bluuebunny/crossref_metadata_2025_split huggingface dataset:
HAEMATOLOGICAL PROFILE DERANGEMENTS IN PATIENTS DUE TO NON-RESISTANT AND RESISTANT TYPHOID FEVER
Authors: Tashfeen Sunila , Asif Naveed , Farooq Muhammad 
Published: January 2022

Objective: To assess and compare the frequency of haematological parameter derangements in patients due to non-resistant and extended drug resistant (XDR) typhoid fever.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Pathology Department of Combined Military Hospital Quetta, from Jan to Dec 2019.
Methodology: A total number of 172 blood culture Salmonella positive patients irrespective of age and gender were included in this study. Salmonella strains were isolated and grouped further according to their drugs sensitivity. 3ml venous blood was collected from these patients in Ethylene diamine tetra acetic acid container and blood complete count was done by semiautomated haematology analyser XP-100.
Results: There were 126 (73%) males and 46 (27%) females with mean age of 17.5 ± 10.3 years. Out of 172 subjects, 106 (61.6%) had non-resistant typhoid and rest 66 (38.4%) were diagnosed with extended drug resistant Typhoid. We compared anaemia, leucopenia and thrombocytopenia between two groups and found anaemia statistically significant with the p-value of 0.001.
Conclusion: This study has documented that changes in haematological parameters are significant in typhoid fever and early patients diagnosis, management and disease course can be monitored with them. Patients with significant anaemia and not responding to first line therapy should be considered as a case of extended drug resistant (XDR) Salmonella.
HEPATITIS B AND HEPATITIS C SEROPOSITIVE SURGICAL CASES AND ITS IMPACT ON PERIOPERATIVE BLOOD TRANSFUSION
Authors: Ikram Mobeen , Mahboob Saira , Yusuf Rizwan 
Published: January 2022

Objective: To evaluate the frequency of Hepatitis B and Hepatitis C on our surgical patients and its impact on operation theater delay, change of anesthesia plan and requirement of perioperative blood and blood products transfusion.
Study Design: Cross sectional, analytical study.
Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital, Okara, from Apr to Sep 2019.
Methodology: After the approval of the hospital ethical review committee, 154 patients with either Hepatitis B or Hepatitis C undergoing various surgeries were included in our study. Data was analyzed using SPSS-20.
Results: The overall frequency of chronic liver disease was 154 (4.71%). A total of 23 (0.70%) were found to be seropositive as viral Hepatitis B and 127 (3.88%) as Hepatitis C; whereas 4 (0.12%) patients were diagnosed to have both virus serology positive. There was mean delay of 26.2 ± 8.29 minutes in 78 (52%) patients. The anesthetist had to change the plan of anesthesia for only 1 (0.7%) patient. There was also no difference in frequency of change of anesthesia plan (p=0.35); delay in surgery (p=0.16) and blood transfusion between the patients with Hepatitis B or Hepatitis C infection (p=0.72).
Conclusion: The frequency of Hepatitis B and Hepatitis C was lower (4.71%) in our surgical patients with no effect of Hepatitis B and Hepatitis C on blood loss, peri-operative transfusion, delay in surgery or change in anesthesia plan.
DIAGNOSTIC UTILITY OF SERUM LACTATE DEHYDROGENASE LEVELS (LDL) IN DIFFERENTIATING MEGALOBLASTIC ANEMIA FROM MYELODYSPLASTIC SYNDROMES IN PAKISTAN
Authors: Rana Faraz Ali , Robert Helen Mary , Ilyas Madiha , Mahmood Asad , Amir Muhammad , Khan Nabeela 
Published: January 2022

Objective: To study the diagnostic utility of lactate dehydrogenase levels in differentiating megaloblastic anemia from myelodysplastic anemia in Pakistan.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from Feb, 2019 to Aug, 2019.
Methodology: In this study, total 240 patients (18-75 years of age) males and females were selected by consecutive sampling technique and were equally divided into 3 groups; patients with megaloblastic anemia, patients with myelodysplastic syndromes and healthy control group. The clinical history and duration of anemia were recorded on special designed proforma. The laboratory investigations including lactate dehydrogenase levels were also noted. Both types of anemia were compared on basis of Lactate Dehydrogenase Levels.
Results: The lactate dehydrogenase levels in megaloblastic group were more than 3000 IU/L in 58 out of 80 patients (72.5%). On other hand, myelodysplastic group had 79 out of 80 patients with lactic acid dehydrogenase levels below 450 IU/L (98.75%). The difference in lactic acid dehydrogenase levels between both groups was found to be statistically significant.
Conclusion: Serum lactate dehydrogenase levels can be used to differentiate megaloblastic anemia from other anemia especially myelodysplastic syndromes before doing a bone marrow examination. High lactate dehydrogenase levels above 3000 IU/L in megaloblastic anemia can differentiate it from other anemia.
COMPARISON OF DEPRESSION, ANXIETY AND STRESS SCORE AMONG CLINICAL AND NON-CLINICAL HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC
Authors: Iqbal Mishal , Iqbal Mehak , Iftikhar Nadia , Inam Syed Hashim Ali , Jamil Hamza , Nisar Shazia 
Published: January 2022

Objective: To assess the psychological impact of COVID-19 pandemic on healthcare workers.
Study Design: Cross sectional study.
Place and duration of Study: Armed Forces Institute of Cardiology/National Institute of Health Diseases in June 2020.
Methodology: A total of 317 healthcare professionals, of different designations, affiliated with different public and private sector hospitals in Pakistan participated in this project. They were asked to complete Depression, anxiety and stress scales-42 (DASS-42).
Results: Out of 317 healthcare workers, 107 (33.75%), 111 (35.02%), 103(32.49%) were depressed, anxious and stressed respectively. Female gender was associated with a higher prevalence of depression, anxiety and stress.
Conclusion: More than one third of healthcare workers were depressed, anxious or stressed during the COVID-19 pandemic. Two out of five female healthcare workers were suffering from depression, anxiety or stress.Keywords:, , .
TECHNETIUM-99M MIBI GATED MYOCARDIAL PERFUSION SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY IMAGING – VALIDATION OF STRESS ONLY PROTOCOL
Authors: Dar Zaigham Salim , Raza Mehdi , Atif Muhammad , Bukhari Aown Raza 
Published: January 2022

Objective: To validate ‘stress only’ protocol against ‘rest stress protocol in normal and essentially normal cases undergoing Tc99m MIBI gated myocardial perfusion Single Photon Emission Computed Tomography imaging.
Study Design: A retrospective observational study.
Place and Duration of Study: Department of Nuclear Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi, Pakistan, from Jul to Sep 2019.
Methodology: 136 cases were included. Patients underwent Tc-99m gated Single Photon Emission Computed Tomography MPI using a single day, rest/stress protocol. The rest study was performed first with 8-10 mCi Tc-99m MIBI followed by stress study, 3 hours later with 3 times the rest dose. The most common stress technique was pharmacological stress and bicycle ergometer exercise with 0.14 mg/kg/min adenosine infusion. Few patients underwent physical stress using Bruce protocol, achieving a minimum of 85% of the target heart rate. Mages–stress followed by rest–were evaluated by two experienced nuclear cardiologists (blinded to the MPI reports) and interpreted as ‘normal’ or ‘essentially normal’.
Results: Evaluation of stress-only and rest-stress Single Photon Emission Computed Tomography myocardial images yielded a concordance rate of 84.56% with Cohen’s kappa coefficient of 0.69.
Conclusion: Substantial agreement and good concordance were found in normal and essentially normal ‘stress only’ and ‘rest stress protocols.
ADHESIVE CAPSULITIS; MANAGEMENT BY PHYSIOTHERAPY VERSUS INTRA-ARTICULAR CORTICOSTEROID INJECTION
Authors: Hashmi Muhammad Umair , Chughtai Babar Bakht , Ahsan Muhammad Nadeem 
Published: January 2022

Objective: To determine outcomes of intra-articular corticosteroids injection versus physiotherapy for the treatment of adhesive capsulitis using mean pain score on the visual analogue scale.
Study Design: Comparative prospective study.
Place and Duration of Study: Orthopedic outpatient department, Bahawal Victoria Hospital Bahawalpur from Jan to Jun 2021.
Methodology: A total of 120 cases having adhesive capsulitis (frozen shoulder) were included in the study according to inclusion criteria. Non-probability consecutive sampling technique was used for the selection of cases. Patients were divided into two groups, group-A and group B, each containing 60 cases. Patients in group-A were given intra-articular steroid injection (2ml triamcinolone 40mg ± 2ml of bupivacaine). Patients in group B received ten sessions of physiotherapy by a welltrained physiotherapist under the supervision of an orthopaedic surgeon on alternate days. After six weeks, outcomes were measured in terms of pain score using a visual analogue pain scale.
Results: Significant improvement was seen among patients in group-A with mean pain score from 7.32 ± 0.89 measured initially to 5.44 ± 1.37 measured after six weeks (p<0.001). No significant improvement was found among patients in group B with a mean pain score of 7.58 ± 0.94 measured initially to 7.12 ± 0.88 measured after six weeks (p>0.05).
Conclusion: Significant improvement in pain relief can be achieved using intra-articular steroid injection administered in the shoulder as compared to supervised sessions of physiotherapy among patients with adhesive capsulitis.
THE ASSOCIATION OF CATARACT TYPE ON CENTRAL CORNEAL THICKNESS AFTER PHACOEMULSIFICATION CATARACT SURGERY
Authors: Abbas Hussnain , Rauf Abdul , Perveen Shagufta , Mehmood Shahid Hamid , Hussain Irshad , Naimat Khalid 
Published: January 2022

Objective: To assess any association between the type of cataract and the central corneal thickness at pre-operative and postoperative three-day and one-month appointments after phacoemulsification surgery.
Study Design: Prospective, comparative study.
Place and Duration of Study: Eye Department Combined Military Hospital Multan, from Jun 2020 to Apr 2021.
Methodology: A total of 89 patients requiring cataract surgery by phacoemulsification were recruited. Age and gender were recorded for each patient. Patient’s type of cataract based on maturity was recorded before the surgery. Phacoemulsification cataract surgery using ‘divide and conquer’ technique was carried out. Patients’ central corneal thickness was measured at the pre-operative, three-day post-operative and one-month post-operative appointment using traditional non-contact tonopachymeter.
Results: There were 49 (55.1%) male and 40 (44.9%) female patients with a mean age of 62.15 ± 12.40 years. No significant association was found between the type of cataract and central corneal thickness at the three-time intervals (p=0.14). Central corneal thickness significantly increased from 0.48 ± 0.04 mm pre-operatively to 0.51 ± 0.04 mm at the three-day post-operative appointment (p<0.001). It then reduced to 0.49 ± 0.04 mm at the one-month appointment (p=0.01).
Conclusion: The type of cataract is not associated with the variation in central corneal thickness due to cataract surgery. Central corneal thickness significantly increases from the pre-operative to right after the cataract surgery. However, it returns to preoperative levels after a one-month period.
IMMUNOEXPRESSION OF CD-10 IN BASAL CELL CARCINOMA AND SQUAMOUS CELL CARCINOMA OF HEAD AND NECK
Authors: Ilyas Maria , Rafiq Muhammad Yasir , Farhan Farha , Ali Misbah , Afzal Saeed , Niazi Zainab 
Published: January 2022

Objective: To compare the expression of CD-10 in basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from Jun 2016 to Jun 2017.
Methodology: After taking ethics approval from the ethical review committee AFIP, previously diagnosed, thirty-eight cases of each basal cell carcinoma and squamous cell carcinoma were taken from the histopathology department of Armed Forces Institute of Pathology, Rawalpindi. CD-10 was applied according to standard protocol. The intensity of the CD-10 expression is assessed and categorized into three groups. CD-10 expression less than 10% in the tumour cell was taken as negative (-), 10 to 50% staining was taken as positive (+) and greater than 50% staining in tumour cells was taken as strong positive (++).
Results: Out of the total 76 cases included in the study, 9 (24%) were strongly positive (++) whereas 20 (52.6%) were positive (+) and 9 (23.7%) were negative (-) for CD-10 expression. Out of the total 38 cases of SCC 4 (11%) cases showed positive CD-10 expression and 34 (89%) showed negative (-) results. A significant association (p-value <0.001) was seen when CD-10 expression in BCC was compared with SCC.
Conclusion: CD-10 expression was higher in basal cell carcinoma when compared to squamous cell carcinoma in which CD-10 expression was very low/absent, hence CD-10 can serve as a useful adjunct marker in differentiating between basal cell carcinoma and squamous cell carcinoma in problematic cases.
IMPACT OF CANCER ON QUALITY OF LIFE & DEPRESSION AMONG CAREGIVERS
Authors: Khan Mahwash Zulfiqar , Qamar Nusrat , Ahmad Shahbaz , Siddique AbuBakar 
Published: January 2022

Objective: To determine the impact of cancer on quality of life and depression among caregivers.
Study Design: Cross-sectional survey.
Place and Duration of Study: Anmol Hospital, Lahore, from Jul 2019 to Jan 2020.
Methodology: Data collected from caregivers of female cancer patients by purposive sampling technique using Standardized Questionnaire of Caregiver Assistance Scale and emotional distress was assessed by the Profile of Mood States. Data were entered into Statistical Package for Social Sciences for statistical analysis.
Results: Among 110 participants (caregivers of female cancer patients) 28 (25.5%) were female while 82 (74.5%) were male caregivers. Patients other than breast cancer were 79 (71.8%), while breast cancer patients were 31 (28.2%). There was a significant association between caregiver health, quality of life and level of depression, one year ago, and at current with p-values= 0.001, 0.001 and 0.01 respectively.
Conclusion: There was a negative impact on the health and quality of life of caregivers. Their health was better in the beginning but with time, their lives became more difficult.
EARLY OUTCOMES OF FLEXIBLE INTRAMEDULLARY NAILING IN PEDIATRIC SHAFT OF FEMUR FRACTURES
Authors: Hashmi Muhammad Umair , Ahsan Muhammad Nadeem , Chughtai Babar Bakht , Majeed Saqib 
Published: January 2022

Objective: To study the early outcomes and complications of fixation of pediatric shaft of femur fractures using flexible intramedullary nail.
Study Design: Prospective observational study.
Place and Duration of Study: Orthopedic Department, Bahawal Victoria Hospital Bahawalpur, from Jan to Jun 2021.
Methodology: Children between the ages of 5-11 years with shaft of femur fractures were included in the study. Fixation of fracture was done using elastic intramedullary nail. Final outcomes of fixation were observed using Flynn and Schwend Scoring System. Six-month follow-up was done in all cases. Data was analyzed using SPSS-20.
Results: Total 70 cases having shaft of femur fracture were included in the study. Age range of cases was 5-11 years with mean age of 7.75 ± 1.66 years and mean weight of 24.44 ± 4.77 kilograms. Mean diameter of femur medullary canal was 7.48 ± 0.63 millimeters and mean diameter of flexible nail was 3.03 ± 0.26 millimeters. Mean post-operative period of radiological union of fracture was 8.57 ± 1.05 weeks. Per-operatively, fracture site was approached in 4 (5.7%) cases. Migration of nail was not seen in any case. Final outcomes according to Flynn and Shwend Score were excellent in 62 (88.5%), satisfactory in 7 (10%) and poor in 1 (1.4%) case.
Conclusion: Fixation of shaft of femur fracture using flexible intramedullary nailing technique is safe and reliable with good outcomes among children between 5-11 years of age.
PATIENT AND OBSERVER SCAR ASSESSMENT FOLLOWING BASAL CELL CARCINOMA SURGERY: MULTICENTER QUASI EXPERIMENTAL STUDY
Authors: Tahir Moizza , Ali Ghazanfar , Ahmad Najia , Khan Jauhar Mumtaz , Sadiq Sakina , Tahir Muhammad Ali 
Published: January 2022

Objective: To assess patient and observer reported scar quality after Basal cell carcinoma surgery of face using the Patient and Observer Scar Assessment Scale (POSAS).
Study Design: Quasi experimental study.
Place and Duration of Study: Dermatology Department, Tertiary Care Hospitals at Multan and Karachi and Plastic Surgery Department, Tertiary Care Hospital Multan, from Apr to Sep 2020.
Methodology: Patients with basal cell carcinoma that full filled inclusion and exclusion criteria were enrolled by consecutive sampling technique at Dermatology and Plastic Surgery Department after informed consent. Surgical excision was followed by reconstruction of defect either by direct closure or by rotation or advancement flap. Surgical scar was assessed independently at 8 weeks by POSAS. Data was analyzed with SPSS-23.
Results: A total of 27 patients were enrolled in study. There were 11 (37.9%) males and 16 (59.25%) females between ages of 45-70 years. Basal cell carcinoma was located on cheek in 15 (55.5%), nose in 9 (33.3%), temple 2 (7.4%) and forehead 1 (3.7%) cases. Direct closure was performed in 6 (22.2%), rotation flaps in 10 (40.7%), and advancement flaps in 11 (40.7%) cases. Mean score of observer opinion about surgical scar between different surgical techniques was not statistically significant (p=0.191). How-ever, mean score of patient opinion of scar between different surgical techniques was statistically significant (p=0.032).
Conclusion: POSAS is a valid tool for scar evaluation by patient and observer-reported scar qualities after Basal cell carcinoma surgery.
MYRINGOTOMY FOR THE TREATMENT OF OTITIS MEDIA WITH EFFUSION; A COMPARISON IN THE OUTCOME WITH AND WITHOUT GROMMET INSERTION
Authors: Akhtar Sunarays , Gul Uzma , Jawaid Arfat , Azam Khalid , Niazi Muhammad Sohail Babur , Najam Atif 
Published: January 2022

Objective: To compare the outcome of myringotomy with and without grommet insertion in the patients of otitis media with effusion in terms of improvement of hearing in a one-month follow-up.
Study Design: Quasi experimental study.
Place and Duration of Study: Pakistan Airforce Hospital Jacobabad and Combined Military Hospital Lahore Pakistan, from Jan to Dec 2020.
Methodology: A total of 28 patients aged 4-12 years diagnosed to have conductive hearing loss due to otitis media with effusion not responding to medical treatment were included. Non probability convenience sampling was done. Children aged less than 4 years and above 12 years were not included in the study. They were randomly divided into two groups of 14 patients each using lottery method. Group A underwent myringotomy alone whereas group B underwent myringotomy with grommet insertion. Patients in both groups also underwent adenoidectomy on case-to-case basis. Both groups were compared in terms of improvement in hearing post operatively in a one-month follow-up.
Results: There was statistically significant reduction in air bone gap at the end of follow up period as compared to preoperative air bone gap in group B (p=0.007). In group A there was statistically significant reduction in air bone gap at one week (p=0.002) however this improvement was not maintained at 4 weeks (p=0.386).
Conclusion: Myringotomy with grommet insertion had significantly more patients with improved hearing as compared to myringotomy alone after one month.
EFFICACY OF ANTIOXIDANT WITH ALOE VERA GEL VERSUS INTRA-LESIONAL STEROIDS IN THE MANAGEMENT OF ORAL SUBMUCOUS FIBROSIS - A PROSPECTIVE COMPARATIVE STUDY
Authors: Tahir Muhammad , Abbas Asim , Nawaz Faiz Ul Hassan , Raza Mohsin , Rafique Atif , Niazi Muhammad Sohail Babar 
Published: January 2022

Objective: To compared efficacy of alpha lipoic acid (antioxidant medication) and aloe vera gel together versus intralesional steroids (hydrocortisone) in management of oral submucous fibrosis by evaluating post treatment clinical features of mouth opening and burning sensation.
Study Design: A prospective comparative study.
Place and Duration of Study: Department of ENT, Combined Military Hospital, Malir Karachi, from Jul 2018 to Mar 2020.
Methodology: Twenty-eight patients were involved in the research and were distributed into two groups, I and II. Alpha lipoid acid with aloe vera gel was given in group I and hydrocortisone was given in group II. Burning sensation and mouth opening were recorded both at start and at monthly interval later on for three consecutive months. The data collected were statistically analyzed by using SPSS-22.
Results: A significant lessening in burning sensation (p<0.001) and improvement in mouth opening were noticed in both groups. However, comparison between alpha lipoic acid with aloe vera gel group versus hydrocortisone group showed almost similar results.
Conclusion: Alpha lipoic acid and aloe vera gel can significantly improve oral submucous fibrosis clinically. So, these can be utilized as an alternative option in cases where intralesional steroid is poorly tolerated or is contraindicated.
The observee’s paradox
Authors: Rutten Gijsbert , Krogull Andreas 
Published: January 2022

Ego-documents are at the heart of historical sociolinguistics. Contrary to what a label such as ego-document may suggest, Early and Late Modern ego-documents constitute a heterogenous group of genres comprising, among others, private letters, diaries and travel journals. Empirical studies have shown that there are important linguistic differences between private letters on the one hand, and diaries/journals on the other. The latter often seem surprisingly standard-like or formal. Theoretical models of register variation and conceptual orality can partially explain the differences, without however offering a full explanation of the surprising formality of diaries/journals. We argue that it is crucial to take into account recent work by social historians concerning diaries/journals in the eighteenth and nineteenth centuries. Diary-writing was an inherently reflexive practice allowing authors to reflect on their lives, and to create a textually fixed point of reference. Authors of diaries had a variable and multilayered audience in mind of known and unknown readers. We introduce the observee’s paradox: while creating private texts for themselves in which they were their own observers and observees, authors of diaries also reckoned with unknown readers in a possibly distant future, which prompted them to shift into a more formal or standard-like register.