bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency of Sapheno-Femoral Junction and Sapheno-Popliteal Junction Incompetence on Duplex Ultrasonography in Patients with Varicose Veins
Authors: Rauf Muhammad Haris , Slehria Atiq-Ur-Rehman , Qasmi Imran Masoud , Saleem Sultan , Sohail Marium 
Published: December 2022

Objective: To determine frequency of sapheno-femoral junction (SFJ) and sapheno-popliteal junction (SPJ) incompetence on duplex ultrasonography in patients with varicose veins.Study Design: Cross-sectional study.Place and Duration of Study: Shaikh Khalifa Bin Zayed Al-Nahyan/Combined Military Hospital, Rawalakot, Azad Jammu & Kashmir, from Aug 2019 to Feb 2020.Methodology: A total of 70 patients were selected using non-probability, consecutive sampling. After ethical approval, informed consent and relevant history taking, duplex ultrasonography (DUS) was done in standing and supine positions in patients with varicose veins, fulfilling inclusion and exclusion criteria. Presence or absence of SFJ and SPJ incompetence was assessed.Results: Mean age was 41.99 ± 11.08 years with 36 (51.43%) patients between 36-50 years. Mean duration of disease was 6.33 ± 2.29 months while 47 (67.14%) patients had symptoms for more than 6 months at the time of presentation. Occupation wise, 40 (57.14%) patients were field workers while 30 (42.86%) were office and domestic workers. Isolated SFJ, SPJ and combined junction incompetence were found in 27 (38.57%), 20 (28.57%) and 23 (32.86%) patients respectively. Both SFJ and SPJ incompetence were more in obese patients (78.6% and 71.4% respectively) as compared to non-obese patients.
Conclusion: Frequency of SFJ incompetence was more than SPJ incompetence on DUS. Obesity, male gender and prolonged motionless standing predispose to the development of varicose veins. Preventive measures and early diagnosis can decrease disease burden.
Evaluation of Non-Pharmacological Remedies Adopted By The Patients with Diabetes Mellitus Type 2
Authors: Hasan Insia , Batool Syeda Ramsha , Dars Jawed Akbar , Batool Rabisa , Ahmad Syed Masroor , Afridi Muhammad Iqbal 
Published: December 2022

Objectives: To determine the different types of non-pharmacological remedies adopted by the patients with type 2 diabetes.
Study Design: Cross-sectional study.
Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi from Oct 2018 to Nov 2019.
Methodology: A total of 280 type 2 diabetes patients were enrolled in the study. All patients with multiple comorbidities and type 1 diabetes were excluded from the study. A pre-designed questionnaire was used to collect data using face to face interviews. The questionnaire was related to the biodata of the patients and the use of non-pharmacological measures to control the diabetes. Data was analyzed by using SPSS version 24.
Results: The mean age of the patients was 54.7 ± 9.77 years. About 256 (91.4%) stated that they used non-pharmacological measures along with their medications to control diabetes. Most of the patients 248 (96.8%), were only on dietary modifications; regular exercise 82 (32%) and various types of medicinal herbs/spices were used by 65 (25.3%) patients. Regular walking was the most common exercise chosen by patients and most of them preferred to walk 30 minutes daily. Out of 241 (97%) patients altered their diet to low carbohydrates and rice consumption, increased use of fruits and vegetables 29 (11.6%) and cereals by 24 (9.6%) patients.
Conclusion: The study concluded that patients were highly inclined towards the use of non-pharmacological measures to control their illness.
Physiotherapists’ Attitude Towards Professionalism
Authors: Mansoor Syeda Rafia , Akram Samrood , Naaz Anam , Ashraf Hafiza Sana , Sohail Maria 
Published: December 2022

Objective: To find out the attitude of physiotherapists towards their profession and to assess the quality of professionalism in physiotherapists.
Study Design: Cross-sectional study.
Place and Duration of Study: Private and government physiotherapy setups in Lahore, Pakistan, from Oct 2019 to Dec 2019.
Methodology: 312 physical therapists were recruited in the study. A modified standard questionnaire by the American Physical Therapy Association (APTA) was used for the data collection. Data were analyzed by using SPSS 22.0.
Results: In the current study, 312 participants were included, out of which 54.2% were male physical therapists and 45.8% were female physical therapists. Their mean age was 26.27 ± 2.15 years. The average professionalism score was 270.56 ± 22.27. Quality of professionalism, measured in physical therapists was 5 (1.60%), 14 (4.5%), 106 (34%), 148 (47.44%), and 39 (12.50%) as poor, fair, good, and excellent professionalism, respectively.
Conclusion: The majority of physical therapists showed a borderline positive attitude and very few had a negative attitude towards professionalism. Moreover, good quality of professionalism was observed prominently in most of the physiotherapists, whereas, minority of them portrayed bad and poor professionalism.
Burden of Rota Virus Gastroenteritis in Children Under 5 Years of Age
Authors: Noor Misbah , Ghani Eijaz , Niazi Saifullah Khan , Junaid Muhammad , Khalid Saadiya , Shakoor Noman 
Published: December 2022

Objective: To detect the burden of Rotavirus gastroenteritis in hospitalized and non-hospitalized children under 5 years of age.
Study Design: Retrospective observational study.
Place and Duration of Study: Department of Virology, Armed Forces Institute of Pathology, from Jan 2015 to Dec 2019.
Methodology: A total of 527 stool samples were analyzed using rapid immunochromatoghraphic testing kit for Rotavirus. Samples were received from both outdoor and indoor children under 5 years of age presenting with diarrheal illness.
Results: 197 (37.4%) patients were positive for rotavirus antigen in stool while 330 (62.6%) were negative. Mean age of participants was 13.4 months ± 16.6 (range: 1-60 months). Out of 197 (37.4%) stool samples which were positive for rotavirus antigen, 66 (33.5%) were female children and 131 (66.5%) were male children. Maximum positive rotavirus stool antigen was observed in 0-2 years age-group i.e., 173 (33%) while 24 (4.4%) were positive in 3-5 years age-group, 110 (20.9%) rotavirus positive samples were from Inpatient Department while 87 (16.5%) were received from Outpatient Department.
Conclusion: Rotavirus is a frequent cause of viral gastroenteritis in both hospitalized and non-hospitalized children. Maximum positivity is seen in children under 2 years of age.
Effect of Prone Positioning As Modality for Improvement in Bedside Oxygen Saturation in Awake Non-Intubated COVID-19 Patients and Its Relationship With High Resolution CT Chest Severity Score
Authors: Qayyum Uzma , Akhtar Naghmana , Nisar Shazia , Qayyum Ayesha , Hussain Amina , Kashif Amer Sohail 
Published: December 2022

Objective: To evaluate the effectiveness of awake proning on bedside oxygen saturation in non-intubated severe COVID-19 cases and its association with high-resolution CT chest severity score.
Study Design: Prospective observational study.
Place and Duration of Study: Pak Emirates Military Hospital Pakistan, from Jun to Jul 2020.
Methodology: This study was conducted on 150 laboratories confirmed SARS-CoV-2 infected cases with moderate to severe category pneumonia, requiring supplemental oxygen but not mechanical ventilation, admitted in the High Dependency Unit of the Military Hospital. Bedside oxygen saturation was recorded via pulse oximeter before and after proning of 10 minutes to evaluate whether oxygen saturation increased, decreased or remained the same post proning.
Results: Out of 150 patients, it was observed that 67 (45%) patients showed 2% increase of oxygen saturation over 10 minutes of proning, 48 (32%) patients showed an increase of 1% while 20 (13%) patients showed an increase of 3%. It was also observed that 13 (14.7%) patients out of 88 patients, with HRCT severity score of >50% showed an increase of 3% compared to 7 (11%) patients out of 62 patients with HRCT severity score of <50%.
Conclusion: At least 60% of the patients showed an improvement of 2% or more after 10 minutes of proning, which concluded that awake proning in non-intubated patients may help improve oxygen saturation.
Primary and Secondary Enuresis in Children Presenting At Pediatric Outpatient Department of Combined Military Hospital Malir Cantt Karachi
Authors: Zahid Meha , Ali Arshad , Zaidi Syed Taqi Hasan , Saba Ameena , Shujaat Wasif , Samina Mubushra 
Published: December 2022

Objective: To determine the frequency of primary and secondary enuresis in the children presenting at outpatient department of Tertiary Care Hospital.
Study Design: A cross sectional study.
Place and Duration of Study: Outpatient Department of Combined Military Hospital Malir, Karachi, from Feb to July 2019.
Methodology: A total of 1200 children with age range of 5-12 years were included in the study. Children presenting with severe acute illness or those with non-willing caregivers were excluded from the study.
Result: Out of the total 1200 study participants, 167 (13.9%) children gave the history of enuresis. There were 109 (65.6%) boys and 58 (34.4%) girls. The children with primary enuresis were 141 (84.3%) while 26 (15.62%) children had secondary enuresis. About 31 (18.7%) children had daytime enuresis, 115 (68.5%) had night-time and 21 (12.5%) children had both day and night time bed wetting. About 57 (34.37%) children previously got the treatment for enuresis which included fluid restriction in 21 (12.5%) and desmopressin in 36 (21.87%). Out of them 52 (91.2%) children showed complete response while 5 (8.77%) showed incomplete response.
Conclusion: Our study found that enuresis is more frequent among boys. Primary enuresis is more common than secondary enuresis and nocturnal enuresis is more common than diurnal enuresis.
An Impact of COVID-19 Pandemic on The Motivation and Psychological Well Being of Dermatology Residents
Authors: Mashhood Asher Ahmed , Shahzadi Shazia 
Published: December 2022

Objective: To analyze the motivation and psychological well-being to perform duties during the COVID-19 pandemic among the dermatology residents.
Study Design: Cross-sectional survey.
Place and Duration of Study: Dermatology Department, Combined Military Hospital, Rawalpindi, from Mar to Sep 2020.
Methodology: A total of 155 dermatology residents were included in the study. Health care provider motivation scale (HCPMS) was used through online Google Doc due to lockdown. Secondary data was also generated from Google scholar, newspapers, journals, reports and the literature review.
Results: We analyzed the impact of COVID-19 on motivation and psychological well-being. The result showed that the COVID-19 pandemic has an adverse effect on motivation due to anxiety (31%), stress (23%) and depression (27%) among dermatology residents. There was statistically significant relationship between decreased motivation and increased stress levels and depression among dermatology residents performing COVID-19 duties (p<0.001).
Conclusion: Due to extra duties in the COVID-19 pandemic, the motivation and psychological well-being were severely affected among dermatology residents.
A Comparative Study of Minimal Invasive and Open Colorectal Surgeries with Regards To PostOperative Hospital Stay and Complications
Authors: Farooq Muhammad Zain , Mahmood Khalid , Zafar Muhammad Arsalan , Chatha Sohail Saqib , Saeed Muhammad Farhan , Qureshi Tansheet Mazhar 
Published: December 2022

Objectives: To compare outcomes of laparoscopic surgery versus open surgery for colorectal carcinoma in terms of hospital stay and post-operative complications.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi, from Mar 2020 to Mar 2021.
Methodology: We studied a total of 114 patients who were diagnosed with colorectal cancer and met the sample selection criteria. Patients with metastatic disease or previous history of abdominal surgery were excluded from the study. Patients were documented for hospital stay and followed for six months for the development of complications. Data was analyzed by SPSS version 26.
Results: We studied a population where 45 (39.5%) were male while 69 (60.5%) were female. The mean age of the sample was 46.96 ± 14.47 years. The study showed that the mean hospital stay was shorter in Group A: 5.40 ± 1.88 days versus 6.59 ± 1.68 days in Group B (p=0.001). Mean blood loss was 65.99 ± 16.41 mL in Group A versus 366.93 ± 95.36 in Group B (p<0.001). The complication rates in Group A and B were 6 (10.5%) and 11 (19.2%), respectively (p=0.18), while the rate of incisional hernia formation was 0 (0%) and 4 (6.9%) (p=0.042).
Conclusion: Laparoscopic surgery is superior to open surgery is the management in terms of shorter in-hospital stay and postoperative complications.
Contraceptive Awareness and Practices in Patients With Rheumatic Diseases Using Disease Modifying Anti-Rheumatic Drugs
Authors: Gul Shahzad , Khan Muhammad Muddasser , Rasheed Uzma , Tahir Saira , Zammurad Shazia 
Published: December 2022

Objective: To determine the contraceptive awareness and practices in patients with rheumatic diseases using disease modifying anti-rheumatic drugs.
Study Design: Cross-sectional study.
Place and Duration of Study: Outpatient of Rheumatology, Department at Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Apr 2021.
Methodology: Patients with any rheumatic disease and taking teratogenic disease modifying anti-rheumatic drugs were included in the study. Patients were asked about if they were counseled regarding the risk of teratogenicity with the antirheumatic drugs and when to stop the drug before pregnancy.
Results: Out of total 150 patients, 87 (58.0%) female patients had Rheumatoid arthritis and 26 (17.3%) had Systemic lupus erythematosus. The majority of female patients (104, 69.3%) were using Methotrexate and 21 (14.0%) females were using Leflunomide. Only 53 (35.3%) females were counseled about drug teratogenicity. Most of the female patients (102, 68.0%) were never counseled about the use of contraception while taking anti-rheumatic drugs. The rate of use of contraceptives was even worse and merely 15 (10.0%) females were using contraceptives.
Conclusion: Majority of the patients with rheumatic diseases being treated with teratogenic disease modifying anti-rheumatic drugs, were not using any form of contraception. The rate of contraceptive use and counseling regarding contraceptives was noted to be very low.
Modified Graham's Patch Repair Versus Graham's Patch Repair for Treatment of Perforated Peptic Ulcer in Terms of Postoperative Morbidity / Mortality
Authors: Khan Fatima Kamran , Shah Mahin , Sheikh Irfan Ali , Mahmood Khalid , Hassan Neelofur 
Published: December 2022

Objective: To compare the surgical procedures; graham’s patch repair and modified graham’s patch repair for the treatment of perforated peptic ulcer in terms of their post-operative morbidity and mortality.
Study Design: Comparative cross-sectional study.
Place and duration of study: Combined Military Hospital Rawalpindi, from May 2020 to Apr 2021.
Methodology: We conducted the study on 60 subjects divided into groups of two, (Group A and Group B) selected via convenience sampling. Group A underwent Graham’s repair and Group B underwent modified Graham’s repair. The morbidity and mortality of both the groups was compared statistically with data analysis done using SPSS-23.
Results: The average operating time and hospital stay was 84.93 ± 7.06 minutes and 7.3 ± 1.63 days for group A and 96.9 ± 9.67 minutes and 7.56 ± 2.27 days for group B, respectively. For both groups, there was no significant association to any complications (p>0.05).
Conclusion: Graham’s repair and modified Graham’s repair are equally effective leaving the decision to the surgeon's preference. We however recommend using Graham’s repair in unstable patients.
Nodular Lymphocytic Predominant Hodgkin Lymphoma (NLPHL); Treatment Outcome Study in a Tertiary Care Cancer Hospital in Pakistan
Authors: . Chandumal , Shah Mohammad Iqbal , Abu Bakar Muhammad , Sheikh Fareeha , Nadeem Iqra , Kulsoom Umme , Siddiqui Neelam 
Published: December 2022

Objective: To determine the demographics, clinical characteristics and treatment outcomes of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) patients treated at our hospital.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from 1996 to 2016.
Methodology: We collected clinical data of all the cases of HL diagnosed over twenty years (between 1996 and 2016) from our electronic hospital information system (HIS). A total of 3426 HL patients were identified, out of whom the pathologically confirmed diagnosis of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) was identified.
Results: In this study, eighty-four patients were studied. The majority of the patients were male (80%). B symptoms were present in 35%. There were 24% patients in stage-I (n=20/84), 33% in stage-II (n=28/84), 12% in stage III (n=10/84) and 31% in stage IV (n=26/84). Hence, early-stage was seen in 57% (n=48/84) and advanced stage was 43% (n=36/84) respectively. The Median follows up time was 30 months (range: 1-60 months). Patients were treated with chemotherapy in most cases (48%), radiotherapy alone in 14% cases, and combined modality (chemotherapy and radiotherapy) was used in 38% patients. The estimated 5–year disease-free survival was 73% and overall survival was 86%. Autologous stem cell transplant was done in only one patient whose disease had transformed from NLPHL to T-rich cell B cell lymphoma.
Conclusion: This study confirmed the divergent features of NLPHL with a comparatively good long-term prognosis. Most patients achieved an excellent response to first-line therapy. There was...
Left Sided Abdominal Ectopic Pregnancy with Placenta in Rudimentary Horn-Complicated With Acute Renal Failure: A Case Report
Authors: Shafiq Nighat , Muzaffar Tabassum , Fatima Sadia , Sohail Amina 
Published: December 2022

Though unicornuate uterus with rudimentary horn is a rare Mullerian duct malformation, it is marked with frequent undesired gynaecological and obstetrical complications. Rupture of gravid horn results in maternal and foetal morbidity and mortality. A case of rudimentary horn pregnancy at 15 ± 4 weeks was reported here, with acute renal failure in the postoperative period. The favorable maternal outcome was only ensured after extensive hemodialysis sessions apart from appropriate intensive care management.
Rehabilitation of Partial Hand Amputations in Pakistan
Authors: Khalil Muhammad Tawab , Raza Ali 
Published: December 2022

Objective: To describe prosthetic/cosmetic rehabilitation of partial hand amputations.
Study Design: Case series.
Place and Duration of Study: Out Patient Department (OPD) of the Rehabilitation Department Combined Military Hospital Multan from Jul to May 2020.
Methodology: Patients with partial hand amputations, due to any cause, reporting to OPD of Rehabilitation Department in CMH Multan were included. Demographic data (age, gender, education), cause, type and duration of injury and cosmetic intervention were documented.
Results: A total of 10 patients were recruited. All the participants were males. The mean age of the patients was 34.1 ± 2.8 years. The average duration of amputation was 5.2 ± 1.7 years. The most common cause of amputation was blast injury (n=3), followed by injury with heavy machinery (n=2), firearm injury (n=2), fall from the train (n=1), electric injury by high tension wire (n=1), and frostbite (n=1). The type of amputation included: left transmetacarpal with thumb sparing (n=3), ray amputation of the right index finger (n=3), right transmetacarpal with thumb sparing (n=1), ray amputation of the right middle finger (n=1), amputation left partial thumb and index finger (n=1), the right fourth and fifth finger amputation (n=1). All the patients could carry out activities of daily living even without a prosthesis. Ottobock silicon finger fillers with cosmetic sleeves were provided to all the patients.
Conclusion: Aesthetically acceptable silicon finger fillers are the mainstay of rehabilitation of hand amputations in lower-middle-income countries with poor access to rehabilitation.
Optical Coherence Tomography Angiography (OCTA) Analysis of Perifoveal Capillary Arcade in Patients with Retinal Vein Occlusion Treated with Anti-VEGF
Authors: Wajid Nida , Muzaffar Waqar , Arain Muhammad Aamir 
Published: December 2022

Objective: To evaluate the changes in perifoveal capillary arcade in patients with retinal vein occlusion treated with intravitreal injections of anti-vascular endothelial growth factor for macular edema resulting from retinal vein occlusion with OCTA.
Study Design: Quasi-experimental study.Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jul 2018 to Jul 2019.
Methodology: Patients diagnosed as case of retinal vein occlusion underwent complete eye examination. Optical coherence tomography angiography (OCTA) was done in all the patients. Patients having macular edema were prescribed intravitreal anti-vascular endothelial growth factor inhibitors on monthly basis. OCTA was repeated at the third month.
Results: In this study, 50 eyes were evaluated. After treatment patients having perifoveal capillary arcade of less than two quadrants increased from 47.7-68.8% (p<0.002) in the superficial capillary plexus and in deep capillary plexus this number increased from 50% to 88.6% (p<0.05). There was also a significant decrease in the number of macular cysts in the superficial and deep capillary plexus post treatment (p<0.05). Mean En face vascular density in superficial capillary plexus decreased in all the quadrants specially the foveal zone.
Conclusion: Optical coherence tomography angiography (OCTA) showed a qualitative improvement in perifoveal arcade disruption and decrease in the number of cystic spaces. Quantitative analysis revealed a significant reduction in vessel density in all quadrants. It enables us to follow up patients with retinal vein occlusion and study the vascular arcade changes with time and treatment.
Pattern of Different Immunohistochemical Stains in Various Types of Hepatoblastoma
Authors: Maqbool Hina , Mushtaq Sajid , Hussain Mudassar , Sheikh Umer Nisar , Hassan Usman , Sarwar Saud , Hameed Maryam , Mehmood Mohammad Tariq , Ahmad Asad Hayat 
Published: December 2022

Objective: To assess the utility of four immunohistochemical stains in the categorization of hepatoblastoma.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Histopathology Department, Shaukat Khanum Memorial Cancer Hospital, Peshawar Pakistan, from 2016 to 2018.
Methodology: We retrospectively reviewed 50 cases of hepatoblastoma from 2016-2018, from our hospital database and studied the pattern of four immunohistochemical stains (Beta-catenin, Glutamine synthetase, Heppar 1 and Cyclin D1) in various subtypes.
Results: Ten out of fifty cases were mixed epithelial and mesenchymal hepatoblastomas, and forty were pure epithelial. In the pure epithelial category, the fetal subtype showed Heppar 1 and Cyclin D1 positivity in twenty-eight cases, while Glutamine synthetase and Beta-catenin were positive in all the thirty cases. One case of embryonal subtype displayed negativity for Heppar 1; the rest of the immunohistochemical stains were positive. Ten tumours exhibiting mixed epithelial and mesenchymal morphology showed positivity for all the four immunohistochemical stains in the epithelial component. However, Heppar 1 and cyclin D1 were negative in the mesenchymal component in all the ten cases. Five cases (50%) showed Glutamine synthetase and Beta-catenin positivity in the mesenchymal component.
Conclusion: All the four immunohistochemical stains, especially Beta-catenin and Glutamine synthetase, were efficient diagnostic tool, especially for tumours with complex or vague morphological features.