected through the outpatient department after they meet the inclusion criteria with one or more trigger fingers in whom percutaneous release was indicated. Patients with previously open release, carpel tunnel syndrome, osteoarthritis of the hand and Dupuytren's contracture were excluded.
Results: The mean age of patients was 34.79 ± 14.08 years with a range of 17-62 years. More patients were male (56.3%), and females were 43.7% with a male to female ratio of 1.27:1. Accordingly, 95 (92.2%) out of 103 had complete relief of symptoms and the procedure was thus efficacious in these patients. Among the remaining 7.8% of patients in whom it was not efficacious, about 2.2% had partial relief while 5.6% had either no benefit or worsening of symptoms as assessed on the 8th week post-operatively. Age was a significant effect modifier (p<0.05).
Conclusion: Overall, the percutaneous technique of trigger finger release is an effective method of treatment