bluuebunny/crossref_metadata_2025_split huggingface dataset:
Focal Resection of Lower Uterine Segment for Morbidly Adherent Placenta. An Alternative to Obstetric Hysterectomy-(Better Modality with Better Outcome)
Authors: Yazdani Tehreem , Zaheer Fareeha , Amin Nabila , Mukhtar Saad 
Published: December 2022

Objectives: To focus on the benefits of focal resection of the lower uterine segment as compared to obstetric hysterectomy in patients with morbidly adherent placenta.Study Design: Quasi-experimental study.Place and Duration of Study: Combined Military Hospital Okara, Oct 2019 to Nov 2020.Methodology: Fifty-two women between 34 to 38 weeks of gestation were operated for morbidly adherent placenta. Group-I women (focal resection of the lower uterine segment) and Group-II (obstetric hysterectomy) were twenty-six each. In Group-I, hemostasis was secured by a figure of 8 sutures, purse-string sutures or continuous sutures. In Group-II, hemostasis was secured, and internal iliac artery ligation was done as required.
Results: Group-I undergoing focal resection of lower uterine segment hemostasis was addressed by the figure of 8 sutures in 21 (80%) women and purse-string sutures in 7 women (27%). Hemostasis of the posterior uterine wall was done in 12 (47%) women. Balloon tamponade was used in 10 (40%) women and B-Lynch suture in 5 (20%) women. Internal iliac artery ligation was done in 4 (11%) women, and the bladder was injured in 10 (40%) women. Group-II undergoing obstetric hysterectomy hemostasis was secured for leftover placental tissue in 5 (18%) women, and internal iliac artery ligation was done in 9 (35%) women. Bladder repair was done in 12 (47%) cases. Conclusion: Although time-consuming, focal resection of the lower uterine segment and hemostasis are associated with less morbidity.
Parental and Children Anxiety in Paediatric Dental Procedures Under General Anaesthesia
Authors: Feroze Rehana , Hussain Aftab , Tariq Muhammad , Toor Abdul Wasay 
Published: December 2022

Objective: To determine factors responsible for anxiety in children and parents undergoing dental procedures under general anaesthesia.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Anaesthesia, CMH Lahore Medical College, from Sep 2019 to Feb 2020.
Methodology: Ninety-one children aged between 3 to 10 years were included in this study. Parental anxiety was assessed using a visual analogue scale-anxiety before induction of anaesthesia, and child's anxiety was assessed using the modified facial affective scale (3-face) at the time of induction of anaesthesia.
Results: Gender, school-going status and previous exposure to GA were not significant factors in predicting pre-operative anxiety in children with p-values of 0.399, 0.183 and 0.122, respectively. On the other hand, parental anxiety had a very strong impact on children pre-operative anxiety (p-value ˂ 0.001), suggesting that children of anxious parents had high pre-operative anxiety. Moreover, the personality of child also had statistical significance (p-value ˂ 0.001).
Conclusion: Non-social behavior of the child and the anxiety level of parents are major determinants of pre-operative anxiety in children undergoing dental procedures.
Association of Socio-Demographic Factors with Vaccination Status of Children at Gilgit Baltistan
Authors: Khattak Saeed Zaman , Nawaz Sadaf , Ahmed Naheem , Khalid Muhammad , Baloch Hamza , Zubair Usama Bin 
Published: December 2022

Objective: To assess the vaccination status of children at Gilgit Baltistan and the association of various socio-demographic factors with none or partial vaccination among these children.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Pediatrics Combined Military Hospital Gilgit, from Oct 2020 to Mar 2021.
Methodology: Children aged 15 months to 10 years presenting with any condition in the Pediatrics OPD were included in the study. Vaccination status regarding basic vaccines, included in the EPI of study participants was confirmed by vaccination card. Education of father, education of mother, type of family (joint or nuclear) and place of living (rural or urban) was correlated with vaccination status of children included in the study.
Results: Out of 600 children presenting at the Pediatrics OPD, 390 (65%) patients were males, and 210 (35%) patients were females The mean age of the patients was 5.554 ± 3.85 years. 242 (40.3%) patients were vaccinated, 190 (31.7%) were partially vaccinated, while 168 (28%) patients were not vaccinated for basic vaccines included in the EPI. After applying the chi-square test, low education of father and mother, living in joint family and rural living were significantly related to non-vaccination or partial vaccination of children (p-value<0.05).
Conclusion: A large group of children from Gilgit-Baltistan remained non-vaccinated or partially vaccinated even for the basic vaccines included in the EPI program. Children born in joint families, rural areas and parents with a low level of education had more chances of skipping the vaccines.
Fibroscan Compared to Aspartate Aminotransferase to Platelet Ratio Index (APRI) and Aspartate Aminotransferase to Alanine Aminotransferase Ratio (AST to ALT) in the Assessment of Liver Fibrosis in Patients with Non Alcoholic Fatty Liver Disease in a Terti
Authors: Ikram Hasan , Jaffar Syed Raza , Hayat Asma , Khattak Mehnaz , Majeed Nauman , Naeem Afnan 
Published: December 2022

Objectives: To compare the extent of liver fibrosis using fibroscan and subsequently compare it with AST/ALT ratio and AST to platelet ratio index (APRI).
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Chemical Pathology Department, Military Hospital Rawalpindi in collaboration with Armed forces institute of Radiology & Imaging and Gastroenterology Department, Military Hospital Rawalpindi from Jan to Apr 2021.
Methodology: A total of 50 patients in group-1 and 24 healthy subject participants in group-2 as controls were studied. Serum AST, ALT, platelet count, APRI and AST to ALT ratio were assessed along with fibroscan results to determine stages of liver fibrosis and results were compared for the association.
Results: There were 49 (66%) males and 25 (34%) females included in the study with the mean age of 49.77 ± 8.3 years. 11 (14.9%) patients had advanced fibrosis. There was a significant negative relationship (p-value <0.001 and r = -0.637) between platelet count and increasing fibroscan score (F1, F2) and a significant positive correlation between fibroscan score and AST (pvalue <0.001 and r=0.623), ALT (p-value <0.001 and r=0.596), fibroscan result and APRI (p-value < 0.001 and r=0.771) and fibroscan scores and AST/ALT ratio (p-value= 0.037 and r=0.243). One third of the study subjects had fibrosis in early and relatively advanced stages (F1, F2 respectively) correlating with serum and blood markers.
Conclusion: Early fibro scan testing and serum markers can help in early diagnosis and timely initiation of treatment.
Analysis of Various Factors Associated with Maternal Near Miss in Karachi Sindh
Authors: Subuktageen Bushra , Raja Ayisha , Subuktageen Rabia , Andleeb Munnaza , Imtiaz Umber , Ghaffar Sadia 
Published: December 2022

Objective: To determine the factors associated with maternal near-miss in booked patients managed at tertiary care hospital.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Malir Cantt from Jun 2019 to Jul 2021.
Methodology: A total of 198 pregnant women of were included in the study. All the women were followed until delivery, and data was collected for near maternal miss and types of complications. Relationship of the age of study participants, gestation, parity and presence of comorbid medical illnesses were analysed with maternal near-miss in our study participants.
Results: Out of 198 pregnant women included in the study, 168 (84.8%) did not have near-miss, while 30 (15.2%) had experienced at least one near-miss. The mean age of the women included in our study was 29.236 ± 2.45 years. Cardiovascular complications 14 (7.1%) were the most common in our study participants, followed by renal complications 8 (4.1%). The second and third trimesters and the presence of medical comorbidities were statistically significantly associated with nearmiss (p-value <0.05).
Conclusion: Near miss was a fairly common finding in booked pregnancies managed at our hospital. Women in the second or third trimester of pregnancy and those with any medical conditions had more chances of having near-miss than those in the first trimester or without any medical comorbidities.
Home Quarantine Among COVID Positive Health Professionals: A Cross-Sectional Study From Hyderabad Pakistan
Authors: Parveen Naheed , Abbasi Madiha , Siddiqui Erum , Awan Shazia , Akhtar Muhammad Naveed , Sikandar Raheel 
Published: December 2022

Objective: To determine the preference for home quarantine and its reasons among health professionals during the COVID-19 pandemic.
Study Design: Cross-sectional study.
Place and Duration: Department of Obstetrics/Gynecology, Liaquat University of Medical and Health Sciences Jamshoro, and other affiliated hospitals with LUMHS, from Apr to Sep 2021.
Methodology: Eighty home-quarantined health professionals (HPs) at our institute following the exposure to confirm COVID-19 cases were included. A pre-designed questionnaire was used to analyze its reliability using Cronbach's alpha value in SPSS after completing the home quarantine period and analyzed.
Results: We enrolled 80 health professionals. 43 (53.8%) were PG Trainees, followed by consultant (20%), doctors (20.0%), nurses (6.2%), and technicians (6.9%). The mean quarantined period was 15.72 ± 6.15 days (7-20 days). Doctors, PG trainees, and nurses perceived a greater level of irritability than the other health professionals. We found an association between irritability and advanced age, confinement, and being single. Generally, PG Trainee revealed higher physical activity (p= <0.001). Physical activity was significantly lower among respondents who were unmarried (p= 0.004).
Conclusion: Increased satisfaction and a more homelike environment, less aggravation of symptoms, and a mild level of depression and anxiety among health care professionals were associated with home quarantine measures during the COVID19 pandemic.
Burden of Pulmonary Tuberculosis and Its Radiological Pattern, in Asymptomatic Young Males in Karachi, Pakistan
Authors: Zaidi Huma , Shah Haider Hussain , Nasrullah Farhan , Ihsan Hussain Rashid , Khan Muhammad Usman 
Published: December 2022

Objective: To estimate the burden of pulmonary tuberculosis among asymptomatic young male applicants in a government organization in Pakistan and to find out the pattern of disease on chest x-ray and high-resolution CT chest.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Pakistan Air Force (PAF) Faisal Base Hospital Karachi, Pakistan, from Dec 2017 to Feb 2019.
Methodology: An active search for detecting pulmonary tuberculosis was conducted in 1819 asymptomatic young male adults between 18 and 30 years who had applied for employment in a government organization with a pay scale ranging from 2 to 14 grade. Screening chest x-ray (CXR) was done as a part of their medical examination. High-resolution CT chest, sputum smear bacilloscopic and GeneXpert mycobacterium tuberculosis/resistance to Rifampicin assay tests were done in cases in which chest x-ray was suggestive of pulmonary tuberculosis.
Results: Chest x-Ray and high-resolution CT of five out of 1819 male applicants were suggestive of pulmonary tuberculosis. Three cases (0.16%) were confirmed as positive on lab tests. Radiographic and High-resolution CT patterns showed upper lobe lesions, consistent with the radiological appearance of the immuno-competent host disease.
Conclusion: The considerable presence of pulmonary tuberculosis was detected among asymptomatic young adults of this region; therefore, formulating a strategy to actively detect and treat analogous populations with high susceptibility to Pulmonary tuberculosis could help reduce this endemic disease.
A Study of Frequency of Low Backache in Pregnant Women
Authors: Shah Syed Fahd , Mumtaz Syed Naveed , Kayani Bushra Afzal , Shah Syed Hussain , Khan M. Wasi Ullah , Khan Abdul Qadir 
Published: December 2022

Objective: To find the frequency of backache in our pregnant women and factors increasing the risk of low backache in pregnancy.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Department of Gynecology & Obstetrics, Avicenna Medical College, Lahore Pakistan, from Jan 2018 to Dec 2019.
Methodology: We included 247 consecutive women between 18 and 45 years of age and between 16 and 35 weeks of a single pregnancy. These were evaluated for low backache. Women with comorbid conditions and multiple fetuses who needed elective caesarian sections were excluded.
Results: Mean age of the pregnant women in our study was 27 ± 3.7 years, with an age range of 18 to 45 years. 197 (80.1%) complained about low back pain during their pregnancy, and 75 (30.3%) had a previous history of back pain when not pregnant. Back pain was present in 47 (19.02%) 6 months postpartum. The risk factors present were higher weight gain in 75 (30 %), age >35 years in 62 (25 %), low haemoglobin 38 (15%) and poor socio-economic condition 25 (10.1%).
Conclusion: Low back pain is common in pregnancy and is a less addressed issue of pregnant women. Many factors responsible for low backache in pregnant women were identified. Analgesics and increased physical activity are the main treatment and prevention options.
Effects of Low and Standard Intra-Abdominal Pressure on Postoperative Pain in Laparoscopic Cholecystectomy
Authors: Ali Afaque , Hussain Zaki , Jamal Ayesha , Rahat Fatima , Makshoof Talha , Islam Saqib 
Published: December 2022

Objective: To analyze the effects of low and standard intra-abdominal pressure on post-operative pain in laparoscopic cholecystectomy.
Study Design: Comparative prospective study.
Place and Duration of the Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Nov 2019 to Feb 2020.
Methodology: The study comprised 53 patients who underwent Laparoscopic Cholecystectomy and were selected for the study. They were randomly divided into two groups by third-party randomization. The first group was operated on under low pneumatic pressure, i.e. 8-12 mmHg and the second group was operated on under high pneumatic pressure, i.e. (≥15 mmHg). The complaint of post-operative pain was evaluated using a visual analogue scale (VAS) in the next 12 hours.
Results: The group that was operated under high pneumatic pressure showed a higher occurrence of post-operative pain (50.9%) than the group that operated under low pneumatic pressure. On the Visual Analogue Scale, 80.0% of patients with high pneumatic pressure showed a pain of score four or more which is very high compared to the other group (p <0.05).
Conclusion: The patients operated for laparoscopic cholecystectomy under low-pressure pneumoperitoneum would suffer from less post-operative abdominal pain, which needs less analgesia and leads to early hospital discharge.
Frequency of Lymphedema after Complete Axillary Lymph Node Dissection in Patients with Breast Cancer
Authors: Bukhari Neelma , Haider Ghulam , Nouman Maryum , Khan Salahuddin , Yousaf Aveen , Abid Zain 
Published: December 2022

Objective: To assess the frequency of lymphedema of the arm and forearm after complete axillary lymph node dissection in patients with breast cancer at one year of follow-up and see its association with body mass index among breast cancer patients presenting at a tertiary care hospital in Karachi.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from Apr 2019 to 2020.
Methodology: One sixty-eight females of age 25-80 years who underwent complete axillary lymph node dissection for breast cancer were included in the study. A breast surgeon performed the axillary lymph node dissection with more than five years of experience. The patients were followed for one year post-operatively to determine the occurrence of lymphedema. All the demographic details and clinic-pathological findings were reported in the predesigned proforma.
Results: About 168 females (97.6%) out of 172 have undergone complete axillary lymph node dissection. Lymphedema was the most common complication among them (38.1%). Common side effect observed after axillary lymph node dissection was pain (66.1%), followed by heaviness (59.5%), firmness/tightness (46.4%) and numbness. The patients with Body mass index ≥ 25 kg/m2, right arm involved, exposure to radiotherapy and moderately differentiated tumour (grade-2) had a significantly higher occurrence of lymphedema (p<0.05).
Conclusion: Lymphedema is higher among breast cancer survivors during the first postoperative year. The risk of lymphedema can be reduced by avoiding potential factors like obesity and carefully selecting patients for postoperative radiotherapy.
Comparison of Light Emitting Diode (LED) Fluorescent Microscopy with Ziehl-Neelsen Microscopy on Sputum Specimens for Diagnosis of Pulmonary Tuberculosis Keeping Culture as ‘Gold Standard’
Authors: Zahra Fatima Tuz , Saleem Muhammad Zeeshan , Mirza Irfan Ali , Sana Fatima , Hussain Ashfaq , Zaman Syed Qamar 
Published: December 2022

Objective: To compare LED fluorescence microscopy and Ziehl-Neelsen staining in terms of their diagnostic performance in diagnosing pulmonary tuberculosis, taking sputum specimens from patients suspected of pulmonary tuberculosis.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology Rawalpindi, from Jan 2019 to Dec 2019.
Methodology: Sputum samples from patients with clinical suspicion of pulmonary tuberculosis were stained using Ziehl-Neelsen (ZN) stain, fluorescent stain with Auramine O staining (AO) stain and Mycobacterial culture on Mycobacterial Growth Indicator Tube (MGIT 960), to detect Mycobacterium tuberculosis. WHO guidelines were followed to grade positive smears.
Results: Among 206 patients with suspicion of tuberculosis, 143 (69%) were male, and 63 (30%) were female patients. The mean age of the patients was 53.67 ± 14.73 years. Out of 206 sputum samples, 64 were negative by all three techniques used. 142 (68%) specimens detected Mycobacterium tuber-culosison MGIT960. Within 142 culture-positive samples, only 40 samples were positive on Ziehl-Neelsen microscopy, whereas 97 samples were detected positive by LED fluorescent microscopy. In culture-negative samples, three were missed on Ziehl-Neelsen staining, which was positive with Fluorescent microscopy. Sensitivity and specificity for Ziehl-Neelsen smear microscopy were 26.7% and 96.8%, respectively. Sensitivity and specificity for Fluorescent smear microscopy were 64.8% and 92.2%, respectively.
Conclusion: We concluded that the efficacy of LED fluorescence microscopy has proven to have many potential advantages over conventional Ziehl-Neelsen microscopy.
Comparison of Pethidine and Ketamine for the Treatment of Postoperative Shivering
Authors: Farooq Muhammad Umar , Younis Fazeela , Atif Muhammad , Khan Rao Ali Shan , Khalique Abdul , Adnan Ahmed 
Published: December 2022

Objective: To compare the effectiveness of Ketamine vs Pethidine for treating postoperative shivering in patients undergoing surgery under general anaesthesia.
Study Design: Quasi-experimental study.
Place and Duration of Study: Operation Theatre, Combined Military Hospital Sialkot Pakistan, from Jan to Apr 2020.
Methodology: Following strict inclusion and exclusion criteria, patients who experienced postoperative shivering in the postanesthesia care unit (recovery) were enrolled through consecutive sampling and randomized into group-A or group B using the lottery method. Group-A received Pethidine 0.5 mg/kg and Group-B received Ketamine 0.2 mg/kg. The shivering grade was evaluated at 0 minutes and 5 minutes after administration of drugs by using a validated four-point scale.
Results: Mean age of the patients was 34.12 ± 9.88 years and 34.83 ± 9.77 years in group-A and group B, respectively. At 5 min, the recovery rate of shivering was significantly higher in the Pethidine group than in the Ketamine group. In group-A, effecttiveness (grade 0) was noticed in 124 patients (86.2%) and in group-B effectiveness (grade-0) was seen in 74 patients (51.4%). A statistically significant difference (p<0.01) was found between the two groups.
Conclusion: Pethidine 0.5 mg/kg is a more effective drug for treating postoperative shivering.
Knowledge, Attitude and Practice of Health Care Professionals Towards Universally Applied Behavior Modification Techniques for Management of Pediatric Patients
Authors: Wahid Maham , Yousuf Ajmal , Ali Shah Pir Jaawad , Shah Dr Jawad Ali , Bhangar Faisal , Shah Muzammil 
Published: December 2022

Objective: To evaluate health care professionals' knowledge, preference and experience about various universally applied behaviour modification techniques for managing anxiety in pediatric patients.
Study Design: Cross-sectional survey.
Place and Duration of study: Operative Department Armed Forces Institute of Dentistry Rawalpindi in Apr 2020.
Methodology: An online questionnaire was circulated among 100 Health Care Professionals of Rawalpindi, including general practitioners, consultants and post-graduate residents of different fields of medicine and dentistry involved in the clinical care of pediatric patients, which included socio-demographic details, closed-ended questions about their knowledge about different universally applied behaviour modification techniques for management of anxiety, their preference in usage and factors affecting selection particular behaviour modification techniques for management of anxiety.
Results: 66 (84.61%) of the healthcare professionals were aware of the different universally accepted behaviour modification techniques; 12 (15.38%) were unaware of such techniques. 33 (42%) of the practitioners admitted that pediatric patients showed non-compliance to simple non-invasive procedures while 45 (58%) to invasive procedures. 49 (62.3%) of respondents used universally accepted behaviour modification techniques. 74 (94.87%) of the respondents opted Tell-Show-Do, while the majority opted combination of different behaviour modification techniques as the preferred method of universally accepted non-pharmacological behavior modification technique.
Conclusion: The majority of the health care professionals preferred Tell-Show-Do and positive reinforcement techniques along with the combination of various non-pharmacological techniques as the most commonly adopted techniques for management of anxiety in pediatric patients.