bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood Adversity and Mental Health Status of Young Adults: A Cross-Sectional Study at the Universities of Islamabad and Rawalpindi, Pakistan
Authors: Fazal Ayesha , Tanvir Seemi , Sikander Siham , Naseem Ayesha , Babar Mariam 
Published: December 2022

Objective: To determine the frequency of childhood adversities among the university students of Islamabad and Rawalpindi and compare those adversities with their current mental health by measuring depression and anxiety.
Study Design: Cross-sectional study.
Place and Duration of Study: Quaid-e-Azam University (QAU), Islamabad and ARID Agricultural University, Rawalpindi Pakistan from May to Aug 2019.
Methodology: Survey data of 388 students between 19-25 years of age group was collected from 2 universities in the twin cities using a simple random sampling method for data collection in the form of questionnaires. First, frequencies of adverse childhood experiences (ACE) were determined, followed by a comparison of ACE with common mental disorders, i.e., depression using Patient Health Questionnaire-9 (PHQ-9) and anxiety using Generalized Anxiety Disorder-7 (GAD-7) using the chi-squared test.
Results: The frequency of adverse childhood experiences (ACE) was found to be highest among those students who had an ACE score of 1-3 (74.7%), followed by those with an ACE score of 4-6 (24.7%). Overall, females had more ACE (66.8%) than males (33.2%). Strong association of ACEs with depression (p-value <0.05) and anxiety (p-value <0.005) was found.
Conclusion: Childhood adversity has adverse results not only on the affected individual's life but also on the people around that individual. For example, early life trauma in children of different age groups results in depression for a lifetime, anxiety disorders, cognitive dysfunctions, and lack of effective communication.
Perinatal Outcome of Intrahepatic Cholestasis of Pregnancy
Authors: Shafqat Hira , Ch Abeera , Jannat Munawar , Yasmeen Almas , Abbas Zainab , Almas Yusra 
Published: December 2022

Objective: To determine the perinatal outcome of intrahepatic cholestasis of pregnancy and its association with obstetric and biochemical parameters.
Study Design: cross-sectional study.
Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Feb to Aug 2020.
Methodology: Among 3201 obstetric patients, 50 patients of obstetric cholestasis were included in the study. Data was collected on a well-designed proforma. Patients’ characteristics such as age, parity, gestational age at diagnosis and delivery, mode of delivery and co-morbidities were taken along with biochemical markers. Two groups were made based on perinatal outcome, and associations with all variables were checked.
Results: Obstetric cholestasis was found to be 1.6%. The mean age of subjects was 27.36. The itching was the most common presenting complaint. (74%) subjects were primigravida. The majority, 29 (58%), were diagnosed between 34-35 weeks. The mean gestational age at delivery was 37.54 ± 1.96 weeks, with 70% caesarean section. Among perinatal outcomes, 24 (48%) had fetal distress, 2 (4%) had intrauterine growth restriction, 20(40%) had meconium-stained liquor, 2 (4%) had intrauterine fetal demise, 7(14%) had low birth weight babies,16.7% had poor APGAR score and 14 needed intensive care admission. The mean alanine aminotransferase (ALT) was higher among those with the adverse perinatal outcome, with a cut-off value of alanine aminotransferase (ALT) of 93.5 by ROC analysis.
Conclusion: Obstetric cholestasis leads to adverse outcomes. Although no definite marker can rule out the risk of intrauterine demise, increased fetomaternal surveillance with active management induction of labour protocols may reduce the incidence of........
Ewing Sarcoma of Chest Wall: Analysis of 19 Patients
Authors: Majeed Farhan Ahmad , Ali Ghazanfar , Paraccha Muhammad Nadeem , Hameed Shahid , Khan Yasser Saeed , Hussain Zahid 
Published: December 2022

Objective: To share the short and long term outcomes of the patients having Ewing Sarcoma of the chest wall.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Thoracic Departments of Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan from Jan 2010 to Jun 2020.
Methodology: In total, 19 patients were enrolled. Inclusion criteria were physiologically fit patients for one-lung ventilation with proven true-cut histopathology. Exclusion criteria were poor performance status and non-compliance to chemotherapy.
Results: Out of 19 cases, 13 males (68.42%) and six females (31.58%) patients. The age range was from 8 to 29 years, with a mean age of 17.6 + 4.16 years. The most common symptom was palpable mass 19, followed by chest pain 8 and one patient presented with fungating mass. All patients showed partial response to neo-adjuvant chemotherapy as per RECIST criteria. Following resection and confirmation of negative margins, primary reconstruction was done. The soft tissue coverage was provided using Latissimus Dorsi Muscle Flap in 16 Cases (84.21%) and in 03 patients (15.79%) Rectus Abdominis muscle was used. Post operatively, less than 02 blood transfusions were needed in six patients. There was no post-operative ventilatory support required, and mortality was zero.
Conclusion: Ewing Sarcoma of the chest wall is a rare tumour in the adult population. An excellent outcome can be achieved through early diagnosis, meticulous surgical technique and good teamwork in a multi-disciplinary setting.
Assessment of Raised Alanine Aminotransferase (ALT) and its Relation with Antibiotic Resistance in Enteric Fever Among Children
Authors: Hussain Irshad , Wahid Sughra , Qureshi Maliha Akhtar , Hashmi Fasih Ul 
Published: December 2022

Objective: To study the abnormality of alanine aminotransferase (ALT) in enteric fever among children and to test the association between raised alanine aminotransferase with antibiotics resistance.
Study Design: A descriptive prospective study.
Place and Duration of Study: This study was conducted at the Pediatric department of KRL Hospital, Islamabad from October 2018 to March 2020.
Material and Methods: A total of 100 patients were enrolled as per inclusion criteria. Detailed clinical history was taken and physical examination was done. Laboratory tests i.e. full blood count, liver function tests and blood culture were performed to validate the inclusion, exclusion criteria and to collect the data of required variables mentioned in structured proforma.
Results: Out of 100 culture-proven typhoid fever patients, 57% were male and 43% female. The average age was 7.79 ± 3.3 years. Raised alanine aminotransferase (>45 U/l) was observed in 60%. The alanine aminotransferase is raised in at least 51% of the population having typhoid fever with p-value 0.035. The results also showed that the proportion of extensive drug resistant (XDR) typhoid is greater in the patients having raised alanine aminotransferase as compared to the patients having normal alanine aminotransferase with p-value 0.003.
Conclusion: On the basis of our study, we concluded that high alanine aminotransferase is related with enteric fever. We also observed that those having raised alanine aminotransferase have more chances of extensive drug resistant typhoid.
Disorders Causing Secondary Hypertension in Patients Less Than 45 Years of Age
Authors: Gilani Sayed Tanveer Abbas , Iftikhar Ghazala , Latif Sobia , Ahmed Bilal , Bokhari Syed Aown Shah , Bukhari Airas 
Published: December 2022

Objective: To determine the frequency of disorders causing secondary hypertension in patients less than 45 years of age.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Pathology and Medicine, Combined Military Hospital (CMH), Risalpur, Pakistan, along with Armed Forces Institute of Pathology (AFIP)and Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan from Apr 2017 to Apr 2019.
Methodology: A total of 50 patients, less than 45 years of age, newly diagnosed with hypertension (systolic blood pres-sure>140 mm Hg or diastolic BP>90 mm Hg) and reported to CMH Risalpur for the workup of HTN were included. Analysis of serum cholesterol, triglycerides, urea, creatinine, sodium, potassium, calcium, thyroid stimulating hormone, plasma glucose random, urine analysis and renal ultrasonography were carried out. In addition, serum cortisol, 24 hours urinary free cortisol, dexamethasone suppression test, growth hormone level, insulin-like growth factor-1,24 hours urinary vanillylmandelic acid, serum aldosterone and renin levels, Doppler renal ultrasonography, renal arteriogram, CT abdomen, MRI pituitary and MR/CT angiography were carried out.
Results: A total of 50 patients comprised of 82% males and 18% females with a mean age of 36.1±6.2years. Primary hypertension was in observed in 31(62%) cases. Secondary causes of HTN in 19(38%) cases, were obstructive sleep apnea (4, 8%), primary hyperaldosteronism (3,6%), renal parenchymal hypertension (3,6%), renal artery stenosis (1,2%), Cushing's syndrome (2,4%), hyperthyroidism (2,4%), hypothyroidism (2,4%), pheochromocytoma (1,2%) and coarctation of aorta (1,2%) cases.
Conclusion: Obstructive sleep apnea primary hyper-aldosteronism and renal parenchymal diseases were the commonest.........
Assessment of Tumour Budding in Colorectal Adenocarcinomas
Authors: Maqbool Hina , Mushtaq Sajid , Hassan Usman , Hussain Mudassar , Akhtar Noreen , Khan Iram 
Published: December 2022

Colorectal cancer (CRC) is the third most common malignancy worldwide. According to
Pakistan Annual Cancer Registry Report, it is the second most common cancer an
males and sixth most common cancer amongst females.There are multiple
histopathological factors which have an impact on prognosis and survival in
CRC.Colorectal cancer (CRC) is the third most common malignancy worldwide.
According to Pakistan Annual Cancer Registry Report, it is the second most common
cancer an males and sixth most common cancer amongst females.There are multiple
histopathological factors which have an impact on prognosis and survival in
CRC.The features of prognostic significance include perineural invasion,
lymphovascular invasion, infiltrating tumor borders, poorly defined clusters, Extra mural
venous invasion (EMVI) and tumor budding.The main purpose of our study is to
calculate tumor budding according to the method proposed by ITBCC in pT2 colorectal
carcinomas and study its association with other prognostic indicators
Effect of Intravitreal Anti-Vascular Endothelial Growth Factor Injection on Intraocular Pressure and Systemic Blood Pressure
Authors: Saleem Beenish , Khizer Muhammad Azeem , Khan Asfandyar , Sarfraz Muhamamd Haroon , Muhammad Shoaib , Ali Dilshad 
Published: December 2022

Objective: To determine the effect of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure and systemic blood pressure in the immediate post-injection period.
Study Design: Quasi-experimental study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Aug 2020 to Jan 2021.
Patients and Methods: Patients over the age of 21 years receiving the first anti-vascular endothelial growth factor injection for various retinal vascular disorders were included in the study. Intraocular pressure (measured with Tono-pen) and systemic blood pressure were recorded 5 minutes before (baseline) and after, as well as 30 minutes after intravitreal injection.
Results: One hundred and thirty-two patients were included in the study. The median intraocular pressure value in the study population was 14.00 (5) mmHg, while median systolic and diastolic blood pressure values were 147.00 (27) mmHg and 86.00 (19) mmHg, respectively. There was a significant rise in median intraocular pressure up to 29.00 (10) mmHg after 5 minutes and up to 29.00 (9) mmHg after 30 minutes (p≤0.001). Similarly, systolic blood pressure was elevated up to 160.00 (25) mmHg at 5 minutes and 151.00 (32) mmHg after 30 minutes (p≤0.001). No statistically significant correlation between intraocular pressure and blood pressure was seen (p=0.156).
Conclusion: Intravitreal anti-vascular endothelial growth factor injections are associated with a significant rise in intraocular pressure and blood pressure in the immediate post-injection period, so the patients need to be monitored during this period to avoid any ocular or cardiovascular complications.
Magnetic Resonance Imaging (MRI) Based Diagnosis of Anterior Cruciate Ligament (ACL) TEARS in Patients with Internal Derangements of Knee
Authors: Rahim Reshyl , Balooch Salahuddin , Usman Khan Muhammad , Bokhari Syed Awon Raza Shah , Baqir Hassan Khawaja Muhammad , Niazi Najam Us Saqib 
Published: December 2022

Objective: To assess the role of magnetic resonance imaging (MRI) in diagnosing anterior cruciate ligament (ACL) tears in patients with knee internal derangements.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Department of Radiology, Combined Military Hospital, Kharian Pakistan, from Sep 2019 Aug 2020.
Methodology: 40 patients of any age and gender were part of the study with painful or unstable knee joints. A clinical examination was performed after recording demographic data. In addition, MRI was performed, and primary and secondary signs were noted for each case.
Results: The range of patients was 15 to 63, with a mean age of 36.3 ± 12.62 years. Most of the patients were male (n=29; 72.5%), whereas only 11 (27.5%) were females. In total, 27 (67.5%) complete and 13 (32.5%) partial Anterior cruciate ligament (ACL) tears were present. Blumensaat’s angle> 15 degree was present in 10 (37.03%) complete tear cases and 2 (15.38 %) partial tear cases. Anterior tibial displacement was evident in 4 (14.81%) complete tear cases and 3 (23.07 %) partial tear cases. Posterior cruciate line (PCL) angle was apparent in 21 (77.77%) complete tear cases and 12 (92.30 %) partial tear cases.
Conclusion: The use of MRI is advocated for diagnosing Anterior cruciate ligament (ACL) tears in patients with knee internal derangements.
Determining Association of Myopia and Primary Open Angle Glaucoma
Authors: Admani Mohammad Uzair , Maree Ghazi Khan , Mirza Azfar Ahmed , Rajput Arsalan Ahmed , Mahesar Mona Liza , Munawar-Ul-Islam Sanam , Shaikh Adil Ali , Zeba Nudrat 
Published: December 2022

Objective: To determine the association between myopia and primary open-angle glaucoma.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Ophthalmology, Liaquat University Hospital Jamshoro from Jan to Jun 2015.
Methodology: A sample of 170 diagnosed cases of myopia and 170 subjects without myopia were selected. Inclusion criteria were age 35-60 years, both genders, cases with myopia >1.0 D and controls - without myopic error. Visual status was determined by the Huwitz autorefractor (model 8800) machine. Retinoscopy, Goldmann's Applanation tonometry, gonioscopy, vertical cup to disc (VCD) ratio and visual field defects were detected.
Results: Age of group – 1 and–2 was 55.7 ± 8.6 and 52.3 ± 7.3 years respectively (p=0.071). VCD ratio in group-1 was 0.6 ± 0.13 compared to 0.5 ± 0.02 in group-2 (p<0.001). Normal and abnormal VCD ratio in cases and control was noted as 161 (94.7%) vs. 168 (98.8%) and 9 (5.2%) vs. 2 (1.1%) respectively (p<0.03). 23 (13.5%) of group–1 show visual field defects compared to 6 (3.5%) in group–2. Intraocular pressure was found elevated in group-1 16.8 ± 2.3 mmHg compared to 14.0 ± 2.7 in group-2 (p<0.001). POAG was observed in 9 (5.2%) myopes group–1 compared to 2 (1.1%) in group–2 (p<0.003).
Conclusion: The present study concludes that myopia is associated with primary open-angle glaucoma, and the risk of glaucoma is high in these patients.
Barriers to the Implementation of Continuous Positive Airway Pressure (Cpap) Ventilation in Neonates at Birthplace in Tertiary Care Teaching Hospitals
Authors: Hussain Shabbir , Hussain Moeez , Ullah Inayat , Shah Syed Awais Ul Hassan 
Published: December 2022

Objective: To explore different barriers to the implementation of continuous positive airway pressure ventilation in neonates at the birthplace.
Study Design: Mixed method study.
Place and Duration of Study: Combined Military Hospital and Pak-Emirates Military Hospital Rawalpindi Pakistan, from Jan to Jun 2021.
Methodology: Health care professionals involved in neonatal care at these two hospitals were included. The sample size was predetermined (60 in total). Participants' written response was obtained on an open-ended self-administered questionnaire distributed in person. All enrolled participants responded. Thematic analysis of data was carried out.
Results: The participants were predominantly female (66.66%), aged 20-30 (66.66%). Eight (13.33%) had received CPAP training. The majority (83.33%) think that CPAP is useful, but only 10 (33.33%) have CPAP experience at the delivery suite. The first theme category was "Health professional related". Participants reported lack of awareness, motivation and training, understaffing, communication gap, responsibility conflict and rapid turnover of health professionals as a barricade. The second theme category was "organization/system related". Nonexistence of CPAP written guidelines, Obstetrics/ Gynaecology health professionals' unawareness about CPAP, CPAP implementation inferiority/ subservience/ subordinationand multi-discipline hierarchy were deterrents. The third emerged theme category was "logistics/resources". Shortage, failed continuous equipment supply, and poor infrastructure is major hurdles.
Conclusion: This study has identified weak areas/glitches on which efforts should be focused and suggested recommenddations to overcome hurdles and implement CPAP use at birthplaces.
Complete Blood Count in Preoperative Assessment of Acute Appendicitis -A Different Aspect
Authors: Khawaja Farukh Gulzar , Mahmood Khalid , Siddiqi Ubaid Ullah , Farooq Muhammad Umer , Abdullah Muhammad , Nayyar Afsa 
Published: December 2022

Objective: To study the role of neutrophils to lymphocytes ratio in predicting the severity of acute appendicitis among patients managed at tertiary care hospital.
Study design: Cross-sectional study.
Place and Duration of Study: Department of Surgery Combined Military Hospital Rawalpindi, from Jan to Jun 2021.
Methodology: Three hundred patients diagnosed with acute appendicitis by a consultant surgeon were included in the study. The neutrophil to lymphocyte ratio was calculated at the time of diagnosis. The severity of the appendix was assessed at the time of surgery and graded between grades 0 and IV, depending upon the gross clinical findings. The severity grade of acute appendicitis and other factors was associated with the neutrophil-to-lymphocytes ratio in all the patients.
Results: Out of 300 operated patients with the clinical diagnosis of acute appendicitis, 169 (56.3%) were males, while 131 (43.7%) were females. The mean age of the study participants was 31.21 ± 2.127 years. Based on severity, 60 (20%) had grade 0, 100 (33.3%) had Grade-I, 86 (28.7%) had Grade-2, 35 (11.7%) had Grade-III, while 19 (6.3%) had a Grade-IV appendicitis. 192 (64%) had neutrophil-to-lymphocyte ratio < 4.6 while 108 (36%) had more than 4.6. Chi-square test revealed that severity of acute appendicitis and raised C-reactive protein had a statistically significant correlation with raised neutrophil to lymphocyte ratio (p-value<0.05).
Conclusion: Neutrophil to lymphocyte ratio was significantly raised in patients presenting with acute appendicitis. Raised C reactive protein and high grade of appendicitis were found significantly more in patients with raised neutrophil to....
Patterns of Retentive Failures in Dislodged Single Crowns
Authors: Sharif Mubashir , Aslam Samina , Khan Imran , Rehman Abdul , Khan Mansoor , Afzal Muhammad 
Published: December 2022

Objective: The study aimed to ascertain the prevalence of retentive failure patterns of single crowns leading to de-cementation of the crowns and to estimate their average length of service.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from May to Nov 2020.
Methodology: 80 patients were selected using the non-probability Consecutive sampling technique. Both male and female patients with only single-unit crowns were included. In addition, the material used for the fabrication of crowns, years of service and site of retentive failure were recorded.
Results: Female patients (41, 51.3%) reported more frequently than males (39, 48.8%). The majority of the dislodged crowns (41, 51.3%) concerned the mandibular posterior region. Almost half of the crowns (44, 55%) dislodged due to fracture occurring at the interface of restoration and the cement. 68.8% of crowns served for 1-3 years before dislodgement. Most of the dislodged restorations (30, 37.5%) were provided by general dentists.
Conclusion: Mandibular posterior crowns were the most prevalent crowns that were dislodged, and the estimated length of most of the crowns was up to 3 years. Therefore, the anatomy of the tooth being prepared must be considered before preparing the tooth so that retentive failure may be reduced, thus improving the overall length of service.
Symptoms, Demographic Parameters and Health Profile of Post-Menopausal Women
Authors: Kiran Ayesha , Yazdani Tehreem , Batool Syeda Sadiqa , Hina Urooj 
Published: December 2022

Objective: To determine the symptoms, demographic parameters and health profile of post-menopausal women and factors related to the deranged health profile.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Gynecology and Obstetrics, Pak Emirates Military Hospital Rawalpindi Pakistan, from Jun 2019 to Aug 2021.
Methodology: Five hundred post-menopausal women were included in this study via convenience sampling. Menopause was confirmed based on clinical and laboratory information. A consultant Gynecologist inquired about details of clinical symptoms and demographic profile. Relationship of age, body mass index, use of hormonal replacement therapy and living with husband was assessed with the presence of deranged health profile among the post-menopausal women participating in this study.
Results: Out of 500 post-menopausal women studied in the given period, 323 (64.6%) had at least one clinical symptom of a deranged health profile, while 177 (35.4%) did not report any such symptom. The mean age of the study participants was 58.47 ± 4.561 years. Hot flushes 200 (40%) were the most commonly reported symptoms, followed by urinary tract infections 121 (24.2%) and palpitations 121 (24.2%). After applying the statistical analysis, high body mass index and not using hormonal replacement therapy emerged as factors associated with deranged health profiles in the study participants (p-value <0.001).
Conclusion: Most of the women had at least one clinical symptom after menopause. Hot flushes, urinary tract infections and palpitations were commonly reported symptoms. Patients with high body mass index and no hormonal replacement therapy were more likely to have a........