bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphological Features of Ewing Sarcoma Post-Neoadjuvant Therapy and Their Impact on Prognosis
Authors: Atique Usman , Mushtaq Sajid , Rana Iftikhar Ali , Hassan Usman 
Published: December 2022

Objective: To study the effect of chemotherapeutic response on resection specimens and to assess their effect on prognosis.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar Pakistan, from Jan 2010 to Mar 2018.
Methodology: This study included 42 cases of Ewing sarcoma diagnosed, treated and followed at our institute. Various diagnostic parameters were noted and were assessed for their impact on two-year overall survival, development of distant metastasis, recurrence and cancer-related death.
Results: This study included 28 males and 14 females. The majority involved long bones followed by the axial skeleton and soft tissue. Nine cases (9) were confirmed by molecular testing. On the post-neoadjuvant chemotherapy resection specimens, 45% cases had Huvos grade I necrosis, 17% had grade-II, 12% had grade-III and 26% cases had Huvos grade-IV necrosis. Increasing Huvos grade was associated with improved disease-free survival (21%, 43% and 69% for grades-I, II and III/IV respectively). The site and size did not significantly affect the development of recurrence, development of metastasis, or twoyear survival (p>0.05).
Conclusion: Meticulous assessment of post neoadjuvant resection specimens for necrosis provides helpful information about the prognostic outcome. Increasing grade of tumour necrosis was associated with increasing disease-free survival. The response to chemotherapy in our study population was worse than Western data, which may be linked to a variety of factors.
monitor mean changes in intraocular pressure following intravitreal injection of bevacizumab in exudative age related macular degeneration and proliferative diabetic retinopathy
Authors: Rajar Rebecca , Jatoi Shafi Muhammad , Shaikh Fahad Feroz , Shahid Muhammad 
Published: December 2022

Objective: To monitor the effect of Intravitreal injection of bevacizumab on intraocular pressure in order to know whether intraocular pressure lowering medication or paracentesis is required prophylactically or thereafter.
Subjects and methods: A prospective intervensional case series of 90 eyes with proliferative diabetic retinopathy and exudative Age related macular degeneration was done who received intravitreal injection of bevacizumab. Intraocular pressure was recorded with Goldman applantaion tonometer at baseline, and then after procedure at 5min, 30 min, 01 hours and 01 weeks. The pateints data was recorded of age, gender, disease, intraocular pressure, history of glaucoma, previous surgery, phakic status and topical and systemic medications.
Results: The mean baseline intraocular pressure was found to be 13.54±2.1 in Proliferative diabetic retinopathy and 12.76±1.8 in Exudative Age related macular degeneration (p-value 0.046). The mean intraocular pressure elevation following Intravitreal bevacizumab at 5min was 32.89±6.3 in proliferative diabetic retinopathy and in exudative Age related macular degeneration was 32.18±5.7 (p-value 0.510), at 30 min was 16.71±2.6 and 15.53±2.4 (p-value <0.024), at one hour was 14.20±2.0 and 13.47±1.9 (p-value 0.095) and at one week 13.82±1.7 and 13.06±1.7 (p-value 0.126) in proliferative diabetic retinopathy and exudative Age related macular degeneration respectively. So there was no significant difference between the two diseases.
Conclusion: There is abrupt and transient rise in the intraocular pressure following intravitreal injection of bevacizumab, but it did not remain elevated for longer duration hence there was no need of intraocular pressure lowering medication and paracentesis.
Comparison of the Sublingual and Vaginal Misoprostol for Medical Termination of Pregnancy in Cases of First and Second Trimester Abortion: A Quasi Experimental Study
Authors: Khan Umber Imtiaz , Iftikhar Bushra , Jabeen Syeda Suraya , Akram Nuzhat Aisha , Subktageen Bushra , Fatima Arwa 
Published: December 2022

Objective: To compare the success rate of sublingual and vaginal Misoprostol for medical termination of pregnancy in the first and second trimesters.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Malir Pakistan, from May 2019 to Nov 2019.
Methodology: Two hundred patients in their first or second trimester of pregnancy with different indications for termination of pregnancy were included through consecutive sampling. Spousal consent was also taken along with wife consent. Patients were randomly assigned to one of the two groups. Group-A received sublingual Misoprostol 600 mcg stat followed by 400 mcg four hourly and group-B received the same dose of Misoprostol vaginally. The success rate was assessed through complete termination of pregnancy within 72 hours. Age, parity, induction to expulsion interval (IEI) and each patient's medical history was also noted.
Results: After 24 hours success rate was 93% in the sublingual group compared to 78% in the vaginal group. After 48 hours sublingual group achieved a 100% success rate compared to 84% in the vaginal group, which was improved to 92% after 72 hours. The difference in success rates of both groups remained significant at 24, 48 and 72 hours IEI (p-value = 0.003, p-value <0.001, p-value=0.004 respectively).
Conclusion: Both sublingually and misoprostol are effective for medical termination of pregnancy in the first and second trimesters. However, the sublingual route showed clear supremacy over the vaginal route, as evident by success rates in the present study.
Point Prevalence of Delirium and Its Subtypes in the Patients Admitted with Acute Coronary Syndrome in Cardiac ICU and Its Impact on Mortality
Authors: Taimoor Lalarukh , Baloch Komal , Ikhlaq Urwah , Abubaker Jawed , Ansari Imran , Ud Din Nawal Salah , Khan Musa 
Published: December 2022

Objective: To measure the point prevalence of delirium in the patients admitted to the cardiac ICU with acute coronary syndromes, with particular attention to the most commonly noted delirium and the impact on ICU mortality and length of ICU stay.
Study Design: Prospective cohort study.
Place and Study Duration: National Institute of Cardiovascular Diseases, Karachi Pakistan, from Mar and Jul 2021.
Methodology: Consecutive adult patients with age >18 years admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the confusion assessment method (CAM)-ICU tool and Richmond agitation sedation score (>-3). The types of delirium were also assessed.
Results: 201 patients were enrolled, half of patients with ST-elevation MI (51.2%) and shock (45.8%). Delirium was identified in 71 (35.3%) patients, 30 (42.2%) had hypoactive delirium and 41 (57.7%) had hyperactive delirium. In multivariable regression, independent risk factors for delirium were: sepsis 3.19 (1.15-8.87), uremia 4.12 (1.18-14.46), mechanical ventilation 7.58 (1.2-47.99), and non-invasive ventilation 8.55 (2.9-25.2). Overall mortality was 35 (17.4%); 27/71 (38%) vs. 8/130 (6.2%); p 0.001 in patients with and without delirium, respectively. In multivariable regression, delirium was an independent risk factor for mortality at 7.12 (2.16-2.23). The mean ICU stay was 7.772.36 days vs. 3.91.44 days; p 0.001 for patients with and without delirium.
Conclusion: The deleterious effect of delirium in terms of higher morbidity and mortality cannot be overemphasised. Hypoactive delirium is as common as the hyperactive type, with the same mortality risk. Assessment for delirium is mandatory for all patients admitted..............
Awareness about Hospital Waste Management System Among Janitorial Staff in Public and Private Hospitals of Hyderabad a Comparative Analysis
Authors: Mahmood Khalid , Ahmed Farah , Ashraf Viqar , Satti Luqman 
Published: December 2022

Objective: To assess and compare the knowledge, attitude and practices of janitorial staff regarding the hospital waste management system in public and private hospitals of Hyderabad.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Public and Private Hospitals of Hyderabad, from Oct 2017 to Mar 2018.
Methodology: All 47 male and female janitorial staff of private and 47 public hospitals, aged 18 years were given a semistructured questionnaire about knowledge, attitude and practices regarding healthcare waste management. Scoring adequate knowledge, positive attitude and good practices were done to draw the results.
Results: Out of the 94 included, 62 were male, and 32 were females. The majority of workers, 52 (55%), had working experience <5 years, whereas 27 (29%) and 15 (16%) of workers had working experience of >10 years and between 5-10 years, respectively. In most of the knowledge and attitude-related questions, scoring of adequate knowledge and positive attitude was significantly higher in staff working in private than in the public hospital. In contrast, the scoring of practice-related questions was found to be significantly higher in staff working in a public hospital compared to those working in a private hospital.
Conclusion: Knowledge, Attitude and Practices among janitorial staff working in public and private hospitals were not up to the mark and were not following the standard operative procedures while handling the healthcare waste. Hospital administration to formulate and implement refresher comprehensive training programs for the janitorial staff.
Etiological Agent and Their Antibiotic Susceptibility Pattern Causing Adult Septicaemia in a Critically Ill Patients in a Tertiary Care Setting
Authors: Zahra Fatima Tuz , Mirza Irfan Ali , Saleem Muhammad Zeeshan , Hussain Wajid , Sana Fatima , Ahmed Aisha 
Published: December 2022

Objective: To determine bacterial profile in adult sepsis with their antimicrobial susceptibility pattern in our setup.
Study Design: Cross-sectional study.
Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Dec 2018 to Dec 2019.
Methodology: Paired blood culture was collected in automated bottles and was processed as per standard protocol. The isolates were further identified and their susceptibility was performed according to Clinical and Laboratory Standards Institute (CLSI) 2019 guidelines.
Results: A total of 580 suspected septicaemia cases were taken into consideration. 169 (29.4%) were positive on blood cultures. Among culture-positive samples, Gram-negative bacilli (GNB) accounted for 113 (66.3%) isolates, while the remaining 56 (33.1%) were gram-positive isolates. Within gram-negative isolates, the most common species were 36 (31.8%) Klebsiella pneumonia, followed by 27 (23.8%) Acinetobacter species and 15 (13.2%) Escherichia coli. Multi-drug resistance (MDR) was observed in 98 (86.7%) isolates. Extended-spectrum beta-lactamase production (ESBL) was reported in 73 (64.6%) of enterobacterial. Among 56 Gram-positive bacterial isolates, 25 (44.6%) were Methicillin-resistant Staphylococcus aureus (MRSA), 23 (41%) were Methicillin-resistant coagulase-negative Staphylococcus (MR-CONS). Of the isolates, 8 (14%) were Methicillin sensitive Staphylococcus aureus (MSSA). None of the MR-CoNS and S. aureus strains was resistant to vancomycin.
Conclusion: Gram-negative bacilli outnumbered Gram-positive organisms in adult septicaemic patients. The majority of these organisms were multidrug-resistant, necessitating the need for timely culture and adjusting antimicrobials according to susceptibility profile.
Platelet Indices in Pregnant and Non Pregnant Females: A Comparative Study at a Tertiary Care Diagnostic Laboratory
Authors: Nayyar Muhammad Wasi , Mahmood Asad , Zohra Sadaf , Khurshid Ayesha , Ali Sadia , Zahir Saima 
Published: December 2022

Objective: To compare the platelet indices in pregnant and non-pregnant females at a tertiary care diagnostic laboratory.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jul to Dec 2020.
Methodology: 166 healthy pregnant females were included in group-1, and 166 non-pregnant healthy females were recruited in group-2. 5 ml of fresh venous blood from the antecubital vein was collected under aseptic conditions in EDTA anticoagulant tubes. This sample was analyzed to determine complete blood counts (TLC, RBC, HB, and Platelet Count) and platelet parameters, namely Platelet distribution width (PDW), Mean platelet volume (MPV) and Plateletcrit (PCT), using an automated haematology analyzer Sysmex XN-3000.
Results: A total of 332 patients with a mean age of 26.5 ± 5.12 years were included in the study. Platelet count, PCT and PDW values were higher among group-2 than the pregnant females (p=0.001). MPV was higher among the group-1 females than the group-2 females (p=0.001). The distribution of platelet parameters across the trimesters showed that platelet count and PDW among the trimesters showed a statistically significant difference (p=0.001).
Conclusion: Pregnancy brings along many physiological changes in the female body. Various haematological and biochemical changes accompany these changes. MPV, PDW and PCT values were decreased in the pregnancy group. However, MPV was found to be increased as compared to group-2.
Thrombocytopenia in Pregnancy: A Cross-Sectional Study in Northern Pakistan
Authors: Ellahi Ayesha , Khan Muhammad Wasiullah , Shahid Samra , Usman Javaid , Ikran Hassan , Naveed Safoora 
Published: December 2022

Objective: To determine the association of thrombocytopenia (mild, moderate & severe) with pregnancy-related disorders.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Haematology of Pakistan Railway Hospital, Rawalpindi Pakistan, in collaboration with the Departments of Obstetrics and Gynecology of Pak Emirates Military Hospital and Fuji Foundation Hospital, Rawalpindi Pakistan, from Oct 2018 to Oct 2019.
Methodology: Seventy-five pregnant females with platelet count <150x109/l were included. Blood samples were taken and analyzed for complete blood count, peripheral blood smear, manual count by Neubauer chamber, uric acid, urinary proteins, liver function tests (bilirubin & aspartate aminotransferase), lactate dehydrogenase, coagulation profile and viral serology (Hepatitis B & C).
Results: Out of a total of 75 thrombocytopenic pregnant females, gestational thrombocytopenia was most common (74.7%), followed by preeclampsia (17.3%), HELLP syndrome (4%), immune thrombocytopenic purpura (4%) respectively. Mild thrombocytopenia was frequently observed in patients of G.T. (62.5%), while moderate thrombocytopenia (84.6%) was generally detected in preeclampsia patients. Severe thrombocytopenia was mostly identified in patients with HELLP syndrome (66.7%) and immune thrombocytopenic purpura (66.7%).
Conclusion: Mild thrombocytopenia is mostly presented in gestational thrombocytopenia. Moderate thrombocytopenia was frequent in patients with preeclampsia, and severe thrombocytopenia was usually diagnosed in patients with HELLP syndrome and immune thrombocytopenic purpura, which require apposite and judicious management for the safety of mother and fetus.
Outcome of Intravenous Levetiracetam Versus Intravenous Phenytoin in Management of Children with Status Epilepticus"
Authors: Zaman Saeed , Shuaib Ayesha , Shah Sajid Ali , Zahid Muhammad , Khan Qamar Uz Zaman , Murad Masud 
Published: December 2022

Objective: To compare the outcome of intravenous Levetiracetam versus intravenous Phenytoin in the management of children with status epilepticus
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Pediatric Medicine, Combined Military Hospital, Kharian, from Jan to Dec 2020.
Methodology: Ninety children fulfilling the inclusion criteria were included in the study from emergency. Then patients were randomly divided into two groups by using the lottery method. In group A, patients were given Phenytoin (20 mg/kg) at presentation. In group B, patients were given Levetiracetam (20 mg/kg). These children were admitted to the pediatric ward and followed up until the resolution of symptoms. Duration of resolution of symptoms was noted. Then children were followed up further for 24 hours. If there was no recurrence of seizures, then it was noted.
Results: The mean duration of resolution of symptoms in Group A and Group B was 22.24 ± 3.85 and 16.40 ± 4.50 seconds, respectively. No significant difference was seen in both treatment groups regarding recurrence, i.e., Group-A: 5 (11.1%) vs Group-B: 7 (15.6%), p-value=0.932.
Conclusion: Based on the results of this study, it can be concluded that with Levetiracetam, the resolution of symptoms was faster than with Phenytoin. But recurrence rate showed no significant difference in children with status epilepticus.
Chlamydia Trachomatis–A Cause of Infertility at Tertiary Care Hospital, Pakistan
Authors: Yousuf Sana , Ikram Aamir , Ikram Sadia , Nadeem Saman , Hussain Syed Saddam , Ali Syed Salman 
Published: December 2022

Objective: To determine the association of Chlamydial infection with infertility in patients reporting to tertiary care set up for evaluation.
Study Design: Cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Pathology, from Jun 2015 to Jun 2016.
Methodology: A total of 100 women with primary or secondary infertility were included. Endo cervical swabs were taken. PAP smear was performed. One drop of anti-chlamydial monoclonal antibody was added to each slide, incubated at 37oC for 10 minutes, and examined for Chlamydia trachomatis under the fluorescent microscope.
Results: The mean age was 29.878±3.48 years. 89.0% of the patients had primary infertility, and 11.0% had secondary infertility. The mean age of primary infertile patients was 29.98 ± 3.51 years, while the same was 29.00 ± 3.28 years among patients with secondary infertility. Chlamydial infection was detected positive by direct immunofluorescence (Elementary Bodies) in 6 patients with mean age of 27.17 ± 1.72 years and positive in 13 patients by polymerase chain reaction with mean age of 28.38 ± 1.85 years, having a significant p-value (<0.05).
Conclusion: There was an association between Chlamydia trachomatis infection and female infertility.
Extensively Drug-Resistant Typhoid Outbreak in Pakistan, Experience at a Tertiary Care Hospital in Lahore; A Tip of An Iceberg
Authors: Imtiaz Anam , Mirza Irfan Ali , Fahim Qanita , Sabir Nargis , Bashir Ayesha , Saleem Salman 
Published: December 2022

Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at a tertiary care hospital in Lahore during the ongoing outbreak.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Mar 2018 to Jun 2019.
Methodology: All positive blood culture samples that yielded the growth of Salmonella Typhi were included in the study. The samples were dealt with according to standard microbiological procedures. Antimicrobial susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) guidelines.
Results: During the study period, (377) Typhoidal Salmonellae were isolated, of which 327 (86.7%) were Salmonella Typhi and 50 (13.3%) were Paratyphi A. The percentage of XDR Salmonella isolates was 41.9%.
Conclusion: Extensively drug-resistant typhoid fever cases reported in this study represent just the tip of an iceberg. Therefore, nationwide surveillance efforts must be undertaken along with implementing effective preventive measures.
Anaemia in Chronic Kidney Disease
Authors: Ali Imran , Khan Malik Nadeem Azam , Ali Asif , Hussain Muhammad Zahid , Khan Muhammad Shahid , Ahmed Syed Nazir 
Published: December 2022

Objective: To gauge the frequency of iron deficiency anaemia among chronic renal disease patients and factors related to the presence of anaemia at our hospital.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, Nine months, Sep 2019 to May 2020.
Methodology: Three hundred patients suffering from the chronic renal disease were included in the study. Iron deficiency anaemia was diagnosed based on haemoglobin and ferritin levels. In addition, the relationship between age, gender, duration of chronic kidney disease and stage of chronic kidney disease was assessed with the presence of iron deficiency anaemia among the patients suffering from chronic kidney disease.
Results: Out of three hundred patients studied, 139 were males, and 161 were females. Out of 300 patients with chronic kidney disease included in our study, 159 (53.0%) showed the presence of iron deficiency anaemia, while 141 (47.0%) had no anaemia. Chi-square analysis showed that female gender, long duration of illness and more severe illness had a significant association with iron deficiency anaemia among the patients with chronic kidney disease.
Conclusion: High frequency of iron deficiency anaemia among the patients of chronic kidney disease in a tertiary care hospital of Pakistan. Routine screening for anaemia should be done, especially on female patients and patients with more severe and long-standing illnesses.
Sars-Cov-2 Specific Antibody Detection in Health Care Workers in Tertiary Care Hospital
Authors: Anwar Muhammad , Javed Mirza Waseem , Parvez Nadia , Latif Majid , Rafiq Muhammad Yasir 
Published: December 2022

Objective: To estimate the sero-positivity of SARS-CoV-2 in health care workers based on specific antibodies in a tertiary care hospital.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Combined Military Hospital Kohat Pakistan, Jun to Jul 2020.
Methodology: 292 Health Care Workers from different departments were included by non-probability consecutive sampling. They were divided into three groups (High risk, Intermediate risk and low risk) according to the exposure risk to COVID-19 patients. In addition, serum samples for SARS- CoV-2 specific quantitative antibodies were collected. The odds ratio for SARSCoV-2 Ab risk was calculated for different risk groups and male and female health care workers.
Result: Out of 292 Health Care Workers, 243 (83.22%) were male, and 49 (16.78%) were female, with a mean age of 34.64 ± 7.25 years. SARS- CoV-2 specific Ab was detected in 43 (14.72%) individuals. The risk of sero-positivity was higher in the high-risk group than the intermediate-risk group (Odds ratio 1.171 vs 0.878) and higher in the intermediate-risk group than the low-risk group (odds ratio 1.120 vs 0.747). The risk was also higher in females than in males (Odds ratio 1.676 vs 0.878).
Conclusion: The sero-positivity of SARS-CoV-2 in healthcare workers in tertiary care hospitals is high. The results indicate that we must improve our local hygiene and protective standards.