bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gallbladder Perforation with Conventional Monopolar Diathermy Versus Harmonic Scalpel in Laparoscopic Cholecystectomy at Combined Military Hospital, Quetta
Authors: Ahmed Ghufran , Ashraf Imran , Jabbar Abdul , Muazzam Muhammad Ali , Ahmed Umair , Ali Amir 
Published: December 2022

Objective: To estimate the frequency of gallbladder perforation with conventional Monopolar Diathermy versus Harmonic scalpel in laparoscopic cholecystectomy.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Surgery, Combined Military Hospital, Quetta Pakistan, from Sep 2018 to Sep 2019.
Methodology: A total of 160 patients undergoing laparoscopic cholecystectomy for symptomatic gallstones were included in the study and were randomly allocated into two groups based on the surgical technique of dissecting gall bladder from the liver bed. In Group-A, Monopolar Diathermy was used, and in Group-B Harmonic scalpel was used. Frequency of gall bladder perforation and demographic details were recorded on predefined proforma.
Results: In our study, mean age was 48.21±8.94 years and 49.14±9.31 years in Group-A and Group-B respectively. Comparison of Gallbladder perforation in both groups showed 17(21.25%) cases in Group-A and 5(6.25%) cases in Group-B, (p-value <0.001).
Conclusion: In laparoscopic cholecystectomy, the frequency of gallbladder perforation with conventional monopolar diathermy is significantly higher compared to the harmonic scalpel.
Bacteremia in Pediatric Oncology Patients; A Single-Center Experience
Authors: Shaukat Zunaira , Wali Rabia , Khan Saadiya Javed , Nizamuddin Summiya , Qazi Romena , Memon Kainat , Shaheen Najma 
Published: December 2022

Objective: To study organisms causing bacteremia and their outcome in cancer children with febrile neutropenia (FN) admitted at our centre.
Study Design: Retrospective longitudinal study.
Place and duration of study: Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, from Feb to Dec 2017.
Methodology: All pediatric oncology patients with febrile neutropenia admitted to the inpatient department were included. Data fields included age, diagnoses, demographics, organism types, time to positivity, multi-drug resistance, antibiotics, and outcome.
Results: A total of 391 episodes of febrile neutropenia were documented among 86 patients. The mean age was 4.7±2.7 years. Twelve (14.0%) patients had intensive care admission, and 9(10.5%) of them died. Fifty-four (63.0%) children had primary diagnoses of haematological malignancies. Sixty-five percent had mucositis, central catheter, or both as risk factors. Thirty-nine isolates were cultured in 391 febrile-neutropenic episodes. Escherichia coli was the most frequently isolated organism in 16(41.0%) cultures, followed by Pseudomonas and Streptococcus pneumoniae in 4(10.3%) each. Poly-microbial isolates were seen in 6(15.4%) cultures. Multi-drug resistance was found in 12(30.8%) isolates. Thirty-four (87.0%) patients with positive cultures received appropriate antibiotics. Majority organisms were sensitive to Piperacillin/Tazobactam (14,35.9%) followed by Meropenem (10, 25.6%) and Colistin (6, 15.4%).
Conclusions: Rapid identification of organisms from positive blood cultures combined with antimicrobial stewardship can have improved antibiotic treatment and outcomes.
Comparison of Frequency of Sore Throat and Cough after Prophylactic Lignocaine and Beclomethasone in Adults
Authors: Ali Ahsan , Ahmed Niaz , Shafqat Huda , Hussain Aftab , Sultan Muhsan , Akram Muhammad 
Published: December 2022

Objective: To compare the frequency of sore throat and cough after prophylactic Lignocaine versus Beclomethasone in adults undergoing tracheal intubation.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2019.
Methodology: A total of 180 patients of both gender scheduled for elective surgery under general anaesthesia with endo-tracheal intubation were recruited for this study. Ninety patients of Group-A received Lignocaine, while 90 patients of Group-B received Beclomethasone. After 24 hours of the procedure, sore throat and cough were assessed from both groups and noted.
Results: The age range in this study was from 18 to 50 years, with a mean age of 34.22±5.31 years in Group -A while 36.57±7.22 years in Group-B. Sore throat was seen in 22(24.4%) patients in Lignocaine-Group (Group-A) as compared to 9(10.0%) patients in Beclomethasone-Group (Group-B) (p=0.010). Cough was seen in 18(20.0%) patients in the Lignocaine-Group as compared to 5(5.6%) patients in the Beclomethasone-Group (p=0.003).
Conclusion: This study concluded that spraying Beclomethasone on the endotracheal tube reduces the frequency and severity of postoperative sore throat and cough in patients given general anaesthesia with endotracheal intubation.
The Association between Vitamin D and Wheezing
Authors: Hussain Murtaza , Malik Qudratullah , Khan Qamar uz Zaman , Bashir Junaid , Abbas Muhammad , Ijaz Maryam 
Published: December 2022

Objective: To determine the association between vitamin D status and recurrent wheezing.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Aug 2019 to Aug 2020.
Methodology: Sixty infants with recurrent wheezing and 60 healthy age-matched infants without acute or chronic illness were inducted into the study. 25 (OH) Vitamin D, immunoglobulin E (IgE) levels and eosinophil counts were measured. In addition, data were analyzed to find the association of vitamin D levels with recurrent wheezing.
Results: In the Control-Group, the mean 25 (OH) vitamin D levels were 25.90±7.57 ng/ml and in the Recurrent Attack- Group was 13.90±4.63 ng/ml (p= 0.02). The mean IgE levels of the Control-Group were 22.80±2.67 IU/ml, and the Recurrent Attack-Group was 149.20±30.60 IU/ml (p=0.001). Eosinophil count in Recurrent Attack-Group was 150.40±23.11 cells/uL and 338.95±33.50 cells/uL in Control-Group respectively (p= 0.08)
Conclusion: There is a strong association between low vitamin D levels and recurrent wheezing.
Influence of Operator Experience on Clinically Achieved Convergence Angle of Tooth Preparations for Metal-Ceramic Crowns
Authors: Naseem Ayesha , Ishaq Waleed , Aziz Sara , Ahmed Salman , Ghafoor Aamir 
Published: December 2022

Objective: To compare clinically achieved convergence angle values of teeth prepared by operators having different experience levels and relate them with recommended values.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Department of Prosthodontics, Islamic International Dental Hospital, Islamabad Pakistan, from Dec 2018 to May 2019.
Methodology: A total of 100 crown dies of molars prepared by House Officers (Group-I) and Postgraduate Residents (Group-II) of the Prosthodontics department were collected retrospectively. Auto CAD 2007 software was used for the measurement of convergence angle. One sample t-test was applied to compare the mean convergence angle values with theoretical values. In addition, independent samples t-test was applied to compare convergence angle values among Clinician Groups with different experience levels.
Results: Significant difference (p <0.001) was found between the tooth preparations performed by both study Groups. Greater convergence angles were achieved by operators having lesser experience, i.e., Group-I (House Officers) in contrast to Group-II (Post-graduate Residents). The convergence angle achieved by both study groups was far greater than the recommended values (4-14 degrees).
Conclusion: Significant discrepancy exists between the recommended guidelines and the clinically achieved convergence angle values recorded in this study. The recommended values were rarely achieved. Operator experience seems to be an important determinant for achieving better convergence angle values.
Level of General Stress in Doctors Community in Pre and Post Covid-19 Scenario in Different Hospitals of Pakistan
Authors: Nayyar Shaista , Niaz Asif , Abbas Naseer Ahmed , Lashari Naveed , Ahmad Jawad , Khan Shahid 
Published: December 2022

Objectives: To find out the level of stress among the doctor community before and during the COVID-19 pandemic in different public sector hospitals.
Study Design: Cross-sectional study.
Place and Duration of Study: Divisional Headquarters DHQ Teaching Hospital, Sahiwal Pakistan and two Public Sector Hospitals at Okara and Islamabad Pakistan, from Aug 2019 to Aug 2020.
Methodology: A total of 320 doctors in two Groups were included in the study. Group-1 included 197 doctors in pre-COVID-19 time i-e from Aug 2019 to Jan 2020, while Group-2 included 123 doctors working in the COVID-19 scenario. The stress was assessed according to responses on a structured questionnaire and patient health questionnaire (PHQ-9) scores.
Results: Three hundred and twenty doctors participated in the study, out of which 78(39.8%) doctors in the First Group and 49(40.4%) in Second Group developed depression during their duties. More female doctors participated in the study, most of whom were young doctors who were actively involved in COVID-19 patients.
Conclusion: There is no significant rise in stress among the doctors working in the COVID-19 situation in public sector hospitals of Pakistan.
Association of Apolipoprotein B and Triglyceride Levels with Coronary Artery Disease
Authors: Habib Hunain , Haroon Zujaja Hina , Aamir Muhammad , Bibi Afshan , Javed Haroon , Jaffer Syed Raza 
Published: December 2022

Objective: To find the association of Apolipoprotein B and triglycerides with coronary artery disease.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, in collaboration with HITEC Institute of Medical Sciences, Taxila Pakistan, from Mar 2019 to Mar 2020.
Methodology: Four hundred and forty-four individuals of either gender and 18-70 years were included in the study. According to CT angiography, participants were differentiated into those with coronary artery disease and without coronary artery disease. In addition, serum triglycerides were analysed by glycerol phosphate enzymatic endpoint method on ADVIA 1800R Clinical Chemistry Auto analyzer, and apolipoprotein B was analysed on BT1500 Clinical Chemistry turbidimetric analyzer.
Results: The sample population had 144(32.0%) females and 300(68.0%) males. 164(37.0%) patients had coronary artery disease. 120(27.0%) participants were between 35 and 45 years of age, and 96(22.0%) were between 56 and 65 years. 126(30.0%) patients had hypertension, 352(79.3%) had apolipoprotein B levels >130 mg/dl. Positive Pearson’s correlation was found between apolipoprotein B and triglycerides with coronary artery disease.
Conclusion: There is a strong association between apolipoprotein B and non-fasting triglyceride levels with coronary artery disease. The apolipoprotein B can be used as a routine biomarker for screening and treatment monitoring coronary artery disease along with other lipid profile parameters.
Clinical Features and Outcome of SARS-CoV 2 Virus Infection in Patients with Autoimmune Diseases
Authors: Perveen Shahida , Salim Babur , Faisal Mohammad Jamal , Samreen Saba 
Published: December 2022

Objectives: To evaluate the clinical features, outcome and poor prognostic factors of COVID-19 in rheumatic disease patients.
Study Design: Cross-sectional study.
Place and duration of Study: Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, from Mar to Sep 2020.
Methodology: The study included rheumatic disease patients with COVID-19. Patients' age, gender, smoking status; details of rheumatic disorder; method of COVID-19 diagnosis, treatment and outcomes were recorded.
Results: The study included 46 patients. Overall mortality rate was 23.8%. The most common symptoms were fever (35, 83.3%), cough (26, 61.9%) and myalgia (23, 54.8%). Dyspnea was associated with mortality (p=0.013), ICU admission (p<0.001), ventilation (p=0.02) and hospitalization (p<0.001). NSAIDs increased the risk of ventilatory support (p= 0.02). Long term steroids predicted mortality (p=0.02), hospitalization (p=0.014) and intensive care admission (p=0.004). Steroid and Hydroxy-chloroquine treatment for COVID-19 was associated with intensive care admission (p= 0.001 and 0.006, respectively) and ventilation (p=0 .007 and 0.03, respectively). Mycophenolate Mofetil was related to intensive care admission, ventilation and hospitalization (p=0.03, 0.03 and 0.02, respectively), whereas Cyclophosphamide was related to hospitalization (p= 0.03). Systemic lupus erythematosus was associated with all poor outcomes except ventilation (p<0.05)
Conclusion: Systemic lupus erythematosus, long-term steroids, Mycophenolate Mofetil, Cyclophosphamide and Dyspnea are associated with severe COVID-19.
Antenatal Diagnosis, Surgical Approach and Maternal Morbidity with Placenta Accreta
Authors: Arif Nadia , Zafar Bushra , Ahmed Raja Qaseem , Shehzad Farrukh 
Published: December 2022

Objective: To emphasize the importance of antenatal diagnosis of the morbidly adherent placenta, employ management options accordingly and their impact on the patient’s outcome.
Study Design: Cross-sectional study.
Place and Duration of Study: Combined Military Hospital, Okara Pakistan, Jan 2018 to Aug 2020.
Methodology: One hundred and twenty-four patients were enrolled in the study. Diagnosed morbidly adherent placenta was made through trans-abdominal ultrasound, and a Doppler study in selected cases of posterior placenta previa magnetic resonance imaging (MRI) was performed. The surgical approach was either a high transverse placenta sparing or a classical incision on the uterus. After delivery of baby, conservative management included resection of part of uterus with adherent placenta followed by reconstruction of the lower uterine segment, segmental resection of myometrial tissue and hemostatic sutures, and over sewing of placental bed. The requirement of blood transfusion, intensive care unit stay, post-operative recovery, and day of discharge, along with all demographic and surgical details, was noted.
Results: In 87(70%) patients, high transverse or placental sparing incision was made to assess the baby. Over sewing of the placental bed was done in 37(29.8%) patients, and myometrial segment resection was done in 57(46%) patients. An obstetrical hysterectomy was carried out in 30 patients. Blood transfusion of > 4 units RCCs was required in 92(74%) patients. 16% the patients required intensive care management.
Conclusion: Antenatal diagnosis of morbidly adherent placenta through useful imaging modality allowed for a planned surgical approach and minimized......
Assessment of Serum Biochemical Changes in Hepatic Encephalopathy
Authors: Rauf Amna , Rauf Sidra 
Published: December 2022

Objective: To analyze the association of various biochemical changes with different grades of hepatic encephalopathy among patients of hepatitis C-related decompensated liver disease presenting at Pak Emirates Military Hospital. Rawalpindi, Pakistan.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Medicine and Gastroenterology Department of Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Mar 2020 to Feb 2021.
Methodology: This study was conducted on 100 patients with hepatitis C-related decompensated liver. A consultant medical specialist or gastroenterologist graded hepatic encephalopathy according to the West Haven criteria. Serum urea, creatinine, albumin and international normalized ratio were performed in all the patients at the time of grading of encephalopathy and derangement in the level of these parameters was analyzed with Grades of encephalopathy.
Results: Out of 100 patients, in the final analysis, 66 were males, and 44 were females. The commonest aetiology of hepatic encephalopathy was Infection (33%) followed by Constipation (29%). 15 patients had Grade-1 encephalopathy, 43 had Grade-2, 26 had Grade-3 while 16 had Grade-4 encephalopathy. Deranged serum creatinine, international normalized ratio and albumin levels were significantly associated with a higher grade of hepatic encephalopathy (p-value<0.05) in our study participants.
Conclusion: Biochemical markers studied in patients with hepatic encephalopathy secondary to hepatitis C-related decompensated chronic liver disease were deranged. In addition, creatinine, albumin and International normalized ratio were found to be more deranged in higher grades of encephalopathy.
Death Anxiety Scale for Pre-Surgical Patients
Authors: Khan Rabia Noor , Dar Rafiq 
Published: December 2022

Objective: To develop a scale for assessing death anxiety in pre-operative patients.
Study Design: Cross sectional study.
Place and Duration of Study: District Head Quarters Gujranwala, Fazal Hospital Gujranwala, Gondal Hospital Gujranwala and Mayo Hospital, Lahore Pakistan, from Apr to Nov 2020.
Methodology: Three hundred and fifty patients were included in the study. The one-factor solution was run on the data as the data was homogenous, and multiple factors were not elicited. The severity level of the patients’ symptoms was explored using the subjective rating scale. The developed scale's validity was compared with the translated Arabian version of death anxiety.
Results: Varimax rotation and scree plot showed that one component solution best fit the indigenously developed scale. The severity level of the patients on the subjective rating scale for each item showed that patients in Pakistani culture would face more psychosomatic symptoms of death anxiety rather than emotional ones.
Conclusion: The indigenously developed scale would help manage pre-surgical patients' psychosomatic symptoms of death anxiety.
Rise CKMB and Myoglobin Levels in Non-Cardiac Patients of Ischemic Stroke Presenting to Emergency Department of a Tertiary Care Hospital
Authors: Dawood Muhammad , Abbas Yasir , Hashmat Asif , Khan Andaleeb , Butt Kamil Rehman , Rehman Shahana 
Published: December 2022

Objective: To assess the rise in CKMB and Myoglobin levels and associated factors in non-cardiac patients of ischemic stroke presenting to the Emergency Department of a Tertiary Care Hospital.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Dec 2020 to May 2021.
Methodology: A total of 150 patients with ischemic stroke diagnosed by the consultant Emergency physician or medical specialist based on clinical and neuro-radiological findings were included in this study. Serum CKMB and myoglobin levels were assessed along with other baseline investigations among the study participants. In addition, the relationship of age, gender, the severity of the stroke and the presence of non-cardiac comorbidities was assessed with the rise in CKMB and myoglobin levels among the target population.
Results: Out of 200 patients with ischemic stroke included in the study, 114(67.0%) were males, while 86(43.0%) were females. 75(37.5%) patients had either raised CKMB or Myoglobin levels, while 125(62.5%) patients had both biomarkers within range. On the National Institutes of Health Stroke Scale, 110(55.0%) patients had mild, 55(22.5%) had mild to moderately severe, 25(12.5%) had severe, and 10(5.0%) had very severe symptoms. Statistical analysis revealed that increased stroke severity had a statistically significant relationship (p-value<0.001) with raised CKMB/Myoglobin levels in the target population.
Conclusion: Raised CKMB or myoglobin levels were found in many patients with acute ischemic stroke. The stroke severity was associated with raised levels of these biomarkers.
Comparison of Nebulized Ketamine with Nebulized Magnesium Sulfate for the Prevention of Postoperative Sore Throat
Authors: Ranjha Chaudhry Raheel , Saeed Muhammad , Shah Syed Qasim Ali , Iqbal Muhammad Rashid , Buland Khalid , Terrence Arona 
Published: December 2022

Objective: To compare the effects of nebulized Ketamine versus nebulized Magnesium Sulfate to prevent post-operative sore throat.
Study Design: Quasi-Experimental Study.
Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2020 to Feb 2021.
Methodology: A total of 154 patients who underwent general anaesthesia for elective procedures were randomly included in the study. These patients were divided into two equal Groups, i.e., Group-A (n=77), who received Magnesium Sulphate 250mg in 5ml saline and Group-B (n=77), who received Ketamine 50mg in 5ml saline, respectively. The effects of nebulized Ketamine versus nebulized Magnesium Sulfate to prevent post-operative sore throat, were observed in both the Groups.
Results: Both drugs were effective in the prevention of sore throat after extubation. Our study showed that Ketamine nebulization was more effective than Magnesium Sulfate nebulization in preventing sore throat. The frequency of sore throat in Group-A was 54.5% (42 out of 77 patients) as compared to 31.2% (24 out of 77 patients) in Group-B, which was statistically significant (p=0.003).
Conclusion: Post-operative sore throat is more effectively controlled with Ketamine as compared to Magnesium Sulfate
Comparison of Scoring Systems for Prognosis in Cirrhotic Patients Admitted with Hepatic Encephalopathy
Authors: Mujahid Muhammad Mamoon , Fazal Imran , Siddiqi Umair AhmEd , Waheed Arsalan , Faheem Muhammad , Mir Abdul Wahab 
Published: December 2022

Objective: To compare various scoring systems to predict the prognosis in patients of cirrhosis presenting with hepatic encephalopathy at Pak Emirates Military Hospital Rawalpindi.
Study Design: Cross-sectional study.
Place and Duration: Gastroenterology Department, Pak Emirates Military Hospital Rawalpindi, from Sep 2018 to Feb 2019.
Methodology: This study was conducted on 55 patients suffering from liver cirrhosis and presetting with hepatic encephalopathy at our hospital. Diagnosis of liver cirrhosis and hepatic encephalopathy was made by a consultant gastroenterologist based on clinical findings and relevant investigations. Chronic liver failure-sequential organ failure assessment (CLIF-SOFA), Model for end stage liver disease (MELD), and Child-Turcotte-Pugh (CTP) scores were calculated for all patients within the first 24 hours of presentation. Outcome in the study was patient either discharged or deceased at the end of study. Comparison was made between the three scores that which is a better predictor for prognosis of these patients.
Results: Out of 55 patients included in the final analysis 35 were male and 20 were female. Commonest etiology of hepatic encephalopathy was Infection followed by Constipation.10 patients had grade 1 encephalopathy, 15 had grade 2, 20 had grade 3 while 10 had grade 4 encephalopathy. CLIF-SOFA emerged as better predictor for prognosis followed by MELD and CTP.
Conclusion: CLIF-SOFA was the best of all scores in predicting the prognosis of patients suffering from liver cirrhosis presenting with hepatic encephalopathy. MELD and CTP were also significant in this regard but less as compared to CLIFSOFA.