bluuebunny/crossref_metadata_2025_split huggingface dataset:
Degloving Injury: Evaluation and Management
Authors: Mumtaz Syed Naveed , Shah Syed Fahd , Kayani Bushra Afzal , Shah Syed Hussain , Khan Muhammad Wasiullah , Khan Abdul Qadir 
Published: December 2022

Objective: To study the frequency, clinical presentation, management and outcome of degloving soft-tissue injuries.
Study Design: Case series.
Place and Duration of Study: Department of Surgery, Federal General Hospital, Islamabad Pakistan, from Jan 2018 to Dec 2019.
Methodology: This study included 28 consecutive patients with degloving injuries. Patients with degloving injuries of the soft tissue were included. Initial assessments of all patients were done according to advanced trauma life support. Regular clinical examination for abnormalities such as excessive local pain that was out of line with the intensity of the trauma, extensive ecchymosis or hematomas, and especially, local and regional hypermobility of the skin, capillary refill and perfusion of the area.
Results: Out of 28 patients, there were 25 males (9.28%) and three females (10.72%). The mean age was 33.07±9.04 years with a range of 6-50 years. The thigh was the most frequently involved area by degloving injury (25.00%). The back was involved in 17.85% of patients. Leg (10.71%) and foot (10.71%) were involved in 21.42% of patients. From the management point of view, 42.85% of patients had some form of debridement and healing by secondary intention, 17.85% patients were managed conservatively, and 10.71 % of the patients' primary closure was successful.
Conclusion: Degloving soft-tissue injury is debilitating and, if not taken care may lead to ischemia necrosis, infection and septicemia of the tissues, which needs extensive debridement, prolonged use of broad-spectrum antibiotics, which result in disability and protracted course of rehabilitation.
Diagnostic Accuracy of Doppler Ultrasound in Testicular Torsion Keeping Surgical Findings as the Gold Standard
Authors: Shafi Aqeel , Zameer Shahla , Liaqat Bushra , Liaqat Rabia , Riaz Ramish , Liaqat Maria 
Published: December 2022

Objective: To determine the diagnostic accuracy of ultrasound with Doppler analysis in testicular torsion, keeping surgical findings as the gold standard.
Study Design: Cross-sectional validation study
Place and Duration of study: Radiology Department of Pakistan Institute of Medical Sciences, from Dec 2017 to Dec 2019.
Methodology: The study included 58 candidates of acute scrotum who were clinically equivocal with a strong suspicion of testicular torsion and were referred by the concerned surgery department to Radiology, where a senior resident performed the testicular ultrasound. The grey scale features, along with doppler findings, were noted. Only those cases that underwent surgical exploration were included. The clinical, sonological, and per-operative findings were recorded.
Results: The mean age of our study was 18.00±6.02 years. The sensitivity, specificity, positive predictive value and negative predictive value of Doppler ultrasound were 98%, 86%, 98% and 86%, respectively. The most consistent Doppler ultrasound feature was absent intra-testicular flow, found among 46 out of 50 surgically confirmed cases of testicular torsion, while four had reduced intra-testicular flow. Similarly, heterogeneous testicular echotexture was the most frequently met grey scale feature. The sonological Whirlpool sign in our study came had 69% sensitivity and 100% specificity.
Conclusion: The overall diagnostic accuracy of ultrasound is significantly high, especially when both greyscale and colour Doppler findings are simultaneously interpreted. The sensitivity of ultrasound in diagnosing testicular torsion is far more than its specificity.
Barriers Faced by Medical and Dental House-Officer During Research in Twin Cities of Pakistan
Authors: Arshad Komal , Ahmed Ayesha , Ibrahim Aqeel , Rehman Abdul , Haroon Zainab , Iqbal Ayousha 
Published: December 2022

Objective: To determine the research activities and perceived barriers among house officers working in different institutions in Rawalpindi/ Islamabad.
Study Design: Cross-sectional study.
Place and Duration of Study: Private and Government Hospitals in Rawalpindi and Islamabad Pakistan, from May to Oct 2019.
Methodology: A questionnaire based on thirteen questions with close-ended answers was administered to house officers at different dental hospitals in Rawalpindi and Islamabad to observe the attitudes toward research and perceived difficulties in doing research.
Results: A total of 126 participants with the mean age of 24.26±2.192 years participated in the study. Out of 126, 68(58.3%) participants showed research interest, and 86(68.25%) participants reported no previous experience with research. In addition, barriers/difficulties in the research were noted regarding personal interests, funding, future job commitment and the data collection process.
Conclusions: Within the limitations of this study, it is concluded that the barriers identified in this study need to be addressed in order to enhance students' participation in research and improve the quality of research done in our country: these barriers such as lack of interest, lack of funding, poor availability of research mentors and proper awareness should be removed. Amendments may be required in the dental undergraduate curriculum to overcome these barriers.
Comparison of Post-Operative Results of Early Versus Delayed Open Reduction and Internal Fixation of Isolated Mandibular Fractures
Authors: Hassan Amna , Shafqat Yumna , Babar Adnan , Mahmood Saad , Muzaffar Amna , Afzal Muhammad 
Published: December 2022

Objective: To evaluate the impact of treatment time of open reduction internal fixation of mandibular fractures in post-operative complications.
Study Design: Quasi-experimental study.
Place and Duration of Study: Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2019.
Methodology: A hundred and four patients with isolated mandibular fractures diagnosed clinically and radiologically were included in the study. Group-I was the early Group consisting of cases reported under 72 hours, and Group-II was the delayed Group consisting of patients after 72 hours and within fourteen days. Treatment outcomes were assessed and compared for all patients based on clinical parameters in the post-operative period during follow-up.
Results: One hundred and four patients with mandibular fractures were treated with open reduction internal fixation. On a periodic follow-up of 6 months, all patients were evaluated for malocclusion, surgical site infection, hardware exposure, and non-union complications. Group-I showed six patients (11.70%) with malocclusion, whereas three patients (6.10%) in Group-II had malocclusion (p-value=0.295). Surgical site infection was present in 2(3.84%) patients in Group-I and 3(5.76%) patients in Group-II (p-value=0.647). There was no case of non-union and three patients (5.76%) of hardware exposure in Group-I and two patients (3.84%) in Group-II (p-value=0.647). No statistically significant increase in post-operative complications in malocclusion, surgical site infection, hardware exposure, and non-union was found in Group-II with comparison Group-I.
Conclusion: Delay in the surgical intervention of mandible fractures does not lead to increased post-operative complications.
Comparison of the Efficacy of Intravenous Lignocaine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation
Authors: Nand Raja , Feroz Shizan Hamid , Ahmed Mirza Sijeel , Jafri Syed Asad Ullah , Sultan Muhsan , Ahmed Niaz 
Published: December 2022

Objective: To study the effect of intravenous Lignocaine and Dexmedetomidine to attenuate cardiovascular stress reaction to laryngeal manipulation.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Peshawar Pakistan, from Oct 2019 to Apr 2020.
Methodology: Patients were randomly divided into two Groups by lottery method. Seventy-three were in the intravenous Lignocaine-Group-(A), while 73 patients were in the intravenous Dexmedetomidine-Group-(B). Blood pressure, Pulse rate and ECG were documented at the start of general anaesthesia and after 1, 3 and 5 minutes of intubation. Efficacy was defined if systolic pressure and pulse remained within 20% of the patient's native findings between 1 and 5 minutes after endotracheal intubation.
Results: A total of 146 patients were included in the stud. The mean baseline systolic BP of Group-A was 121.34±4.47mmHg and mean baseline diastolic BP was 80.31±3.57mmHg. While mean Baseline Systolic BP WAS 121.19±4.37mmHg in Group-B and mean baseline diastolic BP was 80.04±3.66mmHg. Efficacy was seen 74% patients of Group-A and 90.4% of Group-B (p=0.009).
Conclusion: Dexmedetomidine 1 microgram/kg blunts the cardiovascular sympathetic reaction to laryngeal manipulation more pronounced than Lignocaine 1.5 milligram/kg without any harmful outcomes.
Effect on Cuff Pressure of Various Endotracheal Tube Cuff Inflation Methods
Authors: Khan Tanveer Ahmed , Iqbal Muhammad Rashid , Ranjha Chaudhry Raheel , Rukh Mah , Bhalli Hafiz Ahmed Hassam , Raza Muhammad Ahmed 
Published: December 2022

Objective: To compare mean endotracheal tube cuff pressures generated using two endotracheal tube cuff inflation methods;just-Seal versus Stethoscope-Guided in patients undergoing elective surgery under general Anaesthesia.
Study Design: Quasi-experimental study.
Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2021.
Methodology: A total of 100 patients undergoing elective surgery under general endotracheal tube anaesthesia between 18–60 years of age of either gender were included. Patients were equally allocated (n=50 each) to two Groups, A (Just Seal Group) and B (Stethoscope Guided Group). In the Group-A method, the air was injected until no air leak could be heard. The pressure was measured using a “Portex cuff pressure manometer”. In the Group-B method, a stethoscope bell was placed on the thyroid lamina, and harsh breath sounds were auscultated during ventilation. Cuff was inflated till the sounds changed to smooth sounds. The pressure was measured and then noted down.
Results: Among 100 patients, 39 % were males, and 61 % were females. The mean endotracheal cuff pressure in Group-A was 39.90±3.19 centimetres of water and 28.42±3.52 centimetres of water, with Group-B (p-value of 0.001).
Conclusion: Post-intubation cuff pressure measured in patients undergoing elective surgery under general anaesthesia of the just seal group is higher than that in the stethoscope-guided group.
Keywords: Cuff pressure, Stethoscope-guided, Tracheal intubation.
Altered Mental Status and Its Causes: Commonest Dilemma of Residents and Emergency Physicians
Authors: Khan Jamal Azfar , Mehmood Hassaan , Khattak Muhammad Irfan 
Published: December 2022

Objective: To assess the frequency of the various medical conditions in patients presenting with altered mental status (AMS) in the Emergency Department of Pakistan Naval Ship (PNS) Shifa Hospital.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Emergency Department, Pak Naval Ship Shifa Hospital, Karachi Pakistan from Feb-Jul 2021.
Methodology: Adult patients who have presented with altered mental status (Glasgow coma scale score less than 15) or who have the diagnosis "AMS" written in their notes were included in the study. Patients were observed in the wards until a definitive diagnosis could be made.
Results: Sixty patients presented with AMS at the Emergency Department of PNS Shifa, during the study period. The causes of AMS were sepsis (20, 33.33%), CVA (12, 20%), metabolic (hepatic/uremic) encephalopathy (8, 13.33%), diabetic complications (7, 11.66%), seizures (5, 8.33%), drug intoxication (4, 6.66%) and respiratory failure due to lung pathology (4,6.66%). The overall mortality rate was 20%.
Conclusion: Sepsis is the most frequently encountered cause of altered mental state in emergency department patients,followed by CVA, metabolic encephalopathy, and diabetic complications.
Radical Nephrectomy for Renal Cell Carcinoma in a Tertiary Care Hospital in Islamabad
Authors: Roman Mohammad , Habib Bilal , Anwar Khursheed 
Published: December 2022

Objective: to identify the demographic, laboratory, radiological and histological features of RCC patients presenting to a tertiary care hospital in Islamabad.
Study Design: Cross-sectional study.
Place and Duration of Study: Pakistan Atomic Energy Commission General Hospital, Islamabad Pakistan, from Jan 2014 to Aug 2021.
Methodology: All the patients who underwent radical nephrectomy for histologically confirmed RCC at PAEC General Hospital Islamabad were included in the study. Demographic variables, ultrasound features, laboratory measures, histological types and Fuhrman grading were noted.
Results: A total of 65 consecutive patients were included, which included 38(58.5%) males. The mean age of the patients was 52.6±8.6 years. The most common symptom was flank pain (42.2%). The diagnosis was made incidentally in 26 patients. The most common ultrasound feature was capsule involvement (23, 35.3%), and most cases were Fuhrman Grade-II (22, 48.9%). On histology, clear cell carcinoma was the most common RCC (40, 61.5%). Post-operative early RFT deterioration was noted in 32(49.2%) patients. This was significantly associated with greater tumour size, Fuhrman Grade-III/IV, renal vein thrombosis, gerota fascia, and ureteric involvement. There was no mortality in our study during the admission days until discharge.
Conclusion: Renal cell carcinoma was more common among males and at a later stage of life (5th decade). The most common type was clear cell carcinoma. Post-operative early RFT deterioration was noted in 49.2% of patients. It was associated with greater tumour size, Fuhrman Grade III and IV, renal vein thrombosis, gerota fascia, and ureteric involvement.
Determination of the Association Between Serum Ferritin and C-Reactive Protein in Children Presented with Iron Deficiency Anemia in Combined Military Hospital Pathology Department Multan
Authors: Sheikh Waqas Hanif , Iqbal Hamid , Younas Muhammad , Hamdani Naeem Raza , Ali Oshaque 
Published: December 2022

Objective: To determine association between Serum ferritin and C-reactive protein (CRP) in children having iron scarcity anemia.
Study Design: Cross sectional study.
Place and Duration of Study: Pathology Department, Combined Military Hospital Multan Pakistan, from Jun to Dec 2018
Methodology: One hundred and thirty-eight (138) children were consecutively selected as per inclusion and exclusion criteria. Each sample of blood was collected from children for serum ferritin, Blood complete picture (Blood CP) which include hemoglobin level and red blood cell indices and serum sample for C-reactive protein (CRP). Sandwich chemilumine-scence immunoassay technique was used to analyze serum ferritin, Blood CP was analyzed on sysmex and C-reactive protein was analyzed immuneturbidi-metric method.
Result: A total of 138 children were included in our study. Mean age group of our population is 4.5 ± 0.65 years. Out of these 138, 67 (49%) were male children and 71 (51%) were female children. CRP was found negative in 50 (36%) and positive in 88 (64%) children. ANOVA and chi-square test showed association between CRP and anemia was statically significant.
Conclusion: Increased ferritin level, secondary to inflammation may mask an underlying iron inadequacy in children. CRP in children with normal or high ferritin can be helpful in diagnosing iron deficiency. Serum ferritin was found to be positively correlated with CRP in children.
Chemotherapy Induced Neutropenic Fever and Its Response to Empirical Antimicrobial Therapy
Authors: Murtaza Hafiz Muhammad , Maryam Samra , Iqbal Muhammad Shaheen , Ghafoor Tariq , Awan Aamir Aslam , Farid Naeem 
Published: December 2022

Objective: To find out the frequency of chemotherapy-induced febrile neutropenia (FN) in children diagnosed with Acute Lymphoblastic Leukemia (ALL) and its response to empirical antibiotic therapy.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Peadiatric Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2017 to Oct 2018.
Methodology: Newly diagnosed pediatric patients suffering from acute lymphoblastic leukemia between 1 to 15 years of age were included. All patients were treated with chemotherapy according to the United Kingdom National Randomized Trial for Children and Young adults with Acute Lymphoblastic Leukemia (UKALL) 2011 protocol. Patients with febrile neutropenic (FN) episodes were treated with empirical antimicrobial therapy as per hospital guidelines. Patients ‘response to antimicrobial therapy, blood culture results and related complications were noted.
Results: Out of a total 77 patients, 45 (58.4%) had 69 episodes of febrile neutropenia (FN), 62 (78.5%) episodes of febrile neutropenia (FN) were started empirical treatment with first-line antibiotics (piperacillin-tazobactam and amikacin) whereas 15 (21.7%) episodes of febrile neutropenia (FN) not responding to the 1st line were shifted to second-line antibiotics (meropenem and amikacin). Mean duration of fever was 4.1 ± 2.8 days on 1st line antibiotic regimen, 2.6 ± 1 days on 2nd line antibiotics and 6.3 ± 3.3 days on combination with antifungal drug. Ten patients received antifungal therapy empirically. Efficacy of the 1st line and the 2nd line was 72.5% and 77% respectively. Staphylococcus aureus was the most frequent organism isolated from blood culture results. During the induction phase, 10 (12.9%) patients..............
Clinical Spectrum and Laboratory Study of Von Willebrand Disease -Experience from Tertiary Care Hospital in Pakistan
Authors: Hussain Mohsin , Mahmood Asad , Mahmood Rafia , Khurshid Ayesha , Khan Nabeela , Sarwar Nozaif 
Published: December 2022

Objective: To determine the clinical features and laboratory parameters of patients of von Willebrand disease (vWD) in our population.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Jan to Jul 2019.
Methodology: All patients newly diagnosed von Willebrand disease patients were assessed clinically. Complete blood counts, bleeding time, coagulation profile, von Willebrand antigen levels and FVIII levels were determined.
Results: A total of 66diagnosed patients of von Willebrand disease were included in the study. Out of these 15 (22.7%) were male while 51 (77.2%) were females. The most common clinical symptom was pallor, seen in 49 (74.2%) patients, followed by epistaxis in 36 (54.5%) and gum bleeding in 28 (42.4%) patients. Consanguineous marriages were found in 40 cases (60.6%) and family history was positive in 23 (34.8%). Patients mean vWF Ag level was4.29 ± 7.7 IU/dL while mean FVIII levels was 5.18 ± 7.8 1 U/mL.
Conclusion: Von Willebr and disease is among the most common inherited bleeding disorder which presents with a classical pattern of mucocutaneous/soft tissue bleed, with pallor epistaxis and gum bleed being the most common presenting complaints.
The Risk Factors of Chronic Low Backache in Patients Presenting to a Tertiary Care Hospital of Pakistan
Authors: Mushtaq Samina , Mushtaq Salman , Salim Babur , Nasim Amjad 
Published: December 2022

Objective: To identify the risk factors of chronic low backache in patients presenting to a tertiary care hospital of Pakistan.
Study Design: Cross sectional study.
Place and Duration of Study: Department of Rheumatology, Fuji Foundation Hospital, Rawalpindi Pakistan, from Nov 2018 to Apr 2019.
Methodology: Patients of ages between 18-80 years of ages with mechanical low backache were selected excluding those with malignancy and inflammatory backache. Patient’s characteristics including gender, age, education, monthly income, smoking status, exercise, previous back trauma, spinal surgery, posture mostly adopted, sleeping material, body mass index (BMI), and co-morbidities were noted down. For assessment of disability and depression Quebec disability index and patient health questionnaire (PHQ9) were used.
Results: This study included 155 patients with backache with mean age (in years) of 55.45 ± 10.772. Mean duration of backache was 4.78 ± 4.36 years. Most common risk factor for low backache was age >40 years present in 144 patients (92.9%). 136 patients (87.7%) were not doing regular physical exercise.62.5% patients (97) were uneducated and 90 patients (58%) had low income. 82 patients (52.9%) used soft sleeping material. By using Quebec disability index, 57 patients (36.7%) were classified as having severe disability. Mild depression was present in 75 patients (48.3%) when assessed on PHQ-9 scale.
Conclusion: Back pain was caused by many factors. Lack of regular exercise and education, use of soft sleeping material and in appropriate sitting posture can be addressed by education of the patients.
Comparison of Scheimpflug Derived Biomechanical and Tomographical Indices to Detect Corneal Ectasia - A Cross Sectional Study
Authors: Younis Fazla , Zafar Omar 
Published: December 2022

Objective: To compare Corvis ST (Oculus Wetzlar, Germany) and Pentacam (Oculus) derived indices to detect normal cornea, keratoconus and for mefruste keratoconus.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, from Feb to Jul 2019.
Methodology: Following strict inclusion criteria 90 patients were enrolled that were divided into 3 equal groups of normal, Keratoconus and Formefruste kertoconus. One eye of the patient was selected and underwent ophthalmic examination followed by assessment of Corvis ST (Oculus Wetzlar, Germany) and Pentacam (Oculus). Classification analysis between normal, keratoconus and formefruste keratoconus was evaluated using receiver operating characteristic (ROC) curves. The area under the ROC curve (AUC) was compared.
Results: Several corneal response parameters generated by Corvis St (Oculus Wetzlar, Germany) were statistically significant (p-value <0.05) in keratoconus group. The Area under the curve (AUC) ROC values for the keratoconus and normal comparison were 0.84(SPA1), 0.864 (BAD-D), 0.865 (PRFI), 0.92 (CBI), 0.96 (TBI). Among the combined indices TBI showed increase sensitivity of 98.3 % and 94.7% specificity to detect keratoconus. The AUC ROC value for the formefruste and normal control comparison were 0.75 (SPA1), 0.81 (BAD-D), 0.82 (PRFI), 0.81 (CBI), 0.91 (TBI) with 94% sensitivity and 90% specificity to detect formefruste keratoconus.
Conclusion: Our study concluded that among the combined indices TBI demonstrated greater precision to detect keratoconus and formefruste keratoconus thus aiding and augmenting the recent technology.