bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-Treatment with Ketorolac Alongside Venous Occlusion Can Reduce the Pain of Propofol Injection; A Quasi-Experimental Study
Authors: Haider Syed Zulfiqar , Khoso Mujahid Ali , Ayaz Saeed Bin , Abbas Muhammed Ali , Rehman Habib Ur , Iftikhar Hina 
Published: December 2022

Objective: To investigate the efficacy of Ketorolac with and without venous occlusion to relieve pain associated with Propofol injection.
Study Design: Quasi-experimental study.
Place and Duration of Study: Anesthesiology Department, Combined Military Hospital Multan, from Jan 2020 to Mar 2021.
Methodology: One hundred and twenty patients of age more than 16 years with ASA physical status 1 and 2, undergoing elective surgery at Combined Military Hospital Multan were selected. Patients were allocated into the groups to receive Saline with sham occlusion (group-A), 10 mg Ketorolac with sham occlusion (Group-B), or 10 mg Ketorolac with full venous occlusion for 120 seconds (Group-C). Before surgery, the patients were asked to rate any local discomfort on a scale of 0-3 ten seconds after receiving a Propofol injection. On the seventh post-operative day, all the patients were handed a questionnaire to describe any untoward symptoms.
Results: The mean age of the patients was 48.3 ± 2.8 years (range: 16 to 80 years). Mild discomfort was experienced by 4 (10%) patients, while 12 (30%) patients had moderate pain and 5 (12.5%) patients experienced severe pain in Group-A. In group- B, 16 (40%) patients had mild discomfort, 7 (17.5%) had moderate pain, and 5 (12.5%) had severe pain. In Group-C, 10 (25%) individuals experienced mild discomfort, 5 (12.5%) patients experienced moderate pain, whereas none of the patients experienced severe pain (p<0.001). Patients among the three groups reported no significant difference in post-injection venous sequelae.
Conclusion: Pre-treatment with 10 mg Ketorolac and venous occlusion for 120 seconds...
Developing Entrustable Professional Activities (EPAS) for House Officer to Practice Safely and Independently in Dentistry; A Qualitative Study Using Interpretive Paradigm
Authors: . Waqar-Un-Nisa , Orakzai Gulmina Saeed , Jamil Brekhna 
Published: December 2022

Objective: To develop entrustable professional activities for a one-year house job in dentistry.
Study Design: Qualitative study (Interpretive Paradigm).
Place and Duration of Study: Khyber College of Dentistry and Sardar Begum Dental College, Peshawar Pakistan, from Sep 2017 to May 2018.
Methodology: A five-step approach was used to develop four EPAs for a one-year house job. Using maximum variation sampling, faculty members from eleven disciplines of dentistry working in public and private dental colleges of Khyber Pakhtunkhwa and charge of training dental interns participated in the study. Three focus group interviews and three in-depth interviews were conducted. Data was transcribed and thematic analysis was done.
Results: The EPAs were developed for a one-year house job using the five-step approach. This process resulted in developing the content of four EPAs in detail, analysing the results into competencies aligned with Pakistan medical and dental council, assessment methods such as multisource feedback, direct observation, mini CEX assessment with peer coaching and role modelling teaching strategies for each activity. Participants agreed on trusting the house officer to perform independently with a gradual shift of supervision scale from direct action to indirect and finally enacting the EPAs unsupervised.
Conclusion: This study presents the foundation for using specific EPAs in dentistry, a step towards a competency-based approach. The content of EPAs for a transition period of a one-year house job in dentistry was developed using the 5-stage approach. These EPAs can provide explicit guidance for the engagement of dental house officers in clinical workplace activities.
Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial
Authors: Yasrab Mohammad , Haider Naqvi Syed Ehtesham , Ahmed Fariha , Ahmed Madiha , Rana Sumbal , Khushdil Arshad 
Published: December 2022

Objective: To compare the frequency and severity of post-operative CRBD in patients undergoing TURP and TURBT with spinal anaesthesia with pudendal nerve block against spinal anaesthesia alone.
Study Design: A randomized controlled trial (Clinical trials.gov: NCT05022160)
Place and Duration of Study: Armed Forces Institute of Urology (AFIU), Rawalpindi Pakistan, from Aug to Nov, 2021.
Methodology: The trial comprised 250 patients scheduled to have a transurethral resection of the prostate (TURP) or a transurethral resection of a bladder tumour (TURBT) under spinal anaesthesia. They were split into two groups: study (group-P) and control (group-C). After surgery, the patients in the study-group were given a bilateral pudendal nerve block. At 3, 8, 12, and 24 hours following surgery, the frequency and severity of catheter-related bladder discomfort (CRBD) were documented.
Results: CRBD frequencies were significantly lower in pudendal group at 3 hours 42 (33.8%) vs 72 (58.5%), p <0.001), 8 hours 81 (65.3%) vs 111 (90.2%), p<0.001 and 12 hours 53 (42.7%) vs 73 (59.3%), p=0.009 after the surgery. The postoperative pain score in pudendal group was lower at 3 hours (p<0.001), 8 hours (p <0.001), and 12 hours (p=0.02) but there was no statistically significant difference between the two groups at 24 hours (p=0.06).
Conclusion: When used in conjunction with spinal anaesthesia, a pudendal nerve block reduces the frequency and severity of catheter-related bladder discomfort for up to 12 hours after surgery.
A Comparison and Prediction of Irrational Beliefs and Cognitive Functioning Among Depressed and Non-Depressed Adults in Gujrat, Pakistan
Authors: Naz Iram , Ahmed Laiba , Ishaq Amna , Ayyaz Maryyam 
Published: December 2022

Objective: To compare and predict the irrational beliefs and cognitive functioning among depressed and non-depressed adults in Gujrat, Pakistan.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Zulfiqar Hospital, Akram Hospital and Aziz Bhatti Hospital, Gujrat and Department of Psychology, the University of Gujrat from Dec 2017 to Mar 2018.
Methodology: The data was collected from 200 adults, 100 depressed adults and 100 non-depressed adults using consecutive sampling. The non-depressed adults with no past psychiatric history were recruited from the community. The irrational beliefs were assessed using the Evaluative beliefs scale, and cognitive functioning was measured using the Montreal cognitive assessment scale.
Results: The independent sample t-test indicated that there was a statistically significant difference (p<0.001) in the irrational beliefs of depressed and non-depressed adults, and the irrational beliefs of depressed were more (37.83 ± 8.12) than the nondepressed adults (4.33 ± 4.64). The comparison of cognitive functioning of the depressed and non-depressed was also significantly different (p<0.001). The cognitive functioning of depressed adults was poorer (12.44 ± 3.85) than the nondepressed adults (26.92 ± 2.55). Further-more, irrational beliefs predict cognitive functioning [R²=0.729; F (1,198) = 532.763, p<0.001].
Conclusion: The study findings indicated a difference in the irrational beliefs and cognitive functioning of depressed and nondepressed adults. Further, the depressed had more irrational beliefs and worsened cognitive functioning.
Comparison of Streptokinase and Urokinase for Thrombolysis in Blocked Tunnel Cuffed Catheter Among the Patients of Chronic Renal Failure Undergoing Hemodialysis
Authors: Tahir Taleah , Raja Khalid Mehmood , Azam Malik Nadeem , Arshad Abdul Rehman , Mir Abdul Wahab , . Salahuddin 
Published: December 2022

Objective: To compare the efficacy of Streptokinase and Urokinase for thrombolysis in blocked tunnel cuffed catheter among the patients with chronic renal failure undergoing hemodialysis.
Study Design: Comparative prospective study.
Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2019 to Mar 2020.
Methodology: A total of 100 cases were included in the study which was undergoing hemodialysis in the nephrology department and had a poorly functioning or blocked tunnel cuffed catheter. These patients were either given Urokinase or Streptokinase in standard doses for thrombolysis. The lottery method was used to designate the patient either in the Streptokinase or Urokinase groups. The primary endpoint was the resolution of blocking and regain of proper functioning of the catheter.
Results: In our study, 54 (54%) patients were males, and 46 (46%) were females. The mean age of the study participants was 44.63 ± 3.782 years, and the mean duration of chronic kidney disease was 2.19 ± 6.814 years. 43 (43%) patients were given Urokinase, while 57 (57%) were given Streptokinase. After applying the logistic regression, we found that the use of Streptokinase had a significant association with the resolution of blocking and regain of proper functioning of the catheter compared to the use of Urokinase.
Conclusion: This study concluded that most catheters regain the proper functioning after thrombolysis with either Urokinase or Streptokinase. However, Streptokinase emerged as a better agent for this purpose in our study.
Comparison of Feasibility, Efficacy and Patient Acceptability of Manual Vacuum Aspiration Vs Sublingual Misoprostol in Early Pregnancy Loss
Authors: Arif Nadia , Zafar Bushra , Ahmed Raja Qaseem , Shehzad Farrukh 
Published: December 2022

Objective: To compare feasibility, efficacy and patient acceptability of manual vacuum aspiration with sublingual Misoprostol in early pregnancy loss.
Study Design: Comparative prospective study.
Place and Duration of Study: Gynecology and Obstetrics Department, Combined Military Hospital Okara Pakistan, from Aug 2019 to Apr 2020.
Methodology: 200 Patients with early pregnancy loss (missed, incomplete abortion) at gestational age 6 to 12 weeks were randomly allocated to Manual vacuum aspiration (group A) and oral Misoprostol (group B) by lottery methods. Manual vacuum aspiration was done in the outpatient department. While in Group B, oral Misoprostol was given with a protocol 600 micro gram sublingual stat observe for 1 hour for any complication. Afterwards, they were given Misoprostol 600 micrograms sublingual, 3 hourly total of 2 doses. Patients from both groups were called for follow-up after one week.
Results: Efficacy, feasibility and patient acceptability was 88%; p-value <0.001, 95%; p-value <0.001 and 97% respectively in manual vacuum aspiration group as compared to 64%, 68% and 70% in sublingual Misoprostol group. There were fewer systemic side effects and fewer visits in manual vacuum aspiration group 1 vs 3 in the sublingual Misoprostol group.
Conclusion: Manual vacuum aspiration is more effective than Misoprostol as it has no systemic effects. Both options are cheap and can be achieved in outpatient settings. However, manual vacuum aspiration provides complete evacuation and is a good option for low resource settings and a developing country like Pakistan with frequent electricity disruptions. It offers a substantial saving on resources, cost and...
Salicylic Acid Versus Glycolic Acid Peel in Active Acne
Authors: Aftab Kanza , Iftikhar Nadia , Hussain Majid , Zainab Zarnab , Mumtaz Maimoona , Obaid Shanza 
Published: December 2022

Objective: To compare the efficacies of Salicylic acid and Glycolic acid peel in patients with active acne.
Study Design: Quasi-experimental study.
Setting and Duration of Study: Department of dermatology, Pak Emirates Military Hospital, (PEMH) Rawalpindi Pakistan, Dec 2018 to Jan 2020.
Methodology: A total of 300 patients with active acne were included in this study. Patients were randomized into groups by lottery method. Group-A was given 30% Salicylic acid, while Group-B was given 70% Glycolic acid to control active acne. A grading system developed by Hayashi et al, was used to assess the response. A score less than six after 12 weeks was considered a positive response. In addition, the type of treatment and other factors were compared in the patients with and without a positive response after the designated treatment.
Results: Out of 300 patients with active acne included in the study, 172 (57.3%) had a positive response, while 128 (42.7%) had not achieved a positive response after the twelve-week treatment. Use of 30% Salicylic acid, lesser duration of acne and more minor age of the patients had a statistically significant relationship with a positive response in the study population (p-value 0.010, 0.005 and 0.001, respectively).
Conclusion: A significant number of patients did not respond to standard therapy of acne vulgaris. However, chances of achieving a positive response increase with 30% Salicylic acid instead of 70% Glycolic acid, lesser duration of acnes and young patients have more chances of getting a positive response at the end of the therapy.
Efficacy of Sofosbuvir and Daclatasvir in Achieving the End Treatment Response and Sustained Viral Response in Patients infected with Hepatitis C Virus Genotype 3
Authors: Ullah Zabih , Khan Sultan Zeb , Lodhi Hassam , Khan Hafizullah , Hidayat Rania , Ahmed Moiz 
Published: December 2022

Objective: To ascertain the efficacy of sofosbuvir combined with daclatasvir against hepatitis C genotype 3 infection.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Ayub Teaching Hospital, Abbottabad, Pakistan, from Nov 2018 to Jan 2020.
Methodology: About 262 patients were treated during the study. Patients with symptoms associated with liver failure, including ascites, uncontrolled bleeding, encephalopathy and other comorbidities, were excluded from the study. Patients with diagnosed hepatitis C genotype 3 infection were given daclatasvir and sofosbuvir combined with follow-up visits at 12 and 24 weeks of treatment. Primary outcome variables were end treatment response, sustained viral response, nonresponders, and relapse rate. In addition, secondary outcomes of patient variables including age, gender, and baseline viral load were observed.
Results: The mean age of patients was 39.8 ± 8.2 years. The twelve-week course of Sofosbuvir and Daclatasvir produced an end treatment response (ETR) of 98.9%, while the sustained virological response was 95.8%. The combination had no adverse effects, and none of the patients reported treatment discontinuation. There were no deaths due to treatment.
Conclusion: The current study indicates that using Sofosbuvir in conjunction with Daclatasvir is an effective drug regime against the Hepatitis C virus, type 3 infection.
Geriatrics Breast Cancer: Stage at Presentation and Relationship of Various Factors with Advanced Stage
Authors: Shahbaz Shanzah , Cheema Ahmed Ammar , Hussain Muhammad Zahid , Ikram Farooq 
Published: December 2022

Objective: To determine the frequency of various stages of breast cancer at presentation and the relationship of various factors with advanced stage in geriatric patients in Pakistan.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Department of Oncology, Hameed Latif Hospital, Lahore Pakistan, from Feb to Jul 2018.
Methodology: A total of 130 geriatric breast cancer patients between the ages of 60-80 years were included. A biopsy report was noted, which was done in the surgical ward and histopathology was done in the institutional pathology department. The researchers evaluated all the reports. In addition, the stage of the breast cancer documented (stage documented by CT scan chest abdomen and pelvis and bone scan. Chest X-ray and ultrasound abdomen and pelvis report were reviewed in case of CT scan report not available) as per American joint committee on Cancer (AJCC) TNM staging system for breast cancer 8th edition.
Results: Mean age was 69.10 ± 5.89 years. 106 (81.54%) patients were between 60 to 70 years of age. The mean duration of disease was 7.48 ± 3.87 months. 52 (40.0%) geriatrics patients presented in stage IV followed by stage III, II, I as 48 (37.00%), 30 (23.0%) and 00(0.0%) respectively. The long duration of illness has a significant relationship with advanced disease (pvalue<0.05).
Conclusion: Stage IV is the most common stage of breast cancer at presentation in geriatric patients, followed by stages III, II and I, respectively and the long duration of illness has a significant relationship with advanced disease.
Knowledge and Attitude Towards Sexual Practices During Pregnancy
Authors: Fatima Sadia , Shafiq Nighat , Muzaffar Tabassum , Abbas Syed Waqar , Zohra Sadaf , Safdar Isma 
Published: December 2022

Objective: To explore the knowledge, attitude and sexual practices among pregnant women reporting to a tertiary care hospital
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Antenatal clinic of Obstetrics & Gynaecology Department, Combined Military Hospital Rawalpindi Pakistan, from Jan to Jun 2020.
Methodology: Three hundred and seventy women who attended the antenatal clinic during the study period were interviewed. The responses to chosen preferences were recorded on a structured questionnaire.
Results: The majority of participants believed that intercourse could be done throughout pregnancy, it does not result in complications, and improves marital relationships. However, it was difficult due to the changed physical appearance, but it was not unpleasant for the husband. Only 51.1% of participants agreed to decreased libido. 77.6%, 71.6% and 75.4% were of the opinion that it was not prohibited in religion, neither influence baby nor labour respectively.
Conclusion: Most pregnant women maintain sexual activity during pregnancy. The majority had adequate knowledge and a positive attitude.
Clinical Presentation, Complications and Early Predictors for Poor Outcomes in Pediatric Myocarditis in a Tertiary Care Hospital
Authors: Khalid Adeel , Kamraan Amber , Rafiq Nida , Kumari Veena , Sheikh Abdul Sattar , Patel Najma 
Published: December 2022

Objective: To evaluate common clinical presentation, complications and poor prognostic outcomes in children with acute myocarditis.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Pediatric Cardiology Department, National Institute of Cardiovascular Disease Karachi Pakistan, from Feb to Aug 2020.
Methodology: The children aged one month to 16 years were included in the study. Clinical, demographic features, Electrocardiogram, Echocardiography, management, complications, and immediate outcomes were recorded.
Results: The total number of patients enrolled was 161. The median age was 5.01 ± 3.38 years for 66.4% of males and 33.5% females, mean Duration of symptoms was 8.35 ± 3.49 days. Upper respiratory tract infection was present in 84 (52.2%) and diarrhea in 8 (5%) in the preceding illness. Symptoms and signs include loss of appetite in 153 (96.27%), irritability in 148 (91.9%), vomiting in 132 (82%) and abdominal pain in 112 (69.6%), tachycardia in 148 (91.9%) and pallor in 143 (88.8%). Low voltage ECG was present in 125 (77.6%), arrhythmias in 12 (7.45%) and heart block in 6 (3.7%). Left ventricle end-diastolic dimensions (LVIDD)>4SD were present in 30.2% and LV end-systolic dimensions (LVIDS)>4SD in 19.5%, Left ventricular ejection fraction (LVEF)mean was 21.13 ± 5.07 vs 23.45 ± 3.31 at discharge. 9.21% of patients expired, out of which 78.5% had Left bundle branch block (LBBB), mean LVEF was 16.24 ± 3.16, LVID d>4SD in 78%, and LVIDs>4SD in 30%.
Conclusion: The most frequent presentations were loss of appetite, difficulty breathing, irritability and abdominal pain. Tachycardia and pallor were......
Can Steroid Response in Idiopathic Childhood Nephrotic Syndrome be Predicted? A Single Center Quasi-Experimental Study
Authors: Rehman Madeeha , Asghar Ali , Ehsan Afshan , Aziz Madiha , Khatri Sabeeta , Hashmi Seema 
Published: December 2022

Objective: To predict the role of clinical risk factors and urinary β2-microglobulin levels as a biomarker for steroid-resistant nephrotic syndrome.
Study Design: Quasi-experimental study.
Place and Duration of Study: Paediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi Pakistan, from Jun 2019 to Nov 2020.
Methodology: All children (3 months to 12 years) with either first episode or relapse of the nephrotic syndrome were included. A stored urine sample was used on 100 patients with steroid-sensitive (group-1) and 35 patients with steroid-resistant nephrotic syndrome (group-2). In addition, histopathology of all patients with steroid-resistant nephrotic syndrome was recorded.
Results: Both groups and those who had focal segmental glomerulosclerosis were compared and analysed to evaluate the predictability of steroid response. There was a significant association in both groups for microscopic haematuria, hypertension, heavy proteinuria (urine spot protein to creatinine ratio >10 g/g) and increased β2-microglobulin levels (> 3× normal) as individual risk factors (p<0.01). The sensitivity of β2-microglobulin levels was 78% and a positive predictive value of 80%. Multivariate regression analysis on steroid-resistant nephrotic syndrome as a group did not confer a higher risk; however, for children with focal segmental glomerulosclerosis, the likelihood of steroid unresponsiveness was significantly higher for the same parameters.
Conclusion: The addition of biomarker measurement and known clinical risk factors helped predict steroid-resistant focal segmental glomerulosclerosis. However, further studies are warranted before these results can be generalized.
Frequency of Hypertension in Children Presenting at Combined Military Hospital Malir Cantt Karachi
Authors: Zaidi Syed Taqi Hassan , Maqsood Almas , Ali Arshad , Saba Ameena , Ali Wasif Shujaat , Afzal Warda 
Published: December 2022

Objective: To determine the frequency of hypertension in our children and explore its relation to obesity to emphasize the importance of routine blood pressure check-ups in outpatient departments and clinics.
Study Design: Cross-sectional study.
Place and Duration of Study: Pediatric Outpatient Department and Child Ward of the Combined Military Hospital Malir Cantt Karachi Pakistan, from May to Dec 2020.
Methodology: A total of 1000 children of 3-13 years selected on consecutive sampling methods with no history of hypertension were enrolled. Three blood pressure readings were recorded using an aneroid sphygmomanometer using the standard protocol, and their weight and height were measured to calculate their BMI.
Results: Out of 1000 children, 62 (6.20%) were found hypertensive, out of which 42 (67.7%) were male, and 20 (32.3%) children were females. Overall 42/622 (6.75%) male children and 20/378 (5.87%) female children developed hypertension. Obesity was found in 6.45% of positive cases, while 3.22% of hypertensive children were overweight. The frequency of hypertension linearly increased with increasing age. In addition, 12.9% of cases had a positive family history of hypertension.
Conclusion: The frequency of hypertension in the Pediatric population was 6.20%. Male predominance was found in hypertensive cases. Hypertension was more prevalent among children of preadolescent age. Obese and overweight children were more likely to develop hypertension than normal-weight children.